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Sample records for region clinical implications

  1. Regulation of peripheral blood flow in Complex Regional Pain Syndrome: clinical implication for symptomatic relief and pain management

    Directory of Open Access Journals (Sweden)

    Coderre Terence J

    2009-09-01

    Full Text Available Abstract Background During the chronic stage of Complex Regional Pain Syndrome (CRPS, impaired microcirculation is related to increased vasoconstriction, tissue hypoxia, and metabolic tissue acidosis in the affected limb. Several mechanisms may be responsible for the ischemia and pain in chronic cold CPRS. Discussion The diminished blood flow may be caused by either sympathetic dysfunction, hypersensitivity to circulating catecholamines, or endothelial dysfunction. The pain may be of neuropathic, inflammatory, nociceptive, or functional nature, or of mixed origin. Summary The origin of the pain should be the basis of the symptomatic therapy. Since the difference in temperature between both hands fluctuates over time in cold CRPS, when in doubt, the clinician should prioritize the patient's report of a persistent cold extremity over clinical tests that show no difference. Future research should focus on developing easily applied methods for clinical use to differentiate between central and peripheral blood flow regulation disorders in individual patients.

  2. African Regional Integration: Implications for Food Security

    NARCIS (Netherlands)

    Dijk, van M.

    2011-01-01

    This report looks at the African regional trade, regional integration agreements (RIAs) and the implications for food security. An overview is presented on the present state of African regional integration and the determinants of regional trade in agriculture and food commodities. In particular the

  3. Venous chest anatomy: clinical implications

    International Nuclear Information System (INIS)

    Chasen, M.H.; Charnsangavej, C.

    1998-01-01

    This article provides a practical approach to the clinical implications and importance of understanding the collateral venous anatomy of the thorax. Routine radiography, conventional venography, computed tomography (CT), and magnetic resonance (MR) imaging studies provide correlative anatomic models for the demonstration of how interconnecting collateral vascular networks within the thorax maintain venous stability at all times. Five major systems comprise the collateral venous network of the thorax ( Fig. 1 ). These include the paravertebral, azygos-hemiazygos, internal mammary, lateral thoracic, and anterior jugular venous systems (AJVS). The five systems are presented in the following sequence: (a) a brief introduction to the importance of catheter position and malposition in understanding access to the thoracic venous system, (b) the anatomy of the azygos-hemiazygos systems and their relationship with the paravertebral plexus, (c) the importance of the AJVS, (d) 'loop' concepts interconnecting the internal mammary and azygos-hemiazygos systems by means of the lateral thoracic and intercostal veins, and (e) the interconnecting venous networks on the thoracic side of the thoracoabdominal junction. Certain aspects of the venous anatomy of the thorax will not be discussed in this chapter and include (a) the intra-abdominal anastomoses between the superior and inferior vena cavae (IVC) via the internal mammary, lateral thoracic, and azygos-hemiazygos systems (beyond the scope of this article), (b) potential collateral vessels involving vertebral, parascapular, thyroidal, thymic, and other smaller veins that might anastomose with the major systems, and (c) anatomic variants and pitfalls that may mimic pathologic conditions (space limitations). (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  4. Clinical Implications Of Childhood Bilingualism | Southwood ...

    African Journals Online (AJOL)

    Stellenbosch Papers in Linguistics Plus. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 32 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Clinical Implications Of Childhood Bilingualism.

  5. Clinical implications of contemporary gender theory.

    Science.gov (United States)

    Kulish, Nancy

    2010-04-01

    The current intellectual scene in psychoanalysis is marked by vigorous theoretical controversies about gender. The ideas being debated have important implications for clinical work, which have not been thoroughly explicated or integrated into common practice. These implications include the following: gender can accrue idiosyncratic meanings; gender identity is considered fluid and rigidity of gender identity deemed problematic; gender-related conflicts are typically described as divergent; analysis of superego conflicts related to gender becomes particularly important; and, finally, gender-related biases are seen as inevitable and must be taken into account in the clinical situation. A detailed clinical example illustrates the application of these ideas. While the more dramatic cases related to gender have been more frequent subjects of study, conflicts about gender are everyday occurrences for our patients and deserve further attention.

  6. Molecular cytogenetic analysis of Inv Dup(15) chromosomes, using probes specific for the Pradar-Willi/Angelman syndrome region: Clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Leana-Cox, J. (Univ. of Maryland School of Medicine, Baltimore, MD (United States)); Jenkins, L. (Kaiser Permanente Medical Group, San Jose, CA (United States)); Palmer, C.G.; Plattner, R. (Indiana School of Medicine, Indianapolis, IN (United States)); Sheppard, L. (Palo Verde Laboratory, Inc., Chandler, AZ (United States)); Flejter, W.L. (Univ. of Michigan, Ann Arbor, MI (United States)); Zackowski, J. (Univ. of Florida Health Science Center, Gainsville, FL (United States)); Tsien, F. (Tulane Univ. School of Medicine, New Orleans, LA (United States)); Schwartz, S. (Case Western Reserve Univ., Cleveland, OH (United States))

    1994-05-01

    Twenty-seven cases of inverted duplications of chromosome 15 (inv dup[15]) were investigated by FISH with two DNA probes specific for the Prader-Willi syndrome/Angelman syndrome (PWS/AS) region on proximal 15q. Sixteen of the marker chromosomes displayed two copies of each probe, while in the remaining 11 markers no hybridization was observed. A significant association was found between the presence of this region and an abnormal phenotype (P<.01). This is the largest study to date of inv dup(15) chromosomes, that uses molecular cytogenetic methods and is the first to report a significant association between the presence of a specific chromosomal region in such markers and an abnormal phenotype. 30 refs., 1 fig., 4 tabs.

  7. Neurobiology and clinical implications of lucid dreaming.

    Science.gov (United States)

    Mota-Rolim, Sérgio A; Araujo, John F

    2013-11-01

    Several lines of evidence converge to the idea that rapid eye movement sleep (REMS) is a good model to foster our understanding of psychosis. Both REMS and psychosis course with internally generated perceptions and lack of rational judgment, which is attributed to a hyperlimbic activity along with hypofrontality. Interestingly, some individuals can become aware of dreaming during REMS, a particular experience known as lucid dreaming (LD), whose neurobiological basis is still controversial. Since the frontal lobe plays a role in self-consciousness, working memory and attention, here we hypothesize that LD is associated with increased frontal activity during REMS. A possible way to test this hypothesis is to check whether transcranial magnetic or electric stimulation of the frontal region during REMS triggers LD. We further suggest that psychosis and LD are opposite phenomena: LD as a physiological awakening while dreaming due to frontal activity, and psychosis as a pathological intrusion of dream features during wake state due to hypofrontality. We further suggest that LD research may have three main clinical implications. First, LD could be important to the study of consciousness, including its pathologies and other altered states. Second, LD could be used as a therapy for recurrent nightmares, a common symptom of depression and post-traumatic stress disorder. Finally, LD may allow for motor imagery during dreaming with possible improvement of physical rehabilitation. In all, we believe that LD research may clarify multiple aspects of brain functioning in its physiological, altered and pathological states. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Regional Competitiveness and Its Implications for Development

    OpenAIRE

    Daryono Soebagyo; Triyono Triyono; Yuli Tri Cahyono

    2015-01-01

    This study was conducted to identify regional competitiveness in some areas of Central Java. Regional competitiveness became one of the issues in regional development policy since the enactment of local autonomy.Measurement of regional competitiveness has been mostly done through ranking as a benchmark the competitiveness of the region. Mapping regional competitiveness in Indonesia has been made to all counties and cities, which shows the competitiveness ranking of each region. Competitivenes...

  9. A neurophysiological approach to tinnitus: clinical implications.

    Science.gov (United States)

    Jastreboff, P J; Hazell, J W

    1993-02-01

    This paper presents a neurophysiological approach to tinnitus and discusses its clinical implications. A hypothesis of discordant damage of inner and outer hair cells systems in tinnitus generation is outlined. A recent animal model has facilitated the investigation of the mechanisms of tinnitus and has been further refined to allow for the measurement of tinnitus pitch and loudness. The analysis of the processes involved in tinnitus detection postulates the involvement of an abnormal increase of gain within the auditory system. Moreover, it provides a basis for treating patients with hyperacusis, which we are considering to be a pre-tinnitus state. Analysis of the process of tinnitus perception allows for the possibility of facilitating the process of tinnitus habituation for the purpose of its alleviation. The combining of theoretical analysis with clinical findings has resulted in the creation of a multidisciplinary Tinnitus Centre. The foundation of the Centre focuses on two goals: the clinical goal is to remove tinnitus perception from the patient's consciousness, while directing research toward finding a mechanism-based method for the suppression of tinnitus generators and processes responsible for enhancement of tinnitus-related neuronal activity.

  10. Challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials

    Directory of Open Access Journals (Sweden)

    Yunbo Chu

    2016-10-01

    Full Text Available Economic evaluation in the form of cost-effectiveness analysis has become a popular means to inform decisions in healthcare. With multi-regional clinical trials in a global development program becoming a new venue for drug efficacy testing in recent decades, questions in methods for cost-effectiveness analysis in the multi-regional clinical trials setting also emerge. This paper addresses some challenges from variation across regions in cost effectiveness analysis in multi-regional clinical trials. Several discussion points are raised for further attention and a multi-regional clinical trial example is presented to illustrate the implications in industrial application. A general message is delivered to call for a depth discussion by all stakeholders to reach an agreement on a good practice in cost-effectiveness analysis in the multi-regional clinical trials. Meanwhile, we recommend an additional consideration of cost-effectiveness analysis results based on the clinical evidence from a certain homogeneous population as sensitivity or scenario analysis upon data availability.

  11. Glutamate in schizophrenia: clinical and research implications.

    Science.gov (United States)

    Goff, D C; Wine, L

    1997-10-30

    The excitatory amino acids, glutamate and aspartate, are of interest to schizophrenia research because of their roles in neurodevelopment, neurotoxicity and neurotransmission. Recent evidence suggests that densities of glutamatergic receptors and the ratios of subunits composing these receptors may be altered in schizophrenia, although it is unclear whether these changes are primary or compensatory. Agents acting at the phencyclidine binding site of the NMDA receptor produce symptoms of schizophrenia in normal subjects, and precipitate relapse in patients with schizophrenia. The improvement of negative symptoms with agents acting at the glycine modulatory site of the NMDA receptor, as well as preliminary evidence that clozapine may differ from conventional neuroleptic agents in its effects on glutamatergic systems, suggest that clinical implications may follow from this model. While geriatric patients may be at increased risk for glutamate-mediated neurotoxicity, very little is known about the specific relevance of this model to geriatric patients with schizophrenia.

  12. Brain microbleeds: Epidemiology and clinical implications.

    Science.gov (United States)

    Boyano, I; Bravo, N; Miranda, J; Gil-Gregorio, P; Olazarán, J

    2016-06-22

    Brain microbleeds (BMB) are haemosiderin deposits contained within macrophages, which are displayed as hypointense images in some T2-weighted magnetic resonance imaging sequences. There are still many questions to be answered about the pathophysiology and clinical relevance of BMB. We conducted a literature review of the main epidemiological, clinical, and anatomical pathology studies of BMB performed in the general population, in patients at risk of or already suffering from a vascular disease, and in patients with cognitive impairment. We analysed the prevalence of BMB, risk factors, and potential pathophysiological mechanisms and clinical implications. The prevalence of BMB is highly variable (3%-27% in the general population, 6%-80% in patients with vascular risk factors or vascular disease, and 16%-45% in patients with cognitive impairment). BMB are associated with ageing, Alzheimer disease (AD), and in particular haemorrhagic or ischaemic cerebrovascular disease. The pathological substrate of BMB is either lipohyalinosis (subcortical BMB) or cerebral amyloid angiopathy (lobar BMB). BMB exacerbate cognitive impairment, possibly through cortical-subcortical and intracortical disconnection, and increase the risk of death, mostly due to vascular causes. BMB also increase the risk of cerebral haemorrhage, particularly in patients with multiple lobar BMB (probable erebral amyloid angiopathy). Therefore, anticoagulant treatment may be contraindicated in these patients. In patients with lower risk of bleeding, the new oral anticoagulants and the combination of clinical and magnetic resonance imaging follow-up could be helpful in the decision-making process. Copyright © 2016 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

  13. The energy implications of Chinese regional disparities

    International Nuclear Information System (INIS)

    Huang Yuanxi; Todd, Daniel

    2010-01-01

    Chinese regional disparities are readily apparent, with well-being seen the highest at the coast and declining steadily inland. Their mitigation will clearly be hostage to improvement in economic development, since the unevenness of that development created them in the first place. Integral to development is structural change, and the key to effecting that change is improved energy efficiency. Indeed, this paper explores energy usage and regional development from 1952 to the present, establishing that they both conform to an inverted-U pattern. Eastern China, the leader in industrialization, has moved beyond the apogee of the curve, but Central and Western China have failed to follow suit, being held back by poor industrial structures and adverse patterns of energy consumption. Remedying this laggardly performance preoccupies China's Government, for rendering the country energy-efficient and containing regional disparities, both rest on pushing the Central and Western regions down the curve in the wake of the prosperous coast.

  14. Clinical review: Ethnic differences in bone mass--clinical implications.

    Science.gov (United States)

    Leslie, William D

    2012-12-01

    Differences in bone mineral density (BMD) as assessed with dual-energy x-ray absorptiometry are observed between geographic and ethnic groups, with important implications in clinical practice. PubMed was employed to identify relevant studies. A review of the literature was conducted, and data were summarized and integrated. The available data highlight the complex ethnic variations in BMD, which only partially account for observed variations in fracture rates. Factors contributing to ethnic differences include genetics, skeletal size, body size and composition, lifestyle, and social determinants. Despite BMD differences, the gradient of risk for fracture from BMD and other clinical risk factors appears to be similar across ethnic groups. Furthermore, BMD variation is greater within an ethnic population than between ethnic populations. New imaging technologies have identified ethnic differences in bone geometry, volumetric density, microarchitecture, and estimated bone strength that may contribute to a better understanding of ethnic differences in fracture risk. Factors associated with ethnicity affect BMD and fracture risk through direct and indirect mechanisms.

  15. Biological behaviour and clinical implications of micrometastases.

    LENUS (Irish Health Repository)

    Kell, M R

    2012-02-03

    BACKGROUND: The most important prognostic determinant in cancer is the identification of disseminated tumour burden (metastases). Micrometastases are microscopic (smaller than 2 mm) deposits of malignant cells that are segregated spatially from the primary tumour and depend on neovascular formation (angiogenesis) to propagate. METHODS: The electronic literature (1966 to present) on micrometastases and their implications in malignant melanoma and epithelial cancers was reviewed. RESULTS: Immunohistochemical techniques combined with serial sectioning offer the best accuracy for detection of nodal micrometastases. Molecular techniques should be reserved for blood samples or bone marrow aspirates. Detection of micrometastases in regional lymph nodes and\\/or bone marrow confers a poor prognosis in epithelial cancers. The concept of sentinel node biopsy combined with serial sectioning and dedicated screening for micrometastases may improve staging procedures. Strategies against angiogenesis may provide novel therapies to induce and maintain micrometastatic dormancy. CONCLUSION: The concept of micrometastases has resulted in a paradigm shift in the staging of epithelial tumours and our overall understanding of malignant processes.

  16. Clinical implications of vitamin D deficiency

    Directory of Open Access Journals (Sweden)

    Beata Matyjaszek-Matuszek

    2015-06-01

    Full Text Available Vitamin D deficiency is a common medical problem worldwide and its prevalence rises along with latitude, obesity, sedentary lifestyle, limited sunlight exposure and aging. A great body of evidence has shown that patients with vitamin D deficiency have increased cardiovascular risks and total mortality. Conversely, the presence of comorbidities progressive with age such as abdominal obesity, insulin resistance, type 2 diabetes and hypertension places the patients at an increased risk of vitamin D deficiency. The multidirectional effect of vitamin D deficiency is present in different phases of the aging process. Based on the literature review, the risk factors for vitamin D insufficiency most often found in post-menopausal women include limited sun exposure and time spent outdoors, inadequate dietary vitamin D intake, winter season and increased age. Vitamin D supplementation in this group might offer prevention of falls and fractures and may be beneficial for cardiovascular health, what may be especially important in osteoporotic and elderly populations. Prevention and treatment processes involve education regarding sunlight exposure and pharmacological cholecalciferol supplementation according to the recommendations for Central Europe. This manuscript reviews the role of vitamin D and its deficiency and considers their clinical implications, with particular regard to peri- and postmenopausal women.

  17. Prostate cancer epigenetics and its clinical implications.

    Science.gov (United States)

    Yegnasubramanian, Srinivasan

    2016-01-01

    Normal cells have a level of epigenetic programming that is superimposed on the genetic code to establish and maintain their cell identity and phenotypes. This epigenetic programming can be thought as the architecture, a sort of cityscape, that is built upon the underlying genetic landscape. The epigenetic programming is encoded by a complex set of chemical marks on DNA, on histone proteins in nucleosomes, and by numerous context-specific DNA, RNA, protein interactions that all regulate the structure, organization, and function of the genome in a given cell. It is becoming increasingly evident that abnormalities in both the genetic landscape and epigenetic cityscape can cooperate to drive carcinogenesis and disease progression. Large-scale cancer genome sequencing studies have revealed that mutations in genes encoding the enzymatic machinery for shaping the epigenetic cityscape are among the most common mutations observed in human cancers, including prostate cancer. Interestingly, although the constellation of genetic mutations in a given cancer can be quite heterogeneous from person to person, there are numerous epigenetic alterations that appear to be highly recurrent, and nearly universal in a given cancer type, including in prostate cancer. The highly recurrent nature of these alterations can be exploited for development of biomarkers for cancer detection and risk stratification and as targets for therapeutic intervention. Here, we explore the basic principles of epigenetic processes in normal cells and prostate cancer cells and discuss the potential clinical implications with regards to prostate cancer biomarker development and therapy.

  18. Prostate cancer epigenetics and its clinical implications

    Directory of Open Access Journals (Sweden)

    Srinivasan Yegnasubramanian

    2016-01-01

    Full Text Available Normal cells have a level of epigenetic programming that is superimposed on the genetic code to establish and maintain their cell identity and phenotypes. This epigenetic programming can be thought as the architecture, a sort of cityscape, that is built upon the underlying genetic landscape. The epigenetic programming is encoded by a complex set of chemical marks on DNA, on histone proteins in nucleosomes, and by numerous context-specific DNA, RNA, protein interactions that all regulate the structure, organization, and function of the genome in a given cell. It is becoming increasingly evident that abnormalities in both the genetic landscape and epigenetic cityscape can cooperate to drive carcinogenesis and disease progression. Large-scale cancer genome sequencing studies have revealed that mutations in genes encoding the enzymatic machinery for shaping the epigenetic cityscape are among the most common mutations observed in human cancers, including prostate cancer. Interestingly, although the constellation of genetic mutations in a given cancer can be quite heterogeneous from person to person, there are numerous epigenetic alterations that appear to be highly recurrent, and nearly universal in a given cancer type, including in prostate cancer. The highly recurrent nature of these alterations can be exploited for development of biomarkers for cancer detection and risk stratification and as targets for therapeutic intervention. Here, we explore the basic principles of epigenetic processes in normal cells and prostate cancer cells and discuss the potential clinical implications with regards to prostate cancer biomarker development and therapy.

  19. [Clinical implications of polycystic ovary syndrome].

    Science.gov (United States)

    Dravecká, Ingrid

    Polycystic ovary syndrome (PCOS) is a heterogeneous and complex endocrine disease which among the female population belongs to the most widespread endocrinopathies and it is the most frequent cause of hyperthyroidism, anticoagulation and infertility. Insulin resistance is one of the important diabetology factors impacting hyperglycaemia in a majority of women with PCOS (60-80 %). Clinical expressions of PCOS include reproduction disorders, metabolic characteristics and psychological implications. Reproduction disorders include hyperthyroidism, menstruation cycle disorders, infertility and pregnancy complications as well as early abortions, gestational diabetes and pregnancy induced hypertension. Long-term metabolic risks of PCOS include type 2 diabetes mellitus, dyslipidemia, arterial hypertension and endothelial dysfunction. The available data confirms higher incidence of cardiovascular diseases in women with PCOS. In particular among obese women PCOS is more frequently associated with non-alcoholic hepatic steatosis, sleep apnoea syndrome and endometrial cancer. The literature includes some controversial data about the relationship between PCOS and autoimmunity. Women with PCOS are more prone to suffer from insufficient confidence with higher incidence of anxiety, depression, bipolar disorder and eating disorders. autoimmunity - diabetes mellitus - pregnancy - insulin resistance - metabolic syndrome - menstrual disorders - polycystic ovary syndrome.

  20. Surface compositions in the Aristarchus Region: Implications for regional stratigraphy

    Science.gov (United States)

    Hawke, H. R.; Lucey, P. G.; Mccord, T. B.; Pieters, C. M.; Head, J. W.

    1984-01-01

    Near infrared reflectance spectra for the Aristachus region, obtained using the 2.2m UH telescope at the Mauna Kea Observatory, were reduced and analyzed. The spectra obtained for the central peak, southern floor, southwestern wall, eastern wall, and northwestern wall of Aristachus crater exhibit shallow continuum slopes, relatively strong feldspar bands, pyroxene bands stronger than those typically seen in the spectra of fresh higland features, and pyroxene band centers near l micrometer suggesting the dominance of Ca rich clinopyroxene. The spectrum of the south rim of Aristachus is quite distinct from those of other crater units. The position of Aristrchus on the plateau/mare boundary raises questions concerning compositional variations in crater ejects deposits.

  1. Personal Narratives: Cultural Differences and Clinical Implications

    Science.gov (United States)

    Bliss, Lynn S.; McCabe, Allyssa

    2008-01-01

    A study was conducted to examine the misdiagnosis of cultural difference deficits and how mistaking deficits in narrative production for cultural differences can be avoided. Findings reveal the implications for intervention.

  2. Clinical Ethics Consultation After God: Implications for Advocacy and Neutrality.

    Science.gov (United States)

    Parker, J Clint

    2018-06-01

    In After God: Morality and Bioethics in a Secular Age, H. Tristram Engelhardt, Jr. explores the broad implications for moral reasoning once a culture has lost a God's-eye perspective. In this paper, I focus on the implications of Engelhardt's views for clinical ethics consultation. I begin by examining the question of whether clinical ethics consultants (CECs) should advocate a particular viewpoint and/or process during consultations or adopt a neutral stance. I then examine the implications of Engelhardt's views for this question. Finally, I discuss some of Engelhardt's foundational ontological, metaphysical, meta-ethical, and epistemological commitments and how these commitments connect to his views on clinical ethics consultation.

  3. Dependence on carbonated water: Clinical and policy implications

    Directory of Open Access Journals (Sweden)

    Sumit Kumar Gupta

    2015-01-01

    Full Text Available A case of caffeine dependence syndrome with preference for a specific brand of carbonated water (popularly known as soft drinks or colas is discussed to highlight the clinical and policy implications.

  4. Patterns of Primary Tumor Invasion and Regional Lymph Node Spread Based on Magnetic Resonance Imaging in Early-Stage Nasal NK/T-cell Lymphoma: Implications for Clinical Target Volume Definition and Prognostic Significance

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Run-Ye [Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Liu, Kang [Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Wang, Wei-Hu; Jin, Jing; Song, Yong-Wen; Wang, Shu-Lian; Liu, Yue-Ping; Ren, Hua; Fang, Hui; Liu, Qing-Feng; Yang, Yong; Chen, Bo; Qi, Shu-Nan; Lu, Ning-Ning; Tang, Yu; Tang, Yuan; Li, Ning [Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Ouyang, Han [Department of Imaging Diagnosis, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China); Li, Ye-Xiong, E-mail: yexiong12@163.com [Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (China)

    2017-01-01

    Purpose: This study aimed to determine the pathways of primary tumor invasion (PTI) and regional lymph node (LN) spread based on magnetic resonance imaging (MRI) in early-stage nasal NK/T-cell lymphoma (NKTCL), to improve clinical target volume (CTV) delineation and evaluate the prognostic value of locoregional extension patterns. Methods and Materials: A total of 105 patients with newly diagnosed early-stage nasal NKTCL who underwent pretreatment MRI were retrospectively reviewed. All patients received radiation therapy with or without chemotherapy. Results: The incidences of PTI and regional LN involvement were 64.7% and 25.7%, respectively. Based on the incidence of PTI, involved sites surrounding the nasal cavity were classified into 3 risk subgroups: high-risk (>20%), intermediate-risk (5%-20%), and low-risk (<5%). The most frequently involved site was the nasopharynx (35.2%), followed by the maxillary (21.9%) and ethmoid (21.9%) sinuses. Local disease and regional LN spread followed an orderly pattern without LN skipping. The retropharyngeal nodes (RPNs) were most frequently involved (19.0%), followed by level II (11.4%). The 5-year overall survival (OS), progression-free survival (PFS), and locoregional control (LRC) rates for all patients were 72.8%, 65.2%, and 90.0%, respectively. The presence of PTI and regional LN involvement based on MRI significantly and negatively affected PFS and OS. Conclusions: Early-stage nasal NKTCL presents with a high incidence of PTI but a relatively low incidence of regional LN spread. Locoregional spread followed an orderly pattern, and PTI and regional LN spread are powerful prognostic factors for poorer survival outcomes. CTV reduction may be feasible for selected patients.

  5. Clinical implications of The Red Book.

    Science.gov (United States)

    Culliford, Penny

    2012-09-01

    This presentation stresses the uniqueness of both the therapist's and patient's personal experience in clinical work and relates this to the significance of The Red Book as Jung's personal odyssey and for me personally as an analyst. I consider The Red Book's enduring relevance alongside recent psychological theories, neuroscience and early mystical writings, and conclude with a clinical vignette of a patient's response to a piece of choral music and subsequent use of active imagination. © 2012, The Society of Analytical Psychology.

  6. A Rare Chromosome 3 Imbalance and Its Clinical Implications

    Directory of Open Access Journals (Sweden)

    Karen Sims

    2012-01-01

    Full Text Available The duplication of chromosome 3q is a rare disorder with varying chromosomal breakpoints and consequently symptoms. Even rarer is the unbalanced outcome from a parental inv(3 resulting in duplicated 3q and a deletion of 3p. Molecular karyotyping should aid in precisely determining the length and breakpoints of the 3q+/3p− so as to better understand a child’s future development and needs. We report a case of an infant male with a 57.5 Mb duplication from 3q23-qter. This patient also has an accompanying 1.7 Mb deletion of 3p26.3. The duplicated segment in this patient encompasses the known critical region of 3q26.3-q27, which is implicated in the previously reported 3q dup syndrome; however, the accompanying 3p26.3 deletion is smaller than the previously reported cases. The clinical phenotype of this patient relates to previously reported cases of 3q+ that may suggest that the accompanying 1.7 Mb heterozygous deletion is not clinically relevant. Taken together, our data has refined the location and extent of the chromosome 3 imbalance, which will aid in better understanding the molecular underpinning of the 3q syndrome.

  7. ESWT for tendinopathy: technology and clinical implications.

    Science.gov (United States)

    van der Worp, Henk; van den Akker-Scheek, Inge; van Schie, Hans; Zwerver, Johannes

    2013-06-01

    The general consensus that tendinopathy, at least in the chronic stage, is mainly a degenerative condition and inflammation plays a minor role has led to a shift from treatments that target inflammation towards treatment options that promote regeneration. One of these treatments is extracorporeal shockwave therapy (ESWT), a physical therapy modality that uses pressure waves to treat tendinopathy. This review was undertaken to give an overview of the literature concerning this treatment, and special attention is given to the differences between focused and radial ESWT. A narrative description of wave characteristics, generation methods and in vitro effects of ESWT is given. The literature on ESWT as a treatment for one common tendinopathy, patellar tendinopathy, was systematically reviewed. Waves that are generated for focused and radial ESWT have very different physical characteristics. It is unclear how these characteristics are related to clinical effectiveness. Studies into the biological effects of ESWT have mainly used focused shockwave therapy, showing a number of effects of shockwaves on biological tissue. The systematic review of studies into the clinical effects of ESWT for patellar tendinopathy showed conflicting evidence for its effectiveness. Physical characteristics of focused and radial waves differ substantially, but effect on clinical effectiveness is unclear. Whereas in vitro studies often show the effects of ESWT on tendon tissue, results of clinical studies are inconsistent. Based on the review of the literature, suggestions are given for the use of ESWT in clinical practice regarding timing and treatment parameters.

  8. Clinical and nutritional implications of radiation enteritis

    International Nuclear Information System (INIS)

    Beer, W.H.; Fan, A.; Halsted, C.H.

    1985-01-01

    The clinical and nutritional significance of radiation enteritis was assessed in eight patients with chronic diarrhea which followed curative doses of radiotherapy for pelvic malignancies. Steatorrhea, found in seven malnourished patients, was ascribed to ileal disease or previous surgery, or to bacterial contamination of the small intestine. Lactose intolerance, assessed by breath hydrogen excretion after oral lactose and by jejunal lactase levels, was found in six patients. In a subgroup of five patients, the administration of two different defined formula liquid diets by nasoduodenal infusion decreased fecal fluid and energy losses by about one-half. Compared to Vivonex-HN, the infusion of Criticare-HN was associated with greater likelihood of intestinal gas production but a three-fold greater utilization of protein. Intestinal malabsorption and malnutrition in radiation enteritis has diverse etiologies. Whereas nutritional support by liquid diet limits fecal fluid and energy losses, these diets differ significantly in clinical tolerance and biologic value

  9. Clinical and nutritional implications of radiation enteritis

    Energy Technology Data Exchange (ETDEWEB)

    Beer, W.H.; Fan, A.; Halsted, C.H.

    1985-01-01

    The clinical and nutritional significance of radiation enteritis was assessed in eight patients with chronic diarrhea which followed curative doses of radiotherapy for pelvic malignancies. Steatorrhea, found in seven malnourished patients, was ascribed to ileal disease or previous surgery, or to bacterial contamination of the small intestine. Lactose intolerance, assessed by breath hydrogen excretion after oral lactose and by jejunal lactase levels, was found in six patients. In a subgroup of five patients, the administration of two different defined formula liquid diets by nasoduodenal infusion decreased fecal fluid and energy losses by about one-half. Compared to Vivonex-HN, the infusion of Criticare-HN was associated with greater likelihood of intestinal gas production but a three-fold greater utilization of protein. Intestinal malabsorption and malnutrition in radiation enteritis has diverse etiologies. Whereas nutritional support by liquid diet limits fecal fluid and energy losses, these diets differ significantly in clinical tolerance and biologic value.

  10. Urodilatin, a natriuretic peptide with clinical implications.

    Science.gov (United States)

    Meyer, M; Richter, R; Forssmann, W G

    1998-02-21

    Natriuretic peptides (NP) constitute hormonal systems of great clinical impact. This report deals with Urodilatin (URO), a renal natriuretic peptide type A. From the gene of NP type A, a message for the preprohormone is transcribed in heart and kidney. The cardiac prohormone CDD/ANP-1-126 is synthesized in the heart atrium and processed during exocytosis forming the circulating hormone CDD/ANP-99-126. URO (CDD/ANP 95-126) is a product from the same gene, but differentially processed in the kidney and detected only in urine. Physiologically, URO acts in a paracrine fashion. After release from distal tubular kidney cells into the tubular lumen, URO binds to luminal receptors (NPR-A) in the collecting duct resulting in a cGMP-dependent signal transduction. cGMP generation is followed by an interaction with the amiloriode-sensitive sodium channel which induces diuresis and natriuresis. In this way, URO physiologically regulates fluid balance and sodium homeostasis. Moreover, URO excretion and natriuresis are in turn dependent on several physiological states, such as directly by sodium homeostasis. Pharmacologically, URO at low dose administered intravenously shows a strong diuretic and natriuretic effect and a low hypotensive effect. Renal, pulmonary, and cardiovascular effects evoked by pharmacological doses indicate that URO is a putative drug for several related diseases. Clinical trials show promising results for various clinical indications. However, the reduction in hemodialysis/hemofiltration in patients suffering from ARF following heart and liver transplantation, derived from preliminary trials recruiting a small number of patients, was not confirmed by a multicenter phase II study. In contrast, data for the prophylactic use of URO in this clinical setting suggest a better outcome for the patients. Furthermore, treatment of asthmatic patients showed a convincingly beneficial effect of URO on pulmonary function. Patients with congestive heart failure may also

  11. Viral asthma: implications for clinical practice

    Directory of Open Access Journals (Sweden)

    Roger Menendez

    2010-07-01

    Full Text Available Roger Menendez1, Michael D Goldman21Allergy and Asthma Center of El Paso, El Paso, TX, USA; 2Pulmonary Division, UCLA Gaffen School of Medicine, Los Angeles, CA, USAAbstract: The natural history of asthma appears to be driven primarily by the timing and duration of viral respiratory infections. From the very high rate of infections in childhood, to the more sporadic pattern seen in adults, the cycle of acute injury followed by an inefficient repair process helps explain the clinical patterns of asthma severity currently recognized by asthma guidelines. Why the asthmatic host responds to viral injury in a particular way is largely a mystery and the subject of intense investigation. The role of viruses in asthma extends not just to intermittent but to persistent disease, and to both the atopic as well as nonatopic phenotypes. Future therapeutic strategies should include primary prevention via the development of antiviral innate immunity-enhancing vaccines, as well as secondary prevention via the use of antiviral agents, or immunomodulators designed to boost the antiviral response or interrupt the proinflammatory cascade.Keywords: asthma, rhinoviruses, exacerbations, epidemiology, phenotypes, clinical trials

  12. Intestinal Failure: New Definition and Clinical Implications.

    Science.gov (United States)

    Kappus, Matthew; Diamond, Sarah; Hurt, Ryan T; Martindale, Robert

    2016-09-01

    Intestinal failure (IF) is a state in which the nutritional demands of the body are not met by the gastrointestinal absorptive surface. It is a long-recognized complication associated with short bowel syndrome, which results in malabsorption after significant resection of the intestine for many reasons or functional dysmotility. Etiologies have included Crohn's disease, vascular complications, and the effects of radiation enteritis, as well as the effects of intestinal obstruction, dysmotility, or congenital defects. While IF has been long-recognized, it has historically not been uniformly defined, which has made both recognition and management challenging. This review examines the previous definitions of IF as well as the newer definition and classification of IF and how it is essential to IF clinical guidelines.

  13. Clinical implications from monitoring fetal activity.

    Science.gov (United States)

    Rayburn, W F

    1982-12-15

    The monitoring of fetal motion in high-risk pregnancies has been shown to be worthwhile in predicting fetal distress and impending fetal death. The maternal recording of perceived fetal activity is an inexpensive surveillance technique which is most useful when there is chronic uteroplacental insufficiency or when a stillbirth may be expected. The presence of an active, vigorous fetus is reassuring, but documented fetal inactivity required a reassessment of the underlying antepartum complication and further fetal evaluation with real-time ultrasonography, fetal heart rate testing, and biochemical testing. Fetal distress from such acute changes as abruptio placentae or umbilical cord compression may not be predicted by monitoring fetal motion. Although not used for routine clinical investigation, electromechanical devices such as tocodynamometry have provided much insight into fetal behavioral patterns at many stages of pregnancy and in pregnancies with an antepartum complication.

  14. Medical Malpractice Implications of Clinical Practice Guidelines.

    Science.gov (United States)

    Ruhl, Douglas S; Siegal, Gil

    2017-08-01

    Clinical practice guidelines aim to improve medical care by clarifying and making useful recommendations to providers. Although providers should account for patients' unique characteristics when determining a treatment plan, it is generally perceived as good practice to follow guidelines when applicable. This is of interest in malpractice litigation, where it is essential to establish a standard of care to evaluate the performances of providers. Although the opinions of expert witnesses are used to determine standards of care, guidelines are expected to play a leading role. Guidelines alone should not establish a legal standard but may help inform this discussion in the courtroom. Therefore, it is incumbent that excellent, practical, and timely guidelines are continually created and updated in a transparent way. These guidelines must be very clear and underscore the various strengths of recommendation based on the quality of available evidence.

  15. Episodic Memories in Anxiety Disorders: Clinical Implications

    Science.gov (United States)

    Zlomuzica, Armin; Dere, Dorothea; Machulska, Alla; Adolph, Dirk; Dere, Ekrem; Margraf, Jürgen

    2014-01-01

    The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD). The available literature on explicit, autobiographical, and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret, and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms. PMID:24795583

  16. Episodic memories in anxiety disorders: Clinical implications

    Directory of Open Access Journals (Sweden)

    Armin eZlomuzica

    2014-04-01

    Full Text Available The aim of this review is to summarize research on the emerging role of episodic memories in the context of anxiety disorders (AD. The available literature on explicit-, autobiographical- and episodic memory function in AD including neuroimaging studies is critically discussed. We describe the methodological diversity of episodic memory research in AD and discuss the need for novel tests to measure episodic memory in a clinical setting. We argue that alterations in episodic memory functions might contribute to the etiology of AD. We further explain why future research on the interplay between episodic memory function and emotional disorders as well as its neuroanatomical foundations offers the promise to increase the effectiveness of modern psychological treatments. We conclude that one major task is to develop methods and training programs that might help patients suffering from AD to better understand, interpret and possibly actively use their episodic memories in a way that would support therapeutic interventions and counteract the occurrence of symptoms.

  17. Colony stimulating factors and their clinical implication

    International Nuclear Information System (INIS)

    Asano, Shigetaka

    1989-01-01

    Granulocytes and macrophage are dependent for their production and/or functional activation in vitro on the presence of a family of glycoproteins. They are generally called colony-stimulating factors (CSFs) because of their capacity to stimulate colony formation in semi-solid cultures, and are currently classified into four distinct subtypes, that is, Multi-CSF, GM-CSF, G-CSF and M-CSF, according to the cell type of colonies formed under their stimulation or their target cell specificity. All of the murine and human CSF subtypes and the genes for them have become available in a purified form and in a large scale, and now allow us to investigate their interactions, the mechanisms for their actions, the cell-cell interactions leading to their production and secretion, and their actions in vivo. Furthermore, the preclinical and/or clinical studies which were carried out using the purified CSFs strongly indicate that human CSFs will be effective strategies for preventing and treating opportunistic bacterial and fungal infection as a major cause of death in granulocytopenic patients. (author)

  18. A review of the clinical implications of bisphosphonates in dentistry.

    Science.gov (United States)

    Borromeo, G L; Tsao, C E; Darby, I B; Ebeling, P R

    2011-03-01

    Bisphosphonates are drugs that suppress bone turnover and are commonly prescribed to prevent skeletal related events in malignancy and for benign bone diseases such as osteoporosis. Bisphosphonate associated jaw osteonecrosis (ONJ) is a potentially debilitating, yet poorly understood condition. A literature review was undertaken to review the dental clinical implications of bisphosphonates. The present paper briefly describes the postulated pathophysiology of ONJ and conditions with similar clinical presentations. The implications of bisphosphonates for implantology, periodontology, orthodontics and endodontics are reviewed. Whilst bisphosphonates have potential positive applications in some clinical settings, periodontology particularly, further clinical research is limited by the risk of ONJ. Prevention and management are reviewed, including guidelines for reducing cumulative intravenous bisphosphonate dose, cessation of bisphosphonates prior to invasive dental treatment or after ONJ development, and the use of serum beta-CTX-1 in assessing risk. In the context of substantial uncertainty, the implications of bisphosphonate use in the dental clinical setting are still being determined. © 2010 Australian Dental Association.

  19. Exploring accountability of clinical ethics consultants: practice and training implications.

    Science.gov (United States)

    Weise, Kathryn L; Daly, Barbara J

    2014-01-01

    Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

  20. Supernatural impotence: historical review with anthropological and clinical implications.

    Science.gov (United States)

    Margolin, J; Witztum, E

    1989-12-01

    The historical and cultural background of the belief in supernatural impotence is presented, emphasizing its possible implications for clinical practice. A brief historical survey of the concept in Judaism and Christianity is followed by a short anthropological survey of supernatural impotence in different ethnic subcultures in Israel. A case demonstration exemplifies the connection between understanding the patient's cultural background and beliefs and the clinical competence of the therapist. The relationship between the clinical-therapeutic process in psychiatric practice and knowledge of the patient's cultural background and beliefs is stressed.

  1. Complete morphometric analysis of jugular foramen and its clinical implications

    Directory of Open Access Journals (Sweden)

    Sushant Swaroop Das

    2016-01-01

    Conclusion: This study gives knowledge about the various parameters, anatomical variations of jugular foramen in both sexes of an adult Indian population, and its clinical impact on the surgeries of this region.

  2. HBV DNA Integration: Molecular Mechanisms and Clinical Implications

    Science.gov (United States)

    Tu, Thomas; Budzinska, Magdalena A.; Shackel, Nicholas A.; Urban, Stephan

    2017-01-01

    Chronic infection with the Hepatitis B Virus (HBV) is a major cause of liver-related morbidity and mortality. One peculiar observation in cells infected with HBV (or with closely‑related animal hepadnaviruses) is the presence of viral DNA integration in the host cell genome, despite this form being a replicative dead-end for the virus. The frequent finding of somatic integration of viral DNA suggests an evolutionary benefit for the virus; however, the mechanism of integration, its functions, and the clinical implications remain unknown. Here we review the current body of knowledge of HBV DNA integration, with particular focus on the molecular mechanisms and its clinical implications (including the possible consequences of replication-independent antigen expression and its possible role in hepatocellular carcinoma). HBV DNA integration is likely to influence HBV replication, persistence, and pathogenesis, and so deserves greater attention in future studies. PMID:28394272

  3. Hypertensive response to exercise: mechanisms and clinical implication

    OpenAIRE

    Kim, Darae; Ha, Jong-Won

    2016-01-01

    A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates tha...

  4. Implications of expected climate change in the Mediterranean Region

    Energy Technology Data Exchange (ETDEWEB)

    Jeftic, L. [United Nations Environment Programme, Athens (Greece). Mediterranean Coordinating Unit

    1993-09-01

    A Task Team was established in 1987 with the objective of preparing a Mediterranean regional overview of the implications of climate change for coastal, terrestrial and aquatic ecosystems, as well as for socio-economic structures and activities. The paper presents a summary of the results of the first phase (1987-1989) of the work of the Task Team. Assuming a temperature rise of 1.5{degree}C by the year 2025, land degradation would increase, water resources decline, agricultural production would decline, and terrestrial and aquatic ecosystems could be damaged. Impacts of climatic change when combined with the greater impacts of non-climatic factors (e.g. population increases, development plans) would increase the probability of catastrophic events and hasten their occurrence. Case studies on six sites are to be finalised by the end of 1992. Despite the high quality of the Task Team`s study the impact of its work on national authorities and international bodies was below expectation. A specific regional scenario on climate change in the Mediterranean Basin due to global warming was developed following the Task Team`s recommendation. A summary of the approach and results is presented. 25 refs., 2 figs.

  5. Multidrug efflux pumps in Staphylococcus aureus and their clinical implications.

    Science.gov (United States)

    Jang, Soojin

    2016-01-01

    Antibiotic resistance is rapidly spreading among bacteria such as Staphylococcus aureus, an opportunistic bacterial pathogen that causes a variety of diseases in humans. For the last two decades, bacterial multidrug efflux pumps have drawn attention due to their potential association with clinical multidrug resistance. Numerous researchers have demonstrated efflux-mediated resistance in vitro and in vivo and found novel multidrug transporters using advanced genomic information about bacteria. This article aims to provide a concise summary of multidrug efflux pumps and their important clinical implications, focusing on recent findings concerning S. aureus efflux pumps.

  6. The pathophysiology of the trigeminal autonomic cephalalgias, with clinical implications

    DEFF Research Database (Denmark)

    Barloese, Mads C J

    2018-01-01

    , it is obvious that this brainstem reflex is regulated by higher centers that seemingly play a pivotal role in the attacks and the wide range of other symptoms indicating a homeostatic disturbance. These symptoms, as well as a number of well-validated findings, implicate the hypothalamus in the pathophysiology....... over the course of the past 2-3 decades, novel therapies and technological advances have helped increase our knowledge of these clinical syndromes, and will likely continue to do so in the coming years as we witness the arrival of new drugs and neurostimulation options. In this review, the clinical...

  7. Clinical anatomy of the periocular region.

    Science.gov (United States)

    Shams, Pari N; Ortiz-Pérez, Santiago; Joshi, Naresh

    2013-08-01

    The aims of this article are twofold: (1) to provide the facial plastic surgeon with a comprehensive and up-to-date overview of periocular anatomy including the brow, midface, and temporal region and (2) to highlight important anatomical relationships that must be appreciated in order to achieve the best possible functional and aesthetic surgical outcomes. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  8. Ethical, legal, and social implications (ELSI) of microdose clinical trials.

    Science.gov (United States)

    Kurihara, Chieko

    2011-06-19

    A "microdose clinical trial" (microdosing) is one kind of early phase exploratory clinical trial, administering the compound at doses estimated to have no pharmacological or toxicological effects, aimed at screening candidates for further clinical development. This article's objective is to clarify the ethical, legal, and social implications (ELSI) of such an exploratory minimum-risk human trial. The definition and non-clinical study requirements for microdosing have been harmonized among the European Union (EU), United States (US), and Japan. Being conducted according to these regulations, microdosing seems to be ethically well justified in terms of respect for persons, beneficence, justice, human dignity, and animal welfare. Three big projects have been demonstrating the predictability of therapeutic dose pharmacokinetics from microdosing. The article offers suggestions as how microdosing can become a more useful and socially accepted strategy. Copyright © 2011 Elsevier B.V. All rights reserved.

  9. Clinical Implications of Intestinal Stem Cell Markers in Colorectal Cancer

    DEFF Research Database (Denmark)

    Espersen, Maiken Lise Marcker; Olsen, Jesper; Linnemann, Dorte

    2015-01-01

    Colorectal cancer (CRC) still has one of the highest incidence and mortality rate among cancers. Therefore, improved differential diagnostics and personalized treatment are still needed. Several intestinal stem cell markers have been found to be associated with CRC and might have a prognostic...... and predictive significance in CRC patients. This review provides an overview of the intestinal stem cell markers leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5), B cell–specific Moloney murine leukemia virus insertion site 1 (BMI1), Musashi1 (MSI1), and sex-determining region y-box 9 (SOX9......) and their implications in human CRC. The exact roles of the intestinal stem cell markers in CRC development and progression remain unclear; however, high expression of these stem cell markers have a potential prognostic significance and might be implicated in chemotherapy resistance...

  10. HOXA genes cluster: clinical implications of the smallest deletion

    OpenAIRE

    Pezzani, Lidia; Milani, Donatella; Manzoni, Francesca; Baccarin, Marco; Silipigni, Rosamaria; Guerneri, Silvana; Esposito, Susanna

    2015-01-01

    Background HOXA genes cluster plays a fundamental role in embryologic development. Deletion of the entire cluster is known to cause a clinically recognizable syndrome with mild developmental delay, characteristic facies, small feet with unusually short and big halluces, abnormal thumbs, and urogenital malformations. The clinical manifestations may vary with different ranges of deletions of HOXA cluster and flanking regions. Case presentation We report a girl with the smallest deletion reporte...

  11. Implications of inaccurate clinical nodal staging in pancreatic adenocarcinoma.

    Science.gov (United States)

    Swords, Douglas S; Firpo, Matthew A; Johnson, Kirsten M; Boucher, Kenneth M; Scaife, Courtney L; Mulvihill, Sean J

    2017-07-01

    Many patients with stage I-II pancreatic adenocarcinoma do not undergo resection. We hypothesized that (1) clinical staging underestimates nodal involvement, causing stage IIB to have a greater percent of resected patients and (2) this stage-shift causes discrepancies in observed survival. The Surveillance, Epidemiology, and End Results (SEER) research database was used to evaluate cause-specific survival in patients with pancreatic adenocarcinoma from 2004-2012. Survival was compared using the log-rank test. Single-center data on 105 patients who underwent resection of pancreatic adenocarcinoma without neoadjuvant treatment were used to compare clinical and pathologic nodal staging. In SEER data, medium-term survival in stage IIB was superior to IB and IIA, with median cause-specific survival of 14, 9, and 11 months, respectively (P < .001). Seventy-two percent of stage IIB patients underwent resection vs 28% in IB and 36% in IIA (P < .001). In our institutional data, 12.4% of patients had clinical evidence of nodal involvement vs 69.5% by pathologic staging (P < .001). Among clinical stage IA-IIA patients, 71.6% had nodal involvement by pathologic staging. Both SEER and institutional data support substantial underestimation of nodal involvement by clinical staging. This finding has implications in decisions regarding neoadjuvant therapy and analysis of outcomes in the absence of pathologic staging. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Implications of caries diagnostic strategies for clinical management decisions

    DEFF Research Database (Denmark)

    Baelum, Vibeke; Hintze, Hanne; Wenzel, Ann

    2012-01-01

    -specificity) were calculated for each diagnostic strategy. RESULTS: Visual-tactile examination provided a true-positive rate of 34.2% and a false-positive rate of 1.5% for the detection of a cavity. The combination of a visual-tactile and a radiographic examination using the lesion in dentin threshold......OBJECTIVES: In clinical practice, a visual-tactile caries examination is frequently supplemented by bitewing radiography. This study evaluated strategies for combining visual-tactile and radiographic caries detection methods and determined their implications for clinical management decisions...... and cavitated lesions while the radiographic examination determined lesion depth. Direct inspection of the surfaces following tooth separation for the presence of cavitated or noncavitated lesions was the validation method. The true-positive rate (i.e. the sensitivity) and the false-positive rate (i.e. 1...

  13. Regional enteritis and gluten-free diet. A clinical study

    NARCIS (Netherlands)

    Merwe, Christiaan Frederik van der

    1974-01-01

    The purpose of this clinical study was to determine whether the use of a gluten-free diet influenced the course and prognosis of regional enteritis. Following a few clinical communications in the Dutch medical literature reporting favourable results obtained with the gluten-free diet in the

  14. Diet and Sleep Physiology: Public Health and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Sarah Frank

    2017-08-01

    Full Text Available This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.

  15. An updated concept of coagulation with clinical implications.

    Science.gov (United States)

    Romney, Gregory; Glick, Michael

    2009-05-01

    Over the past century, a series of models have been put forth to explain the coagulation mechanism. The coagulation cascade/waterfall model has gained the most widespread acceptance. This model, however, has problems when it is used in different clinical scenarios. A more recently proposed cell-based model better describes the coagulation process in vivo and provides oral health care professionals (OHCPs) with a better understanding of the clinical implications of providing dental care to patients with potentially increased bleeding tendencies. The authors conducted a literature search using the PubMed database. They searched for key words including "coagulation," "hemostasis," "bleeding," "coagulation factors," "models," "prothrombin time," "activated partial thromboplastin time," "international normalized ratio," "anticoagulation therapy" and "hemophilia" separately and in combination. The coagulation cascade/waterfall model is insufficient to explain coagulation in vivo, predict a patient's bleeding tendency, or correlate clinical outcomes with specific laboratory screening tests such as prothrombin time, activated partial thromboplastin time and international normalized ratio. However, the cell-based model of coagulation that reflects the in vivo process of coagulation provides insight into the clinical ramifications of treating dental patients with specific coagulation factor deficiencies. Understanding the in vivo coagulation process will help OHCPs better predict a patient's bleeding tendency. In addition, applying the theoretical concept of the cell-based model of coagulation to commonly used laboratory screening tests for coagulation and bleeding will result in safer and more appropriate dental care.

  16. Typology of Internet gaming disorder and its clinical implications.

    Science.gov (United States)

    Lee, Seung-Yup; Lee, Hae Kook; Choo, Hyekyung

    2017-07-01

    Various perspectives exist regarding Internet gaming disorder. While the concept of behavioral addiction is gaining recognition, some view the phenomenon as merely excessive indulgence in online pastimes. Still, in recent years, complaints from patients or their family members about problems related to Internet use, particularly Internet gaming, have become more common. However, the clinical picture of Internet gaming disorder could be obscured by its heterogeneous manifestations with other intertwined factors, such as psychiatric comorbidities, neurodevelopmental factors, sociocultural factors, and game-related factors, which may influence the pathogenesis as well as the clinical course. To mitigate such problems, clinicians should be able to consider diverse aspects related to Internet gaming disorder. Classifying such a heterogeneous problem into subtypes that share a similar etiology or phenomenology may provide additional clues in the diagnostic process and allow us to designate available clinical resources for particularly vulnerable factors. In this review paper, we suggest a typology of 'impulsive/aggressive,' 'emotionally vulnerable,' 'socially conditioned,' and 'not otherwise specified' as subtypes of the heterogeneous phenomena of pathological Internet gaming. The implications of these subtypes for assessment and treatment planning will also be highlighted. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

  17. Regional social legitimacy of entrepreneurship: Implications for entrepreneurial intention and start-up behaviour

    OpenAIRE

    Kibler, Ewald; Kautonen, Teemu; Fink, Matthias

    2014-01-01

    Regional social legitimacy of entrepreneurship: implications for entrepreneurial intention and start-up behaviour, Regional Studies. A new understanding of the role of regional culture in the emergence of business start-up behaviour is developed. The focal construct is regional social legitimacy: the perception of the desirability and appropriateness of entrepreneurship in a region. The econometric analysis utilizes a combination of bespoke longitudinal survey data from 65 regions in Austria ...

  18. Clinical features and pathophysiology of Complex Regional Pain Syndrome – current state of the art

    Science.gov (United States)

    Marinus, Johan; Moseley, G. Lorimer; Birklein, Frank; Baron, Ralf; Maihöfner, Christian; Kingery, Wade S.; van Hilten, Jacobus J.

    2017-01-01

    That a minor injury can trigger a complex regional pain syndrome (CRPS) - multiple system dysfunction, severe and often chronic pain and disability - has fascinated scientists and perplexed clinicians for decades. However, substantial advances across several medical disciplines have recently increased our understanding of CRPS. Compelling evidence implicates biological pathways that underlie aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity in the clinical features of CRPS. Collectively, the evidence points to CRPS being a multifactorial disorder that is associated with an aberrant host response to tissue injury. Varying susceptibility to perturbed regulation of any of the underlying biological pathways probably accounts for the clinical heterogeneity of CRPS. PMID:21683929

  19. The Location of ICT activities in EU regions. Implications for regional policies

    Directory of Open Access Journals (Sweden)

    Salvador Barrios

    2008-11-01

    Full Text Available The location of ICT producing industries does matter for global competitivenessand long-run growth potential. For instance, the differing contribution ofICT to economic growth between the US and the EU is often mentioned as one of themain cause explaining the diverging growth performance of these two areas since themid-1990s. In turn, since the mid-1990s, countries with especially dynamic economicgrowth have tended to be highly specialized in ICT-producing and ICT-using industries,see van Ark and Inkaar (2005. More generally, ICT producing sectors, tendto promote technological change and innovative capability which are seen to be at thecore of economic growth and competitiveness. When considering the EU economy,ICT industries appear to be concentrated in a limited number of regions, see Koski etal. (2002 for empirical evidence. Afirst objective of the present paper is to documentthe location of ICT producing industries in European regions in order to map existingEU clusters as well as to analyze recent changes in these industries using recent dataon employment and firm location, especially in relation to the EU enlargement thathas taken place in May 2004. The location of the ICT-producing sectors is not the endof the story however. A crucial aspect concerns the nature of activities that are beingundertaken in different regions. Importantly, ICT industries do have different characteristicsin terms of human capital, skill requirement, and knowledge content. In particular,because of the positive association between human capital, knowledge andlong-run growth, it is important to analyze to what extent EU regional ICT clustersdiffer in according to these characteristics. The second question addressed in the paperconcerns the nature of ICT activities undertaken in EU regions. Finally, the paperprovides econometric estimates of the location of firms in ICT industries across EUregions. The paper considers more specifically the case of multinationals

  20. Clinical Implications of Hedgehog Pathway Signaling in Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Daniel L. Suzman

    2015-09-01

    Full Text Available Activity in the Hedgehog pathway, which regulates GLI-mediated transcription, is important in organogenesis and stem cell regulation in self-renewing organs, but is pathologically elevated in many human malignancies. Mutations leading to constitutive activation of the pathway have been implicated in medulloblastoma and basal cell carcinoma, and inhibition of the pathway has demonstrated clinical responses leading to the approval of the Smoothened inhibitor, vismodegib, for the treatment of advanced basal cell carcinoma. Aberrant Hedgehog pathway signaling has also been noted in prostate cancer with evidence suggesting that it may render prostate epithelial cells tumorigenic, drive the epithelial-to-mesenchymal transition, and contribute towards the development of castration-resistance through autocrine and paracrine signaling within the tumor microenvironment and cross-talk with the androgen pathway. In addition, there are emerging clinical data suggesting that inhibition of the Hedgehog pathway may be effective in the treatment of recurrent and metastatic prostate cancer. Here we will review these data and highlight areas of active clinical research as they relate to Hedgehog pathway inhibition in prostate cancer.

  1. α-Synuclein oligomers and clinical implications for Parkinson disease

    Science.gov (United States)

    Kalia, Lorraine V.; Kalia, Suneil K.; McLean, Pamela J.; Lozano, Andres M.; Lang, Anthony E.

    2012-01-01

    Protein aggregation within the central nervous system has been recognized as a defining feature of neurodegenerative diseases since the early 20th century. Since that time, there has been a growing list of neurodegenerative disorders, including Parkinson disease, which are characterized by inclusions of specific pathogenic proteins. This has led to the long-held dogma that these characteristic protein inclusions, which are composed of large insoluble fibrillar protein aggregates and visible by light microscopy, are responsible for cell death in these diseases. However, the correlation between protein inclusion formation and cytotoxicity is inconsistent suggesting another form of the pathogenic proteins may be contributing to neurodegeneration. There is emerging evidence implicating soluble oligomers, smaller protein aggregates not detectable by conventional microscopy, as potential culprits in the pathogenesis of neurodegenerative diseases. The protein α-synuclein is well recognized to contribute to the pathogenesis of Parkinson disease and is the major component of Lewy bodies and Lewy neurites. However, α-synuclein also forms oligomeric species with certain conformations being toxic to cells. The mechanisms by which these α-synuclein oligomers cause cell death are being actively investigated as they may provide new strategies for diagnosis and treatment of Parkinson disease and related disorders. Here we review the possible role of α-synuclein oligomers in cell death in Parkinson disease and discuss the potential clinical implications. PMID:23225525

  2. Impulse control disorders in Parkinson's disease: clinical characteristics and implications.

    Science.gov (United States)

    Leeman, Robert F; Potenza, Marc N

    2011-04-01

    Impulse control disorders (ICDs), specifically those related to excessive gambling, eating, sex and shopping, have been observed in a subset of people with Parkinson's disease (PD). Although some initial case reports claimed that dopamine replacement therapies, particularly dopamine agonists, cause ICDs, more recent, larger and better controlled studies indicate a more complicated picture. While dopamine replacement therapy use is related to ICDs, other vulnerabilities, some related to PD and/or its treatment directly and others seemingly unrelated to PD, have also been associated with ICDs in PD. This suggests a complex etiology with multiple contributing factors. As ICDs occur in a sizable minority of PD patients and can be associated with significant distress and impairment, further investigation is needed to identify factors that can predict who may be more likely to develop ICDs. Clinical implications are discussed and topics for future research are offered.

  3. Genetic recombination of the hepatitis C virus: clinical implications.

    Science.gov (United States)

    Morel, V; Fournier, C; François, C; Brochot, E; Helle, F; Duverlie, G; Castelain, S

    2011-02-01

    Genetic recombination is a well-known feature of RNA viruses that plays a significant role in their evolution. Although recombination is well documented for Flaviviridae family viruses, the first natural recombinant strain of hepatitis C virus (HCV) was identified as recently as 2002. Since then, a few other natural inter-genotypic, intra-genotypic and intra-subtype recombinant HCV strains have been described. However, the frequency of recombination may have been underestimated because not all known HCV recombinants are screened for in routine practice. Furthermore, the choice of treatment regimen and its predictive outcome remain problematic as the therapeutic strategy for HCV infection is genotype dependent. HCV recombination also raises many questions concerning its mechanisms and effects on the epidemiological and physiopathological features of the virus. This review provides an update on recombinant HCV strains, the process that gives rise to recombinants and clinical implications of recombination. © 2010 Blackwell Publishing Ltd.

  4. [Anaesthetic-induced myocardial preconditioning: fundamental basis and clinical implications].

    Science.gov (United States)

    Chiari, P; Bouvet, F; Piriou, V

    2005-04-01

    Volatile halogenated anaesthetics offer a myocardial protection when they are administrated before a myocardial ischaemia. Cellular mechanisms involved in anaesthetic preconditioning are now better understood. The objectives of this review are to understand the anaesthetic-induced preconditioning underlying mechanisms and to know the clinical implications. References were obtained from PubMed data bank (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using the following keywords: volatile anaesthetic, isoflurane, halothane, sevoflurane, desflurane, preconditioning, protection, myocardium. Ischaemic preconditioning (PC) is a myocardial endogenous protection against ischaemia. It has been described as one or several short ischaemia before a sustained ischemia. These short ischaemia trigger a protective signal against this longer ischaemia. An ischemic organ is able to precondition a remote organ. It is possible to replace the short ischaemia by a preadministration of halogenated volatile anaesthetic with the same protective effect, this is called anaesthetic PC (APC). APC and ischaemic PC share similar underlying biochemical mechanisms including protein kinase C, tyrosine kinase activation and mitochondrial and sarcolemnal K(ATP) channels opening. All halogenated anaesthetics can produce an anaesthetic PC effect. Myocardial protection during reperfusion, after the long ischaemia, has been shown by successive short ischaemia or volatile anaesthetic administration, this is called postconditioning. Ischaemic PC has been described in humans in 1993. Clinical studies in human cardiac surgery have shown the possibility of anaesthetic PC with volatile anaesthetics. These studies have shown a decrease of postoperative troponin in patient receiving halogenated anaesthetics.

  5. Clinical Implications of Changing Parameters on an Elliptical Trainer.

    Science.gov (United States)

    Kaplan, Yonatan; Nyska, Meir; Palmanovich, Ezequiel; Shanker, Rebecca

    2014-06-01

    Specific weightbearing instructions continue to be a part of routine orthopaedic clinical practice on an injured or postoperative extremity. Researchers and clinicians have struggled to define the best weightbearing strategies to maximize clinical outcomes. To investigate the average percentage body weight (APBW) values, weightbearing distribution percentages (WBDP), and cadence values on the entire foot, hindfoot, and forefoot during changing resistance and incline on an elliptical trainer, as well as to suggest clinical implications. Descriptive laboratory study. An original research study was performed consisting of 30 asymptomatic subjects (mean age, 29.54 ± 12.64 years; range, 21-69 years). The protocol included 3 consecutive tests of changing resistance and incline within a speed range of 70 to 95 steps/min. The SmartStep weightbearing gait analysis system was utilized to measure the values. The APBW values for the entire foot ranged between 70% and 81%, the hindfoot values were between 27% and 57%, and the forefoot values between 42% and 70%. With regard to WBDP, the forefoot remained planted on the pedal (stance phase) 2 to 3 times more as compared with the hindfoot raise in the swing phase. The study findings highlight the fact that elliptical training significantly reduces weightbearing in the hindfoot, forefoot, and entire foot even at higher levels of resistance and incline. Weightbearing on the hindfoot consistently displayed the lowest weightbearing values. Orthopaedic surgeons, now equipped with accurate weightbearing data, may recommend using the elliptical trainer as a weightbearing exercise early on following certain bony or soft tissue pathologies and lower limb surgical procedures.

  6. Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Özer Makay

    2017-02-01

    Full Text Available Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT patients. Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions. Study Design: Retrospective, clinical-based multi-centric study of 694 patients with pHPT. Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s, histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN- or familial-related disease. Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria. Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT

  7. State fragility and its regional implications for peace and stability

    DEFF Research Database (Denmark)

    Mandrup, Thomas

    of the Cold war left a security void, and the fragility, and in some instances collapse, of the state structures resulted in new state formations and new conflicts, both intra- and inter-state in nature. However, conflicts and security challenges in East Africa are due to amongst other things porous borders......, fragile states and bad governance regional in nature, and cannot be solved by the individual states alone. Regional institutions have been in a weak position dealing with these challenges, and attempts have been to strengthen the capacity of these regional institutions. This paper investigates...

  8. The Roots and Implications of East Asian Regionalism

    National Research Council Canada - National Science Library

    Miller, John

    2004-01-01

    Regionalism in East Asia is driven by historical patterns of cooperation, the common challenge of the West, the century-long quest for an Asian identity, and growing economic interdependence and integration...

  9. Regional and international implications of the Iranian nuclear crisis

    International Nuclear Information System (INIS)

    Reveillard, Ch.

    2006-01-01

    Iran is distinguished in the Middle East and the world by its geopolitical situation, qualified Middle Empire of the crossed worlds, which are all among the most active zones of the planet on the geopolitical and strategic plans. It undergoes on the one hand, region-al influences and inevitably in return acts in-depth on economic, strategic, diplomatic and cultural reality of its regional space made up of the three wholes: Central Asia, The Middle East, Persian Gulf open on the Indian Ocean. In addition, the singularity of its national policy, that tries to make move back the Anglo-Saxon impregnation of re-modelling the Middle East and the containment of the regional powers. (author)

  10. Central Hyperexcitability in Chronic Musculoskeletal Pain: A Conceptual Breakthrough with Multiple Clinical Implications

    Directory of Open Access Journals (Sweden)

    Jan Lidbeck

    2002-01-01

    Full Text Available Recent investigations of dysfunctional pain processing in the central nervous system have contributed much knowledge about the development of chronic musculoskeletal pain. Many common chronic musculoskeletal pain syndromes - including regional myofascial pain syndromes, whiplash pain syndromes, refractory work-related neck-shoulder pain, certain types of chronic low back pain, fibromyalgia and others - may essentially be explained by abnormalities in central pain modulation. The growing awareness of dysfunctional central pain modulation may be a conceptual breakthrough leading to a better understanding of common chronic pain disorders. A new paradigm will have multiple clinical implications, including re-evaluation of clinical practice routines and rehabilitation methods, and will focus on controversial issues of medicolegal concern. The concept of dysfunctional central pain processing will also necessitate a mechanism-based classification of pain for the selection of individual treatment and rehabilitation programs for subgroups of patients with chronic musculoskeletal pain due to different pathophysiological mechanisms.

  11. Epidemiological and clinical characteristics of myasthenia in the Krasnoyarsk region

    Directory of Open Access Journals (Sweden)

    E. D. Gasymly

    2017-01-01

    Full Text Available Aim. To study the epidemiological features of myasthenia gravis in the Krasnoyarsk region.Materials and methods. 314 cases of myasthenia gravis, registered by the Krasnoyarsk regional health information analytical center, 87 of these patients were under constant monitoring.Results. Mean age of the patients was 45.4 (SD 4.5 years. The number of women in the observed group – 66 (75.86 %, which was 3 times more than men – 21 (24.14 %. The prevalence was 10.98 per 100.000 population, the primary incidence – 0.01 by 1000.Conclusion. Clinical features of the disease in the region were established, the register of patients with myasthenia was formed. From September 2016 a department of the neuromuscular pathology on the basis of advice Regional Hospital was formed.

  12. Variability of CSF Alzheimer's disease biomarkers: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Stephanie J B Vos

    Full Text Available BACKGROUND: Cerebrospinal fluid (CSF biomarkers are increasingly being used for diagnosis of Alzheimer's disease (AD. OBJECTIVE: We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. METHODS: We measured CSF amyloid-β (Aβ 1-42, total tau (t-tau, and phosphorylated tau (p-tau by INNOTEST enzyme-linked-immunosorbent assays (ELISA in a memory clinic population (n = 126. Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. RESULTS: CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. CONCLUSIONS: Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.

  13. The development of human visual cortex and clinical implications

    Directory of Open Access Journals (Sweden)

    Siu CR

    2018-04-01

    Full Text Available Caitlin R Siu,1 Kathryn M Murphy1,2 1McMaster Integrative Neuroscience Discovery and Study (MiNDS Program, McMaster University, Hamilton, ON, Canada; 2Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada Abstract: The primary visual cortex (V1 is the first cortical area that processes visual information. Normal development of V1 depends on binocular vision during the critical period, and age-related losses of vision are linked with neurobiological changes in V1. Animal studies have provided important details about the neurobiological mechanisms in V1 that support normal vision or are changed by visual diseases. There is very little information, however, about those neurobiological mechanisms in human V1. That lack of information has hampered the translation of biologically inspired treatments from preclinical models to effective clinical treatments. We have studied human V1 to characterize the expression of neurobiological mechanisms that regulate visual perception and neuroplasticity. We have identified five stages of development for human V1 that start in infancy and continue across the life span. Here, we describe these stages, compare them with visual and anatomical milestones, and discuss implications for translating treatments for visual disorders that depend on neuroplasticity of V1 function. Keywords: development, human visual cortex, amblyopia, synaptic plasticity, glutamatergic, GABAergic, receptors

  14. The image schema and innate archetypes: theoretical and clinical implications.

    Science.gov (United States)

    Merchant, John

    2016-02-01

    Based in contemporary neuroscience, Jean Knox's 2004 JAP paper 'From archetypes to reflective function' honed her position on image schemas, thereby introducing a model for archetypes which sees them as 'reliably repeated early developmental achievements' and not as genetically inherited, innate psychic structures. The image schema model is used to illustrate how the analyst worked with a patient who began life as an unwanted pregnancy, was adopted at birth and as an adult experienced profound synchronicities, paranormal/telepathic phenomena and visions. The classical approach to such phenomena would see the intense affectivity arising out of a ruptured symbiotic mother-infant relationship constellating certain archetypes which set up the patient's visions. This view is contrasted with Knox's model which sees the archetype an sich as a developmentally produced image schema underpinning the emergence of later imagery. The patient's visions can then be understood to arise from his psychoid body memory related to his traumatic conception and birth. The contemporary neuroscience which supports this view is outlined and a subsequent image schema explanation is presented. Clinically, the case material suggests that a pre-birth perspective needs to be explored in all analytic work. Other implications of Knox's image schema model are summarized. © 2016, The Society of Analytical Psychology.

  15. Clinical implications of microRNAs in human glioblastoma

    Directory of Open Access Journals (Sweden)

    Masahiro eMizoguchi

    2013-02-01

    Full Text Available Glioblastoma (GBM is one of the most common and dismal brain tumors in adults. Further elucidation of the molecular pathogenesis of GBM is mandatory to improve the overall survival of patients. A novel small non-coding RNA molecule, microRNA (miRNA, appears to represent one of the most attractive target molecules contributing to the pathogenesis of various types of tumors. Recent global analyses have revealed that several miRNAs are clinically implicated in GBM, with some reports indicating the association of miRNA dysregulation with acquired temozolomide (TMZ resistance. More recent studies have revealed that miRNAs could play a role in cancer stem cell (CSC properties, contributing to treatment resistance. In addition, greater impact might be expected from miRNA-targeted therapies based on tumor-derived exosomes that contain numerous functional miRNAs, which could be transferred between tumor cells and surrounding structures. Tumor-derived miRNAs are now considered to be a novel molecular mechanism promoting the progression of GBM. Establishment of miRNA-targeted therapies based on miRNA dysregulation of CSCs could provide effective therapeutic strategies for TMZ-resistant GBM. Recent progress has revealed that miRNAs are not only putative biological markers for diagnosis, but also one of the most promising targets for GBM treatment. Herein, we summarize the translational aspects of miRNAs in the diagnosis and treatment of GBM.

  16. Hypertensive response to exercise: mechanisms and clinical implication.

    Science.gov (United States)

    Kim, Darae; Ha, Jong-Won

    2016-01-01

    A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates that a HRE is associated with functional and structural abnormalities of left ventricle, especially when accompanied by increased central blood pressure. A HRE harbors prognostic significance in future development of hypertension and increased cardiovascular events, particularly if a HRE is documented in moderate intensity of exercise. As supported by previous studies, a HRE is not a benign phenomenon, however, currently, whether to treat a HRE is controversial with uncertain treatment strategy. Considering underlying mechanisms, angiotensin receptor blockers and beta blockers can be suggested in individuals with HRE, however, evidences for efficacy and outcomes of treatment of HRE in individuals without hypertension is scarce and therefore warrants further studies.

  17. Intercontinental Transport of Aerosols: Implication for Regional Air Quality

    Science.gov (United States)

    Chin, Mian; Diehl, Thomas; Ginoux, Paul

    2006-01-01

    Aerosol particles, also known as PM2.5 (particle diameter less than 2.5 microns) and PM10 (particle diameter less than 10 microns), is one of the key atmospheric components that determine ambient air quality. Current US air quality standards for PM10 (particles with diameter air pollution problems, aerosols can be transported on a hemispheric or global scale. In this study, we use the Goddard Chemistry Aerosol Radiation and Transport (GOCART) model to quantify contributions of long-range transport vs. local/regional pollution sources and from natural vs. anthropogenic sources to PM concentrations different regions. In particular, we estimate the hemispheric impact of anthropogenic sulfate aerosols and dust from major source areas on other regions in the world. The GOCART model results are compared with satellite remote sensing and ground-based network measurements of aerosol optical depth and concentrations.

  18. Acid Rain in Niger Delta Region: Implication on Water Resources ...

    African Journals Online (AJOL)

    This research focused on the effect of acid rain on the water quality of the Niger Delta region of Nigeria. Three hundred water samples were collected: 100 water samples from rain, 100 from open wells and 100 from rivers. The water samples were analysed using the paired t-test and multiple correlation analysis to ascertain ...

  19. Implications of climate change in the ROPME region: an overview

    Energy Technology Data Exchange (ETDEWEB)

    Hassan, M.E.; Gerges, M.A.

    1994-12-31

    The Regional Organization for the Protection of the Marine Environment (ROPME) region is divided into three areas: SA-I, the northern part of the Arabian Sea bounded by the south coast of the Sultanate of Oman, the mouth of the Gulf of Oman and the southern coast of the Islamic Republic of Iran; SA-II, the Gulf of Oman; and SA-III named as the Persian or Arabian Gulf. SA-I is the prime representative of the monsoonal weather system, which produces strong summertime upwelling resulting in rich fisheries that disappear in the winter. SA-II shows transition between the monsoonal system and the desert belt climate of SA-III. Its shallowness mean that the annual range of water temperature is the greatest for any water body freely connected to the world ocean. This restricts the ecosystems that can survive. It also enhances the effect of sea level rise on the tidal pattern. Because the SA-III region is the world`s major oil and gas extraction area, resulting land subsidence can produce an apparent sea level rise of the same order of magnitude as that postulated from expected climate change. Observed sea level rise could be twice the global rate. The shallowness of the area means that the change of tidal pattern resulting from the change of depth will be very dramatic. To help combat climate change it is recommended that: a high quality dense tide recording network be set up and connected to a land subsidence recording network; a regional central data collecting and data processing centre be identified in the region; an active participation in international relevant programs such as TOGA and GOOS by ROPME Member States be maintained; and environmental non-Governmental Organizationsshould be encouraged to publicise these issues.

  20. Water Supply Deficiency and Implications for Rural Development in the Niger-Delta Region of Nigeria

    Science.gov (United States)

    Nkwocha, E. E.

    2009-01-01

    There is a growing concern about the marginalization of the Niger Delta region of Nigeria in terms of infrastructural and social services provision. This study examined the water supply deficiency and its general implications for rural development within the region. Data and other study characteristics were extracted from 501 subjects drawn from…

  1. The pathophysiology of migraine: implications for clinical management.

    Science.gov (United States)

    Charles, Andrew

    2018-02-01

    The understanding of migraine pathophysiology is advancing rapidly. Improved characterisation and diagnosis of its clinical features have led to the view of migraine as a complex, variable disorder of nervous system function rather than simply a vascular headache. Recent studies have provided important new insights into its genetic causes, anatomical and physiological features, and pharmacological mechanisms. The identification of new migraine-associated genes, the visualisation of brain regions that are activated at the earliest stages of a migraine attack, a greater appreciation of the potential role of the cervical nerves, and the recognition of the crucial role for neuropeptides are among the advances that have led to novel targets for migraine therapy. Future management of migraine will have the capacity to tailor treatments based on the distinct mechanisms of migraine that affect individual patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

  2. Multi-regional clinical trials and global drug development

    Directory of Open Access Journals (Sweden)

    Premnath Shenoy

    2016-01-01

    Full Text Available Drug development has been globalized, and multi-regional clinical trial (MRCT for regulatory submission has widely been conducted by many discovery based global pharmaceutical companies with the objective of reducing the time lag of launch in key markets and improve patient access to new and innovative treatments. Sponsors are facing several challenges while conducting multiregional clinical trials. Challenges under the heads statistics, clinical, regulatory operational, and ethics have been discussed. Regulators in different countries such as USA, EU-Japan, and China have issued guidance documents in respect of MRCT's. Lack of harmonization in the design and planning of MRCT is perceived to create a difficult situation to sponsors adversely affecting progressing MRCT in more and more discoveries. International conference on hormonisation (ICH has initiated the process for having a harmonized guidance document on MRCT. This document is likely to be issued in early 2017.

  3. United States - Japanese nuclear relations: implications for the pacific region

    International Nuclear Information System (INIS)

    Suttmeier, R.P.

    1980-01-01

    The initiation of a new approach to non-proliferation policy by the United States in 1977 was the most upsetting development in the history of US-Japanese nuclear relations. The policy has seemingly altered Japanese views of its own nuclear future very little, yet it has altered the tone of the nuclear relationship with the United States. Recent Japanese nuclear power developments, both technical and administrative, are outlined and the prospects for the future of the United States-Japanese nuclear relationship and for Pacific regional cooperation assessed. Issues of importance in the relationship include reprocessing - enrichment, plutonium management, spent fuel and waste management and uranium supplies

  4. Rethinking dry eye disease: a perspective on clinical implications.

    Science.gov (United States)

    Bron, Anthony J; Tomlinson, Alan; Foulks, Gary N; Pepose, Jay S; Baudouin, Christophe; Geerling, Gerd; Nichols, Kelly K; Lemp, Michael A

    2014-04-01

    Publication of the DEWS report in 2007 established the state of the science of dry eye disease (DED). Since that time, new evidence suggests that a rethinking of traditional concepts of dry eye disease is in order. Specifically, new evidence on the epidemiology of the disease, as well as strategies for diagnosis, have changed the understanding of DED, which is a heterogeneous disease associated with considerable variability in presentation. These advances, along with implications for clinical care, are summarized herein. The most widely used signs of DED are poorly correlated with each other and with symptoms. While symptoms are thought to be characteristic of DED, recent studies have shown that less than 60% of subjects with other objective evidence of DED are symptomatic. Thus the use of symptoms alone in diagnosis will likely result in missing a significant percentage of DED patients, particularly with early/mild disease. This could have considerable impact in patients undergoing cataract or refractive surgery as patients with DED have less than optimal visual results. The most widely used objective signs for diagnosing DED all show greater variability between eyes and in the same eye over time compared with normal subjects. This variability is thought to be a manifestation of tear film instability which results in rapid breakup of the tearfilm between blinks and is an identifier of patients with DED. This feature emphasizes the bilateral nature of the disease in most subjects not suffering from unilateral lid or other unilateral destabilizing surface disorders. Instability of the composition of the tears also occurs in dry eye disease and shows the same variance between eyes. Finally, elevated tear osmolarity has been reported to be a global marker (present in both subtypes of the disease- aqueous-deficient dry eye and evaporative dry eye). Clinically, osmolarity has been shown to be the best single metric for diagnosis of DED and is directly related to

  5. Periodic Epileptiform Discharges Clarified for the Nonneurologist Intensivist: Clinical Implications and Current Management.

    Science.gov (United States)

    Lahiri, Shouri; Boro, Alexis D; Shiloh, Ariel L; Milstein, Mark J; Savel, Richard H

    2015-10-01

    Periodic epileptiform discharges (PEDs) are frequently encountered during continuous electroencephalography monitoring in the intensive care unit. Their implications and management are variable and highly dependent on the clinical context. This article is intended for the nonneurologist intensivist, reviews basic terminology and clinical implications (including causes, prognosis, and association with seizures), and suggests an approach to management. Several case vignettes are included to illustrate the clinical variability associated with PEDs. © The Author(s) 2013.

  6. China–Myanmar Energy Cooperation and Its Regional Implications

    Directory of Open Access Journals (Sweden)

    Hong Zhao

    2011-01-01

    Full Text Available Although Myanmar is among the world’s oldest oil-producing countries, Chinese oil and gas companies did not start their oil and gas exploration projects there until recently. The most recent and significant China–Myanmar energy cooperation project is the oil and gas pipelines which got started in 2009. This paper will discuss the reasons and driving forces for this pipeline project and its broader objectives, and testify whether pipelines can deepen regional economic integration and strengthen bilateral relations. This paper concludes by saying that China might use the China–Myanmar pipeline construction as an opportunity to play a more constructive role in Myanmar’s domestic reforms, thus improving its image in Southeast Asia and strengthening its relations with Myanmar.

  7. Centralization of a Regional Clinical Microbiology Service: The Calgary Experience

    Directory of Open Access Journals (Sweden)

    Deirdre L Church

    1999-01-01

    Full Text Available Diagnostic laboratory services in Alberta have been dramatically restructured over the past five years. In 1994, Alberta Health embarked on an aggressive laboratory restructuring that cut back approximately 30% of the overall monies previously paid to the laboratory service sector in Calgary. A unique service delivery model consolidated all institutional and community-based diagnostic testing in a company called Calgary Laboratory Services (CLS in late 1996. CLS was formed by a public/private partnership between the Calgary Regional Health Care Authority (CRHA and MDS-Kasper Laboratories. By virtue of its customer service base and scope of testing, CLS provides comprehensive regional laboratory services to the entire populace. Regional microbiology services within CLS have been successfully consolidated over the past three years into a centralized high volume laboratory (HVL. Because the HVL is not located in a hospital, rapid response laboratories (RRLs are operated at each acute care site. Although the initial principle behind the proposed test menus for the RRLs was that only procedures requiring a clinical turnaround time of more than 2 h stay on-site, many other principles had to be used to develop and implement an efficient and clinically relevant RRL model for microbiology. From these guiding principles, a detailed assessment of the needs of each institution and extensive networking with user groups, the functions of the microbiology RRLs were established and a detailed implementation plan drawn up. The experience at CLS with regards to restructuring a regional microbiology service is described herein. A post-hoc analysis provides the pros and cons of directing and operating a regionalized microbiology service.

  8. Private inherited microdeletion/microduplications: implications in clinical practice.

    Science.gov (United States)

    Mencarelli, Maria Antonietta; Katzaki, Eleni; Papa, Filomena Tiziana; Sampieri, Katia; Caselli, Rossella; Uliana, Vera; Pollazzon, Marzia; Canitano, Roberto; Mostardini, Rosa; Grosso, Salvatore; Longo, Ilaria; Ariani, Francesca; Meloni, Ilaria; Hayek, Josef; Balestri, Paolo; Mari, Francesca; Renieri, Alessandra

    2008-01-01

    The introduction of array-CGH analysis is allowing the identification of novel genomic disorders. However, this new high-resolution technique is also opening novel diagnostic challenges when inherited private CNVs of unclear clinical significance are found. Oligo array-CGH analysis of 84 patients with mild to severe mental retardation associated with multiple congenital anomalies revealed 10 private CNVs inherited from a healthy parent. Three were deletions (7q31, 14q21.1, Xq25) and seven duplications (12p11.22, 12q21.31, 13q31.1, 17q12, Xp22.31, Xq28) ranging between 0.1 and 3.8Mb. Six rearrangements were not polymorphic. Four overlapped polymorphic regions to the extent of 10-61%. In one case the size was different between the proband and the healthy relative. Three small rearrangements were gene deserts. The remaining seven had a mean gene content of five (ranging from 1 to 18). None of the rearranged genes is known to be imprinted. Three disease-genes were found in three different cases: KAL1 in dupXp22.31, STS in another dupXp22.31 and TCF2 in dup17q12. The patient carrying the last duplication presents sex reversal, Peters' anomaly and renal cysts and the duplication is located 4Mb away from the HSD17B1 gene, coding a key enzyme of testosterone biosynthesis. Considering the overlap with polymorphic regions, size-identity within the family, gene content, kind of rearrangement and size of rearrangement we suggest that at least in five cases the relationship to the phenotype has not to be excluded. We recommend to maintain caution when asserting that chromosomal abnormalities inherited from a healthy parent are benign. A more complex mechanism may in fact be involved, such as a concurrent variation in the other allele or in another chromosome that influences the phenotype.

  9. International labour migration in the Asian-Pacific region: patterns, policies and economic implications.

    Science.gov (United States)

    Athukorala, P

    1993-11-01

    "This paper reviews the literature on international labour migration from and within the Asian-Pacific region. It deals with patterns and characteristics of migration flows, government policies towards labour migration, and economic implications of labour migration for both labour-exporting and importing countries in the region. The indications are that, despite gradual slowing down of labour flows to the western industrial countries and the Middle East, labour migration will continue to be a major economic influence on surplus-labour countries in the region. As an integral part of the growth dynamism in the region, labour migration has now begun to take on a regional dimension, with immense implications for the process of industrial restructuring in high growth economies and the changing pattern of economic interdependence among countries." excerpt

  10. The mandible and its foramen: anatomy, anthropology, embryology and resulting clinical implications.

    Science.gov (United States)

    Lipski, M; Tomaszewska, I M; Lipska, W; Lis, G J; Tomaszewski, K A

    2013-11-01

    The aim of this paper is to summarise the knowledge about the anatomy, embryology and anthropology of the mandible and the mandibular foramen and also to highlight the most important clinical implications of the current studies regarding anaesthesia performed in the region of the mandible. An electronic journal search was undertaken to identify all the relevant studies published in English. The search included MEDLINE and EMBASE databases and years from 1950 to 2012. The subject search used a combination of controlled vocabulary and free text based on the search strategy for MEDLINE using key words: 'mandible', 'mandibular', 'foramen', 'anatomy', 'embryology', 'anthropology', and 'mental'. The reference lists of all the relevant studies and existing reviews were screened for additional relevant publications. Basing on relevant manuscripts, this short review about the anatomy, embryology and anthropology of the mandible and the mandibular foramen was written.

  11. [Regional health and autonomy conferences (CRSAs): the implications for medical democracy at a regional level].

    Science.gov (United States)

    Devictor, Bernadette

    2010-01-01

    The HPST law seeks to reorganize the governance of healthcare at a regional level and to maintain the existence of regional health conferences, now known as regional health and autonomy conferences (CRSAs). The purpose of this article is to examine the new duties attributed to the CRSAs and to consider the various issues raised by their practice. The article also provides an analysis of the preconditions required for the successful implementation of medical democracy at a regional level, ie.: the involvement of the CRSAs in the assessment of regional healthcare policies, the mobilization of funds, the composition of the CRSAs (including the full range of healthcare areas), the importance of providing adequate support for territorial conferences, and the elaboration of a communicative space for fostering exchanges between CRSAs.

  12. Balancing regional industrial development: analysis on regional disparity of China's industrial emissions and policy implications

    DEFF Research Database (Denmark)

    Liang, Hanwei; Dong, Liang; Luo, Xiao

    2016-01-01

    Efficient industrial emissions mitigation strategy is critical for China's national action on climate change and sustainable development, considering its rapid industrialization. Regional disparity brings difficulties and uncertainties to policy implementation in China. Therefore, an investigation...... development, and highlight not only disparity, but also inequity exists. It is concluded that, there is a larger unequal distribution of GDP per unit of air pollutants and CO2 emission between eastern and western regions, reveals that less developed western and central regions suffer from the emission leakage...... on the regional features of industrial emissions is critical to better decision makings. While to date, related studies have been rather few. This paper applies a spatial analysis on regional features of China's industrial emissions (SO2, NOx and PM2.5 and CO2 emission) in 31 provinces. Spatial autocorrelation...

  13. DMPD: Innate immunity and toll-like receptors: clinical implications of basic scienceresearch. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 15069387 Innate immunity and toll-like receptors: clinical implications of basic science...te immunity and toll-like receptors: clinical implications of basic scienceresearch. PubmedID 15069387 Title... Innate immunity and toll-like receptors: clinical implications of basic sciencer

  14. Highly restricted deletion of the SNORD116 region is implicated in Prader–Willi Syndrome

    Science.gov (United States)

    Bieth, Eric; Eddiry, Sanaa; Gaston, Véronique; Lorenzini, Françoise; Buffet, Alexandre; Conte Auriol, Françoise; Molinas, Catherine; Cailley, Dorothée; Rooryck, Caroline; Arveiler, Benoit; Cavaillé, Jérome; Salles, Jean Pierre; Tauber, Maïthé

    2015-01-01

    The SNORD116 locus lies in the 15q11-13 region of paternally expressed genes implicated in Prader–Willi Syndrome (PWS), a complex disease accompanied by obesity and severe neurobehavioural disturbances. Cases of PWS patients with a deletion encompassing the SNORD116 gene cluster, but preserving the expression of flanking genes, have been described. We report a 23-year-old woman who presented clinical criteria of PWS, including the behavioural and nutritional features, obesity, developmental delay and endocrine dysfunctions with hyperghrelinemia. We found a paternally transmitted highly restricted deletion of the SNORD116 gene cluster, the shortest described to date (118 kb). This deletion was also present in the father. This finding in a human case strongly supports the current hypothesis that lack of the paternal SNORD116 gene cluster has a determinant role in the pathogenesis of PWS. Moreover, targeted analysis of the SNORD116 gene cluster, complementary to SNRPN methylation analysis, should be carried out in subjects with a phenotype suggestive of PWS. PMID:24916642

  15. Highly restricted deletion of the SNORD116 region is implicated in Prader-Willi Syndrome.

    Science.gov (United States)

    Bieth, Eric; Eddiry, Sanaa; Gaston, Véronique; Lorenzini, Françoise; Buffet, Alexandre; Conte Auriol, Françoise; Molinas, Catherine; Cailley, Dorothée; Rooryck, Caroline; Arveiler, Benoit; Cavaillé, Jérome; Salles, Jean Pierre; Tauber, Maïthé

    2015-02-01

    The SNORD116 locus lies in the 15q11-13 region of paternally expressed genes implicated in Prader-Willi Syndrome (PWS), a complex disease accompanied by obesity and severe neurobehavioural disturbances. Cases of PWS patients with a deletion encompassing the SNORD116 gene cluster, but preserving the expression of flanking genes, have been described. We report a 23-year-old woman who presented clinical criteria of PWS, including the behavioural and nutritional features, obesity, developmental delay and endocrine dysfunctions with hyperghrelinemia. We found a paternally transmitted highly restricted deletion of the SNORD116 gene cluster, the shortest described to date (118 kb). This deletion was also present in the father. This finding in a human case strongly supports the current hypothesis that lack of the paternal SNORD116 gene cluster has a determinant role in the pathogenesis of PWS. Moreover, targeted analysis of the SNORD116 gene cluster, complementary to SNRPN methylation analysis, should be carried out in subjects with a phenotype suggestive of PWS.

  16. Gastrointestinal Motility Disorders and Their Clinical Implications in Cirrhosis

    Directory of Open Access Journals (Sweden)

    Eleni Theocharidou

    2017-01-01

    Full Text Available Gastrointestinal motility is impaired in a substantial proportion of patients with cirrhosis. Cirrhosis-related autonomic neuropathy, increased nitric oxide production, and gut hormonal changes have been implicated. Oesophageal dysmotility has been associated with increased frequency of abnormal gastro-oesophageal reflux. Impaired gastric emptying and accommodation may result in early satiety and may have an impact on the nutritional status of these patients. Small intestinal dysmotility might be implicated in small intestinal bacterial overgrowth and increased bacterial translocation. The latter has been implicated in the pathophysiology of hepatic encephalopathy and spontaneous bacterial peritonitis. Enhanced colonic motility is usually associated with the use of lactulose. Pharmacological interventions aiming to alter gastrointestinal motility in cirrhosis could potentially have a beneficial effect reducing the risk of hepatic decompensation and improving prognosis.

  17. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications

    International Nuclear Information System (INIS)

    Sun, Fei; Crisóstomo, Verónica; Báez-Díaz, Claudia; Sánchez, Francisco M.

    2016-01-01

    Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE

  18. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications.

    Science.gov (United States)

    Sun, Fei; Crisóstomo, Verónica; Báez-Díaz, Claudia; Sánchez, Francisco M

    2016-01-01

    Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.

  19. Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Fei, E-mail: feisun@ccmijesususon.com; Crisóstomo, Verónica, E-mail: crisosto@ccmijesususon.com; Báez-Díaz, Claudia, E-mail: cbaez@ccmijesususon.com; Sánchez, Francisco M., E-mail: msanchez@ccmijesususon.com [Jesús Usón Minimally Invasive Surgery Centre (Spain)

    2016-01-15

    Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.

  20. Implications of greenhouse gas emission mitigation scenarios for the main Asian regions

    NARCIS (Netherlands)

    van Ruijven, B.J.|info:eu-repo/dai/nl/304834521; van Vuuren, D.P.|info:eu-repo/dai/nl/11522016X; van Vliet, J.; Mendoza Beltran, A.; Deetman, S.; den Elzen, M.G.J.

    2012-01-01

    In order to limit global mean temperature increase, long-term greenhouse gas emissions need to be reduced. This paper discusses the implications of greenhouse gas emission reductions for major Asian regions (China, India, Indonesia, South-East Asia, Japan and Korea) based on results from the IMAGE

  1. A gene expression signature for RSV: clinical implications and limitations.

    Directory of Open Access Journals (Sweden)

    Peter J M Openshaw

    2013-11-01

    Full Text Available Peter Openshaw discusses the challenges in advancing respiratory syncytial virus (RSV treatments and the implications of a study by Mejias and colleagues using a newly identified gene signature for diagnosis and prediction of RSV severity. Please see later in the article for the Editors' Summary.

  2. Sexual Objectification of Women: Clinical Implications and Training Considerations

    Science.gov (United States)

    Szymanski, Dawn M.; Carr, Erika R.; Moffitt, Lauren B.

    2011-01-01

    This article focuses on the implications of theory and empirical research on the sexual objectification of women. Drawing largely from the American Psychological Association's 2007 "Guidelines for Psychological Practice With Girls and Women," the 2007 "Report of the American Psychological Association's Task Force on the Sexualization of Girls,"…

  3. Transport of Aerosols: Regional and Global Implications for Climate, Weather, and Air Quality

    Science.gov (United States)

    Chin, Mian; Diehl, Thomas; Yu, Hongbin; Bian, Huisheng; Remer, Lorraine; Kahn, Ralph

    2008-01-01

    Long-range transport of atmospheric aerosols can have a significant impact on global climate, regional weather, and local air quality. In this study, we use a global model GOCART together with satellite data and ground-based measurements to assess the emission and transport of pollution, dust, biomass burning, and volcanic aerosols and their implications. In particular, we will show the impact of emissions and long-range transport of aerosols from major pollution and dust source regions to (1) the surface air quality, (2) the atmospheric heating rates, and (3) surface radiation change near the source and downwind regions.

  4. Osteoarthritis subpopulations and implications for clinical trial design

    NARCIS (Netherlands)

    S.M. Bierma-Zeinstra (Sita); A.P. Verhagen (Arianne)

    2011-01-01

    textabstractTreatment guidelines for osteoarthritis have stressed the need for research on clinical predictors of response to different treatments. However, identifying such clinical predictors of response is less easy than it seems, and there is not a given classification of osteoarthritis

  5. CLINICAL AND EPIDEMIOLOGICAL ASPECTS OF YERSINIOSES IN KHARKIV REGION

    Directory of Open Access Journals (Sweden)

    Mohylenets O.I.

    2015-05-01

    Full Text Available Despite great success in diagnostics of infectious diseases and development of new laboratory methods, vast majority of cases are not diagnosed or registered as different diagnosis. It connected with polymorphism of clinical signs and difficulty of specific diagnostics. The most evidential method of diagnostics is culture, but grows of Yersinia spp. on common media is very bad. More specific and modern methods are immunoferment analysis (IFA, polymerase chain reaction, immunoblot analysis, but this methods are rather expensive and require specialized laboratory equipmet and staff. Indirect hemahlutination test (IHAT is still more common in Ukraine. Materials and methods The object of the study were 61 patients with yersiniosis who were treated in the Kharkiv Regional Clinical Infectious Diseases Hospital during five years. The diagnosis of yersiniosis in all patients was based on epidemiological, clinical, anamnestic data; results of additional laboratory studies which were in accordance with generally accepted clinical criteria. Final diagnosis was confirmed by results of serological studies (IHAT in pair serum with Yersinia enterocolitica 03, Yersinia enterocolitica 09 and Yersinia pseudotuberculosis antigen. For exclusion of viral hepatitis patients with jaundice were checked for anti- HAV IgM, HbsAg, and anti-HCV ІgG by IFA. Statistical data processing was carried out by means of Statistica 6,0 software package. Comparative group analysis was perfomed by using χ 2 (Pearson criterium. Differences with p<0,05 were considered statistically significant. Results and Discussion From the 61 patients that were under our supervision, in 59 was diagnosed intestinal yersiniosis, in 2 – pseudotuberculosis. Patients up to 50 years old were dominated. The incidence was recorded throughout the year in the form of sporadic cases. The severity of the disease in most cases was moderate (55,7% or mild (32,8%. Severe disease was registered in 7 patients

  6. The Location of ICT activities in EU regions. Implications for regional policies

    Directory of Open Access Journals (Sweden)

    Salvador Barrios

    2008-01-01

    estimaciones econométricas sobre la localización de las empresas en la industria de las TIC a través de las regiones de la UE. El trabajo considera específicamente el caso de la localización de las multinacionales. Los resultados de los determinantes de la localización de las empresas parece diferir ampliamente dependiendo del sector de las TIC considerado, como del tipo de empresa considerada. A partir de estos resultados se deriva un número de implicaciones de política.

  7. Chromosomal Aberrations Associated with Clonal Evolution and Leukemic Transformation in Fanconi Anemia: Clinical and Biological Implications

    Directory of Open Access Journals (Sweden)

    Stefan Meyer

    2012-01-01

    Full Text Available Fanconi anaemia (FA is an inherited disease with congenital and developmental abnormalities, bone marrow failure, and extreme risk of leukemic transformation. Bone marrow surveillance is an important part of the clinical management of FA and often reveals cytogenetic aberrations. Here, we review bone marrow findings in FA and discuss the clinical and biological implications of chromosomal aberrations associated with leukemic transformation.

  8. Clinical implication of smoking among patients with schizophrenia at ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to determine if cigarette smoking in schizophrenia is associated with increased disability ... Cite as: Aguocha C, Uwakwe R, Olose E, Amadi K, Onyeama G, Duru C. Clinical ..... addiction and schizophrenia.

  9. Implications of Clinical Trial Design on Sample Size Requirements

    OpenAIRE

    Leon, Andrew C.

    2008-01-01

    The primary goal in designing a randomized controlled clinical trial (RCT) is to minimize bias in the estimate of treatment effect. Randomized group assignment, double-blinded assessments, and control or comparison groups reduce the risk of bias. The design must also provide sufficient statistical power to detect a clinically meaningful treatment effect and maintain a nominal level of type I error. An attempt to integrate neurocognitive science into an RCT poses additional challenges. Two par...

  10. Myasthenia gravis and pregnancy: clinical implications and neonatal outcome

    Directory of Open Access Journals (Sweden)

    Estanol Bruno

    2004-11-01

    Full Text Available Abstract Background The myasthenia gravis is twice as common in women as in men and frequently affects young women in the second and third decades of life, overlapping with the childbearing years. Generally, during pregnancy in one third of patients the disease exacerbates, whereas in two thirds it remains clinically unchanged. Complete remission can occur in some patients. Methods To describe the clinical course, delivery and neonatal outcome of 18 pregnant women with the diagnosis of myasthenia gravis. Retrospective chart review of pregnant patients with myasthenia gravis, followed at the National Institute of Perinatology in Mexico City over an 8-year period. Data was abstracted from the medical records on the clinical course during pregnancy, delivery and neonatal outcome. Results From January 1, 1996 to December 31, 2003 18 patients with myasthenia gravis were identified and included in the study. The mean ± SD maternal age was 27.4 ± 4.0 years. During pregnancy 2 women (11% had an improvement in the clinical symptoms of myasthenia gravis, 7 women (39% had clinical worsening of the condition of 9 other patients (50% remained clinically unchanged. Nine patients delivered vaginally, 8 delivered by cesarean section and 1 pregnancy ended in fetal loss. Seventeen infants were born at mean ± SD gestational age of 37.5 ± 3.0 weeks and a mean birth weight of 2710 ± 73 g. Only one infant presented with transient neonatal myasthenia gravis. No congenital anomalies were identified in any of the newborns. Conclusions The clinical course of myasthenia gravis during pregnancy is variable, with a significant proportion of patients experiencing worsening of the clinical symptoms. However, neonatal transient myasthenia was uncommon in our patient population.

  11. Metabolic fuel and clinical implications for female reproduction.

    Science.gov (United States)

    Mircea, Carmen N; Lujan, Marla E; Pierson, Roger A

    2007-11-01

    Reproduction is a physiologically costly process that consumes significant amounts of energy. The physiological mechanisms controlling energy balance are closely linked to fertility. This close relationship ensures that pregnancy and lactation occur only in favourable conditions with respect to energy. The primary metabolic cue that modulates reproduction is the availability of oxidizable fuel. An organism's metabolic status is transmitted to the brain through metabolic fuel detectors. There are many of these detectors at both the peripheral (e.g., leptin, insulin, ghrelin) and central (e.g., neuropeptide Y, melanocortin, orexins) levels. When oxidizable fuel is scarce, the detectors function to inhibit the release of gonadotropin-releasing hormone and luteinizing hormone, thereby altering steroidogenesis, reproductive cyclicity, and sexual behaviour. Infertility can also result when resources are abundant but food intake fails to compensate for increased energy demands. Examples of these conditions in women include anorexia nervosa and exercise-induced amenorrhea. Infertility associated with obesity appears to be less related to an effect of oxidizable fuel on the hypothalamic-pituitary-ovarian axis. Impaired insulin sensitivity may play a role in the etiology of these conditions, but their specific etiology remains unresolved. Research into the metabolic regulation of reproductive function has implications for elucidating mechanisms of impaired pubertal development, nutritional amenorrhea, and obesity-related infertility. A better understanding of these etiologies has far-reaching implications for the prevention and management of reproductive dysfunction and its associated comorbidities.

  12. The implication of transcultural psychiatry for clinical practice.

    Science.gov (United States)

    Moldavsky, Daniel

    2003-01-01

    This article deals with the main concepts of Transcultural Psychiatry and their applications to everyday psychiatric practice. Transcultural psychiatry has undergone a conceptual reformulation in the last two decades. Having started with a comparative approach, which focused on the diverse manifestations of mental disorders among different societies, it broadened its scope, aiming at present to incorporate social and cultural aspects of illness into the clinical framework. Therefore, transcultural psychiatry now focuses more on what is called the illness experience than on the disease process, the latter understood as illness as it is viewed by health practitioners. Western medicine, of which psychiatry is a part, is grounded in positivist epistemological principles that stress the biological processes of disease. The intention of the paper is to develop an interest in alternative but also complementary ways of thinking. Modern transcultural psychiatry interprets some epidemiological and clinical aspects of major mental disorders (such as schizophrenia and depression) in a different light. However, it also distances itself from the absolute relativism of antipsychiatry, centering on clinical facts and helping clinicians in their primary task of alleviating suffering. An important contribution in addressing this task is the formulation of a cultural axis within the DSM model of multiaxial evaluation. A clinical vignette of a cultural formulation applied to a clinical discussion of a case is described.

  13. The changing face of Usher syndrome: clinical implications.

    Science.gov (United States)

    Cohen, Mazal; Bitner-Glindzicz, Maria; Luxon, Linda

    2007-02-01

    Usher syndrome is both genetically and phenotypically heterogeneous. Traditionally, the condition has been classified into three clinical types, differentiated by the severity and progression of the hearing impairment and by the presence or absence of vestibular symptoms. Recent advances in molecular genetics have enabled researchers to study the phenotypic expression in confirmed molecular groups of Usher. In response to the expansion of clinical and genetic information on Usher, we report an up to date review of the different clinical forms of Usher in known molecular groups and use the emerging evidence to appraise the diagnostic utility of the traditional classification of Usher. Our findings undermine the traditional view that the clinical types of Usher have distinct genetic causes. The pleiotropic effects of some of the major causes of Usher lead to considerable overlap between the different clinical types, with very little evidence for phenotypic-genotypic correlations. The novel synthesis emerging from this review suggests more productive approaches to the diagnosis of Usher in hearing-impaired children which would provide more accurate prognostic information to families.

  14. Ventilator-associated pneumonia: clinical significance and implications for nursing.

    Science.gov (United States)

    Grap, M J; Munro, C L

    1997-01-01

    Pneumonia is the second most common nosocomial infection in the United States and the leading cause of death from nosocomial infections. Intubation and mechanical ventilation greatly increase the risk of bacterial pneumonia. Ventilator-associated pneumonia (VAP) occurs in a patient treated with mechanical ventilation, and it is neither present nor developing at the time of intubation; it is a serious problem--with significant morbidity and mortality rates. Aspiration of bacteria from the oropharynx, leakage of contaminated secretions around the endotracheal tube, patient position, and cross-contamination from respiratory equipment and health care providers are important factors in the development of VAP. Nurses caring for patients treated with mechanical ventilation must recognize risk factors and include strategies for reducing these factors as part of their nursing care. This article summarizes the literature related to VAP: its incidence, associated factors, diagnosis, and current therapies, with an emphasis on nursing implications in the care of these patients.

  15. Potential Clinical Implications of the Urotensin II Receptor Antagonists

    Directory of Open Access Journals (Sweden)

    Emilie Kane

    2011-07-01

    Full Text Available Urotensin-II (UII, which binds to its receptor UT, plays an important role in the heart, kidneys, pancreas, adrenal gland and CNS. In the vasculature, it acts as a potent endothelium-independent vasoconstrictor and endothelium-dependent vasodilator. In disease states, this constriction-dilation equilibrium is disrupted. There is an upregulation of the UII system in heart disease, metabolic syndrome and kidney failure. The increase in UII release and UT expression suggest that UII system may be implicated in the pathology and pathogenesis of these diseases by causing an increase in ACAT-1 activity leading to SMC proliferation and foam cell infiltration, insulin resistance (DMII, as well as inflammation, high blood pressure and plaque formation. Recently, UT antagonists such as SB-611812, palosuran, and most recently a piperazino-isoindolinone based antagonist have been developed in the hope of better understanding the UII system and treating its associated diseases.

  16. Neurophysiology and Clinical Implications of the Laryngeal Adductor Reflex.

    Science.gov (United States)

    Domer, Amanda S; Kuhn, Maggie A; Belafsky, Peter C

    2013-09-01

    The laryngeal adductor reflex (LAR) is an involuntary protective response to stimuli in the larynx. The superior laryngeal nerve (SLN) acts as the afferent limb and the recurrent laryngeal nerve (RLN) as the efferent limb of this reflex, which is modulated by the central nervous system. Perhaps the most clinically significant application of the LAR is its use in laryngopharyngeal (LP) sensory discrimination testing. Importantly, aberrations in the LAR may predict dysphagia or portend clinical phenotypes of chronic cough, vocal cord dysfunction or pediatric apneas. LP sensation is a potential target for interventions addressing the aforementioned conditions though currently remains an area of active investigation.

  17. Seismotectonic Implications Of Clustered Regional GPS Velocities In The San Francisco Bay Region, California

    Science.gov (United States)

    Graymer, R. W.; Simpson, R.

    2012-12-01

    We have used a hierarchical agglomerative clustering algorithm with Euclidean distance and centroid linkage, applied to continuous GPS observations for the Bay region available from the U.S. Geological Survey website. This analysis reveals 4 robust, spatially coherent clusters that coincide with 4 first-order structural blocks separated by 3 major fault systems: San Andreas (SA), Southern/Central Calaveras-Hayward-Rodgers Creek-Maacama (HAY), and Northern Calaveras-Concord-Green Valley-Berryessa-Bartlett Springs (NCAL). Because observations seaward of the San Gregorio (SG) fault are few in number, the cluster to the west of SA may actually contain 2 major structural blocks not adequately resolved: the Pacific plate to the west of the northern SA and a Peninsula block between the Peninsula SA and the SG fault. The average inter-block velocities are 11, 10, and 9 mm/yr across SA, HAY, and NCAL respectively. There appears to be a significant component of fault-normal compression across NCAL, whereas SA and HAY faults appear to be, on regional average, purely strike-slip. The velocities for the Sierra Nevada - Great Valley (SNGV) block to the west of NCAL are impressive in their similarity. The cluster of these velocities in a velocity plot forms a tighter grouping compared with the groupings for the other cluster blocks, suggesting a more rigid behavior for this block than the others. We note that for 4 clusters, none of the 3 cluster boundaries illuminate geologic structures other than north-northwest trending dominantly strike-slip faults, so plate motion is not accommodated by large-scale fault-parallel compression or extension in the region or by significant plastic deformation , at least over the time span of the GPS observations. Complexities of interseismic deformation of the upper crust do not allow simple application of inter-block velocities as long-term slip rates on bounding faults. However, 2D dislocation models using inter-block velocities and typical

  18. Accuracy of family history of cancer : clinical genetic implications

    NARCIS (Netherlands)

    Sijmons, RH; Boonstra, AE; Reefhuis, J; Hordijk-Hos, JM; de Walle, HEK; Oosterwijk, JC; Cornel, MC

    Family medical history is the cornerstone of clinical genetic diagnosis and management in cases of familial cancer. The soundness of medical decisions can be compromised if reports by the family on affected relatives are inaccurate. Although very time consuming, family medical histories are

  19. Sexual Health Attitudes, Knowledge, and Clinical Behaviors: Implications for Counseling

    Science.gov (United States)

    Russell, Elizabeth B.

    2012-01-01

    This article explores the impact of practitioners' attitudes and knowledge of sexual health on clinical behaviors. Sexual health topics are often areas of concern for clients of any age in counseling. Thus, counselors must be trained and equipped to address sexual health across the life span. This study explored whether child and adolescent…

  20. Third universal definition of myocardial infarction. Implications for clinical practice

    International Nuclear Information System (INIS)

    Bazzino, O.

    2013-01-01

    In general, the conceptual meaning of the term myocardial infarction has not changed, although have developed new sensitive diagnostic methods. In this way the clinical diagnosis is based on patient symptoms, electrocardiogram's (ECG) changes and sensitive biochemical markers, as well as the information obtained from various imaging techniques

  1. Tick-borne encephalitis: Pathogenesis and clinical implications

    Czech Academy of Sciences Publication Activity Database

    Růžek, Daniel; Dobler, G.; Mantke, O. D.

    2010-01-01

    Roč. 8, č. 4 (2010), s. 223-232 ISSN 1477-8939 R&D Projects: GA ČR GPP302/10/P438; GA MŠk(CZ) LC06009 Institutional research plan: CEZ:AV0Z60220518 Keywords : Tick-borne encephalitis * Tick-borne encephalitis virus * Pathogenesis * Clinical data Subject RIV: EE - Microbiology, Virology

  2. Bystander effects and their implications for clinical radiotherapy

    International Nuclear Information System (INIS)

    Munro, Alastair J

    2009-01-01

    Radiation-induced bystander effects are defined as those biological effects expressed, after irradiation, by cells whose nuclei have not been directly irradiated. Radiation oncologists are only gradually beginning to appreciate the clinical relevance of radiation-induced bystander effects and associated phenomena: adaptive responses, genomic instability and abscopal effects. Incorporating bystander effects into the science underpinning clinical radiotherapy will involve moving beyond simple mechanistic models and towards a more systems-based approach. It is, given the protean nature of bystander effects, difficult to devise a coherent research strategy to investigate the clinical impact and relevance of bystander phenomena. Epidemiological approaches will be required, the traditional research models based on randomised controlled trials are unlikely to be adequate for the task. Any consideration of bystander effects challenges not only clinicians' preconceptions concerning the effects of radiation on tumours and normal tissues but also their ingenuity. This review covers, from a clinical perspective, the issues and problems associated with radiation-induced bystander effects.

  3. TROUBLING TIMES-THE GFC AND ITS IMPLICATIONS FOR REGIONAL PERFORMANCE. PART TWO: AUSTRALIA

    OpenAIRE

    Robert J. Stimson

    2013-01-01

    The Global Financial Crisis (GFC) was a profound exogenous shock which has had profound impacts the performance of national economies and the regions within them. The differential outcomes are vast. In many parts of the world there is evidence of what is being referred to as the ‘two-speed’ economy - or even a ‘multi-speed’ - economy. This has implications for regional economic development theory in which, over the last two to three decades, there has been an increasing emphasis on endogenous...

  4. MERRF Classification: Implications for Diagnosis and Clinical Trials.

    Science.gov (United States)

    Finsterer, Josef; Zarrouk-Mahjoub, Sinda; Shoffner, John M

    2018-03-01

    Given the etiologic heterogeneity of disease classification using clinical phenomenology, we employed contemporary criteria to classify variants associated with myoclonic epilepsy with ragged-red fibers (MERRF) syndrome and to assess the strength of evidence of gene-disease associations. Standardized approaches are used to clarify the definition of MERRF, which is essential for patient diagnosis, patient classification, and clinical trial design. Systematic literature and database search with application of standardized assessment of gene-disease relationships using modified Smith criteria and of variants reported to be associated with MERRF using modified Yarham criteria. Review of available evidence supports a gene-disease association for two MT-tRNAs and for POLG. Using modified Smith criteria, definitive evidence of a MERRF gene-disease association is identified for MT-TK. Strong gene-disease evidence is present for MT-TL1 and POLG. Functional assays that directly associate variants with oxidative phosphorylation impairment were critical to mtDNA variant classification. In silico analysis was of limited utility to the assessment of individual MT-tRNA variants. With the use of contemporary classification criteria, several mtDNA variants previously reported as pathogenic or possibly pathogenic are reclassified as neutral variants. MERRF is primarily an MT-TK disease, with pathogenic variants in this gene accounting for ~90% of MERRF patients. Although MERRF is phenotypically and genotypically heterogeneous, myoclonic epilepsy is the clinical feature that distinguishes MERRF from other categories of mitochondrial disorders. Given its low frequency in mitochondrial disorders, myoclonic epilepsy is not explained simply by an impairment of cellular energetics. Although MERRF phenocopies can occur in other genes, additional data are needed to establish a MERRF disease-gene association. This approach to MERRF emphasizes standardized classification rather than clinical

  5. Mass Spectrometry for Translational Proteomics: Progress and Clinical Implications

    Energy Technology Data Exchange (ETDEWEB)

    Baker, Erin Shammel; Liu, Tao; Petyuk, Vladislav A.; Burnum-Johnson, Kristin E.; Ibrahim, Yehia M.; Anderson, Gordon A.; Smith, Richard D.

    2012-08-31

    Mass spectrometry (MS)-based proteomics measurements have become increasingly utilized in a wide range of biological and biomedical applications, and have significantly enhanced the understanding of the complex and dynamic nature of the proteome and its connections to biology and diseases. While some MS techniques such as those for targeted analysis are increasingly applied with great success, others such as global quantitative analysis (for e.g. biomarker discovery) are more challenging and continue to be developed and refined to provide the desired throughput, sensitivity and/ or specificity. New MS capabilities and proteomics-based pipelines/strategies also keep enhancing for the advancement of clinical proteomics applications such as protein biomarker discovery and validation. Herein, we provide a brief review to summarize the current state of MS-based proteomics with respect to its advantages and present limitations, while highlighting its potential in future clinical applications.

  6. Implications of clinical trial design on sample size requirements.

    Science.gov (United States)

    Leon, Andrew C

    2008-07-01

    The primary goal in designing a randomized controlled clinical trial (RCT) is to minimize bias in the estimate of treatment effect. Randomized group assignment, double-blinded assessments, and control or comparison groups reduce the risk of bias. The design must also provide sufficient statistical power to detect a clinically meaningful treatment effect and maintain a nominal level of type I error. An attempt to integrate neurocognitive science into an RCT poses additional challenges. Two particularly relevant aspects of such a design often receive insufficient attention in an RCT. Multiple outcomes inflate type I error, and an unreliable assessment process introduces bias and reduces statistical power. Here we describe how both unreliability and multiple outcomes can increase the study costs and duration and reduce the feasibility of the study. The objective of this article is to consider strategies that overcome the problems of unreliability and multiplicity.

  7. Autoinflammatory diseases in adults. Clinical characteristics and prognostic implications.

    Science.gov (United States)

    González García, A; Patier de la Peña, J L; Ortego Centeno, N

    2017-03-01

    Autoinflammatory diseases are clinical conditions with inflammatory manifestations that present in a periodic or persistent manner and are caused by acquired or hereditary disorders of the innate immune response. In general, these diseases are more common in childhood, but cases have been reported in adults and are therefore important for all specialists. There are few references on these diseases in adults due to their low prevalence and underdiagnosis. The aim of this study is to review the scientific literature on these disorders to systematise their clinical, prognostic and treatment response characteristics in adults. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Exercise intolerance in pulmonary hypertension: mechanism, evaluation and clinical implications.

    Science.gov (United States)

    Babu, Abraham Samuel; Arena, Ross; Myers, Jonathan; Padmakumar, Ramachandran; Maiya, Arun G; Cahalin, Lawrence P; Waxman, Aaron B; Lavie, Carl J

    2016-09-01

    Exercise intolerance in pulmonary hypertension (PH) is a major factor affecting activities of daily living and quality of life. Evaluation strategies (i.e., non-invasive and invasive tests) are integral to providing a comprehensive assessment of clinical and functional status. Despite a growing body of literature on the clinical consequences of PH, there are limited studies discussing the contribution of various physiological systems to exercise intolerance in this patient population. This review, through a search of various databases, describes the physiological basis for exercise intolerance across the various PH etiologies, highlights the various exercise evaluation methods and discusses the rationale for exercise training amongst those diagnosed with PH. Expert commentary: With the growing importance of evaluating exercise capacity in PH (class 1, Level C recommendation), understanding why exercise performance is altered in PH is crucial. Thus, the further study is required for better quality evidence in this area.

  9. Copy number variation and autism: New insights and clinical implications

    Directory of Open Access Journals (Sweden)

    Brian Hon-Yin Chung

    2014-07-01

    Full Text Available Genomic research can lead to discoveries of copy number variations (CNVs which can be a susceptibility factor for autism spectrum disorder (ASD. The clinical translation is that this can improve the care of children with ASD. Chromosome microarray is now the first-tiered genetic investigation for ASD, with a detection rate exceeding conventional cytogenetics and any single gene testing. However, interpretation of the results is challenging and there is no consensus on “what” and “how much” to disclose. In this article, we will review how CNV studies have improved our understanding of ASD, the clinical applications, and related counseling issues. Future direction of autism genetic research is also discussed.

  10. Motivation to change in eating disorders: clinical and therapeutic implications.

    Science.gov (United States)

    Casasnovas, C; Fernández-Aranda, F; Granero, R; Krug, I; Jiménez-Murcia, S; Bulik, C M; Vallejo-Ruiloba, J

    2007-11-01

    The aim of this study was to understand the clinical impact of the motivational stage of change on the psychopathology and symptomatology of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). The participants were 218 eating disorder (ED) patients (58 AN, 95 BN and 65 EDNOS), consecutively admitted to our hospital. All patients fulfilled DSM-IV criteria for these disorders. Assessment measures included the Eating Disorders Inventory (EDI), Bulimic Investigation Test Edinburgh (BITE), Beck Depression Inventory (BDI), four analogue scales of motivational stage, as well as a number of other clinical and psychopathological indices. Our results indicated higher motivation for change in BN than in AN and EDNOS patients (p EDNOS (p EDNOS patients are most resistant to change and the younger these patients are, the less likely they are to be motivated to change their disturbed eating behaviour. 2007 John Wiley & Sons, Ltd and Eating Disorders Association

  11. Clinical implications of heterogeneity of tumor response to radiation therapy

    International Nuclear Information System (INIS)

    Suit, H.; Skates, S.; Taghian, A.; Okunieff, P.; Efird, J.T.

    1992-01-01

    Heterogeneity of response of tumor tissue to radiation clearly exists. Major parameters include histopathologic type, size (number of tumor rescue units (TRUs)), hemoglobin concentration, cell proliferation kinetics and immune rejection reaction by host. Further, normal and presumably tumor tissue response is altered in certain genetic diseases, e.g. ataxia telangiectasia. Any assessment of response of tumor tissue to a new treatment method or the testing of a new clinical response predictor is optimally based upon a narrow strata, viz., uniform with respect to known parameters of response, e.g. size, histological type. Even among tumors of such a clinical defined narrow strata, there will be residual heterogeneity with respect to inherent cellular radiation sensitivity, distributions of pO 2 , (SH), cell proliferation, etc. (author). 39 refs., 7 figs., 3 tabs

  12. Circulating mesenchymal stem cells and their clinical implications

    Directory of Open Access Journals (Sweden)

    Liangliang Xu

    2014-01-01

    Full Text Available Circulating mesenchymal stem cells (MSCs is a new cell source for tissue regeneration and tissue engineering. The characteristics of circulating MSCs are similar to those of bone marrow-derived MSCs (BM-MSCs, but they exist at a very low level in healthy individuals. It has been demonstrated that MSCs are able to migrate to the sites of injury and that they have some distinct genetic profiles compared to BM-MSCs. The current review summaries the basic knowledge of circulating MSCs and their potential clinical applications, such as mobilizing the BM-MSCs into circulation for therapy. The application of MSCs to cure a broad spectrum of diseases is promising, such as spinal cord injury, cardiovascular repair, bone and cartilage repair. The current review also discusses the issues of using of allogeneic MSCs for clinical therapy.

  13. Clinical Implications of Technological Advances in Screening for Atrial Fibrillation.

    Science.gov (United States)

    Singh, Nikhil; Chun, Sung; Hadley, David; Froelicher, Victor

    The incidence of atrial fibrillation (AF) continues to increase worldwide as people live longer. AF is the leading cause of stroke among patients older than 75 years and is responsible for at least 15% of all strokes. Industry has responded to this problem with a plethora of monitoring devices. These include single lead ECG adhesive sensors, implantable loop recorders, smartphone attachments and wearables. This review will concentrate on clinical studies using these technologies. There are wearables including watches and watch-like devices that will be mentioned but these have not been validated for clinical use. This review will begin with a background regarding screening for AF and at the end present findings from Cardiac Implantable devices that could influence use of the new mobile health technologies. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. Developments in clinical neuropsychology: implications for school psychological services.

    Science.gov (United States)

    Cleary, Michael J; Scott, Albert J

    2011-01-01

    According to the 2000 Report of the Surgeon General's Conference on Children's Mental Health, a significant percentage of children and adolescents have emotional or behavioral problems serious enough to merit a mental health diagnosis. The No Child Left Behind Act of 2001 and the Individuals With Disabilities Education Improvement Act of 2004 reemphasized the schools' importance in supporting cognitive and behavioral development in students, particularly those identified with learning problems. In this article, we examine the growing specialty of clinical neuropsychology and provide suggestions for integrating this field into school-based psychological services. This article provides a review of the neuropsychological bases for many childhood learning disorders and addresses how school psychologists can work with clinical neuropsychologists to better address the needs of exceptional children through neuropsychological testing. There is substantial neurological evidence for attention-deficit hyperactivity disorder as well as disorders of reading, language, and mathematics. Close collaborative partnerships between clinical neuropsychologists and school psychologists will help develop assessment protocols that are likely to result in more effective intervention services for students with neuropsychological conditions. Schools are being asked to support the physical, cognitive, and emotional development in students, particularly those identified with chronic physical and mental health challenges. Dissatisfaction with minimal screenings, the growing awareness of the neurology of learning disorders, and the passage of the Individuals With Disabilities Education Improvement Act of 2004 obliges all school-based mental health providers to consider how to fully integrate the tools of clinical neuropsychology into school-based psychological services. © 2011, American School Health Association.

  15. Horizontal fissure on neonatal plain chest radiographs: clinical implications

    International Nuclear Information System (INIS)

    Konarzewska, J.; Zawadzka-Kepczynska, A.; Bianek-Bodzak, A.; Kawinska-Kilianczyk, A.; Domzalska-Popadiuk, I.

    2005-01-01

    Regardless of etiology, pleural fluid, even in small amounts, can be visualized on the neonatal chest x-ray picture within pulmonary fissures. It remains unclear whether a marked horizontal fissure unaccompanied by any other radiological symptoms is of diagnostic value or not. Ninety-one consecutive neonatal chest radiographs with marked horizontal fissure were retrospectively analyzed. The images were made between 1999 and 2005 on 69 newborns admitted to the Neonatology Department, Institute of Obstetrics and Gynecology, Medical University of Gdansk. Analysis of the radiographs was conducted independently by three radiologists based on the following criteria: fissure thickness (marked or thickened), bronchovascular markings (increased or normal), size and shape of the heart (normal or abnormal), presence or absence of pulmonary infiltration, atelectasis, and changes related to wet lung syndrome. Due to divergent interpretations, the ultimate interpretation was established by consensus in 25 cases. The radiological findings were compared with clinical data. The compatibility of the three independent interpreters was statistically significant (p<0.0001). Marked transverse fissure was the only radiological finding on 66 x-rays. In 63 cases (69.2%) the children were asymptomatic as well. In 3 cases (3.3%) clinical symptoms of respiratory tract infection occurred. On the other 25 images, horizontal fissure was accompanied by other radiological symptoms. Chest x-ray results corresponded with clinical symptoms in 24 cases (26.4%). One child (1.1%) with radiological evidence of wet lung syndrome did not present any typical clinical symptoms of it. Horizontal fissure noted on a neonatal chest x-ray seems to be of minor diagnostic value if not accompanied by any other radiological symptoms. (author)

  16. The Functional Angiosome: Clinical Implications of the Anatomical Concept.

    Science.gov (United States)

    Taylor, G Ian; Corlett, Russell J; Ashton, Mark W

    2017-10-01

    The angiosome is a three-dimensional block of tissue supplied by a source vessel with its boundary outlined either by an anastomotic perimeter of reduced-caliber choke vessels or by true anastomoses with no reduction of vessel caliber. This article focuses on the role of these anastomotic vessels in defining flap survival or the necrotic pattern seen in fulminating meningococcal septicemia. Experiments in pigs, dogs, guinea pigs, and rabbits over the past 46 years were reviewed, focusing on the necrosis line of flaps, the effects of various toxins in vivo, and correlating these results in the clinical setting. Experimentally, choke anastomoses are functional and control flow between perforator angiosomes. They (1) permit capture of an adjacent angiosome when the flap is raised on a cutaneous perforator in 100 percent of cases, with the necrosis line occurring usually in the next interperforator connection; (2) confine flow to the territory of the involved artery when a toxin is introduced by spasm around its perimeter; and (3) lose this property of spasm when choke vessels are converted to true anastomoses following surgical delay, or where true anastomoses occur naturally, thereby allowing unimpeded blood flow and capture of additional angiosome territories. Clinical experience supports these observations. The functional angiosome is the volume of tissue that clinically can be isolated on a source vessel. The area extends beyond its anatomical territory to capture an adjacent territory if connections are by choke anastomoses, or more if they are by true anastomoses.

  17. Primary empty sella and GH deficiency: prevalence and clinical implications

    Directory of Open Access Journals (Sweden)

    Maurizio Poggi

    2012-01-01

    Full Text Available Primary empty sella (PES is a particular anatomical condition characterized by the herniation of liquor within the sella turcica. The pathogenesis of this alteration, frequently observed in general population, is not yet completely understood. Recently reports demonstrated, in these patients, that hormonal pituitary dysfunctions, specially growth hormone (GH/insulin-like growth factor (IGF-I axis ones, could be relevant. The aim of this paper is to evaluate GH/IGF-I axis in a group of adult patients affected by PES and to verify its clinical relevance. We studied a population of 28 patients with a diagnosis of PES. In each patient we performed a basal study of thyroid, adrenal and gonadal - pituitary axis and a dynamic evaluation of GH/IGF-I after GH-releasing hormone (GHRH plus arginine stimulation test. To evaluate the clinical significance of GH/IGF-I axis dysfunction we performed a metabolic and bone status evaluation in every patients. We found the presence of GH deficit in 11 patients (39.2 %. The group that displayed a GH/IGF-I axis dysfunction showed an impairment in metabolic profile and bone densitometry. This study confirms the necessity to screen the pituitary function in patients affected by PES and above all GH/IGF-I axis. Moreover the presence of GH deficiency could be clinically significant.

  18. Contracting for safety with patients: clinical practice and forensic implications.

    Science.gov (United States)

    Garvey, Keelin A; Penn, Joseph V; Campbell, Angela L; Esposito-Smythers, Christianne; Spirito, Anthony

    2009-01-01

    The contract for safety is a procedure used in the management of suicidal patients and has significant patient care, risk management, and medicolegal implications. We conducted a literature review to assess empirical support for this procedure and reviewed legal cases in which this practice was employed, to examine its effect on outcome. Studies obtained from a PubMed search were reviewed and consisted mainly of opinion-based surveys of clinicians and patients and retrospective reviews. Overall, empirically based evidence to support the use of the contract for safety in any population is very limited, particularly in adolescent populations. A legal review revealed that contracting for safety is never enough to protect against legal liability and may lead to adverse consequences for the clinician and the patient. Contracts should be considered for use only in patients who are deemed capable of giving informed consent and, even in these circumstances, should be used with caution. A contract should never replace a thorough assessment of a patient's suicide risk factors. Further empirical research is needed to determine whether contracting for safety merits consideration as a future component of the suicide risk assessment.

  19. On the Science of Consciousness: Epistemological Reflections and Clinical Implications.

    Science.gov (United States)

    Facco, Enrico; Lucangeli, Daniela; Tressoldi, Patrizio

    Consciousness has been one of the most important and tantalizing issues ever since the origin of philosophy and medicine. The concept of consciousness and the so-called "hard problem" (i.e., the mind-brain relationship) are highly complex topics that have yet to be elucidated, involving the realms of both science and philosophy with profound epistemological implications. In the lively debate on the foundations of the science of consciousness there are several potential biases of an essentially philosophical nature, such as those related to the paradigm and axioms adopted, and the ostensible logical contradiction between monism and dualism. Their origin dates back largely to Descartes' thinking and the birth of the new sciences as a compromise with the Inquisition, but they have been handed down through the Enlightenment and Positivism. A proper investigation of consciousness and the world of subjectivity demands a careful reflection on the paradigm of scientific medicine to identify possible flaws and overcome the limits of the mechanistic-reductionist approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Chemistry, metabolism, and toxicology of cannabis: clinical implications.

    Science.gov (United States)

    Sharma, Priyamvada; Murthy, Pratima; Bharath, M M Srinivas

    2012-01-01

    Cannabis is one of the most widely abused substances throughout the world. The primary psychoactive constituent of cannabis, delta 9-tetrahydrocannabinol (▵(9_)THC), produces a myriad of pharmacological effects in animals and humans. Although it is used as a recreational drug, it can potentially lead to dependence and behavioral disturbances and its heavy use may increase the risk for psychotic disorders.Many studies that endeavor to understand the mechanism of action of cannabis concentrate on pharmacokinetics and pharmacodynamics of cannabinoids in humans. However, there is limited research on the chronic adverse effects and retention of cannabinoids in human subjects.Cannabis can be detected in body fluids following exposure through active/passive inhalation and exposure through breastfeeding. Cannabis detection is directly dependent on accurate analytical procedures for detection of metabolites and verification of recent use.In this review, an attempt has been made to summarize the properties of cannabis and its derivatives, and to discuss the implications of its use with emphasis on bioavailability, limit of detection, carry over period and passive inhalation, important factors for detection and diagnosis.

  1. Chemistry, Metabolism, and Toxicology of Cannabis: Clinical Implications

    Directory of Open Access Journals (Sweden)

    M.M. Srinivas Bharath

    2012-12-01

    Full Text Available Cannabis is one of the most widely abused substances throughout the world. The primary psychoactive constituent of cannabis, delta 9-tetrahydrocannabinol (Δ9_THC, produces a myriad of pharmacological effects in animals and humans. Although it is used as a recreational drug, it can potentially lead to dependence and behavioral disturbances and its heavy use may increase the risk for psychotic disorders.Many studies that endeavor to understand the mechanism of action of cannabis concentrate on pharmacokinetics and pharmacodynamics of cannabinoids in humans. However, there is limited research on the chronic adverse effects and retention of cannabinoids in human subjects.Cannabis can be detected in body fluids following exposure through active/passive inhalation and exposure through breastfeeding. Cannabis detection is directly dependent on accurate analytical procedures for detection of metabolites and verification of recent use.In this review, an attempt has been made to summarize the properties of cannabis and its derivatives, and to discuss the implications of its use with emphasis on bioavailability, limit of detection, carry over period and passive inhalation, important factors for detection and diagnosis.

  2. The progress in radiotherapy techniques and it's clinical implications

    International Nuclear Information System (INIS)

    Reinfuss, M.; Walasek, T.; Byrski, E.; Blecharz, P.

    2011-01-01

    Three modem radiotherapy techniques were introduced into clinical practice at the onset of the 21 st century - stereotactic radiation therapy (SRT), proton therapy and carbon-ion radiotherapy. Our paper summarizes the basic principles of physics, as well as the technical reqirements and clinical indications for those techniques. SRT is applied for intracranial diseases (arteriovenous malformations, acoustic nerve neuromas, brain metastases, skull base tumors) and in such cases it is referred to as stereotactic radiosurgery (SRS). Techniques used during SRS include GammaKnife, CyberKnife and dedicated linacs. SRT can also be applied for extracranial disease (non-small cell lung cancer, lung metastases, spinal and perispinal tumors, primary liver tumors, breast cancer, pancreatic tumors, prostate cancer, head and neck tumors) and in such cases it is referred to as stereotactic body radiation therapy (SBRT). Eye melanomas, skull base and cervical spine chordomas and chordosarcomas, as well as childhood neoplasms, are considered to be the classic indications for proton therapy. Clinical trials are currently conducted to investigate the usefulness of proton beam in therapy of non-small cell lung cancer, prostate cancer, head and neck tumors, primary liver and oesophageal cancer Carbon-ion radiotherapy is presumed to be more advantageous than proton therapy because of its higher relative biological effectiveness (RBE) and possibility of real-time control of the irradiated volume under PET visualization. The basic indications for carbon-ion therapy are salivary glands neoplasms, selected types of soft tissue and bone sarcomas, skull base chordomas and chordosarcomas, paranasal sinus neoplasms, primary liver cancers and inoperable rectal adenocarcinoma recurrences. (authors)

  3. Alcohol Use Disorders: Implications for the Clinical Toxicologist

    Directory of Open Access Journals (Sweden)

    Michael McDonough

    2015-03-01

    Full Text Available Alcohol use disorders (AUDs are a health problem of high prevalence in most communities and such problems account for 5% of the total burden of disease worldwide. Clinical toxicologists are commonly required to treat patients having AUDs and associated drug/alcohol-related harm. There have been recent changes to some of the diagnostic criteria (notably in DSM V relevant to AUDs, with older terms “alcohol abuse” and “alcohol dependence” no longer being classified. AUDs may sometimes not be clearly recognizable and use of evidence-based screening interventions can help identify such conditions and lead to effective brief interventions (e.g. SBIRT programs in emergency departments. AUDs are viewed as chronic disorders of alcohol consumption occurring across a spectrum of severity. While most AUDs are mild to moderate in severity and usually self-limiting conditions, more severe presentations are more commonly encountered by physicians in emergency settings. Hence, clinical toxicologists are more likely to see patients within the more severe form of disorder, at end of the spectrum of AUDs. Among this group of patients, multi-morbidity and particularly high mortality risk exists, and thus they usually require management collaboration with specialist services. Patients with AUDs are most likely to be recognized by a clinical toxicologist in the following scenarios: following acute heavy alcohol ingestion and subsequently developing acute alcohol intoxication (ethanol toxidrome, following accidental or intentional drug overdosage where alcohol has also been consumed, following acute alcohol consumption that has been associated with behavioral risk-taking and/or self-harming (e.g. poisoning, envenomation, etc., when alcohol withdrawal reactions are severe requiring hospitalization and possibly following an adverse drug reaction.

  4. miRNAs in inflammatory skin diseases and their clinical implications

    DEFF Research Database (Denmark)

    Løvendorf, Marianne B; Skov, Lone

    2015-01-01

    biological processes. The clinical implications of miRNAs are intriguing, both from a diagnostic and a therapeutic perspective. Accordingly, there is emerging evidence for the clinical potential of miRNAs as both biomarkers and possible therapeutic targets in skin diseases. Future studies will hopefully...... incomplete; however, it is known that miRNAs are implicated in various cellular processes of both normal and diseased skin. Some miRNAs appear to be consistently deregulated in several different inflammatory skin diseases, including psoriasis and atopic dermatitis, indicating a common role in fundamental...

  5. Myocardial bridges: their clinical implications and prognostic signs

    International Nuclear Information System (INIS)

    Wasfy, I.; Nouh, Mohamed S.; Foda, M.; Al-Shemairi, M.; Al-Sedeeki, A.

    1996-01-01

    Among 980 consecutive selective coronary angiograms performed, nine patients had myocardial bridges of the left anterior descending (LAD) coronary artery. The overall prevalence of myocardial bridge was 0.92%. Among these patients, three patients had coronary artery disease, while six cases were isolated myocardial muscle bridges. With respect to functional abnormality, three had grade III milking effect, three had grade II and three had grade I milking effect. The indications for coronary angiograms were typical chest pain in seven cases and a typical chest pain in two cases. Their clinical and laboratory investigations are presented with literature review. (author)

  6. Process control analysis of IMRT QA: implications for clinical trials

    International Nuclear Information System (INIS)

    Pawlicki, Todd; Rice, Roger K; Yoo, Sua; Court, Laurence E; McMillan, Sharon K; Russell, J Donald; Pacyniak, John M; Woo, Milton K; Basran, Parminder S; Boyer, Arthur L; Bonilla, Claribel

    2008-01-01

    The purpose of this study is two-fold: first is to investigate the process of IMRT QA using control charts and second is to compare control chart limits to limits calculated using the standard deviation (σ). Head and neck and prostate IMRT QA cases from seven institutions in both academic and community settings are considered. The percent difference between the point dose measurement in phantom and the corresponding result from the treatment planning system (TPS) is used for analysis. The average of the percent difference calculations defines the accuracy of the process and is called the process target. This represents the degree to which the process meets the clinical goal of 0% difference between the measurements and TPS. IMRT QA process ability defines the ability of the process to meet clinical specifications (e.g. 5% difference between the measurement and TPS). The process ability is defined in two ways: (1) the half-width of the control chart limits, and (2) the half-width of ±3σ limits. Process performance is characterized as being in one of four possible states that describes the stability of the process and its ability to meet clinical specifications. For the head and neck cases, the average process target across institutions was 0.3% (range: -1.5% to 2.9%). The average process ability using control chart limits was 7.2% (range: 5.3% to 9.8%) compared to 6.7% (range: 5.3% to 8.2%) using standard deviation limits. For the prostate cases, the average process target across the institutions was 0.2% (range: -1.8% to 1.4%). The average process ability using control chart limits was 4.4% (range: 1.3% to 9.4%) compared to 5.3% (range: 2.3% to 9.8%) using standard deviation limits. Using the standard deviation to characterize IMRT QA process performance resulted in processes being preferentially placed in one of the four states. This is in contrast to using control charts for process characterization where the IMRT QA processes were spread over three of the

  7. Implications of utility and deontology for the clinical nurse specialist.

    Science.gov (United States)

    Ayres, L

    1989-01-01

    Faced with prospective payment plans and personnel shortages nurses in advanced clinical practice are under pressure to find practical solutions. These solutions may reflect the institutional philosophy of utility rather than the traditional nursing ethic of deontology, illustrating the need to examine the differences between utilitarian and deontological principles as they affect nursing practice. This paper discusses deontology and utility as they apply to nursing practice, considers how these different philosophical positions may affect advanced practitioners, and describes the current status of ethics in nursing.

  8. Clinical implications of lactose malabsorption versus lactose intolerance.

    Science.gov (United States)

    Levitt, Michael; Wilt, Timothy; Shaukat, Aasma

    2013-07-01

    The majority of the world's adult population and an estimated 80 million Americans are hypolactasic and hence malabsorb ingested lactose. Although lactose malabsorption is easily identified, less readily assessed is the clinically important question of how often does this malabsorption induce symptoms. This review summarizes: (1) knowledge concerning the etiology and diagnosis of hypolactasia and the pathophysiology of the symptoms of lactose malabsorption and (2) the results of well-controlled trials of the symptomatic response of lactose malabsorbers to varying dosages of lactose and the efficacy of therapeutic interventions to alleviate these symptoms. We conclude that the clinical significance of lactose malabsorption has been overestimated by both the lay public and physicians in that commonly ingested doses of lactose (ie, the quantity in a cup of milk) usually do not cause perceptible symptoms when ingested with a meal. Symptoms occur when the lactose dosage exceeds that in a cup of milk or when lactose is ingested without other nutrients. Simple dietary instruction, rather than the use of commercial products to reduce lactose intake, is recommended for the vast majority of lactose-malabsorbing subjects.

  9. Clinical and ultrasonographic implications of uterine leiomyomatosis in pregnancy.

    Science.gov (United States)

    Piazze Garnica, J; Gallo, G; Marzano, P F; Vozzi, G; Mazzocco, M; Anceschi, M M; Rolfini, G

    1995-01-01

    To study the complications related to leiomyomatosis in pregnancy by clinical and ultrasonographic assessment. A retrospective study. All pregnancies admitted to the 2nd Institute of Gynecology and Obstetrics, Policlinico Umberto I, in the period between January 1992 to December 1993 were surveyed. Gestational age at the time of ultrasonographic neoplasm diagnosis was 25.1 +/- 13.4 weeks, 'we found no correlation between maternal age or parity affecting pregnancy outcome, Leiomyomatosis complicated pregnancy rate was 1.68%. Myomatosis was diagnosed clinically in 25 of 67 cases (37.3%). Regarding the location of the neoplasm, 59% was located in the corpus-uteri, 21% was considered a diffuse neoplasm and the 14% was located in the fundus. Threatened abortion was the most frequent complication (20%), abortion was the second (16.4%). We observed an increased abortion threat rate (p pregnancies complicated by myomatosis, and the indication for surgery was given either primarily or exclusively by the presence of myomatous formation in 19 cases (50%). Our study suggests that location of the leiomyoma in relation to the placenta is a higher risk factor than its size, and that there is a higher risk for threats of abortion and abortion rates in pregnancies complicated by leiomyomatosis. We recommend that every pregnant woman with a suspected myoma should be ultrasonographically scanned.

  10. Leptin deficiency: clinical implications and opportunities for therapeutic interventions.

    Science.gov (United States)

    Blüher, Susan; Shah, Sunali; Mantzoros, Christos S

    2009-10-01

    The discovery of leptin has significantly advanced our understanding of the metabolic importance of adipose tissue and has revealed that both leptin deficiency and leptin excess are associated with severe metabolic, endocrine, and immunological consequences. We and others have shown that a prominent role of leptin in humans is to mediate the neuroendocrine adaptation to energy deprivation. Humans with genetic mutations in the leptin and leptin receptor genes have deregulated food intake and energy expenditure leading to a morbidly obese phenotype and a disrupted regulation in neuroendocrine and immune function and in glucose and fat metabolism. Observational and interventional studies in humans with (complete) congenital leptin deficiency caused by mutations in the leptin gene or with relative leptin deficiency as seen in states of negative energy balance such as lipoatrophy, anorexia nervosa, or exercise-induced hypothalamic and neuroendocrine dysfunction have contributed to the elucidation of the pathophysiological role of leptin in these conditions and of the clinical significance of leptin administration in these subjects. More specifically, interventional studies have demonstrated that several neuroendocrine, metabolic, or immune disturbances in these states could be restored by leptin administration. Leptin replacement therapy is currently available through a compassionate use program for congenital complete leptin deficiency and under an expanded access program to subjects with leptin deficiency associated with congenital or acquired lipoatrophy. In addition, leptin remains a potentially forthcoming treatment for several other states of energy deprivation including anorexia nervosa or milder forms of hypothalamic amenorrhea pending appropriate clinical trials.

  11. Pharmacogenetics in Neurodegenerative Diseases: Implications for Clinical Trials.

    Science.gov (United States)

    Tortelli, Rosanna; Seripa, Davide; Panza, Francesco; Solfrizzi, Vincenzo; Logroscino, Giancarlo

    2016-01-01

    Pharmacogenetics has become extremely important over the last 20 years for identifying individuals more likely to be responsive to pharmacological interventions. The role of genetic background as a predictor of drug response is a young and mostly unexplored field in neurodegenerative diseases. Mendelian mutations in neurodegenerative diseases have been used as models for early diagnosis and intervention. On the other hand, genetic polymorphisms or risk factors for late-onset Alzheimer's disease (AD) or other neurodegenerative diseases, probably influencing drug response, are hardly taken into account in randomized clinical trial (RCT) design. The same is true for genetic variants in cytochrome P450 (CYP), the principal enzymes influencing drug metabolism. A better characterization of individual genetic background may optimize clinical trial design and personal drug response. This chapter describes the state of the art about the impact of genetic factors in RCTs on neurodegenerative disease, with AD, frontotemporal dementia, Parkinson's disease, amyotrophic lateral sclerosis, and Huntington's disease as examples. Furthermore, a brief description of the genetic bases of drug response focusing on neurodegenerative diseases will be conducted. The role of pharmacogenetics in RCTs for neurodegenerative diseases is still a young, unexplored, and promising field. Genetic tools allow increased sophistication in patient profiling and treatment optimization. Pharmaceutical companies are aware of the value of collecting genetic data during their RCTs. Pharmacogenetic research is bidirectional with RCTs: efficacy data are correlated with genetic polymorphisms, which in turn define subjects for treatment stratification. © 2016 S. Karger AG, Basel.

  12. The trans-regional implications of the China-Pakistan Economic Corridor and the One Belt and One Road Initiative

    Directory of Open Access Journals (Sweden)

    Khan Samra Sarfraz

    2018-04-01

    Full Text Available The paper is an analytical examination of the geo-political implications of the China-Pakistan Economic Corridor and the One Belt and One Road Initiative. The paper examines the probable implications of the two mega projects for the regional, as well as, trans-regional actors. The paper debates on the likelihood for the creation of a new kind of relationship among China, Pakistan and Russia. It is also discussed how the prospects of reduced western influence in the region, in the backdrop of CPEC and the B&R Initiative, may result in the escalation of Russian and Chinese dominance on regional and trans-regional affairs.

  13. Evaluating Dopamine Reward Pathway in ADHD; clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Wang, G.-J.; Kollins, S.H., Wigal, t.L.; Newcorn, J.H.; Telang, F.; Fowler, J.S.; Zhu, W.; Logan, J.; Ma, Y.; Pradhan, K.; Wong, C.T.; Swanson, J.M.

    2009-09-09

    Attention-deficit/hyperactivity disorder (ADHD) - characterized by symptoms of inattention and hyperactivity-impulsivity - is the most prevalent childhood psychiatric disorder that frequently persists into adulthood, and there is increasing evidence of reward-motivation deficits in this disorder. To evaluate biological bases that might underlie a reward/motivation deficit by imaging key components of the brain dopamine reward pathway (mesoaccumbens). We used positron emission tomography to measure dopamine synaptic markers (transporters and D{sub 2}/D{sub 3} receptors) in 53 nonmedicated adults with ADHD and 44 healthy controls between 2001-2009 at Brookhaven National Laboratory. We measured specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) using [{sup 11}C]cocaine and for D{sub 2}/D{sub 3} receptors using [{sup 11}C]raclopride, quantified as binding potential (distribution volume ratio -1). For both ligands, statistical parametric mapping showed that specific binding was lower in ADHD than in controls (threshold for significance set at P < .005) in regions of the dopamine reward pathway in the left side of the brain. Region-of-interest analyses corroborated these findings. The mean (95% confidence interval [CI] of mean difference) for DAT in the nucleus accumbens for controls was 0.71 vs 0.63 for those with ADHD (95% CI, 0.03-0.13, P = .004) and in the midbrain for controls was 0.16 vs 0.09 for those with ADHD (95% CI, 0.03-0.12; P {le} .001); for D{sub 2}/D{sub 3} receptors, the mean accumbens for controls was 2.85 vs 2.68 for those with ADHD (95% CI, 0.06-0.30, P = .004); and in the midbrain, it was for controls 0.28 vs 0.18 for those with ADHD (95% CI, 0.02-0.17, P = .01). The analysis also corroborated differences in the left caudate: the mean DAT for controls was 0.66 vs 0.53 for those with ADHD (95% CI, 0.04-0.22; P = .003) and the mean D{sub 2}/D{sub 3} for controls was 2.80 vs 2.47 for those with ADHD (95% CI, 0

  14. Targeting dormant micrometastases: rationale, evidence to date and clinical implications.

    Science.gov (United States)

    Hurst, Robert E; Bastian, Anja; Bailey-Downs, Lora; Ihnat, Michael A

    2016-03-01

    In spite of decades of research, cancer survival has increased only modestly. This is because most research is based on models of primary tumors. Slow recognition has begun that disseminated, dormant cancer cells (micrometastatic cells) that are generally resistant to chemotherapy are the culprits in recurrence, and until these are targeted effectively we can expect only slow progress in increasing overall survival from cancer. This paper reviews efforts to understand the mechanisms by which cancer cells can become dormant, and thereby identify potential targets and drugs either on the market or in clinical trials that purport to prevent metastasis. This review targets the most recent literature because several excellent reviews have covered the literature from more than two years ago. The paper also describes recent work in the authors' laboratories to develop a screening-based approach that does not require understanding of mechanisms of action or the molecular target. Success of this approach shows that targeting micrometastatic cells is definitely feasible.

  15. An update on vinpocetine: New discoveries and clinical implications.

    Science.gov (United States)

    Zhang, Yi-Shuai; Li, Jian-Dong; Yan, Chen

    2018-01-15

    Vinpocetine, a derivative of the alkaloid vincamine, has been clinically used in many countries for treatment of cerebrovascular disorders such as stroke and dementia for more than 30 years. Currently, vinpocetine is also available in the market as a dietary supplement to enhance cognition and memory. Due to its excellent safety profile, increasing efforts have been put into exploring the novel therapeutic effects and mechanism of actions of vinpocetine in various cell types and disease models. Recent studies have revealed a number of novel functions of vinpocetine, including anti-inflammation, antagonizing injury-induced vascular remodeling and high-fat-diet-induced atherosclerosis, as well as attenuating pathological cardiac remodeling. These novel findings may facilitate the repositioning of vinpocetine for preventing or treating relevant disorders in humans. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Accurate coding in sepsis: clinical significance and financial implications.

    Science.gov (United States)

    Chin, Y T; Scattergood, N; Thornber, M; Thomas, S

    2016-09-01

    Sepsis is a major healthcare problem and leading cause of death worldwide. UK hospital mortality statistics and payments for patient episodes of care are calculated on clinical coding data. The accuracy of these data depends on the quality of coding. This study aimed to investigate whether patients with significant bacteraemia are coded for sepsis and to estimate the financial costs of miscoding. Of 54 patients over a one-month period with a significant bacteraemia, only 19% had been coded for sepsis. This is likely to lead to falsely high calculated hospital mortality. Furthermore, this resulted in an underpayment of £21,000 for one month alone. Copyright © 2016 The Healthcare Infection Society. All rights reserved.

  17. Clinical Implications of Glucose Variability: Chronic Complications of Diabetes

    Directory of Open Access Journals (Sweden)

    Hye Seung Jung

    2015-06-01

    Full Text Available Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE. MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

  18. Exogenous factors in panic disorder: clinical and research implications.

    Science.gov (United States)

    Roy-Byrne, P P; Uhde, T W

    1988-02-01

    Because panic disorder has an underlying biologic and probably genetic basis, the role of factors outside the organism in initiating and sustaining panic is often overlooked. The authors review certain exogenous factors that seem capable of triggering attacks and/or increasing their frequency and intensity: self-administered pharmacologic agents (caffeine, alcohol, nicotine, over-the-counter cold preparations, cannabis, cocaine); habits (sleep deprivation, diet, exercise, relaxation, hyperventilation); and aspects of the environment (fluorescent lighting, life stressors). There may be a specificity to the action of some of these factors, because certain factors previously thought to trigger panic attacks (e.g., pain, hypoglycemia) have been proved not to have this effect. Although the clinical significance of many of the exogenous factors discussed still awaits empirical confirmation, attention to such factors during the initial evaluation of a patient with panic disorder may be helpful in formulating a successful treatment plan.

  19. Abnormal Congenital Location of Stapes’ Superstructure: Clinical and Embryological Implications

    Directory of Open Access Journals (Sweden)

    Vânia Henriques

    2016-01-01

    Full Text Available Congenital middle ear malformations are rare. Most part of them are usually associated with other malformations, such as aural atresia, microtia, and dysmorphic craniofacial features. A clinical case of a 24-year-old male with a right-sided conductive hearing loss since his childhood, without craniofacial malformation, is presented. He was proposed for exploratory tympanotomy under the suspicious diagnosis of otosclerosis. The surgery revealed an abnormal location of stapes’ superstructure, which was attached to the promontory and had an isolated and mobile osseous footplate in the oval window. A stapes prosthesis was inserted and resulted in closure of the air-bone gap by 25 dB. A review of the literature was also performed using MEDLINE. Two theories diverge on the embryologic origin of the stapes. Our findings seem to be in favour of the theory that defines two different embryologic origins to the stapes.

  20. Prescription opioid abuse, pain and addiction: clinical issues and implications.

    Science.gov (United States)

    Ling, Walter; Mooney, Larissa; Hillhouse, Maureen

    2011-05-01

    Prescription opioid misuse in the USA has increased over threefold since 1990 to epidemic proportions, with substantial increases in prescription opioid use also reported in other countries, such as Australia and New Zealand. The broad availability of prescription pain medications, coupled with public misconceptions about their safety and addictive potential, have contributed to the recent surge in non-medical use of prescription opioids and corresponding increases in treatment admissions for problems related to opioid misuse. Given competing pressures faced by physicians to both diagnose and treat pain syndromes and identify individuals at risk for addictive disorders, the use of opioids in the treatment of pain poses a significant clinical challenge. This paper reviews the interaction between pain and opioid addiction with a focus on clinical management issues, including risk factors for opioid dependence in patients with chronic pain and the use of assessment tools to identify and monitor at-risk individuals. Treatment options for opioid dependence and pain are reviewed, including the use of the partial µ agonist buprenorphine in the management of concurrent pain and opioid addiction. Physicians should strive to find a reasonable balance between minimising potential adverse effects of opioid medications without diminishing legitimate access to opioids for analgesia. The article discusses the need to identify methods for minimising risks and negative consequences associated with opioid analgesics and poses research directions, including the development of abuse-deterrent opioid formulations, genetic risk factors for opioid dependence and opioid-induced hyperalgesia as a potential target for medication therapy. © 2011 Australasian Professional Society on Alcohol and other Drugs.

  1. Albumin-drug interaction and its clinical implication.

    Science.gov (United States)

    Yamasaki, Keishi; Chuang, Victor Tuan Giam; Maruyama, Toru; Otagiri, Masaki

    2013-12-01

    Human serum albumin acts as a reservoir and transport protein for endogenous (e.g. fatty acids or bilirubin) and exogenous compounds (e.g. drugs or nutrients) in the blood. The binding of a drug to albumin is a major determinant of its pharmacokinetic and pharmacodynamic profile. The present review discusses recent findings regarding the nature of drug binding sites, drug-albumin binding in certain diseased states or in the presence of coadministered drugs, and the potential of utilizing albumin-drug interactions in clinical applications. Drug-albumin interactions appear to predominantly occur at one or two specific binding sites. The nature of these drug binding sites has been fundamentally investigated as to location, size, charge, hydrophobicity or changes that can occur under conditions such as the content of the endogenous substances in question. Such findings can be useful tools for the analysis of drug-drug interactions or protein binding in diseased states. A change in protein binding is not always a problem in terms of drug therapy, but it can be used to enhance the efficacy of therapeutic agents or to enhance the accumulation of radiopharmaceuticals to targets for diagnostic purposes. Furthermore, several extracorporeal dialysis procedures using albumin-containing dialysates have proven to be an effective tool for removing endogenous toxins or overdosed drugs from patients. Recent findings related to albumin-drug interactions as described in this review are useful for providing safer and efficient therapies and diagnoses in clinical settings. This article is part of a Special Issue entitled Serum Albumin. Copyright © 2013 Elsevier B.V. All rights reserved.

  2. Angiographic classification of patent ductus arteriosus and its clinical implications

    Energy Technology Data Exchange (ETDEWEB)

    Qingqiao, Zhang; Shiliang, Jiang; Lianjun, Huang; Shihua, Zhao; Jian, Ling; Zhongying, Xu; Hong, Zheng; Ruolan, Xie; Ruping, Dai [Chinese Academy of Medical Sciences and Beijing Union Medical College, Beijing (China). Cardiovascular Inst. and Fuwai Hospital, Dept. of Radiology

    2004-04-01

    Objective: To study the angiographic appearance of patent ductus arteriosus (PDA) and provide information for clinical treatment. Methods: Between July 1994 and October 2002, 483 patients (142 male, 341 female) with isolated PDA underwent aortography before attempted transcatheter closure of PDA, the mean age was (14.6 {+-} 11.4) years (range 0.8 to 63 years). Left lateral aortography was performed in 482 patients. Among them, additional aortography in right anterior oblique 30 degree - 50 degree or left anterior oblique 60 degree - 80 degree (or plus caudal 20 degree) projection was performed in 6 and 4 patients, respectively. One patient with mirror-image dextrocardia underwent aortography in right lateral projection. Results: The configuration of PDA was classified into six types. Four hundred and twenty (87%) patients had funnel shape PDA, the mean minimum diameter of PDA was 4.2 {+-} 1.6 mm (range 1 to 15 mm). Three (0.6%) patients had window shape PDA, the diameters of PDA were 8.0 mm, 9.0 mm, and 9.0 mm, respectively. Thirty four (7.0%) patients had tubular shape PDA, the mean diameter of PDA was (5.4 {+-} 3.8) mm (range 0.8 to 20 mm). Eleven (2.3%) patients had rosary shape PDA, the mean minimum diameter of PDA was (2.1 {+-} 0.5) mm (range 1.0 to 3.7 mm). Ten (2.1%) patients had finger shape PDA, the mean minimum diameter of PDA was (1.5 {+-} 0.4) mm (range 1.0 to 3.0 mm). Five (1.0%) patients had irregular shape PDA, the minimum diameters of PDA were 1.2, 2.1, 3.2, 4.0, and 6.0 mm, respectively. Conclusion: The morphology of PDA varied considerably, and the awareness of these variations is helpful for clinical treatment.

  3. Angiographic classification of patent ductus arteriosus and its clinical implications

    International Nuclear Information System (INIS)

    Zhang Qingqiao; Jiang Shiliang; Huang Lianjun; Zhao Shihua; Ling Jian; Xu Zhongying; Zheng Hong; Xie Ruolan; Dai Ruping

    2004-01-01

    Objective: To study the angiographic appearance of patent ductus arteriosus (PDA) and provide information for clinical treatment. Methods: Between July 1994 and October 2002, 483 patients (142 male, 341 female) with isolated PDA underwent aortography before attempted transcatheter closure of PDA, the mean age was (14.6 ± 11.4) years (range 0.8 to 63 years). Left lateral aortography was performed in 482 patients. Among them, additional aortography in right anterior oblique 30 degree - 50 degree or left anterior oblique 60 degree - 80 degree (or plus caudal 20 degree) projection was performed in 6 and 4 patients, respectively. One patient with mirror-image dextrocardia underwent aortography in right lateral projection. Results: The configuration of PDA was classified into six types. Four hundred and twenty (87%) patients had funnel shape PDA, the mean minimum diameter of PDA was 4.2 ± 1.6 mm (range 1 to 15 mm). Three (0.6%) patients had window shape PDA, the diameters of PDA were 8.0 mm, 9.0 mm, and 9.0 mm, respectively. Thirty four (7.0%) patients had tubular shape PDA, the mean diameter of PDA was (5.4 ± 3.8) mm (range 0.8 to 20 mm). Eleven (2.3%) patients had rosary shape PDA, the mean minimum diameter of PDA was (2.1 ± 0.5) mm (range 1.0 to 3.7 mm). Ten (2.1%) patients had finger shape PDA, the mean minimum diameter of PDA was (1.5 ± 0.4) mm (range 1.0 to 3.0 mm). Five (1.0%) patients had irregular shape PDA, the minimum diameters of PDA were 1.2, 2.1, 3.2, 4.0, and 6.0 mm, respectively. Conclusion: The morphology of PDA varied considerably, and the awareness of these variations is helpful for clinical treatment

  4. The clean development mechanism (CDM) an international perspective and implications for the LAC region

    International Nuclear Information System (INIS)

    2004-08-01

    This paper addresses activity a) an analysis of international CDM experiences and its potential contribution to the LAC region. The paper begins with a section describing the basic principles of the CDM and retrieves the lessons learned from the first two years of the CDM operation. This is followed by a more detailed review in section 2 of the on-going baseline and monitoring methodology approval process. In section 3, the development value of the CDM is explored. Section 4 describes the current CDM markets, while section 5 reviews the response of host countries to the CDM outside the LAC region. Section 6 describes the various capacity building programs established by Annex 1 countries to support the CDM. In each of the first 6 sections, implications for the LAC region are identified. Section 7 brings these conclusions together into a concise summary. (The author)

  5. Micrometastatic cancer cells in lymph nodes, bone marrow, and blood: Clinical significance and biologic implications.

    Science.gov (United States)

    Leong, Stanley P L; Tseng, William W

    2014-01-01

    Cancer metastasis may be regarded as a progressive process from its inception in the primary tumor microenvironment to distant sites by way of the lymphovascular system. Although this type of tumor dissemination often occurs in an orderly fashion via the sentinel lymph node (SLN), acting as a possible gateway to the regional lymph nodes, bone marrow, and peripheral blood and ultimately to distant metastatic sites, this is not a general rule as tumor cells may enter the blood and spread to distant sites, bypassing the SLN. Methods of detecting micrometastatic cancer cells in the SLN, bone marrow, and peripheral blood of patients have been established. Patients with cancer cells in their SLN, bone marrow, or peripheral blood have worse clinical outcomes than patients with no evidence of spread to these compartments. The presence of these cells also has important biologic implications for disease progression and the clinician's understanding of the process of cancer metastasis. Further characterization of these micrometastatic cancer cells at each stage and site of metastasis is needed to design novel selective therapies for a more "personalized" treatment. © 2014 American Cancer Society, Inc.

  6. Evaluating Dopamine Reward Pathway in ADHD; clinical implications

    International Nuclear Information System (INIS)

    Volkow, N.D.; Wang, G.; Volkow, N.D.; Wang, G.-J.; Kollins, S.H.; Wigal, T.L.; Newcorn, J.H.; Telang, F.; Fowler, J.S.; Zhu, W.; Logan, J.; Ma, Y.; Pradhan, K.; Wong, C.T.; Swanson, J.M.

    2009-01-01

    Attention-deficit/hyperactivity disorder (ADHD) - characterized by symptoms of inattention and hyperactivity-impulsivity - is the most prevalent childhood psychiatric disorder that frequently persists into adulthood, and there is increasing evidence of reward-motivation deficits in this disorder. To evaluate biological bases that might underlie a reward/motivation deficit by imaging key components of the brain dopamine reward pathway (mesoaccumbens). We used positron emission tomography to measure dopamine synaptic markers (transporters and D 2 /D 3 receptors) in 53 nonmedicated adults with ADHD and 44 healthy controls between 2001-2009 at Brookhaven National Laboratory. We measured specific binding of positron emission tomographic radioligands for dopamine transporters (DAT) using [ 11 C]cocaine and for D 2 /D 3 receptors using [ 11 C]raclopride, quantified as binding potential (distribution volume ratio -1). For both ligands, statistical parametric mapping showed that specific binding was lower in ADHD than in controls (threshold for significance set at P 2 /D 3 receptors, the mean accumbens for controls was 2.85 vs 2.68 for those with ADHD (95% CI, 0.06-0.30, P = .004); and in the midbrain, it was for controls 0.28 vs 0.18 for those with ADHD (95% CI, 0.02-0.17, P = .01). The analysis also corroborated differences in the left caudate: the mean DAT for controls was 0.66 vs 0.53 for those with ADHD (95% CI, 0.04-0.22; P = .003) and the mean D 2 /D 3 for controls was 2.80 vs 2.47 for those with ADHD (95% CI, 0.10-0.56; P = .005) and differences in D 2 /D 3 in the hypothalamic region, with controls having a mean of 0.12 vs 0.05 for those with ADHD (95% CI, 0.02-0.12; P = .004). Ratings of attention correlated with D 2 /D 3 in the accumbens (r = 0.35; 95% CI, 0.15-0.52; P = .001), midbrain (r = 0.35; 95% CI, 0.14-0.52; P = .001), caudate (r = 0.32; 95% CI, 0.11-0.50; P = .003), and hypothalamic (r = 0.31; CI, 0.10-0.49; P = .003) regions and with DAT in the midbrain

  7. Clinical implications of bile duct injury after transcatheter arterial chemoembolization

    International Nuclear Information System (INIS)

    Wang Maoqiang; Tang Wenjie; Lin Hanying; Ye Huiyi; Dai Guanghai; Wang Zhiqiang

    2005-01-01

    Objective: To evaluate the incidence, risk factors , and clinical course of bile duct injury after transcatheter arterial chemoembolization (TACE) for treatment of hepatic malignancy. Methods: A total of 1240 consecutive patients with hepatic malignancies underwent 2680 TACE procedures. None of these patients were found to have any radiographic evidence of biliary abnormalities pre-TACE. Eighteen patients developed bile duct injuries at 3 weeks to 3 months after TACE. A retrospective review of medical records and imaging studies were carried out to evaluate the occurrence of TACE-induced bile duct injury, the clinical outcome, and the statistical significance of potential predisposing factors. Results: The TACE-induced bile duct injuries occurred in 13 of 148 patients with liver metastatic tumors (8.8%), 5 of 1092 patients with HCC (0.5%). Biliary injuries, including focal (n=4) and multiple intrahepatic bile duct dilatation (n=8), and cystic lesion or biloma (n=6), were identified on the follow-up imaging studies after TACE. Three patients with multiple bile duct injuries had mild jaundice at the presentation, two of them responded well to the conservative treatment, one died of irreversible deterioration of liver function at 2 weeks after the onset of jaundice. Four patients with a large biloma had associated serious bacterial infections; 3 of which were treated with percutaneous catheter drainage and antibiotics, 2 of them died of purulent peritonitis due to rupture of the cystic lesions and 1 cured with antibiotic. The remaining 11 patients were asymptomatic. The mortality related to the biliary injury occurred in 3 patients (16.7%). The incidences of bile duct injury were higher in patients with metastatic tumors in non-cirrhotic livers than in patients with hepatocellular carcinoma associated with cirrhosis (P<0.01), higher in patient with hypovascular lesions (P<0.01), and higher in patients using an emulsion of lipiodol-platinum for selective embolization

  8. Bone Turnover Status: Classification Model and Clinical Implications

    Science.gov (United States)

    Fisher, Alexander; Fisher, Leon; Srikusalanukul, Wichat; Smith, Paul N

    2018-01-01

    Aim: To develop a practical model for classification bone turnover status and evaluate its clinical usefulness. Methods: Our classification of bone turnover status is based on internationally recommended biomarkers of both bone formation (N-terminal propeptide of type1 procollagen, P1NP) and bone resorption (beta C-terminal cross-linked telopeptide of type I collagen, bCTX), using the cutoffs proposed as therapeutic targets. The relationships between turnover subtypes and clinical characteristic were assessed in1223 hospitalised orthogeriatric patients (846 women, 377 men; mean age 78.1±9.50 years): 451(36.9%) subjects with hip fracture (HF), 396(32.4%) with other non-vertebral (non-HF) fractures (HF) and 376 (30.7%) patients without fractures. Resalts: Six subtypes of bone turnover status were identified: 1 - normal turnover (P1NP>32 μg/L, bCTX≤0.250 μg/L and P1NP/bCTX>100.0[(median value]); 2- low bone formation (P1NP ≤32 μg/L), normal bone resorption (bCTX≤0.250 μg/L) and P1NP/bCTX>100.0 (subtype2A) or P1NP/bCTX0.250 μg/L) and P1NP/bCTXturnover (both markers elevated ) and P1NP/bCTX>100.0 (subtype 4A) or P1NP/bCTX75 years and hyperparathyroidism. Hypoalbuminaemia and not using osteoporotic therapy were two independent indicators common for subtypes 3, 4A and 4B; these three subtypes were associated with in-hospital mortality. Subtype 3 was associated with fractures (OR 1.7, for HF OR 2.4), age>75 years, chronic heart failure (CHF), anaemia, and history of malignancy, and predicted post-operative myocardial injury, high inflammatory response and length of hospital stay (LOS) above10 days. Subtype 4A was associated with chronic kidney disease (CKD), anaemia, history of malignancy and walking aids use and predicted LOS>20 days, but was not discriminative for fractures. Subtype 4B was associated with fractures (OR 2.1, for HF OR 2.5), age>75 years, CKD and indicated risks of myocardial injury, high inflammatory response and LOS>10 days. Conclusions: We

  9. Preferred retinal locus in macular disease: characteristics and clinical implications.

    Science.gov (United States)

    Greenstein, Vivienne C; Santos, Rodrigo A V; Tsang, Stephen H; Smith, R Theodore; Barile, Gaetano R; Seiple, William

    2008-10-01

    To investigate the location and fixation stability of preferred retinal locations (PRLs) in patients with macular disease, and the relationship among areas of abnormal fundus autofluorescence, the PRL and visual sensitivity. Fifteen patients (15 eyes) were studied. Seven had Stargardt disease, 1 bull's eye maculopathy, 5 age-related macular degeneration, 1 Best disease, and 1 pattern dystrophy. All tested eyes had areas of abnormal fundus autofluorescence. The PRL was evaluated with fundus photography and the Nidek microperimeter. Visual field sensitivity was measured with the Nidek microperimeter. Of the 15 eyes, 4 had foveal and 11 had eccentric fixation. Eccentric PRLs were above the atrophic lesion and their stability did not depend on the degree of eccentricity from the fovea. Visual sensitivity was markedly decreased in locations corresponding to hypofluorescent areas. Sensitivity was not decreased in hyperfluorescent areas corresponding to flecks but was decreased if hyperfluorescence was in the form of dense annuli. Eccentric PRLs were in the superior retina in regions of normal fundus autofluorescence. Fixation stability was not correlated with the degree of eccentricity from the fovea. To assess the outcomes of treatment trials it is important to use methods that relate retinal morphology to visual function.

  10. Bilateral elongated styloid process: Its anatomical, embryological and clinical implications

    Directory of Open Access Journals (Sweden)

    Bagoji Ishwar B, Hadimani Gavishiddappa A, Patil Balasaheb G, Bannur Balappa M,Ambadasu B

    2013-04-01

    Full Text Available The styloid process is a slender, elongated, cylindrical bony projection from temporal bone. It normally varies in length from 2 cm to 3 cm. During a routine demonstration of skull for MBBS students we found the bilateral elongated styloid process in dry human skull. The length of elongation measured on the right and left side was 6.0 & 5.9 cms respectively. Such abnormal elongation of the styloid process may cause compression on a number of vital vessels and nerves related to it, producing inflammatory changes that include continuous chronic pain in the pharyngeal region. Mechanical stresses stretching the second brachial arch during fetal development probably induce variable involvement of Reichert’s cartilage in morphogenesis of the styloid process. It is important that clinicians especially dentists and otolaryngologists are aware of the natural variations of the styloid process and do not consider the styloid process with a length of 30 mm as an abnormality or as an anomaly.

  11. How motorcycle helmets affect trauma mortality: Clinical and policy implications.

    Science.gov (United States)

    Lee, Jwo-Leun; Chen, Tzu-Chun; Huang, Hung-Chang; Chen, Ray-Jade

    2017-08-18

    Motorcycles are the most popular vehicles in Taiwan, where more than 14.8 million motorcycles (1 motorcycle per 1.6 people) are in service. Despite the mandatory helmet law passed in 1997, less than 80% of motorcyclists in Taiwan wear helmets. The objective of this study was to analyze the effect of using motorcycle helmets on fatality rates. A clinical data set including 2,868 trauma patients was analyzed; the cross-sectional registration database was administered by a university medical center in Central Taiwan. A path analysis framework and multiple logistic regressions were used to estimate the marginal effect of helmet use on mortality. Using a helmet did not directly reduce the mortality rate but rather indirectly reduced the mortality rate through intervening variables such as the severity of head injuries, number of craniotomies, and complications during therapeutic processes. Wearing a helmet can reduce the fatality rate by 1.3%, the rate of severe head injury by 34.5%, the craniotomy rate by 7.8%, and the rate of complications during therapeutic processes by 1.5%. These rates comprise 33.3% of the mortality rate for people who do not wear helmets, 67.3% of the severe head injury rate, 60.0% of the craniotomy rate, and 12.2% of the rate of complications during therapeutic processes. Wearing a helmet and trauma system designation are crucial factors that reduce the fatality rate.

  12. Clinical implications of increased use of MRI in TIA.

    Science.gov (United States)

    Kvistad, C E; Thomassen, L; Waje-Andreassen, U; Moen, G; Logallo, N; Naess, H

    2013-07-01

    Transient ischemic attack has been redefined as a tissue-based diagnosis and MRI recommended as the preferred imaging modality. We aimed to investigate whether an increased use of MRI leads to a decrease in the proportion of TIA as compared to cerebral infarction. We also sought to see whether DWI-positive patients with transient ischemic symptoms TIA patients in terms of performed diagnostic investigations and clinical characteristics. Patients admitted with cerebral infarction or TIA in the period 2006-2011 were prospectively registered. The use of MRI in patients with transient ischemic symptoms TIA were annually recorded. DWI-positive and DWI-negative patients with transient ischemic symptoms TIA as compared to cerebral infarction decreased from 12.2% in 2006-2008 to 8.3% in 2009-2011 (P = 0.002). DWI-positive patients were more often examined with 24-h Holter monitoring (P TIA definition resulted in a decrease in the proportion of TIA at discharge as compared to cerebral infarction. DWI-positive patients had a more extensive cardiac work-up and were associated with lower age and prior myocardial infarction. © 2012 John Wiley & Sons A/S.

  13. Clinical implications of patient-provider agreements in opioid prescribing.

    Science.gov (United States)

    Kraus, Carl N; Baldwin, Alan T; Curro, Frederick A; McAllister, R G

    2015-01-01

    In June, 2012 the United States Food and Drug Administration (FDA) developed a "blueprint" for prescriber education as a means of directing Certified Medical Education (CME) activities that included content which would meet the regulatory requirements of the class-wide, longacting/ extended-release (LA-ER) opioid Risk Evaluation Mitigation Strategies (REMS). Within the blueprint is the suggested adoption of Patient-Provider Agreements (PPAs) to be used in association with opioid prescribing, but, to our knowledge, there have been no reported evaluations of the role played by opioid-agent PPAs in clinical practice, or of the perceptions of this regulatory mandate by clinicians. Therefore, we conducted a survey regarding PPA perceptions by opioid prescribers that was posted for five weeks on a well-trafficked online CME service provider (Medscape). Of the 1,232 respondents (reflecting a 99.5% completion rate), 52.4% treat acute or chronic pain with opioids. The survey identified an improvement of opioid safe-use education (21% of respondents) as the most frequently selected beneficial element of PPAs. Conversely, the challenges to adoption included time constraints (21% of physicians) as well as lack of evidence that PPAs will reduce drug misuse, and the lack of a uniform, patient-friendly PPA. Based on our survey, clinicians consider the PPA of potential value, but data regarding the utility of such an instrument are lacking.

  14. Psychiatric caregiver stress: clinical implications of compassion fatigue.

    Science.gov (United States)

    Franza, Francesco; Del Buono, Gianfranco; Pellegrino, Ferdinando

    2015-09-01

    The capacity to work productively is a key component of health and emotional well-being. People who work in health care can be exposed to the fatigue of care. Compassion fatigue has been described as an occupational hazard specific to clinical work related severe emotional distress. In our study, we have evaluated compassion fatigue in a mental health group (47 psychiatric staff) and its relationship with inpatients (237 inpatients) affected by some psychiatric disorders. At baseline, the more significant data indicate a high percentage of Job Burnout and Compassion Fatigue in psychiatric nurses (respectively, 39.28%, 28.57%). Significant Compassion Fatigue percentage is present also in psychologist group (36.36%). Finally, in psychiatrists, the exposure to patients increased vicarious trauma (28.57%), but not job burnout. After a year of participation in Balint Groups, the psychiatric staff presented an overall reduction in total mean score in any administered scale (CBI: pfatigue causes concern among mental health professionals, and Balint Groups may represent a therapeutic strategy to help health professionals to face difficulties in challenging work environments.

  15. Bisphosphonates and their clinical implications in endodontic therapy.

    Science.gov (United States)

    Moinzadeh, A-T; Shemesh, H; Neirynck, N A M; Aubert, C; Wesselink, P R

    2013-05-01

    This review gives an overview of the factors that may play a role in the development of osteonecrosis of the jaw in patients treated with bisphosphonates (BPs) and undergoing nonsurgical endodontic treatment as well as some recommendations for its prevention. BPs are a widely prescribed group of drugs for diverse bone diseases. The occasional but devastating adverse effect of these drugs has been described as bisphosphonate-related osteonecrosis of the jaw (BRONJ). As this condition is debilitating and difficult to treat, all efforts should be made to prevent its occurence in patients at risk. The main triggering event is considered to be dental extraction. Even though nonsurgical endodontic treatment appears to be a relatively safe procedure, care remains essential. After an overview of this class of drugs, the clinical presentation, epidemiology and pathogenesis of BRONJ, as well as the possible risk factors associated with its development after nonsurgical endodontic treatment will be described. Finally, several strategies will be proposed for the prevention of BRONJ during nonsurgical endodontic treatment. © 2012 International Endodontic Journal. Published by Blackwell Publishing Ltd.

  16. Epigenetic Regulation of Carotid Body Oxygen Sensing: Clinical Implications.

    Science.gov (United States)

    Nanduri, Jayasri; Prabhakar, Nanduri R

    2015-01-01

    Recurrent apnea with intermittent hypoxia (IH) is a major clinical problem in infants born preterm. Recent epidemiological studies showed that adults who were born preterm exhibit increased incidence of sleep-disordered breathing and hypertension. Thus, apnea of prematurity predisposes individuals to autonomic dysfunction in adulthood. Experimental studies showed that adult rats exposed to IH as neonates exhibit augmented carotid body and adrenal chromaffin cells (AMC) response to hypoxia and irregular breathing with apneas and hypertension. The enhanced hypoxic sensitivity of the carotid body and AMC in adult rats exposed to neonatal IH was associated with increased oxidative stress, decreased expression of genes encoding anti-oxidant enzymes, and increased expression of pro-oxidant enzymes. Epigenetic mechanisms including DNA methylation leads to long-term changes in gene expression. The decreased expression of the Sod2 gene, which encodes the anti-oxidant enzyme, superoxide dismutase 2, was associated with DNA hypermethylation of a single CpG dinucleotide close to the transcription start site. Treating neonatal rats with decitabine, an inhibitor of DNA methylation, during IH exposure prevented the oxidative stress, enhanced hypoxic sensitivity, and autonomic dysfunction in adult rats. These findings suggest that epigenetic mechanisms, especially DNA methylation contributes to neonatal programming of hypoxic sensitivity and the ensuing autonomic dysfunction in adulthood.

  17. Clinical features of pedophilia and implications for treatment.

    Science.gov (United States)

    Cohen, Lisa J; Galynker, Igor I

    2002-09-01

    The authors discuss the diagnostic criteria for pedophilia and review the literature on its clinical features, including data on prevalence, gender, age of onset, number of victims, frequency and type of acts, violence, impulsivity, and insight. Findings concerning the characteristics of victims (e.g., sex, age, relationship to the pedophile) and research on pedophilic subtypes-exclusive versus nonexclusive; incestuous versus nonincestuous; heterosexual, homosexual, or bisexual-are reviewed. Studies have shown that pedophiles may share many psychiatric features beyond deviant sexual desire, including high rates of comorbid axis I disorders (affective disorders, substance use disorders, impulse control disorders, other paraphilias) as well as severe axis II psychopathology (especially antisocial and Cluster C personality disorders). The authors present several possible etiological models for pedophilia and conclude that further research is needed concerning the etiological role of a childhood history of sexual abuse as well as the underlying neurobiology of deviant sexual arousal and decreased erotic differentiation. Finally, findings concerning pharmacological and cognitive-behavioral treatments for pedophilia are briefly reviewed. Recidivism, drop-out, and noncompliance are significant problems in the treatment of pedophilia. The authors review predictors of treatment outcome and conclude that pedophilia is extremely difficult to treat and that effective treatment needs to be intensive, long-term, and comprehensive, possibly with lifetime follow-up.

  18. Malnutrition in hospital: the clinical and economic implications.

    Science.gov (United States)

    Löser, Christian

    2010-12-01

    Undernutrition and malnutrition are common in hospitalized patients. Their combined prevalence on admission is estimated at 25% and is rising. Selective literature review with special consideration of current guidelines and meta-analyses. The nutritional state of every patient should be assessed on admission with simple, established parameters, and patients suffering from under- or malnutrition should be treated with a targeted nutritional intervention based on the established stepwise treatment algorithm. Under- and malnutrition are an independent risk and cost factor with a significant influence on mortality, morbidity, length of hospital stay, and quality of life. Their direct costs alone amount to some 9 billion Euros in Germany each year. Therapeutic trials and meta-analyses have clearly documented the therapeutic benefit and cost-effectiveness of oral nutritional supplements and tube feeds. Targeted nutritional intervention is an integral part of medical treatment and prevention. Undernutrition and malnutrition are common in hospitalized patients and are both medically and economically harmful. If they are detected early by targeted assessment and then treated appropriately according to the established stepwise treatment algorithm, better clinical outcomes and lower costs will result.

  19. [Scope of the latest RE-LY substudies: clinical implications].

    Science.gov (United States)

    Ruiz-Giménez Arrieta, N

    2012-03-01

    The approval of the use of dabiatran in stroke prevention in patients with nonvalvular atrial fibrilation (NVAF) is based on the results of the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, one of the largest studies to date in this entity. In this trial, dabigatran showed similar safety and efficacy to warfarin in primary and secondary prevention of stroke in patients with AF. At a dose of 150 mg twice daily, dabigatran was superior to warfarin in the prevention of stroke or systemic embolism and the 110 mg dose twice daily showed similar efficacy and greater safety, given the lower incidence of hemorrhage. These results were consistently found in the various subanalyses, with some slight differences of interest for clinical practice. The ideal candidates for dabiatran are patients with NVAF suitable for cardioversion, who require short periods of anticoagulation, patients in remote geographical areas with difficulty in achieving good anticoagulation control or good control with anti-vitamin K treatment due to IRN fluctuations, and patients with a low risk of hemorrhage and a CHADS score ≥ 3 and/or with prior stroke, whenever there are no contraindications. The choice of dabigatran dose should be evaluated according to the patient's individual characteristics (caution must be exercised when prescribing this drug in the elderly and in renal insufficiency) and embolic and/or hemorrhagic risk. Studies of the long-term safety of this drug, pharmacoeconomic analyses in Spain and post-commercialization pharmacovigilance data are required before the definitive uses of this drug can be established. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. Clinical implications of globally emerging azole resistance in Aspergillus fumigatus

    Science.gov (United States)

    Verweij, Paul E.

    2016-01-01

    Aspergillus fungi are the cause of an array of diseases affecting humans, animals and plants. The triazole antifungal agents itraconazole, voriconazole, isavuconazole and posaconazole are treatment options against diseases caused by Aspergillus. However, resistance to azoles has recently emerged as a new therapeutic challenge in six continents. Although de novo azole resistance occurs occasionally in patients during azole therapy, the main burden is the aquisition of resistance through the environment. In this setting, the evolution of resistance is attributed to the widespread use of azole-based fungicides. Although ubiquitously distributed, A. fumigatus is not a phytopathogen. However, agricultural fungicides deployed against plant pathogenic moulds such as Fusarium, Mycospaerella and A. flavus also show activity against A. fumigatus in the environment and exposure of non-target fungi is inevitable. Further, similarity in molecule structure between azole fungicides and antifungal drugs results in cross-resistance of A. fumigatus to medical azoles. Clinical studies have shown that two-thirds of patients with azole-resistant infections had no previous history of azole therapy and high mortality rates between 50% and 100% are reported in azole-resistant invasive aspergillosis. The resistance phenotype is associated with key mutations in the cyp51A gene, including TR34/L98H, TR53 and TR46/Y121F/T289A resistance mechanisms. Early detection of resistance is of paramount importance and if demonstrated, either with susceptibility testing or through molecular analysis, azole monotherapy should be avoided. Liposomal amphotericin B or a combination of voriconazole and an echinocandin are recomended for azole-resistant aspergillosis. This article is part of the themed issue ‘Tackling emerging fungal threats to animal health, food security and ecosystem resilience’. PMID:28080986

  1. Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery.

    Science.gov (United States)

    Schneider, Christian; Ramaswamy, Vijay; Kulkarni, Abhaya V; Rutka, James T; Remke, Marc; Tabori, Uri; Hawkins, Cynthia; Bouffet, Eric; Taylor, Michael D

    2015-03-01

    While medulloblastoma was initially thought to comprise a single homogeneous entity, it is now accepted that it in fact comprises 4 discrete subgroups, each with its own distinct demographics, clinical presentation, transcriptomics, genetics, and outcome. Hydrocephalus is a common complication of medulloblastoma and not infrequently requires CSF diversion. The authors report the incidence of CSF diversion surgery in each of the subgroups of medulloblastoma (Wnt, Shh, Group 3, and Group 4). The medical and imaging records for patients who underwent surgery for medulloblastoma at The Hospital for Sick Children were retrospectively reviewed. The primary outcome was the requirement for CSF diversion surgery either before or within 60 days of tumor resection. The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was compared among subgroups. Of 143 medulloblastoma patients, treated from 1991 to 2013, sufficient data were available for 130 patients (15 with Wnt, 30 with Shh, 30 with Group 3, and 55 with Group 4 medulloblastomas). Of these, 28 patients (22%) ultimately underwent CSF diversion surgery: 0% with Wnt, 29% with Shh, 29% with Group 3, and 43% with Group 4 tumors. Patients in the Wnt subgroup had a lower incidence of CSF diversion than all other patients combined (p = 0.04). Wnt patients had a lower mCPPRH score (lower risk of CSF diversion, p = 0.045), were older, had smaller ventricles at diagnosis, and had no leptomeningeal metastases. The overall rate of CSF diversion surgery for Shh, Group 3, and Group 4 medulloblastomas is around 30%, but no patients in the present series with a Wnt medulloblastoma required shunting. The low incidence of hydrocephalus in patients with Wnt medulloblastoma likely reflects both host factors (age) and disease factors (lack of metastases). The absence of hydrocephalus in patients with Wnt medulloblastomas likely contributes to their excellent rate of survival and may also contribute to a higher quality

  2. Resource utilization implications of treatment were able to be assessed from appropriately reported clinical trial data

    NARCIS (Netherlands)

    Poole-Wilson, Philip A.; Kirwan, Bridget-Anne; Voko, Zoltan; de Brouwer, Sophie; Dunselman, Peter H. J. M.; van Dalen, Frederik J.; Lubsen, Jacobus

    Background and Objective: Published clinical trial data rarely allow assessment of the health care resource utilization implications of treatment. We give an example of how these can be assessed given appropriate tabulation of data. Methods: Data from a trial comparing long-acting nifedipine

  3. Herpes Simplex Virus Infection in a University Health Population: Clinical Manifestations, Epidemiology, and Implications

    Science.gov (United States)

    Horowitz, Robert; Aierstuck, Sara; Williams, Elizabeth A.; Melby, Bernette

    2010-01-01

    Objective: The authors described clinical presentations of oral and genital herpes simplex virus (HSV) infections in a university health population and implications of these findings. Participants and Methods: Using a standardized data collection tool, 215 records of patients with symptomatic culture-positive HSV infections were reviewed. Results:…

  4. Monomeric insulins and their experimental and clinical implications.

    Science.gov (United States)

    Brange, J; Owens, D R; Kang, S; Vølund, A

    1990-09-01

    Due to the inherent pharmacokinetic properties of available insulins, normoglycemia is rarely, if ever, achieved in insulin-dependent diabetic patients without compromising their quality of life. Subcutaneous insulin absorption is influenced by many factors, among which the associated state of insulin (hexameric) in pharmaceutical formulation may be of importance. This review describes the development of a series of human insulin analogues with reduced tendency to self-association that, because of more rapid absorption, are better suited to meal-related therapy. DNA technology has made it possible to prepare insulins that remain dimeric or even monomeric at high concentration by introducing one or a few amino acid substitutions into human insulin. These analogues were characterized and used for elucidating the mechanisms involved in subcutaneous absorption and were investigated in preliminary clinical studies. Their relative receptor binding and in vitro potency (free-fat cell assay), ranging from 0.05 to 600% relative to human insulin, were strongly correlated (r = 0.97). In vivo, most of the analogues exhibited approximately 100% activity, explainable by a dominating receptor-mediated clearance. This was confirmed by clamp studies in which correlation between receptor binding and clearance was observed. Thus, an analogue with reduced binding and clearance gives higher circulating concentrations, counterbalancing the reduced potency at the cellular level. Absorption studies in pigs revealed a strong inverse correlation (r = 0.96) between the rate of subcutaneous absorption and the mean association state of the insulin analogues. These studies also demonstrated that monomeric insulins were absorbed three times faster than human insulin. In healthy subjects, rates of disappearance from subcutis were two to three times faster for dimeric and monomeric analogues than for human insulin. Concomitantly, a more rapid rise in plasma insulin concentration and an earlier

  5. The financial and accounting implications of the privatization of the regional electricity companies in the UK

    International Nuclear Information System (INIS)

    Thomson, L.

    1993-01-01

    This paper reviews some of the financial and accounting implications of the privatization of the electricity distribution and supply sector in England and Wales, specifically the transformation of the Electricity Area Boards into the 12 Regional Electricity Companies (RECs). It considers the factors influencing the setting of post-privatization price control factors; the capital restructuring of the RECs; the valuation placed by the Secretary of State for Energy on each company at flotation, and market reaction to this as shown in subsequent changes in share price; and changes in the information provided in the RECs' accounts over the privatization period. (Author)

  6. Clinical leadership in contemporary clinical practice: implications for nursing in Australia.

    Science.gov (United States)

    Davidson, P M; Elliott, D; Daly, J

    2006-04-01

    Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.

  7. Anthropogenic activities and coastal environmental quality: a regional quantitative analysis in southeast China with management implications.

    Science.gov (United States)

    Chen, Kai; Liu, Yan; Huang, Dongren; Ke, Hongwei; Chen, Huorong; Zhang, Songbin; Yang, Shengyun; Cai, Minggang

    2018-02-01

    Regional analysis of environmental issues has always been a hot topic in the field of sustainable development. Because the different levels of economic growth, urbanization, resource endowments, etc. in different regions generate apparently different ecological responses, a better description and comparison across different regions will provide more valuable implications for ecological improvement and policymaking. In this study, seven typical bays in southeast China that are a rapid developing area were selected to quantitatively analyze the relationship between socioeconomic development and coastal environmental quality. Based on the water quality data from 2007 to 2015, the multivariate statistical method was applied to analyze the potential environmental risks and to classify the seven bays based on their environmental quality status. The possible variation trends of environmental indices were predicted based on the cross-regional panel data by Environmental Kuznets Curve. The results showed that there were significant regional differences among the seven bays, especially Quanzhou, Xiamen, and Luoyuan Bays, suffered from severer artificial disturbances than other bays, despite their different development patterns. Socioeconomic development level was significantly associated with some water quality indices (pH, DIN, PO 4 -P); the association was roughly positive: the areas with higher GDP per capita have some worse water quality indices. In addition, the decreasing trend of pH values and the increasing trend of nutrient concentration in the seven bays will continue in the foreseeable future. In consideration of the variation trends, the limiting nutrient strategy should be implemented to mitigate the deterioration of the coastal environments.

  8. Referrals to a regional allergy clinic - an eleven year audit

    Directory of Open Access Journals (Sweden)

    Hewson Paul

    2010-12-01

    Full Text Available Abstract Background Allergy is a serious and apparently increasing public health problem yet relatively little is known about the types of allergy seen in routine tertiary practice, including their spatial distribution, co-occurrence or referral patterns. This study reviewed referrals over an eleven year period to a regional allergy clinic that had a well defined geographical boundary. For those patients confirmed as having an allergy we explored: (i differences over time and by demographics, (ii types of allergy, (iii co-occurrence, and (iv spatial distributions. Methods Data were extracted from consultant letters to GPs, from September 1998 to September 2009, for patients confirmed as having an allergy. Other data included referral statistics and population data by postcode. Simple descriptive analysis was used to describe types of allergy. We calculated 11 year standardised morbidity ratios for postcode districts and checked for spatial clustering. We present maps showing 11 year rates by postcode, and 'difference' maps which try to separate referral effect from possible environmental effect. Results Of 5778 referrals, 961 patients were diagnosed with an allergy. These were referred by a total of 672 different GPs. There were marked differences in referral patterns between GP practices and also individual GPs. The mean age of patients was 35 and there were considerably more females (65% than males. Airborne allergies were the most frequent (623, and there were very high rates of co-occurrence of pollen, house dust mite, and animal hair allergies. Less than half (410 patients had a food allergy, with nuts, fruit, and seafood being the most common allergens. Fifteen percent (142 had both a food and a non-food allergy. Certain food allergies were more likely to co-occur, for example, patients allergic to dairy products were more likely to be allergic to egg. There were age differences by types of allergy; people referred with food allergies were

  9. Clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy insertion.

    Science.gov (United States)

    Stewart, Jessica K; Smith, Tony P; Kim, Charles Y

    To determine the clinical implications of acute pelvicaliceal hematoma formation during percutaneous catheter nephrostomy (PCN) insertion. Collecting system hematoma burden was retrospectively assessed for 694 PCN insertions in 502 patients. Pelvicaliceal hematoma formation occurred in 146 kidneys (21%) in 136 patients. Clinically significant blood loss occurred in 3 patients with hematomas within one week compared to 4 patients without hematomas (p=0.39). Twenty-four patients with hematomas underwent catheter exchange within one week, compared to 55 patients without hematomas (p=0.49). Pelvicaliceal hematoma formation after PCN insertion is not uncommon and is associated with very rare clinical sequelae. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. COMPLEX REGIONAL PAIN SYNDROME – CLINIC, DIAGNOSTICS, TREATMENT

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2014-07-01

    Full Text Available The problem of pain today remains one of the fundamental issues of medical care. It is known that the pain is the leading cause of treatmentto the doctor. Among pain syndromes, a special place belongs to the complex regional pain syndromes. They are distinguished by the multidisciplinary problem, the presence of explicit nature of the pain, difficulty of diagnosis and nature of the treatment. The article presentsmodern data on the diagnosis and treatment of the complex regional pain syndromes.

  11. COMPLEX REGIONAL PAIN SYNDROME – CLINIC, DIAGNOSTICS, TREATMENT

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2013-01-01

    Full Text Available The problem of pain today remains one of the fundamental issues of medical care. It is known that the pain is the leading cause of treatmentto the doctor. Among pain syndromes, a special place belongs to the complex regional pain syndromes. They are distinguished by the multidisciplinary problem, the presence of explicit nature of the pain, difficulty of diagnosis and nature of the treatment. The article presentsmodern data on the diagnosis and treatment of the complex regional pain syndromes.

  12. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod

    Directory of Open Access Journals (Sweden)

    Correale J

    2016-06-01

    Full Text Available Jorge Correale,1 Erwin Chiquete,2 Alexey Boyko,3 Roy G Beran,4–6 Jorge Barahona Strauch,7,8 Snezana Milojevic,9 Nadina Frider101Department of Neurology, Raúl Carrea Institute for Neurological Research, Foundation for the Fight against Infant Neurological Illnesses (FLENI, Buenos Aires, Argentina; 2Department of Neurology and Psychiatry, Salvador Zubirán National Institute of Medical Sciences and Nutrition, Mexico City, Mexico; 3Clinical and Research Center “MS and Other Demyelinating Diseases” at the Neuroclinical Hospital, Department of Neurology, Neurosurgery and Medical Genetics of the Pirogov Russian National Research Medical University, Moscow, Russia; 4South Western Clinical School, University of New South Wales, Liverpool, 5Department of Neurology, Liverpool Hospital, Sydney, NSW, 6School of Medicine, Griffith University, Southport, QLD, Australia; 7Department of Neurology, Clínica Alemana de Santiago, 8School of Medicine, Universidad del Desarrollo, Santiago, Chile; 9Novartis Pharma AG, Basel, Switzerland; 10Novartis Latin America and Canada Region, Buenos Aires, ArgentinaAbstract: Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans, they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of

  13. Financial and clinical governance implications of clinical coding accuracy in neurosurgery: a multidisciplinary audit.

    Science.gov (United States)

    Haliasos, N; Rezajooi, K; O'neill, K S; Van Dellen, J; Hudovsky, Anita; Nouraei, Sar

    2010-04-01

    Clinical coding is the translation of documented clinical activities during an admission to a codified language. Healthcare Resource Groupings (HRGs) are derived from coding data and are used to calculate payment to hospitals in England, Wales and Scotland and to conduct national audit and benchmarking exercises. Coding is an error-prone process and an understanding of its accuracy within neurosurgery is critical for financial, organizational and clinical governance purposes. We undertook a multidisciplinary audit of neurosurgical clinical coding accuracy. Neurosurgeons trained in coding assessed the accuracy of 386 patient episodes. Where clinicians felt a coding error was present, the case was discussed with an experienced clinical coder. Concordance between the initial coder-only clinical coding and the final clinician-coder multidisciplinary coding was assessed. At least one coding error occurred in 71/386 patients (18.4%). There were 36 diagnosis and 93 procedure errors and in 40 cases, the initial HRG changed (10.4%). Financially, this translated to pound111 revenue-loss per patient episode and projected to pound171,452 of annual loss to the department. 85% of all coding errors were due to accumulation of coding changes that occurred only once in the whole data set. Neurosurgical clinical coding is error-prone. This is financially disadvantageous and with the coding data being the source of comparisons within and between departments, coding inaccuracies paint a distorted picture of departmental activity and subspecialism in audit and benchmarking. Clinical engagement improves accuracy and is encouraged within a clinical governance framework.

  14. Clinical Implications of TiGRT Algorithm for External Audit in Radiation Oncology.

    Science.gov (United States)

    Shahbazi-Gahrouei, Daryoush; Saeb, Mohsen; Monadi, Shahram; Jabbari, Iraj

    2017-01-01

    Performing audits play an important role in quality assurance program in radiation oncology. Among different algorithms, TiGRT is one of the common application software for dose calculation. This study aimed to clinical implications of TiGRT algorithm to measure dose and compared to calculated dose delivered to the patients for a variety of cases, with and without the presence of inhomogeneities and beam modifiers. Nonhomogeneous phantom as quality dose verification phantom, Farmer ionization chambers, and PC-electrometer (Sun Nuclear, USA) as a reference class electrometer was employed throughout the audit in linear accelerators 6 and 18 MV energies (Siemens ONCOR Impression Plus, Germany). Seven test cases were performed using semi CIRS phantom. In homogeneous regions and simple plans for both energies, there was a good agreement between measured and treatment planning system calculated dose. Their relative error was found to be between 0.8% and 3% which is acceptable for audit, but in nonhomogeneous organs, such as lung, a few errors were observed. In complex treatment plans, when wedge or shield in the way of energy is used, the error was in the accepted criteria. In complex beam plans, the difference between measured and calculated dose was found to be 2%-3%. All differences were obtained between 0.4% and 1%. A good consistency was observed for the same type of energy in the homogeneous and nonhomogeneous phantom for the three-dimensional conformal field with a wedge, shield, asymmetric using the TiGRT treatment planning software in studied center. The results revealed that the national status of TPS calculations and dose delivery for 3D conformal radiotherapy was globally within acceptable standards with no major causes for concern.

  15. Clinical Implications of TiGRT Algorithm for External Audit in Radiation Oncology

    Directory of Open Access Journals (Sweden)

    Daryoush Shahbazi-Gahrouei

    2017-01-01

    Full Text Available Background: Performing audits play an important role in quality assurance program in radiation oncology. Among different algorithms, TiGRT is one of the common application software for dose calculation. This study aimed to clinical implications of TiGRT algorithm to measure dose and compared to calculated dose delivered to the patients for a variety of cases, with and without the presence of inhomogeneities and beam modifiers. Materials and Methods: Nonhomogeneous phantom as quality dose verification phantom, Farmer ionization chambers, and PC-electrometer (Sun Nuclear, USA as a reference class electrometer was employed throughout the audit in linear accelerators 6 and 18 MV energies (Siemens ONCOR Impression Plus, Germany. Seven test cases were performed using semi CIRS phantom. Results: In homogeneous regions and simple plans for both energies, there was a good agreement between measured and treatment planning system calculated dose. Their relative error was found to be between 0.8% and 3% which is acceptable for audit, but in nonhomogeneous organs, such as lung, a few errors were observed. In complex treatment plans, when wedge or shield in the way of energy is used, the error was in the accepted criteria. In complex beam plans, the difference between measured and calculated dose was found to be 2%–3%. All differences were obtained between 0.4% and 1%. Conclusions: A good consistency was observed for the same type of energy in the homogeneous and nonhomogeneous phantom for the three-dimensional conformal field with a wedge, shield, asymmetric using the TiGRT treatment planning software in studied center. The results revealed that the national status of TPS calculations and dose delivery for 3D conformal radiotherapy was globally within acceptable standards with no major causes for concern.

  16. Sources of variation in primary care clinical workflow: implications for the design of cognitive support.

    Science.gov (United States)

    Militello, Laura G; Arbuckle, Nicole B; Saleem, Jason J; Patterson, Emily; Flanagan, Mindy; Haggstrom, David; Doebbeling, Bradley N

    2014-03-01

    This article identifies sources of variation in clinical workflow and implications for the design and implementation of electronic clinical decision support. Sources of variation in workflow were identified via rapid ethnographic observation, focus groups, and interviews across a total of eight medical centers in both the Veterans Health Administration and academic medical centers nationally regarded as leaders in developing and using clinical decision support. Data were reviewed for types of variability within the social and technical subsystems and the external environment as described in the sociotechnical systems theory. Two researchers independently identified examples of variation and their sources, and then met with each other to discuss them until consensus was reached. Sources of variation were categorized as environmental (clinic staffing and clinic pace), social (perception of health information technology and real-time use with patients), or technical (computer access and information access). Examples of sources of variation within each of the categories are described and discussed in terms of impact on clinical workflow. As technologies are implemented, barriers to use become visible over time as users struggle to adapt workflow and work practices to accommodate new technologies. Each source of variability identified has implications for the effective design and implementation of useful health information technology. Accommodating moderate variability in workflow is anticipated to avoid brittle and inflexible workflow designs, while also avoiding unnecessary complexity for implementers and users.

  17. Implications of greenhouse gas emission mitigation scenarios for the main Asian regions

    International Nuclear Information System (INIS)

    Ruijven, Bas J. van; Vuuren, Detlef P. van; Vliet, Jasper van; Mendoza Beltran, Angelica; Deetman, Sebastiaan; Elzen, Michel G.J. den

    2012-01-01

    In order to limit global mean temperature increase, long-term greenhouse gas emissions need to be reduced. This paper discusses the implications of greenhouse gas emission reductions for major Asian regions (China, India, Indonesia, South-East Asia, Japan and Korea) based on results from the IMAGE modelling framework. Energy use in regions and economic sectors is affected differently by ambitious climate policies. We find that the potential for emission reduction varies widely between regions. With respect to technology choices in the power sector, we find major application of CO 2 storage in Indonesia and India, whereas Korea and India apply more solar and wind. Projections for Japan include a (debatable) large share of nuclear power. China and, India, and South-East Asia, show a diverse technology choice in the power sector. For the industry sector, we find that the recent rapid growth in China limits the potential for emission reduction in the next decades, assuming that recently built coal-based industry facilities are in use for the next decades. For the residential sector, the model results show that fewer households switch from traditional fuels to modern fuels in GHG mitigation scenarios. With respect to co-benefits, we find lower imports of fossil energy in mitigation scenarios and a clear reduction of air pollutant emissions. - Highlights: ► The potential for emission reduction varies widely between regions. ► Some regions have attractive CO 2 storage capacity; others have low-cost solar/wind potential. ► The recent rapid growth of Chinese industry may limit emission reduction potential for decades. ► Fewer households switch from traditional fuels to modern fuels in mitigation scenarios. ► Mitigation scenarios show less fossil energy import and reduction of air pollutant emission.

  18. A combined third and fourth branchial arch anomaly: clinical and embryological implications.

    Science.gov (United States)

    Mehrzad, H; Georgalas, C; Huins, C; Tolley, N S

    2007-08-01

    Embryological abnormalities of the branchial apparatus present an interesting diagnostic and surgical challenge. Thymic cysts are a rare form of branchial apparatus anomaly, resulting from abnormal development of the third pharyngeal pouch. We present two cases of a thymic cyst coexisting with a non recurrent inferior laryngeal nerve (NRILN), two anomalies that to our knowledge have not been associated previously. A possible embryological explication for this double abnormality is discussed, while the clinical implications of this association are presented.

  19. Clinical Implications of TiGRT Algorithm for External Audit in Radiation Oncology

    OpenAIRE

    Daryoush Shahbazi-Gahrouei; Mohsen Saeb; Shahram Monadi; Iraj Jabbari

    2017-01-01

    Background: Performing audits play an important role in quality assurance program in radiation oncology. Among different algorithms, TiGRT is one of the common application software for dose calculation. This study aimed to clinical implications of TiGRT algorithm to measure dose and compared to calculated dose delivered to the patients for a variety of cases, with and without the presence of inhomogeneities and beam modifiers. Materials and Methods: Nonhomogeneous phantom as quality dose veri...

  20. Paradigm Shift or Annoying Distraction: Emerging Implications of Web 2.0 for Clinical Practice

    OpenAIRE

    Spallek, H.; O’Donnell, J.; Clayton, M.; Anderson, P.; Krueger, A.

    2010-01-01

    Web 2.0 technologies, known as social media, social technologies or Web 2.0, have emerged into the mainstream. As they grow, these new technologies have the opportunity to influence the methods and procedures of many fields. This paper focuses on the clinical implications of the growing Web 2.0 technologies. Five developing trends are explored: information channels, augmented reality, location-based mobile social computing, virtual worlds and serious gaming, and collaborative research network...

  1. Regional to global changes in drought and implications for future changes under global warming

    Science.gov (United States)

    Sheffield, J.; Wood, E. F.; Kam, J.

    2012-12-01

    Drought can have large impacts on multiple sectors, including agriculture, water resources, ecosystems, transport, industry and tourism. In extreme cases, regional drought can lead to food insecurity and famine, and in intensive agricultural regions, extend to global economic impacts in a connected world. Recent droughts globally have been severe and costly but whether they are becoming more frequent and severe, and the attribution of this, is a key question. Observational evidence at large scales, such as satellite remote sensing are often subject to short-term records and inhomogeneities, and ground based data are sparse in many regions. Reliance on model output is also subject to error and simplifications in the model physics that can, for example, amplify the impact of global warming on drought. This presentation will show the observational and model evidence for changes in drought, with a focus on the interplay between precipitation and atmospheric evaporative demand and its impact on the terrestrial water cycle and drought. We discuss the fidelity of climate models to reproduce our best estimates of drought variability and its drivers historically, and the implications of this on uncertainties in future projections of drought from CMIP5 models, and how this has changed since CMIP3.

  2. Regional cerebral blood flow in psychiatry: Application to clinical research

    International Nuclear Information System (INIS)

    Berman, K.F.; Weinberger, D.R.; Morihisa, J.M.; Zec, R.F.

    1984-01-01

    In the following sections, the authors describe aspects of the xenon-133 inhalation technique as it has been modified in their lab, as well as a number of considerations and prerequisites for setting up such a facility. The authors also discuss the processes by which they technically and clinically validated the methods used. Several case studies follow along with descriptions of the approaches they are taking in investigating psychiatric illnesses with rCBF. Since the concept of a relation between brain functional activity, metabolism, and blood flow has a long history, both in theory and in practice, they first briefly review some of this history and some of the principles involved

  3. Regional medicine use in the Rhine basin and its implication on water quality

    Science.gov (United States)

    Hut, R. W.; Houtman, C. J.; van de Giesen, N. C.; de Jong, S. A. P.

    2012-04-01

    Do Germans use more painkillers than the French? Pharmaceuticals used in our Western society form an important group of contaminants found in the river Rhine. As this river is the drinking water source for millions of Europeans, methods to investigate relations between drug use and their penetration in the watercycle are of great importance. An analysis is presented relating medicine residue in the river Rhine to the number of people living in its watershed. An extensive measuring campaign was carried out, sampling river Rhine at 42 locations from its source to the start of its delta (Dutch-German border). The samples were analyzed for 40 common pharmaceuticals. Using discharge data, digital elevation models and demographic data from Eurostat, the relation between total load of drug residue and population was analyzed. Results show regional differences in drug use as well as implications for (down)stream water quality concerning contamination with pharmaceuticals.

  4. The bright lights of city regions - Assumptions, realities and implications of changing population dynamics: Zooming in on the Gauteng city region

    CSIR Research Space (South Africa)

    Pieterse, A

    2014-09-01

    Full Text Available It is well known that the city regions attract migrants from across the country because of their roles as economic engines and job baskets in South Africa. To address urbanisation implications it is imperative to better understand some...

  5. The bright lights of city regions: Assumptions, realities and implications of changing population dynamics: Zooming in on the Gauteng city region

    CSIR Research Space (South Africa)

    Pieterse, A

    2014-10-01

    Full Text Available It is well known that the city regions attract migrants from across the country because of their roles as economic engines and job baskets in South Africa. To address urbanisation implications it is imperative to better understand some...

  6. UNMASKING MASKED HYPERTENSION: PREVALENCE, CLINICAL IMPLICATIONS, DIAGNOSIS, CORRELATES, AND FUTURE DIRECTIONS

    Science.gov (United States)

    Peacock, James; Diaz, Keith M.; Viera, Anthony J.; Schwartz, Joseph E.; Shimbo, Daichi

    2014-01-01

    ‘Masked hypertension’ is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15–30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared to sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustained hypertension (elevated clinic and ambulatory BP). The confluence of increased cardiovascular risk and a failure to be diagnosed by the conventional approach of clinic BP measurement makes masked hypertension a significant public health concern. However, many important questions remain. First, the definition of masked hypertension varies across studies. Further, the best approach in the clinical setting to exclude masked hypertension also remains unknown. It is unclear whether home BP monitoring is an adequate substitute for ambulatory BP monitoring in identifying masked hypertension. Few studies have examined the mechanistic pathways that may explain masked hypertension. Finally, scarce data are available on the best approach to treating individuals with masked hypertension. Herein, we review the current literature on masked hypertension including definition, prevalence, clinical implications, special patient populations, correlates, issues related to diagnosis, treatment, and areas for future research. PMID:24573133

  7. Dystrophin quantification and clinical correlations in Becker muscular dystrophy: implications for clinical trials.

    Science.gov (United States)

    Anthony, Karen; Cirak, Sebahattin; Torelli, Silvia; Tasca, Giorgio; Feng, Lucy; Arechavala-Gomeza, Virginia; Armaroli, Annarita; Guglieri, Michela; Straathof, Chiara S; Verschuuren, Jan J; Aartsma-Rus, Annemieke; Helderman-van den Enden, Paula; Bushby, Katherine; Straub, Volker; Sewry, Caroline; Ferlini, Alessandra; Ricci, Enzo; Morgan, Jennifer E; Muntoni, Francesco

    2011-12-01

    Duchenne muscular dystrophy is caused by mutations in the DMD gene that disrupt the open reading frame and prevent the full translation of its protein product, dystrophin. Restoration of the open reading frame and dystrophin production can be achieved by exon skipping using antisense oligonucleotides targeted to splicing elements. This approach aims to transform the Duchenne muscular dystrophy phenotype to that of the milder disorder, Becker muscular dystrophy, typically caused by in-frame dystrophin deletions that allow the production of an internally deleted but partially functional dystrophin. There is ongoing debate regarding the functional properties of the different internally deleted dystrophins produced by exon skipping for different mutations; more insight would be valuable to improve and better predict the outcome of exon skipping clinical trials. To this end, we have characterized the clinical phenotype of 17 patients with Becker muscular dystrophy harbouring in-frame deletions relevant to on-going or planned exon skipping clinical trials for Duchenne muscular dystrophy and correlated it to the levels of dystrophin, and dystrophin-associated protein expression. The cohort of 17 patients, selected exclusively on the basis of their genotype, included 4 asymptomatic, 12 mild and 1 severe patient. All patients had dystrophin levels of >40% of control and significantly higher dystrophin (P = 0.013), β-dystroglycan (P = 0.025) and neuronal nitric oxide synthase (P = 0.034) expression was observed in asymptomatic individuals versus symptomatic patients with Becker muscular dystrophy. Furthermore, grouping the patients by deletion, patients with Becker muscular dystrophy with deletions with an end-point of exon 51 (the skipping of which could rescue the largest group of Duchenne muscular dystrophy deletions) showed significantly higher dystrophin levels (P = 0.034) than those with deletions ending with exon 53. This is the first quantitative study on both

  8. From clinical practice guidelines, to clinical guidance in practice - implications for design of computerized guidance

    DEFF Research Database (Denmark)

    Lyng, Karen Marie

    2010-01-01

    an extensive application of what we have named second order guiding artifacts. The deployed protocols underwent a local adaptation and transformation process when initiated. The protocols were adapted to match the local resources and transformed into several activity specific second order guiding artifacts....... The transformation from protocols was executed according to a standard operating procedure. Each activity type had a standardized template ensuring uniformity across second order guiding artifacts within a clinic. The guiding artifacts were multi-functional and a wide variety of standardized graphical attributes...

  9. Implications of the New Regional Trade Agreements for the World Trading System

    Directory of Open Access Journals (Sweden)

    Agnes Ghibuțiu

    2017-04-01

    Full Text Available The year 2013 witnessed an outstanding rise in the pace and scale of negotiations on regional trade agreements (RTAs. While RTAs are not a new phenomenon, current negotiations involve multiple parties and/or major trading countries that have a significant combined economic weight, i.e. mega-RTAs. This paper looks at the recent surge in trade regionalism and addresses some of the key issues related to the potential impact of mega-RTAs upon the world trading system and global trade patterns. It examines the peculiarities of the new mega-RTAs and the factors underlying their proliferation, and discusses the main concerns raised by their foreseeable impact on excluded countries and the wider trading system. The paper finds that, if successfully concluded, mega-RTAs are likely to have far-reaching implications for the world trading regime, affecting its transparency and coherence. Nevertheless, the adverse effects could be cushioned through a revival of trading nations’ interest in the multilateral Doha Round talks.

  10. Portfolio assessment and evaluation: implications and guidelines for clinical nursing education.

    Science.gov (United States)

    Chabeli, M M

    2002-08-01

    With the advent of Outcomes-Based Education in South Africa, the quality of nursing education is debatable, especially with regard to the assessment and evaluation of clinical nursing education, which is complex and renders the validity and reliability of the methods used questionable. This paper seeks to explore and describe the use of portfolio assessment and evaluation, its implications and guidelines for its effective use in nursing education. Firstly, the concepts of assessment, evaluation, portfolio and alternative methods of evaluation are defined. Secondly, a comparison of the characteristics of the old (traditional) methods and the new alternative methods of evaluation is made. Thirdly, through deductive analysis, synthesis and inference, implications and guidelines for the effective use of portfolio assessment and evaluation are described. In view of the qualitative, descriptive and exploratory nature of the study, a focus group interview with twenty students following a post-basic degree at a university in Gauteng regarding their perceptions on the use of portfolio assessment and evaluation method in clinical nursing education was used. A descriptive method of qualitative data analysis of open coding in accordance with Tesch's protocol (in Creswell 1994:155) was used. Resultant implications and guidelines were conceptualised and described within the existing theoretical framework. Principles of trustworthiness were maintained as described by (Lincoln & Guba 1985:290-327). Ethical considerations were in accordance with DENOSA's standards of research (1998:7).

  11. Pathophysiology and clinical implications of peroperative fluid management in elective surgery

    DEFF Research Database (Denmark)

    Holte, Kathrine

    2010-01-01

    The purpose of this thesis was to describe pathophysiological aspects of perioperative fluid administration and create a rational background for future, clinical outcome studies. In laparoscopic cholecystectomy, we have found "liberal" crystalloid administration ( approximately 3 liters) to improve....... Based on the current evidence, administration of liters intravenous fluid without specific indication in major surgical procedures should be avoided, while administration of liters in patients with anastomoses may not be recommended, an issue needing clarification in large-scale clinical studies...... perioperative physiology and clinical outcome, which has implication for fluid management in other laparoscopic procedures such as laparoscopic fundoplication, laparoscopic repair of ventral hernia, hysterectomy etc., where 2-3 liters crystalloid should be administered based on the present evidence. That equal...

  12. Pharmacokinetic drug-drug interaction and their implication in clinical management.

    Science.gov (United States)

    Palleria, Caterina; Di Paolo, Antonello; Giofrè, Chiara; Caglioti, Chiara; Leuzzi, Giacomo; Siniscalchi, Antonio; De Sarro, Giovambattista; Gallelli, Luca

    2013-07-01

    Drug-drug interactions (DDIs) are one of the commonest causes of medication error in developed countries, particularly in the elderly due to poly-therapy, with a prevalence of 20-40%. In particular, poly-therapy increases the complexity of therapeutic management and thereby the risk of clinically important DDIs, which can both induce the development of adverse drug reactions or reduce the clinical efficacy. DDIs can be classify into two main groups: pharmacokinetic and pharmacodynamic. In this review, using Medline, PubMed, Embase, Cochrane library and Reference lists we searched articles published until June 30 2012, and we described the mechanism of pharmacokinetic DDIs focusing the interest on their clinical implications.

  13. Pharmacokinetic drug-drug interaction and their implication in clinical management

    Directory of Open Access Journals (Sweden)

    Palleria Caterina

    2013-01-01

    Full Text Available Drug-drug interactions (DDIs are one of the commonest causes of medication error in developed countries, particularly in the elderly due to poly-therapy, with a prevalence of 20-40%. In particular, poly-therapy increases the complexity of therapeutic management and thereby the risk of clinically important DDIs, which can both induce the development of adverse drug reactions or reduce the clinical efficacy. DDIs can be classify into two main groups: pharmacokinetic and pharmacodynamic. In this review, using Medline, PubMed, Embase, Cochrane library and Reference lists we searched articles published until June 30 2012, and we described the mechanism of pharmacokinetic DDIs focusing the interest on their clinical implications.

  14. Greenhouse gas emissions from cities and regions: International implications revealed by Hong Kong

    International Nuclear Information System (INIS)

    Harris, Paul G.; Chow, Alice S.Y.; Symons, Jonathan

    2012-01-01

    The diversity of greenhouse gas (GHG) accounting methodologies currently utilized by cities around the world make meaningful comparisons of their emissions almost impossible. Consequently, the 2010 United Nations International Standard for Determining Greenhouse Gas Emissions for Cities promotes a “harmonized protocol for quantifying the GHG emissions attributable to cities and local regions.” The UN's common standard has important implications for comparison, benchmarking and policy assessment related to energy policies. This paper uses Hong Kong as a case study to illustrate these implications. Hong Kong's per capita contribution to GHG emissions are among the highest in the world, yet the local government's official statistics indicate emissions that are far below those reported by most affluent economies. This discrepancy arises from a reporting methodology that does not require inclusion of GHG emissions linked to consumption of imported goods or emissions from aviation and shipping. The Hong Kong case reveals that current inventories do not provide sufficient information to guide policymaking related to energy and climate change. They also do not provide adequate information for comparing policies of cities internationally. Alternative emissions-reporting standards that focus more on pollution from consumption will create avenues for more effective climate-related policies. - Highlights: ► Flawed GHG inventory methodologies can lead cities to adopt misguided policies. ► Diverse GHG inventory methodologies make meaningful comparisons among cities difficult. ► A Hong Kong case study highlights that GHG inventories can misrepresent cities' climate impacts. ► City inventories often exclude GHG emissions linked to imports, aviation and shipping. ► The International Standard for Determining GHG Emissions for Cities can assist climate policy.

  15. Terror management theory applied clinically: implications for existential-integrative psychotherapy.

    Science.gov (United States)

    Lewis, Adam M

    2014-01-01

    Existential psychotherapy and Terror Management Theory (TMT) offer explanations for the potential psychological effects of death awareness, although their respective literatures bases differ in clarity, research, and implications for treating psychopathology. Existential therapy is often opaque to many therapists, in part due to the lack of consensus on what constitutes its practice, limited published practical examples, and few empirical studies examining its efficacy. By contrast, TMT has an extensive empirical literature base, both within social psychology and spanning multiple disciplines, although previously unexplored within clinical and counseling psychology. This article explores the implications of a proposed TMT integrated existential therapy (TIE), bridging the gap between disciplines in order to meet the needs of the aging population and current challenges facing existential therapists.

  16. Molecular and clinical pharmacology of intranasal corticosteroids: clinical and therapeutic implications.

    Science.gov (United States)

    Derendorf, H; Meltzer, E O

    2008-10-01

    Intranasal corticosteroids (INSs) are effective treatments for allergic rhinitis, rhinosinusitis, and nasal polyposis. In recent years, increased understanding of corticosteroid and glucocorticoid receptor pharmacology has enabled the development of molecules designed specifically to achieve potent, localized activity with minimal risk of systemic exposure. Pharmacologic potency studies using affinity and other assessments have produced similar rank orders of potency, with the most potent being mometasone furoate, fluticasone propionate, and its modification, fluticasone furoate. The furoate and propionate ester side chains render these agents highly lipophilic, which may facilitate their absorption through nasal mucosa and uptake across phospholipid cell membranes. These compounds demonstrate negligible systemic absorption. Systemic absorption rates are higher among the older corticosteroids (flunisolide, beclomethasone dipropionate, triamcinolone acetonide, and budesonide), which have bioavailabilities in the range of 34-49%. Studies, including 1-year studies with mometasone furoate, fluticasone propionate, and budesonide that evaluated potential systemic effects of INSs in children have generally found no adverse effects on hypothalamic-pituitary-adrenal axis function or growth. Clinical data suggest no significant differences in efficacy between the INSs. Theoretically, newer agents with lower systemic availability may be preferable, and may come closer to the pharmacokinetic/pharmacologic criteria for the ideal therapeutic choice.

  17. Implications of Nursing Clinical Practice to The Student’s Spiritual Health

    Directory of Open Access Journals (Sweden)

    Bhandesa Asthadi Mahendra

    2018-01-01

    Full Text Available This study aimed to clarify the implications of Nursing Clinical Practice (PLKK to the spiritual health of STIKES Bali students. This study employed purposive sampling method to determine the number of respondents. To conduct this study, the fourth grade of nursing students were recruited as the sample with total number 136 respondents. A questionnaire about spirituality from World Health Organization (WHO was used in this study as the instrument. In addition, the data were analysed by using quantitative descriptive technique. The result showed that 50.0% of students had a very good spiritual health, 42.6% had good spiritual health, 6.6% had moderate spiritual health, and 0.7 % had poor spiritual health. It can be interpreted that spiritual health of nursing students of STIKES Bali is good after conducting Nursing Clinical Practice. Thus, this study can be concluded that Nursing Clinical Practice has implication to the ability of students to love themselves and others meaningfully as the evidence of students’ spiritual health.

  18. Ethical implications for clinical practice and future research in "at risk" individuals.

    Science.gov (United States)

    Singh, Fiza; Mirzakhanian, Heline; Fusar-Poli, Paolo; de la Fuente-Sandoval, Camilo; Cadenhead, Kristin S

    2012-01-01

    The last 15 years have witnessed a shift in schizophrenia research with increasing interest in earlier stages of illness with the hope of early intervention and ultimately prevention of psychotic illness. Large-scale longitudinal studies have identified clinical and biological risk factors associated with increased risk of psychotic conversion, which together with symptomatic and demographic risk factors may improve the power of prediction algorithms for psychotic transition. Despite these advances, 45-70% of at risk subjects in most samples do not convert to frank psychosis, but continue to function well below their age matched counterparts. The issue is of utmost importance in light of the upcoming DSM-V and the possible inclusion of the attenuated psychotic symptoms syndrome (APSS) diagnosis, with clinical and ethical implications. Clinical considerations include feasibility of reliably diagnosing the at risk state in non-academic medical centers, variable psychotic conversion rates, a non-uniform definition of conversion and extensive debate about treatment for individuals with an ill-defined outcome. On the ethical side, diagnosing APSS could lead to unnecessary prescribing of antipsychotics with long-term deleterious consequences, slow research by providing a false sense of comfort in the diagnosis, and have psychosocial implications for those who receive a diagnosis. Thus it may be prudent to engage at risk populations early and to use broad-spectrum treatments with low risk benefit ratios to relieve functional impairments, while simultaneously studying all subsets of the at risk population.

  19. Epicardial fat and atrial fibrillation: current evidence, potential mechanisms, clinical implications, and future directions.

    Science.gov (United States)

    Wong, Christopher X; Ganesan, Anand N; Selvanayagam, Joseph B

    2017-05-01

    Obesity is increasingly recognized as a major modifiable determinant of atrial fibrillation (AF). Although body mass index and other clinical measures are useful indications of general adiposity, much recent interest has focused on epicardial fat, a distinct adipose tissue depot that can be readily assessed using non-invasive imaging techniques. A growing body of data from epidemiological and clinical studies has demonstrated that epicardial fat is consistently associated with the presence, severity, and recurrence of AF across a range of clinical settings. Evidence from basic science and translational studies has also suggested that arrhythmogenic mechanisms may involve adipocyte infiltration, pro-fibrotic, and pro-inflammatory paracrine effects, oxidative stress, and other pathways. Despite these advances, however, significant uncertainty exists and many questions remain unanswered. In this article, we review our present understanding of epicardial fat, including its classification and quantification, existing evidence implicating its role in AF, potential mechanisms, implications for clinicians, and future directions for research. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  20. Recent Clinical Drug Trials Evidence in Marfan Syndrome and Clinical Implications.

    Science.gov (United States)

    Singh, Michael N; Lacro, Ronald V

    2016-01-01

    Marfan syndrome is a genetic disorder of connective tissue with principal manifestations in the cardiovascular, ocular, and skeletal systems. Cardiovascular disease, mainly progressive aortic root dilation and aortic dissection, is the leading cause of morbidity and mortality. The primary aims of this report were to examine the evidence related to medical therapy for Marfan syndrome, including recently completed randomized clinical trials on the efficacy of β-blockers and angiotensin II receptor blockers for the prophylactic treatment of aortic enlargement in Marfan syndrome, and to provide recommendations for medical therapy on the basis of available evidence. Medical therapy for Marfan syndrome should be individualized according to patient tolerance and risk factors such as age, aortic size, and family history of aortic dissection. The Pediatric Heart Network trial showed that atenolol and losartan each reduced the rate of aortic dilation. All patients with known or suspected Marfan syndrome and aortic root dilation should receive medical therapy with adequate doses of either β-blocker or angiotensin receptor blocker. The Pediatric Heart Network trial also showed that atenolol and losartan are more effective at reduction of aortic root z score in younger subjects, which suggests that medical therapy should be prescribed even in the youngest children with aortic dilation. For patients with Marfan syndrome without aortic dilation, the available evidence is less clear. If aortic dilation is severe and/or progressive, therapy with a combination of β-blocker and angiotensin receptor blocker should be considered, although trial results are mixed with respect to the efficacy of combination therapy vs monotherapy. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Clinical errors and therapist discomfort with client disclosure of troublesome pornography use: Implications for clinical practice and error reduction.

    Science.gov (United States)

    Walters, Nathan T; Spengler, Paul M

    2016-09-01

    Mental health professionals are increasingly aware of the need for competence in the treatment of clients with pornography-related concerns. However, while researchers have recently sought to explore efficacious treatments for pornography-related concerns, few explorations of potential clinical judgment issues have occurred. Due to the sensitive, and at times uncomfortable, nature of client disclosures of sexual concerns within therapy, therapists are required to manage their own discomfort while retaining fidelity to treatment. The present paper explores clinician examples of judgment errors that may result from feelings of discomfort, and specifically from client use of pornography. Issues of potential bias, bias management techniques, and therapeutic implications are discussed. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  2. Competition for petroleum exploration capital in the Asia-Pacific region - implications for New Zealand and Australia

    International Nuclear Information System (INIS)

    Miller, A.

    1995-01-01

    This paper examines the future energy production and demand profiles for the Asia Pacific region and the global allocation of exploration capital made by major international petroleum companies. The implications of these factors for future government petroleum exploration policies within the region are considered, in particular the Australian and New Zealand situations, together with likely effects of such measures on the ability of exploration and production companies to raise capital. (Author)

  3. Spondylolysis and spondylolisthesis: prevalence of different forms of instability and clinical implications.

    Science.gov (United States)

    Niggemann, Pascal; Kuchta, Johannes; Beyer, Hans-Konrad; Grosskurth, D; Schulze, Thorsten; Delank, Karl-Stefan

    2011-10-15

    Imaging study with an evaluation of incidences and clinical correlation. To evaluate the incidence of 3 different types of instabilities in patients with spondylolysis or isthmic spondylolisthesis. Clinical findings are correlated with imaging findings, and the imaging findings are analyzed with regard to their clinical implications. Spondylolysis and isthmic spondylolisthesis are common disorders. An unstable slip is the most well-known form of instability, but other forms also exist. However, the incidence of these instabilities and their clinical implications are yet unclear. A total of 140 patients with 141 levels of spondylolysis identified by MRI (magnetic resonance imaging) were included in this study. Using positional MRI, the instability of the slip, an increased angular movement, and movement in the spondylolytic cleft were assessed. On the basis of clinical findings, the patients were classified as presenting with either radicular or nonradicular symptoms. The incidence of the instabilities was recorded and correlated with the incidence of radicular symptoms. Fifteen patients had an unstable slip (anterior instability); 35, an increased angular movement (angular instability); and 34 patients, a movement in the spondylolytic cleft (posterior instability). All forms of instability could be found together. No instability at all was found in 76 patients. Radicular symptoms were found significantly more often in patients with one or more of the described instabilities compared with patients without instability. All 3 described forms of instability are common in spondylolysis or isthmic spondylolisthesis and associated with radicular pain. This finding stresses the value of positional MRI in the evaluation of patients with spondylolysis and isthmic spondylolisthesis, especially if radicular symptoms are present.

  4. Molecular Strain Typing of Clinical Isolates, Trichophyton rubrum using Non Transcribed Spacer (NTS) Region as a Molecular Marker.

    Science.gov (United States)

    Ramaraj, Vijayakumar; Vijayaraman, Rajyoganandh S; Elavarashi, Elangovan; Rangarajan, Sudha; Kindo, Anupma Jyoti

    2017-05-01

    Dermatophytes are a group of fungi which infect keratinized tissues and causes superficial mycoses in humans and animals. The group comprises of three major genera, Trichophyton , Microsporum and Epidermophyton . Among them Trichophyton rubrum is a predominant anthropophilic fungi which causes chronic infections. Although, the infection is superficial and treatable, reinfection/coinfection causes inflation in the treatment cost. Identifying the source and mode of transmission is essential to prevent its transmission. Accurate discrimination is required to understand the clinical (relapse or reinfection) and epidemiological implications of the genetic heterogeneity of this species. Polymorphism in the Non Transcribed Spacer (NTS) region of ribosomal DNA (rDNA) clusters renders an effective way to discriminate strains among T. rubrum . To carry out the strain typing of the clinical isolates, Trichophyton rubrum using NTS as a molecular marker. Seventy T.rubrum clinical isolates obtained from April-2011-March 2013, from Sri Ramachandra Medical Centre, Chennai, Tamil Nadu, India, were identified by conventional phenotypic methods and included in this prospective study. The isolates were then subjected to Polymerase Chain Reaction (PCR) targeting two subrepeat elements (SREs), TRS-1 and TRS-2 of the NTS region. Strain-specific polymorphism was observed in both subrepeat loci. Total, nine different strains were obtained on combining both TRS-1 and TRS-2, SREs. The outcome has given a strong representation for using NTS region amplification in discriminating the T. rubrum clinical isolates. The method can be adapted as a tool for conducting epidemiology and population based study in T. rubrum infections. This will help in future exploration of the epidemiology of T. rubrum .

  5. Assessing subject privacy and data confidentiality in an emerging region for clinical trials: United Arab Emirates.

    Science.gov (United States)

    Nair, Satish Chandrasekhar; Ibrahim, Halah

    2015-01-01

    Pharmaceutical sponsored clinical trials, formerly conducted predominantly in the United States and Europe, have expanded to emerging regions, including the Middle East. Our study explores factors influencing clinical trial privacy and confidentiality in the United Arab Emirates. Factors including concept familiarity, informed consent compliance, data access, and preservation, were analyzed to assess current practices in the Arab world. As the UAE is an emerging region for clinical trials, there is a growing need for regulations related to data confidentiality and subject privacy. Informational and decisional privacy should be viewed within the realms of Arab culture and religious background.

  6. Isolated persistent left superior vena cava: A case report and its clinical implications

    Directory of Open Access Journals (Sweden)

    Samarjit Bisoyi

    2017-01-01

    Full Text Available The venous anomaly of a persistent left superior vena cava (PLSVC affects 0.3%-0.5% of the general population. PLSVC with absent right superior vena cava, also termed as "isolated PLSVC," is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.

  7. The biology, function and clinical implications of exosomes in lung cancer.

    Science.gov (United States)

    Zhou, Li; Lv, Tangfeng; Zhang, Qun; Zhu, Qingqing; Zhan, Ping; Zhu, Suhua; Zhang, Jianya; Song, Yong

    2017-10-28

    Exosomes are 30-100 nm small membrane vesicles of endocytic origin that are secreted by all types of cells, and can also be found in various body fluids. Increasing evidence implicates that exosomes confer stability and can deliver their cargos such as proteins and nucleic acids to specific cell types, which subsequently serve as important messengers and carriers in lung carcinogenesis. Here, we describe the biogenesis and components of exosomes mainly in lung cancer, we summarize their function in lung carcinogenesis (epithelial mesenchymal transition, oncogenic cell transformation, angiogenesis, metastasis and immune response in tumor microenvironment), and importantly we focus on the clinical potential of exosomes as biomarkers and therapeutics in lung cancer. In addition, we also discuss current challenges that might impede the clinical use of exosomes. Further studies on the functional roles of exosomes in lung cancer requires thorough research. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Atrial Arrhythmias in Obstructive Sleep Apnea: Underlying Mechanisms and Implications in the Clinical Setting

    Directory of Open Access Journals (Sweden)

    David Filgueiras-Rama

    2013-01-01

    Full Text Available Obstructive sleep apnea (OSA is a common disorder characterized by repetitive interruption of ventilation during sleep caused by recurrent upper airway collapse, which leads to intermittent hypoxia. The disorder is commonly undiagnosed despite its relationship with substantial cardiovascular morbidity and mortality. Moreover, the effects of the disorder appear to be particularly dangerous in young subjects. In the last decade, substantial clinical evidence has identified OSA as independent risk factor for both bradyarrhythmias and tachyarrhythmias. To date the mechanisms leading to such arrhythmias have not been completely understood. However, recent data from animal models and new molecular analyses have increased our knowledge of the field, which might lead to future improvement in current therapeutic strategies mainly based on continuous positive airway pressure. This paper aims at providing readers a brief and specific revision of current knowledge about the mechanisms underlying atrial arrhythmias in OSA and their clinical and therapeutic implications.

  9. Paradigm shift or annoying distraction: emerging implications of web 2.0 for clinical practice.

    Science.gov (United States)

    Spallek, H; O'Donnell, J; Clayton, M; Anderson, P; Krueger, A

    2010-01-01

    Web 2.0 technologies, known as social media, social technologies or Web 2.0, have emerged into the mainstream. As they grow, these new technologies have the opportunity to influence the methods and procedures of many fields. This paper focuses on the clinical implications of the growing Web 2.0 technologies. Five developing trends are explored: information channels, augmented reality, location-based mobile social computing, virtual worlds and serious gaming, and collaborative research networks. Each trend is discussed based on their utilization and pattern of use by healthcare providers or healthcare organizations. In addition to explorative research for each trend, a vignette is presented which provides a future example of adoption. Lastly each trend lists several research challenge questions for applied clinical informatics.

  10. Regional and international implications of the Iranian nuclear crisis; Les implications regionales et internationales de la crise nucleaire iranienne

    Energy Technology Data Exchange (ETDEWEB)

    Reveillard, Ch

    2006-07-15

    Iran is distinguished in the Middle East and the world by its geopolitical situation, qualified Middle Empire of the crossed worlds, which are all among the most active zones of the planet on the geopolitical and strategic plans. It undergoes on the one hand, region-al influences and inevitably in return acts in-depth on economic, strategic, diplomatic and cultural reality of its regional space made up of the three wholes: Central Asia, The Middle East, Persian Gulf open on the Indian Ocean. In addition, the singularity of its national policy, that tries to make move back the Anglo-Saxon impregnation of re-modelling the Middle East and the containment of the regional powers. (author)

  11. Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study.

    Science.gov (United States)

    Kontopantelis, Evangelos; Stevens, Richard John; Helms, Peter J; Edwards, Duncan; Doran, Tim; Ashcroft, Darren M

    2018-02-28

    UK primary care databases (PCDs) are used by researchers worldwide to inform clinical practice. These databases have been primarily tied to single clinical computer systems, but little is known about the adoption of these systems by primary care practices or their geographical representativeness. We explore the spatial distribution of clinical computing systems and discuss the implications for the longevity and regional representativeness of these resources. Cross-sectional study. English primary care clinical computer systems. 7526 general practices in August 2016. Spatial mapping of family practices in England in 2016 by clinical computer system at two geographical levels, the lower Clinical Commissioning Group (CCG, 209 units) and the higher National Health Service regions (14 units). Data for practices included numbers of doctors, nurses and patients, and area deprivation. Of 7526 practices, Egton Medical Information Systems (EMIS) was used in 4199 (56%), SystmOne in 2552 (34%) and Vision in 636 (9%). Great regional variability was observed for all systems, with EMIS having a stronger presence in the West of England, London and the South; SystmOne in the East and some regions in the South; and Vision in London, the South, Greater Manchester and Birmingham. PCDs based on single clinical computer systems are geographically clustered in England. For example, Clinical Practice Research Datalink and The Health Improvement Network, the most popular primary care databases in terms of research outputs, are based on the Vision clinical computer system, used by <10% of practices and heavily concentrated in three major conurbations and the South. Researchers need to be aware of the analytical challenges posed by clustering, and barriers to accessing alternative PCDs need to be removed. © 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.

  12. Water Resources Implications of Cellulosic Biofuel Production at a Regional Scale

    Science.gov (United States)

    Christopher, S. F.; Schoenholtz, S. H.; Nettles, J. E.

    2011-12-01

    Recent increases in oil prices, a strong national interest in greater energy independence, and a concern for the role of fossil fuels in global climate change, have led to a dramatic expansion in use of alternative renewable energy sources in the U.S. The U.S. government has mandated production of 36 billion gallons of renewable fuels by 2022, of which 16 billion gallons are required to be cellulosic biofuels. Production of cellulosic biomass offers a promising alternative to corn-based systems because large-scale production of corn-based ethanol often requires irrigation and is associated with increased erosion, excess sediment export, and enhanced leaching of nitrogen and phosphorus. Although cultivation of switchgrass using standard agricultural practices is one option being considered for production of cellulosic biomass, intercropping cellulosic biofuel crops within managed forests could provide feedstock without primary land use change or the water quality impacts associated with annual crops. Catchlight Energy LLC is examining the feasibility and sustainability of intercropping switchgrass in loblolly pine plantations in the southeastern U.S. Ongoing research is determining efficient operational techniques and information needed to evaluate effects of these practices on water resources in small watershed-scale (~25 ha) studies. Three sets of four to five sub-watersheds are fully instrumented and currently collecting calibration data in North Carolina, Alabama, and Mississippi. These watershed studies will provide detailed information to understand processes and guide management decisions. However, environmental implications of cellulosic systems need to be examined at a regional scale. We used the Soil Water Assessment Tool (SWAT), a physically-based hydrologic model, to examine water quantity effects of various land use change scenarios ranging from switchgrass intercropping a small percentage of managed pine forest land to conversion of all managed

  13. Point-of-care testing for chlamydia and gonorrhoea: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Lisa Natoli

    Full Text Available Point-of-care (POC testing for chlamydia (CT and gonorrhoea (NG offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings.In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise.Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection.The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines.

  14. Point-of-Care Testing for Chlamydia and Gonorrhoea: Implications for Clinical Practice

    Science.gov (United States)

    Natoli, Lisa; Maher, Lisa; Shephard, Mark; Hengel, Belinda; Tangey, Annie; Badman, Steven G.; Ward, James; Guy, Rebecca J.

    2014-01-01

    Objectives Point-of-care (POC) testing for chlamydia (CT) and gonorrhoea (NG) offers a new approach to the diagnosis and management of these sexually transmitted infections (STIs) in remote Australian communities and other similar settings. Diagnosis of STIs in remote communities is typically symptom driven, and for those who are asymptomatic, treatment is generally delayed until specimens can be transported to the reference laboratory, results returned and the patient recalled. The objective of this study was to explore the clinical implications of using CT/NG POC tests in routine clinical care in remote settings. Methods In-depth qualitative interviews were conducted with a purposively selected group of 18 key informants with a range of sexual health and laboratory expertise. Results Participants highlighted the potential impact POC testing would have on different stages of the current STI management pathway in remote Aboriginal communities and how the pathway would change. They identified implications for offering a POC test, specimen collection, conducting the POC test, syndromic management of STIs, pelvic inflammatory disease diagnosis and management, interpretation and delivery of POC results, provision of treatment, contact tracing, management of client flow and wait time, and re-testing at 3 months after infection. Conclusions The introduction of POC testing to improve STI service delivery requires careful consideration of both its advantages and limitations. The findings of this study will inform protocols for the implementation of CT/NG POC testing, and also STI testing and management guidelines. PMID:24956111

  15. Implications of Derived Rule Following of Roulette Gambling for Clinical Practice.

    Science.gov (United States)

    Wilson, Alyssa N; Grant, Tara

    2015-05-01

    Problem gambling is a global concern, and behavior analytic attention has increasingly focused on reasons for why problem gambling occurs and conditions under which it is maintained. However, limited knowledge currently exists on the process to which self-generated rules maintain gambling behaviors. Therefore, the current study assessed six recreational gamblers on a roulette game before and after discrimination training to establish a self-rule to wager on red or black. Following discrimination training, all six participants altered their response allocation among red or black and consistently responded according to the newly derived self-rule. Results maintained during 1-week follow-up sessions across all participants. Implications for clinical application of self-awareness and self-generated rule following are discussed. Implications for practice • Demonstration of how stimuli such as color can alter gambling behavior • Procedures to assist clients with changing self-rules about gambling behavior • Using self-generated rule formulation for more contextually appropriate target behaviors • Highlights how self-generated rules can be altered to change clinical target behaviors.

  16. Economic efficiency and cost implications of habitat conservation: An example in the context of the Edwards Aquifer region

    Science.gov (United States)

    Gillig, Dhazn; McCarl, Bruce A.; Jones, Lonnie L.; Boadu, Frederick

    2004-04-01

    Groundwater management in the Edwards Aquifer in Texas is in the process of moving away from a traditional right of capture economic regime toward a more environmentally sensitive scheme designed to preserve endangered species habitats. This study explores economic and environmental implications of proposed groundwater management and water development strategies under a proposed regional Habitat Conservation Plan. Results show that enhancing the habitat by augmenting water flow costs $109-1427 per acre-foot and that regional water development would be accelerated by the more extreme possibilities under the Habitat Conservation Plan. The findings also indicate that a water market would improve regional welfare and lower water development but worsen environmental attributes.

  17. Neurobrucellosis: clinical, diagnostic, therapeutic features and outcome. Unusual clinical presentations in an endemic region

    Directory of Open Access Journals (Sweden)

    Nurgul Ceran

    Full Text Available Brucellosis is a zoonotic infection and has endemic characteristics. Neurobrucellosis is an uncommon complication of this infection. The aim of this study was to present unusual clinical manifestations and to discuss the management and outcome of a series of 18 neurobrucellosis cases. Initial clinical manifestations consist of pseudotumor cerebri in one case, white matter lesions and demyelinating syndrome in three cases, intracranial granuloma in one case, transverse myelitis in two cases, sagittal sinus thrombosis in one case, spinal arachnoiditis in one case, intracranial vasculitis in one case, in addition to meningitis in all cases. Eleven patients were male and seven were female. The most prevalent symptoms were headache (83% and fever (44%. All patients were treated with rifampicin, doxycycline plus trimethoprim-sulfamethoxazole or ceftriaxone. Duration of treatment (varied 3-12 months was determined on basis of the CSF response. In four patients presented with left mild sequelae including aphasia, hearing loss, hemiparesis. In conclusion, although mortality is rare in neurobrucellosis, its sequelae are significant. In neurobrucellosis various clinical and neuroradiologic signs and symptoms can be confused with other neurologic diseases. In inhabitants or visitors of endemic areas, neurobrucellosis should be kept in mind in cases that have unusual neurological manifestations.

  18. Intra-tumor heterogeneity in head and neck cancer and its clinical implications

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    Edmund A. Mroz

    2016-06-01

    Full Text Available The presence of heritable differences among cancer cells within a tumor, called intra-tumor genetic heterogeneity, has long been suspected of playing a role in poor responses to therapy. Research over the past decade has documented the existence of such heterogeneity within tumors of individual patients and documented its potential clinical significance. The research methods for identifying this heterogeneity were not, however, readily adaptable to widespread clinical application. After a brief review of this background, we describe the development of a measure of intra-tumor genetic heterogeneity, based on whole-exome sequencing of individual tumor samples, that could be applied to biopsy specimens in a clinical setting. This measure has now been used in head and neck squamous cell carcinoma (HNSCC to document, for the first time, a relation of high intra-tumor genetic heterogeneity to shorter overall survival in a large, multi-institutional study. The implications of heterogeneity for research and clinical care thus now need to be addressed. Keywords: Head and neck squamous cell carcinoma, Intra-tumor genetic heterogeneity, Next-generation sequencing, Targeted therapy

  19. The diagnostic and prognostic implications of silver-binding nucleolar organizer regions in periodontal lesions

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    Saluja Mini

    2008-01-01

    Full Text Available Background: The periodontal lesions with cellular proliferation can be assessed by various methods. One of the most recent methods to determine the proliferative activity is silver-staining nucleolar organizer region (AgNOR staining. The purpose of the present study was to evaluate, if AgNOR count can act as a proliferative marker and can aid in the diagnosis and prognosis of periodontal lesions. Materials and Methods: For this study, subjects with healthy gingival status, non-neoplastic lesions, neoplastic lesions, and plaque-induced gingivitis were included. Following the provisional diagnosis of clinical entity, biopsies were taken from the respective selected sites for histopathological diagnosis. In plaque-induced gingivitis cases, a second biopsy was taken from the selected sites 3 weeks following scaling. After histological confirmation, one more section was prepared, which was subjected to AgNOR staining, and AgNOR numbers were counted by individual and cluster counts and statistically analyzed. Results: Results showed the highest AgNOR count in neoplastic lesions. Non-neoplastic lesions showed a higher AgNOR count as compared to clinically healthy gingiva. Plaque-induced gingivitis showed a considerable reduction in AgNOR count after treatment. Conclusion: Results of this study confirmed that AgNOR count reflects the cellular proliferation and has a limited diagnostic value. However, the prognostic value of AgNOR for periodontal lesions is dependable.

  20. Clinical Implications of Associations between Headache and Gastrointestinal Disorders: A Study Using the Hallym Smart Clinical Data Warehouse.

    Science.gov (United States)

    Lee, Sang-Hwa; Lee, Jae-June; Kwon, Youngsuk; Kim, Jong-Ho; Sohn, Jong-Hee

    2017-01-01

    higher in patients with TTH compared with controls ( p  < 0.001). However, no differences were observed in the prevalence of HP infection between the groups. The observed association in this study may suggest that primary headache sufferers who experience migraines or TTH are more prone to GI disorders, which may have various clinical implications. Further research concerning the etiology of the association between headaches and GI disorders is warranted.

  1. The relationship between senior management team culture and clinical governance: Empirical investigation and managerial implications.

    Science.gov (United States)

    Prenestini, Anna; Calciolari, Stefano; Lega, Federico; Grilli, Roberto

    2015-01-01

    Health care organizations are pressured to improve the cost-effectiveness of service delivery. Clinical governance is an important trigger to improve care quality and safety and rank high in the reform agenda of health systems. The senior management team culture plays a major role in establishing clinical governance practices, because it strongly influences the values, attitudes, and behaviors of the members of an organization. The aim of this study was to investigate the relationship between senior management team culture and clinical governance in the public health care organizations of three Italian regions. The assessment of senior management culture was conducted using the Competing Values Framework and a corresponding instrument adapted for the Italian context. Clinical governance was assessed using an ad hoc instrument focused on the senior management team's perception and attitude toward clinical governance. The survey achieved a 54% response rate. The results of four different models demonstrate that organizations characterized by different dominant cultures are associated with significant differences in attitudes toward clinical governance. In particular, on average, dominant cultures with a prevailing external focus are associated with a more positive attitude toward clinical governance. The selection and appointments of top managers should consider the style of leadership that is most apt to facilitate the growth of rational and developmental cultures. Furthermore, the training of top managers and leading doctors should reinforce leadership aptitude and approaches that are consistent with the desired organizational cultures.

  2. Output and substitution elasticities of energy and implications for renewable energy expansion in the ECOWAS region

    International Nuclear Information System (INIS)

    Wesseh, Presley K.; Lin, Boqiang

    2016-01-01

    This study estimates output and substitution elasticities of renewable energy and nonrenewable energy for the Economic Community of West African States (ECOWAS) and discusses implications for expanding the former. The results show that nonrenewable energy promises greater benefits for ECOWAS economic transition, with output elasticities averaging between 0.052–0.579 and −0.055 to 0.223 for nonrenewable energy and renewable energy respectively. Overall estimated technological progress is low (−0.5% to 2.6%); the bulk coming from input efficiency. Substitution elasticities (0.02–0.94) suggest potential for switching towards renewable energy. Notwithstanding, scale, economics and sitting problems inherent in renewable power generation challenge the opportunities for energy substitution. A sustainable policy solution, therefore, appears to be one favoring scaled and efficient electricity generation from fossil energy in the short-run with a gradual switch towards renewable power in the long-run. In general, the applied model provides insights that energy efficiency enhances sustainable growth by propelling technological advancement especially when technical change is scale-biased and factor-augmenting. The study also provides insights that impacts of exogenous shocks to inputs are temporary, and hence, do not jeopardize efforts aimed at scaling output through increased and efficient use of labor, capital and energy; especially nonrenewable energy. - Highlights: • Output and substitution elasticities of energy are estimated for the ECOWAS region. • Nonrenewable energy promises greater opportunities for economic growth. • Technical progress is low and driven mainly by the efficiency of inputs. • Energy efficiency drives technological innovation. • Potential of switching towards renewable energy is high but suffers feasibility gaps.

  3. Recommendations of the IOM clinical preventive services for women committee: implications for obstetricians and gynecologists.

    Science.gov (United States)

    Gee, Rebekah E; Brindis, Claire D; Diaz, Angela; Garcia, Francisco; Gregory, Kimberly; Peck, Magda G; Reece, E Albert

    2011-12-01

    In July 2011, in response to language in the Affordable Care Act (ACA) the Office of the Assistant Secretary for Planning and Evaluation of the US Department of Health and Human Services (HHS) tasked the Institute of Medicine (IOM) to develop a report on the clinical preventive services necessary for women. The committee proposed eight new clinical preventive service recommendations aimed at closing significant gaps in preventive healthcare. This article reviews the process, findings, and the implications for obstetrician gynecologists and other primary care clinicians. Obstetricians and gynecologists play a major role in delivering primary care to women and many of the services recommended by the Committee are part of the core set of obstetrics and gynecology services. The women's health amendment to the ACA (Federal Register, 2010) requires that new private health plans cover - with no cost-sharing requirements - preventive healthcare services for women. Congress requested that a review be conducted to ascertain whether there were any additional needed preventive services specific to women's health that should be included. The IOM Committee on Preventive Services for Women recommended eight clinical measures specific to women's health that should be considered for coverage without co-payment. The US Department of HHS reviewed and adopted these recommendations, and, as a result, new health plans will need to include these services as part of insurance policies with plan years beginning on or after 1 August 2012. The authors discuss the implications of the IOM recommendations on practicing clinicians and on their potential impact on women's health and well being.

  4. An assessment of the Pacific Regional Cancer Coalition: outcomes and implications of a regional coalition internal and external assessment.

    Science.gov (United States)

    Sy, Angela U; Heckert, Karen A; Buenconsejo-Lum, Lee; Hedson, Johnny; Tamang, Suresh; Palafox, Neal

    2011-11-01

    The Pacific Regional Cancer Coalition (PRCC) provides regional leadership in the U.S. Affiliated Pacific Islands (USAPI) to implement the Regional Comprehensive Control Plan: 2007-2012, and to evaluate its coalition and partnerships. The Pacific Center of Excellence in the Elimination of Disparities (CEED), aims to reduce cancer disparities and conducts evaluation activities relevant to cancer prevention and control in the USAPI. The PRCC Self (internal) and Partner (external) Assessments were conducted to assess coalition functioning, regional and national partnerships, sustainability, and the role of regionalism for integrating all chronic disease prevention and control in the Pacific. Self-administered questionnaires and key informant telephone interviews with PRCC members (N=20), and representatives from regional and national partner organizations were administered (N=26). Validated multi item measures using 5-point scales on coalition and partnership characteristics were used. Chronbach's alphas and averages for the measures were computed. Internal coalition measures: satisfaction (4.2, SD=0.48) communication (4.0, SD=0.56), respect (4.0, SD=0.60) were rated more highly than external partnership measures: resource sharing (3.5, SD=0.74), regionalism (3.9, SD=0.47), use of findings (3.9, SD=0.50). The PRCC specifically identified its level of "collaboration" with external partners including Pacific CEED. External partners identified its partnership with the PRCC in the "coalition" stage. PRCC members and external partners are satisfied with their partnerships. All groups should continue to focus on building collaboration with partners to reflect a truly regional approach to sustain the commitment, the coalitions and the programming to reduce cancer in the USAPI. PRCC and partners should also work together to integrate all chronic disease prevention and control efforts in the Pacific.

  5. The impact of a model-based clinical regional registry for attention-deficit hyperactivity disorder.

    Science.gov (United States)

    Zanetti, Michele; Cartabia, Massimo; Didoni, Anna; Fortinguerra, Filomena; Reale, Laura; Mondini, Matteo; Bonati, Maurizio

    2017-09-01

    This article describes the development and clinical impact of the Italian Regional ADHD Registry, aimed at collecting and monitoring diagnostic and therapeutic pathways of care for attention-deficit hyperactivity disorder children and adolescents, launched by the Italian Lombardy Region in June 2011. In particular, the model-based software used to run the registry and manage clinical care data acquisition and monitoring, is described. This software was developed using the PROSAFE programme, which is already used for data collection in many Italian intensive care units, as a stand-alone interface case report form. The use of the attention-deficit hyperactivity disorder regional registry led to an increase in the appropriateness of the clinical management of all patients included in the registry, proving to be an important instrument in ensuring an appropriate healthcare strategy for children and adolescents with attention-deficit/hyperactivity disorder.

  6. Practitioner Review: Multilingualism and neurodevelopmental disorders - an overview of recent research and discussion of clinical implications.

    Science.gov (United States)

    Uljarević, Mirko; Katsos, Napoleon; Hudry, Kristelle; Gibson, Jenny L

    2016-11-01

    Language and communication skills are essential aspects of child development, which are often disrupted in children with neurodevelopmental disorders. Cutting edge research in psycholinguistics suggests that multilingualism has potential to influence social, linguistic and cognitive development. Thus, multilingualism has implications for clinical assessment, diagnostic formulation, intervention and support offered to families. We present a systematic review and synthesis of the effects of multilingualism for children with neurodevelopmental disorders and discuss clinical implications. We conducted systematic searches for studies on multilingualism in neurodevelopmental disorders. Keywords for neurodevelopmental disorders were based on Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition categories as follows; Intellectual Disabilities, Communication Disorders, Autism Spectrum Disorder (ASD), Attention-Deficit/Hyperactivity Disorder, Specific Learning Disorder, Motor Disorders, Other Neurodevelopmental Disorders. We included only studies based on empirical research and published in peer-reviewed journals. Fifty studies met inclusion criteria. Thirty-eight studies explored multilingualism in Communication Disorders, 10 in ASD and two in Intellectual Disability. No studies on multilingualism in Specific Learning Disorder or Motor Disorders were identified. Studies which found a disadvantage for multilingual children with neurodevelopmental disorders were rare, and there appears little reason to assume that multilingualism has negative effects on various aspects of functioning across a range of conditions. In fact, when considering only those studies which have compared a multilingual group with developmental disorders to a monolingual group with similar disorders, the findings consistently show no adverse effects on language development or other aspects of functioning. In the case of ASD, a positive effect on communication and social functioning has

  7. Occurrence of Clinical and Sub-Clinical Mastitis in Dairy Herds in the West Littoral Region in Uruguay

    Directory of Open Access Journals (Sweden)

    Rivero R

    2002-12-01

    Full Text Available Twenty-nine dairy farms were selected to determine the incidence of clinical mastitis, prevalence of sub-clinical mastitis and bacterial aetiology in the West Littoral Region of Uruguay. In samples taken by the owner and frozen at -20°C during a week the incidence rate of clinical mastitis was determined as 1.2 cases per 100 cow-months at risk. Staphylococcus aureus was the most common isolated pathogen in 37.5% of 40 milk samples from clinical cases obtained in 1 month. No bacteria grew in the 32.5% of the total samples. A sub-sample including 1077 dairy cows from randomly selected farms was used to determine the prevalence of sub-clinical mastitis. These samples were taken on one visit to each farm. The prevalence was 52.4% on a cow basis and 26.7% on an udder quarter basis. In 55.1% of the quarters of the selected animals with more than 300 000 cells/ml there was no growth. The isolated pathogens from sub-clinical cases and their relative frequencies were: Staphylococcus aureus 62.8%, Streptococcus agalactiae 11.3%, Enterococcus sp. 8%, coagulase-negative staphylococci 7.4%, Streptococus uberis 6.4%, Streptococcus dysgalactiae 1.8%, Escherichia coli 1.5% and Staphylococcus hyicus coagulase-positive 0.6%.

  8. Clinical and public health implications of acute and early HIV detection and treatment: a scoping review.

    Science.gov (United States)

    Rutstein, Sarah E; Ananworanich, Jintanat; Fidler, Sarah; Johnson, Cheryl; Sanders, Eduard J; Sued, Omar; Saez-Cirion, Asier; Pilcher, Christopher D; Fraser, Christophe; Cohen, Myron S; Vitoria, Marco; Doherty, Meg; Tucker, Joseph D

    2017-06-28

    The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI. We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years. Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI - evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting. There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective

  9. Epidemiological, clinical and immunohistochemical aspects of canine lymphoma in the region of Porto Alegre, Brazil

    Directory of Open Access Journals (Sweden)

    Elisa B. Neuwald

    2014-04-01

    Full Text Available This paper describes the epidemiological, clinical and immunohistochemical characteristics of canine lymphomas diagnosed in the region of Porto Alegre, Brazil. Thirty dogs were enrolled in the study; most of them were male (60%, mixed-breed (23% and middle-aged or older. The majority (87% of affected dogs showed the multicentric form. The B-cell phenotype was most frequently detected (62%; 37% of the animals were in clinical stage IV, and 83% were classified as sub-stage "b". Lymphadenopathy was observed in 67% of the cases, and dyspnea, prostration, decreased appetite and vomiting were the most common clinical signs encountered. Anemia was a frequently encountered laboratory alteration (57%, as were leukocytosis (40%, thrombocytopenia (33%, lymphopenia (30%, hyperglobulinemia (20% and hypercalcemia (13%. The results of this study indicate that the clinical features of dogs with lymphoma in the region of Porto Alegre are similar to those observed worldwide.

  10. Embedding the shapes of regions of interest into a Clinical Document Architecture document.

    Science.gov (United States)

    Minh, Nguyen Hai; Yi, Byoung-Kee; Kim, Il Kon; Song, Joon Hyun; Binh, Pham Viet

    2015-03-01

    Sharing a medical image visually annotated by a region of interest with a remotely located specialist for consultation is a good practice. It may, however, require a special-purpose (and most likely expensive) system to send and view them, which is an unfeasible solution in developing countries such as Vietnam. In this study, we design and implement interoperable methods based on the HL7 Clinical Document Architecture and the eXtensible Markup Language Stylesheet Language for Transformation standards to seamlessly exchange and visually present the shapes of regions of interest using web browsers. We also propose a new integration architecture for a Clinical Document Architecture generator that enables embedding of regions of interest and simultaneous auto-generation of corresponding style sheets. Using the Clinical Document Architecture document and style sheet, a sender can transmit clinical documents and medical images together with coordinate values of regions of interest to recipients. Recipients can easily view the documents and display embedded regions of interest by rendering them in their web browser of choice. © The Author(s) 2014.

  11. Incidence of bovine clinical mastitis in Jammu region and antibiogram of isolated pathogens

    Directory of Open Access Journals (Sweden)

    Adil Majid Bhat

    2017-08-01

    Full Text Available Aim: This study was conducted to evaluate the incidence of clinical mastitis in bovines of Jammu region, to identify the infectious organisms responsible for it, and the antimicrobial sensitivity of isolated pathogens. Materials and Methods: The study was conducted on cases that were presented to the Medicine Division of Teaching Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, R.S. Pura, Jammu, Jammu and Kashmir. A total of 260 cases of bovines were presented from June 30, 2012, to July 01, 2013, out of which 30 cases were of clinical mastitis. The diagnosis of clinical mastitis was made on the basis of history and clinical examination of affected animals. Results: Animal and quarter-wise incidence of clinical mastitis were found to be 11.5% and 5.76%, respectively. Of the 23 isolates obtained, Staphylococcus aureus (60.87% was the most frequently isolated organism, followed by coagulase negative Staphylococci (13.04%, Streptococcus uberis (4.35%, Streptococcus dysgalactiae (8.69%, and Escherichia coli (13.04%. The antimicrobial sensitivity of isolates revealed maximum sensitivity to enrofloxacin, gentamicin, amoxicillin/ sulbactam, ceftriaxone/tazobactam, ceftizoxime, ampicillin/sulbactam and least sensitivity for oxytetracycline and penicillin. Conclusion: Staphylococcus spp. is the major causative agent of clinical mastitis in bovines of Jammu region. The causative agents of the clinical mastitis were most sensitive to enrofloxacin and gentamicin.

  12. Accessory atlantoaxial ligament avulsion fracture of the axis: Are there any clinical implications?

    Directory of Open Access Journals (Sweden)

    Hamid Reza Niknejad

    2016-01-01

    Full Text Available Injuries to the craniocervical support structures are frequently observed in neurotrauma cases. Stability of this region is of vital importance. Literature has mainly focused on three major ligaments of the craniocervical junction: The tectorial membrane, the transverse ligament, and the alar ligaments. However, the accessory atlantoaxial ligament (ALL also seems to be involved in craniocervical stability as shown in cadaveric specimens. Still, the biomechanical importance of this structure needs to be determined, especially in trauma settings. Here, we describe a case of isolated traumatic injury to this structure and discuss the clinical outcome. A 64 year old polytrauma patient with a remarkable avulsion fracture at the site of the insertion of the ALL was admitted to our center. We evaluated the patient both clinical and radiological at admission, after 3 months and after 1 year. We clinically assessed the upper cervical rotational stability using the cervical flexion rotation test. We observed no rotational instability or any other clinical repercussions at the long term after an isolated ALL injury. This case shows that isolated traumatic damage to the ALL is possible. Unilateral damage to the ALL probably does not cause rotational instability of the craniocervical junction. In case a similar avulsion fracture is observed, we recommend performing a magnetic resonance imaging of the craniovertebral region to assess for any ligamentous lesions.

  13. Whole Exome Sequencing in Pediatric Neurology Patients: Clinical Implications and Estimated Cost Analysis.

    Science.gov (United States)

    Nolan, Danielle; Carlson, Martha

    2016-06-01

    Genetic heterogeneity in neurologic disorders has been an obstacle to phenotype-based diagnostic testing. The authors hypothesized that information compiled via whole exome sequencing will improve clinical diagnosis and management of pediatric neurology patients. The authors performed a retrospective chart review of patients evaluated in the University of Michigan Pediatric Neurology clinic between 6/2011 and 6/2015. The authors recorded previous diagnostic testing, indications for whole exome sequencing, and whole exome sequencing results. Whole exome sequencing was recommended for 135 patients and obtained in 53 patients. Insurance barriers often precluded whole exome sequencing. The most common indication for whole exome sequencing was neurodevelopmental disorders. Whole exome sequencing improved the presumptive diagnostic rate in the patient cohort from 25% to 48%. Clinical implications included family planning, medication selection, and systemic investigation. Compared to current second tier testing, whole exome sequencing can result in lower long-term charges and more timely diagnosis. Overcoming barriers related to whole exome sequencing insurance authorization could allow for more efficient and fruitful diagnostic neurological evaluations. © The Author(s) 2016.

  14. Root anatomy and canal configuration of the permanent mandibular first molar: clinical implications and recommendations.

    Science.gov (United States)

    de Pablo, Oliver Valencia; Estevez, Roberto; Heilborn, Carlos; Cohenca, Nestor

    2012-01-01

    Root canal anatomy may present clinicians with a complex clinical challenge that requires diagnostic approaches, access modification, and clinical skills to successfully localize, negotiate, disinfect, and seal the root canal system. This article discusses the clinical implications of endodontic therapy on permanent mandibular first molars. The number of roots on the mandibular first molar is directly related to ethnicity. Canal morphology has a significant effect on treatment protocol: Mesial roots present two canals on a regular basis, adopting 2-2 and 2-1 as the most common configurations. A third canal is present in 2.6% of the population. The most common configuration in the distal root is type I (62.7%), followed by type II (14.5%) and type IV (12.4%). Diagnosis and treatment of complex root canal systems often require specialized training that may be beyond the scope of the average general practitioner. Access modifications are required to find extra roots and/or canals. The instrumentation of the third root requires a different access and small, flexible instruments, given the curvature that is usually present buccally in the apical third. The incidence of isthmuses is 55% in the mesial root and 20% in the distal root. This anatomical configuration should be taken into consideration during endodontic treatment as well as during periapical surgery.

  15. [Network clusters of symptoms as elementary syndromes of psychopathology: implications for clinical practice].

    Science.gov (United States)

    Goekoop, R; Goekoop, J G

    2016-01-01

    In a recent publication we reported the existence of around 11 (to 15) 'elementary syndromes' that may combine in various ways, rather like 'building blocks', to explain the wide range of psychiatric symptoms. 'Bridge symptoms' seem to be responsible both for combining large sets of symptoms into elementary syndromes and for combining the various elementary syndromes to form one globally connected network structure. To discuss the implication of these findings for clinical practice. We performed a network analysis of symptom scores. Elementary syndromes provide a massive simplification of the description of psychiatric disease. Instead of the more than 300 categories in DSM-5, we now need to consider only a handful of elementary syndromes and personality domains. This modular representation of psychiatric illnesses allows us to make a complete, systematic and efficient assessment of patients and a systematic review of treatment options. Clinicians, patients, managerial staff and insurance companies can verify whether symptom reduction is taking place in the most important domains of psychopathology. Unlike classic multidimensional methods of disease description, network models of psychopathology can be used to explain comorbidity patterns, predict the clinical course of psychopathology and to designate primary targets for therapeutic interventions. A network view on psychopathology could significantly improve everyday clinical practice.

  16. Obesity Paradox in Lung Cancer Prognosis: Evolving Biological Insights and Clinical Implications.

    Science.gov (United States)

    Zhang, Xueli; Liu, Yamin; Shao, Hua; Zheng, Xiao

    2017-10-01

    The survival rate of lung cancer remains low despite the progress of surgery and chemotherapy. With the increasing comorbidity of obesity in patients with lung cancer, new challenges are emerging in the management of this patient population. A key issue of interest is the prognostic effect of obesity on surgical and chemotherapeutic outcomes in patients with lung cancer, which is fueled by the growing observation of survival benefits in overweight or obese patients. This unexpected inverse relationship between obesity and lung cancer mortality, called the obesity paradox, remains poorly understood. The evolving insights into the heterogeneity of obesity phenotypes and associated biological connections with lung cancer progression in recent years may help explain some of the seemingly paradoxical relationship, and well-designed clinical studies looking at the causal role of obesity-associated molecules are expected. Here, we examine potential biological mechanisms behind the protective effects of obesity in lung cancer. We highlight the need to clarify the clinical implications of this relationship toward an updated intervention strategy in the clinical care of patients with lung cancer and obesity. Copyright © 2017 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

  17. Bridging the reductive and the synthetic: some reflections on the clinical implications of synchronicity.

    Science.gov (United States)

    Connolly, Angela

    2015-04-01

    When Jung introduced the concepts of synchronicity and the psychoid unconscious, he expanded analytical psychology into decidedly uncanny territory. Despite the early interest shown by Freud, anomalous phenomena such as telepathy have become a taboo subject in psychoanalysis. Today, however, there is an increasing interest in thought transference and synchronicity, thus opening the way for a fruitful exchange between different psychoanalytical schools on their clinical implications. I propose to examine some of the ambiguities of Jung's thinking, to clarify how we define synchronicity, the relationship between synchronicities and parapsychological events, and their clinical significance. At the present moment, we are still unsure if such events should be considered as normal and a way of facilitating individuation, or as an indication of psychopathology in the patient or in the analyst, just as we are uncertain about the particular characteristics of the intersubjective field that can lead to synchronicities. Making use of the typology of mind-matter correlations presented by Atmanspacher and Fach, and the distinction they draw between acategorial and non-categorial states of mind, I will use two clinical vignettes to illustrate the different states of mind in analyst and analysand that can lead to synchronicities. In particular I will focus on the relationship between analytical reverie and synchronicity. © 2015, The Society of Analytical Psychology.

  18. Clinical and functional implications of a history of childhood ADHD in first-episode psychosis.

    Science.gov (United States)

    Rho, Aldanie; Traicu, Alexandru; Lepage, Martin; Iyer, Srividya N; Malla, Ashok; Joober, Ridha

    2015-07-01

    There is mounting evidence indicating that a childhood history of attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for psychotic disorders, including schizophrenia. However, the implications of such a history on the symptomatic and functional outcomes of patients with psychotic disorders are still not well documented. This study examined the prevalence of childhood ADHD in patients with first episode psychosis (FEP) consecutively admitted to a specialized early intervention clinic covering a well-defined catchment area, and compared patients with and without a history of childhood ADHD on socio-demographic, clinical, and functional outcomes over a six to twelve months period. Out of 179 patients with FEP, 27 (15%) were treated for ADHD during childhood, consistent with previous literature indicating an association between childhood ADHD and psychosis. FEP patients with childhood history of ADHD had lower academic achievement, earlier onset of psychosis, and higher rates of childhood conduct and learning disorder. While the two groups had similar scores on psychopathology and functioning at baseline, patients with childhood ADHD showed significantly less improvement in positive and negative symptoms, as well as social and occupational functioning. These results strongly indicate that a history of childhood ADHD in FEP is more frequent than that reported in the general population and predictive of poorer clinical response to treatment. This emphasizes the need for actively screening for a history of ADHD in FEP patients and for treatments that are tailored for these patients. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. Incidence of bovine clinical mastitis in Jammu region and antibiogram of isolated pathogens

    OpenAIRE

    Adil Majid Bhat; Jasvinder Singh Soodan; Rajiv Singh; Ishfaq Ahmad Dhobi; Tufail Hussain; Mohammad Yousuf Dar; Muheet Mir

    2017-01-01

    Aim: This study was conducted to evaluate the incidence of clinical mastitis in bovines of Jammu region, to identify the infectious organisms responsible for it, and the antimicrobial sensitivity of isolated pathogens. Materials and Methods: The study was conducted on cases that were presented to the Medicine Division of Teaching Veterinary Clinical Complex, Faculty of Veterinary Sciences and Animal Husbandry, R.S. Pura, Jammu, Jammu and Kashmir. A total of 260 cases of bovines were prese...

  20. The implications of cross-regional differences for the design of In-vehicle Information Systems: a comparison of Australian and Chinese drivers.

    Science.gov (United States)

    Young, Kristie L; Rudin-Brown, Christina M; Lenné, Michael G; Williamson, Amy R

    2012-05-01

    The increasing global distribution of automobiles necessitates that the design of In-vehicle Information Systems (IVIS) is appropriate for the regions to which they are being exported. Differences between regions such as culture, environment and traffic context can influence the needs, usability and acceptance of IVIS. This paper describes two studies aimed at identifying regional differences in IVIS design needs and preferences across drivers from Australia and China to determine the impact of any differences on IVIS design. Using a questionnaire and interaction clinics, the influence of cultural values and driving patterns on drivers' preferences for, and comprehension of, surface- and interaction-level aspects of IVIS interfaces was explored. Similarities and differences were found between the two regional groups in terms of preferences for IVIS input control types and labels and in the comprehension of IVIS functions. Specifically, Chinese drivers preferred symbols and Chinese characters over English words and were less successful (compared to Australians) at comprehending English abbreviations, particularly for complex IVIS functions. Implications in terms of the current trend to introduce Western-styled interfaces into other regions with little or no adaptation are discussed. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

  1. GABBR1 has a HERV-W LTR in its regulatory region – a possible implication for schizophrenia

    Directory of Open Access Journals (Sweden)

    Hegyi Hedi

    2013-02-01

    Full Text Available Abstract Schizophrenia is a complex disease with uncertain aetiology. We suggest GABBR1, GABA receptor B1 implicated in schizophrenia based on a HERV-W LTR in the regulatory region of GABBR1. Our hypothesis is supported by: (i GABBR1 is in the 6p22 genomic region most often implicated in schizophrenia; (ii microarray studies found that only presynaptic pathway-related genes, including GABA receptors, have altered expression in schizophrenic patients and (iii it explains how HERV-W elements, expressed in schizophrenia, play a role in the disease: by altering the expression of GABBR1 via a long terminal repeat that is also a regulatory element to GABBR1. Reviewers This paper was reviewed by Sandor Pongor and Martijn Huynen.

  2. NICE guidelines, clinical practice and antisocial personality disorder: the ethical implications of ontological uncertainty.

    Science.gov (United States)

    Pickersgill, M D

    2009-11-01

    The British National Institute for Health and Clinical Excellence (NICE) has recently (28 January 2009) released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder (ASPD). Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals "at risk" of raising antisocial children. Although this paper does not argue that NICE is "wrong" in any of its recommendations, more emphasis should have been placed on discussions of the ethical implications of diagnosis and treatment, especially given the multiple uncertainties associated with ASPD. It is proposed that these important issues be examined in more detail in revisions of existing NICE recommendations, and be included in upcoming guidance. This paper thus raises key questions regarding the place and role of ethics within the current and future remit of NICE.

  3. The practice and clinical implications of tablet splitting in international health

    Science.gov (United States)

    Elliott, Ivo; Mayxay, Mayfong; Yeuichaixong, Sengchanh; Lee, Sue J; Newton, Paul N

    2014-01-01

    Objective Tablet splitting is frequently performed to facilitate correct dosing, but the practice and implications in low-income settings have rarely been discussed. Methods We selected eight drugs, with narrow therapeutic indices or critical dosages, frequently divided in the Lao PDR (Laos). These were split, by common techniques used in Laos, by four nurses and four laypersons. The mean percentage deviation from the theoretical expected weight and weight loss of divided tablets/capsules were recorded. Results Five of eight study drugs failed, on splitting, to meet European Pharmacopoeia recommendations for tablet weight deviation from the expected weight of tablet/capsule halves with 10% deviating by more than 25%. There was a significant difference in splitting accuracy between nurses and laypersons (P = 0.027). Coated and unscored tablets were less accurately split than uncoated (P = 0.03 and 0.0019 for each half) and scored (0.0001 for both halves) tablets. Conclusion These findings have potential clinical implications on treatment outcome and the development of antimicrobial resistance. Investment by drug companies in a wider range of dosage units, particularly for narrow therapeutic index and critical dosage medicines, is strongly recommended. PMID:24702766

  4. Clinical neurofeedback: case studies, proposed mechanism, and implications for pediatric neurology practice.

    Science.gov (United States)

    Legarda, Stella B; McMahon, Doreen; Othmer, Siegfried; Othmer, Sue

    2011-08-01

    Trends in alternative medicine use by American health care consumers are rising substantially. Extensive literature exists reporting on the effectiveness of neurofeedback in the treatment of autism, closed head injury, insomnia, migraine, depression, attention deficit hyperactivity disorder, epilepsy, and posttraumatic stress disorder. We speculated that neurofeedback might serve as a therapeutic modality for patients with medically refractory neurological disorders and have begun referring patients to train with clinical neurofeedback practitioners. The modality is not always covered by insurance. Confident their child's medical and neurological needs would continue to be met, the parents of 3 children with epilepsy spectrum disorder decided to have their child train in the modality. The children's individual progress following neurofeedback are each presented here. A proposed mechanism and practice implications are discussed.

  5. Roles of Ubiquitination and SUMOylation on Prostate Cancer: Mechanisms and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Zhenbang Chen

    2015-02-01

    Full Text Available The initiation and progression of human prostate cancer are highly associated with aberrant dysregulations of tumor suppressors and proto-oncogenes. Despite that deletions and mutations of tumor suppressors and aberrant elevations of oncogenes at the genetic level are reported to cause cancers, emerging evidence has revealed that cancer progression is largely regulated by posttranslational modifications (PTMs and epigenetic alterations. PTMs play critical roles in gene regulation, cellular functions, tissue development, diseases, malignant progression and drug resistance. Recent discoveries demonstrate that ubiquitination and SUMOylation are complicated but highly-regulated PTMs, and make essential contributions to diseases and cancers by regulation of key factors and signaling pathways. Ubiquitination and SUMOylation pathways can be differentially modulated under various stimuli or stresses in order to produce the sustained oncogenic potentials. In this review, we discuss some new insights about molecular mechanisms on ubiquitination and SUMOylation, their associations with diseases, oncogenic impact on prostate cancer (PCa and clinical implications for PCa treatment.

  6. Gestational Diabetes Mellitus: a review of the diagnosis, clinical implications and management

    Directory of Open Access Journals (Sweden)

    Vincent Wing-Ming Wong

    2013-04-01

    Full Text Available Gestational diabetes mellitus (GDM is a condition that affects the wellbeing of mother and fetus. Women with GDM are at risk of type 2 diabetes mellitus in the future, while fetal exposure to hyperglycaemia in-utero may affect their glycometabolic profile later in life. Appropriate screening and management of this problem is important in ensuring good pregnancy outcomes. In this review, the clinical implications, the various ways to screen and diagnose GDM, and management strategies during pregnancy will be discussed. For years, insulin is the mainstay of treatment if medical nutrition therapy fails to maintain adequate glycaemic control, but use of other oral pharmacotherapy may gain greater acceptance in the future. Following delivery, ongoing follow-up of these women is worthwhile as early intervention through lifestyle or pharmacotherapy may prevent the development of diabetes.

  7. Mammary Stem Cells and Breast Cancer Stem Cells: Molecular Connections and Clinical Implications.

    Science.gov (United States)

    Celià-Terrassa, Toni

    2018-05-04

    Cancer arises from subpopulations of transformed cells with high tumor initiation and repopulation ability, known as cancer stem cells (CSCs), which share many similarities with their normal counterparts. In the mammary gland, several studies have shown common molecular regulators between adult mammary stem cells (MaSCs) and breast cancer stem cells (bCSCs). Cell plasticity and self-renewal are essential abilities for MaSCs to maintain tissue homeostasis and regenerate the gland after pregnancy. Intriguingly, these properties are similarly executed in breast cancer stem cells to drive tumor initiation, tumor heterogeneity and recurrence after chemotherapy. In addition, both stem cell phenotypes are strongly influenced by external signals from the microenvironment, immune cells and supportive specific niches. This review focuses on the intrinsic and extrinsic connections of MaSC and bCSCs with clinical implications for breast cancer progression and their possible therapeutic applications.

  8. Troubling Times-The GFC and its Implications for Regional Performance. Part One: The United States And Europe

    OpenAIRE

    Robert J. Stimson

    2012-01-01

    The Global Financial Crisis (GFC) was a profound exogenous shock which has had profound impacts the performance of national economies and the regions within them. The differential outcomes are vast. In many parts of the world there is evidence of what is being referred to as the ‘two-speed’ economy - or even a ‘multi-speed’ - economy. This has implications for regional economic development theory in which, over the last two to three decades, there has been an increasing emphasis on endogenous...

  9. A proposed cell model for multiple-occurrence regional landslide events: Implications for landslide susceptibility mapping

    Science.gov (United States)

    Crozier, M. J.

    2017-10-01

    Multiple-occurrence regional landslide events (MORLEs) consist of hundreds to thousands of shallow landslides occurring more or less simultaneously within defined areas, ranging from tens to thousands of square kilometres. While MORLEs can be triggered by rainstorms and earthquakes, this paper is confined to those landslide events triggered by rainstorms. Globally, MORLEs occur in a range of geological settings in areas of moderate to steep slopes subject to intense rainstorms. Individual landslides in rainstorm-triggered events are dominantly small, shallow debris and earth flows, and debris and earth slides involving regolith or weathered bedrock. The model used to characterise these events assumes that energy distribution within the event area is represented on the land surface by a cell structure; with maximum energy expenditure within an identifiable core and rapid dissipation concentrically away from the centre. The version of the model presented here has been developed for rainfall-triggered landslide events. It proposes that rainfall intensity can be used to determine different critical landslide response zones within the cell (referred to as core, middle, and periphery zones). These zones are most readily distinguished by two conditions: the proportion of the slope that fails and the particular type of the slope stability factor that assumes dominance in determining specific sites of landslide occurrence. The latter condition means that the power of any slope stability factor to distinguish between stable and unstable sites varies throughout the affected area in accordance with the landslide response zones within the cell; certain factors critical for determining the location of landslide sites in one part of the event area have little influence in other parts of the event area. The implication is that landslide susceptibility maps (and subsequently derived mitigation measures) based on conventional slope stability factors may have only limited validity

  10. Ocular gene transfer in the spotlight: implications of newspaper content for clinical communications.

    Science.gov (United States)

    Benjaminy, Shelly; Bubela, Tania

    2014-07-16

    Ocular gene transfer clinical trials are raising hopes for blindness treatments and attracting media attention. News media provide an accessible health information source for patients and the public, but are often criticized for overemphasizing benefits and underplaying risks of novel biomedical interventions. Overly optimistic portrayals of unproven interventions may influence public and patient expectations; the latter may cause patients to downplay risks and over-emphasize benefits, with implications for informed consent for clinical trials. We analyze the news media communications landscape about ocular gene transfer and make recommendations for improving communications between clinicians and potential trial participants in light of media coverage. We analyzed leading newspaper articles about ocular gene transfer (1990-2012) from United States (n = 55), Canada (n = 26), and United Kingdom (n = 77) from Factiva and Canadian Newsstand databases using pre-defined coding categories. We evaluated the content of newspaper articles about ocular gene transfer for hereditary retinopathies, exploring representations of framing techniques, research design, risks/benefits, and translational timelines. The dominant frame in 61% of stories was a celebration of progress, followed by human-interest in 30% of stories. Missing from the positive frames were explanations of research design; articles conflated clinical research with treatment. Conflicts-of-interest and funding sources were similarly omitted. Attention was directed to the benefits of gene transfer, while risks were only reported in 43% of articles. A range of visual outcomes was described from slowing vision loss to cure, but the latter was the most frequently represented even though it is clinically infeasible. Despite the prominence of visual benefit portrayals, 87% of the articles failed to provide timelines for the commencement of clinical trials or for clinical implementation. Our analysis confirms

  11. Identification of genomic regions associated with resistance to clinical mastitis in US Holstein cattle

    Science.gov (United States)

    The objective of this research was to identify genomic regions associated with clinical mastitis (MAST) in US Holsteins using producer-reported data. Genome-wide association studies (GWAS) were performed on deregressed PTA using GEMMA v. 0.94. Genotypes included 60,671 SNP for all predictor bulls (n...

  12. Dystonia in complex regional pain syndrome : clinical, pathophysiological and therapeutic aspects

    NARCIS (Netherlands)

    Rijn, Monica Adriana van

    2010-01-01

    The clinical characteristics of Complex Regional Pain Syndrome (CRPS) are defined by pain and various combinations of sensory disturbances, autonomic features, and sudomotor and trophic changes. Furthermore, patients with CRPS may suffer from movement disorders, of which dystonia is the most

  13. Emissions reduction and economic implications of renewable energy market penetration of power generation for residential consumption in the MENA region

    International Nuclear Information System (INIS)

    El Fadel, M.; Rachid, G.; El-Samra, R.; Bou Boutros, G.; Hashisho, J.

    2013-01-01

    This paper examines the implications of renewable energy (RE) deployment in power generation for residential consumption in the Middle East and North Africa (MENA) region under various RE penetration targets. A comparative assessment revealed a great heterogeneity among countries with Turkey dominating as the highest emitter. At the sub-regional level, the Middle East sub-region contributes more than double the GHG emissions estimated for the Gulf and North Africa sub-regions with all sub-regions achieving reductions in the range of 6–38% depending on the RE target penetration and promising up to 54% savings on investment excluding positive externalities associated with the offset of greenhouse gas (GHG) emissions savings. - Highlights: ► Heterogeneity in GHG emissions in MENA region with Turkey contributing the most. ► Average regional GHG tCO 2 e/capita of 0.42 decreases to 0.17 with RE penetration. ► GHG emissions regional reduction reaches 8–36% depending on RE target penetration. ► Return on investment in RE promises up to 54% savings excluding positive externalities. ► Carbon credits offer economic incentives rendering RE investment more attractive.

  14. Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery: Anatomical, Physiologic, and Clinical Considerations.

    Science.gov (United States)

    El-Boghdadly, Kariem; Chin, Ki Jinn; Chan, Vincent W S

    2017-07-01

    Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

  15. Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications.

    Science.gov (United States)

    Rader, Florian; Sachdev, Esha; Arsanjani, Reza; Siegel, Robert J

    2015-04-01

    Valvular aortic stenosis is the second most prevalent adult valve disease in the United States and causes progressive pressure overload, invariably leading to life-threatening complications. Surgical aortic valve replacement and, more recently, transcatheter aortic valve replacement effectively relieve the hemodynamic burden and improve the symptoms and survival of affected individuals. However, according to current American College of Cardiology/American Heart Association guidelines on the management of valvular heart disease, the indications for aortic valve replacement, including transcatheter aortic valve replacement, are based primarily on the development of clinical symptoms, because their presence indicates a dismal prognosis. Left ventricular hypertrophy develops in a sizeable proportion of patients before the onset of symptoms, and a growing body of literature demonstrates that regression of left ventricular hypertrophy resulting from aortic stenosis is incomplete after aortic valve replacement and associated with adverse early postoperative outcomes and worse long-term outcomes. Thus, reliance on the development of symptoms alone without consideration of structural abnormalities of the myocardium for optimal timing of aortic valve replacement potentially constitutes a missed opportunity to prevent postoperative morbidity and mortality from severe aortic stenosis, especially in the face of the quickly expanding indications of lower-risk transcatheter aortic valve replacement. The purpose of this review is to discuss the mechanisms and clinical implications of left ventricular hypertrophy in severe valvular aortic stenosis, which may eventually move to center stage as an indication for aortic valve replacement in the asymptomatic patient. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. The clinical implications of immunogenomics in colorectal cancer: A path for precision medicine.

    Science.gov (United States)

    Riley, Jenny M; Cross, Ashley W; Paulos, Chrystal M; Rubinstein, Mark P; Wrangle, John; Camp, E Ramsay

    2018-04-15

    Colorectal cancer (CRC) remains the third most common malignancy and the second-leading cause of cancer-related deaths in the United States. Large multi-omic databases, such as The Cancer Genome Atlas and the International Colorectal Cancer Subtyping Consortium, have identified distinct molecular subtypes related to anatomy. The identification of genomic alterations in CRC is now critical because of the recent success and US Food and Drug Administration approval of pembrolizumab and nivolumab for microsatellite-instable tumors. In parallel, landmark studies have established the prognostic significance of the CRC tumor-infiltrating lymphocyte and the clinical impact of the tumor immune microenvironment. As a result, there is a growing appreciation for immunogenomics, the interconnected relation between tumor genomics and the immune microenvironment. The clinical implications of CRC immunogenomics continue to expand, and it will likely serve as a guide for next-generation immunotherapy strategies for improving outcomes for this disease. Cancer 2018;124:1650-9. © 2018 American Cancer Society. © 2018 American Cancer Society.

  17. "Suffering" in palliative sedation: Conceptual Analysis and Implications for Decision-Making in Clinical Practice.

    Science.gov (United States)

    Bozzaro, Claudia; Schildmann, Jan

    2018-04-21

    Palliative sedation is an increasingly used and, simultaneously, challenging practice at the end of life. Many controversies associated with this therapy are rooted in implicit differences regarding the understanding of "suffering" as prerequisite for palliative sedation. The aim of this paper is to inform the current debates by a conceptual analysis of two different philosophical accounts of suffering, (1) the subjective and holistic concept and (2) the objective and gradual concept and by a clinical-ethical analysis of the implications of each account for decisions about palliative sedation. We will show that while the subjective and holistic account of suffering fits well with the holistic approach of palliative care, there are considerable challenges to justify limits to requests for palliative sedation. By contrast, the objective and gradual account fits well with the need for an objective basis for clinical decisions in the context of palliative sedation, but runs the risk of falling short when considering the individual and subjective experience of suffering at the end of life. We will conclude with a plea for the necessity of further combined conceptual and empirical research to develop a sound and feasible understanding of suffering which can contribute to consistent decision-making about palliative sedation. Copyright © 2018. Published by Elsevier Inc.

  18. Current computational modelling trends in craniomandibular biomechanics and their clinical implications.

    Science.gov (United States)

    Hannam, A G

    2011-03-01

    Computational models of interactions in the craniomandibular apparatus are used with increasing frequency to study biomechanics in normal and abnormal masticatory systems. Methods and assumptions in these models can be difficult to assess by those unfamiliar with current practices in this field; health professionals are often faced with evaluating the appropriateness, validity and significance of models which are perhaps more familiar to the engineering community. This selective review offers a foundation for assessing the strength and implications of a craniomandibular modelling study. It explores different models used in general science and engineering and focuses on current best practices in biomechanics. The problem of validation is considered at some length, because this is not always fully realisable in living subjects. Rigid-body, finite element and combined approaches are discussed, with examples of their application to basic and clinically relevant problems. Some advanced software platforms currently available for modelling craniomandibular systems are mentioned. Recent studies of the face, masticatory muscles, tongue, craniomandibular skeleton, temporomandibular joint, dentition and dental implants are reviewed, and the significance of non-linear and non-isotropic material properties is emphasised. The unique challenges in clinical application are discussed, and the review concludes by posing some questions which one might reasonably expect to find answered in plausible modelling studies of the masticatory apparatus. © 2010 Blackwell Publishing Ltd.

  19. Evidence behind FDA alerts for drugs with adverse cardiovascular effects: implications for clinical practice.

    Science.gov (United States)

    Rackham, Daniel M; C Herink, Megan; Stevens, Ian G; Cardoza, Natalie M; Singh, Harleen

    2014-01-01

    The U.S. Food and Drug Administration (FDA) periodically publishes Drug Safety Communications and Drug Alerts notifying health care practitioners and the general public of important information regarding drug therapies following FDA approval. These alerts can result in both positive and negative effects on patient care. Most clinical trials are not designed to detect long-term safety end points, and postmarketing surveillance along with patient reported events are often instrumental in signaling the potential harmful effect of a drug. Recently, many cardiovascular (CV) safety announcements have been released for FDA-approved drugs. Because a premature warning could discourage a much needed treatment or prompt a sudden discontinuation, it is essential to evaluate the evidence supporting these FDA alerts to provide effective patient care and to avoid unwarranted changes in therapy. Conversely, paying attention to these warnings in cases involving high-risk patients can prevent adverse effects and litigation. This article reviews the evidence behind recent FDA alerts for drugs with adverse CV effects and discusses the clinical practice implications. © 2013 Pharmacotherapy Publications, Inc.

  20. Social Cognition Dysfunctions in Neurodegenerative Diseases: Neuroanatomical Correlates and Clinical Implications

    Science.gov (United States)

    Santamaría-García, Hernando; Santangelo, Gabriella

    2018-01-01

    Social cognitive function, involved in the perception, processing, and interpretation of social information, has been shown to be crucial for successful communication and interpersonal relationships, thereby significantly impacting mental health, well-being, and quality of life. In this regard, assessment of social cognition, mainly focusing on four key domains, such as theory of mind (ToM), emotional empathy, and social perception and behavior, has been increasingly evaluated in clinical settings, given the potential implications of impairments of these skills for therapeutic decision-making. With regard to neurodegenerative diseases (NDs), most disorders, characterized by variable disease phenotypes and progression, although similar for the unfavorable prognosis, are associated to impairments of social cognitive function, with consequent negative effects on patients' management. Specifically, in some NDs these deficits may represent core diagnostic criteria, such as for behavioral variant frontotemporal dementia (bvFTD), or may emerge during the disease course as critical aspects, such as for Parkinson's and Alzheimer's diseases. On this background, we aimed to revise the most updated evidence on the neurobiological hypotheses derived from network-based approaches, clinical manifestations, and assessment tools of social cognitive dysfunctions in NDs, also prospecting potential benefits on patients' well-being, quality of life, and outcome derived from potential therapeutic perspectives of these deficits. PMID:29854017

  1. Clinical implications of the recent homeopathic medicine and its application to oriental medicine

    Directory of Open Access Journals (Sweden)

    Ok-Byung,Choi

    2007-02-01

    Full Text Available Objectives : The purpose of this study is to analyze the practical implications of homeopathic medicines, their status, their preparation systems and registration rules, recognized by the European Union and other countries. Contents : This paper covers the background of homeopathic medical principle, homeopathy throughout the world, the medicine status and clinical research, increases of the drug potency, the practical regulation of treatment, preparation techniques of homeopathic drugs and registration rules and the clinical practice. Homeopathy has been currently practised in over eighty countries throughout the world, especially in Europe. It had attracted considerable attentions in South and North America (notably in USA, Brazil, and Argentina, India and Pakistan. Although it is not dominantly popular in North America, constant growth has been nevertheless noted. Over the last thirty years, homeopathy has also developed or appeared in South Africa, Tunisia, Morocco, Venezuela, Israel, and Australia, etc. Result & suggestion : As over 300 million patients have put their trust in homeopathy, the study of the integration of homeopathy to oriental medicine, its development and feasibility in Korea are urgently needed. The products, substances, compositions of Homeopathic drugs are very similar to those of oriental medicine theory. Therefore their preparations and applications should prescribed and practised exclusively by oriental doctors. Applying the homeopathic theory and its preparation techniques to oriental medicine, the herbal acupuncture preparation should be modernized and various oriental products are to be developed. To this end, government and herbal acupuncture society need to interact each other for the development of oriental medicine.

  2. Emerging roles of innate lymphoid cells in inflammatory diseases: Clinical implications.

    Science.gov (United States)

    Kortekaas Krohn, I; Shikhagaie, M M; Golebski, K; Bernink, J H; Breynaert, C; Creyns, B; Diamant, Z; Fokkens, W J; Gevaert, P; Hellings, P; Hendriks, R W; Klimek, L; Mjösberg, J; Morita, H; Ogg, G S; O'Mahony, L; Schwarze, J; Seys, S F; Shamji, M H; Bal, S M

    2018-04-01

    Innate lymphoid cells (ILC) represent a group of lymphocytes that lack specific antigen receptors and are relatively rare as compared to adaptive lymphocytes. ILCs play important roles in allergic and nonallergic inflammatory diseases due to their location at barrier surfaces within the airways, gut, and skin, and they respond to cytokines produced by activated cells in their local environment. Innate lymphoid cells contribute to the immune response by the release of cytokines and other mediators, forming a link between innate and adaptive immunity. In recent years, these cells have been extensively characterized and their role in animal models of disease has been investigated. Data to translate the relevance of ILCs in human pathology, and the potential role of ILCs in diagnosis, as biomarkers and/or as future treatment targets are also emerging. This review, produced by a task force of the Immunology Section of the European Academy of Allergy and Clinical Immunology (EAACI), encompassing clinicians and researchers, highlights the role of ILCs in human allergic and nonallergic diseases in the airways, gastrointestinal tract, and skin, with a focus on new insights into clinical implications, therapeutic options, and future research opportunities. © 2017 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.

  3. Subchondral Bone and the Osteochondral Unit: Basic Science and Clinical Implications in Sports Medicine.

    Science.gov (United States)

    Saltzman, Bryan M; Riboh, Jonathan C

    2018-06-01

    Articular cartilage injuries and early osteoarthritis are among the most common conditions seen by sports medicine physicians. Nonetheless, treatment options for articular degeneration are limited once the osteoarthritic cascade has started. Intense research is focused on the use of biologics, cartilage regeneration, and transplantation to help maintain and improve cartilage health. An underappreciated component of joint health is the subchondral bone. A comprehensive, nonsystematic review of the published literature was completed via a PubMed/MEDLINE search of the keywords "subchondral" AND "bone" from database inception through December 1, 2016. Clinical review. Level 4. Articles collected via the database search were assessed for the association of bone marrow lesions and osteoarthritis, cartilage regeneration, and ligamentous and meniscal injury; the clinical disorder known as painful bone marrow edema syndrome; and the subchondral bone as a target for medical and surgical intervention. A complex interplay exists between the articular cartilage of the knee and its underlying subchondral bone. The role of subchondral bone in the knee is intimately related to the outcomes from cartilage restoration procedures, ligamentous injury, meniscal pathology, and osteoarthritis. However, subchondral bone is often neglected when it should be viewed as a critical element of the osteochondral unit and a key player in joint health. Continued explorations into the intricacies of subchondral bone marrow abnormalities and implications for the advent of procedures such as subchondroplasty will inform further research efforts on how interventions aimed at the subchondral bone may provide durable options for knee joint preservation.

  4. The Immunology of Neuromyelitis Optica-Current Knowledge, Clinical Implications, Controversies and Future Perspectives.

    Science.gov (United States)

    Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

    2016-03-02

    Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%-25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients.

  5. The Immunology of Neuromyelitis Optica—Current Knowledge, Clinical Implications, Controversies and Future Perspectives

    Science.gov (United States)

    Jasiak-Zatonska, Michalina; Kalinowska-Lyszczarz, Alicja; Michalak, Slawomir; Kozubski, Wojciech

    2016-01-01

    Neuromyelitis optica (NMO) is an autoimmune, demyelinating disorder of the central nervous system (CNS) with typical clinical manifestations of optic neuritis and acute transverse myelitis attacks. Previously believed to be a variant of multiple sclerosis (MS), it is now considered an independent disorder which needs to be differentiated from MS. The discovery of autoantibodies against aquaporin-4 (AQP4-IgGs) changed our understanding of NMO immunopathogenesis and revolutionized the diagnostic process. AQP4-IgG is currently regarded as a specific biomarker of NMO and NMO spectrum disorders (NMOsd) and a key factor in its pathogenesis. Nevertheless, AQP4-IgG seronegativity in 10%–25% of NMO patients suggests that there are several other factors involved in NMO immunopathogenesis, i.e., autoantibodies against aquaporin-1 (AQP1-Abs) and antibodies against myelin oligodendrocyte glycoprotein (MOG-IgGs). This manuscript reviews current knowledge about NMO immunopathogenesis, pointing out the controversial issues and showing potential directions for future research. Further efforts should be made to broaden our knowledge of NMO immunology which could have important implications for clinical practice, including the use of potential novel biomarkers to facilitate an early and accurate diagnosis, and modern treatment strategies improving long-term outcome of NMO patients. PMID:26950113

  6. Analytical Methods for Quantification of Vitamin D and Implications for Research and Clinical Practice.

    Science.gov (United States)

    Stokes, Caroline S; Lammert, Frank; Volmer, Dietrich A

    2018-02-01

    A plethora of contradictory research surrounds vitamin D and its influence on health and disease. This may, in part, result from analytical difficulties with regard to measuring vitamin D metabolites in serum. Indeed, variation exists between analytical techniques and assays used for the determination of serum 25-hydroxyvitamin D. Research studies into the effects of vitamin D on clinical endpoints rely heavily on the accurate assessment of vitamin D status. This has important implications, as findings from vitamin D-related studies to date may potentially have been hampered by the quantification techniques used. Likewise, healthcare professionals are increasingly incorporating vitamin D testing and supplementation regimens into their practice, and measurement errors may be also confounding the clinical decisions. Importantly, the Vitamin D Standardisation Programme is an initiative that aims to standardise the measurement of vitamin D metabolites. Such a programme is anticipated to eliminate the inaccuracies surrounding vitamin D quantification. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  7. Accessory muscle of the flexor digitorum superficialis and its clinical implications

    Directory of Open Access Journals (Sweden)

    Edie Benedito Caetano

    Full Text Available ABSTRACT Anatomical variations of the flexor digitorum superficialis (FDS muscle and tendon unit are frequently reported by anatomists and clinicians. Anatomical muscle variations of the FDS and its tendons may include variations of muscle belly, presence of accessory or duplicate tendons, abnormal tendon connections, and absence of muscle or tendon components. Such variations may or may not have clinical implications. This report presents a case not described previously: a unilateral accessory muscle of the flexor digitorum superficialis which was connected by a thick tendon to the flexor digitorum superficialis muscle; it was directed proximally to the insertion of the medial epicondyle of the humerus, next to the superficialis head of the pronator teres muscle. The belly of the accessory muscle was positioned anterior to the median and anterior interosseous nerve. This anatomical variation is known as type V in the classification of Elliot et al. The knowledge of these anatomical variations helps hand surgeons interpret the clinical examination, particularly in the evaluation of patients who have suffered tendon injuries or show sign s of possible peripheral nerve entrapment.

  8. Octogenarians' post-acute care use after cardiac valve surgery and recovery: clinical implications.

    Science.gov (United States)

    Edmiston, Elizabeth; Dolansky, Mary A; Zullo, Melissa; Forman, Daniel E

    2017-12-21

    Octogenarians receiving cardiac valve surgery is increasing and recovery is challenging. Post-acute care (PAC) services assist with recovery, yet services provided in facilities do not provide adequate cardiac-focused care or long-term self-management support. The purpose of the paper was to report post-acute care discharge rates in octogenarians and propose clinical implications to improve PAC services. Using a 2003 Medicare Part A database, we studied post-acute care service use in octogenarians after cardiac valve surgery. We propose expansion of the Geriatric Cardiac Care model to include broader clinical therapy dynamics. The sample (n = 10,062) included patients over 80 years discharged from acute care following valve surgery. Post-acute care services were used by 68% of octagarians following cardiac valve surgery (1% intermediate rehabilitation, 35% skilled nursing facility, 32% home health). The large percentage of octagarians using PAC point to the importance of integrating geriatric cardiac care into post-acute services to optimize recovery outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Statin-associated immune-mediated myopathy: biology and clinical implications.

    Science.gov (United States)

    Christopher-Stine, Lisa; Basharat, Pari

    2017-04-01

    In the last 6 years, our understanding of statin-associated myopathy expanded to include not only a toxic myopathy with limited and reversible side-effects but also an autoimmune variety in which statins likely induce an autoimmune myopathy that is both associated with a specific autoantibody and responsive to immunosuppression and immune modulation. This review widens the reader's understanding of statin myopathy to include an autoimmune process. Statin-associated immune-mediated myopathy provides an example of an environmental trigger (statins) directly implicated in an autoimmune disease associated with a genetic predisposition as well as potential risk factors including concomitant diseases and specific statins. Given a median exposure to statins of 38 months, providers should be aware that anti-3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) myopathy may occur even after several years of statin exposure. It is important for the reader to understand the clinical presentation of statin-associated immune-mediated myopathy and the difference in its clinical presentation to that of statins as direct myotoxins. Prompt recognition of such an entity allows the clinician to immediately stop the offending agent if it has not already been discontinued as well as to recognize that statin rechallenge is not a likely option, and that prompt treatment with immunosuppression and/or immunomodulation is usually of enormous benefit to the patient in restoring muscle strength and physical function. VIDEO ABSTRACT.

  10. A rare variant of the ulnar artery with important clinical implications: a case report

    Directory of Open Access Journals (Sweden)

    Casal Diogo

    2012-11-01

    Full Text Available Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

  11. The clinical implications and biologic relevance of neurofilament expression in gastroenteropancreatic neuroendocrine neoplasms.

    Science.gov (United States)

    Schimmack, Simon; Lawrence, Ben; Svejda, Bernhard; Alaimo, Daniele; Schmitz-Winnenthal, Hubertus; Fischer, Lars; Büchler, Markus W; Kidd, Mark; Modlin, Irvin

    2012-05-15

    Although gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) exhibit widely divergent behavior, limited biologic information (apart from Ki-67) is available to characterize malignancy. Therefore, the identification of alternative biomarkers is a key unmet need. Given the role of internexin alpha (INA) in neuronal development, the authors assessed its function in neuroendocrine cell systems and the clinical implications of its expression as a GEP-NEN biomarker. Functional assays were undertaken to investigate the mechanistic role of INA in the pancreatic BON cell line. Expression levels of INA were investigated in 50 pancreatic NENs (43 primaries, 7 metastases), 43 small intestinal NENs (25 primaries, 18 metastases), normal pancreas (n = 10), small intestinal mucosa (n = 16), normal enterochromaffin (EC) cells (n = 9), mouse xenografts (n = 4) and NEN cell lines (n = 6) using quantitative polymerase chain reaction, Western blot, and immunostaining analyses. In BON cells, decreased levels of INA messenger RNA and protein were associated with the inhibition of both proliferation and mitogen-activated protein kinase (MAPK) signaling. INA was not expressed in normal neuroendocrine cells but was overexpressed (from 2-fold to 42-fold) in NEN cell lines and murine xenografts. In pancreatic NENs, INA was overexpressed compared with pancreatic adenocarcinomas and normal pancreas (27-fold [P = .0001], and 9-fold [P = .02], respectively). INA transcripts were correlated positively with Ki-67 (correlation coefficient [r] = 0.5; P biologic information relevant to delineation of both pancreatic NEN tumor phenotypes and clinical behavior. Copyright © 2011 American Cancer Society.

  12. Social Cognition Dysfunctions in Neurodegenerative Diseases: Neuroanatomical Correlates and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Foteini Christidi

    2018-01-01

    Full Text Available Social cognitive function, involved in the perception, processing, and interpretation of social information, has been shown to be crucial for successful communication and interpersonal relationships, thereby significantly impacting mental health, well-being, and quality of life. In this regard, assessment of social cognition, mainly focusing on four key domains, such as theory of mind (ToM, emotional empathy, and social perception and behavior, has been increasingly evaluated in clinical settings, given the potential implications of impairments of these skills for therapeutic decision-making. With regard to neurodegenerative diseases (NDs, most disorders, characterized by variable disease phenotypes and progression, although similar for the unfavorable prognosis, are associated to impairments of social cognitive function, with consequent negative effects on patients’ management. Specifically, in some NDs these deficits may represent core diagnostic criteria, such as for behavioral variant frontotemporal dementia (bvFTD, or may emerge during the disease course as critical aspects, such as for Parkinson’s and Alzheimer’s diseases. On this background, we aimed to revise the most updated evidence on the neurobiological hypotheses derived from network-based approaches, clinical manifestations, and assessment tools of social cognitive dysfunctions in NDs, also prospecting potential benefits on patients’ well-being, quality of life, and outcome derived from potential therapeutic perspectives of these deficits.

  13. HIV-1 Genetic Variability in Cuba and Implications for Transmission and Clinical Progression.

    Science.gov (United States)

    Blanco, Madeline; Machado, Liuber Y; Díaz, Héctor; Ruiz, Nancy; Romay, Dania; Silva, Eladio

    2015-10-01

    INTRODUCTION Serological and molecular HIV-1 studies in Cuba have shown very low prevalence of seropositivity, but an increasing genetic diversity attributable to introduction of many HIV-1 variants from different areas, exchange of such variants among HIV-positive people with several coinciding routes of infection and other epidemiologic risk factors in the seropositive population. The high HIV-1 genetic variability observed in Cuba has possible implications for transmission and clinical progression. OBJECTIVE Study genetic variability for the HIV-1 env, gag and pol structural genes in Cuba; determine the prevalence of B and non-B subtypes according to epidemiologic and behavioral variables and determine whether a relationship exists between genetic variability and transmissibility, and between genetic variability and clinical disease progression in people living with HIV/AIDS. METHODS Using two molecular assays (heteroduplex mobility assay and nucleic acid sequencing), structural genes were characterized in 590 people with HIV-1 (480 men and 110 women), accounting for 3.4% of seropositive individuals in Cuba as of December 31, 2013. Nonrandom sampling, proportional to HIV prevalence by province, was conducted. Relationships between molecular results and viral factors, host characteristics, and patients' clinical, epidemiologic and behavioral variables were studied for molecular epidemiology, transmission, and progression analyses. RESULTS Molecular analysis of the three HIV-1 structural genes classified 297 samples as subtype B (50.3%), 269 as non-B subtypes (45.6%) and 24 were not typeable. Subtype B prevailed overall and in men, mainly in those who have sex with men. Non-B subtypes were prevalent in women and heterosexual men, showing multiple circulating variants and recombinant forms. Sexual transmission was the predominant form of infection for all. B and non-B subtypes were encountered throughout Cuba. No association was found between subtypes and

  14. Associated factors and clinical implications of serum aminotransferase elevation in scrub typhus.

    Science.gov (United States)

    Su, Tung-Hung; Liu, Chun-Jen; Shu, Pei-Yun; Fu, Yang-Hsien; Chang, Chi-Hsien; Jao, Ping; Kao, Jia-Horng

    2016-12-01

    Timely diagnosis and prompt treatment can reduce the complications of scrub typhus. It is thus important to find easy laboratory tests to help in the diagnosis, especially in patients without eschar at initial presentation. Because serum aminotransferase elevation is common in scrub typhus, its associated factors and clinical implications need further investigations. We conducted a retrospective study in Kinmen, Taiwan, to collect clinically suspected scrub typhus patients notified to Taiwan Centers for Disease Control for confirmation during 2005-2010. Scrub typhus was diagnosed and Orientia tsutsugamushi was genotyped by serological or molecular assays. The laboratory data and clinical information were recorded for analysis. Overall, 344 suspected scrub typhus patients were reported to Taiwan Centers for Disease Control and 288 of them were certified scrub typhus. Scrub typhus patients had significantly more thrombocytopenia, serum aminotransferase elevation (76% vs. 54%, p = 0.001), higher frequency of fever, eschar, and lymphadenopathy, compared with nontyphus patients. Hepatic dysfunction in scrub typhus was associated with older age, longer fever duration, and absence of lymphadenopathy, but seemed to be unrelated to the rickettsial genotypes. Multivariate analysis showed that serum aminotransferase elevation (odds ratio: 3.75; p = 0.003; 95% confidence interval: 1.56-9.01) independently predicted scrub typhus. Furthermore, in suspected scrub typhus patients without eschar, 92% of true typhus patients had serum aminotransferase elevation compared with the nontyphus ones (odds ratio: 6.47; p = 0.028, 95% confidence interval: 1.23-34.11). Hepatic dysfunction in scrub typhus patients is associated with older age, longer fever duration, and absence of lymphadenopathy. Serum aminotransferase elevation can aid in the diagnosis of scrub typhus, especially in suspected patients without eschar. Copyright © 2014. Published by Elsevier B.V.

  15. Objective and quantitative equilibriometric evaluation of individual locomotor behaviour in schizophrenia: Translational and clinical implications.

    Science.gov (United States)

    Haralanov, Svetlozar; Haralanova, Evelina; Milushev, Emil; Shkodrova, Diana; Claussen, Claus-Frenz

    2018-04-17

    translational and clinical implications of the new approach and its future perspectives. © 2018 John Wiley & Sons, Ltd.

  16. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder.

    Science.gov (United States)

    Anastasia, Annalisa; Colletti, Chiara; Cuoco, Valentina; Quartini, Adele; Urso, Stefania; Rinaldi, Raffaella; Bersani, Giuseppe

    2016-01-01

    Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry "A. Fiorini" Hospital, Terracina (Latina, Italy), was performed. The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium-high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications.

  17. Clinical and prognostic implications of Roundabout 4 (robo4 in adult patients with acute myeloid leukemia.

    Directory of Open Access Journals (Sweden)

    Yin-Kai Chen

    Full Text Available Robo4 is involved in hematopoietic stem/progenitor cell homeostasis and essential for tumor angiogenesis. Expression of Robo4 was recently found in solid tumors and leukemia stem cells. However, the clinical implications of Robo4 expression in patients with acute myeloid leukemia (AML remain unclear.We investigated the clinical and prognostic relevance of mRNA expression of Robo4 in bone marrow (BM mononuclear cells from 218 adult patients with de novo AML. We also performed immunohistochemical staining to assess the Robo4 protein expression in the BM biopsy specimens from 30 selected AML patients in the cohort.Higher Robo4 expression was closely associated with lower white blood cell counts, expression of HLA-DR, CD13, CD34 and CD56 on leukemia cells, t(8;21 and ASXL1 mutation, but negatively correlated with t(15;17 and CEBPA mutation. Compared to patients with lower Robo4 expression, those with higher expression had significantly shorter disease-free survival (DFS and overall survival (OS. This result was confirmed in an independent validation cohort. Furthermore, multivariate analyses showed that higher Robo4 expression was an independent poor prognostic factor for DFS and OS in total cohort and patients with intermediate-risk cytogenetics, irrespective of age, WBC count, karyotype, and mutation status of NPM1/FLT3-ITD, and CEBPA.BM Robo4 expression can serve as a new biomarker to predict clinical outcomes in AML patients and Robo4 may serve as a potential therapeutic target in patients with higher Robo4 expression.

  18. A cross-sectional MRI study of brain regional atrophy and clinical characteristics of temporal lobe epilepsy with hippocampal sclerosis.

    LENUS (Irish Health Repository)

    2012-02-01

    PURPOSE: Applying a cross-sectional design, we set out to further characterize the significance of extrahippocampal brain atrophy in a large sample of \\'sporadic\\' mesial temporal lobe epilepsy with hippocampal sclerosis (MTLE+HS). By evaluating the influence of epilepsy chronicity on structural atrophy, this work represents an important step towards the characterization of MRI-based volumetric measurements as genetic endophenotypes for this condition. METHODS: Using an automated brain segmentation technique, MRI-based volume measurements of several brain regions were compared between 75 patients with \\'sporadic\\' MTLE+HS and 50 healthy controls. Applying linear regression models, we examined the relationship between structural atrophy and important clinical features of MTLE+HS, including disease duration, lifetime number of partial and generalized seizures, and history of initial precipitating insults (IPIs). RESULTS: Significant volume loss was detected in ipsilateral hippocampus, amygdala, thalamus, and cerebral white matter (WM). In addition, contralateral hippocampal and bilateral cerebellar grey matter (GM) volume loss was observed in left MTLE+HS patients. Hippocampal, amygdalar, and cerebral WM volume loss correlated with duration of epilepsy. This correlation was stronger in patients with prior IPIs history. Further, cerebral WM, cerebellar GM, and contralateral hippocampal volume loss correlated with lifetime number of generalized seizures. CONCLUSION: Our findings confirm that multiple brain regions beyond the hippocampus are involved in the pathogenesis of MTLE+HS. IPIs are an important factor influencing the rate of regional atrophy but our results also support a role for processes related to epilepsy chronicity. The consequence of epilepsy chronicity on candidate brain regions has important implications on their application as genetic endophenotypes.

  19. PDGFRα/β and VEGFR2 polymorphisms in colorectal cancer: incidence and implications in clinical outcome

    Directory of Open Access Journals (Sweden)

    Estevez-Garcia Purificacion

    2012-11-01

    Full Text Available Abstract Background Angiogenesis plays an essential role in tumor growth and metastasis, and is a major target in cancer therapy. VEGFR and PDGFR are key players involved in this process. The purpose of this study was to assess the incidence of genetic variants in these receptors and its potential clinical implications in colorectal cancer (CRC. Methods VEGFR2, PDGFRα and PDGFRβ mutations were evaluated by sequencing their tyrosine kinase domains in 8 CRC cell lines and in 92 samples of patients with CRC. Correlations with clinicopathological features and survival were analyzed. Results Four SNPs were identified, three in PDGFRα [exon 12 (A12: c.1701A>G; exon 13 (A13: c.1809G>A; and exon 17 (A17: c.2439+58C>A] and one in PDGFRβ [exon 19 (B19: c.2601A>G]. SNP B19, identified in 58% of tumor samples and in 4 cell lines (LS174T, LS180, SW48, COLO205, was associated with higher PDGFR and pPDGFR protein levels. Consistent with this observation, 5-year survival was greater for patients with PDGFR B19 wild type tumors (AA than for those harboring the G-allele genotype (GA or GG (51% vs 17%; p=0.073. Multivariate analysis confirmed SNP B19 (p=0.029 was a significant prognostic factor for survival, independent of age (p=0.060 or TNM stage (p Conclusions PDGFRβ exon 19 c.2601A>G SNP is commonly encountered in CRC patients and is associated with increased pathway activation and poorer survival. Implications regarding its potential influence in response to PDGFR-targeted agents remain to be elucidated.

  20. Incidence, Risk Factors, and Clinical Implications of Pneumonia Following Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Bohl, Daniel D; Saltzman, Bryan M; Sershon, Robert A; Darrith, Brian; Okroj, Kamil T; Della Valle, Craig J

    2017-06-01

    The purpose of this study is to determine the incidence, risk factors, and clinical implications of pneumonia following total joint arthroplasty (TJA). The American College of Surgeons National Surgical Quality Improvement Program was used to conduct a retrospective cohort study of patients undergoing TJA. Independent risk factors for the development of pneumonia within 30 days of TJA were identified using multivariate regression. Mortality and readmission rates were compared between patients who did and did not develop pneumonia. Multivariate regression was used to adjust for all demographic, comorbidity, and procedural characteristics. In total, 171,200 patients met inclusion criteria, of whom 66,493 (38.8%) underwent THA and 104,707 (61.2%) underwent TKA. Of the 171,200 patients, 590 developed pneumonia, yielding a rate of 0.34% (95% confidence interval = 0.32%-0.37%). Independent risk factors for pneumonia were chronic obstructive pulmonary disease, diabetes mellitus, greater age (most notably ≥80 years), dyspnea on exertion, dependent functional status, lower body mass index, hypertension, current smoker status, and male sex. The subset of patients who developed pneumonia following discharge had a higher readmission rate (82.1% vs 3.4%, adjusted relative risk [RR] = 16.6, P pneumonia. Pneumonia is a serious complication following TJA that occurs in approximately 1 in 300 patients. Approximately 4 in 5 patients who develop pneumonia are subsequently readmitted, and approximately 1 in 25 die. Given the serious implications of this complication, evidence-based pneumonia prevention programs including oral hygiene with chlorhexidine, sitting upright for meals, elevation of the head of the bed to at least 30°, aggressive incentive spirometry, and early ambulation should be considered for patients at greatest risk. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Ventricular arrhythmias and sudden cardiac arrest in Takotsubo cardiomyopathy: Incidence, predictive factors, and clinical implications.

    Science.gov (United States)

    Jesel, Laurence; Berthon, Charlotte; Messas, Nathan; Lim, Han S; Girardey, Mélanie; Marzak, Halim; Marchandot, Benjamin; Trinh, Annie; Ohlmann, Patrick; Morel, Olivier

    2018-04-06

    Takotsubo cardiomyopathy (TTC) is a stress-related transient cardiomyopathy. Life-threatening arrhythmias (LTA) can occur and worsen prognosis. The purpose of this study was to assess the incidence and outcome of LTA in TTC, as well as its predictive factors and clinical implications. We studied 214 consecutive cases of TTC over 8 years. The study cohort was divided into 2 groups: those with LTA (LTA group) and those without (non-LTA group). LTA was defined as ventricular tachycardia, ventricular fibrillation, or cardiac arrest. LTA occurred in 10.7% of patients mainly in the first 24 hours of hospitalization: ventricular tachycardia (n = 2), ventricular fibrillation (n = 11), cardiac arrest (n = 10: 5 asystole, 3 complete heart block, and 2 sinoatrial block). LTA were associated with lower left ventricular ejection fraction (LVEF) and a high rate of conduction disturbances. In-hospital (39.1% vs 8.9%; P 105 ms were independent predictors of LTA. In cases where a device was implanted, conduction disturbances persisted after the index event despite complete recovery of LVEF. There was no ventricular arrhythmia recurrence during follow-up. LTA occur early in patients presenting with TTC and is associated with significantly worse short- and long-term prognosis. Left ventricular impairment and QRS duration >105 ms are independent predictors of LTA. Ventricular arrhythmias occurred in the acute phase without further recurrence recorded in hospital survivors, whereas severe conduction disorders persisted during long-term follow-up. These findings may have implications on the choice of device therapy for this specific patient subgroup. Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  2. PDGFRα/β and VEGFR2 polymorphisms in colorectal cancer: incidence and implications in clinical outcome

    International Nuclear Information System (INIS)

    Estevez-Garcia, Purificacion; Carnero, Amancio; Paz-Ares, Luis; Garcia-Carbonero, Rocio; Castaño, Angel; Martin, Ana C; Lopez-Rios, Fernando; Iglesias, Joaquin; Muñoz-Galván, Sandra; Lopez-Calderero, Iker; Molina-Pinelo, Sonia; Pastor, Maria D

    2012-01-01

    Angiogenesis plays an essential role in tumor growth and metastasis, and is a major target in cancer therapy. VEGFR and PDGFR are key players involved in this process. The purpose of this study was to assess the incidence of genetic variants in these receptors and its potential clinical implications in colorectal cancer (CRC). VEGFR2, PDGFRα and PDGFRβ mutations were evaluated by sequencing their tyrosine kinase domains in 8 CRC cell lines and in 92 samples of patients with CRC. Correlations with clinicopathological features and survival were analyzed. Four SNPs were identified, three in PDGFRα [exon 12 (A12): c.1701A>G; exon 13 (A13): c.1809G>A; and exon 17 (A17): c.2439+58C>A] and one in PDGFRβ [exon 19 (B19): c.2601A>G]. SNP B19, identified in 58% of tumor samples and in 4 cell lines (LS174T, LS180, SW48, COLO205), was associated with higher PDGFR and pPDGFR protein levels. Consistent with this observation, 5-year survival was greater for patients with PDGFR B19 wild type tumors (AA) than for those harboring the G-allele genotype (GA or GG) (51% vs 17%; p=0.073). Multivariate analysis confirmed SNP B19 (p=0.029) was a significant prognostic factor for survival, independent of age (p=0.060) or TNM stage (p<0.001). PDGFRβ exon 19 c.2601A>G SNP is commonly encountered in CRC patients and is associated with increased pathway activation and poorer survival. Implications regarding its potential influence in response to PDGFR-targeted agents remain to be elucidated

  3. Clinical implications for Vascular Endothelial Growth Factor in the lung: friend or foe?

    Directory of Open Access Journals (Sweden)

    Gourgoulianis Konstantinos I

    2006-10-01

    Full Text Available Abstract Vascular endothelial growth factor (VEGF is a potent mediator of angiogenesis which has multiple effects in lung development and physiology. VEGF is expressed in several parts of the lung and the pleura while it has been shown that changes in its expression play a significant role in the pathophysiology of some of the most common respiratory disorders, such as acute lung injury, asthma, chronic obstructive pulmonary disease, obstructive sleep apnea, idiopathic pulmonary fibrosis, pulmonary hypertension, pleural disease, and lung cancer. However, the exact role of VEGF in the lung is not clear yet, as there is contradictory evidence that suggests either a protective or a harmful role. VEGF seems to interfere in a different manner, depending on its amount, the location, and the underlying pathologic process in lung tissue. The lack of VEGF in some disease entities may provide implications for its substitution, whereas its overexpression in other lung disorders has led to interventions for the attenuation of its action. Many efforts have been made in order to regulate the expression of VEGF and anti-VEGF antibodies are already in use for the management of lung cancer. Further research is still needed for the complete understanding of the exact role of VEGF in health and disease, in order to take advantage of its benefits and avoid its adverse effects. The scope of the present review is to summarize from a clinical point of view the changes in VEGF expression in several disorders of the respiratory system and focus on its diagnostic and therapeutic implications.

  4. Framing the research agenda for sickle cell trait: building on the current understanding of clinical events and their potential implications.

    Science.gov (United States)

    Goldsmith, Jonathan C; Bonham, Vence L; Joiner, Clinton H; Kato, Gregory J; Noonan, Allan S; Steinberg, Martin H

    2012-03-01

    Sickle Cell Trait (HbAS), the heterozygous state for the sickle hemoglobin beta globin gene is carried by as many as 100 million individuals including up to 25% of the population in some regions of the world (World Health Organization, Provisional agenda item 4.8, EB117/34 (22 December 2005) or World Health Organization, Provisional agenda item 11.4 (24 April 2006)). Persons with HbAS have some resistance to falciparum malaria infection in early childhood (Piel FB, Patil AP, Howes RE, et al., Nat Commun 2010;1104:1-7 and Aidoo M, Terlouw DJ, Kolczak M, et al., Lancet 2002;359:1311-1312) and as a result individuals with HbAS living in malarial endemic regions of Africa have a survival advantage over individuals with HbAA. Reports from the US emphasize possible health risks for individuals with HbAS including increased incidence of renal failure and malignancy, thromboembolic disorders, splenic infarction as a high altitude complication, and exercise-related sudden death. The National Heart, Lung, and Blood Institute, National Institutes of Health convened a workshop in Bethesda, Maryland on June 3-4, 2010, Framing the Research Agenda for Sickle Cell Trait, to review the clinical manifestations of HbAS, discuss the exercise-related sudden death reports in HbAS, and examine the public health, societal, and ethical implications of policies regarding HbAS. The goal of the workshop was to identify potential research questions to address knowledge gaps.

  5. Clinical trials in the Middle East and North Africa (MENA) Region: grandstanding or grandeur?

    Science.gov (United States)

    Nair, Satish Chandrasekhar; Ibrahim, Halah; Celentano, David D

    2013-11-01

    Nearly 31% of the world's clinical trials are conducted outside the US and 25% of the new drug applications include data from international sites. The high population growth, demand for medication, increased prevalence of life-style related and rare genetic diseases in the MENA countries should be associated with a consequent scale-up of clinical trials in these countries. However, the region sponsors under 1% of global clinical trials. Determinants including the regulatory environment, patient protection, physician-preparedness, types of diseases, costs of trials and pace of subject recruitment, were analyzed to identify critical factors that influence barriers to the conduct clinical trials in MENA. Strategic planning by the CRO can help overcome challenges related to regulatory and oversight requirements. Barriers related to trial quality and subject protection can be mitigated by risk-based monitoring. Growing healthcare infrastructure and communication technologies provide clear advantages for subject recruitment. Low operating costs combined with the increase in pharmaceutical sales provide incentives for the future conduct of clinical trials. Although the opportunities and challenges cited are common to the MENA region, further studies are needed to assess other potential contributing variables for the conduct of clinical trials specific to each MENA country. Challenges in drug importation and site oversight can be overcome with systematic interventions. Social media network and community awareness programs can assist reductions in barriers in obtaining effective informed consents. Increasing pharmaceutical sales, population growth, high prevalence of genetic and life-style related diseases and reduced clinical trial development costs offer expanding opportunities for future clinical trials in MENA. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Using an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement

    Science.gov (United States)

    Sites, Brian D.; Barrington, Michael J.; Davis, Matthew

    2014-01-01

    Background Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regards to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multi-center clinical registry of regional anesthesia to inform quality improvement strategies. Methods We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of one member institution (a United States medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry. Results The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% CI, 7.2–9.7) per 10,000. Registry wide major hospital events included 7 wrong site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for post procedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions. Conclusions To our

  7. NMR imaging of the head-neck region. Topography of function - clinical findings - imaging and spectroscopy

    International Nuclear Information System (INIS)

    Vogl, T.J.

    1991-01-01

    The book on nmr imaging in the head-neck region offers, on a total of 221 pages, 344 detailed representations with 141 figures and 44 tables. It provides information as to the relevant topography of function, presents clinical findings, explains imaging characteristics and also takes account of spectroscopic procedures. The multifarious methods of investigation are described and discussed in connection with the differential diagnoses. A score of suitable diagnostic measures is assigned to each region of examination. The method's value is assessed against that of other imaging techniques. (orig.) [de

  8. Analysis of clinical features and treatment in mature teratomas at pineal region

    Directory of Open Access Journals (Sweden)

    QI Gui-jun

    2012-04-01

    Full Text Available Surgical treatment through occipital tentorium of cerebellum approach was performed in nine cases of mature teratoma at the pineal region. Diagnosis was confirmed by postoperative pathological examination. No perioperative death occurred. Surgery-related complications (visual difficulties, visual field defects, seizures were seen in 4 cases. All cases were followed for 3 months-7 years (mean 3.70 years. The mature teratoma at the pineal region are more common in male children. The main clinical manifestations are intracranial hypertension and ataxia. Neurosurgical treatment may provide satisfactory outcome.

  9. Modern and last glacial maximum snowline in Peru and Bolivia: implications for regional climatic change

    Directory of Open Access Journals (Sweden)

    1995-01-01

    Full Text Available LIMITES DES NEIGES ACTUELLE ET DURANT LE DERNIER MAXIMUM GLACIAIRE AU PÉROU ET EN BOLIVIE : IMPLICATIONS EN TERMES DE CHANGEMENTS CLIMATIQUES RÉGIONAUX. Dans les Andes centrales (5°-23°S, le front actuel des neiges éternelles et celui datant du dernier maximum glaciaire (DMG ou LMG ont été cartographiés par télédétection et par un système utilisant une technologie basée sur des informations géographiques. La configuration générale du front des neiges éternelles du DMG est semblable à la configuration actuelle. Ce front s’élève d’est en ouest suivant des précipitations décroissantes. La limite des neiges éternelles du DMG dans la région s’écarte considérablement des 1 000 m souvent rencontrés dans les zones de basse latitude. Un modèle décrivant l’abaissement du front des neiges éternelles (Kuhn, 1989 a été utilisé afin de déterminer les changements de températures et de précipitations responsables de l’abaissement du front des neiges DMG. L’abaissement du front des neiges éternelles à 800-1 200 m dans la cordillère occidentale durant le DMG s’explique en partie par une augmentation des précipitations. Sur les flancs de la cordillère orientale, l’abaissement du front neigeux supérieur à 1 200 m est ce qui révèle le mieux le refroidissement subi par la région pendant le DMG. Il correspond à une baisse d’environ 5 à 7,5 °C. LÍMITES DE NIEVE ACTUAL Y DURANTE EL ÚLTIMO MÁXIMO GLACIAL EN PERÚ Y EN BOLIVIA: IMPLICACIONES EN TÉRMINOS CLIMÁTICOS REGIONALES. El límite de nieve perenne actual y la correspondiente a la de la última máxima glaciación (UMG de los Andes Centrales (5°-23° S han sido mapeadas utilizando técnicas de sensores remotos y sistema de información geográfica. La configuración general del límite de nieve perenne durante la UMG era similar a la actual, elevándose de este a oeste en respuesta a la disminución de las precipitaciones. La depresión del límite de

  10. On the Implications of Knowledge Bases for Regional Innovation Policies in Germany

    Directory of Open Access Journals (Sweden)

    Hassink Robert

    2014-12-01

    Full Text Available Regional innovation policies have been criticised for being too standardised, one-size-fits-all and place-neutral in character. Embedded in these debates, this paper has two aims: first, to analyse whether industries with different knowledge bases in regions in Germany have different needs for regional innovation policies, and secondly, to investigate whether knowledge bases can contribute to the fine-tuning of regional innovation policies in particular and to a modern, tailor-made, place-based regional innovation policy in general. It concludes that although needs differ due to differences in knowledge bases, those bases are useful only to a limited extent in fine-tuning regional innovation policies

  11. Regional differences in entrepreneurial perceptions and implications for the Romanian competitiveness policy

    Directory of Open Access Journals (Sweden)

    Nicolae Mariana

    2016-04-01

    Full Text Available Understanding entrepreneurship as being spatially rooted transforms it in a regional and national competitiveness factor. Despite the increasing importance of the territorial dimension in supporting economic growth at policy and declarative levels, in practice, in Romania, the territorial structure and spatial organization of the economy contributes little to the national value added. In this context, we study regional differences in entrepreneurial initiative and perception and their possible impact on the national competitiveness strategy. We use primary data collected in three Romanian regions (Centre, North-East, Bucureşti-Ilfov and conduct a statistical analysis of the data. The results indicate different comparative regional profiles. The regional differences in the intentions, motivations, barriers and limitation for entrepreneurship confirm the theoretical view that personal motivations of becoming an entrepreneur are determined by environmental conditions. We conclude that the regional differences should be taken into account in the elaboration of the competitiveness policy, corroborated with the results of other similar studies.

  12. Assessing Climate Vulnerabilities of Food Distribution Center Sites in Greater Boston and Their Regional Implications: Climate Adaptation Planning in Practice

    Science.gov (United States)

    Teferra, A.; Watson, C.; Douglas, E. M.

    2016-12-01

    The Metro Boston region, an area whose civic leaders have been at the forefront of climate resilience initiatives in recent years, is finalizing a flood vulnerability assessment of food distribution center sites located north of Boston, with the support of the University of Massachusetts Boston and the American Geophysical Union's Thriving Earth Exchange program. The community-scientist collaboration emerged because of the need for more local analyses of the area to inform climate resiliency policy and planning actions for the region. A significant amount of the metro region's food supply passes through two major distribution centers in the cities of Everett and Chelsea, just north of the Mystic River. The Metropolitan Area Planning Council (MAPC), on behalf of the Metro Boston Climate Preparedness Taskforce, is working with Chris Watson and Ellen Douglas of UMass Boston to build on existing analyses of the region's food system and climate vulnerabilities and to develop a report identifying flood risk exposure to the sites. The analysis brings in dynamic modeling techniques that incorporate storm surge and sea level rise projections under different climate scenarios, and aims to align methodologies with those of other regional analyses, such as Climate Ready Boston and the City of Cambridge's Vulnerability Assessment. The study is helping to inform MAPC's and the Metro Boston Climate Preparedness Taskforce's understanding of this critical food distribution infrastructure, illustrate the larger regional implications of climate impacts on food distribution in the Greater Boston area, and guide the development of site-specific strategies for addressing identified vulnerabilities.

  13. Demographic trends in the Lodz region and their implications for seniors 50+

    OpenAIRE

    Jolanta Woźnica; Andrzej Tokarski

    2014-01-01

    The situation on the labor market in the Lodz region will change much in the short term , among other things as a result of unfavorable demographic trends, associated with a decrease in population, and also due to a lowering of labor resources. Decreasing labor resources may in the future adversely affect both the balance between the regional labor market by inducing a state of labor shortages and limit the opportunities for development of the region. Simultaneously, due to declining bi...

  14. An Entropy Approach to Regional Differences in Carbon Dioxide Emissions: Implications for Ethanol Usage

    Directory of Open Access Journals (Sweden)

    Dong Hee Suh

    2018-01-01

    Full Text Available The growth of the U.S. economy has been accompanied with a significant rise in carbon dioxide (CO2 emissions. As CO2 emissions are dependent on regional climatic conditions and energy-related activities in states, this study examines the extent to which the distribution of CO2 emissions vary across nine climatically consistent regions in the U.S. The results obtained from the entropy approach reveal that the inequalities of CO2 emissions vary across the regions. While the total inequality of CO2 emissions is determined by the between-region and the average within-region inequalities, the between-region inequality begins to dominate the average within-region inequalities around 1980s; the emission inequalities between regions increase, but those within each region decrease. Given that ethanol usage is relevant to energy-related CO2 emissions, this study also evaluates the impact of ethanol usage on the changes in the emission inequalities. The results show that an increase in the ratio of ethanol to fossil fuels is associated closely with the reductions in the inequalities of CO2 emissions.

  15. Implications of Sino-American Strategic Competition on Southeast Asia's Post-Cold War Regional Order

    National Research Council Canada - National Science Library

    Suryodipuro, Sidharto

    2003-01-01

    .... The study of international politics after the Cold War has rediscovered the importance of regional interaction as the framework for understanding countries' security strategies and the great powers...

  16. A Functional Neuroimaging Analysis of the Trail Making Test-B: Implications for Clinical Application

    Directory of Open Access Journals (Sweden)

    Mark D. Allen

    2011-01-01

    Full Text Available Recent progress has been made using fMRI as a clinical assessment tool, often employing analogues of traditional “paper and pencil” tests. The Trail Making Test (TMT, popular for years as a neuropsychological exam, has been largely ignored in the realm of neuroimaging, most likely because its physical format and administration does not lend itself to straightforward adaptation as an fMRI paradigm. Likewise, there is relatively more ambiguity about the neural systems associated with this test than many other tests of comparable clinical use. In this study, we describe an fMRI version of Trail Making Test-B (TMTB that maintains the core functionality of the TMT while optimizing its use for both research and clinical settings. Subjects (N = 32 were administered the Functional Trail Making Test-B (f-TMTB. Brain region activations elicited by the f-TMTB were consistent with expectations given by prior TMT neurophysiological studies, including significant activations in the ventral and dorsal visual pathways and the medial pre-supplementary motor area. The f-TMTB was further evaluated for concurrent validity with the traditional TMTB using an additional sample of control subjects (N = 100. Together, these results support the f-TMTB as a viable neuroimaging adaptation of the TMT that is optimized to evoke maximally robust fMRI activation with minimal time and equipment requirements.

  17. Discovery of jarosite within the Mawrth Vallis region of Mars: Implications for the geologic history of the region

    Science.gov (United States)

    Farrand, W. H.; Glotch, T.D.; Rice, J. W.; Hurowitz, J.A.; Swayze, G.A.

    2009-01-01

    Analysis of visible to near infrared reflectance data from the MRO CRISM hyperspectral imager has revealed the presence of an ovoid-shaped landform, approximately 3 by 5 km in size, within the layered terrains surrounding the Mawrth Vallis outflow channel. This feature has spectral absorption features consistent with the presence of the ferric sulfate mineral jarosite, specifically a K-bearing jarosite (KFe3(SO4)2(OH)6). Terrestrial jarosite is formed through the oxidation of iron sulfides in acidic environments or from basaltic precursor minerals with the addition of sulfur. Previously identified phyllosilicates in the Mawrth Vallis layered terrains include a basal sequence of layers containing Fe-Mg smectites and an upper set of layers of hydrated silica and aluminous phyllosilicates. In terms of its fine scale morphology revealed by MRO HiRISE imagery, the jarosite-bearing unit has fracture patterns very similar to that observed in Fe-Mg smectite-bearing layers, but unlike that observed in the Al-bearing phyllosilicate unit. The ovoid-shaped landform is situated in an east-west bowl-shaped depression superposed on a north sloping surface. Spectra of the ovoid-shaped jarosite-bearing landform also display an anomalously high 600 nm shoulder, which may be consistent with the presence of goethite and a 1.92 ??m absorption which could indicate the presence of ferrihydrite. Goethite, jarosite, and ferrihydrite can be co-precipitated and/or form through transformation of schwertmannite, both processes generally occurring under low pH conditions (pH 2-4). To date, this location appears to be unique in the Mawrth Vallis region and could represent precipitation of jarosite in acidic, sulfur-rich ponded water during the waning stages of drying. ?? 2009 Elsevier Inc. All rights reserved.

  18. Discovery of jarosite within the Mawrth Vallis region of Mars: Implications for the geologic history of the region

    Science.gov (United States)

    Farrand, William H.; Glotch, Timothy D.; Rice, James W.; Hurowitz, Joel A.; Swayze, Gregg A.

    2009-12-01

    Analysis of visible to near infrared reflectance data from the MRO CRISM hyperspectral imager has revealed the presence of an ovoid-shaped landform, approximately 3 by 5 km in size, within the layered terrains surrounding the Mawrth Vallis outflow channel. This feature has spectral absorption features consistent with the presence of the ferric sulfate mineral jarosite, specifically a K-bearing jarosite (KFe 3(SO 4) 2(OH) 6). Terrestrial jarosite is formed through the oxidation of iron sulfides in acidic environments or from basaltic precursor minerals with the addition of sulfur. Previously identified phyllosilicates in the Mawrth Vallis layered terrains include a basal sequence of layers containing Fe-Mg smectites and an upper set of layers of hydrated silica and aluminous phyllosilicates. In terms of its fine scale morphology revealed by MRO HiRISE imagery, the jarosite-bearing unit has fracture patterns very similar to that observed in Fe-Mg smectite-bearing layers, but unlike that observed in the Al-bearing phyllosilicate unit. The ovoid-shaped landform is situated in an east-west bowl-shaped depression superposed on a north sloping surface. Spectra of the ovoid-shaped jarosite-bearing landform also display an anomalously high 600 nm shoulder, which may be consistent with the presence of goethite and a 1.92 μm absorption which could indicate the presence of ferrihydrite. Goethite, jarosite, and ferrihydrite can be co-precipitated and/or form through transformation of schwertmannite, both processes generally occurring under low pH conditions (pH 2-4). To date, this location appears to be unique in the Mawrth Vallis region and could represent precipitation of jarosite in acidic, sulfur-rich ponded water during the waning stages of drying.

  19. Adrenal Disorders and the Paediatric Brain: Pathophysiological Considerations and Clinical Implications

    Directory of Open Access Journals (Sweden)

    Vincenzo Salpietro

    2014-01-01

    Full Text Available Various neurological and psychiatric manifestations have been recorded in children with adrenal disorders. Based on literature review and on personal case-studies and case-series we focused on the pathophysiological and clinical implications of glucocorticoid-related, mineralcorticoid-related, and catecholamine-related paediatric nervous system involvement. Childhood Cushing syndrome can be associated with long-lasting cognitive deficits and abnormal behaviour, even after resolution of the hypercortisolism. Exposure to excessive replacement of exogenous glucocorticoids in the paediatric age group (e.g., during treatments for adrenal insufficiency has been reported with neurological and magnetic resonance imaging (MRI abnormalities (e.g., delayed myelination and brain atrophy due to potential corticosteroid-related myelin damage in the developing brain and the possible impairment of limbic system ontogenesis. Idiopathic intracranial hypertension (IIH, a disorder of unclear pathophysiology characterised by increased cerebrospinal fluid (CSF pressure, has been described in children with hypercortisolism, adrenal insufficiency, and hyperaldosteronism, reflecting the potential underlying involvement of the adrenal-brain axis in the regulation of CSF pressure homeostasis. Arterial hypertension caused by paediatric adenomas or tumours of the adrenal cortex or medulla has been associated with various hypertension-related neurological manifestations. The development and maturation of the central nervous system (CNS through childhood is tightly regulated by intrinsic, paracrine, endocrine, and external modulators, and perturbations in any of these factors, including those related to adrenal hormone imbalance, could result in consequences that affect the structure and function of the paediatric brain. Animal experiments and clinical studies demonstrated that the developing (i.e., paediatric CNS seems to be particularly vulnerable to alterations induced by

  20. [Radiation-induced bystander effect: the important part of ionizing radiation response. Potential clinical implications].

    Science.gov (United States)

    Wideł, Maria; Przybyszewski, Waldemar; Rzeszowska-Wolny, Joanna

    2009-08-18

    It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the "bystander effect" or "radiation-induced bystander effect" (RIBE). This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy), but also after conventional irradiation (X-rays, gamma rays) at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not definitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effect may have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation field and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The bystander effect may be a

  1. Radiation-induced bystander effect: The important part of ionizing radiation response. Potential clinical implications

    Directory of Open Access Journals (Sweden)

    Maria Wideł

    2009-08-01

    Full Text Available It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the “bystander effect” or “radiation-induced bystander effect” (RIBE. This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy, but also after conventional irradiation (X-rays, gamma rays at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not defi nitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effectmay have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation fi eld and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The

  2. Chronic administration of anticonvulsants but not antidepressants impairs bone strength: clinical implications.

    Science.gov (United States)

    Gold, P W; Pavlatou, M G; Michelson, D; Mouro, C M; Kling, M A; Wong, M-L; Licinio, J; Goldstein, S A

    2015-06-02

    Major depression and bipolar disorder are associated with decreased bone mineral density (BMD). Antidepressants such as imipramine (IMIP) and specific serotonin reuptake inhibitors (SSRIs) have been implicated in reduced BMD and/or fracture in older depressed patients. Moreover, anticonvulsants such as valproate (VAL) and carbamazepine (CBZ) are also known to increase fracture rates. Although BMD is a predictor of susceptibility to fracture, bone strength is a more sensitive predictor. We measured mechanical and geometrical properties of bone in 68 male Sprague Dawley rats on IMIP, fluoxetine (FLX), VAL, CBZ, CBZ vehicle and saline (SAL), given intraperitoneally daily for 8 weeks. Distinct regions were tested to failure by four-point bending, whereas load displacement was used to determine stiffness. The left femurs were scanned in a MicroCT system to calculate mid-diaphyseal moments of inertia. None of these parameters were affected by antidepressants. However, VAL resulted in a significant decrease in stiffness and a reduction in yield, and CBZ induced a decrease in stiffness. Only CBZ induced alterations in mechanical properties that were accompanied by significant geometrical changes. These data reveal that chronic antidepressant treatment does not reduce bone strength, in contrast to chronic anticonvulsant treatment. Thus, decreased BMD and increased fracture rates in older patients on antidepressants are more likely to represent factors intrinsic to depression that weaken bone rather than antidepressants per se. Patients with affective illness on anticonvulsants may be at particularly high risk for fracture, especially as they grow older, as bone strength falls progressively with age.

  3. Congenital segmental dilatation of jejunoileal region in a newborn: Unusual clinical and radiologic presentation

    Directory of Open Access Journals (Sweden)

    Harjai M

    2010-01-01

    Full Text Available Segmental dilatation of the ileum is one of the uncommon causes of intestinal obstruction in neonates. We present a case of slow transit of bowel contents leading to suspicion of functional bowel obstruction in a new born, which on exploration turned out to be a case of segmental dilatation of the jejuno-ileal region. The clinical and radiological evaluation was suggestive of hypomotility disorder of gut, resulting in diagnostic dilemma and delayed surgical intervention.

  4. Rural Policy and the New Regional Economics: Implications for Rural America.

    Science.gov (United States)

    Quigley, John M.

    This paper discusses gross economic and demographic trends in rural and urban America during the past 30 years, the kinds of competitive advantages enjoyed by urban and rural regions, and insights offered by the new regional economics concerning exploitation of those advantages. The importance of agriculture has declined in rural areas, while that…

  5. Agricultural transformations, livelihoods and rural-city connections. Policy implications for regional development

    NARCIS (Netherlands)

    Steel, G.|info:eu-repo/dai/nl/304349828; van Lindert, P.H.C.M.|info:eu-repo/dai/nl/069299382; Fold, Niels; Mynborg, Tobias

    2016-01-01

    This report analyses agricultural transformations, livelihoods and rural-city connections in Sub-Saharan Africa with the aim to identify key policy areas for regional development. The report draws on the results from comparative empirical studies in various dynamic rural regions characterized by

  6. Implications of Climate Change for Rural Tourism in the Nordic Region

    NARCIS (Netherlands)

    Nicholls, S.; Amelung, B.

    2015-01-01

    In many rural regions, including those of the Nordic region, a former dependence on primary activities such as fishing, forestry, mining and/or agriculture has been superseded in recent decades by increasing involvement in the tourism sector. The purpose of this paper is to explore the potential

  7. The clinical implications of variants of vena cava inferior and aorta on retroperitoneal surgery

    Directory of Open Access Journals (Sweden)

    S. V. Mukhtarulina

    2014-12-01

    Full Text Available Objective: to study variants of retroperitoneal vascular structure and its clinical implications on retroperitoneal surgery in patients with cervical cancer IA–IIB stage.Materials and methods. 101 patients who underwent paraaortic and bilateral pelvic lymphadenectomy were included in this study. 10 patients of the first group with anomalies of inferior vena cava, renal arteries and veins, common iliac vein and ovarian vessels were compared with 91 patients of the second group without anomalies.Results. Variants of major retroperitoneal vascular structure were present in 10 (9.9 % patients. Supernumerary renal arteries and veins observed in 5 (4.9 % patients; retroaortic left renal vein type I and II – in 3 (3.0 % patients. Double vena cava inferior detected in 1 (1.0 % patient. Patients with variants of retroperitoneal vascular structures hadn’t vessel injury. There was no difference in intraoperative hemorrhage, transfusion red blood cell, rate of intraoperative hemoglobin and removed paraaortic lymph nodes between the groups. Risk factors for intraoperative bleeding in patients with cervical cancer, depending on the presence or absence of anomalies of retroperitoneal vessels had no significant difference.Conclusion. Despite the fact that the variants of retroperitoneal vascular structures are rare (9.9 %, the success of retroperitoneal surgery is associated with the knowledge of vascular variations which decrease serious, life-threatening complications.

  8. Cue-induced craving in pathological buying: empirical evidence and clinical implications.

    Science.gov (United States)

    Trotzke, Patrick; Starcke, Katrin; Pedersen, Anya; Brand, Matthias

    2014-01-01

    Pathological buying is associated with marked distress and impaired functioning in important life domains. It is currently under debate whether pathological buying can be considered a behavioral addiction. In analogy to results reported in addicted individuals, craving reactions elicited by addiction-related cues might be an underlying mechanism for the etiology and pathogenesis of pathological buying. In the present study, 30 pathological buyers and 30 matched control participants were examined with a cue-reactivity paradigm consisting of shopping and control cues. Skin conductance responses, as well as subjective ratings for arousal, valence, and urge to buy, were assessed. Subjective craving reactions were measured before and after the cue-reactivity paradigm. On a physiological level, skin conductance responses toward shopping cues were higher in pathological buyers (mean [M; standard deviation {SD}] = 0.26 [0.13]) compared with control participants (M [SD] = 0.19 [0.09]; t(58) = 2.29, p = .025, d = 0.60). On a behavioral level, the individuals with pathological buying rated the shopping cues as more arousing and more positive, and reported a greater urge to buy compared with control participants and with control cues. An increase in subjective craving after completing the cue-reactivity paradigm was observed only in the pathological buyers (Mpre [SD] = 1.95 [1.47], Mpost [SD] = 2.87 [1.79]; t(29) = 5.07, p buying. The results demonstrate similarities between pathological buying and substance or behavioral addictions and provide implications for clinical treatment.

  9. A study of pathogenesis of Acanthosis nigricans and its clinical implications

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    Neerja Puri

    2011-01-01

    Full Text Available Background: Acanthosis nigricans (AN is a dermatosis characterized by thickened, hyperpigmented plaques, typically on the intertriginous surfaces and neck. Common in some populations, its prevalence depends on race. Clinicians should recognize AN; it heralds disorders ranging from endocrinologic disturbances to malignancy. In this review, we discuss the pathogenesis of AN and its clinical implications and management. Materials and Methods: We selected 30 patients for the study. Diagnosis of associated disorders was established by history, physical examination, body mass index (BMI, hormone measurements by radioimmunoassays of thyroidnfunction tests, free testosterone, 17 (OH progesterone, dehydroepiandrosterone sulfate (DHEAS, cortisol, gonadotropins, prolactin, immunoreactive insulin, and C-peptide levels. Results and Discussion: In our study, the flexural involvement (flexures of groins, knees and elbows was seen in 40% patients, lip involvement was seen in 6.6% patients, and dorsal involvement was seen in 3.3% patients each. Increased serum testosterone levels were seen in 13.3% patients and increased DHEAS levels were seen in 20% patients. Regarding the types of AN, obesity induced AN or pseudo-AN was seen 70% patients, syndromic AN was seen in 23.35% patients and malignant AN was seen in 6.6% patients. The commonest histopathological feature of patients with AN was hyperkeratosis, seen in 100% patients, papillomatosis was seen in 90% patients, dermal infiltrate of lymphocytes and plasma cells was seen in 60% patients, horn pseudocysts were seen in 30% patients, and irregular acanthosis was seen in 26.6% patients.

  10. Personality traits in patients with Parkinson's disease: assessment and clinical implications.

    Science.gov (United States)

    Poletti, Michele; Bonuccelli, Ubaldo

    2012-06-01

    This study reviews empirical evidence on the association between personality traits and Parkinson's disease (PD), with a twofold aim. First, to better identify non-motor symptoms, such as affective symptoms and personality changes, that could help to define the pre-motor phase of PD; second, to better understand the neurobiological bases of personality traits, a goal that is not fully accomplished by a purely anatomical approach. A literature review was performed on studies of personality traits in PD patients, in electronic databases ISI Web of Knowledge, Medline and PsychInfo, conducted in July 2011. We found evidence that the existence of a characteristic premorbid personality profile of PD patients is not actually sustained by robust empirical evidence, mainly due to the methodological bias of the retrospective assessment of personality; PD patients present a personality profile of low novelty seeking and high harm avoidance. We concluded that the definition of a pre-motor phase of PD, based on non-motor symptoms, should search for the presence of concomitant affective disorders and for a positive psychiatric history for affective disorders rather than for a typical personality profile or personality changes. The low novelty seeking profile is probably related to the dopaminergic deficit, while the high harm avoidance profile is probably associated with the presence of affective disorders. Clinical implications of these findings, in regard to personality assessment and pharmacological treatments in PD, are also discussed.

  11. What are the clinical implications of nodular gastritis? Clues from histopathology.

    Science.gov (United States)

    Sokmensuer, Cenk; Onal, Ibrahim Koral; Yeniova, Ozgur; Ersoy, Osman; Aydinli, Musa; Yonem, Ozlem; Harmanci, Ozgur; Onal, Eda Demir; Altinok, Gulcin; Batman, Figen; Bayraktar, Yusuf

    2009-10-01

    There is no widely accepted histopathological definition for nodular gastritis. In this study we aim to uncover the pathologic entity responsible for the nodular appearance and to find clues about the clinical implications of nodular gastritis. Antral biopsy specimens of 160 patients with nodular gastritis and 133 patients without nodular gastritis were examined by an experienced pathologist for dysplasia, foveolar hyperplasia, inflammatory activity, intraepithelial lymphocytosis, intestinal metaplasia, and lymphoid follicle/aggregate formation, and comparative analysis was performed between the two groups of patients. The presence of intraepithelial lymphocytosis was more frequent in patients with nodular gastritis (P < 0.05). There was no difference between the two groups regarding the other pathological features such as presence of dysplasia, inflammatory activity, intestinal metaplasia, lymphoid hyperplasia, and Helicobacter pylori (H. pylori) infection. Increase of intraepithelial lymphocytes may contribute to formation of macroscopical nodules in this peculiar type of gastritis. Nodular gastritis would not indicate a new therapeutic approach in addition to the current measures for Helicobacter pylori infection.

  12. Clinical Implication of Anti-Angiogenic Effect of Regorafenib in Metastatic Colorectal Cancer.

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    Yoojoo Lim

    Full Text Available Regorafenib induces distinct radiological changes that represent its anti-angiogenic effect. However, clinical implication of the changes is unclear.Tumor attenuation as measured by Hounsfield units (HU in contrast-enhanced computed tomography (CT and cavitary changes of lung metastases were analyzed in association with treatment outcome of metastatic colorectal cancer patients (N = 80 treated with regorafenib in a prospective study.141 lesions in 72 patients were analyzed with HU. After 2 cycles of regorafenib, 87.5% of patients showed decrease of HU (Median change -23.9%, range -61.5%-20.7%. Lesional attenuation change was modestly associated with metabolic changes of 18-fluoro-deoxyglucose positron emission tomography-CT (Pearson's r = 0.37, p = 0.002. Among 53 patients with lung metastases, 17 (32.1% developed cavitary changes. There were no differences in disease control rate, progression-free survival, or overall survival according to the radiological changes. At the time of progressive disease (PD according to RECIST 1.1, HU was lower than baseline in 86.0% (43/50 and cavitary change of lung metastasis persisted without refilling in 84.6% (11/13.Regorafenib showed prominent anti-angiogenic effect in colorectal cancer, but the changes were not associated with treatment outcome. However, the anti-angiogenic effects persisted at the time of PD, which suggests that we may need to develop new treatment strategies.

  13. Clinical Implication of Anti-Angiogenic Effect of Regorafenib in Metastatic Colorectal Cancer

    Science.gov (United States)

    Yoon, Jeong Hee; Lee, Jeong Min; Lee, Jung Min; Paeng, Jin Chul; Won, Jae-Kyung; Kang, Gyeong Hoon; Jeong, Seung-Yong; Park, Kyu Joo; Lee, Kyung-Hun; Kim, Jee Hyun; Kim, Tae-You

    2015-01-01

    Background Regorafenib induces distinct radiological changes that represent its anti-angiogenic effect. However, clinical implication of the changes is unclear. Methods Tumor attenuation as measured by Hounsfield units (HU) in contrast-enhanced computed tomography (CT) and cavitary changes of lung metastases were analyzed in association with treatment outcome of metastatic colorectal cancer patients (N = 80) treated with regorafenib in a prospective study. Results 141 lesions in 72 patients were analyzed with HU. After 2 cycles of regorafenib, 87.5% of patients showed decrease of HU (Median change -23.9%, range -61.5%–20.7%). Lesional attenuation change was modestly associated with metabolic changes of 18-fluoro-deoxyglucose positron emission tomography-CT (Pearson’s r = 0.37, p = 0.002). Among 53 patients with lung metastases, 17 (32.1%) developed cavitary changes. There were no differences in disease control rate, progression-free survival, or overall survival according to the radiological changes. At the time of progressive disease (PD) according to RECIST 1.1, HU was lower than baseline in 86.0% (43/50) and cavitary change of lung metastasis persisted without refilling in 84.6% (11/13). Conclusion Regorafenib showed prominent anti-angiogenic effect in colorectal cancer, but the changes were not associated with treatment outcome. However, the anti-angiogenic effects persisted at the time of PD, which suggests that we may need to develop new treatment strategies. PMID:26671465

  14. Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications

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    José Humberto Tavares Guerreiro Fregnani

    Full Text Available CONTEXT: The musculocutaneous nerve is one of the terminal branches of the lateral fasciculus of the brachial plexus, and is responsible for innervation of the flexor musculature of the elbow and for skin sensitivity on the lateral surface of the forearm. Its absence has been described previously, but its real prevalence is unknown. CASE REPORT: A case of absence of the musculocutaneous nerve that was observed during the dissection of the right arm of a male cadaver is described. The area of innervation was supplied by the median nerve. From this, three branches emerged: one to the coracobrachialis muscle, another to the biceps brachii muscle and the third to the brachialis muscle. This last branch continued as a lateral antebrachial cutaneous nerve. This is an anatomical variation that has clinical-surgical implications, considering that injury to the median nerve in this case would have caused unexpected paralysis of the flexor musculature of the elbow and hypoesthesia of the lateral surface of the forearm.

  15. Activation of sigma-1 receptor chaperone in the treatment of neuropsychiatric diseases and its clinical implication

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    Kenji Hashimoto

    2015-01-01

    Full Text Available Endoplasmic reticulum (ER protein sigma-1 receptor represents unique chaperone activity in the central nervous system, and it exerts a potent influence on a number of neurotransmitter systems. Several lines of evidence suggest that activation of sigma-1 receptor plays a role in the pathophysiology of neuropsychiatric diseases, as well as in the mechanisms of some therapeutic drugs and neurosteroids. Preclinical studies showed that some selective serotonin reuptake inhibitors (SSRIs; fluvoxamine, fluoxetine, excitalopram, donepezil, and ifenprodil act as sigma-1 receptor agonists. Furthermore, sigma-1 receptor agonists could improve the N-methyl-D-aspartate (NMDA antagonist phencyclidine (PCP-induced cognitive deficits in mice. A study using positron emission tomography have demonstrated that an oral administration of fluvoxamine or donepezil could bind to sigma-1 receptor in the healthy human brain, suggesting that sigma-1 receptor might be involved in the therapeutic mechanisms of these drugs. Moreover, case reports suggest that sigma-1 receptor agonists, including fluvoxamine, and ifenprodil, may be effective in the treatment of cognitive impairment in schizophrenia, delirium in elderly people, and flashbacks in post-traumatic stress disorder. In this review article, the author would like to discuss the clinical implication of sigma-1 receptor agonists, including endogenous neurosteroids, in the neuropsychiatric diseases.

  16. The Role of Serotonin (5-HT) in Behavioral Control: Findings from Animal Research and Clinical Implications

    Science.gov (United States)

    Sanchez, CL; Biskup, CS; Herpertz, S; Gaber, TJ; Kuhn, CM; Hood, SH

    2015-01-01

    The neurotransmitters serotonin and dopamine both have a critical role in the underlying neurobiology of different behaviors. With focus on the interplay between dopamine and serotonin, it has been proposed that dopamine biases behavior towards habitual responding, and with serotonin offsetting this phenomenon and directing the balance toward more flexible, goal-directed responding. The present focus paper stands in close relationship to the publication by Worbe et al. (2015), which deals with the effects of acute tryptophan depletion, a neurodietary physiological method to decrease central nervous serotonin synthesis in humans for a short period of time, on the balance between hypothetical goal-directed and habitual systems. In that research, acute tryptophan depletion challenge administration and a following short-term reduction in central nervous serotonin synthesis were associated with a shift of behavioral performance towards habitual responding, providing further evidence that central nervous serotonin function modulates the balance between goal-directed and stimulus-response habitual systems of behavioral control. In the present focus paper, we discuss the findings by Worbe and colleagues in light of animal experiments as well as clinical implications and discuss potential future avenues for related research. PMID:25991656

  17. Accuracy of flash glucose monitoring and continuous glucose monitoring technologies: Implications for clinical practice.

    Science.gov (United States)

    Ajjan, Ramzi A; Cummings, Michael H; Jennings, Peter; Leelarathna, Lalantha; Rayman, Gerry; Wilmot, Emma G

    2018-02-01

    Continuous glucose monitoring and flash glucose monitoring technologies measure glucose in the interstitial fluid and are increasingly used in diabetes care. Their accuracy, key to effective glycaemic management, is usually measured using the mean absolute relative difference of the interstitial fluid sensor compared to reference blood glucose readings. However, mean absolute relative difference is not standardised and has limitations. This review aims to provide a consensus opinion on assessing accuracy of interstitial fluid glucose sensing technologies. Mean absolute relative difference is influenced by glucose distribution and rate of change; hence, we express caution on the reliability of comparing mean absolute relative difference data from different study systems and conditions. We also review the pitfalls associated with mean absolute relative difference at different glucose levels and explore additional ways of assessing accuracy of interstitial fluid devices. Importantly, much data indicate that current practice of assessing accuracy of different systems based on individualised mean absolute relative difference results has limitations, which have potential clinical implications. Healthcare professionals must understand the factors that influence mean absolute relative difference as a metric for accuracy and look at additional assessments, such as consensus error grid analysis, when evaluating continuous glucose monitoring and flash glucose monitoring systems in diabetes care. This in turn will ensure that management decisions based on interstitial fluid sensor data are both effective and safe.

  18. Clinical implications for substandard, nonproprietary medicines in multiple sclerosis: focus on fingolimod

    Science.gov (United States)

    Correale, Jorge; Chiquete, Erwin; Boyko, Alexey; Beran, Roy G; Strauch, Jorge Barahona; Milojevic, Snezana; Frider, Nadina

    2016-01-01

    Both proprietary and nonproprietary medicines are expected to undergo rigorous preapproval testing and both should meet stringent health authority regulatory requirements related to quality to obtain approval. Nonproprietary (also known as copy, or generic) medicines, which base their authorization and use on the proprietary documentation and label, are often viewed as a means to help lower the cost and, thus, increase patient access. If these medicines fail to meet quality standards, such as good manufacturing practice and bioequivalence (in humans), they are then defined as substandard copies and can pose serious risks to patients in terms of safety and efficacy. Potentially noncontrolled or different manufacturing process and excipients in nonproprietary medicines may result in poor batch-to-batch reproducibility (accurate and consistent quantity of each ingredient in each capsule/tablet) and lower quality. Substandard, nonproprietary copies of medicines that are immunomodulatory or immunosuppressive are of concern to patients due to their possible untoward safety and lack of efficacy events. This article reviews the potential risks associated with nonproprietary medicines that do not meet the regulatory requirements of the United States Food and Drug Administration, the European Medicines Agency, or the World Health Organization. The clinical implications for patients are described. This article focuses on nonproprietary medicines for multiple sclerosis, particularly fingolimod, that are not identical to proprietary versions and could thus fail to meet efficacy expectations or have different impact on the safety of patients with multiple sclerosis. PMID:27418809

  19. Anatomical Variations of Brachial Artery - Its Morphology, Embryogenesis and Clinical Implications

    Science.gov (United States)

    KS, Siddaraju; Venumadhav, Nelluri; Sharma, Ashish; Kumar, Neeraj

    2014-01-01

    Background: Accurate knowledge of variation pattern of the major arteries of upper limb is of considerable practical importance in the conduct of reparative surgery in the arm, forearm and hand however brachial artery and its terminal branches variations are less common. Aim: Accordingly the present study was designed to evaluate the anatomical variations of the brachial artery and its morphology, embryogenesis and clinical implications. Materials and Methods: In an anatomical study 140 upper limb specimens of 70 cadavers (35 males and 35 females) were used and anatomical variations of the brachial artery have been documented. Results: Accessory brachial artery was noted in eight female cadavers (11.43%). Out of eight cadavers in three cadavers (4.29%) an unusual bilateral accessory brachial artery arising from the axillary artery and it is continuing in the forearm as superficial accessory ulnar artery was noted. Rare unusual variant unilateral accessory brachial artery and its reunion with the main brachial artery in the cubital fossa and its variable course in relation to the musculocutaneous nerve and median nerve were also noted in five cadavers (7.14%). Conclusion: As per our knowledge such anatomical variations of brachial artery and its terminal branches with their relation to the surrounding structures are not reported in the modern medical literature. An awareness of such a presence is valuable for the surgeons and radiologists in evaluation of angiographic images, vascular and re-constructive surgery or appropriate treatment for compressive neuropathies. PMID:25653931

  20. Beat-to-beat variability of cardiac action potential duration: underlying mechanism and clinical implications.

    Science.gov (United States)

    Nánási, Péter P; Magyar, János; Varró, András; Ördög, Balázs

    2017-10-01

    Beat-to-beat variability of cardiac action potential duration (short-term variability, SV) is a common feature of various cardiac preparations, including the human heart. Although it is believed to be one of the best arrhythmia predictors, the underlying mechanisms are not fully understood at present. The magnitude of SV is basically determined by the intensity of cell-to-cell coupling in multicellular preparations and by the duration of the action potential (APD). To compensate for the APD-dependent nature of SV, the concept of relative SV (RSV) has been introduced by normalizing the changes of SV to the concomitant changes in APD. RSV is reduced by I Ca , I Kr , and I Ks while increased by I Na , suggesting that ion currents involved in the negative feedback regulation of APD tend to keep RSV at a low level. RSV is also influenced by intracellular calcium concentration and tissue redox potential. The clinical implications of APD variability is discussed in detail.

  1. Factors associated with non-attendance in a general practice super clinic population in regional Australia: A retrospective cohort study.

    Science.gov (United States)

    Nancarrow, Susan; Bradbury, Joanne; Avila, Catherine

    2014-01-01

    Non-attendance at medical appointments is associated with increased patient morbidity and is a significant drain on health service resources. Australian studies have focused on secondary healthcare settings, screening, and interventions to reduce non-attendance. To explore factors associated with non-attendance in a regional primary care setting. A retrospective cohort of all patients with a scheduled appointment between October 2011 and October 2013 at a regional, primary care clinic providing medical and allied health services in a region of New South Wales (NSW) serving a large Aboriginal population (10.7 per cent). Using multivariate logistic regression, non-attendance was regressed on a range of covariates, including number of appointments per person, gender and ethnicity, and day of the week. The overall proportion of missed appointments was 7.6 per cent. Risk factors for non-attendance were day of the week [Mondays (8.1 per cent), Fridays (8.0 per cent), and Thursdays (7.9 per cent), (χ2(4)= 20.208, pattend (FTA) (95% CI: 11-28%)]; Aboriginality (OR=4.022, 95% CI: 3.263, 4.956), and female gender (OR=1.077; 95% CI 1.024, 1.132). There was a trend toward an interaction between gender and Aboriginality, with Aboriginal females being the group most likely to miss appointments (OR=1.272, 95% CI: 0.949, 1.705). This is the largest study of non-attendance in an Australian primary healthcare setting. While not a typical setting, the study had the advantage of a large, mixed population. The suggested high rates of non-attendance by Aboriginal females have potentially important policy implications.

  2. Epidemiological and clinical features of patients with disseminated sclerosis in Perm region

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    Zhelnin A.V.

    2013-03-01

    Full Text Available The purpose of the article is to identify the epidemiological and clinical features of disseminated sclerosis (DS in Perm region. Material and methods: Data have been analyzed in 932 patients with DS. Among them there were 607 women (65% and 325 men (35%. The age of patients with DS varied from 17 to 68 years, in average 44,5±4,5years. All the patients have experienced comprehensive clinical and neurological study, MRI study of brain and spinal cord. Calculation of prevalence and incidence has been conducted among 100,000 people. Results: The prevalence of DS in Perm region on January 1, 2011 amounted to 35.1 cases perthe population of 100,000 people, which can be attributed to our region to the zone of medium risk of DS developing. The growth of incidence of DS in Perm region has been revealed. It has been determined that in 1997 the incidence of DS averaged 3.2. Risk factors have been identified. Conclusion: The data on the prevalence and incidence of disseminated sclerosis help improve the quality of treatment and preventive care for patients with disseminated sclerosis.

  3. Regional hydrological impacts of climate change: implications for water management in India

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    A. Mondal

    2015-04-01

    Full Text Available Climate change is most likely to introduce an additional stress to already stressed water systems in developing countries. Climate change is inherently linked with the hydrological cycle and is expected to cause significant alterations in regional water resources systems necessitating measures for adaptation and mitigation. Increasing temperatures, for example, are likely to change precipitation patterns resulting in alterations of regional water availability, evapotranspirative water demand of crops and vegetation, extremes of floods and droughts, and water quality. A comprehensive assessment of regional hydrological impacts of climate change is thus necessary. Global climate model simulations provide future projections of the climate system taking into consideration changes in external forcings, such as atmospheric carbon-dioxide and aerosols, especially those resulting from anthropogenic emissions. However, such simulations are typically run at a coarse scale, and are not equipped to reproduce regional hydrological processes. This paper summarizes recent research on the assessment of climate change impacts on regional hydrology, addressing the scale and physical processes mismatch issues. Particular attention is given to changes in water availability, irrigation demands and water quality. This paper also includes description of the methodologies developed to address uncertainties in the projections resulting from incomplete knowledge about future evolution of the human-induced emissions and from using multiple climate models. Approaches for investigating possible causes of historically observed changes in regional hydrological variables are also discussed. Illustrations of all the above-mentioned methods are provided for Indian regions with a view to specifically aiding water management in India.

  4. Innervation of periesophageal region of cat's diaphragm - Implication for studies of control of vomiting

    Science.gov (United States)

    Tan, L. K.; Miller, A. D.

    1986-01-01

    The extent of the region of the diaphragm around the esophagus that displays greatly reduced activity during the expulsive phase of vomiting was determined from electromyographic studies in cats to be about 0.75-1.0 cm from the esophagus. Horseradish peroxidase injected into this region retrogradely labeled motoneurons throughout most of the rostral-caudal extent of the phrenic nucleus, with the exception of caudal C6 and rostral C7. This widespread intermingling of motoneurons that innervate the region of reduced activity with other phrenic motoneurons creates a difficulty for needed follow-up studies of diaphragmatic control during vomiting.

  5. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder

    Directory of Open Access Journals (Sweden)

    Anastasia A

    2016-04-01

    suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications. Keywords: adjustment disorder, diagnostic criteria, stressor, mobbing, medicolegal

  6. Distributional pattern of benthic foraminiferal morpho-groups in the shelf region off Mangalore: Environmental implications

    Digital Repository Service at National Institute of Oceanography (India)

    Khare, N.; Sinha, R.; Rai, A.K.; Nigam, R.

    , the population was further placed into two broad morpho-groups namely, angular-asymmetrical and rounded-symmetrical. The surficial distribution of these groups revealed that angular-asymmetrical forms are abundant in relatively deeper region whereas rounded...

  7. Modeling the Impact of Uganda's Safe Male Circumcision Program: Implications for Age and Regional Targeting.

    Science.gov (United States)

    Kripke, Katharine; Vazzano, Andrea; Kirungi, William; Musinguzi, Joshua; Opio, Alex; Ssempebwa, Rhobbinah; Nakawunde, Susan; Kyobutungi, Sheila; Akao, Juliet N; Magala, Fred; Mwidu, George; Castor, Delivette; Njeuhmeli, Emmanuel

    2016-01-01

    Uganda aims to provide safe male circumcision (SMC) to 80% of men ages 15-49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program's progress, and to refine the implementation approach. The Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0), was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM) to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20-34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10-19 will offer the greatest impact over a 15-year period, while focusing on men ages 15-34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed. Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda's SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10-34 as a priority group for SMC in the 2014 application to the Global Fund's new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence.

  8. Modeling the Impact of Uganda's Safe Male Circumcision Program: Implications for Age and Regional Targeting.

    Directory of Open Access Journals (Sweden)

    Katharine Kripke

    Full Text Available Uganda aims to provide safe male circumcision (SMC to 80% of men ages 15-49 by 2016. To date, only 2 million men have received SMC of the 4.2 million men required. In response to age and regional trends in SMC uptake, the country sought to re-examine its targets with respect to age and subnational region, to assess the program's progress, and to refine the implementation approach.The Decision Makers' Program Planning Tool, Version 2.0 (DMPPT 2.0, was used in conjunction with incidence projections from the Spectrum/AIDS Impact Module (AIM to conduct this analysis. Population, births, deaths, and HIV incidence and prevalence were used to populate the model. Baseline male circumcision prevalence was derived from the 2011 AIDS Indicator Survey. Uganda can achieve the most immediate impact on HIV incidence by circumcising men ages 20-34. This group will also require the fewest circumcisions for each HIV infection averted. Focusing on men ages 10-19 will offer the greatest impact over a 15-year period, while focusing on men ages 15-34 offers the most cost-effective strategy over the same period. A regional analysis showed little variation in cost-effectiveness of scaling up SMC across eight regions. Scale-up is cost-saving in all regions. There is geographic variability in program progress, highlighting two regions with low baseline rates of circumcision where additional efforts will be needed.Focusing SMC efforts on specific age groups and regions may help to accelerate Uganda's SMC program progress. Policy makers in Uganda have already used model outputs in planning efforts, proposing males ages 10-34 as a priority group for SMC in the 2014 application to the Global Fund's new funding model. As scale-up continues, the country should also consider a greater effort to expand SMC in regions with low MC prevalence.

  9. Climatic change and environmental implications in the Medicine Hat region using Billings, Montana as an analogue

    International Nuclear Information System (INIS)

    Proudfoot, W.A.

    1994-01-01

    There is concern that climatic change due to anthropogenic enhancement of the greenhouse effect may have considerable impacts on the natural and agricultural environments in Canada. The Palliser Triangle in the southern prairie region is an area in which the impacts of climatic change could be significant; it is an important agricultural zone and is already sensitive due to its semi-arid climate. The possible effects of a change in the climate of the Medicine Hat (Alberta) area in the Palliser Triangle is examined through the use of a regional analogue in a warmer, more southerly area. The selected analogue region is the area around Billings, Montana. Aspects of the natural environment, including potential vegetation distribution, frost-free period, and drought, as well as aspects of the agricultural environment, including agricultural practices and examination of wheat yields, are studied within each region. Comparisons are drawn between the two regions to evaluate whether significant differences exist in the environmental aspects examined. It is shown that although a change in Medicine Hat's climate to one more like that of Billings may not have drastic impacts on the environment, such a change may require adjustments in current practices or adaptations to altered environmental conditions. Reviews of several policy areas will be necessary to ensure appropriate adjustments in agricultural or resource management practices. Regional analogy is shown to be an essential preliminary tool for determining possible effects of climatic change. 138 refs., 42 figs., 22 tabs

  10. A trans-national monarch butterfly population model and implications for regional conservation priorities

    Science.gov (United States)

    Oberhauser, Karen; Wiederholt, Ruscena; Diffendorfer, James E.; Semmens, Darius J.; Ries, Leslie; Thogmartin, Wayne E.; Lopez-Hoffman, Laura; Semmens, Brice

    2017-01-01

    1. The monarch has undergone considerable population declines over the past decade, and the governments of Mexico, Canada, and the United States have agreed to work together to conserve the species.2. Given limited resources, understanding where to focus conservation action is key for widespread species like monarchs. To support planning for continental-scale monarch habitat restoration, we address the question of where restoration efforts are likely to have the largest impacts on monarch butterfly (Danaus plexippus Linn.) population growth rates.3. We present a spatially explicit demographic model simulating the multi-generational annual cycle of the eastern monarch population, and use the model to examine management scenarios, some of which focus on particular regions of North America.4. Improving the monarch habitat in the north central or southern parts of the monarch range yields a slightly greater increase in the population growth rate than restoration in other regions. However, combining restoration efforts across multiple regions yields population growth rates above 1 with smaller simulated improvements in habitat per region than single-region strategies.5. Synthesis and applications: These findings suggest that conservation investment in projects across the full monarch range will be more effective than focusing on one or a few regions, and will require international cooperation across many land use categories.

  11. Regional cerebral blood flow and its correlation with clinical assessment in senile dementia of Alzheimer type and multi-infarct dementia

    International Nuclear Information System (INIS)

    Shinohara, Masao; Kawakatsu, Shinobu; Morinobu, Shigeru; Oiji, Arata; Sagawa, Katsuo; Yazaki, Mitsuyasu; Totsuka, Shirou; Komatani, Akio; Yamaguchi, Koichi

    1989-01-01

    Twenty-one patients with senile dementia of Alzheimer type (SDAT), 11 patients with multi-infarct dementia (MID), and 6 healthy volunteers were examined by SPECT using Xe-inhalation method. These patients also underwent an intelligence test according to the Gottfries-Brane-Steen (GBS) scale. Patients with mild SDAT did not have a significantly decreased regional cerebral blood flow (rCBF). In moderate or severe cases, however, a significantly decreased rCBF was bilaterally observed in all regions, except for the basal ganglia. This was marked in the temporoparietal region. A group of moderate or severe MID patients had a significantly decreased rCBF especially in the basal ganglia. It was also observed in the temporoparietal region, but not in the frontal region. Among the SDAT patients, there was a good correlation between rCBF and GBS scale in all the regions, except for the basal ganglia. In the case of MID patients, correlations were observed both between rCBF in the left side of the brain and clinical findings according to the method of Hasegawa and between rCBF in the right side of the frontal region and the motor function on the GBS scale. These findings may have implications for the different pathophysiology between SDAT and MID. (N.K.)

  12. Clinical investigation: Regional nodal failure patterns in breast cancer patients treated with mastectomy without radiotherapy

    International Nuclear Information System (INIS)

    Strom, Eric A.; Woodward, Wendy A.; Katz, Angela; Buchholz, Thomas A.; Perkins, George H.; Jhingran, Anuja; Theriault, Richard; Singletary, Eva; Sahin, Aysegul; McNeese, Marsha D.

    2005-01-01

    Purpose: The purpose of this study was to describe regional nodal failure patterns in patients who had undergone mastectomy with axillary dissection to define subgroups of patients who might benefit from supplemental regional nodal radiation to the axilla or supraclavicular fossa/axillary apex. Methods and Materials: The cohort consisted of 1031 patients treated with mastectomy (including a level I-II axillary dissection) and doxorubicin-based systemic therapy without radiation on five clinical trials at M.D. Anderson Cancer Center. Patient records, including pathology reports, were retrospectively reviewed. All regional recurrences (with or without distant metastasis) were recorded. Median follow-up was 116 months (range, 6-262 months). Results: Twenty-one patients recurred within the low-mid axilla (10-year actuarial rate 3%). Of these, 16 were isolated regional failures (no chest wall failure). The risk of failure in the low-mid axilla was not significantly higher for patients with increasing numbers of involved nodes, increasing percentage of involved nodes, larger nodal size or gross extranodal extension. Only 3 of 100 patients with 20% involved axillary nodes, and the presence of gross extranodal extension (10-year actuarial rates 15%, 14%, and 19%, respectively, p 20% involved axillary nodes, or gross extranodal extension are at increased risk of failure in the supraclavicular fossa/axillary apex and should receive radiation to undissected regions in addition to the chest wall

  13. Unraveling the nexus between water and food security in Latin America and the Caribbean: regional and global implications

    Science.gov (United States)

    Willaarts, Barbara; Garrido, Alberto; Soriano, Barbara; De Stefano, Lucia; López Gunn, Elena; Aldaya, Maite; Martínez-Santos, Pedro; Llamas, Ramon

    2014-05-01

    Latin American and the Caribbean (LAC) is a water and land abundant region, and plays a key role in meeting global food and water security. During the last decade, LAC has experience a rapid socio-economic growth, largely sustained by its competitive advantage in the production and exports of agricultural and mining products and by the high commodity prices in the global market. This study seeks to quantify the contribution of LAC's agriculture to global food and water security, i.e. virtual water trade, and evaluate the environmental and societal implications for regional development. Results show that between 2000 and 2011, LAC has increase its agricultural production 27%, and it now accounts for nearly 18% of the global agricultural market. As a result, the agricultural water footprint (WF) of LAC was augmented 65%; and yet, nearly 19% to 44% of the actual agricultural WF - depending on the countries - is virtual water exported to third countries. In fact, almost 50% of the increase in global virtual water trade during the last decade, corresponds to LAC. Such global contribution has significant implications for regional water and food security. From an environmental perspective, crop expansion (mostly rain-fed) resulted in the deforestation of nearly 1 million km2, turning this region into the second most important deforestation hotspots worldwide. This land clearing is having large impacts of ecosystem services, e.g. carbon sequestration, water quality or biodiversity conservation. From a socio-economic perspective, increasing agricultural production has improved regional food security indicators, although one every seven children is still stunted in LAC and nearly 10% of the population remains undernourished. Dietary shifts and socio-cultural factors also lag behind the growing problem of malnutrition in the region, i.e. overweight and obesity. Improvements of water access and sanitation, have had a positive impact on food security indicators, especially

  14. Clinical implications of studies with MnDPDP in animal models of hepatic abnormalities

    International Nuclear Information System (INIS)

    Ni, Y.; Marchal, G.

    1997-01-01

    Mangafodipir trisodium (manganese dipyridoxal diphosphate or MnDPDP) has been introduced as a hepatobiliary MR contrast agent (Teslascan). It is potential to assist in the characterisation of focal liver lesions, the diagnosis of local and global obstructive cholestasis and the evaluation of hepatic function in diffuse liver diseases has been explored in multiple pre-clinical experiments with appropriate animal models. The prompt negative contrast enhancement and delayed pertumoural rim-enhancement seen after i.v. injection of MnDPDP are 2 typical features of primary and secondary liver tumours with high malignancy, while the persistent positive enhancement is a sign of liver tumours of well preserved hepatocitic nature. Liver with local and total biliary obstruction can be visualized in MnDPDP-enhanced MR images as a region with prolonged signal enhancement. This agent could also be used to non-invasively evaluate diffuse liver diseases of different causes. In the present paper, we review the experimental data in the literature, provide some unpublished results and discuss the potential impact on the clinical use of MnDPDP in the liver. We conclude that MnDPDP is a promising MR liver contrast agent for the detection and characterisation of focal and diffuse liver diseases. (orig.)

  15. Weight compensation characteristics of Armeo®Spring exoskeleton: implications for clinical practice and research.

    Science.gov (United States)

    Perry, Bonnie E; Evans, Emily K; Stokic, Dobrivoje S

    2017-02-17

    Armeo®Spring exoskeleton is widely used for upper extremity rehabilitation; however, weight compensation provided by the device appears insufficiently characterized to fully utilize it in clinical and research settings. Weight compensation was quantified by measuring static force in the sagittal plane with a load cell attached to the elbow joint of Armeo®Spring. All upper spring settings were examined in 5° increments at the minimum, maximum, and two intermediate upper and lower module length settings, while keeping the lower spring at minimum. The same measurements were made for minimum upper spring setting and maximum lower spring setting at minimum and maximum module lengths. Weight compensation was plotted against upper module angles, and slope was analyzed for each condition. The Armeo®Spring design prompted defining the slack angle and exoskeleton balance angle, which, depending on spring and length settings, divide the operating range into different unloading and loading regions. Higher spring tensions and shorter module lengths provided greater unloading (≤6.32 kg of support). Weight compensation slope decreased faster with shorter length settings (minimum length = -0.082 ± 0.002 kg/°; maximum length = -0.046 ± 0.001 kg/°) independent of spring settings. Understanding the impact of different settings on the Armeo®Spring weight compensation should help define best clinical practice and improve fidelity of research.

  16. Critical Review of Data Evaluation in Teaching Clinics of Traditional Chinese Medicine Outside China: Implications for Education.

    Science.gov (United States)

    Jiang, Jian; Peng, Wenbo; Gu, Tieguang; King, Catherine; Yin, J Kevin

    2016-01-01

    The increasing acceptance of traditional Chinese medicine (TCM) worldwide has highlighted the importance of ensuring the provision of high-quality TCM clinical education. This clinical training should be partly guided by a robust assessment of patient data outcomes in TCM teaching clinics. We undertook a comprehensive literature review to examine the data evaluation in TCM teaching clinics outside China and its implications for TCM education. Literature was retrieved via MEDLINE (from 1946 to January 2015), EMBASE (from 1980 to February 2015), and Google Scholar for studies conducted outside China. The search was restricted to English articles reporting empirical findings related to the assessments of patient data in TCM teaching clinics, with implications for TCM education in countries other than China. Only seven articles from six studies met the inclusion criteria. The characteristics and main symptoms of patients who received any TCM treatment in the context of teaching clinics among all included studies were similar. Symptom relief as well as a high level of patient satisfaction with TCM treatment were found in TCM teaching clinics. Conventional healthcare providers and other complementary practitioners were not the main source of referral to TCM practitioners but rather patients׳ friends/relatives. Patients received acupuncture treatment more frequently than treatments utilizing Chinese herbal medicine in teaching clinics. A standardized and consistent framework for patient records within TCM teaching clinics is currently lacking. There was no robust study which "translated" TCM clinic data evaluation findings into implications for TCM education and clinical training. Recognizing that TCM evolves over time and its practice varies in different settings, there is an urgent need to conduct large-scale, rigorous evaluations of TCM clinic data to address the findings of our review, with the purpose of better informing TCM education and clinical training in

  17. Reasoning by analogy requires the left frontal pole: lesion-deficit mapping and clinical implications.

    Science.gov (United States)

    Urbanski, Marika; Bréchemier, Marie-Laure; Garcin, Béatrice; Bendetowicz, David; Thiebaut de Schotten, Michel; Foulon, Chris; Rosso, Charlotte; Clarençon, Frédéric; Dupont, Sophie; Pradat-Diehl, Pascale; Labeyrie, Marc-Antoine; Levy, Richard; Volle, Emmanuelle

    2016-06-01

    SEE BURGESS DOI101093/BRAIN/AWW092 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE  : Analogical reasoning is at the core of the generalization and abstraction processes that enable concept formation and creativity. The impact of neurological diseases on analogical reasoning is poorly known, despite its importance in everyday life and in society. Neuroimaging studies of healthy subjects and the few studies that have been performed on patients have highlighted the importance of the prefrontal cortex in analogical reasoning. However, the critical cerebral bases for analogical reasoning deficits remain elusive. In the current study, we examined analogical reasoning abilities in 27 patients with focal damage in the frontal lobes and performed voxel-based lesion-behaviour mapping and tractography analyses to investigate the structures critical for analogical reasoning. The findings revealed that damage to the left rostrolateral prefrontal region (or some of its long-range connections) specifically impaired the ability to reason by analogies. A short version of the analogy task predicted the existence of a left rostrolateral prefrontal lesion with good accuracy. Experimental manipulations of the analogy tasks suggested that this region plays a role in relational matching or integration. The current lesion approach demonstrated that the left rostrolateral prefrontal region is a critical node in the analogy network. Our results also suggested that analogy tasks should be translated to clinical practice to refine the neuropsychological assessment of patients with frontal lobe lesions. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Implications of Seismically Active Fault Structures in Ankay and Alaotra Regions of Northern and Central Madagascar

    Science.gov (United States)

    Malloy, S.; Stamps, D. S.

    2017-12-01

    The purpose of the study is to gain a better understanding of the seismically active fault structures in central and northern Madagascar. We study the Ankay and Lake Alaotra regions of Madagascar, which are segmented by multiple faults that strike N-S. In general, normal seismic events occur on faults bounding the Alaotra-Ankay rift basin where Quaternary alluvium is present. Due to this pattern and moderate amounts of low magnitude seismic activity along these faults, it is hypothesized the region currently undergoes E-W extension. In this work we test how variations in fault strength and net slip changes influence expected crustal movement in the region. Using the Coulomb stress failure point as a test of strength we are able to model the Alaotra-Ankay region using MATLAB Coulomb 3.3.01. This program allows us to define realistic Poisson's ratio and Young's modulus of mapped rock compositions in the region, i.e. paragneiss and orthogneiss, create 3D fault geometries, and calculate static stress changes with coinciding surface displacements. We impose slip along multiple faults and calculate seismic moment that we balance by the 3 observed earthquake magnitudes available in the USGS CMT database. Our calculations of surface displacements indicate 1-3 millimeters could be observed across the Alaotra-Ankay rift. These values are within the observable range of precision GNSS observations, therefore our results will guide future research into the area and direct potential GNSS station installation.

  19. EDCTP regional networks of excellence: initial merits for planned clinical trials in Africa.

    Science.gov (United States)

    Miiro, George M; Oukem-Boyer, Odile Ouwe Missi; Sarr, Ousmane; Rahmani, Maerangis; Ntoumi, Francine; Dheda, Keertan; Pym, Alexander; Mboup, Souleymane; Kaleebu, Pontiano

    2013-03-22

    Achieving the Millennium Development Goals (MDGs) and combating hotspots with escalating but preventable communicable diseases remain major challenges in Africa. The European and Developing Countries Clinical Trials Partnership (EDCTP) intervened to combat poverty-related diseases including malaria, tuberculosis and HIV/AIDS, and to conduct multi-centre clinical trials and multi-disciplinary health research through an innovative model of regional Networks of Excellence (NoEs). We participated in a quasi-formative evaluation between October and December 2011 on the 4 regional-led research networks. These included the: Central Africa Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM); East African Consortium for Clinical Research (EACCR); West African Network of Excellence for TB, AIDS and Malaria (WANETAM), and the Trials of Excellence for Southern Africa (TESA) launched between 2009 and 2010. We shared a participatory appraisal of field reports, progress reports and presentations from each network to jointly outline the initial experiences of the merits, outputs and lessons learnt. The self-regulating democratic networks, with 64 institutions in 21 African countries, have trained over 1, 000 African scientists, upgraded 36 sites for clinical trials, leveraged additional € 24 million and generated 38 peer-reviewed publications through networking and partnerships. The shared initial merits and lessons learnt portray in part the strengthened capacity of these networks for improved research coordination and conduct of planned multi-center clinical trials in Africa. Increased funding by African agencies, governments and international health partners will ensure sustainability of these networks for research capacity development and demonstrate their commitment to achieving the MDGs in Africa.

  20. [Clinical pharmacy: Evaluation of physician's satisfactions and expectations in a French regional hospital].

    Science.gov (United States)

    Jennings, P; Lotito, A; Baysson, H; Pineau-Blondel, E; Berlioz, J

    2017-03-01

    The purpose of the study was to evaluate physician's satisfaction with the clinical pharmacy activities in a French regional hospital. Data were collected by face-to-face interviews carried out by a public health intern with physicians from 14 different departments of medicine and surgery. A specifically designed questionnaire was used for this study. This contained 18 closed-ended questions, 3 open-ended questions and 6 questions relating to the multidisciplinary analysis of prescriptions of elderly patients. The questionnaire was proposed to 78 physicians, of which 62 replied (participation rate of 79%). Thirty-seven percent were interns (23/62), 19% were assistants (12/62) and 44% were senior physicians (27/62). Clinical pharmacy satisfaction levels were generally very high. In regard to clinical skills, 87% of the physicians were satisfied with pharmacists' competencies and 91% by the pertinence of transmitted information. Ninety-five percent of the physicians were also satisfied by the logistical aspect and the relationship with pharmacists (reactivity, availability and communication). Analysis of the open-ended questions showed that physicians were in favour of the increased presence of clinical pharmacists on the wards. This study shows a high level of physician satisfaction in relation to the clinical pharmacy activities in our hospital, and should be viewed as a strong endorsement of the work of the clinical pharmacy. This study highlights some areas of improvement such as increase presence of the clinical pharmacists on the wards. In order to assess periodically our activity, this study must be repeated in the future. Copyright © 2016 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.

  1. Adiposity measurements in association with metabolic syndrome in older men have different clinical implications.

    Science.gov (United States)

    Hsu, Chun-Hsien; Lin, Jiunn-Diann; Hsieh, Chang-Hsun; Lau, Shu Chuen; Chiang, Wei-Yong; Chen, Yen-Lin; Pei, Dee; Chang, Jin-Biou

    2014-03-01

    Obesity is a major public health problem, and measuring adiposity accurately and predicting its future comorbidities are important issues. Therefore, we hypothesized that 4 adiposity measurements, body mass index (BMI), waist circumference (WC), waist-to-height ratio, and body fat percentage, have different physiological meanings and distinct associations with adverse health consequences. This study aimed to investigate the relationship of these 4 measurements with metabolic syndrome (MetS) components and identify the most associated factor for MetS occurrence in older, non-medicated men. Cross-sectional data from 3004 men, all 65 years of age and older, were analyzed. The correlation and association between adiposity measurements and MetS components were evaluated by Pearson correlation and multiple linear regression. Based on multivariate logistic regression, BMI and WC were significantly associated with MetS and were selected to build a combined model of receiver operating characteristic curves to increase the diagnosis accuracy for MetS. The results show that BMI is independently associated with systolic and diastolic blood pressure; WC and body fat percentage are associated with fasting plasma glucose and log transformation of triglyceride; BMI and WC are negatively associated with high-density lipoprotein cholesterol (HDL-C); and WC is a better discriminate for MetS than BMI, although the combined model (WC + BMI) is not significantly better than WC alone. Based on these results, we conclude that the 4 adiposity measurements have different clinical implications. Thus, in older men, BMI is an important determinant for blood pressure and HDL-C. Waist circumference is associated with the risk of fasting plasma glucose, HDL-C, triglyceride, and MetS occurrence. The combined model did not increase the diagnosis accuracy. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Clinical Implication of Aortic Wall Biopsy in Aortic Valve Disease with Bicuspid Valve Pathology

    Directory of Open Access Journals (Sweden)

    Yong Han Kim

    2016-12-01

    Full Text Available Background: Although unique aortic pathology related to bicuspid aortic valve (BAV has been previously reported, clinical implications of BAV to aortopathy risk have yet to be investigated. We looked for potential differences in matrix protein expressions in the aortic wall in BAV patients. Methods: Aorta specimens were obtained from 31 patients: BAV group (n=27, tricuspid aortic valve (TAV group (n=4. The BAV group was categorized into three subgroups: left coronary sinus-right coronary sinus (R+L group; n=13, 42%, right coronary sinus-non-coronary sinus (R+N group; n=8, 26%, and anteroposterior (AP group; n=6, 19%. We analyzed the expression of endothelial nitric oxide synthase (eNOS, matrix metalloproteinase (MMP-9, and tissue inhibitor of matrix metalloproteinase (TIMP-2. Results: Based on the mean value of the control group, BAV group showed decreased expression of eNOS in 72.7% of patients, increased MMP-9 in 82.3%, and decreased TIMP in 79.2%. There was a higher tendency for aortopathy in the BAV group: eNOS (BAV:TAV= 53%±7%:57%±11%, MMP-9 (BAV:TAV=48%±10%:38%±1%. The AP group showed lower expression of eNOS than the fusion (R+L, R+N group did; 48%±5% vs. 55%±7% (p=0.081. Conclusion: Not all patients with BAV had expression of aortopathy; however, for patients who had a suspicious form of bicuspid valve, aortic wall biopsy could be valuable to signify the presence of aortopathy.

  3. The Implications of Endoscopic Ulcer in Early Gastric Cancer: Can We Predict Clinical Behaviors from Endoscopy?

    Directory of Open Access Journals (Sweden)

    Yoo Jin Lee

    Full Text Available The presence of ulcer in early gastric cancer (EGC is important for the feasibility of endoscopic resection, only a few studies have examined the clinicopathological implications of endoscopic ulcer in EGC.To determine the role of endoscopic ulcer as a predictor of clinical behaviors in EGC.Data of 3,270 patients with EGC who underwent surgery between January 2005 and December 2012 were reviewed. Clinicopathological characteristics were analyzed in relation to the presence and stage of ulcer in EGC. Based on endoscopic findings, the stage of ulcer was categorized as active, healing, or scar. Logistic regression analysis was performed to analyze factors associated with lymph node metastasis (LNM.2,343 (71.7% patients had endoscopic findings of ulceration in EGC. Submucosal (SM invasion, LNM, lymphovascular invasion (LVI, perineural invasion, and undifferentiated-type histology were significantly higher in ulcerative than non-ulcerative EGC. Comparison across different stages of ulcer revealed that SM invasion, LNM, and LVI were significantly associated with the active stage, and that these features exhibited significant stage-based differences, being most common at the active stage, and least common at the scar stage. The presence of endoscopic ulcer and active status of the ulcer were identified as independent risk factors for LNM.Ulcerative EGC detected by endoscopy exhibited more aggressive behaviors than non-ulcerative EGC. Additionally, the endoscopic stage of ulcer may predict the clinicopathological behaviors of EGC. Therefore, the appearance of ulcers should be carefully evaluated to determine an adequate treatment strategy for EGC.

  4. Accessory neurovascular foramina on the lingual surface of mandible: Incidence, topography, and clinical implications

    Directory of Open Access Journals (Sweden)

    B V Murlimanju

    2012-01-01

    Full Text Available Context: It was suggested that the accessory neurovascular foramina of the mandible might be of significance in relation to the effectiveness of local anesthesia following the routine inferior alveolar nerve block. Aims: To investigate the incidence of neurovascular foramina over the lingual surface of the mandible in South Indian population. Settings and Design: The study was conducted at the department of anatomy. Materials and Methods: The study included 67 human adult dry mandibles, the exact ages and sexes of which were not known. The location and number of neurovascular foramina were topographically analyzed. Statistical Analysis Used: Descriptive statistics. Results: The foramina were observed in 64 mandibles (95.5% and were often multiple in most of the cases. They were located between the two medial incisors in 8 mandibles (1.9%, between the medial and lateral incisor in 34 mandibles (50.7%; 25-bilateral; 7-right; 2-left, between the lateral incisor and canine in 7 mandibles (10.4%; 2-bilateral; 3-right; 2-left, between the canine and first premolar in 6 cases (8.9%; 3 on each side. Foramina were also present around the genial tubercle in 56 mandibles (83.6%. Among them, 52 mandibles showed a single foramen just above the genial tubercle, 34 mandibles had foramina below the tubercles, 13 mandibles had foramina on the right side of genial tubercle and 17 were having on the left side. Conclusion: Since the anatomical details of these foramina are important to various fields of dentistry and oncology, the present investigation was undertaken. The clinical significance and implications are emphasized.

  5. Clinical Implications of Human Population Differences in Genome-wide Rates of Functional Genotypes

    Directory of Open Access Journals (Sweden)

    Ali eTorkamani

    2012-11-01

    Full Text Available There have been a number of recent successes in the use of whole genome sequencing and sophisticated bioinformatics techniques to identify pathogenic DNA sequence variants responsible for individual idiopathic congenital conditions. However, the success of this identification process is heavily influenced by the ancestry or genetic background of a patient with an idiopathic condition. This is so because potential pathogenic variants in a patient’s genome must be contrasted with variants in a reference set of genomes made up of other individuals’ genomes of the same ancestry as the patient. We explored the effect of ignoring the ancestries of both an individual patient and the individuals used to construct reference genomes. We pursued this exploration in two major steps. We first considered variation in the per-genome number and rates likely functional derived (i.e., non-ancestral, based on the chimp genome single nucleotide variants and small indels in 52 individual whole human genomes sampled from 10 different global populations. We took advantage of a suite of computational and bioinformatics techniques to predict the functional effect of over 24 million genomic variants, both coding and non-coding, across these genomes. We found that the typical human genome harbors ~5.5-6.1 million total derived variants, of which ~12,000 are likely to have a functional effect (~5000 coding and ~7000 non-coding. We also found that the rates of functional genotypes per the total number of genotypes in individual whole genomes differ dramatically between human populations. We then created tables showing how the use of comparator or reference genome panels comprised of genomes from individuals that do not have the same ancestral background as a patient can negatively impact pathogenic variant identification. Our results have important implications for clinical sequencing initiatives.

  6. Defining the relationship between COPD and CVD: what are the implications for clinical practice?

    Science.gov (United States)

    Morgan, Ann D; Zakeri, Rosita; Quint, Jennifer K

    2018-01-01

    Cardiovascular diseases (CVDs) are arguably the most important comorbidities in chronic obstructive pulmonary disease (COPD). CVDs are common in people with COPD, and their presence is associated with increased risk for hospitalization, longer length of stay and all-cause and CVD-related mortality. The economic burden associated with CVD in this population is considerable and the cumulative cost of treating comorbidities may even exceed that of treating COPD itself. Our understanding of the biological mechanisms that link COPD and various forms of CVD has improved significantly over the past decade. But despite broad acceptance of the prognostic significance of CVDs in COPD, there remains widespread under-recognition and undertreatment of comorbid CVD in this population. The reasons for this are unclear; however institutional barriers and a lack of evidence-based guidelines for the management of CVD in people with COPD may be contributory factors. In this review, we summarize current knowledge relating to the prevalence and incidence of CVD in people with COPD and the mechanisms that underlie their coexistence. We discuss the implications for clinical practice and highlight opportunities for improved prevention and treatment of CVD in people with COPD. While we advocate more active assessment for signs of cardiovascular conditions across all age groups and all stages of COPD severity, we suggest targeting those aged under 65 years. Evidence indicates that the increased risks for CVD are particularly pronounced in COPD patients in mid-to-late-middle-age and thus it is in this age group that the benefits of early intervention may prove to be the most effective. PMID:29355081

  7. Intra-Genomic Internal Transcribed Spacer Region Sequence Heterogeneity and Molecular Diagnosis in Clinical Microbiology.

    Science.gov (United States)

    Zhao, Ying; Tsang, Chi-Ching; Xiao, Meng; Cheng, Jingwei; Xu, Yingchun; Lau, Susanna K P; Woo, Patrick C Y

    2015-10-22

    Internal transcribed spacer region (ITS) sequencing is the most extensively used technology for accurate molecular identification of fungal pathogens in clinical microbiology laboratories. Intra-genomic ITS sequence heterogeneity, which makes fungal identification based on direct sequencing of PCR products difficult, has rarely been reported in pathogenic fungi. During the process of performing ITS sequencing on 71 yeast strains isolated from various clinical specimens, direct sequencing of the PCR products showed ambiguous sequences in six of them. After cloning the PCR products into plasmids for sequencing, interpretable sequencing electropherograms could be obtained. For each of the six isolates, 10-49 clones were selected for sequencing and two to seven intra-genomic ITS copies were detected. The identities of these six isolates were confirmed to be Candida glabrata (n=2), Pichia (Candida) norvegensis (n=2), Candida tropicalis (n=1) and Saccharomyces cerevisiae (n=1). Multiple sequence alignment revealed that one to four intra-genomic ITS polymorphic sites were present in the six isolates, and all these polymorphic sites were located in the ITS1 and/or ITS2 regions. We report and describe the first evidence of intra-genomic ITS sequence heterogeneity in four different pathogenic yeasts, which occurred exclusively in the ITS1 and ITS2 spacer regions for the six isolates in this study.

  8. Historical Determinants of Regional Divisions of Georgia and their Implications for Territorial Governance

    Directory of Open Access Journals (Sweden)

    Mądry Cezary

    2016-06-01

    Full Text Available Georgia can be characterised by its turbulent history, centuries-old traditions, and a great ethnic diversity. This makes it necessary to include historical determinants, in addition to geopolitical and economic factors, when making a regional analysis of its territory and contemporary governance issues. Five stages of the development of the present territorial division of Georgia are distinguished. They have been identified by means of an analysis of key events (critical junctures of significance in the formation of its historical regions. Additionally, their influence at each of the three levels of the current territorial division of independent Georgia is discussed, in particular in the context of territorial governance.

  9. Integrating substance abuse care with community diabetes care: implications for research and clinical practice

    Directory of Open Access Journals (Sweden)

    Ghitza UE

    2013-01-01

    Full Text Available Udi E Ghitza,1 Li-Tzy Wu,2 Betty Tai11Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, United States Department of Health and Human Services, Bethesda, MD, 2Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USAAbstract: Cigarette smoking and alcohol use are prevalent among individuals with diabetes in the US, but little is known about screening and treatment for substance use disorders in the diabetic population. This commentary discusses the scope and clinical implications of the public health problem of coexisting substance use and diabetes, including suggestions for future research. Diabetes is the seventh leading cause of death in the US, and is associated with many severe health complications like cardiovascular disease, stroke, kidney damage, and limb amputations. There are an estimated 24 million adults in the US with type 2 diabetes. Approximately 20% of adults aged 18 years or older with diabetes report current cigarette smoking. The prevalence of current alcohol use in the diabetic population is estimated to be around 50%–60% in epidemiological surveys and treatment-seeking populations. Cigarette smoking is associated with an increased risk of type 2 diabetes in a dose-dependent manner and is an independent modifiable risk factor for development of type 2 diabetes. Diabetic patients with an alcohol or other drug use disorder show a higher rate of adverse health outcomes. For example, these patients experience more frequent and severe health complications as well as an increased risk of hospitalization, and require longer hospital stays. They are also less likely to seek routine care for diabetes or adhere to diabetes treatment than those without an alcohol or other drug use disorder. The Affordable Care Act of 2010 and the Mental Health Parity Act and Addiction Equity Act of 2008 provide opportunities for facilitating integration of

  10. The clinical implications of hydronephrosis and the level of ureteral obstruction in stage IIIB cervical cancer

    International Nuclear Information System (INIS)

    Chao, K.S. Clifford; Leung, W.-M.; Grigsby, Perry W.; Mutch, David G.; Herzog, Thomas; Perez, Carlos A.

    1998-01-01

    Purpose: There are two criteria for the diagnosis of Stage IIIB cervical cancer in the FIGO staging system: tumor fixation to the pelvic side wall and/or the presence of hydronephrosis due to tumor. However, we often encounter hydronephrosis without tumor fixed to the pelvic side wall or the level of ureteral obstruction not corresponding to the main tumor mass in the pelvis. The clinical implication of these phenomena remains unclear. We investigated the Stage IIIB population treated at the Mallinckrodt Institute of Radiology and hypothesized that, if hydronephrosis presents without tumor fixation to the pelvic side wall or if the level of ureteral obstruction is above the main pelvic tumor mass, it most likely resulted from external compression of ureter(s) by enlarged lymph nodes and, consequently, a worse outcome is expected. Methods and Materials: From 1959 to 1989, there were 297 patients with Stage IIIB cervical cancer who received definitive radiation therapy at the Mallinckrodt Institute of Radiology and were assessable for the presence of hydronephrosis and the level of ureteral obstruction. There were 281 patients who presented with tumor fixed to the pelvic side wall, and 62 of them were associated with concurrent hydronephrosis. An additional 16 patients presented with hydronephrosis without tumor fixation to the pelvic side wall. Among these 78 documented cases of hydronephrosis, the level of ureteral obstruction was above the true pelvis in 39 patients, and below the true pelvis in the other 39. Radiation therapy was individualized according to tumor extension and configuration; para-aortic lymph nodes were not routinely treated except in patients with clinical evidence of nodal metastasis. Results: The progression-free survival (PFS) at 5 years was 35% in 62 patients with hydronephrosis and tumor fixed to the pelvic side wall vs. 43% in 213 patients with tumor fixed to the pelvic side wall only (p 0.12). However, PFS at 5 years decreased to 23% in

  11. [Food addiction: Definition, measurement and limits of the concept, associated factors, therapeutic and clinical implications].

    Science.gov (United States)

    Cathelain, Sarah; Brunault, Paul; Ballon, Nicolas; Réveillère, Christian; Courtois, Robert

    2016-12-01

    Addictions, which are characterized by the inability to control a behavior despite existence of physical or psychological consequences, have biological, psychological and social determinants. Although the possibility of developing an addiction to some psychoactive substances (e.g. alcohol, tobacco, cannabis) and to gambling (i.e., gambling disorder) is now well demonstrated, the possibility to develop a non-drug addiction (i.e., behavioral addiction) to certain behaviors which provide pleasure (e.g. eating, having sex, buying things) is still in debate. The concept of food addiction, which refers to people who exhibit substance dependence criteria in relation to some high-fat and high-sugar foods, was recently proposed by applying substance dependence DSM criteria to eating behavior. To assess food addiction, the Yale Food Addiction Scale is now the only self-administered questionnaire (diagnosis and estimate of the number of symptoms of food addiction). Prevalence for food addiction is higher in overweight and obese patients, and in patients with certain psychopathological characteristics (i.e., depression, Attention Deficit Hyperactivity Disorder, high impulsivity), in patients who are single and in patients with neurobiological alterations in the reward system. However, it is still unclear whether food addiction is necessary associated with subsequent increase in body weight and/or obesity. An increasing number of studies demonstrated that drug addiction and food addiction shares some similar clinical, neurobiological and psychopathological and sociocultural risk factors. To test the pertinence to include food addiction as an addiction, it would be interesting to conduct future studies in patients who may experience harms related to their food addiction, including not only patients with obesity, but also patients with metabolic syndrome, type 2 diabetes, hypertension, dyslipidemia, atherosclerosis, stroke, or coronary heart disease. Food addiction is a clinical

  12. Mesozoic and Cenozoic structural geology of the CP Hills, Nevada Test Site, Nye County, Nevada; and regional implications

    Energy Technology Data Exchange (ETDEWEB)

    Caskey, S. John [Univ. of Nevada, Reno, NV (United States)

    1991-08-01

    Detailed mapping and structural analysis of upper Proterozoic and Paleozoic rocks in the CP Hills of the Nevada Test Site, together with analysis of published maps and cross sections and a reconnaissance of regional structural relations indicate that the CP thrust of Barnes and Poole (1968) actually comprises two separate, oppositely verging Mesozoic thrust systems: (1) the west-vergent CP thrust which is well exposed in the CP Hills and at Mine Mountain, and (2) the east-vergent Belted Range thrust located northwest of Yucca Flat. West-vergence of the CP thrust is indicated by large scale west-vergent recumbent folds in both its hangingwall and footwall and by the fact that the CP thrust ramps up section through hangingwall strata toward the northwest. Regional structural relations indicate that the CP thrust forms part of a narrow sigmoidal belt of west-vergent folding and thrusting traceable for over 180 km along strike. The Belted Range thrust represents earlier Mesozoic deformation that was probably related to the Last Chance thrust system in southeastern California, as suggested by earlier workers. A pre-Tertiary reconstruction of the Cordilleran fold and thrust belt in the region between the NTS and the Las Vegas Range bears a close resemblance to other regions of the Cordillera and has important implications for the development of hinterland-vergent deformation as well as for the probable magnitude of Tertiary extension north of Las Vegas Valley. Subsequent to Mesozoic deformation, the CP Hills were disrupted by at least two episodes of Tertiary extensional deformation: (1) an earlier episode represented by pre-middle Miocene low-angle normal faults, and (2) a later, post-11 Ma episode of high-angle normal faulting. Both episodes of extension were related to regional deformation, the latter of which has resulted in the present basin and range topography of the NTS region.

  13. Mesozoic and Cenozoic structural geology of the CP Hills, Nevada Test Site, Nye County, Nevada; and regional implications

    International Nuclear Information System (INIS)

    Caskey, S.J.

    1991-08-01

    Detailed mapping and structural analysis of upper Proterozoic and Paleozoic rocks in the CP Hills of the Nevada Test Site, together with analysis of published maps and cross sections and a reconnaissance of regional structural relations indicate that the CP thrust of Barnes and Poole (1968) actually comprises two separate, oppositely verging Mesozoic thrust systems: (1) the west-vergent CP thrust which is well exposed in the CP Hills and at Mine Mountain, and (2) the east-vergent Belted Range thrust located northwest of Yucca Flat. West-vergence of the CP thrust is indicated by large scale west-vergent recumbent folds in both its hangingwall and footwall and by the fact that the CP thrust ramps up section through hangingwall strata toward the northwest. Regional structural relations indicate that the CP thrust forms part of a narrow sigmoidal belt of west-vergent folding and thrusting traceable for over 180 km along strike. The Belted Range thrust represents earlier Mesozoic deformation that was probably related to the Last Chance thrust system in southeastern California, as suggested by earlier workers. A pre-Tertiary reconstruction of the Cordilleran fold and thrust belt in the region between the NTS and the Las Vegas Range bears a close resemblance to other regions of the Cordillera and has important implications for the development of hinterland-vergent deformation as well as for the probable magnitude of Tertiary extension north of Las Vegas Valley. Subsequent to Mesozoic deformation, the CP Hills were disrupted by at least two episodes of Tertiary extensional deformation: (1) an earlier episode represented by pre-middle Miocene low-angle normal faults, and (2) a later, post-11 Ma episode of high-angle normal faulting. Both episodes of extension were related to regional deformation, the latter of which has resulted in the present basin and range topography of the NTS region

  14. Dead regions in the cochlea: Implications for speech recognition and applicability of articulation index theory

    DEFF Research Database (Denmark)

    Vestergaard, Martin David

    2003-01-01

    Dead regions in the cochlea have been suggested to be responsible for failure by hearing aid users to benefit front apparently increased audibility in terms of speech intelligibility. As an alternative to the more cumbersome psychoacoustic tuning curve measurement, threshold-equalizing noise (TEN...

  15. Implications of Boy Scout group use of public lands for natural resource managers: a regional comparison

    Science.gov (United States)

    Gail A. Vander Stoep

    1992-01-01

    Resource managers can apply group-specific rather than generic communications and management strategies to different public land user groups. This study compares use patterns of one user group, Boy Scout troops, from two regions of the United States. It identifies their public land use patterns, activities, needs, and motivations. Results can be used by resource...

  16. ESA STSE “SST Diurnal Variability: Regional Extend - Implications in Atmospheric Modelling”

    DEFF Research Database (Denmark)

    Karagali, Ioanna

    The diurnal variability of SST, driven by the coincident occurrence of low enough wind and solar heating, has been observed in various regions of the global ocean [4, 5, 6]. Atmospheric, oceanic and climate models are not adequately resolving the daily SST cycle, resulting in biases of the total...

  17. The 1950-1998 warm ENSO events and regional implications to ...

    African Journals Online (AJOL)

    1998 seasonal El Niño/Southern Oscillation (ENSO) is investigated in 502 rivers gauged in 9 countries of the Southern African region. We found some evidence of possible links between available surface water resources in terms of mean annual ...

  18. Stratigraphy of the Descartes region /Apollo 16/ - Implications for the origin of samples

    Science.gov (United States)

    Head, J. W.

    1974-01-01

    Analysis of terrain in the Apollo 16 Descartes landing region shows a series of features that form a stratigraphic sequence which dominates the history and petrogenesis at the site. An ancient 150-km diam crater centered on the Apollo 16 site is one of the earliest recognizable major structures. Nectaris ejecta was concentrated in a regional low at the base of the back slope of the Nectaris basin to form the Descartes Mountains. Subsequently, a 60-km diam crater formed in the Descartes Mountains centered about 25 km to the west of the site. This crater dominates the geology and petrogenetic history of the site. Stone and Smoky Mountains represent the degraded terraced crater walls, and the dark matrix breccias and metaclastic rocks derived from North and South Ray craters represent floor fallback breccias from this cratering event. The interpretation is developed that the stratigraphy of the Cayley and Descartes, and thus the historical record of the Apollo 16 region, documents the complex interaction of deposits and morphology of local and regional impact cratering events. Large local 60- to 150-km diam craters have had a dramatic and previously unrecognized effect on the history and petrology of the Apollo 16 site.

  19. Water balances of two Piedmont headwater catchments: implications for regional hydrologic landscape classification

    Science.gov (United States)

    C. Dreps; G. Sun; J. Boggs

    2014-01-01

    In the Piedmont of North Carolina, a traditionally water-rich region, reservoirs that serve over 1 million people are under increasing pressure due to naturally occurring droughts and increasing land development. Innovative development approaches aim to maintain hydrologic conditions of the undisturbed landscape, but are based on insufficient target information. This...

  20. Implications of global climate change on water resources of the south Asian region

    International Nuclear Information System (INIS)

    Lal, M.

    1994-01-01

    An assessment of future changes in the mean and/or variances of hydrological parameters due to anthropogenic increases in greenhouse gases is much warranted for south Asia for developing adaptive response strategies. The evolution of changes in surface meteorological as well as hydrological parameters in the transient numerical experiments with the current state-of-art coupled climate models holds much promise for a better understanding of the interannual variability of climate and its change on a regional scale. A plausible future hydrological scenario for the south Asian region based on the numerical results obtained from the reference control and greenhouse warming simulations (using the Business-as-Usual scenario of CO 2 concentration in the atmosphere) with the Hamburg climate model is presented in this paper. For validation of regional-scale model-simulated hydrology and the assessment of future changes, analysis of data has been performed for annual mean conditions as well as for two seasons, namely, winter (December to February) and summer (June to August). Their results suggest a rise in annual mean surface air temperature of about 1.0 to 2.5 C over the ocean and between 2.0 to 4.5 C over the land regions of south Asia during the next hundred years. During the NH-winter, surface warming in the land regions of India and China is considerably higher (3.6 C) than during the NH-summer (2.7 C). The model simulates an increase in total (averaged for land points over the study area) annual precipitation of about 16 cm per year in a warmer atmosphere

  1. Characterization of crystalline rocks in the Lake Superior region, USA: implications for nuclear waste isolation

    International Nuclear Information System (INIS)

    Sood, M.K.; Flower, M.F.J.; Edgar, D.E.

    1984-01-01

    The Lake Superior region (Wisconsin, the Upper Peninsula of Michigan, and Minnesota) contains 41 Precambrian crystalline rock complexes comprising 64 individual but related rock bodies with known surface exposures. Each complex has a map area greater than 78 km 2 . About 54% of the rock complexes have areas of up to 500 km 2 , 15% fall between 500 km 2 and 1000 km 2 , 19% lie between 1000 km 2 and 2500 km 2 , and 12% are over 2500 km 2 . Crystalline rocks of the region vary widely in composition, but they are predominantly granitic. Repeated thermo-tectonic events have produced early Archean gneisses, migmatites, and amphibolites with highly tectonized fabrics that impart a heterogeneous and anisotropic character to the rocks. Late Archean rocks are usually but not invariably gneissose and migmatitic. Proterozoic rocks of the region include synorogenic (foliated) granitic rocks, anorogenic (non-foliated) granites, and the layered gabbro-anorthosite-troctolite intrusives of the rift-related Keweenawan igneous activity. Compared with the Archean rocks of the region, the Proterozoic bodies generally lack highly tectonized fabrics and have more definable contacts where visible. Anorogenic intrusions are relatively homogeneous and isotropic. On the basis of observed geologic characteristics, postorogenic and anorogenic crystalline rock bodies located away from recognized tectonic systems have attributes that make them relatively more desirable as a possible site for a nuclear waste repository in the region. This study was conducted at Argonne National Laboratory under the sponsorship of the US Department of Energy through the Office of Crystalline Repository Development at Battelle Memorial Institute, Columbus, Ohio. 84 references, 4 figures, 3 tables

  2. Characterization of crystalline rocks in the Lake Superior region, USA: implications for nuclear waste isolation

    International Nuclear Information System (INIS)

    Sood, M.K.; Edgar, D.E.; Flower, M.F.J.

    1984-01-01

    The Lake Superior region (Wisconsin, the Upper Peninsula of Michigan, and Minnesota) contains 41 Precambrian crystalline (medium- to coarse-grained igneous and high-grade metamorphic) rock complexes comprising 64 individual but related rock bodies with known surface exposures. Each complex has a map area greater than 78 km 2 . About 54% of the rock complexes have areas of up to 500 km 2 , 15% fall between 500 km 2 and 1000 km 2 , 19% lie between 1000 km 2 and 2500 km 2 , and 12% are over 2500 km 2 . Crystalline rocks of the region vary widely in composition, but they are predominantly granitic. Repeated thermo-tectonic events have produced early Archean gneisses, migmatites, and amphibolites with highly tectonized fabrics that impart a heterogeneous and anisotropic character to the rocks. Late Archean rocks are usually but not invariably gneissose an migmatitic. Proterozoic rocks of the region include synorogenic (foliated) granitic rocks, anorogenic (nonfoliated) granites, and the layered gabbro-anorthosite-troctolite intrusives of the rift-related Keweenawan igneous activity. Compared with the Archean rocks of the region, the Proterozoic bodies generally lack highly tectonized fabrics and have more definable contacts where visible. Anorogenic intrusions are relatively homogeneous and isotropic. On the basis of observed geologic characteristics, postorogenic and anorogenic crystalline rock bodies located away from recognized tectonic systems have attributes that make them relatively more desirable as a possible site for a nuclear waste repository in the region. This study was conducted at Argonne National Laboratory under the sponsorship of the US Department of Energy through the Office of Crystalline Repository Development at Battelle Memorial Institute, Columbus, Ohio

  3. Clinical impact of genetic variants of drug transporters in different ethnic groups within and across regions.

    Science.gov (United States)

    Ono, Chiho; Kikkawa, Hironori; Suzuki, Akiyuki; Suzuki, Misaki; Yamamoto, Yuichi; Ichikawa, Katsuomi; Fukae, Masato; Ieiri, Ichiro

    2013-11-01

    Drug transporters, together with drug metabolic enzymes, are major determinants of drug disposition and are known to alter the response to many commonly used drugs. Substantial frequency differences for known variants exist across geographic regions for certain drug transporters. To deliver efficacious medicine with the right dose for each patient, it is important to understand the contribution of genetic variants for drug transporters. Recently, mutual pharmacokinetic data usage among Asian regions, which are thought to be relatively similar in their own genetic background, is expected to accelerate new drug applications and reduce developmental costs. Polymorphisms of drug transporters could be key factors to be considered in implementing multiethnic global clinical trials. This review addresses the current knowledge on genetic variations of major drug transporters affecting drug disposition, efficacy and toxicity, focusing on the east Asian populations, and provides insights into future directions for precision medicine and drug development in east Asia.

  4. [The computer assisted pacemaker clinic at the regional hospital of Udine (author's transl)].

    Science.gov (United States)

    Feruglio, G A; Lestuzzi, L; Carminati, D

    1978-01-01

    For a close follow-up of large groups of pacemaker patients and for evaluation of long term pacing on a reliable statistical basis, many pacemaker centers in the world are now using computer systems. A patient data system with structured display records, designed to give complete, comprehensive and surveyable information and which are immediately retrievable 24 hours a day, on display or printed sets, seems to offer an ideal solution. The pacemaker clinic at the Regional Hospital of Udine has adopted this type of system. The clinic in linked to a live, on-line patient data system (G/3, Informatica Friuli-Venezia Giulia). The input and retrieval of information are made through a conventional keyboard. The input formats have fixed headings with coded alternatives and a limited space for comments in free text. The computer edits the coded information to surveyable reviews. Searches can be made on coded information and data of interest.

  5. New pricing approaches for bundled payments: Leveraging clinical standards and regional variations to target avoidable utilization.

    Science.gov (United States)

    Hellsten, Erik; Chu, Scally; Crump, R Trafford; Yu, Kevin; Sutherland, Jason M

    2016-03-01

    Develop pricing models for bundled payments that draw inputs from clinician-defined best practice standards and benchmarks set from regional variations in utilization. Health care utilization and claims data for a cohort of incident Ontario ischemic and hemorrhagic stroke episodes. Episodes of care are created by linking incident stroke hospitalizations with subsequent health service utilization across multiple datasets. Costs are estimated for episodes of care and constituent service components using setting-specific case mix methodologies and provincial fee schedules. Costs are estimated for five areas of potentially avoidable utilization, derived from best practice standards set by an expert panel of stroke clinicians. Alternative approaches for setting normative prices for stroke episodes are developed using measures of potentially avoidable utilization and benchmarks established by the best performing regions. There are wide regional variations in the utilization of different health services within episodes of stroke care. Reconciling the best practice standards with regional utilization identifies significant amounts of potentially avoidable utilization. Normative pricing models for stroke episodes result in increasingly aggressive redistributions of funding. Bundled payment pilots to date have been based on the costs of historical service patterns, which effectively 'bake in' unwarranted and inefficient variations in utilization. This study demonstrates the feasibility of novel clinically informed episode pricing approaches that leverage these variations to target reductions in potentially avoidable utilization. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. A model of characteristic earthquakes and its implications for regional seismicity

    DEFF Research Database (Denmark)

    López-Ruiz, R.; Vázquez-Prada, M.; Pacheco, A.F.

    2004-01-01

    Regional seismicity (i.e. that averaged over large enough areas over long enough periods of time) has a size-frequency relationship, the Gutenberg-Richter law, which differs from that found for some seismic faults, the Characteristic Earthquake relationship. But all seismicity comes in the end from...... active faults, so the question arises of how one seismicity pattern could emerge from the other. The recently introduced Minimalist Model of Vázquez-Prada et al. of characteristic earthquakes provides a simple representation of the seismicity originating from a single fault. Here, we show...... that a Characteristic Earthquake relationship together with a fractal distribution of fault lengths can accurately describe the total seismicity produced in a region. The resulting earthquake catalogue accounts for the addition of both all the characteristic and all the non-characteristic events triggered in the faults...

  7. The transport implications of regional policies for the disposal of intermediate level radioactive wastes

    International Nuclear Information System (INIS)

    James, I.A.

    1985-09-01

    This report aims to evaluate transport parameters and logistics associated with the disposal of intermediate-level radioactive wastes, as generated by CEGB, SSEB, UKAEA and BNFL. The assumed power scenario is DoE Scheme 3, which approximates to a moderate power generation scenario, with a 15 GWe PWR programme commissioned between 1991 and 2010, existing Magnox and AGR stations are assumed to have a 30 year lifespan. Three transport options are again assumed, namely; road, rail and a hybrid system, as is consistent with previous studies. These three options will be used in investigating regional policies of disposal, initially at the national level and then progressively disaggregating to a system of three regional depositories serving their respective catchment areas. (author)

  8. Patient Cross-Border Mobility: New Findings and Implications in Spanish Regions

    Directory of Open Access Journals (Sweden)

    Carla Blázquez-Fernández

    2017-06-01

    Full Text Available Spain has a National Health Service with a mixed public-private funded system. In the last decades, a huge effort has gone into reducing barriers to patient migration. We estimate a panel data based on a gravity model of migration since the process of health care decentralization has been completed in Spain. Our empirical results show that income is one of the most important drivers in explaining mobility as well as supply variables. Individual characteristics are not among the main factors for mobility. Besides, it is demonstrated there is a quality-driven mobility in Spain. However, there was no significant difference in the influence on patients’ mobility between those living in the North of the country and the Mediterranean regions. The empirical results also suggest that current regional health policies in Spain, that explain patients’ mobility, should be associated with greater funding system.

  9. Integrated regional changes in arctic climate feedbacks: Implications for the global climate system

    Science.gov (United States)

    McGuire, A.D.; Chapin, F. S.; Walsh, J.E.; Wirth, C.; ,

    2006-01-01

    The Arctic is a key part of the global climate system because the net positive energy input to the tropics must ultimately be resolved through substantial energy losses in high-latitude regions. The Arctic influences the global climate system through both positive and negative feedbacks that involve physical, ecological, and human systems of the Arctic. The balance of evidence suggests that positive feedbacks to global warming will likely dominate in the Arctic during the next 50 to 100 years. However, the negative feedbacks associated with changing the freshwater balance of the Arctic Ocean might abruptly launch the planet into another glacial period on longer timescales. In light of uncertainties and the vulnerabilities of the climate system to responses in the Arctic, it is important that we improve our understanding of how integrated regional changes in the Arctic will likely influence the evolution of the global climate system. Copyright ?? 2006 by Annual Reviews. All rights reserved.

  10. Structural Heterogeneities in Southeast Tibet: Implications for Regional Flow in the Lower Crust and Upper Mantle

    Directory of Open Access Journals (Sweden)

    Zhi Wang

    2012-01-01

    Full Text Available Our seismic study together with the MT analysis reveal a “R-shape” flow existing in both the lower crust and uppermost mantle, which suggests the crustal deformation along the deep, large sutures (such as the Longmen Shan fault and the Anninghe Fault under the southeastern Tibetan Plateau is maintained by dynamic pressure from the regional flow intermingled with the hot upwelling asthenosphere. The material in the lower crust and uppermost mantle flowing outward from the center of the plateau is buttressed by the old, strong lithosphere that underlies the Sichuan basin, pushing up on the crust above and maintaining steep orogenic belt through dynamic pressure. We therefore consider that the “R-shape” regional flow played a key role in the crustal deformation along the deep suture zones of the Bangong-Nujiang, the Longmen-Shan faults, and other local heavily faulted zones beneath the southeastern Tibetan Plateau.

  11. Asymmetric Power Balance and Its Implications for Regionalism in South Asia

    Science.gov (United States)

    2015-03-01

    constitutes an ideal grouping for economic integration.16 The political dimensions are mainly overshadowed with security concerns among member states...United States’ to the North American Free Trade Agreement ( NAFTA ).39 The region’s geo-politics strongly suggest that India is the best candidate for...dynamics in South Asia. Many scholars have put forth their view on what constitutes regional cooperation and integration. E.B. Haas defines the

  12. Central Asia: Regional Developments and Implications for U.S. Interests

    Science.gov (United States)

    2012-09-19

    the Trilateral Cooperation at the Former Semipalatinsk Test Site , March 26, 2012. 13 U.S. Senate, Committee on Foreign Relations, Subcommittee on...former Semipalatinsk Test Site in East Kazakhstan Region.127 Kazakhstan and Uzbekistan hosted major chemical and biological warfare (CBW) facilities...Uzbekistan’s Nukus chemical weapons research facility. CTR aid also was used to eliminate active anthrax spores at a former CBW test site on an island in

  13. Signal displacement in spiral-in acquisitions: simulations and implications for imaging in SFG regions.

    Science.gov (United States)

    Brewer, Kimberly D; Rioux, James A; Klassen, Martyn; Bowen, Chris V; Beyea, Steven D

    2012-07-01

    Susceptibility field gradients (SFGs) cause problems for functional magnetic resonance imaging (fMRI) in regions like the orbital frontal lobes, leading to signal loss and image artifacts (signal displacement and "pile-up"). Pulse sequences with spiral-in k-space trajectories are often used when acquiring fMRI in SFG regions such as inferior/medial temporal cortex because it is believed that they have improved signal recovery and decreased signal displacement properties. Previously postulated theories explain differing reasons why spiral-in appears to perform better than spiral-out; however it is clear that multiple mechanisms are occurring in parallel. This study explores differences in spiral-in and spiral-out images using human and phantom empirical data, as well as simulations consistent with the phantom model. Using image simulations, the displacement of signal was characterized using point spread functions (PSFs) and target maps, the latter of which are conceptually inverse PSFs describing which spatial locations contribute signal to a particular voxel. The magnitude of both PSFs and target maps was found to be identical for spiral-out and spiral-in acquisitions, with signal in target maps being displaced from distant regions in both cases. However, differences in the phase of the signal displacement patterns that consequently lead to changes in the intervoxel phase coherence were found to be a significant mechanism explaining differences between the spiral sequences. The results demonstrate that spiral-in trajectories do preserve more total signal in SFG regions than spiral-out; however, spiral-in does not in fact exhibit decreased signal displacement. Given that this signal can be displaced by significant distances, its recovery may not be preferable for all fMRI applications. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Vegetation-induced turbulence influencing evapotranspiration-soil moisture coupling: Implications for semiarid regions

    Science.gov (United States)

    Haghighi, E.; Kirchner, J. W.; Entekhabi, D.

    2016-12-01

    The relationship between soil moisture and evapotranspiration (ET) fluxes is an important component of land-atmosphere interactions controlling hydrology-climate feedback processes. Important as this relationship is, it remains empirical and physical mechanisms governing its dynamics are insufficiently studied. This is particularly of importance for semiarid regions (currently comprising about half of the Earth's land surface) where the shallow surface soil layer is the primary source of ET and direct evaporation from bare soil is likely a large component of the total flux. Hence, ET-soil moisture coupling in these regions is hypothesized to be strongly influenced by soil evaporation and associated mechanisms. Motivated by recent progress in mechanistic modeling of localized heat and mass exchange rates from bare soil surfaces covered by cylindrical bluff-body elements, we developed a physically based ET model explicitly incorporating coupled impacts of soil moisture and vegetation-induced turbulence in the near-surface region. Model predictions of ET and its partitioning were in good agreement with measured data and suggest that the strength and nature of ET-soil moisture interactions in sparsely vegetated areas are strongly influenced by aerodynamic (rather than radiative) forcing namely wind speed and near-surface turbulence generation as a function of vegetation type and cover fraction. The results demonstrated that the relationship between ET and soil moisture varies from a nonlinear function (the dual regime behavior) to a single moisture-limited regime (linear relationship) by increasing wind velocity and enhancing turbulence generation in the near-surface region (small-scale woody vegetation species of low cover fraction). Potential benefits of this study for improving accuracy and predictive capabilities of remote sensing techniques when applied to semiarid environments will also be discussed.

  15. VOCs and OVOCs distribution and control policy implications in Pearl River Delta region, China

    Science.gov (United States)

    Louie, Peter K. K.; Ho, Josephine W. K.; Tsang, Roy C. W.; Blake, Donald R.; Lau, Alexis K. H.; Yu, Jian Zhen; Yuan, Zibing; Wang, Xinming; Shao, Min; Zhong, Liuju

    2013-09-01

    Ambient air measurements of volatile organic compounds (VOCs) and oxygenated volatile organic compounds (OVOCs) were conducted and characterised during a two-year grid study in the Pearl River Delta (PRD) region of southern China. The present grid study pioneered the systematic investigation of the nature and characteristics of complex VOC and OVOC sources at a regional scale. The largest contributing VOCs, accounting over 80% of the total VOCs mixing ratio, were toluene, ethane, ethyne, propane, ethene, butane, benzene, pentane, ethylbenzene, and xylenes. Sub-regional VOC spatial characteristics were identified, namely: i) relatively fresh pollutants, consistent with elevated vehicular and industrial activities, around the PRD estuary; and ii) a concentration gradient with higher mixing ratios of VOCs in the west as compared with the eastern part of PRD. Based on alkyl nitrate aging determination, a high hydroxyl radical (OH) concentration favoured fast hydrocarbon reactions and formation of locally produced ozone. The photochemical reactivity analysis showed aromatic hydrocarbons and alkenes together consisted of around 80% of the ozone formation potential (OFP) among the key VOCs. We also found that the OFP from OVOCs should not be neglected since their OFP contribution was more than one-third of that from VOCs alone. These findings support the choice of current air pollution control policy which focuses on vehicular sources but warrants further controls. Industrial emissions and VOCs emitted by solvents should be the next targets for ground-level ozone abatement.

  16. Modeling a clean energy standard for electricity: Policy design implications for emissions, supply, prices, and regions

    International Nuclear Information System (INIS)

    Paul, Anthony; Palmer, Karen; Woerman, Matt

    2013-01-01

    The electricity sector is responsible for roughly 40% of U.S. carbon dioxide (CO 2 ) emissions, and a reduction in CO 2 emissions from electricity generation is an important component of the U.S. strategy to reduce greenhouse gas emissions. Toward that goal, several proposals for a clean energy standard (CES) have been put forth, including one espoused by the Obama administration that calls for 80% clean electricity by 2035 phased in from current levels of roughly 40%. This paper looks at the effects of such a policy on CO 2 emissions from the electricity sector, the mix of technologies used to supply electricity, electricity prices, and regional flows of clean energy credits. The CES leads to a 30% reduction in cumulative CO 2 emissions between 2013 and 2035 and results in dramatic reductions in generation from conventional coal. The policy also results in fairly modest increases on national electricity prices, but this masks a wide variety of effects across regions. - Highlights: ► We model a clean energy standard (CES) for electricity at 80% by 2035. ► We analyze effects on CO 2 emissions, investment, prices, and credit trading. ► 80% CES leads to 30% reduction in cumulative CO 2 emissions by 2035. ► Modest national average electricity price increase masks regional heterogeneity

  17. Implications of the cattle trade network in Cameroon for regional disease prevention and control

    Science.gov (United States)

    Motta, Paolo; Porphyre, Thibaud; Handel, Ian; Hamman, Saidou M.; Ngu Ngwa, Victor; Tanya, Vincent; Morgan, Kenton; Christley, Rob; Bronsvoort, Barend M. Dec.

    2017-03-01

    Movement of live animals is a major risk factor for the spread of livestock diseases and zoonotic infections. Understanding contact patterns is key to informing cost-effective surveillance and control strategies. In West and Central Africa some of the most rapid urbanization globally is expected to increase the demand for animal-source foods and the need for safer and more efficient animal production. Livestock trading points represent a strategic contact node in the dissemination of multiple pathogens. From October 2014 to May 2015 official transaction records were collected and a questionnaire-based survey was carried out in cattle markets throughout Western and Central-Northern Cameroon. The data were used to analyse the cattle trade network including a total of 127 livestock markets within Cameroon and five neighboring countries. This study explores for the first time the influence of animal trade on infectious disease spread in the region. The investigations showed that national borders do not present a barrier against pathogen dissemination and that non-neighbouring countries are epidemiologically connected, highlighting the importance of a regional approach to disease surveillance, prevention and control. Furthermore, these findings provide evidence for the benefit of strategic risk-based approaches for disease monitoring, surveillance and control, as well as for communication and training purposes through targeting key regions, highly connected livestock markets and central trading links.

  18. The intersubject and intrasubject reproducibility of FMRI activation during three encoding tasks: implications for clinical applications

    Energy Technology Data Exchange (ETDEWEB)

    Harrington, Greg S. [Virginia Commonwealth University, Department of Radiology, Richmond, VA (United States); Tomaszewski Farias, Sarah [University of California at Davis, Department of Neurology, Sacramento (United States); Buonocore, Michael H. [University of California at Davis, Department of Radiology, Sacramento (United States); Yonelinas, Andrew P. [University of California at Davis, Department of Psychology, Davis (United States)

    2006-07-15

    The goal of the present study was to evaluate the inter- and intrasubject reproducibility of FMRI activation for three memory encoding tasks previously used in the context of presurgical functional mapping. The primary region of interest (ROI) was the medial temporal lobe (MTL). Comparative ROIs included the inferior frontal and fusiform gyri which are less affected by susceptibility-induced signal losses than the MTL regions. Eighteen subjects were scanned using three memory encoding paradigms: word-pair, pattern, and scene encoding. Nine subjects underwent repeat scanning. Intersubject reproducibility of FMRI activation was evaluated by examining the percent of subjects who showed activation within a given ROI and the range to which individual laterality indices (LIs) varied from the mean. Intrasubject test-retest reproducibility was evaluated by examining the LI test-retest correlation, the average difference between LIs from two separate imaging sessions, and concordance ratios of activation volumes (R{sub volume} and R{sub overlap}). For scene encoding the reproducibility of activation volume and LIs within the MTL were as good as or better than the reproducibility within the fusiform and inferior frontal ROIs. For pattern encoding and word-pair encoding, the reproducibility of activation volume and LIs within the MTL tended to be worse compared to the fusiform and inferior frontal ROIs. The differences in FMRI reproducibility appeared more dependent on the task than the susceptibility effects. The results of this study suggest that FMRI-based assessment of the neural substrates of memory using a scene encoding task may be a useful clinical tool. (orig.)

  19. The intersubject and intrasubject reproducibility of FMRI activation during three encoding tasks: implications for clinical applications

    International Nuclear Information System (INIS)

    Harrington, Greg S.; Tomaszewski Farias, Sarah; Buonocore, Michael H.; Yonelinas, Andrew P.

    2006-01-01

    The goal of the present study was to evaluate the inter- and intrasubject reproducibility of FMRI activation for three memory encoding tasks previously used in the context of presurgical functional mapping. The primary region of interest (ROI) was the medial temporal lobe (MTL). Comparative ROIs included the inferior frontal and fusiform gyri which are less affected by susceptibility-induced signal losses than the MTL regions. Eighteen subjects were scanned using three memory encoding paradigms: word-pair, pattern, and scene encoding. Nine subjects underwent repeat scanning. Intersubject reproducibility of FMRI activation was evaluated by examining the percent of subjects who showed activation within a given ROI and the range to which individual laterality indices (LIs) varied from the mean. Intrasubject test-retest reproducibility was evaluated by examining the LI test-retest correlation, the average difference between LIs from two separate imaging sessions, and concordance ratios of activation volumes (R volume and R overlap ). For scene encoding the reproducibility of activation volume and LIs within the MTL were as good as or better than the reproducibility within the fusiform and inferior frontal ROIs. For pattern encoding and word-pair encoding, the reproducibility of activation volume and LIs within the MTL tended to be worse compared to the fusiform and inferior frontal ROIs. The differences in FMRI reproducibility appeared more dependent on the task than the susceptibility effects. The results of this study suggest that FMRI-based assessment of the neural substrates of memory using a scene encoding task may be a useful clinical tool. (orig.)

  20. Clinical Implications of Basic Science Discoveries: Immune Homeostasis and the Microbiome-Dietary and Therapeutic Modulation and Implications for Transplantation.

    Science.gov (United States)

    Fishman, J A; Thomson, A W

    2015-07-01

    Links between the human microbiome and the innate and adaptive immune systems and their impact on autoimmune and inflammatory diseases are only beginning to be recognized. Characterization of the complex human microbial community is facilitated by culture-independent nucleic acid sequencing tools and bioinformatics systems. Specific organisms and microbial antigens are linked with initiation of innate immune responses that, depending on the context, may be associated with tolerogenic or effector immune responses. Further complexity is introduced by preclinical data that demonstrate the impacts of dietary manipulation on the prevention of genetically determined, systemic autoimmune disorders and on gastrointestinal microbiota. Investigation of interactions of complex microbial populations with the human immune system may provide new targets for clinical management in allotransplantation. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.

  1. Geodynamic models assist in determining the South Loyalty Basin's slab location and its implications for regional topography

    Science.gov (United States)

    Clark, Stuart R.

    2010-05-01

    In the Western Pacific, two competing kinematic reconstructions exist: one with wholly westward subduction of the Pacific plate at what is now the Tonga-Kermadec trench and one combining a degree of eastward subduction under what has been termed the New Caledonia trench. New seismological observations indicate that eastward subduction could explain the existence of a fast anomaly, the hyothesised South Loyalty Basin slab, below the 660km transition zone distinct from the fast anomaly aligned with the Tonga-Kermadec slab. A plate reconstruction dated from the suggested initiation of New Caledonia subduction in the Eocene has been developed. This reconstruction is then used to predict the thermal history of the region and together provide kinematic and thermal boundary conditions for a regional mantle convection model. The model-predicted location of the South Loyalty Basin slab's location will be presented along with the location's dependence on the mantle rheological parameters and the hotspot reference frame. The implications for the topography of the region will also be discussed.

  2. Intraspecific venom variation in the medically significant Southern Pacific Rattlesnake (Crotalus oreganus helleri): biodiscovery, clinical and evolutionary implications.

    Science.gov (United States)

    Sunagar, Kartik; Undheim, Eivind A B; Scheib, Holger; Gren, Eric C K; Cochran, Chip; Person, Carl E; Koludarov, Ivan; Kelln, Wayne; Hayes, William K; King, Glenn F; Antunes, Agosthino; Fry, Bryan Grieg

    2014-03-17

    the Catalina Island population appears to have evolved under the constraint of negative selection. Both lectin chains were conspicuously absent in both the proteomics and transcriptomics of the Idyllwild population. Thus, we not only highlight the tremendous biochemical diversity in C. o. helleri's venom-arsenal, but we also show that they experience remarkably variable strengths of evolutionary selection pressures, within each toxin class among populations and among toxin classes within each population. The mapping of geographical venom variation not only provides additional information regarding venom evolution, but also has direct medical implications by allowing prediction of the clinical effects of rattlesnake bites from different regions. Such information, however, also points to these highly variable venoms as being a rich source of novel toxins which may ultimately prove to be useful in drug design and development. These results have direct implications for the treatment of envenomed patients. The variable venom profile of Crotalus oreganus helleri underscores the biodiscovery potential of novel snake venoms. Copyright © 2014 Elsevier B.V. All rights reserved.

  3. Regional flood reconstruction in Kullu District (Himachal Pradesh, India): implication for Disaster Risk Management

    Science.gov (United States)

    Ballesteros-Cánovas, Juan Antonio; Stoffel, Markus; Trappmann, Daniel; Shekhar, Mayank; Bhattacharyya, Amalava

    2016-04-01

    Floods are a common natural hazard in the Western Indian Himalayas. They usually occur when humid monsoon airs are lifted along the Himalayan relief, thereby creating intense orographic rainfall and runoff, a process which is often enhanced by simultaneous snowmelt. Monsoon floods are considered a major threat in the region and frequently affect inhabited valleys, disturbing the status quo of communities, stressing the future welfare and condition of their economic development. Given the assumption that ongoing and future climatic changes may impact on monsoon patterns and extreme precipitation, the implementation of adaptation policies in this region is critically needed in order to improve local resilience of Himalayan communities. However, its success implementation is highly dependent on system knowledge and hence reliable baseline data of past disasters. In this communication, we demonstrate how newly gained knowledge on past flood incidents may improve flood hazard and risk assessments. Based on growth-ring analysis of trees growing in the floodplains and other, more classical paleo-hydrology techniques, we reconstruct the regional flood activity for the last decades. This information is then included as non-systematic data into the regional flood frequency by using Bayesian Markov Monte Carlo Chain algorithms, so as to analyse the impact of the additional data on flood hazard assessments. Moreover, through a detailed analysis of three flood risk hotspots, we demonstrate how the newly gained knowledge on past flood disasters derived from indirect proxies can explain failures in the implementation of disaster risk management (DRM). Our methodology allowed identification of thirty-four unrecorded flood events at the study sites located in the upper reaches since the early 20th century, and thus completion of the existing flood history in the region based on flow measurements in the lower part of the catchment. We observe that 56% of the floods occurred

  4. Regional Distribution Shifts Help Explain Local Changes in Wintering Raptor Abundance: Implications for Interpreting Population Trends

    Science.gov (United States)

    Paprocki, Neil; Heath, Julie A.; Novak, Stephen J.

    2014-01-01

    Studies of multiple taxa across broad-scales suggest that species distributions are shifting poleward in response to global climate change. Recognizing the influence of distribution shifts on population indices will be an important part of interpreting trends within management units because current practice often assumes that changes in local populations reflect local habitat conditions. However, the individual- and population-level processes that drive distribution shifts may occur across a large, regional scale and have little to do with the habitats within the management unit. We examined the latitudinal center of abundance for the winter distributions of six western North America raptor species using Christmas Bird Counts from 1975–2011. Also, we considered whether population indices within western North America Bird Conservation Regions (BCRs) were explained by distribution shifts. All six raptors had significant poleward shifts in their wintering distributions over time. Rough-legged Hawks (Buteo lagopus) and Golden Eagles (Aquila chrysaetos) showed the fastest rate of change, with 8.41 km yr−1 and 7.74 km yr−1 shifts, respectively. Raptors may be particularly responsive to warming winters because of variable migration tendencies, intraspecific competition for nesting sites that drives males to winter farther north, or both. Overall, 40% of BCR population trend models were improved by incorporating information about wintering distributions; however, support for the effect of distribution on BCR indices varied by species with Rough-legged Hawks showing the most evidence. These results emphasize the importance of understanding how regional distribution shifts influence local-scale population indices. If global climate change is altering distribution patterns, then trends within some management units may not reflect changes in local habitat conditions. The methods used to monitor and manage bird populations within local BCRs will fundamentally change as

  5. Global and regional phosphorus budgets in agricultural systems and their implications for phosphorus-use efficiency

    Directory of Open Access Journals (Sweden)

    F. Lun

    2018-01-01

    Full Text Available The application of phosphorus (P fertilizer to agricultural soils increased by 3.2 % annually from 2002 to 2010. We quantified in detail the P inputs and outputs of cropland and pasture and the P fluxes through human and livestock consumers of agricultural products on global, regional, and national scales from 2002 to 2010. Globally, half of the total P inputs into agricultural systems accumulated in agricultural soils during this period, with the rest lost to bodies of water through complex flows. Global P accumulation in agricultural soil increased from 2002 to 2010 despite decreases in 2008 and 2009, and the P accumulation occurred primarily in cropland. Despite the global increase in soil P, 32 % of the world's cropland and 43 % of the pasture had soil P deficits. Increasing soil P deficits were found for African cropland vs. increasing P accumulation in eastern Asia. European and North American pasture had a soil P deficit because the continuous removal of biomass P by grazing exceeded P inputs. International trade played a significant role in P redistribution among countries through the flows of P in fertilizer and food among countries. Based on country-scale budgets and trends we propose policy options to potentially mitigate regional P imbalances in agricultural soils, particularly by optimizing the use of phosphate fertilizer and the recycling of waste P. The trend of the increasing consumption of livestock products will require more P inputs to the agricultural system, implying a low P-use efficiency and aggravating P-stock scarcity in the future. The global and regional phosphorus budgets and their PUEs in agricultural systems are publicly available at https://doi.pangaea.de/10.1594/PANGAEA.875296.

  6. Implications of regional improvement in global climate models for agricultural impact research

    International Nuclear Information System (INIS)

    Ramirez-Villegas, Julian; Thornton, Philip K; Jarvis, Andy; Challinor, Andrew J

    2013-01-01

    Global climate models (GCMs) have become increasingly important for climate change science and provide the basis for most impact studies. Since impact models are highly sensitive to input climate data, GCM skill is crucial for getting better short-, medium- and long-term outlooks for agricultural production and food security. The Coupled Model Intercomparison Project (CMIP) phase 5 ensemble is likely to underpin the majority of climate impact assessments over the next few years. We assess 24 CMIP3 and 26 CMIP5 simulations of present climate against climate observations for five tropical regions, as well as regional improvements in model skill and, through literature review, the sensitivities of impact estimates to model error. Climatological means of seasonal mean temperatures depict mean errors between 1 and 18 ° C (2–130% with respect to mean), whereas seasonal precipitation and wet-day frequency depict larger errors, often offsetting observed means and variability beyond 100%. Simulated interannual climate variability in GCMs warrants particular attention, given that no single GCM matches observations in more than 30% of the areas for monthly precipitation and wet-day frequency, 50% for diurnal range and 70% for mean temperatures. We report improvements in mean climate skill of 5–15% for climatological mean temperatures, 3–5% for diurnal range and 1–2% in precipitation. At these improvement rates, we estimate that at least 5–30 years of CMIP work is required to improve regional temperature simulations and at least 30–50 years for precipitation simulations, for these to be directly input into impact models. We conclude with some recommendations for the use of CMIP5 in agricultural impact studies. (letter)

  7. Managing saltwater intrusion in coastal arid regions and its societal implications for agriculture

    Directory of Open Access Journals (Sweden)

    J. Grundmann

    2016-05-01

    Full Text Available Coastal aquifers in arid and semiarid regions are particularly at risk due to intrusion of salty marine water. Since groundwater is predominantly used in irrigated agriculture, its excessive pumping – above the natural rate of replenishment – strengthen the intrusion process. Using this increasingly saline water for irrigation, leads to a destruction of valuable agricultural resources and the economic basis of farmers and their communities. The limitation of resources (water and soil in these regions requires a societal adaptation and change in behaviour as well as the development of appropriate management strategies for a transition towards stable and sustainable future hydrosystem states. Besides a description of the system dynamics and the spatial consequences of adaptation on the resources availability, the contribution combines results of an empirical survey with stakeholders and physically based modelling of the groundwater-agriculture hydrosystem interactions. This includes an analysis of stakeholders' (farmers and decision makers behaviour and opinions regarding several management interventions aiming on water demand and water resources management as well as the thinking of decision makers how farmers will behave. In this context, the technical counter measures to manage the saltwater intrusion by simulating different groundwater pumping strategies and scenarios are evaluated from the economic and social point of view and if the spatial variability of the aquifer's hydrogeology is taken into consideration. The study is exemplarily investigated for the south Batinah region in the Sultanate of Oman, which is affected by saltwater intrusion into a coastal aquifer system due to excessive groundwater withdrawal for irrigated agriculture.

  8. Global and regional phosphorus budgets in agricultural systems and their implications for phosphorus-use efficiency

    Science.gov (United States)

    Lun, Fei; Liu, Junguo; Ciais, Philippe; Nesme, Thomas; Chang, Jinfeng; Wang, Rong; Goll, Daniel; Sardans, Jordi; Peñuelas, Josep; Obersteiner, Michael

    2018-01-01

    The application of phosphorus (P) fertilizer to agricultural soils increased by 3.2 % annually from 2002 to 2010. We quantified in detail the P inputs and outputs of cropland and pasture and the P fluxes through human and livestock consumers of agricultural products on global, regional, and national scales from 2002 to 2010. Globally, half of the total P inputs into agricultural systems accumulated in agricultural soils during this period, with the rest lost to bodies of water through complex flows. Global P accumulation in agricultural soil increased from 2002 to 2010 despite decreases in 2008 and 2009, and the P accumulation occurred primarily in cropland. Despite the global increase in soil P, 32 % of the world's cropland and 43 % of the pasture had soil P deficits. Increasing soil P deficits were found for African cropland vs. increasing P accumulation in eastern Asia. European and North American pasture had a soil P deficit because the continuous removal of biomass P by grazing exceeded P inputs. International trade played a significant role in P redistribution among countries through the flows of P in fertilizer and food among countries. Based on country-scale budgets and trends we propose policy options to potentially mitigate regional P imbalances in agricultural soils, particularly by optimizing the use of phosphate fertilizer and the recycling of waste P. The trend of the increasing consumption of livestock products will require more P inputs to the agricultural system, implying a low P-use efficiency and aggravating P-stock scarcity in the future. The global and regional phosphorus budgets and their PUEs in agricultural systems are publicly available at https://doi.pangaea.de/10.1594/PANGAEA.875296.

  9. Regional distribution shifts help explain local changes in wintering raptor abundance: implications for interpreting population trends.

    Directory of Open Access Journals (Sweden)

    Neil Paprocki

    Full Text Available Studies of multiple taxa across broad-scales suggest that species distributions are shifting poleward in response to global climate change. Recognizing the influence of distribution shifts on population indices will be an important part of interpreting trends within management units because current practice often assumes that changes in local populations reflect local habitat conditions. However, the individual- and population-level processes that drive distribution shifts may occur across a large, regional scale and have little to do with the habitats within the management unit. We examined the latitudinal center of abundance for the winter distributions of six western North America raptor species using Christmas Bird Counts from 1975-2011. Also, we considered whether population indices within western North America Bird Conservation Regions (BCRs were explained by distribution shifts. All six raptors had significant poleward shifts in their wintering distributions over time. Rough-legged Hawks (Buteo lagopus and Golden Eagles (Aquila chrysaetos showed the fastest rate of change, with 8.41 km yr(-1 and 7.74 km yr(-1 shifts, respectively. Raptors may be particularly responsive to warming winters because of variable migration tendencies, intraspecific competition for nesting sites that drives males to winter farther north, or both. Overall, 40% of BCR population trend models were improved by incorporating information about wintering distributions; however, support for the effect of distribution on BCR indices varied by species with Rough-legged Hawks showing the most evidence. These results emphasize the importance of understanding how regional distribution shifts influence local-scale population indices. If global climate change is altering distribution patterns, then trends within some management units may not reflect changes in local habitat conditions. The methods used to monitor and manage bird populations within local BCRs will fundamentally

  10. Comparison of regional and global land cover products and the implications for biogenic emission modeling.

    Science.gov (United States)

    Huang, Ling; McDonald-Buller, Elena; McGaughey, Gary; Kimura, Yosuke; Allen, David T

    2015-10-01

    Accurate estimates of biogenic emissions are required for air quality models that support the development of air quality management plans and attainment demonstrations. Land cover characterization is an essential driving input for most biogenic emissions models. This work contrasted the global Moderate Resolution Imaging Spectroradiometer (MODIS) land cover product against a regional land cover product developed for the Texas Commissions on Environmental Quality (TCEQ) over four climate regions in eastern Texas, where biogenic emissions comprise a large fraction of the total inventory of volatile organic compounds (VOCs) and land cover is highly diverse. The Model of Emissions of Gases and Aerosols from Nature (MEGAN) was utilized to investigate the influences of land cover characterization on modeled isoprene and monoterpene emissions through changes in the standard emission potential and emission activity factor, both separately and simultaneously. In Central Texas, forest coverage was significantly lower in the MODIS land cover product relative to the TCEQ data, which resulted in substantially lower estimates of isoprene and monoterpene emissions by as much as 90%. Differences in predicted isoprene and monoterpene emissions associated with variability in land cover characterization were primarily caused by differences in the standard emission potential, which is dependent on plant functional type. Photochemical modeling was conducted to investigate the effects of differences in estimated biogenic emissions associated with land cover characterization on predicted ozone concentrations using the Comprehensive Air Quality Model with Extensions (CAMx). Mean differences in maximum daily average 8-hour (MDA8) ozone concentrations were 2 to 6 ppb with maximum differences exceeding 20 ppb. Continued focus should be on reducing uncertainties in the representation of land cover through field validation. Uncertainties in the estimation of biogenic emissions associated with

  11. Duration of Parana magmatism and implications for the evolution and source regions of continental flood basalts

    International Nuclear Information System (INIS)

    Mantovani, M.S.M.; Stewart, K.; Turner, S.; Hawkesworth, C.J.

    1995-01-01

    Duration of Continental Floods Basalts magmatism has generally been considered to be extremely short. Ar-Ar data for different magma type, over a broad region within Parana, demonstrate a duration of 10 Ma, an order of magnitude greater than the usually accepted duration of magmatism. The dating method included rigorous geochemical selection tests, to discard altered samples, combined with the analysis of laser spot technique using the isochron approach. This methodology allows discrimination between rocks which yield precise ages and those which are too altered or heterogeneous. The agreement between the determined age and the relative stratigraphic position of samples supports the above statement. 4 figs

  12. Duration of Parana magmatism and implications for the evolution and source regions of continental flood basalts

    Energy Technology Data Exchange (ETDEWEB)

    Mantovani, M.S.M. [Sao Paulo Univ., SP (Brazil). Inst. Astronomico e Geofisico; Stewart, K.; Turner, S.; Hawkesworth, C.J. [Open Univ., Milton Keynes (United Kingdom). Dept. of Earth Sciences

    1995-12-31

    Duration of Continental Floods Basalts magmatism has generally been considered to be extremely short. Ar-Ar data for different magma type, over a broad region within Parana, demonstrate a duration of 10 Ma, an order of magnitude greater than the usually accepted duration of magmatism. The dating method included rigorous geochemical selection tests, to discard altered samples, combined with the analysis of laser spot technique using the isochron approach. This methodology allows discrimination between rocks which yield precise ages and those which are too altered or heterogeneous. The agreement between the determined age and the relative stratigraphic position of samples supports the above statement. 4 figs.

  13. Demographic trends in the Lodz region and their implications for seniors 50+

    Directory of Open Access Journals (Sweden)

    Jolanta Woźnica

    2014-12-01

    Simultaneously, due to declining birth rates, prolongation of human life and emigration, especially young people, are progressing aging of the population, including labor resources. It is already a serious problem is the high proportion of economically inactive older people , and also low rates of labor force participation and employment. Shaped so the situation there is a need to take action at the regional level, aimed at creating conditions for continuation of work for persons having a retirement age through measures to improve the functioning of the working environment of older people.

  14. Development of ghrelin transgenic mice for elucidation of clinical implication of ghrelin.

    Science.gov (United States)

    Aotani, Daisuke; Ariyasu, Hiroyuki; Shimazu-Kuwahara, Satoko; Shimizu, Yoshiyuki; Nomura, Hidenari; Murofushi, Yoshiteru; Kaneko, Kentaro; Izumi, Ryota; Matsubara, Masaki; Kanda, Hajime; Noguchi, Michio; Tanaka, Tomohiro; Kusakabe, Toru; Miyazawa, Takashi; Nakao, Kazuwa

    2017-01-01

    To elucidate the clinical implication of ghrelin, we have been trying to generate variable models of transgenic (Tg) mice overexpressing ghrelin. We generated Tg mice overexpressing des-acyl ghrelin in a wide variety of tissues under the control of β-actin promoter. While plasma des-acyl ghrelin level in the Tg mice was 44-fold greater than that of control mice, there was no differences in the plasma ghrelin level between des-acyl ghrelin Tg and the control mice. The des-acyl ghrelin Tg mice exhibited the lower body weight and the shorter body length due to modulation of GH-IGF-1 axis. We tried to generate Tg mice expressing a ghrelin analog, which possessed ghrelin-like activity (Trp 3 -ghrelin Tg mice). The plasma Trp 3 -ghrelin concentration in Trp 3 -ghrelin Tg mice was approximately 85-fold higher than plasma ghrelin (acylated ghrelin) concentration seen in the control mice. Because Trp 3 -ghrelin is approximately 24-fold less potent than ghrelin, the plasma Trp 3 -ghrelin concentration in Trp 3 -ghrelin Tg mice was calculated to have approximately 3.5-fold biological activity greater than that of ghrelin (acylated ghrelin) in the control mice. Trp 3 -ghrelin Tg mice did not show any phenotypes except for reduced insulin sensitivity in 1-year old. After the identification of ghrelin O-acyltransferase (GOAT), we generated doubly Tg mice overexpressing both mouse des-acyl ghrelin and mouse GOAT in the liver by cross-mating the two kinds of Tg mice. The plasma ghrelin concentration of doubly Tg mice was approximately 2-fold higher than that of the control mice. No apparent phenotypic changes in body weight and food intake were observed in doubly Tg mice. Further studies are ongoing in our laboratory to generate Tg mice with the increased plasma ghrelin level to a greater extent. The better understanding of physiological and pathophysiological significance of ghrelin from experiments using an excellent animal model may provide a new therapeutic approach for human

  15. Clinical implications of diffuse slow washout of thallium-201 in exercise stress myocardial SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Murano, Kenichi; Usami, Masahisa; Honda, Minoru (Sumitomo Hospital, Osaka (Japan))

    1991-07-01

    Clinical implications of diffuse slow washout of thallium-201 (DSWO) in exercise-redistribution myocardial SPECT were studied. Thallium-201 washout rate was calculated by Bull's-eye method. DSWO was defined as having abnormal thallium-201 washout rate (<30% per 3 hours) in more than two thirds of each coronary artery (CA) area. Of 974 patients whose exercise heart rate exceeded 120/min, 51 (5.2%) showed DSWO and coronary angiography was performed in 43. Twenty-three patients (53%) showed triple vessel disease (3VD), 8 (19%) showed single or double vessel disease (1VD/2VD) and 12 (28%) showed normal CA. Patients with normal CA consisted of 6 patients with hypertrophic cardiomyopathy (HCM), 5 with hypertension (HT) and one with electrocardiographic abnormality only. The cause of DSWO were assessed from the history of effort angina (EA) and congestive heart failure (CHF), delayed fill-in of the perfusion defect and the ratio of lung to heart thallium-201 activity (L/M) at exercise as an indicator of the left ventricular (LV) function. High prevalence of EA (74%), high incidence of scintigraphic delayed fill-in (83%) and normal L/M suggested diffuse LV ischemia as the cause of DSWO in 3VD. On the other hand in patients with 1VD/2VD, LV dysfunction at exercise was considered as the cause of DSWO because of low prevalence of EA (13%) and scintigraphic delayed fill-in (13%)(p<0.01, p<0.005 each vs 3VD), and high L/M (p<0.001 vs 3VD) and high prevalence of CHF (38%, NS). In patients with HCM LV ischemia at small vessel levels was assumed as the cause of DSWO from the high incidence of EA (83%) and delayed fill-in (50%), low L/M and normal CA. In cases of HTLV dysfunction and/or LV ischemia at the small vessel levels were considered as the cause of DSWO. Thus, it was concluded that DSWO is a noteworthy finding in exercise stress myocardial imaging. (author).

  16. Attitudes of psychology students to depression and its treatment: Implications for clinical practice.

    Science.gov (United States)

    Economou, M; Peppou, L E; Geroulanou, K; Kontoangelos, K; Prokopi, A; Pantazi, A; Zervakaki, A; Stefanis, C N

    2017-01-01

    . The core misconception espoused pertains to the view that major depression is not a medical illness; a finding which can also be interpreted in light of the lingering controversy on the medicalization of normal sadness and human predicament. The clinical implications of these findings are substantial. Mental health professionals-educators should reflect on their own beliefs and attitudes towards depression, as they may convey stigmatizing messages to their students and thus perpetuate the stigmatization of the illness. Concomitantly, psychology students' attitudes to depression and its treatment might render them incapable of understanding their patients, responding to their needs and providing them with appropriate help, while they may hinder their effective collaboration with psychiatrists.

  17. Reassessing carbamazepine in the treatment of bipolar disorder: clinical implications of new data.

    Science.gov (United States)

    Akiskal, Hagop S; Fuller, Matthew A; Hirschfeld, Robert M A; Keck, Paul E; Ketter, Terence A; Weisler, Richard H

    2005-06-01

    This monograph summarizes the proceedings of a roundtable meeting convened to discuss the role of carbamazepine in the treatment of bipolar disorder, in light of new data and the recent indication of carbamazepine extended-release capsules (CBZ ERC) for use in the treatment of acute manic and mixed episodes. Two lectures were presented, followed by a panel discussion among all 6 participants. A summary of the two pivotal trials of CBZ ERC and their pooled data along with other relevant data is presented first. Next, historical trends of carbamazepine and the agent's use in acute mania, bipolar depression, and maintenance are reviewed, emphasizing clinical implications of efficacy, safety, tolerability, and drug interactions. Finally, the panel discussion provides recommendations for the use of carbamazepine in different phases of the illness, taking into account adverse effects and drug-drug interactions. Panel discussants agree that current data confirm the utility of CBZ ERC as an effective treatment for acute manic and mixed episodes in bipolar disorder. Carbamazepine may also prove to be an option for maintenance treatment. Tolerability of the drug is related to dose and titration, and overall safety limitations regarding carbamazepine usage are comparable to other medications. For some patients, the main challenges to use of carbamazepine may be common drug-drug interactions and increased side effects related to aggressive introduction during treatment of acute manic and mixed episodes. Thus, carbamazepine may be a lower priority option for patients who are taking multiple medications, such as elderly individuals with medical comorbidity, due to the potential for drug interactions. Important benefits of carbamazepine include the low propensity toward weight gain and evidence of good tolerability with long-term treatment. (At present there are no available data from long-term, placebo-controlled studies evaluating the effects of carbamazepine or CBZ ERC on

  18. Comparative Genomics of Methanopyrus sp. SNP6 and KOL6 Revealing Genomic Regions of Plasticity Implicated in Extremely Thermophilic Profiles

    Directory of Open Access Journals (Sweden)

    Zhiliang Yu

    2017-07-01

    Full Text Available Methanopyrus spp. are usually isolated from harsh niches, such as high osmotic pressure and extreme temperature. However, the molecular mechanisms for their environmental adaption are poorly understood. Archaeal species is commonly considered as primitive organism. The evolutional placement of archaea is a fundamental and intriguing scientific question. We sequenced the genomes of Methanopyrus strains SNP6 and KOL6 isolated from the Atlantic and Iceland, respectively. Comparative genomic analysis revealed genetic diversity and instability implicated in niche adaption, including a number of transporter- and integrase/transposase-related genes. Pan-genome analysis also defined the gene pool of Methanopyrus spp., in addition of ~120-Kb genomic region of plasticity impacting cognate genomic architecture. We believe that Methanopyrus genomics could facilitate efficient investigation/recognition of archaeal phylogenetic diverse patterns, as well as improve understanding of biological roles and significance of these versatile microbes.

  19. Climate change in the four corners and adjacent regions: Implications for environmental restoration and land-use planning

    Energy Technology Data Exchange (ETDEWEB)

    Waugh, W.J. [ed.

    1995-09-01

    This document contains the workshop proceedings on Climate Change in the Four Corners and Adjacent Regions: Implications for Environmental Restoration and Land-Use Planning which took place September 12-14, 1994 in Grand Junction, Colorado. The workshop addressed three ways we can use paleoenvironmental data to gain a better understanding of climate change and its effects. (1) To serve as a retrospective baseline for interpreting past and projecting future climate-induced environmental change, (2) To differentiate the influences of climate and humans on past environmental change, and (3) To improve ecosystem management and restoration practices in the future. The papers presented at this workshop contained information on the following subjects: Paleoclimatic data from the Pleistocene and Holocene epochs, climate change and past cultures, and ecological resources and environmental restoration. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.

  20. [Tobacco cultivationin Salento (Apulia Region, Southern Italy) from 1929 to 1993: possible health implications].

    Science.gov (United States)

    Montinari, Maria Rosa; Minelli, Pierluca; Gianicolo, Emilio Antonio Luca

    2018-01-01

    The Province of Lecce (Apulia Region, Southern Italy) is one of the Italian areas where the prevalence of respiratory disease and cancer of the respitartory tract is very high. Through a descriptive analysis of the historical series of tobacco culture indicators, a historical reconstruction of the development of tobacco cultivation in Salento (the area where the Province of Lecce is located) is here presented, in order to provide an additional element of knowledge on potential risk factors for respiratory diseases and cancers. Data regarding extensions in hectares and crop productions in the province of Lecce, in Apulia, and in Italy are from the Chamber of commerce of Lecce province and from the Italian National Institute of Statistics (Istat). From 1929 to 1993, the province of Lecce provided between 75% and 94% of the tobacco cultivated in Apulia Region and 25% of the national tobacco until 1945. Since the late Sixties, a growing increase in annual average production was observed, reaching 21.5 quintals per hectare in 1991 in Salento. This large tobacco production, associated with intensive use of pesticides, could be an element to be observed in analytical studies as a determining potential for the high prevalence of respiratory diseases and pulmonary cancers in the male population of the province of Lecce.

  1. Regional cerebral glucose metabolic changes in oculopalatal myoclonus: implication for neural pathways, underlying the disorder

    International Nuclear Information System (INIS)

    Cho, Sang Soo; Moon, So Young; Kim, Ji Soo; Kim, Sang Eun

    2004-01-01

    Palatal myoclonus (PM) is characterized by rhythmic involuntary jerky movements of the soft palate of the throat. When associated with eye movements, it is called oculopalatal myoclonus (OPM). Ordinary PM is characterized by hypertrophic olivary degeneration, a trans-synaptic degeneration following loss of neuronal input to the inferior olivary nucleus due to an interruption of the Guillain-Mollaret triangle usually by a hemorrhage. However, the neural pathways underlying the disorder are uncertain. In an attempt to understand the pathologic neural pathways, we examined the metabolic correlates of this tremulous condition. Brain FDG PET scans were acquired in 8 patients with OPM (age, 49.9±4.6 y: all males: 7 with pontine hemorrhage, 1 with diffuse brainstem infarction) and age-matched 50 healthy males (age, 50.7± 9.0) and the regional glucose metabolism compared using SPM99. For group analysis, the hemispheres containing lesions were assigned to the right side of the brain. Patients with OPM had significant hypometabolism in the ipsilateral (to the lesion) brainstem and superior temporal and parahippocampal gyri (P < 0.05 corrected, k = 100). By contrast, there was significant hypermetabolism in the contralateral middle and inferior temporal gyri, thalamus, middle frontal gyrus and precuneus (P < 0.05 corrected, k=l00). Our data demonstrate the distinct metabolic changes between several ipsilateral and contralateral brain regions (hypometabolism vs. hypermetabolism) in patients with OPM. This may provide clues for understanding the neural pathways underlying the disorder

  2. Regional cerebral glucose metabolic changes in oculopalatal myoclonus: implication for neural pathways, underlying the disorder

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Sang Soo; Moon, So Young; Kim, Ji Soo; Kim, Sang Eun [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    2004-07-01

    Palatal myoclonus (PM) is characterized by rhythmic involuntary jerky movements of the soft palate of the throat. When associated with eye movements, it is called oculopalatal myoclonus (OPM). Ordinary PM is characterized by hypertrophic olivary degeneration, a trans-synaptic degeneration following loss of neuronal input to the inferior olivary nucleus due to an interruption of the Guillain-Mollaret triangle usually by a hemorrhage. However, the neural pathways underlying the disorder are uncertain. In an attempt to understand the pathologic neural pathways, we examined the metabolic correlates of this tremulous condition. Brain FDG PET scans were acquired in 8 patients with OPM (age, 49.9{+-}4.6 y: all males: 7 with pontine hemorrhage, 1 with diffuse brainstem infarction) and age-matched 50 healthy males (age, 50.7{+-} 9.0) and the regional glucose metabolism compared using SPM99. For group analysis, the hemispheres containing lesions were assigned to the right side of the brain. Patients with OPM had significant hypometabolism in the ipsilateral (to the lesion) brainstem and superior temporal and parahippocampal gyri (P < 0.05 corrected, k = 100). By contrast, there was significant hypermetabolism in the contralateral middle and inferior temporal gyri, thalamus, middle frontal gyrus and precuneus (P < 0.05 corrected, k=l00). Our data demonstrate the distinct metabolic changes between several ipsilateral and contralateral brain regions (hypometabolism vs. hypermetabolism) in patients with OPM. This may provide clues for understanding the neural pathways underlying the disorder.

  3. Enrichment of risk SNPs in regulatory regions implicate diverse tissues in Parkinson's disease etiology.

    Science.gov (United States)

    Coetzee, Simon G; Pierce, Steven; Brundin, Patrik; Brundin, Lena; Hazelett, Dennis J; Coetzee, Gerhard A

    2016-07-27

    Recent genome-wide association studies (GWAS) of Parkinson's disease (PD) revealed at least 26 risk loci, with associated single nucleotide polymorphisms (SNPs) located in non-coding DNA having unknown functions in risk. In order to explore in which cell types these SNPs (and their correlated surrogates at r(2) ≥ 0.8) could alter cellular function, we assessed their location overlap with histone modification regions that indicate transcription regulation in 77 diverse cell types. We found statistically significant enrichment of risk SNPs at 12 loci in active enhancers or promoters. We investigated 4 risk loci in depth that were most significantly enriched (-logeP > 14) and contained 8 putative enhancers in the different cell types. These enriched loci, along with eQTL associations, were unexpectedly present in non-neuronal cell types. These included lymphocytes, mesendoderm, liver- and fat-cells, indicating that cell types outside the brain are involved in the genetic predisposition to PD. Annotating regulatory risk regions within specific cell types may unravel new putative risk mechanisms and molecular pathways that contribute to PD development.

  4. Enrichment of risk SNPs in regulatory regions implicate diverse tissues in Parkinson’s disease etiology

    Science.gov (United States)

    Coetzee, Simon G.; Pierce, Steven; Brundin, Patrik; Brundin, Lena; Hazelett, Dennis J.; Coetzee, Gerhard A.

    2016-01-01

    Recent genome-wide association studies (GWAS) of Parkinson’s disease (PD) revealed at least 26 risk loci, with associated single nucleotide polymorphisms (SNPs) located in non-coding DNA having unknown functions in risk. In order to explore in which cell types these SNPs (and their correlated surrogates at r2 ≥ 0.8) could alter cellular function, we assessed their location overlap with histone modification regions that indicate transcription regulation in 77 diverse cell types. We found statistically significant enrichment of risk SNPs at 12 loci in active enhancers or promoters. We investigated 4 risk loci in depth that were most significantly enriched (−logeP > 14) and contained 8 putative enhancers in the different cell types. These enriched loci, along with eQTL associations, were unexpectedly present in non-neuronal cell types. These included lymphocytes, mesendoderm, liver- and fat-cells, indicating that cell types outside the brain are involved in the genetic predisposition to PD. Annotating regulatory risk regions within specific cell types may unravel new putative risk mechanisms and molecular pathways that contribute to PD development. PMID:27461410

  5. Climate Change, Extreme Weather Events, and Human Health Implications in the Asia Pacific Region.

    Science.gov (United States)

    Hashim, Jamal Hisham; Hashim, Zailina

    2016-03-01

    The Asia Pacific region is regarded as the most disaster-prone area of the world. Since 2000, 1.2 billion people have been exposed to hydrometeorological hazards alone through 1215 disaster events. The impacts of climate change on meteorological phenomena and environmental consequences are well documented. However, the impacts on health are more elusive. Nevertheless, climate change is believed to alter weather patterns on the regional scale, giving rise to extreme weather events. The impacts from extreme weather events are definitely more acute and traumatic in nature, leading to deaths and injuries, as well as debilitating and fatal communicable diseases. Extreme weather events include heat waves, cold waves, floods, droughts, hurricanes, tropical cyclones, heavy rain, and snowfalls. Globally, within the 20-year period from 1993 to 2012, more than 530 000 people died as a direct result of almost 15 000 extreme weather events, with losses of more than US$2.5 trillion in purchasing power parity. © 2015 APJPH.

  6. Local knowledge of the flora of a region: implications in biodiversity conservation

    Directory of Open Access Journals (Sweden)

    Maria da Conceição Pereira

    2016-11-01

    Full Text Available The flora of a region is important in aesthetic, environmental and economic terms. Academic degree holders are fundamental for the sustainable development of a geographically isolated region such as the Azores, the University of Azores (UAc contributing to that goal. We assessed the perception of the UAc students about the origin and the importance of the Azorean flora for conservation, culture and economy, by applying a questionnaire to 309 students in different scientific areas, addressing origin, symbolic importance, economic importance, and environmental functions. Students showed some knowledge about the concepts of endemic, native, introduced and invasive species, but often failed to connect those to specific plant taxa. Most species cited as symbolic were animals, and the plants mentioned were mainly exotic/invasive. Respondents had a sense of the most important crops and forest species, and attributed several functions related to biodiversity and environmental conservation to the flora. Despite the many actions already implemented, more initiatives are required to increase the connection between Azoreans and Azorean flora.

  7. Hearing Impaired Education of the Department of Education in Region X, Philippines: Its Approaches and Implication

    Directory of Open Access Journals (Sweden)

    James Mirabeau B. Undalok

    2015-11-01

    Full Text Available One way to attain improvement of the educational programs of the hearing impaired is by conducting survey and assessment of the status of the hearing impaired education of the Department of Education in Region X, Philippines. The Special Education (SpEd teachers play a vital role for the pupils of the hearing impaired children as they are viewed as linchpins in the learning process of the children. This cannot be attained without the different approaches on hearing impaired education. Survey -questionnaires were used to gather information needed. Data were analyzed using the descriptive statistics such as weighted mean and standard deviation. The ANOVA test was used to determine the significance of the hearing impaired education of the Department of Education in Region X. Anchored on the findings, the following conclusions are made about different educational approaches should be given priority by the SPED teachers is further enhance the lifelong learning skills of the pupils. It helps them for their learning process and acquiring language skills. There should be an advocacy on the hearing impaired education program to the public and stakeholders.

  8. Colloquy and workshops: regional implications of the engineering manpower requirements of the National Energy Program

    Energy Technology Data Exchange (ETDEWEB)

    Segool, H. D. [ed.

    1979-05-01

    The crucial interrelationships of engineering manpower, technological innovation, productivity and capital re-formaton were keynoted. Near-term, a study has indicated a much larger New England energy demand-reduction/economic/market potential, with a probably larger engineering manpower requirement, for energy-conservation measures characterized by technological innovation and cost-effective capital services than for alternative energy-supply measures. Federal, regional, and state energy program responsibilities described a wide-ranging panorama of activities among many possible energy options which conveyed much endeavor without identifiable engineering manpower demand coefficients. Similarly, engineering manpower assessment data was described as uneven and unfocused to the energy program at the national level, disaggregated data as non-existent at the regional/state levels, although some qualitative inferences were drawn. A separate abstract was prepared for each of the 16 individual presentations for the DOE Energy Data Base (EDB); 14 of these were selected for Energy Abstracts for Policy Analysis (EAPA) and 2 for Energy Research Abstracts (ERA).

  9. Local and regional energy companies offering energy services: Key activities and implications for the business model

    International Nuclear Information System (INIS)

    Kindström, Daniel; Ottosson, Mikael

    2016-01-01

    Highlights: • Many companies providing energy services are experiencing difficulties. • This research identifies key activities for the provision of energy services. • Findings are aggregated to the business-model level providing managerial insights. • This research identifies two different business model innovation paths. • Energy companies may need to renew parts of, or the entire, business model. - Abstract: Energy services play a key role in increasing energy efficiency in the industry. The key actors in these services are the local and regional energy companies that are increasingly implementing energy services as part of their market offering and developing service portfolios. Although expectations for energy services have been high, progress has so far been limited, and many companies offering energy services, including energy companies, are experiencing difficulties in implementing energy services and providing them to the market. Overall, this research examines what is needed for local and regional energy companies to successfully implement energy services (and consequently provide them to the market). In doing this, a two-stage process is used: first, we identify key activities for the successful implementation of energy services, and second, we aggregate the findings to the business model level. This research demonstrates that to succeed in implementing energy services, an energy company may need to renew parts or all of its existing product-based business model, formulate a new business model, or develop coexisting multiple business models. By discussing two distinct business model innovation processes, this research demonstrates that there can be different paths to success.

  10. Use of electrical impedance tomography to monitor regional cerebral edema during clinical dehydration treatment.

    Directory of Open Access Journals (Sweden)

    Feng Fu

    Full Text Available OBJECTIVE: Variations of conductive fluid content in brain tissue (e.g. cerebral edema change tissue impedance and can potentially be measured by Electrical Impedance Tomography (EIT, an emerging medical imaging technique. The objective of this work is to establish the feasibility of using EIT as an imaging tool for monitoring brain fluid content. DESIGN: a prospective study. SETTING: In this study EIT was used, for the first time, to monitor variations in cerebral fluid content in a clinical model with patients undergoing clinical dehydration treatment. The EIT system was developed in house and its imaging sensitivity and spatial resolution were evaluated on a saline-filled tank. PATIENTS: 23 patients with brain edema. INTERVENTIONS: The patients were continuously imaged by EIT for two hours after initiation of dehydration treatment using 0.5 g/kg intravenous infusion of mannitol for 20 minutes. MEASUREMENT AND MAIN RESULTS: Overall impedance across the brain increased significantly before and after mannitol dehydration treatment (p = 0.0027. Of the all 23 patients, 14 showed high-level impedance increase and maintained this around 4 hours after the dehydration treatment whereas the other 9 also showed great impedance gain during the treatment but it gradually decreased after the treatment. Further analysis of the regions of interest in the EIT images revealed that diseased regions, identified on corresponding CT images, showed significantly less impedance changes than normal regions during the monitoring period, indicating variations in different patients' responses to such treatment. CONCLUSIONS: EIT shows potential promise as an imaging tool for real-time and non-invasive monitoring of brain edema patients.

  11. Prevalence, Clinical Presentation, and Factors Associated With Diabetic Foot Ulcer in Two Regional Hospitals in Cameroon.

    Science.gov (United States)

    Tindong, Maxime; Palle, John N; Nebongo, Daniel; Aminde, Leopold Ndemnge; Mboue-Djieka, Yannick; Mbarga, Nicole T Fouda; Dehayem, Mesmin Y; Choukem, Siméon-Pierre

    2018-03-01

    This study aimed to determine the prevalence of diabetic foot ulcer and high risk for ulceration, describe the clinical presentation, and identify factors associated with diabetic foot ulcer in the Southwest regional hospitals of Cameroon. In this cross-sectional study, data were collected using a structured questionnaire administered to consecutive patients with diabetes. Findings from detailed foot examination were recorded. Diabetic foot ulcer was diagnosed according to the International Working Group on Diabetic Foot (IWGDF) definition. Data were analyzed with Stata IC version 12. Of the 203 participants included, 63.1% were females. Age ranged from 26 to 96 years. The median duration of diabetes was 4.0 years (interquartile range 1.0-8.0 years). The prevalence of diabetic foot ulcer was 11.8% (24), of whom 29.2% (7) had high grade (grades 2 to 4), and most of the ulcers 58.3% (14) were located at the plantar region. The prevalence of high risk for ulceration was 21.8% (39). Loss of protective sensation (OR = 3.73, 95% CI = 1.43-9.71; P = .007), and peripheral arterial disease (OR = 3.48, 95% CI = 1.14-10.56; P = .028) were independently associated with diabetic foot. Diabetic foot ulcer is a common complication among patients with diabetes attending these regional hospitals. Loss of protective sensation, and peripheral arterial disease increase the odds of having diabetic foot ulcer, and we suggest them as the main target of interest for prevention.

  12. Tuberculosis lymphadenitis in a southeastern region in Tunisia: Epidemiology, clinical features, diagnosis and treatment.

    Science.gov (United States)

    Smaoui, Salma; Mezghanni, Mohamed Amine; Hammami, Bousaima; Zalila, Neila; Marouane, Chema; Kammoun, Sana; Ghorbel, Abdelmonoom; Ben Jemaa, Mounir; Messadi-Akrout, Férièle

    2015-09-01

    To evaluate patients' profiles, demographics, clinical and therapeutic approaches and strategies in patients with tuberculous lymphadenitis (TBG). A retrospective study of all TBG-confirmed cases admitted in a tuberculosis-specific health care facility between 1 January 2009 and 16 June 2013. A total of 181 clinical files were examined. Mean age was 32years old; the female/male ratio was 1.78 to 1. Raw milk consumption was noted in 1/3 of patients. Most cases involved the head and neck region (83.4%), nodes involvement, including axillary (12 cases), and mediastinal (9 cases). Clinical symptoms were present in only 55.2%. Tuberculin skin test (TST) was conducted with 82.6% positive responses. Diagnostics confirmation was done with anatomical pathology in most of the patients; only 56 of them had any microbiology analysis done. Demonstration of acid-fast bacilli in microscopy from either fine-needle aspirates or biopsies was done in 17.5% of cases, and cultures yielded positive results in 27%. Treatment duration was varied. Paradoxical reactions were noted in 12% and persistent lymphadenopathy after treatment completion was noted in 10% of cases. TBG remains a disease of interest. Today, its diagnosis and management is still a problem despite its increasing worldwide incidence, and especially in this study area. Disease control should be strengthened in this country. Copyright © 2015 Asian-African Society for Mycobacteriology. Published by Elsevier Ltd. All rights reserved.

  13. Tuberculosis lymphadenitis in a southeastern region in Tunisia: Epidemiology, clinical features, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Salma Smaoui

    2015-01-01

    Full Text Available Aim: To evaluate patients’ profiles, demographics, clinical and therapeutic approaches and strategies in patients with tuberculous lymphadenitis (TBG. Patients and methods: A retrospective study of all TBG-confirmed cases admitted in a tuberculosis-specific health care facility between 1 January 2009 and 16 June 2013. Results: A total of 181 clinical files were examined. Mean age was 32 years old; the female/male ratio was 1.78 to 1. Raw milk consumption was noted in 1/3 of patients. Most cases involved the head and neck region (83.4%, nodes involvement, including axillary (12 cases, and mediastinal (9 cases. Clinical symptoms were present in only 55.2%. Tuberculin skin test (TST was conducted with 82.6% positive responses. Diagnostics confirmation was done with anatomical pathology in most of the patients; only 56 of them had any microbiology analysis done. Demonstration of acid-fast bacilli in microscopy from either fine-needle aspirates or biopsies was done in 17.5% of cases, and cultures yielded positive results in 27%. Treatment duration was varied. Paradoxical reactions were noted in 12% and persistent lymphadenopathy after treatment completion was noted in 10% of cases. Conclusions: TBG remains a disease of interest. Today, its diagnosis and management is still a problem despite its increasing worldwide incidence, and especially in this study area. Disease control should be strengthened in this country.

  14. Longitudinal Regional Brain Development and Clinical Risk Factors in Extremely Preterm Infants.

    Science.gov (United States)

    Kersbergen, Karina J; Makropoulos, Antonios; Aljabar, Paul; Groenendaal, Floris; de Vries, Linda S; Counsell, Serena J; Benders, Manon J N L

    2016-11-01

    To investigate third-trimester extrauterine brain growth and correlate this with clinical risk factors in the neonatal period, using serially acquired brain tissue volumes in a large, unselected cohort of extremely preterm born infants. Preterm infants (gestational age regions covering the entire brain. Multivariable regression analysis was used to determine the influence of clinical variables on volumes at both scans, as well as on volumetric growth. MRIs at term equivalent age were available for 210 infants and serial data were available for 131 infants. Growth over these 10 weeks was greatest for the cerebellum, with an increase of 258%. Sex, birth weight z-score, and prolonged mechanical ventilation showed global effects on brain volumes on both scans. The effect of brain injury on ventricular size was already visible at 30 weeks, whereas growth data and volumes at term-equivalent age revealed the effect of brain injury on the cerebellum. This study provides data about third-trimester extrauterine volumetric brain growth in preterm infants. Both global and local effects of several common clinical risk factors were found to influence serial volumetric measurements, highlighting the vulnerability of the human brain, especially in the presence of brain injury, during this period. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Fracture liaison service in a non-regional orthopaedic clinic--a cost-effective service.

    LENUS (Irish Health Repository)

    Ahmed, M

    2012-01-01

    Fracture liaison services (FLS) aim to provide cost-effective targeting of secondary fracture prevention. It is proposed that a dedicated FLS be available in any hospital to which a patient presents with a fracture. An existing orthopaedic clinic nurse was retrained to deliver a FLS. Proformas were used so that different nurses could assume the fracture liaison nurse (FLN) role, as required. Screening consisted of fracture risk estimation, phlebotomy and DXA scanning. 124 (11%) of all patients attending the orthopaedic fracture clinic were reviewed in the FLS. Upper limb fractures accounted for the majority of fragility fractures screened n=69 (55.6%). Two-thirds of patients (n=69) had reduced bone mineral density (BMD). An evidence based approach to both non-pharmacological and pharmacotherapy was used and most patients (76.6%) receiving pharmacotherapy received an oral bisphosphonate (n=46). The FLS has proven to be an effective way of delivering secondary prevention for osteoporotic fracture in a non-regional fracture clinic, without increasing staff costs.

  16. Regional implications of heat flow of the Snake River Plain, Northwestern United States

    Science.gov (United States)

    Blackwell, D. D.

    1989-08-01

    The Snake River Plain is a major topographic feature of the Northwestern United States. It marks the track of an upper mantle and crustal melting event that propagated across the area from southwest to northeast at a velocity of about 3.5 cm/yr. The melting event has the same energetics as a large oceanic hotspot or plume and so the area is the continental analog of an oceanic hotspot track such as the Hawaiian Island-Emperor Seamount chain. Thus, the unique features of the area reflect the response of a continental lithosphere to a very energetic hotspot. The crust is extensively modified by basalt magma emplacement into the crust and by the resulting massive rhyolite volcanism from melted crustal material, presently occurring at Yellowstone National Park. The volcanism is associated with little crustal extension. Heat flow values are high along the margins of the Eastern and Western Snake River Plains and there is abundant evidence for low-grade geothermal resources associated with regional groundwater systems. The regional heat flow pattern in the Western Snake River Plains reflects the influence of crustal-scale thermal refraction associated with the large sedimentary basin that has formed there. Heat flow values in shallow holes in the Eastern Snake River Plains are low due to the Snake River Plains aquifer, an extensive basalt aquifer where water flow rates approach 1 km/yr. Below the aquifer, conductive heat flow values are about 100 mW m -2. Deep holes in the region suggest a systematic eastward increase in heat flow in the Snake River Plains from about 75-90 mW m -2 to 90-110 mW m -2. Temperatures in the upper crust do not behave similarly because the thermal conductivity of the Plio-Pleistocene sedimentary rocks in the west is lower than that in the volcanic rocks characteristic of the Eastern Snake River Plains. Extremely high heat loss values (averaging 2500 mW m -2) and upper crustal temperatures are characteristic of the Yellowstone caldera.

  17. Two unique patients with novel microdeletions in 4p16.3 that exclude the WHS critical regions: implications for critical region designation.

    Science.gov (United States)

    South, Sarah T; Bleyl, Steven B; Carey, John C

    2007-09-15

    Wolf-Hirschhorn syndrome (WHS) is characterized by growth delay, developmental delay, hypotonia, seizures, feeding difficulties, and characteristic facial features. Deletion of either of two critical regions (WHSCR and WHSCR-2) within chromosome band 4p16.3 has been proposed as necessary for the minimal clinical manifestations of WHS and controversy remains regarding their designation. We describe two patients with novel terminal microdeletions in 4p16.3 who lack the characteristic facial features but do show some of the more nonspecific manifestations of WHS. The first patient had a ring chromosome 4 with an intact 4q subtelomere and a terminal 4p microdeletion of approximately 1.27-1.46 Mb. This deletion was distal to both proposed critical regions. The second patient had a normal karyotype with a terminal 4p microdeletion of approximately 1.78 Mb. This deletion was distal to WHSCR and the breakpoint was near or within the known distal boundary for WHSCR-2. Both patients showed significant postnatal growth delay, mild developmental delays and feeding difficulties. Their facial features were not typical for WHS. The phenotype of the first patient may have been influenced by the presence of a ring chromosome. Seizures were absent in the first patient whereas the second patient had a complex seizure disorder. Characterization of these patients supports the hypothesis that a gene in WHSCR-2, LETM1, plays a direct role in seizure development, and demonstrates that components of the WHS phenotype can be seen with deletions distal to the known boundaries of the two proposed critical regions. These patients also emphasize the difficulty of mapping clinical manifestations common to many aneusomy syndromes. (c) 2007 Wiley-Liss, Inc.

  18. Regional distribution of volcaniclastic layer and its implication for segmentation of the Nankai seismogenic zone

    Science.gov (United States)

    Sasaki, T.; Lim, J.; Higashi, M.; Park, J.

    2010-12-01

    volcaniclastic layer, volcanic ash layer and turbidite layers which were found at drilling sites in the IODP Expedition 322 in the northern Shikoku Basin. As a result, we recognized that these prominent seismic layers are widely distributed in the northern Shikoku Basin. In this talk, we will show specific seismic layers directly connecting to the decollement at the Nankai Trough axis, and discuss its implications for subduction processes in the Nankai Trough margin.

  19. HOW SOCIAL CAPITAL HELPS SMALL ENTERPRISE?: IMPLICATIONS FOR REGIONAL ECONOMIC DEVELOPMENT

    Directory of Open Access Journals (Sweden)

    Feray ERSELCAN

    2011-07-01

    Full Text Available Presenting findings from a sample survey carried among manufacturing small and medium sized enterprises in Kayseri Sub-Region (TR72 – Sivas, Kayseri and Yozgat, this study attempts to understand whether and how social capital has an impact on small firms’ performance. Besides, the study goes further to bring into question the effectiveness of different types of social capital, norms and networks and how social capital is created at local level. Social capital is measured at two different (potential and actual levels. Results of our analysis point to the fact that measuring social capital at its “actual” level might be more useful than measuring it as a “potential”. Our findings suggest that firms perform better, if they enjoy higher levels of collective action and can reduce their transaction costs through social relations.

  20. Important historical efforts at emergency department categorization in the United States and implications for regionalization.

    Science.gov (United States)

    Mehrotra, Abhishek; Sklar, David P; Tayal, Vivek S; Kocher, Keith E; Handel, Daniel A; Myles Riner, R

    2010-12-01

    This article is drawn from a report created for the American College of Emergency Physicians (ACEP) Emergency Department (ED) Categorization Task Force and also reflects the proceedings of a breakout session, "Beyond ED Categorization-Matching Networks to Patient Needs," at the 2010 Academic Emergency Medicine consensus conference, "Beyond Regionalization: Integrated Networks of Emergency Care." The authors describe a brief history of the significant national and state efforts at categorization and suggest reasons why many of these efforts failed to persevere or gain wider implementation. The history of efforts to categorize hospital (and ED) emergency services demonstrates recognition of the potential benefits of categorization, but reflects repeated failures to implement full categorization systems or limited excursions into categorization through licensing of EDs or designation of receiving and referral facilities. An understanding of the history of hospital and ED categorization could better inform current efforts to develop categorization schemes and processes. 2010 by the Society for Academic Emergency Medicine.

  1. The Korean Peninsula Energy Development Organization : implications for Northeast Asian regional security co-operation?

    International Nuclear Information System (INIS)

    Snyder, S.

    2000-01-01

    This paper identifies opportunities for co-operation on regional development and security in the North Pacific region. The Korean Peninsula Energy Development Organization (KEDO) was created in 1993 during bilateral negotiations between the United States and the Democratic People's Republic of Korea (US-DPRK) over North Korea's alleged nuclear weapons program. The negotiations resulted in an agreement to freeze North Korea's known nuclear weapons program in return for the construction of two proliferation-resistant 100 MWe light water reactors (LWR) in North Korea, and the provision of 500,000 tons of heavy fuel oil per year until the completion of the LWR construction as compensation for lost energy production capacity resulting from the shutting down of North Korea's nuclear reactors. The author described the activities of KEDO and examined its internal dynamics. The unique circumstances that produced the Agreed Framework and KEDO in response to a major international crisis of the nuclear program in the DPRK were also highlighted along with the US-DPRK bilateral agreement and the multilateral institution involving the United States, South Korea, Japan and the European Union. Financial support from Australia and Canada was discussed along with the mechanism for engaging North Korea in regularized interaction and technical cooperation. It was concluded that KEDO's record of successes and failures is mixed. The energy security issue has been identified as an area that could result in conflict among Northeast Asian countries which are increasingly dependent on oil supplies from the Middle East. In response, numerous multilateral financing mechanisms have been developed to promote joint business opportunities that exploit natural gas resources in the Russian Far East to address Japanese, Korean and Chinese energy needs. 35 refs

  2. GHG emissions from primary aluminum production in China: Regional disparity and policy implications

    International Nuclear Information System (INIS)

    Hao, Han; Geng, Yong; Hang, Wen

    2016-01-01

    Highlights: • GHG emissions from primary aluminum production in China were accounted. • The impact of regional disparity of power generation was considered for this study. • GHG emissions factor of China’s primary aluminum production was 16.5 t CO_2e/t Al ingot in 2013. • Total GHG emissions from China’s primary aluminum production were 421 mt CO_2e in 2013. - Abstract: China is the world-leading primary aluminum production country, which contributed to over half of global production in 2014. Primary aluminum production is power-intensive, for which power generation has substantial impact on overall Greenhouse Gas (GHG) emissions. In this study, we explore the impact of regional disparity of China’s power generation system on GHG emissions for the sector of primary aluminum production. Our analysis reveals that the national GHG emissions factor (GEF) of China’s primary aluminum production was 16.5 t CO_2e/t Al ingot in 2013, with province-level GEFs ranging from 8.2 to 21.7 t CO_2e/t Al ingot. There is a high coincidence of provinces with high aluminum productions and high GEFs. Total GHG emissions from China’s primary aluminum production were 421 mt CO_2e in 2013, approximately accounting for 4% of China’s total GHG emissions. Under the 2020 scenario, GEF shows a 13.2% reduction compared to the 2013 level, but total GHG emissions will increase to 551 mt CO_2e. Based on our analysis, we recommend that the government should further promote energy efficiency improvement, facilitate aluminum industry redistribution with low-carbon consideration, promote secondary aluminum production, and improve aluminum industry data reporting and disclosure.

  3. Relating coccolithophore calcification rates to phytoplankton community dynamics: Regional differences and implications for carbon export

    Science.gov (United States)

    Poulton, Alex J.; Adey, Tim R.; Balch, William M.; Holligan, Patrick M.

    2007-03-01

    Recent measurements of surface coccolithophore calcification from the Atlantic Ocean (50°N-50°S) are compared to similar measurements from other oceanic settings. By combining the different data sets of surface measurements, we examine general and regional patterns of calcification relative to organic carbon production (photosynthesis) and other characteristics of the phytoplankton community. Generally, surface calcification and photosynthesis are positively correlated, although the strength of the relationship differs between biogeochemical provinces. Relationships between surface calcification, chlorophyll- a and calcite concentrations are also statistically significant, although again there is considerable regional variability. Such variability appears unrelated to phytoplankton community composition or hydrographic conditions, and may instead reflect variations in coccolithophore physiology. The contribution of inorganic carbon fixation (calcification) to total carbon fixation (calcification plus photosynthesis) is ˜1-10%, and we estimate a similar contribution from coccolithophores to total organic carbon fixation. However, these contributions vary between biogeochemical provinces, and occasionally coccolithophores may account for >20% of total carbon fixation in unproductive central subtropical gyres. Combining surface calcification and photosynthetic rates with standing stocks of calcite, particulate organic carbon, and estimated phytoplankton carbon allows us to examine the fates of these three carbon pools. The relative turnover times vary between different biogeochemical provinces, with no clear relationship to the overall productivity or phytoplankton community structure found in each province. Rather, interaction between coccolithophore physiology (coccolith production and detachment rates), species diversity (cell size), and food web dynamics (grazer ecology) may control the composition and turnover times of calcite particles in the upper ocean.

  4. Activation of midbrain and ventral striatal regions implicates salience processing during a modified beads task.

    Directory of Open Access Journals (Sweden)

    Christine Esslinger

    Full Text Available INTRODUCTION: Metacognition, i.e. critically reflecting on and monitoring one's own reasoning, has been linked behaviorally to the emergence of delusions and is a focus of cognitive therapy in patients with schizophrenia. However, little is known about the neural processing underlying metacognitive function. To address this issue, we studied brain activity during a modified beads task which has been used to measure a "Jumping to Conclusions" (JTC bias in schizophrenia patients. METHODS: We used functional magnetic resonance imaging to identify neural systems active in twenty-five healthy subjects when solving a modified version of the "beads task", which requires a probabilistic decision after a variable amount of data has been requested by the participants. We assessed brain activation over the duration of a trial and at the time point of decision making. RESULTS: Analysis of activation during the whole process of probabilistic reasoning showed an extended network including the prefronto-parietal executive functioning network as well as medial parieto-occipital regions. During the decision process alone, activity in midbrain and ventral striatum was detected, as well as in thalamus, medial occipital cortex and anterior insula. CONCLUSIONS: Our data show that probabilistic reasoning shares neural substrates with executive functions. In addition, our finding that brain regions commonly associated with salience processing are active during probabilistic reasoning identifies a candidate mechanism that could underlie the behavioral link between dopamine-dependent aberrant salience and JTC in schizophrenia. Further studies with delusional schizophrenia patients will have to be performed to substantiate this link.

  5. New Directions in European Regional Policy and their Implications for Spain

    Directory of Open Access Journals (Sweden)

    Keith Salmon

    2008-01-01

    Full Text Available Este artículo se centra en la nueva arquitectura de la Política de Cohesión y del nuevo marco financiero europeo dentro del cual se establece. La discusión se divide en cinco secciones. La primera sección examina la estructura del nuevo marco financiero europeo, destacando su impacto en las transferencias financieras entre Europa y España. En la segunda sección se explica la nueva arquitectura de la Política de Cohesión, precisando que relaciones mantiene con las políticas agrícolas y pesqueras y se concluye con una presentación de las características principales de esta nueva arquitectura. La tercera sección examina los recursos financieros que sustentan la Política de Cohesión y su distribución en España. En la sección cuatro la discusión gira en torno a la consideración de los conceptos de convergencia y de la naturaleza de regiones. Finalmente, las conclusiones sugieren que existen implicaciones significativas en los ámbitos administrativos, financieros y en el planeamiento estratégico del nuevo marco financiero y de la renovada Política de Cohesión: para el desarrollo económico en general y para el desarrollo regional en particular en los próximos años.

  6. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

    Science.gov (United States)

    Bonilauri Ferreira, Ana Paula Ribeiro; Ferreira, Rodrigo Fernando; Rajgor, Dimple; Shah, Jatin; Menezes, Andrea; Pietrobon, Ricardo

    2010-04-20

    Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  7. Clinical reasoning in the real world is mediated by bounded rationality: implications for diagnostic clinical practice guidelines.

    Directory of Open Access Journals (Sweden)

    Ana Paula Ribeiro Bonilauri Ferreira

    Full Text Available BACKGROUND: Little is known about the reasoning mechanisms used by physicians in decision-making and how this compares to diagnostic clinical practice guidelines. We explored the clinical reasoning process in a real life environment. METHOD: This is a qualitative study evaluating transcriptions of sixteen physicians' reasoning during appointments with patients, clinical discussions between specialists, and personal interviews with physicians affiliated to a hospital in Brazil. RESULTS: FOUR MAIN THEMES WERE IDENTIFIED: simple and robust heuristics, extensive use of social environment rationality, attempts to prove diagnostic and therapeutic hypothesis while refuting potential contradictions using positive test strategy, and reaching the saturation point. Physicians constantly attempted to prove their initial hypothesis while trying to refute any contradictions. While social environment rationality was the main factor in the determination of all steps of the clinical reasoning process, factors such as referral letters and number of contradictions associated with the initial hypothesis had influence on physicians' confidence and determination of the threshold to reach a final decision. DISCUSSION: Physicians rely on simple heuristics associated with environmental factors. This model allows for robustness, simplicity, and cognitive energy saving. Since this model does not fit into current diagnostic clinical practice guidelines, we make some propositions to help its integration.

  8. Dose reconstruction in deforming lung anatomy: Dose grid size effects and clinical implications

    International Nuclear Information System (INIS)

    Rosu, Mihaela; Chetty, Indrin J.; Balter, James M.; Kessler, Marc L.; McShan, Daniel L.; Ten Haken, Randall K.

    2005-01-01

    In this study we investigated the accumulation of dose to a deforming anatomy (such as lung) based on voxel tracking and by using time weighting factors derived from a breathing probability distribution function (p.d.f.). A mutual information registration scheme (using thin-plate spline warping) provided a transformation that allows the tracking of points between exhale and inhale treatment planning datasets (and/or intermediate state scans). The dose distributions were computed at the same resolution on each dataset using the Dose Planning Method (DPM) Monte Carlo code. Two accumulation/interpolation approaches were assessed. The first maps exhale dose grid points onto the inhale scan, estimates the doses at the 'tracked' locations by trilinear interpolation and scores the accumulated doses (via the p.d.f.) on the original exhale data set. In the second approach, the 'volume' associated with each exhale dose grid point (exhale dose voxel) is first subdivided into octants, the center of each octant is mapped to locations on the inhale dose grid and doses are estimated by trilinear interpolation. The octant doses are then averaged to form the inhale voxel dose and scored at the original exhale dose grid point location. Differences between the interpolation schemes are voxel size and tissue density dependent, but in general appear primarily only in regions with steep dose gradients (e.g., penumbra). Their magnitude (small regions of few percent differences) is less than the alterations in dose due to positional and shape changes from breathing in the first place. Thus, for sufficiently small dose grid point spacing, and relative to organ motion and deformation, differences due solely to the interpolation are unlikely to result in clinically significant differences to volume-based evaluation metrics such as mean lung dose (MLD) and tumor equivalent uniform dose (gEUD). The overall effects of deformation vary among patients. They depend on the tumor location, field

  9. The epidemiology and clinical features of melioidosis in Far North Queensland: Implications for patient management.

    Directory of Open Access Journals (Sweden)

    James D Stewart

    2017-03-01

    Full Text Available The epidemiology, clinical presentation and management of melioidosis vary around the world. It is essential to define the disease's local features to optimise its management.Between 1998 and 2016 there were 197 cases of culture confirmed melioidosis in Far North Queensland; 154 (78% presented in the December-April wet season. 145 (74% patients were bacteraemic, 58 (29% were admitted to the Intensive Care Unit and 27 (14% died; nine (33% of these deaths occurred within 48 hours of presentation. Pneumonia was the most frequent clinical finding, present in 101 (61% of the 166 with available imaging. A recognised risk factor for melioidosis (diabetes, hazardous alcohol use, chronic renal disease, chronic lung disease, immunosuppression or malignancy was present in 148 (91% of 162 patients with complete comorbidity data. Despite representing only 9% of the region's population, Aboriginal and Torres Strait Island (ATSI people comprised 59% of the cases. ATSI patients were younger than non-ATSI patients (median (interquartile range: 46 (38-56 years versus 59 (43-69 years (p<0.001 and had a higher case-fatality rate (22/117 (19% versus 5/80 (6.3% (p = 0.01. In the 155 patients surviving the initial intensive intravenous phase of treatment, eleven (7.1% had disease recurrence, despite the fact that nine (82% of these patients had received prolonged intravenous therapy. Recurrence was usually due to inadequate source control or poor adherence to oral eradication therapy. The case fatality rate declined from 12/44 (27% in the first five years of the study to 7/76 (9% in the last five (p = 0.009, reflecting national improvements in sepsis management.Melioidosis in Far North Queensland is a seasonal, opportunistic infection of patients with specific comorbidities. The ATSI population bear the greatest burden of disease. Although the case-fatality rate is declining, deaths frequently occur early after hospitalisation, reinforcing the importance of prompt

  10. Developments in our understanding of the effects of growth hormone on white adipose tissue from mice: implications to the clinic.

    Science.gov (United States)

    Berryman, Darlene E; Henry, Brooke; Hjortebjerg, Rikke; List, Edward O; Kopchick, John J

    2016-01-01

    Adipose tissue (AT) is a well-established target of growth hormone (GH) and is altered in clinical conditions associated with excess, deficiency and absence of GH action. Due to the difficulty in collecting AT from clinical populations, genetically modified mice have been useful in better understanding how GH affects this tissue. Recent findings in mice would suggest that the impact of GH on AT is beyond alterations of lipolysis, lipogenesis or proliferation/ differentiation. AT depot-specific alterations in immune cells, extracellular matrix, adipokines, and senescence indicate an expanded role for GH in AT physiology. This mouse data will guide additional studies necessary to evaluate the therapeutic potential and safety of GH for conditions associated with altering AT, such as obesity. In this review, we introduce several relatively new intricacies of GH's effect on AT, focusing on recent studies in mice. Finally, we summarize the clinical implications of these findings.

  11. Regional metamorphism at extreme conditions: Implications for orogeny at convergent plate margins

    Science.gov (United States)

    Zheng, Yong-Fei; Chen, Ren-Xu

    2017-09-01

    Regional metamorphism at extreme conditions refers either to Alpine-type metamorphism at low geothermal gradients of geothermal gradients of >30 °C/km. Extreme pressures refer to those above the polymorphic transition of quartz to coesite, so that ultrahigh-pressure (UHP) eclogite-facies metamorphism occurs at mantle depths of >80 km. Extreme temperatures refer to those higher than 900 °C at crustal depths of ≤80 km, so that ultrahigh-temperature (UHT) granulite-facies metamorphism occurs at medium to high pressures. While crustal subduction at the low geothermal gradients results in blueschist-eclogite facies series without arc volcanism, heating of the thinned orogenic lithosphere brings about the high geothermal gradients for amphibolite-granulite facies series with abundant magmatism. Therefore, UHP metamorphic rocks result from cold lithospheric subduction to the mantle depths, whereas UHT metamorphic rocks are produced by hot underplating of the asthenospheric mantle at the crustal depths. Active continental rifting is developed on the thinned lithosphere in response to asthenospheric upwelling, and this tectonism is suggested as a feasible mechanism for regional granulite-facies metamorphism, with the maximum temperature depending on the extent to which the mantle lithosphere is thinned prior to the rifting. While lithospheric compression is associated with subduction metamorphism in accretionary and collisional orogens, the thinned orogenic lithosphere undergoes extension due to the asthenospheric upwelling to result in orogen-parallel rifting metamorphism and magmatism. Thus, the rifting metamorphism provides a complement to the subduction metamorphism and its operation marks the asthenospheric heating of the orogenic lithosphere. Because of the partial melting and melt extraction of the lower continental crust, contemporaneous granite-migmatite-granulite associations may serve as a petrological indicator of rifting orogeny that is superimposed on

  12. Implications of climate change for wetland-dependent birds in the Prairie Pothole Region

    Science.gov (United States)

    Steen, Valerie; Skagen, Susan K.; Melcher, Cynthia P.

    2016-01-01

    The habitats and food resources required to support breeding and migrant birds dependent on North American prairie wetlands are threatened by impending climate change. The North American Prairie Pothole Region (PPR) hosts nearly 120 species of wetland-dependent birds representing 21 families. Strategic management requires knowledge of avian habitat requirements and assessment of species most vulnerable to future threats. We applied bioclimatic species distribution models (SDMs) to project range changes of 29 wetland-dependent bird species using ensemble modeling techniques, a large number of General Circulation Models (GCMs), and hydrological climate covariates. For the U.S. PPR, mean projected range change, expressed as a proportion of currently occupied range, was −0.31 (± 0.22 SD; range − 0.75 to 0.16), and all but two species were projected to lose habitat. Species associated with deeper water were expected to experience smaller negative impacts of climate change. The magnitude of climate change impacts was somewhat lower in this study than earlier efforts most likely due to use of different focal species, varying methodologies, different modeling decisions, or alternative GCMs. Quantification of the projected species-specific impacts of climate change using species distribution modeling offers valuable information for vulnerability assessments within the conservation planning process.

  13. Quantifying spatial scaling patterns and their local and regional correlates in headwater streams: implications for resilience

    Directory of Open Access Journals (Sweden)

    Emma Göthe

    2014-09-01

    Full Text Available The distribution of functional traits within and across spatiotemporal scales has been used to quantify and infer the relative resilience across ecosystems. We use explicit spatial modeling to evaluate within- and cross-scale redundancy in headwater streams, an ecosystem type with a hierarchical and dendritic network structure. We assessed the cross-scale distribution of functional feeding groups of benthic invertebrates in Swedish headwater streams during two seasons. We evaluated functional metrics, i.e., Shannon diversity, richness, and evenness, and the degree of redundancy within and across modeled spatial scales for individual feeding groups. We also estimated the correlates of environmental versus spatial factors of both functional composition and the taxonomic composition of functional groups for each spatial scale identified. Measures of functional diversity and within-scale redundancy of functions were similar during both seasons, but both within- and cross-scale redundancy were low. This apparent low redundancy was partly attributable to a few dominant taxa explaining the spatial models. However, rare taxa with stochastic spatial distributions might provide additional information and should therefore be considered explicitly for complementing future resilience assessments. Otherwise, resilience may be underestimated. Finally, both environmental and spatial factors correlated with the scale-specific functional and taxonomic composition. This finding suggests that resilience in stream networks emerges as a function of not only local conditions but also regional factors such as habitat connectivity and invertebrate dispersal.

  14. Western Region Renewable Energy Markets: Implications for the Bureau of Land Management

    Energy Technology Data Exchange (ETDEWEB)

    Haase, S.; Billman, L.; Gelman, R.

    2012-01-01

    The purpose of this analysis is to provide the U.S. Department of the Interior (DOI) and the Bureau of Land Management (BLM) with an overview of renewable energy (RE) generation markets, transmission planning efforts, and the ongoing role of the BLM RE projects in the electricity markets of the 11 states (Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming) that comprise the Western Electricity Coordinating Council (WECC) Region. This analysis focuses on the status of, and projections for, likely development of non-hydroelectric renewable electricity from solar (including photovoltaic [PV] and concentrating solar power [CSP]), wind, biomass and geothermal resources in these states. Absent new policy drivers and without the extension of the DOE loan guarantee program and Treasury's 1603 program, state RPS requirements are likely to remain a primary driver for new RE deployment in the western United States. Assuming no additional policy incentives are implemented, projected RE demand for the WECC states by 2020 is 134,000 GWh. Installed capacity to meet that demand will need to be within the range of 28,000-46,000 MW.

  15. Integrating Recovery within a Resilience Framework: Empirical Insights and Policy Implications from Regional Australia

    Directory of Open Access Journals (Sweden)

    Lex Drennan

    2016-12-01

    Full Text Available Within Australia’s federal system, responsibility for preventing, preparing for, responding to and recovering from natural disasters is shared between the three tiers of government. Intergovernmental policy and funding arrangements are premised on shared responsibility and aim to foster individual, business and community resilience. These arrangements underpin Australia’s international reputation for effectiveness in its management of natural disasters. The capacity of the diverse networks that comprise the disaster management system to coordinate and deliver in the preparedness and response phases of a disaster, and to provide relief in the immediate aftermath, has been developed over time and tested and refined through the experience of frequent, severe disaster events over recent decades. Less well developed is the system’s ability to support economic recovery in disaster-affected communities over the longer term. This paper presents case studies of regional communities affected by two of Australia’s most expensive and deadly natural disasters—the 2009 Victorian bushfires and the cyclones and floods that struck the state of Queensland in 2010–2011. It highlights significant gaps in policy and funding arrangements to support recovery and offers lessons for aligning recovery within a resilience framework.

  16. Quantifying spatial scaling patterns and their local and regional correlates in headwater streams: Implications for resilience

    Science.gov (United States)

    Gothe, Emma; Sandin, Leonard; Allen, Craig R.; Angeler, David G.

    2014-01-01

    The distribution of functional traits within and across spatiotemporal scales has been used to quantify and infer the relative resilience across ecosystems. We use explicit spatial modeling to evaluate within- and cross-scale redundancy in headwater streams, an ecosystem type with a hierarchical and dendritic network structure. We assessed the cross-scale distribution of functional feeding groups of benthic invertebrates in Swedish headwater streams during two seasons. We evaluated functional metrics, i.e., Shannon diversity, richness, and evenness, and the degree of redundancy within and across modeled spatial scales for individual feeding groups. We also estimated the correlates of environmental versus spatial factors of both functional composition and the taxonomic composition of functional groups for each spatial scale identified. Measures of functional diversity and within-scale redundancy of functions were similar during both seasons, but both within- and cross-scale redundancy were low. This apparent low redundancy was partly attributable to a few dominant taxa explaining the spatial models. However, rare taxa with stochastic spatial distributions might provide additional information and should therefore be considered explicitly for complementing future resilience assessments. Otherwise, resilience may be underestimated. Finally, both environmental and spatial factors correlated with the scale-specific functional and taxonomic composition. This finding suggests that resilience in stream networks emerges as a function of not only local conditions but also regional factors such as habitat connectivity and invertebrate dispersal.

  17. Positive implications from socially accountable, community-engaged medical education across two Philippines regions.

    Science.gov (United States)

    Woolley, Torres; Cristobal, Fortunato; Siega-Sur, Jusie; Ross, Simone; Neusy, Andre-Jacques; Halili, Servando; Reeve, Carole

    2018-02-01

    Hundreds of millions of people worldwide lack access to quality health services, largely because of geographic and socioeconomic maldistribution of qualified practitioners. This study describes differences between the practice locations of Philippines medical graduates from two 'socially accountable, community-engaged' health professional education (SAHPE) schools and the practice locations of graduates from two 'conventionally trained' medical schools located in the same respective geographic regions. Licensed medical graduates were currently practising in the Philippines and had been practising for at least 6 months. Graduates were from two Philippines SAHPE schools (Ateneo de Zamboanga University-School of Medicine (ADZU-SOM) on the Zamboanga Peninsula (n=212) and the University of the Philippines Manila-School of Health Sciences (SHS-Palo) in Eastern Visayas (n=71), and from two 'conventional' medical schools Methods: Current graduate practice locations in municipalities or cities were linked with their respective population size and socioeconomic income class, and geocoded using Geographical Information System software onto a geospatial map of the Philippines. Bivariate analysis compared the population size and socioeconomic class of communities where the SAHPE medical graduates practised to communities where 'conventional' medical school graduates practised. Thirty-one percent of ADZU-SOM medical graduates practised in communities play a significant role in graduates choosing to practice in rural and/or economically disadvantaged communities. Governments experiencing medical workforce maldistributions similar to those in the Philippines should consider SAHPE as a potentially cost-effective strategy in recruiting and retaining health graduates to underserved areas.

  18. E-Cigarettes: Implications for Health Promotion in the Asian Pacific Region.

    Science.gov (United States)

    Jancey, Jonine; Maycock, Bruce; McCausland, Kahlia; Howat, Peter

    2018-03-01

    Since their introduction to the United States in 2007, electronic cigarettes (e-cigarettes) use has grown exponentially. This rapid growth in e-cigarette use has been heralded by some as a potential important public health measure that could ultimately replace tobacco cigarettes, while others recommend a cautionary approach until there is clear evidence they will not become "new tobacco" bringing a possible myriad of other problems. E-cigarettes may have real benefits, however they do expose users and those nearby to organic compounds, solvents and particulate matter, with there being limited data relating to their health impact. It is unclear as to whether this relatively new device has the potential to exacerbate nicotine addictions, or play a part in reducing harm and smoking cessation. The fundamental requirement of public health practice is to do no harm and from the inconclusive evidence we have to date on e-cigarettes, it appears a cautious approach is warranted. This commentary reviews evidence that supports a cautious approach to e-cigarette availability in Australia and the Asian Pacific region.

  19. Eastern Canadian crude oil supply and its implications for regional energy security

    International Nuclear Information System (INIS)

    Hughes, Larry

    2010-01-01

    Canada has been blessed with immense energy resources; however, their distribution is not uniform. One such example is crude oil, which is found primarily in western Canada. Eastern Canada, consisting of the six eastern-most provinces (Newfoundland and Labrador, New Brunswick, Nova Scotia, Ontario, Prince Edward Island, and Quebec), produce limited quantities of crude oil, most of which is exported to the United States. Ideally, western Canadian crude oil would meet the demands of eastern Canada; however, the North American Free Trade Agreement (NAFTA) and the absence of oil pipelines means that eastern Canada increasingly relies on supplies of crude oil from a small number of oil exporting countries, many with declining production. This paper examines crude oil production, supply, and its refining in eastern Canada. It shows that crude production in the region has reached its peak and that increasing global competition for crude oil will affect energy security in eastern Canada, either through price increases or supply shortages, or both. (author)

  20. Micro ionization chamber dosimetry in IMRT verification: Clinical implications of dosimetric errors in the PTV

    International Nuclear Information System (INIS)

    Sanchez-Doblado, Francisco; Capote, Roberto; Rosello, Joan V.; Leal, Antonio; Lagares, Juan I.; Arrans, Rafael; Hartmann, Guenther H.

    2005-01-01

    Background and purpose: Absolute dose measurements for Intensity Modulated Radiotherapy (IMRT) beamlets is difficult due to the lack of lateral electron equilibrium. Recently we found that the absolute dosimetry in the penumbra region of the IMRT beamlet, can suffer from significant errors (Capote et al., Med Phys 31 (2004) 2416-2422). This work has the goal to estimate the error made when measuring the Planning Target Volume's (PTV) absolute dose by a micro ion chamber (μIC) in typical IMRT treatment. The dose error comes from the assumption that the dosimetric parameters determining the absolute dose are the same as for the reference conditions. Materials and Methods: Two IMRT treatment plans for common prostate carcinoma case, derived by forward and inverse optimisation, were considered. Detailed geometrical simulation of the μIC and the dose verification set-up was performed. The Monte Carlo (MC) simulation allows us to calculate the delivered dose to water and the dose delivered to the active volume of the ion chamber. However, the measured dose in water is usually derived from chamber readings assuming reference conditions. The MC simulation provides needed correction factors for ion chamber dosimetry in non reference conditions. Results: Dose calculations were carried out for some representative beamlets, a combination of segments and for the delivered IMRT treatments. We observe that the largest dose errors (i.e. the largest correction factors) correspond to the smaller contribution of the corresponding IMRT beamlets to the total dose delivered in the ionization chamber within PTV. Conclusion: The clinical impact of the calculated dose error in PTV measured dose was found to be negligible for studied IMRT treatments

  1. UNMASKING MASKED HYPERTENSION: PREVALENCE, CLINICAL IMPLICATIONS, DIAGNOSIS, CORRELATES, AND FUTURE DIRECTIONS

    OpenAIRE

    Peacock, James; Diaz, Keith M.; Viera, Anthony J.; Schwartz, Joseph E.; Shimbo, Daichi

    2014-01-01

    ‘Masked hypertension’ is defined as having non-elevated clinic blood pressure (BP) with elevated out-of-clinic average BP, typically determined by ambulatory BP monitoring. Approximately 15–30% of adults with non-elevated clinic BP have masked hypertension. Masked hypertension is associated with increased risks of cardiovascular morbidity and mortality compared to sustained normotension (non-elevated clinic and ambulatory BP), which is similar to or approaching the risk associated with sustai...

  2. Implications of process evaluation for clinical effectiveness and clinical practice in a trial on chronic shoulder complaints.

    NARCIS (Netherlands)

    Geraets, J.J.; Goossens, M.E.J.B.; Haastregt, J.C. van; Groot, I.J.M. de; Bruijn, C.P. de; Bie, R.A. de; Koke, A.J.; Heuvel, W.J.A. van den

    2006-01-01

    OBJECTIVE: The intervention process was evaluated in a randomised clinical trial on the effectiveness of a behavioural Graded Exercise Therapy (GET) programme for patients with chronic shoulder complaints in primary care settings. This process evaluation was done for three reasons: first, to know

  3. Positive selection neighboring functionally essential sites and disease-implicated regions of mammalian reproductive proteins.

    LENUS (Irish Health Repository)

    Morgan, Claire C

    2010-01-01

    ABSTRACT: BACKGROUND: Reproductive proteins are central to the continuation of all mammalian species. The evolution of these proteins has been greatly influenced by environmental pressures induced by pathogens, rival sperm, sexual selection and sexual conflict. Positive selection has been demonstrated in many of these proteins with particular focus on primate lineages. However, the mammalia are a diverse group in terms of mating habits, population sizes and germ line generation times. We have examined the selective pressures at work on a number of novel reproductive proteins across a wide variety of mammalia. RESULTS: We show that selective pressures on reproductive proteins are highly varied. Of the 10 genes analyzed in detail, all contain signatures of positive selection either across specific sites or in specific lineages or a combination of both. Our analysis of SP56 and Col1a1 are entirely novel and the results show positively selected sites present in each gene. Our findings for the Col1a1 gene are suggestive of a link between positive selection and severe disease type. We find evidence in our dataset to suggest that interacting proteins are evolving in symphony: most likely to maintain interacting functionality. CONCLUSION: Our in silico analyses show positively selected sites are occurring near catalytically important regions suggesting selective pressure to maximize efficient fertilization. In those cases where a mechanism of protein function is not fully understood, the sites presented here represent ideal candidates for mutational study. This work has highlighted the widespread rate heterogeneity in mutational rates across the mammalia and specifically has shown that the evolution of reproductive proteins is highly varied depending on the species and interacting partners. We have shown that positive selection and disease are closely linked in the Col1a1 gene.

  4. Brain local and regional neuroglial alterations in Alzheimer's Disease: cell types, responses and implications.

    Science.gov (United States)

    Toledano, Adolfo; Álvarez, María-Isabel; Toledano-Díaz, Adolfo; Merino, José-Joaquín; Rodríguez, José Julio

    2016-01-01

    From birth to death, neurons are dynamically accompanied by neuroglial cells in a very close morphological and functional relationship. Three families have been classically considered within the CNS: astroglia, oligodendroglia and microglia. Many types/subtypes (including NGR2+ cells), with a wide variety of physiological and pathological effects on neurons, have been described using morphological and immunocytochemical criteria. Glio-glial, glio-neuronal and neuro-glial cell signaling and gliotransmission are phenomena that are essential to support brain functions. Morphofunctional changes resulting from the plasticity of all the glial cell types parallel the plastic neuronal changes that optimize the functionality of neuronal circuits. Moreover, neuroglia possesses the ability to adopt a reactive status (gliosis) in which, generally, new functions arise to improve and restore if needed the neural functionality. All these features make neuroglial cells elements of paramount importance when attempting to explain any physiological or pathological processes in the CNS, because they are involved in both, neuroprotection/neurorepair and neurodegeneration. There exist diverse and profound, regional and local, neuroglial changes in all involutive processes (physiological and pathological aging; neurodegenerative disorders, including Alzheimer ´s disease -AD-), but today, the exact meaning of such modifications (the modifications of the different neuroglial types, in time and place), is not well understood. In this review we consider the different neuroglial cells and their responses in order to understand the possible role they fulfill in pathogenesis, diagnosis and treatment (preventive or palliative) of AD. The existence of differentiated and/or concurrent pathogenic and neuro-protective/neuro-restorative astroglial and microglial responses is highlighted.

  5. Evaporative concentration of arsenic in groundwater: health and environmental implications, La Laguna Region, Mexico.

    Science.gov (United States)

    Ortega-Guerrero, Adrián

    2017-10-01

    High arsenic concentrations in groundwater have been documented in La Laguna Region (LLR) in arid northern Mexico, where arsenic poisoning is both chronic and endemic. A heated debate has continued for decades on its origin. LLR consisted of a series of ancient connected lakes that developed at the end of a topographic depression under closed basin conditions. This study addresses the isotopic, chemical composition of the groundwater and geochemical modeling in the southeasternmost part of the LLR to determine the origin of arsenic. Groundwater samples were obtained from a carbonate and granular aquifers and from a clayey aquitard at terminal Viesca Lake. Results show that groundwater originated as meteoric water that reached the lakes mainly via abundant springs in the carbonate aquifer and perennial flooding of the Nazas-Aguanaval Rivers. Paleo-lake water underwent progressive evaporation as demonstrated by the enrichment of δ 18 O, δ 2 H and characteristic geochemical patterns in the granular aquifer and aquitard that resulted in highly saline (>90,000 mS/cm), arsenic-rich (up to 5000 μg/L) paleo-groundwater (>30,000 years BP). However, adsorption or co-precipitation on iron oxides, clay-mineral surfaces and organic carbon limited arsenic concentration in the groundwater. Arsenic-rich groundwater and other solutes are advancing progressively from the lacustrine margins toward the main granular aquifer, due to reversal of hydraulic gradients caused by intensive groundwater exploitation and the reduction in freshwater runoff provoked by dam construction on the main rivers. Desorption of arsenic will incorporate additional concentrations of arsenic into the groundwater and continue to have significant negative effects on human health and the environment.

  6. Regional dynamics of persistent organic pollutants (POPs) in the Pearl River Delta, China: Implications and perspectives

    International Nuclear Information System (INIS)

    Zhang Kai; Zhang Baozhong; Li Shaomeng; Zeng, Eddy Y.

    2011-01-01

    The mass transport budgets of 1,1,1-trichloro-2,2-bis(chlorophenyl)ethane (p,p'-DDT) and decabromodiphenyl ether (BDE-209) in the Pearl River Delta, South China were calculated based on previously collected data. Residual p,p'-DDT, mostly related to historical use, has largely settled into soil (780,000 kg), while the soil BDE-209 inventory (44,000 kg) is considerably smaller. Conversely, large amounts of BDE-209 currently used in numerous commercial products have resulted in a much higher atmospheric depositional flux of BDE-209 (28,100 kg/yr) relative to p,p'-DDT (310 kg/yr). The soil inventory of p,p'-DDT is predicted to decrease to half of its current value after 22 years, and the percent area containing soil p,p'-DDT at levels exceeding the effects range-medium (27 ng/g) will decrease from 40% to 20%. Finally, soil BDE-209 inventory will reach an equilibrium value of 940 tons in ∼60 years, when BDE-209 levels in 50% of soil will be above an equivalent risk guideline value (125 ng/g). - Highlights: → Transport budgets of p,p'-DDT and BDE-209 in the Pearl River Delta were built. → Dry aerial deposition is the dominant route to transport p,p'-DDT and BDE-209. → Soil inventory of p,p'-DDT is much larger than that of BDE-209. → Soil inventory of p,p'-DDT would decline to half of its current value in 22 years. → Soil BDE-209 inventory is expected to reach an equilibrium value in ∼60 years. - Regional dynamics of p,p'-DDT and BDE-209 in the Pearl River Delta (South China) are examined and used to predict temporal variances.

  7. Mediterranean Outflow Water dynamics during the past 570 kyr: Regional and global implications

    Science.gov (United States)

    Kaboth, Stefanie; de Boer, Bas; Bahr, André; Zeeden, Christian; Lourens, Lucas J.

    2017-06-01

    The Gulf of Cadiz constitutes a prime area to study teleconnections between the North Atlantic Ocean and climate change in the Mediterranean realm. In particular, the highly saline Mediterranean Outflow Water (MOW) is an important modulator of the North Atlantic salt budget on intermediate water levels. However, our understanding of its paleoceanographic evolution is poorly constrained due to the lack of high-resolution proxy records that predate the last glacial cycle. Here we present the first continuous and high-resolution ( 1 kyr) benthic δ18O and δ13C as well as grain size records from Integrated Ocean Drilling Program Site U1386 representing the last 570 kyr. We find three distinct phases of MOW variability throughout the Late to Middle Pleistocene at Site U1386 associated with prominent shifts in its composition and flow strength. We attribute this long-term variability to changes in water mass sourcing of the MOW. Superimposed on the long-term change in water mass sourcing is the occurrence of distinct and precession paced δ18O enrichment events, which contrast the pattern of global ice volume change as inferred from the global mean δ18O signal (i.e., LR04) but mimics that of the adjacent Mediterranean Sea. We attribute these enrichment events to a profound temperature reduction and salinity increases of the MOW, aligning with similar changes in the Mediterranean source region. These events might further signify ice volume increases as inferred from significant sea level drops recorded in the Red Sea and/or increased influence of North Atlantic intermediate water masses when MOW influence was absent at Site U1386.

  8. Regional facies variations in the Vempalle formation of Cuddapah Basin: implications on uranium exploration

    International Nuclear Information System (INIS)

    Rajaraman, H.S.; Mukundhan, A.R.; Ramesh Kumar, K.; Achar, K.K.; Umamaheswar, K.

    2012-01-01

    Strata-bound large tonnage uranium deposit hosted by the Grey-impure-dolostone of Vempalle Formation of Cuddapah Basin is known in Tummalapalle-Rachakuntapalle sector. Deposition of rocks of Cuddapah Basin commenced with Papaghni Group, which comprises Clastic - Gulcheru Formation and Chemogenic - Vempalle Formation. The Vempalle Formation is developed over 280 km stretch from south to north along the western margin of Cuddapah Basin with maximum thickness of about 2.1 km. Recent studies helped in classifying the Vempalle Formation into five major lithofacies viz. Massive Dolostone, Conglomerate, Grey-impure-dolostone (host rock for uranium mineralization), Purple shale and Cherty Dolostone. The lithofacies studies along selected traverses from Tummalapalle in south to Dhone in north revealed the development of all five facies upto Narpala near Chitravati River whereas towards its north, the Grey-impure-dolostone and Cherty Dolostone dominate. The study also revealed over lapping nature of Cherty Dolostone in North of Nossam-Peddapaya lineament; where it directly rests above the Gulcheru Formation. Environment of deposition for these facies of Vempalle Formation place this in a Shallowing-upward carbonate depositional system with characteristic tidal flat environment. The Grey-impure-dolostone facies hosting uranium is interpreted to be developed in Supratidal environment with a narrow pH range of 7.0 - 7.5 in a reducing environment along with precipitation of phosphate. Since the tidal flats have later extension over several kilometers, favorable environment of Grey-impure-dolostone may exist over wide area in northern part also. The search for Grey-impure-dolostone hosted uranium, therefore has a bearing an understanding the regional facies variations in Vempalle Formation. The paper presents the studies carried out in this direction and results thereof. (author)

  9. Stratigraphic units overlying the Zambales Ophiolite Complex (ZOC) in Luzon, (Philippines): Tectonostratigraphic significance and regional implications

    Science.gov (United States)

    Queaño, Karlo L.; Dimalanta, Carla B.; Yumul, Graciano P.; Marquez, Edanjarlo J.; Faustino-Eslava, Decibel V.; Suzuki, Shigeyuki; Ishida, Keisuke

    2017-07-01

    The Zambales Ophiolite Complex (ZOC) on the island of Luzon, Philippines is one of the most well-studied crust-mantle sequences in the region. Several massifs comprise the ZOC, one of which is the Coto Block overlain by clastic sedimentary units previously dated as Eocene. Geochronologic studies from diabase, granodiorites and other late-stage magmatic products similarly yielded the same age. Succeeding tectonic models have therefore all been grounded on the assumption that the entire ZOC is Eocene. Recent investigations, however, revealed the presence of chert blocks within the Early to Middle Miocene clastic formation overlying the Acoje Block in the northern part of the ophiolite complex. Radiolarians extracted from the cherts yielded a stratigraphic range that suggests a Late Jurassic to Early Cretaceous age. The recognition of a much older age than previously reported of the ZOC warrants a re-examination of its actual distribution and genesis. Correlating with other similarly-aged ophiolites, we suggest defining a western Mesozoic ophiolite belt, largely extending from the west-central portion of the archipelago to the northeastern tip of Luzon island. Tentatively, we attribute the Mesozoic ophiolitic and associated rocks in western Luzon to an arc-continent collision involving the Philippine Mobile Belt and the Palawan Microcontinental Block. In addition, differences in the clastic compositions of the Cenozoic sedimentary formations provide material not only for deciphering the ZOC's unroofing history but also for constraining the timing of province linkage. The intermittent appearance of lithic fragments and detrital minerals from the ophiolite in the units of the Middle Miocene Candelaria Limestone and the Late Miocene to Early Pliocene Sta. Cruz Formation indicates significant but geographically variable contributions from the ophiolite complex. In the northern Zambales Range, the Sta. Cruz Formation caps the Coto Block and the Acoje Block of the ZOC

  10. Paleoseismicity of two historically quiescent faults in Australia: Implications for fault behavior in stable continental regions

    Science.gov (United States)

    Crone, A.J.; De Martini, P. M.; Machette, M.M.; Okumura, K.; Prescott, J.R.

    2003-01-01

    Paleoseismic studies of two historically aseismic Quaternary faults in Australia confirm that cratonic faults in stable continental regions (SCR) typically have a long-term behavior characterized by episodes of activity separated by quiescent intervals of at least 10,000 and commonly 100,000 years or more. Studies of the approximately 30-km-long Roopena fault in South Australia and the approximately 30-km-long Hyden fault in Western Australia document multiple Quaternary surface-faulting events that are unevenly spaced in time. The episodic clustering of events on cratonic SCR faults may be related to temporal fluctuations of fault-zone fluid pore pressures in a volume of strained crust. The long-term slip rate on cratonic SCR faults is extremely low, so the geomorphic expression of many cratonic SCR faults is subtle, and scarps may be difficult to detect because they are poorly preserved. Both the Roopena and Hyden faults are in areas of limited or no significant seismicity; these and other faults that we have studied indicate that many potentially hazardous SCR faults cannot be recognized solely on the basis of instrumental data or historical earthquakes. Although cratonic SCR faults may appear to be nonhazardous because they have been historically aseismic, those that are favorably oriented for movement in the current stress field can and have produced unexpected damaging earthquakes. Paleoseismic studies of modern and prehistoric SCR faulting events provide the basis for understanding of the long-term behavior of these faults and ultimately contribute to better seismic-hazard assessments.

  11. Acute changes in clinical breast measurements following bra removal: Implications for surgical practice

    Directory of Open Access Journals (Sweden)

    Joanna Scurr

    2015-03-01

    Conclusions: Internipple distance and breast projection can be measured first following bra removal, followed by sternal notch to nipple distance, any measures associated with the vertical nipple position should be made more than 6 min after bra removal. These guidelines have implications for breast surgery, particularly for unilateral reconstruction based on the residual breast position.

  12. Apoptosis and Vocal Fold Disease: Clinically Relevant Implications of Epithelial Cell Death

    Science.gov (United States)

    Novaleski, Carolyn K.; Carter, Bruce D.; Sivasankar, M. Preeti; Ridner, Sheila H.; Dietrich, Mary S.; Rousseau, Bernard

    2017-01-01

    Purpose: Vocal fold diseases affecting the epithelium have a detrimental impact on vocal function. This review article provides an overview of apoptosis, the most commonly studied type of programmed cell death. Because apoptosis can damage epithelial cells, this article examines the implications of apoptosis on diseases affecting the vocal fold…

  13. Co-morbidity in a cystic fibrosis population attending a regional clinic.

    LENUS (Irish Health Repository)

    Healy, F

    2010-11-01

    Pulmonary disease remains the major cause of morbidity in patients with cystic fibrosis (CF). However, of 115 patients attending a regional CF clinic we noted 16 cases (14%) with co-morbid conditions. Of this group, 4 of 115 patients (3.5%) had renal problems including both structural and functional defects and 4 (3.5%) had neurological disorders, 3 of which were types of epilepsy. Notably, 3 of 115 patients (2.6%) had different forms of neoplasia, all of which required significant surgical and\\/or chemotherapeutic intervention. There is now increasing evidence of the association between digestive tract malignancy and CF, which further complicates management of these already complex cases.

  14. Lymphoid tissue neoplasms in the neck region - epidemiological and clinical analysis over 15 years.

    Science.gov (United States)

    Rzepakowska, Anna; Zwierzyńska, Klaudyna; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

    2017-06-30

    Epidemiological and clinical analysis of lymphoid tissue neoplasms in the neck region over a 15-year period. There was performed retrospective analysis of 97 patients, aged 17 to 88 years, mean age of 60.3 years. The analysis included data from subjective study, physical examination, image and histopathological studies Results: Almost all cases were lymphoid neoplasms - 95 patients (98%). B cell lymphoma was the most commonly diagnosed lymphoma - 74 cases (76%), followed by Hodgkin's lymphoma- 19 cases (20%). Only two patients had T-cell lymphoma (2%). There was observed prevalence among women, K: M ratio for the whole group was 51: 46, while male predominance was reported in Hodgkin's lymphoma patients (K: M = 7: 12). Over the 15-year period, there was an increase in the number of lymphoid tumors. The most common location on the neck were lymph nodes - 71 (73.2%). Extranodal localizations (26.8%) were most often associated with salivary glands: parotid and submandibular involvement and with the dominant lymphoma of the marginal zone MALT (14 cases). In 57% of patients the fine needle aspiration biopsy (FNAB) results were false, with positive results only in 32% of patients. Tumors from lymphoid tissue in the neck region are most commonly B-cell lymphomas or Hodgkin,s lymphomas. Non-specific clinical signs and non-specific radiological images, as well as non-diagnostic results o FNAB, make it difficult to effectively differentiate lymphomas with cancer metastasis in neck lymph nodes. Histopathology results of the excised lymph nodes remains a standard for lymphoma diagnosis.

  15. Diagnosis of human fascioliasis in Arusha region, northern Tanzania by microscopy and clinical manifestations in patients.

    Science.gov (United States)

    Lukambagire, Abdul-Hamid Settenda; Mchaile, Deborah N; Nyindo, Mramba

    2015-12-23

    Human fascioliasis (HF) is a zoonotic disease that has been identified in many countries worldwide. This report concerns the identification and clinical management of cases of human fascioliasis in the suburbs of Arusha city, northern Tanzania in 2013. Fascioliasis is included among the WHO's Neglected Tropical Diseases as a plant transmitted trematode infection. Human fascioliasis has not been described before in the East Africa region, including Tanzania. Patients presenting at a primary healthcare centre in Arusha Region, northern Tanzania provided fresh stool samples for routine ova and parasite screening (saline and iodine preparations). Subsequent stool samples were preserved in 5 % formalin in saline and subjected to ether sedimentation for examination. Out of 1460 patients, 305 (21 %) were diagnosed positive for fascioliasis based on the demonstration of brownish, oval eggs with inconspicuous opercula in stool. Two distinct egg sizes were identified; large 170-212.5 by 115-150 μm (mean 194.5 by 130.5 μm) and smaller eggs 120-150 by 87.5 - 112.5 μm (mean 138.8 by 101 μm). Clinically, patients presented with fever (39 - 40 °C) and abdominal pain. Some patients had pruritis around the mouth and their lips were swollen. 3 patients were treated and cured with single dose Triclabendazole. The remaining 302 patients were treated with Nitazoxanide and 122 (40 %) were cleared of infection with a single course. Snails of the genus Lymnaea were found in the surroundings. This report serves to remind medical professionals in East Africa that HF is a probable differential diagnosis in patients presenting with similar symptoms. It is possible to diagnose fascioliasis by light microscopy although specific antigen tests are required for confirmation. Human fascioliasis however, has not been described or reported in Tanzania before and begs further investigation.

  16. Heat flow study of the Emeishan large igneous province region: Implications for the geodynamics of the Emeishan mantle plume

    Science.gov (United States)

    Jiang, Qiang; Qiu, Nansheng; Zhu, Chuanqing

    2018-01-01

    The Emeishan large igneous province (ELIP) is widely considered to be a consequence of a mantle plume. The supporting evidence includes rapid emplacement, voluminous flood basalt eruptions, and high mantle potential temperature estimates. Several studies have suggested that there was surface uplift prior to the eruption of the Emeishan flood basalts. Additionally, the plume's lateral extent is hard to constrain and has been variously estimated to be 800-1400 km in diameter. In this study, we analyzed present-day heat flow data and reconstructed the Permian paleo-heat flow using vitrinite reflectance and zircon (U-Th)/He thermochronology data in the ELIP region and discussed implications for the geodynamics of the Emeishan mantle plume. The present-day heat flow is higher in the inner and intermediate zones than in the outer zone, with a decrease of average heat flow from 76 mW/m2 to 51 mW/m2. Thermal history modeling results show that an abnormal high paleo-heat flow of 90-110 mW/m2 was caused by the Emeishan mantle plume activity. Based on the present-day heat flow data, we can calculate that there is lithospheric thinning in the central ELIP region, which may be due to the destruction of the lithosphere by mantle plume upwelling and magmatic underplating. The Permian paleo-heat flow anomaly implies that there was a temperature anomaly in the mantle. The ascending high-temperature mantle plume and the thinned lithosphere may have induced the large-scale uplift in the ELIP region. According to the range of the surface heat flow anomaly, it can be estimated that the diameter of the flattened head of the Emeishan mantle plume could have reached 1600-1800 km. Our research provides new insights into the geodynamics of the Emeishan mantle plume through study of heat flow.

  17. Clinical and hormonal aspects of reproductive disorders in women from Semipalatinsk test site region

    International Nuclear Information System (INIS)

    Mamedalieva, N.M.; Moshcheeva, A.M.; Nauryzbaeva, B.U.

    1997-01-01

    90 women (62 during pregnancy and 28 out of pregnancy) from different districts of Semipalatinsk region were examined with aims of clinic-hormonal aspects study for reproductive disorders of pregnant from Semipalatinsk test site (STS) region. Age of examined women was within limits 18-40 years old. Patients have from 1 to 4 miscarriage abortions. Particular burdening of somatic, gynaecological and reproductive health of examined women is emphasized. Taking into consideration that among causes of reproductive disorders one of top places takes endocrine disorders the hormone background by content in blood of estradiol, progesterone and thyroid hormones was studied. It was determined, that hormonal disbalance or endocrine deficiency of women from STS during pregnancy and out the time does not guarantee normal course of hesitation process on the very early stages of development. When pregnancy was preserved the hormonal disbalance conducts to disfunction of fete-placental system. High frequency of both the obstetric and the perinatal pathology are caused by mentioned disfunctions

  18. [Vaginal infections in a Family Health Clinic in the Metropolitan Region, Chile].

    Science.gov (United States)

    Villaseca, Rodrigo; Ovalle, Alfredo; Amaya, Fernando; Labra, Bayron; Escalona, Natalia; Lizana, Paola; Montoya, M José; Lillo, Eduardo; Martínez, M Angélica

    2015-02-01

    Vaginal infections are a frequent cause for consultation, but their prevalence and etiology vary in different populations. To determine the prevalence and etiologies of vaginal infection in women attending a family health center in the Metropolitan Region of Chile. The microbiological diagnosis was made by wet mount and Gram stain. Diagnosis of trichomoniasis was performed by wet mount, culture and polymerase chain reaction. 101 women aged 15-54, not selected by signs or symptoms of vaginal infection, 46 of them pregnant were included. In 47 women (46.5%), vaginal infections were diagnosed. An association was observed between age and frequency of vaginal infection. The proportion of infections among pregnant and non-pregnant women was similar. The most frequent infections were bacterial vaginosis (16.8%), vulvovaginal candidiasis (11.9%) and co-infections (6.9%). We found 5.9% of intermediate microbiota cases, 3% of trichomoniasis and 2% of aerobic vaginitis. Symptoms of vaginal infection had poor agreement with microbiological findings. Otherwise physical signs had good agreement with the presence of infection, but low to moderate concordance with a specific etiology. We found a high prevalence of vaginal infections in the study population. It is necessary to improve the definitions and criteria of microbiological diagnosis of co-infections and intermediate microbiota, for them to be diagnosed in the clinical practice. More descriptive questionnaires are recommended to enhance the usefulness of clinical examination.

  19. Endoscopic endonasal anatomy of superior orbital fissure and orbital apex regions: critical considerations for clinical applications.

    Science.gov (United States)

    Dallan, Iacopo; Castelnuovo, Paolo; de Notaris, Matteo; Sellari-Franceschini, Stefano; Lenzi, Riccardo; Turri-Zanoni, Mario; Battaglia, Paolo; Prats-Galino, Alberto

    2013-05-01

    The superior orbital fissure is a critical three-dimensional space connecting the middle cranial fossa and the orbit. From an endoscopic viewpoint, only the medial aspect has a clinical significance. It presents a critical relationship with the lateral sellar compartment, the pterygopalatine fossa and the middle cranial fossa. The connective tissue layers and neural and vascular structures of this region are described. The role of Muller's muscle is confirmed, and the utility of the maxillary and optic strut is outlined. Muller's muscle extends for the whole length of the inferior orbital fissure, passes over the maxillary strut and enters the superior orbital fissure, representing a critical surgical landmark. Dividing the tendon between the medial and inferior rectus muscle allows the identification of the main trunk of the oculomotor nerve, and a little laterally, it is usually possible to visualize the first part of the ophthalmic artery. Based on a better knowledge of anatomy, we trust that this area could be readily addressed in clinical situations requiring an extended approach in proximity of the orbital apex.

  20. INCIDENCE AND CLINICAL FEATURES OF TUBERCULOSIS IN HIV-INFECTED CHILDREN IN THE SVERDLOVSK REGION

    Directory of Open Access Journals (Sweden)

    N. V. Eismont

    2014-01-01

    Full Text Available The paper analyzes the structure of HIV-infected children who was ill with tuberculosis in the Sverdlovsk Region in 2004-2012. The incidence of tuberculosis in children aged 0 to 14 years in the Sverdlovsk Region showed a 79.4% increase in the above period due to the introduction of Russian innovative technologies for the diagnosis of this disease in children. At the same time there was a rise in both the number of HIV-infected children aged 0 to 14 years and the proportion of same-age children with late-stage HIV infection. Simultaneously, the incidence of tuberculosis in the non-HIV-infected children aged 0 to 14 years was 55.2-193.2 times lower than that in the HIV-infected children. In 2004-2014, the Sverdlovsk Region notified fewer new cases of tuberculosis among the children without HIV infection than among those with its late stages. Non-HIV-infected children of both sexes were also ill with tuberculosis less frequently than HIV-infected boys and girls. HIV-infected children 1-3 and 7-14 years of age proved to be most vulnerable to tuberculosis. Among those who fell ill with tuberculosis, there was a preponderance of patients with late-stage HIV infection; moreover, the majority (79.6% received highly active antiretroviral therapy. 63.3% of the cases were in contact with a tuberculosis patient, only every five patients had chemoprophylaxis for this disease. High-quality vaccination against tuberculosis prevented complications and bacterial excretion in children with comorbidity. Out of the clinical forms of tuberculosis in children with HIV infection, there was a predominance of primary tuberculous complex and intrathoracic lymph node tuberculosis. The latter was less common in children without HIV infection than in those with this disease; the same was true of bacterial excretion in respiratory tuberculosis.

  1. Clinical and epidemiological features of hemorrhagic fever with renal syndrome course in Perm region

    Directory of Open Access Journals (Sweden)

    M. V. Ivanova

    2011-01-01

    Full Text Available The results of retrospective analysis of hemorrhagic fever with renal syndrome (HFRS incidence in the Perm region for 1995–2009 are shown in the article. There are highly active natural foci of infection on the territory of the region, mainly in the subzone of mixed coniferous-deciduous forests. Factors supporting the morbidity are high numbers of small mammals, in particular, the bank vole, with a large circulation of the HFRS virus and active population visit of natural foci in summer-autumn period. Analysis of clinical features of HFRS in 338 patients living in the Perm region, revealed some peculiarities of its course. Among surveyed contingent men (72,4% prevailed. Most of the patients (80,4% were of working age (16 to 60 years. More frequently mild and moderate forms (92,8% of HFRS were observed. A typical picture of the disease with the development of all specific syndromes occurred mainly in patients with severe and moderate forms. Mild cases occurred blurry in the absence of pathognomonic symptoms. Notable was the frequent lesion of liver, with the development of acute anicteric hepatitis (51,2%. Among the complications dominated: pneumonia (4,7% and acute renal  ailure (4,4%. Manifestations of DIC syndrome with recurrent bleeding were registered in 0,6% of patients, toxic shock – at 0,3%. Case fatality rate was 0,6%.

  2. Mutation of the N-Terminal Region of Chikungunya Virus Capsid Protein: Implications for Vaccine Design.

    Science.gov (United States)

    Taylor, Adam; Liu, Xiang; Zaid, Ali; Goh, Lucas Y H; Hobson-Peters, Jody; Hall, Roy A; Merits, Andres; Mahalingam, Suresh

    2017-02-21

    Mosquito-transmitted chikungunya virus (CHIKV) is an arthritogenic alphavirus of the Togaviridae family responsible for frequent outbreaks of arthritic disease in humans. Capsid protein, a structural protein encoded by the CHIKV RNA genome, is able to translocate to the host cell nucleolus. In encephalitic alphaviruses, nuclear translocation induces host cell transcriptional shutoff; however, the role of capsid protein nucleolar localization in arthritogenic alphaviruses remains unclear. Using recombinant enhanced green fluorescent protein (EGFP)-tagged expression constructs and CHIKV infectious clones, we describe a nucleolar localization sequence (NoLS) in the N-terminal region of capsid protein, previously uncharacterized in CHIKV. Mutation of the NoLS by site-directed mutagenesis reduced efficiency of nuclear import of CHIKV capsid protein. In the virus, mutation of the capsid protein NoLS (CHIKV-NoLS) attenuated replication in mammalian and mosquito cells, producing a small-plaque phenotype. Attenuation of CHIKV-NoLS is likely due to disruption of the viral replication cycle downstream of viral RNA synthesis. In mice, CHIKV-NoLS infection caused no disease signs compared to wild-type CHIKV (CHIKV-WT)-infected mice; lack of disease signs correlated with significantly reduced viremia and decreased expression of proinflammatory factors. Mice immunized with CHIKV-NoLS, challenged with CHIKV-WT at 30 days postimmunization, develop no disease signs and no detectable viremia. Serum from CHIKV-NoLS-immunized mice is able to efficiently neutralize CHIKV infection in vitro Additionally, CHIKV-NoLS-immunized mice challenged with the related alphavirus Ross River virus showed reduced early and peak viremia postchallenge, indicating a cross-protective effect. The high degree of CHIKV-NoLS attenuation may improve CHIKV antiviral and rational vaccine design. IMPORTANCE CHIKV is a mosquito-borne pathogen capable of causing explosive epidemics of incapacitating joint pain

  3. Negative Symptom Dimensions of the Positive and Negative Syndrome Scale Across Geographical Regions: Implications for Social, Linguistic, and Cultural Consistency.

    Science.gov (United States)

    Khan, Anzalee; Liharska, Lora; Harvey, Philip D; Atkins, Alexandra; Ulshen, Daniel; Keefe, Richard S E

    2017-12-01

    factors, but not the experiential factors, across regions. This could be due to a lack of equivalence between the original and translated versions, cultural differences with the interpretation of items, dissimilarities in rater training, or diversity in the understanding of scoring anchors. Knowing which items are challenging for raters across regions can help to guide Positive and Negative Syndrome Scale training and improve the results of international clinical trials aimed at negative symptoms.

  4. Dental artifacts in the head and neck region: implications for Dixon-based attenuation correction in PET/MR

    Energy Technology Data Exchange (ETDEWEB)

    Ladefoged, Claes N; Hansen, Adam E; Keller, Sune H; Fischer, Barbara M [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen East (Denmark); Rasmussen, Jacob H [Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen East (Denmark); Law, Ian; Kjær, Andreas; Højgaard, Liselotte [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen East (Denmark); Lauze, Francois [Department of Computer Science, University of Copenhagen, Universitetsparken 5, 2100 Copenhagen East (Denmark); Beyer, Thomas [Centre for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20/4L, Vienna, A-1090 (Austria); Andersen, Flemming L [Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen East (Denmark)

    2015-03-11

    In the absence of CT or traditional transmission sources in combined clinical positron emission tomography/magnetic resonance (PET/MR) systems, MR images are used for MR-based attenuation correction (MR-AC). The susceptibility effects due to metal implants challenge MR-AC in the neck region of patients with dental implants. The purpose of this study was to assess the frequency and magnitude of subsequent PET image distortions following MR-AC. A total of 148 PET/MR patients with clear visual signal voids on the attenuation map in the dental region were included in this study. Patients were injected with [{sup 18}F]-FDG, [{sup 11}C]-PiB, [{sup 18}F]-FET, or [{sup 64}Cu]-DOTATATE. The PET/MR data were acquired over a single-bed position of 25.8 cm covering the head and neck. MR-AC was based on either standard MR-AC{sub DIXON} or MR-AC{sub INPAINTED} where the susceptibility-induced signal voids were substituted with soft tissue information. Our inpainting algorithm delineates the outer contour of signal voids breaching the anatomical volume using the non-attenuation-corrected PET image and classifies the inner air regions based on an aligned template of likely dental artifact areas. The reconstructed PET images were evaluated visually and quantitatively using regions of interests in reference regions. The volume of the artifacts and the computed relative differences in mean and max standardized uptake value (SUV) between the two PET images are reported. The MR-based volume of the susceptibility-induced signal voids on the MR-AC attenuation maps was between 1.6 and 520.8 mL. The corresponding/resulting bias of the reconstructed tracer distribution was localized mainly in the area of the signal void. The mean and maximum SUVs averaged across all patients increased after inpainting by 52% (± 11%) and 28% (± 11%), respectively, in the corrected region. SUV underestimation decreased with the distance to the signal void and correlated with the volume of the susceptibility

  5. Microenvironmental influence on pre-clinical activity of polo-like kinase inhibition in multiple myeloma: implications for clinical translation.

    Directory of Open Access Journals (Sweden)

    Douglas W McMillin

    Full Text Available Polo-like kinases (PLKs play an important role in cell cycle progression, checkpoint control and mitosis. The high mitotic index and chromosomal instability of advanced cancers suggest that PLK inhibitors may be an attractive therapeutic option for presently incurable advanced neoplasias with systemic involvement, such as multiple myeloma (MM. We studied the PLK 1, 2, 3 inhibitor BI 2536 and observed potent (IC50<40 nM and rapid (commitment to cell death <24 hrs in vitro activity against MM cells in isolation, as well as in vivo activity against a traditional subcutaneous xenograft mouse model. Tumor cells in MM patients, however, don't exist in isolation, but reside in and interact with the bone microenvironment. Therefore conventional in vitro and in vivo preclinical assays don't take into account how interactions between MM cells and the bone microenvironment can potentially confer drug resistance. To probe this question, we performed tumor cell compartment-specific bioluminescence imaging assays to compare the preclinical anti-MM activity of BI 2536 in vitro in the presence vs. absence of stromal cells or osteoclasts. We observed that the presence of these bone marrow non-malignant cells led to decreased anti-MM activity of BI 2536. We further validated these results in an orthotopic in vivo mouse model of diffuse MM bone lesions where tumor cells interact with non-malignant cells of the bone microenvironment. We again observed that BI 2536 had decreased activity in this in vivo model of tumor-bone microenvironment interactions highlighting that, despite BI 2536's promising activity in conventional assays, its lack of activity in microenvironmental models raises concerns for its clinical development for MM. More broadly, preclinical drug testing in the absence of relevant tumor microenvironment interactions may overestimate potential clinical activity, thus explaining at least in part the gap between preclinical vs. clinical efficacy in MM