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Sample records for underlying diseases generally

  1. The use of sugammadex in a patient with Kennedy′s disease under general anesthesia

    Directory of Open Access Journals (Sweden)

    Risa Takeuchi

    2014-01-01

    Full Text Available Kennedy′s disease (KD, also known as spinal and bulbar muscular atrophy, is a rare, X-linked recessive, neurodegenerative disorder of the lower motor neurons characterized by progressive bulbar and appendicle muscular atrophy. Here we report a case of a 62-year-old male patient with KD, weighing 70 kg and 173 cm tall, was scheduled for frontal sinusectomy due to sinusitis. General anesthesia was induced through propofol 80 mg, remifentanil 0.25 μg/kg/min and 40 mg rocuronium. We were successfully able to use a sugammadex on a patient suffering from KD in order to reverse rocuronium-induced neuromuscular blockade.

  2. Oxygen general saturation after bronchography under general ...

    African Journals Online (AJOL)

    Thirty-six patients undergoing bronchography or bronchoscopy under general anaesthesia were continuously monitored by pulse oximetry for 5 hours after these procedures. Significant falls in oxygen saturation were observed in the first hour and were of most clinical relevance in patients with preexisting pulmonary ...

  3. Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience

    International Nuclear Information System (INIS)

    Sadigh, Sophie; Chopra, Mark; Olsen, Oeystein E.; Watson, Tom A.; Sury, Michael R.; Shah, Neil

    2017-01-01

    MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia. (orig.)

  4. Paediatric magnetic resonance enteroclysis under general anaesthesia - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Sadigh, Sophie; Chopra, Mark; Olsen, Oeystein E.; Watson, Tom A. [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Radiology, London (United Kingdom); Sury, Michael R. [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Anaesthetics, London (United Kingdom); Shah, Neil [Great Ormond Street Hospital NHS Foundation Trust, Department of Paediatric Gastroenterology, London (United Kingdom)

    2017-06-15

    MR enterography is the accepted imaging reference standard for small bowel assessment in inflammatory bowel disease. There is an increasing cohort of children with inflammatory bowel disease presenting at an early age (<5 years) with severe disease. Younger children present a technical challenge for enterography because of the need for sedation/general anaesthesia to allow image optimisation and the need for oral contrast to allow adequate luminal assessment. Through our experiences, MR enteroclysis under general anaesthesia has proven to be a successful imaging technique for the work-up of these patients. In this paper, we present our institutional practice for performing MR enteroclysis under general anaesthesia. (orig.)

  5. Fiberoptic laryngoscopy under general anesthesia in neonates

    NARCIS (Netherlands)

    L.J. Hoeve (Hans); R.H.M. van Poppelen

    1990-01-01

    textabstractAbstract In the Sophia Children's Hospital we perform fiberoptic laryngoscopy in neonates under general anesthesia without the use of muscle relaxants in the diagnostics of functional laryngeal disorders. The necessary diagnostic and anesthetic equipment is described. Special attention

  6. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  7. Is nighttime laparoscopic general surgery under general anesthesia safe?

    Science.gov (United States)

    Koltka, Ahmet Kemalettin; İlhan, Mehmet; Ali, Achmet; Gök, Ali Fuat Kaan; Sivrikoz, Nükhet; Yanar, Teoman Hakan; Günay, Mustafa Kayıhan; Ertekin, Cemalettin

    2018-01-01

    Fatigue and sleep deprivation can affect rational decision-making and motor skills, which can decrease medical performance and quality of patient care. The aim of the present study was to investigate the association between times of the day when laparoscopic general surgery under general anesthesia was performed and their adverse outcomes. All laparoscopic cholecystectomies and appendectomies performed at the emergency surgery department of a tertiary university hospital from 01. 01. 2016 to 12. 31. 2016 were included. Operation times were divided into three groups: 08.01-17.00 (G1: daytime), 17.01-23.00 (G2: early after-hours), and 23.01-08.00 (G3: nighttime). The files of the included patients were evaluated for intraoperative and postoperative surgery and anesthesia-related complications. We used multiple regression analyses of variance with the occurrence of intraoperative complications as a dependent variable and comorbidities, age, gender, body mass index (BMI), ASA score, and operation time group as independent variables. This revealed that nighttime operation (p<0.001; OR, 6.7; CI, 2.6-16.9) and older age (p=0.004; OR, 1.04; CI, 1.01-1.08) were the risk factor for intraoperative complications. The same analysis was performed for determining a risk factor for postoperative complications, and none of the dependent variables were found to be associated with the occurrence of postoperative complications. Nighttime surgery and older patient age increased the risk of intraoperative complications without serious morbidity or mortality, but no association was observed between the independent variables and the occurrence of postoperative complications.

  8. Crack initiation under generalized plane strain conditions

    International Nuclear Information System (INIS)

    Shum, D.K.M.; Merkle, J.G.

    1991-01-01

    A method for estimating the decrease in crack-initiation toughness, from a reference plane strain value, due to positive straining along the crack front of a circumferential flaw in a reactor pressure vessel is presented in this study. This method relates crack initiation under generalized plane strain conditions with material failure at points within a distance of a few crack-tip-opening displacements ahead of a crack front, and involves the formulation of a micromechanical crack-initiation model. While this study is intended to address concerns regarding the effects of positive out-of- plane straining on ductile crack initiation, the approach adopted in this work can be extended in a straightforward fashion to examine conditions of macroscopic cleavage crack initiation. Provided single- parameter dominance of near-tip fields exists in the flawed structure, results from this study could be used to examine the appropriateness of applying plane strain fracture toughness to the evaluation of circumferential flaws, in particular to those in ring-forged vessels which have no longitudinal welds. In addition, results from this study could also be applied toward the analysis of the effects of thermal streaming on the fracture resistance of circumferentially oriented flaws in a pressure vessel. 37 refs., 8 figs., 1 tab

  9. Gamma knife radiosurgery under general anesthesia in childhood

    International Nuclear Information System (INIS)

    Higuchi, Yoshinori; Serizawa, Toru; Nagano, Osamu

    2008-01-01

    Gamma knife radiosurgery (GKS) is an important treatment option for pediatric intracranial diseases, such as arteriovenous malformations and brain tumors. To perform GKS in children, general anesthesia is required for placing a stereotactic frame around the head of the patient, who must remain supine for the entire procedure. This report describes the anesthetic management of children who have undergone GKS at our institution. Fifty-one GKS procedures were performed in 43 patients (age range, 2-15 years). Twenty-one patients had arteriovenous malformations, and 14 patients had brain tumors. Twenty-nine patients (67.4%) received general anesthesia. All children 10 years or younger were treated under general anesthesia. General anesthesia for GKS is performed outside of the operating room and involves unique conditions. First, the patients must be transported to multiple sites in the hospital (the neuroangiography suite, the department of radiology for magnetic resonance imaging and computed tomography, and the gamma knife unit). Second, general anesthesia must be maintained in a high magnetic field. Third, medical staff, including anesthesiologists, must remain outside the room during irradiation. Safe and efficient general anesthesia is essential for performing GKS in children. (author)

  10. Endogenous Generalized Weights under DEA Control

    DEFF Research Database (Denmark)

    Agrell, Per J.; Bogetoft, Peter

    Non-parametric efficiency analysis, such as Data Envelopment Analysis (DEA) relies so far on endogenous local or exogenous general weights, based on revealed preferences or market prices. However, as DEA is gaining popularity in regulation and normative budgeting, the strategic interest...... of the evaluated industry calls for attention. We offer endogenous general prices based on a reformulation of DEA where the units collectively propose the set of weights that maximize their efficiency. Thus, the sector-wide efficiency is then a result of compromising the scores of more specialized smaller units...

  11. Generalized production planning problem under interval uncertainty

    Directory of Open Access Journals (Sweden)

    Samir A. Abass

    2010-06-01

    Full Text Available Data in many real life engineering and economical problems suffer from inexactness. Herein we assume that we are given some intervals in which the data can simultaneously and independently perturb. We consider the generalized production planning problem with interval data. The interval data are in both of the objective function and constraints. The existing results concerning the qualitative and quantitative analysis of basic notions in parametric production planning problem. These notions are the set of feasible parameters, the solvability set and the stability set of the first kind.

  12. Value maximizing maintenance policies under general repair

    International Nuclear Information System (INIS)

    Marais, Karen B.

    2013-01-01

    One class of maintenance optimization problems considers the notion of general repair maintenance policies where systems are repaired or replaced on failure. In each case the optimality is based on minimizing the total maintenance cost of the system. These cost-centric optimizations ignore the value dimension of maintenance and can lead to maintenance strategies that do not maximize system value. This paper applies these ideas to the general repair optimization problem using a semi-Markov decision process, discounted cash flow techniques, and dynamic programming to identify the value-optimal actions for any given time and system condition. The impact of several parameters on maintenance strategy, such as operating cost and revenue, system failure characteristics, repair and replacement costs, and the planning time horizon, is explored. This approach provides a quantitative basis on which to base maintenance strategy decisions that contribute to system value. These decisions are different from those suggested by traditional cost-based approaches. The results show (1) how the optimal action for a given time and condition changes as replacement and repair costs change, and identifies the point at which these costs become too high for profitable system operation; (2) that for shorter planning horizons it is better to repair, since there is no time to reap the benefits of increased operating profit and reliability; (3) how the value-optimal maintenance policy is affected by the system's failure characteristics, and hence whether it is worthwhile to invest in higher reliability; and (4) the impact of the repair level on the optimal maintenance policy. -- Highlights: •Provides a quantitative basis for maintenance strategy decisions that contribute to system value. •Shows how the optimal action for a given condition changes as replacement and repair costs change. •Shows how the optimal policy is affected by the system's failure characteristics. •Shows when it is

  13. Concrete structures under impact loading: general aspects

    Directory of Open Access Journals (Sweden)

    Cornelia Baeră

    2016-09-01

    Full Text Available Dynamic loading conditions distress the structural integrity of a structure differently than the static ones. Such actions transfer high rate strains and instant energy waves to the structure, inducing the possibility of imminent collapse and casualties as a direct consequence. In the latest years, considering the dramatic increase of terrorist threats and global warming, the structural safety criteria imply more than ever the need to withstand this kind of loading (e.g., missiles and blast, projectiles, strong winds, tornados and earthquakes in addition to the static ones. The aim of this paper is to provide a general overview with regard to impact loading in terms of defining the phenomenon from physical and mechanical perspective, its complex local or global effect on the targeted structure, relevant material characteristics, main research approaches, namely theoretical studies and experimental procedures developed for improving the predictability of the dynamic loads and their effects. New directions in developing superior cementitious composites, with better characteristics in terms of dynamic loading performance are also emphasized.

  14. Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms?

    Directory of Open Access Journals (Sweden)

    Xiaoqin Huang

    2017-05-01

    Full Text Available The occurrence of depression is higher in patients with chronic liver disease (CLD than that in the general population. The mechanism described in previous studies mainly focused on inflammation and stress, which not only exists in CLD, but also emerges in common chronic diseases, leaving the specific mechanism unknown. This review was to summarize the prevalence and risk factors of depression in CLD including chronic hepatitis B, chronic hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease, and to point out the possible underlying mechanism of this potential link. Clarifying the origins of this common comorbidity (depression and CLD may provide more information to understand both diseases.

  15. 28 CFR 30.4 - What are the Attorney General's general responsibilities under the Order?

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false What are the Attorney General's general... REVIEW OF DEPARTMENT OF JUSTICE PROGRAMS AND ACTIVITIES § 30.4 What are the Attorney General's general responsibilities under the Order? (a) The Attorney General provides opportunities for consultation by elected...

  16. General Concepts in Adult Congenital Heart Disease.

    Science.gov (United States)

    Mutluer, Ferit Onur; Çeliker, Alpay

    2018-01-20

    Congenital heart disease in adults (adult congenital heart disease) is a growing burden for healthcare systems. While infant mortality due to congenital heart disease in the last four decades decreased by almost 3-fold, adult congenital heart disease prevalence increased by more than 2-fold in United States. Adult congenital heart disease prevalence is expected to increase steadily until 2050 in projections. Adult congenital heart disease is a multifaceted problem with many dimensions. This manuscript aims to provide an overview of the common adult congenital heart diseases and summarize important points in management of these diseases with possible problems and complications that the patients and the physicians face.

  17. General Concepts in Adult Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Ferit Onur Mutluer

    2018-02-01

    Full Text Available Congenital heart disease in adults (adult congenital heart disease is a growing burden for healthcare systems. While infant mortality due to congenital heart disease in the last four decades decreased by almost 3-fold, adult congenital heart disease prevalence increased by more than 2-fold in United States. Adult congenital heart disease prevalence is expected to increase steadily until 2050 in projections. Adult congenital heart disease is a multifaceted problem with many dimensions. This manuscript aims to provide an overview of the common adult congenital heart diseases and summarize important points in management of these diseases with possible problems and complications that the patients and the physicians face

  18. Effects of music therapy under general anesthesia in patients ...

    African Journals Online (AJOL)

    2016-12-13

    Dec 13, 2016 ... The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, ..... Morphine consumption was lower in the ... psychological consequences such as post-traumatic stress disorder ...

  19. Radiodiagnosis of general diseases of the stomach

    International Nuclear Information System (INIS)

    Mikhajlov, A.N.

    1986-01-01

    Modern representations of X-ray diagnostics of the most wide-spread stomach diseases are shown. X-ray-anatomical-functional peculiarities of the stomach technique of its X-ray examination as well as X-ray diagnostics of diseases of the stomach are stated on the basis of data of special literature and own author experience. X-ray pattern of the operated stomach and its complications is described in detail

  20. Cardiovascular effects of oesophageal dilation under general anaesthesia

    DEFF Research Database (Denmark)

    Jakobsen, C H; Rasmussen, V; Rosenberg, J

    1999-01-01

    , but was not associated with the actual time of oesophageal distension. Thus, all cases of myocardial ischaemia were related to the time of extubation. No lasting complications were seen, and all patients could be discharged a maximum of 24 hours after the procedure. Pneumatic dilation of the oesophagus under general......Myocardial ischaemia and cardiac arrhythmias may occur during oesophageal dilation under conscious sedation, but no prospective data exist regarding dilation under general anaesthesia. We have studied the haemodynamic and electrocardiographic changes during routine oesophageal balloon dilation...... the procedure. Four patients developed significant hypotension at the time of balloon inflation with two patients requiring medical intervention to re-establish sufficient cardiovascular function. Tachycardia and ST-deviation occurred in four and three patients, respectively, during the general anaesthesia...

  1. Generalized thermalization for integrable system under quantum quench.

    Science.gov (United States)

    Muralidharan, Sushruth; Lochan, Kinjalk; Shankaranarayanan, S

    2018-01-01

    We investigate equilibration and generalized thermalization of the quantum Harmonic chain under local quantum quench. The quench action we consider is connecting two disjoint harmonic chains of different sizes and the system jumps between two integrable settings. We verify the validity of the generalized Gibbs ensemble description for this infinite-dimensional Hilbert space system and also identify equilibration between the subsystems as in classical systems. Using Bogoliubov transformations, we show that the eigenstates of the system prior to the quench evolve toward the Gibbs Generalized Ensemble description. Eigenstates that are more delocalized (in the sense of inverse participation ratio) prior to the quench, tend to equilibrate more rapidly. Further, through the phase space properties of a generalized Gibbs ensemble and the strength of stimulated emission, we identify the necessary criterion on the initial states for such relaxation at late times and also find out the states that would potentially not be described by the generalized Gibbs ensemble description.

  2. Effects of music therapy under general anesthesia in patients ...

    African Journals Online (AJOL)

    Background: Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. Methods: This is a ...

  3. A retrospective comparison of dental treatment under general ...

    African Journals Online (AJOL)

    Purpose: The purpose of this study is to determine the properties of the dental procedures performed on children with dental problems under general anesthesia and compared between the patterns of dental treatment provided for intellectual disability and non.cooperate healthy child. Materials and Methods: In this ...

  4. Approximation solutions for indifference pricing under general utility functions

    NARCIS (Netherlands)

    Chen, An; Pelsser, Antoon; Vellekoop, M.H.

    2008-01-01

    With the aid of Taylor-based approximations, this paper presents results for pricing insurance contracts by using indifference pricing under general utility functions. We discuss the connection between the resulting "theoretical" indifference prices and the pricing rule-of-thumb that practitioners

  5. Approximate Solutions for Indifference Pricing under General Utility Functions

    NARCIS (Netherlands)

    Chen, A.; Pelsser, A.; Vellekoop, M.

    2007-01-01

    With the aid of Taylor-based approximations, this paper presents results for pricing insurance contracts by using indifference pricing under general utility functions. We discuss the connection between the resulting "theoretical" indifference prices and the pricing rule-of-thumb that practitioners

  6. Gauge theories under incorporation of a generalized uncertainty principle

    International Nuclear Information System (INIS)

    Kober, Martin

    2010-01-01

    There is considered an extension of gauge theories according to the assumption of a generalized uncertainty principle which implies a minimal length scale. A modification of the usual uncertainty principle implies an extended shape of matter field equations like the Dirac equation. If there is postulated invariance of such a generalized field equation under local gauge transformations, the usual covariant derivative containing the gauge potential has to be replaced by a generalized covariant derivative. This leads to a generalized interaction between the matter field and the gauge field as well as to an additional self-interaction of the gauge field. Since the existence of a minimal length scale seems to be a necessary assumption of any consistent quantum theory of gravity, the gauge principle is a constitutive ingredient of the standard model, and even gravity can be described as gauge theory of local translations or Lorentz transformations, the presented extension of gauge theories appears as a very important consideration.

  7. Generalized anxiety disorder: A comorbid disease.

    Science.gov (United States)

    Nutt, David; Argyropoulos, Spilos; Hood, Sean; Potokar, John

    2006-07-01

    Generalized anxiety disorder (GAD) frequently occurs comorbidly with other conditions, including depression and somatic complaints. Comorbid GAD sufferers have increased psychologic and social impairment, request additional treatment, and have an extended course and poorer outcome than those with GAD alone; therapy should alleviate both the psychic and somatic symptoms of GAD without negatively affecting the comorbid condition. The ideal treatment would provide relief from both GAD and the comorbid condition, reducing the need for polypharmacy. Physicians need suitable tools to assist them in the detection and monitoring of GAD patients-the GADI, a new, self-rating scale, may meet this requirement. Clinical data have shown that various neurobiologic irregularities (e.g., in the GABA and serotonin systems) are associated with the development of anxiety. Prescribing physicians must take into account these abnormalities when choosing a drug. Effective diagnosis and treatment should improve patients' quality of life and their prognosis for recovery.

  8. Dental management of PHACE syndrome under general anesthesia

    Directory of Open Access Journals (Sweden)

    S Fernandes

    2011-01-01

    Full Text Available PHACE syndrome was first described by Dr. Ilonia Frieden and colleagues in 1996. It is an under-recognized rather than a very rare condition among patients with large facial hemangiomas. It is challenging as it has significant neurological, vascular and airway implications. Vascular malformations compromising cerebral blood flow predispose the patient to strokes and seizures. Subglottic hemangiomas, if present, could bleed during intubation. Meticulous neurological monitoring is mandatory in those undergoing repair of the great vessels. We describe the perioperative management of a child with PHACE syndrome subjected to dental treatment under general anesthesia.

  9. Colonoscopic Polypectomy of Colorectal Polyps in Children Under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Chien-Heng Lin

    2009-02-01

    Full Text Available In many countries, general anesthesia is not routinely used for colonoscopic polypectomy in children because of either feasibility or cost-effectiveness issues. However, we have been using general anesthesia for colonoscopic polypectomy in pediatric patients in our hospital for the past 5 years. The aim of this study was to evaluate the safety of the procedure and the degree of satisfaction that the patients' parents and endoscopists had with the use of general anesthesia. We retrospectively analyzed the results of colonoscopic polypectomies under general anesthesia in 18 patients performed between January 2001 and December 2005. The removed polyps were examined histologically and the patients were observed to assess complications during the first 24-hour postoperative period. The patients' parents' and endoscopists' satisfaction with the use of general anesthesia was surveyed after the procedure. In our patient group, there were 10 boys and eight girls. The mean age was 5.5 ± 3.4 years (range, 2–15 years. Seventeen of the 18 patients had rectal bleeding (mean duration, 3.7 months as the main symptom. There were 12 patients with juvenile polyps, four with hyperplastic polyps, one with juvenile polyposis and one with Peutz-Jeghers syndrome. The majority (70.6% of the polyps were located in the rectosigmoid colon. No significant complications related to colonoscopic polypectomy or anesthesia were observed. Satisfaction among parents and endoscopists ranged from good to excellent. General anesthesia is recommended for pediatric patients undergoing colonoscopic polypectomy.

  10. Comparison of patients with and without intellectual disability under general anesthesia: A retrospective study.

    Science.gov (United States)

    Sitilci, T; Demirgan, S; Akcay, C; Kahraman, N; Koseoglu, B G; Erdem, M A; Cankaya, A B

    2017-04-01

    We analyzed and retrospectively compared patients with and without intellectual disability (ID) who underwent oral surgery under general anesthesia at Istanbul University, Faculty of Dentistry, Department of General Anesthesia, between October 2012 and June 2013 with regard to the following categories: Demographic features, American Society of Anesthesiologists (ASA) classification, Mallampati score, type of anesthetic drug used during the operation, type of intubation used, any difficulties with tracheal intubation, presence of systemic diseases, and recovery times after ending general anesthesia. A total of 348 patients were selected from the Department of Maxillofacial Surgery and the Department of Pedodontics who underwent surgery with general anesthesia. Medical histories of all patients were taken, and their electrocardiography, chest X-rays, complete blood count, and blood clotting tests were checked during a preoperative assessment. Mallampati evaluations were also performed. Patients were grouped into ASA I, II, or III according to the ASA classification and were treated under general anesthesia. There was no significant difference between normal and intellectually disabled patients in terms of gender, Mallampati scores, intubation difficulties, mean anesthetic period, time to discharge, or postoperative nausea and vomiting. Epilepsy and genetic diseases in intellectually disabled patients were significantly more common than in non-ID (NID) patients. However, the frequency of diabetes and chronic obstructive pulmonary disease in NID patients was significantly higher than in the intellectually disabled patients. Dental treatment of intellectually disabled patients under general anesthesia can be performed just as safely as that with NID patients.

  11. Dental management of hemophiliac child under general anesthesia.

    Science.gov (United States)

    Rayen, R; Hariharan, V S; Elavazhagan, N; Kamalendran, N; Varadarajan, R

    2011-01-01

    Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

  12. Project management under uncertainty beyond beta: The generalized bicubic distribution

    Directory of Open Access Journals (Sweden)

    José García Pérez

    2016-01-01

    Full Text Available The beta distribution has traditionally been employed in the PERT methodology and generally used for modeling bounded continuous random variables based on expert’s judgment. The impossibility of estimating four parameters from the three values provided by the expert when the beta distribution is assumed to be the underlying distribution has been widely debated. This paper presents the generalized bicubic distribution as a good alternative to the beta distribution since, when the variance depends on the mode, the generalized bicubic distribution approximates the kurtosis of the Gaussian distribution better than the beta distribution. In addition, this distribution presents good properties in the PERT methodology in relation to moderation and conservatism criteria. Two empirical applications are presented to demonstrate the adequateness of this new distribution.

  13. Dental management of hemophiliac child under general anesthesia

    Directory of Open Access Journals (Sweden)

    R Rayen

    2011-01-01

    Full Text Available Hemophilia is the most common inherited bleeding disorder. Hemophilic patients should be cosidered as special patients. There is no contraindication to general dental treatment for hemophiliacs, as they generally do not involve bleeding. But caution must be used with any surgical procedures that involve the local and general anesthesia. Such patients should always be managed in the setting of specialized units with appropriate clinical expertise and laboratory support. Recent advances in the management of hemophilia have enabled many hemophiliac patients to receive surgical dental procedures in an outpatient dental care on a routine basis. The purpose of this case report is to provide a few management strategies when providing full mouth rehabilitation under anesthesia and replacement therapies that are available. In addition, overviews of possible complication that may be encountered when providing such treatment are discussed here.

  14. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

    International Nuclear Information System (INIS)

    Mahmoud, Mohamed; Towe, Christopher; Fleck, Robert J.

    2015-01-01

    Today's practice of medicine involves ever more complex patients whose care is coordinated with multidisciplinary teams. Caring for these patients can challenge all members of the health care team. Sedation/anesthesia in infants/toddlers as well as uncooperative or intellectually or emotionally impaired children who require imaging studies of the chest are ongoing challenges. High-quality computed tomography (CT) chest imaging studies in children under general anesthesia are extremely important for accurate interpretation and subsequent medical decision-making. Anesthesia-induced atelectasis may obscure or mimic true pathology creating a significant quality issue. Obtaining a high-quality, motion-free chest imaging study in infants and children under general anesthesia remains a difficult task in many institutions. Meticulous attention to anesthesia and imaging techniques and specialized knowledge are required to properly perform and interpret chest imaging studies. In this commentary, we discuss the continuous struggle to obtain high-quality CT chest imaging under general anesthesia. We will also discuss the major concerns of the anesthesiologist, radiologist and pulmonologist and why cooperation and coordination among these providers are critical for an optimal quality study.

  15. CT chest under general anesthesia: pulmonary, anesthetic and radiologic dilemmas

    Energy Technology Data Exchange (ETDEWEB)

    Mahmoud, Mohamed [Cincinnati Children' s Hospital Medical Center, Department of Anesthesiology, Cincinnati, OH (United States); Towe, Christopher [Cincinnati Children' s Hospital Medical Center, Department of Pulmonary Medicine, Cincinnati, OH (United States); Fleck, Robert J. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States)

    2015-07-15

    Today's practice of medicine involves ever more complex patients whose care is coordinated with multidisciplinary teams. Caring for these patients can challenge all members of the health care team. Sedation/anesthesia in infants/toddlers as well as uncooperative or intellectually or emotionally impaired children who require imaging studies of the chest are ongoing challenges. High-quality computed tomography (CT) chest imaging studies in children under general anesthesia are extremely important for accurate interpretation and subsequent medical decision-making. Anesthesia-induced atelectasis may obscure or mimic true pathology creating a significant quality issue. Obtaining a high-quality, motion-free chest imaging study in infants and children under general anesthesia remains a difficult task in many institutions. Meticulous attention to anesthesia and imaging techniques and specialized knowledge are required to properly perform and interpret chest imaging studies. In this commentary, we discuss the continuous struggle to obtain high-quality CT chest imaging under general anesthesia. We will also discuss the major concerns of the anesthesiologist, radiologist and pulmonologist and why cooperation and coordination among these providers are critical for an optimal quality study.

  16. Generalized connective tissue disease in Crtap-/- mouse.

    Directory of Open Access Journals (Sweden)

    Dustin Baldridge

    2010-05-01

    Full Text Available Mutations in CRTAP (coding for cartilage-associated protein, LEPRE1 (coding for prolyl 3-hydroxylase 1 [P3H1] or PPIB (coding for Cyclophilin B [CYPB] cause recessive forms of osteogenesis imperfecta and loss or decrease of type I collagen prolyl 3-hydroxylation. A comprehensive analysis of the phenotype of the Crtap-/- mice revealed multiple abnormalities of connective tissue, including in the lungs, kidneys, and skin, consistent with systemic dysregulation of collagen homeostasis within the extracellular matrix. Both Crtap-/- lung and kidney glomeruli showed increased cellular proliferation. Histologically, the lungs showed increased alveolar spacing, while the kidneys showed evidence of segmental glomerulosclerosis, with abnormal collagen deposition. The Crtap-/- skin had decreased mechanical integrity. In addition to the expected loss of proline 986 3-hydroxylation in alpha1(I and alpha1(II chains, there was also loss of 3Hyp at proline 986 in alpha2(V chains. In contrast, at two of the known 3Hyp sites in alpha1(IV chains from Crtap-/- kidneys there were normal levels of 3-hydroxylation. On a cellular level, loss of CRTAP in human OI fibroblasts led to a secondary loss of P3H1, and vice versa. These data suggest that both CRTAP and P3H1 are required to maintain a stable complex that 3-hydroxylates canonical proline sites within clade A (types I, II, and V collagen chains. Loss of this activity leads to a multi-systemic connective tissue disease that affects bone, cartilage, lung, kidney, and skin.

  17. Homotopy Method for a General Multiobjective Programming Problem under Generalized Quasinormal Cone Condition

    Directory of Open Access Journals (Sweden)

    X. Zhao

    2012-01-01

    Full Text Available A combined interior point homotopy continuation method is proposed for solving general multiobjective programming problem. We prove the existence and convergence of a smooth homotopy path from almost any interior initial interior point to a solution of the KKT system under some basic assumptions.

  18. Pricing Participating Products under a Generalized Jump-Diffusion Model

    Directory of Open Access Journals (Sweden)

    Tak Kuen Siu

    2008-01-01

    Full Text Available We propose a model for valuing participating life insurance products under a generalized jump-diffusion model with a Markov-switching compensator. It also nests a number of important and popular models in finance, including the classes of jump-diffusion models and Markovian regime-switching models. The Esscher transform is employed to determine an equivalent martingale measure. Simulation experiments are conducted to illustrate the practical implementation of the model and to highlight some features that can be obtained from our model.

  19. Respiratory Diseases in Children: studies in general practice

    NARCIS (Netherlands)

    J.H.J.M. Uijen (Hans)

    2011-01-01

    textabstractThe work presented in this thesis covers various aspects of the epidemiology, diagnosis and management of various respiratory symptoms and diseases in children frequently encountered in general practice. These respiratory tract symptoms and diseases can be categorized into symptoms and

  20. Does the dilution effect generally occur in animal diseases?

    NARCIS (Netherlands)

    Huang, Zheng Y.X.; Yu, Yang; Langevelde, Van Frank; Boer, De Willem F.

    2017-01-01

    The dilution effect (DE) has been reported in many diseases, but its generality is still highly disputed. Most current criticisms of DE are related to animal diseases. Particularly, some critical studies argued that DE is less likely to occur in complex environments. Here our meta-analyses

  1. Neural correlates underlying micrographia in Parkinson's disease.

    Science.gov (United States)

    Wu, Tao; Zhang, Jiarong; Hallett, Mark; Feng, Tao; Hou, Yanan; Chan, Piu

    2016-01-01

    Micrographia is a common symptom in Parkinson's disease, which manifests as either a consistent or progressive reduction in the size of handwriting or both. Neural correlates underlying micrographia remain unclear. We used functional magnetic resonance imaging to investigate micrographia-related neural activity and connectivity modulations. In addition, the effect of attention and dopaminergic administration on micrographia was examined. We found that consistent micrographia was associated with decreased activity and connectivity in the basal ganglia motor circuit; while progressive micrographia was related to the dysfunction of basal ganglia motor circuit together with disconnections between the rostral supplementary motor area, rostral cingulate motor area and cerebellum. Attention significantly improved both consistent and progressive micrographia, accompanied by recruitment of anterior putamen and dorsolateral prefrontal cortex. Levodopa improved consistent micrographia accompanied by increased activity and connectivity in the basal ganglia motor circuit, but had no effect on progressive micrographia. Our findings suggest that consistent micrographia is related to dysfunction of the basal ganglia motor circuit; while dysfunction of the basal ganglia motor circuit and disconnection between the rostral supplementary motor area, rostral cingulate motor area and cerebellum likely contributes to progressive micrographia. Attention improves both types of micrographia by recruiting additional brain networks. Levodopa improves consistent micrographia by restoring the function of the basal ganglia motor circuit, but does not improve progressive micrographia, probably because of failure to repair the disconnected networks. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  2. Failure Rate of Pediatric Dental Treatment under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Effat Khodadadi

    2018-06-01

    Full Text Available Aim: To assess the failure rates of various pediatric dental treatments performed under general anesthesia (GA after six months to five years of follow-up. Design: This multicenter retrospective cohort study was performed on patients treated by five pedodontists in two private hospitals located in northern Iran during 2010–2013 and comprised 155 patients. The patients were recalled and clinically examined. During the clinical examination of the primary teeth, oral hygiene, dmft index, and failure of previous treatments was evaluated. The data were analyzed using the Chi square and regression analyses with a significance level of 0.05. Results: 114 patients (74 males and 40 females, mean age: 37.17 ± 10.75 months with 1155 primary teeth treated under GA participated in the follow-up. The overall failure rate was 6.59%. The failure rates of pulpectomy, pulopotomy, fissure sealant, stainless steel crown (SSC, amalgam, and composite fillings were 2.90%, 3.03%, 4.83%, 5.26%, 5.33%, and 9.63%, respectively. Among the confounding factors, only gender had a significant effect on the anterior composite failure rate (p = 0.029 and age had a significant effect on the failure rate of fissure sealant therapy (p = 0.015 and SSC (p = 0.018. Conclusion: The overall rate of treatment failure in pediatric patients, treated under GA, was 6.59%.

  3. Hard decoding algorithm for optimizing thresholds under general Markovian noise

    Science.gov (United States)

    Chamberland, Christopher; Wallman, Joel; Beale, Stefanie; Laflamme, Raymond

    2017-04-01

    Quantum error correction is instrumental in protecting quantum systems from noise in quantum computing and communication settings. Pauli channels can be efficiently simulated and threshold values for Pauli error rates under a variety of error-correcting codes have been obtained. However, realistic quantum systems can undergo noise processes that differ significantly from Pauli noise. In this paper, we present an efficient hard decoding algorithm for optimizing thresholds and lowering failure rates of an error-correcting code under general completely positive and trace-preserving (i.e., Markovian) noise. We use our hard decoding algorithm to study the performance of several error-correcting codes under various non-Pauli noise models by computing threshold values and failure rates for these codes. We compare the performance of our hard decoding algorithm to decoders optimized for depolarizing noise and show improvements in thresholds and reductions in failure rates by several orders of magnitude. Our hard decoding algorithm can also be adapted to take advantage of a code's non-Pauli transversal gates to further suppress noise. For example, we show that using the transversal gates of the 5-qubit code allows arbitrary rotations around certain axes to be perfectly corrected. Furthermore, we show that Pauli twirling can increase or decrease the threshold depending upon the code properties. Lastly, we show that even if the physical noise model differs slightly from the hypothesized noise model used to determine an optimized decoder, failure rates can still be reduced by applying our hard decoding algorithm.

  4. A Generalized Formulation of Demand Response under Market Environments

    Science.gov (United States)

    Nguyen, Minh Y.; Nguyen, Duc M.

    2015-06-01

    This paper presents a generalized formulation of Demand Response (DR) under deregulated electricity markets. The problem is scheduling and controls the consumption of electrical loads according to the market price to minimize the energy cost over a day. Taking into account the modeling of customers' comfort (i.e., preference), the formulation can be applied to various types of loads including what was traditionally classified as critical loads (e.g., air conditioning, lights). The proposed DR scheme is based on Dynamic Programming (DP) framework and solved by DP backward algorithm in which the stochastic optimization is used to treat the uncertainty, if any occurred in the problem. The proposed formulation is examined with the DR problem of different loads, including Heat Ventilation and Air Conditioning (HVAC), Electric Vehicles (EVs) and a newly DR on the water supply systems of commercial buildings. The result of simulation shows significant saving can be achieved in comparison with their traditional (On/Off) scheme.

  5. Vehicle technology under CO2 constraint: a general equilibrium analysis

    International Nuclear Information System (INIS)

    Schaefer, Andreas; Jacoby, Henry D.

    2006-01-01

    A study is presented of the rates of penetration of different transport technologies under policy constraints on CO 2 emissions. The response of this sector is analyzed within an overall national level of restriction, with a focus on automobiles, light trucks, and heavy freight trucks. Using the US as an example, a linked set of three models is used to carry out the analysis: a multi-sector computable general equilibrium model of the economy, a MARKAL-type model of vehicle and fuel supply technology, and a model simulating the split of personal and freight transport among modes. Results highlight the importance of incremental improvements in conventional internal combustion engine technology, and, in the absence of policies to overcome observed consumer discount rates, the very long time horizons before radical alternatives like the internal combustion engine hybrid drive train vehicle are likely to take substantial market share

  6. Postoperative Submandibular Gland Swelling following Craniotomy under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Haruka Nakanishi

    2015-01-01

    Full Text Available Objective. Reporting of a rare case of postoperative submandibular gland swelling following craniotomy. Case Report. A 33-year-old male underwent resection for a brain tumor under general anesthesia. The tumor was resected via a retrosigmoid suboccipital approach and the patient was placed in a lateral position with his face down and turned to the right. Slight swelling of the right submandibular gland was observed just after the surgery. Seven hours after surgery, edematous change around the submandibular gland worsened and he required emergent reintubation due to airway compromise. The cause of submandibular gland swelling seemed to be an obstruction of the salivary duct due to surgical positioning. Conclusion. Once submandibular swelling and edematous change around the submandibular gland occur, they can worsen and compromise the air way within several hours after operation. Adequate precaution must be taken for any predisposing skull-base surgery that requires strong cervical rotation and flexion.

  7. Mitochondrial dysfunction underlying outer retinal diseases

    DEFF Research Database (Denmark)

    Lefevere, Evy; Toft-Kehler, Anne Katrine; Vohra, Rupali

    2017-01-01

    Dysfunction of photoreceptors, retinal pigment epithelium (RPE) or both contribute to the initiation and progression of several outer retinal disorders. Disrupted Müller glia function might additionally subsidize to these diseases. Mitochondrial malfunctioning is importantly associated with outer...

  8. Exploration of Disease Markers under Translational Medicine Model

    Directory of Open Access Journals (Sweden)

    Rajagopal Krishnamoorthy

    2015-06-01

    Full Text Available Disease markers are defined as the biomarkers with specific characteristics during the general physical, pathological or therapeutic process, the detection of which can inform the progression of present biological process of organisms. However, the exploration of disease markers is complicated and difficult, and only a few markers can be used in clinical practice and there is no significant difference in the mortality of cancers before and after biomarker exploration. Translational medicine focuses on breaking the blockage between basic medicine and clinical practice. In addition, it also establishes an effective association between researchers engaged on basic scientific discovery and clinical physicians well informed of patients' requirements, and gives particular attentions on how to translate the basic molecular biological research to the most effective and appropriate methods for the diagnosis, treatment and prevention of diseases, hoping to translate basic research into the new therapeutic methods in clinic. Therefore, this study mainly summarized the exploration of disease markers under translational medicine model so as to provide a basis for the translation of basic research results into clinical application.

  9. Fatigue, General Health, and Ischemic Heart Disease in Older Adults

    DEFF Research Database (Denmark)

    Ekmann, Anette; Petersen, Inge; Mänty, Minna Regina

    2013-01-01

    Backgrounds.Fatigue has been shown to predict ischemic heart disease (IHD) and mortality in nonsmoking middle-aged men free of cardiovascular disease. The aim of this study was to investigate the predictive value of fatigue for IHD and general health in nondisabled individuals free...... of cardiovascular disease and older than 70 years. METHODS: The study population was drawn from The Longitudinal Study of Aging Danish Twins. In total, 1,696 participants were followed up for 2-10 years by questionnaires and 10-16 years through registries. Kaplan Meier, Cox Proportional Hazard and logistic.......08-2.00) compared with participants without fatigue. CONCLUSION: We concluded that fatigue in nondisabled older adults free of cardiovascular disease is an early predictor for development of subsequent poor general health and IHD....

  10. General gastroscopy of gastroesophageal reflux disease: Analysis of 4086 cases

    Directory of Open Access Journals (Sweden)

    Zhi-wei HU

    2018-04-01

    Full Text Available Objective To analyze the characteristics of gastroesophageal reflux disease (GERD under general gastroscope. Methods The detection rates of GERD related abnormalities such as esophagitis, Barrett esophagus and hiatal hernia under the first gastroscopy of the adult GERD patients from January 2013 to January 2017 in our center and the statistical relationship between the abnormal findings were analyzed retrospectively. Results A total of 4086 GERD patients, 2004 males and 2082 females, were included in this study, and the age was 18-89(50.4±13.3 years old. The detection rate of non erosive GERD was 78.7%, esophagitis 21.3%; non Barrett esophagus 87.7%, suspected Barrett esophagus 8.3%, Barrett esophagus 3.9%; generally normal cardia 61.4%, short segment hiatus hernia 20.4%, and long segment hiatal hernia 18.2%. The detection rates of esophagitis showed statistically significant differences (P0.013. Comparing the three age groups of 18-39, 40-59 and ≥60 years old, the detection rate of hiatal hernia was significantly higher in the group of ≥60 years old than in the 18-39 and 40-59 years old groups (P=0.007, while there was no significant difference (P>0.013 between the 18-39 and 40-59 years old groups. The detection rate of esophagitis was significantly higher in ≥60 years old group than in 18-39 and 40-59 years old groups (P=0.004, P=0.008, while no significant statistically difference (P>0.013 was found between the later two groups. Conclusions Gastroscopy can be used as a basic examination means for GERD; short segment hiatal hernia can be regarded as an early form of hiatal hernia, and is of importantreference value for the diagnosis and treatment of GERD; more serious hiatal hernia and esophagitis could be found in elderly GERD patients. DOI: 10.11855/j.issn.0577-7402.2018.01.08

  11. Disease prevalence estimations based on contact registrations in general practice

    NARCIS (Netherlands)

    Hoogenveen, Rudolf; Westert, Gert; Dijkgraaf, Marcel; Schellevis, François; de Bakker, Dinny

    2002-01-01

    This paper describes how to estimate the prevalence of chronic diseases in a population using data from contact registrations in general practice with a limited time length. Instead of using only total numbers of observed patients adjusted for the length of the observation period, we propose the use

  12. Bilateral corneal denting after surgery under general anesthesia: A case report

    Directory of Open Access Journals (Sweden)

    Satsuki Obata

    2018-06-01

    Full Text Available Purpose: To report a case of temporary bilateral corneal denting in a patient who underwent cardiovascular surgery under general anesthesia. Observations: A 71-year-old male with no history of ophthalmological disease experienced bilateral corneal denting immediately after undergoing surgery for aneurysm of the thoracic aorta under general anesthesia. Anesthesia was induced with propofol and maintained with rocuronium bromide and remifentanil hydrochloride. The initial examination revealed significant denting on the surface of both the corneas and ocular hypotension. Visual evaluation could not be performed due to the patient's low level of consciousness resulting from delayed emergence from anesthesia. After applying tropicamide and phenylephrine ophthalmic solution for fundus examination, the ocular morphology improved. Ocular pressure was normal on the day after surgery, and creasing on the surface of the corneas had disappeared. Conclusions: and Importance: We experienced a patient with bilateral corneal denting following a cardiovascular surgery under general anesthesia. The dents could be attributed to augmentation of ocular hypotension using several types of anesthesia at relatively high doses. Keywords: General anesthesia, Cornea denting, Complication, Cardiovascular surgery

  13. Chest computed tomography in children under general anesthesia - cases of an atelectasis

    International Nuclear Information System (INIS)

    Laskowska, K.; Lasek, W.; Drewa, S.; Karolkiewicz, M.; Pogorzala, M.; Wysocki, M.

    2003-01-01

    Computed tomography is a routine examination in children with diagnosed or suspected cancer. Despite the procedure is painless, it requires stillness for some time. Thus, general anesthesia is provided in selected cases. An aim of this paper was an evaluation of an atelectasis incidence in children referred to CT examination under general anesthesia. Material consisted of 11 children aged 2-61 months with neoplasmatic disease diagnosed or suspected. All of them had a regular chest CT exam under general anesthesia with lungs parenchyma, mediastinum and chest wall analyzed. In 4 of 11 children (36%) atelectasis was seen, located in supradiaphragmatic and paravertebral segments of the lungs. None of the children had clinical symptoms of atelectasis. In two of them control chest radiograms did not show any changes. In some patients general anesthesia may reduce the lungs pneumatization which can hide metastases in lungs. It could be summarized that in infants and young children sedation instead of general anesthesia in chest CT should be considered, which could improve the quality of the imaging and the safety of the examination. (author)

  14. Emergency general surgery: definition and estimated burden of disease.

    Science.gov (United States)

    Shafi, Shahid; Aboutanos, Michel B; Agarwal, Suresh; Brown, Carlos V R; Crandall, Marie; Feliciano, David V; Guillamondegui, Oscar; Haider, Adil; Inaba, Kenji; Osler, Turner M; Ross, Steven; Rozycki, Grace S; Tominaga, Gail T

    2013-04-01

    Acute care surgery encompasses trauma, surgical critical care, and emergency general surgery (EGS). While the first two components are well defined, the scope of EGS practice remains unclear. This article describes the work of the American Association for the Surgery of Trauma to define EGS. A total of 621 unique International Classification of Diseases-9th Rev. (ICD-9) diagnosis codes were identified using billing data (calendar year 2011) from seven large academic medical centers that practice EGS. A modified Delphi methodology was used by the American Association for the Surgery of Trauma Committee on Severity Assessment and Patient Outcomes to review these codes and achieve consensus on the definition of primary EGS diagnosis codes. National Inpatient Sample data from 2009 were used to develop a national estimate of EGS burden of disease. Several unique ICD-9 codes were identified as primary EGS diagnoses. These encompass a wide spectrum of general surgery practice, including upper and lower gastrointestinal tract, hepatobiliary and pancreatic disease, soft tissue infections, and hernias. National Inpatient Sample estimates revealed over 4 million inpatient encounters nationally in 2009 for EGS diseases. This article provides the first list of ICD-9 diagnoses codes that define the scope of EGS based on current clinical practices. These findings have wide implications for EGS workforce training, access to care, and research.

  15. Postanesthetic Emergence Agitation in Pediatric Patients under General Anesthesia

    OpenAIRE

    Mohkamkar, Masoumeh; Farhoudi, Fatemeh; Alam-Sahebpour, Alireza; Mousavi, Seyed-Abdullah; Khani, Soghra; Shahmohammadi, Soheila

    2014-01-01

    Abstract Objective Postanesthetic emergence agitation is a common problem in pediatric postanesthetic care unit with an incidence ranging from 10 to 80%. This study was done to determine the prevalence of emergence agitation and associated risk factors in pediatric patients who underwent general anesthesia. Methods This cross-sectional descriptive and analytic study was performed on 747 pediatric patients aged 3- 7 years that underwent general anesthesia for various elective surgeries at Bou-...

  16. Effect of Epidural Block under General Anesthesia on Pulse Transit Time

    International Nuclear Information System (INIS)

    Choi, Byeong Cheol; Kim, Seong Min; Jung, Dong Keun; Kim, Gi Ryon; Lee, He Jeong; Jeon, Gye Rock

    2005-01-01

    Epidural block under general anesthesia has been widely used to control postoperative pain. In this anesthetic state many hemodynamic parameters are changed. Moreover pulse transit time is influenced by this memodynamic change. PPT change in the finger and the toe due to relaxation of arterial wall muscle after general anesthesia and epidural block under general anesthesia. This study, in the both general anesthesia and epidural block under general anesthesia, ΔPTT of the toe and of the finger are measured. In addition, ΔPTT(toe-finger) of the epidural block under general anesthesia and of the general anesthesia were compared

  17. General principles underlying the decommissioning of nuclear facilities

    International Nuclear Information System (INIS)

    1988-03-01

    Previous statements on the use of the term 'decommissioning' by the International Atomic Energy Agency, the Atomic Energy Control Board, and the Advisory Committee on Nuclear Safety are reviewed, culminating in a particular definition for its use in this paper. Three decommissioning phases are identified and discussed, leading to eight general principles governing decommissioning including one related to financing

  18. Survey of comprehensive restorative treatment for children under general anesthesia

    Directory of Open Access Journals (Sweden)

    Yai-Tin Lin

    2015-09-01

    Conclusion: Although general anesthesia provides an optimal condition for treating children with high caries risk, high failure rates of composite restorations were noted. Indirect pulp capping and ferric sulfate pulpotomy followed by stainless steel crown restorations are successful techniques and can be used to treat deep carious lesions.

  19. Does a carpal tunnel syndrome predict an underlying disease?

    NARCIS (Netherlands)

    M.C. de Rijk (Maarten); F.H. Vermeij (Frederique); M. Suntjens (Maartje); P.A. van Doorn (Pieter)

    2007-01-01

    textabstractCarpal tunnel syndrome (CTS) may be the presenting symptom of an underlying disease such as diabetes mellitus, hypothyroidism or connective tissue disease (CTD). It was investigated whether additional blood tests (glucose level, thyroid-stimulating hormone level and erythrocyte

  20. Failure of Sierra White granite under general states of stress

    Science.gov (United States)

    Ingraham, M. D.; Dewers, T. A.; Lee, M.; Holdman, O.; Cheung, C.; Haimson, B. C.

    2017-12-01

    The effect of the intermediate principal stress on the failure of Sierra White granite was investigated by performing tests under true triaxial states of stress. Tests were performed under constant Lode angle conditions with Lode angles ranging from 0 to 30°, pure shear to axisymmetric compression. Results show that the failure of Sierra White granite is heavily dependent on the intermediate principal stress which became more dramatic as the mean stress increased. An analysis of the shear bands formed at failure was performed using an associated flow rule and the Rudnicki and Rice (1975) localization criteria. The localization analysis showed excellent agreement with experimental results. Sandia National Laboratories is a multimission laboratory managed and operated by National Technology and Engineering Solutions of Sandia LLC, a wholly owned subsidiary of Honeywell International Inc. for the U.S. Department of Energy's National Nuclear Security Administration under contract DE-NA0003525.

  1. REJUVENATING CHRONIC DISEASE MANAGEMENT IN MALAYSIAN PRIVATE GENERAL PRACTICE

    Directory of Open Access Journals (Sweden)

    PITERMAN L

    2010-01-01

    Full Text Available Rapid epidemiological transition globally has witnessed a rising prevalence of major chronic diseases such as hypertension, diabetes, hyperlipidaemia, obesity, chronic respiratory diseases and cancers over the past 30 years. In Malaysia, these conditions are commonly managed in primary care and published evidence has consistently shown suboptimal management and poor disease control. This in turn, has led to the massive burden of treating complications in secondary care, burden tothe patients and their families with regards to morbidity and premature death, and burden to the country with regards to premature loss of human capital. The crushing burden and escalating health care costs in managing chronic diseases pose a daunting challenge to our primary care system, as we remain traditionally oriented to care for acute, episodic illnesses. This paper re-examines the current evidence supporting the implementation of Wagner Chronic Care Model in primary careglobally; analyses the barriers of implementation of this model in the Malaysian private general practice through SWOT(strengths, weaknesses, opportunities and threats analysis; and discusses fundamental solutions needed to bridge the gap to achieve better outcomes.

  2. Dynamic generalized linear models for monitoring endemic diseases

    DEFF Research Database (Denmark)

    Lopes Antunes, Ana Carolina; Jensen, Dan; Hisham Beshara Halasa, Tariq

    2016-01-01

    The objective was to use a Dynamic Generalized Linear Model (DGLM) based on abinomial distribution with a linear trend, for monitoring the PRRS (Porcine Reproductive and Respiratory Syndrome sero-prevalence in Danish swine herds. The DGLM was described and its performance for monitoring control...... and eradication programmes based on changes in PRRS sero-prevalence was explored. Results showed a declining trend in PRRS sero-prevalence between 2007 and 2014 suggesting that Danish herds are slowly eradicating PRRS. The simulation study demonstrated the flexibility of DGLMs in adapting to changes intrends...... in sero-prevalence. Based on this, it was possible to detect variations in the growth model component. This study is a proof-of-concept, demonstrating the use of DGLMs for monitoring endemic diseases. In addition, the principles stated might be useful in general research on monitoring and surveillance...

  3. Soleus muscle H-reflex monitoring in endoscopic surgery under general anesthesia percutaneous interlaminar approach.

    Science.gov (United States)

    Wang, Huixue; Gao, Yingji; Ji, Lixin; Bai, Wanshan

    2018-05-01

    The clinical value of soleus muscle H-reflex monitoring in general anesthesia percutaneous interlaminar approach was investigated. A total of 80 cases with unilateral L5-S1 disc herniation between January 2015 and October 2016 were randomly divided into control group (without soleus muscle H-reflex monitoring, n=40) and observation group (with soleus muscle H-reflex monitoring, n=40). Results showed that the operation time of the observation group was shorter than that of the control group (Ph after operation, the amplitude of H-reflex in diseased side soleus muscle was significantly lower than that in healthy side (Ph postoperatively, the latency of H-reflex in diseased side soleus muscle was shorter than that of healthy side (PH-reflex latency in soleus muscle were significantly lower (PH-reflex monitoring can effectively reduce the damage to the nerve roots under percutaneous endoscopic intervertebral endoscopic surgery under general anesthesia, improve the accuracy of surgery, reduce the complications, shorten the operation time and reduce the surgical bleeding, which is more beneficial to patients smooth recovery.

  4. Characteristics and Associated Comorbidities of Pediatric Dental Patients Treated under General Anesthesia.

    Science.gov (United States)

    Delfiner, Alexandra; Myers, Aaron; Lumsden, Christie; Chussid, Steve; Yoon, Richard

    To describe characteristics and identify common comorbidities of children receiving dental treatment under general anesthesia at Children's Hospital of New York-Presbyterian. Electronic medical records of all children that received dental treatment under general anesthesia through the Division of Pediatric Dentistry from 2012-2014 were reviewed. Data describing patient characteristics (age, sex, race/ethnicity, insurance carrier, and American Society of Anesthesiologists physical status classification system), medical history, and justification for treatment were collected. Descriptive statistics, including frequencies, percentages and t-tests, were calculated. A total of 298 electronic medical records were reviewed, of which 50 records were excluded due to missing information. Of the 248 electronic medical records included, the average age was 5-years-old and 58% were male. The most common reason for dental treatment under general anesthesia was extent and severity of dental disease (53%), followed by significant medical history (47%) and behavior/pre-cooperative age (39%). Those who were ASA III or IV were older (6.6-years) (p<.001). Common medical comorbidities appear evenly distributed: autism (12%), cardiac anomalies (14%), developmental delay (14%), genetic syndromes/chromosomal disorders (13%), and neurological disorders (12%). Younger age groups (1 to 2 years and 3 to 5 years) had a high percentage of hospitalizations due to the extent and severity of the dental disease (83%) and behavior (77%) (p<0.001). No single comorbidity was seen more often than others in this patient population. The range of medical conditions in this population may be a reflection of the range of pediatric specialty services at Children's Hospital of NewYork-Presbyterian.

  5. Changes of the skull in general body diseases

    International Nuclear Information System (INIS)

    Koval', G.Yu.; Perepust, L.A.; Novikova, Eh.Z.

    1984-01-01

    Changes of the skull in the following body disease are considered. Diseases: endocrine diseases, fibrous osteodystrophy, reticulohistocytoses and noninfectious granulomas, the blood system diseases, disturbance of vitamin balance. Skull roentgenograms in some above-mentioned diseases are presented and analysed

  6. Fungal diseases of tree stands under urbanized conditions of Moscow

    Directory of Open Access Journals (Sweden)

    Smirnova Oksana G.

    2013-01-01

    Full Text Available Phytosanitary and ecological estimation of tree-stands has been con­ducted at the Forest Experimental Station of Moscow Agricultural Academy and parks of Northeast of Moscow in 2007-2011. Fomes fomentarius was proved to be a very serious pathogen of trees under conditions of Moscow, Piptoporus betulinus, Phellinus igniarius, and Fomitopsis pinicola also occurred and caused damage to trees. This rather bad phytosanitary situation depends on alarming ecological situation in Moscow. At the Forest Experimental Station of Moscow Agricultural Academy a number and cover of lichens decreased. In general, all trees in Moscow are in dynamic equilibrium with the urbanized environment. In connection with this, the following classification of tree-stands was proposed for the urbanized environment: 1 - healthy trees, 2 - affected trees which can be managed, 3 - dry woods, 3a - very diseased. Many tree-stands in investigated regions of Moscow are found to belong to the groups 2 and 3c. All tree-stands must be carefully monitored and managed in order to provide a well-timed decision on the support system for preservation of trees as ‘lungs of city’ and avoid unpredictable tree falling which put people and traffic at risk.

  7. The influence of general anesthesia on the brain in aged patients with previous ischemic cerebrovascular disease

    International Nuclear Information System (INIS)

    Kokubo, Yasuaki; Kayama, Takamasa; Kondo, Rei; Oki, Masato; Takaoka, Seiji

    2008-01-01

    Whenever we discuss the overall results of surgical treatment for unruptured cerebral aneurysms, especially in aged patients, we tend to consider advanced age or general anesthesia as causes for unfavorable results. There are no reports concerning ischemic stroke events following general anesthesia in aged patients with a prior history of cerebrovascular disease. The purpose of this study is to clarify the influence of general anesthesia on the brats in aged patients with a previous history of ischemic cerebrovascular disease. The subjects were 30 consecutive patients over 70 years of age with previous ischemic cerebrovascular disease who underwent various surgeries except brain and cardiac surgery under general anesthesia. The patients were 70 to 85 years old, with a mean age of 76. Twenty-three were men and 7 were women. Surgical procedures were 12 gastrointestinal, 6 orthopedic and 4 urogenital and others. The type of cerebrovascular disease evaluated by neuroradiologist and anesthesiologist based on MR imaging was devided as follows: 16 patients had minor stroke, 7 had transient ischemic attack/reversible ischemic neurological deficit (TIA/RIND) and 7 had asymptomatic cerebral infarction. MR angiography was also assessed to evaluate the main artery in the brain. Blood pressure and arterial blood gas (PaCO 2 ) during general anesthesia were analyzed, and the rate of systemic and neurological complications following general anesthesia were evaluated. MR angiography revealed no occlusion or severe stenosis of the main artery in the brain of any of the patients. The minimum systolic blood pressure showed less than 100 mmHg transiently for 5-20 minutes in 28 of 30 patients during general anesthesia. The minimum value was 65 mmHg maintained for 5 minutes. The minimum PaCO 2 during general anesthesia was as follows: 1 case 36 mmHg. There were no neurological complications following general anesthesia in this study. One of 30 patients (3.3%) had suffered from pneumonia

  8. General Anesthesia in the Surgical Treatment of Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    N. A. Karpun

    2012-01-01

    Full Text Available The paper deals with the problem of anesthetic maintenance during surgical correction of coronary blood flow. The basis for this is the results of the investigations conducted at the V. A. Negovsky Research Institute of General Reanimatology, the objective of which was to improve the results of surgical treatment in patients with different forms of coronary heart disease (CHD, by optimizing the anesthetic maintenance of open heart surgery. Clinical and special examinations were made in 367 patients who had undergone surgical treatment (aortocoronary bypass surgery; formation of a mammary coronary anastomosis; resection and plastic repair of left ventricular aneurysms; thrombectomy from the heart chambers for CHD and its complications. The main methodological approach to this study is to personalize intensive therapy and general anesthesia, which are relied on both evidence-based medicine and an individual pathophysiological approach. The paper details how to choose the basic mode of general anesthesia depending on the form of CHD and myocardial contractile function. Furthermore, the authors propose methods for optimizing the perioperative period: postoperative analgesia; correction of the aggregate state of blood; operative hemodilution; prevention and correction of critically reduced blood oxygen capacity 

  9. Postoperative Pain in Children After Dentistry Under General Anesthesia.

    Science.gov (United States)

    Wong, Michelle; Copp, Peter E; Haas, Daniel A

    2015-01-01

    The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

  10. Declining Prevalence of Disease Vectors Under Climate Change

    Science.gov (United States)

    Escobar, Luis E.; Romero-Alvarez, Daniel; Leon, Renato; Lepe-Lopez, Manuel A.; Craft, Meggan E.; Borbor-Cordova, Mercy J.; Svenning, Jens-Christian

    2016-12-01

    More than half of the world population is at risk of vector-borne diseases including dengue fever, chikungunya, zika, yellow fever, leishmaniasis, chagas disease, and malaria, with highest incidences in tropical regions. In Ecuador, vector-borne diseases are present from coastal and Amazonian regions to the Andes Mountains; however, a detailed characterization of the distribution of their vectors has never been carried out. We estimate the distribution of 14 vectors of the above vector-borne diseases under present-day and future climates. Our results consistently suggest that climate warming is likely threatening some vector species with extinction, locally or completely. These results suggest that climate change could reduce the burden of specific vector species. Other vector species are likely to shift and constrain their geographic range to the highlands in Ecuador potentially affecting novel areas and populations. These forecasts show the need for development of early prevention strategies for vector species currently absent in areas projected as suitable under future climate conditions. Informed interventions could reduce the risk of human exposure to vector species with distributional shifts, in response to current and future climate changes. Based on the mixed effects of future climate on human exposure to disease vectors, we argue that research on vector-borne diseases should be cross-scale and include climatic, demographic, and landscape factors, as well as forces facilitating disease transmission at fine scales.

  11. Metabolic epidermal necrosis in two dogs with different underlying diseases.

    Science.gov (United States)

    Bond, R; McNeil, P E; Evans, H; Srebernik, N

    1995-05-06

    Two dogs with metabolic epidermal necrosis had hyperkeratosis of the footpads accompanied by erythematous, erosive and crusting lesions affecting the muzzle, external genitalia, perineum and periocular regions. Histopathological examination of skin biopsies revealed a superficial hydropic dermatitis with marked parakeratosis. Both dogs had high plasma activities of alkaline phosphatase and alanine aminotransferase and high concentrations of glucose, and also a marked hypoaminoacidaemia. Despite these similarities, the cutaneous eruptions were associated with different underlying diseases. One dog had a pancreatic carcinoma which had metastasised widely; the primary tumour and the metastases showed glucagon immunoreactivity on immunocytochemical staining, and the dog's plasma glucagon concentration was markedly greater than that of control dogs. The other dog had diffuse hepatic disease; its plasma glucagon concentration was similar to that of control samples and cirrhosis was identified post mortem. Metabolic epidermal necrosis in dogs is a distinct cutaneous reaction pattern which may be associated with different underlying systemic diseases; however, the pathogenesis of the skin lesions remains unclear.

  12. [Natural progression of premature pubarche and underlying diseases].

    Science.gov (United States)

    Sancho Rodríguez, María Luisa; Bueno Lozano, Gloria; Labarta Aizpún, José Ignacio; de Arriba Muñoz, Antonio

    2018-04-25

    Premature pubarche (PP) is generally thought to be a benign condition, but it can also be the first sign of underlying disease. To analyse the aetiology and the evolution of the anthropometric, analytical and metabolic risk parameters of a group of patients with PP. A descriptive and analytical retrospective study of 92 patients affected by PP. Anthropometry, analyses, bone age and indicators of lipid metabolism were all evaluated. The sample included 92 patients with PP (67 female and 25 male), with a mean age of 7.1±0.6 for girls and 8.3±0.7 for boys. Small for gestational age was recorded in 7.7%. There was an accelerated bone age (1.20±0.1 years). A total of 21 patients were classified as idiopathic (23%), 60 as idiopathic premature adrenarche (65%), and 11 with non-classic congenital adrenal hyperplasia (12%). Puberty was reached early (11+0.9 years old in boys and 9.9±0.8 in girls), as was menstruation age (11.8+1.1 years old), P<.001. The stature finally reached was close to their genetic stature. There is a positive correlation between body mass index, blood glucose and LDL cholesterol, as well as a tendency towards hyperinsulinaemia. The present study shows that PP is a benign condition in the majority of cases, but non-classic congenital adrenal hyperplasia (12%) is not uncommon. Menstruation and puberty started early and bone age was accelerated. Growth was normal, and more or less in line with genetic size. PP associated with obesity is linked with analytical variations of metabolic risks. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. General practitioners' perceptions of the effectiveness of medical interventions: an exploration of underlying constructs

    Directory of Open Access Journals (Sweden)

    Marteau Theresa M

    2010-02-01

    Full Text Available Abstract Background Many interventions shown to be effective through clinical trials are not readily implemented in clinical practice. Unfortunately, little is known regarding how clinicians construct their perceptions of the effectiveness of medical interventions. This study aims to explore general practitioners' perceptions of the nature of 'effectiveness'. Methods The design was qualitative in nature using the repertory grid technique to elicit the constructs underlying the perceived effectiveness of a range of medical interventions. Eight medical interventions were used as stimuli (diclophenac to reduce acute pain, cognitive behaviour therapy to treat depression, weight loss surgery to achieve weight loss, diet and exercise to prevent type 2 diabetes, statins to prevent heart disease, stopping smoking to prevent heart disease, nicotine replacement therapy to stop smoking, and stop smoking groups to stop smoking. The setting involved face-to-face interviews followed by questionnaires in London Primary Care Trusts. Participants included a random sample of 13 general practitioners. Results Analysis of the ratings showed that the constructs clustered around two dimensions: low patient effort versus high patient effort (dimension one, and small impact versus large impact (dimension two. Dimension one represented constructs such as 'success requires little motivation', 'not a lifestyle intervention', and 'health-care professional led intervention'. Dimension two represented constructs such as 'weak and/or minimal evidence of effectiveness', 'small treatment effect for users', 'a small proportion of users will benefit' and 'not cost-effective'. Constructs within each dimension were closely related. Conclusions General practitioners judged the effectiveness of medical interventions by considering two broad dimensions: the extent to which interventions involve patient effort, and the size of their impact. The latter is informed by trial evidence, but

  14. A prospective randomized study comparing percutaneous nephrolithotomy under combined spinal-epidural anesthesia with percutaneous nephrolithotomy under general anesthesia.

    Science.gov (United States)

    Singh, Vishwajeet; Sinha, Rahul Janak; Sankhwar, S N; Malik, Anita

    2011-01-01

    A prospective randomized study was executed to compare the surgical parameters and stone clearance in patients who underwent percutaneous nephrolithotomy (PNL) under combined spinal-epidural anesthesia (CSEA) versus those who underwent PNL under general anesthesia (GA). Between January 2008 to December 2009, 64 patients with renal calculi were randomized into 2 groups and evaluated for the purpose of this study. Group 1 consisted of patients who underwent PNL under CSEA and Group 2 consisted of patients who underwent PNL under GA. The operative time, stone clearance rate, visual pain analog score, mean analgesic dose and mean hospital stay were compared amongst other parameters. The difference between visual pain analog score after the operation and the dose of analgesic requirement was significant on statistical analysis between both groups. PNL under CSEA is as effective and safe as PNL under GA. Patients who undergo PNL under CESA require lesser analgesic dose and have a shorter hospital stay. Copyright © 2011 S. Karger AG, Basel.

  15. Poisson-generalized gamma empirical Bayes model for disease ...

    African Journals Online (AJOL)

    In spatial disease mapping, the use of Bayesian models of estimation technique is becoming popular for smoothing relative risks estimates for disease mapping. The most common Bayesian conjugate model for disease mapping is the Poisson-Gamma Model (PG). To explore further the activity of smoothing of relative risk ...

  16. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study.

    Science.gov (United States)

    Garg, Rakesh; Khanna, Puneet; Sinha, Renu

    2011-05-01

    An osteo-odonto-keratoprosthesis (OOKP) procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males) underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson's syndrome (SJS) (7) and chemical burn (1). Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  17. Visualizing the Comorbidity Burden in Children with Autism Spectrum Disorder Receiving Dental Treatment Under General Anesthesia.

    Science.gov (United States)

    Mathu-Muju, Kavita R; Li, Hsin-Fang; Nam, Lisa H; Bush, Heather M

    2016-01-01

    The purposes of this study were to: (1) describe the comorbidity burden in children with autism spectrum disorder (ASD) receiving dental treatment under general anesthesia (GA); and (2) characterize the complexity of these concurrent comorbidities. A retrospective chart review was completed of 303 children with ASD who received dental treatment under GA. All comorbidities, in addition to the primary diagnosis of ASD, were categorized using the International Classification of Diseases-10 codes. The interconnectedness of the comorbidities was graphically displayed using a network plot. Network indices (degree centrality, betweenness centrality, closeness centrality) were used to characterize the comorbidities that exhibited the highest connectedness to ASD. The network plot of medical diagnoses for children with ASD was highly complex, with multiple connected comorbidities. Developmental delay, speech delay, intellectual disability, and seizure disorders exhibited the highest connectedness to ASD. Children with autism spectrum disorder may have a significant comorbidity burden of closely related neurodevelopmental disorders. The medical history review should assess the severity of these concurrent disorders to evaluate a patient's potential ability to cooperate for dental treatment and to determine appropriate behavior guidance techniques to facilitate the delivery of dental care.

  18. CROHN'S DISEASE: GENERAL CHARACTERISTICS AND TREATMENT WITH ADALIMUMABE BIOPHARMACEUTICAL

    Directory of Open Access Journals (Sweden)

    S. A. Marques

    2018-02-01

    Full Text Available Crohn's Disease (CD is a chronic inflammatory disease that affects the gastrointestinal system. The etiology is not fully understood, however, genetic, immunological, microbiological and environmental factors are related to its genesis. The most common manifestations of this disease are diarrhea, abdominal pain, ulcers and fistulas. In the absence of adequate treatment it can evolve into extra intestinal complications and is also an important risk factor for colon and rectal cancer. The treatment of the disease is palliative and there is no cure for the disease, being considered only the period of remission of symptoms, as a good prognosis. The biopharmaceutical, Adalimumabe, produced by recombinant DNA technology has demonstrated efficacy in the treatment of this disease, as it prevents the action of TNF-α, a cytokine involved in inflammation and is abundant in individuals with CD. Although Adalimumabe has good results, its use leads to side effects that can be mild or fatal, such as the activation of tuberculosis.

  19. Dental treatment under general anesthesia for special-needs patients: analysis of the literature.

    Science.gov (United States)

    Mallineni, Sreekanth K; Yiu, Cynthia K Y

    2016-11-01

    The aim of the present review was to identify the studies published on dental treatment under general anesthesia for special-needs patients. A comprehensive search of the reported literature from January 1966 to May 2012 was conducted using PubMed, Medline, and Embase. Keywords used in the search were "dental treatment under general anesthesia", "special-needs patients", "medically-compromised patients", and "children", in various combinations. Studies published only on dental treatment under general anesthesia and in English were included. Only 10 studies were available for final analysis. Age range from 1 to 50 years, and restorative procedures, were most prevalent. Only two studies discussed repeated general anesthesia, with rates of 7.2% and 10.2%. Over time, the provision of general anesthesia for special-needs patients has changed from dental clinics to general hospitals. The demand for dental treatment for special-needs patients under general anesthesia continues to increase. Currently, there are no certain accepted protocols for the provision of dental treatment under general anesthesia. © 2015 Wiley Publishing Asia Pty Ltd.

  20. A comparison of disease prevalence in general practice in the Netherlands and in England & Wales.

    NARCIS (Netherlands)

    Fleming, D.; Schellevis, F.; Linden, M. van der; Westert, G.

    2006-01-01

    General practice-based morbidity surveys have been conducted in the Netherlands and in England and Wales primarily to estimate disease prevalence and examine health inequalities. We have compared disease prevalence in general practice reported in the second Dutch Natinal Survey of General Practice

  1. Variations in cardiovascular disease under-diagnosis in England: national cross-sectional spatial analysis

    Directory of Open Access Journals (Sweden)

    Walford Hannah

    2011-03-01

    Full Text Available Abstract Background There is under-diagnosis of cardiovascular disease (CVD in the English population, despite financial incentives to encourage general practices to register new cases. We compared the modelled (expected and diagnosed (observed prevalence of three cardiovascular conditions- coronary heart disease (CHD, hypertension and stroke- at local level, their geographical variation, and population and healthcare predictors which might influence diagnosis. Methods Cross-sectional observational study in all English local authorities (351 and general practices (8,372 comparing model-based expected prevalence with diagnosed prevalence on practice disease registers. Spatial analyses were used to identify geographic clusters and variation in regression relationships. Results A total of 9,682,176 patients were on practice CHD, stroke and transient ischaemic attack, and hypertension registers. There was wide spatial variation in observed: expected prevalence ratios for all three diseases, with less than five per cent of expected cases diagnosed in some areas. London and the surrounding area showed statistically significant discrepancies in observed: expected prevalence ratios, with observed prevalence much lower than the epidemiological models predicted. The addition of general practitioner supply as a variable yielded stronger regression results for all three conditions. Conclusions Despite almost universal access to free primary healthcare, there may be significant and highly variable under-diagnosis of CVD across England, which can be partially explained by persistent inequity in GP supply. Disease management studies should consider the possible impact of under-diagnosis on population health outcomes. Compared to classical regression modelling, spatial analytic techniques can provide additional information on risk factors for under-diagnosis, and can suggest where healthcare resources may be most needed.

  2. Design management of general contractor under nuclear power project EPC mode

    International Nuclear Information System (INIS)

    Su Shaojian

    2013-01-01

    Design management has not yet formed a theoretical system recognized, general contractor design managers under nuclear power project EPC Mode lack the clear theory basis. This paper aims to discuss Design management from the angle of general contractor under nuclear power project EPC mode, Gives the concept of design management Clearly, by Combining the characteristics of nuclear power project, Gives the specific content and meaning of the design management of nuclear power project. (authors)

  3. 49 CFR 40.11 - What are the general responsibilities of employers under this regulation?

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false What are the general responsibilities of employers... PROCEDURES FOR TRANSPORTATION WORKPLACE DRUG AND ALCOHOL TESTING PROGRAMS Employer Responsibilities § 40.11 What are the general responsibilities of employers under this regulation? (a) As an employer, you are...

  4. Reasons of repeat dental treatment under general anaesthesia: A retrospective study.

    Science.gov (United States)

    Guidry, J; Bagher, S; Felemban, O; Rich, A; Loo, C

    2017-12-01

    The purpose of this chart review study was to investigate the common factors that exist in paediatric patients requiring a repeat dental treatment under general anaesthesia (GA2) within four years after the initial dental treatment under general anaesthesia (GA1). The Electronic Health Records of one to 12 year-old children who received dental treatment under general anaesthesia (GA) between April 2004 and October 2009 were identified and analysed by a single examiner. Children who had GA2, within a four year period following GA1 were categorised as cases. Children who had only one dental treatment under GA were considered the control pool. Each case was matched to three controls based on sex and age range at GA1 of ± 6 months. Other recorded variables included: date of birth, date of GAs (GA1 and GA2 for cases; GA1 for controls), type of payment, dmfs before GA1, dental treatments provided under GA, return of 1-week post-GA1 follow-up, frequency of recare/recall visits following one-year post-GA1 visit and the type and frequency of post GA1 emergency visits. Out of 581 subjects, 29 (4.99%) cases were matched to 87 controls. Medically compromised patients had four times the risk of GA2. At GA1, cases received statistically significant less sealants (p=0.026), less extractions (pdental treatment under general anaesthesia were more likely to have a repeat dental treatment under general anaesthesia within 4 years.

  5. Generalized Vitiligo Associated Autoimmune Diseases in Japanese Patients Their Families

    Directory of Open Access Journals (Sweden)

    Tomohiko Narita

    2011-01-01

    Conclusions: Among Japanese vitiligo patients, there is a subgroup with strong evidence of genetically determined susceptibility to not only vitiligo, but also to autoimmune thyroid disease and other autoimmune disorders.

  6. General Anesthesia versus Local Anesthesia in StereotaXY (GALAXY) for Parkinson's disease: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Holewijn, R. A.; Verbaan, D.; de Bie, R. M. A.; Schuurman, P. R.

    2017-01-01

    Background: The aim of the study is to investigate if deep brain stimulation (DBS) in the subthalamic nucleus (STN) for Parkinson's disease (PD) under general anesthesia further improves outcome by lessening postoperative cognitive, mood, and behavioral adverse effects; shorten surgical time and

  7. The Chronic Kidney Disease Model: A General Purpose Model of Disease Progression and Treatment

    Directory of Open Access Journals (Sweden)

    Patel Uptal D

    2011-06-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is the focus of recent national policy efforts; however, decision makers must account for multiple therapeutic options, comorbidities and complications. The objective of the Chronic Kidney Disease model is to provide guidance to decision makers. We describe this model and give an example of how it can inform clinical and policy decisions. Methods Monte Carlo simulation of CKD natural history and treatment. Health states include myocardial infarction, stroke with and without disability, congestive heart failure, CKD stages 1-5, bone disease, dialysis, transplant and death. Each cycle is 1 month. Projections account for race, age, gender, diabetes, proteinuria, hypertension, cardiac disease, and CKD stage. Treatment strategies include hypertension control, diabetes control, use of HMG-CoA reductase inhibitors, use of angiotensin converting enzyme inhibitors, nephrology specialty care, CKD screening, and a combination of these. The model architecture is flexible permitting updates as new data become available. The primary outcome is quality adjusted life years (QALYs. Secondary outcomes include health state events and CKD progression rate. Results The model was validated for GFR change/year -3.0 ± 1.9 vs. -1.7 ± 3.4 (in the AASK trial, and annual myocardial infarction and mortality rates 3.6 ± 0.9% and 1.6 ± 0.5% vs. 4.4% and 1.6% in the Go study. To illustrate the model's utility we estimated lifetime impact of a hypothetical treatment for primary prevention of vascular disease. As vascular risk declined, QALY improved but risk of dialysis increased. At baseline, 20% and 60% reduction: QALYs = 17.6, 18.2, and 19.0 and dialysis = 7.7%, 8.1%, and 10.4%, respectively. Conclusions The CKD Model is a valid, general purpose model intended as a resource to inform clinical and policy decisions improving CKD care. Its value as a tool is illustrated in our example which projects a relationship between

  8. Perioperative management of patients for osteo-odonto-kreatoprosthesis under general anaesthesia: A retrospective study

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2011-01-01

    Full Text Available An osteo-odonto-keratoprosthesis (OOKP procedure is indicated in patients with failed corneal transplant but having intact retina for visual improvement. We studied perioperative concerns of patients who underwent the staged OOKP procedure. This was a retrospective analysis of patients who underwent OOKP. The information regarding symptoms, associated comorbidities, perioperative events including anaesthetic management were collected. Eight patients (five females and three males underwent the staged OOKP procedure. The median age was 18 years. The median weight was 45 kg. The median duration of loss of vision was 4 years. The aetiology of blindness included Stevens-Johnson′s syndrome (SJS (7 and chemical burn (1. Four patients had generalized skin problem due to SJS. All cases were managed under general anaesthesia, and airway management included nasotracheal intubation for stage I and orotracheal intubation for stage II. The median mallampati classification was I prior to OOKP stage I procedure while it changed to II at stage II procedure. Two patients required fibreoptic nasotracheal intubation. One patient had excessive oozing from the mucosal harvest site and was managed conservatively. In one patient, tooth harvesting was done twice as the first tooth was damaged during creating a hole in it. We conclude that OOKP requires multidisciplinary care. Anaesthesiologist should evaluate the airway carefully and disease-associated systemic involvements. The use of various drugs requires caution and steroid supplementation should be done. Airway difficulty should be anticipated, mandating thorough evaluation. Re-evaluation of airway is prudent as it may become difficult during the staged OOKP procedure.

  9. A survey of dental treatment under general anesthesia in a Korean university hospital pediatric dental clinic.

    Science.gov (United States)

    Shin, Bisol; Yoo, Seunghoon; Kim, Jongsoo; Kim, Seungoh; Kim, Jongbin

    2016-09-01

    In South Korea, the number of cases of dental treatment for the disabled is gradually increasing, primarily at regional dental clinics for the disabled. This study investigated pediatric patients at a treatment clinic for the disabled within a university hospital who received dental treatment under general anesthesia. This data could assist those that provide dental treatment for the disabled and guide future treatment directions and new policies. This study was a retrospective analysis of 263 cases in which patients received dental treatment under general anesthesia from January 2011 to May 2016. The variables examined were gender, age, reason for anesthesia, type of disability, time under anesthesia, duration of treatment, type of procedure, treatment details, and annual trends in the use of general anesthesia. Among pediatric patients with disabilities who received dental treatment under general anesthesia, the most prevalent age group was 5-8 years old (124 patients, 47.1%), and the primary reason for administering anesthesia was dental anxiety or phobia. The mean time under anesthesia was 132.7 ± 77.6 min, and the mean duration of treatment was 101.9 ± 71.2 min. The most common type of treatment was restoration, accounting for 158 of the 380 treatments performed. Due to increasing demand, the number of cases of dental treatment performed under general anesthesia is expected to continue increasing, and it can be a useful method of treatment in patients with dental anxiety or phobia.

  10. [Underlying Mechanisms and Management of Refractory Gastroesophageal Reflux Disease].

    Science.gov (United States)

    Lee, Kwang Jae

    2015-08-01

    The prevalence of gastroesophageal reflux disease (GERD) in South Korea has increased over the past 10 years. Patients with erosive reflux disease (ERD) shows better response to proton pump inhibitors (PPIs) than those with non-erosive reflux disease (NERD). NERD is a heterogeneous condition, showing pathological gastroesophageal reflux or esophageal hypersensitivity to reflux contents. NERD patients with pathological gastroesophageal reflux or hypersensitivity to acid may respond to PPIs. However, many patients with esophageal hypersensitivity to nonacid or functional heartburn do not respond to PPIs. Therefore, careful history and investigations are required when managing patients with refractory GERD who show poor response to conventional dose PPIs. Combined pH-impedance studies and a PPI diagnostic trial are recommended to reveal underlying mechanisms of refractory symptoms. For those with ongoing reflux-related symptoms, split dose administration, change to long-acting PPIs or PPIs less influenced by CYP2C19 genotypes, increasing dose of PPIs, and the addition of alginate preparations, prokinetics, selective serotonin reuptake inhibitors, or tricyclic antidepressants can be considered. Pain modulators, selective serotonin reuptake inhibitors, or tricyclic antidepressants are more likely to be effective for those with reflux-unrelated symptoms. Surgery or endoscopic per oral fundoplication may be effective in selected patients.

  11. Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective.

    Science.gov (United States)

    Chandran, D; Woods, C M; Schar, M; Ma, N; Ooi, E H; Athanasiadis, T

    2018-02-01

    To conduct a cost analysis of injection laryngoplasty performed in the operating theatre under local anaesthesia and general anaesthesia. The retrospective study included patients who had undergone injection laryngoplasty as day cases between July 2013 and March 2016. Cost data were obtained, along with patient demographics, anaesthetic details, type of injectant, American Society of Anesthesiologists score, length of stay, total operating theatre time and surgeon procedure time. A total of 20 cases (general anaesthesia = 6, local anaesthesia = 14) were included in the cost analysis. The mean total cost under general anaesthesia (AU$2865.96 ± 756.29) was significantly higher than that under local anaesthesia (AU$1731.61 ± 290.29) (p costs. Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.

  12. Notification of occupational diseases by general practitioners in the ...

    African Journals Online (AJOL)

    One hundred and forty GPs were randoinly selected from a provincial sampling frame of 1 000 GPs. Main outcome measures. Knowledge of notification procedures for occupational diseases, and problems encountered with the reporting system. Results. Of a total of 109 GPs interviewed, 75% had diagnosed more than one ...

  13. Prevention of cardiovascular disease in a rural general practice

    Directory of Open Access Journals (Sweden)

    Elżbieta Tomiak

    2016-09-01

    The higher number of preventive consultations had an impact on a statistically significant decrease in mean blood pressure and mean SCORE value. The year-long cardiovascular disease prophylaxis programme proved less effective than expected, and neither a decrease in body weight nor an improvement in lipid metabolism was achieved in any of the groups.

  14. Treatment Needs and Adverse Events Related to Dental Treatment under General Anesthesia for Individuals with Autism

    Science.gov (United States)

    Rada, Robert E.

    2013-01-01

    Individuals with autism can be quite challenging to treat in a routine dental-office setting, especially when extensive dental treatment and disruptive behavioral issues exist. Individuals with autism may also be at higher risk for oral disease. Frequently, general anesthesia is the only method to facilitate completion of the needed dental…

  15. Antagonism between phytohormone signalling underlies the variation in disease susceptibility of tomato plants under elevated CO2

    Science.gov (United States)

    Zhang, Shuai; Li, Xin; Sun, Zenghui; Shao, Shujun; Hu, Lingfei; Ye, Meng; Zhou, Yanhong; Xia, Xiaojian; Yu, Jingquan; Shi, Kai

    2015-01-01

    Increasing CO2 concentrations ([CO2]) have the potential to disrupt plant–pathogen interactions in natural and agricultural ecosystems, but the research in this area has often produced conflicting results. Variations in phytohormone salicylic acid (SA) and jasmonic acid (JA) signalling could be associated with variations in the responses of pathogens to plants grown under elevated [CO2]. In this study, interactions between tomato plants and three pathogens with different infection strategies were compared. Elevated [CO2] generally favoured SA biosynthesis and signalling but repressed the JA pathway. The exposure of plants to elevated [CO2] revealed a lower incidence and severity of disease caused by tobacco mosaic virus (TMV) and by Pseudomonas syringae, whereas plant susceptibility to necrotrophic Botrytis cinerea increased. The elevated [CO2]-induced and basal resistance to TMV and P. syringae were completely abolished in plants in which the SA signalling pathway nonexpressor of pathogenesis-related genes 1 (NPR1) had been silenced or in transgenic plants defective in SA biosynthesis. In contrast, under both ambient and elevated [CO2], the susceptibility to B. cinerea highly increased in plants in which the JA signalling pathway proteinase inhibitors (PI) gene had been silenced or in a mutant affected in JA biosynthesis. However, plants affected in SA signalling remained less susceptible to this disease. These findings highlight the modulated antagonistic relationship between SA and JA that contributes to the variation in disease susceptibility under elevated [CO2]. This information will be critical for investigating how elevated CO2 may affect plant defence and the dynamics between plants and pathogens in both agricultural and natural ecosystems. PMID:25657213

  16. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Frikke-Schmidt, Ruth; Schnohr, Peter

    2011-01-01

    To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population.......To test the hypothesis that xanthelasmata and arcus corneae, individually and combined, predict risk of ischaemic vascular disease and death in the general population....

  17. Mechanisms Underlying HIV-Associated Noninfectious Lung Disease.

    Science.gov (United States)

    Presti, Rachel M; Flores, Sonia C; Palmer, Brent E; Atkinson, Jeffrey J; Lesko, Catherine R; Lau, Bryan; Fontenot, Andrew P; Roman, Jesse; McDyer, John F; Twigg, Homer L

    2017-11-01

    Pulmonary disease remains a primary source of morbidity and mortality in persons living with HIV (PLWH), although the advent of potent combination antiretroviral therapy has resulted in a shift from predominantly infectious to noninfectious pulmonary complications. PLWH are at high risk for COPD, pulmonary hypertension, and lung cancer even in the era of combination antiretroviral therapy. The underlying mechanisms of this are incompletely understood, but recent research in both human and animal models suggests that oxidative stress, expression of matrix metalloproteinases, and genetic instability may result in lung damage, which predisposes PLWH to these conditions. Some of the factors that drive these processes include tobacco and other substance use, direct HIV infection and expression of specific HIV proteins, inflammation, and shifts in the microbiome toward pathogenic and opportunistic organisms. Further studies are needed to understand the relative importance of these factors to the development of lung disease in PLWH. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  18. Histiocytoid Sweet Syndrome in a Child without Underlying Systemic Disease.

    Science.gov (United States)

    Yeom, Seung Dohn; Ko, Hye Soo; Moon, Jong Hyuk; Kang, Min Ji; Byun, Ji Won; Choi, Gwang Seong; Shin, Jeonghyun

    2017-10-01

    Sweet syndrome (acute, febrile, neutrophilic dermatosis) is characterized by the acute onset of an eruption of painful nodules or erythematous or violaceous plaques on the limbs, face and neck. These symptoms are accompanied by fever. The diagnostic features include histopathological findings of dermal neutrophilic infiltration without leukocytoclastic vasculitis or peripheral blood leukocytosis. Sweet syndrome is associated with infection, malignancies, autoimmune disease, pregnancy, and drugs. Patients with Sweet syndrome demonstrate a complete and rapid response to systemic steroid administration. Recently, a distinct variant of Sweet syndrome was reported, termed "histiocytoid Sweet syndrome", in which the infiltration of myeloperoxidase-positive histiocytoid mononuclear cells are observed (in contrast to the infiltration of neutrophils). The other clinical features are similar to those of classic Sweet syndrome. Pediatric Sweet syndrome is uncommon, and the histiocytoid type is even rarer. To date, four cases of histiocytoid Sweet syndrome have been reported in children. Herein, we describe a case of histiocytoid Sweet syndrome in an otherwise healthy 10-year-old boy with no underlying systemic disease in whom non-steroidal, anti-inflammatory drug treatment was successful.

  19. The Comparison of Four Different Methods of Perioperative Eye Protection under General Anesthesia in Prone Position

    OpenAIRE

    Özlem Kocatürk; Tolga Kocatürk; Nil Kaan; Volkan Dayanır

    2012-01-01

    Aim: The purpose of this study was to compare and assess the efficacy of hypoallergen adhesive tape, antibiotic ointment, artificial tear liquid gel and ocular lubricant pomade for perioperative protection of eyes under general anesthesia in prone position. Material and Method: One hundred and eighty four patients (368 eyes) undergoing general anesthesia for >90 min for spinal procedures were divided randomly into four groups. Hypoallergen adhesive tape, antibiotic ointment, artificial tea...

  20. Inflammatory Profile of Awake Function-Controlled Craniotomy and Craniotomy under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Markus Klimek

    2009-01-01

    Results. Plasma IL-6 level significantly increased with time similarly in both groups. No significant plasma IL-8 and IL-10 change was observed in both experimental groups. The VAS pain score was significantly lower in the awake group compared to the anesthesia group at 12 hours postoperative. Postoperative anxiety and stress declined similarly in both groups. Conclusion. This study suggests that awake function-controlled craniotomy does not cause a significantly different inflammatory response than craniotomy performed under general anesthesia. It is also likely that function-controlled craniotomy does not cause a greater emotional challenge than tumor resection under general anesthesia.

  1. A comparative study of pain following endodontic treatment under general anesthesia

    Directory of Open Access Journals (Sweden)

    Feizi Ghader

    2015-01-01

    Full Text Available   Background and Aims: Postoperativee endodontic pain is an outstanding problem for dental patients. Therefore, a successful management of endodontic pain has become as one of the main dental objectives. The aim of the present study was to compare the postoperative endodontic pain in patients under general anesthesia versus local anesthesia.   Materials and Methods: For conducting this clinical trial study, 50 patients having mandibular molars candidate for root canal therapy were selected. Twenty-five patients treated under general anesthesia because of their fear, anxiety or gag reflex. Other 25 patients treated under local anesthesia. All teeth were prepared using engine-driven rotary system in a crown-down technique and filled using lateral condensation technique. Heft- parker visual analog scale was used to measure the degree of pain at 6, 12, 24, and 48 hours after the treatment. Mann-Whitney, Chi-square, and T-tests were used to compare the intensity of postoperative pain between the groups.   Results: The mean intensity of postoperative pain in local and general anesthesia groups at 6, 12 and 24 hours had statistically significant difference (P<0.05.   Conclusion: Postoperative pain in patients who treated under general anesthesia was significantly less than the patients who treated under local anesthesia.

  2. Generalization of a global model for reinforced concrete beams under combined axial force and bending moments

    International Nuclear Information System (INIS)

    Bairrao, R.; Millard, A.; Barbe, B.

    1991-01-01

    A large set of numerical data was obtained using a program recently developed. From the various results achieved, new analytical expressions for the definition of damage and plasticity criteria are being derived. The importance of taking into account the presence of general bending was highlighted. The extension to 3D bending, of the previous global models for reinforced concrete beams under combined axial force and bending, is under development. (author)

  3. Criteria for selecting children with special needs for dental treatment under general anaesthesia

    OpenAIRE

    Nova García, M. Joaquín de; Gallardo López, Nuria E.; Martín Sanjuán, Carmen; Mourelle Martínez, M. Rosa; Alonso García, Yolanda; Carracedo Cabaleiro, Esther

    2007-01-01

    Objective: To study criteria for helping to select children with special needs for dental treatment under general anaesthesia. Materials and methods: Group of 30 children (aged under 18) examined on the Course at the Universidad Complutense de Madrid (UCM) (Specialisation on holistic dental treatment of children with special needs) and subsequently referred to the Disabled Children’s Oral Health Unit (DCOHU) within Primary Health Care Area 2 of the Madrid Health Service (SERMAS) where dental ...

  4. Resolving inconsistencies in utility measurement under risk: Tests of generalizations of expected utility

    OpenAIRE

    Han Bleichrodt; José María Abellán-Perpiñan; JoséLuis Pinto; Ildefonso Méndez-Martínez

    2005-01-01

    This paper explores inconsistencies that occur in utility measurement under risk when expected utility theory is assumed and the contribution that prospect theory and some other generalizations of expected utility can make to the resolution of these inconsistencies. We used five methods to measure utilities under risk and found clear violations of expected utility. Of the theories studied, prospect theory was the most consistent with our data. The main improvement of prospect theory over expe...

  5. Lahore general hospital protocol for treatment of neovascular glaucoma caused by retinal disease

    International Nuclear Information System (INIS)

    Khaqan, H.A.; Haider, S.A.

    2013-01-01

    To evaluate efficacy of LGH (Lahore General Hospital) protocol for treatment of neovascular glaucoma caused by retinal diseases. Material and Methods: This case series was performed on 9 consecutive eyes of nine patients with uncontrolled neovascular glaucoma at Department of Ophthalmology, Unit II, Lahore General Hospital/PGMI, Lahore. All nine patients completed six months follow up. Among them 6 patients were having PDR (proliferative diabetic retinopathy) and 3 patients having CRVO (central retinal vein occlusion). LGH protocol for treatment of neovascular glaucoma was: To give intravitreal injection of avastin and then PRP (Pan Retinal Photocoagulation) or Trabeculectomy with MMC (Mitomycin C), if PRP and intravitreal avastin fails to control the intra ocular-pressure (IOP). Results: Three patients had IOP control after intravitreal injection of avastin and PRP, 5 patients had uncontrolled IOP after intravitreal avastin and two sessions of PRP, so they under went trabeculectomy with MMC. One patient had uncontrolled IOP despite of full treatment protocol. All other 8 patients IOP remained stable for six months. Conclusion: Significant decrease in intraocular pressure was achieved after observing LGH protocol for treatment of NVG (Neovascular Glaucoma) caused by retinal diseases. (author)

  6. General health checks in adults for reducing morbidity and mortality from disease

    DEFF Research Database (Denmark)

    Krogsbøll, Lasse T; Jørgensen, Karsten Juhl; Grønhøj Larsen, Christian

    2012-01-01

    General health checks are common elements of health care in some countries. These aim to detect disease and risk factors for disease with the purpose of reducing morbidity and mortality. Most of the commonly used screening tests offered in general health checks have been incompletely studied. Als......, screening leads to increased use of diagnostic and therapeutic interventions, which can be harmful as well as beneficial. It is, therefore, important to assess whether general health checks do more good than harm....

  7. A 10-year trend of dental treatments under general anesthesia of children in Taipei Veterans General Hospital.

    Science.gov (United States)

    Chen, Yung-Pan; Hsieh, Chun-Yi; Hsu, Wen-Ting; Wu, Fu-Ya; Shih, Wen-Yu

    2017-04-01

    General anesthesia (GA) as a pediatric dental procedure is a well-established method of behavior management. However, studies of pediatric dentistry under GA have mostly focused on handicapped patients, and various retrospective studies in Taiwan have mainly reviewed only a limited number of years. The purpose of the present study was to report trends in pediatric dental treatment performed under GA over the past 10 years. A retrospective review of the hospital records of patients receiving dental treatment under GA from 2006 until 2015 was performed. The patients were divided into three age groups:  6 years. A range of information including basic patient characteristics and types of dental treatment was identified and then analyzed. A total of 791 cases ( 6 years old: 235; 549 male, 242 female) were treated under GA. The case number was found to have increased from 94 during 2006-2007 to 238 during 2014-2015, with the increase being especially pronounced among those aged 3-6 years (2006-2007: 49, 2014-2015: 165). The most common treatments (extraction, restoration, and pulp therapy) were associated with multiple dental caries (684, 86.4%). The  6-years-old group had the lowest mean number of treated teeth by stainless-steel crowns (SSCs) and fewest cases treated with pulp therapy. From 2011 onwards, the number of primary tooth extractions significantly increased, while in 2013, there was a crossover whereby the SSC count surpassed the composite resin filling count. Over the past 10 years, there has been an increased use of GA for pediatric dental treatments, in particular, in cases with multiple dental caries. In addition, there has also been an increasing trend towards extraction of primary teeth and the use of SSCs. Copyright © 2017. Published by Elsevier Taiwan LLC.

  8. General introduction into the Ebola virus biology and disease.

    Science.gov (United States)

    Zawilińska, Barbara; Kosz-Vnenchak, Magdalena

    2014-01-01

    Epidemic of Ebola hemorrhagic fever which appeared in the countries of West Africa in 2014, is the largest outbreak which occurred so far. The virus causing this epidemic, Zaire Ebolavirus (ZEBOV), along with four other species of Ebolaviruses is classified to the genus Ebolavirus in the family Filoviridae. ZEBOV is one of the most virulent pathogens among the viral haemorrhagic fevers, and case fatality rates up to 90% have been reported. Mortality is the result of multi-organ failure and severe bleeding complications. The aim of this review is to present the general characteristics of the virus and its biological properties, pathogenicity and epidemiology, with a focus on laboratory methods used in the diagnosis of these infections.

  9. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca.

    Science.gov (United States)

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. A retrospective cohort study was carried out in pediatric dentistry unit of the University Hospital of Casablanca. Data were collected from records of patients seen for the first time between 2006 and 2011. The waiting time was defined as the time between the date of the first consultation and intervention date. 127 children received dental care under general anesthesia, 57.5% were male and the average age was 9.2 (SD = 3.4). Decay was the most frequent reason for consultation (48%), followed by pain (32%). The average waiting time was 7.6 months (SD = 4.2 months). The average number of acts performed per patient was 13.5. Waiting times were long, it is necessary to take measures to reduce delays and improve access to oral health care for this special population.

  10. 76 FR 1096 - Pay Under the General Schedule and Recruitment, Relocation, and Retention Incentives

    Science.gov (United States)

    2011-01-07

    ... RIN 3206-AM13 Pay Under the General Schedule and Recruitment, Relocation, and Retention Incentives... instructions for submitting comments. Mail: Jerome D. Mikowicz, Deputy Associate Director, Pay and Leave...-0824; or by e-mail at pay[email protected] . SUPPLEMENTARY INFORMATION: The U.S. Office of...

  11. Inflammatory Profile of Awake Function-Controlled Craniotomy and Craniotomy under General Anesthesia

    Science.gov (United States)

    Klimek, Markus; Hol, Jaap W.; Wens, Stephan; Heijmans-Antonissen, Claudia; Niehof, Sjoerd; Vincent, Arnaud J.; Klein, Jan; Zijlstra, Freek J.

    2009-01-01

    Background. Surgical stress triggers an inflammatory response and releases mediators into human plasma such as interleukins (ILs). Awake craniotomy and craniotomy performed under general anesthesia may be associated with different levels of stress. Our aim was to investigate whether those procedures cause different inflammatory responses. Methods. Twenty patients undergoing craniotomy under general anesthesia and 20 patients undergoing awake function-controlled craniotomy were included in this prospective, observational, two-armed study. Circulating levels of IL-6, IL-8, and IL-10 were determined pre-, peri-, and postoperatively in both patient groups. VAS scores for pain, anxiety, and stress were taken at four moments pre- and postoperatively to evaluate physical pain and mental duress. Results. Plasma IL-6 level significantly increased with time similarly in both groups. No significant plasma IL-8 and IL-10 change was observed in both experimental groups. The VAS pain score was significantly lower in the awake group compared to the anesthesia group at 12 hours postoperative. Postoperative anxiety and stress declined similarly in both groups. Conclusion. This study suggests that awake function-controlled craniotomy does not cause a significantly different inflammatory response than craniotomy performed under general anesthesia. It is also likely that function-controlled craniotomy does not cause a greater emotional challenge than tumor resection under general anesthesia. PMID:19536349

  12. Inflammatory profile of awake function-controlled craniotomy and craniotomy under general anesthesia

    NARCIS (Netherlands)

    M. Klimek (Markus); J.W. Hol (Jaap Willem); S.C.A. Wens (Stephan); C. Heijmans-Antonissen (Claudia); S.P. Niehof (Sjoerd); A.J. Vincent (Arnaud); J. Klein (Jan); F.J. Zijlstra (Freek)

    2009-01-01

    textabstractBackground. Surgical stress triggers an inflammatory response and releases mediators into human plasma such as interleukins (ILs). Awake craniotomy and craniotomy performed under general anesthesia may be associated with different levels of stress. Our aim was to investigate whether

  13. Factors associated with the risk of caries development after comprehensive dental rehabilitation under general anesthesia

    Directory of Open Access Journals (Sweden)

    Yai-Tin Lin

    2016-06-01

    Conclusion: This study has shown that SM count and CRA score were associated with new caries development in ECC children who needed to be treated under general anesthesia. The modified Cariogram used in this study is another significant tool for predicting new carries development in this particular population.

  14. [Legendary Hwa Tuo's surgery under general anesthesia in the second century China].

    Science.gov (United States)

    Chu, Nai-Shin

    2004-12-01

    In traditional Chinese medicine, Hwa Tuo (110 ? - 208 A.D.) is one of the most famous doctors. He used only few herbs in drug treatment or applied few points in acupuncture, and achieved excellent results. His ultimate fame came from his remarkable surgical skills and his discovery of general anesthesia. According to the Chronicle of the Three Kingdoms (ca. 270 A.D.) and the Annals of the Later Han Dynasty (ca. 430 A.D.), Hwa Tuo performed operations under general anesthesia and the operations even included major ones such as dissection of gangrenous intestines. Before the surgery, he gave patient an anesthetic to drink to become drunk, numb and insensible. The anesthetic was called " foamy narcotic powder" and probably dissolved in wine. Because Confucian teachings regarded the body sacred, surgery as a form of body mutilation was not encouraged, or even became a taboo. Despite his great achievement, practice of surgery could hardly take off and the death of Hwa Tuo marked the end of Chinese surgery. Unfortunately, the composition of the anesthetic powder was not mentioned in those two books or other Chinese medical writings. The herb has been thought to be datura flower, aconite root, rhododendron flower, or jasmine root. Furthermore, Hwa Tuo's operations under general anesthesia were not described in details. Therefore, his remarkable achievement needs to be further documented. In Western medicine, the first operation under general anesthesia occurred at the Massachusetts General Hospital in 1846 when William Morton demonstrated the effectiveness of ether. How could Hwa Tuo accomplish such scientific achievement in the second century has remained a mystery. Even so, it seems quite remarkable that Hwa Tuo had come up with the idea of performing surgery under general anesthesia using the "foamy narcotic powder".

  15. Neural correlates underlying micrographia in Parkinson’s disease

    Science.gov (United States)

    Zhang, Jiarong; Hallett, Mark; Feng, Tao; Hou, Yanan; Chan, Piu

    2016-01-01

    Micrographia is a common symptom in Parkinson’s disease, which manifests as either a consistent or progressive reduction in the size of handwriting or both. Neural correlates underlying micrographia remain unclear. We used functional magnetic resonance imaging to investigate micrographia-related neural activity and connectivity modulations. In addition, the effect of attention and dopaminergic administration on micrographia was examined. We found that consistent micrographia was associated with decreased activity and connectivity in the basal ganglia motor circuit; while progressive micrographia was related to the dysfunction of basal ganglia motor circuit together with disconnections between the rostral supplementary motor area, rostral cingulate motor area and cerebellum. Attention significantly improved both consistent and progressive micrographia, accompanied by recruitment of anterior putamen and dorsolateral prefrontal cortex. Levodopa improved consistent micrographia accompanied by increased activity and connectivity in the basal ganglia motor circuit, but had no effect on progressive micrographia. Our findings suggest that consistent micrographia is related to dysfunction of the basal ganglia motor circuit; while dysfunction of the basal ganglia motor circuit and disconnection between the rostral supplementary motor area, rostral cingulate motor area and cerebellum likely contributes to progressive micrographia. Attention improves both types of micrographia by recruiting additional brain networks. Levodopa improves consistent micrographia by restoring the function of the basal ganglia motor circuit, but does not improve progressive micrographia, probably because of failure to repair the disconnected networks. PMID:26525918

  16. Forest pathogens and diseases under changing climate-A review

    International Nuclear Information System (INIS)

    Raza, M. M.; Khan, M. A.; Aslam, H. M. U.; Riaz, K.

    2015-01-01

    Changing climate threatens tree health by affecting the likelihood, frequency of occurrence, types and severity of forest diseases caused by diverse pests, resultantly altering the forest ecosystems. The present review covers the relationship between climate and diverse cases of forest diseases and potential shocks of climate change on pathogens and diseases. Biotic diseases, cankers, decays, declines, foliar diseases, root diseases and stem rust of pine have been reviewed with some illustrations of potential disease effects with predicted changing climate. The impact of changing climate on host, pathogen, and their interaction will have frequent and mostly unsympathetic outcomes to forest ecosystems. By employing the proactive and modern scientific management strategies like monitoring, modeling prediction, risk rating, planning, genetic diversity and facilitated migration, genetic protection and breeding for disease resistance and relating results to forest policy, planning as well as decision making, the suspicions innate to climate change effects can be minimized. (author)

  17. A retrospective comparison of dental treatment under general anesthesia on children with and without mental disabilities.

    Science.gov (United States)

    Sari, M E; Ozmen, B; Koyuturk, A E; Tokay, U

    2014-01-01

    The purpose of this study is to determine the properties of the dental procedures performed on children with dental problems under general anesthesia and compared between the patterns of dental treatment provided for intellectual disability and non-cooperate healthy child. In this retrospective study, the records of patients between the ages of 4 and 18 who were treated under general anesthesia were evaluated. Patients were divided into two groups: Those with intellectual disability and healthy patients who had difficulty cooperating. A statistical analysis of the mean standard deviation was conducted with a focus on two factors: Age and dental treatment methods. In this study, it was observed that restorative treatment and tooth extraction was generally higher in intellectual disability children than in their healthy children. When evaluating the health status of teeth, the value of decayed missing and filled teeth (dmf-t) was observed to be close in healthy and intellectual disability individuals in the 4-6 age groups; it was higher in individuals with intellectual disability in the 7-12 age groups. There was no significant difference in terms of periodontal treatment and fissure sealants in the 12-18 age groups. By comparing the different patient groups who received dental treatment under general anesthesia, both the number of teeth extracted and DMF-T indices were higher in the disabled group. Therefore, especially more efforts should be made at encouraging these patients to visit the dentist earlier and receive primary preventive care.

  18. Declining Prevalence of Disease Vectors Under Climate Change

    DEFF Research Database (Denmark)

    Escobar, Luis E.; Romero-Alvarez, Daniel; Leon, Renato

    2016-01-01

    More than half of the world population is at risk of vector-borne diseases including dengue fever, chikungunya, zika, yellow fever, leishmaniasis, chagas disease, and malaria, with highest incidences in tropical regions. In Ecuador, vector-borne diseases are present from coastal and Amazonian...

  19. Ebola Virus Disease Candidate Vaccines Under Evaluation in Clinical Trials

    Science.gov (United States)

    2016-06-02

    evidence that oral vaccines fail in populations with disturbed microbiota, poor nutrition , and high intestinal inflammation [102-104]. Additionally...countermeasure development against Ebola virus disease becoming a global public- health priority. This review summarizes the status quo of candidate...members of the mononegaviral family Filoviridae) cause two diseases recognized by the World Health Organization (WHO): Ebola virus disease (EVD) can be

  20. Compliance with preventive care following dental treatment of children under general anaesthesia.

    Science.gov (United States)

    Peerbhay, F B M

    2009-11-01

    This study evaluated the self-reported preventive dental care compliance of parents/families whose children received dental treatment under general anaesthesia. Complete records of 68 pediatric patients who attended the University of Stellenbosch's Paediatric Dentistry Department for dental treatment were included in the survey. Parents of 41 (60%) patients were interviewed telephonically to evaluate parental dental health knowledge and preventive practices. The majority (85%) of parents had a good idea about the aetiology of dental caries. An assessment of the children's dental health behaviour reveals that parents were mostly responsible for brushing the childs' teeth (44%).The majority of parents (51%) reported that following dental treatment of the child under general anaesthesia, there was no change in their child's frequency of sugar consumption. Sixty-three percent of children treated under GA had returned for the one-week follow-up. However, only 22% of children returned for the three-month follow up appointment. Parents were informed about the importance of these follow-up appointments. Parental belief that proper dental health behaviour helps maintain the teeth, did not influence parents preventive compliance, despite them having received preventive instruction. Parents were mostly responsible for brushing their child's teeth following dental treatment of their children under general anaesthesia. This research found however that, in the majority of cases there was no change in the children's frequency of sugar intake.

  1. COMPARATIVE STUDY OF MODIFIED RADICAL MASTECTOMY PERFORMED UNDER LOCAL ANAESTHESIA WITH DEXMEDETOMIDINE INFUSION VS. GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Ramesan Chayampurath

    2016-11-01

    Full Text Available BACKGROUND The incidence of breast cancer is on the rise in developing countries. Though, there have been significant advances in general anaesthesia, surgery in elderly and those with comorbid illness still have an attendant morbidity and mortality. After the introduction of local anaesthesia by Kolher in 1884 and in spite of steady refinement, local anaesthesia is still not being widely used in major general surgical procedures. MATERIALS AND METHODS The study was conducted in Government Medical College, Calicut, a tertiary care centre in Kerala. The outcome of Modified Radical Mastectomy performed under Local Anaesthesia (LA and dexmedetomidine infusion was compared to similar cases done under General Anaesthesia (GA. RESULTS Rapid recovery from sedation leading to early restoration of normal physical activity was observed in the LA group when compared to GA group. Early initiation of oral feeds was possible in the former group as Postoperative Nausea and Vomiting (PONV was significantly less. Effective postoperative pain relief and significant reduction in respiratory complications was observed in the LA group compared to GA group. CONCLUSION Modified Radical Mastectomy under LA and procedural sedation with dexmedetomidine was significantly better in selected cases when compared to similar cases done under GA with respect to early recovery pain relief and decreased incidence of respiratory complications.

  2. A General Contact Force Analysis of an Under-Actuated Finger in Robot Hand Grasping

    Directory of Open Access Journals (Sweden)

    Xuan Vinh Ha

    2016-02-01

    Full Text Available This paper develops a mathematical analysis of contact forces for the under-actuated finger in a general under-actuated robotic hand during grasping. The concept of under-actuation in robotic grasping with fewer actuators than degrees of freedom (DOF, through the use of springs and mechanical limits, allows the hand to adjust itself to an irregularly shaped object without complex control strategies and sensors. Here the main concern is the contact forces, which are important elements in grasping tasks, based on the proposed mathematical analysis of their distributions of the n-DOF under-actuated finger. The simulation results, along with the 3-DOF finger from the ADAMS model, show the effectiveness of the mathematical analysis method, while comparing them with the measured results. The system can find magnitudes of the contact forces at the contact positions between the phalanges and the object.

  3. Reflection of Plane Waves in Generalized Thermoelastic Half Space under the Action of Uniform Magnetic Field

    Directory of Open Access Journals (Sweden)

    Narottam Maity

    2016-01-01

    Full Text Available Reflection of longitudinal displacement waves in a generalized thermoelastic half space under the action of uniform magnetic field has been investigated. The magnetic field is applied in such a direction that the problem can be considered as a two-dimensional one. The discussion is based on the three theories of generalized thermoelasticity: Lord-Shulman (L-S, Green-Lindsay (G-L, and Green-Naghdi (G-N with energy dissipation. We compute the possible wave velocities for different models. Amplitude ratios have been presented. The effects of magnetic field on various subjects of interest are discussed and shown graphically.

  4. A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases

    Directory of Open Access Journals (Sweden)

    Supreet Kaur

    2015-01-01

    Full Text Available Background: An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. Materials and Methods: A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Results: Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. Conclusion: General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum.

  5. A survey on acquaintance, orientation and behavior of general medical practitioners toward periodontal diseases.

    Science.gov (United States)

    Kaur, Supreet; Khurana, Pankaj; Kaur, Harjit

    2015-01-01

    An association between oral conditions such as periodontal diseases and systemic conditions is noted. As such, periodontal disease is associated with an increased risk of systemic illnesses such as cardiovascular disease, diabetes, adverse pregnancy outcome, atherosclerosis, stroke and hospital acquired pneumonia. The concept of diagnosing and treating a potential patient to minimize the deleterious effects of this chronic infectious and inflammatory condition on systemic conditions represents both an unprecedented challenge and opportunity to our profession. Keeping this in view, the present survey was designed to evaluate the acquaintance, orientation and behavior of general medical practitioners; concerning the effects of periodontal disease on systemic health. A typed questionnaire carrying four sets of questions was distributed among general medical practitioners of seven different government and private medical colleges and hospitals. Questionnaire was developed to assess the acquaintance, orientation and behavior of general medical practitioners toward periodontal disease. Most of the respondents have knowledge regarding the signs and symptoms of periodontal disease and its association with cardiovascular disease. However, majority of them do not know about the potential effect of periodontal disease on other organ systems. General medical practitioners have inadequate knowledge regarding periodontal diseases. Hence, oral health related training should be an integral part of the medical curriculum.

  6. Awareness of the association between periodontal disease and adverse pregnancy outcome among the general female population

    Directory of Open Access Journals (Sweden)

    Fouzia Tarannum

    2015-01-01

    Conclusion: Younger and educated females had better awareness of the association between periodontal diseases and PTLBW. Hence, efforts to educate the general female population on this association could contribute toward the reduction of the risk of PTLBW.

  7. Numerically pricing American options under the generalized mixed fractional Brownian motion model

    Science.gov (United States)

    Chen, Wenting; Yan, Bowen; Lian, Guanghua; Zhang, Ying

    2016-06-01

    In this paper, we introduce a robust numerical method, based on the upwind scheme, for the pricing of American puts under the generalized mixed fractional Brownian motion (GMFBM) model. By using portfolio analysis and applying the Wick-Itô formula, a partial differential equation (PDE) governing the prices of vanilla options under the GMFBM is successfully derived for the first time. Based on this, we formulate the pricing of American puts under the current model as a linear complementarity problem (LCP). Unlike the classical Black-Scholes (B-S) model or the generalized B-S model discussed in Cen and Le (2011), the newly obtained LCP under the GMFBM model is difficult to be solved accurately because of the numerical instability which results from the degeneration of the governing PDE as time approaches zero. To overcome this difficulty, a numerical approach based on the upwind scheme is adopted. It is shown that the coefficient matrix of the current method is an M-matrix, which ensures its stability in the maximum-norm sense. Remarkably, we have managed to provide a sharp theoretic error estimate for the current method, which is further verified numerically. The results of various numerical experiments also suggest that this new approach is quite accurate, and can be easily extended to price other types of financial derivatives with an American-style exercise feature under the GMFBM model.

  8. Multiple systemic embolism in infective endocarditis underlying in Barlow's disease.

    Science.gov (United States)

    Yu, Ziqing; Fan, Bing; Wu, Hongyi; Wang, Xiangfei; Li, Chenguang; Xu, Rende; Su, Yangang; Ge, Junbo

    2016-08-11

    Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE. Unfortunately, clinical trial results have been inconclusive. We describe a previously healthy 50-year-old man who presented with dysarthria secondary to bacterial endocarditis with multiple cerebral, coronary, splenic, and peripheral emboli; antibiotic therapy contributed to the multiple emboli. Emergency splenectomy was performed, with subsequent mitral valve repair. Pathological examination confirmed mucoid degeneration and mitral valve prolapse (Barlow's disease) as the underlying etiology of the endocardial lesion. Continuous antibiotics were prescribed, postoperatively. Transthoracic echocardiography at 1.5, 3, and 6 months after the onset of his illness showed no severe regurgitation, and there was no respiratory distress, fever, or lethargy during follow-up. Although antibiotic use in IE carries a risk of septic embolism, these drugs have bactericidal and antithrombotic benefits. It is important to consider that negative blood culture and symptom resolution do not confirm complete elimination of bacteria. However, vegetation size and Staphylococcus aureus infection accurately predict embolization. It is also important to consider that bacteria can be segregated from the microbicide when embedded in platelets and fibrin. Therefore, antimicrobial therapy with concurrent antiplatelet therapy should be considered carefully.

  9. Genetic variation in ABCA1 predicts ischemic heart disease in the general population

    DEFF Research Database (Denmark)

    Frikke-Schmidt, Ruth; Nordestgaard, BG; Jensen, Gorm B

    2008-01-01

    We tested the hypothesis that 6 nonsynonymous single nucleotide polymorphisms (SNPs) in ATP-Binding-Cassette transporter A1 (ABCA1) affect risk of ischemic heart disease (IHD) in the general population.......We tested the hypothesis that 6 nonsynonymous single nucleotide polymorphisms (SNPs) in ATP-Binding-Cassette transporter A1 (ABCA1) affect risk of ischemic heart disease (IHD) in the general population....

  10. Magnetohydrodynamic flow of generalized Maxwell fluids in a rectangular micropump under an AC electric field

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Guangpu [School of Mathematical Science, Inner Mongolia University, Hohhot, Inner Mongolia 010021 (China); Jian, Yongjun, E-mail: jianyj@imu.edu.cn [School of Mathematical Science, Inner Mongolia University, Hohhot, Inner Mongolia 010021 (China); Chang, Long [School of Mathematics and Statistics, Inner Mongolia University of Finance and Economics, Hohhot, Inner Mongolia 010051 (China); Buren, Mandula [School of Mathematical Science, Inner Mongolia University, Hohhot, Inner Mongolia 010021 (China)

    2015-08-01

    By using the method of separation of variables, an analytical solution for the magnetohydrodynamic (MHD) flow of the generalized Maxwell fluids under AC electric field through a two-dimensional rectangular micropump is reduced. By the numerical computation, the variations of velocity profiles with the electrical oscillating Reynolds number Re, the Hartmann number Ha, the dimensionless relaxation time De are studied graphically. Further, the comparison with available experimental data and relevant researches is presented. - Highlights: • MHD flow of the generalized Maxwell fluids under AC electric field is analyzed. • The MHD flow is confined to a two-dimensional rectangular micropump. • Analytical solution is obtained by using the method of separation of variables. • The influences of related parameters on the MHD velocity are discussed.

  11. Magnetohydrodynamic flow of generalized Maxwell fluids in a rectangular micropump under an AC electric field

    International Nuclear Information System (INIS)

    Zhao, Guangpu; Jian, Yongjun; Chang, Long; Buren, Mandula

    2015-01-01

    By using the method of separation of variables, an analytical solution for the magnetohydrodynamic (MHD) flow of the generalized Maxwell fluids under AC electric field through a two-dimensional rectangular micropump is reduced. By the numerical computation, the variations of velocity profiles with the electrical oscillating Reynolds number Re, the Hartmann number Ha, the dimensionless relaxation time De are studied graphically. Further, the comparison with available experimental data and relevant researches is presented. - Highlights: • MHD flow of the generalized Maxwell fluids under AC electric field is analyzed. • The MHD flow is confined to a two-dimensional rectangular micropump. • Analytical solution is obtained by using the method of separation of variables. • The influences of related parameters on the MHD velocity are discussed

  12. Convenient and General Zinc‐Catalyzed Borylation of Aryl Diazonium Salts and Aryltriazenes under Mild Conditions

    Science.gov (United States)

    Qi, Xinxin; Jiang, Li‐Bing; Zhou, Chao; Peng, Jin‐Bao

    2017-01-01

    Abstract A convenient and general zinc‐catalyzed borylation of aryl diazonium salts and aryltriazenes has been developed. With bis‐ (pinacolato)diboron as the borylation reagent, aryldiazonium tetrafluoroborate salts and aryltriazenes were transformed into the corresponding arylboronates in moderate to excellent yields under mild conditions. As a convenient and practical methodology, no additional ligands, base, or any other additives are required here. PMID:28638765

  13. Cellular registration without behavioral recall of olfactory sensory input under general anesthesia.

    Science.gov (United States)

    Samuelsson, Andrew R; Brandon, Nicole R; Tang, Pei; Xu, Yan

    2014-04-01

    Previous studies suggest that sensory information is "received" but not "perceived" under general anesthesia. Whether and to what extent the brain continues to process sensory inputs in a drug-induced unconscious state remain unclear. One hundred seven rats were randomly assigned to 12 different anesthesia and odor exposure paradigms. The immunoreactivities of the immediate early gene products c-Fos and Egr1 as neural activity markers were combined with behavioral tests to assess the integrity and relationship of cellular and behavioral responsiveness to olfactory stimuli under a surgical plane of ketamine-xylazine general anesthesia. The olfactory sensory processing centers could distinguish the presence or absence of experimental odorants even when animals were fully anesthetized. In the anesthetized state, the c-Fos immunoreactivity in the higher olfactory cortices revealed a difference between novel and familiar odorants similar to that seen in the awake state, suggesting that the anesthetized brain functions beyond simply receiving external stimulation. Reexposing animals to odorants previously experienced only under anesthesia resulted in c-Fos immunoreactivity, which was similar to that elicited by familiar odorants, indicating that previous registration had occurred in the anesthetized brain. Despite the "cellular memory," however, odor discrimination and forced-choice odor-recognition tests showed absence of behavioral recall of the registered sensations, except for a longer latency in odor recognition tests. Histologically distinguishable registration of sensory processing continues to occur at the cellular level under ketamine-xylazine general anesthesia despite the absence of behavioral recognition, consistent with the notion that general anesthesia causes disintegration of information processing without completely blocking cellular communications.

  14. Existence of Generalized Homoclinic Solutions of Lotka-Volterra System under a Small Perturbation

    OpenAIRE

    Mi, Yuzhen

    2016-01-01

    This paper investigates Lotka-Volterra system under a small perturbation vxx=-μ(1-a2u-v)v+ϵf(ϵ,v,vx,u,ux), uxx=-(1-u-a1v)u+ϵg(ϵ,v,vx,u,ux). By the Fourier series expansion technique method, the fixed point theorem, the perturbation theorem, and the reversibility, we prove that near μ=0 the system has a generalized homoclinic solution exponentially approaching a periodic solution.

  15. Existence of Generalized Homoclinic Solutions of Lotka-Volterra System under a Small Perturbation

    Directory of Open Access Journals (Sweden)

    Yuzhen Mi

    2016-01-01

    Full Text Available This paper investigates Lotka-Volterra system under a small perturbation vxx=-μ(1-a2u-vv+ϵf(ϵ,v,vx,u,ux, uxx=-(1-u-a1vu+ϵg(ϵ,v,vx,u,ux. By the Fourier series expansion technique method, the fixed point theorem, the perturbation theorem, and the reversibility, we prove that near μ=0 the system has a generalized homoclinic solution exponentially approaching a periodic solution.

  16. Dental Treatments under the General Anesthesia in a Child with Keratitis, Ichthyosis, and Deafness Syndrome

    Directory of Open Access Journals (Sweden)

    Sera Sımsek Derelioglu

    2013-01-01

    Full Text Available KID syndrome is a rare genodermatosis characterized by keratitis, ichthyosis, and sensorineural deafness. Although the dermatological, ophthalmologic, and sensorineural defects are emphasized in the literature, oral and dental evaluations are so superficial. In this case report, dental and oral symptoms of a three year and five months old boy with KID syndrome, suffering severe Early Childhood Caries (s-ECC and dental treatments done under General Anesthesia (GA were reported.

  17. CT-guided percutaneous radiofrequency ablation of hepatic malignancies located in unusual regions under general anesthesia

    International Nuclear Information System (INIS)

    Pan Jie; Chen Shaohui; Lu Xin; Mao Yilei; Sang Xinting; Chen Fang; Li Yumei; Huang Yuguang; Jin Zhengyu

    2010-01-01

    Objective: To discuss the feasibility of CT-guided percutaneous radiofrequency ablation (RFA) of liver malignancies located in unusual regions under general anesthesia, and to assess its clinical value. Methods: Eighteen patients with a total of 26 malignant hepatic lesions were enrolled in this study. The lesions were located at diaphragmatic surface, hepatic hilum, hepatic subcapsular site,side of inferior vena cava, side of gallbladder or near by colon. Transcatheter arterial chemoembolization was performed in all patients, which was followed by CT-guided percutaneous RFA under general anesthesia. The time used for puncturing and the time used for putting the needles to the scheduled sites were recorded. A follow-up for 115 months was conducted. The complications and the therapeutic results were observed. Results: For all patients,the procedure of puncture and needle placement was completed in 1-3 minutes. A total of 35 RFA procedures were conducted for 26 lesions. No severe complications occurred. Complete necrosis was observed in 20 tumors and partial necrosis in 6 tumors. Conclusion: The result of this study indicates that CT-guided percutaneous RFA under general anesthesia is a feasible technique for the treatment of liver malignancies located at unusual regions. This technique is very helpful for reducing the manipulating difficulty and lowing the complication risk of RFA procedures. (authors)

  18. Treatment of malignant central airway obstruction with Y-type metallic stent placement under general anaesthesia

    International Nuclear Information System (INIS)

    Yang Zhengqiang; Shi Haibin; Zhou Weizhong; Leng Derong; Li Linsun

    2010-01-01

    Objective: To report the clinical experience in treating malignant central airway obstruction with the placement of a domestic Y-shaped stent under general anaesthesia. Methods: The placement of a domestic Y-stent under general anaesthesia together with tracheal intubation was performed in three male patients of central lung cancer with the involvement of carina and subsequent malignant airway stenosis. The combination of Y-stent delivering and tracheal intubation had not been reported in the literature so far, so the technical experience was introduced in this paper. Results: The placement of Y-stent was successfully completed in all 3 patients. The whole procedure was smoothly carried out with no severe complications. After the operation the dyspnea was markedly relieved in all the patients. Conclusion: As a safe and effective treatment for malignant central airway obstructions, the placement of a domestic Y-stent under general anaesthesia can reduce patient's discomfort during the stent delivering process. A large cohort of patients is required in order to evaluate the long-term efficacy and related complications of this technique. (authors)

  19. Simulating policy options for psychiatric care in general hospitals under Medicare's PPS.

    Science.gov (United States)

    Freiman, M P; Mitchell, J B; Rosenbach, M L

    1988-11-01

    Psychiatric hospitals and certain distinct part psychiatric units of general hospitals are currently exempt from diagnosis related group (DRG)-based payment under Medicare's prospective payment system (PPS), in large part due to concern about the degree to which such payment would match historical costs for these facilities. This communication simulates DRG-based payments for psychiatric admissions to general hospitals under the PPS and also under a modified version of the PPS. Two major types of modifications are made: (1) an increase in the role of outlier payments and (2) a restructuring of the DRG classification to allow for a difference in the basic payment rate, depending on whether or not care is provided in a facility that is currently exempt. When compared with cost data from just before the start of the PPS, the simulation results show the degree to which these hypothetical modifications will decrease the systematic risk of general hospitals with exempt units from receiving payments that fall short of costs.

  20. Nonallergic rhinitis and its association with smoking and lower airway disease: A general population study

    DEFF Research Database (Denmark)

    Håkansson, Kåre; von Buchwald, Christian; Thomsen, Simon F

    2011-01-01

    The cause of nonallergic rhinitis (NAR) and its relation to lower airway disease remains unclear. The purpose of this study was to perform a descriptive analysis of the occurrence of rhinitis in a Danish general population with focus on NAR and its association with smoking and lower airway disease....

  1. Outbreaks of emerging infectious diseases: Risk perception and behaviour of the general public

    NARCIS (Netherlands)

    M. Bults (Marloes)

    2014-01-01

    markdownabstract__Abstract__ This thesis focuses on risk perception and behaviour of the public during the outbreaks of emerging infectious diseases. It consists of studies on Influenza A (H1N1), Q fever and Lyme disease. These studies were conducted among both the general public and specific

  2. Awake craniotomy induces fewer changes in the plasma amino acid profile than craniotomy under general anesthesia.

    Science.gov (United States)

    Hol, Jaap W; Klimek, Markus; van der Heide-Mulder, Marieke; Stronks, Dirk; Vincent, Arnoud J; Klein, Jan; Zijlstra, Freek J; Fekkes, Durk

    2009-04-01

    In this prospective, observational, 2-armed study, we compared the plasma amino acid profiles of patients undergoing awake craniotomy to those undergoing craniotomy under general anesthesia. Both experimental groups were also compared with a healthy, age-matched and sex-matched reference group not undergoing surgery. It is our intention to investigate whether plasma amino acid levels provide information about physical and emotional stress, as well as pain during awake craniotomy versus craniotomy under general anesthesia. Both experimental groups received preoperative, perioperative, and postoperative dexamethasone. The plasma levels of 20 amino acids were determined preoperative, perioperative, and postoperatively in all groups and were correlated with subjective markers for pain, stress, and anxiety. In both craniotomy groups, preoperative levels of tryptophan and valine were significantly decreased whereas glutamate, alanine, and arginine were significantly increased relative to the reference group. Throughout time, tryptophan levels were significantly lower in the general anesthesia group versus the awake craniotomy group. The general anesthesia group had a significantly higher phenylalanine/tyrosine ratio, which may suggest higher oxidative stress, than the awake group throughout time. Between experimental groups, a significant increase in large neutral amino acids was found postoperatively in awake craniotomy patients, pain was also less and recovery was faster. A significant difference in mean hospitalization time was also found, with awake craniotomy patients leaving after 4.53+/-2.12 days and general anesthesia patients after 6.17+/-1.62 days; P=0.012. This study demonstrates that awake craniotomy is likely to be physically and emotionally less stressful than general anesthesia and that amino acid profiling holds promise for monitoring postoperative pain and recovery.

  3. Level of understanding of Alzheimer disease among caregivers and the general population.

    Science.gov (United States)

    Jorge, C; Cetó, M; Arias, A; Blasco, E; Gil, M P; López, R; Dakterzada, F; Purroy, F; Piñol-Ripoll, G

    2018-05-11

    Understanding of Alzheimer disease is fundamental for early diagnosis and to reduce caregiver burden. The objective of this study is to evaluate the degree of understanding of Alzheimer disease among informal caregivers and different segments of the general population through the Alzheimer's Disease Knowledge Scale. We assessed the knowledge of caregivers in different follow-up periods (less than one year, between 1 and 5 years, and over 5 years since diagnosis) and individuals from the general population. Alzheimer's Disease Knowledge Scale scores were grouped into different items: life impact, risk factors, symptoms, diagnosis, treatment, disease progression, and caregiving. A total of 419 people (215 caregivers and 204 individuals from the general population) were included in the study. No significant differences were found between groups for overall Alzheimer's Disease Knowledge Scale score (19.1 vs. 18.8, P = .9). There is a scarce knowledge of disease risk factors (49.3%) or the care needed (51.2%), while symptoms (78.6%) and course of the disease (77.2%) were the best understood aspects. Older caregiver age was correlated with worse Alzheimer's Disease Knowledge Scale scores overall and for life impact, symptoms, treatment, and disease progression (P < .05). Time since diagnosis improved caregivers' knowledge of Alzheimer disease symptoms (P = .00) and diagnosis (P = .05). Assessing the degree of understanding of Alzheimer disease is essential to the development of health education strategies both in the general population and among caregivers. Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Implementing guidelines in general practice: evaluation of process and outcome of care in chronic diseases.

    NARCIS (Netherlands)

    Schellevis, F.G.; Eijk, J.T.M. van; Lisdonk, E.H. van de; Velden, J. van der; Weel, C. van

    1994-01-01

    In a prospective longitudinal study over 21 months the performance of general practitioners and the disease status of their patients was measured during the formulation and implementation of guidelines on follow-up care. Data on 15 general practitioners and on 613 patients with hypertension, 95 with

  5. Prothrombin and risk of venous thromboembolism, ischemic heart disease and ischemic cerebrovascular disease in the general population

    DEFF Research Database (Denmark)

    Weischer, Maren; Juul, Klaus; Zacho, Jeppe

    2010-01-01

    OBJECTIVE: We tested the hypotheses that Prothrombin G20210A heterozygosity associate with increased risk of venous thromboembolism (VTE), ischemic heart disease (IHD), and ischemic cerebrovascular disease (ICVD) in the general population and re-tested risk of IHD and ICVD in two case......-control studies. METHODS: 9231 individuals from the Danish general population were followed for VTE (VTE=DVT+PE), deep venous thrombosis (DVT), pulmonary embolism (PE), IHD, myocardial infarction (MI), ICVD, and ischemic stroke (IS) for a median of 24 years. Case-control studies included 2461 IHD cases and 867...

  6. Primary prevention of cardio-metabolic diseases in general practice: a Dutch survey of attitudes and working methods of general practitioners.

    NARCIS (Netherlands)

    Nielen, M.M.J.; Assendelft, W.J.J.; Drenthen, A.J.M.; Hombergh, P. van den; Dis, I. van; Schellevis, F.G.

    2010-01-01

    BACKGROUND: To study the attitudes and working methods of general practitioners (GPs) in primary prevention of cardiovascular diseases, diabetes mellitus and chronic kidney diseases. METHODS: A questionnaire with questions about attitude and working methods in the primary prevention of

  7. Variation in examination and treatment offers to patients with allergic diseases in general practice

    DEFF Research Database (Denmark)

    Hansen, Dorte Gilså; Jarbøl, Dorte Ejg; Munck, Anders Peter

    2010-01-01

    in general practice to patients with allergic diseases, and to evaluate guideline compliance with respect to anaphylaxis emergency treatment kits. DESIGN: A questionnaire-based survey among general practitioners (GPs) about examination and treatment procedures offered in the surgery to patients with allergic...... recommendations for preparedness for anaphylactic shock in connection with allergy vaccine therapy were not fully implemented. CONCLUSION: General practice is substantially involved in the examination and treatment of patients with allergic diseases. There is room for further involvement of staff members...

  8. VERTIGO AS AN ENT DISEASE : GENERAL PHYSICIAN AND THE COMMON MAN’S PERCEPTION

    Directory of Open Access Journals (Sweden)

    Sumit

    2015-08-01

    Full Text Available BACKGROUND : To study consciousness amongst General Physicians and common people, on their perception of Vertigo related to ENT disease. METHODS : Study was conducted in two different places of Eastern India from 2006 to 2015 . The patients with complaints of vertigo attending Otorhinolaryngologists at the first instance or by GP referral were studied . General Physicians also underwent a survey through a questionnaire. RESULTS : From the last 9 years of data , we find a defin ite increment in the number of vertigo patients at our OPD along with an increase in consciousness amongst the general physicians, though majority of doctors still don't think Vertigo to be predominantly an ENT disease

  9. [Advances on pharmacokinetics of traditional Chinese medicine under disease states].

    Science.gov (United States)

    Gong, Zi-peng; Chen, Ying; Zhang, Rui-jie; Yang, Qing; Zhu, Xiao-xin

    2015-01-01

    In recent years, more and more research shows that the pharmacokinetic parameter of traditional Chinese medicine can be affected by the disease states. It's possible that drug metabolic enzymes, transporters, cell membrane permeability and the change of microbes group could be interfered with physiological and pathological changes, which enables the pharmacokinetics of traditional Chinese medicine in the body to be altered, including the process of absorption, distribution, metabolism and excretion, and then the pharmacokinetic parameters of traditional chinese medicine are altered. It's found that investigating the pharmacokinetic of traditional Chinese medicine in the pathological state is more useful than that of in normal state because the great part of traditional Chinese medicine is mainly used to treat disease. This article reflects the latest research on the pharmacokinetic of traditional Chinese medicine in the disease state such as diabete, cerebral ischemia, liver injury, inflammatory disease, nervous system disorders and fever in order to provide certain reference for clinicians designing reasonable administration dose.

  10. Polycystic ovary syndrome and periodontal disease: Underlying links- A review

    Directory of Open Access Journals (Sweden)

    Sri Chandana Tanguturi

    2018-01-01

    Full Text Available Polycystic ovary syndrome (PCOS is the most common endocrine disorder among women of reproductive age, which negatively affects various health systems. There is an extensive literature regarding the association of PCOS and other systemic conditions such as diabetes mellitus, cardiovascular disease, and psychological disorders. However, there is a lack of literature in associating PCOS and periodontal disease. Hence, PubMed search was done for various articles related to PCOS and its association with other comorbidities, including periodontal diseases. Analysis was done and data were synthesized and compiled in a sequential and presentable paradigm. This literature review of the pathophysiological mechanisms linking the two diseases suggests a positive relation between the two comorbidities. However, multicenter studies, with larger sample sizes, are to be conducted to establish a clearer and stronger association.

  11. [Comparison of long-term dental treatment effects of children treated under general anesthesia and passive restraint].

    Science.gov (United States)

    Zhou, F; Xia, B; Zhang, S; Ma, W L; Xiao, Y M; Ge, L H

    2017-02-09

    Objective: To compare the long-term dental treatment effects, oral health habits and oral-health-related qualities of life of children treated under general anesthesia (GA) and passive restraint (PR), respectively. Methods: Twenty seven 2 to 4-year-old children treated under GA and thirty four children treated under PR were recruited in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. Up to 2 years after the treatment, a follow up assessment was conducted. The data of general information, dental plaque level and the unplanned treatments were recorded and analyzed. The questionnaire of oral health habits and early childhood oral health impact scale (ECOHIS) for each child was also completed and analyzed. The survival rate and median survival time of the deciduous teeth were calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results: Twenty-five children under GA and 32 under PR were finally included, with a total of 1 098 deciduous teeth. The postoperative dental plaque indicesin both GA and PR groups had significantly improved than that of before the treatments ( P= 0.019, P< 0.001). The oral health habits had also improved, and the improvement in PR group was more obvious than that in GA group. Totally 128 teeth (27.0%) appeared unplanned treatments in GA group and 232 teeth (37.2%) in PR group during the follow-ups. The new caries and recurrent caries in PR group were significantly more than that in GA group ( P< 0.001, P= 0.012). No significant differences were found between the two groups in restoration failure, secondary caries and endodontic diseases ( P= 0.129, P= 0.822, P= 0.642). However, the time of occurrence of endodontic disease and secondary caries in GA group were significantly longer than that in PR group ( P< 0.01, P< 0.001). The median survival time of teeth in GA group was 1 018 days comparing to 944 days in PR group. The difference was statistically significant ( P

  12. Factors associated with chronic diseases among the elderly receiving treatment under the Family Health Strategy.

    Science.gov (United States)

    Pimenta, Fernanda Batista; Pinho, Lucinéia; Silveira, Marise Fagundes; Botelho, Ana Cristina de Carvalho

    2015-08-01

    The profile of a sample population of elderly receiving treatment under the Family Health Strategy in the municipality of Teófilo Otoni, State of Minas Gerais, Brazil, is described, and the factors associated with diseases prevalence examined. Using simple random sampling, 385 elderly were interviewed using Form A and Elderly Form from the Primary Health Care Information System. The majority of the sample (83.1%) self-reported at least one disease, 69.9% had hypertension, and 17.7% had diabetes. Poisson regression analysis showed that the main factors associated with hypertension and other diseases were being non-white, having a low level of education, medication use, dental prosthesis use, and lack of a private health plan. The prevalence of diabetes was greater among women and individuals who depended on other people to live. It can be concluded that this sample population of elderly has a generally low socioeconomic status and are more susceptible to developing diseases, particularly hypertension. Diabetes should be controlled although had relatively low prevalence. It is suggested investments in structuring the health system network to provide adequate care for the elderly and in training health professionals to play an effective role in improving the quality of life of the elderly in Brazil.

  13. General Principles for the welfare of animals in production systems: the underlying science and its application.

    Science.gov (United States)

    Fraser, David; Duncan, Ian J H; Edwards, Sandra A; Grandin, Temple; Gregory, Neville G; Guyonnet, Vincent; Hemsworth, Paul H; Huertas, Stella M; Huzzey, Juliana M; Mellor, David J; Mench, Joy A; Spinka, Marek; Whay, H Rebecca

    2013-10-01

    In 2012, the World Organisation for Animal Health adopted 10 'General Principles for the Welfare of Animals in Livestock Production Systems' to guide the development of animal welfare standards. The General Principles draw on half a century of scientific research relevant to animal welfare: (1) how genetic selection affects animal health, behaviour and temperament; (2) how the environment influences injuries and the transmission of diseases and parasites; (3) how the environment affects resting, movement and the performance of natural behaviour; (4) the management of groups to minimize conflict and allow positive social contact; (5) the effects of air quality, temperature and humidity on animal health and comfort; (6) ensuring access to feed and water suited to the animals' needs and adaptations; (7) prevention and control of diseases and parasites, with humane euthanasia if treatment is not feasible or recovery is unlikely; (8) prevention and management of pain; (9) creation of positive human-animal relationships; and (10) ensuring adequate skill and knowledge among animal handlers. Research directed at animal welfare, drawing on animal behaviour, stress physiology, veterinary epidemiology and other fields, complements more established fields of animal and veterinary science and helps to create a more comprehensive scientific basis for animal care and management. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. The pricing of credit default swaps under a generalized mixed fractional Brownian motion

    Science.gov (United States)

    He, Xinjiang; Chen, Wenting

    2014-06-01

    In this paper, we consider the pricing of the CDS (credit default swap) under a GMFBM (generalized mixed fractional Brownian motion) model. As the name suggests, the GMFBM model is indeed a generalization of all the FBM (fractional Brownian motion) models used in the literature, and is proved to be able to effectively capture the long-range dependence of the stock returns. To develop the pricing mechanics of the CDS, we firstly derive a sufficient condition for the market modeled under the GMFBM to be arbitrage free. Then under the risk-neutral assumption, the CDS is fairly priced by investigating the two legs of the cash flow involved. The price we obtained involves elementary functions only, and can be easily implemented for practical purpose. Finally, based on numerical experiments, we analyze quantitatively the impacts of different parameters on the prices of the CDS. Interestingly, in comparison with all the other FBM models documented in the literature, the results produced from the GMFBM model are in a better agreement with those calculated from the classical Black-Scholes model.

  15. General equilibrium effects of a supply side GHG mitigation option under the Clean Development Mechanism.

    Science.gov (United States)

    Timilsina, Govinda R; Shrestha, Ram M

    2006-09-01

    The Clean Development Mechanism (CDM) under the Kyoto Protocol to the United Nations Framework Convention on Climate Change is considered a key instrument to encourage developing countries' participation in the mitigation of global climate change. Reduction of greenhouse gas (GHG) emissions through the energy supply and demand side activities are the main options to be implemented under the CDM. This paper analyses the general equilibrium effects of a supply side GHG mitigation option-the substitution of thermal power with hydropower--in Thailand under the CDM. A static multi-sector general equilibrium model has been developed for the purpose of this study. The key finding of the study is that the substitution of electricity generation from thermal power plants with that from hydropower plants would increase economic welfare in Thailand. The supply side option would, however, adversely affect the gross domestic product (GDP) and the trade balance. The percentage changes in economic welfare, GDP and trade balance increase with the level of substitution and the price of certified emission reduction (CER) units.

  16. Imaging of Brain Connectivity in Dementia: Clinical Implications for Diagnosis of its Underlying Diseases

    NARCIS (Netherlands)

    R. Meijboom (Rozanna)

    2017-01-01

    markdownabstractIn this thesis we investigated the use of advanced magnetic resonance imaging (MRI) techniques in identifying subtle brain abnormalities, associating brain abnormalities with disease symptomatology, and improving early (differential) diagnosis in several diseases underlying dementia.

  17. Preventive aspects in children's caries treatments preceding dental care under general anaesthesia.

    Science.gov (United States)

    Savanheimo, Nora; Vehkalahti, Miira M

    2008-03-01

    In Helsinki Public Dental Service (PDS) the Special Oral Health Care Unit (SOHCU) provides comprehensive dental treatments under general anaesthesia (GA). For the present study, all dental treatment given under GA for generally healthy children (n = 102) below 16 years of age (range 2.3-15.8) during a 1-year period and dental treatment and visits of these children in the preceding 2 years in Helsinki PDS was recorded in detail. These children were referred to the SOHCU because of serious difficulties in dental care due to large treatment needs or failures in psychological and chemical management, including sedation. To describe treatments given to generally healthy children under GA and to evaluate preventive aspects of their dental care in the preceding 2 years. The study was cross-sectional and retrospective. Data came from the patients' individual records. Treatments under GA included an average of 6.0 restorations (SD = 2.7, range 0-12) and 1.7 extractions (SD = 2.1, range 0-10). In the 2 preceding years, these children had visited dentist an average of 5.1 times (SD = 2.7, range 1-14) with an average of 2.4 restorations (SD = 1.9, range 0-12) and 0.5 extractions (SD = 1.4, range 0-10). Of the restorations made, 36% were temporary. Of all visits, those with an operative approach accounted for 35%, preventive for 37%, operative and preventive for 5%, and visits with total uncooperation for 23%. Of the children, 90% had at least one preventive visit. Children treated under conscious sedation in the preceding 2 years received less prevention (P = 0.02). Remaining without preventive measures was most likely for those children exhibiting visits with total uncooperation (odds ratio = 4.6; P = 0.004) and for those receiving numerous temporary fillings (odds ratio = 4.1; P = 0.0005). The uncooperative high-caries children pose a demanding challenge to PDS. The early identification of high-caries risk and efforts of intensive preventive care are in key position to

  18. Tourniquet-induced cardiovascular responses in anterior cruciate ligament reconstruction surgery under general anesthesia: Effect of preoperative oral amantadine

    Directory of Open Access Journals (Sweden)

    Ashraf Abd Elmawgood

    2015-01-01

    Conclusion: Preoperative oral amantadine reduced tourniquet induced hypertension and postoperative analgesic requirements in anterior cruciate ligament reconstruction surgery under general anesthesia.

  19. Maremar, prevalence of chronic kidney disease, how to avoid over-diagnosis and under-diagnosis.

    Science.gov (United States)

    De Broe, Marc E; Gharbi, Mohammed Benghanem; Elseviers, Monique

    2016-04-01

    Chronic kidney disease is considered as a major public health problem. Recent studies mention a prevalence rate between 8%-12%. Several editorials, comments, short reviews described the weaknesses (lack of confirmation of proteinuria, and of chronicity of decreased estimated glomerular filtration rate) of a substantial number of studies and the irrational of using a single arbitrary set point, i.e. diagnosis of chronic kidney disease whenever the estimated glomerular filtration rate is less than 60mL/min/1.73m(2). Maremar (Maladies rénales chroniques au Maroc) is a prevalence study of chronic kidney disease, hypertension, diabetes and obesity in a randomized, representative, high response rate (85%), sample of the adult population of Morocco, strictly applying the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Compared to the vast majority of the available studies, Maremar has a low prevalence of chronic kidney disease (2.9% adjusted to the actual adult population of Morocco). The population pyramid, and particularly the confirmation of proteinuria and "chronicity" of the decreased estimated glomerular filtration rate are the main reasons for this low prevalence of chronic kidney disease. The choice of arbitrary single threshold of estimated glomerular filtration rate for classifying stage 3-5 chronic kidney disease inevitably leads to "over-diagnosis" (false positives) of the disease in the elderly, particularly those without proteinuria, hematuria or hypertension, and to "under-diagnosed" (false negatives) in younger individuals with an estimated glomerular filtration rate above 60mL/min/1.73m(2) and below the 3rd percentile of their age/gender category. There is an urgent need for quality studies using in a correct way the recent KDIGO guidelines when investigating the prevalence of chronic kidney disease, in order to avoid a 50 to 100% overestimation of a disease state with potential dramatic consequences. The combination of the general population

  20. Regularization in Hilbert space under unbounded operators and general source conditions

    International Nuclear Information System (INIS)

    Hofmann, Bernd; Mathé, Peter; Von Weizsäcker, Heinrich

    2009-01-01

    The authors study ill-posed equations with unbounded operators in Hilbert space. This setup has important applications, but only a few theoretical studies are available. First, the question is addressed and answered whether every element satisfies some general source condition with respect to a given self-adjoint unbounded operator. This generalizes a previous result from Mathé and Hofmann (2008 Inverse Problems 24 015009). The analysis then proceeds to error bounds for regularization, emphasizing some specific points for regularization under unbounded operators. The study finally reviews two examples within the light of the present study, as these are fractional differentiation and some Cauchy problems for the Helmholtz equation, both studied previously and in more detail by U Tautenhahn and co-authors

  1. Beam wandering statistics of twin thin laser beam propagation under generalized atmospheric conditions.

    Science.gov (United States)

    Pérez, Darío G; Funes, Gustavo

    2012-12-03

    Under the Geometrics Optics approximation is possible to estimate the covariance between the displacements of two thin beams after they have propagated through a turbulent medium. Previous works have concentrated in long propagation distances to provide models for the wandering statistics. These models are useful when the separation between beams is smaller than the propagation path-regardless of the characteristics scales of the turbulence. In this work we give a complete model for these covariances, behavior introducing absolute limits to the validity of former approximations. Moreover, these generalizations are established for non-Kolmogorov atmospheric models.

  2. Brachial Plexus Injury from CT-Guided RF Ablation Under General Anesthesia

    International Nuclear Information System (INIS)

    Shankar, Sridhar; Sonnenberg, Eric van; Silverman, Stuart G.; Tuncali, Kemal; Flanagan, Hugh L.; Whang, Edward E.

    2005-01-01

    Brachial plexus injury in a patient under general anesthesia (GA) is not uncommon, despite careful positioning and, particularly, awareness of the possibility. The mechanism of injury is stretching and compression of the brachial plexus over a prolonged period. Positioning the patient within the computed tomography (CT) gantry for abdominal or chest procedures can simulate a surgical procedure, particularly when GA is used. The potential for brachial plexus injury is increased if the case is prolonged and the patient's arms are raised above the head to avoid CT image degradation from streak artifacts. We report a case of profound brachial plexus palsy following a CT-guided radiofrequency ablation procedure under GA. Fortunately, the patient recovered completely. We emphasize the mechanism of injury and detail measures to combat this problem, such that radiologists are aware of this potentially serious complication

  3. A general circuit model for spintronic devices under electric and magnetic fields

    KAUST Repository

    Alawein, Meshal

    2017-10-25

    In this work, we present a circuit model of diffusive spintronic devices capable of capturing the effects of both electric and magnetic fields. Starting from a modified version of the well-established drift-diffusion equations, we derive general equivalent circuit models of semiconducting/metallic nonmagnets and metallic ferromagnets. In contrast to other models that are based on steady-state transport equations which might also neglect certain effects such as thermal fluctuations, spin dissipation in the ferromagnets, and spin precession under magnetic fields, our model incorporates most of the important physics and is based on a time-dependent formulation. An application of our model is shown through simulations of a nonlocal spin-valve under the presence of a magnetic field, where we reproduce experimental results of electrical measurements that demonstrate the phenomena of spin precession and dephasing (“Hanle effect”).

  4. On the thermal stability of a radiating gas under general differential approximation

    International Nuclear Information System (INIS)

    Bestman, A.R.

    1988-02-01

    The thermal stability of a radiating gas in a semi-infinite space is studied under a general differential approximation. The fluid is bounded on the axis z'=0 by a horizontal infinite wall maintained at a temperature T 0 which is high enough for radiative heat transfer to be significant. At z'=∞, the fluid is at uniform temperature T ∞ such that T 0 >T ∞ . The equations of motion under small perturbation theory reduce to a set of linear homogeneous equations with a variable coefficient subject to homogeneous boundary conditions when the unperturbed temperature is adopted as the independent variable. The solution is effected via a finite difference scheme and the Rayleigh number is determined by Newton's iterative method. (author). 8 refs

  5. Hemodynamic Effect of 2% Lidocaine with 1:80,000 Epinephrine Infiltration in Maxillofacial Surgeries under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Baratollah Shaban

    2013-12-01

    Full Text Available Introduction: Epinephrine-containing lidocaine is the most used anestheic drug in dentistry. The aim of this study was to investigate the hemodynamic changes following local infiltration of 2% lidocaine with 1:80,000 epinephrine in subjects undergoing orthognatic surgery under general anesthesia. Methods: Twenty five patients without any systemic disease participated. After general anesthesia, two cartridges of 2% lidocaine + 1:80,000 epinephrine were infiltrated around the surgery site. Systolic (SBP and diastolic (DBP blood pressure, mean arterial blood pressure (MAP, heart rate (HR, and blood sugar (BS were measured in three stages: before the injection (M1, at the end of injection (M2, and 10 min after injection (M3. Results: No significant difference observed in SBP, DBP, and MAP at the end of injection and 10 min later. HR was increased significantly after injection and remained significantly higher than baseline after 10 min. BS increased slightly at the end of injection and continued to increase after 10 min. However, changes in BS were not significant. Conclusion: Using two cartridges of epinephrine-containing lidocaine have slight systemic changes in healthy subjects; as a result, this dosage could be used in patients with cardiovascular complications undergoing general anesthesia.

  6. Hemodynamic Effect of 2% Lidocaine with 1:80,000 Epinephrine Infiltration in Maxillofacial Surgeries under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Baratollah Shaban

    2013-01-01

    Full Text Available Introduction: Epinephrine-containing lidocaine is the most used anestheic drug in dentistry. The aim of this study was to investigate the hemodynamic changes following local infiltration of 2%lidocaine with 1:80,000 epinephrine in subjects undergoing orthognatic surgery under general anesthesia. Methods: Twenty five patients without any systemic disease participated. After general anesthesia, two cartridges of 2% lidocaine + 1:80,000 epinephrine were infiltrated around the surgery site. Systolic (SBP and diastolic (DBP blood pressure, mean arterial blood pressure (MAP, heart rate (HR, and blood sugar (BS were measured in three stages: before the injection (M1, at the end of injection (M2, and 10 min after injection (M3. Results: No significant difference observed in SBP, DBP, and MAP at the end of injection and 10 min later. HR was increased significantly after injection and remained significantly higher than baseline after 10 min. BS increased slightly at the end of injection and continued to increase after 10 min. However, changes in BS were not significant. Conclusion: Using two cartridges of epinephrine-containing lidocaine have slight systemic changes in healthy subjects; as a result, this dosage could be used in patients with cardiovascular complications undergoing general anesthesia.

  7. Differences Between Expressive Suppression and Cognitive Reappraisal Between Heart Disease and Generalal Population

    Directory of Open Access Journals (Sweden)

    Seyyed Mohammad Reza Mirlohi

    2017-09-01

    Full Text Available Aim: Heart disease and emotional disorders often co-occur, but effective role in dysregulation of heart disease that is often overlooked. Evidence suggests that people with heart disease are more problems in regulating their emotions. The study compared the re-evaluation of cognitive emotion regulation commonly used two strategies- and suppression- between heart disease and the general population. Methods: Sixty men (30 with heart complaints and 30 without the condition were selected by convenience sampling method and they responded to the Emotion Regulation Questionnaire (Gross and John and a demographic questionnaire responded. To analyze the results and descriptive statistics such as frequency tables and inferential statistics, independent T-test was used SPSS software was used. Results: The result shows that heart disease and general population re-evaluation strategies groups (P<0.01. This is not only different from the strategy reassessment, but in different repression, too. (P <0.001. Conclusion: The results showed that heart disease and general population used different strategies to regulate their emotions. The key to finding the heart disease group prefer repression to regulate their emotions.

  8. Orbital Tumors Excision without Bony Marginotomy under Local and General Anesthesia

    Directory of Open Access Journals (Sweden)

    Robert A. Goldberg

    2014-01-01

    Full Text Available To present our experience of removing middle to deep orbital tumors using a combination of minimally invasive soft tissue approaches, sometimes under local anesthesia. Methods. In this retrospective case series, 30 patients (13 males and 17 females underwent tumor removal through eyelid crease (17 eyes, conjunctival (nine eyes, lateral canthal (two eyes, and transcaruncular (two eyes approaches. All tumors were located in the posterior half of the orbit. Six cases were removed under monitored anesthesia care with local block, and 24 were under general anesthesia. Results. The median (range age and follow-up duration were 48.5 (31–87 years old and 24.5 (4–375 weeks, respectively. Visual acuity and ocular motility showed improvement or no significant change in all but one patient at the latest followup. Confirmed pathologies revealed cavernous hemangioma (15 cases, pleomorphic adenoma (5 cases, solitary fibrous tumor (4 cases, neurofibroma (2 cases, schwannoma (2 cases, and orbital varix (1 case. None of the patients experienced recurrence. Conclusions. Creating a bony marginotomy increases intraoperative exposure of the deep orbit but adds substantial time and morbidity. Benign orbital tumors can often be removed safely through small soft-tissue incisions, without bone removal and under local anesthesia.

  9. Underlying congenital heart disease in Nigerian children with ...

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... Abstract. Background: Pneumonia is a common cause of childhood morbidity and mortality globally. Some congenital heart disease. (CHD) may predispose their sufferer to bronchopneumonia. Objective: To evaluate the contribution of CHD to pneumonia in children seen in a tertiary hospital. Methods: Over ...

  10. Underlying congenital heart disease in Nigerian children with ...

    African Journals Online (AJOL)

    Background: Pneumonia is a common cause of childhood morbidity and mortality globally. Some congenital heart disease(CHD) may predispose their sufferer to bronchopneumonia. Objective: To evaluate the contribution of CHD to pneumonia in children seen in a tertiary hospital. Methods: Over a year, consecutive ...

  11. High-utilizing Crohn's disease patients under psychosomatic therapy*

    Directory of Open Access Journals (Sweden)

    Jantschek Günther

    2008-10-01

    Full Text Available Abstract Objective Few studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers. Methods The present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD and sick leave days (SLD collected by German insurance companies and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment. Results Multivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p 2 = 0.15, p = 0.09. The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p 2 = 0.22, p Among high utilizers, a significantly greater drop in HD (p Conclusion The course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup.

  12. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery.

    Science.gov (United States)

    Kahloul, Mohamed; Mhamdi, Salah; Nakhli, Mohamed Said; Sfeyhi, Ahmed Nadhir; Azzaza, Mohamed; Chaouch, Ajmi; Naija, Walid

    2017-12-01

    Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.

  13. Modified Dual Second-order Generalized Integrator FLL for Frequency Estimation Under Various Grid Abnormalities

    Directory of Open Access Journals (Sweden)

    Kalpeshkumar Rohitbhai Patil

    2016-10-01

    Full Text Available Proper synchronization of Distributed Generator with grid and its performance in grid-connected mode relies on fast and precise estimation of phase and amplitude of the fundamental component of grid voltage. However, the accuracy with which the frequency is estimated is dependent on the type of grid voltage abnormalities and structure of the phase-locked loop or frequency locked loop control schemes. Among various control schemes, second-order generalized integrator based frequency- locked loop (SOGI-FLL is reported to have the most promising performance. It tracks the frequency of grid voltage accurately even when grid voltage is characterized by sag, swell, harmonics, imbalance, frequency variations etc. However, estimated frequency contains low frequency oscillations in case when sensed grid-voltage has a dc offset. This paper presents a modified dual second-order generalized integrator frequency-locked loop (MDSOGI-FLL for three-phase systems to cope with the non-ideal three-phase grid voltages having all type of abnormalities including the dc offset. The complexity in control scheme is almost the same as the standard dual SOGI-FLL, but the performance is enhanced. Simulation results show that the proposed MDSOGI-FLL is effective under all abnormal grid voltage conditions. The results are validated experimentally to justify the superior performance of MDSOGI-FLL under adverse conditions.

  14. Dextromethorphan Reduces Postoperative Pain of Post Partum Tubal Ligation under General Anesthesia

    Directory of Open Access Journals (Sweden)

    N. Manochehrian

    2009-04-01

    Full Text Available Introduction & Objective: Postoperative pain has harmful effects in many systems. Dextromethorphan reduces postoperative pain in post partum tubal ligation under general anesthesia. Materials & Methods: In this research 40 patients with ASA class I and II in double blind randomized clinical trial were studied in two groups. 90 minutes before surgery the patients received 90 mg dextromethorphan or placebo (oral. The patients induced general anesthesia with thiopental (5mg/kg, fentanyl 1.5 g/kg and succinylcholin(1-1.5 mg/kg and maintenance with halothane and N2O 50%. Patients were observed studied for analgesic requirement, nausea, vomiting, urinary retention and respiratory depression in recovery and 2,4,8 and 24 hours after surgery. Results: There was no significant difference in age, education, . . . Pain in recovery, 2 and 4 hours after surgery in dextromethorphan was less than placebo group. The analgesic requirement (pethidine in dextromethophan was less than placebo group.Conclusion: Administration of 90 mg dextromethorphan 90 minutes before the surgery under GA reduces pain in recovery time , 2 and 4 hours after the surgery.

  15. Immediate Postoperative Pain and Recovery Time after Pulpotomy Performed under General Anaesthesia in Young Children

    Directory of Open Access Journals (Sweden)

    Sultan Keles

    2017-01-01

    Full Text Available Background. The aim of this retrospective study was to compare immediate postoperative pain scores and need for rescue analgesia in children who underwent pulpotomies and restorative treatment and those who underwent restorative treatment only, all under general anaesthesia. Methods. Ninety patients aged between 3 and 7 years who underwent full mouth dental rehabilitation under general anaesthesia were enrolled in the study and reviewed. The experimental group included patients who were treated with at least one pulpotomy, and the control group was treated with dental fillings only. The Wong-Baker FACES scale was used to evaluate self-reported pain and need for rescue analgesia. The data were analysed using the Kruskal-Wallis test, two sample t-tests, chi-square tests, and Pearson’s correlation analysis. Results. Ninety percent of the children experienced postoperative pain in varying degrees of severity. Immediate postoperative pain scores in experimental group were found to be significantly higher than in control group (x2=24.82, p<0.01. In the experimental group, 48% of the children needed rescue analgesia, compared with only 13% of the children in the control group (x2=13.27, p<0.05. Conclusion. Children who underwent pulpotomy treatment had higher postoperative pain scores and greater need for rescue analgesia than control group who underwent only dental fillings.

  16. Spatially explicit models, generalized reproduction numbers and the prediction of patterns of waterborne disease

    Science.gov (United States)

    Rinaldo, A.; Gatto, M.; Mari, L.; Casagrandi, R.; Righetto, L.; Bertuzzo, E.; Rodriguez-Iturbe, I.

    2012-12-01

    Metacommunity and individual-based theoretical models are studied in the context of the spreading of infections of water-borne diseases along the ecological corridors defined by river basins and networks of human mobility. The overarching claim is that mathematical models can indeed provide predictive insight into the course of an ongoing epidemic, potentially aiding real-time emergency management in allocating health care resources and by anticipating the impact of alternative interventions. To support the claim, we examine the ex-post reliability of published predictions of the 2010-2011 Haiti cholera outbreak from four independent modeling studies that appeared almost simultaneously during the unfolding epidemic. For each modeled epidemic trajectory, it is assessed how well predictions reproduced the observed spatial and temporal features of the outbreak to date. The impact of different approaches is considered to the modeling of the spatial spread of V. cholera, the mechanics of cholera transmission and in accounting for the dynamics of susceptible and infected individuals within different local human communities. A generalized model for Haitian epidemic cholera and the related uncertainty is thus constructed and applied to the year-long dataset of reported cases now available. Specific emphasis will be dedicated to models of human mobility, a fundamental infection mechanism. Lessons learned and open issues are discussed and placed in perspective, supporting the conclusion that, despite differences in methods that can be tested through model-guided field validation, mathematical modeling of large-scale outbreaks emerges as an essential component of future cholera epidemic control. Although explicit spatial modeling is made routinely possible by widespread data mapping of hydrology, transportation infrastructure, population distribution, and sanitation, the precise condition under which a waterborne disease epidemic can start in a spatially explicit setting is

  17. General anesthetics inhibit erythropoietin induction under hypoxic conditions in the mouse brain.

    Directory of Open Access Journals (Sweden)

    Tomoharu Tanaka

    Full Text Available Erythropoietin (EPO, originally identified as a hematopoietic growth factor produced in the kidney and fetal liver, is also endogenously expressed in the central nervous system (CNS. EPO in the CNS, mainly produced in astrocytes, is induced under hypoxic conditions in a hypoxia-inducible factor (HIF-dependent manner and plays a dominant role in neuroprotection and neurogenesis. We investigated the effect of general anesthetics on EPO expression in the mouse brain and primary cultured astrocytes.BALB/c mice were exposed to 10% oxygen with isoflurane at various concentrations (0.10-1.0%. Expression of EPO mRNA in the brain was studied, and the effects of sevoflurane, halothane, nitrous oxide, pentobarbital, ketamine, and propofol were investigated. In addition, expression of HIF-2α protein was studied by immunoblotting. Hypoxia-induced EPO mRNA expression in the brain was significantly suppressed by isoflurane in a concentration-dependent manner. A similar effect was confirmed for all other general anesthetics. Hypoxia-inducible expression of HIF-2α protein was also significantly suppressed with isoflurane. In the experiments using primary cultured astrocytes, isoflurane, pentobarbital, and ketamine suppressed hypoxia-inducible expression of HIF-2α protein and EPO mRNA.Taken together, our results indicate that general anesthetics suppress activation of HIF-2 and inhibit hypoxia-induced EPO upregulation in the mouse brain through a direct effect on astrocytes.

  18. The Comparison of Four Different Methods of Perioperative Eye Protection under General Anesthesia in Prone Position

    Directory of Open Access Journals (Sweden)

    Özlem Kocatürk

    2012-04-01

    Full Text Available Aim: The purpose of this study was to compare and assess the efficacy of hypoallergen adhesive tape, antibiotic ointment, artificial tear liquid gel and ocular lubricant pomade for perioperative protection of eyes under general anesthesia in prone position. Material and Method: One hundred and eighty four patients (368 eyes undergoing general anesthesia for >90 min for spinal procedures were divided randomly into four groups. Hypoallergen adhesive tape, antibiotic ointment, artificial tear liquid gel or ocular lubricant pomade was applied into the eyes. The patients underwent complete ophthalmic examination, including corrected visual acuity measurement, basal tear production, corneal and conjunctival staining both before and after surgery. Results: Basal tear production was reduced in all groups compared to preoperative values (P0.05. There was no difference between pre and postoperative visual acuity. Discussion: All of the methods are suitable for protecting corneal injuries. But none of them is good enough to avoid temporary symptoms in postoperative period. During general anesthesia eyes need protection either by tape, gel, ointment or pomade to reduce the incidence of corneal injuries.

  19. The immune system, natural autoantibodies and general homeostasis in health and disease.

    Science.gov (United States)

    Poletaev, A; Boura, P

    2011-10-01

    It is generally accepted that the destination of the immune system is not only to discriminate between self and non-self but also to mount responses against non-self. During the last decades, it became evident that weak self-reactivity is a necessary condition for immune homeostasis. Natural self reactivity and the internal image created by autoantibodies, participate greatly to the maintenance of homeostasis. Under conditions of increased or altered antigenic pressure, the homeostatic status is disrupted and the organism becomes vulnerable to the emergence of diseases. "Immunculus" is the self-reactive and interconnected entity of the immune system, provided by a complicated network of natural autoantibobies of different specificity, as a mosaic picture. Quantitative changes in each part of the image are related to variations of expression of relative antigens. The immune system takes in account image information from the continuous screening of the antigenic status and compares between presented state and the desired (optimal) one. Substantial and prolonged deviations from the optimal state, triggers the induction of compensatory and reparative processes, aiming to restore molecular and functional homeostasis. So, natural autoimmunity through the ability of natural a-Abs to induce mechanisms of natural and acquired immunity, aims to prevent pathogenic processes and maintain or restore health status.

  20. Analysis of a general age-dependent vaccination model for a vertically transmitted disease

    International Nuclear Information System (INIS)

    El Doma, M.

    1995-05-01

    A SIR epidemic model of a general age-dependent vaccination for a vertically as well as horizontally transmitted disease is investigated when the total population is time dependent, and fertility, mortality and removal rates depend on age. We establish the existence and the uniqueness of the solution and obtain the asymptotic behaviour for the solution. For the steady state solution a critical vaccination coverage which will eventually eradicate the disease is determined. (author). 18 refs

  1. Under the lash: Demodex mites in human diseases.

    Science.gov (United States)

    Lacey, Noreen; Kavanagh, Kevin; Tseng, Scheffer C G

    2009-08-01

    Demodex mites, class Arachnida and subclass Acarina, are elongated mites with clear cephalothorax and abdomens, the former with four pairs of legs. There are more than 100 species of Demodex mite, many of which are obligatory commensals of the pilosebaceous unit of mammals including cats, dogs, sheep, cattle, pigs, goats, deer, bats, hamsters, rats and mice. Among them, Demodex canis, which is found ubiquitously in dogs, is the most documented and investigated. In excessive numbers D. canis causes the inflammatory disease termed demodicosis (demodectic mange, follicular mange or red mange), which is more common in purebred dogs and has a hereditary predisposition in breeding kennels1. Two distinct Demodex species have been confirmed as the most common ectoparasite in man. The larger Demodex folliculorum, about 0.3-0.4 mm long, is primarily found as a cluster in the hair follicle (Figure 1a), while the smaller Demodex brevis, about 0.2-0.3 mm long with a spindle shape and stubby legs, resides solitarily in the sebaceous gland (Figure 1b). These two species are also ubiquitously found in all human races without gender preference. The pathogenic role of Demodex mites in veterinary medicine is not as greatly disputed as in human diseases. In this article, we review the key literature and our joint research experience regarding the pathogenic potential of these two mites in causing inflammatory diseases of human skin and eye. We hope that the evidence summarized herein will invite readers to take a different look at the life of Demodex mites in several common human diseases.

  2. 50 CFR 216.16 - Prohibitions under the General Authorization for Level B harassment for scientific research.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Prohibitions under the General Authorization for Level B harassment for scientific research. 216.16 Section 216.16 Wildlife and Fisheries... Prohibitions under the General Authorization for Level B harassment for scientific research. It shall be...

  3. The Number of Candidate Variants in Exome Sequencing for Mendelian Disease under No Genetic Heterogeneity

    Directory of Open Access Journals (Sweden)

    Jo Nishino

    2013-01-01

    Full Text Available There has been recent success in identifying disease-causing variants in Mendelian disorders by exome sequencing followed by simple filtering techniques. Studies generally assume complete or high penetrance. However, there are likely many failed and unpublished studies due in part to incomplete penetrance or phenocopy. In this study, the expected number of candidate single-nucleotide variants (SNVs in exome data for autosomal dominant or recessive Mendelian disorders was investigated under the assumption of “no genetic heterogeneity.” All variants were assumed to be under the “null model,” and sample allele frequencies were modeled using a standard population genetics theory. To investigate the properties of pedigree data, full-sibs were considered in addition to unrelated individuals. In both cases, particularly regarding full-sibs, the number of SNVs remained very high without controls. The high efficacy of controls was also confirmed. When controls were used with a relatively large total sample size (e.g., N=20, 50, filtering incorporating of incomplete penetrance and phenocopy efficiently reduced the number of candidate SNVs. This suggests that filtering is useful when an assumption of no “genetic heterogeneity” is appropriate and could provide general guidelines for sample size determination.

  4. Hand hygiene compliance in patients under contact precautions and in the general hospital population.

    Science.gov (United States)

    Almaguer-Leyva, Martín; Mendoza-Flores, Lidia; Medina-Torres, Ana Gabriela; Salinas-Caballero, Ana Gabriela; Vidaña-Amaro, Jose Antonio; Garza-Gonzalez, Elvira; Camacho-Ortiz, Adrián

    2013-11-01

    Hand hygiene (HH) is the single most important intervention for preventing hospital-acquired infections. Contact precautions are a series of actions that infection control units take to reduce the transmission of nosocomial pathogens. We conducted an observational study of HH compliance. Observations were stratified as opportunities in patients under contact precautions and in the general hospital population. Trained infection control personnel performed all direct evaluations. A total of 3,270 opportunities were recorded. HH compliance was statistically higher in patients on contact precautions than in the overall population (70.3% vs 60.4%; P = .0001). Critical care areas had higher HH compliance when patients were isolated by contact precautions. Medical wards were statistically lower in HH when patients were under contact precautions. Respiratory technicians had the highest HH compliance in both overall performance and in patients under contact precautions. Medical students had a lower HH compliance in both evaluations (P Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  5. Under-reporting of notifiable infectious disease hospitalizations in a health board region in Ireland: room for improvement?

    LENUS (Irish Health Repository)

    Brabazon, E D

    2008-02-01

    Rapid notification of infectious diseases is essential for prompt public health action and for monitoring of these diseases in the Irish population at both a local and national level. Anecdotal evidence suggests, however, that the occurrence of notifiable infectious diseases is seriously underestimated. This study aims to assess the level of hospitalization for notifiable infectious diseases for a 6-year period in one health board region in Ireland and to assess whether or not there was any under-reporting during this period. All hospital in-patient admissions from 1997 to 2002 inclusive with a principal diagnosis relating to \\'infectious and parasitic diseases\\' (ICD codes 001-139) of residents from a health board region in Ireland were extracted from the Hospital In-Patient Enquiry System (HIPE). All notifiable infectious diseases were identified based on the 1981 Irish Infectious Disease Regulations and the data were analysed in the statistical package, JMP. These data were compared with the corresponding notification data. Analysis of the hospital in-patient admission data revealed a substantial burden associated with notifiable infectious diseases in this health board region: there were 2758 hospitalizations by 2454 residents, 17,034 bed days and 33 deaths. The statutory notification data comprises both general practitioner and hospital clinician reports of infectious disease. Therefore, only in cases where there are more hospitalizations than notifications can under-reporting be demonstrated. This occurred in nine out of 22 notifiable diseases and amounted to an additional 18% of notifications (or 572 cases) which were \\'missed\\' due to hospital clinician under-reporting. The majority of these under-reported cases were for viral meningitis (45%), infectious mononucleosis (27%), viral hepatitis C unspecified (15%) and acute encephalitis (5.8%). This study has highlighted the extent of under-reporting of hospitalized notifiable infectious diseases, in a

  6. Assessment of Antibiotic Utilization Pattern in Treatment of Acute Diarrhoea Diseases in Bishoftu General Hospital, Oromia Ethiopia.

    Science.gov (United States)

    Tulu, Selamawit; Tadesse, Tarekegne; Alemayehu Gube, Addisu

    2018-01-01

    Majority of acute diarrhoeal diseases are self-limiting and do not require routine treatment. Treatment with empirical antimicrobials is recommended only for dysenteric and invasive bacterial diarrhoea. Irrational use of antibiotics in treatment of acute diarrhoea is common in clinical practice worldwide. This study was carried out to assess the pattern of antibiotic use for acute diarrhoeal diseases in Bishoftu General Hospital, East Shewa Ethiopia. Institution based cross-sectional study was conducted from April 1 to April 30, 2016. Data were collected retrospectively from patients treated for diarrhoeal diseases from January 2015 to December 2015 using structured questionnaires and entered into SPSS (IBM 20) and descriptive statistics was carried out. Among the 303 patients, 51.2% were males and 48.8% were females. Of them, 62% were children under five years. Two hundred sixty three (86.8%) patients received eight different types of antibiotics and cotrimoxazole (178 patients, 58.7%) was the most prescribed antibiotics, followed by ciprofloxacin (33, 10.9%) and amoxicillin (14, 4.6%). Based on the presence of blood in stools, 14.5% of cases were of invasive bacterial type. According to the recommendations of WHO, the rate of overuse of antibiotics was 72.3%. This study revealed that there was high overuse of antibiotics for both adults and children under five with acute diarrhoea in Bishoftu General Hospital. And Cotrimoxazole was the most prescribed antibiotic.

  7. Metallic stent implantation in the treatment of malignant tracheal stenosis under general anaesthesia

    International Nuclear Information System (INIS)

    Bai Xuming; Jin Yong; Xie Hong; Cheng Long; Gu Xingshi; Chang Liuhui

    2012-01-01

    Objective: To evaluate the safety and feasibility of the tracheal stent implantation for treatment of malignant tracheal stenosis under general anaesthesia. Methods: Eighteen patients with malignant tracheal stenosis underwent preoperative 64-slice spiral CT scan and airway reconstruction. The stenotic sites were located in main tracheal trunk (5 patients), in right main bronchus (1 patient), in trachea and left main bronchus (4 patients), in trachea and right main bronchus (3 patients), in main tracheal trunk and bilateral main bronchus (5 patients). The degree of stenosis was rated 51% to 70% in 7 cases, 71% to 90% in 11 cases. All patients, 17 patients of ASA grade Ⅳ and 1 patient of grade Ⅲ, presented with severe dyspnea. Under general anaesthesia, implantation of metallic stent was performed through the sputum aspiration hole of the connecting tubing with DSA guidance. The NBP, ECG, RR, SaO 2 of the patients were recorded and compared with t test during the entire procedure. At the end of the procedure, relief of dyspnea, complications related to anesthesia and operation were recorded. Results: The success rate of stent placement was 18/18, and dyspnea was significantly relived in all patients. Slightly bloody sputum occurred in 7 cases. The stent was obstructed by sputum in 1 case,and the patient was treated with medication. There were no severe complications. The operative course were rated 11 to 9 in 17 cases, and 6 to 8 in 1 case. All 18 patients were cooperative during the procedure. Sixteen patients rated the procedure as very comfortable and 2 rated the procedure as comfortable. Respiratory rate (RR) and heart rate (HR) decreased in all patients after the operation [(37.1 ± 2.8)/min and (106.5 ± 14.2) bpm before the operation respectively, (18.6 ± 1.4)/min and (73.2 ± 7.6) bpm after the operation respectively], t=17.81 and 3.80, P<0.01. Pulse oxygen saturation (SaO 2 ) during the operation [(91.2 ± 1.8)%]increased [(76.3 ± 8.6 )% before the

  8. Normal Mode Analysis to a Poroelastic Half-Space Problem under Generalized Thermoelasticity

    Directory of Open Access Journals (Sweden)

    Chunbao Xiong

    Full Text Available Abstract The thermo-hydro-mechanical problems associated with a poroelastic half-space soil medium with variable properties under generalized thermoelasticity theory were investigated in this study. By remaining faithful to Biot’s theory of dynamic poroelasticity, we idealized the foundation material as a uniform, fully saturated, poroelastic half-space medium. We first subjected this medium to time harmonic loads consisting of normal or thermal loads, then investigated the differences between the coupled thermohydro-mechanical dynamic models and the thermo-elastic dynamic models. We used normal mode analysis to solve the resulting non-dimensional coupled equations, then investigated the effects that non-dimensional vertical displacement, excess pore water pressure, vertical stress, and temperature distribution exerted on the poroelastic half-space medium and represented them graphically.

  9. Recursive Subspace Identification of AUV Dynamic Model under General Noise Assumption

    Directory of Open Access Journals (Sweden)

    Zheping Yan

    2014-01-01

    Full Text Available A recursive subspace identification algorithm for autonomous underwater vehicles (AUVs is proposed in this paper. Due to the advantages at handling nonlinearities and couplings, the AUV model investigated here is for the first time constructed as a Hammerstein model with nonlinear feedback in the linear part. To better take the environment and sensor noises into consideration, the identification problem is concerned as an errors-in-variables (EIV one which means that the identification procedure is under general noise assumption. In order to make the algorithm recursively, propagator method (PM based subspace approach is extended into EIV framework to form the recursive identification method called PM-EIV algorithm. With several identification experiments carried out by the AUV simulation platform, the proposed algorithm demonstrates its effectiveness and feasibility.

  10. Implementation of selective prevention for cardiometabolic diseases; is general practice adequately prepared ?

    NARCIS (Netherlands)

    Stol, D.M.; Hollander, M.; Nielen, M.M.J.; Badenbroek, I.F.; Schellevis, F.G.; Wit, N.J. de

    2018-01-01

    Objective: Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general

  11. Validating the Beck Depression Inventory-II in Indonesia's general population and coronary heart disease patients

    NARCIS (Netherlands)

    Ginting, H.; Näring, G.W.B.; Veld, W.M. van der; Srisayekti, W.; Becker, E.S.

    2013-01-01

    This study assesses the validity and determines the cut-off point for the Beck Depression Inventory-II (the BDI-II) among Indonesians. The Indonesian version of the BDI-II (the Indo BDI-II) was administered to 720 healthy individuals from the general population, 215 Coronary Heart Disease (CHD)

  12. Stability analysis of a general age-dependent vaccination model of a vertically transmitted disease

    International Nuclear Information System (INIS)

    El Doma, M.

    1995-07-01

    An SIR epidemic model of a general age-dependent vaccination of a vertically as well as horizontally transmitted disease is investigated when the population is in steady state and the fertility, mortality and removal rates depends on age. We determine the steady states and examine their stabilities. (author). 24 refs

  13. Evaluation of a program to strengthen general practice care for patients with chronic disease in Germany

    NARCIS (Netherlands)

    Wensing, M.; Szecsenyi, J.; Stock, C.; Kolle, P.K.; Laux, G.

    2017-01-01

    BACKGROUND: A program to strengthen general practice care for patients with chronic disease was offered in Germany. Enrollment was a free individual choice for both patients and physicians. This study aimed to examine the long-term impact of this program. METHODS: Two comparative evaluations were

  14. An Experience of General Anesthesia in a Case of Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Sinan Yılmaz

    2017-08-01

    Full Text Available Parkinson's disease (PD is a neurodegenerative disease which is resulted from loss of dopaminergic neurones in the substantia nigra of the basal ganglia and is a characterized by the triad of resting tremor, muscle rigidity, and bradykinesia. PD is an important cause of perioperative morbidity and a major risk factor for postoperative complications in the elderly surgical patients. In these patients, the postoperative risks are determined with the presence of additional diseases, interaction of antiparkinsonian medication and anesthesic drugs. In the patients with PD, general anesthesia may mask neurological symptoms in the intraoperative period so the general anesthesia is preferred in these patients. Randomized clinical trials about the preference of anesthetic technique in the PD are not enough. Premedication, induction and continuation of anesthesia, and drugs for postoperative pain must not affect the dopamine senthesis. Treated for PD for 8 year at the age of 73, a female patient and with American Society of Anesthesiologists physical classification III (chronic kidney disease and chronic obstructive lung disease was planned for undergoing operation of L4 fracture. In this case, we aimed to report a patient with PD who underwent general anesthesia. During the operation hemodynamic data was stable and the operation was successfully carried out without any complication.

  15. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

    Directory of Open Access Journals (Sweden)

    Savanheimo Nora

    2012-10-01

    Full Text Available Abstract Background Dental general anaesthesia (DGA is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients’ overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care. Methods The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age ( Results The DGA patients (n=349 were aged 2.3 to 67.2 years. Immigrants predominated in the youngest age group (p Conclusions Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA.

  16. Pseudo-Hermitian coherent states under the generalized quantum condition with position-dependent mass

    International Nuclear Information System (INIS)

    Yahiaoui, S A; Bentaiba, M

    2012-01-01

    In the context of the factorization method, we investigate the pseudo-Hermitian coherent states and their Hermitian counterpart coherent states under the generalized quantum condition in the framework of a position-dependent mass. By considering a specific modification in the superpotential, suitable annihilation and creation operators are constructed in order to reproduce the Hermitian counterpart Hamiltonian in the factorized form. We show that by means of these ladder operators, we can construct a wide range of exactly solvable potentials as well as their accompanying coherent states. Alternatively, we explore the relationship between the pseudo-Hermitian Hamiltonian and its Hermitian counterparts, obtained from a similarity transformation, to construct the associated pseudo-Hermitian coherent states. These latter preserve the structure of Perelomov’s states and minimize the generalized position–momentum uncertainty principle. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical devoted to ‘Quantum physics with non-Hermitian operators’. (paper)

  17. Fear of going under general anesthesia: A cross-sectional study.

    Science.gov (United States)

    Ruhaiyem, M E; Alshehri, A A; Saade, M; Shoabi, T A; Zahoor, H; Tawfeeq, N A

    2016-01-01

    Fears related to anesthesia have affected a considerable number of patients going for surgery. The purpose of this survey was to identify the most common concerns about general anesthesia during the preoperative anesthetic clinic in different healthcare settings, and whether they are affected by patients' sex, age, education, or previous experience of anesthesia or not. Structured questionnaires with consent forms were distributed to patients in their preanesthesia clinic visit in three tertiary hospitals (King Abdul-Aziz Medical City, King Faisal Specialist Hospital, and King Khalid University Hospital) in Riyadh, Saudi Arabia. Patients' demographics and questions related to their fears regarding general anesthesia were included in the questionnaires. All categorical and interval variables were compared statically using a Chi-square test for independence and a t-test, respectively. All statistical tests were declared significant at α level of 0.05 or less. Among 450 questionnaires that were disturbed, 400 questionnaires were collected and analyzed. Eighty-eight percent experienced preoperative fear. The top three causes of their fears were fear of postoperative pain (77.3%), fear of intraoperative awareness (73.7%), and fear of being sleepy postoperatively (69.5%). Patients are less fearful of drains and needles in the operative theater (48%), of revealing personal issues under general anesthesia (55.2%), and of not waking up after surgery (56.4%). Age and gender were significant predictors of the overall fear among preanesthetic patients. Females are 5 times more likely to experience fear before surgery (P = 0.0009). Patients aged more than 40 years old are also at 75% higher risk of being afraid (P = 0.008). The majority of the patients going for surgery experienced a fear of anesthesia. Mostly females, especially those over 40, were at a higher risk of being afraid. Fear can bring anxiety which, in turn, might affect the patient's surgery.

  18. Low Use and Adherence to Maintenance Medication in Chronic Obstructive Pulmonary Disease in the General Population

    DEFF Research Database (Denmark)

    Ingebrigtsen, Truls S; Marott, Jacob L; Nordestgaard, Børge G

    2015-01-01

    OBJECTIVE: We tested the hypothesis that use of and adherence to maintenance medication is low among individuals in the general population who have chronic obstructive pulmonary disease (COPD) , even in cases of severe and very severe COPD. DESIGN AND PARTICIPANTS: We identified 5,812 individuals...... with COPD from the Copenhagen General Population Study, and classified them according to the Global Initiative for Obstructive Lung Disease (GOLD) airflow limitation grades 1-4. Dispensing of fixed-dose combinations of inhaled corticosteroids with long-acting beta2-agonists, long-acting anti...... for COPD in the general population was associated with the severity of COPD as defined by GOLD, but even in severe and very severe COPD, use and adherence was low....

  19. Fatigue in the Danish general population. Influence of sociodemographic factors and disease

    DEFF Research Database (Denmark)

    Watt, T; Groenvold, M; Bjorner, J B

    2000-01-01

    -77 with an equal gender distribution (response rate 67%). MAIN OUTCOME MEASURES: Five fatigue scales from the questionnaire Multidimensional Fatigue Inventory: General Fatigue, Physical Fatigue, Reduced Activity, Reduced Motivation and Mental Fatigue. RESULTS: Fatigue scores were skewed towards absence of fatigue....... The General Fatigue and Physical Fatigue scales showed the highest fatigue levels while the Reduced Motivation scale showed lowest levels. Gender differences in fatigue scores were small, but the variability among women was higher-that is, more women had high scores. A multiple linear regression analysis......, gender and/or whether the person was living alone. For example, General and Physical Fatigue decreased with age among healthy people, whereas scores on these scales increased with age among those with a somatic disease. CONCLUSIONS: Physical and mental diseases play essential parts for the level...

  20. Comparisons of receive array interference reduction techniques under erroneous generalized transmit beamforming

    KAUST Repository

    Radaydeh, Redha Mahmoud

    2014-02-01

    This paper studies generalized single-stream transmit beamforming employing receive array co-channel interference reduction algorithms under slow and flat fading multiuser wireless systems. The impact of imperfect prediction of channel state information for the desired user spatially uncorrelated transmit channels on the effectiveness of transmit beamforming for different interference reduction techniques is investigated. The case of over-loaded receive array with closely-spaced elements is considered, wherein it can be configured to specified interfering sources. Both dominant interference reduction and adaptive interference reduction techniques for statistically ordered and unordered interferers powers, respectively, are thoroughly studied. The effect of outdated statistical ordering of the interferers powers on the efficiency of dominant interference reduction is studied and then compared against the adaptive interference reduction. For the system models described above, new analytical formulations for the statistics of combined signal-to-interference-plus-noise ratio are presented, from which results for conventional maximum ratio transmission and single-antenna best transmit selection can be directly deduced as limiting cases. These results are then utilized to obtain quantitative measures for various performance metrics. They are also used to compare the achieved performance of various configuration models under consideration. © 1972-2012 IEEE.

  1. Office bladder distention with Electromotive Drug Administration (EMDA is equivalent to distention under General Anesthesia (GA

    Directory of Open Access Journals (Sweden)

    Azevedo Kathryn J

    2005-11-01

    Full Text Available Abstract Background Bladder distention is commonly used in diagnosis and treatment of interstitial cystitis (IC. Traditionally performed in the operating room under general or spinal anesthesia (GA, it is expensive and associated with short term morbidity. Office bladder distention using electromotive drug administration (EMDA has been suggested as an alternative that is well tolerated by patients. We report the first comparative findings of patients undergoing both office distention with EMDA and distention in the operating room (OR with GA. Methods This retrospective chart review identified 11 patients participating in two protocols of EMDA bladder distention who also underwent bladder distention under GA either prior to or after the EMDA procedure. Results The median absolute difference in bladder capacity between GA and EMDA was only 25 cc; the median percent difference was 5%. Cystoscopic findings, while not prospectively compiled, appear to have been similar. Conclusion This study represents the first comparison between distention with EMDA versus GA and confirms the technical feasibility of performing bladder distention in an office setting. The distention capacity achieved in the office was nearly identical to that in the OR and the cystoscopic findings very similar. Further investigation into the comparative morbidity, cost, and other outcome measures is warranted to define the ultimate role of EMDA bladder distention in the clinical evaluation and care of patients with IC.

  2. Oral Health Education in Children before Dental Treatment under General Anesthesia.

    Science.gov (United States)

    Valéra, Marie-Cécile; Aragon, Isabelle; Monsarrat, Paul; Vaysse, Fréderic; Noirrit-Esclassan, Emmanuelle

    The aim of this study was to evaluate the attitude of parents towards the oral health of their children before oral rehabilitation under general anesthesia (GA). Children receiving dental treatment under GA between November 2013 and July 2014 in the Pediatric Dentistry Department (University Hospital Center, Toulouse, France) were enrolled in an oral health preventive program. An anonymous questionnaire was self-administered by the parents during the pre-operative session. The sample comprised 67 children with a mean age of 4.8 years. 48 % of the parents had difficulties in maintaining the oral hygiene of their child. Two thirds of them reported a lack of cooperation. An adult cleaned the child's teeth in 43% of the cases. 14% of the study population brushed their teeth twice a day or more. In addition, half of the parents reported that they modified food consumption or teeth cleaning habits of their children since the initial consultation. This study suggests a low compliance of parents and children with the recommendations on oral hygiene and food consumption given at the initial visit and demonstrates the feasibility of a preventive program in this population.

  3. Effect of Governance Indicators on Under-Five Mortality in OECD Nations: Generalized Method of Moments.

    Science.gov (United States)

    Emamgholipour, Sara; Asemane, Zahra

    2016-01-01

    Today, it is recognized that factors other than health services are involved in health improvement and decreased inequality so identifying them is the main concern of policy makers and health authorities. The aim of this study was to investigate the effect of governance indicators on health outcomes. A panel data study was conducted to investigate the effect of governance indicators on child mortality rate in 27 OECD countries from 1996 to 2012 using the Generalized Method of Moments (GMM) model and EVIEWS.8 software. According to the results obtained, under-five mortality rate was significantly related to all of the research variables (p corruption and rule of law indicators decreased child mortality rate by 0.05 and 0.08%, respectively. Furthermore, 1% increase in public health expenditure per capita resulted in a 0.03% decrease in under-five mortality rate. The results of the study suggest that considering control variables, including GDP per capita, public health expenditure per capita, total fertility rate, and improvement of governance indicators (control of corruption and rule of law) would decrease the child mortality rate.

  4. [Risk factors and frequency of postoperative nausea and vomiting in patients operated under general anesthesia].

    Science.gov (United States)

    Grabowska-Gaweł, Anna; Porzych, Katarzyna; Piskunowicz, Grazyna

    2006-01-01

    Postoperative nausea and vomiting belong to fairly frequent postoperative complications, but they occupy a distant position on the list of complications, which most probably result from a general conviction that they do not pose a direct threat to patients. The objective of this work is specification of factors facilitating occurrence of postoperative nausea and vomiting, and determination of frequency of their occurrence in patients operated under general anesthesia. Questionnaire about the occurrence of postoperative nausea and vomiting (PONV), was carried out and included 253 adult sick persons (102 female and 151 male patients), in the age between 23-76 (average 42.3 +/- 6.1 years), who had undergone operative procedure in the field of abdominal and urology surgery, orthopedic, thyroid surgery and laryngological, ophthalmology and plastic surgery, under general anesthesia. The questionnaire form included preoperative characteristics of a patient (age, sex, smoking, motion sickness and migraine headaches in history, and PONV occurring earlier), type of operative procedure, used anesthetic agents, and analgesic agents applied in postoperative analgesia. The anesthesiologist administering anesthetic was not informed about the investigation carried out and did not receive any additional pieces of advice regarding the type of applied anesthetic agents or the method of conducting postoperative analgesia. Visual Analogue Scale (VAS) was used in the evaluation of nausea. Nausea and vomiting were assessed every two hours within the first postoperative 12 hours and every 4 hours for the next 24 hours. Nausea and vomiting were treated as two separate complications. Nausea itself occurred in 22.7% of patients; whereas vomiting in 13.2%. Both symptoms occurred in 14.2% of patients. Nausea occurred 4.1 +/- 0.8 hours after operation; whereas vomiting after 5.3 +/- 1.1 hours. Women suffered more often than men from (R = 0.678 p patients suffering from PONV earlier (R = 0

  5. Non-Hodgkin's lymphoma - Part II: Management of primary extranodal lymphomas, generalized disease and salvage treatment

    International Nuclear Information System (INIS)

    Gospodarowicz, Mary K.; Sutcliffe, Simon B.

    1996-01-01

    Objective: To review the approach to the diagnosis, classification, assessment, treatment and continuing management of patients with primary extranodal non-Hodgkin's lymphoma, and the management of generalized disease with the emphasis on the current role of salvage treatment with high dose chemotherapy and stem cell/bone marrow support strategies. Non-Hodgkin's lymphoma may involve any part of the body. Many lymphomas, such as MALT, angiocentric T-cell, etc., commonly present in extranodal sites. Lymphomas presenting in the GI tract, and head and neck, are most common with the single most common site being the stomach. Gastric lymphoma is associated with Helicobacter pylorii and is most common in areas endemic for Helicobacter pylorii infection. Recent advances in the understanding of the etiology of gastric MALT, thyroid, and intestinal lymphomas present new opportunities for the application of novel therapeutic approaches e.g. antibiotic therapy for Helicobacter pylori and early stage IPSID. Lymphomas presenting in the orbit, thyroid, breast, bone, extradural and skin are of interest because of the importance of expert RT in securing local control. Primary brain lymphomas present a particular challenge to the radiation oncologist. Although localized, primary brain lymphomas are extremely difficult to control. Rare sites of extranodal lymphoma include testis, female genital tract, and lung. Extranodal lymphomas are often localized and cure with RT or CMT is possible. They represent a assorted group of diseases with diverse presentations, prognosis, sensitivity to RT and expected outcome. They are of particular importance to radiation oncologists as they require special attention to patterns of spread and treatment planning. The principles of management of primary extranodal lymphoma, however, follow those applicable to localized nodal presentations. Although primary extranodal lymphomas are highly curable, a proportion of patients will fail with disseminated

  6. Disease prevention policy under Medicare: a historical and political analysis.

    Science.gov (United States)

    Schauffler, H H

    1993-01-01

    I review the history and politics of Medicare disease prevention policy and identify factors associated with the success or failure of legislative initiatives to add preventive services benefits to Medicare. Between 1965 and 1990, 453 bills for Medicare preventive services were introduced in the U.S. Congress, but not until 1980, after 350 bills had failed, was the first preventive service added to the Medicare program. Medicare currently pays for only four of the 44 preventive services recommended for the elderly by the U.S. Preventive Services Task Force (pneumococcal and hepatitis B vaccinations, Pap smears, and mammography). In addition, Congress has funded demonstration programs for the influenza vaccine and comprehensive preventive services. The preventive services added to Medicare reflect the bias of the biomedical model toward screening and immunizations. Counseling services have received the least legislative attention. Factors associated with successful enactment include single-benefit bills, incorporation into budget-deficit reduction legislation, documented evidence of cost-effectiveness, public hearings, sponsorship by chairs of key congressional committees, and persistent congressional leadership. Factors associated with failure include lack of support from Medicare beneficiaries, lack of professional support, impact on total Medicare expenditures, disagreement over or failure to address payment and financing mechanisms, and competing congressional priorities.

  7. Disease course and management strategy of pouch neoplasia in patients with underlying inflammatory bowel diseases.

    Science.gov (United States)

    Wu, Xian-Rui; Remzi, Feza H; Liu, Xiu-Li; Lian, Lei; Stocchi, Luca; Ashburn, Jean; Shen, Bo

    2014-11-01

    To evaluate the disease course and management strategy for pouch neoplasia. Patients undergoing ileal pouch surgery for underlying ulcerative colitis who developed low-grade dysplasia (LGD), high-grade dysplasia, or adenocarcinoma in the pouch were identified. All eligible 44 patients were evaluated. Of the 22 patients with initial diagnosis of pouch LGD, 6 (27.3%) had persistence or progression after a median follow-up of 9.5 (4.1-17.6) years. Family history of colorectal cancer was shown to be a risk factor associated with persistence or progression of LGD (P = 0.03). Of the 12 patients with pouch high-grade dysplasia, 5 (41.7%) had a history of (n = 2, 16.7%) or synchronous (n = 4, 33.3%) pouch LGD. Pouch high-grade dysplasia either persisted or progressed in 3 patients (25.0%) after the initial management, during a median time interval of 5.4 (2.2-9.2) years. Of the 14 patients with pouch adenocarcinoma, 12 (85.7%) had a history of (n = 2, 14.3%) or synchronous dysplasia (n = 12, 85.7%). After a median follow-up of 2.1 (0.6-5.2) years, 6 patients with pouch cancer (42.9%) died. Comparison of patients with a final diagnosis of pouch adenocarcinoma (14, 32.6%), and those with dysplasia (29, 67.4%) showed that patients with adenocarcinoma were older (P = 0.04) and had a longer duration from IBD diagnosis or pouch construction to the detection of pouch neoplasia (P = 0.007 and P = 0.0013). The risk for progression of pouch dysplasia can be stratified. The presence of family history of colorectal cancer seemed to increase the risk for persistence or progression for patients with pouch LGD. The prognosis for pouch adenocarcinoma was poor.

  8. Dental treatment for handicapped patients; sedation vs general anesthesia and update of dental treatment in patients with different diseases

    Science.gov (United States)

    Corcuera-Flores, José R.; Delgado-Muñoz, José M.; Ruiz-Villandiego, José C.; Maura-Solivellas, Isabel

    2014-01-01

    Dental treatment on Handicapped Patients is often difficult because many people with a wide range of ages (from children to the elderly) with different pathologies that can affect the oral cavity and differ widely are included in this group. This situation creates some controversy, because according to pathology, each patient will be treated differently depending on collaboration, general health status, age or medication used to treat this pathologies. According to this situation we can opt for an outpatient treatment without any kind of previous medication, a treatment under conscious or deep sedation or a under general anesthesia treatment. With this systematic review is intended to help clarify in which cases patients should be treated under general anesthesia, sedation (conscious or deep) or outpatient clinic without any medication, as well as clarify what kind of treatments can be carried in private dental clinics and which should be carried out in a hospital. It will also discuss the most common diseases among this group of patients and the special care to be taken for their dental treatment. Key words:Hospital dentistry, handicapped patient. PMID:24121922

  9. Prevalence of Periodontal Disease in the General Population of India-A Systematic Review.

    Science.gov (United States)

    Shewale, Akhilesh H; Gattani, Deepti R; Bhatia, Nidhi; Mahajan, Rupali; Saravanan, S P

    2016-06-01

    Periodontal disease is a chronic inflammatory disease resulting in destruction of tissues and structures surrounding the teeth thus, if left untreated causes loss of teeth and ultimately results in edentulism, posing a great negative impact on individuals' quality of life. Hence the global epidemiological data suggests periodontal disease to be one of a major burden on oral diseases. To reduce this burden it is necessary to know the true prevalence of the disease according to which proper initiatives can be formulated. India being home to nearly 1.2 billion people and one amongst the rapidly developing country, its population requires being systemically as well as orally healthy to lead a good quality of life. However due to large heterogenecity amongst its residing population in terms of geographical area, culture, education, socioeconomic status, a variety of oral diseases like periodontal diseases are prevalent here. Even though the early studies suggested that the population is highly susceptible to the disease, the true prevalence of periodontal disease has not been found yet due to paucity in literature available. To systematically review the available literature taken from various parts of India and find the prevalence rate of periodontal disease amongst the general population of India. A literature search was performed using PUB MED, COCHRANE and EMBASE databases on August 6, 2015. Following full text assessment a thorough references search was made and potential studies were included. A Quality assessment of retrieved articles from 2(nd) round was done using a self designed questionnaire and only field survey studies were included in the systematic review. The literature search yielded six studies which had performed field surveys to find the prevalence of periodontal disease in their respective areas. These studies have observed different sets of age groups and the same has been accomplished by using Community Periodontal Index (CPI) or Community

  10. Awareness of the association between periodontal disease and adverse pregnancy outcome among the general female population.

    Science.gov (United States)

    Tarannum, Fouzia; Prasad, R K Shiva; Shobha, R; Kumar, B B Santosh; Ebenezer, Supriya

    2015-01-01

    Preterm low birth weight (PTLBW) is a public health issue which needs to be dealt with by educating the general female population. One of the major contributing factors is periodontal disease and treatment of the same could reduce the occurrence of PTLBW babies. Therefore, awareness of this among the female population is highly essential. Hence, this survey was planned with the aim to explore the awareness of the general female population regarding the association of periodontal disease and PTLBW. This survey consisted of nine close-ended questions answered by 1284 females. Younger individuals had higher knowledge scores as compared to the older individuals (r = -0.161) and the more educated group had a higher knowledge score as compared to the less educated groups (r = 0.322). Furthermore, married women seemed to be more aware of the relation of PTLBW to periodontal disease as compared to unmarried women. Younger and educated females had better awareness of the association between periodontal diseases and PTLBW. Hence, efforts to educate the general female population on this association could contribute toward the reduction of the risk of PTLBW.

  11. WrpA Is an Atypical Flavodoxin Family Protein under Regulatory Control of the Brucella abortus General Stress Response System.

    Science.gov (United States)

    Herrou, Julien; Czyż, Daniel M; Willett, Jonathan W; Kim, Hye-Sook; Chhor, Gekleng; Babnigg, Gyorgy; Kim, Youngchang; Crosson, Sean

    2016-04-01

    The general stress response (GSR) system of the intracellular pathogen Brucella abortus controls the transcription of approximately 100 genes in response to a range of stress cues. The core genetic regulatory components of the GSR are required for B. abortus survival under nonoptimal growth conditions in vitro and for maintenance of chronic infection in an in vivo mouse model. The functions of the majority of the genes in the GSR transcriptional regulon remain undefined. bab1_1070 is among the most highly regulated genes in this regulon: its transcription is activated 20- to 30-fold by the GSR system under oxidative conditions in vitro. We have solved crystal structures of Bab1_1070 and demonstrate that it forms a homotetrameric complex that resembles those of WrbA-type NADH:quinone oxidoreductases, which are members of the flavodoxin protein family. However, B. abortus WrbA-related protein (WrpA) does not bind flavin cofactors with a high affinity and does not function as an NADH:quinone oxidoreductase in vitro. Soaking crystals with flavin mononucleotide (FMN) revealed a likely low-affinity binding site adjacent to the canonical WrbA flavin binding site. Deletion of wrpA (ΔwrpA) does not compromise cell survival under acute oxidative stress in vitro or attenuate infection in cell-based or mouse models. However, a ΔwrpA strain does elicit increased splenomegaly in a mouse model, suggesting that WrpA modulates B. abortus interaction with its mammalian host. Despite high structural homology with canonical WrbA proteins, we propose that B. abortus WrpA represents a functionally distinct member of the diverse flavodoxin family. Brucella abortus is an etiological agent of brucellosis, which is among the most common zoonotic diseases worldwide. The general stress response (GSR) regulatory system of B. abortus controls the transcription of approximately 100 genes and is required for maintenance of chronic infection in a murine model; the majority of GSR-regulated genes

  12. [Venereal diseases in a "general practice" in the 17th and early 18th centuries].

    Science.gov (United States)

    Fries, F; Winckelmann, H J

    2018-01-31

    The diary of the town physician Johannes Franc (1649-1725), handwritten in Latin, gives-among other diseases-an overview of sexually transmitted infections affecting citizens in Ulm such as syphilis and gonorrhea. Franc reported on his own experiences in the diary and also included many theoretical details on the causes of the diseases and the corresponding therapies, including ethical considerations. Even in ancient times, there are indications of venereal diseases. However, at the latest with the outbreak of syphilis around the year 1495, the treatment and control of the spread of venereal diseases became an important task of medicine. Before gonococci were detected by Neisser in 1879, sexually transmitted diseases were generally seen as a single disease. However, at the beginning of the 18 th century, there were several doctors who treated syphilis and gonorrhea as separate entities. Franc was one of them. Examining the milestones in the history of syphilis and gonorrhea, the present article reviews the existing theories that tried to explain the origins of these diseases. Franc's treatment patterns are illustrated. Franc's case reports indicate a fundamental change in the perception of STIs at the end of the 17 th /beginning of the 18 th century.

  13. Outcomes and opportunities: a nurse-led model of chronic disease management in Australian general practice.

    Science.gov (United States)

    Eley, Diann S; Patterson, Elizabeth; Young, Jacqui; Fahey, Paul P; Del Mar, Chris B; Hegney, Desley G; Synnott, Robyn L; Mahomed, Rosemary; Baker, Peter G; Scuffham, Paul A

    2013-01-01

    The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.

  14. Dental care and treatments provided under general anaesthesia in the Helsinki Public Dental Service

    Science.gov (United States)

    2012-01-01

    Background Dental general anaesthesia (DGA) is a very efficient treatment modality, but is considered only in the last resort because of the risks posed by general anaesthesia to patients’ overall health. Health services and their treatment policies regarding DGA vary from country to country. The aims of this work were to determine the reasons for DGA in the Helsinki Public Dental Service (PDS) and to assess the role of patient characteristics in the variation in reasons and in the treatments given with special focus on preventive care. Methods The data covered all DGA patients treated in the PDS in Helsinki in 2010. The data were collected from patient documents and included personal background: age (periodontics, surgical procedures and miscellaneous. The reasons for DGA and the treatments provided varied according to age, immigration, previous sedation and DGA and medical background. The logistic regression model showed that previous sedation (OR 2.3; 95%CI 1.3-4.1; p=0.005) and extreme non-cooperation (OR 1.7; 95%CI 0.9-3.2; p=0.103) were most indicative of preventive measures given. Conclusions Extreme non-cooperation, dental fear and an excessive need for treatment were the main reasons for the use of comprehensive, conservative DGA in the Helsinki PDS. The reasons for the use of DGA and the treatments provided varied according to personal and medical background, and immigration status with no gender-differences. Preventive measures formed only a minor part of the dental care given under DGA. PMID:23102205

  15. Electroconvulsive Therapy Under General Anesthesia With Cisatracurium, Laryngeal Mask Airways, and Bispectral Index.

    Science.gov (United States)

    Liu, Cai-Cai; Qian, Xiao-Yan; An, Jian-Xiong; Yu, Zeng-Lei; Wu, Jian-Ping; Wen, Hui; Cao, Zong-Xin; Wang, Yong; Fang, Qi-Wu; Williams, John P

    2016-03-01

    Electroconvulsive therapy (ECT) has dramatically reduced musculoskeletal complications when carried out with muscle relaxants under general anesthesia. However, seizure quality can be affected by the depth of anesthesia and choice of anesthetic agent. The purpose of this study was to describe a general anesthetic technique for ECT by using laryngeal mask, bispectral index (BIS), and muscle relaxant monitoring. Twenty-one patients, between ages 18 and 70 years (American Society of Anesthesiologists physical status I-III), who underwent a total of 89 sessions of ECT were examined in a retrospective study. Anesthesia was induced by use of propofol (1.0 mg/kg) followed by cisatracurium (0.2 mg/kg). The BIS, train-of-four, and end-tidal carbon dioxide were all monitored continuously. A laryngeal mask airway was used to maintain and protect the airway during the procedure. Electroconvulsive therapy stimuli were applied bilaterally when the train-of-four was assessed as being zero and BIS scores were 70. All patients then received 5 μg sufentanil and 2 mg midazolam, while titrated to maintain the BIS value at 40 to 50, before the muscle relaxation exhibited complete recovery. The mean duration of treatment process takes approximately 82.5 minutes. Mean (SD) seizure length was 58.8 (28.3) seconds, with 4.5% incidence of restimulation per treatment. Incidence of awareness was 0%. No patients exhibited delirium, nausea, vomiting, or myalgia in the postseizure phase. Bispectral index monitoring of the depth of anesthesia may have improved seizure quality, and awareness did not occur.

  16. Postoperative dental morbidity in children following dental treatment under general anesthesia.

    Science.gov (United States)

    Hu, Yu-Hsuan; Tsai, Aileen; Ou-Yang, Li-Wei; Chuang, Li-Chuan; Chang, Pei-Ching

    2018-05-10

    General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.

  17. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

    Directory of Open Access Journals (Sweden)

    Márcio Luiz Benevides

    Full Text Available Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

  18. Implementation of selective prevention for cardiometabolic diseases; are Dutch general practices adequately prepared?

    Science.gov (United States)

    Stol, Daphne M; Hollander, Monika; Nielen, Markus M J; Badenbroek, Ilse F; Schellevis, François G; de Wit, Niek J

    2018-03-01

    Current guidelines acknowledge the need for cardiometabolic disease (CMD) prevention and recommend five-yearly screening of a targeted population. In recent years programs for selective CMD-prevention have been developed, but implementation is challenging. The question arises if general practices are adequately prepared. Therefore, the aim of this study is to assess the organizational preparedness of Dutch general practices and the facilitators and barriers for performing CMD-prevention in practices currently implementing selective CMD-prevention. Observational study. Dutch primary care. General practices. Organizational characteristics. General practices implementing selective CMD-prevention are more often organized as a group practice (49% vs. 19%, p = .000) and are better organized regarding chronic disease management compared to reference practices. They are motivated for performing CMD-prevention and can be considered as 'frontrunners' of Dutch general practices with respect to their practice organization. The most important reported barriers are a limited availability of staff (59%) and inadequate funding (41%). The organizational infrastructure of Dutch general practices is considered adequate for performing most steps of selective CMD-prevention. Implementation of prevention programs including easily accessible lifestyle interventions needs attention. All stakeholders involved share the responsibility to realize structural funding for programmed CMD-prevention. Aforementioned conditions should be taken into account with respect to future implementation of selective CMD-prevention. Key Points   There is need for adequate CMD prevention. Little is known about the organization of selective CMD prevention in general practices.   • The organizational infrastructure of Dutch general practices is adequate for performing most steps of selective CMD prevention.   • Implementation of selective CMD prevention programs including easily accessible

  19. [Results of 30 children treated under dental general anesthesia in pediatric dentistry].

    Science.gov (United States)

    Chen, Xu; Liu, Yao; Jin, Shi-fu; Zhang, Qian; Jin, Xuan-yu

    2008-12-01

    To determine the age and sex characteristics of the children and type of dental procedures performed under dental general anesthesia (DGA) and to assess the results after six months to one year's follow-up. A sample of 30 patients treated under dental general anesthesia (DGA) during 2006-2007 in the Department of Pediatric Dentistry of China Medical University was reviewed. All the teeth were treated one time. The dental procedures performed included caries restoration, indirect pulp capping, pulpotomy, root canal therapy (RCT) and dental extraction. Oral prophylaxis and topical fluoride applications were performed on all teeth. Pit and fissure sealing was performed on all healthy premolars and molars. SPSS10.0 software package was used for statistical analysis. Chi-square test was used to analyze the difference of the sex distribution in different age group and the difference of dental procedures performed between the primary teeth and the permanent teeth. The age of the patients ranged from 19 months to 14 years. The mental retardation patients accounted for 10% and mental healthy patients accounted for 90% of the sample studied. Males were more than females with the ratio about 2 to 1 in each age group. The dental procedures performed were caries restoration (18.67%), indirect pulp capping (23.26%), pulpotomy (0.77%), RCT (29.16%), dental extractions (2.05%) and fissure sealants (26.09%). The percentage of RCT was higher than that of caries restoration in the primary teeth, whereas the result was opposite as for the permanent teeth as indicated by Chi-square test (X(2)=11.630, P=0.001). New dental caries was not found except 2 patients who suffered from dysnoesia and were not cooperative to have regular examination. Fillings were lost in 3 cases, with 3 anterior teeth and 2 posterior teeth after RCT. All the children could cooperate except two mental retardation patients during the follow-up visit. Caries restoration and RCT are the most frequently performed

  20. Elevated plasma YKL-40, lipids and lipoproteins, and ischemic vascular disease in the general population

    DEFF Research Database (Denmark)

    Kjaergaard, Alisa D; Johansen, Julia S; Bojesen, Stig E

    2015-01-01

    BACKGROUND AND PURPOSE: We tested the hypothesis that observationally and genetically elevated YKL-40 is associated with elevated lipids and lipoproteins and with increased risk of ischemic vascular disease. METHODS: We conducted cohort and Mendelian randomization studies in 96 110 individuals from...... the Danish general population, with measured plasma levels of YKL-40 (n=21 647), plasma lipids and lipoproteins (n=94 461), and CHI3L1 rs4950928 genotype (n=94 579). RESULTS: From 1977 to 2013, 3256 individuals developed ischemic stroke, 5629 ischemic cerebrovascular disease, 4183 myocardial infarction...

  1. Risk assessment models to predict caries recurrence after oral rehabilitation under general anaesthesia: a pilot study.

    Science.gov (United States)

    Lin, Yai-Tin; Kalhan, Ashish Chetan; Lin, Yng-Tzer Joseph; Kalhan, Tosha Ashish; Chou, Chein-Chin; Gao, Xiao Li; Hsu, Chin-Ying Stephen

    2018-05-08

    Oral rehabilitation under general anaesthesia (GA), commonly employed to treat high caries-risk children, has been associated with high economic and individual/family burden, besides high post-GA caries recurrence rates. As there is no caries prediction model available for paediatric GA patients, this study was performed to build caries risk assessment/prediction models using pre-GA data and to explore mid-term prognostic factors for early identification of high-risk children prone to caries relapse post-GA oral rehabilitation. Ninety-two children were identified and recruited with parental consent before oral rehabilitation under GA. Biopsychosocial data collection at baseline and the 6-month follow-up were conducted using questionnaire (Q), microbiological assessment (M) and clinical examination (C). The prediction models constructed using data collected from Q, Q + M and Q + M + C demonstrated an accuracy of 72%, 78% and 82%, respectively. Furthermore, of the 83 (90.2%) patients recalled 6 months after GA intervention, recurrent caries was identified in 54.2%, together with reduced bacterial counts, lower plaque index and increased percentage of children toothbrushing for themselves (all P < 0.05). Additionally, meal-time and toothbrushing duration were shown, through bivariate analyses, to be significant prognostic determinants for caries recurrence (both P < 0.05). Risk assessment/prediction models built using pre-GA data may be promising in identifying high-risk children prone to post-GA caries recurrence, although future internal and external validation of predictive models is warranted. © 2018 FDI World Dental Federation.

  2. CHRNA3 genotype, nicotine dependence, lung function and disease in the general population

    DEFF Research Database (Denmark)

    Kaur-Knudsen, Diljit; Nordestgaard, Børge G; Bojesen, Stig E

    2012-01-01

    The CHRNA3 rs1051730 polymorphism has been associated to chronic obstructive pulmonary disease (COPD), lung cancer and nicotine dependence in case-control studies with high smoking exposure; however, its influence on lung function and COPD severity in the general population is largely unknown. We...... genotyped 57,657 adult individuals from the Copenhagen General Population Study, of whom 34,592 were ever-smokers. Information on spirometry, hospital admissions, smoking behaviour and use of nicotinic replacement therapy was recorded. In homozygous (11%), heterozygous (44%) and noncarrier (45%) ever...

  3. A novel technique to check the occlusion during the placement of stainless steel crowns under general anesthesia

    Directory of Open Access Journals (Sweden)

    Mohiddin Dimashkieh

    2015-01-01

    Full Text Available Stainless steel crowns are the restoration of choice for the treatment of badly decayed posterior teeth under general anesthesia. The evaluation of occlusion after the placement of these crowns, however, remains a difficult task. This paper outlines a technique to evaluate the occlusion of stainless steel crowns placed under general anesthesia using a specially designed tray and a fast setting polyvinyl siloxane bite registration material (Regisil® PB™, Dentsply, Surrey UK.

  4. Mission reliability of semi-Markov systems under generalized operational time requirements

    International Nuclear Information System (INIS)

    Wu, Xiaoyue; Hillston, Jane

    2015-01-01

    Mission reliability of a system depends on specific criteria for mission success. To evaluate the mission reliability of some mission systems that do not need to work normally for the whole mission time, two types of mission reliability for such systems are studied. The first type corresponds to the mission requirement that the system must remain operational continuously for a minimum time within the given mission time interval, while the second corresponds to the mission requirement that the total operational time of the system within the mission time window must be greater than a given value. Based on Markov renewal properties, matrix integral equations are derived for semi-Markov systems. Numerical algorithms and a simulation procedure are provided for both types of mission reliability. Two examples are used for illustration purposes. One is a one-unit repairable Markov system, and the other is a cold standby semi-Markov system consisting of two components. By the proposed approaches, the mission reliability of systems with time redundancy can be more precisely estimated to avoid possible unnecessary redundancy of system resources. - Highlights: • Two types of mission reliability under generalized requirements are defined. • Equations for both types of reliability are derived for semi-Markov systems. • Numerical methods are given for solving both types of reliability. • Simulation procedure is given for estimating both types of reliability. • Verification of the numerical methods is given by the results of simulation

  5. The p - n junction under nonuniform strains: general theory and application to photovoltaics

    Science.gov (United States)

    Guin, L.; Jabbour, M. E.; Triantafyllidis, N.

    2018-01-01

    It is well known that mechanical strains influence the electronic properties of semiconductor devices. Modeling the fully coupled mechanical, electrical, and electronic responses of semiconductors is therefore essential for predicting the effects of mechanical loading on their overall electronic response. In the first part of this paper, we develop a general continuum model that couples the mechanical, electrical, and electronic responses of a finitely deformable semiconductor. The proposed model accounts for the dependence of the band edge energies, densities of states, and electronic mobilities on strain. The governing equations are derived from the basic principles of the thermomechanics of electromagnetic continua undergoing electronic transport. In particular, we find that there exists electronically induced strains that can exceed their electromagnetic (Maxwell) counterparts by an order of magnitude. In the second part, motivated by applications that involve the bending of a photovoltaic cell, we use asymptotic methods to compute the current-voltage characteristic of a p - n junction under nonuniform strains. We find that, for a typical monocrystalline silicon solar cell, the changes in dark current are significant, i.e., of the order of 20% for strains of 0.2%.

  6. Fear of going under general anesthesia: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    M E Ruhaiyem

    2016-01-01

    Results: Among 450 questionnaires that were disturbed, 400 questionnaires were collected and analyzed. Eighty-eight percent experienced preoperative fear. The top three causes of their fears were fear of postoperative pain (77.3%, fear of intraoperative awareness (73.7%, and fear of being sleepy postoperatively (69.5%. Patients are less fearful of drains and needles in the operative theater (48%, of revealing personal issues under general anesthesia (55.2%, and of not waking up after surgery (56.4%. Age and gender were significant predictors of the overall fear among preanesthetic patients. Females are 5 times more likely to experience fear before surgery (P = 0.0009. Patients aged more than 40 years old are also at 75% higher risk of being afraid (P = 0.008. Conclusion: The majority of the patients going for surgery experienced a fear of anesthesia. Mostly females, especially those over 40, were at a higher risk of being afraid. Fear can bring anxiety which, in turn, might affect the patient′s surgery.

  7. Effects of positive end-expiratory pressure on arthroscopic shoulder surgery under general anesthesia.

    Science.gov (United States)

    Ersoy, Ayşın; Çakırgöz, Mensure; Ervatan, Zekeriya; Kıran, Özlem; Türkmen, Aygen; Esenyel, Cem Zeki

    2016-01-01

    Our study is a prospective, randomized study on patients undergoing arthroscopic shoulder surgery in the beach-chair position to evaluate the effects of positive end-expiratory pressure (PEEP) on hemodynamic stability, providing a bloodless surgical field and surgical satisfaction. Fifty patients were divided into two groups. Group I (n=25) had zero end-expiratory pressure (ZEEP) administered under general anesthesia, and group II (n=25) had +5 PEEP administered. During surgery, intraarticular hemorrhage and surgical satisfaction were evaluated on a scale of 0-10. During surgery, at the 5th, 30th, 60th, and 90th minutes and at the end of surgery, heart rate, mean arterial pressure (MAP), and positive inspiratory pressure were recorded. At the end of the surgery, the amount of bleeding and duration of the operation were recorded. In group I, the duration of operation and amount of bleeding were found to be significantly greater than those in group II (pshoulder surgery in the beach-chair position reduces the amount of hemorrhage in the surgical field and thus increases surgical satisfaction without requiring the creation of controlled hypotension.

  8. The effect of warmed inspired gases on body temperature during arthroscopic shoulder surgery under general anesthesia.

    Science.gov (United States)

    Jo, Youn Yi; Kim, Hong Soon; Chang, Young Jin; Yun, Soon Young; Kwak, Hyun Jeong

    2013-07-01

    Perioperative hypothermia can develop easily during shoulder arthroscopy, because cold irrigation can directly influence core body temperature. The authors investigated whether active warming and humidification of inspired gases reduces falls in core body temperature and allows redistribution of body heat in patients undergoing arthroscopic shoulder surgery under general anesthesia. Patients scheduled for arthroscopic shoulder surgery were randomly assigned to receive either room temperature inspired gases using a conventional respiratory circuit (the control group, n = 20) or inspired gases humidified and heated using a humidified and electrically heated circuit (HHC) (the heated group, n = 20). Core temperatures were significantly lower in both groups from 30 min after anesthesia induction, but were significantly higher in the heated group than in the control group from 75 to 120 min after anesthesia induction. In this study the use of a humidified and electrically heated circuit did not prevent core temperature falling during arthroscopic shoulder surgery, but it was found to decrease reductions in core temperature from 75 min after anesthesia induction.

  9. Trends and Characteristics of Pediatric Dentistry Patients Treated under General Anesthesia.

    Science.gov (United States)

    Rudie, Maxwell N; Milano, Michael M; Roberts, Michael W; Divaris, Kimon

    2018-05-11

    The aims of this study were to describe the demographic characteristics of pediatric dentistry patients undergoing dental rehabilitation under general anesthesia (DRGA) at UNC-Chapel Hill during the last 13 years and identify factors associated with multiple (1 versus 2 or more) DRGA visits during that timeframe. Administrative claims data were used to identify children and adolescents (age <18 years) who underwent DRGA between 1/1/2002 and 12/31/2014 at the UNC Hospitals system. Information on children's age, sex and all treatment-associated CDT codes were collected. Descriptive statistics and bivariate tests of association were used for data analyses. There were 4,413 DRGAs among 3,973 children (median age=4 years 8 months, males=55%) during the study period. The annual rate of DRGAs increased over time, peaking (n=447) in 2013. Overall, 9% of children had ≥2 visits with repeat rates up to 18%. There was no association between children's sex and receipt of one versus multiple DRGAs; however, craniofacial cases were more likely (p<0.0005) to have multiple DRGAs compared to non-craniofacial ones. DRGAs are on the increase-with the exception of craniofacial and special health care needs patients, multiple DRGAs may be reflective of sub-optimal adherence to preventive and continuing care recommendations.

  10. Success of Dental Treatments under Behavior Management, Sedation and General Anesthesia.

    Science.gov (United States)

    Blumer, Sigalit; Costa, Liora; Peretz, Benjamin

    To present comparative study aims to assist the practitioner to choose between behavior modification (BM) techniques, pharmacologic sedation (N 2 O-O 2 alone or combined with midazolam 0.5 mg/ kg) or routine general anesthesia (GA) for the most successful approach in enabling pediatric dental care. Dental records of 56 children treated in a university dental clinic between 2006-2016 were reviewed, and data on age, gender, required treatment (amalgam restorations, composite restorations, pulpotomy, and stainless steel crowns [SSC]), treatment approaches and therapeutic success at final follow-up were retrieved. Treatment under GA had the best success rates compared to both BM and pharmacologic sedation. N 2 O-O 2 alone had a 6.1-fold greater risk of failure compared to N 2 O-O 2 +midazolam (p- <0.008). Amalgam restorations had a 2.61-fold greater risk of failure than SSC (p- <0.008). The GA mode yielded significantly greater success than the N 2 O-O 2 mode alone. There were no significant differences in success rates between GA and combined midazolam 0.5 mg/kg+N 2 O-O 2 . When choosing restoration material, it is important to remember the high success rate of SSC compared to amalgam restoration.

  11. Underlying mechanism of antimicrobial activity of chitosan microparticles and implications for the treatment of infectious diseases.

    Directory of Open Access Journals (Sweden)

    Soo Jin Jeon

    Full Text Available The emergence of antibiotic resistant microorganisms is a great public health concern and has triggered an urgent need to develop alternative antibiotics. Chitosan microparticles (CM, derived from chitosan, have been shown to reduce E. coli O157:H7 shedding in a cattle model, indicating potential use as an alternative antimicrobial agent. However, the underlying mechanism of CM on reducing the shedding of this pathogen remains unclear. To understand the mode of action, we studied molecular mechanisms of antimicrobial activity of CM using in vitro and in vivo methods. We report that CM are an effective bactericidal agent with capability to disrupt cell membranes. Binding assays and genetic studies with an ompA mutant strain demonstrated that outer membrane protein OmpA of E. coli O157:H7 is critical for CM binding, and this binding activity is coupled with a bactericidal effect of CM. This activity was also demonstrated in an animal model using cows with uterine diseases. CM treatment effectively reduced shedding of intrauterine pathogenic E. coli (IUPEC in the uterus compared to antibiotic treatment. Since Shiga-toxins encoded in the genome of bacteriophage is often overexpressed during antibiotic treatment, antibiotic therapy is generally not recommended because of high risk of hemolytic uremic syndrome. However, CM treatment did not induce bacteriophage or Shiga-toxins in E. coli O157:H7; suggesting that CM can be a potential candidate to treat infections caused by this pathogen. This work establishes an underlying mechanism whereby CM exert antimicrobial activity in vitro and in vivo, providing significant insight for the treatment of diseases caused by a broad spectrum of pathogens including antibiotic resistant microorganisms.

  12. Natriuretic peptides: prediction of cardiovascular disease in the general population and high risk populations

    DEFF Research Database (Denmark)

    Hildebrandt, Per

    2009-01-01

    (General Practitioner) setting as in the acute setting. Supporting this use is a very strong prognostic value of the natriuretic peptides. This has been shown in as well heart failure as acute coronary syndromes, but also in the general population and in high-risk groups as patients with diabetes......, hypertension and coronary artery disease. This has of course raised interest for the use of the natriuretic peptides as a risk marker and for screening for heart failure with reduced systolic function in these populations. In symptomatic persons and in high risk populations, the natriuretic peptides have...... demonstrated a high sensitivity for ruling out the disease, if the right decision limits are choosen. Thus the number of normal echocardiographies can be reduced. More recently, the use in screening asymptomatic persons for left ventricular systolic dysfunction has gained more interest. In the unselected...

  13. Association between air pollution and general practitioner visits for respiratory diseases in Hong Kong

    OpenAIRE

    Wong, TW; Tam, W; Wun, YT; Wong, CM; Yu, ITS; Wong, AHS

    2006-01-01

    Background: Few studies have explored the relation between air pollution and general practitioner (GP) consultations in Asia. Clinic attendance data from a network of GPs were studied, and the relationship between daily GP consultations for upper respiratory tract infections (URTI) and non-URTI respiratory diseases and daily air pollutant concentrations measured in their respective districts was examined. Methods: A time series study was performed in 2000-2002 using data on daily patient cons...

  14. Building chronic disease management capacity in General Practice: The South Australian GP Plus Practice Nurse Initiative.

    Science.gov (United States)

    Fuller, Jeffrey; Koehne, Kristy; Verrall, Claire C; Szabo, Natalie; Bollen, Chris; Parker, Sharon

    2015-01-01

    This paper draws on the implementation experience of the South Australian GP Plus Practice Nurse Initiative in order to establish what is needed to support the development of the chronic disease management role of practice nurses. The Initiative was delivered between 2007 and 2010 to recruit, train and place 157 nurses across 147 General Practices in Adelaide. The purpose was to improve chronic disease management in General Practice, by equipping nurses to work as practice nurses who would coordinate care and establish chronic disease management systems. Secondary analysis of qualitative data contained in the Initiative evaluation report, specifically drawing on quarterly project records and four focus groups conducted with practice nurses, practice nurse coordinators and practice nurse mentors. As evidenced by the need to increase the amount of support provided during the implementation of the Initiative, nurses new to General Practice faced challenges in their new role. Nurses described a big learning curve as they dealt with role transition to a new work environment and learning a range of new skills while developing chronic disease management systems. Informants valued the skills development and support offered by the Initiative, however the ongoing difficulties in implementing the role suggested that change is also needed at the level of the Practice. While just over a half of the placement positions were retained, practice nurses expressed concern with having to negotiate the conditions of their employment. In order to advance the role of practice nurses as managers of chronic disease support is needed at two levels. At one level support is needed to assist practice nurses to build their own skills. At the level of the Practice, and in the wider health workforce system, support is also needed to ensure that Practices are organisationally ready to include the practice nurse within the practice team.

  15. Assessment of Olfactory Function in MAPT-Associated Neurodegenerative Disease Reveals Odor-Identification Irreproducibility as a Non-Disease-Specific, General Characteristic of Olfactory Dysfunction.

    Directory of Open Access Journals (Sweden)

    Katerina Markopoulou

    Full Text Available Olfactory dysfunction is associated with normal aging, multiple neurodegenerative disorders, including Parkinson's disease, Lewy body disease and Alzheimer's disease, and other diseases such as diabetes, sleep apnea and the autoimmune disease myasthenia gravis. The wide spectrum of neurodegenerative disorders associated with olfactory dysfunction suggests different, potentially overlapping, underlying pathophysiologies. Studying olfactory dysfunction in presymptomatic carriers of mutations known to cause familial parkinsonism provides unique opportunities to understand the role of genetic factors, delineate the salient characteristics of the onset of olfactory dysfunction, and understand when it starts relative to motor and cognitive symptoms. We evaluated olfactory dysfunction in 28 carriers of two MAPT mutations (p.N279K, p.P301L, which cause frontotemporal dementia with parkinsonism, using the University of Pennsylvania Smell Identification Test. Olfactory dysfunction in carriers does not appear to be allele specific, but is strongly age-dependent and precedes symptomatic onset. Severe olfactory dysfunction, however, is not a fully penetrant trait at the time of symptom onset. Principal component analysis revealed that olfactory dysfunction is not odor-class specific, even though individual odor responses cluster kindred members according to genetic and disease status. Strikingly, carriers with incipient olfactory dysfunction show poor inter-test consistency among the sets of odors identified incorrectly in successive replicate tests, even before severe olfactory dysfunction appears. Furthermore, when 78 individuals without neurodegenerative disease and 14 individuals with sporadic Parkinson's disease were evaluated twice at a one-year interval using the Brief Smell Identification Test, the majority also showed inconsistency in the sets of odors they identified incorrectly, independent of age and cognitive status. While these findings may

  16. Assessment of Olfactory Function in MAPT-Associated Neurodegenerative Disease Reveals Odor-Identification Irreproducibility as a Non-Disease-Specific, General Characteristic of Olfactory Dysfunction.

    Science.gov (United States)

    Markopoulou, Katerina; Chase, Bruce A; Robowski, Piotr; Strongosky, Audrey; Narożańska, Ewa; Sitek, Emilia J; Berdynski, Mariusz; Barcikowska, Maria; Baker, Matt C; Rademakers, Rosa; Sławek, Jarosław; Klein, Christine; Hückelheim, Katja; Kasten, Meike; Wszolek, Zbigniew K

    2016-01-01

    Olfactory dysfunction is associated with normal aging, multiple neurodegenerative disorders, including Parkinson's disease, Lewy body disease and Alzheimer's disease, and other diseases such as diabetes, sleep apnea and the autoimmune disease myasthenia gravis. The wide spectrum of neurodegenerative disorders associated with olfactory dysfunction suggests different, potentially overlapping, underlying pathophysiologies. Studying olfactory dysfunction in presymptomatic carriers of mutations known to cause familial parkinsonism provides unique opportunities to understand the role of genetic factors, delineate the salient characteristics of the onset of olfactory dysfunction, and understand when it starts relative to motor and cognitive symptoms. We evaluated olfactory dysfunction in 28 carriers of two MAPT mutations (p.N279K, p.P301L), which cause frontotemporal dementia with parkinsonism, using the University of Pennsylvania Smell Identification Test. Olfactory dysfunction in carriers does not appear to be allele specific, but is strongly age-dependent and precedes symptomatic onset. Severe olfactory dysfunction, however, is not a fully penetrant trait at the time of symptom onset. Principal component analysis revealed that olfactory dysfunction is not odor-class specific, even though individual odor responses cluster kindred members according to genetic and disease status. Strikingly, carriers with incipient olfactory dysfunction show poor inter-test consistency among the sets of odors identified incorrectly in successive replicate tests, even before severe olfactory dysfunction appears. Furthermore, when 78 individuals without neurodegenerative disease and 14 individuals with sporadic Parkinson's disease were evaluated twice at a one-year interval using the Brief Smell Identification Test, the majority also showed inconsistency in the sets of odors they identified incorrectly, independent of age and cognitive status. While these findings may reflect the

  17. ESTIMATION OF PARAMETERS AND RELIABILITY FUNCTION OF EXPONENTIATED EXPONENTIAL DISTRIBUTION: BAYESIAN APPROACH UNDER GENERAL ENTROPY LOSS FUNCTION

    Directory of Open Access Journals (Sweden)

    Sanjay Kumar Singh

    2011-06-01

    Full Text Available In this Paper we propose Bayes estimators of the parameters of Exponentiated Exponential distribution and Reliability functions under General Entropy loss function for Type II censored sample. The proposed estimators have been compared with the corresponding Bayes estimators obtained under Squared Error loss function and maximum likelihood estimators for their simulated risks (average loss over sample space.

  18. An Investigation of the Mechanism Underlying Teacher Aggression: Testing I[superscript 3] Theory and the General Aggression Model

    Science.gov (United States)

    Montuoro, Paul; Mainhard, Tim

    2017-01-01

    Background: Considerable research has investigated the deleterious effects of teachers responding aggressively to students who misbehave, but the mechanism underlying this dysfunctional behaviour remains unknown. Aims: This study investigated whether the mechanism underlying teacher aggression follows I[superscript 3] theory or General Aggression…

  19. Relationship between Metabolic Syndrome Components and Periodontal Disease in a Japanese General Population: the Suita Study.

    Science.gov (United States)

    Kikui, Miki; Kokubo, Yoshihiro; Ono, Takahiro; Kida, Momoyo; Kosaka, Takayuki; Yamamoto, Masaaki; Watanabe, Makoto; Maeda, Yoshinobu; Miyamoto, Yoshihiro

    2017-05-01

    A positive association between metabolic syndrome (MetS) and periodontal status has recently been noted. However, no study has evaluated the relationship by sex and in a general urban population using the uniform definition proposed in the 2009 Joint Interim Statement. The aim of this study was to clarify the relationship between MetS and periodontal status using the uniform definition in a general urban Japanese population. A total of 1,856 Japanese men and women (mean age: 66.4 years) were studied using data from the Suita study. Periodontal status was evaluated by the Community Periodontal Index (CPI). MetS was defined using the 2009 Joint Interim Statement. The associations of the MetS and its components with periodontal disease were investigated using multiple logistic regression analysis adjusting for age, drinking, and smoking. Among the components of the MetS, low HDL cholesterol level was significantly associated with periodontal disease in men and women [odds ratios (OR)=2.39 and 1.53; 95% confidence intervals=1.36-4.19 and 1.06-2.19]. Furthermore, the risk of periodontal disease showed 1.43-, 1.42-, and 1.89-fold increases in those with 2, 3, and ≥4 components, respectively, compared with those having no components (P trend <0.001). For the analysis by sex, the risk of periodontal disease was increased 2.27- and 1.76-fold in those with ≥4 components in men and women, respectively (both P trend =0.001). These findings suggest that MetS and lower HDL cholesterol are associated with periodontal disease. Subjects with two or more MetS components had a significantly higher prevalence of periodontal disease.

  20. Distrust As a Disease Avoidance Strategy: Individual Differences in Disgust Sensitivity Regulate Generalized Social Trust

    DEFF Research Database (Denmark)

    Aarøe, Lene; Osmundsen, Mathias; Petersen, Michael Bang

    2016-01-01

    pathogens influence people's propensity to interact and cooperate with others, as measured by individual differences in generalized social trust. While extant studies on pathogen avoidance have argued that such motivations should prompt people to avoid interactions with outgroups specifically, we argue...... social trust. We furthermore compare the effects of pathogen disgust sensitivity on generalized social trust and outgroup prejudice and explore whether generalized social trust to some extent constitutes a pathway between pathogen avoidance motivations and prejudice.......Throughout human evolutionary history, cooperative contact with others has been fundamental for human survival. At the same time, social contact has been a source of threats. In this article, we focus on one particular viable threat, communicable disease, and investigate how motivations to avoid...

  1. A generalized electron energy probability function for inductively coupled plasmas under conditions of nonlocal electron kinetics

    Science.gov (United States)

    Mouchtouris, S.; Kokkoris, G.

    2018-01-01

    A generalized equation for the electron energy probability function (EEPF) of inductively coupled Ar plasmas is proposed under conditions of nonlocal electron kinetics and diffusive cooling. The proposed equation describes the local EEPF in a discharge and the independent variable is the kinetic energy of electrons. The EEPF consists of a bulk and a depleted tail part and incorporates the effect of the plasma potential, Vp, and pressure. Due to diffusive cooling, the break point of the EEPF is eVp. The pressure alters the shape of the bulk and the slope of the tail part. The parameters of the proposed EEPF are extracted by fitting to measure EEPFs (at one point in the reactor) at different pressures. By coupling the proposed EEPF with a hybrid plasma model, measurements in the gaseous electronics conference reference reactor concerning (a) the electron density and temperature and the plasma potential, either spatially resolved or at different pressure (10-50 mTorr) and power, and (b) the ion current density of the electrode, are well reproduced. The effect of the choice of the EEPF on the results is investigated by a comparison to an EEPF coming from the Boltzmann equation (local electron kinetics approach) and to a Maxwellian EEPF. The accuracy of the results and the fact that the proposed EEPF is predefined renders its use a reliable alternative with a low computational cost compared to stochastic electron kinetic models at low pressure conditions, which can be extended to other gases and/or different electron heating mechanisms.

  2. Clinical application of self-expandable metallic stents in the treatment of malignant tracheal stenosis under general anesthesia

    International Nuclear Information System (INIS)

    Wang Weitao; Shi Haibin; Yang Zhengqiang; Liu Sheng; Zhou Chungao; Zhao Linbo; Xia Jinguo; Li Linsun

    2009-01-01

    Objective: To evaluate the safety and efficacy of self-expandable metallic stent placement for the treatment of malignant tracheal stenosis under general anesthesia and fluoroscopic guidance. Methods: Under general anesthesia the placement of self-expandable metallic stent was performed in 10 patients with malignant tracheal stenosis, the procedure was completed under fluoroscopic guidance in all patients. Results: Successful tracheal stenting was achieved in all 10 patients. In one patient, a Y-shaped stent was used as the tracheal carina was involved in the airway stenosis. The symptoms of dyspnea and asthma were markedly improved immediately after the implantation of stent in all patients. Conclusion: Tracheal implantation of self-expandable metallic stent under general anesthesia and fluoroscopic guidance is a safe and effective treatment for malignant tracheal stenosis, it can promptly relieve various symptoms caused by malignant tracheal stenosis and obviously improve patient's living quality, therefore,t his technique is of great value in clinical practice. (authors)

  3. Regulation of sorLA in general and in Alzheimer's disease

    DEFF Research Database (Denmark)

    Andersen, Olav Michael; Poulsen, Annemarie Svane Aavild; Zole, Egija

    Background: The Sortillin-related receptor (sorLA) is involved in cellular trafficking and processing of the Amyloid precursor protein (APP). A decrease in sorLA expression has been identified in brain tissue from patients suffering from Alzheimer's disease (AD), suggesting that sorLA may be a key...... tissue from patients with Alzheimer's disease. Conclusions: We have investigated the regulation of sorLA expression and identified several cis - and trans -regulatory elements important for the proper expression of sorLA. These studies may help to elucidate the mechanisms underlying the observ ed down...... regulation of sorLA and the linkage to disease onset of SORL1 SNPs in AD patients....

  4. Missed Diagnosis of Cardiovascular Disease in Outpatient General Medicine: Insights from Malpractice Claims Data.

    Science.gov (United States)

    Quinn, Gene R; Ranum, Darrell; Song, Ellen; Linets, Margarita; Keohane, Carol; Riah, Heather; Greenberg, Penny

    2017-10-01

    Diagnostic errors are an underrecognized source of patient harm, and cardiovascular disease can be challenging to diagnose in the ambulatory setting. Although malpractice data can inform diagnostic error reduction efforts, no studies have examined outpatient cardiovascular malpractice cases in depth. A study was conducted to examine the characteristics of outpatient cardiovascular malpractice cases brought against general medicine practitioners. Some 3,407 closed malpractice claims were analyzed in outpatient general medicine from CRICO Strategies' Comparative Benchmarking System database-the largest detailed database of paid and unpaid malpractice in the world-and multivariate models were created to determine the factors that predicted case outcomes. Among the 153 patients in cardiovascular malpractice cases for whom patient comorbidities were coded, the majority (63%) had at least one traditional cardiac risk factor, such as diabetes, tobacco use, or previous cardiovascular disease. Cardiovascular malpractice cases were more likely to involve an allegation of error in diagnosis (75% vs. 47%, p <0.0001), have high clinical severity (86% vs. 49%, p <0.0001) and result in death (75% vs. 27%, p <0.0001), as compared to noncardiovascular cases. Initial diagnoses of nonspecific chest pain and mimics of cardiovascular pain (for example, esophageal disease) were common and independently increased the likelihood of a claim resulting in a payment (p <0.01). Cardiovascular malpractice cases against outpatient general medicine physicians mostly occur in patients with conventional risk factors for coronary artery disease and are often diagnosed with common mimics of cardiovascular pain. These findings suggest that these patients may be high-yield targets for preventing diagnostic errors in the ambulatory setting. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  5. Understanding the process of patient satisfaction with nurse-led chronic disease management in general practice.

    Science.gov (United States)

    Mahomed, Rosemary; St John, Winsome; Patterson, Elizabeth

    2012-11-01

      To investigate the process of patient satisfaction with nurse-led chronic disease management in Australian general practice.   Nurses working in the primary care context of general practice, referred to as practice nurses, are expanding their role in chronic disease management; this is relatively new to Australia. Therefore, determining patient satisfaction with this trend is pragmatically and ethically important. However, the concept of patient satisfaction is not well understood particularly in relation to care provided by practice nurses.   A grounded theory study underpinned by a relativist ontological position and a relativist epistemology.   Grounded theory was used to develop a theory from data collected through in-depth interviews with 38 participants between November 2007-April 2009. Participants were drawn from a larger project that trialled a practice nurse-led, collaborative model of chronic disease management in three Australian general practices. Theoretical sampling, data collection, and analysis were conducted concurrently consistent with grounded theory methods.   Patients undergo a cyclical process of Navigating Care involving three stages, Determining Care Needs, Forming Relationship, and Having Confidence. The latter two processes are inter-related and a feedback loop from them informs subsequent cycles of Determining Care Needs. If any of these steps fails to develop adequately, patients are likely to opt out of nurse-led care.   Navigating Care explains how and why time, communication, continuity, and trust in general practitioners and nurses are important to patient satisfaction. It can be used in identifying suitable patients for practice nurse-led care and to inform the practice and organization of practice nurse-led care to enhance patient satisfaction. © 2012 Blackwell Publishing Ltd.

  6. Heat-Related Mortality Projections for Cardiovascular and Respiratory Disease Under the Changing Climate in Beijing, China

    Science.gov (United States)

    Li, Tiantian; Ban, Jie; Horton, Radley M.; Bader, Daniel A.; Huang, Ganlin; Sun, Qinghua; Kinney, Patrick L.

    2015-01-01

    Because heat-related health effects tend to become more serious at higher temperatures, there is an urgent need to determine the mortality projection of specific heat-sensitive diseases to provide more detailed information regarding the variation of the sensitivity of such diseases. In this study, the specific mortality of cardiovascular and respiratory disease in Beijing was initially projected under five different global-scale General Circulation Models (GCMs) and two Representative Concentration Pathways scenarios (RCPs) in the 2020s, 2050s, and 2080s compared to the 1980s. Multi-model ensembles indicated cardiovascular mortality could increase by an average percentage of 18.4 percent, 47.8 percent, and 69.0 percent in the 2020s, 2050s, and 2080s under RCP 4.5, respectively, and by 16.6 percent, 73.8 percent and 134 percent in different decades respectively, under RCP 8.5 compared to the baseline range. The same increasing pattern was also observed in respiratory mortality. The heat-related deaths under the RCP 8.5 scenario were found to reach a higher number and to increase more rapidly during the 21st century compared to the RCP4.5 scenario, especially in the 2050s and the 2080s. The projection results show potential trends in cause-specific mortality in the context of climate change, and provide support for public health interventions tailored to specific climate-related future health risks.

  7. Heat-related mortality projections for cardiovascular and respiratory disease under the changing climate in Beijing, China

    Science.gov (United States)

    Li, Tiantian; Ban, Jie; Horton, Radley M.; Bader, Daniel A.; Huang, Ganlin; Sun, Qinghua; Kinney, Patrick L.

    2015-08-01

    Because heat-related health effects tend to become more serious at higher temperatures, there is an urgent need to determine the mortality projection of specific heat-sensitive diseases to provide more detailed information regarding the variation of the sensitivity of such diseases. In this study, the specific mortality of cardiovascular and respiratory disease in Beijing was initially projected under five different global-scale General Circulation Models (GCMs) and two Representative Concentration Pathways scenarios (RCPs) in the 2020s, 2050s, and 2080s compared to the 1980s. Multi-model ensembles indicated cardiovascular mortality could increase by an average percentage of 18.4%, 47.8%, and 69.0% in the 2020s, 2050s, and 2080s under RCP 4.5, respectively, and by 16.6%,73.8% and 134% in different decades respectively, under RCP 8.5 compared to the baseline range. The same increasing pattern was also observed in respiratory mortality. The heat-related deaths under the RCP8.5 scenario were found to reach a higher number and to increase more rapidly during the 21st century compared to the RCP4.5 scenario, especially in the 2050s and the 2080s. The projection results show potential trends in cause-specific mortality in the context of climate change, and provide support for public health interventions tailored to specific climate-related future health risks.

  8. Different Temporal Patterns of Specific and General Autobiographical Memories across the Lifespan in Alzheimer's Disease.

    Science.gov (United States)

    Philippi, Nathalie; Rousseau, François; Noblet, Vincent; Botzung, Anne; Després, Olivier; Cretin, Benjamin; Kremer, Stéphane; Blanc, Frédéric; Manning, Liliann

    2015-01-01

    We compared specific (i.e., associated with a unique time and space) and general (i.e., extended or repeated events) autobiographical memories (AbM) in Alzheimer's disease (AD). The comparison aims at investigating the relationship between these two components of AbM across the lifespan and the volume of cerebral regions of interest within the temporal lobe. We hypothesized that the ability to elicit specific memories would correlate with hippocampal volume, whereas evoking general memories would be related to lateral temporal lobe. AbM was assessed using the modified Crovitz test in 18 patients with early AD and 18 matched controls. The proportions of total memories-supposed to reflect the ability to produce general memories-and specific memories retrieved were compared between AD patients and controls. Correlations to MRI volumes of temporal cortex were tested. We found different temporal patterns for specific and general memories in AD patients, with (i) relatively spared general memories, according to a temporal gradient that preserved remote memories, predominantly associated with right lateral temporal cortex volume. (ii) Conversely, the retrieval of specific AbMs was impaired for all life periods and correlated with bilateral hippocampal volumes. Our results highlight a shift from an initially episodic to a semantic nature of AbMs during AD, where the abstracted form of memories remains.

  9. Forecasting the future risk of Barmah Forest virus disease under climate change scenarios in Queensland, Australia.

    Directory of Open Access Journals (Sweden)

    Suchithra Naish

    Full Text Available BACKGROUND: Mosquito-borne diseases are climate sensitive and there has been increasing concern over the impact of climate change on future disease risk. This paper projected the potential future risk of Barmah Forest virus (BFV disease under climate change scenarios in Queensland, Australia. METHODS/PRINCIPAL FINDINGS: We obtained data on notified BFV cases, climate (maximum and minimum temperature and rainfall, socio-economic and tidal conditions for current period 2000-2008 for coastal regions in Queensland. Grid-data on future climate projections for 2025, 2050 and 2100 were also obtained. Logistic regression models were built to forecast the otential risk of BFV disease distribution under existing climatic, socio-economic and tidal conditions. The model was applied to estimate the potential geographic distribution of BFV outbreaks under climate change scenarios. The predictive model had good model accuracy, sensitivity and specificity. Maps on potential risk of future BFV disease indicated that disease would vary significantly across coastal regions in Queensland by 2100 due to marked differences in future rainfall and temperature projections. CONCLUSIONS/SIGNIFICANCE: We conclude that the results of this study demonstrate that the future risk of BFV disease would vary across coastal regions in Queensland. These results may be helpful for public health decision making towards developing effective risk management strategies for BFV disease control and prevention programs in Queensland.

  10. Forecasting the future risk of Barmah Forest virus disease under climate change scenarios in Queensland, Australia.

    Science.gov (United States)

    Naish, Suchithra; Mengersen, Kerrie; Hu, Wenbiao; Tong, Shilu

    2013-01-01

    Mosquito-borne diseases are climate sensitive and there has been increasing concern over the impact of climate change on future disease risk. This paper projected the potential future risk of Barmah Forest virus (BFV) disease under climate change scenarios in Queensland, Australia. We obtained data on notified BFV cases, climate (maximum and minimum temperature and rainfall), socio-economic and tidal conditions for current period 2000-2008 for coastal regions in Queensland. Grid-data on future climate projections for 2025, 2050 and 2100 were also obtained. Logistic regression models were built to forecast the otential risk of BFV disease distribution under existing climatic, socio-economic and tidal conditions. The model was applied to estimate the potential geographic distribution of BFV outbreaks under climate change scenarios. The predictive model had good model accuracy, sensitivity and specificity. Maps on potential risk of future BFV disease indicated that disease would vary significantly across coastal regions in Queensland by 2100 due to marked differences in future rainfall and temperature projections. We conclude that the results of this study demonstrate that the future risk of BFV disease would vary across coastal regions in Queensland. These results may be helpful for public health decision making towards developing effective risk management strategies for BFV disease control and prevention programs in Queensland.

  11. Retrofitting Non-Cognitive-Diagnostic Reading Assessment under the Generalized DINA Model Framework

    Science.gov (United States)

    Chen, Huilin; Chen, Jinsong

    2016-01-01

    Cognitive diagnosis models (CDMs) are psychometric models developed mainly to assess examinees' specific strengths and weaknesses in a set of skills or attributes within a domain. By adopting the Generalized-DINA model framework, the recently developed general modeling framework, we attempted to retrofit the PISA reading assessments, a…

  12. Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care

    Directory of Open Access Journals (Sweden)

    Meyboom-de Jong Betty

    2009-05-01

    Full Text Available Abstract Background Schizophrenia patients frequently develop somatic co-morbidity. Core tasks for GPs are the prevention and diagnosis of somatic diseases and the provision of care for patients with chronic diseases. Schizophrenia patients experience difficulties in recognizing and coping with their physical problems; however GPs have neither specific management policies nor guidelines for the diagnosis and treatment of somatic co-morbidity in schizophrenia patients. This paper systematically reviews the prevalence and treatment of somatic co-morbidity in schizophrenia patients in general practice. Methods The MEDLINE, EMBASE, PsycINFO data-bases and the Cochrane Library were searched and original research articles on somatic diseases of schizophrenia patients and their treatment in the primary care setting were selected. Results The results of this search show that the incidence of a wide range of diseases, such as diabetes mellitus, the metabolic syndrome, coronary heart diseases, and COPD is significantly higher in schizophrenia patients than in the normal population. The health of schizophrenic patients is less than optimal in several areas, partly due to their inadequate help-seeking behaviour. Current GP management of such patients appears not to take this fact into account. However, when schizophrenic patients seek the GP's help, they value the care provided. Conclusion Schizophrenia patients are at risk of undetected somatic co-morbidity. They present physical complaints at a late, more serious stage. GPs should take this into account by adopting proactive behaviour. The development of a set of guidelines with a clear description of the GP's responsibilities would facilitate the desired changes in the management of somatic diseases in these patients.

  13. Somatic diseases in patients with schizophrenia in general practice: their prevalence and health care.

    Science.gov (United States)

    Oud, Marian J T; Meyboom-de Jong, Betty

    2009-05-09

    Schizophrenia patients frequently develop somatic co-morbidity. Core tasks for GPs are the prevention and diagnosis of somatic diseases and the provision of care for patients with chronic diseases. Schizophrenia patients experience difficulties in recognizing and coping with their physical problems; however GPs have neither specific management policies nor guidelines for the diagnosis and treatment of somatic co-morbidity in schizophrenia patients. This paper systematically reviews the prevalence and treatment of somatic co-morbidity in schizophrenia patients in general practice. The MEDLINE, EMBASE, PsycINFO data-bases and the Cochrane Library were searched and original research articles on somatic diseases of schizophrenia patients and their treatment in the primary care setting were selected. The results of this search show that the incidence of a wide range of diseases, such as diabetes mellitus, the metabolic syndrome, coronary heart diseases, and COPD is significantly higher in schizophrenia patients than in the normal population. The health of schizophrenic patients is less than optimal in several areas, partly due to their inadequate help-seeking behaviour. Current GP management of such patients appears not to take this fact into account. However, when schizophrenic patients seek the GP's help, they value the care provided. Schizophrenia patients are at risk of undetected somatic co-morbidity. They present physical complaints at a late, more serious stage. GPs should take this into account by adopting proactive behaviour. The development of a set of guidelines with a clear description of the GP's responsibilities would facilitate the desired changes in the management of somatic diseases in these patients.

  14. Systematic review of general burden of disease studies using disability-adjusted life years

    Directory of Open Access Journals (Sweden)

    Polinder Suzanne

    2012-11-01

    Full Text Available Abstract Objective To systematically review the methodology of general burden of disease studies. Three key questions were addressed: 1 what was the quality of the data, 2 which methodological choices were made to calculate disability adjusted life years (DALYs, and 3 were uncertainty and risk factor analyses performed? Furthermore, DALY outcomes of the included studies were compared. Methods Burden of disease studies (1990 to 2011 in international peer-reviewed journals and in grey literature were identified with main inclusion criteria being multiple-cause studies that quantified the burden of disease as the sum of the burden of all distinct diseases expressed in DALYs. Electronic database searches included Medline (PubMed, EMBASE, and Web of Science. Studies were collated by study population, design, methods used to measure mortality and morbidity, risk factor analyses, and evaluation of results. Results Thirty-one studies met the inclusion criteria of our review. Overall, studies followed the Global Burden of Disease (GBD approach. However, considerable variation existed in disability weights, discounting, age-weighting, and adjustments for uncertainty. Few studies reported whether mortality data were corrected for missing data or underreporting. Comparison with the GBD DALY outcomes by country revealed that for some studies DALY estimates were of similar magnitude; others reported DALY estimates that were two times higher or lower. Conclusions Overcoming “error” variation due to the use of different methodologies and low-quality data is a critical priority for advancing burden of disease studies. This can enlarge the detection of true variation in DALY outcomes between populations or over time.

  15. Longevity of animals under reactive oxygen species stress and disease susceptibility due to global warming

    Science.gov (United States)

    Paital, Biswaranjan; Panda, Sumana Kumari; Hati, Akshaya Kumar; Mohanty, Bobllina; Mohapatra, Manoj Kumar; Kanungo, Shyama; Chainy, Gagan Bihari Nityananda

    2016-01-01

    The world is projected to experience an approximate doubling of atmospheric CO2 concentration in the next decades. Rise in atmospheric CO2 level as one of the most important reasons is expected to contribute to raise the mean global temperature 1.4 °C-5.8 °C by that time. A survey from 128 countries speculates that global warming is primarily due to increase in atmospheric CO2 level that is produced mainly by anthropogenic activities. Exposure of animals to high environmental temperatures is mostly accompanied by unwanted acceleration of certain biochemical pathways in their cells. One of such examples is augmentation in generation of reactive oxygen species (ROS) and subsequent increase in oxidation of lipids, proteins and nucleic acids by ROS. Increase in oxidation of biomolecules leads to a state called as oxidative stress (OS). Finally, the increase in OS condition induces abnormality in physiology of animals under elevated temperature. Exposure of animals to rise in habitat temperature is found to boost the metabolism of animals and a very strong and positive correlation exists between metabolism and levels of ROS and OS. Continuous induction of OS is negatively correlated with survivability and longevity and positively correlated with ageing in animals. Thus, it can be predicted that continuous exposure of animals to acute or gradual rise in habitat temperature due to global warming may induce OS, reduced survivability and longevity in animals in general and poikilotherms in particular. A positive correlation between metabolism and temperature in general and altered O2 consumption at elevated temperature in particular could also increase the risk of experiencing OS in homeotherms. Effects of global warming on longevity of animals through increased risk of protein misfolding and disease susceptibility due to OS as the cause or effects or both also cannot be ignored. Therefore, understanding the physiological impacts of global warming in relation to

  16. Longevity of animals under reactive oxygen species stress and disease susceptibility due to global warming.

    Science.gov (United States)

    Paital, Biswaranjan; Panda, Sumana Kumari; Hati, Akshaya Kumar; Mohanty, Bobllina; Mohapatra, Manoj Kumar; Kanungo, Shyama; Chainy, Gagan Bihari Nityananda

    2016-02-26

    The world is projected to experience an approximate doubling of atmospheric CO2 concentration in the next decades. Rise in atmospheric CO2 level as one of the most important reasons is expected to contribute to raise the mean global temperature 1.4 °C-5.8 °C by that time. A survey from 128 countries speculates that global warming is primarily due to increase in atmospheric CO2 level that is produced mainly by anthropogenic activities. Exposure of animals to high environmental temperatures is mostly accompanied by unwanted acceleration of certain biochemical pathways in their cells. One of such examples is augmentation in generation of reactive oxygen species (ROS) and subsequent increase in oxidation of lipids, proteins and nucleic acids by ROS. Increase in oxidation of biomolecules leads to a state called as oxidative stress (OS). Finally, the increase in OS condition induces abnormality in physiology of animals under elevated temperature. Exposure of animals to rise in habitat temperature is found to boost the metabolism of animals and a very strong and positive correlation exists between metabolism and levels of ROS and OS. Continuous induction of OS is negatively correlated with survivability and longevity and positively correlated with ageing in animals. Thus, it can be predicted that continuous exposure of animals to acute or gradual rise in habitat temperature due to global warming may induce OS, reduced survivability and longevity in animals in general and poikilotherms in particular. A positive correlation between metabolism and temperature in general and altered O2 consumption at elevated temperature in particular could also increase the risk of experiencing OS in homeotherms. Effects of global warming on longevity of animals through increased risk of protein misfolding and disease susceptibility due to OS as the cause or effects or both also cannot be ignored. Therefore, understanding the physiological impacts of global warming in relation to

  17. Comparative Assessment of Oral Health Related Quality of Life of Children Before and After Full Mouth Rehabilitation under General Anaesthesia and Local Anaesthesia.

    Science.gov (United States)

    Rane, Jaai Vinod; Winnier, Jasmin; Bhatia, Rupinder

    2017-01-01

    Early Childhood Caries (ECC) is an aggressive form of caries in a child who is 71 months of age or younger. If the child is cooperative, the treatment may be completed under Local Anaesthesia (LA). General Anaesthesia (GA) is considered if the child is uncooperative, medically compromised or if the parents are unable to return for regular visits and requests treatment under GA. Improved Oral health Related Quality of Life (OHRQoL) has been reported after dental treatment under GA. To assess and compare the improvements in OHRQoL of children who have undergone dental treatment under GA or LA. To study the preoperative severity of events that may prompt the parents to consider treatment under GA. Parents of paediatric patients who had to undergo full mouth rehabilitation under GA and LA were selected for this study. Parents were given a questionnaire to evaluate OHRQoL of children before and after completion of treatment. Preoperative and postoperative assessments were analyzed using paired t-test. Dental disease was found to have a significant impact on children's overall well being. There was a considerable improvement with relation to eating preferences, amount of food intake, sleep and pain relief before and after dental treatment. There was no significant difference if the child was treated under GA or LA. Severe caries affects the quality of life of preschool children and improvement on quality of life is significant regardless of treatment performed under GA or LA.

  18. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population

    DEFF Research Database (Denmark)

    Jørgensen, Torben; Jacobsen, Rikke Kart; Toft, Ulla

    2014-01-01

    of Copenhagen, Denmark PARTICIPANTS: 59 616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n=11 629) and a control group (n=47 987). INTERVENTION: The intervention group was invited for screening, risk assessment, and lifestyle counselling up to four...... of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening. MAIN......OBJECTIVE: To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level. DESIGN: Randomised controlled community based trial. SETTING: Suburbs...

  19. Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population

    DEFF Research Database (Denmark)

    Jørgensen, Torben; Jacobsen, Rikke Kart; Toft, Ulla

    2014-01-01

    of Copenhagen, Denmark. PARTICIPANTS: 59,616 people aged 30-60 years randomised with different age and sex randomisation ratios to an intervention group (n = 11,629) and a control group (n = 47,987). INTERVENTION: The intervention group was invited for screening, risk assessment, and lifestyle counselling up...... sessions of group based lifestyle counselling on smoking cessation, diet, and physical activity. After five years all were invited for a final counselling session. Participants were referred to their general practitioner for medical treatment, if relevant. The control group was not invited for screening......OBJECTIVE: To investigate the effect of systematic screening for risk factors for ischaemic heart disease followed by repeated lifestyle counselling on the 10 year development of ischaemic heart disease at a population level. DESIGN: Randomised controlled community based trial. SETTING: Suburbs...

  20. A generalized-growth model to characterize the early ascending phase of infectious disease outbreaks

    DEFF Research Database (Denmark)

    Viboud, Cecile; Simonsen, Lone; Chowell, Gerardo

    2016-01-01

    the importance of sub-exponential growth for forecasting purposes.Results: We applied the generalized-growth model to 20 infectious disease outbreaks representing a range of transmission routes. We uncovered epidemic profiles ranging from very slow growth (p = 0.14 for the Ebola outbreak in Bomi, Liberia (2014...... African Ebola epidemic provided a unique opportunity to explore how growth profiles vary by geography; analysis of the largest district-level outbreaks revealed substantial growth variations (mean p = 0.59, range: 0.14–0.97). The districts of Margibi in Liberia and Bombali and Bo in Sierra Leone had near......-exponential growth, while the districts of Bomi in Liberia and Kenema in Sierra Leone displayed near constant incidences.Conclusions: Our findings reveal significant variation in epidemic growth patterns across different infectious disease outbreaks and highlights that sub-exponential growth is a common phenomenon...

  1. Spatial statistical analysis of basal stem root disease under natural field epidemic of oil palm

    Science.gov (United States)

    Kamu, Assis; Phin, Chong Khim; Seman, Idris Abu; Wan, Hoong Hak; Mun, Ho Chong

    2015-02-01

    Oil palm or scientifically known as Elaeis guineensis Jacq. is the most important commodity crop in Malaysia and has greatly contributed to the economy growth of the country. As far as disease is concerned in the industry, Basal Stem Rot (BSR) caused by Ganoderma boninence remains the most important disease. BSR disease is the most widely studied with information available for oil palm disease in Malaysia. However, there is still limited study on the spatial as well as temporal pattern or distribution of the disease especially under natural field epidemic condition in oil palm plantation. The objective of this study is to spatially identify the pattern of BSR disease under natural field epidemic using two geospatial analytical techniques, which are quadrat analysis for the first order properties of partial pattern analysis and nearest-neighbor analysis (NNA) for the second order properties of partial pattern analysis. Two study sites were selected with different age of tree. Both sites are located in Tawau, Sabah and managed by the same company. The results showed that at least one of the point pattern analysis used which is NNA (i.e. the second order properties of partial pattern analysis) has confirmed the disease is complete spatial randomness. This suggests the spread of the disease is not from tree to tree and the age of palm does not play a significance role in determining the spatial pattern of the disease. From the spatial pattern of the disease, it would help in the disease management program and for the industry in the future. The statistical modelling is expected to help in identifying the right model to estimate the yield loss of oil palm due to BSR disease in the future.

  2. Generalized Euler-Lagrange Equations for Fuzzy Fractional Variational Problems under gH-Atangana-Baleanu Differentiability

    Directory of Open Access Journals (Sweden)

    Jianke Zhang

    2018-01-01

    Full Text Available We study in this paper the Atangana-Baleanu fractional derivative of fuzzy functions based on the generalized Hukuhara difference. Under the condition of gH-Atangana-Baleanu fractional differentiability, we prove the generalized necessary and sufficient optimality conditions for problems of the fuzzy fractional calculus of variations with a Lagrange function. The new kernel of gH-Atangana-Baleanu fractional derivative has no singularity and no locality, which was not precisely illustrated in the previous definitions.

  3. Distrust As a Disease Avoidance Strategy: Individual Differences in Disgust Sensitivity Regulate Generalized Social Trust.

    Science.gov (United States)

    Aarøe, Lene; Osmundsen, Mathias; Petersen, Michael Bang

    2016-01-01

    Throughout human evolutionary history, cooperative contact with others has been fundamental for human survival. At the same time, social contact has been a source of threats. In this article, we focus on one particular viable threat, communicable disease, and investigate how motivations to avoid pathogens influence people's propensity to interact and cooperate with others, as measured by individual differences in generalized social trust. While extant studies on pathogen avoidance have argued that such motivations should prompt people to avoid interactions with outgroups specifically, we argue that these motivations should prompt people to avoid others more broadly. Empirically, we utilize two convenience samples and a large nationally representative sample of US citizens to demonstrate the existence of a robust and replicable effect of individual differences in pathogen disgust sensitivity on generalized social trust. We furthermore compare the effects of pathogen disgust sensitivity on generalized social trust and outgroup prejudice and explore whether generalized social trust to some extent constitutes a pathway between pathogen avoidance motivations and prejudice.

  4. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  5. WrpA Is an Atypical Flavodoxin Family Protein under Regulatory Control of the Brucella abortus General Stress Response System

    Energy Technology Data Exchange (ETDEWEB)

    Herrou, Julien; Czyż, Daniel M.; Willett, Jonathan W.; Kim, Hye-Sook; Chhor, Gekleng; Babnigg, Gyorgy; Kim, Youngchang; Crosson, Sean; Stock, A. M.

    2016-02-08

    high structural homology with canonical WrbA proteins, we propose thatB. abortusWrpA represents a functionally distinct member of the diverse flavodoxin family.

    IMPORTANCEBrucella abortusis an etiological agent of brucellosis, which is among the most common zoonotic diseases worldwide. The general stress response (GSR) regulatory system ofB. abortuscontrols the transcription of approximately 100 genes and is required for maintenance of chronic infection in a murine model; the majority of GSR-regulated genes remain uncharacterized. We presentin vitroandin vivofunctional and structural analyses of WrpA, whose expression is strongly induced by GSR under oxidative conditions. Though WrpA is structurally related to NADH:quinone oxidoreductases, it does not bind redox cofactors in solution, nor does it exhibit oxidoreductase activityin vitro. However, WrpA does affect spleen inflammation in a murine infection model. Our data provide evidence that WrpA forms a new functional class of WrbA/flavodoxin family proteins.

  6. The Peripheral Arterial disease study (PERART/ARTPER: prevalence and risk factors in the general population

    Directory of Open Access Journals (Sweden)

    Vicheto Marisa

    2010-01-01

    Full Text Available Abstract Background The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease. The aim of the study is to know the prevalence and associated risk factors of peripheral arterial disease in the general population. Methods We performed a cross-sectional, multicentre, population-based study in 3786 individuals >49 years, randomly selected in 28 primary care centres in Barcelona (Spain. Peripheral arterial disease was evaluated using the ankle-arm index. Values Results The prevalence (95% confidence interval of peripheral arterial disease was 7.6% (6.7-8.4, (males 10.2% (9.2-11.2, females 5.3% (4.6-6.0; p Multivariate analysis showed the following risk factors: male sex [odds ratio (OR 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44; inability to perform physical activity [OR 1.77 (1.17-2.68 for mild limitation to OR 7.08 (2.61-19.16 for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58 for former smokers and OR 3.83 (2.23-6.58 for current smokers]; hypertension OR 1.85 (1.29-2.65; diabetes OR 2.01 (1.42-2.83; previous cardiovascular disease OR 2.19 (1.52-3.15; hypercholesterolemia OR 1.55 (1.11-2.18; hypertriglyceridemia OR 1.55 (1.10-2.19. Body mass index ≥25 Kg/m2 OR 0.57 (0.38-0.87 and walking >7 hours/week OR 0.67 (0.49-0.94 were found as protector factors. Conclusions The prevalence of peripheral arterial disease is low, higher in males and increases with age in both sexes. In addition to previously described risk factors we found a protector effect in physical exercise and overweight.

  7. Several factors influenced general practitioner participation in the implementation of a disease management programme.

    Science.gov (United States)

    Ribe, Anette Riisgaard; Fenger-Grøn, Morten; Vedsted, Peter; Bro, Flemming; Kærsvang, Lone; Vestergaard, Mogens

    2014-09-01

    Disease management programmes (DMPs) require a high degree of participation from general practitioners (GPs) in order to succeed. We aimed to describe the participation among Danish GPs in a DMP. A quality improvement project entitled the Chronic Care Compass (CCC) was introduced in 2010 by the Central Denmark Region. The project was based on DMPs targeting persons suffering from three chronic diseases (diabetes, chronic obstructive pulmonary disease and acute coronary syndrome). All GPs in the region were invited to participate. We obtained data from administrative registries and studied the participation and its association with characteristics of practices and patients. Differences in participation were assessed using binomial regression models. A total of 271 (69.1%) practices participated in the CCC. The participation was 28.9 percentage points (pp) (confidence interval (CI): 14.3; 43.6) lower among GPs who were older than 60 years versus younger than 50 years, 32.2 pp (CI: 19.1; 45.2) lower among GPs who provided few versus many chronic care consultations, 13.7 pp (CI: 1.7; 25.6) lower among GPs with lower versus medium practice gross income, and 16.9 pp (CI:6.1; 27.8) lower among GPs with a patient population with medium versus low degree of socio-economic deprivation. Participation in the CCC was lower among GPs who provided less chronic care, had a lower practice gross income and had a patient population with a higher degree of deprivation. The project was supported by the Research Unit for General Practice, Aarhus University, and the Lundbeck Foundation. not relevant.

  8. Changes in some coronary disease risk factors under influence of treatment with Swieradow radon waters

    Energy Technology Data Exchange (ETDEWEB)

    Szczeklik, E; Halawa, B; Kwiatkowski, J

    1977-01-01

    In 66 patients subbivided into group of patients with coronary disease and group of control subjects the effect of radioactive waterbath and climatotherapy in Swieradow upon coronary disease risk factors was studied. The following risk factors were taken into account: cholesterol level, triglicerides, LDL, uric acid, the serum glucose level, arterial tension and weight. The results obtained indicate that the therapy with radon waters of Swieradow complexed with climatotherapy decreases the content of some coronary disease risk factors. The decrease of the urin acid in the serum, the lowering of arterial tension and decrease of body weight was noted. The lipid level in the serum did not change under effect of radioactive waters.

  9. Proteins Encoded in Genomic Regions Associated with Immune-Mediated Disease Physically Interact and Suggest Underlying Biology

    Science.gov (United States)

    Rossin, Elizabeth J.; Lage, Kasper; Raychaudhuri, Soumya; Xavier, Ramnik J.; Tatar, Diana; Benita, Yair

    2011-01-01

    Genome-wide association studies (GWAS) have defined over 150 genomic regions unequivocally containing variation predisposing to immune-mediated disease. Inferring disease biology from these observations, however, hinges on our ability to discover the molecular processes being perturbed by these risk variants. It has previously been observed that different genes harboring causal mutations for the same Mendelian disease often physically interact. We sought to evaluate the degree to which this is true of genes within strongly associated loci in complex disease. Using sets of loci defined in rheumatoid arthritis (RA) and Crohn's disease (CD) GWAS, we build protein–protein interaction (PPI) networks for genes within associated loci and find abundant physical interactions between protein products of associated genes. We apply multiple permutation approaches to show that these networks are more densely connected than chance expectation. To confirm biological relevance, we show that the components of the networks tend to be expressed in similar tissues relevant to the phenotypes in question, suggesting the network indicates common underlying processes perturbed by risk loci. Furthermore, we show that the RA and CD networks have predictive power by demonstrating that proteins in these networks, not encoded in the confirmed list of disease associated loci, are significantly enriched for association to the phenotypes in question in extended GWAS analysis. Finally, we test our method in 3 non-immune traits to assess its applicability to complex traits in general. We find that genes in loci associated to height and lipid levels assemble into significantly connected networks but did not detect excess connectivity among Type 2 Diabetes (T2D) loci beyond chance. Taken together, our results constitute evidence that, for many of the complex diseases studied here, common genetic associations implicate regions encoding proteins that physically interact in a preferential manner, in

  10. COMPLICATIONS OF ORAL AND MAXILLOFACIAL SURGERY UNDER GENERAL ANESTHESIA IN TUBE-FED CHILDREN: A RETROSPECTIVE ANALYSIS.

    Science.gov (United States)

    Nguyen, Trang D; Freilich, Marshall M; Macpherson, Bruce A

    2016-06-01

    To assess morbidity and mortality associated with oral and maxillofacial surgery procedures requiring general anesthesia among children with aspiration tendency requiring enteral feeding. A retrospective chart review was conducted of children surgically treated under general anesthesia by the oral and maxillofacial surgery service at the Hospital for Sick Children in Toronto, Canada. Medical and dental records over a 9-year period (January 1, 2000 to January 1, 2010) were reviewed. Data were collected on demographics, primary illness, coexisting medical conditions, procedures performed, medications administered, type of airway management used, duration of general anesthesia, American Society of Anesthesiologists' physical status classification and adverse events. During the period reviewed, 28 children underwent 35 oral and maxillofacial surgery procedures under general anesthesia. The mean patient age was 12 years (range 4-17 years). No deaths occurred. Of the 35 surgeries, 10 (29%) were associated with at least 1adverse event. Adverse events included 1incident of respiratory distress, 2incidents of fever, 5incidents of bleeding, 1incident of seizure and 4incidents of oxygen saturation below 90% for more than 30s. Children with a history of aspiration tendency that necessitates enteral feeding, who undergo oral and maxillofacial surgery under general anesthesia, are at increased risk of morbidity. Before initiating treatment, the surgeon and parents or guardians of such children should carefully consider these risks compared with the anticipated benefit of surgery.

  11. Rapid detoxification from opioid dependence under general anaesthesia versus standard methadone tapering : abstinence rates and withdrawal distress experiences

    NARCIS (Netherlands)

    Krabbe, Paul F M; Koning, Jeroen P F; Heinen, Nadia; Laheij, Robert J F; van Cauter, R M Victory; De Jong, Cor A J

    The aim of this work was to study abstinence rates and withdrawal effects of rapid detoxification of opioid-dependents under general anaesthesia (RD-GA) compared to standard methadone tapering (SMT) using a prospective clinical trial with a follow-up of 3 months, as a preliminary study at the

  12. Rapid detoxification from opioid dependence under general anaesthesia versus standard methadone tapering: abstinence rates and withdrawal distress experiences.

    NARCIS (Netherlands)

    Krabbe, P.F.M.; Koning, J.P.; Heinen, N.; Laheij, R.J.F.; Cauter, R.M.V. van; Jong, C.A.J. de

    2003-01-01

    The aim of this work was to study abstinence rates and withdrawal effects of rapid detoxification of opioid-dependents under general anaesthesia (RD-GA) compared to standard methadone tapering (SMT) using a prospective clinical trial with a follow-up of 3 months, as a preliminary study at the

  13. Awake craniotomy versus craniotomy under general anesthesia for the surgical treatment of insular glioma: choices and outcomes

    NARCIS (Netherlands)

    Gravesteijn, B.Y. (B. Y.); Keizer, M.E. (M. E.); A. Vincent (Audrey); J.W. Schouten (Joost); R.J. Stolker (Robert); M. Klimek (Markus)

    2017-01-01

    textabstractObjective: To investigate differences in outcomes in patients who underwent surgery for insular glioma using an awake craniotomy (AC) vs. a craniotomy under general anesthesia (GA). Methods: Data from patients treated at our hospital between 2005 and 2015 were analyzed retrospectively.

  14. Strategic directions for developing the Australian general practice nurse role in cardiovascular disease management.

    Science.gov (United States)

    Halcomb, Elizabeth J; Davidson, Patricia M; Yallop, Julie; Griffiths, Rhonda; Daly, John

    2007-08-01

    Practice nursing is an integral component of British and New Zealand primary care, but in Australia it remains an emerging specialty. Despite an increased focus on the Australian practice nurse role, there has been limited strategic role development, particularly relating to national health priority areas. This paper reports the third stage of a Project exploring the Australian practice nurse role in the management of cardiovascular disease (CVD). This stage involved a consensus development conference, undertaken to identify strategic, priority recommendations for practice nurse role development. 1. Practice nurses have an important role in developing systems and processes for CVD management; 2. A change in the culture of general practice is necessary to promote acceptance of nurse-led CVD management; 3. Future research needs to evaluate specific models of care, incorporating outcome measures sensitive to nursing interventions; 4. Considerable challenges exist in conducting research in general practice; and 5. Changes in funding models are necessary for widespread practice nurse role development. The shifting of funding models provides evidence to support interdisciplinary practice in Australian general practice. The time is ripe, therefore, to engage in prospective and strategic planning to inform development of the practice nurse role.

  15. Vascular disease in women: comparison of diagnoses in hospital episode statistics and general practice records in England

    Directory of Open Access Journals (Sweden)

    Wright F

    2012-10-01

    Full Text Available Abstract Background Electronic linkage to routine administrative datasets, such as the Hospital Episode Statistics (HES in England, is increasingly used in medical research. Relatively little is known about the reliability of HES diagnostic information for epidemiological studies. In the United Kingdom (UK, general practitioners hold comprehensive records for individuals relating to their primary, secondary and tertiary care. For a random sample of participants in a large UK cohort, we compared vascular disease diagnoses in HES and general practice records to assess agreement between the two sources. Methods Million Women Study participants with a HES record of hospital admission with vascular disease (ischaemic heart disease [ICD-10 codes I20-I25], cerebrovascular disease [G45, I60-I69] or venous thromboembolism [I26, I80-I82] between April 1st 1997 and March 31st 2005 were identified. In each broad diagnostic group and in women with no such HES diagnoses, a random sample of about a thousand women was selected for study. We asked each woman’s general practitioner to provide information on her history of vascular disease and this information was compared with the HES diagnosis record. Results Over 90% of study forms sent to general practitioners were returned and 88% of these contained analysable data. For the vast majority of study participants for whom information was available, diagnostic information from general practice and HES records was consistent. Overall, for 93% of women with a HES diagnosis of vascular disease, general practice records agreed with the HES diagnosis; and for 97% of women with no HES diagnosis of vascular disease, the general practitioner had no record of a diagnosis of vascular disease. For severe vascular disease, including myocardial infarction (I21-22, stroke, both overall (I60-64 and by subtype, and pulmonary embolism (I26, HES records appeared to be both reliable and complete. Conclusion Hospital admission data

  16. Application of a uniform anatomic grading system to measure disease severity in eight emergency general surgical illnesses.

    Science.gov (United States)

    Crandall, Marie L; Agarwal, Suresh; Muskat, Peter; Ross, Steven; Savage, Stephanie; Schuster, Kevin; Tominaga, Gail T; Shafi, Shahid

    2014-11-01

    Emergent general surgical diseases encompass a broad spectrum of anatomy and pathophysiology, creating challenges for outcomes assessment, research, and surgical training. The goal of this study was to measure anatomic disease severity for eight emergent general surgical diseases using the uniform grading system of the American Association for the Surgery of Trauma (AAST). The Committee on Patient Assessment and Outcomes of AAST applied the previously developed uniform grading system to eight emergent general surgical diseases using a consensus of experts. It was then reviewed and approved by the Board of Managers of AAST. Severity grades for eight commonly encountered emergent general surgical conditions were created: breast abscess, esophageal perforation, infectious colitis, pelvic inflammatory disease, perirectal abscess, pleural space infections, soft tissue infections, and surgical site infections. The range of grades from I through V, reflect progression from mild disease, limited to within the organ itself, to widespread severe disease. This article provides a uniform grading system for measuring anatomic severity of eight emergent general surgical diseases. Consistent adoption of these grades could improve standardization for quality assurance, outcomes research, and surgical training.

  17. Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report.

    Science.gov (United States)

    Shariyate, Mohammad J; Kachooei, Amir R; Ebrahimzadeh, Mohammad H

    2017-11-01

    The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.

  18. Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad J. Shariati

    2017-11-01

    Full Text Available The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.

  19. Tension pneumothorax during peroral endoscopic myotomy for treatment of esophageal achalasia under general anesthesia

    Directory of Open Access Journals (Sweden)

    Tsung-Shih Li

    Full Text Available Abstract More and more endoscopically gastrointestinal procedures require anesthesiologists to perform general anesthesia, such as "peroral endoscopic myotomy". Peroral endoscopic myotomy is a novel invasive treatment for the primary motility disorder of esophagus, called esophageal achalasia. Despite of its minimally invasive feature, there are still complications during the procedure which develop to critical conditions and threat patients’ lives. Herein we describe a case about tension pneumothorax subsequent to esophageal rupture during peroral endoscopic myotomy. The emergent management of the complication is stated in detail. The pivotal points of general anesthesia for patients undergoing peroral endoscopic myotomy are emphasized and discussed. Also, intraoperative and post-operative complications mentioned by literature are integrated.

  20. A general formula considering one group delayed neutron under nonequilibrium condition

    International Nuclear Information System (INIS)

    Li Haofeng; Chen Wenzhen; Zhu Qian; Luo Lei

    2008-01-01

    A general neutron breeder formula is developed when the reactor does not reach the steady state and the reactivity changes in phase. This formula can be used to calculate the results of six groups delayed neutron model through a way of amending λ in one group delayed neutron model. The analysis shows that the solution of amended single group delayed neutron model is approximately equal to that of six-group delayed neutron model, and the amended model meets the engineering accuracy. (authors)

  1. What Differentiates Employees' Job Performance Under Stressful Situations: The Role of General Self-Efficacy.

    Science.gov (United States)

    Lu, Chang-Qin; Du, Dan-Yang; Xu, Xiao-Min

    2016-10-02

    The aim of this research is to verify the two-dimensional challenge-hindrance stressor framework in the Chinese context, and investigate the moderating effect of general self-efficacy in the stress process. Data were collected from 164 Chinese employee-supervisor dyads. The results demonstrated that challenge stressors were positively related to job performance while hindrance stressors were negatively related to job performance. Furthermore, general self-efficacy strengthened the positive relationship between challenge stressors and job performance, whereas the attenuating effect of general self-efficacy on the negative relationship between hindrance stressors and job performance was nonsignificant. These findings qualify the two-dimensional challenge-hindrance stressor framework, and support the notion that employees with high self-efficacy benefit more from the positive effect of challenge stressors in the workplace. By investigating the role of an individual difference variable in the challenge-hindrance stressor framework, this research provides a more accurate picture of the nature of job stress, and enhances our understanding of the job stressor-job performance relationship.

  2. Genome Sequencing Reveals Loci under Artificial Selection that Underlie Disease Phenotypes in the Laboratory Rat

    NARCIS (Netherlands)

    Atanur, Santosh S.; Diaz, Ana Garcia; Maratou, Klio; Sarkis, Allison; Rotival, Maxime; Game, Laurence; Tschannen, Michael R.; Kaisaki, Pamela J.; Otto, Georg W.; Ma, Man Chun John; Keane, Thomas M.; Hummel, Oliver; Saar, Kathrin; Chen, Wei; Guryev, Victor; Gopalakrishnan, Kathirvel; Garrett, Michael R.; Joe, Bina; Citterio, Lorena; Bianchi, Giuseppe; McBride, Martin; Dominiczak, Anna; Adams, David J.; Serikawa, Tadao; Flicek, Paul; Cuppen, Edwin; Hubner, Norbert; Petretto, Enrico; Gauguier, Dominique; Kwitek, Anne; Jacob, Howard; Aitman, Timothy J.

    2013-01-01

    Large numbers of inbred laboratory rat strains have been developed for a range of complex disease phenotypes. To gain insights into the evolutionary pressures underlying selection for these phenotypes, we sequenced the genomes of 27 rat strains, including 11 models of hypertension, diabetes, and

  3. Unraveling the mechanisms underlying postural instability in Parkinson's disease using dynamic posturography

    NARCIS (Netherlands)

    Nonnekes, J.H.; Kam, D. de; Geurts, A.C.; Weerdesteijn, V.G.M.; Bloem, B.R.

    2013-01-01

    Postural instability, one of the cardinal symptoms of Parkinson's disease (PD), has devastating consequences for affected patients. Better strategies to prevent falls are needed, but this calls for an improved understanding of the complex mechanisms underlying postural instability. We must also

  4. TRIB1 and GCKR polymorphisms, lipid levels, and risk of ischemic heart disease in the general population

    DEFF Research Database (Denmark)

    Varbo, Anette; Benn, Marianne; Tybjærg-Hansen, Anne

    2011-01-01

    The goal of this study was to test whether TRIB1-rs2954029 and GCKR-rs1260326 associate with lipid levels and risk of ischemic heart disease (IHD) and myocardial infarction (MI) in the general population.......The goal of this study was to test whether TRIB1-rs2954029 and GCKR-rs1260326 associate with lipid levels and risk of ischemic heart disease (IHD) and myocardial infarction (MI) in the general population....

  5. Clinical Analysis of Analgesics and Steroids Use for Extraction of Teeth in Patients with Intellectual Disability Under General Anesthesia.

    Science.gov (United States)

    Maeda, Shigeru; Honda, Yuka; Tanimura, Hiroshi; Tomoyasu, Yumiko; Higuchi, Hitoshi; Murata, Naomichi; Egusa, Masahiko; Miyawaki, Takuya

    2017-01-01

    The extraction of lower wisdom teeth is often performed under general anesthesia in patients with intellectual disabilities. However, the choice of analgesics has not yet been investigated. To analyze the use of analgesics during general anesthesia for extraction including lower wisdom teeth in patients with intellectual disabilities. This research is a retrospective observational study. The study population was composed of all patients presenting for extraction of lower wisdom teeth under ambulatory general anesthesia in the clinic of Special Needs Dentistry in Okayama University Hospital from April 2011 to March 2016. The distribution of the combination of analgesics and the relationship between the use of analgesics and the type of extraction were investigated. One hundred and twelve cases were enrolled in this study. Intravenous injections of flurbiprofen, acetaminophen and betamethasone were used in 96 (85.7%), 12 (10.7%) and 26 cases (23.2%), respectively. Flurbiprofen is a non-steroid anti-inflammatory drugs (NSAIDs). Acetaminophen is an old analgesic, but an injection of acetaminophen is new, which was released in 2013 in Japan. And betamethasone is not an analgesic, but a steroid. Betamethasone was used in combination with other analgesics, and was used at a higher dose in a case in which four wisdom teeth were extracted. Flurbiprofen was the main analgesic used for extraction of wisdom teeth under general anesthesia in patients with intellectual disabilities. Betamethasone was used to support flurbiprofen or acetaminophen for extractions of multiple wisdom teeth, with the aim of controlling swelling rather than relieving pain.

  6. Chronic disease management in general practice: results from a national study.

    Science.gov (United States)

    Darker, C; Martin, C; O'Dowd, T; O'Kelly, F; O'Shea, B

    2012-04-01

    The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380/527).The majority of GPs (240/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267/380; 71%), asthma / COPD (279/380; 74%) and hypertension (297/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379/380; 99%), lack of appropriate funding (286/380; 76%), with GPs interested in targeted payments (244/380; 68%). This study provides baseline data to assess future changes in CDM.

  7. Chronic disease management in general practice: results from a national study.

    LENUS (Irish Health Repository)

    Darker, C

    2012-04-01

    The aim of this study was to provide baseline data on chronic disease management (CDM) provision in Irish general practice (GP). The survey instrument was previously used in a study of primary care physicians in 11 countries, thus allowing international comparisons. The response rate was 72% (380\\/527).The majority of GPs (240\\/380; 63%) reported significant changes are needed in our health care system to make CDM work better. Small numbers of routine clinical audits are being performed (95\\/380; 25%). Irish GPs use evidence based guidelines for treatment of diabetes (267\\/380; 71%), asthma \\/ COPD (279\\/380; 74%) and hypertension (297\\/380; 79%), to the same extent as international counterparts. Barriers to delivering chronic care include increased workload (379\\/380; 99%), lack of appropriate funding (286\\/380; 76%), with GPs interested in targeted payments (244\\/380; 68%). This study provides baseline data to assess future changes in CDM.

  8. Internal thermotopography and shifts in general thermal balance in man under special heat transfer conditions

    Science.gov (United States)

    Gorodinskiy, S. M.; Gramenitskiy, P. M.; Kuznets, Y. I.; Ozerov, O. Y.; Yakovleva, E. V.; Groza, P.; Kozlovskiy, S.; Naremski, Y.

    1974-01-01

    Thermal regulation for astronauts working in pressure suits in open space provides for protection by a system of artificial heat removal and compensation to counteract possible changes in the heat regulating function of the human body that occur under the complex effects of space flight conditions. Most important of these factors are prolonged weightlessness, prolonged limitation of motor activity, and possible deviations of microclimatic environmental parameters.

  9. Estimation and model selection of semiparametric multivariate survival functions under general censorship.

    Science.gov (United States)

    Chen, Xiaohong; Fan, Yanqin; Pouzo, Demian; Ying, Zhiliang

    2010-07-01

    We study estimation and model selection of semiparametric models of multivariate survival functions for censored data, which are characterized by possibly misspecified parametric copulas and nonparametric marginal survivals. We obtain the consistency and root- n asymptotic normality of a two-step copula estimator to the pseudo-true copula parameter value according to KLIC, and provide a simple consistent estimator of its asymptotic variance, allowing for a first-step nonparametric estimation of the marginal survivals. We establish the asymptotic distribution of the penalized pseudo-likelihood ratio statistic for comparing multiple semiparametric multivariate survival functions subject to copula misspecification and general censorship. An empirical application is provided.

  10. Frequency-dependent failure mechanisms of nanocrystalline gold interconnect lines under general alternating current

    Science.gov (United States)

    Luo, X. M.; Zhang, B.; Zhang, G. P.

    2014-09-01

    Thermal fatigue failure of metallization interconnect lines subjected to alternating currents (AC) is becoming a severe threat to the long-term reliability of micro/nanodevices with increasing electrical current density/power. Here, thermal fatigue failure behaviors and damage mechanisms of nanocrystalline Au interconnect lines on the silicon glass substrate have been investigated by applying general alternating currents (the pure alternating current coupled with a direct current (DC) component) with different frequencies ranging from 0.05 Hz to 5 kHz. We observed both thermal fatigue damages caused by Joule heating-induced cyclic strain/stress and electromigration (EM) damages caused by the DC component. Besides, the damage formation showed a strong electrically-thermally-mechanically coupled effect and frequency dependence. At lower frequencies, thermal fatigue damages were dominant and the main damage forms were grain coarsening with grain boundary (GB) cracking/voiding and grain thinning. At higher frequencies, EM damages took over and the main damage forms were GB cracking/voiding of smaller grains and hillocks. Furthermore, the healing effect of the reversing current was considered to elucidate damage mechanisms of the nanocrystalline Au lines generated by the general AC. Lastly, a modified model was proposed to predict the lifetime of the nanocrystalline metal interconnect lines, i.e., that was a competing drift velocity-based approach based on the threshold time required for reverse diffusion/healing to occur.

  11. Non-linear general instability of ring-stiffened conical shells under external hydrostatic pressure

    International Nuclear Information System (INIS)

    Ross, C T F; Kubelt, C; McLaughlin, I; Etheridge, A; Turner, K; Paraskevaides, D; Little, A P F

    2011-01-01

    The paper presents the experimental results for 15 ring-stiffened circular steel conical shells, which failed by non-linear general instability. The results of these investigations were compared with various theoretical analyses, including an ANSYS eigen buckling analysis and another ANSYS analysis; which involved a step-by-step method until collapse; where both material and geometrical nonlinearity were considered. The investigation also involved an analysis using BS5500 (PD 5500), together with the method of Ross of the University of Portsmouth. The ANSYS eigen buckling analysis tended to overestimate the predicted buckling pressures; whereas the ANSYS nonlinear results compared favourably with the experimental results. The PD5500 analysis was very time consuming and tended to grossly underestimate the experimental buckling pressures and in some cases, overestimate them. In contrast to PD5500 and ANSYS, the design charts of Ross of the University of Portsmouth were the easiest of all these methods to use and generally only slightly underestimated the experimental collapse pressures. The ANSYS analyses gave some excellent graphical displays.

  12. Generalized transmission line method to study the far-zone radiation of antennas under a multilayer structure

    CERN Document Server

    Wu, Xuan Hui

    2008-01-01

    This book gives a step-by-step presentation of a generalized transmission line method to study the far-zone radiation of antennas under a multilayer structure. Normally, a radiation problem requires a full wave analysis which may be time consuming. The beauty of the generalized transmission line method is that it transforms the radiation problem for a specific type of structure, say the multilayer structure excited by an antenna, into a circuit problem that can be efficiently analyzed. Using the Reciprocity Theorem and far-field approximation, the method computes the far-zone radiation due to

  13. Computer templates in chronic disease management: ethnographic case study in general practice.

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

    2012-01-01

    To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry-an approach called linguistic ethnography. Two general practices in England. Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients' stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient-as 'individual' or as 'one of a population'. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work

  14. Barriers and facilitators to opportunistic chronic kidney disease screening by general practice nurses.

    Science.gov (United States)

    Sinclair, Peter M; Day, Jenny; Levett-Jones, Tracy; Kable, Ashley

    2017-10-01

    Opportunistic screening in general practice (GP) is a cost-effective and viable approach to the early identification of chronic kidney disease (CKD). This study sought to identify the barriers and facilitators to CKD screening practices of GP nurses working in a regional area of New South Wales, Australia. An eight-item elicitation questionnaire informed by the Theory of Planned Behaviour was administered to a convenience sample of 26 GP nurses. Participants identified that the advantages of CKD screening were its early detection and treatment, the reduction of disease burden, and the opportunity to increase awareness and provide disease prevention education. These positive attitudinal beliefs were offset by negative beliefs about the impost of opportunistic screening on nursing time, particularly when there were other competing clinical priorities. Participants reported that practice doctors were wary of the financial costs associated with additional non-claimable services and believed that unfunded services, regardless of patient benefit, were difficult to justify in a private business environment. Screening was enabled in GP settings with existing screening protocols or initiatives, and when patients presented with known risk factors. Barriers to screening were more frequently described and illustrated a strong focus on financial aspects of GP. Without reimbursement through the Medicare Benefits Scheme, screening was not considered an economical use of nursing time. Other competing and billable clinical services took precedence. The findings of this study can be used to inform the development and evaluation of interventions that target opportunistic CKD screening in the GP setting. © 2016 Asian Pacific Society of Nephrology.

  15. General practitioners' perspectives on management of early-stage chronic kidney disease: a focus group study.

    Science.gov (United States)

    van Dipten, Carola; van Berkel, Saskia; de Grauw, Wim J C; Scherpbier-de Haan, Nynke D; Brongers, Bouke; van Spaendonck, Karel; Wetzels, Jack F M; Assendelft, Willem J J; Dees, Marianne K

    2018-06-06

    Guideline adherence in chronic kidney disease management is low, despite guideline implementation initiatives. Knowing general practitioners' (GPs') perspectives of management of early-stage chronic kidney disease (CKD) and the applicability of the national interdisciplinary guideline could support strategies to improve quality of care. Qualitative focus group study with 27 GPs in the Netherlands. Three analysts open-coded and comparatively analysed the data. Mind-mapping sessions were performed after data-saturation. Five themes emerged: defining CKD, knowledge and awareness, patient-physician interaction, organisation of CKD care and value of the guideline. A key finding was the abstractness of the CKD concept. The GPs expressed various perspectives about defining CKD and interpreting estimated glomerular filtration rates. Views about clinical relevance influenced the decision-making, although factual knowledge seems lacking. Striving to inform well enough without creating anxiety and to explain suitably for the intellectual ability of the patient caused tension in the patient-physician interaction. Integration with cardiovascular disease-management programmes was mentioned as a way of implementing CKD care in the future. The guideline was perceived as a rough guide rather than a leading document. CKD is perceived as an abstract rather than a clinical concept. Abstractness plays a role in all formulated themes. Management of CKD patients in primary care is complex and is influenced by physician-bound considerations related to individual knowledge and perception of the importance of CKD. Strategies are needed to improve GPs' understanding of the concept of CKD by education, a holistic approach to guidelines, and integration of CKD care into cardiovascular programmes. Not applicable.

  16. General practitioners′ knowledge and approach to chronic kidney disease in Karachi, Pakistan

    Directory of Open Access Journals (Sweden)

    S Yaqub

    2013-01-01

    Full Text Available Due to lack of adequate number of formally trained nephrologists, many patients with chronic kidney disease (CKD are seen by general practitioners (GPs. This study was designed to assess the knowledge of the GPs regarding identification of CKD and its risk factors, and evaluation and management of risk factors as well as complications of CKD. We conducted a cross-sectional survey of 232 randomly selected GPs from Karachi during 2011. Data were collected on a structured questionnaire based on the kidney disease outcomes and quality initiative recommendations on screening, diagnosis, and management of CKD. A total of 235 GPs were approached, and 232 consented to participate. Mean age was 38.5 ± 11.26 years; 56.5% were men. Most of the GPs knew the traditional risk factors for CKD, i.e., diabetes (88.4% and hypertension (80%, but were less aware of other risk factors. Only 38% GPs were aware of estimated glomerular filtration rate in evaluation of patients with CKD. Only 61.6% GPs recognized CKD as a risk factor for cardiovascular disease. About 40% and 29% GPs knew the correct goal systolic and diastolic blood pressure, respectively. In all, 41% GPs did not know when to refer the patient to a nephrologist. Our survey identified specific gaps in knowledge and approach of GPs regarding diagnosis and management of CKD. Educational efforts are needed to increase awareness of clinical practice guidelines and recommendations for patients with CKD among GPs, which may improve management and clinical outcomes of this population.

  17. Person-Based Versus Generalized Impulsivity Disinhibition in Frontotemporal Dementia and Alzheimer Disease.

    Science.gov (United States)

    Paholpak, Pongsatorn; Carr, Andrew R; Barsuglia, Joseph P; Barrows, Robin J; Jimenez, Elvira; Lee, Grace J; Mendez, Mario F

    2016-09-19

    While much disinhibition in dementia results from generalized impulsivity, in behavioral variant frontotemporal dementia (bvFTD) disinhibition may also result from impaired social cognition. To deconstruct disinhibition and its neural correlates in bvFTD vs. early-onset Alzheimer's disease (eAD). Caregivers of 16 bvFTD and 21 matched-eAD patients completed the Frontal Systems Behavior Scale disinhibition items. The disinhibition items were further categorized into (1) "person-based" subscale which predominantly associated with violating social propriety and personal boundary and (2) "generalized-impulsivity" subscale which included nonspecific impulsive acts. Subscale scores were correlated with grey matter volumes from tensor-based morphometry on magnetic resonance images. In comparison to the eAD patients, the bvFTD patients developed greater person-based disinhibition (P dementia, violations of social propriety and personal boundaries involved fronto-parieto-temporal network of Theory of Mind, whereas nonspecific disinhibition involved the OFC and aTL. © The Author(s) 2016.

  18. Identifying asthma and chronic obstructive pulmonary disease in patients with persistent cough presenting to general practitioners : descriptive study

    NARCIS (Netherlands)

    Thiadens, HA; de Bock, GH; Deker, FW; Huysman, JAN; Springer, MP; Postma, DS

    1998-01-01

    Objective: To determine the prevalence of asthma and chronic obstructive pulmonary disease in patients not known to have these disorders, who present in general practice with persistent cough, and to ascertain criteria to help general practitioners in diagnosis. Design: Descriptive study. Setting:

  19. The virialization density of peaks with general density profiles under spherical collapse

    OpenAIRE

    Rubin, Douglas; Loeb, Abraham

    2013-01-01

    We calculate the non-linear virialization density, $\\Delta_c$, of halos under spherical collapse from peaks with an arbitrary initial and final density profile. This is in contrast to the standard calculation of $\\Delta_c$ which assumes top-hat profiles. Given our formalism, the non-linear halo density can be calculated once the shape of the initial peak's density profile and the shape of the virialized halo's profile are provided. We solve for $\\Delta_c$ for halos in an Einstein de-Sitter an...

  20. Arthroscopic shoulder surgery under general anesthesia with brachial plexus block: postoperative respiratory dysfunction of combined obstructive and restrictive pathology.

    Science.gov (United States)

    Gwak, M S; Kim, W H; Choi, S J; Lee, J J; Ko, J S; Kim, G S; Kim, Y I; Kim, M H

    2013-02-01

    Changes in respiratory parameters and pulmonary function tests were evaluated after shoulder arthroscopic surgery with brachial plexus block (BPB). The purpose of this study was to identify the mechanism of respiratory dysfunction after this type of surgery. Patients undergoing arthroscopic rotator cuff repair under general anesthesia (GA) with BPB were enrolled in the arthroscopy group (n = 30) while those undergoing open reduction of a clavicle or humerus fracture under GA were enrolled in the control group (n = 30). Forced vital capacity (FVC) and forced expiratory volume 1 s (FEV(1)) were measured at the outpatient clinic stage (#1) before (#2) and 20 min after BPB (#3) and 1 h after extubation (#4). Respiratory variable measurements along with the cuff leak test were performed 5 min after surgical positioning (T1) and at the start of skin closure (T2). Respiratory discomfort was evaluated after extubation. The upper airway diameters and soft tissue depth of chest wall were also measured by ultrasonography at stages #3 and #4. Static compliance decreased significantly at T2 in the arthroscopy group (50 ± 11 at T1 vs. 44 ± 9 ml/cm H(2)O at T2, p =0.035) but not in the control group. The incidence of positive cuff leak tests at T2 was significantly higher in the arthroscopy group than in the control group (47% in the arthroscopy group vs. 17% in controls, p =0.010). While FEV(1) and FVC remained stable at stages #1 and #2, FVC and FEV(1) decreased at stages #3 and #4 only in the arthroscopy group (FVC in arthroscopy group, #2: 3.26 ± 0.77 l; #3: 2.55 ± 0.63 l, p =0.015 vs. #2; #4: 2.66 ± 0.41 l, p =0.040 vs. #2). The subglottic diameter decreased at #4 in the arthroscopy group, while no changes occurred in the control group (0.70 ± 0.21 cm vs. 0.85 ± 0.23 cm in the arthroscopy and control groups, respectively, p =0.011). Depth of skin to pleura increased at both intercostal spaces 1-2 and 3-4 in the

  1. Percolation Model of Sensory Transmission and Loss of Consciousness Under General Anesthesia

    Science.gov (United States)

    Zhou, David W.; Mowrey, David D.; Tang, Pei; Xu, Yan

    2015-09-01

    Neurons communicate with each other dynamically; how such communications lead to consciousness remains unclear. Here, we present a theoretical model to understand the dynamic nature of sensory activity and information integration in a hierarchical network, in which edges are stochastically defined by a single parameter p representing the percolation probability of information transmission. We validate the model by comparing the transmitted and original signal distributions, and we show that a basic version of this model can reproduce key spectral features clinically observed in electroencephalographic recordings of transitions from conscious to unconscious brain activities during general anesthesia. As p decreases, a steep divergence of the transmitted signal from the original was observed, along with a loss of signal synchrony and a sharp increase in information entropy in a critical manner; this resembles the precipitous loss of consciousness during anesthesia. The model offers mechanistic insights into the emergence of information integration from a stochastic process, laying the foundation for understanding the origin of cognition.

  2. Measures of gender role attitudes under revision: The example of the German General Social Survey.

    Science.gov (United States)

    Walter, Jessica Gabriele

    2018-05-01

    Using the example of the German General Social Survey, this study describes how measures of gender role attitudes can be revised. To date measures have focused on the traditional male breadwinner model. However, social developments in female labor force participation, education, and family structure suggest that a revision and adjustment of existing measures are required. First, these measures need to be supplemented with items that represent more egalitarian models of division of labor and the role of the father in the family. Second, the phrasing of existing items needs to be revised. The results of this study indicate that especially regarding the amount of working hours and the age of children, a specification is needed. This study presents a revised measure, to facilitate analyses over time. This revised measure represents two factors: one referring to traditional and one to modern gender role attitudes. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. On the Performance Analysis of Free-Space Optical Links under Generalized Turbulence and Misalignment Models

    KAUST Repository

    AlQuwaiee, Hessa

    2016-11-01

    One of the potential solutions to the radio frequency (RF) spectrum scarcity problem is optical wireless communications (OWC), which utilizes the unlicensed optical spectrum. Long-range outdoor OWC are usually referred to in the literature as free-space optical (FSO) communications. Unlike RF systems, FSO is immune to interference and multi-path fading. Also, the deployment of FSO systems is flexible and much faster than optical fibers. These attractive features make FSO applicable for broadband wireless transmission such as optical fiber backup, metropolitan area network, and last mile access. Although FSO communication is a promising technology, it is negatively affected by two physical phenomenon, namely, scintillation due to atmospheric turbulence and pointing errors. These two critical issues have prompted intensive research in the last decade. To quantify the effect of these two factors on FSO system performance, we need effective mathematical models. In this work, we propose and study a generalized pointing error model based on the Beckmann distribution. Then, we aim to generalize the FSO channel model to span all turbulence conditions from weak to strong while taking pointing errors into consideration. Since scintillation in FSO is analogous to the fading phenomena in RF, diversity has been proposed too to overcome the effect of irradiance fluctuations. Thus, several combining techniques of not necessarily independent dual-branch free-space optical links were investigated over both weak and strong turbulence channels in the presence of pointing errors. On another front, improving the performance, enhancing the capacity and reducing the delay of the communication link has been the motivation of any newly developed schemes, especially for backhauling. Recently, there has been a growing interest in practical systems to integrate RF and FSO technologies to solve the last mile bottleneck. As such, we also study in this thesis asymmetric an RF-FSO dual-hop relay

  4. Creatinine, eGFR and association with myocardial infarction, ischemic heart disease and early death in the general population

    DEFF Research Database (Denmark)

    Sibilitz, Kirstine L; Benn, Marianne; Nordestgaard, Børge G

    2014-01-01

    OBJECTIVE: We tested the hypothesis that moderately elevated plasma creatinine levels and decreased levels of estimated glomerular filtration rate (eGFR) are associated with increased risk of myocardial infarction, ischemic heart disease, and early death in the general population. METHODS: We...... studied 10,489 individuals with a plasma creatinine measurement and calculated eGFR from the Danish general population, of which 1498 developed myocardial infarction, 3001 ischemic heart disease, and 7573 died during 32 years follow-up. RESULTS: Cumulative incidences of myocardial infarction and ischemic...... heart disease as a function of age increased with increasing levels of creatinine, and survival decreased (log-rank trends: creatinine levels

  5. Why do people with chronic disease not contact consumer health organisations? A survey of general practice patients.

    Science.gov (United States)

    Boyle, Frances M; Dean, Julie H; Young, Charlotte E; Mutch, Allyson J

    2016-07-01

    Aim Consumer health organisations (CHOs) are non-profit or voluntary sector organisations that promote and represent the interests of patients and carers affected by particular conditions. The purpose of this study was to examine, among patients with chronic disease, what differentiates those who contact CHOs from those who do not and what stops people from making contact. CHOs can enhance people's capacity to manage chronic disease by providing information, education and psychosocial support, but are under-utilised. Little is known about barriers to access. Data were from a baseline telephone survey conducted as part of a randomised trial of an intervention to improve access to CHOs. Participants constituted a consecutive sample of 276 adults with diagnosed chronic disease recruited via 18 general practitioners in Brisbane, Australia. Quantitative survey items examined participants' use and perceptions of CHOs and a single open-ended question explored barriers to CHO use. Multiple logistic regression and thematic analysis were used. Findings Overall, 39% of participants had ever contacted a CHO for their health and 28% had contacted a CHO specifically focussed on their diagnosed chronic condition. Diabetes, poorer self-reported physical health and greater health system contact were significantly associated with CHO contact. The view that 'my doctor does it all' was prevalent and, together with a belief that their health problems were 'not serious enough', was the primary reason patients did not make contact. Attitudinal and system-related barriers limit use of CHOs by those for whom they are designed. Developing referral pathways to CHOs and promoting awareness about what they offer is needed to improve access.

  6. Invariance of the Berry phase under unitary transformations: application to the time-dependent generalized harmonic oscillator

    International Nuclear Information System (INIS)

    Kobe, D.H.

    1989-01-01

    The Berry phase is derived in a manifestly gauge-invariant way, without adiabatic or cyclic requirements. It is invariant under unitary transformations, contrary to recent assertions. A time-dependent generalized harmonic oscillator is taken as an example. The energy of the system is not in general the Hamiltonian. An energy, the time derivative of which is the power, is obtained from the equation of motion. When the system is quantized, the Berry phase is zero, and is invariant under unitary transformations. If the energy is chosen incorrectly to be the Hamiltonian, a nonzero Berry phase is obtained. In this case the total phase, the sun of the dynamical and Berry phases, is equal to the correct total phase through first order in perturbation theory. (author)

  7. Shared activity patterns arising at genetic susceptibility loci reveal underlying genomic and cellular architecture of human disease

    DEFF Research Database (Denmark)

    Baillie, J. Kenneth; Bretherick, Andrew; Haley, Christopher S.

    2018-01-01

    Genetic variants underlying complex traits, including disease susceptibility, are enriched within the transcriptional regulatory elements, promoters and enhancers. There is emerging evidence that regulatory elements associated with particular traits or diseases share similar patterns of transcrip...

  8. Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methods.

    Science.gov (United States)

    Gibbons, Cheryl L; Mangen, Marie-Josée J; Plass, Dietrich; Havelaar, Arie H; Brooke, Russell John; Kramarz, Piotr; Peterson, Karen L; Stuurman, Anke L; Cassini, Alessandro; Fèvre, Eric M; Kretzschmar, Mirjam E E

    2014-02-11

    Efficient and reliable surveillance and notification systems are vital for monitoring public health and disease outbreaks. However, most surveillance and notification systems are affected by a degree of underestimation (UE) and therefore uncertainty surrounds the 'true' incidence of disease affecting morbidity and mortality rates. Surveillance systems fail to capture cases at two distinct levels of the surveillance pyramid: from the community since not all cases seek healthcare (under-ascertainment), and at the healthcare-level, representing a failure to adequately report symptomatic cases that have sought medical advice (underreporting). There are several methods to estimate the extent of under-ascertainment and underreporting. Within the context of the ECDC-funded Burden of Communicable Diseases in Europe (BCoDE)-project, an extensive literature review was conducted to identify studies that estimate ascertainment or reporting rates for salmonellosis and campylobacteriosis in European Union Member States (MS) plus European Free Trade Area (EFTA) countries Iceland, Norway and Switzerland and four other OECD countries (USA, Canada, Australia and Japan). Multiplication factors (MFs), a measure of the magnitude of underestimation, were taken directly from the literature or derived (where the proportion of underestimated, under-ascertained, or underreported cases was known) and compared for the two pathogens. MFs varied between and within diseases and countries, representing a need to carefully select the most appropriate MFs and methods for calculating them. The most appropriate MFs are often disease-, country-, age-, and sex-specific. When routine data are used to make decisions on resource allocation or to estimate epidemiological parameters in populations, it becomes important to understand when, where and to what extent these data represent the true picture of disease, and in some instances (such as priority setting) it is necessary to adjust for underestimation

  9. Predicting the multi-domain progression of Parkinson's disease: a Bayesian multivariate generalized linear mixed-effect model.

    Science.gov (United States)

    Wang, Ming; Li, Zheng; Lee, Eun Young; Lewis, Mechelle M; Zhang, Lijun; Sterling, Nicholas W; Wagner, Daymond; Eslinger, Paul; Du, Guangwei; Huang, Xuemei

    2017-09-25

    It is challenging for current statistical models to predict clinical progression of Parkinson's disease (PD) because of the involvement of multi-domains and longitudinal data. Past univariate longitudinal or multivariate analyses from cross-sectional trials have limited power to predict individual outcomes or a single moment. The multivariate generalized linear mixed-effect model (GLMM) under the Bayesian framework was proposed to study multi-domain longitudinal outcomes obtained at baseline, 18-, and 36-month. The outcomes included motor, non-motor, and postural instability scores from the MDS-UPDRS, and demographic and standardized clinical data were utilized as covariates. The dynamic prediction was performed for both internal and external subjects using the samples from the posterior distributions of the parameter estimates and random effects, and also the predictive accuracy was evaluated based on the root of mean square error (RMSE), absolute bias (AB) and the area under the receiver operating characteristic (ROC) curve. First, our prediction model identified clinical data that were differentially associated with motor, non-motor, and postural stability scores. Second, the predictive accuracy of our model for the training data was assessed, and improved prediction was gained in particularly for non-motor (RMSE and AB: 2.89 and 2.20) compared to univariate analysis (RMSE and AB: 3.04 and 2.35). Third, the individual-level predictions of longitudinal trajectories for the testing data were performed, with ~80% observed values falling within the 95% credible intervals. Multivariate general mixed models hold promise to predict clinical progression of individual outcomes in PD. The data was obtained from Dr. Xuemei Huang's NIH grant R01 NS060722 , part of NINDS PD Biomarker Program (PDBP). All data was entered within 24 h of collection to the Data Management Repository (DMR), which is publically available ( https://pdbp.ninds.nih.gov/data-management ).

  10. Generalized stochastic target problems for pricing and partial hedging under loss constraints - Application in optimal book liquidation

    OpenAIRE

    Bouchard , Bruno; Dang , Ngoc Minh

    2013-01-01

    International audience; We consider a singular with state constraints version of the stochastic target problems studied in Soner and Touzi (2002) and more recently Bouchard, Elie and Touzi (2008), among others. This provides a general framework for the pricing of contingent claims under risk constraints. Our extended version perfectly suits to market models with proportional transaction costs and to order book liquidation issues. Our main result is a PDE characterization of the associated pri...

  11. RANDOMIZED DOUBLE BLIND STUDY COMPARING ONDANSETRON, PALONOSETRON & GRANISETRON TO PREVENT POST OPERATIVE NAUSEA & VOMITING AFTER LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Rajendra

    2015-11-01

    Full Text Available The aim of the study is to compare the efficacy of intravenously administered 5-HT3 receptor antagonists namely Ondansetron, Palonosetron and Granisetron given as prophylaxis for postoperative nausea and vomiting in patients undergoing laparoscopic surgeries under general anaesthesia. A single dose of palonosetron (0.75 µg when given prophylactically results in a significantly lower incidence of PONV after laparoscopic surgeries than ondansetron (4mg and granisetron (2.5mg during the first 24 hours

  12. Changes in children′s oral health related quality of life following dental treatment under general anesthesia

    Directory of Open Access Journals (Sweden)

    Seyed Ebrahim Jabarifar

    2009-01-01

    Full Text Available Background: Children′s oral health related quality of life (OHRQoL evaluates the impacts of oral daily activities of children and family on quality of life. Oral health related quality of life as outcome can be used to evaluate the dental health services. This study aimed to assess the extent to which den-tal treatment under general anesthesia affects quality of life of children and their families. Methods: One hundred parents of 3-10 year-old children who needed dental treatment under general anesthesia completed a parent-children perception questionnaire (P-CPQ and family impact scale (FIS before, and 4 weeks after dental treatment under general anesthesia. The questionnaire had statements related to oral health, functional limitation, emotional state and well being social well-being and family issues. Data were analyzed using SPSS version 11.5. Results: The mean scores and standard deviations of oral health quality of life of the children before and after dental treatment were 43.3 ± 7.14 and 39.24 ± 5.47 respectively. The mean scores of FIS before and after dental treatment were 8.00 ± 3.21 and 3.66 ± 2.62, respectively. The effect size of mean differences in P-CPQ and FIS scores were 1.84 ± 1.64 and 1.35 ± 4.34, respectively. Conclusion: Provision of dental treatment under general anesthesia for uncooperative, young chil-dren with extensive dental problems had significant effects on quality of life of both children and their families.

  13. Cases of Trichohepatoenteric Syndrome (Syndromic Diarrhea with Underlying Crohn’s Disease

    Directory of Open Access Journals (Sweden)

    Е. А. Roslavtseva

    2015-01-01

    Full Text Available Tricho-hepato-enteric syndrome (syndromic, phenotypic diarrhea, SD/THES is a rare inborn disease, which affects bowels. It is caused by the mutation of genes SKIV2L or TTC37. Manifestations include intrauterine hypotrophy, severe chronic diarrhea, which starts in infancy, characteristic facial features and hair growth abnormalities, immune disorders. There are data on two patients dealing with tricho-hepato-enteric syndrome with underlying Crohn’s disease. This is the first description of cases of aggravated tricho-hepatoenteric syndrome ever found in Russian medical literature. 

  14. Energy from sugarcane bagasse under electricity rationing in Brazil: a computable general equilibrium model

    International Nuclear Information System (INIS)

    Scaramucci, Jose A.; Perin, Clovis; Pulino, Petronio; Bordoni, Orlando F.J.G.; Cunha, Marcelo P. da; Cortez, Luis A.B.

    2006-01-01

    In the midst of the institutional reforms of the Brazilian electric sectors initiated in the 1990s, a serious electricity shortage crisis developed in 2001. As an alternative to blackout, the government instituted an emergency plan aimed at reducing electricity consumption. From June 2001 to February 2002, Brazilians were compelled to curtail electricity use by 20%. Since the late 1990s, but especially after the electricity crisis, energy policy in Brazil has been directed towards increasing thermoelectricity supply and promoting further gains in energy conservation. Two main issues are addressed here. Firstly, we estimate the economic impacts of constraining the supply of electric energy in Brazil. Secondly, we investigate the possible penetration of electricity generated from sugarcane bagasse. A computable general equilibrium (CGE) model is used. The traditional sector of electricity and the remainder of the economy are characterized by a stylized top-down representation as nested CES (constant elasticity of substitution) production functions. The electricity production from sugarcane bagasse is described through a bottom-up activity analysis, with a detailed representation of the required inputs based on engineering studies. The model constructed is used to study the effects of the electricity shortage in the preexisting sector through prices, production and income changes. It is shown that installing capacity to generate electricity surpluses by the sugarcane agroindustrial system could ease the economic impacts of an electric energy shortage crisis on the gross domestic product (GDP)

  15. Optimal capacity and buffer size estimation under Generalized Markov Fluids Models and QoS parameters

    International Nuclear Information System (INIS)

    Bavio, José; Marrón, Beatriz

    2014-01-01

    Quality of service (QoS) for internet traffic management requires good traffic models and good estimation of sharing network resource. A link of a network processes all traffic and it is designed with certain capacity C and buffer size B. A Generalized Markov Fluid model (GMFM), introduced by Marrón (2011), is assumed for the sources because describes in a versatile way the traffic, allows estimation based on traffic traces, and also consistent effective bandwidth estimation can be done. QoS, interpreted as buffer overflow probability, can be estimated for GMFM through the effective bandwidth estimation and solving the optimization problem presented in Courcoubetis (2002), the so call inf-sup formulas. In this work we implement a code to solve the inf-sup problem and other optimization related with it, that allow us to do traffic engineering in links of data networks to calculate both, minimum capacity required when QoS and buffer size are given or minimum buffer size required when QoS and capacity are given

  16. Generalized anxiety disorder in urban China: Prevalence, awareness, and disease burden.

    Science.gov (United States)

    Yu, Wei; Singh, Shikha Satendra; Calhoun, Shawna; Zhang, Hui; Zhao, Xiahong; Yang, Fengchi

    2018-07-01

    Limited published research has quantified the Generalized Anxiety Disorder (GAD) prevalence and its burden in China. This study aimed to fill in the knowledge gap and to evaluate the burden of GAD among adults in urban China. This study utilized existing data from the China National Health and Wellness Survey (NHWS) 2012-2013. Prevalence of self-reported diagnosed and undiagnosed GAD was estimated. Diagnosed and undiagnosed GAD respondents were compared with non-anxious respondents in terms of health-related quality of life (HRQoL), resource utilization, and work productivity and activity impairment using multivariate generalized linear models. A multivariate logistic model assessed the risk factors for GAD. The prevalence of undiagnosed/diagnosed GAD was 5.3% in urban China with only 0.5% of GAD respondents reporting a diagnosis. Compared with non-anxious respondents, both diagnosed and undiagnosed GAD respondents had significantly lower HRQoL, more work productivity and activity impairment, and greater healthcare resource utilization in the past six months. Age, gender, marital status, income level, insurance status, smoking, drinking and exercise behaviors, and comorbidity burdens were significantly associated with GAD. This was a patient-reported study; data are therefore subject to recall bias. The survey was limited to respondents in urban China; therefore, these results focused on urban China and may be under- or over-estimating GAD prevalence in China. Causal inferences cannot be made given the cross-sectional nature of the study. GAD may be substantially under-diagnosed in urban China. More healthcare resources should be invested to alleviate the burden of GAD. Copyright © 2018 Elsevier B.V. All rights reserved.

  17. Severe exacerbations of chronic obstructive pulmonary disease: management with noninvasive ventilation on a general medicine ward

    Directory of Open Access Journals (Sweden)

    Sirio Fiorino

    2013-04-01

    Full Text Available Introduction: Recent evidence suggests that, with a well-trained staff, severe exacerbations of chronic obstructive pulmonary disease (COPD with moderate respiratory acidosis (pH > 7.3 can be successfully treated with noninvasive mechanical ventilation (NIMV on a general respiratory care ward. We conducted an open prospective study to evaluate the efficacy of this approach on a general medicine ward. Material and methods: This study population consisted in 27 patients admitted to a general medicine ward (median nurse:patient ratio 1:12 December 1, 2004 May 31, 2006 for acute COPD exacerbation with hypercapnic respiratory failure and acidosis (arterial pH < 7.34, PaC02 > 45 mmHg. All received assist-mode NIMV (average 12 h / day via oronasal masks (inspiratory pressure 10-25 cm H2O, expiratory pressure 4-6 cm H2O to maintain O2 saturation at 90-95%. Treatment was supervised by an experienced pulmonologist, who had also provided specific training in NIMV for medical and nursing staffs (90-day course followed by periodic refresher sessions. Arterial blood pressure, O2 saturation, and respiratory rate were continuously monitored during NIMV. Based on baseline arterial pH, the COPD was classified as moderate (7.25-7.34 or severe (< 7.25. Results: In patients with moderate and severe COPD, significant improvements were seen in arterial pH after 2 (p < 0.05 and 24 h (p< 0.05 of NIMV and in the PaC02 after 24 hours (p < 0.05. Four (15% of the 27 patients died during the study hospitalization (in-hospital mortality 15%, in 2 cases due to NIMV failure. For the other 23, mean long-term survival was 14.5 months (95% CI 10.2 to 18.8, and no significant differences were found between the moderate and severe groups. Over half (61% the patients were alive 1 year after admission. Conclusions: NIMV can be a cost-effective option for management of moderate or severe COPD on a general medicine ward. Its proper use requires: close monitoring of ventilated subjects

  18. Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia

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    Anahita Hirmanpour

    2018-01-01

    Full Text Available Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section. Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS, 0 (entering the recovery, 0.5, 1, 4, 12 and 24 hours after the surgery. Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery. Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants.

  19. Effect of Intravenous Infusion of Lidocaine on Pain Reduction after Cesarean Section under General Anesthesia

    Directory of Open Access Journals (Sweden)

    Anahita Hirmanpour

    2018-01-01

    Full Text Available Background: The present study was conducted to evaluate the effect of Lidocaine on pain reduction during and ileus and the need for opioids after caesarean section.Methods: For this randomized double-blind controlled clinical trial, 40 ASA I, II pregnant women who were candidates for caesarean section with general anesthesia, were randomly allocated into two groups of Lidocaine receivers and placebo using randomized block design; the Lidocaine group received 1.5 mg/kg of Lidocaine right before the surgery and then its infusion with a dose of 2 mg/kg.h until the end of the surgery and the placebo group received normal saline with the same volume and application. Patients’ pain intensity was measured using numerical rating scale (NRS, 0 (entering the recovery, 0.5, 1, 4, 12 and 24 hours after the surgery.Results: Lidocaine decreased the systolic and diastolic pressures of the patients only during the first minute after intubation, decreased the mean of arterial blood pressure at the 10th minute after intubation and 40th minute after surgery, and also decreased the mean of patients’ pain intensity, Diclofenac and Pethidine consumption, side effects (nausea and vomiting and reduced the time interval before the first time of tolerating oral liquids; but it had effect on infants’ Apgar score 1 and 5 minutes after delivery.Conclusions: Lidocaine was definitely effective on reducing the intensity of pain, opioid and non-steroidal anti-inflammatory drugs consumption and ileus after surgery with the least occurrence of side effects for mothers and infants.

  20. Middle cerebral artery blood flow velocity during beach chair position for shoulder surgery under general anesthesia.

    Science.gov (United States)

    Hanouz, Jean-Luc; Fiant, Anne-Lise; Gérard, Jean-Louis

    2016-09-01

    The goal of the present study was to examine changes of middle cerebral artery (VMCA) blood flow velocity in patients scheduled for shoulder surgery in beach chair position. Prospective observational study. Operating room, shoulder surgery. Fifty-three consecutive patients scheduled for shoulder surgery in beach chair position. Transcranial Doppler performed after induction of general anesthesia (baseline), after beach chair positioning (BC1), during surgery 20minutes (BC2), and after back to supine position before stopping anesthesia (supine). Mean arterial pressure (MAP), end-tidal CO2, and volatile anesthetic concentration and VMCA were recorded at baseline, BC1, BC2, and supine. Postoperative neurologic complications were searched. Beach chair position induced decrease in MAP (baseline: 73±10mm Hg vs lower MAP recorded: 61±10mm Hg; P<.0001) requiring vasopressors and fluid challenge in 44 patients (83%). There was a significant decrease in VMCA after beach chair positioning (BC1: 33±10cm/s vs baseline: 39±14cm/s; P=.001). The VMCA at baseline (39±2cm/s), BC2 (35±14cm/s), and supine (39±14cm/s) were not different. The minimal alveolar concentration of volatile anesthetics, end-tidal CO2, SpO2, and MAP were not different at baseline, BC1, BC2, and supine. Beach chair position resulted in transient decrease in MAP requiring fluid challenge and vasopressors and a moderate decrease in VMCA. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Proper Generalized Decomposition (PGD) for the numerical simulation of polycrystalline aggregates under cyclic loading

    Science.gov (United States)

    Nasri, Mohamed Aziz; Robert, Camille; Ammar, Amine; El Arem, Saber; Morel, Franck

    2018-02-01

    The numerical modelling of the behaviour of materials at the microstructural scale has been greatly developed over the last two decades. Unfortunately, conventional resolution methods cannot simulate polycrystalline aggregates beyond tens of loading cycles, and they do not remain quantitative due to the plasticity behaviour. This work presents the development of a numerical solver for the resolution of the Finite Element modelling of polycrystalline aggregates subjected to cyclic mechanical loading. The method is based on two concepts. The first one consists in maintaining a constant stiffness matrix. The second uses a time/space model reduction method. In order to analyse the applicability and the performance of the use of a space-time separated representation, the simulations are carried out on a three-dimensional polycrystalline aggregate under cyclic loading. Different numbers of elements per grain and two time increments per cycle are investigated. The results show a significant CPU time saving while maintaining good precision. Moreover, increasing the number of elements and the number of time increments per cycle, the model reduction method is faster than the standard solver.

  2. Is treatment under general anaesthesia associated with dental neglect and dental disability among caries active preschool children?

    Science.gov (United States)

    Kvist, T; Zedrén-Sunemo, J; Graca, E; Dahllöf, G

    2014-10-01

    To study if treatment under general anaesthesia (GA) is associated with dental neglect or dental disability. This was a retrospective study. Dental records of all children in the age 0-6 years who underwent GA at a specialist paediatric dentistry clinic during 2006-2011 were studied with regard to decayed-missed-filled teeth, traumatic injuries, emergency visits, behaviour management problems and the history of attendance. The final sample consisted of 134 children. Matched controls were selected among recall patients who had not received treatment under GA. Fishers exact test or Pearson Chi-square test analysed response distribution and comparisons between groups, and for multivariate analyses, logistic regression was used. The results show that children treated under GA had significantly higher caries prevalence, apical periodontitis and infections due to pulpal necrosis. Dental neglect as well as dental disability was significantly more prevalent in the GA group compared to the control group. In a multivariate analysis with dental neglect as independent factor, dental disability was the only significant factor (p = 0.006). Children treated under general anaesthesia were significantly more often diagnosed with both dental neglect and dental disability. Dental disability was the only factor significantly related to dental neglect. There is a need for improved documentation in the dental records to better identify dental neglect and dental disability, and also a continued training of dentists regarding child protection.

  3. Computer templates in chronic disease management: ethnographic case study in general practice

    Science.gov (United States)

    Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

    2012-01-01

    Objective To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Design Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry—an approach called linguistic ethnography. Setting Two general practices in England. Participants and methods Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Results Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients’ stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient—as ‘individual’ or as ‘one of a population’. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Conclusions Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the

  4. Non-linear increase of respiratory diseases and their costs under severe air pollution.

    Science.gov (United States)

    Shen, Ying; Wu, Yiyun; Chen, Guangdi; Van Grinsven, Hans J M; Wang, Xiaofeng; Gu, Baojing; Lou, Xiaoming

    2017-05-01

    China is experiencing severe and persistent air pollution, with concentrations of fine particulate matters (PM 2.5 ) reaching unprecedentedly high levels in many cities. Quantifying the detrimental effects on health and their costs derived from high PM 2.5 levels is crucial because of the unsolved challenges to mitigate air pollution in the following decades. Using the daily monitoring data on PM 2.5 concentrations and clinic visits, we found a non-linear increase of respiratory diseases, but not for other diseases (e.g., digestive diseases) under severe air pollution. We found an increase of respiratory diseases by 1% for each 10 μg m -3 increase in PM 2.5 when the annual average daily PM 2.5 concentration was less than 50 μg m -3 ; while this ratio was doubled (around 2%) with the daily PM 2.5 concentration larger than 50 μg m -3 . Under severe air pollution (PM 2.5 concentration >150 μg m -3 ), the respiratory diseases increased by over 50% compared to that in clean days. Children are more sensitive to the severe air pollution. The increase of clinic visits, especially for adults, was observed mainly in bigger (>500 beds) hospitals. Re-allocating medical resources (e.g., doctors) from big hospitals to community hospitals can benefit the respiratory patients due to air pollution. The total medical cost of clinic visits of respiratory diseases derived from PM 2.5 pollution was estimated at 17.2-57.0 billion Yuan in 2014 in China, accounting for 0.5-1.6% of national total health expenditure. Because these medical costs only represent a small part of total health cost derived from air pollution, the reduction of associated health costs would be an important co-benefit of implementation of air pollution preventive strategies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Control of Root Rot and Wilt Diseases of Roselle under Field Conditions

    Science.gov (United States)

    Hassan, Naglaa; Elsharkawy, Mohsen Mohamed; Shimizu, Masafumi

    2014-01-01

    Roselle (Hibiscus sabdariffa L.) is one of the most important medicinal crops in many parts of the world. In this study, the effects of microelements, antioxidants, and bioagents on Fusarium oxysporum, F. solani, and Macrophomina phaseolina, the causal pathogens of root rot and wilt diseases in roselle, were examined under field conditions. Preliminary studies were carried out in vitro in order to select the most effective members to be used in field control trials. Our results showed that microelements (copper and manganese), antioxidants (salicylic acid, ascorbic acid, and EDTA), a fungicide (Dithane M45) and biological control agents (Trichoderma harzianum and Bacillus subtilis) were significantly reduced the linear growth of the causal pathogens. Additionally, application of the previous microelements, antioxidants, a fungicide and biological control agents significantly reduced disease incidence of root rot and wilt diseases under field conditions. Copper, salicylic acid, and T. harzianum showed the best results in this respect. In conclusion, microelements, antioxidants, and biocontrol agents could be used as alternative strategies to fungicides for controlling root rot and wilt diseases in roselle. PMID:25606010

  6. [Summary of the practice guideline 'Viral hepatitis and other liver diseases' (second revision) from the Dutch College of General Practitioners].

    Science.gov (United States)

    Bouma, M; van Geldrop, W J; Numans, M E; Wiersma, Tj; Goudswaard, A N

    2008-12-06

    The revised Dutch College of General Practitioners' practice guideline 'Viral hepatitis and other liver diseases' offers advice in the diagnosis and management of viral hepatitis A, B and C and other liver diseases. The guideline is important for general practitioners as well as specialists in internal medicine and gastroenterology. The emphasis is on the management of chronic hepatitis B en C, because the prevalence of these diseases has increased in the Netherlands and, in addition, the treatment options for chronic hepatitis have improved. Consequently, timely recognition and adequate referral of patients with chronic hepatitis B or hepatitis C have become more important. However, many patients with a chronic liver disease have no symptoms. Therefore, the general practitioner should be aware that a patient visiting the practice with fatigue and malaise could have a liver disease if he or she belongs to a high-risk group or has had high-risk contacts. If the general practitioner repeatedly finds increased liver transaminase values during routine examination of asymptomatic patients, additional diagnostic tests should be performed. Further tests should focus on viral hepatitis as well as on non-alcoholic fatty liver disease and non-alcoholic steatohepatitis or, depending on the history-taking, liver damage due to excessive alcohol, medication or drug use.

  7. General Principles and Convention on Contracts for the International Sale of Goods (CISG – Uniformity under an Interpretation Umbrella?

    Directory of Open Access Journals (Sweden)

    Laura Lassila

    2017-01-01

    Full Text Available Globalization and digitalization of international sales creates needs to harmonize rules of international commercial contracts. The question is whether the harmonization should be done by binding rules or using soft law tools or through digitalization. In this article I argue on favor of harmonization through international contracts law rules’ international interpretation.The international interpretation principles used in this article are found from on Art. 7(1 of the Convention on Contracts for the International Sale of Goods (CISG which sets three interpretation rules: international character; promoting uniformity; and observance of good faith in international trade. These principles are not only principles of the CISG, but also principles commonly recognized in international commercial practice and also in domestic contract rules. I argue that by adopting an international interpretation umbrella – the meta-principle of international interpretation, cross-border contracts could be interpreted under the same principle no matter applicable substantial law. The meta-principle functions as an interpretation umbrella covering general principles and Articles of the CISG, general principles of international commercial contracts, Lex Mercatoria, and cross-border contract provision under national law.The outcomes points out that arbitral tribunals have interpreted general principles of the CISG and Lex Mercatoria in various ways. General principles and their application in case law is analyzed in connection with the Civil Code of the Russian Federation. Tribunals found that general principles of the CISG are applicable even if the CISG is not. It follows Art.’s 7(2 logic to promote international standard to cross-border contracts where the closes connection is international commercial practice rather than any national jurisdiction.

  8. Craniofacial CT findings of Gorham-Stout disease and generalized lymphatic anomaly

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Hiroki; Matsuo, Masayuki [Gifu University School of Medicine, Department of Radiology, Gifu (Japan); Ozeki, Michio; Fukao, Toshiyuki [Gifu University School of Medicine, Department of Pediatrics, Gifu (Japan)

    2016-08-15

    The present study aimed to assess the craniofacial CT imaging features for differentiating between Gorham-Stout disease (GSD) and generalized lymphatic anomaly (GLA). Seven patients with GSD and four patients with GLA were included in this study. All patients underwent CT examinations that encompassed the craniofacial bones. The presence, distribution, and type of craniofacial osteolysis were assessed. The clinical symptoms that were associated with craniofacial osteolysis were also reviewed. Craniofacial osteolysis including cranial osteolysis was seen in four of seven (57 %) patients with GSD and in three of four (75 %) patients with GLA. Facial osteolysis was seen in two (29 %) patients with GSD, but this was not observed in patients with GLA. Among patients with craniofacial osteolysis, those with GSD showed diffuse involvement, whereas those with GLA showed multifocal involvement. The craniofacial osteolysis of GSD could be classified into three patterns: medullary involvement, thinning bone, and disappearing bone. The clinical symptoms of craniofacial osteolysis were observed in all patients with GSD but were not present in patients with GLA. Craniofacial involvement was observed in both groups. The craniofacial osteolysis of GSD showed diffuse involvement with clinical symptoms, whereas that of GLA showed multifocal involvement without clinical symptoms. (orig.)

  9. Selye's general adaptation syndrome: stress-induced gastro-duodenal ulceration and inflammatory bowel disease.

    Science.gov (United States)

    Fink, George

    2017-03-01

    Hans Selye in a note to Nature in 1936 initiated the field of stress research by showing that rats exposed to nocuous stimuli responded by way of a 'general adaptation syndrome' (GAS). One of the main features of the GAS was the 'formation of acute erosions in the digestive tract, particularly in the stomach, small intestine and appendix'. This provided experimental evidence for the view based on clinical data that gastro-duodenal (peptic) ulcers could be caused by stress. This hypothesis was challenged by Marshall and Warren's Nobel Prize (2005)-winning discovery of a causal association between Helicobacter pylori and peptic ulcers. However, clinical and experimental studies suggest that stress can cause peptic ulceration in the absence of H. pylori Predictably, the etiological pendulum of gastric and duodenal ulceration has swung from 'all stress' to 'all bacteria' followed by a sober realization that both factors play a role, separately as well as together. This raises the question as to whether stress and H. pylori interact, and if so, how? Stress has also been implicated in inflammatory bowel disease (IBD) and related disorders; however, there is no proof yet that stress is the primary etiological trigger for IBD. Central dopamine mechanisms seem to be involved in the stress induction of peptic ulceration, whereas activation of the sympathetic nervous system and central and peripheral corticotrophin-releasing factor appears to mediate stress-induced IBD. © 2017 Society for Endocrinology.

  10. Dental treatment and caries prevention preceding treatment under general anaesthesia in healthy children and adolescents: a retrospective cohort study.

    Science.gov (United States)

    Grindefjord, M; Persson, J; Jansson, L; Tsilingaridis, G

    2018-04-01

    This was to examine healthy children and adolescents treated under general anaesthesia (GA) and a matched control group not receiving GA to compare treatment and preventive care received prior to GA treatment. This retrospective cohort study included 71 healthy subjects and 213 age- and gender-matched control subjects. The treatment group had been consecutively referred from the Public Dental Health Service (PDS) in Stockholm to the Department of Paediatric Dentistry, Eastman Institute, Stockholm during 2006-2007. Data was extracted from the patient records at the PDS, including variables such as number of dental visits, treatment/prophylaxis prior to GA, number of missed and cancelled appointments, and number of decayed teeth. On average, the treatment group had significantly more decayed teeth (p general dentists to paediatric specialists had no behaviour management treatment and nearly half, no preventive treatment, despite receiving significantly more operative treatment compared with matched controls. General dentists should target high caries-risk patients for additional behaviour management and preventive care to reduce the need for treatment under GA.

  11. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation.

    Science.gov (United States)

    Gison, Annalisa; Rizza, Federica; Bonassi, Stefano; Donati, Valentina; Giaquinto, Salvatore

    2015-01-01

    This study was performed with the aim of assessing dispositional optimism (DO) in a sample of Parkinson's disease (PD) patients, in order to evaluate its association with clinical outcomes and its impact on rehabilitation. Before entering an outpatient rehabilitation program, 58 participants suffering from idiopathic PD completed the Life Orientation Test-Revised (LOT-R) to evaluate their level of DO, the WHO-5 scale to evaluate their health-related quality of life (HR-QoL), the Hospital Anxiety and Depression Scale (HADS) to identify emotional distress, and the Barthel Index to evaluate their level of disability. All the measures were repeated four months later, at their discharge from the program. Disease stage and severity measures (Unified Parkinson's Disease Rating Scale) were also taken into consideration. Correlations and multivariate regression analyses compared DO with the health-related variables. On admission a high level of DO was found to be associated with less severe disease, a better quality of life (QoL) and lower emotional distress, but not with level of disability (Barthel Index). Consistent results were found at discharge. The level of DO di not change after rehabilitation, while anxiety was significantly reduced, especially in subjects with low LOT-R and high HADS scores. The Barthel Index values significantly improved. At discharge, participants with high DO showed the best improvements in disability and in QoL. Effects of dispositional optimism on quality of life, emotional distress and disability in Parkinson's disease outpatients under rehabilitation In conclusion, a high level of DO was associated with QoL, HADS and UPDRS both on admission and at discharge. The level of DO remained stable after rehabilitation, while disability and anxiety were reduced. Participants with high DO generally had better QoL, and better clinical and psychological performances.

  12. Estimating genetic effect sizes under joint disease-endophenotype models in presence of gene-environment interactions

    Directory of Open Access Journals (Sweden)

    Alexandre eBureau

    2015-07-01

    Full Text Available Effects of genetic variants on the risk of complex diseases estimated from association studies are typically small. Nonetheless, variants may have important effects in presence of specific levels of environmental exposures, and when a trait related to the disease (endophenotype is either normal or impaired. We propose polytomous and transition models to represent the relationship between disease, endophenotype, genotype and environmental exposure in family studies. Model coefficients were estimated using generalized estimating equations and were used to derive gene-environment interaction effects and genotype effects at specific levels of exposure. In a simulation study, estimates of the effect of a genetic variant were substantially higher when both an endophenotype and an environmental exposure modifying the variant effect were taken into account, particularly under transition models, compared to the alternative of ignoring the endophenotype. Illustration of the proposed modeling with the metabolic syndrome, abdominal obesity, physical activity and polymorphisms in the NOX3 gene in the Quebec Family Study revealed that the positive association of the A allele of rs1375713 with the metabolic syndrome at high levels of physical activity was only detectable in subjects without abdominal obesity, illustrating the importance of taking into account the abdominal obesity endophenotype in this analysis.

  13. Combined heat and gamma-irradiation treatments for the control of strawberry diseases under market conditions

    International Nuclear Information System (INIS)

    Brodrick, H.T.; Thomas, A.C.; Van Tonder, A.J.; Terblanche, J.C.

    1977-02-01

    The spoilage of strawberries under local market conditions was investigated. It was confirmed that the major losses are due to 'leak' disease caused by Rhizopus stolonifer (Ehr. ex Fr.) Lind. It was also established that further fruit losses in summer are due to anthracnose caused by the fungus Colletotrichum acutatum Simmonds. This is the first time that the latter pathogen has been isolated and identified and recognised as a problem on strawberries in South Africa. Studies with R. stolonifer in culture showed that 46 degrees Celsius for 20 min (the previous international standard heat treatment for fruit) was disappointing, while a treatment at 50 degrees Celsius for 10 min effectively inhibited spore germination. Irradiation studies with cultures of R. stolonifer and C. acutatum showed that a dose of 200 and 100 krad, respectively, resulted in excellent inhibition of spore germination. However, irradiating in nitrogen gas resulted in a tenfold reduction in the effectiveness of the irradiation treatments. The use of nitrogen during irradiation, therefore, cannot be considered, especially where an effective control of the fungal pathogens is desired. Investigations with different cultivars clearly demonstrated the synergistic effect on disease control obtained when combining heat and irradiation treatments. The combination treatment (moist heat at 50-52 degrees Celsius for 10 min plus 200 krad), besides effectively controlling both diseases in strawberries, did not adversely affect berry quality. In simulated transport tests it was shown that a minimal amount of berry softening did occur with this treatment, but this adverse effect was negligible compared with the beneficial effect obtained from disease control. In semi-commercial experiments it was shown that the combination heat and irradiation treatment effectively controlled spoilage diseases for a period of several days from picking, thus allowing sufficient time to market the fruit under local market

  14. Decisions under risk in Parkinson's disease: preserved evaluation of probability and magnitude.

    Science.gov (United States)

    Sharp, Madeleine E; Viswanathan, Jayalakshmi; McKeown, Martin J; Appel-Cresswell, Silke; Stoessl, A Jon; Barton, Jason J S

    2013-11-01

    Unmedicated Parkinson's disease patients tend to be risk-averse while dopaminergic treatment causes a tendency to take risks. While dopamine agonists may result in clinically apparent impulse control disorders, treatment with levodopa also causes shift in behaviour associated with an enhanced response to rewards. Two important determinants in decision-making are how subjects perceive the magnitude and probability of outcomes. Our objective was to determine if patients with Parkinson's disease on or off levodopa showed differences in their perception of value when making decisions under risk. The Vancouver Gambling task presents subjects with a choice between one prospect with larger outcome and a second with higher probability. Eighteen age-matched controls and eighteen patients with Parkinson's disease before and after levodopa were tested. In the Gain Phase subjects chose between one prospect with higher probability and another with larger reward to maximize their gains. In the Loss Phase, subjects played to minimize their losses. Patients with Parkinson's disease, on or off levodopa, were similar to controls when evaluating gains. However, in the Loss Phase before levodopa, they were more likely to avoid the prospect with lower probability but larger loss, as indicated by the steeper slope of their group psychometric function (t(24) = 2.21, p = 0.04). Modelling with prospect theory suggested that this was attributable to a 28% overestimation of the magnitude of loss, rather than an altered perception of its probability. While pre-medicated patients with Parkinson's disease show risk-aversion for large losses, patients on levodopa have normal perception of magnitude and probability for both loss and gain. The finding of accurate and normally biased decisions under risk in medicated patients with PD is important because it indicates that, if there is indeed anomalous risk-seeking behaviour in such a cohort, it may derive from abnormalities in components of

  15. Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients.

    Science.gov (United States)

    Blok, J L; Boersma, M; Terra, J B; Spoo, J R; Leeman, F W J; van den Heuvel, E R; Huizinga, J; Jonkman, M F; Horváth, B

    2015-08-01

    Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure. To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia. A clinical records-based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires. A total of 482 operations (363 primary operations and 119 re-operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied). The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery. © 2015 European Academy of Dermatology and Venereology.

  16. RISK FACTORS AFFECTING THE INCIDENCE OF CORONARY HEART DISEASE AT THE DR. WAHIDIN SUDIROHUSODO GENERAL HOSPITAL IN MAKASSAR IN 2010

    OpenAIRE

    arsin, A. Arsunan

    2011-01-01

    Dipresentasikan pada kegiatan " The 43rd APACPH Conference" di Graduate School of Public Health, Yonsei University, Korea. pada tanggal 20-22 Oktober 2011 RISK FACTORS AFFECTING THE INCIDENCE OF CORONARY HEART DISEASE AT THE DR. WAHIDIN SUDIROHUSODO GENERAL HOSPITAL IN MAKASSAR IN 2010 A. Arsunan Arsin, Wiwik, Ridwan Amiruddin Hasanuddin University, Indonesia Coronary heart disease is the first cause of death in the world and the fifth cause of death in all hospitals in Indonesi...

  17. [Neonatal ABO incompatibility underlies a potentially severe hemolytic disease of the newborn and requires adequate care].

    Science.gov (United States)

    Senterre, T; Minon, J-M; Rigo, J

    2011-03-01

    ABO allo-immunization is the most frequent hemolytic disease of the newborn and ABO incompatibility is present in 15-25 % of pregnancies. True ABO alloimmunization occurs in approximately one out of 150 births. Intensity is generally lower than in RhD allo-immunization. We report on three cases showing that ABO allo-immunization can lead to severe hemolytic disease of the newborn with potentially threatening hyperbilirubinemia and complications. Early diagnosis and adequate care are necessary to prevent complications in ABO incompatibility. A direct antiglobulin test is the cornerstone of diagnosis and should be performed at birth on cord blood sampling in all group infants born to O mothers, especially if of African origin. Risk factor analysis and attentive clinical monitoring during the first days of life are essential. Vigilance is even more important for infants discharged before the age of 72 h. Every newborn should be assessed for the risk of developing severe hyperbilirubinemia and should be examined by a qualified healthcare professional in the first days of life. Treatment depends on the total serum bilirubin level, which may increase very rapidly in the first 48 h of life in cases of hemolytic disease of the newborn. Phototherapy and, in severe cases, exchange transfusion are used to prevent hyperbilirubinemia encephalopathy. Intravenous immunoglobulins are used to reduce exchange transfusion. Treatments of severe hemolytic disease of the newborn should be provided and performed by trained personnel in neonatal intensive care units. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

  18. Periodontal Diseases and Systemic Disorders: What Do Our Doctors Know? A General Practitioner's Survey Conducted in Southern France.

    Science.gov (United States)

    Alexia, Vinel; Chloé, Vachon; Pierre, Barthet; Sara, Laurencin-Dalicieux

    2017-12-01

    With 39,359 entries on PubMed, periodontal medicine has a prominent position in periodontal research. Good patient care requires well-advised physicians, and whereas the dental community is informed about the relationships between periodontal diseases (PDs) and an increasing number of systemic pathologies, we wondered whether general practitioners were too. Thus, we aimed to evaluate their knowledge of the links between periodontal and systemic diseases. To this end, we sent an electronic questionnaire to the 2350 general practitioners registered to the URPS (Union régionale des Professionnels de Santé) of Midi-Pyrénées, France. They were asked about their practice, their attitude during a medical examination, and their knowledge about PDs. The analysis of 222 properly answered questionnaires showed that while most general practitioners are aware of the relationships between PDs and diabetes or cardiovascular diseases, the majority of them are unaware that obesity and respiratory and joint diseases are also concerned. Indeed, 94% of the questioned subjects consider their insight of PDs to be insufficient. Nevertheless, more than half of the interrogated physicians cared about their patients' oral health and dental care. Education regarding relationships between periodontal and systemic diseases must be improved among general practitioners who are in the front line to refer high-risk patients to a periodontist. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. An integrative view of mechanisms underlying generalized spike-and-wave epileptic seizures and its implication on optimal therapeutic treatments.

    Directory of Open Access Journals (Sweden)

    Boyuan Yan

    Full Text Available Many types of epileptic seizures are characterized by generalized spike-and-wave discharges. In the past, notable effort has been devoted to understanding seizure dynamics and various hypotheses have been proposed to explain the underlying mechanisms. In this paper, by taking an integrative view of the underlying mechanisms, we demonstrate that epileptic seizures can be generated by many different combinations of synaptic strengths and intrinsic membrane properties. This integrative view has important medical implications: the specific state of a patient characterized by a set of biophysical characteristics ultimately determines the optimal therapeutic treatment. Through the same view, we further demonstrate the potentiation effect of rational polypharmacy in the treatment of epilepsy and provide a new angle to resolve the debate on polypharmacy. Our results underscore the need for personalized medicine and demonstrate that computer modeling and simulation may play an important role in assisting the clinicians in selecting the optimal treatment on an individual basis.

  20. Generalized glycogen storage and cardiomegaly in a knockout mouse model of Pompe disease

    NARCIS (Netherlands)

    A.G.A. Bijvoet (Agnes); A.T. van der Ploeg (Ans); E.H. van de Kamp; M.A. Kroos (Marian); J.-H. Ding (Jia-Huan); B.Z. Yang (Bing); P. Visser (Pim); C.E. Bakker (Cathy); M.Ph. Verbeet (Martin); B.A. Oostra (Ben); A.J.J. Reuser (Arnold)

    1998-01-01

    textabstractGlycogen storage disease type II (GSDII; Pompe disease), caused by inherited deficiency of acid alpha-glucosidase, is a lysosomal disorder affecting heart and skeletal muscles. A mouse model of this disease was obtained by targeted disruption of the

  1. Effect of Maize Hybrid and Foliar Fungicides on Yield Under Low Foliar Disease Severity Conditions.

    Science.gov (United States)

    Mallowa, Sally O; Esker, Paul D; Paul, Pierce A; Bradley, Carl A; Chapara, Venkata R; Conley, Shawn P; Robertson, Alison E

    2015-08-01

    Foliar fungicide use in the U.S. Corn Belt increased in the last decade; however, questions persist pertaining to its value and sustainability. Multistate field trials were established from 2010 to 2012 in Illinois, Iowa, Ohio, and Wisconsin to examine how hybrid and foliar fungicide influenced disease intensity and yield. The experimental design was in a split-split plot with main plots consisting of hybrids varying in resistance to gray leaf spot (caused by Cercospora zeae-maydis) and northern corn leaf blight (caused by Setosphaera turcica), subplots corresponding to four application timings of the fungicide pyraclostrobin, and sub-subplots represented by inoculations with either C. zeae-maydis, S. turcica, or both at two vegetative growth stages. Fungicide application (VT/R1) significantly reduced total disease severity relative to the control in five of eight site-years (P<0.05). Disease was reduced by approximately 30% at Wisconsin in 2011, 20% at Illinois in 2010, 29% at Iowa in 2010, and 32 and 30% at Ohio in 2010 and 2012, respectively. These disease severities ranged from 0.2 to 0.3% in Wisconsin in 2011 to 16.7 to 22.1% in Illinois in 2010. The untreated control had significantly lower yield (P<0.05) than the fungicide-treated in three site-years. Fungicide application increased the yield by approximately 6% at Ohio in 2010, 5% at Wisconsin in 2010 and 6% in 2011. Yield differences ranged from 8,403 to 8,890 kg/ha in Wisconsin 2011 to 11,362 to 11,919 kg/ha in Wisconsin 2010. Results suggest susceptibility to disease and prevailing environment are important drivers of observed differences. Yield increases as a result of the physiological benefits of plant health benefits under low disease were not consistent.

  2. Australian general practitioners’ current practice for chronic kidney disease (CKD detection and management

    Directory of Open Access Journals (Sweden)

    Marie Ludlow

    2017-06-01

    Full Text Available Background Guidelines for early detection of chronic kidney disease (CKD emphasise regular testing of kidney health in high-risk individuals. However, evidence suggests that CKD is not being adequately detected or appropriately managed in primary care. Aims Assess Australian general practitioners’ (GP current practice in relation to CKD detection and management. Methods This was a cross-sectional study utilising a random sample of GPs identified by interrogation of the national online telephone directory, and stratified by geographical location. Data collection occurred between October 2014 and January 2015. Of 2,815 eligible contacts, the final response rate was 23 per cent. Results Of the 656 respondents, over 90 per cent assessed kidney health at least annually in people with diabetes or high blood pressure, and 71 per cent correctly assessed kidney health every 3–6 months in a patient with Stage 3b CKD. The tests most commonly used to assess kidney health were serum creatinine (with eGFR, blood pressure and urine albumin creatinine ratio. The most commonly reported CKD management strategies were ‘blood pressure reduction using pharmacological agents’ (81 per cent and ‘glycaemic control if diabetes present’ (64 per cent. Knowledge testing highlighted that 32 per cent of respondents were not able to correctly identify how to properly assess absolute cardiovascular risk, and this was significantly more common in more experienced GPs (p=0.003. Conclusion The results indicate that Australian GPs are mainly practising in accordance with current guidelines for detection and management of patients with CKD, but with room for improvement in some areas

  3. Exposure to general anesthesia and risk of alzheimer's disease: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Seitz Dallas P

    2011-12-01

    Full Text Available Abstract Background Alzheimer's disease (AD is common among older adults and leads to significant disability. Volatile anesthetic gases administered during general anesthesia (GA have been hypothesized to be a risk factor for the development of AD. The objective of this study is to systematically review the association between exposure to GA and risk of AD. Methods We searched electronic databases including MEDLINE, Embase, and Google scholar for observational studies examining the association between exposure to GA and risk of AD. We examined study quality using a modified version of the Newcastle-Ottawa risk of bias assessment for observational studies. We used standard meta-analytic techniques to estimate pooled odds ratios (OR and 95% confidence intervals (CI. Subgroup and sensitivity analyses were undertaken to evaluate the robustness of the findings. Results A total of 15 case-control studies were included in the review. No cohort studies were identified that met inclusion criteria. There was variation in the methodological quality of included studies. There was no significant association between any exposure to GA and risk of AD (pooled OR: 1.05; 95% CI: 0.93 - 1.19, Z = 0.80, p = 0.43. There was also no significant association between GA and risk of AD in several subgroup and sensitivity analyses. Conclusions A history of exposure to GA is not associated with an increased risk of AD although there are few high-quality studies in this area. Prospective cohort studies with long-term follow-up or randomized controlled trials are required to further understand the association between GA and AD.

  4. Age- and Parkinson's disease-related evaluation of gait by General Tau Theory.

    Science.gov (United States)

    Zhang, Shutao; Qian, Jinwu; Zhang, Zhen; Shen, Linyong; Wu, Xi; Hu, Xiaowu

    2016-10-01

    The degeneration of postural control in the elderly and patients with Parkinson's disease (PD) can be debilitating and may lead to increased fall risk. This study evaluated the changes in postural control during gait affected by PD and aging using a new method based on the General Tau Theory. Fifteen patients with PD, 11 healthy old adults (HOs), and 15 healthy young adults (HYs) were recruited. Foot trajectories of each participant were monitored during walking by a three-camera Optotrak Certus(®) motion capture system. The anteroposterior direction of foot movement during stepping was analyzed by tau-G and tau-J guidance strategies. Two linear regression analyses suggested that the tau of the step-gap was strongly coupled onto the tau-J guidance during walking. The regression slope K could estimate the coupling ratio in the tau-coupling equation which reflects the performance of postural control during gait. The mean K value for the PD group, which was highest among the three groups, was approximately 0.5. Therefore, participants in the PD group walked with the poorest postural control and exhibited a relatively hard contact with the endpoint during stepping when compared with those in the HO and HY groups. The HY and HO groups obtained mean K values significantly lower than 0.5, which indicated that the gait was well controlled and ended at low speed with low deceleration. However, the HO group showed a decreased tendency for postural control, in which the mean K value was significantly higher than that of the HY group. The K value was moderately positively correlated with the double support time and negatively correlated with the stride length and walking speed. The tau-J coupling ratio can provide additional insight into gait disturbances and may serve as a reliable, objective, and quantitative tool to evaluate dynamic postural control during walking.

  5. A neural network underlying intentional emotional facial expression in neurodegenerative disease

    Directory of Open Access Journals (Sweden)

    Kelly A. Gola

    2017-01-01

    Full Text Available Intentional facial expression of emotion is critical to healthy social interactions. Patients with neurodegenerative disease, particularly those with right temporal or prefrontal atrophy, show dramatic socioemotional impairment. This was an exploratory study examining the neural and behavioral correlates of intentional facial expression of emotion in neurodegenerative disease patients and healthy controls. One hundred and thirty three participants (45 Alzheimer's disease, 16 behavioral variant frontotemporal dementia, 8 non-fluent primary progressive aphasia, 10 progressive supranuclear palsy, 11 right-temporal frontotemporal dementia, 9 semantic variant primary progressive aphasia patients and 34 healthy controls were video recorded while imitating static images of emotional faces and producing emotional expressions based on verbal command; the accuracy of their expression was rated by blinded raters. Participants also underwent face-to-face socioemotional testing and informants described participants' typical socioemotional behavior. Patients' performance on emotion expression tasks was correlated with gray matter volume using voxel-based morphometry (VBM across the entire sample. We found that intentional emotional imitation scores were related to fundamental socioemotional deficits; patients with known socioemotional deficits performed worse than controls on intentional emotion imitation; and intentional emotional expression predicted caregiver ratings of empathy and interpersonal warmth. Whole brain VBMs revealed a rightward cortical atrophy pattern homologous to the left lateralized speech production network was associated with intentional emotional imitation deficits. Results point to a possible neural mechanisms underlying complex socioemotional communication deficits in neurodegenerative disease patients.

  6. Are the educational differences in incidence of cardiovascular disease explained by underlying familial factors?

    DEFF Research Database (Denmark)

    Madsen, Mia; Andersen, Per Kragh; Gerster, Mette

    2014-01-01

    To isolate the effect of education from the influence of potential underlying factors, we investigated the association of education with the risk of cardiovascular disease (CVD) and ischemic heart disease (IHD) using twin data to adjust for familial factors shared within twins, including genetic...... make-up and childhood environment. The study was based on data from the Danish Twin Registry linked to administrative and heath registers in Statistics Denmark. A total of 11,968 monozygotic and 20,464 dizygotic same sexed twins were followed from 1980 to 2009, including more than 8000 events of CVD....... Unpaired and intra-pair analyses were compared. In the unpaired analyses, an inverse educational gradient in CVD- and IHD risk was observed. This association was not replicated in the intra-pair analyses that control for shared familial factors exploiting that twins share their intrauterine- and childhood...

  7. Adult CHD patients under clinical follow-up have a similar quality of life to the general population in Malta.

    Science.gov (United States)

    Caruana, Maryanne; Grech, Victor

    2017-08-01

    The improved survival of patients born with CHD has led to increasing interest in research on quality of life of adult survivors. We report the findings of the first study in Malta carried out to investigate quality of life in adults with CHD under follow-up. A self-reporting questionnaire modelled on the basis of the European Health Interview Survey 2008, including questions on mental health and vitality, was administered to consecutive adult CHD outpatients, aged 16 years and over, between May, 2013 and May, 2014. Foreigners and patients with learning difficulties or cognitive impairment were excluded. Quality-of-life data were compared with that from 371 age- and sex-matched 2008 survey responders - general population cohort. The impact of congenital lesion complexity, hospitalisation in the preceding 12 months, arrhythmias, co-morbidities, and cardiac medication use on quality of life of the CHD cohort was also investigated. There were a total of 120 patient responders (63 males; mean age 30.53, SD 12.77 years). Overall, there were no significant differences in mental health and vitality between patient and general population cohorts, although older patients had better mental health scores compared with age-matched controls. Within the adult CHD cohort, hospitalisation in the preceding 12 months was the only factor associated with a poorer quality of life. Overall, CHD has no negative impact on mental health and vitality in Maltese adult patients under follow-up. Patients needing frequent hospitalisations might warrant closer attention by clinical psychologists.

  8. A generalized fuzzy credibility-constrained linear fractional programming approach for optimal irrigation water allocation under uncertainty

    Science.gov (United States)

    Zhang, Chenglong; Guo, Ping

    2017-10-01

    The vague and fuzzy parametric information is a challenging issue in irrigation water management problems. In response to this problem, a generalized fuzzy credibility-constrained linear fractional programming (GFCCFP) model is developed for optimal irrigation water allocation under uncertainty. The model can be derived from integrating generalized fuzzy credibility-constrained programming (GFCCP) into a linear fractional programming (LFP) optimization framework. Therefore, it can solve ratio optimization problems associated with fuzzy parameters, and examine the variation of results under different credibility levels and weight coefficients of possibility and necessary. It has advantages in: (1) balancing the economic and resources objectives directly; (2) analyzing system efficiency; (3) generating more flexible decision solutions by giving different credibility levels and weight coefficients of possibility and (4) supporting in-depth analysis of the interrelationships among system efficiency, credibility level and weight coefficient. The model is applied to a case study of irrigation water allocation in the middle reaches of Heihe River Basin, northwest China. Therefore, optimal irrigation water allocation solutions from the GFCCFP model can be obtained. Moreover, factorial analysis on the two parameters (i.e. λ and γ) indicates that the weight coefficient is a main factor compared with credibility level for system efficiency. These results can be effective for support reasonable irrigation water resources management and agricultural production.

  9. Effect of Rotation for Two-Temperature Generalized Thermoelasticity of Two-Dimensional under Thermal Shock Problem

    Directory of Open Access Journals (Sweden)

    Kh. Lotfy

    2013-01-01

    Full Text Available The theory of two-temperature generalized thermoelasticity based on the theory of Youssef is used to solve boundary value problems of two-dimensional half-space. The governing equations are solved using normal mode method under the purview of the Lord-Şhulman (LS and the classical dynamical coupled theory (CD. The general solution obtained is applied to a specific problem of a half-space subjected to one type of heating, the thermal shock type. We study the influence of rotation on the total deformation of thermoelastic half-space and the interaction with each other under the influence of two temperature theory. The material is homogeneous isotropic elastic half-space. The methodology applied here is use of the normal mode analysis techniques that are used to solve the resulting nondimensional coupled field equations for the two theories. Numerical results for the displacement components, force stresses, and temperature distribution are presented graphically and discussed. The conductive temperature, the dynamical temperature, the stress, and the strain distributions are shown graphically with some comparisons.

  10. General internal medicine at the crossroads of prosperity and despair: caring for patients with chronic diseases in an aging society.

    Science.gov (United States)

    Larson, E B

    2001-05-15

    During the past quarter century, general internal medicine has emerged as a vital discipline. In the realm of patient care, it is the integrating discipline par excellence. Ironically, as general internists face the challenge of integrating advances of dizzying speed and complexity, and as their clinical practice becomes increasingly effective, it has become much more difficult for them to earn a living. General internists find themselves at the crossroads of prosperity and despair. Although general medicine research leads the research agenda in many departments of medicine, it is particularly vulnerable. The necessary multidisciplinary "programmatic" infrastructure is expensive, and results often take many years to obtain, particularly in the study of chronic disease. The educational environment in many institutions is particularly difficult for general medicine, both because the current emphasis on technical skills obscures patients' and learners' real needs and because complex patients on general medicine services are now so ill and their turnover so rapid. General internal medicine and geriatrics are synergistic, especially in today's marketplace. A focus on geriatric medicine could help general medicine continue to flourish. General internists are ideally suited to the integrated care of elderly patients with multiple problems, research opportunities are enormous in the geriatric population, and the teaching of geriatrics requires a high level of generalist skills. Problems that plague current generalist practice have unique significance to older patients. Organizations that represent general internists would do well to join forces with many other advocacy groups, especially those representing the interests of elderly patients and geriatric medicine.

  11. Health Information-Seeking Patterns of the General Public and Indications for Disease Surveillance: Register-Based Study Using Lyme Disease.

    Science.gov (United States)

    Pesälä, Samuli; Virtanen, Mikko J; Sane, Jussi; Mustonen, Pekka; Kaila, Minna; Helve, Otto

    2017-11-06

    People using the Internet to find information on health issues, such as specific diseases, usually start their search from a general search engine, for example, Google. Internet searches such as these may yield results and data of questionable quality and reliability. Health Library is a free-of-charge medical portal on the Internet providing medical information for the general public. Physician's Databases, an Internet evidence-based medicine source, provides medical information for health care professionals (HCPs) to support their clinical practice. Both databases are available throughout Finland, but the latter is used only by health professionals and pharmacies. Little is known about how the general public seeks medical information from medical sources on the Internet, how this behavior differs from HCPs' queries, and what causes possible differences in behavior. The aim of our study was to evaluate how the general public's and HCPs' information-seeking trends from Internet medical databases differ seasonally and temporally. In addition, we aimed to evaluate whether the general public's information-seeking trends could be utilized for disease surveillance and whether media coverage could affect these seeking trends. Lyme disease, serving as a well-defined disease model with distinct seasonal variation, was chosen as a case study. Two Internet medical databases, Health Library and Physician's Databases, were used. We compared the general public's article openings on Lyme disease from Health Library to HCPs' article openings on Lyme disease from Physician's Databases seasonally across Finland from 2011 to 2015. Additionally, media publications related to Lyme disease were searched from the largest and most popular media websites in Finland. Both databases, Health Library and Physician's Databases, show visually similar patterns in temporal variations of article openings on Lyme disease in Finland from 2011 to 2015. However, Health Library openings show not only

  12. A Four-Year Monocentric Study of the Complications of Third Molars Extractions under General Anesthesia: About 2112 Patients

    Directory of Open Access Journals (Sweden)

    A. Guerrouani

    2013-01-01

    Full Text Available Introduction. The aim of this study was to assess the complications resulting from third molar extraction under general anesthesia. Material and Methods. The retrospective study included all patients who underwent impacted third molars extraction from January 2008 until December 2011. 7659 third molars were extracted for 2112 patients. Postoperative complications were retrieved from medical files. Results. No complications were related to general anesthesia. The most frequent postoperative complication was infection (7.15%. Lingual nerve injuries affected 1.8% of the patients. All of them were transient and were not related to tooth section. Inferior alveolar nerve injuries were reported in 0.4% of the cases. 95.8% of these patients were admitted for one-day ambulatory care, and only two patients were readmitted after discharge from hospital. Discussion. This surgical technique offers comfort for both surgeons and patients. Risks are only linked to the surgical procedure as we observed no complication resulting from general anesthesia. One-day hospitalization offers a good balance between comfort, security, and cost. The incidence of complications is in agreement with the literature data, especially regarding pain, edema, and infectious and nervous complications. It is of utmost importance to discuss indications with patients, and to provide them with clear information.

  13. Comparative Evaluation of Pediatric Patients with Mental Retardation undergoing Dental Treatment under General Anesthesia: A Retrospective Analysis.

    Science.gov (United States)

    Ahuja, Ravish; Jyoti, Bhuvan; Shewale, Vinod; Shetty, Shridhar; Subudhi, Santosh Kumar; Kaur, Manpreet

    2016-08-01

    Behavioral management of patients forms one of the foremost components of pediatric dental treatment. Some children readily cooperate with dental treatment, while others require general anesthesia as a part of treatment protocol for carrying out various dental procedures. Hence, we evaluated the pediatric patients with and without mental retardation, who underwent dental treatment under general anesthesia. The present study analyzed the record of 480 pediatric patients reporting in the department of pedodontics from 2008 to 2014. Analysis of the records of the patients who underwent dental treatment under general anesthesia was done and all the patients were divided into two study groups depending upon their mental level. For the purpose of evaluation, the patients were also grouped according to their age; 4 to 7 years, 8 to 12 years, and 13 to 18 years. Measurement of decayed, missing, and filled teeth and scores for both deciduous and permanent dentition was done before and after the commencement of the dental treatment. Chi-square test and independent t-test were used for evaluating the level of significance. While comparing the patients in the two groups, maximum number of patients is present in the age group of 13 to 18 years. While comparing the indices' score between the two study groups in various age intervals, no statistically significant results were obtained. Restorative treatment and dental extractions were the most common dental treatments that were seen at a higher frequency in the intellectual disability study group. In patients with mental retardation, a higher frequency of restorative treatment and extractions occurs as compared to healthy subjects of similar age group. Therefore, they require special attention regarding maintenance of their oral health. Special attention should be given for maintaining the oral health of patients with special health care needs as compared to their physically and mentally normal counterparts.

  14. Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection.

    Science.gov (United States)

    Eseonu, Chikezie I; Rincon-Torroella, Jordina; ReFaey, Karim; Lee, Young M; Nangiana, Jasvinder; Vivas-Buitrago, Tito; Quiñones-Hinojosa, Alfredo

    2017-09-01

    A craniotomy with direct cortical/subcortical stimulation either awake or under general anesthesia (GA) present 2 approaches for removing eloquent region tumors. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under GA is chosen for these lesions. To evaluate a single-surgeon's experience with awake craniotomies (AC) vs surgery under GA for resecting perirolandic, eloquent, motor-region gliomas. Between 2005 and 2015, a retrospective analysis of 27 patients with perirolandic, eloquent, motor-area gliomas that underwent an AC were case-control matched with 31 patients who underwent surgery under GA for gliomas in the same location. All patients underwent direct brain stimulation with neuromonitoring and perioperative risk factors, extent of resection, complications, and discharge status were assessed. The postoperative Karnofsky Performance Score (KPS) was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 ( P = .040). The extent of resection for GA patients was 79.6% while the AC patients had an 86.3% resection ( P = .136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%; P = .041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group at 4.2 days ( P = .049). We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma. Copyright © 2017 by the Congress of Neurological Surgeons

  15. Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized poisson regression model.

    Science.gov (United States)

    Islam, Mohammad Mafijul; Alam, Morshed; Tariquzaman, Md; Kabir, Mohammad Alamgir; Pervin, Rokhsona; Begum, Munni; Khan, Md Mobarak Hossain

    2013-01-08

    Malnutrition is one of the principal causes of child mortality in developing countries including Bangladesh. According to our knowledge, most of the available studies, that addressed the issue of malnutrition among under-five children, considered the categorical (dichotomous/polychotomous) outcome variables and applied logistic regression (binary/multinomial) to find their predictors. In this study malnutrition variable (i.e. outcome) is defined as the number of under-five malnourished children in a family, which is a non-negative count variable. The purposes of the study are (i) to demonstrate the applicability of the generalized Poisson regression (GPR) model as an alternative of other statistical methods and (ii) to find some predictors of this outcome variable. The data is extracted from the Bangladesh Demographic and Health Survey (BDHS) 2007. Briefly, this survey employs a nationally representative sample which is based on a two-stage stratified sample of households. A total of 4,460 under-five children is analysed using various statistical techniques namely Chi-square test and GPR model. The GPR model (as compared to the standard Poisson regression and negative Binomial regression) is found to be justified to study the above-mentioned outcome variable because of its under-dispersion (variance variable namely mother's education, father's education, wealth index, sanitation status, source of drinking water, and total number of children ever born to a woman. Consistencies of our findings in light of many other studies suggest that the GPR model is an ideal alternative of other statistical models to analyse the number of under-five malnourished children in a family. Strategies based on significant predictors may improve the nutritional status of children in Bangladesh.

  16. Projection of temperature-related mortality due to cardiovascular disease in beijing under different climate change, population, and adaptation scenarios.

    Science.gov (United States)

    Zhang, Boya; Li, Guoxing; Ma, Yue; Pan, Xiaochuan

    2018-04-01

    Human health faces unprecedented challenges caused by climate change. Thus, studies of the effect of temperature change on total mortality have been conducted in numerous countries. However, few of those studies focused on temperature-related mortality due to cardiovascular disease (CVD) or considered future population changes and adaptation to climate change. We present herein a projection of temperature-related mortality due to CVD under different climate change, population, and adaptation scenarios in Beijing, a megacity in China. To this end, 19 global circulation models (GCMs), 3 representative concentration pathways (RCPs), 3 socioeconomic pathways, together with generalized linear models and distributed lag non-linear models, were used to project future temperature-related CVD mortality during periods centered around the years 2050 and 2070. The number of temperature-related CVD deaths in Beijing is projected to increase by 3.5-10.2% under different RCP scenarios compared with that during the baseline period. Using the same GCM, the future daily maximum temperatures projected using the RCP2.6, RCP4.5, and RCP8.5 scenarios showed a gradually increasing trend. When population change is considered, the annual rate of increase in temperature-related CVD deaths was up to fivefold greater than that under no-population-change scenarios. The decrease in the number of cold-related deaths did not compensate for the increase in that of heat-related deaths, leading to a general increase in the number of temperature-related deaths due to CVD in Beijing. In addition, adaptation to climate change may enhance rather than ameliorate the effect of climate change, as the increase in cold-related CVD mortality greater than the decrease in heat-related CVD mortality in the adaptation scenarios will result in an increase in the total number of temperature-related CVD mortalities. Copyright © 2018 Elsevier Inc. All rights reserved.

  17. [The importance of local and general factors in development of inflammatory periodontal diseases in children and adolescents].

    Science.gov (United States)

    Shishinashvili, T E; Tsagareli, Z G; Khimshiashvili, N B

    2012-10-01

    The aim of the study was to investigate the influence of local and general adverse risk factors and their role in the development of inflammatory periodontal diseases in children and adolescents. The study of the dental status among 618 school children, 9 to 15 years of age has been performed. The obtained results revealed an ambiguous influence of general and local risk factors on the development of inflammatory periodontal diseases. Namely, among the general risk factors the main role is given to hormonal functioning state of juvenile age (26.5%) - (arhythmia formation of hormonal activity). Among the local risk factors inducing inflammatory periodontal diseases at young age, the most significant are tooth-jaw anomalies (32.2%), especially - dental occlusion pathology, lips' bridle attachment anomalies, absence of interdental contacts, small vestibule of the mouth and so on. Poor oral hygiene, however, is also a significant factor in all age groups. Definition of the role and importance of general and local risk factors, taking into consideration patient's age, is of great importance in organization of early prevention, giving the possibility to predict disease possible development, choose most appropriate way to treat the specific situation, reduce the need of complex treatment and improve treatment outcomes.

  18. Comparison of Younger and Older Adults' Acceptability of Treatment for Generalized Anxiety Disorder Co-Occurring with Parkinson's Disease

    Science.gov (United States)

    Lundervold, Duane A.; Ament, Patrick A.; Holt, Peter S.; Hunt, Lauren S.

    2013-01-01

    Acceptability ratings of medication or Behavioral Relaxation Training (BRT), for general anxiety disorder (GAD) co-occurring with Parkinson's Disease (PD) were obtained from younger ("n" = 79) and older ("n" = 54) adults. Participants read a case description of an older adult with PD and comorbid GAD followed by a description…

  19. Attitudes toward Alzheimer's disease: a qualitative study of the role played by social representation on a convenient sample of French general practitioners.

    Science.gov (United States)

    Lahjibi-Paulet, Hayat; Dauffy Alain, Agnès; Minard, Aurélien; Gaxatte, Cédric; Saint-Jean, Olivier; Somme, Dominique

    2012-08-01

    It is commonly thought that Alzheimer's disease (AD) is under-diagnosed and that insufficient numbers of patients are receiving pharmacological treatment. These observations are often attributed to poor management of the disease by general practitioners (GPs) related to their lack of training in identifying cognitive decline. Our hypothesis is that there may be a relation between GPs' perceptions and their attitudes toward AD. We conducted a qualitative study, through semi-directive interviews focusing on their representations, of 25 GPs, masters in training courses, in Paris. Analysis of interviews revealed five general trends. AD is seen by GPs as a "disease of autonomy", without specific medical treatment. Cognitive symptoms are less meaningful in GPs' view than the loss of autonomy. The main thing is to keep the patient at home. For GPs, the family is described as an essential partner in coping with the insufficiencies of available social programs. The use of specialists is less to confirm the diagnosis than to announce the "bad news". GPs declare scepticism as to the efficacy of AD medications, only granting them a certain "care" effect or a social role. The image of AD remains highly negative. The stigma of AD is seen as a barrier to its diagnosis. This study is somewhat preliminary because of sample size. Nevertheless, the social representations of the disease influence GPs' attitudes toward making diagnoses in France. Priority seems to focus more on assisting GPs and families at the social level, rather than diagnosis or access to treatment.

  20. Music and Memory in Alzheimer's Disease and The Potential Underlying Mechanisms.

    Science.gov (United States)

    Peck, Katlyn J; Girard, Todd A; Russo, Frank A; Fiocco, Alexandra J

    2016-01-01

    With population aging and a projected exponential expansion of persons diagnosed with Alzheimer's disease (AD), the development of treatment and prevention programs has become a fervent area of research and discovery. A growing body of evidence suggests that music exposure can enhance memory and emotional function in persons with AD. However, there is a paucity of research that aims to identify specific underlying neural mechanisms associated with music's beneficial effects in this particular population. As such, this paper reviews existing anecdotal and empirical evidence related to the enhancing effects of music exposure on cognitive function and further provides a discussion on the potential underlying mechanisms that may explain music's beneficial effect. Specifically, this paper will outline the potential role of the dopaminergic system, the autonomic nervous system, and the default network in explaining how music may enhance memory function in persons with AD.

  1. A Retrospective Audit of Dental Treatment Provided to Special Needs Patients under General Anesthesia During a Ten-Year Period.

    Science.gov (United States)

    Mallineni, Sreekanth Kumar; Yiu, Cynthia Kar Y

    The purpose of this study was to perform a comprehensive audit of dental treatment provided to special needs patients (SNP) under general anesthesia (GA) over a ten-year period. Special needs patients who received dental treatment under GA as an in-patient at Queen Mary Hospital, Hong Kong SAR during the time period January 2002 and December 2011 were included in the study. The study population was divided into three groups, based on age (12 years). One-way ANOVA was used to evaluate the effect of "age group" on duration of treatment, post-recovery time, treatment procedures and utilization of different restorative materials. Kappa statistics were used for intra-examiner reliability. A total of 275 patients (174 males and 101 females) were included in the study. The mean age of the patients at the time they received GA was 12.37±10.18 years. Dental procedures performed were mostly restorative in nature (47%). The >12 years group had significantly shorter treatment duration (pdifference in post-operative recovery time was observed among the three age groups (p>0.05). The group received significantly less preventive, but more restorative procedures (pgroup (puse of composite restorations was significantly higher in the group; while amalgam restorations were more frequently used in the >12 years group (Page (page, had longer treatment time under GA. Composite restorations and stainless steel crowns were more frequently used in the primary dentition and amalgam restorations were more frequently employed in the permanent dentition.

  2. Stressors, social support, depressive symptoms and general health status of Taiwanese caregivers of persons with stroke or Alzheimer's disease.

    Science.gov (United States)

    Huang, Chiung-Yu; Sousa, Valmi D; Perng, Shao-Jen; Hwang, Mei-Yi; Tsai, Chun-Ching; Huang, Mei-Huang; Yao, Shu-Ying

    2009-02-01

    This study examined the relationships among stressors, social support, depressive symptoms and the general health status of Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Caring for a disabled or cognitively impaired person can be extremely stressful and often has adverse effects on caregivers' health. While research on caregiving in Taiwan has examined caregivers' characteristics, caregivers' need and caregivers' burden in caring for older people in general, little is known about Taiwanese caregivers of individuals with stroke or Alzheimer's disease. Cross-sectional, descriptive correlation design. Data were obtained from a convenience sample of 103 Taiwanese informal caregivers in the South of Taiwan and analysed using descriptive statistics, Pearson's correlations, multiple and hierarchical regressions and t-tests. Caregivers who had lower household incomes and were taking care of individuals with more behaviour problems had more depressive symptoms. In addition, caregivers who were older and were taking care of individuals with more behaviour problems had worse general health. Caregivers who had more emotional support had less depressive symptoms. Caregivers of persons with Alzheimer's disease had more depressive symptoms and worse general health than caregivers of persons with stroke. Only emotional support moderated the relationship between one of the stressors (household income) and depressive symptoms. The findings of this study may be helpful for nurses and other health care professionals in designing effective interventions to minimise the negative impacts of stressors on the psychological and general health of caregivers in Taiwan.

  3. Prevalence and Significance of Unrecognized Lower Extremity Peripheral Arterial Disease in General Medicine Practice

    Science.gov (United States)

    McGrae McDermott, Mary; Kerwin, Diana R; Liu, Kiang; Martin, Gary J; O'Brien, Erin; Kaplan, Heather; Greenland, Philip

    2001-01-01

    OBJECTIVE To determine the prevalence of unrecognized lower extremity peripheral arterial disease (PAD) among men and women aged 55 years and older in a general internal medicine (GIM) practice and to identify characteristics and functional performance associated with unrecognized PAD. DESIGN Cross-sectional. SETTING Academic medical center. PARTICIPANTS We identified 143 patients with known PAD from the noninvasive vascular laboratory, and 239 men and women aged 55 and older with no prior PAD history from a GIM practice. Group 1 consisted of patients with PAD consecutively identified from the noninvasive vascular laboratory (n = 143). Group 2 included GIM practice patients found to have an ankle brachial index less than 0.90, consistent with PAD (n = 34). Group 3 consisted of GIM practice patients without PAD (n = 205). MEASUREMENTS AND MAIN RESULTS Leg functioning was assessed with the 6-minute walk, 4-meter walking velocity, and Walking Impairment Questionnaire (WIQ). Of GIM practice patients, 14% had unrecognized PAD. Only 44% of patients in Group 2 had exertional leg symptoms. Distances achieved in the 6-minute walk were 1,130, 1,362, and 1,539 feet for Groups 1, 2, and 3, respectively, adjusting for age, gender, and race (P < .001). The degree of difficulty walking due to leg symptoms as reported on the WIQ was comparable between Groups 2 and 3 and significantly greater in Group 1 than Group 2. In multiple logistic regression analysis including Groups 2 and 3, current cigarette smoking was associated independently with unrecognized PAD (odds ratio [OR], 6.82; 95% confidence interval [95% CI], 1.55 to 29.93). Aspirin therapy was nearly independently associated with absence of PAD (OR, 0.37; 95% CI, 0.12 to 1.12). CONCLUSION Unrecognized PAD is common among men and women aged 55 years and older in GIM practice and is associated with impaired lower extremity functioning. Ankle brachial index screening may be necessary to diagnose unrecognized PAD in a GIM

  4. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease

    Directory of Open Access Journals (Sweden)

    James Yates

    2016-08-01

    Full Text Available Background: Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease. This has not been reported in a general practice setting. Aim: To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. Design and setting: A prospective observational study of 80 patients aged over 50 years and who had not received echocardiography or chest CT within 12 months presenting to a general practice. Method: Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. Results and conclusion: Echocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20% patients, including aortic stenosis in 9 (11% and cardiac failure in 7 (9%, which were missed by clinical examination in 10 (62.5% of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease including referral for diagnostic echocardiography in 8 (10%, commencement of heart failure treatment in 3 (4% and referral to a cardiologist in 1 patient (1%. Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50 years presenting to a general practice.

  5. Can systemically generated reactive oxygen species help to monitor disease activity in generalized vitiligo? A pilot study

    Directory of Open Access Journals (Sweden)

    Richeek Pradhan

    2014-01-01

    Full Text Available Background: Generalized vitiligo is a disease with unpredictable bursts of activity, goal of treatment during the active phase being to stabilize the lesions. This emphasizes the need for a prospective marker for monitoring disease activity to help decide the duration of therapy. Aims and Objectives: In the present study, we examined whether reactive oxygen species (ROS generated in erythrocytes can be translated into a marker of activity in vitiligo. Materials and Methods: Level of intracellular ROS was measured flow cytometrically in erythrocytes from venous blood of 21 patients with generalized vitiligo and 21 healthy volunteers using the probe dichlorodihydrofluorescein diacetate. Results: The levels of ROS differed significantly between patients and healthy controls, as well as between active versus stable disease groups. In the active disease group, ROS levels were significantly lower in those being treated with systemic steroids than those that were not. ROS levels poorly correlated with disease duration or body surface area involved. Conclusion: A long-term study based on these findings can be conducted to further validate the potential role of ROS in monitoring disease activity vitiligo.

  6. General Diseases Influence on Peri-Implantitis Development: a Systematic Review

    Directory of Open Access Journals (Sweden)

    Zygimantas Guobis

    2016-09-01

    Full Text Available Objectives: To systematically review the influence of systemic diseases or medications used in their treatment on the dental implant therapy success. Material and Methods: The search strategy was implemented on the National Library of Medicine database (MEDLINE (Ovid and EMBASE electronic databases between January 2006 and January 2016. Human studies with available English articles analysing the relationship between dental implant therapy success and systemic diseases, such as diabetes mellitus, AIDS/HIV, rheumatoid arthritis, osteoporosis, Crohn’s disease, cardiovascular diseases, scleroderma, Sjögren’s syndrome, lichen planus, ectodermal dysplasia, post-transplantation status, were included in present review according to the PRISMA guidelines. The review protocol was registered on PROSPERO system with the code CRD42016033662. Results: Present review included forty one retrospective and prospective follow-up studies, case-control studies, case report series and cohort studies. Despite some limitations this study reveals positive results of implantation in most systemic conditions that should be interpreted with caution. Influence of cardiovascular diseases on the dental implantation success should be explored deeply, because of controversial results and likelihood of comorbidity expressed by a history of cardiovascular diseases and periodontitis. There is only a weak relationship with bone density in osteoporosis and implant failure. All the other diseases did not show significant effect on implantation success. Conclusions: Recent studies with low strength of evidence and controversy show that systemic diseases may have potential effect on the success of implantation, but further detailed studies are needed to provide these findings.

  7. Seasonal variation of diseases in children : a 6-year prospective cohort study in a general hospital

    NARCIS (Netherlands)

    Schrijver, Tessa V.; Brand, Paul L. P.; Bekhof, Jolita

    Seasonal variation in pediatrics has been well described in some infectious diseases, asthma, and diabetes, but data on seasonality for other diseases in children are sparse. To explore the extent of seasonal variation of the entire pediatric field, we analyzed diagnostic codes of all newly referred

  8. Delayed pneumothorax after laparoscopic sigmoid colectomy in a patient without underlying lung disease

    Directory of Open Access Journals (Sweden)

    Richie K Huynh

    2014-10-01

    Full Text Available We present an unusual case of a delayed pneumothorax occurring approximately 72 h post-operatively in a patient without any underlying lung disease who had undergone laparoscopic sigmoid colon resection. The patient was in her mid-40s with a body mass index of 28.0 and had no history of smoking. Her spontaneous pneumothorax manifested without any precipitating events or complications during recovery. There was no evidence of any infectious process. There were no central line attempts and all ports were placed intra-peritoneally, and there was no evidence of any subcutaneous emphysema. One possible mechanism of injury that we propose is barotrauma from an extended period of time in Trendelenburg position. Notably, the only abnormal finding throughout the entire post-operative period preceding the delayed pneumothorax was a PO 2 desaturation the day before. This case highlights the necessity to examine and investigate any desaturation post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying lung disease or risk factors, spontaneous pneumothorax could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure.

  9. Statistical analysis of general, clinical and radiographic parameters of navicular disease in the horse

    International Nuclear Information System (INIS)

    Langfeldt, N.; Hertsch, B.

    1988-01-01

    With 20,4 % the syndrome navicular disease has a remarkable part of lameness in the equine fore limb. Although intensive investigations of the last years, there is no uniform opinion in the clinical diagnosis of navicular disease. At first there is a differential description of the diagnosis of navicular disease and a presentation of the importance of this disease from the whole patients of the equine hospital of the Tierärztliche Hochschule Hannover about five years (1980-1984). After that, the importance of the identification of pain with pain provocation test and the elimination of pain by anesthetic nerve blocking are described. The result of the anesthetic block of the ''Ramus pulvinus'' of the medial and lateral palmar digital nerves is a necessary part in clinical diagnosis of navicular disease [de

  10. Shared activity patterns arising at genetic susceptibility loci reveal underlying genomic and cellular architecture of human disease

    DEFF Research Database (Denmark)

    Baillie, J Kenneth; Bretherick, Andrew; Haley, Christopher S

    2018-01-01

    Genetic variants underlying complex traits, including disease susceptibility, are enriched within the transcriptional regulatory elements, promoters and enhancers. There is emerging evidence that regulatory elements associated with particular traits or diseases share similar patterns...... the regulation of the OCT1 cation transporter and genetic variants underlying circulating cholesterol levels. NDA strongly implicates particular cell types and tissues in disease pathogenesis. For example, distinct groupings of disease-associated regulatory regions implicate two distinct biological processes...... in the pathogenesis of ulcerative colitis; a further two separate processes are implicated in Crohn's disease. Thus, our functional analysis of genetic predisposition to disease defines new distinct disease endotypes. We predict that patients with a preponderance of susceptibility variants in each group are likely...

  11. Turbulent dispersivity under conditions relevant to airborne disease transmission between laboratory animals

    Science.gov (United States)

    Halloran, Siobhan; Ristenpart, William

    2013-11-01

    Virologists and other researchers who test pathogens for airborne disease transmissibility often place a test animal downstream from an inoculated animal and later determine whether the test animal became infected. Despite the crucial role of the airflow in pathogen transmission between the animals, to date the infectious disease community has paid little attention to the effect of airspeed or turbulent intensity on the probability of transmission. Here we present measurements of the turbulent dispersivity under conditions relevant to experimental tests of airborne disease transmissibility between laboratory animals. We used time lapse photography to visualize the downstream transport and turbulent dispersion of smoke particulates released from a point source downstream of an axial fan, thus mimicking the release and transport of expiratory aerosols exhaled by an inoculated animal. We show that for fan-generated turbulence the plume width is invariant with the mean airspeed and, close to the point source, increases linearly with downstream position. Importantly, the turbulent dispersivity is insensitive to the presence of meshes placed downstream from the point source, indicating that the fan length scale dictates the turbulent intensity and corresponding dispersivity.

  12. Proliferative kidney disease in brown trout: infection level, pathology and mortality under field conditions.

    Science.gov (United States)

    Schmidt-Posthaus, Heike; Hirschi, Regula; Schneider, Ernst

    2015-05-21

    Proliferative kidney disease (PKD) is an emerging disease threatening wild salmonid populations. In temperature-controlled aquaria, PKD can cause mortality rates of up to 85% in rainbow trout. So far, no data about PKD-related mortality in wild brown trout Salmo trutta fario are available. The aim of this study was to investigate mortality rates and pathology in brown trout kept in a cage within a natural river habitat known to harbor Tetracapsuloides bryosalmonae. Young-of-the-year (YOY) brown trout, free of T. bryosalmonae, were exposed in the River Wutach, in the northeast of Switzerland, during 3 summer months. Samples of wild brown trout caught by electrofishing near the cage location were examined in parallel. The incidence of PKD in cage-exposed animals (69%) was not significantly different to the disease prevalence of wild fish (82 and 80% in the upstream and downstream locations, respectively). The mortality in cage-exposed animals, however, was as low as 15%. At the termination of the exposure experiment, surviving fish showed histological lesions typical for PKD regression, suggesting that many YOY brown trout survive the initial infection. Our results at the River Wutach suggest that PKD in brown trout does not always result in high mortality under natural conditions.

  13. Participation of general practitioners in disease management: experiences from the Netherlands

    Directory of Open Access Journals (Sweden)

    L.M.G. Steuten

    2002-03-01

    Full Text Available Objective: To investigate the extent to which GPs in the Netherlands participate in disease management and how personal opinions, impeding and promoting incentives as well as physician characteristics influence their attitude towards disease management. Methods: The attitude-model of Fishbein and Ajzen was used to describe the attitude of GPs towards disease management and main influencing factors. After interviewing seventeen representatives of the GPs and testing a questionnaire, the final questionnaire was sent to all GPs in the Netherlands (7680 GPs barring those involved in the testing of the questionnaire. Results: At least 10.4% of all Dutch GPs are active in disease management. The main factors predicting a positive attitude towards disease management are the following: GPs' opinion that they are improving quality and efficiency of care when executing disease management, presence of a good quality network between actors involved prior to the start of disease management, working in a health centre, and performing sideline activities besides their daily activities as GPs. The main factors predicting a negative attitude are: GPs' opinion that the investment-time is too high, lack of reimbursement for disease management activities, working in a solo practice, and not performing any sideline activities beside their daily activities as GP. Conclusions: The factors predicting a negative attitude of Dutch GPs towards disease management dominate the factors predicting a positive attitude. The arguments in favour of disease management are matters of belief, for example concerning improvements in the quality of care, while arguments against are more concrete barriers e.g. high workload and financial reimbursement. Placed on the innovation timeline, the 10.4% participation might be taken to represent the start of a trend.

  14. Transcriptomic Analysis and the Expression of Disease-Resistant Genes in Oryza meyeriana under Native Condition.

    Directory of Open Access Journals (Sweden)

    Bin He

    Full Text Available Oryza meyeriana (O. meyeriana, with a GG genome type (2n = 24, accumulated plentiful excellent characteristics with respect to resistance to many diseases such as rice shade and blast, even immunity to bacterial blight. It is very important to know if the diseases-resistant genes exist and express in this wild rice under native conditions. However, limited genomic or transcriptomic data of O. meyeriana are currently available. In this study, we present the first comprehensive characterization of the O. meyeriana transcriptome using RNA-seq and obtained 185,323 contigs with an average length of 1,692 bp and an N50 of 2,391 bp. Through differential expression analysis, it was found that there were most tissue-specifically expressed genes in roots, and next to stems and leaves. By similarity search against protein databases, 146,450 had at least a significant alignment to existed gene models. Comparison with the Oryza sativa (japonica-type Nipponbare and indica-type 93-11 genomes revealed that 13% of the O. meyeriana contigs had not been detected in O. sativa. Many diseases-resistant genes, such as bacterial blight resistant, blast resistant, rust resistant, fusarium resistant, cyst nematode resistant and downy mildew gene, were mined from the transcriptomic database. There are two kinds of rice bacterial blight-resistant genes (Xa1 and Xa26 differentially or specifically expressed in O. meyeriana. The 4 Xa1 contigs were all only expressed in root, while three of Xa26 contigs have the highest expression level in leaves, two of Xa26 contigs have the highest expression profile in stems and one of Xa26 contigs was expressed dominantly in roots. The transcriptomic database of O. meyeriana has been constructed and many diseases-resistant genes were found to express under native condition, which provides a foundation for future discovery of a number of novel genes and provides a basis for studying the molecular mechanisms associated with disease

  15. Engaging general practice nurses in chronic disease self-management support in Australia: insights from a controlled trial in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Walters, Julia A E; Courtney-Pratt, Helen; Cameron-Tucker, Helen; Nelson, Mark; Robinson, Andrew; Scott, Jenn; Turner, Paul; Walters, E Haydn; Wood-Baker, Richard

    2012-01-01

    The growing burden of chronic disease will increase the role of primary care in supporting self-management and health behaviour change. This role could be undertaken to some extent by the increased practice nurse workforce that has occurred over recent years. Mixed methods were used to investigate the potential for general practice nurses to adopt this role during a 12-month randomised controlled study of telephone-delivered health mentoring in Tasmanian practices. Nurses (general practice and community health) were trained as health mentors to assist chronic obstructive pulmonary disease patients to identify and achieve personal health related goals through action plans. Of 21% of invited practices that responded, 19 were allocated to health mentoring; however, general practice nurses were unable to train as health mentors in 14 (74%), principally due to lack of financial compensation and/or workload pressure. For five general practice nurses trained as health mentors, their roles had previously included some chronic disease management, but training enhanced their understanding and skills of self-management approaches and increased the focus on patient partnership, prioritising patients' choices and achievability. Difficulties that led to early withdrawal of health mentors were competing demands, insufficient time availability, phone calls having lower priority than face-to-face interactions and changing employment. Skills gained were rated as valuable, applicable to all clinical practice and transferable to other health care settings. Although these results suggest that training can enhance general practice nurses' skills to deliver self-management support in chronic disease, there are significant system barriers that need to be addressed through funding models and organisational change.

  16. Results of surgical treatment for secondary spontaneous pneumothorax according to underlying diseases.

    Science.gov (United States)

    Ichinose, Junji; Nagayama, Kazuhiro; Hino, Haruaki; Nitadori, Jun-ichi; Anraku, Masaki; Murakawa, Tomohiro; Nakajima, Jun

    2016-04-01

    The outcome of surgical treatment for secondary spontaneous pneumothorax (SSP) has rarely been investigated. We retrospectively reviewed 183 patients who underwent surgery for SSP. We categorized the patients into three groups according to underlying diseases: Group A (chronic obstructive pulmonary disease), Group B (interstitial pneumonia [IP]) and Group C (others). We defined treatment success as surgery without hospital mortality, postoperative complications, death within 6 months or ipsilateral recurrence of pneumothorax within 2 years. We assessed the risk factors for unsuccessful treatment using a Cox regression hazard model. There were 123 patients in Group A, 20 in Group B and 40 in Group C. The hospital mortality rates were 2, 15 and 0% in Groups A, B and C, respectively. The hospital mortality, morbidity and pneumothorax recurrence rates in the IP group were higher than in the other groups. The 5-year overall survival rates were 78, 32 and 84% in Groups A, B and C, respectively; the prognosis of the IP group was significantly poorer. The treatment success rates were 86, 45 and 83% in Groups A, B and C, respectively. SSPs caused by IP and SSPs requiring open surgery were identified as the risk factors for unsuccessful treatment. Surgery for SSP caused by underlying diseases other than IP yielded favourable results. However, a careful examination of surgical indication and a realistic disclosure for informed consent are required for patients with SSP caused by IP, because of the high treatment failure rate. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  17. Transversus abdominis plane block reduces postoperative pain intensity and analgesic consumption in elective cesarean delivery under general anesthesia.

    Science.gov (United States)

    Eslamian, Laleh; Jalili, Zorvan; Jamal, Ashraf; Marsoosi, Vajiheh; Movafegh, Ali

    2012-06-01

    It is reported that following abdominal surgery, transversus abdominis plane (TAP) block can reduce postoperative pain. The primary outcome of this study was the evaluation of the efficacy of TAP block on pain intensity following cesarean delivery with Pfannenstiel incision. Fifty pregnant women were randomized blindly to receive either a TAP block with 15 ml 0.25% bupivacaine in both sides (group T, n = 25) or no blockade (group C, n = 25) at the end of the surgery, which was performed with a Pfannenstiel incision under general anesthesia. The pain intensity in the patients was assessed by a blinded investigator at the time of discharge from recovery and at 6, 12, and 24 h postoperatively, with a visual analogue scale (VAS) for pain. The women in the TAP block group had significantly lower VAS pain scores at rest and during coughing and consumed significantly less tramadol than the women in group C [50 mg (0-150) vs. 250 mg (0-400), P = 0.001]. There was a significantly longer time to the first request for analgesic in the TAP block group [210 min (0-300) vs. 30 min (10-180) in group C, P = 0.0001]. Two-sided TAP block with 0.25% bupivacaine in parturients who undergo cesarean section with a Pfannenstiel incision under general anesthesia can decrease postoperative pain and analgesic consumption. The time to the first analgesic rescue was longer in the parturients who received the TAP block.

  18. Chagas disease: national survey of seroprevalence in children under five years of age conducted in 2008.

    Science.gov (United States)

    Russomando, Graciela; Cousiño, Blanca; Sanchez, Zunilda; Franco, Laura X; Nara, Eva M; Chena, Lilian; Martínez, Magaly; Galeano, María E; Benitez, Lucio

    2017-05-01

    Since the early 1990s, programs to control Chagas disease in South America have focused on eradicating domiciliary Triatoma infestans, the main vector. Seroprevalence studies of the chagasic infection are included as part of the vector control programs; they are essential to assess the impact of vector control measures and to monitor the prevention of vector transmission. To assess the interruption of domiciliary vector transmission of Chagas disease by T. infestans in Paraguay by evaluating the current state of transmission in rural areas. A survey of seroprevalence of Chagas disease was carried out in a representative sample group of Paraguayans aged one to five years living in rural areas of Paraguay in 2008. Blood samples collected on filter paper from 12,776 children were tested using an enzyme-linked immunosorbent assay. Children whose serology was positive or undetermined (n = 41) were recalled to donate a whole blood sample for retesting. Their homes were inspected for current triatomine infestation. Blood samples from their respective mothers were also collected and tested to check possible transmission of the disease by a congenital route. A seroprevalence rate of 0.24% for Trypanosoma cruzi infection was detected in children under five years of age among the country's rural population. Our findings indicate that T. cruzi was transmitted to these children vertically. The total number of infected children, aged one to five years living in these departments, was estimated at 1,691 cases with an annual incidence of congenital transmission of 338 cases per year. We determined the impact of vector control in the transmission of T. cruzi, following uninterrupted vector control measures employed since 1999 in contiguous T. infestans-endemic areas of Paraguay, and this allowed us to estimate the degree of risk of congenital transmission in the country.

  19. Estimating the total number of susceptibility variants underlying complex diseases from genome-wide association studies.

    Directory of Open Access Journals (Sweden)

    Hon-Cheong So

    2010-11-01

    Full Text Available Recently genome-wide association studies (GWAS have identified numerous susceptibility variants for complex diseases. In this study we proposed several approaches to estimate the total number of variants underlying these diseases. We assume that the variance explained by genetic markers (Vg follow an exponential distribution, which is justified by previous studies on theories of adaptation. Our aim is to fit the observed distribution of Vg from GWAS to its theoretical distribution. The number of variants is obtained by the heritability divided by the estimated mean of the exponential distribution. In practice, due to limited sample sizes, there is insufficient power to detect variants with small effects. Therefore the power was taken into account in fitting. Besides considering the most significant variants, we also tried to relax the significance threshold, allowing more markers to be fitted. The effects of false positive variants were removed by considering the local false discovery rates. In addition, we developed an alternative approach by directly fitting the z-statistics from GWAS to its theoretical distribution. In all cases, the "winner's curse" effect was corrected analytically. Confidence intervals were also derived. Simulations were performed to compare and verify the performance of different estimators (which incorporates various means of winner's curse correction and the coverage of the proposed analytic confidence intervals. Our methodology only requires summary statistics and is able to handle both binary and continuous traits. Finally we applied the methods to a few real disease examples (lipid traits, type 2 diabetes and Crohn's disease and estimated that hundreds to nearly a thousand variants underlie these traits.

  20. Chagas disease: national survey of seroprevalence in children under five years of age conducted in 2008

    Directory of Open Access Journals (Sweden)

    Graciela Russomando

    Full Text Available BACKGROUND Since the early 1990s, programs to control Chagas disease in South America have focused on eradicating domiciliary Triatoma infestans, the main vector. Seroprevalence studies of the chagasic infection are included as part of the vector control programs; they are essential to assess the impact of vector control measures and to monitor the prevention of vector transmission. OBJECTIVE To assess the interruption of domiciliary vector transmission of Chagas disease by T. infestans in Paraguay by evaluating the current state of transmission in rural areas. METHODS A survey of seroprevalence of Chagas disease was carried out in a representative sample group of Paraguayans aged one to five years living in rural areas of Paraguay in 2008. Blood samples collected on filter paper from 12,776 children were tested using an enzyme-linked immunosorbent assay. Children whose serology was positive or undetermined (n = 41 were recalled to donate a whole blood sample for retesting. Their homes were inspected for current triatomine infestation. Blood samples from their respective mothers were also collected and tested to check possible transmission of the disease by a congenital route. FINDINGS A seroprevalence rate of 0.24% for Trypanosoma cruzi infection was detected in children under five years of age among the country’s rural population. Our findings indicate that T. cruzi was transmitted to these children vertically. The total number of infected children, aged one to five years living in these departments, was estimated at 1,691 cases with an annual incidence of congenital transmission of 338 cases per year. MAIN CONCLUSION We determined the impact of vector control in the transmission of T. cruzi, following uninterrupted vector control measures employed since 1999 in contiguous T. infestans-endemic areas of Paraguay, and this allowed us to estimate the degree of risk of congenital transmission in the country.

  1. A Clinical Experience of Dental Treatment under Ambulatory General Anesthesia for A Disabled Patient Who Accepts Only One Favorite Dental Chair

    OpenAIRE

    佐藤, 潤; 川合, 宏仁; 山崎, 信也; 相澤, 徳久; 島村, 和宏; 鈴木, 康生; サトウ, ジュン; カワイ, ヒロヨシ; ヤマザキ, シンヤ; アイザワ, ノリヒサ; シマムラ, カズヒロ; スズキ, ヤスオ; Jun, SATO; Hiroyoshi, KAWAAI; Shinya, YAMAZAKI

    2007-01-01

    In our hospital, we have many cases of ambulatory general anesthesia in the dental treatment of disabled patients. However, if the disability patients have strong refusal to enter the general anesthesia room due to strong phobia, we can not apply the general anesthesia induction. We experienced a dental treatment under ambulatory general anesthesia of a disabled patient who could not sit on any dental chair except for his favorite one. The patient was a 16-year-old boy. He was diagnosed Down ...

  2. The general public's willingness to pay for tax increases to support unrestricted access to an Alzheimer's disease medication.

    Science.gov (United States)

    Oremus, Mark; Tarride, Jean-Eric; Raina, Parminder; Thabane, Lehana; Foster, Gary; Goldsmith, Charlie H; Clayton, Natasha

    2012-11-01

    Alzheimer's disease (AD) is a neurodegenerative disorder highlighted by progressive declines in cognitive and functional abilities. Our objective was to assess the general public's maximum willingness to pay ((M)WTP) for an increase in annual personal income taxes to fund unrestricted access to AD medications. We randomly recruited 500 Canadians nationally and used computer-assisted telephone interviewing to administer a questionnaire. The questionnaire contained four 'efficacy' scenarios describing an AD medication as capable of symptomatically treating cognitive decline or modifying disease progression. The scenarios also described the medication as having no adverse effects or a 30% chance of adverse effects. We randomized participants to order of scenarios and willingness-to-pay bid values; (M)WTP for each scenario was the highest accepted bid for that scenario. We conducted linear regression and bootstrap sensitivity analyses to investigate potential determinants of (M)WTP. Mean (M)WTP was highest for the 'disease modification/no adverse effects' scenario ($Can130.26) and lowest for the 'symptomatic treatment/30% chance of adverse effects' scenario ($Can99.16). Bootstrap analyses indicated none of our potential determinants (e.g. age, sex) were associated with participants' (M)WTP. The general public is willing to pay higher income taxes to fund unrestricted access to AD (especially disease-modifying) medications. Consequently, the public should favour placing new AD medications on public drug plans. As far as we are aware, no other study has elicited the general public's willingness to pay for AD medications.

  3. Chances of employment in women and men after surgery of congenital heart disease: comparisons between patients and the general population.

    Science.gov (United States)

    Geyer, Siegfried; Norozi, Kambiz; Buchhorn, Reiner; Wessel, Armin

    2009-01-01

    It was examined whether women and men (17-45 years) with operated congenital heart disease differ with respect to chances of employment. Patients were compared with the general population. Patients (n = 314) were classified by type of surgery (curative, reparative, palliative) as indicator of initial severity of disease. The second classification was performed according to a system proposed by the New York Heart Association in order to take reported impairments into account. Controls (n = 1165) consisted of a 10% random sample drawn from the German Socio-Economic Panel. Chances of full-time employment decreased as disease severity increased. Chances of part-time and minor employment were higher in patients than among controls. These general effects were because of male patients, while the employment patterns of women did not differ from the control group. Independent of patient status, women were more likely to have lower rates of full-time employment, and the rates of part-time and minor employment were higher. Long-term adaptation to impairments as a result of congenital heart disease differs between women and men with respect to employment status. While female patients do not differ from the general population, males may lower their engagement in paid work.

  4. Biomarkers in patients with Chronic Obstructive Pulmonary Disease in general practice: A prospective cohort study

    DEFF Research Database (Denmark)

    Waldorff, Frans Boch; Halling, Anders; Ledderer, Loni

    Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common chronic disease primarily treated in primary care. It is a complex and heterogeneous disease and the trajectory is difficult to predict. The overall aim of this study is to investigate predictors of the trajectory of COPD...... were a diagnosis of COPD (ICPC code R95-), age ≥ 40 years, Danish language speaking, no severe psychiatric or cognitive disease and ability to visit the GP surgery. Prevalent as well as incident patients diagnosed with COPD were eligible. Baseline data included a patient questionnaire and validated...... treated in primary care and to determine the added value of selected biomarkers such as microfibrillar-associated protein 4 (MFAP4) and surfactant protein D (SP-D). Methods: Prospective cohort study comprising COPD patients. A total of 38 Danish practices were included in the study. Criteria for inclusion...

  5. Biomarkers in patients with Chronic Obstructive Pulmonary Disease in general practice

    DEFF Research Database (Denmark)

    Waldorff, Frans Boch; Halling, Anders; Ledderer, Loni Kraus

    Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common chronic disease primarily treated in primary care. It is a complex and heterogeneous disease and the trajectory is difficult to predict. The overall aim of this study is to investigate predictors of the trajectory of COPD...... were a diagnosis of COPD (ICPC code R95-), age ≥ 40 years, Danish language speaking, no severe psychiatric or cognitive disease and ability to visit the GP surgery. Prevalent as well as incident patients diagnosed with COPD were eligible. Baseline data included a patient questionnaire and validated...... treated in primary care and to determine the added value of selected biomarkers such as microfibrillar-associated protein 4 (MFAP4) and surfactant protein D (SP-D). Methods: Prospective cohort study comprising COPD patients. A total of 38 Danish practices were included in the study. Criteria for inclusion...

  6. Overlap of symptoms of gastroesophageal reflux disease, dyspepsia and irritable bowel syndrome in the general population

    DEFF Research Database (Denmark)

    Rasmussen, Sanne; Jensen, Trine Holm; Henriksen, Susanne Lund

    2014-01-01

    Abstract Introduction. Gastroesophageal reflux disease (GERD), functional dyspepsia (FD) and irritable bowel syndrome (IBS) are common functional gastrointestinal conditions with significant impact on the daily lives of individuals. The objective was to investigate the prevalence and overlap...

  7. A generalized-growth model to characterize the early ascending phase of infectious disease outbreaks

    Directory of Open Access Journals (Sweden)

    Cécile Viboud

    2016-06-01

    Conclusions: Our findings reveal significant variation in epidemic growth patterns across different infectious disease outbreaks and highlights that sub-exponential growth is a common phenomenon, especially for pathogens that are not airborne. Sub-exponential growth profiles may result from heterogeneity in contact structures or risk groups, reactive behavior changes, or the early onset of interventions strategies, and consideration of “deceleration parameters” may be useful to refine existing mathematical transmission models and improve disease forecasts.

  8. The elastic properties, generalized stacking fault energy and dissociated dislocations in MgB2 under different pressure

    KAUST Repository

    Feng, Huifang

    2013-05-31

    The 〈112̄0〉 perfect dislocation in MgB2 is suggested to dissociate into two partial dislocations in an energy favorable way 〈112̄0〉 → 1/2 〈112̄0〉 + SF + 1/2 〈112̄0〉. This dissociation style is a correction of the previous dissociation 〈1000〉 → 1/3 〈11̄00〉 SF + 1/3 〈 2100〉proposed by Zhu et al. to model the partial dislocations and stacking fault observed by transmission electron microscopy. The latter dissociation results in a maximal stacking fault energy rather than a minimal one according to the generalized stacking fault energy calculated from first-principles methods. Furthermore, the elastic constants and anisotropy of MgB2 under different pressure are investigated. The core structures and mobilities of the 〈112̄0〉 dissociated dislocations are studied within the modified Peierls-Nabarro (P-N) dislocation theory. The variational method is used to solve the modified P-N dislocation equation and the Peierls stress is also determined under different pressure. High pressure effects on elastic anisotropy, core structure and Peierls stress are also presented. © 2013 Springer Science+Business Media New York.

  9. Under general anesthesia arginine vasopressin prevents hypotension but impairs cerebral oxygenation during arthroscopic shoulder surgery in the beach chair position.

    Science.gov (United States)

    Cho, Soo Y; Kim, Seok J; Jeong, Cheol W; Jeong, Chang Y; Chung, Sung S; Lee, JongUn; Yoo, Kyung Y

    2013-12-01

    Patients undergoing surgery in the beach chair position (BCP) are at a risk of cerebral ischemia. We evaluated the effect of arginine vasopressin (AVP) on hemodynamics and cerebral oxygenation during surgery in the BCP. Thirty patients undergoing shoulder surgery in BCP under propofol-remifentanil anesthesia were randomly allocated either to receive IV AVP 0.07 U/kg (AVP group, N = 15) or an equal volume of saline (control group, N = 15) 2 minutes before taking BCP. Mean arterial blood pressure (MAP), heart rate (HR), jugular venous bulb oxygen saturation (SjvO2), and regional cerebral tissue oxygen saturation (SctO2) were measured after induction of anesthesia and before (presitting in supine position) and after patients took BCP. AVP itself given before the positioning increased MAP and decreased SjvO2 and SctO2 (P 20% SctO2 decrease from presitting value) (80% vs 13%; P = 0.0003) was higher in the AVP group. The incidence of jugular desaturation (SjvO2 shoulder surgery under general anesthesia. However, it was associated with regional cerebral but not jugular venous oxygen desaturation on upright positioning.

  10. Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals.

    Science.gov (United States)

    Chambers, John; Kabir, Saleha; Cajeat, Eric

    2014-02-01

    Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Retrospective database analysis in a teaching hospital open access echocardiography service. Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology.

  11. Detection of heart disease by open access echocardiography: a retrospective analysis of general practice referrals

    Science.gov (United States)

    Chambers, John; Kabir, Saleha; Cajeat, Eric

    2014-01-01

    Background Heart disease is difficult to detect clinically and it has been suggested that echocardiography should be available to all patients with possible cardiac symptoms or signs. Aim To analyse the results of 2 years of open access echocardiography for the frequency of structural heart disease according to request. Design and setting Retrospective database analysis in a teaching hospital open access echocardiography service. Method Reports of all open access transthoracic echocardiograms between January 2011 and December 2012 were categorised as normal, having minor abnormalities, or significant abnormalities according to the indication. Results There were 2343 open access echocardiograms performed and there were significant abnormalities in 29%, predominantly valve disease (n = 304, 13%), LV systolic dysfunction (n = 179, 8%), aortic dilatation (n = 80, 3%), or pulmonary hypertension (n = 91, 4%). If echocardiography had been targeted at a high-risk group, 267 with valve disease would have been detected (compared to 127 with murmur alone) and 139 with LV systolic dysfunction (compared to 91 with suspected heart failure alone). Most GP practices requested fewer than 10 studies, but 6 practices requested over 70 studies. Conclusion Open access echocardiograms are often abnormal but structural disease may not be suspected from the clinical request. Uptake by individual practices is patchy. A targeted expansion of echocardiography in patients with a high likelihood of disease is therefore likely to increase the detection of clinically important pathology. PMID:24567615

  12. Studies of generalized elemental imbalances in neurological disease patients using INAA [instrumental neutron activation analysis

    International Nuclear Information System (INIS)

    Ehmann, W.D.; Vance, D.E.; Khare, S.S.; Kasarskis, E.J.; Markesbery, W.R.

    1988-01-01

    Evidence has been presented in the literature to implicate trace elements in the etiology of several age-related neurological diseases. Most of these studies are based on brain analyses. Using instrumental neutron activation analysis (INAA), we have observed trace element imbalances in brains of patients with Alzheimer's disease, amyotrophic lateral sclerosis (ALS), and Picks's disease. The most prevalent elemental imbalances found in the brain were for bromine, mercury, and the alkali metals. In this study the authors report INAA studies of trace elements in nonneural tissues from Alzheimer's disease and ALS patients. Samples from household relatives were collected for use as controls wherever possible. Hair samples were washed according to the International Atomic Energy Agency recommended procedure. Fingernail samples were scraped with a quartz knife prior to washing by the same procedure. For ALS patients, blood samples were also collected. These data indicate that elemental imbalances in Alzheimer's disease and ALS are not restricted to the brain. Many elements perturbed in the brain are also altered in the several nonneural tissues examined to date. The imbalances in different tissues, however, are not always in the same direction. The changes observed may represent causes, effects, or simply epiphenomena. Longitudinal studies of nonneural tissues and blood, as well as tissue microprobe analyses at the cellular and subcellular level, will be required in order to better assess the role of trace elements in the etiology of these diseases

  13. Treatment of Experimental Acute Radiation Disease in Mice with Probiotics, Quinolones, and General Gnotobiological Isolation

    National Research Council Canada - National Science Library

    Korschunov, V

    1998-01-01

    .... The effect of lactobacilli was higher under gnotobiological isolation. Lactobacilli suppressed the gram-negative enterics and decreased translocation of the strict anaerobes, but not streptococci...

  14. An investigation of the mechanism underlying teacher aggression: Testing I3 theory and the General Aggression Model.

    Science.gov (United States)

    Montuoro, Paul; Mainhard, Tim

    2017-12-01

    Considerable research has investigated the deleterious effects of teachers responding aggressively to students who misbehave, but the mechanism underlying this dysfunctional behaviour remains unknown. This study investigated whether the mechanism underlying teacher aggression follows I 3 theory or General Aggression Model (GAM) metatheory of human aggression. I 3 theory explains exceptional, catastrophic events of human aggression, whereas the GAM explains common human aggression behaviours. A total of 249 Australian teachers participated in this study, including 142 primary school teachers (Mdn [age] = 35-39 years; Mdn [years teaching] = 10-14 years; 84% female) and 107 secondary school teachers (Mdn [age] = 45-49 years; Mdn [years teaching] = 15-19 years; 65% female). Participants completed four online self-report questionnaires, which assessed caregiving responsiveness, trait self-control, misbehaviour provocation, and teacher aggression. Analyses revealed that the GAM most accurately captures the mechanism underlying teacher aggression, with lower caregiving responsiveness appearing to indirectly lead to teacher aggression via higher misbehaviour provocation and lower trait self-control in serial, controlling for gender, age, years teaching, and current role (primary, secondary). This study indicates that teacher aggression proceeds from 'the person in the situation'. Specifically, lower caregiving responsiveness appears to negatively shape a teacher's affective, cognitive, and arousal states, which influence how they perceive and interpret student misbehaviour. These internal states, in turn, appear to negatively influence appraisal and decision processes, leading to immediate appraisal and impulsive actions. These results raise the possibility that teacher aggression is a form of countertransference. © 2017 The British Psychological Society.

  15. Genetic variation in liver x receptor alpha and risk of ischemic vascular disease in the general population

    DEFF Research Database (Denmark)

    Stender, Stefan; Frikke-Schmidt, Ruth; Anestis, Aristomenis

    2011-01-01

    Although animal studies indicate that liver X receptor alpha (LXRα) might influence risk of atherosclerosis, data in humans remain scarce. We tested the hypothesis that genetic variation in LXRα associates with risk of ischemic vascular disease and/or plasma lipid and lipoprotein levels in the ge......Although animal studies indicate that liver X receptor alpha (LXRα) might influence risk of atherosclerosis, data in humans remain scarce. We tested the hypothesis that genetic variation in LXRα associates with risk of ischemic vascular disease and/or plasma lipid and lipoprotein levels...... in the general population....

  16. Genetic variation in liver x receptor alpha and risk of ischemic vascular disease in the general population

    DEFF Research Database (Denmark)

    Stender, Stefan; Frikke-Schmidt, Ruth; Anestis, Aristomenis

    2011-01-01

    Although animal studies indicate that liver X receptor alpha (LXRa) might influence risk of atherosclerosis, data in humans remain scarce. We tested the hypothesis that genetic variation in LXRa associates with risk of ischemic vascular disease and/or plasma lipid and lipoprotein levels in the ge......Although animal studies indicate that liver X receptor alpha (LXRa) might influence risk of atherosclerosis, data in humans remain scarce. We tested the hypothesis that genetic variation in LXRa associates with risk of ischemic vascular disease and/or plasma lipid and lipoprotein levels...... in the general population....

  17. Potential distribution of pine wilt disease under future climate change scenarios.

    Directory of Open Access Journals (Sweden)

    Akiko Hirata

    Full Text Available Pine wilt disease (PWD constitutes a serious threat to pine forests. Since development depends on temperature and drought, there is a concern that future climate change could lead to the spread of PWD infections. We evaluated the risk of PWD in 21 susceptible Pinus species on a global scale. The MB index, which represents the sum of the difference between the mean monthly temperature and 15 when the mean monthly temperatures exceeds 15°C, was used to determine current and future regions vulnerable to PWD (MB ≥ 22. For future climate conditions, we compared the difference in PWD risks among four different representative concentration pathways (RCPs 2.6, 4.5, 6.0, and 8.5 and two time periods (2050s and 2070s. We also evaluated the impact of climate change on habitat suitability for each Pinus species using species distribution models. The findings were then integrated and the potential risk of PWD spread under climate change was discussed. Within the natural Pinus distribution area, southern parts of North America, Europe, and Asia were categorized as vulnerable regions (MB ≥ 22; 16% of the total Pinus distribution area. Representative provinces in which PWD has been reported at least once overlapped with the vulnerable regions. All RCP scenarios showed expansion of vulnerable regions in northern parts of Europe, Asia, and North America under future climate conditions. By the 2070s, under RCP 8.5, an estimated increase in the area of vulnerable regions to approximately 50% of the total Pinus distribution area was revealed. In addition, the habitat conditions of a large portion of the Pinus distribution areas in Europe and Asia were deemed unsuitable by the 2070s under RCP 8.5. Approximately 40% of these regions overlapped with regions deemed vulnerable to PWD, suggesting that Pinus forests in these areas are at risk of serious damage due to habitat shifts and spread of PWD.

  18. Bispectoral index scores of pediatric patients under dental treatment and recovery conditions: Study of children assigned for general anesthesia under propofol and isofloran regimes

    Directory of Open Access Journals (Sweden)

    Dana Tahririan

    2016-01-01

    Full Text Available Background: This study was planned to determine the relationship between bispectoral index (BIS during dental treatment and recovery conditions in children undergoing two regimes of anesthesia of propofol and isoflurane. Materials and Methods: In this single-blind clinical trial study, 57 4-7-year-old healthy children who had been referred for dental treatment under general anesthesia between 60 and 90 min were selected by convenience sampling and assigned to two groups, after obtaining their parents′ written consent. The anesthesia was induced by inhalation. For the first group, the anesthesia was preserved by a mixture of oxygen (50%, nitrous oxide (50%, and isoflurane (1%. For the second group, the anesthesia was preserved by a mixture of oxygen (50%, nitrous oxide (50%, and propofol was administered intravenously at a dose of 100 Ng/kg/min. The patients′ vital signs, BIS, and agitation scores were recorded every 10 min. The data were analyzed by repeated measure ANOVA and t-tests at a significance level of α = 0.05 using SPSS version 20. Results: The results of independent t-test for anesthesia time showed no statistically significant difference between isoflurane and propofol (P = 0.87. Controlling age, the BIS difference between the two anesthetic agents was not significant (P > 0.05; however, it was negatively correlated with the duration of anesthesia and the discharge time (P = 0.001, r = -0.308 and (P < 0.001, r = -0.55. Conclusion: The same depth of anesthesia is produced by propofol and isoflurane, but lower recovery complications from anesthesia are observed with isoflurane.

  19. 42 CFR 413.210 - Conditions for payment under the end-stage renal disease (ESRD) prospective payment system.

    Science.gov (United States)

    2010-10-01

    ... disease (ESRD) prospective payment system. 413.210 Section 413.210 Public Health CENTERS FOR MEDICARE... § 413.210 Conditions for payment under the end-stage renal disease (ESRD) prospective payment system... prospective payment system described in § 413.215 through § 413.235 of this part. (a) Qualifications for...

  20. The Mechanisms of Traditional Chinese Medicine Underlying the Prevention and Treatment of Parkinson's Disease

    Directory of Open Access Journals (Sweden)

    Xiaoliang Li

    2017-09-01

    Full Text Available Parkinson's disease (PD, characterized with bradykinesia, static tremor, rigidity and disturbances in balance, is the second most common neurodegenerative disorder. Along with the largely aging population in the world, the incidence is increasing year by year, which imposes the negative impacts on patients, their families and the whole society. Traditional Chinese medicine (TCM has a positive prospect for the prevention and cure of PD due to its advantages of less side effects and multi-target effects. At present, the pathogenesis of PD is not yet fully discovered. This paper elaborates the mechanisms of TCM underlying the prevention and treatment of PD with regards to the inhibition of oxidative stress, the regulation of mitochondrial dysfunction, the reduction of toxic excitatory amino acids (EAA, the inhibition of neuroinflammation, the inhibition of neuronal apoptosis, and the inhibition of abnormal protein aggregation.

  1. Exploring the genetics underlying autoimmune diseases with network analysis and link prediction

    KAUST Repository

    Alanis Lobato, Gregorio; Cannistraci, Carlo; Ravasi, Timothy

    2014-01-01

    Ever since the first Genome Wide Association Study (GWAS) was carried out we have seen an important number of discoveries of biological and clinical relevance. However, there are some scientists that consider that these research outcomes and their utility are far from what was expected from this experimental design. We instead believe that the thousands of genetic variants associated with complex disorders by means of GWASs are an extremely valuable source of information that needs to be mined in a different way. Based on this philosophy, we followed a holistic perspective to analyze GWAS data and explored the structural properties of the network representation of one of these datasets with the aim to advance our understanding of the genetic intricacies underlying autoimmune human diseases. The simplicity, computational efficiency and precision of the tools proposed in this paper represent a new means to address GWAS data and contribute to the better exploitation of these rich sources of information. © 2014 IEEE.

  2. Unraveling the mechanisms underlying postural instability in Parkinson's disease using dynamic posturography.

    Science.gov (United States)

    Nonnekes, Jorik; de Kam, Digna; Geurts, Alexander C H; Weerdesteyn, Vivian; Bloem, Bastiaan R

    2013-12-01

    Postural instability, one of the cardinal symptoms of Parkinson's disease (PD), has devastating consequences for affected patients. Better strategies to prevent falls are needed, but this calls for an improved understanding of the complex mechanisms underlying postural instability. We must also improve our ability to timely identify patients at risk of falling. Dynamic posturography is a promising avenue to achieve these goals. The latest moveable platforms can deliver 'real-life' balance perturbations, permitting study of everyday fall circumstances. Dynamic posturography studies have shown that PD patients have fundamental problems in scaling their postural responses in accordance with the need of the actual balance task at hand. On-going studies evaluate the predictive ability of impaired posturography performance for daily life falls. We also review recent work aimed at exploring balance correcting steps in PD, and the presumed interaction between startle pathways and postural responses.

  3. Exploring the genetics underlying autoimmune diseases with network analysis and link prediction

    KAUST Repository

    Alanis Lobato, Gregorio

    2014-02-01

    Ever since the first Genome Wide Association Study (GWAS) was carried out we have seen an important number of discoveries of biological and clinical relevance. However, there are some scientists that consider that these research outcomes and their utility are far from what was expected from this experimental design. We instead believe that the thousands of genetic variants associated with complex disorders by means of GWASs are an extremely valuable source of information that needs to be mined in a different way. Based on this philosophy, we followed a holistic perspective to analyze GWAS data and explored the structural properties of the network representation of one of these datasets with the aim to advance our understanding of the genetic intricacies underlying autoimmune human diseases. The simplicity, computational efficiency and precision of the tools proposed in this paper represent a new means to address GWAS data and contribute to the better exploitation of these rich sources of information. © 2014 IEEE.

  4. Resistance Potential of Bread Wheat Genotypes Against Yellow Rust Disease Under Egyptian Climate.

    Science.gov (United States)

    Mahmoud, Amer F; Hassan, Mohamed I; Amein, Karam A

    2015-12-01

    Yellow rust (stripe rust), caused by Puccinia striiformis f. sp. tritici, is one of the most destructive foliar diseases of wheat in Egypt and worldwide. In order to identify wheat genotypes resistant to yellow rust and develop molecular markers associated with the resistance, fifty F8 recombinant inbred lines (RILs) derived from a cross between resistant and susceptible bread wheat landraces were obtained. Artificial infection of Puccinia striiformis was performed under greenhouse conditions during two growing seasons and relative resistance index (RRI) was calculated. Two Egyptian bread wheat cultivars i.e. Giza-168 (resistant) and Sakha-69 (susceptible) were also evaluated. RRI values of two-year trial showed that 10 RILs responded with RRI value >6 2 rust. However, further molecular analyses would be performed to confirm markers associated with the resistance and suitable for marker-assisted selection. Resistant RILs identified in the study could be efficiently used to improve the resistance to yellow rust in wheat.

  5. Attorney General forces Infectious Diseases Society of America to redo Lyme guidelines due to flawed development process.

    Science.gov (United States)

    Johnson, L; Stricker, R B

    2009-05-01

    Lyme disease is one of the most controversial illnesses in the history of medicine. In 2006 the Connecticut Attorney General launched an antitrust investigation into the Lyme guidelines development process of the Infectious Diseases Society of America (IDSA). In a recent settlement with IDSA, the Attorney General noted important commercial conflicts of interest and suppression of scientific evidence that had tainted the guidelines process. This paper explores two broad ethical themes that influenced the IDSA investigation. The first is the growing problem of conflicts of interest among guidelines developers, and the second is the increasing centralisation of medical decisions by insurance companies, which use treatment guidelines as a means of controlling the practices of individual doctors and denying treatment for patients. The implications of the first-ever antitrust investigation of medical guidelines and the proposed model to remediate the tainted IDSA guidelines process are also discussed.

  6. NOD2/CARD15 genotype, cardiovascular disease and cancer in 43 600 individuals from the general population

    DEFF Research Database (Denmark)

    Yazdanyar, S.; Nordestgaard, B.G.

    2010-01-01

    from two large Danish general population cohorts followed for 31 years: the Copenhagen City Heart Study (n = 10 597) and the Copenhagen General Population Study (n = 32 999). We examined the risk of cardiovascular disease (2743 and 3890, respectively, in the two studies) and cancer (2144 and 3241......, respectively) by NOD2/CARD15 genotype using Cox and logistic regressions in both studies. To maximize statistical power, the three NOD2/CARD15 genetic variants were analysed together as follows: noncarriers for all three variants, heterozygotes for one of the three variants and homozygotes for one of the three...... variants pooled with compound heterozygotes for two variants. Results. Multifactorially adjusted hazard ratios for cardiovascular disease and cancer in NOD2/CARD15 heterozygotes or homozygotes/compound heterozygotes versus noncarries did not differ from 1.0 in the Copenhagen City Heart Study...

  7. Effect of multidisciplinary disease management for hospitalized heart failure under a national health insurance programme.

    Science.gov (United States)

    Mao, Chun-Tai; Liu, Min-Hui; Hsu, Kuang-Hung; Fu, Tieh-Cheng; Wang, Jong-Shyan; Huang, Yu-Yen; Yang, Ning-I; Wang, Chao-Hung

    2015-09-01

    Multidisciplinary disease management programmes (MDPs) for heart failure have been shown to be effective in Western countries. However, it is not known whether they improve outcomes in a high population density country with a national health insurance programme. In total, 349 patients hospitalized because of heart failure were randomized into control and MDP groups. All-cause death and re-hospitalization related to heart failure were analyzed. The median follow-up period was approximately 2 years. Mean patient age was 60 years; 31% were women; and 50% of patients had coronary artery disease. MDP was associated with fewer all-cause deaths [hazard ratio (HR) = 0.49, 95% confidence interval (CI) = 0.27-0.91, P = 0.02] and heart failure-related re-hospitalizations (HR = 0.44, 95% CI = 0.25-0.77, P = 0.004). MDP was still associated with better outcomes for all-cause death (HR = 0.53, 95% CI = 0.29-0.98, P = 0.04) and heart failure-related re-hospitalization (HR = 0.46, 95% CI = 0.26-0.81, P = 0.007), after adjusting for age, diuretics, diabetes mellitus, chronic kidney disease, hypertension, sodium, and albumin. However, MDPs' effect on all-cause mortality and heart failure-related re-hospitalization was significantly attenuated after adjusting for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers or β-blockers. A stratified analysis showed that MDP combined with guideline-based medication had synergistic effects. MDP is effective in lowering all-cause mortality and re-hospitalization rates related to heart failure under a national health insurance programme. MDP synergistically improves the effectiveness of guidelines-based medications for heart failure.

  8. Hygiene and sanitation risk factors of diarrhoeal disease among under-five children in Ibadan, Nigeria.

    Science.gov (United States)

    Oloruntoba, Elizabeth Omoladun; Folarin, Taiwo Bukola; Ayede, Adejumoke Idowu

    2014-12-01

    Diarrhoea diseases are among the leading causes of morbidity and mortality in under-five-children (U-5C) in Nigeria. Inadequate safe water, sanitation, and hygiene account for the disease burden. Cases of diarrhoea still occur in high proportion in the study area despite government-oriented interventions. To determine the hygiene and sanitation risk factors predisposing U-5C to diarrhoea in Ibadan, Nigeria. Two hundred and twenty pairs of children, matched on age, were recruited as cases and controls over a period of 5 months in Ibadan. Questionnaire and observation checklist were used to obtain information on hygiene practices from caregivers/mothers and sanitation conditions in the households of 30% of the consenting mothers/caregivers. Data were analysed using descriptive and inferential statistics. Caregivers/mothers' mean ages were 31.3 ±7.5 (cases) and 30.6 ±6.0(controls) years. The risk of diarrhoea was significantly higher among children whose mothers did not wash hands with soap before food preparation (OR=3.0, pHygiene and sanitation conditions within households were risk factors for diarrhoea. This study revealed the feasibility of developing and implementing an adequate model to establish intervention priorities in sanitation in Ibadan, Nigeria.

  9. Paget's disease of jaw bones as primary manifestation: A case report of a proper diagnosis made by general dentist.

    Science.gov (United States)

    Campolongo, Martin G; Cabras, Marco; Bava, Luca; Arduino, Paolo G; Carbone, Mario

    2018-06-01

    To present a case of early diagnosis mandibular Paget's disease of bone (PDB), recognised by a general dentist. PDB is responsible of rapid bone resorption and disorganised bone formation. The patient was a 72-year-old female patient complaining of dental malposition and blatant prognathism. Clinicians should consider PDB in differential diagnosis for an elderly patient undergoing unexplained alteration in face profile and occlusion. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

  10. [Differences in risk factors for disease and health problems between monks and the general population in The Netherlands].

    Science.gov (United States)

    van Meel, D; de Vrij, J H; Kunst, A E; Mackenbach, J P

    1992-08-08

    The aim of this study was to determine whether the austerely living Trappist and Benedictine monks have a lower prevalence of a number of risk factors and health problems than the general Dutch population. A written questionnaire was submitted to monks of 7 monasteries. The response was 67 per cent (134 monks). The data were compared with data from the national Health Interview Survey of 1989, which used an almost identical questionnaire. Adjustment was made for differences in age and education. Monks consume less alcohol and tobacco and have a more austere diet. Their average Quetelet index is lower. The prevalence of cardiovascular disease is lower. On the other hand, monks more often report a number of other chronic diseases, physical complaints, and problems with activities of daily life. They more often have contact with general practitioners and with consultants. The lower prevalence of a number of risk factors among monks reflects their austere way of life. It is not certain whether the lower prevalence of cardiovascular diseases can be attributed to this way of life. The fact that, in general, health problems are more prevalent among monks suggests that changes in lifestyle do not necessarily lead to compression of morbidity.

  11. Dexmedetomidine infusion during middle ear surgery under general anaesthesia to provide oligaemic surgical field: A prospective study

    Directory of Open Access Journals (Sweden)

    Kumkum Gupta

    2015-01-01

    Full Text Available Background and Aims: Middle ear surgery requires bloodless surgical field for better operating conditions, deep level of anaesthesia and rapid emergence. Recent studies suggest that α2 agonists could provide desired surgical field, sedation and analgesia. The present study was aimed to evaluate the clinical effects of dexmedetomidine infusion as anaesthetic adjuvant during middle ear surgery using operating microscope. Methods: Sixty four adult patients aged 18-58 years, American Society of Anaesthesiologists Grades I and II, of both gender were randomised into two comparable equal groups of 32 patients each for middle ear surgery under general anaesthesia with standard anaesthetic technique. After induction of general anaesthesia, patients of Group I were given dexmedetomidine infusion of 0.5 μg/kg/h and patients of Group II were given placebo infusion of normal saline. Isoflurane concentration was titrated to achieve a systolic blood pressure 30% below the baseline value. All patients were assessed intra-operatively for bleeding at surgical field, haemodynamic changes, awakening time and post-operative recovery. Results: Statistically significant reduction was observed in the required percentage of isoflurane (0.8 ± 0.6% to maintain the systolic blood pressure 30% below the baseline values in patients receiving dexmedetomidine infusion when compared to those receiving placebo infusion (1.6 ± 0.7%. Patients receiving dexmedetomidine infusion had statistically significant lesser bleeding at surgical field (P < 0.05. The mean awakening time and recovery from anaesthesia did not show any significant difference between the groups. Conclusion: Dexmedetomidine infusion can be safely used to provide oligaemic surgical field for better visualization using operating microscope for middle ear surgery.

  12. Effect of Different Doses of Granisetron on Preventing Postoperative Shivering in Patients undergoing Septorhinoplasty under General Anesthesia

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    Reza Movassaghi Gargari

    2017-04-01

    Full Text Available Background: Postoperative shivering is a frequent complication in recovery room after general anesthesia and has been reported in 40-70% of patients undergoing surgery. Postoperative shivering might cause hypoxemia, increase in oxygen consumption, a linear increase in carbon dioxide production, lactic acidosis, and increased intraocular pressure and intracranial pressure. The aim of this study was to compare the effects of different doses of granisetron on preventing postoperative shivering in patients undergoing septorhinoplasty under general anesthesia. Methods: 90 patients aged 18-60 years old with grades Ι or ΙΙ of American Society of Anesthesiologists (ASA physicals classification were allocated to the study. The first group (G1 received Granisetron 1mg Intra Venous (IV before anesthesia induction; the second group (G2 received 3mg Granisetron IV before anesthesia induction and the last group, the control group, received Normal Saline (NS. Three groups were matched regarding age, gender, weight and duration of surgery. Shivering grade and time of operation were recorded in the recovery room. Results: 90 patients scheduled for septorhinoplasty, including 54 men and 36 women, were enrolled to the study.  The mean age of the patients was 28.53 ± 8.62 (18-60 years. The number of the patients suffering from shivering in the recovery room was significantly less in group G2 rather than control group (P=0.006 and also need to therapy was significantly less in this group (G2 compared with the control group (P=0.002.  Conclusion: Prophylactic use of granisetron (3mg, IV can be effective in preventing postoperative shivering following septorhinoplasty.

  13. Parental views on delivering preventive advice to children referred for treatment of dental caries under general anaesthesia: a qualitative investigation.

    Science.gov (United States)

    Aljafari, A K; Scambler, S; Gallagher, J E; Hosey, M T

    2014-06-01

    To: 1, Explore opinions of parents of children undergoing caries treatment under general anaesthesia (GA) regarding delivery of oral health advice; 2, Discover current oral health practices and beliefs; 3, Inform further research and action. Qualitative study using semi-structured interviews and thematic data analysis, sampling parents of children aged 3-10 years undergoing GA tooth extraction due to dental caries. Twenty nine parents were interviewed (mean age 38.9 years, range 28-50, sd 6.4). The mean age of their children was seven years (range 3-10, sd 2.1). All children required deciduous tooth extractions (5.1 teeth on average). Those that also required permanent tooth extractions had on average 2.1 permanent teeth extracted. Many parents knew the importance of oral hygiene and sugar limitation, describing it as 'general knowledge' and 'common sense'. However, few understood that fruit juice is potentially cariogenic. Parenting challenges seemed to restrict their ability to control the child's diet and establish oral hygiene. Many reported not previously receiving oral health advice and reported never having fluoride varnish applied. There were requests for more caries prevention information and advice via the internet, schools or video games. Parental oral health knowledge, parenting skills, and previous advice received seem to all be issues related to the oral health of those children. Providing advice, especially in respect to fruit juice cariogenicity and the benefits of fluoride application through a child-friendly website, including a video game, as well as the use of school programmes might be an acceptable approach.

  14. Circulating Total Bilirubin and Risk of Incident Cardiovascular Disease in the General Population

    NARCIS (Netherlands)

    Kunutsor, Setor K.; Bakker, Stephan J. L.; Gansevoort, Ronald T.; Chowdhury, Rajiv; Dullaart, Robin P. F.

    OBJECTIVE: To assess the association of circulating total bilirubin and cardiovascular disease (CVD) risk in a new prospective study and to determine whether adding information on total bilirubin values to established cardiovascular risk factors is associated with improvement in prediction of CVD

  15. Robotic surgery in complicated gynecologic diseases: Experience of Tri-Service General Hospital in Taiwan

    Directory of Open Access Journals (Sweden)

    Shun-Jen Tan

    2012-03-01

    Conclusion: The present analyses include various complicated gynecologic conditions, which make the estimation of the effectiveness of robotic surgery in each situation individually not appropriate. However, our experiences do show that robotic surgery is feasible and safe for patients with complicated gynecologic diseases.

  16. YKL-40 and Alcoholic Liver and Pancreas Damage and Disease in 86258 Individuals from the General Population

    DEFF Research Database (Denmark)

    Kjaergaard, Alisa D; Bojesen, Stig E; Nordestgaard, Børge G

    2014-01-01

    BACKGROUND: We tested the hypothesis that observationally and genetically increased YKL-40 concentrations are associated with alcoholic liver and pancreas damage and disease. METHODS: We performed cohort and mendelian randomization in 86,258 individuals from the Danish general population......, with measured concentrations of plasma YKL-40 (n = 21 646) and CHI3L1 rs4950928 genotype (n = 84 738). RESULTS: Increased YKL-40 was associated with increased alanine aminotransferase, bilirubin, alkaline phosphatase, γ-glutamyl transferase, erythrocyte mean corpuscular volume, C-reactive protein...... alcoholic liver disease, 4.1 (1.7-10) for alcoholic pancreatitis, and 3.4 (1.9-6.1) for any pancreatitis. CHI3L1 rs4950928 genotype explained 14% of the variation in plasma YKL-40 concentrations but was not associated with alcoholic liver and pancreas damage or disease. A doubling in YKL-40 concentrations...

  17. COMPARISON OF ANTIEMETIC EFFICACY OF ONDANSETRON, GRANISETRON AND PALONOSETRON IN HIGH-RISK PATIENTS UNDERGOING ABDOMINAL HYSTERECTOMY UNDER GENERAL ANAESTHESIA

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    Rakesh Kumar

    2016-03-01

    Full Text Available BACKGROUND Postoperative nausea and vomiting is (PONV a very distressing complication and preventive measures are justified when the risk of PONV is very high. Ondansetron is the first 5-HT3 antagonist used alone or in combination for prophylaxis of PONV due to its lower cost. Granisetron and palonosetron are recently introduced 5-HT3 antagonists with greater affinity for 5-HT3 receptor and having longer half-life. Aim of the present study is to compare the antiemetic efficacy of ondansetron, granisetron and palonosetron in high-risk patients undergoing abdominal hysterectomy under general anaesthesia. METHODS After obtaining Institutional Ethical Committee approval and written informed consent from all the participants, 150 patients of ASA grade I & II, aged between 20-50 years and weight between 30-60 kg undergoing abdominal hysterectomy under general anaesthesia were assigned randomly in to three groups of 50 patients each using random number table receiving either ondansetron 4 mg (Group O or granisetron 2 mg (Group G or palonosetron 0.75 mg (Group P intravenously just before the induction of anaesthesia. Incidence and severity of nausea and frequency of retching and vomiting were recorded in each group at the end of 2-hour and then at 24-hour and 48-hour intervals. RESULTS The incidence of nausea during first two hours postoperatively was found to be 14(28% in Group O, which was found to be significantly higher than 6(12% in group G and 4(8% in group P (p value = 0.016. The incidence of vomiting was found to be 6(12% in group O, which was found to be significantly higher than 2(4% in both group G and group P (p value = 0.018. Number of complete responders was significantly higher in Group P and group G as compared to group O. Number of patients requiring rescue antiemetic treatment was significantly high in group O{10(20%} as compared to 3(6% in both the group G and group P. CONCLUSIONS Newly introduced 5-HT3 antagonists, granisetron and

  18. Tremor frequency characteristics in Parkinson's disease under resting-state and stress-state conditions.

    Science.gov (United States)

    Lee, Hong Ji; Lee, Woong Woo; Kim, Sang Kyong; Park, Hyeyoung; Jeon, Hyo Seon; Kim, Han Byul; Jeon, Beom S; Park, Kwang Suk

    2016-03-15

    Tremor characteristics-amplitude and frequency components-are primary quantitative clinical factors for diagnosis and monitoring of tremors. Few studies have investigated how different patient's conditions affect tremor frequency characteristics in Parkinson's disease (PD). Here, we analyzed tremor characteristics under resting-state and stress-state conditions. Tremor was recorded using an accelerometer on the finger, under resting-state and stress-state (calculation task) conditions, during rest tremor and postural tremor. The changes of peak power, peak frequency, mean frequency, and distribution of power spectral density (PSD) of tremor were evaluated across conditions. Patients whose tremors were considered more than "mild" were selected, for both rest (n=67) and postural (n=25) tremor. Stress resulted in both greater peak powers and higher peak frequencies for rest tremor (pstate condition. The distributions of PSD of tremor were symmetrical, regardless of conditions. Tremor is more evident and typical tremor characteristics, namely a lower frequency as amplitude increases, are different in stressful condition. Patient's conditions directly affect neural oscillations related to tremor frequencies. Therefore, tremor characteristics in PD should be systematically standardized across patient's conditions such as attention and stress levels. Copyright © 2016. Published by Elsevier B.V.

  19. Early Activation of Patients after Surgery for Coronary Heart Disease under Extracorporeal Circulation

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    I. A. Kozlov

    2008-01-01

    Full Text Available Objective: to analyze the safety and clinical efficiency of early activation of patients operated on for coronary heart disease under extracorporeal circulation. Subjects and methods. The data available in the case histories of 673 patients aged 29—76 years, operated on in 1995, 2004, and 2006, were analyzed. The study excluded patients with severe intraoperative complications (acute myocardial infarction, a need for extracorporeal circulation, and surgical bleeding. Early activation was made on an operating table if there were no contraindications. Some sections of the study were performed in the matched patient groups. Results. With early activation, the dosages of fentanyl were reduced by 2.5-3 times as compared with the 1995 data; the use of ketamine and diazepam was stopped. Instead of the latter, the currently available inhalational agents are coming into use: midazolam has been introduced and the rate of propofol use has increased. The higher activation rate required the use of flumazenil, naloxone, and proserin. The goal-oriented study of central hemodynamics with emphasis on early activation has indicated that lower dosages of fentanyl have no negative impact on cardiac pump function or myocardial oxygen balance. When the trachea was extubated on the operating table, there was appropriate central hemodynamic stabilization. It was found that the incidence of postoperative myocardial infarctions did not depend on the rate of activation. The frequency of cardiovascular complications was 38.8±5.9% and 22.9±5.0% in the prolonged artificial ventilation (AV and early activation groups, respectively (p<0.05; that of pulmonary complications was 16.4±4.5% and 5.7±2.8%, respectively (p<0.05. Early activation halved the length of stay at an intensive care unit (p<0.05 and reduced postoperative hospitalization at surgery units by 5 days (p< 0.05. Introduction of early activation caused a decrease in the duration of postoperative AV in the

  20. Evaluation of cardiovascular risk in patients with Parkinson disease under levodopa treatment.

    Science.gov (United States)

    Günaydın, Zeki Yüksel; Özer, Fahriye Feriha; Karagöz, Ahmet; Bektaş, Osman; Karataş, Mehmet Baran; Vural, Aslı; Bayramoğlu, Adil; Çelik, Abdullah; Yaman, Mehmet

    2016-01-01

    Levodopa is the indispensable choice of medial therapy in patients with Parkinson disease (PD). Since L-dopa treatment was shown to increase serum homocysteine levels, a well-known risk factor for cardiovascular disorders, the patients with PD under L-dopa treatment will be at increased risk for future cardiovascular events. The objective of this study is to evaluate cardiovascular risk in patients with PD under levodopa treatment. The study population consisted of 65 patients with idiopathic PD under L-dopa treatment. The control group included 32 age and gender matched individuals who had no cognitive decline. Echocardiographic measurements, serum homocysteine levels and elastic parameters of the aorta were compared between the patients with PD and controls. As an expected feature of L-dopa therapy, the Parkinson group had significantly higher homocystein levels (15.1 ± 3.9 µmol/L vs. 11.5 ± 3.2 µmol/L, P = 0.02). Aortic distensibility was significantly lower in the patients with PD when compared to controls (4.8 ± 1.5 dyn/cm(2) vs. 6.2 ± 1.9 dyn/cm(2), P = 0.016). Additionally, the patients with PD had higher aortic strain and aortic stiffness index (13.4% ± 6.4% vs. 7.4% ± 3.6%, P homocysteine levels were found to be positively correlated with aortic stiffness index and there was a negative correlation between aortic distensibility and levels of serum homocysteine (r = 0.674, P homocysteine levels may be a possible pathophysiological mechanism.

  1. Do heart failure disease management programs make financial sense under a bundled payment system?

    Science.gov (United States)

    Eapen, Zubin J; Reed, Shelby D; Curtis, Lesley H; Hernandez, Adrian F; Peterson, Eric D

    2011-05-01

    Policy makers have proposed bundling payments for all heart failure (HF) care within 30 days of an HF hospitalization in an effort to reduce costs. Disease management (DM) programs can reduce costly HF readmissions but have not been economically attractive for caregivers under existing fee-for-service payment. Whether a bundled payment approach can address the negative financial impact of DM programs is unknown. Our study determined the cost-neutral point for the typical DM program and examined whether published HF DM programs can be cost saving under bundled payment programs. We used a decision analytic model using data from retrospective cohort studies, meta-analyses, 5 randomized trials evaluating DM programs, and inpatient claims for all Medicare beneficiaries discharged with an HF diagnosis from 2001 to 2004. We determined the costs of DM programs and inpatient care over 30 and 180 days. With a baseline readmission rate of 22.9%, the average cost for readmissions over 30 days was $2,272 per patient. Under base-case assumptions, a DM program that reduced readmissions by 21% would need to cost $477 per patient to be cost neutral. Among evaluated published DM programs, 2 of the 5 would increase provider costs (+$15 to $283 per patient), whereas 3 programs would be cost saving (-$241 to $347 per patient). If bundled payments were broadened to include care over 180 days, then program saving estimates would increase, ranging from $419 to $1,706 per patient. Proposed bundled payments for HF admissions provide hospitals with a potential financial incentive to implement DM programs that efficiently reduce readmissions. Copyright © 2011 Mosby, Inc. All rights reserved.

  2. Genetic variation in the ABCA1 gene, HDL cholesterol, and risk of ischemic heart disease in the general population

    DEFF Research Database (Denmark)

    Frikke-Schmidt, Ruth

    2010-01-01

    Epidemiological studies consistently demonstrate a strong inverse association between low levels of high-density lipoprotein (HDL) cholesterol and increased risk of ischemic heart disease (IHD). This review focuses on whether both rare and common genetic variation in ABCA1 contributes to plasma...... levels of HDL cholesterol and to risk of IHD in the general population, and further seeks to understand whether low levels of HDL cholesterol per se are causally related to IHD. Studies of the ABCA1 gene demonstrate a general strategy for detecting functional genetic variants, and show that both common...... and rare ABCA1 variants contribute to levels of HDL cholesterol and risk of IHD in the general population. The association between ABCA1 variants and risk of IHD appears, however, to be independent of plasma levels of HDL cholesterol. With the recent identification of the largest number of individuals...

  3. [Knowledge of human papilloma virus-associated disease among women in general practice].

    Science.gov (United States)

    Petersen, Lone Kjeld; Nielsen, Jesper; Vaesel, Hanne; Brønsgaard, Poul Hede; Kolby, Peter; Madsen, Klaus Gregaard

    2009-03-30

    Cervical cancer is caused by oncogenic human papilloma virus (HPV) serotypes. Types 16 and 18 are responsible for approximately 75% of all cases in Europe. Low-malignant serotypes like HPV 6 and 11 are the cause of approximately 90% of all cases of conyloma accuminata. Approximately 75% of the adult population has or will become infected by one or more HPV serotypes. The purpose of the study was to investigate the level of knowledge of the cause of cervical cancer, cervical dysplasia and condylomas among women seen in Danish general practice, and to investigate the women's expectations to communication with regard to prophylactic initiatives and, finally, to determine which aspects would influence their wish for HPV-vaccination. Patient questionnaire in 26 general practices between September 2006 through February 2007. A total of 425 women aged 14-39 years were included in the study. Only 1.2% of the women correctly stated HPV as the cause of cervical cancer and 0.7% stated HPV as the cause of condylomas. In all, 96.2% thought that general practitioners should actively inform their patients of prophylactic initiatives such as vaccination against cervical cancer. Among all women, 96.4% considered HPV-vaccination. In this population, knowledge about the cause of cervical cancer and condylomas was limited. There was a clear wish - and expectation - to be actively informed on prophylactic initiatives by the general practitioner.

  4. [Effect of general magnetotherapy on specific activity of blood phagocytes in patients with ischemic heart disease].

    Science.gov (United States)

    Ishutin, I S; Klemenkov, S V; Lesovskaia, M I; Spiridonova, M S; Krotova, T K; Ishutin, E I; Tsyganova, O B

    2007-01-01

    In general magnetotherapy for patients with hyporeactive phagocytes (less than 67% from the level of normal chelicoluminescent response) the adequate level of magnetic induction is 1 mT, for patients with normoreactive phagocytes--0.5 mT and for patients with hyperreactive phagocytes (more than 133% from the level of normal chelicoluminescent response)--0.75 mT daily.

  5. General Stroke Management In Stroke Unit: Guidelines Of Turkish Society Of Cerebrovascular Diseases – 2015

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    Mehmet Akif Topçuoğlu

    2015-08-01

    Full Text Available In this section, in the light of evidence-based data concerning essentiality that the stoke patients should be treated in A stroke unit and related centers, a brief and current information about general stroke treatment of patients with stroke during acute phase will be offered.

  6. Considerations concerning ''de minimis'' quantities of radioactive waste suitable for dumping at sea under a general permit

    International Nuclear Information System (INIS)

    1981-02-01

    Following the principles proposed by the ICRP of balancing the costs and detriments of any practice involving radioactivity, there must be some level of radioactivity below which considerations other than those of the radioactivity itself are of overriding importance. For very low-level radioactive wastes, it is necessary to define a quantitative criterion which allows practical implementation of these principles within the terms of the London Dumping Convention. It will be necessary therefore to consider how these requirements can be met by defining material that can be regarded as non-radioactive for the purposes of the London Dumping Convention, defining a category of radioactivity in wastes whose content is sufficiently low (de minimis) that it can be dumped under a general permit if its other characteristics so permit. It is stressed that even if a material has been deemed to contain less than de minimis quantities of radioactive materials its suitability for dumping due to it's other constituents must still be carried out. The question of defining such a de minimis level of radioactivity was considered by an Advisory Group meeting convened at the IAEA headquarters in Vienna from 2 to 6 July 1979

  7. A generalized correlation for steam condensation rates in the presence of air under turbulent free convection - 15549

    International Nuclear Information System (INIS)

    Dehbi, A.

    2015-01-01

    In the past several decades, experimentalists have proposed a large number of correlations to estimate steam condensation rates in the presence of noncondensable gases in free convection regimes. These correlations are largely empirical, and usually of limited scope, which often leads to their use outside their range of validity, thus incurring the risk of significant errors. In this investigation, we disregard the correlations altogether, and instead go back to their underlying original data, consolidate them in a single set, and propose a generalized correlation that is compatible with the heat and mass transfer analogy. This best-estimate correlation for steam-air mixtures, based on six different investigations and 350 data points, covers two orders of magnitude in the heat transfer coefficient, and is valid for pressures up to 20 bars and steam mass fraction from 0.1 to 0.95. The consolidated raw data are self-consistent and collapse around a curve with a standard deviation of 16 %, thus well within typical experimental error bands. This demonstrates that there is no physical justification for the large deviations (factor 2 or more) observed sometimes when one compares the heat transfer coefficients predicted by different empirical correlations. (author)

  8. Posture with elevated and extended thorax. The influence of the position on some haemodynamic and ventilatory parameters under general anaesthesia.

    Science.gov (United States)

    Videbaek, F

    1980-12-01

    The effects of a change in posture from flat supine to supine with elevated and extended thorax have been investigated in 12 healthy patients under general anaesthesia prior to elective surgery on the stomach. The following parameters were measured: pulse rate, mean arterial blood pressure (MABP), central venous pressure (CVP), ventilation pressure, oesophageal pressure, and arterial oxygen and carbon dioxide tensions. Changes were measured as deviations from initial values before the change of position at 4 and 15 min after the change. One patient (8%) had a 31% fall in MABP and a 87% fall in CVP, requiring treatment outside the standard procedure, but acceptable values were obtained by simple means. Eleven patients showed only minor changes: a mean initial rise in pulse rate of 10% and a fall in CVP of 25%, after which the pulse rate returned to the initial level and the CVP remained stable. MABP was unchanged, as were ventilation pressure, oesophageal pressure and gas tensions. On the basis of reports in the literature and findings in this study, it is concluded that otherwise healthy patients tolerate the posture well, the slight risk of haemodynamic complications being outweighed by the surgical advantages. This posture should be used with caution in patients who may be haemodynamically unable to compensate.

  9. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia

    Science.gov (United States)

    El Batawi, Hisham Yehia

    2015-01-01

    Aim: To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Methods: Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. Results: The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Conclusions: Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time. PMID:25992332

  10. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia.

    Science.gov (United States)

    El Batawi, Hisham Yehia

    2015-01-01

    To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control group were premedicated with a placebo. Scores for parental separation, mask acceptance, postoperative emergence delirium, and time spent in the post-anesthesia care unit were compared statistically. The test group showed significantly lower parental separation scores and high acceptance rate for anesthetic mask. There was no significant difference between the two groups regarding emergence delirium and time spent in post-anesthesia care unit. Preoperative oral Midazolam could be a useful adjunct in anxiety management for children suffering dental anxiety. The drug may not reduce the incidence of postoperative emergence delirium. The suggested dose does not seem to affect the post-anesthesia care unit time.

  11. Urinary magnesium excretion and risk of cardiovascular disease in the general population

    Directory of Open Access Journals (Sweden)

    Michel Joosten

    2012-06-01

    We prospectively followed 7747 adults free of diagnosed cardiovascular diseases or cancer at baseline (1997-1998 from the community-based, observational PREVEND (Prevention of Renal and Vascular End-Stage Disease Study. Urinary magnesium excretion was estimated from two 24-h urine collections and was measured by a xylidyl blue method on a Modular analyzer (Roche. During a median follow-up of 10.5 year, 638 CVD events occurred. After adjustment for age, BMI, sex, smoking status, alcohol consumption and educational attainment, urinary magnesium excretion showed a nonlinear relationship with CVD risk. The hazard ratios (HR for CVD were significantly lower (PIn conclusion, low urinary magnesium excretion was associated with a higher risk of CVD, even after controlling for possible intermediates in the causal pathway such as blood pressure, diabetes and markers of inflammation and atherosclerosis. These results highlight the need to evaluate whether increasing the uptake of dietary magnesium could be effective for primary prevention of CVD.

  12. Darier′s disease - Oral, general and histopathological features in a 7 year old child

    Directory of Open Access Journals (Sweden)

    Sreedevi Dharman

    2016-01-01

    Full Text Available Darier′s disease, also known as keratosis follicularis, is a rare autosomal dominant genodermatosis, manifesting clinically as hyperkeratotic, firm papule that predominates in the seborrheic areas and flexures with accompanying nail abnormalities. Heat, sweating, sunlight, and stress are exacerbating factors of the lesion. The oral lesions are asymptomatic and comprise multiple white papules in the buccal mucosa and hard palate, giving a cobblestone appearance, and it is characterized histologically by loss of desmosomal adhesion and abnormal keratinization resulting in mucocutaneous abnormalities. Pruritus, recurrent infections, and malodor can decrease the quality of life. We report a case of a 7-year-old boy with clinical and histological features of Darier′s disease.

  13. Dosimetric considerations in treating mediastinal disease with mantle fields: Characterization of the dose under mantle blocks

    International Nuclear Information System (INIS)

    Miller, R.W.; Geijn, J. van de; Okunieff, P.

    1995-01-01

    While the rationale for using mantle fields is well understood and the prescription of these fields is straightforward, the underlying complexity of the dose distributions that result is not generally appreciated. This is especially true in the choice of lung block design, which affects the dose to both the target volume as well as to the normal lung tissue. The key to the design of optimal lung blocks is the physician's perception of the complex relationship between the geometric and dosimetric aspects of heavily modified fields, as well as how the physical and anatomical properties of the target volume and the shape of the patient's lungs relate to the images visualized on simulator films. Depth doses and cross-beam profiles of blocks ranging in width from 1 cm to 10 cm were taken using an automated beam scanning system. These data were then converted to open-quotes shadow fields.close quotes Shadow fields behave quite similarly to small, open fields in terms of x-ray-light field congruence, flatness, symmetry, and penumbra. There is a 2-3 mm rim between the edge of the block and the point at which it becomes nominally effective. The dose at the center of a block, which gives the normalization of the shadow fields, is given by a block transmission factor (BTF), which produces results in excellent agreement with measurements over a wide variety of block sizes and tissue depths. The radiation dose under shielding blocks can be considerably higher than expected, and care must be exercised when drawing blocks close to critical structures. The effects of blocks can be described in terms of normalized shadow fields, which behave similar to narrow, open fields, but with a divergence characteristic of their position relative to the radiation source. The normalization value for these fields, which gives the relative dose under the block, can be obtained from a straightforward analytical expression, the BTF. 33 refs., 9 figs., 4 tabs

  14. Sex differences in correlates of intermediate phenotypes and prevalent cardiovascular disease in the general population

    Directory of Open Access Journals (Sweden)

    Renate B. Schnabel

    2015-04-01

    Full Text Available Background-There are marked sex differences in cardiovascular disease [CVD] manifestation. It is largely unknown how the distribution of CVD risk factors or intermediate phenotypes explain sex-specific differences.Methods and Results-In 5000 individuals of the population-based Gutenberg Health Study, mean age 55±11 years, 51% males, we examined sex-specific associations of classical CVD risk factors with intima-media thickness, ankle-brachial index, flow-mediated dilation, peripheral arterial tonometry, echocardiographic and electrocardiographic variables. Intermediate cardiovascular phenotypes were related to prevalent CVD (coronary artery disease, heart failure, stroke, myocardial infarction, lower extremity artery disease [LEAD] N=561.We observed differential distributions of CVD risk factors with a higher risk factor burden in men. Manifest coronary artery disease, stroke, myocardial infarction and LEAD were more frequent in men; the proportion of heart failure was higher in women. Intermediate phenotypes showed clear sex differences with more beneficial values in women. Fairly linear changes towards less beneficial values with age were observed in both sexes. In multivariable-adjusted regression analyses age, systolic blood pressure and body mass index were consistently associated with intermediate phenotypes in both sexes with different ranking according to random forests, maximum model R² 0.43. Risk factor-adjusted associations with prevalent CVD showed some differences by sex. No interactions by menopausal status were observed. Conclusions-In a population-based cohort we observed sex differences in risk factors and a broad range of intermediate phenotypes of noninvasive cardiovascular structure and function. Their relation to prevalent CVD differed markedly. Our results indicate the need of future investigations to understand sex differences in CVD manifestation.

  15. Hydatid disease of the Central Nervous System: imaging characteristics and general features

    International Nuclear Information System (INIS)

    Abbassioun, K.; Amirjamshidi, A.; Sabouri Deylamie, M.

    2003-01-01

    Background: Hydatid disease primarily affects the liver and typically demonstrates characteristic imaging findings. Secondary involvement due to hematogenous dissemination may be seen in almost any locations, e.g., lung, kidney, spleen, bone and central nervous system. Objectives: To review the different aspects of hydatidosis of the central nervous system briefly and discuss the pathognomonic features and rare varieties of radiological findings useful in preoperative diagnosis of the disease in the human central nervous system. Materials and Methods: In a retrospective study, the records of almost 100 cases of central nervous system hydatidosis were analyzed . The available images were reviewed by independent observers, either a radiologist or a neurosurgeon, and reported separately. Results: In skull x-ray films, nonspecific changes denoted increased intracranial pressure, skull asymmetry and curvilinear calcification in rare instances. Computed tomography and magnetic resonance imaging demonstrated the round or oval, well-defined cystic mass with an attenuation or signal intensity similar to that of cerebrospinal fluid, with no associated perifocal edema, and no contrast enhancement as the pathognomonic findings of brain hydatidosis. Similar findings were detected in hydatid cysts involving the orbit, spinal column and spinal cord with some variations. Such findings as mild perifocal edema, non homogenous contrast enhancement, non-uniform shapes, calcification and multiplicity or septations have been the atypical radiological findings. Conclusion: In endemic areas, familiarity with typical and atypical radiological manifestations of hydatid disease of the central nervous system, will be helpful in making prompt and correct preoperative diagnosis leading to a better surgical outcome

  16. Quantifying the importance of disease burden on perceived general health and depressive symptoms in patients within the Mayo Clinic Biobank.

    Science.gov (United States)

    Ryu, Euijung; Takahashi, Paul Y; Olson, Janet E; Hathcock, Matthew A; Novotny, Paul J; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R; Sloan, Jeff A

    2015-07-03

    Deficits in health-related quality of life (HRQOL) may be associated with worse patient experiences, outcomes and even survival. While there exists evidence to identify risk factors associated with deficits in HRQOL among patients with individual medical conditions such as cancer, it is less well established in more general populations without attention to specific illnesses. This study used patients with a wide range of medical conditions to identify contributors with the greatest influence on HRQOL deficits. Self-perceived general health and depressive symptoms were assessed using data from 21,736 Mayo Clinic Biobank (MCB) participants. Each domain was dichotomized into categories related to poor health: deficit (poor/fair for general health and ≥3 for PHQ-2 depressive symptoms) or non-deficit. Logistic regression models were used to test the association of commonly collected demographic characteristics and disease burden with each HRQOL domain, adjusting for age and gender. Gradient boosting machine (GBM) models were applied to quantify the relative influence of contributors on each HRQOL domain. The prevalence of participants with a deficit was 9.5 % for perception of general health and 4.6 % for depressive symptoms. For both groups, disease burden had the strongest influence for deficit in HRQOL (63 % for general health and 42 % for depressive symptoms). For depressive symptoms, age was equally influential. The prevalence of a deficit in general health increased slightly with age for males, but remained stable across age for females. Deficit in depressive symptoms was inversely associated with age. For both HRQOL domains, risk of a deficit was associated with higher disease burden, lower levels of education, no alcohol consumption, smoking, and obesity. Subjects with deficits were less likely to report that they were currently working for pay than those without a deficit; this association was stronger among males than females. Comorbid health burden has the

  17. Impulse control disorder in patients with Parkinson's disease under dopamine agonist therapy: a multicentre study.

    Science.gov (United States)

    Garcia-Ruiz, Pedro J; Martinez Castrillo, Juan Carlos; Alonso-Canovas, Araceli; Herranz Barcenas, Antonio; Vela, Lydia; Sanchez Alonso, Pilar; Mata, Marina; Olmedilla Gonzalez, Nuria; Mahillo Fernandez, Ignacio

    2014-08-01

    Impulse control disorders (ICDs) encompass a wide spectrum of abnormal behaviour frequently found in cases of Parkinson's disease (PD) treated with dopamine agonists (DAs). The main aim of this study was to analyse ICD prevalence with different DAs. We carried out a multicentre transversal study to evaluate the presence of ICDs in patients with PD chronically treated (>6 months) with a single non-ergolinic DA (pramipexole, ropinirole, or rotigotine). Clinical assessment of ICD was performed using the Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease. Thirty-nine per cent of patients (91/233) fulfilled the clinical criteria for ICD. The group of patients with ICD symptoms (ICD+) differed from those without ICD symptoms (ICD-) in younger age and type of DA intake. Oral DA treatment (pramipexole and ropinirole) was associated with higher risk of ICDs compared with transdermal DA (rotigotine): 84/197 (42%) patients treated with oral DA developed ICD, versus 7/36 (19%) patients treated with transdermal DA (Fisher's exact text <0.01). In univariate analysis, a younger age (p<0.01), treatment with rasagiline (p<0.05), and especially treatment with an oral DA (pramipexole or ropinirole) (p<0.01) were significantly associated with ICD. Multivariate analysis confirmed that oral DA remained significantly associated with ICD (p: 0.014, OR: 3.14; 1.26-7.83). ICD was significantly associated with the use of the non-ergolinic oral DA (pramipexole and ropinirole) when compared with transdermal non-ergolinic DA (rotigotine). Since pramipexole, ropinirole and rotigotine are non-ergolinic DAs with very similar pharmacodynamic profiles, it is likely that other factors including route of administration (transdermal vs oral) explain the difference in risk of ICD development. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. A pragmatic cluster randomized controlled trial of early intervention for chronic obstructive pulmonary disease by practice nurse-general practitioner teams: Study Protocol

    Directory of Open Access Journals (Sweden)

    Bunker Jeremy M

    2012-09-01

    Full Text Available Abstract Background Chronic Obstructive Pulmonary Disease (COPD is a leading cause of disability, hospitalization, and premature mortality. General practice is well placed to diagnose and manage COPD, but there is a significant gap between evidence and current practice, with a low level of awareness and implementation of clinical practice guidelines. Under-diagnosis of COPD is a world-wide problem, limiting the benefit that could potentially be achieved through early intervention strategies such as smoking cessation, dietary advice, and exercise. General practice is moving towards more structured chronic disease management, and the increasing involvement of practice nurses in delivering chronic care. Design A pragmatic cluster randomised trial will test the hypothesis that intervention by a practice nurse-general practitioner (GP team leads to improved health-related quality of life and greater adherence with clinical practice guidelines for patients with newly-diagnosed COPD, compared with usual care. Forty general practices in greater metropolitan Sydney Australia will be recruited to identify patients at risk of COPD and invite them to attend a case finding appointment. Practices will be randomised to deliver either practice nurse-GP partnership care, or usual care, to patients newly-diagnosed with COPD. The active intervention will involve the practice nurse and GP working in partnership with the patient in developing and implementing a care plan involving (as appropriate, smoking cessation, immunisation, pulmonary rehabilitation, medication review, assessment and correction of inhaler technique, nutritional advice, management of psycho-social issues, patient education, and management of co-morbidities. The primary outcome measure is health-related quality of life, assessed with the St George’s Respiratory Questionnaire 12 months after diagnosis. Secondary outcome measures include validated disease-specific and general health related

  19. General Practitioner Education Reform in China: Most Undergraduate Medical Students do not Choose General Practitioner as a Career Under the 5+3 Model

    Directory of Open Access Journals (Sweden)

    Shuang Wang

    2018-06-01

    Full Text Available Purpose: In order to train more high-level general practitioners (GPs to work in primary care institutions, China launched the 5+3 model in 2015 as a way to educate GPs nationwide. In this study, we investigated the awareness of the 5+3 model, career choices after graduation, and influences on GP career choice of undergraduate medical students from Zhengzhou University. Methods: The study population consisted of 288 undergraduate medical students from Zhengzhou University. We explored the students׳ awareness of the 5+3 model, career choices after graduation, influences on general practitioner career choice and mental status by using a self-report questionnaire and the Chinese version of the 21-item Depression Anxiety Stress Scale. Results: We found 34.2% of students did not understand the new policy. Only 23.2% of students would choose to work as a GP after graduation, and those tended to be female, to have a monthly family income less than 4000 ¥, or to be from rural areas. Only 10% of undergraduate medical students expressed a preference to work at primary care institutions. The participants showed higher anxiety and stress scores than did a previously published group of Chinese college students, and those who chose to pursue higher education had more anxiety and stress than those who decided to become general practitioners. Discussion: More efforts should be made to popularize the 5+3 model and mental intervention among medical students. More efforts should be tried to increase the income/welfare benefits and strengthen the infrastructure of primary care institutions to attract more medical students. Keywords: 5+3 model, General practitioner, Health care reform, Hierarchical medical system

  20. Robotic surgery in complicated gynecologic diseases: experience of Tri-Service General Hospital in Taiwan.

    Science.gov (United States)

    Tan, Shun-Jen; Lin, Chi-Kung; Fu, Pei-Te; Liu, Yung-Liang; Sun, Cheng-Chian; Chang, Cheng-Chang; Yu, Mu-Hsien; Lai, Hung-Cheng

    2012-03-01

    Minimally invasive surgery has been the trend in various specialties and continues to evolve as new technology develops. The development of robotic surgery in gynecology remains in its infancy. The present study reports the first descriptive series of robotic surgery in complicated gynecologic diseases in Taiwan. From March 2009 to February 2011, the records of patients undergoing robotic surgery using the da Vinci Surgical System were reviewed for patient demographics, indications, operative time, hospital stay, conversion to laparotomy, and complications. Sixty cases were reviewed in the present study. Forty-nine patients had benign gynecologic diseases, and 11 patients had malignancies. These robot-assisted laparoscopic procedures include nine hysterectomy, 15 subtotal hysterectomy, 13 myomectomy, eight staging operation, two radical hysterectomy, five ovarian cystectomy, one bilateral salpingo-oophorectomy and myomectomy, two resections of deep pelvic endometriosis, one pelvic adhesiolysis, three sacrocolpopexy and one tuboplasty. Thirty-three patients had prior pelvic surgery, and one had a history of pelvic radiotherapy. Adhesiolysis was necessary in 38 patients to complete the whole operation. Robotic myomectomy was easily accomplished in patients with huge uterus or multiple myomas. The suturing of myometrium or cervical stump after ligation of the uterine arteries minimized the blood loss. In addition, it was much easier to dissect severe pelvic adhesions. The dissection of para-aortic lymph nodes can be easily accomplished. All these surgeries were performed smoothly without ureteral, bladder or bowel injury. The present analyses include various complicated gynecologic conditions, which make the estimation of the effectiveness of robotic surgery in each situation individually not appropriate. However, our experiences do show that robotic surgery is feasible and safe for patients with complicated gynecologic diseases. Copyright © 2012. Published by

  1. Indirect Genetic Effects and the Spread of Infectious Disease: Are We Capturing the Full Heritable Variation Underlying Disease Prevalence?

    Science.gov (United States)

    Lipschutz-Powell, Debby; Woolliams, John A.; Bijma, Piter; Doeschl-Wilson, Andrea B.

    2012-01-01

    Reducing disease prevalence through selection for host resistance offers a desirable alternative to chemical treatment. Selection for host resistance has proven difficult, however, due to low heritability estimates. These low estimates may be caused by a failure to capture all the relevant genetic variance in disease resistance, as genetic analysis currently is not taylored to estimate genetic variation in infectivity. Host infectivity is the propensity of transmitting infection upon contact with a susceptible individual, and can be regarded as an indirect effect to disease status. It may be caused by a combination of physiological and behavioural traits. Though genetic variation in infectivity is difficult to measure directly, Indirect Genetic Effect (IGE) models, also referred to as associative effects or social interaction models, allow the estimation of this variance from more readily available binary disease data (infected/non-infected). We therefore generated binary disease data from simulated populations with known amounts of variation in susceptibility and infectivity to test the adequacy of traditional and IGE models. Our results show that a conventional model fails to capture the genetic variation in infectivity inherent in populations with simulated infectivity. An IGE model, on the other hand, does capture some of the variation in infectivity. Comparison with expected genetic variance suggests that there is scope for further methodological improvement, and that potential responses to selection may be greater than values presented here. Nonetheless, selection using an index of estimated direct and indirect breeding values was shown to have a greater genetic selection differential and reduced future disease risk than traditional selection for resistance only. These findings suggest that if genetic variation in infectivity substantially contributes to disease transmission, then breeding designs which explicitly incorporate IGEs might help reduce disease

  2. Visible Age-Related Signs and Risk of Ischemic Heart Disease in the General Population

    DEFF Research Database (Denmark)

    Christoffersen, Mette; Frikke-Schmidt, Ruth; Schnohr, Peter

    2014-01-01

    developed MI. Presence of frontoparietal baldness, crown top baldness, earlobe crease, and xanthelasmata was associated with increased risk of IHD or MI after multifactorial adjustment for chronological age and well-known cardiovascular risk factors. The risk of IHD and MI increased stepwise with increasing...... risk of IHD and MI increased with increasing number of visible age-related signs. CONCLUSIONS: Male pattern baldness, earlobe crease, and xanthelasmata-alone or in combination-associate with increased risk of ischemic heart disease and myocardial infarction independent of chronological age and other...

  3. Alcohol intake, alcohol dehydrogenase genotypes, and liver damage and disease in the Danish general population

    DEFF Research Database (Denmark)

    Tolstrup, J.S.; Gronbaek, M.; Tybjaerg-Hansen, A.

    2009-01-01

    the Copenhagen City Heart Study. Biochemical tests for the detection of liver damage were specific for alanine aminotransferase (ALT), aspartate aminotransferase (AST)-to-ALT ratio (AST/ALT), gamma-glutamyl transpeptidase (gamma-GT), albumin, bilirubin, alkaline phosphatase, coagulation factors, and erythrocyte...... volume. RESULTS: Increasing alcohol intake was associated with increasing erythrocyte volume, AST/ALT, and levels of ALT, gamma-GT, albumin, bilirubin, coagulation factors, and with decreasing levels of alkaline phosphatase. Multifactorially adjusted hazard ratios for alcoholic liver disease overall were...

  4. Abnormal activity of corneal cold thermoreceptors underlies the unpleasant sensations in dry eye disease.

    Science.gov (United States)

    Kovács, Illés; Luna, Carolina; Quirce, Susana; Mizerska, Kamila; Callejo, Gerard; Riestra, Ana; Fernández-Sánchez, Laura; Meseguer, Victor M; Cuenca, Nicolás; Merayo-Lloves, Jesús; Acosta, M Carmen; Gasull, Xavier; Belmonte, Carlos; Gallar, Juana

    2016-02-01

    Dry eye disease (DED) affects >10% of the population worldwide, and it provokes an unpleasant sensation of ocular dryness, whose underlying neural mechanisms remain unknown. Removal of the main lachrymal gland in guinea pigs caused long-term reduction of basal tearing accompanied by changes in the architecture and density of subbasal corneal nerves and epithelial terminals. After 4 weeks, ongoing impulse activity and responses to cooling of corneal cold thermoreceptor endings were enhanced. Menthol (200 μM) first excited and then inactivated this augmented spontaneous and cold-evoked activity. Comparatively, corneal polymodal nociceptors of tear-deficient eyes remained silent and exhibited only a mild sensitization to acidic stimulation, whereas mechanonociceptors were not affected. Dryness-induced changes in peripheral cold thermoreceptor responsiveness developed in parallel with a progressive excitability enhancement of corneal cold trigeminal ganglion neurons, primarily due to an increase of sodium currents and a decrease of potassium currents. In corneal polymodal nociceptor neurons, sodium currents were enhanced whereas potassium currents remain unaltered. In healthy humans, exposure of the eye surface to menthol vapors or to cold air currents evoked unpleasant sensations accompanied by increased blinking frequency that we attributed to cold thermoreceptor stimulation. Notably, stimulation with menthol reduced the ongoing background discomfort of patients with DED, conceivably due to use-dependent inactivation of cold thermoreceptors. Together, these data indicate that cold thermoreceptors contribute importantly to the detection and signaling of ocular surface wetness, and develop under chronic eye dryness conditions an injury-evoked neuropathic firing that seems to underlie the unpleasant sensations experienced by patients with DED.

  5. Non-Alcoholic Fatty Liver Disease (NAFLD): new challenge for general practitioners and important burden for health authorities?

    Science.gov (United States)

    Ahmed, Mohamed H; Abu, Emmanuel O; Byrne, Christopher D

    2010-10-01

    Non-alcoholic fatty liver disease (NAFLD) is the most common cause of hepatic dysfunction encountered in general practice. A large proportion of individuals with type 2 diabetes and the metabolic syndrome develop NAFLD. NAFLD is associated with severe insulin resistance and increased risk of cardiovascular disease and can progress to non-alcoholic steato-hepatitis, liver cirrhosis and cancer. Currently the only known effective treatments for NAFLD are lifestyle changes including stable weight loss and a diet low in calories. General practitioners will increasingly play a key role in dealing with this evolving but serious epidemic of NAFLD and associated metabolic complications. However, success will depend on the appropriate systems and mechanisms being in place in primary care and the proper motivation, support and education of the patient. This review provides the primary care physician with: (a) a step-by step guide of how to identify NAFLD, (b) information to exclude common other causes of liver fat accumulation and (c) additional insight into relationships between NAFLD and other conditions such as obesity, cardiovascular disease and type 2 diabetes. Copyright © 2010 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  6. Quality of life of gestational trophoblastic neoplasia survivors: a study of patients at the Philippine General Hospital trophoblastic disease section.

    Science.gov (United States)

    Cagayan, M Stephanie Fay S; Llarena, Raquel T

    2010-01-01

    To evaluate the quality of life (QOL) of patients who were diagnosed with gestational trophoblastic neoplasia (GTN) at the Philippine General Hospital Trophoblastic Disease Section and who were in remission at the time of this study. A cross-sectional descriptive study designed to measure the QOL of all patients diagnosed as having GTN in remission and following up at the Philippine General Hospital Trophoblastic Disease Outpatient Clinic from May-August 2008 (N = 46). This study used the short form 12-question (SF-12) survey forms to evaluate the QOL of patients diagnosed with GTN. Scores from the SF-12 were analyzed using Pearson's correlation. Statistical significance was assumed for p values educational level and physical functioning. A negative correlation was found between the stage of GTN and patients' general health. In conclusion, the survivors' age, educational level and type of treatment had impact on the QOL among GTN survivors in terms of physical functioning. No relationship was established between the demographic variables and mental status. SF-12 appears to be a reliable instrument, suggesting its potential in measuring health status in GTN survivors. Age, educational attainment and type of treatment were shown to have an impact on the QOL of the surviving GTN patients.

  7. Changes in the oral health-related quality of life in children following comprehensive oral rehabilitation under general anaesthesia.

    Science.gov (United States)

    Yawary, Rana; Anthonappa, Robert P; Ekambaram, Manikandan; McGrath, Colman; King, Nigel M

    2016-09-01

    To assess changes in the oral health-related quality of life (OHRQoL), after comprehensive oral rehabilitation under general anaesthesia (CORGA), among children (i) <6 years using the Early Childhood Oral Health Impact Scale (ECOHIS) and (ii) aged 6-14 years using the child oral health-related quality of life (COHRQoL) instrument. A total of 136 healthy children who had CORGA were recruited over a period of 12 months. The parent or caregiver of the study participants completed the age-appropriate questionnaire prior to the dental treatment and at the subsequent follow-up appointments (2 weeks and 3 months). Data were analysed using repeated-measures anova and Bonferroni tests. The overall ECOHIS scores decreased significantly (P < 0.001) demonstrating large effect sizes. The greatest decreases were for the domains of child oral symptoms (57.5%) and psychology (38.7%) in the child impact section (CIS) and for the domain of parental distress (38.9%) and family function (40%) in the family impact section (FIS). For COHRQoL, the overall P-CPQ and FIS scores decreased significantly for all items (P < 0.001), demonstrating large effect sizes. The greatest decreases were for the domains of oral symptoms (77.7%), functional limitations (74.3%), and the FIS (80.1%). The OHRQoL of children in both age groups (<6 and 6-14 years) was significantly improved after CORGA. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  8. Intravenous Dexmedetomidine Infusion Compared with that of Fentanyl in Patients Undergoing Arthroscopic Shoulder Surgery under General Anesthesia.

    Science.gov (United States)

    Abdel Hamid, Mona Hossam Eldin

    2017-01-01

    Anesthesia for arthroscopic shoulder surgery is challenging due to the need for oligaemic surgical field as well as a good postoperative recovery profile. The present study was prospective, randomized to evaluate the efficacy of dexmdetomidine infusion compared to that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. A total of 60 patients aged from thirty to fifty years, American Society of Anesthesiologists Class I/II of either sex for arthroscopic shoulder surgery, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine loading 1 μg/kg over 10 min followed by maintenance 0.5 μg/kg/h and Group II Fentanyl loading 1 μg/kg followed by maintenance 0.5 μg/kg/h. Hemodynamic readings (Heart rate HR, and mean arterial blood pressure MAP) were recorded after the start of the study drug infusion (T1), after intubation (T2), then every 15 minutes till the end of surgery (T15, T30, T45, T60, T75, T90). In the PACU, MAP, and HR were recorded on arrival, after 30 min, 1 hr, and 2 hrs (R0, R30, R1 hr, R2 hr) Postoperative analgesia was assessed by visual analogue scale (VAS), Modified Observers's Assessment of Alertness and Sedation OAA/S was recorded on arrival to PACU. This study showed that in the dexmedatomidine group there was statistically significant decrease of MAP and HR after drug infusion up to two hours in the recovery period, more sedation, better control of pain and surgeon satisfaction. Iv infusion of dexamedatomidine may be an attractive option during arthroscopic shoulder surgery as it provided a better hypotensive anesthesia by lowering MAP and HR which leads to better surgical field and surgeon satisfaction than iv infusion fentanyl along with a better postoperative VAS.

  9. Respiratory variation in peak aortic velocity accurately predicts fluid responsiveness in children undergoing neurosurgery under general anesthesia.

    Science.gov (United States)

    Morparia, Kavita G; Reddy, Srijaya K; Olivieri, Laura J; Spaeder, Michael C; Schuette, Jennifer J

    2018-04-01

    The determination of fluid responsiveness in the critically ill child is of vital importance, more so as fluid overload becomes increasingly associated with worse outcomes. Dynamic markers of volume responsiveness have shown some promise in the pediatric population, but more research is needed before they can be adopted for widespread use. Our aim was to investigate effectiveness of respiratory variation in peak aortic velocity and pulse pressure variation to predict fluid responsiveness, and determine their optimal cutoff values. We performed a prospective, observational study at a single tertiary care pediatric center. Twenty-one children with normal cardiorespiratory status undergoing general anesthesia for neurosurgery were enrolled. Respiratory variation in peak aortic velocity (ΔVpeak ao) was measured both before and after volume expansion using a bedside ultrasound device. Pulse pressure variation (PPV) value was obtained from the bedside monitor. All patients received a 10 ml/kg fluid bolus as volume expansion, and were qualified as responders if stroke volume increased >15% as a result. Utility of ΔVpeak ao and PPV and to predict responsiveness to volume expansion was investigated. A baseline ΔVpeak ao value of greater than or equal to 12.3% best predicted a positive response to volume expansion, with a sensitivity of 77%, specificity of 89% and area under receiver operating characteristic curve of 0.90. PPV failed to demonstrate utility in this patient population. Respiratory variation in peak aortic velocity is a promising marker for optimization of perioperative fluid therapy in the pediatric population and can be accurately measured using bedside ultrasonography. More research is needed to evaluate the lack of effectiveness of pulse pressure variation for this purpose.

  10. Mitochondrial mislocalization underlies Abeta42-induced neuronal dysfunction in a Drosophila model of Alzheimer's disease.

    Directory of Open Access Journals (Sweden)

    Kanae Iijima-Ando

    2009-12-01

    Full Text Available The amyloid-beta 42 (Abeta42 is thought to play a central role in the pathogenesis of Alzheimer's disease (AD. However, the molecular mechanisms by which Abeta42 induces neuronal dysfunction and degeneration remain elusive. Mitochondrial dysfunctions are implicated in AD brains. Whether mitochondrial dysfunctions are merely a consequence of AD pathology, or are early seminal events in AD pathogenesis remains to be determined. Here, we show that Abeta42 induces mitochondrial mislocalization, which contributes to Abeta42-induced neuronal dysfunction in a transgenic Drosophila model. In the Abeta42 fly brain, mitochondria were reduced in axons and dendrites, and accumulated in the somata without severe mitochondrial damage or neurodegeneration. In contrast, organization of microtubule or global axonal transport was not significantly altered at this stage. Abeta42-induced behavioral defects were exacerbated by genetic reductions in mitochondrial transport, and were modulated by cAMP levels and PKA activity. Levels of putative PKA substrate phosphoproteins were reduced in the Abeta42 fly brains. Importantly, perturbations in mitochondrial transport in neurons were sufficient to disrupt PKA signaling and induce late-onset behavioral deficits, suggesting a mechanism whereby mitochondrial mislocalization contributes to Abeta42-induced neuronal dysfunction. These results demonstrate that mislocalization of mitochondria underlies the pathogenic effects of Abeta42 in vivo.

  11. [Automutilation with indistinct underlying disease--difficulties of care in the community].

    Science.gov (United States)

    Gehb, Iris; Reuhl, Joachim; Volk, Stephan; Urban, Reinhard

    2009-11-01

    Self-mutilation is well-known in various psychiatric diseases and represents a challenge for forensic pathologists as regards the differentiation of accidental versus self-inflicted injuries, especially when a criminal charge is likely to emerge. A case of extraordinarily severe self-inflicted injuries is presented as well as the related implications concerning clinical and ambulatory care for patients, whose underlying motivation remains unknown. A 60 year-old worker exhibited an open scull fracture and 14 abdominal wounds with protrusion of small intestine, from which a part of 160 cm length was completely removed beforehand. The patient claimed the wounds having been caused accidentally. When examined by a psychiatrist, disturbances in orientation, unrest and ill concentration were found, but no symptoms related to psychosis, depression or suicidal behaviour. Although the need for more detailed examination seemed to be clearly evident, the medical authorities did not take action. Consequently, no further psychiatric treatment was initiated. The implications of this case on the background of the literature are discussed. Georg Thieme Verlag KG Stuttgart.New York.

  12. iPSC-Based Models to Unravel Key Pathogenetic Processes Underlying Motor Neuron Disease Development

    Directory of Open Access Journals (Sweden)

    Irene Faravelli

    2014-10-01

    Full Text Available Motor neuron diseases (MNDs are neuromuscular disorders affecting rather exclusively upper motor neurons (UMNs and/or lower motor neurons (LMNs. The clinical phenotype is characterized by muscular weakness and atrophy leading to paralysis and almost invariably death due to respiratory failure. Adult MNDs include sporadic and familial amyotrophic lateral sclerosis (sALS-fALS, while the most common infantile MND is represented by spinal muscular atrophy (SMA. No effective treatment is ccurrently available for MNDs, as for the vast majority of neurodegenerative disorders, and cures are limited to supportive care and symptom relief. The lack of a deep understanding of MND pathogenesis accounts for the difficulties in finding a cure, together with the scarcity of reliable in vitro models. Recent progresses in stem cell field, in particular in the generation of induced Pluripotent Stem Cells (iPSCs has made possible for the first time obtaining substantial amounts of human cells to recapitulate in vitro some of the key pathogenetic processes underlying MNDs. In the present review, recently published studies involving the use of iPSCs to unravel aspects of ALS and SMA pathogenesis are discussed with an overview of their implications in the process of finding a cure for these still orphan disorders.

  13. General Corrosion studies of a Titanium and Incoloy based alloys under ammoniacal medium and at 290 deg. C

    International Nuclear Information System (INIS)

    Gokhale, B.K.; Keny, S.J.; Kumbhar, A.G.; Rangarajan, S.; Bera, S.; Nuwad Jitendra; Kumar, Sanjukta A.; Wagh, D. N.; Pradhan, S.

    2012-09-01

    For their use in future PWR applications, the general corrosion behaviors of two modified alloys of titanium and Incoloy were studied at high temperature and high pressure (290 deg. C, 7400 Kpa) under ammoniated atmosphere and compared. Coupons were exposed to solutions of varying ammonia concentrations of (10, 50 and 100 ppm ) at 290 deg. C under non-deaerated conditions in a static autoclave for 20 days. Surface characteristics of exposed coupons were studied using XRF, SEM, EDAX and XPS. The solution in the autoclave was analyzed for its specific conductivity, pH and for the elemental concentrations leached from alloy. The exposed titanium based alloy showed deposition of white crystalline material (300-1000 nm size) on the surface. Depletion of Ti and increase in the oxygen concentration on the exposed surface was observed. This indicated dissolution of Ti in solution from surface at high temperature and pressure and its reaction with oxygen in solution to form oxide and its redeposition on surface. The oxide film compositions were found to change drastically between 10 and 50 ppm ammoniated solution. Ti was found to be enriched in the oxide film when the solution contained 50 ppm of ammonia whereas the opposite effect was observed at 10 ppm of ammonia. The presence Ti 4+ in oxide environment and traces of Cr 3+ were observed but no nitrogen or Zr was detected. Specific conductivity of the exposed solution was found to increase by 30 μS/cm and pH to decrease by 1.5 units. Slight leaching of Ti was observed in solution. No Zr was found in the leached solution. Presence of other elements like Al, Cr, Ni in the exposed solution indicated leaching of autoclave construction material (hastelloy). This alloy showed good resistance for corrosion under the experimental conditions. The exposed surface of Incoloy based alloy showed Ni, Cr, Cu and Mn on the surface with deposition of crystalline particles (200-300 nm size). The exposed surface also showed a decrease in Cr

  14. The features of general anesthesia by sevofluran in pediatric vitreoretinal surgery with different diseases and ophthalmosurgeral pathologies

    Directory of Open Access Journals (Sweden)

    Pronin S.N.

    2017-06-01

    Full Text Available Objective: clinical studies of inhalation anesthesia with sevoflurane as the main anesthetic for various diseases in children with vitreoretinal operations. Material and Methods. There was considered the age groups of children from 3 to 16 years old. Among 76 children: 18 with non-prosperrous psycho-emotional statuses, 2 with ICP, 2 with bronchial asthma, 3 with atopic dermatitis, 5 with small anomalies of heart development, 46 were somatically healthy. All of children had different ophthalmosuregery pathology. Results. The performing of general anesthesia by sevoflurane at vitreoretinal surgeries of children with the different diseases and ophthalmological pathologies displayed appropriateness and safety during the surgeries. Conclusion. The appliance of sevoflurane is the reasonable and optimal scheme in modern ophtalmosurgery and anesthesiology.

  15. [Clinical and economic analysis of an internal medicine-infectious disease department at a university general hospital (2005-2006)].

    Science.gov (United States)

    Gómez, Joaquín; García-Vázquez, Elisa; Antonio Puertas, José; Ródenas, Julio; Herrero, José Antonio; Albaladejo, Carmen; Baños, Víctor; Canteras, Manuel; Alcaraz, Manolo

    2009-02-01

    Comparative study in patients with infectious diseases admitted to a specialized Internal Medicine-Infectious Diseases Department (IMID) versus those admitted to other medical departments in a university general hospital, investigating quality and cost-effectiveness. Analysis of patients in 10 principle diagnosis-related groups (DRGs) of infectious diseases admitted to the IMID were compared to those admitted to other medical departments (2005-2006). The DRG were divided in 4 main groups: respiratory infections (DGR 88, 89, 90, 540), urinary infections (DRG 320, 321), sepsis (DRG 416, 584), and skin infections (DRG 277, 278). For each group, quality variables (mortality and readmission rate), efficacy variables (mean hospital stay and mean DRG-based cost per patient) and complexity variables (case mix, relative weight, and functional index) were analyzed. 542 patients included in the 10 main infectious disease DRGs were admitted to IMID and 2404 to other medical departments. After adjusting for DRG case mix (case mix 0.99 for IMID and 0.89 for others), mean hospital stay (5.11 days vs. 7.65 days), mortality (3.5% vs. 7.9%) and mean DRG-based economic cost per patient (1521euro/patient vs. 2952euro/patient) was significantly lower in the group of patients hospitalized in IMID than the group in other medical departments (peconomic cost per patient. Creation and development of IMID departments should be an essential objective to improve healthcare quality and respond to social demands.

  16. Disability and functional burden of disease because of mental in comparison to somatic disorders in general practice patients.

    Science.gov (United States)

    Linden, M; Linden, U; Schwantes, U

    2015-09-01

    Severity of illness is not only depending on the symptom load, but also on the burden in life. Mental disorders are among those illnesses, which in particular cause suffering to the individual and society. To study burden of disease for mental in comparison to somatic disorders, 2099 patients from 40 general practitioners filled in (a) the Burvill scale which measures acute and chronic illnesses in ten different body systems and (b) the IMET scale which measures impairment in ten different areas of life. Patients were suffering on average from acute and/or chronic illness in 3.5 (SD: 2.0) body systems and 56.6% of patients complained about acute and/or chronic mental disorders. The most significant negative impact on the IMET total score have acute and chronic mental disorders, followed by chronic neurological and musculoskeletal and acute respiratory and gastrointestinal disorders, while cardiovascular, metabolic, urogenital, haematological and ear/eye disorders have no greater impact. Acute as well as chronic mental disorders cause impairment across all areas of life and most burden of disease (functional burden of disease 1.69), followed by musculoskeletal disorders (1.62). Mental disorders are among the most frequent health problems with high negative impact across all areas of life. When combining frequency and impairment mental disorders cause most burden of disease in comparison to other illnesses. This should be reflected in the organization of medical care including family medicine. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  17. Treatment of severe generalized chronic periodontitis in a patient with Behçet's disease: A case report.

    Science.gov (United States)

    Morikawa, Satoru; Ouchi, Takehito; Asoda, Seiji; Horie, Nobuyuki; Tsunoda, Kazuyuki; Kawana, Hiromasa; Nakagawa, Taneaki

    2018-05-01

    Behçet's disease is a systemic disorder of unknown etiology. It involves multiple organ systems and is characterized by recurring episodes of oral ulcers as well as ocular, genital, and skin lesions. Oral ulcers can affect tooth brushing and impair proper oral hygiene. As a result, a dental biofilm accumulates, and the condition of the teeth and periodontal tissue deteriorates. The aim of this case report is to highlight the efficacy of periodontal treatment for patients with Behçet's disease. A 51-year-old man with Behçet's disease presented with generalized severe periodontitis. After basic treatment of the periodontal tissues, periodontal surgery was performed at several sites with bony defects. However, the patient developed severe stomatitis in the oral mucosa and gingiva after periodontal surgery. Administration of the antimicrobial agent cefdinir had little effect on recovery; however, subsequent administration of sitafloxacin resulted in significant improvement of the stomatitis. This case demonstrates that periodontal therapy is very useful for alleviating the oral signs and symptoms of Behçet's disease. Systemic antibiotic treatment with sitafloxacin (but not cefdinir) and mechanical debridement were effective in preventing the recurrence of aphthous ulcer outbreaks after periodontal surgery.

  18. Resting-state connectivity of the sustained attention network correlates with disease duration in idiopathic generalized epilepsy.

    Directory of Open Access Journals (Sweden)

    Mona Maneshi

    Full Text Available INTRODUCTION: In idiopathic generalized epilepsy (IGE, a normal electroencephalogram between generalized spike and wave (GSW discharges is believed to reflect normal brain function. However, some studies indicate that even excluding GSW-related errors, IGE patients perform poorly on sustained attention task, the deficit being worse as a function of disease duration. We hypothesized that at least in a subset of structures which are normally involved in sustained attention, resting-state functional connectivity (FC is different in IGE patients compared to controls and that some of the changes are related to disease duration. METHOD: Seeds were selected based on a sustained attention study in controls. Resting-state functional magnetic resonance imaging (fMRI data was obtained from 14 IGE patients and 14 matched controls. After physiological noise removal, the mean time-series of each seed was used as a regressor in a general linear model to detect regions that showed correlation with the seed. In patients, duration factor was defined based on epilepsy duration. Between-group differences weighted by the duration factor were evaluated with mixed-effects model. Correlation was then evaluated in IGE patients between the FC, averaged over each significant cluster, and the duration factor. RESULTS: Eight of 18 seeds showed significant difference in FC across groups. However, only for seeds in the medial superior frontal and precentral gyri and in the medial prefrontal area, average FC taken over significant clusters showed high correlation with the duration factor. These 3 seeds showed changes in FC respectively with the premotor and superior frontal gyrus, the dorsal premotor, and the supplementary motor area plus precentral gyrus. CONCLUSION: Alterations of FC in IGE patients are not limited to the frontal areas. However, as indicated by specificity analysis, patients with long history of disease show changes in FC mainly within the frontal areas.

  19. An investigation of the mechanism underlying teacher aggression : Testing I3 theory and the General Aggression Model

    NARCIS (Netherlands)

    Montuoro, Paul; Mainhard, Tim

    2017-01-01

    Background: Considerable research has investigated the deleterious effects of teachers responding aggressively to students who misbehave, but the mechanism underlying this dysfunctional behaviour remains unknown. Aims: This study investigated whether the mechanism underlying teacher aggression

  20. Adrenal crisis in treated Addison's disease: a predictable but under-managed event.

    Science.gov (United States)

    White, Katherine; Arlt, Wiebke

    2010-01-01

    Adrenal crisis is a life-threatening event that occurs regularly in Addison's patients receiving standard replacement therapy. Patient reports suggest that it is an underestimated and under-managed event. To assess the frequency of adrenal crisis in diagnosed patients and to understand the factors contributing to the risks of adrenal crisis. We conducted a postal survey of Addison's patients in four countries, UK (n=485), Canada (n=148), Australia (n=123) and New Zealand (n=85) in 2003, asking about patients' experiences of adrenal crisis and their demographic characteristics. In 2006, a shorter follow-up survey was conducted in the UK (n=261). The frequency and causes of adrenal crisis were compared across both surveys. Demographic data from the 2003 survey were analysed to establish the main variables associated with an elevated risk of crisis. Around 8% of diagnosed cases can be expected to need hospital treatment for adrenal crisis annually. Exposure to gastric infection is the single most important factor predicting the likelihood of adrenal crisis. Concomitant diabetes and/or asthma increase the frequency of adrenal crises reported by patients. The endocrinologist has a responsibility to ensure that Addison's patients have adequate access to life-saving emergency injection materials and repeated, practical training sessions in how to use them, while the general practitioner plays a vital role as in arranging prompt emergency admissions.

  1. Under-diagnosis of rickettsial disease in clinical practice: A systematic review

    NARCIS (Netherlands)

    van Eekeren, Louise E.; de Vries, Sophia G.; Wagenaar, Jiri F. P.; Spijker, René; Grobusch, Martin P.; Goorhuis, Abraham

    2018-01-01

    Rickettsial diseases present as acute febrile illnesses, sometimes with inoculation eschars. We performed a systematic review of studies published between 1997 and 2017 to assess the underestimation of non-eschar rickettsial disease (NERD) relative to eschar rickettsial disease (ERD), as a cause of

  2. General anesthesia exposure in early life reduces the risk of allergic diseases: A nationwide population-based cohort study.

    Science.gov (United States)

    Kuo, Ho-Chang; Yang, Ya-Ling; Ho, Shu-Chen; Guo, Mindy Ming-Huey; Jiang, Jyun-Hong; Huang, Ying-Hsien

    2016-07-01

    General anesthesia (GA) has been used for second line treatment strategy for status asthmaticus in pediatric patients. The association between GA in children and risk of followed-up allergic diseases is unclear. This study aims to assess the risk of allergic diseases after GA in children.We did a nationwide retrospective cohort study by analyzing data from the National Health Insurance Research Database (NHIRD) in Taiwan. The subsequent risks for allergic diseases, including asthma (ICD-9: 493.X), allergic rhinitis (AR; ICD-9 CM code 477.X), and atopic dermatitis (AD; ICD-9-CM code 691.X), were compared between exposure to GA and none before 1 year of age throughout the follow-up period using the Cox proportional hazards model.Insurance claims data for 32,742 children younger than 1 year old from all insured children in the NHIRD. Of those, 2358 subjects were exposed to GA; 414 and 1944 children exposed to mask and intubation ventilation, respectively, served as the study cohort, whereas the remaining 30,384 children made up the comparison cohort. Children in the GA group were at a lower risk of developing asthma, AR and AD, with adjusted hazard ratios of 0.67 (0.62-0.72, 95%CI), 0.72 (0.68-0.77, 95%CI), 0.60 (0.56-0.64, 95%CI), respectively.Children who were exposed to GA in early life before 1 year of age had reduced risk of subsequently developing allergic diseases such as asthma, AD, and AR, when compared with general population.

  3. A Bayesian Framework for Generalized Linear Mixed Modeling Identifies New Candidate Loci for Late-Onset Alzheimer's Disease.

    Science.gov (United States)

    Wang, Xulong; Philip, Vivek M; Ananda, Guruprasad; White, Charles C; Malhotra, Ankit; Michalski, Paul J; Karuturi, Krishna R Murthy; Chintalapudi, Sumana R; Acklin, Casey; Sasner, Michael; Bennett, David A; De Jager, Philip L; Howell, Gareth R; Carter, Gregory W

    2018-03-05

    Recent technical and methodological advances have greatly enhanced genome-wide association studies (GWAS). The advent of low-cost whole-genome sequencing facilitates high-resolution variant identification, and the development of linear mixed models (LMM) allows improved identification of putatively causal variants. While essential for correcting false positive associations due to sample relatedness and population stratification, LMMs have commonly been restricted to quantitative variables. However, phenotypic traits in association studies are often categorical, coded as binary case-control or ordered variables describing disease stages. To address these issues, we have devised a method for genomic association studies that implements a generalized linear mixed model (GLMM) in a Bayesian framework, called Bayes-GLMM Bayes-GLMM has four major features: (1) support of categorical, binary and quantitative variables; (2) cohesive integration of previous GWAS results for related traits; (3) correction for sample relatedness by mixed modeling; and (4) model estimation by both Markov chain Monte Carlo (MCMC) sampling and maximal likelihood estimation. We applied Bayes-GLMM to the whole-genome sequencing cohort of the Alzheimer's Disease Sequencing Project (ADSP). This study contains 570 individuals from 111 families, each with Alzheimer's disease diagnosed at one of four confidence levels. With Bayes-GLMM we identified four variants in three loci significantly associated with Alzheimer's disease. Two variants, rs140233081 and rs149372995 lie between PRKAR1B and PDGFA The coded proteins are localized to the glial-vascular unit, and PDGFA transcript levels are associated with AD-related neuropathology. In summary, this work provides implementation of a flexible, generalized mixed model approach in a Bayesian framework for association studies. Copyright © 2018, Genetics.

  4. 30 CFR 285.902 - What are the general requirements for decommissioning for facilities authorized under my SAP, COP...

    Science.gov (United States)

    2010-07-01

    ... decommissioning for facilities authorized under my SAP, COP, or GAP? 285.902 Section 285.902 Mineral Resources... SAP, COP, or GAP? (a) Except as otherwise authorized by MMS under § 285.909, within 2 years following... under your SAP, COP, or GAP, you must submit a decommissioning application and receive approval from the...

  5. Evaluation of a potential parathyroid dysfunction under treatment with radioactive iodine of benign thyroid diseases

    International Nuclear Information System (INIS)

    Schumacher, Serena Christine

    2011-01-01

    The intention of the present thesis was the evaluation of a potential parathyroid dysfunction under treatment with radioactive iodine of benign thyroid diseases. It was to be examined whether a change in the parathyroid function would arise within the first week on treatment. So far there are some minor studies existing describing significant changes in the parathyroid hormone serum level within the first months after radioactive iodine therapy of benign and malignant thyroid diseases. Moreover, it is a fact that external beam-radiotherapy can induce neoplasia and that the risk for the subsequent development of primary hyperparathyroidism doubles or triples after external beam-radiotherapy of the head and neck. Up to now, however, an increased incidence for primary hyperparathyroidism following treatment with radioactive iodine ( 131 I) could not be proved. At the department of nuclear medicine of the university hospital Giessen-Marburg GmbH, location Marburg, a prospective cohort study was executed on radioactive iodine therapy of benign thyroid diseases with 105 probands (75 women / 30 men, mean age 60.62 ± 14.3 years). According to their thyroid diseases these 105 probands were classified into following subgroups: thyroid adenoma with 23 patients, multifocal thyroid autonomy with 8 patients, disseminated thyroid autonomy with 37 patients as well as the subgroup Graves' hyperthyroidism (without Graves' ophtalmopathy) and accordingly Graves' disease (with Graves' ophtalmopathy) with 37 patients. The serum level of the intact parathyroid hormone was determined directly before starting the radioactive iodine therapy on the admission day and on day 1, 3 and 5 of the radioactive iodine therapy as well as at the ambulant follow-up examination one month after the start of the therapy. In case of 99 of 105 probands the serum level of parathyroid hormone declined on treatment with 131 I with its nadir on day 3 of therapy (decline by 15.71 ng/l or 27

  6. Health improvement and prevention study (HIPS - evaluation of an intervention to prevent vascular disease in general practice

    Directory of Open Access Journals (Sweden)

    Davies Gawaine

    2010-08-01

    Full Text Available Abstract Background The Health Improvement and Prevention Study (HIPS study aims to evaluate the capacity of general practice to identify patients at high risk for developing vascular disease and to reduce their risk of vascular disease and diabetes through behavioural interventions delivered in general practice and by the local primary care organization. Methods/Design HIPS is a stratified randomized controlled trial involving 30 general practices in NSW, Australia. Practices are randomly allocated to an 'intervention' or 'control' group. General practitioners (GPs and practice nurses (PNs are offered training in lifestyle counselling and motivational interviewing as well as practice visits and patient educational resources. Patients enrolled in the trial present for a health check in which the GP and PN provide brief lifestyle counselling based on the 5As model (ask, assess, advise, assist, and arrange and refer high risk patients to a diet education and physical activity program. The program consists of two individual visits with a dietician or exercise physiologist and four group sessions, after which patients are followed up by the GP or PN. In each practice 160 eligible patients aged between 40 and 64 years are invited to participate in the study, with the expectation that 40 will be eligible and willing to participate. Evaluation data collection consists of (1 a practice questionnaire, (2 GP and PN questionnaires to assess preventive care attitudes and practices, (3 patient questionnaire to assess self-reported lifestyle behaviours and readiness to change, (4 physical assessment including weight, height, body mass index (BMI, waist circumference and blood pressure, (5 a fasting blood test for glucose and lipids, (6 a clinical record audit, and (7 qualitative data collection. All measures are collected at baseline and 12 months except the patient questionnaire which is also collected at 6 months. Study outcomes before and after the

  7. Indirect Genetic Effects and the Spread of Infectious Disease: Are We Capturing the Full Heritable Variation Underlying Disease Prevalence?

    NARCIS (Netherlands)

    Lipschutz-Powell, D.; Woolliams, J.A.; Bijma, P.; Doeschl-Wilson, A.B.

    2012-01-01

    Reducing disease prevalence through selection for host resistance offers a desirable alternative to chemical treatment. Selection for host resistance has proven difficult, however, due to low heritability estimates. These low estimates may be caused by a failure to capture all the relevant genetic

  8. General procedures in diagnosis of malignant diseases in dogs and cats

    Directory of Open Access Journals (Sweden)

    Jovanović Milan

    2012-01-01

    Full Text Available Tumors occur in all domestic and wild animals. They are most often diagnosed in dogs and cats, and their numbers increase from year to year. In the recent years, cancer is believed to be the most frequent cause of pet deaths. A speedy and reliable diagnosis is of paramount importance because it enables the veterinarian to begin therapy and make a prognosis. The objective of an early diagnosis is to enable the detection of neoplastic diseases before the tumor spreads throughout the organism, consequently enabling the timely administration of therapy and providing greater chances for curing the animal. A tumor is diagnosed on the grounds of the anamnesis, clinical picture, and special diagnostic procedures. The most frequently applied diagnostic procedures are laboratory diagnostics, cytology, biopsy and pathohistology, imaging diagnostics (roentgenography and roentgenoscopy, ultrasound diagnostics, endoscopy, computer tomography, magnetic resonance, and scintigraphy and molecular diagnostics. Each of these methods has its advantages and faults in connection with costs, availability, sensitivity, specificity and quality of anatomic vs functional pictures. Every one of these techniques has its own field of implementation and each one provides different and additional information in connection with the nature and position of the primary lesion and the presence of metastases.

  9. Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility.

    Science.gov (United States)

    Gale, Catharine R; Batty, G David; Osborn, David P J; Tynelius, Per; Rasmussen, Finn

    2014-01-14

    Depression, anxiety, and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders. Participants were 1 107 524 Swedish men conscripted at a mean age of 18.3 years. Mental disorders were assessed by psychiatric interview on conscription, and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. An increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.62) (depressive disorders) to 1.90 (1.58, 2.38) (alcohol-related disorders). [corrected]. The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24-1.80) (schizophrenia) to 2.82 (2.53-3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes mellitus, and blood pressure measured at conscription, but they were partially attenuated by the adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position. Increased risk of incident CHD is present across a range of mental disorders and is observable when the disorders are diagnosed at a young age.

  10. Gastroesophageal reflux disease symptoms and dietary behaviors are significant correlates of short sleep duration in the general population: the Nagahama Study.

    Science.gov (United States)

    Murase, Kimihiko; Tabara, Yasuharu; Takahashi, Yoshimitsu; Muro, Shigeo; Yamada, Ryo; Setoh, Kazuya; Kawaguchi, Takahisa; Kadotani, Hiroshi; Kosugi, Shinji; Sekine, Akihiro; Nakayama, Takeo; Mishima, Michiaki; Chiba, Tsutomu; Chin, Kazuo; Matsuda, Fumihiko

    2014-11-01

    To examine relationships among gastroesophageal reflux disease (GERD) symptoms, dietary behaviors, and sleep duration in the general population. Cross-sectional. Community-based. There were 9,643 participants selected from the general population (54 ± 13 y). None. Sleep duration, sleep habits, and unfavorable dietary behaviors of each participant were assessed with a structured questionnaire. Participants were categorized into five groups according to their sleep duration: less than 5 h, 5 to less than 6 h, 6 to less than 7 h, 7 to less than 8 h, and 8 or more h per day. GERD was evaluated using the Frequency Scale for the Symptoms of GERD (FSSG) and participants having an FSSG score of 8 or more or those under treatment of GERD were defined as having GERD. Trend analysis showed that both the FSSG score and the number of unfavorable dietary habits increased with decreasing sleep duration. Further, multiple logistic regression analysis showed that both the presence of GERD (odds ratio = 1.19, 95% confidence interval (CI) = 1.07-1.32) and the number of unfavorable dietary behaviors (odds ratio = 1.19, 95% CI = 1.13-1.26) were independent and potent factors to identify participants with short sleep duration even after controlling for other confounding factors. The current study showed that both GERD symptoms and unfavorable dietary behaviors were significant correlates of short sleep duration independently of each other in a large sample from the general population.

  11. [Challenge and strategy of prevention and control of important parasitic diseases under the Belt and Road Initiative].

    Science.gov (United States)

    Chun-Li, Cao; Jia-Gang, Guo

    2018-04-17

    China was once a country with the heaviest burden of parasitic diseases. Under the leadership of the Communist Party and national authority, after more than 60 years' efforts of prevention and control, the remarkable results have been achieved in China. However, affected by the social and economic development and environmental changes, the prevention and control of parasitic diseases, especially imported parasitic diseases, are facing new challenges, and the parasitic diseases, such as malaria, schistosomiasis, leishmaniasis, filariasis and trypanosomiasis, appear increasingly. With the development of the Belt and Road Initiative, the transmission risks of these diseases are more increased. The purpose of this paper is to describe the experience and results of parasitic disease prevention and control in China, understand the present parasitic disease epidemic situation of the Belt and Road Initiative related countries, analyze the transmission risks of important parasitic diseases, and present some relevant suggestions, so as to provide the evidence for the health administrative department formulating the prevention and control strategies of such parasitic diseases timely and effectively.

  12. Mental disorders across the adult life course and future coronary heart disease: evidence for general susceptibility

    Science.gov (United States)

    Gale, Catharine R; Batty, G David; Osborn, David P J; Tynelius, Per; Rasmussen, Finn

    2014-01-01

    Background Depression, anxiety and psychotic disorders have been associated with an increased risk of coronary heart disease (CHD). It is unclear whether this association between mental health and CHD is present across a wider range of mental disorders. Methods and Results Participants were 1,107,524 Swedish men conscripted at mean age 18.3 years. Mental disorders were assessed by psychiatric interview on conscription and data on hospital admissions for mental disorder and CHD were obtained from national registers during 22.6 years of follow-up. Increased risk of incident CHD was evident across a range of mental disorders whether diagnosed at conscription or on later hospital admission. Age-adjusted hazard ratios (95% confidence intervals) according to diagnoses at conscription ranged from 1.30 (1.05, 1.60) (depressive disorders) to 1.92 (1.60, 2.31) (alcohol-related disorders). The equivalent figures according to diagnoses during hospital admission ranged from 1.49 (1.24, 1.80) (schizophrenia) to 2.82 (2.53, 3.13) (other substance use disorders). Associations were little changed by adjustment for parental socioeconomic status, or body mass index, diabetes and blood pressure measured at conscription, but were partially attenuated by adjustment for smoking, alcohol intake, and intelligence measured at conscription, and for education and own socioeconomic position. Conclusions Increased risk of incident CHD is present across a range of mental disorders and is observable when disorders are diagnosed at a young age. PMID:24190959

  13. Standardization of a model to study revaccination against Marek's disease under laboratory conditions.

    Science.gov (United States)

    Gimeno, Isabel M; Witter, Richard L; Cortes, Aneg L; Reddy, Sanjay M; Pandiri, Arun R

    2012-01-01

    Revaccination, the practice of administering Marek's disease (MD) vaccine a second time, has been used in commercial poultry flocks for many years. The rationale is largely anecdotal as the few published reports have failed to provide support for the value of the practice. In the present work, we have standardized a model to study MD revaccination under laboratory conditions. Nine bird experiments were conducted to evaluate homologous revaccination (same vaccine administered twice) and heterologous revaccination (administration of two different vaccines) with various challenge models. Our results demonstrated that heterologous revaccination (with a second vaccine more protective than the first vaccine) but not homologous revaccination provided a beneficial increase in protection. Administration of the first vaccine at 18 days of embryonation followed by a more protective second vaccine at hatch reproduced systematically the benefits of revaccination. In addition, our results show that revaccination protocols might aid in solving major drawbacks associated with various highly protective experimental MD vaccines; that is, lymphoid organ atrophy and residual virulence. Strain RM1 is one of the most protective vaccines against early challenge with highly virulent MD virus but it induces severe lymphoid atrophy in chickens lacking maternal antibodies against MD virus. In this study, strain RM1 did not induce lymphoid organ atrophy when administered as second vaccine in a revaccination protocol. Similarly, strain 648A100/BP5 maintains residual virulence in chickens lacking maternal antibodies against MD virus but did not induce any lesions when used as a second vaccine. Until now, arbitrary revaccination protocols have been occasionally proven useful to the poultry industry. The model developed in this study will allow for a better understanding of this phenomenon and its optimization. A more rational use of this practice will be of great help to control MD outbreaks

  14. New variant of Creutzfeldt-Jakob (vCJD disease and other human prion diseases under epidemiological surveillance in Brazil

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Gattás

    Full Text Available Abstract To increase the timeliness of detection of human cases of the new variant of Creutzfeldt-Jakob disease (vCJD and to reduce the risk of transmission, the Brazilian Ministry of Health has established and standardized rules and control measures. These include the definition of criteria for suspect cases, reporting, monitoring, and control measures for illness prevention and transmission. Guidelines to be used by the team of health care staff were published and distributed to health workers. A detailed proposal for a simplified system of surveillance for prion diseases was developed and mandatory reporting introduced. Additional effort is necessary to increase vCJD case detection, thus making it necessary to establish a partnership with health care services for best identification of suspected cases and dissemination of information to all involved in the service dealing with vCJD investigation.

  15. New variant of Creutzfeldt-Jakob (vCJD) disease and other human prion diseases under epidemiological surveillance in Brazil

    OpenAIRE

    Gattás, Vera Lúcia; Lima Neto, Antonio Silva; Dimech, George Santiago; Mancini, Denise; Cantarino, Ligia Maria; Marins, José Ricardo Pio; Luna, Expedito José Albuquerque

    2007-01-01

    Abstract To increase the timeliness of detection of human cases of the new variant of Creutzfeldt-Jakob disease (vCJD) and to reduce the risk of transmission, the Brazilian Ministry of Health has established and standardized rules and control measures. These include the definition of criteria for suspect cases, reporting, monitoring, and control measures for illness prevention and transmission. Guidelines to be used by the team of health care staff were published and distributed to health wor...

  16. Ménière's Disease and Underlying Medical and Mental Conditions: Towards Factors Contributing to the Disease.

    Science.gov (United States)

    Mohamed, Shwan; Khan, Imran; Iliodromiti, Stamatina; Gaggini, Margaret; Kontorinis, Georgios

    2016-01-01

    To investigate the relation of Ménière's disease (MD) with medical comorbidity or mental conditions. Demographic data, medical and mental comorbidities were retrospectively collected and compared from 3 groups of 30 patients each: a group with patients with definite MD, a second one with patients with vestibulopathies other than MD (non-Ménière's vertigo, NMV) and a third one with patients without any vestibular symptoms (control). The level of significance was set at 0.05. The prevalence of mental conditions was 26.7, 23.3 and 6.7% for the MD, the NMV and the control group, respectively. Medical comorbidity was found in 80% of patients in the MD, 63% in the NMV and 20% in the control group. Arthritis was encountered in 8 patients with MD, 3 with NMV and none from the control group. The differences in prevalence of mental disease, comorbidities and arthritis between the MD and the control group were statistically significant (p = 0.02, p disease. © 2016 S. Karger AG, Basel.

  17. Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia – case report

    Directory of Open Access Journals (Sweden)

    Márcio Luiz Benevides

    2016-07-01

    Full Text Available Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day. Resumo: Justificativa e objetivos: O aumento na prevalência da obesidade na população geral se estende para mulheres na idade reprodutiva. O objetivo deste estudo é relatar o controle perioperatório de uma gestante obesa mórbida com índice de massa corporal >50 Kg/m2, submetida a parto cesariano sob anestesia geral. Relato do caso: Gestante de 35 anos com índice de massa corporal

  18. Do clinicians accept the role of Helicobacter pylori in duodenal ulcer disease: a survey of European gastroenterologists and general practitioners

    DEFF Research Database (Denmark)

    Christensen, A H; Logan, R P; Noach, L A

    1994-01-01

    OBJECTIVES. To examine to what extent clinicians in Europe accepted the theory of the casual role of Helicobacter pylori (H.pylori) in duodenal ulcer disease in the year 1992, and to what extent the theory had influenced their diagnostic and therapeutic habits in the management of duodenal ulcer ....../315) of the doctors. CONCLUSIONS. H.pylori treatment is frequently used in some countries. However, the role of H. pylori in duodenal ulcer disease has not been accepted to the same extent in different European countries.......OBJECTIVES. To examine to what extent clinicians in Europe accepted the theory of the casual role of Helicobacter pylori (H.pylori) in duodenal ulcer disease in the year 1992, and to what extent the theory had influenced their diagnostic and therapeutic habits in the management of duodenal ulcer...... patients at that time. DESIGN. Postal questionnaire. SETTING. Three European countries: the UK, the Netherlands, and Denmark. SUBJECTS. Three hundred and three gastroenterologists, 250 general practitioners, 83 junior hospital doctors. MAIN OUTCOME MEASURES. Number of doctors believing H. pylori...

  19. General and disease-specific pain trajectories as predictors of social and political outcomes in arthritis and cancer.

    Science.gov (United States)

    James, Richard J E; Walsh, David A; Ferguson, Eamonn

    2018-04-09

    While the heterogeniety of pain progression has been studied in chronic diseases, the extent to which patterns of pain progression among people in general as well as across different diseases affect social, civic and political engagement is unclear. We explore these issues for the first time. Using data from the English Longitudinal Study of Ageing, latent class growth models were used to estimate trajectories of self-reported pain in the entire cohort, and within subsamples reporting diagnoses of arthritis and cancer. These were compared at baseline on physical health (e.g. body mass index, smoking) and over time on social, civic and political engagement. Very similar four-trajectory models fit the whole sample and arthritis subsamples, whereas a three-trajectory model fit the cancer subsample. All samples had a modal group experiencing minimal chronic pain and a group with high chronic pain that showed slight regression (more pronounced in cancer). Biometric indices were more predictive of the most painful trajectory in arthritis than cancer. In both samples the group experiencing the most pain at baseline reported impairments in social, civic and political engagement. The impact of pain differs between individuals and between diseases. Indicators of physical and psychological health differently predicted membership of the trajectories most affected by pain. These trajectories were associated with differences in engagement with social and civic life, which in turn were associated with poorer health and well-being.

  20. Group spike-and-slab lasso generalized linear models for disease prediction and associated genes detection by incorporating pathway information.

    Science.gov (United States)

    Tang, Zaixiang; Shen, Yueping; Li, Yan; Zhang, Xinyan; Wen, Jia; Qian, Chen'ao; Zhuang, Wenzhuo; Shi, Xinghua; Yi, Nengjun

    2018-03-15

    Large-scale molecular data have been increasingly used as an important resource for prognostic prediction of diseases and detection of associated genes. However, standard approaches for omics data analysis ignore the group structure among genes encoded in functional relationships or pathway information. We propose new Bayesian hierarchical generalized linear models, called group spike-and-slab lasso GLMs, for predicting disease outcomes and detecting associated genes by incorporating large-scale molecular data and group structures. The proposed model employs a mixture double-exponential prior for coefficients that induces self-adaptive shrinkage amount on different coefficients. The group information is incorporated into the model by setting group-specific parameters. We have developed a fast and stable deterministic algorithm to fit the proposed hierarchal GLMs, which can perform variable selection within groups. We assess the performance of the proposed method on several simulated scenarios, by varying the overlap among groups, group size, number of non-null groups, and the correlation within group. Compared with existing methods, the proposed method provides not only more accurate estimates of the parameters but also better prediction. We further demonstrate the application of the proposed procedure on three cancer datasets by utilizing pathway structures of genes. Our results show that the proposed method generates powerful models for predicting disease outcomes and detecting associated genes. The methods have been implemented in a freely available R package BhGLM (http://www.ssg.uab.edu/bhglm/). nyi@uab.edu. Supplementary data are available at Bioinformatics online.

  1. Entropy maximization under the constraints on the generalized Gini index and its application in modeling income distributions

    Science.gov (United States)

    Khosravi Tanak, A.; Mohtashami Borzadaran, G. R.; Ahmadi, J.

    2015-11-01

    In economics and social sciences, the inequality measures such as Gini index, Pietra index etc., are commonly used to measure the statistical dispersion. There is a generalization of Gini index which includes it as special case. In this paper, we use principle of maximum entropy to approximate the model of income distribution with a given mean and generalized Gini index. Many distributions have been used as descriptive models for the distribution of income. The most widely known of these models are the generalized beta of second kind and its subclass distributions. The obtained maximum entropy distributions are fitted to the US family total money income in 2009, 2011 and 2013 and their relative performances with respect to generalized beta of second kind family are compared.

  2. Application of Generalized Hukuhara derivative approach in an economic production quantity model with partial trade credit policy under fuzzy environment

    Directory of Open Access Journals (Sweden)

    Pinki Majumder

    2016-01-01

    Full Text Available In this present study, a production inventory model with partial trade credit is formulated and solved in fuzzy environment via Generalized Hukuhara derivative approach. To capture the market, a supplier offers a trade credit period to its retailers. Due to this facility, retailer also offers a partial trade credit period to his/her customer to boost the demand of the item. In practical life situation, demands are generally dependent upon time. Constant demand of an item varies time to time. In this vague situation, demands are taken as time dependent, where its constant part is taken as Left Right - type fuzzy number. In this paper, Generalized Hukuhara derivative approach is used to solve the fuzzy inventory model. Four different cases are considered by using Generalized Hukuhara-(i differentiability and Generalized Hukuhara-(ii differentiability. The objective of this paper is to find out the optimal time so as the total inventory cost is minimum. Finally the model is solved by generalized reduced gradient method. The proposed model and technique are illustrated by numerical examples. Some sensitivity analyses both in tabular and graphical forms are presented and the effects of minimum cost with respect to various inventory parameters are discussed.

  3. Radiographic findings of pulmonary tuberculosis in adult diabetic patients: comparison of diabetics with nondiabetics of no other underlying diseases

    International Nuclear Information System (INIS)

    Park, Hyun Mee; Shin, Cheol Yong; Kim, Tae Hoon; Young Shin So; Lee, Shin Hyung; Lee, Chang Joon; Gang, Hye Jung

    1995-01-01

    The purpose of our study is to evaluate the plain radiographic features of pulmonary tuberculosis in adult diabetic patients compared with those in patients without any underlying diseases. We analyzed the chest PA and lateral views of 100 patients having active pulmonary tuberculosis; 14 patients had diabetes mellitus and 60 patients had no other underlying diseases. Their images were assesed for anatomical distributions, extents of lesions, size and number of cavity and patterns of radiographic findings. Diabetic tuberculosis had higher prevalence and wider involvement of unusual segments for the tuberculosis such as anterior segment, lingular segment of upper lobe and basal segment of the lower lobe, and they showed the tendency of having more cavities than those who had no other underlying diseases, but there were no meaningful differences in the cavity size between the two groups. Pulmonary tuberculosis in diabetic patients tends to have wider extent with unusual segmental involvement and multiple cavities than in the patients who had no other underlying diseases

  4. Economically optimal timing for crop disease control under uncertainty: an options approach

    NARCIS (Netherlands)

    Ndeffo Mbah, M.L.; Forster, G.; Wesseler, J.H.H.; Gilligan, C.A.

    2010-01-01

    Severe large-scale disease and pest infestations in agricultural regions can cause significant economic damage. Understanding if and when disease control measures should be taken in the presence of risk and uncertainty is a key issue. We develop a framework to examine the economically optimal timing

  5. Molecular mechanisms underlying the potential antiobesity-related diseases effect of cocoa polyphenols

    NARCIS (Netherlands)

    Ali, F.; Ismail, A.; Kersten, A.H.

    2014-01-01

    Obesity and related metabolic diseases (e.g., type 2 diabetes, cardiovascular diseases, and hypertension) are the most prevailing nutrition-related issues in the world. An emerging feature of obesity is their relationship with chronic inflammation that begins in white adipose tissue and eventually

  6. Health-related needs of people with multiple chronic diseases: differences and underlying factors.

    NARCIS (Netherlands)

    Hopman, P.; Schellevis, F.G.; Rijken, M.

    2016-01-01

    Purpose: To examine the health-related needs of people with multiple chronic diseases in the Netherlands compared to people with one chronic disease, and to identify different subgroups of multimorbid patients based on differences in their health problems. Methods: Participants were 1092 people with

  7. An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia

    OpenAIRE

    Song, Ki Un; Nam, Ok Hyung; Kim, Mi Sun; Choi, Sung Chul; Lee, Hyo-Seol

    2015-01-01

    Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management a...

  8. Use of the emergency department for less-urgent care among type 2 diabetics under a disease management program

    Directory of Open Access Journals (Sweden)

    Myers Leann

    2009-12-01

    Full Text Available Abstract Background This study analyzed the likelihood of less-urgent emergency department (ED visits among type 2 diabetic patients receiving care under a diabetes disease management (DM program offered by the Louisiana State University Health Care Services Division (LSU HCSD. Methods All ED and outpatient clinic visits made by 6,412 type 2 diabetic patients from 1999 to 2006 were extracted from the LSU HCSD Disease Management (DM Evaluation Database. Patient ED visits were classified as either urgent or less-urgent, and the likelihood of a less-urgent ED visit was compared with outpatient clinic visits using the Generalized Estimating Equation methodology for binary response to time-dependent variables. Results Patients who adhered to regular clinic visit schedules dictated by the DM program were less likely to use the ED for less urgent care with odds ratio of 0.1585. Insured patients had 1.13 to 1.70 greater odds of a less-urgent ED visit than those who were uninsured. Patients with better-managed glycated hemoglobin (A1c or HbA1c levels were 82 times less likely to use less-urgent ED visits. Furthermore, being older, Caucasian, or a longer participant in the DM program had a modestly lower likelihood of less-urgent ED visits. The patient's Charlson Comorbidity Index (CCI, gender, prior hospitalization, and the admitting facility showed no effect. Conclusion Patients adhering to the DM visit guidelines were less likely to use the ED for less-urgent problems. Maintaining normal A1c levels for their diabetes also has the positive impact to reduce less-urgent ED usages. It suggests that successful DM programs may reduce inappropriate ED use. In contrast to expectations, uninsured patients were less likely to use the ED for less-urgent care. Patients in the DM program with Medicaid coverage were 1.3 times more likely to seek care in the ED for non-emergencies while commercially insured patients were nearly 1.7 times more likely to do so. Further

  9. Relative Handgrip Strength Is Inversely Associated with Metabolic Profile and Metabolic Disease in the General Population in China.

    Science.gov (United States)

    Li, Dongxue; Guo, Guanghong; Xia, Lili; Yang, Xinghua; Zhang, Biao; Liu, Feng; Ma, Jingang; Hu, Zhiping; Li, Yajun; Li, Wei; Jiang, Jiajia; Gaisano, Herbert; Shan, Guangliang; He, Yan

    2018-01-01

    Background: Absolute handgrip strength has been correlated with metabolic profile and metabolic disease. Whether relative handgrip strength is also associated with metabolic disease has not been assessed. This study aimed at assessing the association of relative handgrip strength with metabolic profile and metabolic disease in the general population in China. Methods: Data were derived from an ongoing cross-sectional survey of the 2013 National Physical and Health in Shanxi Province, which involved 5520 participants. Multiple linear regression or multiple logistic regression analysis were used to assess the association of absolute/relative handgrip strength with the metabolic profile, preclinical, and established stages of metabolic diseases. Results: This study revealed that relative handgrip strength, that is when normalized to BMI, was associated with: (1) in both genders for more favorable blood lipid levels of high-density lipoprotein cholesterol [males: b = 0.19 (0.15, 0.23); females: b = 0.22 (0.17, 0.28)], low-density lipoprotein cholesterol [males: b = -0.14 (-0.23, -0.05); females: b = -0.19 (-0.31, -0.18)], triglycerides [males: b = -0.58 (-0.74, -0.43); females: b = -0.55 (-0.74, -0.36)] and total cholesterol [males: b = -0.20 (-0.31, -0.10); females: b = -0.19 (-0.32, -0.06)]; and better serum glucose levels in males [ b = -0.30 (-0.46, -0.15)]. (2) lower risk of impaired fasting glucose in males {third quartile [OR = 0.66 (0.45-0.95)] and fourth quartile [OR = 0.46 (0.30-0.71)] vs. first quartile} and dyslipidemia in both genders {third quartile [males: OR = 0.65 (0.48-0.87); females: OR = 0.68 (0.53-0.86)] and fourth quartile [males: OR = 0.47 (0.35-0.64); females: OR = 0.47(0.36-0.61)] vs. first quartile}. (3) lower risk of hyperlipidemia in both genders third quartile [males: OR = 0.66 (0.50-0.87); females: OR = 0.57 (0.43-0.75)] and fourth quartile [males: OR = 0.35 (0.26-0.47); females: OR = 0.51 (0.38-0.70)] vs. first quartile. However, contrary

  10. An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial

    OpenAIRE

    Hayek, Adina; Joshi, Rohina; Usherwood, Tim; Webster, Ruth; Kaur, Baldeep; Saini, Bandana; Armour, Carol; Krass, Ines; Laba, Tracey-Lea; Reid, Christopher; Shiel, Louise; Hespe, Charlotte; Hersch, Fred; Jan, Stephen; Lo, Serigne

    2016-01-01

    Background Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general p...

  11. Prevalence of chronic liver disease and cirrhosis by underlying cause in understudied ethnic groups: The multiethnic cohort.

    Science.gov (United States)

    Setiawan, Veronica Wendy; Stram, Daniel O; Porcel, Jacqueline; Lu, Shelly C; Le Marchand, Loïc; Noureddin, Mazen

    2016-12-01

    Chronic liver disease (CLD) and cirrhosis are major sources of morbidity and mortality in the United States. Little is known about the epidemiology of these two diseases in ethnic minority populations in the United States. We examined the prevalence of CLD and cirrhosis by underlying etiologies among African Americans, Native Hawaiians, Japanese Americans, Latinos, and whites in the Multiethnic Cohort. CLD and cirrhosis cases were identified using Medicare claims between 1999 and 2012 among the fee-for-service participants (n = 106,458). We used International Classification of Diseases Ninth Revision codes, body mass index, history of diabetes mellitus, and alcohol consumption from questionnaires to identify underlying etiologies. A total of 5,783 CLD (3,575 CLD without cirrhosis and 2,208 cirrhosis) cases were identified. The prevalence of CLD ranged from 3.9% in African Americans and Native Hawaiians to 4.1% in whites, 6.7% in Latinos, and 6.9% in Japanese. Nonalcoholic fatty liver disease (NAFLD) was the most common cause of CLD in all ethnic groups combined (52%), followed by alcoholic liver disease (21%). NAFLD was the most common cause of cirrhosis in the entire cohort. By ethnicity, NAFLD was the most common cause of cirrhosis in Japanese Americans, Native Hawaiians, and Latinos, accounting for 32% of cases. Alcoholic liver disease was the most common cause of cirrhosis in whites (38.2%), while hepatitis C virus was the most common cause in African Americans (29.8%). We showed racial/ethnic variations in the prevalence of CLD and cirrhosis by underlying etiology; NAFLD was the most common cause of CLD and cirrhosis in the entire cohort, and the high prevalence of NAFLD among Japanese Americans and Native Hawaiians is a novel finding, warranting further studies to elucidate the causes. (Hepatology 2016;64:1969-1977). © 2016 by the American Association for the Study of Liver Diseases.

  12. Shared activity patterns arising at genetic susceptibility loci reveal underlying genomic and cellular architecture of human disease.

    Science.gov (United States)

    Baillie, J Kenneth; Bretherick, Andrew; Haley, Christopher S; Clohisey, Sara; Gray, Alan; Neyton, Lucile P A; Barrett, Jeffrey; Stahl, Eli A; Tenesa, Albert; Andersson, Robin; Brown, J Ben; Faulkner, Geoffrey J; Lizio, Marina; Schaefer, Ulf; Daub, Carsten; Itoh, Masayoshi; Kondo, Naoto; Lassmann, Timo; Kawai, Jun; Mole, Damian; Bajic, Vladimir B; Heutink, Peter; Rehli, Michael; Kawaji, Hideya; Sandelin, Albin; Suzuki, Harukazu; Satsangi, Jack; Wells, Christine A; Hacohen, Nir; Freeman, Thomas C; Hayashizaki, Yoshihide; Carninci, Piero; Forrest, Alistair R R; Hume, David A

    2018-03-01

    Genetic variants underlying complex traits, including disease susceptibility, are enriched within the transcriptional regulatory elements, promoters and enhancers. There is emerging evidence that regulatory elements associated with particular traits or diseases share similar patterns of transcriptional activity. Accordingly, shared transcriptional activity (coexpression) may help prioritise loci associated with a given trait, and help to identify underlying biological processes. Using cap analysis of gene expression (CAGE) profiles of promoter- and enhancer-derived RNAs across 1824 human samples, we have analysed coexpression of RNAs originating from trait-associated regulatory regions using a novel quantitative method (network density analysis; NDA). For most traits studied, phenotype-associated variants in regulatory regions were linked to tightly-coexpressed networks that are likely to share important functional characteristics. Coexpression provides a new signal, independent of phenotype association, to enable fine mapping of causative variants. The NDA coexpression approach identifies new genetic variants associated with specific traits, including an association between the regulation of the OCT1 cation transporter and genetic variants underlying circulating cholesterol levels. NDA strongly implicates particular cell types and tissues in disease pathogenesis. For example, distinct groupings of disease-associated regulatory regions implicate two distinct biological processes in the pathogenesis of ulcerative colitis; a further two separate processes are implicated in Crohn's disease. Thus, our functional analysis of genetic predisposition to disease defines new distinct disease endotypes. We predict that patients with a preponderance of susceptibility variants in each group are likely to respond differently to pharmacological therapy. Together, these findings enable a deeper biological understanding of the causal basis of complex traits.

  13. Epidemiología de la enfermedad de Chagas, Departamento General Paz, Argentina Chagas' disease epidemiology in the province of General Paz, Argentina