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PubMed2003

The cost-effectiveness of screening mammography beyond age 65 years: a systematic review for the U.S. Preventive Services Task Force.

PURPOSE: There are few data on the effects of disease biology and competing mortality on the effectiveness of screening women for breast cancer after age 65 years. The authors performed a review to determine the costs and benefits of mammography screening after age 65 years. DATA SOURCES: Cost-effectiveness articles published between January 1989 and March 2002. STUDY SELECTION: Studies were identified by using MEDLINE and the National Health Service Economic Evaluation Database. The authors included research on screening after age 65 years conducted from a societal or government perspective; reviews and analyses of other technologies were excluded. DATA SYNTHESIS: 115 studies were identified and 10 met inclusion criteria. One study modeled age-dependent assumptions of disease biology. No study fully captured the potential harms of screening, including anxiety associated with false-positive results, overdiagnosis, and previous knowledge of cancer or living longer with the consequences of treatment. Studies differed in the specific strategies compared and in analytic approaches. On average, extending biennial screening to age 75 or 80 years was estimated to cost 34 000 dollars to 88 000 dollars (2002 U.S. dollars) per life-year gained, compared with stopping screening at age 65 years. Two studies suggested that it was more cost-effective to target healthy women than those with several competing risks for death. CONCLUSIONS: Current estimates suggest that biennial breast cancer screening after age 65 years reduces mortality at reasonable costs for women without clinically significant comorbid conditions. More data are needed on disease biology and preferences for benefits and harms in older women.

Age Factors↗

PubMed2003

Minimum specific cost control of technological processes realized in a living objects-containing microenvironment.

The purpose of the present work is to work out an approach for the development of software and the choice of hardware structures when designing subsystems for automatic control of technological processes realized in living objects containing limited space (microenvironment). The subsystems for automatic control of the microenvironment (SACME) under development use the Devices for Air Prophylactic Treatment, Aeroionization, and Purification (DAPTAP) as execution units for increasing the level of safety and quality of agricultural raw material and foodstuffs, for reducing the losses of agricultural produce during storage and cultivation, as well as for intensifying the processes of activation of agricultural produce and industrial microorganisms. A set of interconnected SACMEs works within the framework of a general microenvironmental system (MES). In this research, the population of baker's yeast is chosen as a basic object of control under the industrial fed-batch cultivation in a bubbling bioreactor. This project is an example of a minimum cost automation approach. The microenvironment optimal control problem for baker's yeast cultivation is reduced from a profit maximum to the maximization of overall yield by the reason that the material flow-oriented specific cost correlates closely with the reciprocal value of the overall yield. Implementation of the project partially solves a local sustainability problem and supports a balance of microeconomical, microecological and microsocial systems within a technological subsystem realized in a microenvironment maintaining an optimal value of economical criterion (e.g. minimum material, flow-oriented specific cost) and ensuring: (a) economical growth (profit increase, raw material saving); (b) high security, safety and quality of agricultural raw material during storage process and of food produce during a technological process; elimination of the contact of gaseous harmful substances with a subproduct during various technological stages; (c) improvement of labour conditions for industrial personnel from an ecological point of view (positive effect of air aeroionization and purification on human organism promoting strengthened health and an increase in life duration, pulverent and gaseous chemical and biological impurity removal). An alternative aspect of a controlled living microenvironment forming is considered.

Agriculture↗

PubMed2006

[Predictors of smoking cessation in a national representative random sample of Danish adults].

INTRODUCTION: Smoking is the largest modifiable risk factor for early death in Denmark, and reduction of the number of smokers is a high-priority health goal. The aim of this study was to investigate the importance of tobacco consumption and social position on smoking cessation in a representative sample of the Danish population. This had not previously been done in Denmark. MATERIALS AND METHODS: The data were derived from the Danish Health and Morbidity Surveys of 1994 and 2000. The study population consisted of persons between 25 and 64 years of age who smoked in 1994 and who were re-interviewed in 2000. A total of 1,056 smokers participated, of whom 180 were no longer smoking in 2000. The data were analysed using logistic regression analysis. RESULTS: Smoking cessation was achieved more frequently by light smokers than by heavy smokers (OR 1.74; CI 1.24-2.43). The odds of smoking cessation increased with the number of years of education, for example smokers with at least 15 years of education were more likely to quit smoking than those with 10 or fewer years of education (OR 3.48; CI 2.07-5.87). CONCLUSION: As expected, the amount of tobacco consumption influenced smoking cessation, since consumption is associated with nicotine dependence, which makes quitting difficult. The significance of education on smoking cessation may reflect the degree of knowledge of harmful effects of smoking. Further, people with less education more often work in environments where smoking is accepted. Our results may be useful in future smoking cessation interventions.

Adult↗

PubMed2000

Position of the American Dietetic Association: food irradiation.

Food irradiation has been identified a sa safe technology to reduce the risk of foodborne illness as part of high-quality food production, processing, handling, and preparation. Food irradiation's history of scientific research , evaluation, and testing spans more than 40 countries around the world and it has been endorsed or support by numerous national and international food and organizations and professional groups. Food irradiation utilizes a source of ionizing energy that passes through food to destroy harmful bacteria and other organism. Often referred to as "cold pasteurization," food irradiation offers negligible loss of nutrients or sensory qualities in food as it does not substantially raise the temperature of the food during processing. Food irradiation does not replace proper food production, processing, handling, or preparation, nor can it enhance the quality of or prevent contact with foodborne bacteria after irradiation. In the United States, manufacturers are required to identify irradiated food sold to consumers with an international symbol (Radura) and and terminology describing the process on product labels. In addiction, food irradiation facilities are thoroughly regulated and monitored for worker and environmental safety. Members of The American Dietetic Association (ADA) and other food, nutrition, and health professionals have a responsibility to educate consumers, food processors, manufacturers and retailers about the safety and application of the technology. When consumers are educated about food irradiation, many prefer irradiated products because of their increased safety. It is the position of ADA that food irradiation enhances the safety and quality of the food supply and helps protect consumers from foodborne illness. The ADA encourages the government, food manufactures, food commodity groups, and qualified food and nutrition professionals to work together to educate consumers about this additional food safety tool and make this choice available in the marketplace.

Consumer Product Safety↗

PubMed2003

Twentieth century overview of heavy metals in the Galician Rias (NW Iberian Peninsula).

The 18 Galician Rias, comprising 25% of the Iberian Peninsula coastline, form a unique system within the European continental Atlantic coast and provide a useful reference area for studies of metals. These rias are sensitive to anthropogenic influence due to the socioeconomic importance generated in these areas by industry, aquaculture, port activities, fishing, tourism and, accordingly, several islands lying within close proximity to the rias have recently been declared natural parks. Aquaculture in the Galician Rias is a growth industry and in 2000 the rias supported 3386 mussel rafts producing 2.5 x 10(8) kg year(-1), i.e. 40% of European Union total seafood production. The Galician Rias are partially stratified estuaries with positive residual circulation with fresh (runoff lower than 100 m3 s(-1) and salt water mixing inside the basins. This behaviour has direct consequences on metal fluxes whereby the rias behave as a barrier and accumulate metals in the sediments. Metals tend to deposit close to point sources and remobilization occurs inside the ria, leading to a seaward decrease in metal concentration. With the exception of the Ulla (Arosa Ria) and Eume (Ares-Betanzos Ria) head rivers and the Lagares river (Vigo Ria) the available data suggest that riverine freshwater inputs are not the main source of contamination. Metal studies reported in the literature mainly relate to Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb and Zn, and to a lesser extent Hg and Sn. Studies of other harmful metals such as Ag, Se and As are notably lacking. In addition, the studies have been localized and mainly restricted to the surface sediment. Data of heavy metals in the dissolved phase, suspended particulate matter and biota is scarce in the mainstream literature and should be considered in the future research. From the entire Galician coast, data from seven rias of socio-economic importance form the bulk of the published work. There is an urgent need to standardize procedures, employ 'clean' procedures to avoid contamination of samples and regular assessment of analytical accuracy with CRMs in order that results can be compared among the scientific community and produce reliable results. The continuation of coastal environmental studies requires an enlargement of the sampling locations as well as systematic and periodic analysis of known pollution sources in order to decide whether coastal regeneration action is needed. Studies dedicated to metals in the water column are lacking and need more attention in future research. The majority of the available data correspond to the fluvial front (30%) at ria head and, to a lesser extent, to the oceanic front (3%), under summer upwelling events. Current awareness of the rias suggests that they are not contaminated although there is some evidence of important localized anthropogenically induced enrichments at the outflow of the Lagares River (Pb, Zn), the San Simón inlet (Pb) and near to the harbor (Pb, Zn, Cu) in the Vigo Ria, the inner part (Cu, Zn, Hg, Pb) of the Pontevedra Ria, the Ulla River estuary (Cu, Cr, Mn, Ni; Zn) in the Arosa Ria, the inner zone (Cu, Pb, Zn) of the Coruña Ria, the Ferrol Ria (Zn) and the Eume Estuary (Zn, Mn, Ni, Co) in the Ares-Betanzos Ria. In addition, TBT enrichment has been found along the Galician coast, being highest in the industrial bays (Vigo, Coruña and Ferrol). Nevertheless, it is important to point out the lack of information concerning the relationship between metal concentrations in different fractions of sediments and/or water and their bioavailability and toxicity on biota in order to confirm metal contamination dangers. The present paper reviews all the information published on metals in the rias up to the year 2000 and takes a biogeochemical standpoint, i.e. metal presence in the ria reservoirs: water column, suspended particulate matter, sediments and biota, as well as the fluvial and oceanic frontiers.

Atlantic Ocean↗

PubMed2005

Differential experiences of the psychobiological sequelae of ecstasy use: quantitative and qualitative data from an internet study.

Previous work provided preliminary evidence that different patterns of use among ecstasy users may impact on perceived side-effects. Participants recruited via an ecstasy-related bulletin board differed in their responses compared to those recruited via other means. The present investigation compares self-reports of psychobiological difficulties among ecstasy users recruited either via a bulletin board or by alternative methods. Qualitative data included reports of any negative or positive changes attributable to ecstasy use and reasons for cessation of use. An Internet-based design was utilized and 209 volunteers completed the study, 117 of whom were recruited via a bulletin board devoted to discussion of ecstasy. Psychobiological difficulties attributable to ecstasy use varied, with mood fluctuation the most common. Differences between the two groups in the extent to which these problems were reported was found. Bulletin board recruits were less likely to report anxiety or poor concentration, but more likely to report tremors/twitches. For the whole sample, lifetime use was associated more with psychobiologial problems, although this pattern was stronger and more pervasive for the non-bulletin board participants. Bulletin board recruits were more aware of possible negative psychological effects and were more likely to report adopting harm reduction strategies. From the qualitative data three negative consequences of use were identified, the most common of which was "psychological problems". In support of the quantitative findings the likelihood of reporting psychological problems increased with lifetime exposure to ecstasy in both recruitment conditions but interestingly this did not appear to impact on reasons for cessation of use. Participants also reported a number of effects that they regarded as beneficial. Future research should also take these aspects of use into account.

Adolescent↗

PubMed2005

Secondhand smoke and respiratory ill health in current smokers.

BACKGROUND: Numerous studies have concluded that secondhand smoke (SHS) is harmful to non-smokers but controversy persists regarding its effects on smokers. The impact of SHS exposure on the acute respiratory health of current active smokers was examined using a cross sectional design. METHODS: 9923 uniformed staff in the Hong Kong Police Force completed a standardised questionnaire on current and past smoking, SHS exposure at home and at work, acute respiratory symptoms, and recent physician consultation. 3999 male current smokers were included in the analysis. RESULTS: About 5% of the smokers were exposed to SHS at home only, 53% were exposed at work only, and 30% were exposed both at home and at work. The prevalence ratios for respiratory symptoms (throat and nasal problems, cough, phlegm, and wheeze), physician consultation, and self medication were higher for those who were exposed to SHS at home or at work. The odds ratios of reporting one or more respiratory symptoms, for SHS exposures at home or at work, were 1.33 (95% confidence interval (CI) 1.12 to 1.59) and 1.66 (95% CI 1.36 to 2.02) respectively, after adjusting for age, marital status, education, rank and duties, exposure to self perceived dusty or polluted environment in previous job, and total dose of active smoking. The adjusted odds ratios showed significant positive dose-response gradients with SHS exposure at home, at work, and at both places combined. CONCLUSIONS: SHS exposure is strongly associated with increased acute respiratory symptoms and recent outpatient service utilisation in current smokers. If the association is causal, public health action to limit SHS exposure could also benefit smokers.

Acute Disease↗

PubMed2001

Screening mammography for frail older women: what are the burdens?

OBJECTIVE: The potential benefits and harms of screening mammography in frail older women are unknown. Therefore, we studied the outcomes of a screening mammography policy that was instituted in a population of community-living nursing home-eligible women as a result of requirements of state auditors. We focused on the potential burdens that may be experienced. METHODS: Between January 1995 and December 1997, we identified 216 consecutive women who underwent screening mammography after enrolling in a program designed to provide comprehensive care to nursing home-eligible patients who wished to stay at home. Mammograms were performed at 4 radiology centers. From computerized medical records, we tracked each woman through September 1999 for performance and results of mammography, additional breast imaging and biopsies, documentation of psychological reactions to screening, as well as vital status. Mean follow-up was 2.6 years. RESULTS: The mean age of the 216 women was 81 years. Sixty-three percent were Asian, 91% were dependent in at least 1 activity of daily living, 49% had cognitive impairment, and 11% died within 2 years. Thirty-eight women (18%) had abnormal mammograms requiring further work-up. Of these women, 6 refused work-up, 28 were found to have false-positive mammograms after further evaluation, 1 was diagnosed with ductal carcinoma in situ (DCIS), and 3 were diagnosed with local breast cancer. The woman diagnosed with DCIS and 1 woman diagnosed with breast cancer were classified as not having benefited, because screening identified clinically insignificant disease that would not have caused symptoms in the women's lifetimes, since these women died of unrelated causes within 2 years of diagnosis. Therefore, 36 women (17%; 95% confidence interval [CI], 12 to 22) experienced burden from screening mammography (28 underwent work-up for false-positive mammograms, 6 refused further work-up of an abnormal mammogram, and 2 had clinically insignificant cancers identified and treated). Forty-two percent of these women had chart-documented pain or psychological distress as a result of screening. Two women (0.9%; 95% CI, 0 to 2) may have received benefit from screening mammography. CONCLUSION: We conclude that screening mammography in frail older women frequently necessitates work-up that does not result in benefit, raising questions about policies that use the rate of screening mammograms as an indicator of the quality of care in this population. Encouraging individualized decisions may be more appropriate and may allow screening to be targeted to older women for whom the potential benefit outweighs the potential burdens.

Aged↗

PubMed2025

Patient Ethnicity and Staff Use of Restraints and Restrictive Practice in Inpatient Psychiatric Services: A Systematic Review.

Restrictive practices such as restraints, seclusion, and forced medication are only intended to be used when the threat is at a level whereby an individual is likely to inflict harm on themselves or another individual. Demographic variations, including ethnicity, may be associated with the use of these practices. However, there is no systematic review on patient ethnicity specifically. The review therefore aimed to establish whether a patient's ethnic identity was associated with staff use of restrictive practices in inpatient psychiatric services. The systematic review followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Four databases were searched (PsycINFO, Medline, Embase, and CINAHL). Methodological quality was assessed using the Critical Appraisal Skills Program Checklists. Fifteen studies met the inclusion criteria. A variety of ethnicities were identified within the studies. These were driven by the location of the study. Seclusion (14 studies), forced medication (4), and physical restraint (4) were explored. There were mixed findings, with ethnicity shown to predict restrictive practices in studies having larger participant numbers, longer follow-up periods and less methodological bias. It remains unclear whether ethnicity is a genuinely independent predictor of restraint and coercive practices or interacts with other risk factors. Staff working in inpatient settings should be aware of how unconscious biases might affect clinical practice. Recruiting a diverse workforce from minority ethnic groups into inpatient psychiatric services would be a positive step. However, support for these staff members is important, and all staff should be equipped to respond to ethnic diversity. Future research should explore beyond patient-level factors.

Humans↗

PubMed2005

Alcohol, stress-related factors, and short-term absenteeism among urban transit operators.

Transit operators, relative to workers in many other occupations, experience high levels of work-related stress, as documented through neuroendocrine elevations on the job vis-a-vis resting states (J Occup Health Psychol. 1998;3:122-129). Previous research suggests that self-reported job stress is associated with higher levels of alcohol consumption among transit operators (Alcohol Clin Exp Res. 2000;24:1011-1019) and with absenteeism (Working Environment for Local Public Transport Personnel, Stockholm: Swedish Work Environmental Fund, 1982; Work Stress. 1990;4:83-89). The purpose of this study was to examine the interrelationships between alcohol use, stress-related factors (stressful life events, job stressors, and burnout), and short-term absenteeism among a multiethnic cohort of urban transit operators. Self-reported measures of alcohol, stress-related factors, and short-term absenteeism were obtained from a sample (n=1,446) of San Francisco municipal transit operators who participated in the 1993-1995 Municipal Railway Health and Safety Study. Multivariate logistic regression analyses showed that absenteeism among drinkers was associated with risk for alcohol dependence [odds ratio (OR)=2.46, heavy drinking (OR=1.87), alcohol-related harm (OR=2.17), increased drinking since becoming a transit operator (OR=1.74), and having any problem drinking indicator (OR=1.72). The association between absenteeism and stress-related factors varied by gender and drinking status. Final multivariate models among drinkers indicated that among males, problem drinking (OR=1.82), stressful life events (OR=1.62), and job burnout (OR=1.22) were independently associated with elevated odds of absenteeism. Among female drinkers, only stressful life events (OR=5.17) was significantly associated with elevated odds of absenteeism. Findings suggest that workplace interventions that address both individual and environmental stressors are most likely to have a positive impact on health-related outcomes, including problem drinking, thereby reducing absenteeism.

Absenteeism↗

PubMed2006

Electromagnetically navigated brachytherapy as a new treatment option for peripheral pulmonary tumors.

PURPOSE: This technical note describes the principles of navigated brachytherapy for treatment of peripheral non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: In a prospective feasibility trial a first patient with medically inoperable NSCLC in the right upper lobe was treated with external-beam radiotherapy (50 Gy) and navigated endoluminal brachytherapy (15 Gy). Navigated bronchoscopy was performed with an electromagnetic navigation system for localization of a microsensor mounted on the tip of a dedicated catheter placed within the working channel of a bronchoscope. The probe can be actively guided by a steering mechanism to targeted lesions in the periphery of the lung. After successful localization of the NSCLC, endobronchial ultrasound (EBUS) was performed to confirm the exact position in the center of the lesion. A 6-F brachytherapy catheter was placed within the tumor. Primary 3-D-planned brachytherapy was performed on chest CTs acquired with the inserted catheter. High-dose-rate brachytherapy (370 GBq iridium-192) was applied as a boost three times a week (single dose 5 Gy) and provided highly conformal irradiations of the NSCLC including the draining bronchovascular bundle. RESULTS: The brachytherapy catheter was tolerated well during treatment (5 days) and alimentation was possible without any problems. Repeated CTs showed stable positioning of the catheter. During follow-up (12 months), endoluminal ultrasound and CT demonstrated a partial remission while histology showed a complete remission of the tumor. CONCLUSION: Navigated brachytherapy for peripheral pulmonary tumors not amenable to conventional bronchoscopy is feasible.

Brachytherapy↗

PubMed2005

Exploring risk perception and behaviour of homeless injecting drug users diagnosed with hepatitis C.

Injecting drug users (IDUs) are at the greatest risk of hepatitis C infection by using any item of injecting equipment that has come into contact with contaminated blood. Alongside this, homeless IDUs have been identified as being at increased risk of harm in their illicit drug taking behaviour. This study interviewed 17 hepatitis C positive homeless IDUs about their injecting practices. In-depth interviews explored the impact of a positive hepatitis C diagnosis on their injecting and identified their risk behaviours and perceptions. The interviews were tape-recorded, transcribed and analysed using the framework approach. Homeless IDUs engaged in both high risk and unhygienic injecting practices, such as using drugs outside and in public places, sharing injecting equipment and re-using cleaned needles. Excessive needle reuse whilst in prison was also identified. However, the findings were not universally bleak as a positive diagnosis of hepatitis C did lead to some behaviour change towards safer injecting and some adopted other lifestyle and behaviour changes. It was, however, common for homeless people to devolve responsibility for preventing hepatitis C transmission to their peers, especially when injecting with others. Knowledge regarding possible transmission through injecting paraphernalia appeared to make users more careful to reduce it through these routes. Placing a continuous emphasis on health promotion is therefore important in educating IDUs about the hepatitis C transmission risks associated with injecting drug use. Information regarding safer and hygienic use, including accurate information regarding the most effective methods to clean used equipment, must be re-enforced by people working with homeless injecting drug users.

Blood-Borne Pathogens↗

PubMed2002

Effects of respiratory muscle unloading on exercise-induced diaphragm fatigue.

We previously compared the effects of increased respiratory muscle work during whole body exercise and at rest on diaphragmatic fatigue and showed that the amount of diaphragmatic force output required to cause fatigue was reduced significantly during exercise (Babcock et al., J Appl Physiol 78: 1710, 1995). In this study, we use positive-pressure proportional assist ventilation (PAV) to unload the respiratory muscles during exercise to determine the effects of respiratory muscle work, per se, on exercise-induced diaphragmatic fatigue. After 8-13 min of exercise to exhaustion under control conditions at 80-85% maximal oxygen consumption, bilateral phrenic nerve stimulation using single-twitch stimuli (1 Hz) and paired stimuli (10-100 Hz) showed that diaphragmatic pressure was reduced by 20-30% for up to 60 min after exercise. Usage of PAV during heavy exercise reduced the work of breathing by 40-50% and oxygen consumption by 10-15% below control. PAV prevented exercise-induced diaphragmatic fatigue as determined by bilateral phrenic nerve stimulation at all frequencies and times postexercise. Our study has confirmed that high- and low-frequency diaphragmatic fatigue result from heavy-intensity whole body exercise to exhaustion; furthermore, the data show that the workload endured by the respiratory muscles is a critical determinant of this exercise-induced diaphragmatic fatigue.

Adult↗

PubMed2002

Continuing HIV transmission among injection drug users in Eastern Central Canada: the SurvUDI Study, 1995 to 2000.

OBJECTIVE: To document HIV prevalence/incidence trends from 1995-2000 and associated risk factors among injection drug users (IDUs) in Eastern Central Canada as an indication of harm reduction strategy effectiveness. METHODS: Nonnominal cross-sectional data (one-time participants) and longitudinal data (repeat participants) were collected using convenience sampling. Participants provided informed consent for face-to-face interviews focused on injection drug use and sexual practices during the previous 6 months; oral fluid samples were taken for HIV testing by enzyme immunoassay. Unique encrypted codes for initially HIV-negative repeat participants permitted incidence rate calculations. RESULTS: In all, 6387 IDUs (median age, 31 years; range, 13-67; males, 73.5%) participated on 9724 occasions. HIV prevalence ranged from 4.7% (95% confidence interval [CI], 2.9-6.5) in semiurban areas to 20.1% (95% CI, 17.6-22.7) in Ottawa, Ontario. HIV incidence was 6.0 (95%CI, 4.5-7.6) per 100 person-years (py) in Montréal, Québec, 3.2 (95% CI, 2.2-4.2) per 100 py in Québec City and 7.0 (95% CI, 4.1-9.8) per 100 py in Ottawa/Hull. Reusing other IDUs' needles was reported by 38.4%. In multivariate logistic regression, IDUs injecting for 6 or more years were more likely to be HIV positive, particularly if cocaine was the predominant drug injected. Multivariate Cox regression revealed higher HIV incidence among those who predominantly injected cocaine, reused others' needles, had injected 6 years or more, injected with strangers, or were men reporting commercial sex work. CONCLUSIONS: These results reveal a volatile situation of continuing HIV transmission among IDUs in Eastern Central Canada.

AIDS Serodiagnosis↗

PubMed2004

Stalemating a clever opportunist: lessons from murine cytomegalovirus.

Cytomegaloviruses and their specific hosts have come to an arrangement that avoids disease but allows the viruses to persist in the individual host and to spread in the host species. Recent work has uncovered some of the molecular details of this evolutionary "contract for mutual survival." Cytomegaloviruses encode proteins, referred to as "immunoevasins," which are specifically committed to subvert the immune defense of the host for evading virus elimination. In reply, the hosts have evolved countermeasures to overcome the viral immunoevasins and present antigenic peptides to an extent that is sufficient for confining virus replication to below a harmful level. Accordingly, cytomegalic inclusion disease is a disease only of the immunocompromised. Although the details of the contract differ between the various cytomegalovirus host pairs, the general principles are strikingly analogous. Paradigmatic findings were made in the murine model, which adds the advantage of providing proof of principle by in vivo studies. With the focus on CD8 T cells and the major histocompatibility complex class I pathway of antigen presentation, we will discuss our view on the immune surveillance of cytomegalovirus in the murine model.

Animals↗

PubMed2002

[Allocation of responsibility for positioning patients for surgery and liability for damages consequent on faulty positioning].

The cooperation of surgeon and anaesthetist in positioning of the patient is subject to the principles of horizontal division of labour recognized in the interdisciplinary agreement and confirmed by the legislature: anaesthetist and surgeon carry out their respective tasks independently of each other, each bearing full responsibility for their own work (principle of strict separation of functions), they tailor their procedures to fit in with each other (duty of coordination), and each is entitled to expect and rely on due care in the other (principle of trust). In the case of conflict--when the best position for the specific intervention leads to a higher anaesthesiological risk--the principle of predominance of the actual requirements applies. If no agreement is reached it is incumbent on the surgeon to make the decision; this means that the surgeon bears the medical and legal responsibility for appropriate deliberation. Faults in organization are regarded under the law as faulty treatment. Anaesthetist and surgeon are each responsible for their own errors. According to the interdisciplinary agreements, positioning and checks on position are the task of the surgeon, while the anaesthetist is responsible for the "infusion arm". This does not exclude the possibility that anaesthetist and surgeon may agree on a different division of labour in the operating room. The patient bears the burden of proof that errors were committed in a case for damages. The doctor does, however, have to prove that the patient was correctly positioned. The demands of jurisdiction in terms of documentation of the positioning and of presentation of evidence are practically oriented and can basically be met. The same is true of the information supplied to the patient on the risk that positioning can cause harm. The doctor is obliged to supply evidence of the patient's substantive consent and the provision of information that this implies.

Anesthesia↗

PubMed2002

[Determining responsibility for surgical positioning of the patient and malpractice for damage caused by patient position].

Anesthesiology↗

PubMed2001

Surface contamination to UV-curable acrylates in the furniture and parquet industry.

Surface contamination to ultraviolet radiation curable coatings (UV coatings), used increasingly in the parquet and furniture industry, is a matter of concern as a source for skin contamination. UV coatings contain chemically and biologically reactive acrylates, well known as skin contact irritants and sensitizers. Surface contamination may spread secondarily to equipment and other unexpected areas even outside the workplace. Yet, studies concerning this type of contamination are lacking due to lack of suitable sampling methods. Surface contamination of the work environment with risk for skin exposure to UV coating was measured employing a quantitative adhesive tape sampling method developed for this purpose. A pilot study was first performed at three workplaces to evaluate the contamination. In the main study, we wanted to locate and identify in detail the surface contamination of areas where problems exist, and to determine the extent of the problem. Measurements were performed at seven workplaces on two separate workdays (round 1 and 2) within a six-month period. Samples were collected from the workplaces based on the video monitoring of skin contact frequency with the surfaces and categorized into three groups to analyze risk. The pilot study indicated that surface contamination to TPGDA containing UV coatings was common, found in 76 percent of the surfaces, and varied with a maximum of 909 microg TPGDA 10 cm(-2) sampling area. In the main study TPGDA was found in 153 out of 196 collected samples (78.1%); for round one 78.1 percent (82 out of 105 samples) and for round two 78.0 percent (71 out of 91 samples). The average TPGDA mass on positive surface samples was on the first round 2,247 +/- 7,462 microg, and on the second round 2,960 +/- 4,590 microg. We conclude that surface contamination to uncured UV coatings at UV-curing lines is common and this involves a risk for harmful, unintentional skin exposure to acrylates.

Acrylates↗