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PubMed1995

Syphilis control in pregnancy: decentralization of screening facilities to primary care level, a demonstration project in Nairobi, Kenya.

A decentralized syphilis control program in pregnant women was implemented in nine Nairobi City Council antenatal clinics between July 1992 and August 1993, whereby pregnant women were screened for syphilis, treated before leaving the clinic if RPR seroreactive, and counselled on the importance of partner treatment and sexual abstinence during treatment in order to protect their unborn babies from getting congenital syphilis. A total of 13,131 pregnant women were screened for syphilis (RPR test), 87.3% of seroreactive women were treated on site and 50% of partners returned to the clinic and were treated. The prevalence of RPR reactivity was 6.5%. Based on other data the program could theoretically have prevented 413 cases of congenital syphilis at a cost of approximately 50 USD per prevented case. This demonstration project shows that decentralized prevention of congenital syphilis in antenatal clinics by nurses is feasible and inexpensive and should receive priority in resource allocation in reproductive health and child survival programs.

Female↗
PubMed1991

Effect of decentralization and partial outflow obstruction on cholinergic receptors in urinary bladder of rabbit.

In this study we have examined the cholinergic receptor density on the detrusor smooth muscle from rabbits with decentralized autonomous bladders and animals with partial outlet obstructions using (3H) quinuclidinyl benzilate ([3H] QNB). Decentralized spinal bladders were obtained from rabbits made paraplegic by a twenty-minute ischemic lesion to the lumbar and sacral spinal cord. Bladder tissues from these rabbits were studied from one, two, five, and nine-day intervals after the ischemic lesion. The affinity of the muscarinic binding sites for (3H) QNB was virtually unchanged at any of the time intervals, while the total Bmax was significantly reduced at one and two days but recovered to normal levels by the fifth and ninth day after the ischemic lesion, provided the bladder had been effectively manually emptied on a regular basis. In a parallel study animals with a partial outlet obstruction or spinal animals with marked bladder distention at the time of sacrifice showed that the cholinergic receptor density was significantly reduced.

Animals↗
PubMed1990

Population decentralization within metropolitan areas: 1970-1980.

Using a data set that maintains geographic and fiscal continuity over time and across a sample of major U.S. metropolitan areas, the authors identify factors of economic and population decentralization that affected central city areas between 1970 and 1980. The problems of annexation are resolved by estimating population changes for central cities and suburban areas with constant 1980 boundaries, and by calculating fiscal variables from overlapping jurisdictions by city area as opposed to municipal city government only. "The empirical investigation supports the view that demographic and housing stock variables seem to have had a greater impact on decentralization than central city-suburban fiscal differences."

Americas↗
PubMed1984

A decentralized approach to maintenance of intravenous therapy.

A prospective experiment was conducted in a university-affiliated hospital to evaluate the effectiveness of a core of specially trained staff nurses in the maintenance of IV therapy. Five staff nurses for each of two experimental units were trained for 1 month by an IV nurse educator and were expected to perform venipuncture and monitor peripheral IV care on their units. On three control units, IV therapy continued to be a shared function of all medical house staff and nurses. During this study, 876 IV infusions on 707 patients were studied. There was a decrease in the phlebitis rate on experimental units from baseline to study periods of from 33.5% to 20.9% (relative risk, controlled for duration of the use of an IV device, 0.53, p = 0.05), whereas the rate on control units increased slightly (23.8% to 26.7%, p = greater than 0.5). Regardless of duration of use, steel needles were associated with lower phlebitis rates than were plastic catheters. The mean duration that each infusion device was in place was significantly shorter on experimental units than on control units (2.4 vs. 3.3 days, p = less than 0.001). However, bacterial colonization of IV devices occurred more often on experimental units than on control units both at baseline (12.7% vs. 7.1%; p = 0.25) and during the study phase (19.4% vs. 5.9%; p = less than 0.01). This increased colonization occurred with IV infusions started by both physicians and nurses. There were no septic complications of IV therapy in the patients studied. Patient comfort, measured by number of sticks for each venipuncture and patient interview, was significantly improved (p = less than 0.001) on experimental units during the study phase. Costs to start such a decentralized IV program on 10 clinical units was calculated to be about +10,000. This study provides information useful to those making administrative decisions regarding the value of IV teams or other methods for IV therapy maintenance. We concluded that a decentralized program can be successful with commitment of time and money resources and with a system of monitoring to ensure compliance with written IV guidelines.

Adult↗
PubMed1983

Synaptic transmission in the decentralized middle cervical ganglion of the dog.

The middle cervical ganglion (MCG) was decentralized in 30 dogs by cutting the thoracic vagus and rami on one side. Two or more cardiopulmonary nerves were then dissected free and placed on bipolar stimulating and recording electrodes in mineral-oil baths. Stimulation of one cardiopulmonary nerve generated a compound action potential (CAP) in one or two others. The CAP was altered by changing the frequency of stimulation and by stimulating preganglionic fibers in the rami. These alterations displayed latency changes and temporal summation or inhibition. The ansae were sectioned to neurally isolate the MCG from the stellate ganglion. A CAP generated after blockade by hexamethonium, atropine, propranolol and phentolamine was abolished transiently by chymotrypsin, and for longer periods by manganese, injected locally into the MCG. These results suggest that a CAP that is generated by stimulating one cardiopulmonary nerve in a decentralized MCG and recorded from another may result from synaptic activity in the MCG and that complex neuronal interactions occur within the MCG.

Animals↗
PubMed2005

Nutrient removal by NF and RO membranes in a decentralized sanitation system.

Decentralized treatment of domestic wastewater offers the possibility of water and nutrient reuse. In a decentralized sanitation system the household wastewater streams are separated in a large diluted stream (gray water) and a small and concentrated stream (black water) containing important nutrients like ammonium and phosphate. Nanofiltration (NF) and reverse osmosis (RO) membranes might be used to recover the nutrients from anaerobically treated black water. The permeate might be used in a water reuse scheme. In case of water reuse the produced permeate should meet guidelines for potable water or meet new guidelines which might be applied in the future for intermediate quality of water, for example toilet flushwater; when this is not possible the permeate should meet guidelines for discharge. The most stringent guidelines apply for ammonium and phosphate. The focus of this paper is to test commercially available NF and RO membranes to remove nutrients from anaerobically treated black water in order to meet the Dutch guidelines. A large number of commercial tubular, capillary and flat sheet NF and RO membranes was tested on laboratory scale on their performance to meet the Dutch guidelines for ammonium and phosphate. The ammonium and phosphate concentrations used were based on the effluent composition of anaerobically treated black water. Ammonium and phosphate rejection were both measured in synthetic single salt and multi-ion mixtures and in anaerobic effluent. The rejection for ammonium (30-95%) is neither sufficient for discharge nor potable water use. The rejection of phosphate (74-99%) is in most cases almost sufficient to meet the standards for potable water.

Conservation of Natural Resources↗
PubMed1978

The hypertransradiant hemithorax: the importance of lateral decentring, and the explanation for its appearance due to rotation.

Experimental evidence is presented indicating that 80% of the increase in unilateral film blackening on the chest radiograph resulting from rotation of the patient is due to asymmetrical absorption of the X-ray beam. Scatter contributes 20% to this increase in blackening. The effect on the radiograph of lateral decentring is also described. In the rotated patient, the hypertransradiant hemithorax always occurs on the side to which the patient is rotated, and is independent of the projection. If this rule is broken, then decentring or a thoracic abnormality is present.

Absorption↗
PubMed2001

Topography-driven excimer laser for the retreatment of decentralized myopic photorefractive keratectomy.

OBJECTIVE: This study evaluated the efficacy, predictability, stability, and safety of a software program (Corneal Interactive Programmed Topographic Ablation, CIPTA, LIGI, Taranto, Italy), which, by transferring programmed ablation from the corneal topograph to a flying-spot excimer laser, provides customized laser ablation for correction of postmyopic photorefractive keratectomy (PRK) decentrations. DESIGN: Noncomparative consecutive case series. PARTICIPANTS: Thirty-two eyes of 32 subjects with a mean age of 35 years (range, 19-49; standard deviation [SD], 7.9) had CIPTA-guided PRK at the Clinica Oculistica of Bari University (Italy). All the subjects had irregular astigmatism after postmyopic PRK because of clinically significant, decentered treatments of more than 1 mm. OPERATION: Individual topographies were acquired by a corneal topograph (Orbscan II, Orbtek, Inc., Salt Lake City, UT). These, together with refractive data, were processed to obtain a customized altimetric ablation profile that was transferred to a flying-spot laser (Laserscan 2000, Lasersight, Orlando, FL). MAIN OUTCOME MEASURES: The topographic study of centration and data on uncorrected (UCVA) and best-corrected (BCVA) visual acuity, predictability, and stability of refraction, and any complications, were analyzed. RESULTS: Mean follow-up was 10.3 months (range, 4-18 months; SD, 5.8). At the last postoperative examination, 29 eyes (90.6%) had a UCVA superior to 20/40. Nineteen eyes (59.4%) had a UCVA of 20/20. Twenty-two eyes (68.75%) were within 0.50 diopters (D) of attempted correction in the spherical equivalent and 28 eyes (87.5%) were within 1 D. The index of success of astigmatic correction was 0.15. No eye lost Snellen lines of BCVA, whereas 18 eyes (56.25%) gained Snellen lines. Postoperative topographies revealed well-centered treatments. CONCLUSIONS: The combination of topographic data with computer controlled flying-spot excimer laser ablation is a suitable solution for correcting irregular astigmatism after postmyopic PRK decentrations.

Adult↗
PubMed1995

Theoretical analysis of image defocus with intraocular lens decentration.

We used a theoretical eye model to evaluate the effect on peripheral images when planoconvex, biconvex, and meniscus intraocular lenses (IOLs) decenter 1 mm or 2 mm upward or downward from the pupillary center. A light source was projected from an angle of 0, 20, 28, or 40 degrees downward to a retina with a radius of curvature of 11 mm. When the IOL was centered, the light focused at a single point on the retina. When the IOL was decentered, the light became more dispersed as the incident angle of the light increased. The most dispersion was noted with the meniscus IOL; the least with the biconvex IOL. Astigmatism and aberration, which IOL decentration increases, were thought to cause the image defocus. These results suggest that IOL decentration may affect the sharpness of peripheral images.

Accommodation, Ocular↗
PubMed1993

Experimental evaluation of posterior capsule opacification and intraocular lens decentration: comparison of intraocular lenses of 12.5 mm and 14.0 mm diameter.

Most posterior chamber intraocular lenses (IOLs) in common use today measure 13.5 mm to 14.0 mm in diameter. Some investigators recommend using smaller lenses (e.g., 12.0 mm to 12.5 mm). To investigate the effect of smaller lenses, experimental phacoemulsification procedures were performed in 16 eyes of white rabbits using two intraocular lens sizes: 14.0 mm and 12.5 mm. Each lens was evaluated for its effects on posterior capsule opacification and optic decentration, two of the most common complications of modern cataract surgery and intraocular lens implantation. The 12.5 mm lens showed a slightly smaller amount of decentration than the larger lens and a comparable amount of posterior capsule opacification.

Animals↗
PubMed1990

Effect of intraocular lens decentration on retinal image contrast.

We describe an optical model of the eye that allowed the effect of intraocular lens (IOL) decentration on retinal image contrast to be photographically studied. Decentrations of varying degrees of severity were modeled to correlate the amount of aphakic pupillary area with the contrast of the resulting images as measured by a digital photometer. Image contrast was found to decrease linearly as the proportion of aphakic pupillary area increased. Human clinical correlates are discussed.

Contrast Sensitivity↗
PubMed1988

Posterior capsular opacification and intraocular lens decentration. Part I: Comparison of various posterior chamber lens designs implanted in the rabbit model.

Experimental phacoemulsification procedures were performed in 54 Rex rabbits. In 96 eyes, posterior chamber intraocular lenses (IOLs) were implanted in the capsular sac, and 12 eyes served as controls with no lens implantation. The IOLs were divided into eight groups consisting of both one-piece and three-piece styles with various optic designs. Each lens was evaluated for the relative effect on posterior capsular opacification (PCO) and optic decentration, two of the most common complications of modern cataract surgery and IOL implantation. Optics with a convex-anterior, plano-posterior design (the type of IOL optic most frequently implanted today) had the highest incidence of PCO. With capsular fixated IOLs, the features that have a statistically significant impact on reducing PCO include (1) one-piece, all-polymethylmethacrylate (PMMA) IOL styles, (2) a biconvex or posterior convex optic design, and (3) angulated loops. Lens decentration was not affected by the optic design, but statistical analysis showed that one-piece, all-PMMA IOL construction provided the most consistent centration.

Animals↗
PubMed1999

Silicone and poly(methyl methacrylate) lens decentration associated with asymmetric capsule shrinkage in rabbits.

PURPOSE: To determine whether silicone intraocular lenses (IOLs) are readily affected by capsule shrinkage. SETTING: Department of Ophthalmology, Wakayama Medical College, Wakayama, Japan. METHODS: A D-shaped incision was made in the anterior capsule of 38 eyes of 20 white rabbits. One of 2 IOL types was implanted in the capsular bag: 3-piece silicone or single-piece all-poly(methyl methacrylate) (PMMA). Twenty-eight eyes were evaluated for IOL rotation and optic decentration. RESULTS: The extent of postoperative decentration and rotation observed with the silicone IOLs did not significantly exceed that of the PMMA IOLs. CONCLUSIONS: Our results, coupled with the advantages of small incision surgery, indicate that a silicone IOL is an effective choice.

Animals↗
PubMed2001

Effect of parasympathetic decentralization on interferon-gamma release from rat submandibular lymph nodes in vitro.

The aim of this study was to examine the regulation of interferon (IFN)-gamma release by cells from submandibular lymph nodes of rats subjected to a unilateral parasympathetic decentralization by severing the ipsilateral chorda tympani 7 days earlier. Cells obtained from contralateral sham-operated submandibular lymph nodes were employed as control. Parasympathetic decentralization of lymph nodes resulted in significantly less IFN-gamma release as compared to that found in innervated lymph nodes. Mitogens (lipopolysaccharide, concanavalin A) stimulated IFN-gamma release in cells derived from the innervated lymph nodes only. The muscarinic agonist metacholine decreased IFN-gamma release in cells derived from innervated lymph nodes. At the highest concentration employed (10(-4) M), metacholine suppressed the stimulatory effect of mitogens on IFN-gamma release in cells of innervated lymph nodes while the muscarinic antagonist atropine (10(-8) - 10(-4) M) lacked to affect IFN-gamma release. Addition of nicotine (10(-5) - 10(-3) M) failed to modify IFN-gamma release. The results support the occurrence of significant effects of local parasympathetics in modulating IFN-gamma release by submandibular lymph nodes.

Animals↗
PubMed2000

Decentring and distraction reduce overgeneral autobiographical memory in depression.

BACKGROUND: Increased recall of categorical autobiographical memories is a phenomenon unique to depression and post-traumatic stress disorder, and is associated with a poor prognosis for depression. Although the elevated recall of categorical memories does not change on remission from depression, recent findings suggest that overgeneral memory may be reduced by cognitive interventions and maintained by rumination. This study tested whether cognitive manipulations could influence the recall of categorical memories in dysphoric participants. METHODS: Forty-eight dysphoric and depressed participants were randomly allocated to rumination or distraction conditions. Before and after the manipulation, participants completed the Autobiographical Memory Test, a standard measure of overgeneral memory. Participants were then randomized to either a 'decentring' question (Socratic questions designed to facilitate viewing moods within a wider perspective) or a control question condition, before completing the Autobiographical Memory Test again. RESULTS: Distraction produced significantly greater decreases in the proportion of memories retrieved that were categorical than rumination. Decentring questions produced significantly greater decreases in the proportion of memories retrieved that were categorical than control questions, with this effect independent of the prior manipulation. CONCLUSIONS: Elevated categorical memory in depression is more modifiable than has been previously assumed; it may reflect the dynamic maintenance of a cognitive style that can be interrupted by brief cognitive interventions.

Adult↗
PubMed1996

Denervation, but not decentralization, reduces nerve growth factor content of the mesenteric artery.

In the present study we applied an improved nerve growth factor (NGF) extraction method to examine the effects of denervation and sympathetic decentralization on NGF levels in vascular tissue. Adult male Wistar Kyoto rats underwent mesenteric arterial denervation or splanchnic nerve transection. Four days after operation, animals were killed, and the mesenteric artery and coeliac-superior mesenteric ganglia were removed. The arterial adventitia was stripped from the media to measure NGF levels in nerve and smooth muscle separately. A high concentration of NGF was detected in the normal artery, 90% of which was in the adventitial layer. Surgical denervation significantly reduced the NGF levels in the artery and ganglia by 78 and 71%, respectively. However, within the artery the level of NGF was reduced in the adventitia but not in the media. Thus, the large reduction of NGF content resulted from the loss of nerve plexus from the artery. In contrast, decentralization did not alter the NGF content in the artery, in either the adventitia or media. Our results are in marked contrast to previous studies reporting elevated levels of NGF following denervation. This discrepancy is explained by the ability of our new procedure to extract much greater amounts of NGF from the tissue.

Animals↗
PubMed2002

Use of a disposable sheath system for flexible sigmoidoscopy in decentralized colorectal cancer screening.

BACKGROUND AND STUDY AIMS: To prevent transmission of infectious agents and to reduce instrument reprocessing time, the use of disposable sheath systems instead of conventionally reprocessed endoscopes has been promoted for flexible sigmoidoscopy. This trial primarily investigated the feasibility of a disposable sheath system for flexible sigmoidoscopy in decentralized colorectal cancer screening. PATIENTS AND METHODS: In an ongoing colorectal cancer screening trial, 226 consecutive participants were randomly allocated to have their flexible sigmoidoscopy performed with either a fiberoptic sigmoidoscope covered with a disposable sheath ("EndoSheath group") or a conventional video colonoscope ("standard colonoscope group"). All examinations were performed at a temporary screening center. The patients' experience was documented using a questionnaire. The feasibility of running temporary screening units was evaluated. RESULTS: Examinations beyond the 60-cm level were excluded. Thus, 113 patients (examined with the disposable instrument) and 87 (standard instrument) were eligible for analysis. When the sheathed system was used, all the devices needed could be satisfactorily transported. A screening center could be set up within a few hours. No differences were observed in patient discomfort. Fewer patients with polyps were observed in the EndoSheath group (48 [42%]), compared with 55 (63%) in the standard colonoscope group; P = 0.005). No significant differences were observed for polyps larger than 5 mm (14 [12%] in the EndoSheath group, 13 [15%] in the standard colonoscope group; P = 0.6). CONCLUSIONS: Using the disposable system, decentralized colorectal cancer screening was easily established. However, fewer polyps were found, possibly due to the fiberoptic nature of the instrument. Sheathed video instruments are desirable and may increase the diagnostic yield.

Colorectal Neoplasms↗
PubMed2004

[Reduction of decentration after LASIK using a modified eye tracker ring for the MEL-70 excimer laser].

BACKGROUND: The aim of this study was to determine and compare the rate of eccentric laser ablation after LASIK depending on the eye tracker ring used. PATIENTS AND METHODS: All LASIK treatments were carried out using the MEL-70 flying spot excimer laser (Zeiss-Meditec, Jena). The flap was produced using a Corneal Shaper trade mark or Hansatome trade mark Microkeratome (B and L Surgical, Heidelberg). Initially we used an 11 mm eye tracker ring without hinge protector. At the end of February 2001 this ring was replaced by a 10 mm and a 9.5 mm ring with built-in hinge protector. An additional modification was introduced by us: at 1 mm separations little teeth-like spikes were engraved into the eyeward side of the ring, thus stabilising the position of the ring on the globe and allowing free liquid to flow through the spaces between each spike. The built-in calibration system of the corneal topography (TMS 3, Tomey, Erlangen) from patients with a follow-up of one month or longer was used to determine the distance between the centre of the ablation zone from the fixation point. RESULTS: In group I patients (old ring) 42 eyes were treated. In 4 eyes ablation was perfect, in 21 eyes the ablation centre was located 0.1 to 0.49 mm from the fixation point, in 11 eyes 0.51 to 0.99 mm and in 5 eyes 1.1 to 1.49 mm whereas one eye showed a decentred ablation of 1.53 mm. In group II (new ring) 42 eyes were investigated also. In 11 eyes ablation was perfect, in 20 eyes the ablation centre was located 0.1 to 0.49 mm from the fixation point, in 10 eyes 0.5 to 0.99 mm and one eye had an eccentric ablation of 1.28 mm from the fixation point. CONCLUSION: The further development of our eye tracker ring for the MEL-70 laser considerably reduced the rate of decentred ablations. An enhanced grip of the ring onto the globe reduces a slow slide during the laser procedure.

Calibration↗