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The ubiquitin-proteasome system (UPS) plays a vital role in directing molecules to the 26S proteasome for degradation as well as other locales in the cell. Disrupting UPS function can lead to the aggregation of mutant or misfolded proteins, which disrupts normal cellular activity in diverse ways. Here we discuss how UPS dysfunction might contribute to a variety of neurological problems.
DATA SOURCES: Trials were sourced using the Cochrane Oral Health Group Trials Register, the Cochrane Central Register of Controlled Trials, Medline and Embase. Reference lists from relevant articles were scanned and the authors of some papers were contacted to identify further trials and obtain additional information. STUDY SELECTION: Trials were selected if they met the following criteria:design: random allocation of participants;participants: all children and adults receiving dental check-ups in primary-care settings, irrespective of their level of risk for oral disease;interventions: recall intervals for either clinical examination only, clinical examination plus scale and polish, clinical examination plus preventive advice, clinical examination plus scale and polish plus preventive advice, no recall interval/patient-driven attendance (which may be symptomatic), or clinician risk-based recall intervals;outcomes: clinical status outcomes for dental caries including, but not limited to, mean dmft/DMFT, dmfs/DMFS scores, caries increment, filled teeth (including replacement restorations), early carious lesions (arrested or reversed); periodontal disease (including, but not limited to, plaque, calculus, gingivitis, periodontitis, change in probing depth, and attachment level); oral mucosa (presence or absence of mucosal lesions, potentially malignant lesions, cancerous lesions, and size and stage of cancerous lesions at diagnosis). In addition, the following outcomes were considered where reported: patient-centred outcomes, economic-cost outcomes, other outcomes such as improvements in oral health knowledge and attitudes, harms, changes in dietary habits, and any other oral health-related behavioural change. DATA EXTRACTION AND SYNTHESIS: Information regarding methods, participants, interventions, outcome measures, and results were independently extracted, in duplicate, by two authors. Authors were contacted, where deemed necessary and where possible, for further details regarding study design and for data clarification. A quality assessment of the included trial was carried out. The Cochrane Oral Health Group's statistical guidelines were followed. RESULTS: Only one study (with 188 participants) was included in this review and was assessed as having a high risk of bias. This study provided limited data for dental caries outcomes (dmfs/DMFS increment) and economic cost outcomes (reported time taken to provide examinations and treatment). CONCLUSIONS: There is insufficient evidence from randomised controlled trials (RCT) to draw any conclusions regarding the potential beneficial and harmful effects of altering the recall interval between dental check-ups. There is insufficient evidence to support or refute the practice of encouraging patients to attend for dental check-ups at 6-monthly intervals. It is important that high quality RCT are conducted for the outcomes listed in this review in order to address its objectives.
The purpose of this prospective study was to assess the incidence of flare-ups (a severe problem requiring an unscheduled visit and treatment) among patients who received endodontic treatment by the two authors in their respective practices during a period of one year, and also to examine the correlation with pre-operative and operative variables. The results showed an incidence of 1.58% for flare-ups from 1012 endodontically treated teeth. Statistical analysis using the chi-square test (P<0.05) indicated that flare-ups were found to be positively correlated with multiple appointments, retreatment cases, periradicular pain prior to treatment, presence of radiolucent lesions, and patients taking analgesic or anti-inflammatory drugs. In contrast, there was no correlation between flare-up, and age, sex, different arch/tooth groups and the status of the pulp.
The purpose of the study was to compare the effect of three intracanal medicaments on the incidence of post-instrumentation flare-ups. All teeth were instrumented to a predetermined minimum size using a 0.5% solution of sodium hypochlorite as the irrigant. Formocresol, Ledermix, and calcium hydroxide were placed in strict sequence irrespective of the presence or absence of symptoms or radiographic signs of apical periodontitis. The patients were given written post-operative instructions and a prescription for 600 mg ibuprofen to be taken if mild to moderate pain developed. If severe pain and/or swelling developed the patient was instructed to call the office immediately and was considered to have had a flare-up. Twelve flare-ups occurred in teeth with radiographic signs of apical periodontitis; none in teeth without periapical radiolucencies. Six of the twelve flare-ups occurred in retreatment cases and the other six occurred in teeth without previous endodontic treatment. No significant difference was found in the flare-up rate among the three intracanal medicaments.
The purpose of this study was to calibrate a nationally used sit-ups test using the Rasch Poisson Counts model and evaluate the model-data fit. The total number of subjects was 8,723, consisting of 4,486 girls and 4,237 boys, ages 10 to 18. The estimated difficulty of the sit-ups task was -2.80, which was appropriate for a majority of examinees whose ability levels ranged from .09 to 1.39. After the calibration, boys and girls as well as different age groups were compared under the same metric. Graphs of the model-data fit demonstrated that the model-data fit at a low ability level was not as good as the fit at a high ability, which could be caused by violation of assumptions of the model that examinees have the same performance speed throughout the test and that the speed at a given time is independent of the number of sit-ups completed so far.
BACKGROUND: To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting. METHODS: A prospective cluster randomized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto. Preventive Care Checklist Forms were created to be used by family physicians at adult health check-ups over a five-month period. The sex-specific forms incorporate evidence-based recommendations on preventive health services and documentation space for routine procedures such as physical examination. The forms were used in two intervention clinics and two control clinics. Rates and relative risks (RR) of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to-date preventive health services delivered per patient were compared between the two groups. RESULTS: Randomly-selected charts were reviewed at baseline (n = 509) and post-intervention (n = 608). Baseline rates for provision of preventive health services ranged from 3% (fecal occult blood testing) to 93% (blood pressure measurement), similar to other settings. The percentage of up-to-date preventive health services delivered per patient at the end of the intervention was 48.9% in the control group and 71.7% in the intervention group. This is an overall 22.8% absolute increase (p = 0.0001), and 46.6% relative increase in the delivery of preventive health services per patient in the intervention group compared to controls. Eight of thirteen preventive health services showed a statistically significant change (p < 0.05) in favor of the intervention (adjusted RR (95% C.I.)): counseling on brushing/flossing teeth (9.2 (4.3-19.6)), folic acid counseling (7.5 (2.7-20.8)), fecal occult blood testing (6.7 (1.9-24.1)), smoking cessation counseling (3.9 (2.2-7.2)), tetanus immunization (3.0 (1.7-5.2)), history of alcohol intake (1.33 (1.2-1.5)), history of smoking habits (1.28 (1.2-1.4)) and blood pressure measurement (1.05 (1.00-1.10)). CONCLUSION: This simple, low cost, clinically relevant intervention improves the delivery of preventive health services by prompting physicians of evidence-based recommendations in a checklist format that incorporates existing practice patterns. Periodic updates of the Preventive Care Checklist Forms will allow a feasible and easy-to-use tool for primary care physicians to provide evidence-based preventive health services to adults at routine health check-ups. The forms can also be incorporated into an electronic health record. The Preventive Care Checklist Forms are accessible in English and French at the College of Family Physicians of Canada web site.
The purpose of the study was to assess the accuracy, using electronic portal imaging, of daily set-ups, in patients undergoing radiotherapy for prostate carcinoma. We used a scanning liquid ion chamber to assess the accuracy of set-ups in 25 consecutive patients undergoing a 6 1/2 week course of radiotherapy to the prostate. Electronic images (EPIs) were collected during 33 treatments to each of four ports. The positions of anatomical structures on the EPIs were compared with the same structures seen on digitally reconstructed radiographs (DRRs) made after CT simulation before beginning radiotherapy. Displacements of the EPIs compared with the DRRs were computer-calculated in millimetres in lateral, longitudinal and rotational directions for each port. 11 patients had ports moved because of discrepancies between the EPIs and the DRRs; eight required moves in the first five treatments to correct systematic (simulator) errors. In the right-left and anterior-posterior directions, nearly 95% of the EPIs were within 5 mm of the simulated port position. In the superior-inferior direction, 98% of the ports were within 5 mm of the simulated port position. Two patients had in-plane rotational errors on the lateral ports (8 degrees and 10 degrees respectively). It was concluded that daily electronic imaging is an effective technique for assessing the accuracy of set-ups in prostate radiotherapy.
From 1975 through 1986, repeated preventive oncologic check-ups were carried out in the District Sumperk. In the course of the check-ups, 49,426 persons were examined. The examinations were aimed at surveillance of initial stadium of cancers as well as at detection of other serious chronic diseases. The results of the check-ups form a large database suitable for a number of epidemiological analyses. In this article, methods of the data collection are described, individual data items are characterized and their summary is presented in tables. Utilization of the database is proposed in specified types of epidemiological studies.
The aim of this study was to evaluate the influence of health examination provided by municipalities in Japan on the use of medical care by elderly patients aged 70 and above. The study was carried out to compare health indicators of cities with high and low usage rates for health check ups over 14 years. The indicators of health service utilization included mean bed days, mean inpatient fees, and mean outpatient fees in 1983, 1988, 1993 and 1996. The data for these indicators were collected from all 12 Japanese cities, where more than 50% of the target population had annual health check-ups in 1983, 1986, 1989 and 1992, as the subjects of high rate cities. All other 134 cities belonging to the same prefectures with the 12 cities were included as the control low rate cities. The correlation coefficients for all the 146 cities showed that usage rates of health check ups had an inverse relationship with mean bed days and mean inpatient fees for the elderly population in all the fiscal years 1983, 1988, 1993 and 1996. In nine out of the ten prefectures, mean bed days and mean inpatient fees were lower in the high rate cities as compared to the low rate cities for all the fiscal years compared. The bed days in the 12 high rate cities were 72% of those in 134 low rate cities in 1983, and the percentages were 66%, 72%, and 78% in 1988, 1993 and 1996 respectively. No remarkable differences in mean outpatient fees were observed between the high and low rate cities. The differences in use of medical care by inpatients suggest that providing preventive health services would decrease the demand by the elderly and result in a more efficient use of health resources.
OBJECTIVE: To investigate whether regular check ups and preventive drug use reduce asthma symptoms in school children. METHODS: Cross sectional retrospective questionnaire responses obtained from 2193 children aged 6-7 years in 34 primary schools, and 3650 children aged 13-14 years in nine secondary schools, selected at random by cluster sampling. MAIN OUTCOME MEASURES: Asthma severity in the past 12 months as measured by the number of attacks of wheezing, visits to a doctor, visits to a hospital emergency department, and hospital admissions, all for wheezing or asthma. ANALYSIS: Multivariate ordinal logistic regression. RESULTS: Regular general practitioner check ups were associated with reduced asthma severity. Regular use of prophylactic and bronchodilator medications was associated with reduced symptoms. Asthma action plans and peak flow meter usage were associated with reduced hospital admissions. DISCUSSION: If these associations are causal, then regular GP check ups are effective in reducing the health consequences of asthma in children.
Objective evaluations of population's health belong to the most important tasks of the public-health science. Such evaluations made in respect to children are of extra importance. One must comprehensively understand the potentialities and abilities of the methods used for the purpose. A comparative evaluation of 387 children, aged 10, was based on the findings of medical check-ups and on questionnaires of their parents. 37.7% of children, who were evaluated by their mothers as having good health, were diagnosed by doctors as having a chronic disease, i.e. the diagnosis did not entail any life limitations for such children. 40% of those children, who were referred to by their parents as sick (poor health), were classified by doctors as belonging not to category 3 (chronic pathology) but to a category of healthier children (category 2). Below 10% of children, who were describe by their parents as having poor health, were among those who were put by doctors on the list of group 3 on the basis of medical check-ups. As for those children who had an actively displayed chronic disease with a pronounced clinical course, like bronchial asthma, ulcer etc., the opinions of doctors and of their parents coincided in a majority of cases. The comparative evaluations of children' health based on questionnaires of their parents and on medical check-ups exposed a certain coincidence and specificity of such evaluations since they are based on different approaches.
OBJECTIVE: To report the changes in self-reported dental check-up patterns of British adults in both the NHS and non-NHS sectors over the period 1991 to 2000. METHOD: Longitudinal cross-sectional questionnaire. RESULTS: Between 1991 and 2000, the annual British House-hold Panel Survey (BHPS) indicated that there was a steady increase in the percentage of adults who reported having a dental check-up within the previous 12 months, from 53.6% to 62.3%. While the percentage reporting having had a dental check-up under NHS arrangements rose slightly from 44% to 46%, reported non-NHS check-ups rose from 6% to 14%. Variations in reported attendance patterns for check-ups were noted between the sexes and age groups. A higher percentage of females reported having had a dental check-up under NHS arrangements than males, while no differences were found in the non-NHS sector. Those aged between 46-55 years had the highest percentage of dental check-ups (72%) while the lowest was in those aged 66 years or older (43%). CONCLUSIONS: The results of the BHPS indicate that there was an increase in the percentage of British adults attending for a dental check-up within any 12-month period for 1991 to 2000 and that there was considerable variation in attendance by both age and sex.
OBJECTIVE: For maternal and child health, in addition to assistance to children, support to guardians is needed with the change in the social environment due to child-rearing. In Kobe city, from 2002/ 04/01, interview sheets for health check-ups at 4 months, 18 months and 3 years of age were revised and questions about child-rearing were added. The purpose of the present study was to clarify revisions to interview sheets regarding childcare support. METHODS: A total of 3,308 cases of mothers and children who underwent their health check-ups between 2002/04/01 and 2002/12/31 were surveyed, and the replies in the interview sheets were analyzed using the chi-square test for independence and the Pearson's correlation coefficient. RESULTS: In addition to children's development, factors for child-rearing in the home, including cooperation from the father, are of great importance. Moreover, subjectivity about mother's child-rearing is influenced by the support of child-rearing friends. CONCLUSIONS: Public health nurses should use not only the replies in interview sheets but also the appearance of guardians at health check-ups as important factors for screening. Further consideration of the influence of each question for evaluation is necessary to establish screening standards.
OBJECTIVE: To detect HBV antigen specific cytotoxic T lymphocyte (CTL) changes in patients during acute flare-ups and to study their association with flare-ups and aggravations into grave hepatitis by quantitative analysis of HLA-A2* restricted HBcAg-specific CTL cells. METHODS: The frequency of HBcAg-specific CTL cells in the peripheral blood mononuclear cells (PBMC) from 29 patients with persistent infection with HBV were quantified by flow cytometry using one HLA-A2*HBV peptide pentamers complex (Pro5TM MHC Pentamers). RESULTS: There was a statistical difference of HBcAg specific CTLs between the patients with acute exacerbations (1.4%+/-0.8%) and the patients with immune tolerance (0.6%+/-0.4%) (t = 2.180, P = 0.01-0.05); There was no significant difference between the grave hepatitis group (1.3%+/-1.0%) and the chronic hepatitis group (1.4%+/-0.8%) regarding frequencies of antigen specific CTL (t = 0.215, P = 0.833-0.05). The level of antigen specific CTLs in PBMC in the 6 cases of chronic hepatitis B with acute exacerbations maintained a relatively high level (more than 0.7%) within the 12 week follow-up period. CONCLUSION: HBcAg-specific CTLs may play an important role in hepatic flare-ups in patients with chronic HBV infection, but there was no direct relationship between antigen- specific CTLs and grave hepatitis.
Eighteen men were studied during 15 minutes of inversion to determine the effects of 4 sit-ups per minute for 5 minutes on the cardiorespiratory system. Systolic blood pressure, diastolic blood pressure, ventilation, oxygen uptake, and METS increased significantly from preinversion/standing (A) to inversion (B). Arterial blood pressure increased from 122/81 mmHg to 142/99 mmHg during the first 5 minutes of inversion. Oxygen uptake increased from 341 ml.min-1 to 456 ml.min-1. Heart rate decreased significantly from (A) to (B). Double product, frequency of breaths, and tidal volume were not significantly changed from (A) to (B). Blood pressure, double product, ventilation, frequency of breaths, oxygen uptake, and METS increased significantly from the first 5 minutes of inversion (B) to the second 5 minutes of inversion with sit-ups (C). Arterial blood pressure increased from 142/99 mmHg (B) to 163/104 mmHg (C). The diastolic value remained significantly increased following the muscle strengthening exercise. Double product increased from 104 (B) to 126 (C), and oxygen uptake increased from 456 ml.min-1 (B) to 565 ml.min-1 (C). Following inversion/sit-ups (C), oxygen uptake decreased significantly during the third 5 minutes of inversion (D). Systolic blood pressure was also significantly decreased at (D) following the sit-ups. Upon returning to the standing position (E) versus the third 5 minutes of inversion (D), arterial blood pressure decreased significantly from 151/108 mmHg (D) to 123/84 mmHg (E). The postinversion/standing (E) blood pressure was nonsignificantly different from the preinversion/standing (A) blood pressure as was also the case with heart rate, double product, and tidal volume. Ventilation, frequency of breaths, oxygen uptake, and METS were still significantly increased during (E) versus (A). These data illustrate the influence of muscular exercise on the cardiorespiratory system during full -90 degree inversion. The increase in blood pressure is no cause for concern, and the assumed dangerous effects of full inversion have been overestimated.
The purpose of this study was to investigate the clinical variables influencing endodontic flare-ups. Three hundred and thirteen teeth receiving endodontic treatment at the Endodontic Department, Chang Gung Memorial Hospital were studied from December 1992 to February 1993. Among them, 21 teeth with significant pain and 9 with apical swelling were noted after the first appointment of treatment. Three teeth with persistent pain and one with apical swelling were also found one week after completion of endodontic therapy. The results showed significant improvement of clinical symptoms and signs one week after completion of endodontic treatment in comparison with pretreatment and after the first appointment (p < 0.025). The factors such as presence of pretreatment complaints, periapical lesions and vital pulp had significant effects on the incidence of endodontic flare-ups after the first appointment of treatment (P < 0.025). In contrast, patients' sex, the number of visits, and whether this was a retreatment case or not had no significant effect on the frequency of these endodontic flare-ups.
The influence of mixing and phase hold-ups on gas-producing fluidized-bed reactors was investigated and compared with an ideal flow reactor performance (CSTR). The liquid flow in the anaerobic fluidized bed reactor could be described by the classical axially dispersed plug flow model according to measurements of residence time distribution. Gas effervescence in the fluidized bed was responsible for bed contraction and for important gas hold-up, which reduced the contact time between the liquid and the bioparticles. These results were used to support the modeling of large-scale fluidized-bed reactors. The biological kinetics were determined on a 180-L reactor treating wine distillery wastewater where the overall total organic carbon uptake velocity could be described by a Monod model. The outlet concentration and the concentration profile in the reactor appeared to be greatly influenced by hydrodynamic limitations. The biogas effervescence modifies the mixing characteristics and the phase hold-ups. Bed contraction and gas hold-up data are reported and correlated with liquid and gas velocities. It is shown that the reactor performance can be affected by 10% to 15%, depending on the mode of operation and recycle ratio used. At high organic loading rates, reactor performance is particularly sensitive to gas effervescence effects. Copyright 1998 John Wiley & Sons, Inc.
Fligstein (1996) contends that organizations act to exploit the institutional context in which they are embedded so as to stabilize the competition they face. Drawing on Fligstein's theoretical analysis, we conceptualize incumbent biotechnology firms' patent-ing and alliance-building activities as attempts to stabilize and control potential competition and analyze how these activities shape rates of founding in the Canadian biotechnology industry. We find that increases in the level and concentration of incumbents' patenting discourage founding, particularly in human application sectors of the industry where development and approval processes are more costly and time consuming. Incumbents' horizontal alliances depress start-ups; vertical alliances stimulate start-ups. Our findings highlight how technology appropriation and strategic alliances structure the competitive dynamics and evolution of high-technology, knowledge-intensive industries.