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PubMedDate not supplied

[Ultrasonographic evaluation of the thyroid palpation method in determining its dimensions in children and adolescents].

The authors analyze the diagnostic value of thyroid palpation method (two modifications) comparing its results with those of ultrasonographic volumetry. The study involved 118 children aged 5 and 14 of both sexes living in regions endemic for goiter. The thickness of thyroid isthmus was found virtually the same no matter how greatly the gland was enlarged. The results proved the necessity of age-specific corrections in the criteria of current interpretation of palpation data: the first degree in preschool children was most often indicative of thyroid hypertrophy whereas in the pubertal age it was just a variant of normal size. Interpretation with due account of these amendments improved the reliability of diagnostic value of palpation, its sensitivity being 63 +/- 6, specificity 67 +/- 6, and accuracy 65 +/- 4%. When the results of palpation are adequately interpreted, the examinees' age and sex and the method of examination proper do not influence the data accuracy. The sensitivity of palpation in detection of nodules up to 10 mm in diameter proved to be null (in 6 of the 81 examined adolescents sonographic signs of encapsulated formation were seen in the thyroid). Bearing all this in mind, the authors discuss differentiated approaches to management of children and adolescents with the first degree of palpated enlargement of the thyroid.

Adolescent↗
PubMed2005

Cultivation-independent in situ molecular analysis of bacteria involved in degradation of pentachlorophenol in soil.

The central aim of this study was to determine which components of an indigenous bacterial community in pristine grassland soil were capable of degrading pentachlorophenol (PCP) using two cultivation-independent, in situ, molecular techniques. The first involved polymerase chain reaction (PCR) and reverse transcription polymerase chain reaction (RT-PCR) amplification of 16S rRNA genes from DNA and RNA, respectively, extracted from PCP-amended soil. The second involved stable isotope probing (SIP), with incubation of soil with 13C-PCP and molecular analysis of 13C-labelled RNA, derived from cells incorporating PCP or its breakdown products, after separation from 12C-RNA by ultracentrifugation. Bacterial communities were characterized by denaturing gradient gel electrophoresis (DGGE) analysis of amplification products. PCP was degraded at an approximate rate of 1.18+/-0.25 (SEM) mg kg-1 day-1 and 39% of the measurable PCP fraction was degraded after incubation for 63 days. PCP degradation was associated with significant changes in bacterial community structure, leading to the appearance of seven bands in both DNA- and RNA-based DGGE profiles, the latter providing clearer evidence of qualitative shifts in community structure. The majority of novel bands increased in relative intensity during the first 35 days and subsequently decreased in relative intensity as incubation continued. Sequence and phylogenetic analysis of six of these bands indicated most to have closest database relatives that were uncultured bacteria with sequence homologies to reported hydrocarbon degraders. No band could be detected in RNA-SIP-DGGE profiles derived from 13C-RNA fractions at day 0 but several faint bands appeared in these fractions after incubation of soil for 4 days, indicating assimilation of PCP or its degradation products. These bands increased in intensity during subsequent incubation for 21 days and decreased with further incubation. With one exception, RNA-SIP-DGGE and RNA-DGGE profiles were similar, indicating that RNA-targeted DGGE, in this case, provided a good indication of the metabolically active microbial community.

Base Sequence↗
PubMed2001

Factors influencing the turnover of intensive care nurses.

Access to the intensive care unit (ICU) is often tortuous as there is a high incidence of bed closure due to staff shortage, a problem exacerbated by a high rate of turnover. It is proposed that the first step in addressing the problem is to explore the reasons why people leave, illuminating areas of policy and practice that would benefit from amendment. Given that the issues concerned are complex and contextual in nature, an open exploratory approach was adopted, whereby respondents were interviewed using open questions and given the freedom to shape their responses according to their perceptions of the problem. The transcripts of eleven interviews were analysed, with four themes emerging which represent the most dominant factors influencing the respondents' decision to leave. These included stresses related to the work; inadequate opportunity for professional development; recognition and respect of others and the implications of shift-work. It was concluded that there needs to be a greater awareness of the potential for nurses to become excessively stressed in the ICU environment; that a decentralized management style may help maintain motivation; that rostering systems need to retain flexibility; and that there is a requirement for greater incentives to pursue a career in intensive care.

Decision Making, Organizational↗
PubMed2003

Naturally occurring bacteria similar to the methyl tert-butyl ether (MTBE)-degrading strain PM1 are present in MTBE-contaminated groundwater.

Methyl tert-butyl ether (MTBE) is a widespread groundwater contaminant that does not respond well to conventional treatment technologies. Growing evidence indicates that microbial communities indigenous to groundwater can degrade MTBE under aerobic and anaerobic conditions. Although pure cultures of microorganisms able to degrade or cometabolize MTBE have been reported, to date the specific organisms responsible for MTBE degradation in various field studies have not be identified. We report that DNA sequences almost identical (99% homology) to those of strain PM1, originally isolated from a biofilter in southern California, are naturally occurring in an MTBE-polluted aquifer in Vandenberg Air Force Base (VAFB), Lompoc, California. Cell densities of native PM1 (measured by TaqMan quantitative PCR) in VAFB groundwater samples ranged from below the detection limit (in anaerobic sites) to 10(3) to 10(4) cells/ml (in oxygen-amended sites). In groundwater from anaerobic or aerobic sites incubated in microcosms spiked with 10 microg of MTBE/liter, densities of native PM1 increased to approximately 10(5) cells/ml. Native PM1 densities also increased during incubation of VAFB sediments during MTBE degradation. In controlled field plots amended with oxygen, artificially increasing the MTBE concentration was followed by an increase in the in situ native PM1 cell density. This is the first reported relationship between in situ MTBE biodegradation and densities of MTBE-degrading bacteria by quantitative molecular methods.

Aerobiosis↗
PubMed1988

Act No. 88-38 completing and amending Act No. 60-30 of 14 December 1960 relating to the organization of the social security regime, 6 May 1988.

This Act amends Act No. 60-30 of 14 December 1960 to provide that family allowances in Tunisia for employees will be granted for only the first three children, including adopted children. The quarterly allowances are set as the following percentages of the overall quarterly salary of the worker up to 122,000: 1) 18% for the first child; 2) 16% for the second child; and 3) 14% for the third child. Act No. 88-39 of 6 May 1988 makes the same changes in family allowances granted to public employees. See the same issue and page of the Journal Officiel.

Africa↗
PubMed1975

Sudden infant death syndrome (SIDS): a burgeoning medicolegal problem.

This Article presents a summary analysis of the administrative and statutory bases for the documented, prevalent mismanagement of Suddern Infant Death Syndrome (SIDS) cases by a majority of local death investigation agencies in the United States. Herein, Alan P. Cleveland, J.D. advances the theory that the unsatisfactory handling of cases of SIDS by the medicolegal community is the inevitable outgrowth of state laws that expressly require investigative agencies to approach a sudden, unexplained death from the direction of determining first whether or not a criminal act has occurred. In so doing, most statutorily mandated autopsy procedures are socially counterproductive since, in ignoring an acute medical need for supportive family counselling, they often constitute an insuperable obstacle to the effective management of SIDS as a public health problem. The author recommends that a requisite first step in implementing an SIDS management program at the state level is to insulate surviving family members form criminal investigative procedures by appropriate amendment of state laws governing local death investigation systems.

Autopsy↗
PubMed2002

[Typhoid fever in Amsterdam, 1991-2000, and the simplification of the national protocol for source and contact tracing].

OBJECTIVE: To determine the incidence of patients reported with typhoid fever in Amsterdam (1991-2000) and to evaluate the contact tracing for those patients with the specific objective of examining whether contact tracing can be simplified. DESIGN: Retrospective. METHOD: From an automated database, data were collected on all reported typhoid fever patients in Amsterdam during the period 1991-2000 and on their contact persons. RESULTS: One hundred and one patients with typhoid fever were reported during the study period, and Salmonella typhi infection was diagnosed in 12 of the 281 household contacts. For 96 of the 101 index patients, travelling abroad was the most likely source of infection. In 8 of the 12 contact persons with an S. typhi infection, the index person was the most likely source of infection, which is equivalent to a secondary transmission rate of 2.8% (8/277). Seven of the 8 secondary infected persons had symptoms indicative of typhoid fever infection and S. typhi was found in all their first stool samples. CONCLUSION: Supported by these results, the national guidelines for source and contact tracing in the case of typhoid fever have been amended. In the case of index patients with bad toilet hygiene or who are responsible for food preparation, the faeces of all household contacts must be examined once. If the contact persons have symptoms indicative of an S. typhi infection and/or if their work involves food preparation, their faeces should also be tested once. The changes to the national protocol will markedly reduce the labour-intensity of tracing and testing the contacts of patients with typhoid fever, thereby maintaining the quality of the process. Tracing the source of infection in the case of patients with typhoid fever will also remain important in the future in order to detect potential transmission within the Netherlands at an early stage.

Adolescent↗
PubMed2006

National guidelines for the management of HIV-1 in pregnancy.

Management of HIV-1 in pregnancy has reduced the mother-to-child-transmission (MTCT) rate from 25-30% to <2% in the developed world, including Ireland. In Ireland most HIV positive pregnant women are diagnosed through antenatal screening many of whom arrive here late in pregnancy. Geographic dispersal and subsequent involvement of obstetric units throughout the country has resulted in a need for clear, accessible management guidelines. The Irish Infection Society first published guidelines for the management of HIV-1 in pregnancy in 2001 (1). The updated guidelines became operational in January 2002 with some amendments in March 2003 and July 2004. These guidelines offer a broad management outline for HIV positive pregnant women. Ultimately, each woman is assessed individually by a multidisciplinary team and a careful plan is determined.

Anti-Retroviral Agents↗
PubMed2006

Trace element availability and plant growth in a mine-spill contaminated soil under assisted natural remediation I. Soils.

We evaluated the effects of different amendments and/or a plant cover on reclamation of a trace element contaminated soil. Seven treatments were established: four organic (leonardite (LEO), litter (LIT), municipal waste compost (MWC), biosolid compost (BC)), one inorganic (sugar beet lime (SL)) and two controls (control without amendment but with Agrostis (CTRP) and control without amendment and without Agrostis (CTR)). Results showed that total organic C was significantly higher in organic treatments in all samplings. Water-soluble C was lower in CTR compared to other treatments, but no significant differences were observed between organic treatments and SL and CTR. SL, BC and MWC treatments increased soil pH and reduced 0.01 M CaCl2-extractable Cd, Cu and Zn concentrations more efficiently, especially in the first 2 years. At the end of the experiment 0.01 M CaCl2-extractable trace element concentrations were similar in all treatments. 0.01 M CaCl2-extractable As and Pb were below the detection limit. Addition of amendments showed no clear reduction in 0.05 M EDTA-extractable trace element concentrations and some amendments even increased 0.05 M EDTA-extractable As and Cu with time. Pseudo-total trace element concentrations were higher for As in controls. On the other hand, mean values of Cu and Zn were higher in MWC treatment. BC and SL treatments also showed higher Zn mean concentration than controls. No amendment effect was observed for Cd and Pb.

Journal Article↗
PubMed2002

A phase II study to evaluate the efficacy of dexmedetomidine for sedation in the medical intensive care unit.

OBJECTIVE: To evaluate dexmedetomidine for sedation of patients in the medical ICU. DESIGN AND SETTING: Prospective observational study in an intensive care unit of a university hospital. PATIENTS. Twelve ventilated patients with median APACHE II score 23 (range 10-26). INTERVENTIONS: Patients received a loading dexmedetomidine infusion of 1 microg x kg(-1) over 10 min followed by a maintenance infusion rate of 0.2-0.7 microg x kg(-1) x h(-1) for up to 7 days. After experience with the first four patients this maintenance rate of infusion was increased to a maximum of 2.5 microg kg(-1) x h(-1). If required, propofol and morphine provided rescue sedation and analgesia, respectively. RESULTS: The first four patients with dexmedetomidine infusion at 0.7 microg x kg(-1) x h(-1)all required rescue sedation with a propofol infusion. A protocol amendment allowed the next eight patients to receive higher dexmedetomidine infusions (mean 1.0+/- microg x kg(-1) x h(-1)). Five of the next eight patients did not required propofol, and two patients only required minimal propofol infusions (20-40 mg x h(-1)). A further patient, with hepatic encephalopathy, required a propofol at 50-100 mg x h(-1). Only modest falls in arterial pressure, heart rate and cardiac output were seen, and no rebound sequelae occurred on discontinuation of dexmedetomidine. Adverse cardiovascular events were nearly all confined to the initial loading dose period of dexmedetomidine. CONCLUSIONS: Sedation with dexmedetomidine is efficacious in critically ill medical patients requiring mechanical ventilation in the intensive care unit. A reduction in loading infusion is advised, but higher maintenance infusions may be required to that seen previously in the postoperative ICU patient.

APACHE↗
PubMed2005

Identification of biogenic dimethyl selenodisulfide in the headspace gases above genetically modified Escherichia coli.

Escherichia coli JM109 cells were modified to express the genes encoded in a 3.8-kb chromosomal DNA fragment from a metalloid-resistant thermophile, Geobacillus stearothermophilus V. Manual headspace extraction was used to collect the gases for gas chromatography with fluorine-induced sulfur chemiluminescence analysis while solid-phase microextraction was used for sample collection in gas chromatography/mass spectrometry (GC/MS) analysis. When grown in the presence of selenate or selenite, these bacteria produced both organo-sulfur and organo-selenium in the headspace gases above the cultures. Organo-sulfur compounds detected were methanethiol, dimethyl sulfide, dimethyl disulfide, and dimethyl trisulfide. Organo-selenium compounds detected were dimethyl selenide and dimethyl diselenide. Two mixed sulfur-selenium compounds, dimethyl selenenyl sulfide and a chromatographically late-eluting compound, were detected. Dimethyl selenodisulfide, CH(3)SeSSCH(3), and dimethyl bis(thio)selenide, CH(3)SSeSCH(3), were synthesized and analyzed by GC/MS and fluorine-induced chemiluminescence to determine which corresponded to the late-eluting compound that was bacterially produced. CH(3)SeSSCH(3) was positively identified as the compound detected in bacterial headspace above Se-amended cultures. Using GC retention times, the boiling point of CH(3)SeSSCH(3) was estimated to be approximately 192 degrees C. This is the first report of CH(3)SeSSCH(3) produced by bacterial cultures.

Escherichia coli↗
PubMed1999

A bench-scale investigation of land treatment of soil contaminated with diesel fuel.

A bench-scale investigation (soil pan testing) was conducted with the objective of studying degradation rates of diesel contaminated soil (2500 and 10,000 ppm by weight of total petroleum hydrocarbons (TPH) to dry weight of soil) under different treatment conditions over a 17 week testing period. The greatest degradation of the diesel contaminated soil was obtained with the addition of nutrients (Co = 10,000 ppm of TPH; k = 0.19 week-1). 'k' for soil not amended with nutrients was 0.07 week-1. The control cell (C0 = 2500 ppm TPH), with sodium azide (to suppress degradation) was compared with an experimental cell of 2500 ppm initial concentration of TPH without nutrient amendment. The control cell exhibited a relatively low uniform degradation (k = 0.08 week-1) of TPH over the duration of the experiment with reasonable first-order kinetic regression statistics.

Biodegradation, Environmental↗
PubMed1999

Trace element inputs into soils by anthropogenic activities and implications for human health.

Trace element definition and functions, and inputs into soils from the most important anthropogenic sources, related and not related to agricultural practices, of general and local or incidental concern, are discussed in the first part of this review. Trace element inputs include those from commercial fertilizers, liming materials and agrochemicals, sewage sludges and other wastes used as soil amendments, irrigation waters, and atmospheric depositions from urban, industrial, and other sources. In the second part of the review, the most important ascertained effects of soil trace elements on human health are presented. The possible relations found between some specific soil trace elements, such as Cd, Se, As and others, and cancer incidence and mortality, and diffusion of other important human diseases are reviewed. Brief conclusions and recommendations conclude this review.

Agriculture↗
PubMedDate not supplied

Public health and food safety: a historical association.

Since the initial passage in 1906 of the first Pure Food and Drug Act and the Meat Inspection Act, public health, as measured by mortality trends, has greatly improved. These acts have been amended several times, and other laws dealing with safety of foods and drinks have been enacted. Food- and beverage-transmitted infectious diseases that were so devastating after the Civil War have been controlled. Nutritional deficiencies such as pellagra are almost nonexistent. Mass episodes of poisoning of food by chemical contaminants that have plagued some other countries have not occurred in the United States. Other factors such as refrigeration and improved transportation have helped, but it is probable that food safety regulatory activities have contributed to the saving of the 1.8 million Americans who would die each year if the public health advances since 1900 had not been made. Effective use of information was a key factor in the improvement in public health. Now, as then, effective information systems are needed.

Bacterial Infections↗
PubMed1997

[Oral hygiene in the hadiths of the Holy Prophet, Mohammed S.A.V.S].

The problem of oral hygiene in contemporary dental medicine is the problem of successful maintainance of oral health. Contemporary dental medicine recommends the methods for maintaining of total oral hygiene, as preventive action against dental ills. Hadith of Holly Prophet Muhammad s.a.v.s. is a note about what he has done, recommended or amended. Holly Prophet Muhammad s.a.v.s. recommended entire hygiene of teeth, gums, through tooth brushing and washing mouths by water three times. Actually, this was the first time in the available literature that someone recommended maintaining of oral hygiene. It can be said without reserve that Muhammad s.a.v.s. has established a preventive dental medicine. Muslims are recommended to maintain hygiene through Holly Qor'an: "There are the people that like washing themselves in it (mosque), and Allah loves those, who clean themselves very much."

History, Medieval↗
PubMedDate not supplied

Generalized model of pentachlorophenol distribution in amended soil-water systems.

This paper describes laboratory experiments and subsequent statistical data analysis performed to reevaluate the overall effect of soil characteristics and liquid-phase composition on the extent of pentachlorophenol (PCP) adsorption in complex soil-water systems. The PCP adsorption isotherms were first generated for eight soils of varying physical and chemical properties. Binding tests were then performed in the presence of different additives (surfactant, oil, etc.) and conditions (temperature and pH) based on a fractional factorial design. Statistical analysis of data showed strong interdependencies among several of the soil parameters, but confirmed that organic carbon content (foc) and pH of the soils were the best predictors of the adsorption constant of PCP (Kd) for nonamended soil-water systems. It was determined that the effect on Kd of a 0.2 unit decrease in soil pH was approximately the same as increasing foc by 1%. From studying the effect of the amendments, two interactions (surfactant-pH and surfactant-oil) and two primary effects (surfactant and oil) have been detected. The effectiveness of the surfactant in decreasing Kd varied depending on the pH and oil content of the soil. A generalized nonlinear model expressing Kd as a function of pH, foc, oil content of soil, and surfactant dose was developed for the range of conditions studied. The proposed model and modeling approach can be adapted to other types of contaminants or variables for specific natural and engineered systems.

Adsorption↗
PubMedDate not supplied

[Helsinki Declaration VI: a necessary revision, but sufficient?].

With the fifth amendment of the Declaration of Helsinki (Edinburg, 2000), the World Medical Association took a fundamental step forward in the history of the document, after years of internal and external debate. The Declaration was firstly adopted in 1964 as a clear intent to show that the medical profession could manage the ethical control of medical research with human beings. However, several disgraced episodes, like the Tuskegee Syphilis study, showed the insufficiency of such a system. An external control in the form of legal regulation was then proposed. Paradoxically, the importance of the Declaration did not decrease because many national regulations included it as a reference, actually providing it a legal status. But, though formally important, the Declaration hardly had an impact on real-world terms, because it assumed an old-fashion logic of clinical research failing to incorporate the modern methodological developments. The amendment could not be put off longer. In the present paper, I analyse the main shortcomings of the Declaration before the 2000 amendment and to what extent the fifth revision has corrected them.

Helsinki Declaration↗
PubMed2005

Optimizing chemotherapy for advanced non-small cell lung cancer: focus on docetaxel.

Systemic chemotherapy with platinum-based combinations provides modest improvements in both survival and quality of life for patients with advanced non-small cell lung cancer (NSCLC). For first-line treatment of advanced NSCLC patients with a good performance status, the accepted standard of care is a platinum agent combined with docetaxel, paclitaxel, gemcitabine, vinorelbine or irinotecan. Several studies have attempted to identify an optimal platin-based regimen, however, all regimens offer some combination of clinical benefit with characteristic toxicities and no regimen appears clearly superior. Non-platinum regimens have also shown equivalent efficacy compared to platinum combinations, but again, none are clearly superior. Most recently, the existing standard of care is being amended to reflect the survival advantage gained from adding a new targeted agent, bevacizumab, to traditional platinum-doublet therapy for patients with non-squamous NSCLC. Docetaxel is the only agent currently approved for both first- and second-line treatment of advanced NSCLC. Multiple randomized clinical trials have established the efficacy of platin-docetaxel regimens for first-line treatment of advanced NSCLC. Improvements in various lung cancer related symptoms and global quality of life indices have also been noted with docetaxel-based regimens. Based on the efficacy of platin-docetaxel regimens in advanced disease, they are now being incorporated into the adjuvant and neoadjuvant treatment of early-stage disease.

Journal Article↗