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PubMed1979

Newer experimental methods for classifying depression. A report from the NIMH collaborative pilot study.

A total of 83 patients receiving diagnoses of major depressive disorder in the pilot phase of the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression were used to evaluate two newer methods of classifying depressive disorders on the basis of family history or course. A third subtype based on family history, nonfamilial depression, was compared with the two subtypes originally proposed by Winokur and colleagues, pure depression and depression spectrum diseases. The system for classifying depressions on the basis of course and antecedent disorder, primary vs secondary depression, was also compared. These data from the pilot study indicate that two newer systems for classification have some predictive, construct, and content validity, but both are in need of further investigation before they become accepted methods for the classification of depressive disorders.

Depression↗

PubMed2006

Dual protection: more needed than practised or understood.

Although non-barrier contraceptive use has become a global norm, unprotected sex in relation to sexually transmitted infections remains the norm almost everywhere. Dual protection is protection from unwanted pregnancy, HIV and other sexually transmitted infections, and is a form of safer sex for heterosexual couples that is more needed than practised or understood. This paper draws on a review of the literature in family planning, obstetrics and gynaecology, and AIDS-related journals from 1998 to early 2005. Definitions of dual protection, found mainly in family planning literature, are very narrow. Condoms remain the mainstay of dual protection, but the aim of this paper is to provide an expanded list of dual protection methods to show that there is a range of options. These include non-penetrative sex and the increasing use of condoms with the back-up of emergency contraception on the part of young people. The fact that people may fail to use dual protection consistently and correctly is not a valid reason not to promote it. It is never too late for those providing family planning and STI/HIV prevention services to start promoting condoms and dual protection. In the long-term, the development of highly efficacious and highly acceptable methods of dual protection is an urgent research priority, starting with a wider range of condoms that will appeal to more people.

Condoms↗

PubMed1990

Results of a multilateral study with Anteovin.

The development of biphasic oral contraceptives is briefly reported and the theoretical basis and advantages of the biphasic method are discussed. The clinical observations referring to Anteovin which have been published until present are summarized and data of 43 authors are statistically analysed. Target specific examinations on the haemostasis and lipid metabolism influencing effect of Anteovin are mentioned. The therapeutic usefulness of biphasic tablet is analysed, the age-related possibilities, the problems of drug interactions and the dermatological advantages of the product are also discussed. With the present study the author wants to prove that the use of the low-dose multiphasic tablets is at present the most acceptable method of oral contraception.

Adolescent↗

PubMed2000

Compliance with tricyclic antidepressants: the value of four different methods of assessment.

AIMS: To assess the advantages and disadvantages of four methods for studying compliance with antidepressants: self-report scores, tablet counts, a microprocessor (MEMS) container system and the assay of nordothiepin and dothiepin concentrations in plasma. METHODS: The techniques were used in 88 patients commencing tricyclic antidepressants in the setting of UK general practice. RESULTS: The MEMS system proved to be the most informative technique allowing identification of the precise time of container opening, the demonstration of 'drug holidays' and early cessation of therapy. Self-report scores (Morisky) proved a useful screening technique with a sensitivity of 72.2% and specificity of 74.1% for > or = 80% compliance. Although tablet counts were possible in 84 patients (95. 5%) they were unreliable in 19 (21.6%). Blood concentration assays proved the least acceptable method to patients and were possible in only 53 (60.2%). A ratio of nordothiepin:dothiepin > or = 1.1 claimed, by others, to identify noncompliance was only reliable when concentrations were low. CONCLUSIONS: Both the MEMS system and self-report scores proved useful methods for identifying noncompliant patients in the setting of UK general practice. Although compliance was higher than reported in previous studies with 70 patients (79.5%) completing 6 weeks treatment, general practitioners tended to prescribe subtherapeutic doses.

Adult↗

PubMed1999

Protein binding of piroxicam studied by means of affinity chromatography and circular dichroism.

The protein binding of piroxicam, a widely used non-steroidal anti-inflammatory drug has been investigated by high-performance liquid affinity chromatography, with phenylbutazone and diazepam used as markers for binding-site characterization, and by circular dichroism titration. It was found that piroxicam binds to high-affinity phenylbutazone-binding sites and to high-affinity diazepam-binding sites. No binding to the low-affinity sites of either marker was established. High values of the primary (high-affinity) binding constants corresponding to both types of binding site were obtained by means of a mathematical method cited in the literature. The circular dichroic spectra of piroxicam were studied at a given albumin concentration and various drug concentrations. A new Cotton effect was observed and was ascribed to the binding of piroxicam to the protein molecule. The values of differential molar ellipticity (delta theta) were treated by a new mathematical procedure for analysis of the data obtained. A high affinity constant was calculated for one class of binding site. Its value is in good agreement with the values obtained by affinity chromatography. These results reveal that circular dichroism is an acceptable method for investigation of protein binding.

Binding Sites↗

PubMed2005

A practical comparison of group-sequential and adaptive designs.

Sequential methods provide a formal framework by which clinical trial data can be monitored as they accumulate. The results from interim analyses can be used either to modify the design of the remainder of the trial or to stop the trial as soon as sufficient evidence of either the presence or absence of a treatment effect is available. The circumstances under which the trial will be stopped with a claim of superiority for the experimental treatment, must, however, be determined in advance so as to control the overall type I error rate. One approach to calculating the stopping rule is the group-sequential method. A relatively recent alternative to group-sequential approaches is the adaptive design method. This latter approach provides considerable flexibility in changes to the design of a clinical trial at an interim point. However, a criticism is that the method by which evidence from different parts of the trial is combined means that a final comparison of treatments is not based on a sufficient statistic for the treatment difference, suggesting that the method may lack power. The aim of this paper is to compare two adaptive design approaches with the group-sequential approach. We first compare the form of the stopping boundaries obtained using the different methods. We then focus on a comparison of the power of the different trials when they are designed so as to be as similar as possible. We conclude that all methods acceptably control type I error rate and power when the sample size is modified based on a variance estimate, provided no interim analysis is so small that the asymptotic properties of the test statistic no longer hold. In the latter case, the group-sequential approach is to be preferred. Provided that asymptotic assumptions hold, the adaptive design approaches control the type I error rate even if the sample size is adjusted on the basis of an estimate of the treatment effect, showing that the adaptive designs allow more modifications than the group-sequential method.

Algorithms↗

PubMed2003

Reversing urban decay: brownfield redevelopment and environmental health.

While the United States government concentrates more of its political and financial resources on fighting terrorism, the continuing decay of older cities and industrial suburbs has fallen far down on the national political priority agenda. An exception is the redevelopment of so-called brownfields, which are abandoned, idled, or underutilized factories, railroad yards, bus stations, garages, electricity-generating stations, and other commercial facilities. A modest national government program to identify, clean up, and redevelop brownfields into job fields began during the administration of Bill Clinton and has continued into the George W. Bush administration (Powers et al. 2000; Simons 1998; Van Horn et al. 1999). The political reasons are apparent: Developing brownfields is a politically acceptable method of stimulating private enterprise, local government, and community groups into building new businesses, housing, and community facilities. Also, brownfields projects have a beginning and an end; the national government does not have an indefinite responsibility. In contrast, social assistance programs that grew during the 1960s and proliferated for more than three decades have been politically portrayed by some as give-away programs that build dependency with no ending. Whether this characterization of social programs is morally or empirically justified, the reality is that in today's political environment brownfields redevelopment is a politically acceptable way of helping distressed urban areas.

Cities↗

PubMed1991

A convenient method for differentiation of coagulase-negative staphylococci isolated from bovine mammary glands.

The utility of trehalose-mannitol broth and arabinose-cellobiose broth for identification of Staphylococcus epidermidis and novobiocin-resistant staphylococci was determined using 236 coagulase-negative staphylococci isolated from bovine mammary glands. None of the 49 S. epidermidis strains was positive in trehalose-mannitol broth; whereas, all strains of Staphylococcus hyicus, Staphylococcus chromogenes, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warneri, and Staphylococcus simulans were positive. Of the novobiocin-resistant staphylococcal species, only Staphylococcus saprophyticus was negative in arabinose-cellobiose broth. Except for one strain of Staphylococcus sciuri and one strain of Staphylococcus kloosii, all remaining strains of novobiocin-resistant staphylococcal species were positive in arabinose-cellobiose broth. Results indicate that trehalose-mannitol broth is an acceptable method for identification of S. epidermidis isolated from bovine mammary glands. Furthermore, arabinose-cellobiose broth is a useful method of screening for novobiocin-resistant staphylococci.

Animals↗

PubMed1981

[Evaluation of a complex method of identifying enteropathogenic Escherichia using O- and H-sera and a rational combination of biochemical tests].

A complex method for the identification of enteropathogenic Escherichia by means of adsorbed monogroup and factor O-sera, H-sera and a rational combination of biochemical tests (using triple sugar iron agar or Kligler iron agar, Simmons citrate agar, phenylalanine-, urea-, sodium malonate-containing media, indole broth, medium for mobility determination) was evaluated. The use of adsorbed monogroup O-sera in the slide agglutination test reduced the time of the study and increased its accuracy by 20.0 +/- 2.5% (6.9 +/- 2.5% to 52.4 +/- 11.1% for Escherichia of different O-groups) in comparison with the generally accepted method. The use factor O-sera and H-sera and H-sera revealed the circulation of the same O-groups belonging to different serovars and differing in partial composition a O-antigen (of the type ab - ac) and in H-antigens, which should be taken into consideration for epidemiological purposes. The combination of biochemical tests ensured correct determination of the genus of the organisms under study. The tested method is recommended for practical use.

Escherichia↗

PubMed1989

[Continuous axillary catheter plexus anesthesia--a method of postoperative analgesia and sympathetic nerve block following hand surgery].

During a period of one year (March 1985 to March 1986) 52 axillary brachial plexus catheters were left in place for two to twelve days. The main indications were postoperative analgesia and sympatholysis after microvascular surgery of the hand. With the continuous infusion of 0.25% or 0.375% bupivacaine, 6-8 ml/h a sufficient effect was seen. There was no evidence of accumulation of the administered drug after a prolonged period of infusion. A steady state of serum levels built up in the range between 0.5 to 1.5 micrograms/ml. There were no toxic side effects by the local anaesthetic agent. In one case an infection of the axillary region developed, which disappeared after removal of the catheter without any consequences. In summary the continuous axillary brachial plexus block is an acceptable method for intra and postoperative analgesia and sympatholysis in microvascular surgery of the hand.

Autonomic Nerve Block↗

PubMed1977

Inhibition by concanavalin A as the basis for a specific assay of serum 5'-nucleotidase activity.

Concanavalin A inhibits serum 5'-nucleotidase activity, without causing significant inhibition of alkaline phosphatase activity. This observation serves as the basis for a new method for assaying the 5'-nucleotidase activity in serum, which depends upon the difference between the enzymic hydrolysis of adenosine-5'-monophosphate in the presence and absence of concanavalin A. A denosine released by the 5'-nucleotidase reaction is deaminated by a coupled reaction with adenosine deaminase to liberate inosine and ammonia, and ammonia is measured colorimetrically by the Berthelot reaction. In sera from 40 healthy adult persons, 5'-nucleotidase activity averaged 6.4 U/liter (SD, +/-2.0; range, 3-12). In sera from 100 patients, measurements of 5'-nucleotidase activity by the new assay averaged 8% lower than by a generally accepted method in which phenyl phosphate is used to suppress hydrolysis of adenosine-5'-monophosphate by alkaline phosphatase activity. The clinical validy of the new assay was tested by measuring serum 5'-nucleotidase activities in rats with bile duct ligation and in rats treated with thioacetamide to induce hepatocellular injury.

Adult↗

PubMed1986

Intraocular pressure--physiology and implications for anaesthetic management.

The major factors controlling intraocular pressure during surgery are the dynamic balance between aqueous humour production in the ciliary body and its elimination via the canal of Schlemm; the auto-regulation and chemical control of choridal blood volume; the extraocular muscle tone and vitreous humour volume. Prior to surgical incision of the anterior chamber in open intraocular procedures, a low-normal intraocular pressure is mandatory to avoid the hazards of iris or lens prolapse and vitreous loss associated with sudden decompression. In general, the central nervous system depressant drugs, hypnotics, narcotics, major tranquillizers, volatile anaesthetic agents are associated with a reduction in intraocular pressure, with the exception of ketamine and possibly trichloroethylene. The mechanism of action of anaesthetic agents in reducing intraocular pressure may involve a direct effect on central diencephalic control centres, reduction of aqueous production, facilitation of aqueous drainage or relaxation of extraocular muscle tone. Succinylcholine administration is associated with a significant rise in intraocular pressure, with a peak increase between two to four minutes following administration and a return to base line values after six minutes. The intraocular hypertensive effect may be due to a tonic contraction of the extraocular muscles, choroidal vascular dilatation or relaxation of orbital smooth muscle. Despite many claims to the contrary, no reported method to date has been shown to consistently prevent the intraocular hypertensive response to intravenous succinylcholine administration. Because the non-depolarizing relaxants are associated with a reduced intraocular pressure, a barbiturate-non-depolarizing relaxant technique utilizing preoxygenation and cricoid pressure has evolved as the most commonly employed induction technique for the emergency repair of a penetrating eye injury. The alternative non-depolarizing relaxant pretreatment-barbiturate-succinylcholine technique may offer the advantages of more rapid onset of relaxation with only minor increases in intraocular pressure and in a carefully controlled rapid sequence induction technique may be the most acceptable method of handling emergency penetrating eye injuries.

Anesthesia↗

PubMed2005

Preferences and practices related to vaginal lubrication: implications for microbicide acceptability and clinical testing.

BACKGROUND: Research on vaginal microbicides for HIV prevention is progressing rapidly; the first large-scale effectiveness trials were launched in 2004. The majority of candidate microbicides are formulated as gels, which will act as lubricants when used during sex. Preferences and practices regarding lubrication during sex, therefore, likely influence microbicide acceptability and use. Researchers seek to maximize consistent and correct use of candidate microbicides during clinical trials to enable valid estimates of product effectiveness, and if proven effective, microbicides will be widely used only if acceptable. METHODS: We conducted a comprehensive literature review and interviewed 13 key informants from nine countries in Africa, Asia, Latin America, and North America. RESULTS: We found that norms and practices regarding lubrication during sex exist in many different countries. Despite significant variation, common themes emerged. In the majority of countries, women's genital hygiene is highly valued, and women are expected to achieve a moderate amount of vaginal lubrication during sex that is neither excessive nor inadequate. Women may try to achieve this by engaging in a wide variety of vaginal practices. CONCLUSIONS: Even though some informants expressed concerns about the acceptability of lubricating microbicides in some settings, they thought that microbicides should be developed, that women and men may be willing to accept a certain level of increased lubrication in exchange for protection from HIV, and that lubricating microbicides may be considered more acceptable when perceived as genital hygiene products. Recommendations are made on how to take vaginal practices into account during clinical testing of microbicides.

Administration, Intravaginal↗

PubMed1991

ABO-incompatible pediatric bone marrow transplantation: a simple method to remove red blood cells from small volume marrow grafts.

A simple and reliable technique for removal of ABO incompatible marrow red cells is described. This method requires a blood cell processor and third party red cells are used as a shelf. Using this technique, nine children age 0.5-11.5 years received allogeneic bone marrow transplantation from ABO incompatible donors. A median of 4.8 ml of incompatible red cells were transfused. There was no evidence of a hemolytic transfusion reaction in any patient. A median of 75% of nucleated marrow cells were recovered and used for transplantation. Engraftment occurred at the same time as with ABO compatible transplants. Autologous marrow red cells were reinfused into four young donors. This 'shelf' technique for red cell depletion is an acceptable method for processing small volume, ABO incompatible marrow harvests from pediatric donors.

ABO Blood-Group System↗

PubMed2005

Comparison of body fatness measurements by BMI and skinfolds vs dual energy X-ray absorptiometry and their relation to cardiovascular risk factors in adolescents.

OBJECTIVE: To compare estimates of adiposity by dual emission X-ray absorptiometry (DXA), skinfolds and body mass index (BMI); and to evaluate the relation of these measures to cardiovascular risk in adolescents. DESIGN: In a cohort of adolescents participating in a longitudinal study of insulin resistance, Slaughter formulas were used to estimate adiposity from skinfolds and DXA was used to estimate adiposity as % body fat (%BF) and fat mass (FBM). BMI, blood pressure, lipids and insulin resistance were measured. SUBJECTS: Male and female, 11-17 y old (n=130). MEASUREMENTS: To compare DXA with two office-based methods of assessing fatness and cardiovascular risk. RESULTS: Slaughter estimates were highly correlated with DXA (%BF r=0.92, P=0.0001; FBM r=0.96, P=0.0001). Correlations were similar in heavy and thin children. BMI was also highly correlated with DXA (%BF r=0.85, P=0.0001; FBM r=0.95, P=0.0001), and these relations were stronger in heavy than thin children. BMI and the Slaughter formulas were similar to DXA in their relations to cardiovascular risk factors. CONCLUSIONS: Adiposity by BMI and Slaughter formulas are highly correlated with DXA and similarly related to cardiovascular risk factors. BMI is easy to obtain and is an acceptable method for initial office estimation of body fatness. BMI and skinfolds compare well with DXA in predicting adverse cardiovascular risk profile.

Absorptiometry, Photon↗

PubMed2000

[Prevention of vaginal prolapse in patients undergoing abdominal hysterectomy].

BACKGROUND: In our study we evaluate a personally developed surgical technique that, when used for abdominal hysterectomy, helps prevent posthysterectomy vaginal wall prolapse. METHODS: We have used this modified surgical procedure in 244 consecutive abdominal hysterectomies performed from January 1973 through December 1986, compared with 133 abdominal hysterectomies performed without this new procedure. Patients returned monthly and annually thereafter for follow-up. The longest follow-up period to date is 12 years. RESULTS: Of the 244 patients in our study followed up for 12 years, 234 (95.9%) retained excellent vaginal support. Vaginal wall prolapse occurred in 10 patients (4.1%), and it was asymptomatic prolapse, with the vaginal wall descending less than halfway from the ischial spines to the hymen. CONCLUSIONS: This procedure is an acceptable method to help prevent posthysterectomy vaginal wall prolapse.

Adult↗

PubMed2004

[Maxilla reconstruction with the free iliac osteomuscular flap and simultaneous osseointegrated implant embeding].

OBJECTIVE: To evaluate the clinical outcome of reconstruction of maxillary defects with vascularized iliac crest flap and simultaneous osseointegrated implant embedding. METHODS: During September to October 2003, two patients with maxillary defects from tumor resection underwent microsurgical reconstruction. The free iliac osteomuscular flap transferring and simultaneous osseointegrated implant embedding were performed to repair the defects. Three months after the reconstructive surgery, an abutment operation was preformed and denture was applied in both cases. RESULTS: The flaps survived well. Postoperative follow-up for 8 to 9 months showed that the patients obtained good zygomaxillary appearance, normal occlusion, and satisfactory pronunciation, without oronasal fistula or other serious complications. CONCLUSIONS: The free iliac crest osteomuscular flap with simultaneous osseointegrated implant embedding is an ideal, effective and cosmetically acceptable method for maxilla reconstruction.

Adult↗

PubMed1981

Comparison of an immunoassay and a microbiological assay for tobramycin serum concentrations.

An enzyme multiplied immunoassay technique (EMIT) and a microbiological assay were compared as methods for determining the concentration of tobramycin in human serum. Tobramycin sulfate in various concentrations (0.4-20.0 microgram/ml) was dissolved in lyophilized human serum. Tobramycin concentration was determined by EMIT assay and a microbiological agar diffusion assay using Bacillus subtilis ATCC 6633 as the test organism. Serum samples of 162 patients who received tobramycin 60 mg i.m. were also assayed by the two methods. The effect of six antibiotics on the determination of tobramycin concentration by EMIT assay was measured. To test whether freezing affects tobramycin concentration measured by EMIT assay, tobramycin in five concentrations in lyophilized human serum were frozen and analyzed at weekly intervals for seven weeks. The concentration of tobramycin determined by EMIT assay and microbiological assay in both lyophilized human serum and patient samples were highly correlated (r = 0.994 and 0.949) respectively). Dibekacin, an aminoglycoside structurally similar to tobramycin, interfered with the determination of tobramycin concentration. No effect of freezing was observed. The results of this study show that EMIT assay is an acceptable method for routine laboratory analysis of tobramycin serum concentration. It is as accurate as the microbiological assay tested.

Anti-Bacterial Agents↗