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Determination of arsenic, cadmium, cobalt, chromium, lead, molybdenum, nickel, and selenium in fertilizers by microwave digestion and inductively coupled plasma-optical emission spectrometry detection: collaborative study.

There is increasing regulatory interest in the non-nutritive metals content of fertilizer materials, but at present there is no consensus analytical method for acid digestion and instrument detection of those elements in fertilizer matrixes. This lack of method standardization has resulted in unacceptable variability of results between fertilizer laboratories performing metals analysis. A method has been developed using microwave digestion with nitric acid at 200 degrees C, followed by inductively coupled plasma-optical emission spectrometry instrument detection, for the elements arsenic, cadmium, cobalt, chromium, molybdenum, nickel, lead, and selenium. The method has been collaboratively studied, and statistical results are here reported. Fourteen collaborators were sent 62 sample materials in a blind duplicate design. Materials represented a broad cross section of fertilizer types, including phosphate ore, manufactured phosphate products, N-P-K blends, organic fertilizers, and micro-nutrient materials. As much as possible within the limit of the number of samples, materials were selected from different regions of the United States and the world. Limit of detection (LOD) was determined using synthetic fertilizers consisting of reagent grade chemicals with near zero levels of the non-nutritive elements, analyzed blindly. Samples with high iron content caused the most variability between laboratories. Most samples reasonably above LOD gave HorRat values within the range 0.5 to 2.0, indicating acceptable method performance according to AOAC guidelines for analyses in the mg/kg range. The method is recommended for AOAC Official First Action status.

Fertilizers↗

Importance of various methods of blood pressure measurement in clinical trials.

Ambulatory blood pressure (ABP) monitoring and self-measurement of blood pressure (BP) are more reproducible than clinic BP measurement, minimize the white coat effect, and can reduce the sample size necessary to demonstrate the efficacy of a drug in clinical trials. For many years, the trough:peak ratio has been considered the key index for demonstrating the efficacy of antihypertensive agents. However, several potential problems are associated with the use of this index, and ABP monitoring makes it possible to examine changes in BP over the entire 24-hour period, not only at a preset time of peak effect and at the end of the dosing interval. The smoothness index provides more comprehensive information on the 24-hour BP control with treatment and avoids part of the problems encountered with the trough:peak ratio. One simple way to summarize the results of ABP monitoring in clinical trials is to provide the mean 24-hour BP difference from placebo and the BP decrease at trough. The numerous advantages summarized above make ABP monitoring an accepted method of BP measurement in hypertension therapy trials. Self-measurement of BP may be a valid and less expensive alternative to ABP monitoring.

Antihypertensive Agents↗

A clinical study of the effect of pellicle on the degradation of 10% carbamide peroxide within the first hour.

OBJECTIVE: The purpose of this study was to determine the degradation of 10% carbamide peroxide within the first hour of use and the effect of pellicle on the degradation of carbamide peroxide in vivo. METHOD AND MATERIALS: Fifteen subjects were assigned to wear nightguard trays filled with bleaching gel for 0.5, 2.5, 5.0, 10.0, 20.0, 40.0, and 60.0 minutes under 2 conditions: (1) subjects did not receive a prophylaxis before each bleaching treatment (pellicle was assumed to be present on the tooth surface); and (2) subjects received prophylaxis to remove pellicle from the tooth surface. At each evaluation time, 3 types of sample were collected: (1) a "grab sample," a sample of gel taken with a spatula from the reservoir of the tray on the maxillary right central incisor; (2) the remaining gel from the tray; and (3) the remaining gel scraped from the teeth. The collected gel samples were analyzed for the amount of peroxide using the United States Pharmacopeia-accepted method. Subjects were asked not to swallow the saliva during treatment but to expectorate into a beaker. The collected saliva was analyzed to determine the amount of peroxide. This sample represented the approximate amount of peroxide that subject would ingest during treatment. RESULTS: Pellicle did not affect the degradation of carbamide peroxide for the teeth or grab samples. The degradation of carbamide peroxide was exponential, except during the first 5 minutes, when the degradation rate was much higher. The saliva collected from subjects during use of the bleaching tray revealed an average of 2.1 mg of carbamide peroxide for 1 hour of bleaching treatment. CONCLUSION: The degradation rate is not affected by the removal of the pellicle.

Analysis of Variance↗

[Effectiveness and patient tolerance of screening colonoscopy -- first results].

BACKGROUND: In Germany screening colonoscopy was introduced into the national program on colorectal cancer prevention in October 2002 for asymptomatic subjects older than 55 years. It is the aim of this program to reduce the rate of mortality of colorectal cancer (CRC) during the next decade. Up to now no data are available concerning the outcome and patient tolerance of screening colonoscopy. METHODS: Patients were enrolled in the prospective study between October 2002 and June 2003. The diagnoses from colonoscopy and complications were recorded. A short interview provided information on individual family risks of CRC. During June 2003 all subjects were handed a questionnaire to evaluate their satisfaction and tolerance concerning screening colonoscopy. All subjects were offered sedation (Disoprivan: Propofol). RESULTS: A total of 1117 subjects (776 [69.5 %] female, 341 [30.5 %] male) underwent screening colonoscopy; age: 64.3 +/- 6.9 years. 1104 (98.8 %) requested sedation. In 1090 cases (97.6 %) colonoscopy was completed to the cecum (photographic documentation of cecal landmarks). A total of 11 patients had invasive cancer (1 %), 4 of these had adenomas containing invasive carcinoma. The stage was T1/N0 or T2/N0. A total of 138 (12.4 %) patients had 168 polypoid lesions, which were treated by complete polypectomy. 402 small polypoid lesions (< 0.5 cm) were only detected by biopsy. In this group 233 adenomas (20.9 %) were found. Complications were: 1 perforation and 4 haemorrhages after polypectomy. Patient tolerance was very high. 99.4 % of all subjects agreed to a control colonoscopy or recommended screening colonoscopy to their relatives and friends. CONCLUSION: Screening colonoscopy is an effective and well-accepted method in our unit for gastroenterology. The high prevalence of adenoma and invasive carcinoma suggests that screening colonoscopy should be provided for all persons at the age of 55, especially for men.

Adenoma, Villous↗

Recurrent urinary conduit bleeding in a patient with portal hypertension: management with a transjugular intrahepatic portosystemic shunt.

OBJECTIVE: To determine if a transjugular intrahepatic portosystemic shunt can control recurrent urinary conduit bleeding in a patient with portal hypertension. METHODS: Following transjugular catheterization of the right hepatic vein, a long curve Colapinto needle was advanced through the liver parenchyma into the portal vein near its bifurcation. After a guide wire exchange, a catheter was advanced into the portal system and venogram was obtained. Following another guide wire exchange, a balloon angioplasty catheter was used to create the shunt by dilating the parenchymal tract between the hepatic and portal veins. A self-expandable stent was used to ensure patency of the shunt. RESULTS: After shunt placement, bleeding from the ileal conduit and stroma decreased significantly. A duplex ultrasound at five-month follow-up demonstrated the shunt to be completely patent. CONCLUSIONS: Based on this limited experience, it appears that the transjugular, intrahepatic, portosystemic shunt is an acceptable method to control massive, recurrent urinary conduit bleeding in patients with portal hypertension.

Aged↗

Registration of natural head posture in children.

A method for registration of natural head posture is presented. The subject is photographed with contrast markers positioned on one side of the face and an adjacent plumb line as vertical reference. Systematic errors due to rotation and lateral tipping movements of the head were shown to be small and of no clinical importance. The measurement error in the transfer of the plumb line from profile photograph to lateral skull radiograph was shown to be small. Extension-flexion movements were found to have a standard deviation of 2 degrees about the mean in a group of patients between the ages of 12-14 years. Earlier studies show similar results for adults. The study supports the mirror-orientated registration of head posture viewed laterally in children as a biologically acceptable method.

Adolescent↗

A study to determine the efficacy of combination LED light therapy (633 nm and 830 nm) in facial skin rejuvenation.

BACKGROUND: The use of visible or near infrared spectral light alone for the purpose of skin rejuvenation has been previously reported. A method of light emitting diode (LED) photo rejuvenation incorporating a combination of these wavelengths and thus compounding their distinct stimulation of cellular components is proposed.Objective. To assess the efficacy and local tolerability of combination light therapy in photo rejuvenation of facial skin. METHODS: Thirty-one subjects with facial rhytids received nine light therapy treatments using the Omnilux LED system. The treatments combined wavelengths of 633 nm and 830 nm with fluences of 126 J/cm(2) and 66 J/cm(2) respectively. Improvements to the skin surface were evaluated at weeks 9 and 12 by profilometry performed on periorbital casts. Additional outcome measures included assessments of clinical photography and patient satisfaction scores. RESULTS: Key profilometry results Sq, Sa, Sp and St showed significant differences at week 12 follow-up; 52% of subjects showed a 25%-50% improvement in photoaging scores by week 12; 81% of subjects reported a significant improvement in periorbital wrinkles on completion of follow-up. CONCLUSION: Omnilux combination red and near infrared LED therapy represents an effective and acceptable method of photo rejuvenation. Further study to optimize the parameters of treatment is required.

Adult↗

Knowledge, self-help and socioeconomic factors in South Asian and Caucasian diabetic patients.

AIMS: We carried out a survey of important nonclinical issues including awareness and self-management of diabetes on a group of South Asian and Caucasian patients attending diabetic clinics within a set period. METHODS: A structured questionnaire examined various issues including demographics, perceived knowledge and awareness of diabetes, perceived self-help/support, and psycho-social factors. A total of 500 patients (268 South Asians and 232 Caucasian) took part. RESULTS: Univariate analysis showed significant differences (P<0.05) with various issues including a lower perceived awareness of diabetes and its complications in South Asians, and of the nutritional content of their diet. Asians also appeared to be less worried in the event of missed clinical appointments and if treatment was not strictly adhered to. CONCLUSIONS: The study provides evidence of the inability of health information systems to convey the importance of diabetic control to the Asian population. In order that this important information reaches the required recipients, more assertive and perhaps more culturally acceptable methods need to be explored.

Adult↗

Assessment of clinical outcome after flashlamp pumped pulsed dye laser treatment of portwine stains: a comprehensive questionnaire.

A generally accepted method to assess the clinical outcome of laser treatment of portwine stains is not available. This paper describes the development and evaluation of a comprehensive questionnaire for the assessment of the following portwine stain characteristics: color (hue and lightness), sharpness of boundary, pigmentation, size, shape, skin surface-structure, and hypertrophy of underlying tissue. The questionnaire was applied to photographs of 70 patients with previously untreated portwine stains in the head/neck area. Photographs were taken before treatment and after five treatments of the entire portwine stain with a flashlamp pumped pulsed dye laser. Each photograph was evaluated separately by a panel of five professionals: the treating physician, two plastic surgeons, a dermatologist, and a clinical photographer. Treatment results were assessed by comparing ratings before and after treatment. Agreement among raters was acceptable for all portwine stain characteristics, as was shown by weighted kappa analysis. The reliability of the answers was further improved by taking the average rating of the five panel members. The scores thus obtained were very reliable, with Cronbach alpha coefficients of 0.8 on average. After five treatments of the entire portwine stain, the most considerable changes were measured in the ratings for color (lightening of the stain by 33 percent), boundary (sharpness reduced by 38 percent), and size (13-percent decrease). Using the questionnaire can be helpful in the design of comparative clinical trials on portwine stain treatment and may facilitate comparison of treatment results between different treatment centers and/or different lasers.

Adolescent↗

Parents'/guardians' willingness to vaccinate their children against genital herpes.

PURPOSE: To describe parents' acceptance of a hypothetical herpes simplex virus type 2 (HSV-2) vaccine, attitudes toward vaccine legislation, beliefs regarding appropriate timing of vaccination and correlates of vaccine acceptance. METHODS: A telephone survey of 315 parents/guardians in the Southeast United States. Descriptive statistics describe the sample's overall attitudes toward HSV-2 vaccination, vaccine legislation, and age preferences. A logistic regression model tested the correlates of intention to vaccinate their children against HSV-2. RESULTS: A majority of parents (69%) said they would have their children vaccinated. Nearly one-third (29.3%) thought genital herpes vaccination should take place between the ages of 11 and 13 years. Logistic regression revealed that females, single parents, parents whose children had influenza shots, those with more favorable attitudes to vaccination in general, and those who believed sexually transmitted disease (STD) vaccines would be beneficial were more likely to state they would vaccinate their children. CONCLUSIONS: Overall, a large proportion of parents indicated they would accept HSV-2 vaccination for their children. These results help identify those parents who may or may not be open to vaccinating their children against HSV-2 and inform future interventions to encourage HSV-2 vaccination. This research highlights the need for interventions that differentially target those who would and would not be likely to support vaccination of their children. Results also indicate that many parents believe vaccination should be given after an age when many adolescents have initiated sexual activity. Interventions to promote STD vaccines should not only encourage vaccination, but should also seek to change parental attitudes about optimal timing of the vaccination.

Adolescent↗

A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias.

BACKGROUND/PURPOSE: The aim of this study was to determine whether a novel laparoscopic technique for pediatric umibilical and epigastric hernia repair is safe, quick, effective, durable, and cosmetically acceptable. METHODS: Forty-one consecutive umbilical and 13 epigastric hernias were repaired laparoscopically. Six patients had concomitant epigastric and umbilical hernias repaired during one procedure. Two 3-mm ports were used via a lateral approach. Mean age was 4.2 years for those with an umbilical hernia and 2.0 years for those with an epigastric hernia. RESULTS: All procedures were completed laparoscopically. The mean operative time was 27 minutes for umbilical hernia repair and 16 minutes for epigastric hernia repair. There were no intraoperative or postoperative complications. Follow-up was 100% and ranged from 6 to 35 months. There have been no recurrent hernias, and patient/parent satisfaction was subjectively excellent. CONCLUSION: This case series demonstrated that this novel technique of laparoscopic anterior abdominal wall hernia repair is safe, quick, effective, durable, and cosmetically acceptable. It requires few instruments and minimal advanced laparoscopic techniques.

Child, Preschool↗

DNA microsatellite analysis using ion-pair reversed-phase high-performance liquid chromatography.

Genotyping based on short tandem repeat (STR) regions is used in human identification and parentage testing, gene mapping studies, cancer diagnostics, and diagnosis of hereditary diseases. Analysis of STR systems using slab gel electrophoresis requires lengthy and labor-intensive procedures. Therefore, alternative methods such as capillary electrophoresis or ion-pair reversed-phase high-performance liquid chromatography (IPRP HPLC) have been used to analyze DNA. IPRP HPLC offers an attractive substitute to gel electrophoresis for STR analysis because of the reduced analysis time, and there is no need for the waste disposal associated with radioisotopic, enzyme-linked, or fluorescence detection systems. We evaluated the use of IPRP HPLC for the sizing and typing of STR alleles from the HUMTHO1 locus. The IPRP HPLC conditions (column temperature, flow rate, percent organic modifier per minute) were optimized for the separation of PCR products. Using the optimized separation conditions, the alleles of the HUMTHO1 system were sized in their native state (double standard) with the use of internal markers. The typing results correlated 100% to accepted methods of DNA typing. The analysis time for the HUMTHO1 locus was less than 14 min, and the alleles could be peak captured for further examination following such as sequencing.

Alleles↗

Pharmacokinetic model selection for target controlled infusions of propofol. Assessment of three parameter sets.

BACKGROUND: Computer-assisted target controlled infusions (TCI) result in prediction errors that are influenced by pharmacokinetic variability among and within patients. It is uncertain whether the selection of a propofol pharmacokinetic parameter set significantly influences drug concentrations and clinical acceptability. METHODS: Thirty patients received similar propofol TCI regimens after being randomly allocated to one of three parameter sets. Arterial and venous concentrations were measured and prediction errors calculated from pooled and intrasubject data. RESULTS: Arterial propofol concentrations in the Dyck group revealed greater bias (mean 43%) than did those in the Marsh (-1%) and Tackley (-3%) groups. The Dyck group also showed greater inaccuracy (mean:47%) than the Marsh (29%) and Tackley (24%) groups. There was little tendency for measured concentrations to vary from targeted values over time (divergence). Variability about an observed mean in individual patients (wobble) was low. Venous propofol concentrations were initially much less than arterial concentrations, but this difference decreased over time. CONCLUSIONS: Although it may be preferable to administer propofol TCI by using a locally derived parameter set, it is acceptable to use a model from elsewhere. The Marsh and Tackley models produced equally good performance and are appropriate for propofol TCI within the range of 3-6 micrograms/ml. The Dyck model was less accurate at maintaining anesthetic concentrations, possibly because it was derived from low concentrations. Concentrations in blood, the most sensitive indicators of performance, demonstrated differences among the parameter sets. Clinically, TCI worked well, and by clinical criteria, the choice of pharmacokinetic model did not appear to make a difference.

Adult↗

Tension band fixation of medial malleolus fractures.

A prospective study on tension band fixation of medial malleolus fractures was performed on 30 consecutive patients with 31 fractures from October 1987 until December 1990. All patients had at least a displaced medial malleolus fracture unreduced by closed methods. The fractures were classified into small, medium and large using a modified Lauge-Hansen classification. There were no nonunions or movements of wires postoperatively and only two patients had subjective complaints with reference to the wires that required hardware removal. There was one 2-mm malreduction and one patient with a wound slough and subsequent osteomyelitis. One fragment had 2 mm of displacement after fixation but went on to union. A biomechanical study was undertaken to compare fixation of the medial malleolus with K wires alone, K wires plus a tension band, and two cancellous screws. The tension band fixation provided the greatest resistance to pronation forces: for times stiffer than the two screws and 62% of the intact specimen. Tension band fixation of the medial malleolus is a biomechanically strong and clinically acceptable method of treatment for displaced medial malleolus fractures. This method of fixation may be especially useful for small fragments and in osteoporotic bone.

Aged↗

A comparative study of the traditional long case with the objective structured clinical examination in Lagos, Nigeria.

An apparent difference in the results of the clinical examination of the final M.B., B.S. was observed following replacement of the traditional long case (TLC) with the Objective Structured Clinical Examination (OSCE) in 1979. This led to a study of the results of two consecutive years of each method, 1976 and 1978 (TLC), and 1979 and 1980 (OSCE). The OSCE pass rate of 61% was found to be significantly lower than TLC pass rate of 93% (P less than 0.05). Using the analysis of variance and the critical difference (CD) of the mean scores of the different types of examination, no significant difference was found to exist between the two TLC examinations or between the two OSCE examinations. However, significant difference exists between the TLC of 1978 and the OSCE of 1979, P less than 0.05. A comparison of the CD of MCQ to those of TLC and OSCE suggests that less differences exist between MCQ and OSCE scores compared to MCQ and TLC scores, and by 1980 no significant difference exists between MCQ and OSCE. OSCE, like MCQ, will therefore appear an acceptable method of examination and perhaps a more effective method of clinical examination than TLC.

Clinical Competence↗

Analysis of trauma outcome at a university hospital in Zahedan, Iran using the TRISS method.

OBJECTIVE: To evaluate validity of TRISS (Trauma score and injury severity score) method in trauma outcome analysis and compare trauma care at a university hospital, with the standards reported in the Major Trauma Outcome Study (MTOS). DESIGN: Analytical and descriptive study. SETTING: Khatam-ol-anbia University Hospital in Zahedan, Iran, from March 22, 1997 to March 21, 1998. SUBJECTS: Seven hundred and sixty eight consecutive patients with multiple trauma were included in the study. Survival analysis was completed for all of the patients. RESULTS: The majority of patients were men (82%), and the average age was 23 years. Seven hundred and one patients (91%) sustained blunt trauma, with road traffic accidents being the most common (59%). The predicted mortality was 3.1% and the observed mortality was 8%. The M-statistics was 0.91. CONCLUSION: In developing countries the same as developed countries, the TRISS methodology is an acceptable method for evaluation of the difference between predicted and observed mortality. This study shows that our mortality is significantly more than universal standards and there are weak points in our trauma care system.

Adult↗

Accuracy of pacifier thermometers in young children.

Nurses and families are continually searching for less invasive yet accurate methods of measuring temperature in children. Although pacifier thermometers are readily accessible to consumers, few studies report the accuracy of such instruments. This study aimed to determine the validity/reliability of one type of pacifier thermometer in approximating core body temperature using a prospective, within-subjects design, comparing pacifier and rectal temperatures in children (n=25), ages 7 days to 24 months, in one pediatric hospital-based setting. The mean +/-SD difference between rectal and supralingual temperatures adjusted upward by 0.5 degrees F was 0.012 degrees F +/- 0.777 degrees F, which was not statistically significant. The 95% confidence interval (-0.309-0.333) fit within the manufacturer specifications. The correlations between the rectal and adjusted pacifier temperature was 0.772 and between 3-and 6-minute pacifier temperatures was 0.913. These data provide support to previous assertions that pacifier thermometry is an acceptable method of temperature approximation in young children.

Cross-Sectional Studies↗

[Transvaginal echography in the study of urinary stress incontinence].

Hypermobility of the bladder neck in response to increased intraabdominal pressure is one cause of stress urinary incontinence in women. Vaginal ultrasound (u.s.) is reliable and minimally invasive method for demonstrating bladder neck hypermobility. The Authors studied 50 women with S.U.I. and 40 with no history of S.U.I. measuring the distance from the bladder neck to the midline of the symphysis pubis (P.V.) and the angle between the BP line and the midline of the symphysis pubis (A.I.U.). The continent women were characterized by a median A.I.U. of 70 degrees and mean B.P. of 25.6 mm, at rest, a median A.I.U. of 80 degrees and a mean B.P. of 20 mm. at stress. The incontinent women were characterized by a median A.I.U. of 80 degrees and mean P.V. of 22.5 mm. at rest, and a median A.I.U. of 95 degrees and mean P.V. of 10 mm. at stress. There is a significant difference between the two groups. The Authors recommend the vaginal u.s. as reliable, practical, economical and patient accepted method to study the bladder neck mobility.

Female↗