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Wildlife parasites: lessons for parasite control in livestock.

For sustainable livestock production it is suggested that the parasitologist take a leaf out of Nature's book in the search for solutions to the mounting problems concerning parasite control. While the farmer has come to regard all parasites affecting livestock as entirely without benefit, indigenous parasites and diseases are normal and play an essential role as interacting components of a natural environment in an ecosystem such as the 19,000 km2-sized Kruger National Park, Republic of South Africa. The parasites help to select their hosts for fitness and are assisted by predators and intra-species territorial aggression which continually eliminate the weak individuals from the system. It is essential to guard against the introduction of foreign parasites or infectious agents which have no real ecological niche or role in an established ecosystem, however, as they cause untoward interactions, sometimes of a violent nature. The policy must be to block off or, failing that, to control or eliminate these foreign parasites and diseases as far as possible. Often, when Man intervenes in an ecosystem, it leads to stress, overcrowding and stagnation and predisposes to disease and death. Intensification of the system, as in farming units, denies Nature the chance to manage on its own, because of clashing interests with Man. Frank parasitism and disease should almost invariably be seen as indicators of an imbalance in the ecosystem and should be rectified. Chemicals and vaccines should be used to produce sufficient food for all, but without exploiting Nature, or else Nature will be unable to continue catering for Man's needs.

Animals↗

Cancer treatment-induced bone loss in patients with breast or prostate cancer.

PURPOSE/OBJECTIVES: To review the prevalence, consequences, pathophysiology, diagnosis, and treatment of cancer treatment-induced bone loss (CTIBL) in patients with breast or prostate cancer. DATA SOURCES: Published articles, abstracts, book chapters, electronic resources, and manufacturer information. DATA SYNTHESIS: CTIBL is a long-term complication associated with cancer therapies that cause hypogonadism in patients with breast or prostate cancer. Early diagnosis and treatment of CTIBL is essential to prevent bone fractures. CTIBL treatment includes modification of lifestyles that increase the risk of developing bone loss and fractures and includes the use of bone loss therapies (e.g., bisphosphonates, selective estrogen receptor modifiers, calcitonin). CONCLUSIONS: CTIBL is becoming more common as patients with breast or prostate cancer survive longer. Identifying and treating CTIBL early are important because once bone is lost, damaged bone becomes more difficult to repair; early diagnosis and treatment also may prevent fractures. IMPLICATIONS FOR NURSING: Nurses must be knowledgeable about CTIBL to identify high-risk patients and educate patients and their families about CTIBL, bone loss therapies, and lifestyle modifications.

Bone Resorption↗

The quality of perinatal care received by patients in the Greater Harare area during 1973.

The perinatal deaths which occurred during 1973 in the Harare perinatal service were analysed in relation to their obstetric associations. Seventy-one per cent of all the deaths were associated with just five obstetric complications, namely asphyxia in laubour, preterm delivery, minor antepartum haemorrhage, unexplained intra-uterine death and disproportion. It is suggested that asphyxial deaths occurring labour will only be eliminated when continous cardiotocographic monitoring becomes standard practice for all patients. Until then, selected cardiotocography will remain as the main diagnostic aid. Its value will be improved by reviewing the principles of selection. The potential exists to eliminate preterm delivery by the use of beta-adrenergic stimulant drugs. It is suggested that the rational application of this potential would reduce perinatal mortality from preterm delivery. The unexplained intra-uterine deaths and those associated with a minor antepartum haemorrhage presented major problems of understanding and therefore management. These are discussed. Deaths associated with disproportion occurred in 0,10% of booked patients and 3,22% of unbooked patients. The management of the booked patient is satisfactory, and improvement in perinatal mortality will only be achieved by decreasing the number of unbooked patients.

Asphyxia Neonatorum↗

The development of interpretations for novel noun-noun conceptual combinations during the early school years.

This research investigates issues surrounding early school children's use of the similarity between head and modifier terms in deriving interpretations for novel noun-noun conceptual combinations. In these experiments, 6- and 9-year-olds and adults were asked to formulate interpretations of similar and dissimilar conceptual combinations. Both children and adults were sensitive to the similarity aspect of conceptual combinations, although the children had some difficulty with the property interpretations that high-similarity combinations require. Next, we examined 40 popular children's books for the presence of noun-noun conceptual combinations. Adult participants provided interpretations for these combinations and rated the similarity of the head and modifier nouns. Results indicated that there were few high-similarity combinations and few combinations requiring property interpretations, suggesting that children have limited exposure to highly similar combinations and property interpretations. Further analysis of children's interpretations indicates that they may have difficulty in selecting and integrating properties of the modifier onto the head, a process required by property interpretations.

Child↗

What American surgeons read: a survey of a thousand Fellows of the American College of Surgeons.

PURPOSE: The modern American surgeon is immersed in an ever-deepening sea of printed and electronic information. Although publishers know how many books and journals they sell, and journals can quote their calculated impact factor, no information exists whatsoever about what surgeons read. Which surgical journals are "popular," and how does it compare with their impact factor (IF)? Our objective was to assess the sources of information and reading habits of American surgeons and to compare the "popularity" of journals with their IFs.A questionnaire was mailed to 1000 American surgeons, randomly selected from a list provided by the American College of Surgeons.A total of 418 surgeons responded, and 371 responses could be analyzed (37%). The leading sources of medical information were medical literature (93%), professional meetings (88%), and CME courses (69%). The average time per surgeon/month dedicated to medical literature was 14 hours (range, 1 to 120). Peer-reviewed journals were read by 95%, textbooks by 68%, and update series by 60% of the respondents. The three most popular surgical journals were Annals of Surgery (IF, 5.40), selected by 60%; Journal of the American College of Surgery (IF, 1.87), selected by 48%; and Archives of Surgery (IF, 2.53), selected by 36%. The most popular subspecialty journals were Cancer (IF, 3.66), selected by 31%; Critical Care Medicine (IF, 3.74), selected by 17%; and Gastroenterology (IF, 10.33), selected by 12%. The New England Journal of Medicine (IF, 28.66), selected by 67%, and the Journal of the American Medical Association (IF, 9.55), selected by 66%, were the most popular general medical journals, followed by Mayo Clinic Proceedings (IF, 1.98), selected by 16%. Among the "leaders" on the IF list for international, British medical and surgical journals were Lancet (IF, 11.79), selected by 5%, and British Journal of Surgery (IF, 2.38), selected by 0.5% of the respondents.Those American surgeons responding consider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non-United States publications and select the journals they read without considering its IF.

Journal Article↗

Perspectives in laryngopharyngeal reflux: an international survey.

OBJECTIVES: Although data exists to support the relationship between laryngopharyngeal reflux (LPR) and laryngitis, there is variability among otolaryngologists regarding the methods and criteria used to make the diagnosis. This study was undertaken to discern the current attitudes and practices of a select cohort of otolaryngologists in regards to LPR. METHODS: Four hundred fifteen surveys were mailed to members of the American Broncho-Esophagological Association. Survey recipients were asked to rate patient symptomatology and physical examination findings in terms of their relationship to LPR and their preferred laryngeal visualization procedure in terms of clinical use and diagnostic accuracy. The role and validity of adjunctive diagnostic tests were also surveyed. RESULTS: Survey response rate was 38%. Symptoms felt to be most related to reflux were: throat clearing (98.3%), persistent cough (96.6%), heartburn/dyspepsia (95.7%), globus sensation (94.9%), and voice quality change (94.9%). The physical examination findings felt to be most related to reflux included: arytenoid erythema (97.5%), vocal cord erythema (95.7%) and edema (95.7%), posterior commissure hypertrophy (94.9%), and arytenoid edema (94.0%). Fiberoptic laryngoscopy was the most commonly performed diagnostic visualization procedure (75.7%) and was also considered to be most sensitive and specific (45.0%). The most commonly ordered adjunctive test was a double pH probe (37.2%), which was also felt to be the most sensitive and specific adjunctive test (75.9%). CONCLUSION: A polling of a select group of otolaryngologists demonstrated agreement in the criteria used to diagnose reflux laryngitis, although some variability exists. The development of objective guidelines for the diagnosis of LPR is a critical initial step toward evaluating the manifestations and therapeutic interventions for this disease process.

Humans↗

The effect of structural empowerment and perceived organizational support on middle level nurse managers' role satisfaction.

BACKGROUND: The restructuring of Canadian health care organizations during the past decade has reduced the visibility of nursing leadership. This has resulted in job conditions that have disempowered nurse managers and influenced their ability to create positive work environments, mentor potential nurse leaders, and gain satisfaction in the leadership role. These conditions threaten the retention of a cadre of high quality nurse leaders in today's chaotic health care setting. OBJECTIVE: The purpose of this study was to examine the relationship between structural empowerment and perceived organizational support and the effect of these factors on the role satisfaction of middle level nurse managers. METHOD: A secondary analysis was conducted as part of a larger study of 126 middle level nurse managers working in Canadian acute care hospitals, randomly selected from the Ontario provincial registry. Eighty-four nurse managers responded to a questionnaire mailed to their home addresses. RESULTS: Structural empowerment was positively associated with middle level nurse managers' perceived organizational support. The combination of empowerment and perceptions of organizational support were significant predictors of middle level nurse managers' role satisfaction. CONCLUSIONS: The findings support R.M. Kanter's (1977, 1993; Men and Women of the Corporation. Basic Books, New York) contention that empowering work conditions have an impact on employees' feelings of support and sense of accomplishment at work. Positive perceptions of organizational support may play an important role in retaining current middle managers, and possibly attracting future leaders to management positions.

Canada↗

Harmonising adverse drug reaction terminology: the role of the Council for International Organizations of Medical Sciences.

Health professionals from different countries are known to differ considerably in their use of medical terminology, including the terminology used for adverse drug reactions (ADRs) and in the exact meanings attributed to terms. To remedy this situation, the Council for International Organizations of Medical Sciences (CIOMS) has attempted to provide definitions and basic requirements for proper use of ADR terms. The work has concentrated on terms liable to be misinterpreted and those used for serious and frequently reported ADRs. For every selected term a short monograph has been prepared. It consists of a preamble, definition, basic requirements for use of the term and additional comments, if any. In cooperation with medical experts, drug regulators and the pharmaceutical industry, 13 papers have been published so far. Approximately 160 terms have been defined and work on another 50 terms continues. The full collection of monographs will eventually appear in the form of a book and CD-ROM intended to help doctors fill in case reports, and regulatory agencies and the pharmaceutical industry assess reports. Pharmaceutical companies receive numerous reports of suspected ADRs from medical practitioners and other prescribing professionals. Each company is required to transmit these reports to the drug regulatory agency of the country, or countries, in which the drug is used. Therefore, in addition to receiving the correct name of the ADR, collecting and evaluating centres, regardless of whether they are part of a regulatory agency or a pharmaceutical company, need to be provided with sufficient supporting data to be convinced that what is reported was what was actually observed, and that the ADR term used represents the observed event.

Drug-Related Side Effects and Adverse Reactions↗

[Analysis of surgical activity of residents in pediatric surgery].

In the last years we have experienced a remarkable growth of the Credited Educational Units in Pediatric Surgery. However any methodological system is not applied that evaluated qualitative and quantitatively the efficiency of these Units, neither the formative results of the residents. From the mark of the European Community a program is designed for the first time that includes, among other sections, the residents book ("log-book"). This initiative channeled through the National Commission of the specialty has allowed to know in a homogeneous and detailed way the activity of the residents in Pediatric Surgery. The objective of this work is to analyze the surgical activity developed by the Spanish residents of Pediatric Surgery through the book of residents. All the gathered data of the books of residents were reviewed differentiating the surgical activity in the following ones remote: total surgical activity, neonatal surgery, pediatric general surgery, urology, plastic surgery, tumors and thoracic surgery. This type of studies allows to guide to the National Commission and the Spanish Society of Pediatric Surgery about the quality of the formation of the residents, the national necessities, the appropriate number of the credited Units and on the selection-evaluation approaches.

Curriculum↗

Sources of salary statistics for health care professionals.

Salary statistics for various health care professions are much in demand, yet finding them is not always an easy task. This article provides an annotated list of selected sources of salary statistics for medicine, dentistry, nursing, pharmacy, occupational therapy, and physical therapy. Emphasis is placed on sources which are published regularly. Strategies for finding additional sources of salary statistics are also discussed.

Data Collection↗

The South African Medical Research Council's Guidelines on Ethics for Medical Research--implications for HIV-preventive vaccine trials with children.

Children are at risk of HIV infection, stand to benefit from the development of HIV preventive vaccines, and therefore should be enrolled in trials of HIV vaccines in order to generate relevant safety, immunogenicity and efficacy data. In South Africa, the national vaccine initiative is considering the future conduct of trials involving children; this requires an analysis of the current ethical framework, including elements that facilitate or constrain the conduct of such trials. In this article, we examine the Medical Research Council (MRC)'s Guidelines on Ethics for Medical Research: General Principles (Book 1), and their provisions on research involving children. We argue that this set of influential guidelines includes provisions on research with children that are conceptually problematic and may prohibit critical research with healthy (but at-risk) child participants, including trials of HIV-preventive vaccines. We recommend that Book 1 provisions should be redrafted to reflect a balance between protecting children from research-related risks and testing interventions critical to their health.

AIDS Vaccines↗

The role of perception, language, and preference in the developmental acquisition of basic color terms.

When learning basic color vocabulary, young children show a selective delay in the acquisition of brown and gray relative to other basic color terms. In this study, we first establish the robustness of this finding and then investigate the extent to which perception, language, and color preference may influence color conceptualization. Experimental tasks were designed to measure different aspects of perceptual color processing (discrimination and saliency), color preference and objective counts of color term frequency in preschool-directed language (books and mothers' speech) were used to compare the acquisition of three groups of colors: primary colors, secondary colors (orange, pink, and purple) that appear at the same time as the primary colors, and secondary colors (brown and gray) that appear late. Although our results suggest that perception does not directly shape young children's color term acquisition, we found that children prefer brown and gray significantly less than basic colors and that these color terms appear significantly less often in child-directed speech, suggesting that color preference, linguistic input, and developing color cognition may be linked.

Child Development↗

A randomized controlled trial in a hospital population of ultrasound measurement screening for the small for dates baby.

Poor fetal growth is an important cause of perinatal mortality and morbidity. Based on the hypothesis that early diagnosis of fetal growth problems leads to more appropriate management and therefore, improved outcome, a randomized controlled trial of ultrasound measurement was performed on 1,528 women booked through a hospital antenatal clinic. This compared a number of perinatal outcomes between the group who had a routine 2-stage examination (early dating and 34-week scan) and a group who had only a dating scan and then additional scans as generated by their clinical situations. No significant differences could be found between the groups when these perinatal outcomes were considered. These results mirror previously published randomized controlled trials. Selection of women for third trimester ultrasound examination for suspected fetal growth problems should be based on careful clinical assessment and should not be routine.

Birth Weight↗

Laparoscopic techniques versus open techniques for inguinal hernia repair.

BACKGROUND: Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh. This mesh can be placed by either using an open approach or by using a minimal access laparoscopic technique. Although many studies have explored the relative merits and potential risks of laparoscopic surgery for the repair of inguinal hernia, most individual trials have been too small to show clear benefits of one type of surgical repair over another. OBJECTIVES: The objective of this review was to compare minimal access laparoscopic mesh techniques with open techniques. Comparisons of open mesh techniques versus open non-mesh techniques have been considered in a separate Cochrane review. SEARCH STRATEGY: We searched MEDLINE, EMBASE, and The Cochrane Central Controlled Trials Registry for relevant randomised controlled trials. The reference list of identified trials, journal supplements, relevant book chapters and conference proceedings were searched for further relevant trials. Through the EU Hernia Trialists Collaboration (EUHTC) communication took place with authors of identified randomised controlled trials to ask for information on any other recent and ongoing trials known to them. Specialists involved in research on the repair of inguinal hernia were contacted to ask for information about any further completed and ongoing trials. The world wide web was also searched. SELECTION CRITERIA: All published and unpublished randomised controlled trials and quasi-randomised controlled trials comparing laparoscopic groin hernia repair with open groin hernia repair were eligible for inclusion. Trials were included irrespective of the language in which they were reported. DATA COLLECTION AND ANALYSIS: Individual patient data were obtained, where possible, from the responsible trialist for all eligible studies. All reanalyses were cross-checked by the reviewers and verified by the trialists before inclusion. Where IPD were unavailable additional aggregate data were sought from trialists and published aggregate data checked and verified by the trialists. IPD were available for 25 trials, additional aggregated data for seven and published data only for nine. Where possible, time to event analysis for hernia recurrence and return to usual activities were performed on an intention to treat principle. The main analyses were based on all trials. Sensitivity analyses based on the data source and trial quality were also performed. Pre-defined subgroup analyses based on recurrent hernias, bilateral hernias and femoral hernias were also carried out. MAIN RESULTS: 41 published reports of eligible trials were included involving 7161 participants. Sample sizes ranged from 38 to 994, with follow-up from 6 weeks to 36 months. Duration of operation was longer in the laparoscopic groups (WMD 14.81 minutes, 95% CI 13.98 to 15.64; p<0001). Operative complications were uncommon for both methods but more frequent in the laparoscopic group for visceral (Overall 8/2315 versus 1/2599) and vascular (Overall 7/2498 versus 5/2758) injuries. Length of hospital stay did not differ between groups (WMD -0.04 days, 95% CI -0.08 to 0.00; p=0.05, but return to usual activity was earlier for laparoscopic groups (HR 0.56, 95%CI 0.51 to 0.61; p<0.0001 - equivalent to 7 days). The data available showed less persisting pain (Overall 290/2101 versus 459/2399; Peto OR 0.54, 95% CI 0.46 to 0.64; p<0.0001), and less persisting numbness (Overall 102/1419 versus 217/1624; Peto OR 0.38, 95% CI 0.4286 to 0.49; p<0.0001) in the laparoscopic groups. In total, 86 recurrences were reported amongst 3138 allocated laparoscopic repair and 109 amongst 3504 allocated to open repair (Peto OR 0.81, 95% CI 0.61 to 1.08; p = 0.16). The use of mesh during laparoscopic hernia repair is associated with a reduction in the risk of hernia recurrence, significantly so for the transabdominal preperitoneal repair (TAPP) versus open non-mesh repair (overall 26/1440 versus preperitoneal repair (TAPP) versus open non-mesh repair (overall 26/1440 versus 47/1119; Peto OR 0.45, 95% CI 0.28 to 0.72; p=0.0009). However, no difference was detected when comparing laparoscopic methods with open mesh methods of hernia repair. REVIEWER'S CONCLUSIONS: The use of mesh during laparoscopic hernia repair is associated with a relative reduction in the risk of hernia recurrence of around 30-50%. However, there is no apparent difference in recurrence between laparoscopic and open mesh methods of hernia repair. The data suggests less persisting pain and numbness following laparoscopic repair. Return to usual activities is faster. However, operation times are longer and there appears to be a higher risk of serious complication rate in respect of visceral (especially bladder) and vascular injuries.

Hernia, Inguinal↗

Developing a strategic marketing plan for hospitals.

The initial stages of developing a strategic marketing plan for hospitals are explored in this excerpt from the book, The Role of the Hospital in an Aging Society: A Blueprint for Action. The elderly have unique perceptual, cognitive, social, and psychological needs and preferences, and a marketing strategy for eldercare services must reflect these factors, as well as the financial role of third-party payers and the decision-making influence of families and physicians. Among the elements the hospital must address when developing a marketing strategy are market selection and segmentation, targeting markets with specific services, pricing, and positioning the hospital for a maximum share of the eldercare market.

Age Factors↗

Evolutionary patterns in ontogenetic transformation: from laws to regularities.

The concept of heterochrony derives from classical approaches to the study of ontogeny and phylogeny. Under the influence of landmark books by deBeer (1930) and Gould (1977), the traditional theories have been revised to fit into the conceptual framework of modern genetics and evolutionary theory. The current scheme, however, suffers from a problem of lack of precise definitions. The term heterochrony is now used to refer to a developmental process as well as to an evolutionary pattern. That is, it refers to a microevolutionary process of adaptation, operating in local populations under selection and to a macroevolutionary pattern based on undefined internal laws of form. Such conceptually contradictory frameworks are a source of confusion and of empirical misuse of concepts. We propose to reduce the dependence of current thinking about heterochrony on the concept of "timing" and instead focus on the organization of sequences of developmental events in ontogeny. Although Haeckelian views have been rejected, most experts would agree that some subtle parallelism between ontogeny and phylogeny does occur. This relationship deserves renewed attention and urodeles are particularly suited to study it due to their variable patterns of ontogeny and complex life cycles. Current reductionist attempts to apply the morphological terminology and postulates of classical heterochrony concepts to cellular and molecular (genetic) aspects of morphogenesis are problematic. Molecular heterochrony requires a linear or strictly hierarchical structure of gene regulation of development. In addition, isomorphism between genetic mutations and morphological changes would be required for the existing terminology to apply. Finally, we caution against a broad interpretation of heterochronic processes at the molecular level, since the approach may end up permitting the meaningless interpretation of any developmental change as heterochrony.

Animals↗

Pitch discrimination accuracy in musicians vs nonmusicians: an event-related potential and behavioral study.

Previously, professional violin players were found to automatically discriminate tiny pitch changes, not discriminable by nonmusicians. The present study addressed the pitch processing accuracy in musicians with expertise in playing a wide selection of instruments (e.g., piano; wind and string instruments). Of specific interest was whether also musicians with such divergent backgrounds have facilitated accuracy in automatic and/or attentive levels of auditory processing. Thirteen professional musicians and 13 nonmusicians were presented with frequent standard sounds and rare deviant sounds (0.8, 2, or 4% higher in frequency). Auditory event-related potentials evoked by these sounds were recorded while first the subjects read a self-chosen book and second they indicated behaviorally the detection of sounds with deviant frequency. Musicians detected the pitch changes faster and more accurately than nonmusicians. The N2b and P3 responses recorded during attentive listening had larger amplitude in musicians than in nonmusicians. Interestingly, the superiority in pitch discrimination accuracy in musicians over nonmusicians was observed not only with the 0.8% but also with the 2% frequency changes. Moreover, also nonmusicians detected quite reliably the smallest pitch changes of 0.8%. However, the mismatch negativity (MMN) and P3a recorded during a reading condition did not differentiate musicians and nonmusicians. These results suggest that musical expertise may exert its effects merely at attentive levels of processing and not necessarily already at the preattentive levels.

Acoustic Stimulation↗

Rethinking asthma from business to bedside.

OBJECTIVE: To explore the possible application of concepts, methods, and tools validated in the worlds of statistics, business, engineering, and system dynamics to improve insight and outcomes in asthma care. DATA SOURCES: Peer-reviewed articles, books, and other publications on the topic of asthma care, dating back to 1931, were retrieved using MEDLINE searches and other external sources. Searches were restricted to include only studies with human subjects and the English language as descriptors, and the terms used included the following: system dynamics, statistical process control charts, continual improvement, mental models, personal mastery, systems thinking, team learning, and shared vision. Personal author observations and experiences were also included. STUDY SELECTION: Review and original research studies that reported on these concepts were evaluated. RESULTS: Results show that the concepts behind these models may be transferred to the system of asthma care. Indeed, case studies have shown that control charts can be used to detect signals of improved or declined function in asymptomatic patients, monitor medication adverse effects and the effects of adding a new medication, and evaluate the effectiveness of different medication delivery systems. CONCLUSIONS: These concepts and tools can provide immeasurable value to the process of rethinking and redesigning asthma care. They have the potential to help physicians and patients alike in designing and executing systems of care that are capable of not only delivering better outcomes but also inviting commitment to the long-term care many require.

Asthma↗