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PubMed1994

[Bioreactor for long-term maintenance of differentiated hepatic cell functions]

A culture model and a bioreactor construction for hepatocyte in vitro culture is described. The reactor is based on capillaries for hepatocyte immobilisation. Four discrete capillary membrane systems, each serving different purposes, are woven to create a three-dimensional framework for decentralized cell perfusion with low metabolite gradients and decentralized oxygenation and CO2 removal. The biochemical performance of reactors initially seeded with 2.5 x 109 pig hepatocytes was evaluated (pig albumin synthesis, midazolam- and lidocaine/MEGX metabolism, galactose elimination, enzymeleakage). The specific construction of the reactor enables a use in pharmacology alternatively to animal experiments.

Journal Article↗
PubMed2000

[Use of AutoTopograf TMS-3 keratoconus screening program for keratoconus detection].

PURPOSE: The purpose of this study was to investigate sensitivity of Klyce-Maeda and Smolek-Klyce methods in detection of early or suspect keratoconus by using AutoTopographer TMS-3 (Tomey). MATERIAL AND METHODS: At the First Department and Clinique of Ophthalmology, Silesian Medical School in Katowice, 175 eyes underwent ophthalmological examinations. There were 67 eyes with irregular astigmatism, 39 eyes with PRK decentration and 69 eyes with early or suspected keratoconus. The procedure was performed with the TMS-3 AutoTopographer (Tomey). During the study we investigated index definitions included in Keratoconus Screening Program. RESULTS: The examination showed the false positive results: in irregular astigmatism (KSI index in 31.3%, KPI index in 10.4%), in PRK decentration (KSI and KPS index in 18%). The results of analysis of keratoconus detection by Keratoconus Screening Program in early or suspected keratoconus were false negative (it means there were no keratoconus symptoms) in KCI index--24.6%, in KSI index--11.6% and KPI index--21.7%. CONCLUSION: To sum up, we can say that Keratoconus Screening Program is a good program for confirming diagnosis of early keratoconus in 80%, but it has to be assisted by a clinical examination.

Astigmatism↗
PubMed2001

Get inside the lives of your customers.

Many companies have become adept at the art of customer relationship management. They've collected mountains of data on preferences and behavior, divided buyers into ever-finer segments, and refined their products, services, and marketing pitches. But all too often those efforts are too narrow--they concentrate only on the points where the customer comes into contact with the company. Few businesses have bothered to look at what the author calls the customer scenario--the broad context in which customers select, buy, and use products and services. As a result, consultant Patricia Seybold maintains, they've routinely missed chances to deepen loyalty and expand sales. In this article, the author shows how effective three very different companies have been at using customer scenarios as the centerpiece of their marketing plans. Chip maker National Semiconductor looked beyond the purchasing agents that buy in bulk to find ways to make it easier for engineers to design National's components into their specifications for mobile telephones. Each time they do so, it translates into millions of dollars in orders. By developing a customer scenario that describes how people actually shop for groceries, Tesco learned the importance of decentralizing its Web shopping site and how the extra costs of decentralization could be outweighed by the higher profit margins on-line customers generate. And Buzzsaw.com used customer scenarios as the basis for its entire business. It has used the Web to create a better way for the dozens of participants in a construction project to share their drawings and manage their projects. Seybold lays out the steps managers can take to develop their own customer scenarios. By thinking broadly about the challenges your customers face, she suggests, you can almost always find ways to make their lives easier--and thus earn their loyalty.

Commerce↗
PubMedDate not supplied

Endotoxemia severely affects circulation during normoxia and asphyxia in immature fetal sheep.

OBJECTIVE: The purpose of the present study was to determine whether endotoxins (lipopolysaccharides, LPS) affect the fetal cardiovascular system in a way likely to cause brain damage. METHODS: Thirteen fetal sheep were chronically instrumented at a mean gestational age of 107 +/- 1 days. After control measurements of organ blood flow (microsphere method), blood gases, and acid base balance were obtained, seven of 13 fetuses received LPS (53 +/- 3 microg/kg fetal weight) intravenously. Sixty minutes later, asphyxia was induced by occlusion of the maternal aorta for 2 minutes. Measurements of organ blood flows were made at -60, -1, +2, +4, +30, and +60 minutes. RESULTS: Unlike in the control group, after LPS infusion there was a significant decrease in arterial oxygen saturation (-46%; P <.001) and pH (P <.001). In LPS-treated fetuses the portion of combined ventricular output directed to the placenta decreased significantly (-76%; P <.001), whereas output to the fetal body (+60%; P <.001), heart (+167%; P <.05), and adrenals (+229%; P <.01) increased. Furthermore, during asphyxia circulatory centralization was impaired considerably in LPS-treated fetuses, and there was clear evidence of circulatory decentralization. This decentralization caused a severe decrease in cerebral oxygen delivery by 70%. Within 30 minutes after induction of asphyxia five of seven LPS-treated fetuses died, whereas all control fetuses recovered completely. CONCLUSIONS: Endotoxemia severely impaired fetal cardiovascular control during normoxia and asphyxia, resulting in a considerable decrease in cerebral oxygen delivery. These effects might have important effects in the development of fetal brain damage associated with intrauterine infection.

Animals↗
PubMed1975

Influence on medication therapy of increased patient services by pharmacists in a pediatric hospital.

The effect of decentralized pharmacy services on medication therapy was studied. The records of 200 patients at a 175-bed, nonprofit, pediatric hospital were reviewed to determine the drug therapy received agreed with the indications, contraindications, ages and dosages recommended by the official labeling. Half the patients received treatment before decentralized pharmacy services and half after. For all drug-use variables, a one-way analysis of variance revealed no significant differences between the two groups of patients.

Age Factors↗
PubMed2001

Employee reactions to the introduction of a bulk food distribution system in a nursing home.

Decentralized bulk food distribution was implemented in a nursing home. Employees working with elderly residents with dementia were asked their opinion of the impact of the new system on residents and workload. A convenience sample of 24 employees (57% of the staff) completed a 31-item, self-administered Likert-scale questionnaire that allowed open-ended comments. Responses were subjected to descriptive quantitative analysis, and a qualitative approach was used to explore themes that emerged in comments. Qualitative analysis indicated that 52% of responses were negative in tone, 30% were positive, and 18% were neutral. Initially, three categories of comments emerged, with specific multiple themes related to the residents (41%), the employees (37%), or the food-service system (22%). Most comments in the employee category were negative, and suggested that the decentralized food-service system caused hardship for the staff. This problem was resolved by adding one staff-hour at the midday meal. One year later, an abbreviated repeat survey of 29 employees revealed adaptation and general acceptance of the system. Because a motivated patient care staff is essential to the successful feeding of nursing home residents with dementia, employees' concerns must be considered when operational changes are planned.

Attitude of Health Personnel↗
PubMed1975

Morphological and biochemical changes in supersensitive smooth muscle.

The effect of postganglionic denervation on the incidence of nexal contacts in the smooth muscle of the rat vas deferens was investigated. The chronically denervated tissue exhibited twice as many nexuses as control. This increase in the incidence of cell contacts may contribute to the supersensitivity and/or the increase in maximum response of the denervated vas deferens. The effects of denervation, decentralization, and pretreatment with reserpine on the concentration of adenosine triphosphate (ATP) in vasa deferentia of rats and guinea pigs were also investigated. One day after denervation there was a substantial decrease in the endogenous norepinephrine and ATP concentrations. The norepinephrine concentration remained low (less than 10% of control) throughout subsequent days (up to 14 days) whereas the ATP concentration, after the first postoperative day, rose significantly. The rise in ATP concentration was temporally correlated with the development of postjunctional supersensitivity. Decentralization and pretreatment with reserpine both resulted in a significant increase in ATP concentration which preceded by 2 to 3 days a significant increase in sensitivity of the vas deferens. It appears that a change in the tissue concentration of ATP may be one of the initial events that occurs following interruption of the neural contact to the smooth muscle of the vas deferens.

Adenosine Triphosphate↗
PubMed1996

[The development of radiotherapy in Denmark through 100 years. From radiology to oncology].

A short review is given of the development of radiotherapy from its early beginning in 1896 to the establishment of the first three radium centres in 1913/14 which caused strong protest from the surgeons. The Radium Foundation was established on private initiative and was, via money collections, able to finance purchase of radium and in the 1930s erection of new buildings for the three centres. Radiotherapy became a basic specialty from 1950. In the beginning of the 1960s megavoltage therapy was introduced and at the same time chemotherapy was becoming interesting for therapy of solid tumours. This caused a centralisation of the patients to the centres for non-surgical therapy resulting in need for building of two centres (Aalborg and Herlev), and a gradual closing down of the decentral treatment with low voltage equipment in the counties. After 1970 the counties became responsible for the health care including running of the hospitals. This caused a return of some of the patients to decentral treatment facilities, usually the biggest hospital in the county and predominantly for adjuvant or palliative chemotherapy. The speciality has changed name to oncology in 1987.

Cancer Care Facilities↗
PubMedDate not supplied

Organizational and professional characteristics predicting external communications in Canadian public health units.

This study is a survey of administrative divisions involved in tobacco programs in Canadian public health units. It aims to identify correlates of public health units' contacts and collaborations with external agencies, as predisposing factors in their capacity to innovate. Heads of 124 divisions involved in tobacco control completed a questionnaire about their budgets, staff, and management practices. In each of these divisions, professionals involved in tobacco programs also completed a questionnaire about their characteristics and experience. Results showed a high level of contacts and collaborations with external agencies. Four variables emerged as correlates of external communications: professionals' degree of access to public health information sources, the diversity of disciplines within the administrative division, the decentralization of authority, and the level of professionals' participation in decision-making. Because of the potential relationship between innovation and external communication, public health units should consider fostering external communication by management practices and policies, such as favouring professional diversity, increasing access to sources of information, and adopting more decentralized, participatory management.

Canada↗
PubMed1998

[Corneal topography analysis after excimer laser photorefractive keratectomy].

OBJECTIVE: To study the pattern of ablation, evaluate centration and stability following excimer laser photorefractive keratectomy (PRK) for myopia. METHOD: Corneal topography of 312 patients (366 eyes) with a month, 3 months and 6 months of follow-up after PRK was examined. RESULTS: The mean decentration from the pupillary center to ablating center was 0.266 mm. In both eyes, the mean decentration was located supernasally. At one month postoperative examination, uniform ablation was 49.5%, semicircular, keyhole, kidney and dumbbell shaped ablations were 42.9% and central island one was 6.0%. Central island pattern affected the best corrected visual acuity greatly. High myopia began regression at 1-3 months after PRK. CONCLUSION: Corneal topography is essential for evaluating surface changes after PRK. Long-time stability issues are answered with continued topographic follow-up.

Corneal Topography↗
PubMed2001

Comparison of trans-scleral fixation of PMMA and foldable intraocular lens in children.

PURPOSE: To observe the difference of the effects of PMMA and foldable intraocular lenses (IOLs) trans-sclerally fixed in pediatric eyes. METHODS: Thirty-two children (43 eyes) who had undergone trans-scleral fixation of IOL were retrospected, of whom 5 children were implanted PMMA IOL in both eyes, 6 children were implanted PMMA IOL in one eye and foldable IOL in the other eye, 12 children were implanted foldable IOL in one eye and 9 children were implanted PMMA IOL in one eye. Mean age was 5.3 years (range 2.5-12 years). Twelve children had traumatic cataract and the others congenital cataract before lens extraction. RESULTS: Foldable group (18 eyes): Mean follow-up was 12.1 months. Visual acuity (VA): compared with the best corrected VA before IOL fixation, postoperative best corrected VA improved in 16 eyes, remained unchanged in 2 eyes. In 14 eyes, one or two stitches were needed to seal the incision. COMPLICATIONS: Severe anterior chamber reaction was seen in 3 eyes. Intraocular bleeding was found in 3 eyes. IOL decentration was detected in 1 eye. Iris capture of IOL was seen in one eye. PMMA group (25 eyes): Mean follow-up was 20.3 months. Visual acuity (VA): compared with the best corrected VA before IOL fixation, postoperative best corrected VA improved in 19 eyes, remained unchanged in 5 eyes and got worse in one eye. In 24 eyes, one to three stitches were needed to seal the incision. COMPLICATIONS: Severe anterior chamber reaction was seen in 5 eyes. Intraocular bleeding was found in 4 eyes. IOL decentration was seen in one eye. Iris capture of IOL was seen in 3 eyes. Intraocular pressure elevated in one eye. CONCLUSION: Our study shows that trans-scleral fixation of IOL is a safe procedure in pediatric eyes. Foldable IOL showed similar effect compared with PMMA IOL in pediatric trans-scleral fixation.

Anterior Chamber↗
PubMed2003

[Application of capsular tension ring in cataract surgery for zonular dialysis].

OBJECTIVE: To evaluate the application of capsular tension ring (CTR) in the cataract surgery for zonular dialysis. METHODS: Eleven cases of partially traumatized zonular dialysis patients were managed with CTR after continuous curvilinear capsulorrhexis (CCC), cataract extraction and posterior chamber intraocular lens (IOL) implantation. RESULTS: The IOLs in all the eyes were basically in the normal position without tilting or obvious decentration. One month postoperatively, the best-corrected visual acuity (BCVA) was 0.4 in 4 eyes, 0.5-0.8 in 5 eyes and over 0.8 in 2 eyes. A side-by-side overlap of both eyelets of the ring happened in 1 eye due to the bigger diameter of CTR, and no other complications were seen except the original complication of cataract surgery. CONCLUSIONS: For the patients of zonular dialysis, the CTR can preserve the integrity of the capsular bag, provide the necessary capsular space while giving a counter-traction, reduce asymmetric capsular forces, stabilize the vitreous base, facilitate phacoemulsification, aspiration of cortex and IOL implantation, prevent the postoperative IOL decentration and allow a quicker visual recovery. The CTR is a useful device that effectively supplements the currently available cataract surgery armamentarium, and develops the application of posterior chamber IOL implantation.

Adolescent↗
PubMed1992

[Comparison of various capsulectomy techniques in cataract surgery. An experimental study].

Radial tears at the edge of an anterior capsulectomy are often associated with the occurrence of intraocular lens (IOL) loops coming out of the capsular bag with subsequent IOL decentration. We analyzed the incidence of radial tear formation in 40 human eyes obtained postmortem. These eyes were randomly assigned to four groups: "can opener," linear capsulotomy, capsulopuncture ("postage stamp"), and continuous curvilinear capsulorhexis (CCC). The CCC appeared to be much less likely to be associated with anterior capsular radial tears as opposed to the other three techniques. With the nucleus expression technique used in this study, radial tears occurred in all cases of "can opener," linear capsulotomy and capsulopuncture, whereas no tears occurred with the CCC technique. The results of this study show that CCC is currently the best available anterior capsulectomy procedure for minimizing the incidence of radial tears and sequelae such as decentration.

Aged↗
PubMed1992

[Dumb August. Freud's "dream interpretation" as a critique of traditional common sense].

Freud's profound scepticism about philosophy and its fondness for philosophical "systems" is well-known. From an early stage, the author of the "Interpretation of Dreams" was convinced that philosophy--like animism--was nothing other than a narcissistic attempt to explain the world systematically from one single point. That point is the ego, synthesising everything manifold, alien and threatening into an intelligible mould and subjecting it to the intellectual censorship of the cogito. Gekle shows that Freud's "Interpretation of Dreams" undercuts and decentralizes the imperialist claims of the ego, thus opening up vistas on the areas where the ego is not sole and undisputed master. At the same time, however, it becomes apparent that the decentralizing work of dream interpretation is itself confronted by a paradox. The insights gained in the process cannot be presented in any other than a theoretical, systematic and hence ego-oriented form.

Dreams↗
PubMed1964

MEDLARS AND THE LIBRARY COMMUNITY.

The intention of the National Library of Medicine is to share with other libraries the products and the capabilities developed by the MEDLARS system. MEDLARS will provide bibliographic services of use to other libraries from the central system. The decentralization of the central system to permit libraries with access to computers to establish local machine retrieval systems is also indicated. The implications of such decentralization for the American medical library network and its effect on library evolution are suggested, as are the implications for international development of mechanized storage and retrieval systems.

Abstracting and Indexing↗
PubMed1992

The dialectically constituted/decentred subject of psychoanalysis. II. The contributions of Klein and Winnicott.

The present paper focuses on the contributions of Klein and Winnicott to a psychoanalytic conception of the dialectically constituted and decentred subject. Klein's idea of 'positions' represents a conception of the subject constituted in the creative and negating dialectical interplay of fundamentally different modes of attributing meaning to experience. The Kleinian subject is decentred in psychological space and in psychoanalytic time. The concept of projective identification provides the elements of a theory of the creation of the subject in the context of a psychological-interpersonal dialectic. The subject for Winnicott is not coincident with the individual psyche: 'There is no such thing as an infant [apart from the mother]'. Winnicott's notion of the creation of the subject in the psychological space between mother and infant involves a conception of the on-going constitution of the subject in the simultaneity of forms of dialectical tension between at-one-ment and separateness, internality and externality, I and me, I and Thou.

Humans↗
PubMedDate not supplied

Visual results and complications of posterior chamber intraocular lens implantation after capsular tear during phacoemulsification.

BACKGROUND AND OBJECTIVE: To determine the visual outcome and complications of posterior chamber intraocular lens implantation after capsular tear in patients undergoing phacoemulsification at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul, Turkey. PATIENTS AND METHODS: The medical records of patients who underwent phacoemulsification surgery for senile cataract from January 1, 1996, to December 31, 1998, were reviewed. Patient inclusion criteria were implantation of a posterior chamber intraocular lens after phacoemulsification, being operated on by one of two surgeons, and a follow-up of at least 1 year. There were 58 eyes in the group with capsular tear and 159 eyes in the group with intact capsule. RESULTS: A final visual acuity of 0.8 or more was more common in eyes with uncomplicated phacoemulsification surgery (chi-square = 16.25, P = .03). Refraction stabilized most commonly at 2 to 6 months postoperatively in patients with capsular tear and 1 to 21 days postoperatively in patients with uncomplicated phacoemulsification (chi-square = 22.61, P < .001). Complications such as retinal detachment (odds ratio = 11.70, P < .05), cystoid macular edema (odds ratio = 26.33, P < .01), increased intraocular pressure (odds ratio = 14.54, P < .05), and decentration of the intraocular lens (odds ratio = 32.79, P = .001) were more frequently observed in eyes with capsular tear. CONCLUSIONS: It takes longer for the refraction to stabilize in eyes with posterior chamber intraocular lens implantation after capsular tear during phacoemulsification. Complications such as retinal detachment, cystoid macular edema, increased intraocular pressure, and decentration of the intraocular lens are more common in these patients, and therefore they should be observed for a longer period of time.

Adult↗
PubMed2004

Drug resistance pattern of Mycobacterium tuberculosis in a university hospital in Taiwan, 1998-2002.

BACKGROUND AND PURPOSE: During 1998-2002, most specialized tuberculosis (TB) hospitals in Taiwan were closed; as a result, more TB patients are being managed in general hospital settings. This study investigated the prevalence, patterns and risk factors of drug-resistant Mycobacterium tuberculosis at a university hospital in the 5 years after decentralization of the TB administrative and clinical control infrastructure which occurred during the implementation of the national health insurance system in Taiwan. METHODS: A total of 1411 initial isolates of M. tuberculosis from specimens collected during January 1998 through December 2002 were tested for drug susceptibility of first-line anti-TB drugs using the agar proportional method. RESULTS: The numbers of newly diagnosed culture-positive TB patients increased from 139 in 1998 to 380 in 2002. The drug resistance pattern of M. tuberculosis among these isolates was as follows: 268 (19.0%) strains were resistant to isoniazid, 86 (6.1%) to rifampin, 221 (15.7%) to ethambutol, 141 (10.0%) to streptomycin, and 430 (30.5%) to 1 of these 4 drugs. Multidrug resistance (MDR), i.e., resistance to at least rifampin and isoniazid, was observed in 72 isolates (5.1%). Of the 1411 patients, isolates from patients with age < 65 years had a higher multiple drug resistance rate than those from patients with age > or = 65 years (57/781, 7.3% vs 15/630, 2.4%; p < 0.001). In the analysis of risk factors for MDR, patients with MDR isolates had a significantly higher incidence of previous TB history, anti-TB therapy, longer duration of symptoms, cavitary lesions in chest X-ray, and mortality. CONCLUSION: A dramatic increase in cases of TB among patients treated at this university hospital was seen after the decentralization of the TB control infrastructure in Taiwan. The prevalence of drug resistance in isolates from culture-positive TB patients was 30.5% and the prevalence of MDR was 5.1%.

Adult↗