bluuebunny/crossref_metadata_2025 huggingface dataset:
Supervised Exercise for Intermittent Claudication – An Under-Utilised Tool
Authors: Shalhoub Joseph , Hamish Maher , Davies Alun H
Published: August 2009

INTRODUCTION

The use of supervised exercise in the management of intermittent claudication is well supported by level I evidence upon which are based grade A recommendations by the TASC II Inter-Society Consensus for the Management of Peripheral Arterial Disease and the Scottish Intercollegiate Guidelines Network (SIGN). These include that supervised exercise should be made available as part of the initial treatment for all peripheral arteriopaths.

SUBJECTS AND METHODS

A questionnaire, comprising 10 questions, was drawn up to address the issues pertinent to supervised exercise in intermittent claudication. This was distributed by post, along with a pre-stamped return envelope, to all ordinary members of the Vascular Society of Great Britain and Ireland (VSGBI). All returned and received questionnaires had their responses entered onto a pre-prepared spreadsheet.

RESULTS

Of the 186 questionnaires posted to UK resident surgeons, 84 were returned. This equates to a response rate of 45%. Of the responders, only 24% had access to supervised exercise. There was a large spread in the proportion of eligible patients which were referred to a programme, with only 14% of VSGBI members recommending 100% of eligible patients. Rates of non-compliance varied greatly. Contra-indications to supervised exercise included cardiac (27%), and vascular, musculoskeletal, geographic, and respiratory (8% each). Most supervised exercise sessions (85%) were 1 h in duration. The majority (65%) of programmes comprised one session per week. With regards the duration of programme, 55% were 3 months. Almost all classes were led by either a physiotherapist (41%) or a nurse (48%). In centres where no supervised exercise programme was available, verbal advice was given by 63%, with 34% offering leaflets. A supervised exercise set up has not been achieved due to lack of resource in 72%.

CONCLUSIONS

These results are contrary to the recommendations offered by the TASC II Inter-Society Consensus and SIGN, in particular in terms of availability and referral to supervised exercise, as well as frequency of the classes where programmes were in place. The offer of information either verbally or via leaflet is commended; however, this has been shown as inferior to supervised exercise. Quoting resource as the reason for non-implementation goes against the published quality-of-life and pharmaco-economic data, which promote supervised exercise as both functionally and financially effective. This work highlights the importance of translating the results of research into evidence-based clinical practice.
How is Adrenocortical Cancer being Managed in the UK?
Authors: Aspinall Sebastian R , Imisairi AH , Bliss RD , Scott-Coombes D , Harrison BJ , Lennard TWJ
Published: August 2009

INTRODUCTION

Adrenocortical carcinomas are rare. This case series is reported to give an overview of how adrenocortical carcinoma is currently managed in the UK.

PATIENTS AND METHODS

A retrospective review was made of case notes from patients with adrenocortical carcinomas presenting to the authors (TWJL, RDB, BJH, and DS-C) over the past 10 years in Newcastle, Sheffield and Cardiff.

RESULTS

Newcastle treated twelve, Sheffield eleven and Cardiff seven cases. The median follow-up was 25.5 months (range, 1–102 months). All tumours were greater than 5 cm in diameter. The majority presented with symptoms of hormone excess. Adrenalectomy was performed in 83% – this was radical in 30% and followed by excision of recurrence in 13%. Adjuvant mitotane was given in 64% of patients, in combination with cytotoxic chemotherapy in 20%. One-third of patients did not receive any adjuvant therapy. There was no significant difference in survival between the three centres. The majority of patients (57%) died during the period of follow-up of this study. The median survival was 37 months (range, 2–102 months).

CONCLUSIONS

The size of tumour, stage and mode of presentation, age and overall survival of patients in this study are comparable to published series of adrenocortical carcinomas from major endocrine surgical centres world-wide. Despite controversies about benefits, adjuvant mitotane was used in the majority of cases, whereas cytotoxic chemotherapy was only used in the minority. The exact role of adjuvant therapy in the management of adrenocortical carcinoma is not as well established as for other more common malignancies. Establishing a database for adrenocortical carcinomas in the UK would contribute to our understanding of the management of this disease.
Specialised Chronic Compartment Measurement Clinic in a District General Hospital: Is it Worthwhile?
Authors: Zeineh Nedal , Ardolino Antonella , O'Connor David
Published: August 2009

INTRODUCTION

Chronic compartment syndrome is one of the conditions that cause exertional pain in the young. In this condition, a careful history taking is usually the key for making the correct diagnosis, but intracompartmental pressure measurement that has high sensitivity and specificity rates can add invaluable confirmation, especially when surgical decompression is indicated. In a district general hospital there is usually a logistical problem in performing compartmental pressure measurement. In this study, we describe our experience in dealing with such a problem by setting up a quarterly specialised clinic for intracompartmental pressure measurement that, according to our knowledge, is unique in the UK.

PATIENTS AND METHODS

We retrospectively reviewed the medical records of 42 patients referred to our specialised clinic and documented the referral patterns, clinical picture, additional investigations, pressure measurement results, final diagnosis and outcome of treatment. The intracompartmental measurement was recorded pre- and post-exercise on the treadmill for 1 min or 5 min and results were interpreted according to published criteria.

RESULTS

The mean age of the referred 42 patients was 33.1 years (range, 15–78 years). There were 16 positive results (38%) confirming the diagnosis of chronic compartment syndrome and four clinically characteristic cases of this condition with negative results. There were 22 negative results (53%), one borderline, and three patients were not tested for different reasons. All of the 10 patients who were treated surgically had positive pre-operative test results.

CONCLUSIONS

An inappropriate referral rate of approximately 52% was encountered that had a significant impact on the waiting time for the proposed test (5.7 months), which is far longer than the 18-week target for treatment in the NHS. We found that a positive test is a strong predictor of a successful outcome of surgical treatment. Such a specialised clinic, therefore, should only receive carefully assessed patients.
Clostridium difficile: How Much do Hospital Staff Know About it?
Authors: Aroori Somaiah , Blencowe Natalie , Pye Geoff , West Reuben
Published: August 2009

INTRODUCTION

The aim of this study was to determine the awareness of Clostridium difficile infection amongst healthcare professionals.

SUBJECTS AND METHODS

A total of 132 healthcare professionals (18 consultants, 40 trainee doctors, and 74 nursing staff) in our hospital were randomly surveyed using a questionnaire consisting of 17 questions covering various aspects of C. difficile.

RESULTS

More than 50% of healthcare professionals correctly identified C. difficile as an anaerobic bacillus. Half of the consultants and one-third of the trainees and nurses were aware that 5% of adults carry C. difficile in the gut. Overall, 80% of doctors and 40% of nursing staff (P = 0.001) were aware of the spectrum of illnesses caused by C. difficile. Seven (39%) consultants, 25 (63%) trainees, and 26 (37%) nurses correctly identified the various predisposing factors for the acquisition of C. difficile infection. Only one-third of doctors and 8% of nursing staff were aware that antibiotic restriction was the single most effective C. difficile infection control measure. In addition, 40% of doctors and 8% of nursing staff were aware that cytotoxin assay is the gold standard diagnostic test. Less than 30% of healthcare professionals were aware of the differences between the most common strain and the strain of C. difficile responsible for recent outbreaks. Only 6 (33%) consultants, 21 (53%) trainees (P = not significant), and 28 (38%) nursing staff were aware that hand washing with soap and water is the most effective way of preventing transmission of C. difficile infection. Results showed that 93% of trainees, 78% of consultants (P = 0.05) and 70% of nurses correctly answered that oral metronidazole is the drug of choice for the treatment of C. difficile infection. Compared to 73% of trainees, only two (11%) consultants (P < 0.0001) and 20 (27%) nursing staff correctly stated that oral vancomycin is the second-line treatment for persistent symptomatic C. difficile infection.

CONCLUSIONS

There is a significant lack of knowledge concerning C. difficile infection amongst healthcare professions, in particular amongst consultants and nurses in our hospital.
Audit of Anticoagulation After Embolectomy for Acute Ischaemia
Authors: Robinson T , Hunter I , Wathes R , Keeling D , Hands L
Published: August 2009

INTRODUCTION

Intravenous unfractionated heparin (UFH) is routinely used in patients after arterial embolectomy. Achieving and maintaining therapeutic levels requires a co-ordinated approach which may be difficult for busy junior doctors and laboratories. There is no current evidence regarding the use of subcutaneous low molecular weight heparin (LMWH) as an alternative.

PATIENTS AND METHODS

The study retrospectively examined all patients who had undergone any form of embolectomy during 2006 and 2007 by review of their medical records, an electronic laboratory database, and the patients' drug charts.

RESULTS

Overall, 45 patients were studied. A total of 389 activated partial thromboplastin time (APTT) tests were performed of which 146 (37.6%) were in the therapeutic range (50–90 s), 40.4% were < 50 s and 22.1% were > 90 s. Five patients (11.1%) had further surgical procedures. Significant bleeding occurred in two patients.

CONCLUSIONS

The results indicate that many patients are not appropriately anticoagulated. Whilst a new UFH protocol is being developed by our hospital trust, the authors believe the use of LMWH could provide a more effective and user-friendly alternative to UFH.
Non-Occlusive Small Bowel Necrosis in Association with Feeding Jejunostomy After Elective Upper Gastrointestinal Surgery
Authors: Spalding Duncan RC , Behranwala Kasim A , Straker Peter , Thompson Jeremy N , Williamson Robin CN
Published: August 2009

INTRODUCTION

Non-occlusive small bowel necrosis (NOSBN) has been associated with early postoperative enteral feeding. The purpose of this study was to determine the incidence of this complication in an elective upper gastrointestinal (GI) surgical patient population and the influence of both patient selection and type of feeding jejunostomy (FJ) inserted, based on the experience of two surgical units in affiliated hospitals.

PATIENTS AND METHODS

The records were reviewed of 524 consecutive patients who underwent elective upper GI operations with insertion of a FJ for benign or malignant disease between 1997 and 2006. One unit routinely inserted needle catheter jejunostomies (NCJ), whilst the other selectively inserted tube jejunostomies (TJ).

RESULTS

Six cases of NOSBN were identified over 120 months in 524 patients (1.15%), with no difference in incidence between routine NCJ (n = 5; 1.16%) and selective TJ (n = 1; 1.06%). Median rate of feeding at time of diagnosis was 105 ml/h (range, 75–125 ml/h), and diagnosis was made at a median of 6 days (range, 4–18 days) postoperatively. All patients developed abdominal distension, hypotension and tachycardia in the 24 h before re-exploratory laparotomy. Five patients died and one patient survived.

CONCLUSIONS

The understanding of the pathophysiology of NOSBN is still rudimentary; nevertheless, its 1% incidence in the present study does call into question its routine postoperative use especially in those at high risk with an open abdomen, planned repeat laparotomies or marked bowel oedema. Patients should be fully resuscitated before initiating any enteral feeding, and feeding should be interrupted if there is any evidence of feed intolerance.
Length of Stay Following Primary Total Hip Replacement
Authors: Foote Julian , Panchoo Kirby , Blair Peter , Bannister Gordon
Published: August 2009

INTRODUCTION

Much of the cost of primary total hip arthroplasty (THA) comprises the length of stay in hospital. Given the increasing drive for cost-effective surgery in today's National Health Service, the aim of this investigation was to determine the patient and surgical factors that most influence the length of stay following surgery.

PATIENTS AND METHODS

A large, population-based study of 675 consecutive patients in a regional orthopaedic centre in the South West of Britain.

RESULTS

The median length of stay was 8 days. The majority of patients (81.5%) left hospital within 2 weeks, 13.6% within 2–4 weeks and 4.9% after 4 weeks. On multivariate analysis, age above 70 years, ASA grades 3 and 4, prolonged operations and long incisions were highly significantly associated with hospital stay of over 2 weeks.

CONCLUSIONS

Prolonged stay after THA is largely predetermined by case mix and this should be taken into account when units are compared for performance and in the remuneration they receive for providing this service. Slick surgery through limited incisions may reduce the length of stay.
Ship to Shore: National Archives Project Opens up Navy Surgeons' Journals
Authors: Worrall Matthew
Published: August 2009

I trace my finger down the ledger of fading and elegantly handwritten names. Alongside each a terse entry, 'canister shot, part of elbow bone removed' or 'leg amputated at thigh'. At the end of the list a statement in which the surgeon briefly states his results: of 102 injured, five died on board, one more when the ship returned to Gibraltar and 'all the others got well on board'.
Foundation year doctors are enhancing CVs after MMC
Authors: Shaw A , Longman C , Wicks C , Lund JN
Published: August 2009

Last year as many as 45% of applicants for training jobs had not been offered a training post at the end of round 1 of Modernising Medical Careers (MMC). For example, for the 850 jobs available at ST1 run-through position in surgery in general, there were 5,225 applicants. Foundation year 1 (FY1) doctors are also presently advised to take a 'flexible approach' to the area of the country in which they want to train. To be competitive then, newly qualified doctors may feel that enhancement of their CV may maximise the chances of them obtaining the job they want. This questionnaire study aimed to investigate changes in attitudes to enhancing the CV before application for entry into specialist training.n for entry into specialist training.
British Academy of Cosmetic Practice: an authoritative and independent overarching academic body
Authors: Lowry John , Khoo Chris , Henley Mark
Published: August 2009

In the autumn of 2001 the chief medical officer (CMO) for England, Professor Sir Liam Donaldson, raised concerns with The Royal College of Surgeons of England about quality standards in and the safety of patients undergoing cosmetic surgery. These anxieties followed a number of adverse outcomes, including one death, which had reached high profile in the media. These concerns were shared by a number of independent sector providers who raised issues about the variability of outcomes and an apparent lack of training structures for those undertaking cosmetic surgical and medical procedures. The Department of Health published the national minimum standards, although no attempt was made to address the position of those already working in the independent sector.
The 12 Commandments of vascular surgery
Authors: Weisters Mary , Pusey Jane , Handa Ashok
Published: August 2009

Vascular surgery is regarded as a high-risk and complex surgical speciality. The following advice is aimed at surgical trainees to highlight the guiding principles of vascular surgery and to help them to avoid some common pitfalls. We hope that you will love your time in vascular surgery, honour Virchow's triad and obey these Commandments.
National study on bisphosphonate-induced jaw necrosis
Authors: Narain Amrita
Published: August 2009

The FGDP(UK) and the British Association of Oral and Maxillofacial Surgeons (BAOMS) are leading on a two-year study from 1 June 2009, focusing on national new registration of patients with avascular necrosis of the jaws, including bisphosphonate-related osteonecrosis (BRONJ), referred to oral surgery, oral medicine, oral and maxillofacial departments and dental hospitals in England, Wales, Scotland and Northern Ireland.
How Relevant is the College Today?
Authors: Stanley John , Thomas Bill , Mitchell Judith
Published: August 2009

At a time of major professional political and financial challenges, many fellows and members understandably may ask: 'What relevance is the College to me today?' The Council feels that the role of the College is and should become increasingly important to the surgeon in the workplace. This article seeks to demonstrate what the College is doing to support you, its fellows and members.
EWTD: maintaining the pressure
Authors: Black John
Published: August 2009

The ill-judged introduction of the 48-hour week demanded by the European Working Time Directive (EWTD) was the first news item on every television and radio programme on Saturday 1 August, indicating just how successful the College has been in raising public concern. It was encouraging that the British Medical Association (BMA) speakers were for the first time expressing serious anxiety, largely about the effects on training and about pressure being put on junior doctors to falsify their hours returns. All conversions to the cause are welcome, however late in the day. It is disappointing that the BMA is not yet stressing the dangers to patients, which they are surely hearing about from their members working in the acute specialties.
Surgery School: Trainee Surgeons to Star in ITV Documentary
Authors: Towell Elaine
Published: August 2009

Ten junior doctors are set to star in a prime-time ITV documentary about surgical training. Autumn sees the release of the three-part documentary Surgery School, which will follow the lives of the doctors as they begin life as surgical trainees.
Measurement of Ribosomal RNA Turnover In Vivo by Use of Deuterium-Labeled Glucose
Authors: Defoiche Julien , Zhang Yan , Lagneaux Laurence , Pettengell Ruth , Hegedus Andrea , Willems Luc , Macallan Derek C
Published: August 2009

Background: Most methods for estimation of rates of RNA production are not applicable in human in vivo clinical studies. We describe here an approach for measuring ribosomal RNA turnover in vivo using [6,6-2H2]-glucose as a precursor for de novo RNA synthesis. Because this method involves neither radioactivity nor toxic metabolites, it is suitable for human studies.

Methods: For method development in vitro, a lymphocyte cell line (PM1) was cultured in the presence of [6,6-2H2]-glucose. RNA was extracted, hydrolyzed enzymatically to ribonucleosides, and derivatized to either the aldonitrile tetra-acetate or the pentafluoro triacetate derivative of the pentose before GC-MS. We identified optimum derivatization and analysis conditions and demonstrated quantitative incorporation of deuterium from glucose into RNA of dividing cells.

Results: Pilot clinical studies demonstrated the applicability of this approach to blood leukocytes and solid tissues. A patient with chronic lymphocytic leukemia received [6,6-2H2]-glucose (1 g/kg) orally in aliquots administered every 30 min for a period of 10 h. When we analyzed CD3– B cells that had been purified by gradient centrifugation and magnetic-bead adhesion, we observed deuterium enrichment, a finding consistent with a ribosomal RNA production rate of about 7%/day, despite the slow division rates observed in concurrent DNA-labeling analysis. Similarly, in 2 patients with malignant infiltration of lymph nodes, administration of [6,6-2H2]-glucose (by intravenous infusion for 24 h) before excision biopsy allowed estimation of DNA and RNA turnover in lymph node samples.

Conclusions: Our study results demonstrate the proof-of-principle that deuterium-labeled glucose may be used to analyze RNA turnover, in addition to DNA production/cell proliferation, in clinical samples.
New ELISA for B Cell–Activating Factor
Authors: Le Pottier Laëtitia , Bendaoud Boutahar , Renaudineau Yves , Youinou Pierre , Pers Jacques-Olivier , Daridon Capucine
Published: August 2009

Background: The B cell–activating factor of the TNF family (BAFF) is upregulated in autoimmune diseases, but a number of conflicting results have cast doubts on the reliability of the ELISA protocols currently used for its quantification. This situation led us to develop a new ELISA for the measurement of BAFF.

Methods: BAFF was purified for use alongside nonglycosylated recombinant BAFF. Two monoclonal antibodies (mAbs) and two polyclonal antibodies (pAbs) to BAFF were used.

Results: The optimization process showed that the pAb format was preferable to the mAb format as capture antibody, because the pAbs recognized the glycosylated as well as the nonglycosylated forms of BAFF. The most efficient pair of Abs involved using the unconjugated form of a goat pAb to capture BAFF and the same biotinylated goat pAb to detect bound BAFF. This ELISA was not influenced by the presence of rheumatoid factor.

Conclusions: This new ELISA helped provide insights into why serum concentrations of BAFF vary between studies for a given population of patients. It is a reliable tool for the management of the diseases in which BAFF is an indication of response to therapy.
Mutations of CXorf6 are associated with a range of severities of hypospadias
Authors: Kalfa Nicolas , Liu Benchun , Klein Ophir , Audran Francoise , Wang Ming-Hsieh , Mei Cao , Sultan Charles , Baskin Laurence S
Published: August 2009

The authors and journal apologize for an error in the above paper above which appeared in 159 (4) 453–458. The third author's name should have appeared as Ophir Klein, as shown correctly above.
Evaluation of an enzyme immunoassay for plasma-free metanephrines in the diagnosis of catecholamine-secreting tumors
Authors: Procopiou Michel , Finney Hazel , Akker Scott A , Chew Shern L , Drake William M , Burrin Jacky , Grossman Ashley B
Published: August 2009

The authors and journal apologize for the error in the above paper which appeared in 161 (1) 131–140. The kits for the assay of free metanephrines were supplied by both Immunodiagnostic Systems Ltd (IDS), Tyne and Wear, UK and also Biotech-IgG (UK) Ltd, Wilmslow, UK.
Free thyroxine is an independent predictor of subcutaneous fat in euthyroid individuals
Authors: Alevizaki Maria , Saltiki Katerina , Voidonikola Paraskevi , Mantzou Emily , Papamichael Christos , Stamatelopoulos Kimon
Published: August 2009

Objective

Thyroid function parameters have been associated with obesity, but associations with the type of adiposity have not been examined. We used ultrasound (US) to assess regional adiposity and investigated associations of thyroid function with parameters of central obesity.

Design

Cross-sectional study.

Methods

A total of 303 apparently healthy individuals (age 42.9±8.8, body mass index (BMI) 19.0–43.3, median 26.2 kg/m2, 181 women) were examined for indices of the metabolic syndrome. BMI, waist and hip circumference, abdominal subcutaneous fat (SF), and preperitoneal fat (PF) layer was estimated. TSH, free thyroxine (fT4), triiodothyronine (T3), thyroid autoantibodies, insulin, glucose, and lipid levels were measured. Subjects receiving T4(9.2%) were excluded.

Results

SF and SF/PF ratio were inversely correlated with fT4levels (r=−0.169,P=0.023,r=−0.193,P=0.009 respectively). In multivariate analysis, fT4was a predictor of SF and SF/PF, independently of age, sex, and smoking. SF correlated with TSH levels (r=0.149,P=0.037). PF and SF were positively associated with T3levels (r=0.245,P=0.004 andr=0.189,P=0.019 respectively). T3levels were positively associated with BMI (r=0.257,P=0.0004), waist perimeter (r=0.324,P<0.0001), and waist-to-hip ratio (WHR;r=0.363,P<0.0001). The T3/fT4ratio was positively correlated with SF (r=0.182,P=0.028), WHR (r=0.267,P=0.0003), and BMI (r=0.146,P=0.043).

Conclusions

Increasing SF accumulation as assessed by US is associated with lower fT4and higher TSH levels among euthyroid slightly overweight individuals. These associations indicate that subtle variation in thyroid function may participate in regional adiposity.
Partial restoration of GH responsiveness to ghrelin in Cushing's disease after 6 months of ketoconazole treatment: comparison with GHRP-6 and GHRH
Authors: Correa-Silva Silvia R , Nascif Sérgio O , Molica Patrícia , Sá Larissa B P C , Vieira José G , Lengyel Ana-Maria J
Published: August 2009

Objective

In Cushing's disease (CD), GH responsiveness to several stimuli, including ghrelin, GHRP-6, and GHRH, is blunted. Recovery of GH secretion after remission of hypercortisolism after transsphenoidal surgery, radiotherapy, or adrenalectomy is controversial. There are no studies evaluating the effect of primary clinical treatment with ketoconazole on GH secretion in CD. The aim of this study is to compare ghrelin-, GHRP-6-, and GHRH-induced GH release before and after ketoconazole in CD.

Design

GH responses to ghrelin, GHRP-6, and GHRH of eight untreated patients with CD (mean age: 33.8±3.1 years; body mass index: 28.5±0.8 kg/m2) were evaluated before and after 3 and 6 months of ketoconazole treatment, and compared with 11 controls (32.1±2.5; 25.0±0.8).

Methods

Serum GH was measured by an immunofluorometric assay and urinary free cortisol (UFC) by liquid chromatography and tandem mass spectrometry.

Results

After ketoconazole use, mean UFC decreased significantly (before: 222.4±35.0 μg/24 h; third month: 61.6±10.1; sixth month: 39.1±10.9). Ghrelin-induced GH secretion increased significantly after 6 months (peak before: 6.8±2.3 μg/l; sixth month: 16.0±3.6), but remained lower than that of controls (54.1±11.2). GH release after GHRP-6 increased, although not significantly, while GH responsiveness to GHRH was unchanged.

Conclusions

Ghrelin-induced GH release increases significantly after 6 months of ketoconazole treatment in CD. This could suggest that a decrease in cortisol levels during this time period can partially restore glucocorticoid-induced GH suppression in CD. GH-releasing mechanisms stimulated by ghrelin/GHS could be more sensitive, as no changes in GHRH-induced GH release were observed.
Phra Payutto and Debates ‘On the Very Idea of the Pali Canon’ in Thai Buddhism
Authors: Seeger Martin
Published: August 2009

In this paper I investigate a number of public intellectual debates in current Thai Theravada Buddhism that are related to several fundamental questions regarding the meaning and function of the Pali canon. The focal point of this investigation will be debates in which the Thai scholar monk Phra Payutto (b. 1939) has been playing a significant role. In these debates, the Pali canon is regarded as a central text endowed with special normative and formative authority. I will look at contestations that concern Theravada-ness and, at the same time, and inextricably linked with this, at concepts of demarcation to systems of religious beliefs and practices that are believed to be ‘outside’ Theravada. This, of course, engages the question of inclusivism, exclusivism and pluralism within Theravada. In so doing, I explore and posit concepts on the meanings and functions of the Pali canon that position it either as the or an authoritative reference.
Rebirth From China To Japan In Nara Hagiography: A Reconsideration
Authors: Barrett T. H.
Published: August 2009

This study takes up a portion of the early hagiography of a Japanese prince who was reputedly a reincarnated Chinese monk, and uses a peculiarity in a colophon dated 718 to argue that though the text may have been composed in China, it must in that case derive from the writing of a Japanese visitor. A possible identification of the visitor is made, and some attention is given to the likely sources he used.
What the Nik?yas Say and Do not Say about Nibb?na
Authors: Brahmāli Bhikkhu
Published: August 2009

The only way of moving towards consensus on the controversial subject of the nature of Nibb?na is by appealing to the sole source of authority common to practically all Buddhists: the Nik?yas/?gamas. In the present paper I will first give an overview of the usage of the term Nibb?na in the Nik?yas. I will then argue that, according to the Nik?yas, Nibb?na cannot be regarded as a self. Next, I will point out that the Nik?yas do not see Nibb?na as a form of consciousness, including such exceptional kinds of consciousness as anidassana viññ??a and appati??hita viññ??a. Nor can Nibb?na be regarded as equivalent to mind, or any particular state of mind. In the final section I aim to show that the most reasonable interpretation of the Nik?yas is that final Nibb?na is no more than the cessation of the five khandhas.
Trabalho de jovens estudantes de uma escola pública: fortalecimento ou desgaste?
Authors: Lachtim Sheila Aparecida Ferreira , Soares Cássia Baldini
Published: August 2009

O objetivo desta pesquisa foi reconhecer os potenciais de desgaste e de fortalecimento de jovens trabalhadores que estudam em uma escola pública de um município da RMSP. Trata-se de um estudo qualitativo, que entrevistou 19 estudantes, de 16 a 20 anos do período noturno. Os principais potenciais de desgaste foram: longa jornada de trabalho, excesso de responsabilidade, falta de estabilidade e trabalho essencialmente manual, fragmentado e repetitivo. Os poucos potenciais de fortalecimento foram: socialização e satisfação de necessidades de reprodução social. Verificou-se o fenômeno da regressão intergeracional. O estudo do binômio desgaste-fortalecimento dos jovens denuncia mais sentidos negativos do que positivos na concomitância trabalho-estudo, intrinsecamente relacionada à necessidade de sobrevivência das famílias. Esse processo é potencialmente desgastante, podendo ocasionar problemas de saúde aos jovens.
The relevance of subsidiary initiatives for Brazilian multinationals
Authors: Borini Felipe Mendes , Fleury Tereza Leme , Fleury Afonso Carlos Corrêa , Oliveira Junior Moacir de Miranda
Published: August 2009

The purpose of this paper is to analyze relationship patterns between headquarters and subsidiaries of Brazilian Multinationals Enterprises (BrMNEs). The key construct for that investigation is Subsidiary Initiative, which comprises Subsidiary Entrepreneurial Orientation, Autonomy, Integration, Local Competitive Context and Business Network. A survey was carried out in a sample of 65 subsidiaries of 29 BrMNEs. The main outcome is that subsidiaries are highly integrated and receive Entrepreneurial Orientation from Headquarters (HQs), but Initiative is limited. Actually, the main determinants of subsidiary's initiatives are Local Context and Business Networking in the host country. This apparent paradox may be explained by what we call 'rebellious subsidiaries', which take initiatives based on their business environment and connections, regardless of their HQs' directions or delegation of autonomy.
Características dos relacionamentos estabelecidos em diferentes contextos de serviços sob a ótica do consumidor
Authors: Souza Neto Arcanjo Ferreira de , Mello Sérgio Carvalho Benício de
Published: August 2009

Programas de relacionamento com clientes vêm sendo cada vez mais desenvolvidos pelas empresas de serviços. Na concepção de tais programas, quase sempre as empresas são quem decide com quem que-rem se relacionar e qual formato o relacionamento deve assumir. Com base em um levantamento e com a utilização da técnica de escalonamento multidimensional, o presente estudo investiga se os consumidores percebem seus relacionamentos com as empresas da mesma forma, ainda que elas sejam de tipos diferentes de serviços, e como as características dos serviços podem ser relacionadas com as percepções dos atributos dos relacionamentos. Os resultados identificam a forma como alguns serviços podem ser agregados de acordo com as características que os consumidores percebem no relacionamento estabelecido entre a empresa e o consumidor. Diante disso, as empresas de serviços podem procurar agrupar seus consumidores com base não mais apenas em suas características, mas na forma como eles percebem e/ou desejam o relacionamento.
Políticas de diversidade nas organizações: uma questão de discurso?
Authors: Saraiva Luiz Alex Silva , Irigaray Hélio Arthur dos Reis
Published: August 2009

O objetivo deste artigo é analisar a efetividade da implementação de políticas de estímulo à diversidade em filiais brasileiras de uma empresa multinacional. Foi realizada uma pesquisa de campo baseada em documentos oficiais e entrevistas com empregados representantes de minorias e de não minorias nos escritórios da empresa, no Rio de Janeiro e em São Paulo, material tratado por meio da análise do discurso. Os resultados sugerem contradições entre os discursos e as práticas adotadas, o que possivelmente se deve a arraigados processos de preconceito por parte dos próprios empregados, a certa permissividade no nível gerencial e a um direcionamento das políticas de estímulo à diversidade e inclusão, mais voltadas para o mercado do que para as demandas da sociedade. As principais contribuições se referem à efetividade das políticas organizacionais sob múltiplos olhares (empresa, minorias e não minorias), uma discussão sobre a real importância dos indivíduos para as organizações
Ensaio clínico duplo-cego randomizado e placebocontrolado com naltrexona e intervenção breve no tratamento ambulatorial da dependência de álcool
Authors: Castro Luís André , Laranjeira Ronaldo
Published: August 2009

OBJETIVO: O objetivo deste estudo é avaliar a eficácia da naltrexona com intervenção breve em pacientes com dependência de álcool. MÉTODO: Este estudo é um ensaio clínico randomizado, duplo-cego, placebo-controlado de 12 semanas. A amostra de 71 pacientes foi dividida randomicamente em dois grupos (um recebendo naltrexona e outro placebo). Sujeitos dependentes de álcool foram tratados com 50 mg de naltrexona ou placebo diariamente por 12 semanas. Ambos os grupos de tratamento receberam intervenção breve. Os desfechos clínicos primários para este estudo foram taxa de recaída e mudança no padrão de consumo de álcool. RESULTADOS: Na intenção de tratar, menor porcentagem de sujeitos tratados com naltrexona recaíram (3% 21%; p = 0,054). Naltrexona com intervenção breve não foi superior ao placebo para diminuir os dias de consumo (6,2 + 10,6 3,05 + 7,3; p = 0,478), os dias de consumo moderado (0 2,2 + 6,9; p = 0,345) e os dias de consumo pesado (0,03 + 0,2 0,3 + 0,9; p = 0,887). Naltrexona foi bem tolerada. Os efeitos adversos mais frequentes na presente amostra foram: cefaleia (25,4%), sonolência (20,9%), náuseas (16,4%), hiperfagia (16,4%), anorexia (14,9%), ansiedade (10,4%), pirose (10,4%) e irritabilidade (10,4%). CONCLUSÕES: Embora o grupo naltrexona tenha demonstrado tendência para reduzir taxa de recaída (> 5 doses/dia), não foi encontrada nenhuma diferença em outras variáveis de consumo de álcool entre os grupos naltrexona e placebo. Estudos futuros devem examinar a eficácia desse tipo de combinação de tratamento nos cuidados primários de saúde.
Suicide attempts and substance use in an emergency room sample
Authors: Diehl Alessandra , Laranjeira Ronaldo
Published: August 2009

OBJECTIVE: Describe suicide attempts assisted in an emergency room (ER) and acute substance consumption or dependence on these individuals. METHODS: Descriptive epidemiologic study was carried out during one year, evaluating suicide attempts assisted at Embu das Artes ER, São Paulo, Brazil. Patients were scheduled to a non structured psychiatric interview. Main outcomes measures were: socio demographic data, suicide attempt method, drugs or alcohol acute use in the six hours prior to attempt, patients with ICD-10 substance dependence diagnosis. The descriptive analyses and chi-square test (p < 0.05) were used to verify associations between the variables studied. RESULTS: sample was formed of 80 patients, mean age of 26.9 years (SD = 8.91), predominantly female (72.5%) and 21.2% adolescents. Most suicide attempts were made through medicine ingestion (62.5%). Approximately 21.2% and 7.5% related to have used alcohol and an illicit drug respectively within 6 hours prior to attempt and 10% were found to be substance dependent. All substance dependents had attempted suicide previously (p-value = 0.4). There was a significant association between suicide attempt through medicine ingestion and psychiatric treatment history (p = 0.02). CONCLUSION: More national studies are necessary to consider the role of alcohol and drug in suicide attempts assisted in ER, especially in chemical dependents whose suicidal behavior is relevant.
Fluoxetina: indícios de uso inadequado
Authors: Carlini Elisaldo A. , Noto Ana Regina , Nappo Solange Aparecida , Sanchez Zila van der Meer , Franco Vera Lúcia da Silva , Silva Luiz Carlos Franco , Santos Vilmar Ezequiel dos , Alves Décio de Castro
Published: August 2009

OBJETIVO: Investigar o uso da fluoxetina na cidade de Santo André, SP, por meio de coleta e análise das receitas especiais (RE) prescritas por médicos e arquivadas nas farmácias e drogarias daquela cidade. MÉTODOS: Foram coletadas as receitas especiais retidas durante os meses de agosto do ano de 2005 a julho de 2006, em 13 farmácias de manipulação e em 27 drogarias em diferentes regiões de Santo André. Cada receita especial foi analisada em relação à presença de fluoxetina, em associação ou não a outros princípios ativos, e o sexo do(a) paciente foi anotado. RESULTADOS: Foram analisadas 39.782 RE - 16.124 coletadas das farmácias magistrais e 23.658 das drogarias. Desses totais, 10.919 prescrições continham fluoxetina - 9.259 provenientes das farmácias magistrais (84,8%) e apenas 1.660 (15,2%) das drogarias. As prescrições de fluoxetina eram predominantemente destinadas a mulheres (79,8%). Na imensa maioria das RE, a fluoxetina foi prescrita em associação com um grande número de outras substâncias ativas, inclusive anfetaminas anoréticas, chegando a mais de dez outras em quase a metade das prescrições. Esse tipo de prescrição múltipla, principalmente para mulheres, é comparado com as prescrições de fórmulas magistrais para emagrecer, muito utilizadas no Brasil. CONCLUSÃO: Os dados obtidos sugerem que a utilização de fluoxetina teria um fim estético (perda de peso), e não um fim terapêutico (tratamento de depressão). Discute-se a relação risco-benefício desse possível uso, que poderia ser classificado de inadequado dado as conhecidas reações adversas da fluoxetina e a sua interferência no sistema citocromo P450.
A influência de fatores emocionais sobre a hipertensão arterial
Authors: Fonseca Fabiana de Cássia Almeida , Coelho Renata Zumerle , Nicolato Rodrigo , Malloy-Diniz Leandro Fernandes , Silva Filho Humberto Corrêa da
Published: August 2009

OBJETIVO: Realizar revisão bibliográfica de artigos que abordam a relação entre hipertensão arterial e fatores emocionais, levando em consideração a relevância do tema. MÉTODOS: Fez-se busca ativa na Biblioteca Virtual em Saúde, na base de dados MedLine (1997-2008), utilizando palavras da língua portuguesa. Os descritores de assunto escolhidos foram "hipertensão" e "doença cardíaca coronária". Em seguida, refinou-se a busca com os termos "hostilidade", "raiva", "ansiedade", "comportamento impulsivo" e "personalidade impulsiva". Não foram selecionados artigos que tratavam exclusivamente de doenças cardiovasculares e fatores psicológicos ou que associavam hipertensão e doenças cardiovasculares com depressão e doença de Alzheimer. RESULTADOS E DISCUSSÃO: Há inconsistência nos achados que relacionam os fatores emocionais com a hipertensão arterial e cardiopatias. Foram encontrados tanto estudos que demonstram relação positiva da raiva, hostilidade, ansiedade, impulsividade e estresse com hipertensão e doenças cardiovasculares quanto estudos que retratam relações negativas. CONCLUSÃO: O que se pode inferir das relações pesquisadas é que o risco de desenvolvimento da hipertensão arterial e a reatividade cardiovascular parecem ser influenciados por fatores emocionais como impulsividade, hostilidade, estressores, ansiedade e raiva. No entanto, mais estudos são necessários para melhor elucidar essas relações.
[NO TITLE AVAILABLE]
Authors: Garnham P. C. C. , Lainson R. , Shaw J. J.
Published: August 2009

Polychromophilus deanei n. sp. (Haemosporidiidea, Haemoproteidae) is described from a vespertilionid bat, Myotis nigricans nigricans (SCHINZ, 1821), captured on the Rio Maracapuçu, Município of Abaetetuba, Pará, Brasil. Mature oocysts were found in 2 specimens of the ectoparasite Basilia sp., taken form the infected animal. The parasite is probably the same as that previously described in another bat, Glossophaga soricina soricina, from the same general area, by DEANE & DEANE in 1961.
Estudo dos megacarióticos em material humano
Authors: Kastner M. R. Q. de
Published: August 2009

Repetimos não desejar tirar conclusões de um material histopatológico procedente de necrópsias e biópsias de doentes com afecções diversas. Todavia, podemos admitir o seguinte: 1. Tem-se a impressão de que nos portadores de neoplasias malignias, o número de megacariócitos presentes na medula óssea é elevado; no pulmão é regular, dependente da megacariocitopoiese medular. 2 Não foi possível identificar nenhum megacariócito nos outros órgãos por nós estudados, procedentes dêstes mesmos doentes, parecendo, portanto, que não exitirá uma megacariocitopoiese extramedular nos adultos. Os megacariócitos procedentes de medula, por ser células muito volumosas, serão retidas em sua maior parte pelo pulmão, pois é o órgão que recebe tôda a circulação venosa. 3. Quanto à citologia cabe assinalar que, no grupo formado por indivíduos portadores de neoplasias malignas, os megacariócitos de medula óssea apresentam-se bem conservados, morfològicamente normais, bi ou polilobulados, porém maiores e às vezes com formas bizarras. No pulmão, são geralmente de formas alongadas ou bizarras, com núcleos densos, picnóticos e com o citoplasma reduzido a uma fina camada periférica.
Funktionshistologie der Follikelzellen im Ovar von Nasutitermes sp. (Isoptera)
Authors: Barth Rudolf
Published: August 2009

Es werden Histologie und Funktionen der Zellen der Follikelepithelien in den Ovariolen von Nasutitermes sp., unter Hinzuziehung von Syntermes dirus zu Vergleichszwecken, untersucht, und ihre Entwicklung von ihrer ersten Differenzierung im Mittelteil des Germariums durch sieben verschiedene Zonen der Ovariole bis zur Bildung des Chorions verfolgt. 1. Neben ihrer Schutzfunktion vermitteln die Follikelzellen waehrend der Wachstumsphasen einen grossen Teil des Stofftransportes von der Haemolymphe in die Oozyten. Ihre Funktion ist hierbei druesiger Art. Es lassen sich drei verschieden Funktinsstadien unterscheiden. 2. Am Ende der Naehrfunktion wechseln die Zellen ihre Taetigkeit und bilden das Chorion. 3. Das Epithel laesst zwischen mehreren zusammenstossenden Zellen dreiecksfoermige Durchbrueche frei, die nur von der tunica propria ueberzogen sind und die ebengalls, jetzt aber einen unmittelbaren Uebertritt von Substanzen aus der Haemolymphe in die Oozyten zulassen. 4. Die interfollikulaeren Zellen produzieren eine der Tunica propria aehnliche Substanz. Dieser Komplex dient zum festern Zusammenhalt der Komponenten der Ovariole.
Anatomy and histology of Embolyntha batesi MacLahlan, 1877 (Embiidina)
Authors: Lacombe Dyrce
Published: August 2009

The Embioptera are rather generalized insects whose internal anatomy is simple and not subject to great modifications. For this reason these insects form an ideal group for elementary anatomical and histological studies (fig. 2). The digestive tract is a long, simple tube without convolutions or diverticulae from the buccal cavity to the rectum. The buccal structures are of the chewing type. The oesophagus and ingluvia are differentiated only by slight dilation of their walls. In nymphs and females the proventriculus is very distinct due to folds which flatten as the structure becomes packed with food. The enteron is the largest in such forms and in both sexes limited caudally by the Malpighian tubules. The proctodeus has six large rectal papillae. The nervous system is complete with only the fifth abdominal segment lacking a ganglion in the metathorax includes the ganglion of the first abdominal segment. The brain exhibits very clear structure in histological sections. The tracheal system includes two pairs of thoracic spiracles and eight abdominal pairs. Only th metathoracic spiracle has an air expiration function; all others serve for inspiration. Various structures in the spiracles protect the atrium. The circulatory system includes a long, simple dorsal vessel which extends forward from the ninth abdominal segment into the cranium. It opens anteriorly near the circumoesophageal connectives. The dorsal vessel has a pair of ostia and valves corresponding to each abdominal and thoracic segment. It lacks the diverticulae or folds commonly found in more highly evolved insects. The excretory system is represented by Malphighian tubules, pericardial cells, and fat-body. The number and disposition of Malpighian tubules is variable within the order. The pericardial cells are localized around the entire dorsal vessel up to the opening of the aorta in the head. The fat-bodies form compact layers in the dorsal and ventral regions of the body. In males they are more developed in the abdominal region. The mandibles, maxillae, and salivary glands are of a simple type with very few cytological modifications. Only the salivary glands which extend into the mesothoracic region show appreciable specialization. The reproductive system is bi-sixual and shows considerable sexual dimorphism. Males have five pair of testes with a metameric disposition, two distinct ducts, two epidymis, and the ejaculatory organs. The accessory glands vary in number and size and open in the anterior portion of the ejaculatory duct. The female reproductive organs are of the panoistic type. The system includes five pairs of ovarioles, two long paired oviducts a small, unpaired oviduct and the spermatheca which opens in the vagina. Reproduction usually involves a union of male and female gametes, and eggs are usually laid in clusters attached to a substrate.