Social and economically influenced factors associated with breast cancer treatment among blacks and whites. A qualitative study

Background: Despite the fact breast cancer mortality has declined in recent years, the mortality gap between African-American and white women continues to grow. A part of these disparities may be due to either inadequately following guideline recommended treatment or treatment delays. Although racial/ethnic disparities in breast cancer treatment and mortality have been extensively documented, the mechanisms by which these disparities occur remain largely unknown. Social and economically influenced factors such as choice of providers, distance of treatment facility, transportation, health insurance, and job related factors may also contribute to racial differences in breast cancer treatment; however, these have not been explored sufficiently in previous research. ^ Aim: The purpose of this study was to evaluate the role of social and economically influenced factors that may contribute to racial disparities in the receipt of guideline recommended treatment using the Health Disparities Model. ^ Methods: In this qualitative comparative case study, data from medical records, structured telephone interviews, and in-depth patient interviews explored the relationship between social and economically influenced factors and breast cancer treatment. Transcripts were analyzed using standard iterative process followed by immersion/crystallization approach. Participants were identified through rapid ascertainment from the New Jersey Cancer Registry and this study included 8 African-American and 8 white women aged 20-85 years old diagnosed with early stage breast cancer between 2003-2007, matched on age, race, and physician recommended treatment. ^ Results: We did not identify differences by race in factors that influenced the receipt of breast cancer treatment among the individual matched pairs. Four prominent themes emerged among women from both groups who experienced similar difficulties influenced by socioeconomic factors. Choice of providers, distance of facility, health insurance, and job related factors all contributed to breast cancer treatment experience among these women. Conclusions: We identified common issues influenced by socioeconomic factors and its relation with the receipt of breast cancer treatment, regardless of race. However, more research is needed to study the additional factors conveying racial differences affecting breast cancer treatment. ^

Modelado dinámico y control de maniobras de dispositivos submarinos

Es bien conocido por todos que la Primera Revolución Industrial, que tuvo su inicio en la segunda mitad del Siglo XVIII, conllevó un aumento del uso de los recursos energéticos que no se ha detenido para llegar a los niveles de desarrollo tecnológico, industrial y de calidad de vida, de los que se dispone en la actualidad. A simple vista podría intuirse que para disponer de un mayor nivel tecnológico, industrial, de confort, etc. sea necesario un mayor consumo de energía primaria. La actual generación de energía está principalmente basada en el procesamiento de los diversos compuestos del carbono (hidrocarburos, gases y productos derivados del petróleo), que son contaminantes y además, se agotan. Desde hace unas pocas décadas, la humanidad ha sido consciente que es necesario generar energía a partir de fuentes de origen renovable, y que además resulten menos contaminantes. Así, en la actualidad, se ha llegado a un estado de desarrollo avanzado para la explotación de diversas fuentes de energías como la eólica, a la vez que se comienza a mirar con realismo la posibilidad de explotación de diversas energías de origen marino. Se considera que las energías renovables procedentes de los océanos que se encuentran más desarrolladas tecnológicamente hablando, sin tener en cuenta la energía eólica fuera costa (offshore), son la denominada energía undimotriz o de las olas y la energía de las corrientes marinas, no necesariamente en este orden. El trabajo propuesto en esta Tesis se centra en este último recurso energético y, aunque no se dispone todavía de ningún dispositivo en fase de explotación comercial, la concepción, diseño y desarrollo de dispositivos para la extracción de energía de las corrientes, y su evolución, han sido relativamente rápidos e importantes en estos últimos años. Existen ya diferentes dispositivos en fase de pruebas con resultados muy prometedores. Aunque los dispositivos actuales se encuentran limitados a la explotación energética en zonas de poca profundidad, los diferentes estudios del recurso indican la necesidad de explotar corrientes marinas a mayores profundidades, para lo que se están desarrollando actualmente dispositivos, cuya evolución en lo que a sistemas de fondeo se refiere, está siendo muy parecida a la que se ha producido en los parques eólicos fuera costa, similar a su vez, a la evolución llevada a cabo en las plataformas oceánicas para la explotación de recursos petrolíferos (denominados oil & gas) que se extraen de profundidades cada vez mayores. Las soluciones tecnológicas que resulten válidas han de ser también económicamente viables, y en la actualidad se requiere todavía reducir costos en todas las fases de instalación, explotación y mantenimiento de estos dispositivos, sea cual sea su profundidad de operación. Uno de los focos de estudio para abaratar los costes de explotación en general, pasa por abaratar y reducir los costes en las maniobras necesarias de inmersión (de la superficie del mar a la profundidad de operación) y emersión (de la profundidad de operación a la superficie del mar) de estos dispositivos, para llevar a cabo tareas de mantenimiento in situ, en el mar, y sin necesidad de buques especializados ni de su transporte a tierra. En esta Tesis se propone, en primer lugar, un método para evaluar el ciclo de vida de diversos dispositivos de aprovechamiento de las corrientes marinas. Se evidencia que el coste de la energía así generada sigue siendo no plenamente competitivo, por lo que se requiere avanzar en el abaratamiento de costes, principalmente en la instalación y en su mantenimiento. Para ello se propone como novedad principal, introducir sistemas de control en lazo cerrado para realizar maniobras de instalación y mantenimiento de forma automática. También se aporta un modelo dinámico original y muy sencillo para dispositivos bajo estos movimientos de emersión/inmersión, a partir del cual se han desarrollado los algoritmos de control para el propósito mencionado, que no es otro sino automatizar en todo lo posible las maniobras completas. Los algoritmos de control propuestos han sido validados mediante simulación. Se proponen trayectorias de referencia de movimiento suaves (smooth) similares a las utilizadas en robótica. Estos movimientos de cambios de profundidad en lazo cerrado, combinados con secuencias de movimientos en bucle abierto para cuando el dispositivo interacciona en la superficie libre, han dado lugar a nuevas maniobras completas de instalación y mantenimiento que se presentan en esta Tesis, diferentes a las actuales. Finalmente, y como justificación de la viabilidad económica del método novedoso aportado, se ha realizado un estudio comparativo de los costes de la tecnología propuesta, frente a la tecnología actual. Este nuevo sistema de maniobras automáticas implica un ciclo de vida diferente para los dispositivos de aprovechamiento de la energía de las corrientes, ciclo que se cuantifica a partir de un dispositivo base que ha sido modificado y adaptado para la nueva tecnología propuesta, demostrando su viabilidad tanto técnica como económica. ABSTRACT It’s well known that the First Industrial Revolution started in the second half of the eighteenth century, carried the increasing of the use of energy resource which have not been stopped until reach the present technology, industrial evolution and daily life quality. On the surface, it can be known intuitively that a higher consumption of primary energy resource is demanded for benefiting from a higher technological industrial and daily life level. Today, the generation of energy is mainly based in the processing of carbon products (hydrocarbons, gases and petroleum products) which are pollutants, and additionally, are depleted. From a few decades ago, the humanity is aware the energy should be obtained from renewable resources, which besides, should be cleaner. So, at the present, a technical develop has been gained to exploit several energy source, as wind energy, and, at the same time, the extraction of the marine energy starts to seem as a reality. The renewable marine energies considered more advanced and technically developed, without keeping in mind, the offshore wind energy, are the wave energy and the tidal current energy, not necessarily in that order. This Thesis is focused in this last energy resource, and, although, any device is under commercial operation, the concept, design and develop of this type of devices to extract the tidal current energy and their evolution has been comparatively fast and important the last years. There are several devices under test with promising results. Even through the current devices are limited to lower depth areas, the several studies of the tidal energy resource suggest the need to exploit the marine current at greater depths to what is being developed devices, where their evolution in the anchoring system is being very similar to the evolution performed in the offshore wind farms, which is at the same time, similar to the evolution in the oil and gas exploitation which are extracted to greatest depths. Viable technical solutions should be also viable economically and nowadays the cost in all phases of the project (installation, maintenance and operation) should be decreased whatever the operation depth is. One focus of study to lower the operation cost is the cost decreasing of immersion manoeuvring operations (from sea surface to the operation depth) and immersion manoeuvring operations (from operation depth to the sea surface), therefore the maintenance operations can be performed on – site, in the sea, and no specialized vessels are required to transport the devices from the sea to shore. In this dissertation, firstly is proposed a method to evaluate the life cycle of the tidal energy current devices. It is proved the energy generated by these devices is not fully competitive; therefore, the cost falling is mainly an objective in the installation and the maintenance operations. For that, it is proposed as main novelty, the using of closed loop control systems to perform the automatic installation and manoeuvring operations. It is also contributed with an original and simple dynamic model and for controlling the immersion/emersion movements of these devices, from which the control algorithms are developed in order to automate as much as possible the complete manoeuvring. The control algorithms proposed has been validated by simulations. Reference paths with smooth movements, similar which are used in robotics, are suggested. These movements to change the depth using closed loop control, combined with the sequences in open loop movements when the device is in free surface, have been development for a new complete manoeuvring to installation and maintenance operations which are advanced in this Thesis and they are different to the present manoeuvrings. Finally and as justification of the economic viability of this original method, a comparative cost study between the technology proposed and the current technology is performed. This new automatic manoeuvring system involves a different life cycle for the tidal energy current devices, cycle that is quantified from a base device which has been modified and adapted for the new proposed technology, showing the technical and economic viability.

The impact of the language barrier on the management of multinational companies : a case study and survey, based exploration of the impact of the language barrier on the strategies, policies and systems by which multinational companies manage their subsidaries

The thesis begins with a conceptual model of the way that language diversity affects the strategies, organisation and subsidiary control policies of multinational companies. The model is based solely on the researcher'’ personal experience of working in a variety of international management roles, but in Chapter 2 a wide-ranging review of related academic literature finds evidence to support the key ideas. The model is developed as a series of propositions which are tested in a comparative case study, refined and then re-tested in a global survey of multinational subsidiaries. The principal findings of the empirical phases of the thesis endorse the main tenets of the model: - That language difference between parent and subsidiary will impair communication, create mistrust and impede relationship development. - That subsequently the feelings of uncertainty, suspicion and mistrust will influence the decisions taken by the parent company. - They will have heightened sensitivity to language issues and will implement policies to manage language differences. - They will adopt low-risk strategies in host countries where they are concerned about language difference. - They will use organisational and manpower strategies to minimise the consequences and risks of the communications problems with the subsidiary. - As a consequence the level of integration and knowledge flow between parent and subsidiary will be curtailed. - They will adopt styles of control that depend least on their ability to communicate with their subsidiary. Although there is adequate support for all of the above conclusions, on some key points the evidence of the Case Studies and Survey is contradictory. The thesis, therefore, closes with an agenda for further research that would address these inconsistencies.

Comparative Genomics of Field Isolates of Mycobacterium bovis and M. caprae Provides Evidence for Possible Correlates with Bacterial Viability and Virulence

Mycobacteria of the Mycobacterium tuberculosis complex (MTBC) greatly affect humans and animals worldwide. The life cycle of mycobacteria is complex and the mechanisms resulting in pathogen infection and survival in host cells are not fully understood. Recently, comparative genomics analyses have provided new insights into the evolution and adaptation of the MTBC to survive inside the host. However, most of this information has been obtained using M. tuberculosis but not other members of the MTBC such as M. bovis and M. caprae. In this study, the genome of three M. bovis (MB1, MB3, MB4) and one M. caprae (MB2) field isolates with different lesion score, prevalence and host distribution phenotypes were sequenced. Genome sequence information was used for whole-genome and protein-targeted comparative genomics analysis with the aim of finding correlates with phenotypic variation with potential implications for tuberculosis (TB) disease risk assessment and control. At the whole-genome level the results of the first comparative genomics study of field isolates of M. bovis including M. caprae showed that as previously reported for M. tuberculosis, sequential chromosomal nucleotide substitutions were the main driver of the M. bovis genome evolution. The phylogenetic analysis provided a strong support for the M. bovis/M. caprae clade, but supported M. caprae as a separate species. The comparison of the MB1 and MB4 isolates revealed differences in genome sequence, including gene families that are important for bacterial infection and transmission, thus highlighting differences with functional implications between isolates otherwise classified with the same spoligotype. Strategic protein-targeted analysis using the ESX or type VII secretion system, proteins linking stress response with lipid metabolism, host T cell epitopes of mycobacteria, antigens and peptidoglycan assembly protein identified new genetic markers and candidate vaccine antigens that warrant further study to develop tools to evaluate risks for TB disease caused by M. bovis/M.caprae and for TB control in humans and animals.

The quality of the physical environment and its association with activities and well-being among older people in residential care facilities

The physical environment can influence older people’s health and well-being, and is often mentioned as being an important factor for person-centred care. Due to high levels of frail health, many older people spend a majority of their time within care facilities and depend on the physical environment for support in their daily life. However, the quality of the physical environment is rarely evaluated, and knowledge is sparse in terms of how well the environment meets the needs of older people. This is partly due to the lack of valid and reliable instruments that could provide important information on environmental quality. Aim: The aim of this thesis was to study the quality of the physical environment in Swedish care facilities for older people, and how it relates to residents’ activities and well-being. Methods: The thesis comprises four papers where both qualitative and quantitative methods were used. Study I involved the translation and adaptation of the Sheffield Care Environment Assessment Matrix (SCEAM) into a Swedish version (S-SCEAM). Several methods were used including forward and backward translation, test of validity via expert consultation and reliability tests. In Study II, S-SCEAM was used to assess the quality of the environment, and descriptive data were collected from 20 purposively sampled residential care facilities (RCFs). Study III was a comparative case study conducted at two RCFs using observations, interviews and S-SCEAM to examine how the physical environment relates to older people’s activities and interactions. In study IV, multilevel modeling was used to determine the association between the quality of the physical environment and the psychological and social well-being of older people living in RCFs. The data in the thesis were analysed using qualitative content analysis, and descriptive, bivariate and multilevel statistics. Results: A specific result was the production of the Swedish version of SCEAM. The instrument contains 210 items structured into eight domains reflecting the needs of older people. When using S-SCEAM, the results showed a substantial variation in the quality of the physical environment between and within RCFs. In general, private apartments and dining areas had high quality, whereas overall building layout and outdoor areas had lower quality. Also, older people’s safety was supported in the majority of facilities, whereas cognitive support and privacy had lower quality. Further, the results showed that environmental quality in terms of cognitive support was associated with residents’ social well-being. Specific environmental features, such as building design and space size, were also noted, through observation, as influencing residents’ activities, and several barriers were found that seemed to restrict residents’ full use of the environment. Conclusions: This thesis contributes to the growing evidence-based design field. The S-SCEAM can be used in future research on the association between the environment and people’s health and well-being. The instrument could also serve as a guide in the planning and design process of new RCFs.

The Power of the Synthetic Control Method

The synthetic control method (SCM) is a new, popular method developed for the purpose of estimating the effect of an intervention when only one single unit has been exposed. Other similar, unexposed units are combined into a synthetic control unit intended to mimic the evolution in the exposed unit, had it not been subject to exposure. As the inference relies on only a single observational unit, the statistical inferential issue is a challenge. In this paper, we examine the statistical properties of the estimator, study a number of features potentially yielding uncertainty in the estimator, discuss the rationale for statistical inference in relation to SCM, and provide a Web-app for researchers to aid in their decision of whether SCM is powerful for a specific case study. We conclude that SCM is powerful with a limited number of controls in the donor pool and a fairly short pre-intervention time period. This holds as long as the parameter of interest is a parametric specification of the intervention effect, and the duration of post-intervention period is reasonably long, and the fit of the synthetic control unit to the exposed unit in the pre-intervention period is good.

El concepto y la práctica de la actividad física y su relación con calidad de vida en los modelos teóricos de la salud

Los estudios acerca del concepto actividad física (AF) son diversos, presentando diferentes concepciones; su relación con calidad de vida suele estar generada dentro del discurso médico, que propende por la ejecución de la Actividad Física desde una mirada netamente biológica. Si bien esta disertación es importante, se debe tener en cuenta que los estudios relacionados con calidad de vida y la AF se basan en la condición de bienestar y percepción frente al estado de salud; dichos estudios no se han realizado desde las condiciones de vida y del contexto social. Si bien es cierto que la mirada médica y lo estudios objetivos son relevantes, ya que arrojan estadísticas que permiten abordar recomendaciones en cuanto a la actividad física, en este documento se elaboró una investigación de tipo cualitativo por medio de la revisión documental del concepto de actividad física, sus prácticas y su relación con calidad de vida, que abordan diferentes autores. Para ello se elige la base de datos PubMed por su énfasis en las publicaciones de salud; se seleccionan artículos publicados del 2004 y 2014, que estudien el concepto de actividad física, sus prácticas y relaciones con calidad de vida, para finalmente hacer un análisis desde los modelos de determinación y determinantes sociales. De esta forma se analiza la posición de los autores con respecto al concepto, sus prácticas y las relaciones que puede llegar a surgir con la calidad de vida. En esta investigación se obtuvo como resultados tendencias biológicas, psicológicas, sociales y culturales, en los cuales los autores dejan clara la posición médica ya que en la mayoría de investigaciones centran sus relaciones en la funcionalidad, y es a través de la visión terapéutica donde buscan el bienestar, la satisfacción de los pacientes que padecen cualquier enfermedad. Además, aparecen categorías emergentes como: cuerpo como medio de publicidad, cibernética que avanza vertiginosamente y el papel del poder en la actividad física que pueden ser contempladas para otros estudios.

Estudo eletroquímico comparativo do aço ISO 5832-9 em diferentes meios de interesse biológico

Foi estudado o comportamento eletroquímico a 37°C do aço inoxidável ISO 5832-9, em meios de NaCl 0,9 %, de Ringer Lactato e meio mínimo de Eagle (MEM), por voltametria linear e análises da superfície por microscopia eletrônica de varredura (MEV) e por espectroscopia por dispersão de energia (EDS). Foram feitos ensaios mecânicos e testes de toxicidade. O aço ISO 5832-9 se encontra passivado no potencial de corrosão e não apresenta corrosão por pite nos três meios estudados em toda faixa de potencial investigada, desde o potencial de corrosão até 50 mV acima do potencial de transpassivação. Em meio de MEM, no entanto, as análises por MEV e EDS mostraram que o referido aço, nesse valor mais elevado de potencial, apresentou um comportamento diferente, com perda das inclusões de óxido de manganês. Os potenciais de corrosão, Ecorr (potencial de circuito aberto estacionário) bem como os valores de densidade de corrente de passivação, variaram na seguinte ordem: Ecorr, RL < Ecorr, NaCl < Ecorr, MEM. e jMEM << jRL ≅ jNaCl. No ensaio de citotoxicidade, o aço foi caracterizado como não-tóxico.

Karyotypic evolution trends in Rhamdia quelen (Siluriformes, Heptapteridae) with considerations about the origin and differentiation of its supernumerary chromosomes

Among catfish species of the genus Rhamdia reported for the Brazilian territory, R. quelen is the most widespread, being found in nearly all hydrographic basins of Brazil. Nowadays, R. quelen is a synonym for at least 47 other species in this genus, its taxonomic status still being controversial. The available cytogenetic reports show a wide variation in the karyotypic macrostructure, with the frequent presence of supernumerary chromosomes. The remarkable cytogenetic variability associated with taxonomic issues in this species indicates that R. quelen is actually a species complex. In order to carry out a wide comparative cytogenetic study in R. quelen from southern and southeastern Brazil and examine a species complex, we analyzed the chromosomes of 14 populations from the main hydrographic basins of these two regions. Using classic and molecular cytogenetic techniques, we found seven distinct karyotypic formulae, all bearing 2n = 58 chromosomes. Supernumerary chromosomes were present in most of the populations; their number, size and C-banding pattern allowed us to differentiate populations with similar karyotypic compositions. We examined patterns of chromosomal evolution as well as the probable mechanisms involved in the origin and morphological differentiation of their supernumerary chromosomes.

Supercritical steam cycles and biomass integrated gasification combined cycles for sugarcane mills

Back in 1970s and 1980s, cogeneration plants in sugarcane mills were primarily designed to consume all bagasse, and produce steam and electricity to the process. The plants used medium pressure steam boilers (21 bar and 300 degrees C) and backpressure steam turbines. Some plants needed also an additional fuel, as the boilers were very inefficient. In those times, sugarcane bagasse did not have an economic value, and it was considered a problem by most mills. During the 1990s and the beginning of the 2000s, sugarcane industry faced an open market perspective, thus, there was a great necessity to reduce costs in the production processes. In addition, the economic value of by-products (bagasse, molasses, etc.) increased, and there was a possibility of selling electricity to the grid. This new scenario led to a search for more advanced cogeneration systems, based mainly on higher steam parameters (40-80 bar and 400-500 degrees C). In the future, some authors suggest that biomass integrated gasification combined cycles are the best alternative to cogeneration plants in sugarcane mills. These systems might attain 35-40% efficiency for the power conversion. However, supercritical steam cycles might also attain these efficiency values, what makes them an alternative to gasification-based systems. This paper presents a comparative thermoeconomic study of these systems for sugarcane mills. The configurations studied are based on real systems that could be adapted to biomass use. Different steam consumptions in the process are considered, in order to better integrate these configurations in the mill. (C) 2009 Elsevier Ltd. All rights reserved.

Evaluation of two round baling systems for harvesting understory biomass

The objective of this study was to evaluate the performance and to estimate costs of two round baling systems for harvesting understory biomass. One system was a cutter-shredderbaler prototype (Bio-baler). The other system required two successive operations. The first operation was cutting and shredding with a Supertrak tractor equipped with a Fecon mulcher head. The second operation was baling with a Claas baler. The machines were evaluated in three different pine stands on the Osceola National Forest in Florida, United States. Data collection included time study, fuel consumption and bale measurements. Material was collected from a sample of bales for heat and moisture content determination. On the most representative site (Site 2), the Bio-baler recovered 8.05 green t ha(-1) while the mulcher and the Claas baler recovered 9.75 green t ha(-1) (43 and 52 percent of original understory biomass, respectively). Productivity was 0.30 ha h(-1) for the Bio-baler and 0.51 ha h(-1) for the Claas baler. Density of the bales was 321 green kg m(-3) for the Bio-baler and 373 green kg m(-3) for the Claas baler. Average net heat content was 6263 MJ bale(-1) for the Bio-baler and 6695 MJ bale(-1) for the Claas baler with biomass containing 38 percent of moisture content on a wet basis. cost per unit area was less with the Bio-baler (US$320.91 ha(-1)) than with the mulcher-baler system (US$336.62-US$596.77 ha(-1)). Published by Elsevier Ltd.

Decentralized control design for nonlinear plants: a v-metric approach

In this paper, a new v-metric based approach is proposed to design decentralized controllers for multi-unit nonlinear plants that admit a set of plant decompositions in an operating space. Similar to the gap metric approach in literature, it is shown that the operating space can also be divided into several subregions based on a v-metric indicator, and each of the subregions admits the same controller structure. A comparative case study is presented to display the advantages of proposed approach over the gap metric approach. (C) 2000 Elsevier Science Ltd. All rights reserved.

Fragmentation of a Neotropical migratory fish population by a century-old dam

Loss of connectivity in impounded rivers is among the impacts imposed by dams, and mitigation measures such as fish passages might not accomplish their purpose of reestablishing an efficient bi-directional gene flow in the fish populations affected. As a consequence, fish populations remain fragmented, and a new interpopulational structure may develop, with increased risk of reduced genetic diversity and stochastic extinction. In order to evaluate the effects of the Gavio Peixoto Dam, which was constructed almost a century ago on the Jacar,-Gua double dagger u River in the Upper Parana River basin, Brazil, a comparative morphometric study was undertaken on the populations of the Neotropical migratory characid fish Salminus hilarii living up- and downstream of this dam. Population dynamics, spatial segregation, and habitat use by different age classes were monitored for 2 years. We found that segregation caused by the dam and long periods with no efficient connection by fish passages have led to fragmentation and interpopulational structuring of S. hilarii, as revealed by canonical variable analysis of morphometric features. The fish populations occupying the up- and downstream sections have succeeded in performing short-distance reproductive migrations in the main river and tributaries, have found suitable habitats for completing their life cycle, and have been able to maintain distinct small-sized populations so far.

Evaluate of the efficacy and safety of tacrolimus ointment 0,03% to treat atopic dermatitis in pediatric patients

BACKGROUND: Tacrolimus ointment has been shown to be effective in treatment of atopic dermatitis. OBJECTIVES: To evaluate the efficacy and safety of 0.03% tacrolimus ointment (Protopic(R)) in pediatric patients with mild, moderate and severe atopic dermatitis. METHODS.. Open, non-comparative, multicentric study carried out in Brazil. 174 patients (ages from two to 10) with mild to severe atopic dermatitis were included. Patients were instructed to apply Protopic(R) twice a day for six weeks. Primary efficacy criterion was clinical improvement >= 90% assessed by the pbysician (Clinical Response Global Evaluation Scale). Other efficacy criteria included reduction of the Eczema Area Severity Index (EASI), decrease of the affected body surface area (%BSA) and evaluation of the itching by the patients or their guardians (visual analogical scale). Safety was evaluated by adverse events reported by patients and/or guardians or by investigators. RESULTS: Thirty-three percent of patients showed clinical improvement 90%. 45.5% of patients (1st week) decreased EASI and 61.8% (6th week) (p<0,001). %BSA decreased 30.4% and 55.5% in the first and sixth week. improvement was also significant when measured by itching (p<0, 001). Most frequent adverse effects were: burning and itching. CONCLUSION: 0.03% tacrolimus ointment is a safe and effective therapy for mild to severe atopic dermatitis in pediatric patients.

Translabial color Doppler urodynamics

Color Doppler ultrasound is a new method for documenting fluid leakage in the setting of video-urodynamic testing. In order to compare color Doppler ultrasound with traditional fluoroscopic imaging we performed a prospective blinded comparative clinical study. Fifty-two consecutive patients undergoing urodynamic investigations for symptoms of incontinence or prolapse were examined using fluoroscopy and translabial color Doppler ultrasound to document stress leakage. The investigators were blinded to each other's results. Both tests were performed at maximum bladder capacity and with an indwelling 5 Fr microtransducer catheter, in both the supine and the erect positions. Equivalent results for both methods were obtained in 48 out of 52 patients (Cohen's kappa = 0.82). It was therefore concluded that translabial color Doppler ultrasound imaging can reliably demonstrate leakage through the female urethra on Valsalva maneuver or coughing.