Persistent symptoms after elective sigmoid resection for diverticulitis

PURPOSE: Despite technically successful surgery for diverticular disease, a significant group of patients who experience persistent or recurrent symptoms remains. This study was designed to determine the incidence and pattern of persistent symptoms and their association with peroperative parameters. METHODS: Follow-up (33 (range, 4-72) months) through structured interviews with patients who had surgery for diverticulitis in our department from December 1999 to November 2004 was conducted. Of 162 patients, 124 (76.5 percent) were available for follow-up. Nonparametric tests were used for comparison of patients who had undergone elective (n = 68) or emergency (n = 56) procedures. RESULTS: Of patients who had elective surgery, 25 percent suffered persistent symptoms, including painful constipation, painful abdominal distension, abdominal cramps, and frequent painful diarrhea. Neither the stage of disease (complicated or uncomplicated) nor the surgical technique (laparotomy or laparoscopy) were significantly related to the occurrence of symptoms. Recurrent diverticulitis was not observed. Similar results were obtained from comparisons with emergency patients. CONCLUSIONS: The prevalence of persistent symptoms after successful surgery for diverticular disease may be an additional reason to carefully discuss the indication for prophylactic surgery. In any case, preoperative counseling and informed consent regarding the possibility of persistent symptoms after prophylactic elective surgery is essential.

A Case Study of Muscular Strength, Endurance, and Power Responses to a 6-Week High Intensity Training Program

We evaluated the muscular strength, endurance, and power responses of 12 college students, ranging in age from 19-40 years, who participated in a 6-wk high-intensity training program commonly used to improve muscular endurance. Muscular strength was measured by a one repetition maximum (1RM) bench press test and a 1RM Hammer bench press test; muscular endurance was measured by administering a 70-percent 1RM test to failure on the Hammer bench press; and upper body power was measured by adminstering a medicine ball throw test. We observed a 4.8-percent improvement of 2.7 kg on the bench press, a 14.6-percent improvement of 10.5 kg on the Hammer bench press, a 45.5-percent improvement with an average increase of five repetitions on the submaximal test to failure and an average improvement of ~ 20 percent, 60 cm, for the medicine ball throw. Foe our subjects, a commonly used high-intensity training muscular endurance program resulted in improved performance on tests measuring muscular strength, endurance, and power, and resulted in zero reported injuries during training or assessment procedures.

Critical Control Points for Profitability in the Cow-Calf Enterprise

Financial, economic, and biological data collected from cow-calf producers who participated in the Illinois and Iowa Standardized Performance Analysis (SPA) programs were used in this study. Data used were collected for the 1996 through 1999 calendar years, with each herd within year representing one observation. This resulted in a final database of 225 observations (117 from Iowa and 108 from Illinois) from commercial herds with a range in size from 20 to 373 cows. Two analyses were conducted, one utilizing financial cost of production data, the other economic cost of production data. Each observation was analyzed as the difference from the mean for that given year. The independent variable utilized in both the financial and economic models as an indicator of profit was return to unpaid labor and management per cow (RLM). Used as dependent variables were the five factors that make up total annual cow cost: feed cost, operating cost, depreciation cost, capital charge, and hired labor, all on an annual cost per cow basis. In the economic analysis, family labor was also included. Production factors evaluated as dependent variables in both models were calf weight, calf price, cull weight, cull price, weaning percentage, and calving distribution. Herd size and investment were also analyzed. All financial factors analyzed were significantly correlated to RLM (P < .10) except cull weight, and cull price. All economic factors analyzed were significantly correlated to RLM (P < .10) except calf weight, cull weight and cull price. Results of the financial prediction equation indicate that there are eight measurements capable of explaining over 82 percent of the farm-to-farm variation in RLM. Feed cost is the overriding factor driving RLM in both the financial and economic stepwise regression analyses. In both analyses over 50 percent of the herd-to-herd variation in RLM could be explained by feed cost. Financial feed cost is correlated (P < .001) to operating cost, depreciation cost, and investment. Economic feed cost is correlated (P < .001) with investment and operating cost, as well as capital charge. Operating cost, depreciation, and capital charge were all negatively correlated (P < .10) to herd size, and positively correlated (P < .01) to feed cost in both analyses. Operating costs were positively correlated with capital charge and investment (P < .01) in both analyses. In the financial regression model, depreciation cost was the second critical factor explaining almost 9 percent of the herd-to-herd variation in RLM followed by operating cost (5 percent). Calf weight had a greater impact than calf price on RLM in both the financial and economic regression models. Calf weight was the fourth indicator of RLM in the financial model and was similar in magnitude to operating cost. Investment was not a significant variable in either regression model; however, it was highly correlated to a number of the significant cost variables including feed cost, depreciation cost, and operating cost (P < .001, financial; P < .10, economic). Cost factors were far more influential in driving RLM than production, reproduction, or producer controlled marketing factors. Of these cost factors, feed cost had by far the largest impact. As producers focus attention on factors that affect the profitability of the operation, feed cost is the most critical control point because it was responsible for over 50 percent of the herd-to-herd variation in profit.

Development and testing of a procedure for systematically assigning gestational age for clinical and research use

A graphing method was developed and tested to estimate gestational ages pre-and postnatally in a consistent manner for epidemiological research and clinical purposes on feti/infants of women with few consistent prenatal estimators of gestational age. Each patient's available data was plotted on a single page graph to give a comprehensive overview of that patient. A hierarchical classification of gestational age determination was then applied in a systematic manner, and reasonable gestational age estimates were produced. The method was tested for validity and reliability on 50 women who had known dates for their last menstrual period or dates of conception, and multiple ultrasound examinations and other gestational age estimating measures. The feasibility of the procedure was then tested on 1223 low income women with few gestational age estimators. The graphing method proved to have high inter- and intrarater reliability. It was quick, easy to use, inexpensive, and did not require special equipment. The graphing method estimate of gestational age for each infant was tested against the last menstrual period gestational age estimate using paired t-Tests, F tests and the Kolmogorov-Smirnov test of similar populations, producing a 98 percent probability or better that the means and data populations were the same. Less than 5 percent of the infants' gestational ages were misclassified using the graphing method, much lower than the amount of misclassification produced by ultrasound or neonatal examination estimates. ^

Fine-scale population structure analysis of seven local Swiss sheep breeds using genome-wide SNP data

As part of the global sheep Hapmap project, 24 individuals from each of seven indigenous Swiss sheep breeds (Bundner Oberländer sheep (BOS), Engadine Red sheep (ERS), Swiss Black-Brown Mountain sheep (SBS), Swiss Mirror sheep (SMS), Swiss White Alpine (SWA) sheep, Valais Blacknose sheep (VBS) and Valais Red sheep (VRS)), were genotyped using Illumina’s Ovine SNP50 BeadChip. In total, 167 animals were subjected to a detailed analysis for genetic diversity using 45 193 informative single nucleotide polymorphisms. The results of the phylogenetic analyses supported the known proximity between populations such as VBS and VRS or SMS and SWA. Average genomic relatedness within a breed was found to be 12 percent (BOS), 5 percent (ERS), 9 percent (SBS), 10 percent (SMS), 9 percent (SWA), 12 percent (VBS) and 20 percent (VRS). Furthermore, genomic relationships between breeds were found for single individuals from SWA and SMS, VRS and VBS as well as VRS and BOS. In addition, seven out of 40 indicated parent–offspring pairs could not be confirmed. These results were further supported by results from the genome-wide population cluster analysis. This study provides a better understanding of fine-scale population structures within and between Swiss sheep breeds. This relevant information will help to increase the conservation activities of the local Swiss sheep breeds.

US medical students' knowledge of obstetric fistula in developing countries

Obstetric fistula is a devastating child birth injury affecting millions of women worldwide. This paper explores the knowledge and understanding of medical students at the University of Texas Health Science Center at San Antonio regarding this global public health issue. Obstetric fistula has been eradicated in most industrialized nations, and has therefore faded from view of many modern medical organizations. The United Nations Population Fund has launched a “Campaign to End Fistula” in an attempt to bring global awareness to this preventable and treatable condition. Based on a survey administered to medical students at UTHSCSA, a baseline understanding of this disorder based on current curriculum is reviewed, with the objective of improving future physicians’ awareness of obstetric fistula. Despite a low survey response rate, there was a significant association between greater knowledge about causes, treatment, and complications of obstetric fistula and advanced years in medical school. However, the fourth year medical students averaged only a 70.5 percent of correct responses on the survey, indicating room for improvement in addressing this topic during medical school. ^

AN ESTIMATION OF IN UTERO DRUG EXPOSURE BY DETERMINANTS OF FREQUENCY AND DISTRIBUTION OF MATERNAL DRUG CONSUMPTION

Data derived from 1,194 gravidas presenting at the observation unit of a city/county hospital between October 11, 1979 through December 7, 1979 were evaluated with respect to the proportion ingesting drugs during pregnancy. The mean age of the mother at the time of the interview was 22.0 years; 43.0 percent were Black; 34.0 percent Latin-American, 21.0 percent White and 2.0 percent other; mean gravida was 2.5 pregnancies; mean parity was 1.0; and mean number of previous abortions was 0.34. Completed interview data was available for 1,119 gravida, corresponding urinalyses for 997 subjects. Ninety and one-tenth percent (90.1 percent) of the subjects reported ingestion of one or more drug preparation(s) (prescription, OTC, or substances used for recreational purposes) during pregnancy with a range of 0 to 11 substances and a mean of 2.7. Dietary supplements (vitamins and minerals) were most frequently reported followed by non-narcotic analgesics. Seventy-six and one tenth percent (76.1 percent) of the population reported consumption of prescription medication, 42.5 percent reported consumption of over-the-counter medications, 45.7 percent reported consumption of a substance for recreational purposes and 4.3 percent reported illicit consumption of a substance. For selected substances, no measurable difference was found between obtaining the information from the interview method or from a urinalysis assay. ^

Interpretation services for immigrants in federally qualified health centers: Barriers, best practices, and suggestions for the future

This paper examines the provision of interpretation services to immigrants with limited English proficiency in Federally Qualified Health Centers, through examination of barriers and best practices. The United States is a nation of immigrants; currently, more than 38 million, or 12.5 percent of the total population, is foreign-born. A substantial portion of this population does not have health insurance or speak English fluently: barriers that reduce the likelihood that they will access traditional health care organizations. This service void is filled by FQHCs, which are non-profit, community-directed providers that remove common barriers to care by serving communities who otherwise confront financial, geographic, language, and cultural barriers. By examining the importance and the implementation of medical interpretation services in FQHCs, suggestions for the future are presented.^

Evaluation of a Blended Refuge for Corn Rootworm

The purpose of this study was to evaluate the effectiveness of the blended refuge concept against corn rootworms. The treatments evaluated include a pure stand of Herculex XTRA (HXX), a pure stand of Roundup Ready 2 (RR2), a pure stand of RR2 with Force 3G applied overtop, and two treatments with the refuge in a bag concept–one with 95 percent HXX and a 5 percent RR2 blended refuge and the other with 90 percent HXX and a 10 percent RR2 blended refuge.

Permian manganese nodules near Dillon, Montana

Concentrically ringed manganese nodules, similar in form to many found on modern ocean and sea floors, occur in a very fine grained argillaceous sandstone bed of the Permian Park City Formation near Dillon, Montana. They are enriched in many rare elements and contain us much as 2.5 percent zinc, l.3 percent nickel, and 0.22 percent cobalt. The manganese minerals are chalcophanite and todorokite. The nodules probably formed in a shallow marine oxidizing environment on the western side of the Permian sedimentary basin. The occurrence of an appreciable amount of fluorite in the bed suggests that the water was saline.

Medallones de carne vacuna : reducción del contenido de sal por incorporación de oleorresinas de especias

Para evaluar la posible disminución de la adición de cloruro de sodio, mediante el agregado de oleorresinas de especias, se elaboró una masa en la que se empleó 85 % de carne vacuna y 15 % de grasa. Se fraccionó en tres lotes, adicionándoles: 1000 mg/kg de oleorresina de Origanum x Majoricum, 750 mg/kg de la de Capsicum annum o de la de Acantholippia seriphioides, respectivamente. Luego se dividieron en cinco porciones iguales y se agregó sal, hasta alcanzar contenidos de 0.00 %; 0.25 %; 0.50 %; 0.75 % y 1.00 %. Se homogeneizaron y se elaboraron medallones de 100 g, que se cocinaron en horno hasta alcanzar una temperatura interna de 72 °C. Se realizó una evaluación sensorial con 15 jueces semientrenados, solicitándoles que asignaran puntajes, mediante escalas estructuradas de siete puntos e indicaran cuál/es rechazarían. Los puntajes asignados por el panel se sometieron a un análisis exploratorio de datos, a las pruebas de Page y de comparaciones múltiples. Los medallones adicionados con los tres tipos de oleorresinas para las dosis de sal ensayadas presentaron diferencias (= 0.05): las dosis de 0 y 1% fueron las menos aceptadas y la de 0.25 % fue la más aceptada. El 50 % de los jueces rechazó el medallón con 0 % de sal, para los tres tipos de oleorresinas. En las condiciones ensayadas, la incorporación de oleorresinas en dosis de 1000 mg/kg para orégano o de 750 mg/kg para pimiento y tomillo mendocino, permite formular medallones de carne vacuna, con bajo contenido de sal y alta aceptación.

Chemical composition of ferromanganese micronodules and bulk sediments from ODP Hole 199-1216A

Distribution, size, mineral, and chemical compositions of ferromanganese micronodules (FMMNs) and chemical composition of host sediments were examined in a series of red clay samples with ages from Eocene to the present at Ocean Drilling Program Leg 199, Site 1216, south of the Molokai Fracture Zone in the Central Pacific Basin. The number of FMMNs changed drastically throughout the 40-m-long red clay intervals. FMMNs are abundant in the upper 9 m of core, decrease between 9 and 25 meters below seafloor (mbsf) with depth, and are very rare from 30 to 40 mbsf. Chemical composition of FMMNs showed high Mn/Fe ratios and Ni and Cu contents and a distinct positive Ce anomaly because of the existence of buserite. This suggests that FMMNs in the red clay from 25 mbsf to the top of the cored interval were deposited continuously in an oxic diagenetic bottom environment. The red clay below 30 mbsf with higher Mn contents contains few FMMNs but abundant tiny Mn particles within brown silicates coated by Fe (oxy-hydro)oxides. This indicates that the mode of manganese deposition changed between 25 and 30 mbsf.

Perfil clínico y social del paciente adicto hospitalizado

Objetivos: Determinar las características clínicas y morbilidad de los pacientes (pac.) adictos ingresados a un Servicio de Clínica Médica. Material y métodos: Estudio protocolizado, observacional, descriptivo y transversal. Criterio de inclusión: pac. adicto con consumo de sustancias ilícitas. Informe preliminar: Periodo: 24 meses. Datos analizados en Epi info 6.4 Resultados: Se incluyeron 40 pac. Prevalencia: 0.2/1000 egresos. El 82.5% eran hombres. Edad media: 31.5 años (DS±9.65). Permanencia media: 11 días (DS±13.98) vs 7.12 (DS±10.1) del Servicio (p=0.016). Consumían cocaína el 82.5% (IC95%67.22-92.66) marihuana el 77.5% (IC95% 61.65- 89.16), tolueno el 10% (IC95%2.79-23.66), floripondio y hachis el 2.5% (IC95% 0.06-13.16) cada uno. En el 2.5% la vía de administración era endovenosa y el 60% eran poliadictos. Solo el 10% recibió tratamiento para abandonar la adicción (100% tratamiento psicológico y 5.13% farmacológico). De clase social pobre el 75%. El 62.5% de los pac. estaban desocupados, tenían antecedentes judiciales el 10% y el 7.5% había estado en prisión. El 92.5% (IC95% 76.34-97.21) era heterosexual, 2.5% hombres que tenían sexo con hombres y bisexuales 5% (IC95% 0.61-16.92). Solo el 10% tenían secundaria completa. El 80% ingreso por Emergencias y por causa infecciosa el 45%. El 12.5% ingreso por complicaciones de la adicción. Las manifestaciones relacionadas con la adicción fueron: manifestaciones del sistema nervioso central: 12.5% (IC95%4.19-26.80); síndrome de abstinencia y temblor 7.5% cada uno y excitación psicomotriz, delirium, signo de foco neurológico y rigidez 5% cada uno. El 100% presentaba alguna comórbida; tabaquismo 80%, depresión 12.8% Y alcoholismo 57.5%, entre otras. Presentaban enfermedades de transmisión sexual 5 pac. (4 HIV, 2 VHC y 1 pediculus pubis). No hubo mortalidad hospitalaria. Conclusión: El paciente adicto internado se caracteriza por ser joven, pertenecer a un grupo social desprotegido, sin trabajo y sin educación, tener poliadicción, con alta carga de comórbidas y de internación, principalmente por complicaciones infecciosas.

Comparación de variables fisiológicas y rendimiento alcanzado entre un ejercicio continuo vs. un ejercicio intermitente en futbolista amateur

El objetivo del presente trabajo es determinar si existen diferencias entre los promedios de frecuencia cardíaca intra, final, post esfuerzo, veloci-dad final de desplazamiento y tiempo de permanencia dentro de cada patrón de ejercicio realizado: Continuo, Yo-Yo Endurance Test nivel 1(ETN1) r = 0,84 vs. Intermitente, Yo-Yo Recovery Test nivel 1(RTN1) r = 0,90. Se seleccionaron 9 jugadores amateur. Se diseño un estudio intrasujetos, experimental. El primer patrón de ejercicio denominado ETN1 que nos infiere datos sobre el Consumo Máximo de Oxígeno valorado de forma indi-recta, y el RTN1 que nos informa aspectos relacionados con la resistencia a realizar esfuerzos intermitentes, muy utilizados en el fútbol. (BANGSBO, 1994) En ambos test se monitoreó la FC cada 5 segundos, al final y en los instantes de recuperación post-esfuerzo (3, 5 y 7 minuto). Se encontraron diferencias estadísticamente significati-vas en la velocidad final de carrera (RTN1 15.9 Km/h. vs. ETN1 14.1 Km/h. p < 0.001), en el tiempo de per-manencia en las pruebas (RTN1 17,0 minutos vs. ETN1 13,0 minutos p < 0.01), FC (RTN1 190.5 latidos por minuto vs. ETN1 196.1 latidos por minuto p < 0.001) son significativamente diferentes, arrojando menores valores en el protocolo intermitente

Comparación de variables fisiológicas y rendimiento alcanzado entre un ejercicio continuo vs. un ejercicio intermitente en futbolista amateur

El objetivo del presente trabajo es determinar si existen diferencias entre los promedios de frecuencia cardíaca intra, final, post esfuerzo, veloci-dad final de desplazamiento y tiempo de permanencia dentro de cada patrón de ejercicio realizado: Continuo, Yo-Yo Endurance Test nivel 1(ETN1) r = 0,84 vs. Intermitente, Yo-Yo Recovery Test nivel 1(RTN1) r = 0,90. Se seleccionaron 9 jugadores amateur. Se diseño un estudio intrasujetos, experimental. El primer patrón de ejercicio denominado ETN1 que nos infiere datos sobre el Consumo Máximo de Oxígeno valorado de forma indi-recta, y el RTN1 que nos informa aspectos relacionados con la resistencia a realizar esfuerzos intermitentes, muy utilizados en el fútbol. (BANGSBO, 1994) En ambos test se monitoreó la FC cada 5 segundos, al final y en los instantes de recuperación post-esfuerzo (3, 5 y 7 minuto). Se encontraron diferencias estadísticamente significati-vas en la velocidad final de carrera (RTN1 15.9 Km/h. vs. ETN1 14.1 Km/h. p < 0.001), en el tiempo de per-manencia en las pruebas (RTN1 17,0 minutos vs. ETN1 13,0 minutos p < 0.01), FC (RTN1 190.5 latidos por minuto vs. ETN1 196.1 latidos por minuto p < 0.001) son significativamente diferentes, arrojando menores valores en el protocolo intermitente