940 resultados para Patient in the terminal phase
Resumo:
The aim of this study was to evaluate the difference between a 5-day and a 1-day postoperative course of antibiotic on the incidence of infection after mandibular fractures involving the alveolus. Sixty-two patients with fractures of the mandible involving the dentoalveolar region were randomly assigned to 2 groups, both of which were given amoxicillin/clavulanic acid 1.2 g intravenously every 8 h from admission until 24 h postoperatively. The 5-day group were then given amoxicillin/clavulanic acid 625 mg orally every 8 h for another 4 days. The 1-day group was given an oral placebo at the same intervals. Follow-up appointments were 1, 2, 4, 6, 12 weeks and 6 months postoperatively. Development of an infection was the primary end point. Fifty-nine of the 62 patients completed this study. Six of the 30 patients in the 5-day group (20%) and 6 out of the 29 in the 1-day group (21%) developed local wound infections. Three of the 6 in the 1-day group developed purulent discharge and swelling. One patient in the 5-day group developed a rash on the trunk. There were no significant differences in the incidence of infection or side effects between the groups. In fractures of the mandible involving the alveolus, a 1-day postoperative course of antibiotic is as effective in preventing infective complications as a 5-day regimen.
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We study the phase diagram of the two-dimensional N = 1 Wess-Zumino model using Wilson fermions and the fermion loop formulation. We give a complete non-perturbative determination of the ground state structure in the continuum and infinite volume limit. We also present a determination of the particle spectrum in the supersymmetric phase, in the supersymmetry broken phase and across the supersymmetry breaking phase transition. In the supersymmetry broken phase we observe the emergence of the Goldstino particle.
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We study the phase diagram of the two-dimensional N=1 Wess-Zumino model on the lattice using Wilson fermions and the fermion loop formulation. We give a complete nonperturbative determination of the ground state structure in the continuum and infinite volume limit. We also present a determination of the particle spectrum in the supersymmetric phase, in the supersymmetry broken phase and across the supersymmetry breaking phase transition. In the supersymmetry broken phase, we observe the emergence of the Goldstino particle.
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Europeanization challenges national democratic systems. As part and parcel of the broader internationalization of politics, Europeanization is associated with a shift from policymaking within majoritarian, elected representative bodies towards technocratic decisions among non-majoritarian and non-elected bodies (Kohler-Koch and Rittberger 2008, Lavenex 2013). It is thus said to weaken the influence of citizens and parliaments on the making of policies and to undermine democratic collective identity (Lavenex 2013, Schimmelfennig 2010). The weakening of national parliaments has been referred to as “de-parliamentarisation” (Goetz and Meyer-Sahling 2008) and has nurtured a broader debate regarding the democratic deficit in the EU. While not being a member of the EU, Switzerland has not remained unaffected by these changes. As discussed in the contribution by Fischer and Sciarini, state executive actors take the lead in Switzerland's European policy. They are responsible for the conduct of international negotiations, they own the treaty making power, and it is up to them to decide whether they wish to launch a negotiation with the EU. In addition, the strong take-it or leave-it character of Europeanized acts limits the room for manoeuver of the parliamentary body also in the ratification phase. Among the public, the rejection of the treaty on the European constitution has definitely closed the era of “permissive consensus” (Hooghe and Marks 2009). However, the process of European unification remains far remote from the European public. In Switzerland, the strongly administrative character of international legislation hinders public discussion (Vögeli 2007). In such a context, the media may serve as cue for the public: By delivering information about the extent and nature of Europeanized policymaking, the media enable citizens to form their own opinions and to hold their representatives accountable. In this sense media coverage may not only be considered an indicator of the information delivered to the public, but it may also enhance the democratic legitimacy of Europeanized policymaking (for a similar argument, see Tresch and Jochum 2005). While the previous contributions to this debate have examined the Europeanization of Swiss (primary and secondary) legislation, we take a closer look at two additional domestic arenas that are both supposed to be under pressure due to Europeanization: The parliament and the media. To that end, we rely on data gathered in a research project that two of us carried out in the context of the NCCR Democracy.1 While this project was primarily interested in the mediatization of decision-making processes in Switzerland, it also investigated the conditional role played by internationalization/Europeanization. For our present purposes, we shall exploit the two data-sets that were developed as part of a study of the political agenda-setting power of the media (Sciarini and Tresch 2012, 2013, Tresch et al. 2013): A data-set on issue attention in parliamentary interventions (initiatives, motions, postulates,2 interpellations and questions) and a data-set on issue attention in articles from the Neue Zürcher Zeitung (NZZ). The data covers the years 1995 to 2003 and the coding of issues followed the classification system developed in the “Policy Agendas Project” (Baumgartner and Jones 1993).
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Antisense oligonucleotides are medical agents for the treatment of genetic diseases that are designed to interact specifically with mRNA. This interaction either induces enzymatic degradation of the targeted RNA or modifies processing pathways, e.g. by inducing alternative splicing of the pre-mRNA. The latter mechanism applies to the treatment of Duchenne muscular dystrophy with a sugar-modified DNA analogue called tricyclo-DNA (tcDNA). In tcDNA the ribose sugar-moiety is extended to a three-membered ring system, which augments the binding affinity and the selectivity of the antisense oligonucleotide for its target. The advent of chemically modified nucleic acids for antisense therapy presents a challenge to diagnostic tools, which must be able to cope with a variety of structural analogues. Mass spectrometry meets this demand for non-enzyme based sequencing methods ideally, because the technique is largely unaffected by structural modifications of the analyte. Sequence coverage of a fully modified tcDNA 15mer can be obtained in a single tandem mass spectrometric experiment. Beyond sequencing experiments, tandem mass spectrometry was applied to elucidate the gas-phase structure and stability of tcDNA:DNA and tcDNA:RNA hybrid duplexes. Most remarkable is the formation of truncated duplexes upon collision-induced dissociation of these structures. Our data suggest that the cleavage site within the duplex is directed by the modified sugar-moiety. Moreover, the formation of truncated duplexes manifests the exceptional stability of the hybrid duplexes in the gas-phase. This stability arises from the modified sugar-moiety, which locks the tcDNA single strand into a conformation that is similar to RNA in A-form duplexes. The conformational particularity of tcDNA in the gas-phase was confirmed by ion mobility-mass spectrometry experiments on tcDNA, DNA, and RNA.
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Peritoneal transport characteristics and residual renal function require regular control and subsequent adjustment of the peritoneal dialysis (PD) prescription. Prescription models shall facilitate the prediction of the outcome of such adaptations for a given patient. In the present study, the prescription model implemented in the PatientOnLine software was validated in patients requiring a prescription change. This multicenter, international prospective cohort study with the aim to validate a PD prescription model included patients treated with continuous ambulatory peritoneal dialysis. Patients were examined with the peritoneal function test (PFT) to determine the outcome of their current prescription and the necessity for a prescription change. For these patients, a new prescription was modeled using the PatientOnLine software (Fresenius Medical Care, Bad Homburg, Germany). Two to four weeks after implementation of the new PD regimen, a second PFT was performed. The validation of the prescription model included 54 patients. Predicted and measured peritoneal Kt/V were 1.52 ± 0.31 and 1.66 ± 0.35, and total (peritoneal + renal) Kt/V values were 1.96 ± 0.48 and 2.06 ± 0.44, respectively. Predicted and measured peritoneal creatinine clearances were 42.9 ± 8.6 and 43.0 ± 8.8 L/1.73 m2/week and total creatinine clearances were 65.3 ± 26.0 and 63.3 ± 21.8 L/1.73 m2/week, respectively. The analysis revealed a Pearson's correlation coefficient for peritoneal Kt/V of 0.911 and Lin's concordance coefficient of 0.829. The value of both coefficients was 0.853 for peritoneal creatinine clearance. Predicted and measured daily net ultrafiltration was 0.77 ± 0.49 and 1.16 ± 0.63 L/24 h, respectively. Pearson's correlation and Lin's concordance coefficient were 0.518 and 0.402, respectively. Predicted and measured peritoneal glucose absorption was 125.8 ± 38.8 and 79.9 ± 30.7 g/24 h, respectively, and Pearson's correlation and Lin's concordance coefficient were 0.914 and 0.477, respectively. With good predictability of peritoneal Kt/V and creatinine clearance, the present model provides support for individual dialysis prescription in clinical practice. Peritoneal glucose absorption and ultrafiltration are less predictable and are likely to be influenced by additional clinical factors to be taken into consideration.
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Even the best school health education programs will be unsuccessful if they are not disseminated effectively in a manner that encourages classroom adoption and implementation. This study involved two components: (1) the development of a videotape intervention to be used in the dissemination phase of a 4-year, NCI-funded diffusion study and (2) the evaluation of that videotape intervention strategy in comparison with a print (information transfer) strategy. Conceptualization has been guided by Social Learning Theory, Diffusion Theory, and communication theory. Additionally, the PRECEDE Framework has been used. Seventh and 8th grade classroom teachers from Spring Branch Independent School District in west Houston participated in the evaluation of the videotape and print interventions using a 57-item preadoption survey instrument developed by the UT Center for Health Promotion Research and Development. Two-way ANOVA was used to study individual score differences for five outcome variables: Total Scale Score (comprised of 57 predisposing, enabling, and reinforcing items), Adoption Characteristics Subscale, Attitude Toward Innovation Subscale, Receptivity Toward Innovation, and Reinforcement Subscale. The aim of the study is to compare the effect upon score differences of video and print interventions alone and in combination. Seventy-three 7th and 8th grade classroom teachers completed the study providing baseline and post-intervention measures on factors related to the adoption and implementation of tobacco-use prevention programs. Two-way ANOVA, in relation to the study questions, found significant scoring differences for those exposed to the videotape intervention alone for both the Attitude Toward Innovation Subscale and the Receptivity to Adopt Subscale. No significant results were found to suggest that print alone influences favorable scoring differences between baseline and post-intervention testing. One interaction effect was found suggesting video and print combined are more effective for influencing favorable scoring differences for the Reinforcement for the Adoption Subscale.^ This research is unique in that it represents a newly emerging field in health promotion communications research with implications for Social Learning Theory, Diffusion Theory, and communication science that are applicable to the development of improved school health interventions. ^
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In September 1999 two short-term moorings with cylindrical sediment traps were deployed to collect sinking particles in bottom waters off the Ob and Yenisei river mouths. Samples were studied for their bulk composition, pigments, phytoplankton, microzooplankton, fecal material, amino acids, hexosamines, fatty acids and sterols and compared to suspended matter and surface sediments in order to collect information about the nature and cycling of particulate matter in the water column. Results of all measured components in sinking particles point to an ongoing seasonality in the pelagic system from blooming diatoms in the first phase to a more retention system in the second half of trap deployment. Due to a phytoplankton bloom observed north of the Ob estuary, flux rates were generally higher in the trap deployed off the Ob than off the Yenisei. The Ob trap collected fresh surface-derived particulate matter. Particles from the Yenisei trap were more degraded and resembled deep water suspension. This material may partly have been derived from resuspended sediments.
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The iterative evolutionary radiation of planktic foraminifers is a well-documented macroevolutionary process. Here we document the accompanying size changes in entire planktic foraminiferal assemblages for the past 70 My and their relationship to paleoenvironmental changes. After the size decrease at the Cretaceous/Paleogene (K/P) boundary, high latitude assemblages remained consistently small. Size evolution in low latitudes can be divided into three major phases: the first is characterized by dwarfs (65-42 Ma), the second shows moderate size fluctuations (42-14 Ma), and in the third phase, planktic foraminifers have grown to the unprecedented sizes observed today. Our analyses of size variability with paleoproxy records indicate that periods of size increase coincided with phases of global cooling (Eocene and Neogene). These periods were characterized by enhanced latitudinal and vertical temperature gradients in the oceans and high diversity (polytaxy). In the Paleocene and during the Oligocene, the observed (minor) size changes of the largely low-diversity (oligotaxic) assemblages seem to correlate with productivity changes. However, polytaxy per se was not responsible for larger test sizes.
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The distribution of 210Pb and 210 Po on dissolved (< 0.4 micron) and particulate (> 0.4 micron) phases has been measured at ten stations occupied during cruise 32 of F.S. "Meteor" in the tropical and eastern North Atlantic. Both radionuclides occur principally in the dissolved phase. Unsupported 210Pb activities, maintained by flux from the atmosphere, are present in the surface mixed layer and penetrate into the thermocline to depths of about 500 m. Dissolved 210Po is ordinarily present in the mixed layer at less than equilibrium concentrations, suggesting rapid biological removal of this nuclide. Particulate matter is enriched in 210Po, with 210Po/210Pb activity ratios greater than 1.0, similar to those reported for phytoplankton. At depths of 100-300 m, 210Po maxima occur, and unsupported 210Po is frequently present, an observation that suggests rapid re-cycling within the thermocline. Comparison of the 210Pb distributions with those reported for 226Ra at nearby GEOSECS stations confirms the widespread existence of a 210Pb/226Ra disequilibrium in the deep sea. Close to the bottom, profiles of 210Pb and 226Ra usually diverge, and 210Pb concentrations frequently decrease with depth, suggesting a sink 210 Pb near the seafloor. Particulate 210Pb concentrations ordinarily show little systematic variation with depth. At depths greater than 1000 m, dissolved 210Po activities are, on the average, less than those of 210Pb by 12%. A corresponding 210 Po enrichment in the particulate phase is found.
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The environmental impact of systems managing large (kg) tritium amount represents a public scrutiny issue for the next coming fusion facilities as ITER and DEMO. Furthermore, potentially new dose limits imposed by international regulations (ICRP) shall impact next coming devices designs and the overall costs of fusion technology deployment. Refined environmental tritium dose impact assessment schemes are then overwhelming. Detailed assessments can be procured from the knowledge of the real boundary conditions of the primary tritium discharge phase into atmosphere (low levels) and into soils. Lagrangian dispersion models using real-time meteorological and topographic data provide a strong refinement. Advance simulation tools are being developed in this sense. The tool integrates a numerical model output records from European Centre for Medium range Weather Forecast (ECMWF) with a lagrangian atmospheric dispersion model (FLEXPART). The composite model ECMWF/FLEXTRA results can be coupled with tritium dose secondary phase pathway assessment tools. Nominal tritium discharge operational reference and selected incidental ITER-like plant systems tritium form source terms have been assumed. The realtime daily data and mesh-refined records together with lagrangian dispersion model approach provide accurate results for doses to population by inhalation or ingestion in the secondary phase
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The geochemical fingerprint of sediment retrieved from the banks of the River Manzanares as it passes through the City of Madrid is presented here. The river collects the effluent water from several Waste Water Treatment (WWT) plants in and around the city, such that, at low flows, up to 60% of the flow has been treated. A total of 18 bank-sediment cores were collected along the course of the river, down to its confluence with the Jarama river, to the south–east of Madrid. Trace and major elements in each sample were extracted following a double protocol: (a) “Total” digestion with HNO3, HClO4 and HF; (b) “Weak” digestion with sodium acetate buffered to pH=5 with acetic acid, under constant stirring. The digests thus obtained were subsequently analysed by ICP-AES, except for Hg which was extracted with aqua regia and sodium chloride-hydroxylamine sulfate, and analysed by Cold Vapour-AAS. X-ray diffraction was additionally employed to determine the mineralogical composition of the samples. Uni- and multivariate analyses of the chemical data reveal the influence of Madrid on the geochemistry of Manzanares' sediments, clearly manifested by a marked increase in the concentration of typically “urban” elements Ag, Cr, Cu, Pb and Zn, downstream of the intersection of the river with the city's perimeter. The highest concentrations of these elements appear to be associated with illegal or accidental dumping of waste materials, and with the uncontrolled incorporation of untreated urban runoff to the river. The natural matrix of the sediment is characterised by fairly constant concentrations of Ce, La and Y, whereas changes in the lithology intersected by the river cause corresponding variations in Ca–Mg and Al–Na contents. In the final stretch of the river, the presence of carbonate materials seems to exert a strong geochemical control on the amount of Zn and, to a lesser extent, Cu immobilised in the sediments. This fact suggests that a variable but significant proportion of both elements may be susceptible to reincorporation in the aqueous phase under realistic environmental conditions.
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Checkpoints maintain the order and fidelity of the eukaryotic cell cycle, and defects in checkpoints contribute to genetic instability and cancer. Much of our current understanding of checkpoints comes from genetic studies conducted in yeast. In the fission yeast Schizosaccharomyces pombe (Sp), SpRad3 is an essential component of both the DNA damage and DNA replication checkpoints. The SpChk1 and SpCds1 protein kinases function downstream of SpRad3. SpChk1 is an effector of the DNA damage checkpoint and, in the absence of SpCds1, serves an essential function in the DNA replication checkpoint. SpCds1 functions in the DNA replication checkpoint and in the S phase DNA damage checkpoint. Human homologs of both SpRad3 and SpChk1 but not SpCds1 have been identified. Here we report the identification of a human cDNA encoding a protein (designated HuCds1) that shares sequence, structural, and functional similarity to SpCds1. HuCds1 was modified by phosphorylation and activated in response to ionizing radiation. It was also modified in response to hydroxyurea treatment. Functional ATM protein was required for HuCds1 modification after ionizing radiation but not after hydroxyurea treatment. Like its fission yeast counterpart, human Cds1 phosphorylated Cdc25C to promote the binding of 14-3-3 proteins. These findings suggest that the checkpoint function of HuCds1 is conserved in yeast and mammals.
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The semiempirical PM3 method, calibrated against ab initio HF/6–31+G(d) theory, has been used to elucidate the reaction of 1,2-dichloroethane (DCE) with the carboxylate of Asp-124 at the active site of haloalkane dehalogenase of Xanthobacter autothropicus. Asp-124 and 13 other amino acid side chains that make up the active site cavity (Glu-56, Trp-125, Phe-128, Phe-172, Trp-175, Leu-179, Val-219, Phe-222, Pro-223, Val-226, Leu-262, Leu-263, and His-289) were included in the calculations. The three most significant observations of the present study are that: (i) the DCE substrate and Asp-124 carboxylate, in the reactive ES complex, are present as an ion-molecule complex with a structure similar to that seen in the gas-phase reaction of AcO− with DCE; (ii) the structures of the transition states in the gas-phase and enzymatic reaction are much the same where the structure formed at the active site is somewhat exploded; and (iii) the enthalpies in going from ground states to transition states in the enzymatic and gas-phase reactions differ by only a couple kcal/mol. The dehalogenase derives its catalytic power from: (i) bringing the electrophile and nucleophile together in a low-dielectric environment in an orientation that allows the reaction to occur without much structural reorganization; (ii) desolvation; and (iii) stabilizing the leaving chloride anion by Trp-125 and Trp-175 through hydrogen bonding.
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The flavin hydroperoxide at the active site of the mixed-function oxidase 2-aminobenzoyl-CoA monooxygenase/reductase (Azoarcus evansii) transfers an oxygen to the 5-position of the 2-aminobenzoyl-CoA substrate to provide the alkoxide intermediate II−. Hydrogen migration from C5 to C6 follows this monooxygenation. The nature of the monooxygenation intermediate and plausible competing reactions leading to hydrogen migration have been considered. Ab initio molecular orbital theory has been used to calculate structures and electron distributions in intermediate and transition state structures. Electrostatic potential surface calculations establish that the transition state and product, associated with the C5 to C6 hydrogen transfer, are stabilized by electron distribution to the benzoyl-CoA thioester carbonyl oxygen. This is not so for the transition state and product associated with hydrogen transfer from C5 to C4. The activation energy for the 5,6-shift is 2.5 kcal/mol lower than that for the 5,4-shift. In addition, the product of the hydrogen 5,6-shift is more stable than is the product of the hydrogen 5,4-shift, by ≈6 kcal/mol. These results explain why only the shift of hydrogen from C5 to C6 is observed experimentally. Oxygen transfer and hydrogen migration almost coincide in the gas phase (activation energy of ≈0.6 kcal/mol, equivalent to a single bond vibration). Enzymatic formation of alkoxide II− requires its stabilization; thus, the rate constant for its breakdown would be slower than in the gas phase.