Ambulatory blood pressure monitoring in the elderly hypertensive patient.

In this retrospective analysis, we assessed the usefulness of ambulatory blood pressure monitoring in the evaluation of elderly hypertensive patients. Thirty-eight untreated and 31 treated hypertensives aged 70 years or more had a systolic blood pressure greater than or equal to 160 mmHg and/or a diastolic blood pressure greater than or equal to 95 mmHg in the clinic. All 69 patients underwent blood pressure monitoring during their customary daily activities using a portable semi-automatic blood pressure recorder (Remier M2000). The mean of all blood pressures obtained with this device was taken as the ambulatory recorded blood pressure. Recorded blood pressures were greater than or equal to 160 mmHg systolic and greater than or equal to 90 mmHg diastolic in 17 untreated and 17 treated patients. In these patients, the introduction of antihypertensive therapy, or its modification, markedly reduced blood pressure during a 4-8 month follow-up. A further 21 untreated and 14 treated patients had recorded blood pressures of less than 160/90 mmHg. The treatment status of these patients was left unchanged for 4-8 months of follow-up. Nevertheless, office blood pressure in these groups, with no change in treatment, decreased significantly during the observation period. At the last visit to the outpatient clinic, there was no significant difference in blood pressure between the four subgroups of patients. Thus, ambulatory blood pressure monitoring appears to be useful in the elderly hypertensive patient in detecting those patients whose blood pressure is elevated only in the clinic. Blood pressure profiles obtained outside the clinic may therefore be useful in making therapeutic decisions in the aged hypertensive.

Advances in the pharmacological treatment of gastro-oesophageal cancer.

Despite a sharp decline in the incidence of gastric cancer during the second half of the 20th century, this malignancy remains the second leading cause of cancer mortality in the world. The incidence and mortality rate of gastric cancer increase with age; at present, the median ages at diagnosis are 67 years for men and 72 years for women in the US. This article reviews and discusses current medical treatment options for both the general population and elderly gastric cancer patients. Management of localized gastric cancer has changed significantly over recent years. Adjuvant chemoradiation is not generally recommended outside the US. After decades of trials of adjuvant chemotherapy with inconclusive results, a significant survival benefit for perioperative combination chemotherapy - as compared with surgery alone - in patients with resectable or locally advanced gastro-oesophageal cancer was recently demonstrated in the UK MAGIC trial. A further large, randomized trial from Japan demonstrated a significant survival benefit for adjuvant chemotherapy with S-1 after D2 resection for gastric cancer. However, both trials are applicable only to the population in which the trials were conducted. Specific data on elderly patients are missing. For patients with metastatic disease, oral fluoropyrimidines, such as capecitabine, have been developed. In Asian patients, treatment with the oral fluoropyrimidine S-1 is safe and effective. Docetaxel, oxaliplatin and irinotecan have demonstrated activity against gastric cancer in appropriately designed, randomized, phase III trials and have increased the available treatment options significantly. In addition, according to preliminary data, trastuzumab in combination with chemotherapy has significantly improved activity when compared to chemotherapy alone in patients with human epidermal receptor (HER)-2-positive gastric and gastro-oesophageal cancers. Thus, therapeutic decisions in patients with advanced gastric cancer may be adapted to the molecular subtype and co-morbidities of the individual patient. Data from retrospective analyses suggest that oxaliplatin seems to be better tolerated than cisplatin in elderly patients.

Influence of emergence timing of weeds on the establishment of woody natives and ground cover species

Les invasions biològiques són produïdes per espècies transportades per l'home fora de la regió d'origen a altres regions on s'estableixen i expandeixen. Són actualment de les majors causes de perduda de biodiversitat, amb el canvi d'usos del sòl, tret rellevant en zones insulars. Comprendre mecanismes de competència amb les espècies autòctones és clau per gestionar el problema. L’experiment evidencia diferències de creixement de 7 plantes natives australianes (3 espècies d’eucaliptus, 3 espècies d’acàcia, 1 pasturatge natiu), competint intraespecífica (entre mateixa espècie) i interespecíficament (acàcies o eucaliptus convivint amb pasturatge natiu) plantejant tres tractaments (sense males herbes, males herbes i males herbes a posteriori) per definir la naturalesa de la interacció dels diferents tipus funcionals d'espècies. S’analitzen tendències temporals de creixement de plàntules, així com la supervivència. S’ha detectat una moderada correlació entre taxes de creixement d’espècies i mida de la llavor, (p ≈ 0.6), així com una correlació entre la supervivència i la humitat del sòl (p ≈ 0.5); efectes estacionals. A curt termini i en escenari de primavera la convivència amb males herbes reporta creixement nul. Tractaments sense males herbes, presenten major supervivència en escenaris en competència interespecífica. A llarg termini les espècies amb major supervivència són les que conviuen amb pasturatge natiu i sense males herbes, indicant un efecte beneficiós en espècies millor adaptades a la sequera (E. loxophleba).

Hidradenitis suppurativa of the groin treated by radical excision and defect closure by medial thigh lift: aesthetic surgery meets reconstructive surgery.

INTRODUCTION: Hidradenitis suppurativa of the groin is a chronic, relapsing inflammatory disease of the skin and subcutaneous tissues. Radical surgical excision is the treatment of choice. Often split-skin grafting or wound healing by secondary intention are used for defect closure, sometimes with disfiguring results. We describe our experience with radical excision of localised inguinal hidradenitis suppurativa and immediate defect closure with a medial thigh lift. PATIENTS AND METHODS: Our hospital database was searched for all patients presenting to our institution for surgical treatment of hidradenitis suppurativa between 2001 and 2006. Only patients with hidradenitis confined to the groin were included. Exclusion criteria were simple abscess incisions, recurrence after previous grafting or flap surgery and extension of the disease outside the groin and presence of clinical signs of infection at the time of surgery. We documented patient demographics, sizes of defects, complications, time of follow-up, recurrences and patient satisfaction. RESULTS: A total of 8 patients with localised inguinal hidradenitis suppurativa were identified and 15 thigh lifts were performed. Defect size assessed on pathologic examination of the excised specimens averaged 15.9 cm x 4.3 cm x 1.3 cm (length x width x depth). All wounds but one healed primarily. Functional and aesthetic results were satisfactory. No major complications and no irritations of the genital area were observed. No recurrences were observed either. CONCLUSION: We propose the medial thigh lift to be considered for immediate defect closure after radical excision of localised inguinal hidradenitis suppurativa provided that no perifocal signs of infection are present after debridement.

A prospective observational safety study on MF59(®) adjuvanted cell culture-derived vaccine, Celtura(®) during the A/H1N1 (2009) influenza pandemic.

BACKGROUND: The present study was a prospective observational study to evaluate the safety profile of Celtura(®), a monovalent, cell culture-derived, inactivated subunit influenza vaccine prepared from A/California/07/2009(H1N1) with the adjuvant MF59(®). Subjects were enrolled prospectively during the H1N1 2009 influenza pandemic at medical centres in Colombia, Chile, Switzerland, and Germany during the period December 2009 to June 2010. METHODS: Subjects ages 18 and older were followed for the occurrence of adverse events (AEs) for six months after vaccination. Adverse events of special interest (AESIs) were neuritis, convulsion (seizure), anaphylaxis, encephalitis, vasculitis, Guillain-Barre syndrome, demyelinating conditions, Bell's palsy, and laboratory-confirmed vaccination failure. RESULTS: Overall, 7348 AEs were reported in 2296 of 3989 enrolled subjects (57.6%). Only two AEs were considered related to injection site reactions. No laboratory-confirmed cases of influenza were reported. There were 108 medically confirmed serious adverse events (SAEs) reported among 73 subjects with 6 such SAEs described as possibly or probably related to vaccination. Three fatal cases were reported and assessed as not related to vaccination. Two AESIs classified as convulsion were reported and assessed as not related to vaccination. Both AESIs occurred well outside the pre-specified 7 day risk window representing the likely timeframe of the occurrence of seizure following vaccination. CONCLUSIONS: The results of this study support the overall good safety profile of MF59 adjuvanted cell culture-derived influenza vaccine as administered in adults during the 2009-2010 H1N1 influenza pandemic. No concern is raised regarding the occurrence of AESIs.

Corruption in building the image of politics in television news broadcasts

This work analyses the political news of eight Spanish television channels in order to see what image is built of politics, and particularly how the news of corruption affects the image of politics in Spanish news broadcasts. Different cases of corruption such as Gürtel, Palma Arena and those associated with judge Baltasar Garzón in his final stage in office, occupy part of the study. A new methodology is therefore proposed that enables the quality of the political information emitted from inside and outside the political content of the news programmes to be observed. Particular attention is paid to the news broadcasts of Televisión Española and Cuatro as those which offer a more balanced view of politics, and channels such as La Sexta, which give priority to a narrative construction of politics in the news programmes around causes of corruption.

The slow transformation of Swiss federal administrative elites

This article sets out to study the profile of Swiss administrative elites at federal level by showing how their profile has evolved in the light of what has come to be known as the wave of New Public Management (NPM), which has benefited from a very fertile ground in Switzerland. These elites correspond to a specific institutional order, in relation to specific organizational structures and workings, and have specific characteristics in terms of career paths and academic background. However, the administrative reforms that have been rolled out since the 1980s have transformed the institutional order within which executives of the federal administration evolve. This article analyses the extent to which these transformations have had an impact on the characteristics of these elites, through indicators such as academic capital, social capital, and career path within and outside the administration. The results show a slow but significant transformation in the profiles of these elites towards an increasing managerialization, reflecting that of the context in which they evolve.Points for practitioners The relationship between politics and the administration is naturally shaped by individuals but is closely dependent on the profiles of the players. They are currently undergoing a transformation in the wake of administrative reforms, and also of the changing profiles of both the political and administrative players. Gaining an insight into the slow transformation of the profiles of administrative elites therefore sheds light on the political-administrative nexus. The gradual managerialization of the administrative elite highlighted in this article also allows for a better understanding of which professional experiences, qualifications and skills are valued today within the senior civil service in Switzerland.

Being at the right place at the right time.

I am tremendously honored to receive the 2012 Women in Cell Biology Junior Award. In this essay, I recount my career path over the past 15 years. Although many details are specific to my own experiences, I hope that some generalizations can be made to encourage more women to pursue independent scientific careers. Mine is a story of choosing a captivating question, making the most of your opportunities, and finding a balance with life outside the lab.

Characterisation of the putative effector interaction site of the regulatory HbpR protein from Pseudomonas azelaica by site-directed mutagenesis.

Bacterial transcription activators of the XylR/DmpR subfamily exert their expression control via σ(54)-dependent RNA polymerase upon stimulation by a chemical effector, typically an aromatic compound. Where the chemical effector interacts with the transcription regulator protein to achieve activation is still largely unknown. Here we focus on the HbpR protein from Pseudomonas azelaica, which is a member of the XylR/DmpR subfamily and responds to biaromatic effectors such as 2-hydroxybiphenyl. We use protein structure modeling to predict folding of the effector recognition domain of HbpR and molecular docking to identify the region where 2-hydroxybiphenyl may interact with HbpR. A large number of site-directed HbpR mutants of residues in- and outside the predicted interaction area was created and their potential to induce reporter gene expression in Escherichia coli from the cognate P(C) promoter upon activation with 2-hydroxybiphenyl was studied. Mutant proteins were purified to study their conformation. Critical residues for effector stimulation indeed grouped near the predicted area, some of which are conserved among XylR/DmpR subfamily members in spite of displaying different effector specificities. This suggests that they are important for the process of effector activation, but not necessarily for effector specificity recognition.

Axiomatization of the nucl eolus of assignment games

On the domain of general assignment games (with possible reservation prices) the core is axiomatized as the unique solution satisfying two consistency principles: projection consistency and derived consistency. Also, an axiomatic characterization of the nucleolus is given as the unique solution that satisfies derived consistency and equal maximum complaint between groups. As a consequence, we obtain a geometric characterization of the nucleolus. Maschler et al. (1979) provide a geometrical characterization for the intersection of the kernel and the core of a coalitional game, showing that those allocations that lie in both sets are always the midpoint of certain bargaining range between each pair of players. In the case of the assignment game, this means that the kernel can be determined as those core allocations where the maximum amount, that can be transferred without getting outside the core, from one agent to his / her optimally matched partner equals the maximum amount that he / she can receive from this partner, also remaining inside the core. We now prove that the nucleolus of the assignment game can be characterized by requiring this bisection property be satisfied not only for optimally matched pairs but also for optimally matched coalitions. Key words: cooperative games, assignment game, core, nucleolus

Anteromedian, central, and posterolateral infarcts of the thalamus : three variant types

Résumé Introduction et but: Les accidents vasculaires cérébraux (AVC) ischémiques thalamiques sont traditionnellement classés en quatre territoires : antérieur (polaire ou tubérothalamique), paramédian (ou thalamo-perforant), inférolatéral (ou thalamo-genouillé) et postérieur. Le but de cette thèse est de déterminer, à l'aide des techniques d'imagerie actuelles, si cette classification est appropriée ou si il existe d'autres territoires à la jonction entre les précédents territoires. Méthode: Nous avons étudié les 3712 patients hospitalisés pour un premier AVC dans le service de neurologie du CHUV à Lausanne et inclus dans le « Lausanne Stroke Registry » entre 1990 et 2002. Parmi les 71 patients avec un infarctus thalamique confirmé par IRM, nous avons sélectionné tous les patients présentant un AVC hors des quatre territoires classiques en étudiant leur tableau clinique, étiologique et radiologique. Résultats: 21 patients (30% des patients avec AVC thalamiques) avaient un AVC hors des quatre territoires classiques, permettant de délimiter trois nouveaux territoires. 1) territoire anteromédian (9 patients (13%)), atteignant la partie postérieure du territoire antérieur et la partie antérieure du territoire paramédian, avec en premier lieu des troubles cognitifs (principalement troubles dysexecutifs, amnésie antérograde ainsi qu'une aphasie dans les lésions gauches). L'étiologie principale était cardio-embolique. 2) territoire central (4 patients (6%)), atteignant la partie centrale du thalamus provoquant différents signes neurologiques et neuropsychologiques, reflétant l'atteinte de différentes structures. La cause la plus fréquente était microangiopathique. 3) territoire posterolateral (8 patients (8%)), atteignant la partie postérieure du territoire inférolatéral et la partie antérieure du territoire postérieur provoquant en premier lieu une hémihypesthesie mais aussi une hémiataxie ainsi que des troubles dysexécutifs et une aphasie dans les lésions gauches. Les étiologies les plus fréquentes étaient artério-artérielle et microangiopathique. Conclusions: Nous décrivons trois nouvelles variantes topographiques d'AVC thalamiques avec des tableaux cliniques et étiologiques distincts. Nous postulons que ces variantes sont le résultat de variations de la vascularisation thalamique ou reflètent une atteinte ischémique jonctionnelle. Abstract Background and Purpose -Thalamic infarcts have traditionally been classified into 4 territories: anterior, paramedian, inferolateral, and posterior. The purpose of this study was to review this classical versus variant distribution in patients with thalamic stroke. Methods - We reviewed all patients with a first clinical stroke included in the Lausanne Stroke Registry between 1990 and 2002. Among 71 patients with an acute stroke isolated to the thalamus confirmed by MRI, we selected all patients with lesions outside the classical territories and studied their clinical, etiological, and radiological features. Results - A total of 21 patients (30% of all thalamic stroke patients) showed infarction outside the classical territories, allowing us to delineate 3 variant distributions: (1) Anteromedian territory (9 patients [13%]) involving anterior and paramedian territories, with predominantly cognitive impairment, including executive dysfunction, anterograde amnesia, and aphasia in left-sided or bilateral lesions. The most frequent stroke mechanism was cardiac embolism. (2) Central territory (4 patients [6%]), with lesions on the central part of the thalamus, resulting in a variety of neurological and neuropsychological signs, reflecting the involvement of several adjacent structures. Microangiopathy was the most frequent etiology. (3) Posterolateral territory (8 patients [11%]), involving inferolateral and posterior territories, with hemihypesthesia as the most frequent manifestation, followed by hemiataxia, executive dysfunction, and aphasia in left-sided lesions. Artery-to-artery embolism and microangiopathy were the main stroke mechanisms. Conclusions - We describe 3 variant topographic patterns of thalamic infarction with distinct manifestations and etiologies. We postulate that these infarcts are the result of a variation in thalamic arterial supply or reflect borderzone ischemia.

Monitoring bank performance in the presence of risk

This paper proposes a managerial control tool that integrates risk in efficiency scores. Building on existing efficiency specifications, our proposal reflects the real banking technology and accurately models the relationship between desirable and undesirable outputs. Specifically, the undesirable output is defined as non-performing loans to capture credit risk, and is linked only to the relevant dimension of the output set. We empirically illustrate how our efficiency measure functions for managerial control purposes. The application considers a unique dataset of Costa Rican banks during 1998-2012. Efficiency scores? implications are mostly discussed at bank-level, and their interpretations are enhanced by using accounting ratios. We also show the usefulness of our tool for corporate governance by examining performance changes around executive turnover. Results confirm that appointing CEOs from outside the bank significantly improves performance, thus suggesting the potential benefits of new organisational practices.

Factors affecting the adoption of electronic invoicing

Tämän diplomityön tarkoituksena oli selvittää tekijät, jotka vaikuttavat verkkolaskutuksen leviämiseen yrityksissä sekä selvittää verkkolaskutuksen levinneisyys Etelä-Karjalassa. Erityisesti haluttiin selvittää tekijät, jotka hidastavat diffuusiota. Työn teoreettinen osuus esittelee lyhyesti diffuusionkäsitettä; pääpaino on kirjallisuudesta löytyvillä innovaatioiden omaksumiseen vaikuttavilla tekijöillä. Teorian pohjalta muodostettiin 16 hypoteesia, jotka testattiin empiirisessä osassa. Empiirinen aineisto kerättiin eteläkarjalaisilta pk-yrityksiltä postikyselyn avulla. Vastanneet yritykset jaettiin verkkolaskutuksen omaksuneisiin ja ei-omaksuneisiin yrityksiin. Vastanneista yrityksistä 7.5 % käytti verkkolaskutusta. 17.8 % vasta testasi verkkolaskujen lähetystä ja/tai vastaanottamista. Näin ollen 25.3 % yrityksistä oli verkkolaskuominaisuudet tietojärjestelmissään. Suurin osa vastaajista ei ollut tehnyt päätöstä verkkolaskutukseen siirtymisen suhteen. Seitsemän hypoteesia jäi voimaan ja yhdeksän hylättiin.Hypoteesien ulkopuolelta löydettiin lisäksi kaksi tärkeää tekijää, joilla on mahdollisesti vaikutusta verkkolaskutuksen omaksumiseen yrityksissä. Yritykset kokivat, että suurempi painostus yrityksen ulkopuolelta nopeuttaisi penetraatiota, ja toisaalta verkkolaskutusta koskevan informaation määrä on koettu liian alhaiseksi. Työn lopussa esitellään toimenpide-ehdotuksia verkkolaskutuksen leviämisennopeuttamiseksi.

Contemporary engagements within corridors of the past: temporal elasticity, graffiti, and the materiality of St. Rock Street, Barcelona

In a medieval Barcelonan side-street, urine, rubbish, and a bewildering array of graphic imagery splatters the narrowing walls between two major thoroughfares. A contemporary conflict between residents, unknown artists and others is played out using banners, bottles, stickers, posters, stencils, spray paint, and bodily substances. In this shadowed liminality, local and global debates are superimposed upon substructures constructed from disease, prostitution, and the Saint of the Plague. The continuing urban struggle constitutes temporal statements of dirt and purity, violence and humour, dominance and resistance, death and salvation. Like the renovated facades masking the crumbling remains of structures long neglected, the government’s literal whitewashing of the art is a temporal cover-up of a discursive symptom stretching from deeply embedded preconditions. However, from his niche in the angular bend of the alley bearing his name, the statue of St. Rock remains unblinkingly staring, raised above the contestations expressed below.

25-Hydroxyvitamin D in African-origin populations at varying latitudes challenges the construct of a physiologic norm.

BACKGROUND: The vitamin D-endocrine system is thought to play a role in physiologic processes that range from mineral metabolism to immune function. Serum 25-hydroxyvitamin D [25(OH)D] is the accepted biomarker for vitamin D status. Skin color is a key determinant of circulating 25(OH)D concentrations, and genes responsible for melanin content have been shown to be under strong evolutionary selection in populations living in temperate zones. Little is known about the effect of latitude on mean concentrations of 25(OH)D in dark-skinned populations. OBJECTIVE: The objective was to describe the distribution of 25(OH)D and its subcomponents in 5 population samples of African origin from the United States, Jamaica, Ghana, South Africa, and the Seychelles. DESIGN: Participants were drawn from the Modeling of the Epidemiologic Transition Study, a cross-sectional observational study in 2500 adults, ages 25-45 y, enrolled between January 2010 and December 2011. Five hundred participants, ∼50% of whom were female, were enrolled in each of 5 study sites: Chicago, IL (latitude: 41°N); Kingston, Jamaica (17°N); Kumasi, Ghana (6°N); Victoria, Seychelles (4°S); and Cape Town, South Africa (34°S). All participants had an ancestry primarily of African origin; participants from the Seychelles trace their history to East Africa. RESULTS: A negative correlation between 25(OH)D and distance from the equator was observed across population samples. The frequency distribution of 25(OH)D in Ghana was almost perfectly normal (Gaussian), with progressively lower means and increasing skewness observed at higher latitudes. CONCLUSIONS: It is widely assumed that lighter skin color in populations outside the tropics resulted from positive selection, driven in part by the relation between sun exposure, skin melanin content, and 25(OH)D production. Our findings show that robust compensatory mechanisms exist that create tolerance for wide variation in circulating concentrations of 25(OH)D across populations, suggesting a more complex evolutionary relation between skin color and the vitamin D pathway. This trial was registered at clinicaltrials.gov as NCT02111902.