Falling incidence of amputations for peripheral occlusive arterial disease in western Australia between 1980 and 1992

Objectives: To assess temporal trends in the incidence of surgical procedures for peripheral occlusive arterial disease (POAD) and associated changes in outcome as measured by the rate of major lower limb amputations for POAD. Design: a retrospective descriptive population-based study was conducted of the geographically isolated population of Western Austrialia between 1980 and 1992. Methods: Vascular procedures with an accompanying diagnosis of POAD were identified in a computerised system of name-identified records of all discharges from hospital for the population. These procedures were detected using relevant codes from the International Classification of Disease and Procedures. Records of angioplasty and thrombolysis procedures were augmented by searches of hospital-based registers of invasive radiological procedures. The data for the remaining procedures were validated by a review of a random sample of medical records. Results: over the 13 years of the study, rates of major amputations fell significantly for in non-amputation vascular surgery for individuals under the age of 60. In addition, rather than an overall rise in surgery there was shift away from sympathectomy and thromboendarterectomy to angioplasty and bypass surgery. Furthermore, an increasing proportion of all major amputations had a prior attempt at arterial reconstruction. Conclusion: These observations suggest the decrease in major amputations for POAD may reflect a fall in the incidence of POAD, possibly aided by move effective surgery, rather than increased rates of vascular surgery.

Chronic obstructive pulmonary disease in Brazil: mortality and hospitalization trends and rates, 1996-2008

SETTING: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death among adults in Brazil. OBJECTIVE: To evaluate the mortality and hospitalisation trends in Brazil caused by COPD during the period 1996-2008. DESIGN: We used the health official statistics system to obtain data about mortality (1996-2008) and morbidity (1998-2008) due to COPD and all respiratory diseases (tuberculosis: codes A15-16; lung cancer: code C34, and all diseases coded from J40 to 47 in the 10th Revision of the International Classification of Diseases) as the underlying cause, in persons aged 45-74 years. We used the Joinpoint Regression Program log-linear model using Poisson regression that creates a Monte Carlo permutation test to identify points where trend lines change significantly in magnitude/direction to verify peaks and trends. RESULTS: The annual per cent change in age-adjusted death rates due to COPD declined by 2.7% in men (95%CI -3.6 to -1.8) and -2.0% (95%CI -2.9 to -1.0) in women; and due to all respiratory causes it declined by -1.7% (95%CI 2.4 to -1.0) in men and -1.1% (95%CI -1.8 to -0.3) in women. Although hospitalisation rates for COPD are declining, the hospital admission fatality rate increased in both sexes. CONCLUSION: COPD is still a leading cause of mortality in Brazil despite the observed decline in the mortality/hospitalisation rates for both sexes.

Association of polymorphisms of glutamate-cystein ligase and microsomal triglyceride transfer protein genes in non-alcoholic fatty liver disease

Background and Aims: Although the metabolic risk factors for non-alcoholic fatty liver disease (NAFLD) progression have been recognized, the role of genetic susceptibility remains a field to be explored. The aim of this study was to examine the frequency of two polymorphisms in Brazilian patients with biopsy-proven simple steatosis or non-alcoholic steatohepatitis (NASH): -493 G/T in the MTP gene, which codes the protein responsible for transferring triglycerides to nascent apolipoprotein B, and -129 C/T in the GCLC gene, which codes the catalytic subunit of glutamate-cystein ligase in the formation of glutathione. Methods: One hundred and thirty-one biopsy-proven NAFLD patients (n = 45, simple steatosis; n = 86, NASH) and 141 unrelated healthy volunteers were evaluated. Genomic DNA was extracted from peripheral blood cells, and the -129 C/T polymorphism of the GCLC gene was determined by restriction fragment length polymorphism (RFLP). The -493 G/T polymorphism of the MTP gene was determined by direct sequencing of the polymerase chain reaction products. Results: The presence of at least one T allele in the -129 C/T polymorphism of the GCLC gene was independently associated with NASH (odds ratio 12.14, 95% confidence interval 2.01-73.35; P = 0.007), whereas, the presence of at least one G allele in the -493 G/T polymorphism of the MTP gene differed slightly between biopsy-proven NASH and simple steatosis. Conclusion: This difference clearly warrants further investigation in larger samples. These two polymorphisms could represent an additional factor for consideration in evaluating the risk of NAFLD progression. Further studies involving a larger population are necessary to confirm this notion.

A decision support system to facilitate management of patients with acute gastrointestinal bleeding

Objective: To develop a model to predict the bleeding source and identify the cohort amongst patients with acute gastrointestinal bleeding (GIB) who require urgent intervention, including endoscopy. Patients with acute GIB, an unpredictable event, are most commonly evaluated and managed by non-gastroenterologists. Rapid and consistently reliable risk stratification of patients with acute GIB for urgent endoscopy may potentially improve outcomes amongst such patients by targeting scarce health-care resources to those who need it the most. Design and methods: Using ICD-9 codes for acute GIB, 189 patients with acute GIB and all. available data variables required to develop and test models were identified from a hospital medical records database. Data on 122 patients was utilized for development of the model and on 67 patients utilized to perform comparative analysis of the models. Clinical data such as presenting signs and symptoms, demographic data, presence of co-morbidities, laboratory data and corresponding endoscopic diagnosis and outcomes were collected. Clinical data and endoscopic diagnosis collected for each patient was utilized to retrospectively ascertain optimal management for each patient. Clinical presentations and corresponding treatment was utilized as training examples. Eight mathematical models including artificial neural network (ANN), support vector machine (SVM), k-nearest neighbor, linear discriminant analysis (LDA), shrunken centroid (SC), random forest (RF), logistic regression, and boosting were trained and tested. The performance of these models was compared using standard statistical analysis and ROC curves. Results: Overall the random forest model best predicted the source, need for resuscitation, and disposition with accuracies of approximately 80% or higher (accuracy for endoscopy was greater than 75%). The area under ROC curve for RF was greater than 0.85, indicating excellent performance by the random forest model Conclusion: While most mathematical models are effective as a decision support system for evaluation and management of patients with acute GIB, in our testing, the RF model consistently demonstrated the best performance. Amongst patients presenting with acute GIB, mathematical models may facilitate the identification of the source of GIB, need for intervention and allow optimization of care and healthcare resource allocation; these however require further validation. (c) 2007 Elsevier B.V. All rights reserved.

A single amino acid substitution in one of the lipases of Aspergillus nidulans confers resistance to the antimycotic drug undecanoic acid

A plausible approach to evaluate the inhibitory action of antifungals is through the investigation of the fungal resistance to these drugs. We describe here the molecular cloning and initial characterization of the A. nidulans lipA gene, where mutation (lipA1) conferred resistance to undecanoic acid, the most fungitoxic fatty acid in the C(7:0)-C(18:0) series. The lipA gene codes for a putative lipase with the sequence consensus GVSIS and WIFGGG as the catalytic signature. Comparison of the wild-type and LIP1 mutant strain nucleotide sequences showed a G -> A change in lipA1 allele, which results in a Glu(214) -> Lys substitution in LipA protein. This ionic charge change in a conserved LipA region, next to its catalytic site, may have altered the catalytic properties of this enzyme resulting in resistance to undecanoic acid.

Earth pressure on cantilever walls at design retained heights

There are many methods for the analysis and design of embedded cantilever retaining walls. They involve various different simplifications of the pressure distribution to allow calculation of the limiting equilibrium retained height and the bending moment when the retained height is less than the limiting equilibrium value, i.e. the serviceability case. Recently, a new method for determining the serviceability earth pressure and bending moment has been proposed. This method makes an assumption defining the point of zero net pressure. This assumption implies that the passive pressure is not fully mobilised immediately below the excavation level. The finite element analyses presented in this paper examine the net pressure distribution on walls in which the retained height is less, than the limiting equilibrium value. The study shows that for all practical walls, the earth pressure distributions on the front and back of the wall are at their limit values, Kp and K-a respectively, when the lumped factor of safety F-r is less than or equal to2.0. A rectilinear net pressure distribution is proposed that is intuitively logical. It produces good predictions of the complete bending moment diagram for walls in the service configuration and the proposed method gives results that have excellent agreement with centrifuge model tests. The study shows that the method for determining the serviceability bending moment suggested by Padfield and Mair(1) in the CIRIA Report 104 gives excellent predictions of the maximum bending moment in practical cantilever walls. It provides the missing data that have been needed to verify and justify the CIRIA 104 method.

From aesthetic principles to collective sentiments: The logics of everyday judgements of taste

Contemporary research into the sociology of taste has, following Bourdieu (1984), primarily emphasised the role of social position, or more broadly as implicated int he reproduction of social inequality. We argue that although important, such a preoccupation with the social distribution of objectified tastes--for example in music, literature, and art--has been at the expense of investigating the everyday perceptual schemes and resources used by actors to accomplish a judgement of taste. Our argument is traced using a range of classical and contemporary literature which deals with the personal/collective tension in taste, aesthetics and fashion. We use data from a recent national survey to investigate how a sample of ordinary fashion. We use data from a recent national survey to investigate how a sample of ordinary actors understand the categories of 'good' and 'bad' taste. The analysis shows a strong collective strand in everyday definitions of taste, often linked to moral codes of interpersonal conduct. Also, taste is largely defined by people as a strategy for managing relations with others, and as a mode of self-discipline which relies on the mastery of a number of general principles that are resources for people to position their own tastes within an imagined social sphere. This paper proposes a schematic model which accounts for the range of discriminatory resources used to make judgements of taste.

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.

Determining when the absolute state complexity of a Hermitian code achieves its DLP bound

Let g be the genus of the Hermitian function field H/F(q)2 and let C-L(D,mQ(infinity)) be a typical Hermitian code of length n. In [Des. Codes Cryptogr., to appear], we determined the dimension/length profile (DLP) lower bound on the state complexity of C-L(D,mQ(infinity)). Here we determine when this lower bound is tight and when it is not. For m less than or equal to n-2/2 or m greater than or equal to n-2/2 + 2g, the DLP lower bounds reach Wolf's upper bound on state complexity and thus are trivially tight. We begin by showing that for about half of the remaining values of m the DLP bounds cannot be tight. In these cases, we give a lower bound on the absolute state complexity of C-L(D,mQ(infinity)), which improves the DLP lower bound. Next we give a good coordinate order for C-L(D,mQ(infinity)). With this good order, the state complexity of C-L(D,mQ(infinity)) achieves its DLP bound (whenever this is possible). This coordinate order also provides an upper bound on the absolute state complexity of C-L(D,mQ(infinity)) (for those values of m for which the DLP bounds cannot be tight). Our bounds on absolute state complexity do not meet for some of these values of m, and this leaves open the question whether our coordinate order is best possible in these cases. A straightforward application of these results is that if C-L(D,mQ(infinity)) is self-dual, then its state complexity (with respect to the lexicographic coordinate order) achieves its DLP bound of n /2 - q(2)/4, and, in particular, so does its absolute state complexity.

Ethical dilemmas confronting dentists in Queensland, Australia

Background: This paper details contemporary ethical dilemmas encountered by Queensland dentists. Methods: An age-stratified sample of 499 dentists resident in Queensland was surveyed. The questionnaire contained scenarios of five common ethical dilemmas. In addition, open-ended questions sought the respondent's most frequent, difficult and recent ethical dilemmas, and where they would seek guidance in dealing with ethical problems. Results: Respondents acknowledged the patient's rights in treatment decisions and the dentist's right to refuse demands for inappropriate treatment. However, responses varied in the extent to which dentists may influence treatment decisions. Few respondents would ignore evidence of poor dental treatment but they are evenly divided in choosing to inform the patient, the dentist or both. Poor quality treatment is the most frequent and difficult dilemma, and half have experienced this problem recently. Requests by patients for fraudulent receipts occur in a third of responses. Dentists develop ethical values from multiple sources but for help with dental ethical problems, 90 per cent of respondents would consult another dentist. Conclusions: Of the ethical dilemmas discussed in this survey, those relating to poor quality treatment confronted most respondents. Also the actions of dentists in dealing with these dilemmas were most varied.

The number of rational points of a class of Artin-Schreier curves

We determine the number of F-q-rational points of a class of Artin-Schreier curves by using recent results concerning evaluations of some exponential sums. In particular, we determine infinitely many new examples of maximal and minimal plane curves in the context of the Hasse-Weil bound. (C) 2002 Elsevier Science (USA).

The beliefs of nurses who were involved in a whistleblowing event

Background. Nursing codes of ethics bind nurses to the role of patient advocate and compel them to take action when the rights or safety of a patient are jeopardized. Reporting misconduct is known as whistleblowing and studies indicate that there are personal and professional risks involved in blowing the whistle. Aim. The aim of this study was to explore the beliefs of nurses who wrestled with this ethical dilemma. Design. A descriptive survey design was used to examine the beliefs of nurses in Western Australia who reported misconduct (whistleblowers) and of those who did not report misconduct (nonwhistleblowers). Methods. The instrument listed statements from current ethical codes, statements from traditional views on nursing and statements of beliefs related to the participant's whistleblowing experience. Respondents were asked to rate each item on a five-point Likert format which ranged from strongly agree to strongly disagree. Data were analysed using a Pearson's correlation matrix and one-way ANOVA. To further explore the data, a factor analysis was run with varimax rotation. Results. Results indicated that whistleblowers supported the beliefs inherent in patient advocacy, while nonwhistleblowers retained a belief in the traditional role of nursing. Participants who reported misconduct (whistleblowers) supported the belief that nurses were primarily responsible to the patient and should protect a patient from incompetent or unethical people. Participants who did not report misconduct (nonwhistleblowers) supported the belief that nurses are obligated to follow a physician's order at all times and that nurses are equally responsible to the patient, the physician and the employer. Conclusion. These findings indicate that nurses may respond to ethical dilemmas based on different belief systems.

Habitat requirements for the conservation of arboreal marsupials in dry sclerophyll forests of Southeast Queensland, Australia

The habitat requirements of arboreal marsupials were investigated in the dry sclerophyll forests of southeast Queensland, Australia. Species richness and abundance of arboreal marsupials was correlated to the proportion of total stand basal area occupied by lemon-scented gum (Corymbia citriodora), the height of the tallest trees, and density of hollow-bearing trees. The first two factors suggested that the most productive forests were also the most suitable habitats for arboreal marsupials. Importantly, the number of hollow-bearing trees was a significant factor in determining species richness and abundance of arboreal marsupials in this study, with the maximum number of species reached at sites containing greater than or equal to4 hollow-bearing trees/ha, and maximum abundance occurring at sites with :6 hollow-bearingtrees/ha. The proportion of C. citriodora was significant for the presence of the common brushtail possum (Trichosurus vulpecula), greater glider (Petauroides volans), and the yellow-bellied glider (Petaurus australis), while understory Acacia sp. density was important for the presence of the sugar glider (Petaurus breviceps). The yellow-bellied glider was also affected by two other variables: the density of hollow-bearing trees >50 cm diameter at breast height (dbh), and the time since the last logging. Current Codes of Practice regulating the density of hollow-bearing trees and silvicultural practices in state-owned timber production forests appear to provide adequate protection for arboreal marsupials, but the recently introduced increase in timber extraction rates within state forests may be detrimental to the animals. Also, protective prescriptions do not apply to the privately owned and leasehold estates, which contain the majority of the dry sclerophyll forests in southeast Queensland.

A new joint coding and modulation scheme for channels with clipping

A major limitation in any high-performance digital communication system is the linearity region of the transmitting amplifier. Nonlinearities typically lead to signal clipping. Efficient communication in such conditions requires maintaining a low peak-to-average power ratio (PAR) in the transmitted signal while achieving a high throughput of data. Excessive PAR leads either to frequent clipping or to inadequate resolution in the analog-to-digital or digital-to-analog converters. Currently proposed signaling schemes for future generation wireless communications suffer from a high PAR. This paper presents a new signaling scheme for channels with clipping which achieves a PAR as low as 3. For a given linear range in the transmitter's digital-to-analog converter, this scheme achieves a lower bit-error rate than existing multicarrier schemes, owing to increased separation between constellation points. We present the theoretical basis for this new scheme, approximations for the expected bit-error rate, and simulation results. (C) 2002 Elsevier Science (USA).

Preparing encoded states in an oscillator

Recently a scheme has been proposed for constructing quantum error-correcting codes that embed a finite-dimensional code space in the infinite-dimensional Hilbert space of a system described by continuous quantum variables. One of the difficult steps in this scheme is the preparation of the encoded states. We show how these states can be generated by coupling a continuous quantum variable to a single qubit. An ion trap quantum computer provides a natural setting for a continuous system coupled to a qubit. We discuss how encoded states may be generated in an ion trap.