Effect of untreated bed nets on blood-fed Phlebotomus argentipes in kala-azar endemic foci in Nepal and India

Observational studies in the Indian subcontinent have shown that untreated nets may be protective against visceral leishmaniasis (VL). In this study, we evaluated the effect of untreated nets on the blood feeding rates of Phlebotomus argentipes as well as the human blood index (HBI) in VL endemic villages in India and Nepal. The study had a "before and after intervention" design in 58 households in six clusters. The use of untreated nets reduced the blood feeding rate by 85% (95% CI 76.5-91.1%) and the HBI by 42.2% (95% CI 11.1-62.5%). These results provide circumstantial evidence that untreated nets may provide some degree of personal protection against sand fly bites.

A prediction rule to identify low-risk patients with pulmonary embolism.

BACKGROUND: A simple prognostic model could help identify patients with pulmonary embolism who are at low risk of death and are candidates for outpatient treatment. METHODS: We randomly allocated 15,531 retrospectively identified inpatients who had a discharge diagnosis of pulmonary embolism from 186 Pennsylvania hospitals to derivation (67%) and internal validation (33%) samples. We derived our rule to predict 30-day mortality using classification tree analysis and patient data routinely available at initial examination as potential predictor variables. We used data from a European prospective study to externally validate the rule among 221 inpatients with pulmonary embolism. We determined mortality and nonfatal adverse medical outcomes across derivation and validation samples. RESULTS: Our final model consisted of 10 patient factors (age > or = 70 years; history of cancer, heart failure, chronic lung disease, chronic renal disease, and cerebrovascular disease; and clinical variables of pulse rate > or = 110 beats/min, systolic blood pressure < 100 mm Hg, altered mental status, and arterial oxygen saturation < 90%). Patients with none of these factors were defined as low risk. The 30-day mortality rates for low-risk patients were 0.6%, 1.5%, and 0% in the derivation, internal validation, and external validation samples, respectively. The rates of nonfatal adverse medical outcomes were less than 1% among low-risk patients across all study samples. CONCLUSIONS: This simple prediction rule accurately identifies patients with pulmonary embolism who are at low risk of short-term mortality and other adverse medical outcomes. Prospective validation of this rule is important before its implementation as a decision aid for outpatient treatment.

Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: Results from the global valve-in-valve registry.

BACKGROUND Transcatheter aortic valve-in-valve implantation is an emerging therapeutic alternative for patients with a failed surgical bioprosthesis and may obviate the need for reoperation. We evaluated the clinical results of this technique using a large, worldwide registry. METHODS AND RESULTS The Global Valve-in-Valve Registry included 202 patients with degenerated bioprosthetic valves (aged 77.7±10.4 years; 52.5% men) from 38 cardiac centers. Bioprosthesis mode of failure was stenosis (n=85; 42%), regurgitation (n=68; 34%), or combined stenosis and regurgitation (n=49; 24%). Implanted devices included CoreValve (n=124) and Edwards SAPIEN (n=78). Procedural success was achieved in 93.1% of cases. Adverse procedural outcomes included initial device malposition in 15.3% of cases and ostial coronary obstruction in 3.5%. After the procedure, valve maximum/mean gradients were 28.4±14.1/15.9±8.6 mm Hg, and 95% of patients had ≤+1 degree of aortic regurgitation. At 30-day follow-up, all-cause mortality was 8.4%, and 84.1% of patients were at New York Heart Association functional class I/II. One-year follow-up was obtained in 87 patients, with 85.8% survival of treated patients. CONCLUSIONS The valve-in-valve procedure is clinically effective in the vast majority of patients with degenerated bioprosthetic valves. Safety and efficacy concerns include device malposition, ostial coronary obstruction, and high gradients after the procedure.

Multiple miscarriages are associated with the risk of ovarian cancer: results from the European Prospective Investigation into Cancer and Nutrition.

While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR(≥4vs.0): 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR(≥4vs.0): 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR(≥4vs.0): 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.

Constraint algorithm for k-presymplectic Hamiltonian systems. Application to singular field theories

The k-symplectic formulation of field theories is especially simple, since only tangent and cotangent bundles are needed in its description. Its defining elements show a close relationship with those in the symplectic formulation of mechanics. It will be shown that this relationship also stands in the presymplectic case. In a natural way,one can mimick the presymplectic constraint algorithm to obtain a constraint algorithmthat can be applied to k-presymplectic field theory, and more particularly to the Lagrangian and Hamiltonian formulations offield theories defined by a singular Lagrangian, as well as to the unified Lagrangian-Hamiltonian formalism (Skinner--Rusk formalism) for k-presymplectic field theory. Two examples of application of the algorithm are also analyzed.

Le théâtre moral de la vie humaine , représentée en plus de cent tableaux divers tirez du poëte Horace par le sieur Otho Venius, et expliquez en autant de discours moraux par le sieur de Gomberville. Avec la table du philosophe Cebes

Comprend : [Epigramma] ; La Table

Le thème de la liberté chez Agyeya : l'apport de la fiction hindi à l'histoire intellectuelle de l'Inde moderne

Ce travail de doctorat a pour objet central l'usage du thème de la liberté dans les fictions narratives de l'auteur hindi S.H. Vatsyayan 'Agyeya' (1911-­-1987), plus précisément dans ses romans et nouvelles appartenant aux années 1936-­-1961, encadrant donc le double évènement capital pour l'histoire de l'Inde de son indépendance et de sa partition en août 1947. En basant sa recherche sur la littérature fictionnelle écrite en hindi, son objectif est de contribuer de manière féconde et novatrice à la connaissance de l'Inde moderne dans ses développements littéraires et intellectuels. La thèse de ce travail postule qu'une étude de textes fictionnels centrée sur l'analyse sémantique de la notion de « liberté » fournit, grâce à la polysémie de cette dernière et à ses multiples lexicalisations hindi (azadi, chu?kara, mukti, svadhinata, svaraj, svatantrata, etc.), une clé d'interprétation privilégiée de l'oeuvre d'Agyeya en particulier et de l'Inde moderne en général. La recherche effectuée à cette fin a été guidée par l'hypothèse suivante, à savoir que les sources fictionnelles hindi représentent, par rapport aux sources argumentatives et normatives habituellement utilisées en sciences humaines et sociales, un apport précieux de données culturelles concrètes à l'étude de l'Asie du Sud. La principale conclusion de ce travail est que la polysémie de la notion de « liberté » permet comme nulle autre de mettre en évidence le caractère foncièrement interdépendant des diverses composantes du social, dans ses dimensions politique et économique, religieuse et spirituelle, juridique et sociale, ou encore culturelle et artistique. Un deuxième résultat marquant de cette étude est la mise en lumière de l'importance grandissante qu'occupe l'individu dans la société indienne moderne. L'ouvrage débute par un chapitre introductif sur la méthode d'analyse adoptée et les critères ayant présidé à la sélection de la période, du genre textuel et de l'auteur. Le deuxième chapitre est précisément consacré à l'auteur ainsi qu'à son contexte historique et linguistique. Prolongeant cette partie de contextualisation, le troisième chapitre se concentre sur la notion de « liberté » dans l'Inde moderne en se penchant notamment sur les usages de cette notion chez quelques-­- unes de ses figures intellectuelles majeures (Aurobindo, Gandhi, Ambedkar, M.N. Roy, etc.). L'analyse chronologique et l'interprétation du thème de la liberté dans les oeuvres d'Agyeya forment la partie centrale du travail (chapitre 4). Le chapitre cinq élargit l'analyse aux essais d'Agyeya et propose un retour comparatif sur les oeuvres de l'écrivain avec ce qu'il est dit de la liberté au XXe s. chez les intellectuels indiens. La conclusion inclut une réflexion sur l'apport potentiel de cette notion aux études en sciences humaines et sociales. L'ouvrage se termine par les annexes contenant mes traductions de quelques textes emblématiques du développement de l'oeuvre d'Agyeya et par les références bibliographiques.

Bladder cancer documentation of causes: multilingual questionnaire, 'bladder cancer doc'

There is a considerable discrepancy between the number of identified occupational-related bladder cancer cases and the estimated numbers particularly in emerging nations or less developed countries where suitable approaches are less or even not known. Thus, within a project of the World Health Organisation Collaborating Centres in Occupational Health, a questionnaire of the Dortmund group, applied in different studies, was translated into more than 30 languages (Afrikaans, Arabic, Bengali, Chinese, Czech, Dutch, English, Finnish, French, Georgian, German, Greek, Hindi, Hungarian, Indonesian, Italian, Japanese, Kannada, Kazakh, Kirghiz, Korean, Latvian, Malay, Persian (Farsi), Polish, Portuguese, Portuguese/Brazilian, Romanian, Russian, Serbo-Croatian, Slovak, Spanish, Spanish/Mexican, Tamil, Telugu, Thai, Turkish, Urdu, Vietnamese). The bipartite questionnaire asks for relevant medical information in the physician's part and for the occupational history since leaving school in the patient's part. Furthermore, this questionnaire is asking for intensity and frequency of certain occupational and non-occupational risk factors. The literature regarding occupations like painter, hairdresser or miner and exposures like carcinogenic aromatic amines, azo dyes, or combustion products is highlighted. The questionnaire is available on www.ifado.de/BladderCancerDoc.

Heterogeneous metabolic adaptation of C57BL/6J mice to high-fat diet.

C57BL/6J mice were fed a high-fat, carbohydrate-free diet (HFD) for 9 mo. Approximately 50% of the mice became obese and diabetic (ObD), approximately 10% lean and diabetic (LD), approximately 10% lean and nondiabetic (LnD), and approximately 30% displayed intermediate phenotype. All of the HFD mice were insulin resistant. In the fasted state, whole body glucose clearance was reduced in ObD mice, unchanged in the LD mice, and increased in the LnD mice compared with the normal-chow mice. Because fasted ObD mice were hyperinsulinemic and the lean mice slightly insulinopenic, there was no correlation between insulin levels and increased glucose utilization. In vivo, tissue glucose uptake assessed by 2-[(14)C]deoxyglucose accumulation was reduced in most muscles in the ObD mice but increased in the LnD mice compared with the values of the control mice. In the LD mice, the glucose uptake rates were reduced in extensor digitorum longus (EDL) and total hindlimb but increased in soleus, diaphragm, and heart. When assessed in vitro, glucose utilization rates in the absence and presence of insulin were similar in diaphragm, soleus, and EDL muscles isolated from all groups of mice. Thus, in genetically homogenous mice, HFD feeding lead to different metabolic adaptations. Whereas all of the mice became insulin resistant, this was associated, in obese mice, with decreased glucose clearance and hyperinsulinemia and, in lean mice, with increased glucose clearance in the presence of mild insulinopenia. Therefore, increased glucose clearance in lean mice could not be explained by increased insulin level, indicating that other in vivo mechanisms are triggered to control muscle glucose utilization. These adaptive mechanisms could participate in the protection against development of obesity.

Die Reichweite von Theorien als Indikator für ihre Umsetzbarkeit in der Praxis [The scope as an indicator of the applicability of nursing theories to practice]

In der Pflegewissenschaft geben der Einsatz von Theorien und der daraus folgende Gewinn immer wieder Anlass zu Diskussionen. Ein Hauptvorwurf ist, dass Pflegetheorien als sehr abstrakt und wenig praxisnah gelten. Jedoch gibt es wenige Indikatoren, um das Abstraktionsniveau von Theorien und die damit verbundene Reichweite zu bestimmen. Im vorliegenden Artikel werden Fragen basierend auf die Definitionen und Grundannahmen von Theorien erstellt. Damit werden anschließend drei ausgesuchte Theorien auf ihr Abstraktionsniveau und Reichweite untersucht. Es wurden 18 Fragen zu den drei Bereichen ,,Zweck der Theorie", ,,Aufgabe der Theorie" und ,,Beschreibung der Theorie" entwickelt. Diese 18 Fragen wurden auf die Theorie der Adaptation von Sister Callista Roy, die Theorie zur Unsicherheit von Merle M. Mishel und die Theorie der Omnipräsenz von Krebs von Maya Shaha angewendet. [The use of nursing theories and their associated benefits remain an area of repeated discussion in nursing. One of the main objections is that nursing theories are abstract and therefore cannot be easily applied to practice. However, only few indicators exist to help identify a theory's level of abstraction or its scope. In this article, questions based on definitions and assumptions of theories have been developed. These questions have then been applied to three selected theories to investigate their level of abstraction and scope. A total of 18 questions divided into three domains were developed. The three categories were: ,,the purpose of the theory", ,,the aim of the theory" and ,,the description of the theory". The theory of Adaptation by Sister Callista Roy, the Theory of Uncertainty by Merle M. Mishel and the Theory of the Omnipresence of Cancer by Maya Shaha were selected to be analysed following the three domains with the 18 questions.]

Descemet membrane detachment after nonpenetrating filtering surgery.

PURPOSE: To make surgeons performing nonpenetrating filtering surgery aware of an unusual complication namely Descemet membrane detachment. METHODS: We retrospectively reviewed nine eyes of nine patients seen in our hospital with Descemet membrane detachment occurring after nonpenetrating filtering surgery from January 1994 to December 2000. RESULTS: Both planar and nonplanar detachments were reported. Neither scrolls nor tears in the Descemet membrane were observed in any patient. After viscocanalostomy (four patients), the detachment was generally noticed shortly after the procedure and the cornea maintained its clarity. After deep sclerectomy with a collagen implant (five patients), it developed weeks to months postoperatively with adjacent corneal edema. Four patients had descemetopexy. None required more than one procedure. However, at the last visit, two detachments persisted although they had diminished in size: one after viscocanalostomy and conservative treatment and one after descemetopexy after deep sclerectomy with a collagen implant. To date otherwise, no signs of significant corneal damage could be observed clinically nor by specular microscopy and pachymetry. CONCLUSIONS: The diagnosis of Descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.