The Effects of Reduction Mammaplasty

Symptomatic hypertrophic breasts cause a health burden with physical and psychosocial morbidity. The value of reduction mammaplasty in the treatment of symptomatic breast hypertrophy has been consistently reported by patients and has been well recognised by plastic surgeons for a long time. However, the scientific evidence of the effects of reduction mammaplasty has been weak or lacking. During the design of this study most of the previous studies were retrospective and the few prospective studies had methodological limitations. Therefore, an obvious need for prospective randomised studies was present. Nevertheless, practical and ethical considerations seemed to make this study design impossible, because the waiting time for the operation was several years. The legislation and subsequent introduction of the uniform criteria for access to non-emergency treatment in Finland removed these obstacles, as all patients received their treatment within a reasonable time. As a result, a randomised controlled trial with a six-month follow-up time was designed and conducted. In addition, a follow-up study with two to five years follow-up was also carried out later. The effects of reduction mammaplasty on the patients breast-related symptoms, psychological symptoms, pain and quality of life was assessed. In addition, factors affecting the outcome were investigated. This study was carried out in the Hospital District of Helsinki and Uusimaa, Finland. Eighty-two out of the approximately 300 patients on the waiting list in 2004 agreed to participate in the study. Patients were randomised either to be operated (40 patients) on or to be followed up (42 patients). The follow-up time for both groups was six months. The patients were operated on by plastic surgeons or trainees at the Department of Plastic Surgery at Helsinki University Central Hospital or at the Department of Surgery at Hyvinkää Hospital. The patients completed five questionnaires: the SF-36 and the 15D quality of life questionnaires, the Finnish Breast-Associated Symptoms questionnaire (FBAS), a mood questionnaire (Raitasalo s modification of the short form of the Beck Depression Inventory, RBDI), and a pain questionnaire (The Finnish Pain Questionnaire, FPQ). Sixty-two out of the original 82 patients agreed to participate in the prospective follow-up study. In this study, patients completed the 15D quality of life questionnaire, the Finnish Breast-Associated Symptoms questionnaire, and the RBDI mood questionnaire. After six months follow-up, patients who had undergone reduction mammaplasty had a significantly better quality of life, fewer breast-associated symptoms and less pain, and they were less depressed or anxious when compared to patients who had not undergone surgery. The change in quality of life was more than two times the minimal clinically important difference. The patients preoperative quality of life was significantly inferior when compared to the age-standardised general population. This health burden was removed with reduction mammaplasty. The health loss related to symptomatic breast hypertrophy was comparable to that of patients with major joint arthrosis. In terms of change in quality of life, the intervention effect of reduction mammaplasty was comparable to that of hip joint replacement and more pronounced than that of knee joint replacement surgery. The outcome of reduction mammaplasty was affected more by preoperative psychosocial factors than by changes in breast dimensions. The effects of reduction mammaplasty remained stable at two to five years follow-up. In terms of quality of life, symptomatic breast hypertrophy causes a considerable health loss comparable to that of major joint arthrosis. Patients who undergo surgery have fewer breast-associated symptoms and less pain, and they are less depressed or anxious and have an improved quality of life. The intervention effect is comparable to that of major joint replacement surgery, and it remains stable at two to five years follow-up. The outcome of reduction mammaplasty is affected by preoperative psychosocial factors.

Bonding Of Alumina And Metal Using Bulk Metallic Glass Forming Alloy

Metal-alumina joints have found various practical applications in electronic devices and high technology industry. However, making of sound metal ceramic brazed couple is still a challenge in terms of its direct application in the industry. In this work we successfully braze copper with Al2O3 ceramic using Zr52.5Cu17.9Ni14.6Al10Ti5 bulk metallic glass forming alloy as filler alloy. The shear strength of the joints can reach 140 MPa, and the microstructrural analysis confirms a reliable chemical boning of the interface. The results show that the bulk metallic glass forming alloys with high concentration of active elements are prospective for using as filler alloy in metal-ceramic bonding.

A small perturbation theory for cycloidal propellers

A hydromechanical theory is developed for cycloidal propellers for two limiting modes of operation wherein U » ΩR and U « ΩR, with U the rectilinear propeller speed (speed of advance) and ΩR the rotational blade speed. A first order theory is developed from the basic principles of the kinematics and dynamics of fluid motion and proceeds from the point of view of unsteady hydrofoil theory.

Explicit expressions for the instantaneous forces and moments produced by blade motions are presented. On the basis of these results an optimization procedure is carried out which minimizes the energy loss under the constraint of specified mean thrust. Under optimal conditions the propeller is found to possess high Froude efficiencies in both the high and low speed modes of propulsion. This efficiency is defined as the ratio of the average useful work obtained during one cycle of propeller operation to the average power input required to sustain the motion of the propeller during the cycle.

Assessment of fish populations and habitat on Oculina Bank, a deep-sea coral marine protected area off eastern Florida

A portion of the Oculina Bank located off eastern Florida is a marine protected area (MPA) preserved for its dense populations of the ivory tree coral (Oculina varicosa), which provides important habitat for fish. Surveys of fish assemblages and benthic habitat were conducted inside and outside the MPA in 2003 and 2005 by using remotely operated vehicle video transects and digital still imagery. Fish species composition, biodiversity, and grouper densities were used to determine whether O. varicosa forms an essential habitat compared to other structure-forming habitats and to examine the effectiveness of the MPA. Multivariate analyses indicated no differences in fish assemblages or biodiversity among hardbottom habitat types and grouper densities were highest among the most complex habitats; however the higher densities were not exclusive to coral habitat. Therefore, we conclude that O. varicosa was functionally equivalent to other hardbottom habitats. Even though fish assemblages were not different among management areas, biodiversity and grouper densities were higher inside the MPA compared to outside. The percentage of intact coral was also higher inside the MPA. These results provide initial evidence demonstrating effectiveness of the MPA for restoring reef fish and their habitat. This is the first study to compare reef fish populations on O. varicosa with other structure-forming reef habitats and also the first to examine the effectiveness of the MPA for restoring fish populations and live reef cover.

O modelo neoliberal e suas repercussões para a saúde do trabalhador de enfermagem

O objeto deste estudo são as repercussões do modelo neoliberal na saúde dos trabalhadores de enfermagem que atuam no contexto hospitalar. Os objetivos foram: (I) identificar as características do modelo produtivo neoliberal no trabalho hospitalar e de enfermagem; (II) analisar as implicações do neoliberalismo no processo saúde-doença dos trabalhadores de enfermagem; e (III) propor recomendações à organização do trabalho para minimização dos efeitos do modelo neoliberal na saúde desses trabalhadores. A pesquisa, de caráter qualitativo, descritivo e exploratório, foi desenvolvida em um hospital universitário localizado no Município do Rio de Janeiro. Os sujeitos são trabalhadores de enfermagem, dos quais 14 são enfermeiros e 20, técnicos de enfermagem. O instrumento de coleta de dados caracteriza-se na entrevista semiestruturada. O projeto foi aprovado pelo comitê de ética da instituição na qual se desenvolveu o estudo, sob número de protocolo 365.716, conforme resolução 466/12. A técnica utilizada para o tratamento dos dados coletados é a Análise Temática de Conteúdo, que fez emergir quatro categorias. I) As configurações da organização e processo de trabalho hospitalar no contexto neoliberal, em que se discutem as características dessa organização laboral e do processo de trabalho da enfermagem diante do impacto do modelo neoliberal na forma de gestão. Elabora-se também uma análise dos efeitos desse modelo tanto na previsão e provisão de recursos, humano e material, quanto na precarização dos vínculos de trabalho e seus efeitos sobre a qualidade e a quantidade da produtividade da enfermagem. Discute-se ainda o modo operatório dos trabalhadores de enfermagem diante das transformações do mundo do trabalho, impostas pela influência do neoliberalismo no ambiente hospitalar. II) O modelo neoliberal no ambiente hospitalar: implicações políticas e interpessoais no coletivo de enfermagem, em que se discutem (i) as relações hierárquicas e de poder tecidas nesse contexto; e (ii) o uso e as consequências das tecnologias em saúde e a demanda por capacitação e treinamento dos profissionais. III) Os impactos do modelo neoliberal no processo saúde-doença dos trabalhadores, em que se analisa que, devido à configuração da organização do trabalho, há muitas repercussões negativas para o processo saúde-doença dos trabalhadores, tais como estresse, taquicardia, hipertensão arterial sistêmica, sonolência, sudorese, esgotamento físico e mental, depressão, desgaste físico, cefaleia, dor epigástrica e irritabilidade. IV) As recomendações para melhoria do ambiente de trabalho na ótica dos profissionais, em que (i) se discutem as propostas para melhoria das condições laborais e do processo de trabalho dos profissionais de enfermagem e (ii) se elencam sugestões para minimização dos impactos causados pelas inúmeras formas de precarização presentes nesse contexto laboral, objetivando assim, o incremento da qualidade de vida e da saúde dos trabalhadores. Conclui-se que diversas foram as repercussões do neoliberalismo para o processo e organização do trabalho hospitalar, assim como para a saúde do trabalhador.

Identification and characterization of a cathepsin L-like cysteine protease from Taenia solium metacestode

Taenia solium metacestode, a larval pork tapeworm, is a causative agent of neurocysticercosis, one of the most common parasitic diseases in the human central nervous system. In this study, we identified a cDNA encoding for a cathepsin L-like cysteine protease from the T solium metacestode (TsCL-1) and characterized the biochemical properties of the recombinant enzyme. The cloned cDNA of 1216 bp encoded 339 amino acids with an approximate molecular weight of 37.6 kDa which containing a typical signal peptide sequence (17 amino acids), a pro-domain (106 amino acids), and a mature domain (216 amino acids). Sequence alignments of TsCL-1 showed low sequence similarity of 27.3-44.6 to cathepsin L-like cysteine proteases from other helminth parasites, but the similarity was increased to 35.9-55.0 when compared to mature domains. The bacterially expressed recombinant protein (rTsCL-1) did not show enzyme activity; however, the rTsCL-1 expressed in Pichia pastoris showed typical biochemical characteristics of cysteine proteases. It degraded human immunoglobulin G (IgG) and bovine serum albumin (BSA), but not collagen. Western blot analysis of the rTsCL-1 showed antigenicity against the sera from patients with cysticercosis, sparganosis or fascioliasis, but weak or no antigenicity against the sera from patients with paragonimiasis or clonorchiasis. (c) 2006 Published by Elsevier B.V.

In-situ resistivity measurement of ZnS in diamond anvil cell under high pressure

An effective method is developed to fabricate metallic microcircuits in diamond anvil cell (DAC) for resistivity measurement under high pressure. The resistivity of nanocrystal ZnS is measured under high pressure up to 36.4 GPa by using designed DAC. The reversibility and hysteresis of the phase transition are observed. The experimental data is confirmed by an electric current field analysis accurately. The method used here can also be used under both ultrahigh pressure and high temperature conditions.

Kinetic isotope effects of proton transfer reaction for amines by ultrasonic relaxation methods: Unexpected evidence from the results in ethylamine solutions

Ultrasonic absorption coefficients for ethylamine in heavy water (D2O) and in light water (H2O) have been measured in the frequency range from 0.8 to 220 MHz at 25 degrees C. A single relaxational process has been observed in these two kinds of solutions. From the concentration dependence of the ultrasonic relaxation parameters, and following the reaction mechanism proposed by Eigen et al. for ethylamine in H2O, the causes of the relaxations have been attributed to a perturbation of an equilibrium associated with a deuteron or proton transfer reaction. The rate and equilibrium constants have been estimated from deuterioxide or hydroxide ion concentration dependence of the relaxation frequency, and the kinetic isotope effects have been determined. In addition, the standard volume changes of the reactions have been calculated from the concentration dependence of the maximum absorption per wavelength, and the adiabatic compressibility has also been determined from the density and sound velocity for ethylamine in D2O and in H2O, respectively. These results are compared with those for propylamine and butylamine and are discussed in relation to the different kinetic properties between D2O and H2O, the reaction radii derived by Debye theory, and the structural properties of the reaction intermediate.

L'Écho de Paris

1908/07/20 (Numéro 8802).