Showing papers by "University of Ottawa published in 1999"
TL;DR: This report hopes this report will generate further thought about ways to improve the quality of reports of meta-analyses of RCTs and that interested readers, reviewers, researchers, and editors will use the QUOROM statement and generate ideas for its improvement.
4,767 citations
TL;DR: A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina.
Abstract: BACKGROUND To determine whether a restrictive strategy of red-cell transfusion and a liberal strategy produced equivalent results in critically ill patients, we compared the rates of death from all causes at 30 days and the severity of organ dysfunction. METHODS We enrolled 838 critically ill patients with euvolemia after initial treatment who had hemoglobin concentrations of less than 9.0 g per deciliter within 72 hours after admission to the intensive care unit and randomly assigned 418 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hemoglobin concentration dropped below 7.0 g per deciliter and hemoglobin concentrations were maintained at 7.0 to 9.0 g per deciliter, and 420 patients to a liberal strategy, in which transfusions were given when the hemoglobin concentration fell below 10.0 g per deciliter and hemoglobin concentrations were maintained at 10.0 to 12.0 g per deciliter. RESULTS Overall, 30-day mortality was similar in the two groups (18.7 percent vs. 23.3 percent, P= 0.11). However, the rates were significantly lower with the restrictive transfusion strategy among patients who were less acutely ill -- those with an Acute Physiology and Chronic Health Evaluation II score of < or =20 (8.7 percent in the restrictive-strategy group and 16.1 percent in the liberal-strategy group; P=0.03) -- and among patients who were less than 55 years of age (5.7 percent and 13.0 percent, respectively; P=0.02), but not among patients with clinically significant cardiac disease (20.5 percent and 22.9 percent, respectively; P=0.69). The mortality rate during hospitalization was significantly lower in the restrictive-strategy group (22.3 percent vs. 28.1 percent, P=0.05). CONCLUSIONS A restrictive strategy of red-cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients, with the possible exception of patients with acute myocardial infarction and unstable angina.
4,529 citations
TL;DR: A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results.
Abstract: The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient's pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.
2,528 citations
TL;DR: In this article, a total of 2128 calcitic and phosphatic shells, mainly brachiopods with some conodonts and belemnites, were measured for their δ 18 O, δ 13 C and 87 Sr / 86 S values.
2,241 citations
TL;DR: This review attempts to delineate common themes on the physiological and metabolic roles of cortisol in teleost fishes and to suggest new approaches that might overcome some of the inconsistencies on the role of this multifaceted hormone.
Abstract: Cortisol is the principal corticosteriod in teleost fishes and its plasma concentrations rise dramatically during stress. The relationship between this cortisol increase and its metabolic consequences are subject to extensive debate. Much of this debate arises from the different responses of the many species used, the diversity of approaches to manipulate cortisol levels, and the sampling techniques and duration. Given the extreme differences in experimental approach, it is not surprising that inconsistencies exist within the literature. This review attempts to delineate common themes on the physiological and metabolic roles of cortisol in teleost fishes and to suggest new approaches that might overcome some of the inconsistencies on the role of this multifaceted hormone. We detail the dynamics of cortisol, especially the exogenous and endogenous factors modulating production, clearance and tissue availability of the hormone. We focus on the mechanisms of action, the biochemical and physiological impact, and the interaction with other hormones so as to provide a conceptual framework for cortisol under resting and/or stressed states. Interpretation of interactions between cortisol and other glucoregulatory hormones is hampered by the absence of adequate hormone quantification, resulting in correlative rather than causal relationships.
2,139 citations
TL;DR: In this article, the mouse homolog of the gene encoding PTP-1B yielded healthy mice that, in the fed state, had blood glucose concentrations that were slightly lower and concentrations of circulating insulin that were one-half those of their PTP−1B+/+ littermates.
Abstract: Protein tyrosine phosphatase–1B (PTP-1B) has been implicated in the negative regulation of insulin signaling. Disruption of the mouse homolog of the gene encoding PTP-1B yielded healthy mice that, in the fed state, had blood glucose concentrations that were slightly lower and concentrations of circulating insulin that were one-half those of their PTP-1B+/+ littermates. The enhanced insulin sensitivity of the PTP-1B−/− mice was also evident in glucose and insulin tolerance tests. The PTP-1B−/− mice showed increased phosphorylation of the insulin receptor in liver and muscle tissue after insulin injection in comparison to PTP-1B+/+ mice. On a high-fat diet, the PTP-1B−/− and PTP-1B+/− mice were resistant to weight gain and remained insulin sensitive, whereas the PTP-1B+/+ mice rapidly gained weight and became insulin resistant. These results demonstrate that PTP-1B has a major role in modulating both insulin sensitivity and fuel metabolism, thereby establishing it as a potential therapeutic target in the treatment of type 2 diabetes and obesity.
2,101 citations
01 Aug 1999
TL;DR: The first distributed algorithms for routing that do not require duplication of packets or memory at the nodes and yet guarantee that a packet is delivered to its destination are described.
Abstract: We consider routing problems in ad hoc wireless networks modeled as unit graphs in which nodes are points in the plane and two nodes can communicate if the distance between them is less than some fixed unit. We describe the first distributed algorithms for routing that do not require duplication of packets or memory at the nodes and yet guarantee that a packet is delivered to its destination. These algorithms can be extended to yield algorithms for broadcasting and geocasting that do not require packet duplication. A byproduct of our results is a simple distributed protocol for extracting a planar subgraph of a unit graph. We also present simulation results on the performance of our algorithms.
1,537 citations
TL;DR: Patients with a first episode of idiopathic venous thromboembolism should be treated with anticoagulant agents for longer than three months, according to a prespecified interim analysis of efficacy.
Abstract: Background Patients who have a first episode of venous thromboembolism in the absence of known risk factors for thrombosis (idiopathic thrombosis) are often treated with anticoagulant therapy for three months. Such patients may benefit from longer treatment, however, because they appear to have an increased risk of recurrence after anticoagulant therapy is stopped. Methods In this double-blind study, we randomly assigned patients who had completed 3 months of anticoagulant therapy for a first episode of idiopathic venous thromboembolism to continue receiving warfarin, with the dose adjusted to achieve an international normalized ratio of 2.0 to 3.0, or to receive placebo for a further 24 months. Our goal was to determine the effects of extended anticoagulant therapy on rates of recurrent symptomatic venous thromboembolism and bleeding. Results A prespecified interim analysis of efficacy led to the early termination of the trial after 162 patients had been enrolled and followed for an average of 10 months....
1,046 citations
TL;DR: Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures.
Abstract: Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, casebased programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.
884 citations
TL;DR: In this paper, a systematic review of randomised trials of patient decision aids in improving decision making and outcomes was conducted, which included randomized trials of interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making.
Abstract: Objective: To conduct a systematic review of randomised trials of patient decision aids in improving decision making and outcomes. Design: We included randomised trials of interventions providing structured, detailed, and specific information on treatment or screening options and outcomes to aid decision making. Two reviewers independently screened and extracted data on several evaluation criteria. Results were pooled by using weighted mean differences and relative risks. Results: 17 studies met the inclusion criteria. Compared with the controls, decision aids produced higher knowledge scores (weighted mean difference=19/100, 95% confidence interval 14 to 25); lower decisional conflict scores (weighted mean difference=−0.3/5, −0.4 to −0.1); more active patient participation in decision making (relative risk = 2.27, 95% confidence interval 1.3 to 4); and no differences in anxiety, satisfaction with decisions (weighted mean difference=0.6/100, −3 to 4), or satisfaction with the decision making process (2/100,−3 to 7). Decision aids had a variable effect on decisions. When complex decision aids were compared with simpler versions, they were better at reducing decisional conflict, improved knowledge marginally, but did not affect satisfaction. Conclusions: Decision aids improve knowledge, reduce decisional conflict, and stimulate patients to be more active in decision making without increasing their anxiety. Decision aids have little effect on satisfaction and a variable effect on decisions. The effects on outcomes of decisions (persistence with choice, quality of life) remain uncertain.
835 citations
TL;DR: Treatment of tissue with CuSO4 or SB provides a reasonable compromise between reduction of lipofuscin-like fluorescence and maintenance of specific fluorescent labels.
Abstract: The fluorescent pigment lipofuscin accumulates with age in the cytoplasm of cells of the CNS. Because of its broad excitation and emission spectra, the presence of lipofuscin-like autofluorescence complicates the use of fluorescence microscopy (e.g., fluorescent retrograde tract tracing and fluorescence immunocytochemistry). In this study we examined several chemical treatments of tissue sections for their ability to reduce or eliminate lipofuscin-like autofluorescence without adversely affecting other fluorescent labels. We found that 1-10 mM CuSO4 in 50 mM ammonium acetate buffer (pH 5) or 1% Sudan Black B (SB) in 70% ethanol reduced or eliminated lipofuscin autofluorescence in sections of monkey, human, or rat neural tissue. These treatments also slightly reduced the intensity of immunofluorescent labeling and fluorescent retrograde tract tracers. However, the reduction of these fluorophores was far less dramatic than that for the lipofuscin-like compound. We conclude that treatment of tissue with CuSO4 or SB provides a reasonable compromise between reduction of lipofuscin-like fluorescence and maintenance of specific fluorescent labels.
TL;DR: Among patients who underwent transplantation for aplastic anemia, the risk of death by the sixth year after transplantation did not differ significantly from the general population, and the probability of living for five more years was 89 percent.
Abstract: Background and Methods It is uncertain whether mortality rates among patients who have undergone bone marrow transplantation return to the level of the mortality rates of the general population. We analyzed the characteristics of 6691 patients listed in the International Bone Marrow Transplant Registry. All the patients were free of their original disease two years after allogeneic bone marrow transplantation. Mortality rates in this cohort were compared with those of an age-, sex-, and nationality-matched general population. Cox proportional-hazards regression was used to identify risk factors for death more than two years after transplantation (late death). Results Among patients who were free of disease two years after transplantation, the probability of living for five more years was 89 percent (95 percent confidence interval, 88 to 90 percent). Among patients who underwent transplantation for aplastic anemia, the risk of death by the sixth year after transplantation did not differ significantly from ...
TL;DR: It is shown that PCs in the developing mouse cerebellum express the gene encoding the morphogen Sonic hedgehog (Shh) and that dividing cells in the EGL express Patched and Gli1, two target genes of which expression is upregulated in response to Hedgehog signalling.
TL;DR: The reliability of the Jadad scale and the effect of blinding on interrater agreement in another group of primary studies was determined and a significant effect of blindness on the quality scores was unable to be demonstrated.
TL;DR: The authors examined how students' perceptions of their teachers' communicative style, particularly the extent to which teachers are perceived to support students' autonomy and to provide useful feedback about students' learning progress, are related to students' extrinsic and intrinsic motivational orientations.
Abstract: This study considers how students’ perceptions of their teachers’ communicative style, particularly the extent to which teachers are perceived to support students’ autonomy and to provide useful feedback about students’ learning progress, are related to students’ extrinsic and intrinsic motivational orientations. It also examines the link between these variables and various language learning outcomes, including effort, anxiety, and language competence. Students registered in a summer French immersion course (N = 78) completed a questionnaire that was used to assess the constructs described above. Correlational analyses determined that stronger feelings of intrinsic motivation were related to positive language learning outcomes, including greater motivational intensity, greater self-evaluations of competence, and a reduction in anxiety. Moreover, perceptions of the teacher’s communicative style were related to intrinsic motivation, such that the more controlling and the less informative students perceived the teacher to be, the lower students’ intrinsic motivation was. The implications of perceptions of teacher communicative style for motivation and language learning outcomes are discussed.
TL;DR: Morphological and functional equivalents to human corneas that can be produced in vitro have immediate applications in toxicity and drug efficacy testing, and form the basis for future development of implantable tissues.
Abstract: Human corneal equivalents comprising the three main layers of the cornea (epithelium, stroma, and endothelium) were constructed. Each cellular layer was fabricated from immortalized human corneal cells that were screened for use on the basis of morphological, biochemical, and electrophysiological similarity to their natural counterparts. The resulting corneal equivalents mimicked human corneas in key physical and physiological functions, including morphology, biochemical marker expression, transparency, ion and fluid transport, and gene expression. Morphological and functional equivalents to human corneas that can be produced in vitro have immediate applications in toxicity and drug efficacy testing, and form the basis for future development of implantable tissues.
TL;DR: Sensitivity analysis demonstrated that, regardless of the patients' age or baseline risk of stroke, the risk of falling was not an important factor in determining their optimal antithrombotic therapy.
Abstract: Objective To determine whether the risk of falling (with a possible increased chance of subdural hematoma) should influence the choice of antithrombotic therapy in elderly patients with atrial fibrillation. Design A Markov decision analytic model was used to determine the preferred treatment strategy (no antithrombotic therapy, long-term aspirin use, or long-term warfarin use) for patients with atrial fibrillation who are 65 years of age and older, are at risk for falling, and have no other contraindications to antithrombotic therapy. Input data were obtained by systematic review of MEDLINE. Outcomes were expressed as quality-adjusted life-years. Results For patients with average risks of stroke and falling, warfarin therapy was associated with 12.90 quality-adjusted life-years per patient; aspirin therapy, 11.17 quality-adjusted life-years; and no antithrombotic therapy, 10.15 quality-adjusted life-years. Sensitivity analysis demonstrated that, regardless of the patients' age or baseline risk of stroke, the risk of falling was not an important factor in determining their optimal antithrombotic therapy. Conclusions For elderly patients with atrial fibrillation, the choice of optimal therapy to prevent stroke depends on many clinical factors, especially their baseline risk of stroke. However, patients' propensity to fall is not an important factor in this decision.
TL;DR: In this article, the authors present a guide to evaluate the quality of clinical decision rules for radiography in trauma, using examples from emergency medicine and their own research on clinical decisions rules.
TL;DR: A review of the existing research base on how second language listening is taught can be found in this article, with an explanation of how listeners can use strategies to enhance the learning process and how teachers can nurture the development of these strategies.
Abstract: This paper presents arguments for an emphasis on listening comprehen- sion in language learning/teaching. An explanation of how listeners can use strategies to enhance the learning process is presented, with a review of the existing research base on how second language listening is taught. The major part of the paper presents and discusses pedagogical re- commendations, as well as examples of performance checklists for de- veloping metacognitive awareness. Introduction Listening comprehension is anything but a passive activity. It is a complex, active process in which the listener must discriminate between sounds, understand vocabulary and grammatical structures, interpret stress and intonation, retain what was gathered in all of the above, and interpret it within the immediate as well as the larger sociocultural context of the utterance. Co-ordinating all of this involves a great deal of mental activity on the part of the listener. Listening is hard work, and deserves more analysis and support. Listening comprehension as a separate and important component of language learning only came into focus after significant debate about its validity. Recent research has demonstrated the critical role of language input in language learning (e.g. Dunkel 1991, Feyten 1991), providing support for the primacy of listening comprehension in instructional methods. This has led Dunkel to assert that the study of listening comprehension has become the 'polestar' of second language acquisition theory building, research, and pedagogy. This paper will explain how listening comprehension can enhance the process of language learning/acquisition, how listeners can use strategies to facilitate that process, and how teachers can nurture the development of these strategies. Listening As mentioned above, it is now generally recognized that listening comprehension comprehension plays a key role in facilitating language learning. and language According to Gary (1975) giving pre-eminence to listening comprehen- learning sion, particularly in the early stages of second language teaching/ learning, provides advantages of four different types: cognitive, efficiency, utility, and affective. The cognitive advantage of an initial
TL;DR: In this article, the authors demonstrate the extent to which item score data can vary across cultures despite measurements from an instrument for which the factorial structure is equivalently specified in each group.
Abstract: The purpose of this article is to demonstrate, paradigmatically, the extent to which item score data can vary across cultures despite measurements from an instrument for which the factorial structure is equivalently specified in each group. Based on item scores from the Beck Depression Inventory, the authors first tested for the group invariance of factorial structure and then examined the patterns of item score distributions and response frequencies across Canadian (n = 658), Swedish (n = 1,096), and Bulgarian (n = 691) high school adolescents. Findings carry important implications for multigroup comparisons research in general, and for cross-cultural research in particular, where the primary interest focuses on testing for mean group differences.
TL;DR: The authors found that learners tended to ignore a large proportion of the words they attended to, while inferencing was the main strategy employed for those words they attend to, and provided a taxonomy of the knowledge sources they used in inferring word meanings from various textual and other cues.
Abstract: The present study is a follow-up to a classroom experiment with university ESL students that
demonstrated incidental acquisition of new lexical knowledge through the reading of thematically
related texts. Introspective data from similar students using the same materials are analyzed in this
study to explore how vocabulary knowledge may be acquired as a by-product of reading for
comprehension. The researchers sought to identify the strategies and the kinds of knowledge and
information learners used when dealing with new L2 words they encountered while reading.
Learners tended to ignore a large proportion of the words. For those words they attended to,
inferencing was the main strategy employed. A taxonomy of the knowledge sources they used in
inferring word meanings from various textual and other cues was developed, which provided a
framework for describing learners' inferencing behavior. Findings are interpreted in terms
of existing research and theory on incidental vocabulary acquisition within an input-processing
framework. Pedagogical implications are drawn.
TL;DR: It is demonstrated that p53-induced cell death in postmitotic neurons involves a Bax-dependent caspase-3 activation, suggesting that these molecules are important determinants in neuronal cell death after injury.
Abstract: p53 is a pivotal molecule regulating the death of neurons both after acute injury and during development The molecular mechanisms by which p53 induces apoptosis in neuronal cells, however, are not well understood We have shown previously that adenovirus-mediated p53 gene delivery to neurons was sufficient to induce apoptosis In the present study we have examined the molecular mechanism by which p53 evokes neuronal cell death Adenovirus-mediated delivery of p53 to cerebellar granule neurons resulted in caspase-3 (CPP32) activation followed by terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick end labeling (TUNEL) staining and loss of viability as determined by an MTT survival assay To determine whether Bax is essential for caspase-3 activation, p53 was expressed in Bax-deficient cells Bax null neurons did not exhibit caspase-3 activation in response to p53 and were protected from apoptosis To determine whether Bax-dependent caspase-3 activation was required in p53-mediated neuronal cell death, caspase-3-deficient neurons were examined Our results indicate that caspase-3-deficient neurons exhibit a remarkable delay in apoptosis and a dramatic decrease in TUNEL-positive cells These studies demonstrate that p53-induced cell death in postmitotic neurons involves a Bax-dependent caspase-3 activation, suggesting that these molecules are important determinants in neuronal cell death after injury
Journal Article•
TL;DR: The peptide cholecystokinin has been shown to mediate pancreatic secretion and contraction of gallbladder and was described in the mammalian central nervous system (CNS) as a gastrin-like peptide.
Abstract: The peptide cholecystokinin (CCK)2was originally discovered in the gastrointestinal tract ([Ivy and Oldberg, 1928][1]) and has been shown to mediate pancreatic secretion and contraction of gallbladder. Then, CCK was described in the mammalian central nervous system (CNS) as a gastrin-like
TL;DR: In this article, emotionally focused couples therapy (EFT) is presented as one of the most researched and most effective approaches to changing distressed marital relationships, and the theoretical context of EFT is described.
Abstract: This article presents the basis for, and the research on, emotionally focused couples therapy (EFT), now recognized as one of the most researched and most effective approaches to changing distressed marital relationships. Drawing on attachment theory and the research on interactional patterns in distressed relationships, we describe the theoretical context of EFT. We then outline the nature of the clinical interventions used in EFT and the steps hypothesized to be crucial to couple change. The central role of accessing and working with emotional issues in the relationship context is highlighted. Following this presentation, we review both the outcome and process research on EFT and present meta-analytic data from randomized clinical trials to substantiate the clinical impact of EFT on couple adjustment. Finally, the empirical and clinical challenges facing EFT are summarized.
TL;DR: This paper examined the relationship between different types of situational motivation and flow and situational motivational determinants (perceptions of autonomy, competence, and relatedness) and the experience of flow and found that situational self-determined forms of motivation (intrinsic motivation and self-defined extrinsic motivations) and perceptions of autonomy and competence were positively related to flow.
Abstract: The study examined the relationships between different types of situational motivation and flow and situational motivational determinants (perceptions of autonomy, competence, and relatedness) and the experience of flow. Immediately following a swim practice, 203 Canadian master's-level swimmers completed a questionnaire that assessed different variables. Results indicated that situational self-determined forms of motivation (intrinsic motivation and self-determined extrinsic motivation) and perceptions of autonomy, competence, and relatedness were positively related to flow, whereas amotivation was negatively related to flow.
TL;DR: An inexpensive, multifaceted system optimization approach to rapid defibrillation can lead to significant improvements in survival after cardiac arrest in a large BLS-D EMS system.
Abstract: ContextSurvival rates for out-of-hospital cardiac arrest are
low; published survival rates in Ontario are only 2.5%. This study
represents phase II of the Ontario Prehospital Advanced Life Support
(OPALS) study, which is designed to systematically evaluate the
effectiveness and efficiency of various prehospital interventions for
patients with cardiac arrest, trauma, and critical illnesses.ObjectiveTo assess the impact on out-of-hospital
cardiac arrest survival of the implementation of a rapid defibrillation
program in a large multicenter emergency medical services (EMS) system
with existing basic life support and defibrillation (BLS-D) level of
care.DesignControlled clinical trial comparing survival for 36 months
before (phase I) and 12 months after (phase II) system optimization.SettingNineteen urban and suburban Ontario communities
(populations ranging from 16,000 to 750,000 [total, 2.7
million]).PatientsAll patients who had out-of-hospital cardiac arrest in
the study communities for whom resuscitation was attempted by emergency
responders.InterventionsStudy communities optimized their EMS systems to
achieve the target response interval from when a call was received
until a vehicle stopped with a defibrillator of 8 minutes or less for
90% of cardiac arrest cases. Working both locally and provincially,
communities implemented multiple measures, including defibrillation by
firefighters, base paging, tiered response agreements with fire
departments, continuous quality improvement for response intervals, and
province-wide revision and implementation of standard dispatch
policies. All response times were obtained from a central dispatch
system.Main Outcome MeasureSurvival to hospital discharge.ResultsThe 4690 cardiac arrest patients studied in phase I and
the 1641 in phase II were similar for all clinical and demographic
characteristics, including age, sex, witnessed status, rhythm, and
receipt of bystander cardiopulmonary resuscitation. The proportion of
cases meeting the 8-minute response criterion improved (76.7% vs
92.5%; P<.001) as did most median response intervals.
Overall survival to hospital discharge for all rhythm groups combined
improved from 3.9% to 5.2% (P=.03). The 33%
relative increase in survival represents an additional 21 lives saved
each year in the study communities (approximately 1 life per
120,000 residents). The charges were estimated to be US
$46,900 per life saved for establishing the rapid defibrillation
program and US $2400 per life saved annually for maintaining the
program.ConclusionAn inexpensive, multifaceted system optimization
approach to rapid defibrillation can lead to significant improvements
in survival after cardiac arrest in a large BLS-D EMS
system.
TL;DR: The results suggest that antidepressants, at concentrations in the therapeutical range, have negative immunoregulatory effects through inhibition of IFNγ and stimulation of IL-10 release.
TL;DR: In this article, the impact of becoming Black on ESL learning is discussed, that is, the interrelation between identity and learning, and it is argued that ESL is neither neutral nor without its politics and pedagogy of desire and investment.
Abstract: This article is about the impact of becoming Black on ESL learning, that is, the interrelation between identity and learning. It contends that a group of French-speaking immigrant and refugee continental African youths who are attending an urban Franco-Ontarian high school in southwestern Ontario, Canada, enters a social imaginary—a discursive space in which they are already imagined, constructed, and thus treated as Blacks by hegemonic discourses and groups. This imaginary is directly implicated in whom the students identify with (Black America), which in turn influences what and how they linguistically and culturally learn. They learn Black stylized English, which they access in hip-hop culture and rap lyrical and linguistic styles. This critical ethnography, conducted within an interdisciplinary framework, shows that ESL is neither neutral nor without its politics and pedagogy of desire and investment.
Journal Article•
TL;DR: To assess the risk factors associated with the development of contralateral breast cancer among women with a first primary breast cancer, the epidemiological literature concerning these factors was reviewed and summarized.
Abstract: Two to 11% of women diagnosed with breast cancer will develop contralateral breast cancer in their lifetime. Women with a first primary are at a 2-6-fold increased risk of developing contralateral breast cancer compared with the risk in the general population of women developing a first primary cancer. The incidence rate of contralateral breast cancer varies from four to eight per 1000 person-years. To assess the risk factors associated with the development of contralateral breast cancer among women with a first primary breast cancer, the epidemiological literature concerning these factors was reviewed and summarized. Studies have shown that a family history of breast cancer, an early age at initial diagnosis, and a lobular histology of the first primary breast cancer increase the risk of developing contralateral breast cancer. Although chemotherapy and tamoxifen therapy may reduce this risk, there are inconsistent results regarding the effects of radiotherapy and the effects of reproductive, environmental and other factors. Additional analytical studies addressing all potential risk factors associated with the development of contralateral breast cancer are necessary in view of the increasing incidence and survival of women with a first primary.
TL;DR: Comparisons of duty-related trauma exposures and the prevalences of posttraumatic stress in U.S. and Canadian firefighters revealed significant differences in both frequencies and categories of traumatic incident exposures.
Abstract: Urban firefighters are at risk for posttraumatic stress disorder (PTSD) due in part to their exposure to duty-related trauma. This study compared duty-related trauma exposures and the prevalences of posttraumatic stress in U.S. and Canadian firefighters. Both samples reported relatively numerous and frequent posttrauma symptoms, and the rates of self-reported PTSD prevalence did not differ significantly. However, analysis of departmental records for respondents' previous year on duty revealed significant differences in both frequencies and categories of traumatic incident exposures. Some of the vulnerability and moderating risk factors associated with PTSD caseness differed between the U.S. and Canadian samples. Potential explanations for the observed differences in risk factors for PTSD in these 2 firefighter samples are considered.