RESUMO
Cost performance by NASA programs can generate two stable states within the organization system used for program performance management. These states could be stable individually or show multistability with cusp-like behavior. To test this, we constructed a cusp catastrophe model in a multilevel modeling (HLM) procedure on the cost components of an eleven-month period of one NASA program. HLM was used for its ability to estimate random effects as replacements for unknown control parameters. The cusp catastrophe model was a good description of the data and there was some evidence that the overall budget size functioned as a control parameter. Results are presented in terms of three different forms of uncertainty: attractor strength, unistability or multistability, and control parameters. Recommendations and future directions are focused towards understanding the cause of uncertainty in complex management systems.
RESUMO
Post-transplant lymphoproliferative disease remains a complication with a high morbidity and mortality. The present study examined 291 pediatric liver transplants performed in 263 children from October 1984 to December 1999. Post-transplant lymphoproliferative disease has an overall incidence of 12%. Tacrolimus and cyclosporine had a similar incidence of post-transplant lymphoproliferative disease. Fifty-six per cent of patients who developed post-transplant lymphoproliferative disease were Epstein-Barr virus negative at the time of transplantation. Mean time of conversion to Epstein-Barr virus positivity was 1.1 years after liver transplantation. Ten per cent of those who developed post-transplant lymphoproliferative disease never had Epstein-Barr virus detected. Mean time from Epstein-Barr virus positivity to detection of post-transplant lymphoproliferative disease was 2.68 years, and 3.13 years from liver transplantation (OLTx) to post-transplant lymphoproliferative disease. There was a 35% incidence of mortality. Deaths occurred a mean of 0.76 years after diagnosis of post-transplant lymphoproliferative disease. Most cases of post-transplant lymphoproliferative disease had extranodal location. There was one recurrence in 10% of patients, and two in 3%. All recurrent cases were seen in recipients who became Epstein-Barr virus positive after transplantation. There has been a decrease in the incidence of post-transplant lymphoproliferative disease from 15% to 9% to 4%. Post-transplant lymphoproliferative disease should be diagnosed promptly and treated aggressively. The best treatment, however, seems to be prevention, starting in the immediate postoperative period. Survivors should be monitored for both recurrence of post-transplant lymphoproliferative disease and acute cellular rejection.
Assuntos
Transplante de Fígado/imunologia , Transtornos Linfoproliferativos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Infecções por Vírus Epstein-Barr/epidemiologia , Feminino , Seguimentos , Herpesvirus Humano 4/isolamento & purificação , Humanos , Incidência , Lactente , Transplante de Fígado/mortalidade , Transtornos Linfoproliferativos/mortalidade , Transtornos Linfoproliferativos/virologia , Masculino , Recidiva , Estudos Retrospectivos , Fatores de TempoRESUMO
Forty-five measurements of diameters of 12 human cerebral arteries were performed during 10 craniotomies under moderate changes in mean blood pressure and end tidal CO2. The mean change in blood pressure was 30 +/- 16 mm Hg (standard deviation) and that of end tidal CO2 was 14 +/- 6 mm Hg (standard deviation). These changes were induced with nitroprusside, phenylephrine, and adjustment of ventilator rate. Measurements were made through the operating microscope focused at the highest power, with meticulous attention to constant angle and distance from the artery. The mean diameter change in the large cerebral arteries (carotid, middle cerebral artery, vertebral artery) was less than 4%, but the smaller arteries (anterior cerebral artery, M2 segment of middle cerebral artery) showed diameter changes as large as 29% and 21% to end tidal CO2 and blood pressure changes, respectively. These data suggest that at the time of craniotomy, diameters of the large cerebral vessels do not significantly change during moderate variations in blood pressure and CO2, but that larger changes may occur in smaller vessels. This constancy of diameter suggests that the transcranial Doppler velocities obtained during intraoperative monitoring of craniotomies may closely reflect blood flow through the insonated artery.
Assuntos
Pressão Sanguínea/fisiologia , Encéfalo/irrigação sanguínea , Dióxido de Carbono/sangue , Artérias Cerebrais/fisiopatologia , Craniotomia , Resistência Vascular/fisiologia , Aneurisma Roto/fisiopatologia , Aneurisma Roto/cirurgia , Velocidade do Fluxo Sanguíneo/fisiologia , Epilepsia do Lobo Temporal/fisiopatologia , Epilepsia do Lobo Temporal/cirurgia , Humanos , Aneurisma Intracraniano/fisiopatologia , Aneurisma Intracraniano/cirurgia , Microcirurgia , Psicocirurgia , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/cirurgia , Insuficiência Vertebrobasilar/fisiopatologia , Insuficiência Vertebrobasilar/cirurgiaRESUMO
This study investigated the relation between stress and current disease activity in rheumatoid arthritis (RA). During a routine clinic appointment, subjects were given ratings of global disease status by their physicians and completed self-report measures of major stress and minor stress. In addition, each subject's erythrocyte sedimentation rate was taken. After controlling for disease severity and major stress, minor stress accounted for a significant amount of the variance in inflammation level. These results suggest that minor stress is associated with current disease activity in RA.
Assuntos
Artrite Reumatoide/diagnóstico , Estresse Psicológico/complicações , Adaptação Psicológica , Artrite Reumatoide/sangue , Artrite Reumatoide/fisiopatologia , Sedimentação Sanguínea , Feminino , Hospitais Privados , Hospitais de Ensino , Humanos , Masculino , Personalidade , Prognóstico , Índice de Gravidade de DoençaRESUMO
This paper presents a wide-ranging overview of compact disc technology in the library environment. It raises important issues currently being debated in the literature and aims to question and stimulate thought on the nature and purpose of CD-ROM provision in health-care libraries.
Assuntos
CD-ROM , Bases de Dados Bibliográficas , Bibliotecas Médicas , Comércio , Estudos de Avaliação como Assunto , MEDLINERESUMO
Serum, eye secretions, post-nasal swabs, external ear swabs and middle ear effusions (MEE) were collected from 131 Australian Aboriginal children with chronic otitis media with effusion (COME). The children were all resident in a trachoma endemic region. Chlamydia trachomatis was recovered from the MEE of 2 children. Probable bacterial pathogens were isolated from 34 (12.7%) ears. The remainder were sterile (52.4%) or contained normal skin flora (34.9%). Serum and secretions were examined by the microimmunofluorescent technique for the presence, titre and serotype of anti-chlamydial antibody. Antibody, predominantly of the C serotype, was found in a high percentage of sera (80%) and secretions (approximately 50%). This serotype is associated with ocular trachoma. It is concluded that C. trachomatis is associated with COME among some Aboriginal children in this trachoma endemic area.
Assuntos
Infecções por Chlamydia/microbiologia , Otite Média com Derrame/microbiologia , Otite Média/microbiologia , Adolescente , Anticorpos Antibacterianos/análise , Austrália , Criança , Pré-Escolar , Infecções por Chlamydia/etiologia , Infecções por Chlamydia/imunologia , Chlamydia trachomatis/imunologia , Chlamydia trachomatis/isolamento & purificação , Feminino , Humanos , Masculino , Havaiano Nativo ou Outro Ilhéu do Pacífico , Otite Média com Derrame/etiologia , Otite Média com Derrame/imunologiaRESUMO
Ear, nose and throat diseases in children living in the Kimberley region of Western Australia have been systematically studied over the last 15 years. A "diagnostic triad" is described; this offers a comprehensive approach to the assessment of middle-ear disease. The aetiology of chronic ear disease in Aboriginal children has been investigated. Management problems of deafness are discussed.
Assuntos
Otopatias/epidemiologia , Havaiano Nativo ou Outro Ilhéu do Pacífico , Adolescente , Criança , Pré-Escolar , Doença Crônica , Etnicidade , Feminino , Inquéritos Epidemiológicos , Transtornos da Audição/epidemiologia , Humanos , Lactente , Masculino , Septo Nasal/anormalidades , Doenças Nasofaríngeas/epidemiologia , Doenças Dentárias/epidemiologia , Tracoma/epidemiologiaAssuntos
Insulina , Nutrição Parenteral , Adsorção , Vidro , Glucose , Humanos , Nutrição Parenteral/instrumentação , Plásticos , Albumina Sérica , SoluçõesRESUMO
Twenty-one patients had acupuncture treatment for chronic, disabling pain. Ten (47.5%) thought they had obtained worthwhile relief by the time treatment was completed. Six (30%) had no or negligible benefit and five (25%) had some aggravation of their pain at some stage of the procedure. In this group of patients, with the technique we describe, we were unable to achieve the high degree of short-term success claimed by other workers. Until further scientific studies can confirm the value of acupuncture in medical practice, we urge caution in the use of this procedure.
Assuntos
Terapia por Acupuntura , Dor Intratável/terapia , Terapia por Acupuntura/efeitos adversos , Adulto , Idoso , Dor nas Costas/terapia , Doença Crônica , Feminino , Herpes Zoster/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/terapiaRESUMO
The efficacy of naproxen in treating rheumatoid arthritis patients was evaluated in a double-blind clinical trial using aspirin as the control drug. The study was conducted at seven centers and involved 80 patients. After an unequivocal increase in disease activity during a drug-free period, patients were randomly assigned to either drug and continued in the trial for 16 weeks. Some patients took low maintenance doses of corticosteroids, or gold salts, or both throughout the trial. Both test drugs significantly decreased disease activity as measured by a number of ways. By objective measurements, naproxen was as effective as aspirin, although patients in the naproxen-treated group entered the trial with more severe disease. By some subjective evaluations, naproxen was considered more effective than aspirin. Although patients taking naproxen had less frequent gastrointestinal side effects and fewer symptoms VIIIth nerve toxicity, the differences were not statistically significant. We conclude that naproxen is a useful addition to the physician's armamentarium for the treatment of rheumatoid arthritis.
Assuntos
Artrite Reumatoide/tratamento farmacológico , Ácidos Naftalenoacéticos/uso terapêutico , Naproxeno/uso terapêutico , Corticosteroides/uso terapêutico , Artrite Reumatoide/sangue , Aspirina/efeitos adversos , Aspirina/uso terapêutico , Sedimentação Sanguínea , Ensaios Clínicos como Assunto , Feminino , Ouro/uso terapêutico , Humanos , Masculino , Naproxeno/efeitos adversos , Fator Reumatoide/análiseRESUMO
Five isozymes of LDH are demonstrable in the epidermis of the ear pinnae, hind feet, trunk dorsa, and tails of adult C57BL, C57HR, and C3HB mice by polyacrylamide gel electrophoresis. LDH-5 activity predominates in electropherograms. The ratio of LDH-1 to LDH-K is greater in the epidermis of ear pinna and trunk dorsum than in that of tail and hind foot. The region-specific patterns of epidermal LDH isozymes are not correlated with melanin pigmentation or "hairiness' of the skin.