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Ecology and Society : a Journal of... Dec 2013This paper introduces the special feature of entitled "Traditional Ecological Knowledge and Global Environmental Change. The special feature addresses two main research...
This paper introduces the special feature of entitled "Traditional Ecological Knowledge and Global Environmental Change. The special feature addresses two main research themes. The first theme concerns the resilience of Traditional Ecological Knowledge (hereafter TEK) and the conditions that might explain its loss or persistence in the face of global change. The second theme relates to new findings regarding the way in which TEK strengthens community resilience to respond to the multiple stressors of global environmental change. Those themes are analyzed using case studies from Africa, Asia, America and Europe. Theoretical insights and empirical findings from the studies suggest that despite the generalized worldwide trend of TEK erosion, substantial pockets of TEK persist in both developing and developed countries. A common trend on the studies presented here is hybridization, where traditional knowledge, practices, and beliefs are merged with novel forms of knowledge and technologies to create new knowledge systems. The findings also reinforce previous hypotheses pointing at the importance of TEK systems as reservoirs of experiential knowledge that can provide important insights for the design of adaptation and mitigation strategies to cope with global environmental change. Based on the results from papers in this feature, we discuss policy directions that might help to promote maintenance and restoration of living TEK systems as sources of social-ecological resilience.
PubMed: 26097492
DOI: 10.5751/ES-06288-180472 -
United European Gastroenterology Journal Oct 2013There is a general belief that gastro-oesophageal reflux increases after meals and especially following a rapid intake.
BACKGROUND
There is a general belief that gastro-oesophageal reflux increases after meals and especially following a rapid intake.
OBJECTIVE
To evaluate the impact of rapid vs. slow food intake on gastro-oesophageal reflux disease (GORD) patients.
MATERIALS AND METHODS
Forty-six GORD patients with heartburn and / or acid regurgitation once a week or more often common were included in this study. Participants were asked to eat the same standard meal within either 5 or 30 minutes under observation in a random order on 2 consecutive days. A total of 28 hours of recording were obtained by intraoesophageal impedance pH and number of liquid and mixed reflux episodes within 3 hours of the slow- and fast-eating postprandial periods were calculated.
RESULTS
While all patients defined GORD symptoms, 10 (21.7%) had pathological 24-h intraoesophageal impedance measurement, 15 (32.6%) had pathological DeMeester and 21.7% had erosive oesophagitis. No difference has been shown according to the eating speed when all reflux episodes were taken together (754 vs. 733). Speed of food intake also did not have an impact on patients with normal vs. pathological 24-h intraoesophageal impedance or erosive vs. non-erosive. During the first postprandial hour, approximately half of the reflux events were non-acid, compared to 34.2% during the second hour and 26.8% during the third hour (p < 0.001). The number of acid reflux episodes was significantly higher than non-acid reflux especially during the second and third hours and in total for 3 hours.
CONCLUSIONS
This first study addressing the effect of eating speed on reflux episodes in GORD patients did not support the general belief that reflux increases following fast eating. Acid and non-acid reflux were similar at the first postprandial hour, then acid reflux episodes were predominantly higher, which implicate the importance of acid pockets.
PubMed: 24917982
DOI: 10.1177/2050640613500266 -
Medicine Aug 2015Vascular cutdown and echo guide puncture methods have its own limitations under certain conditions. There was no available algorithm for choosing entry vessel. A... (Observational Study)
Observational Study
Vascular cutdown and echo guide puncture methods have its own limitations under certain conditions. There was no available algorithm for choosing entry vessel. A standard algorithm was introduced to help choose the entry vessel location according to our clinical experience and review of the literature. The goal of this study is to analyze the treatment results of the standard algorithm used to choose the entry vessel for intravenous port implantation.During the period between March 2012 and March 2013, 507 patients who received intravenous port implantation due to advanced chemotherapy were included into this study. Choice of entry vessel was according to standard algorithm. All clinical characteristic factors were collected and complication rate and incidence were further analyzed.Compared with our clinical experience in 2006, procedure-related complication rate declined from 1.09% to 0.4%, whereas the late complication rate decreased from 19.97% to 3.55%. No more pneumothorax, hematoma, catheter kinking, fractures, and pocket erosion were identified after using the standard algorithm. In alive oncology patients, 98% implanted port could serve a functional vascular access to fit therapeutic needs.This standard algorithm for choosing the best entry vessel is a simple guideline that is easy to follow. The algorithm has excellent efficiency and can minimize complication rates and incidence.
Topics: Algorithms; Brachiocephalic Veins; Catheterization, Central Venous; Catheters, Indwelling; Drug Therapy; Equipment Failure; Equipment Failure Analysis; Female; Hematoma; Humans; Male; Middle Aged; Neoplasms; Pneumothorax; Reproducibility of Results; Retrospective Studies; Taiwan; Treatment Outcome; Venous Cutdown
PubMed: 26287429
DOI: 10.1097/MD.0000000000001381 -
Indian Journal of Otolaryngology and... Dec 2007To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the...
AIMS
To present a case report of a child presenting with lateral sinus thrombosis with bilateral multiple lung abscesses as a rare consequence of CSOM with an emphasis on the radiological findings.
MATERIAL AND METHODS
An 11-year-old male child with a history of pyrexia of unknown origin, right-sided torticollis, cough with expectoration and right ear discharge was referred to us from department of paediatric medicine. Chest examination revealed dull areas on percussion and areas with bronchial breath sounds on auscultation bilaterally. Otological examination revealed right attic retraction pocket filled with cholesteatoma, post-auricular tenderness and Greisinger's sign along with foul smelling muco-purulent discharge.
RESULTS
Routine blood investigations revealed normocytic normochromic anaemia, polymorpho-nuclear leucocytosis and raised ESR. Audiological investigations showed a right-sided mixed hearing loss. Digital radiography of chest showed multiple thin walled cavities involving all of the lung zones bilaterally. USG (Ultrasonography) of neck showed thrombosis of right internal jugular vein. CT scanning of head, neck and thorax showed soft tissue collection within the right mastoid with erosion of posterior wall & presence of gas bubble in the right sigmoid sinus and thrombosis of right internal jugular vein and multiple abscess cavities occupying both lung parenchyma. The patient was initially managed with conservative antibiotic therapy for lung abscess followed by radical mastoidectomy and thromboembolectomy from the lateral sinus.
CONCLUSION
Otogenic lung abscess though rare in this present postantibiotic era, it can occur in underprivileged and poor population like our country.
PubMed: 23120471
DOI: 10.1007/s12070-007-0099-x -
Acta Cardiologica Sinica Jul 2017Cardiac device-related infective endocarditis is an uncommon but potentially fatal complication. Therefore, cardiac devices should be removed as soon as a device-related...
BACKGROUND
Cardiac device-related infective endocarditis is an uncommon but potentially fatal complication. Therefore, cardiac devices should be removed as soon as a device-related infection is suspected.
CASE REPORT
A 56-year-old male with a history of arrhythmogenic right ventricular dysplasia with implantable cardioverter-defibrillators (ICDs) 7 years earlier and re-implantation of ICDs due to dysfunction 18 months ago presented with erosion of the ICD pocket with Pseudomonas bacteremia. For the past year, only multiple wound debridements were performed. Accordingly, we performed debridement and removal of the generator during this admission; however, bacteremia still persisted. Using transesophageal echocardiography, we detected vegetation on the pacing leads and tricuspid valve in the right atrium. We performed thoracotomy with tricuspid valve repair and pacing wire removal. However, anterior chest pain and refractory bacteremia occurred 3 months later after discharge, and an infectious foreign body in the wall of the innominate vein was detected using chest computer tomography. Thoracotomy was again performed for resection of the innominate vein with the infection source. Postoperative recovery was good, with no systemic infection or bacteremia.
CONCLUSIONS
Pacing lead extraction is a common procedure following cardiac rhythm management device-related infection. However, residual foreign body-related bacteremia should be suspected in cases with fever of unknown origin after primary surgery. Preserving the innominate vein with patch repair is a feasible option. However, a postoperative 4-week course of antibiotics is recommended.
PubMed: 29033518
DOI: 10.6515/acs20160911a -
British Heart Journal Oct 1994Pacemaker pocket infection is a potentially serious problem after permanent pacemaker implantation. Antibiotic prophylaxis is commonly prescribed to reduce the incidence... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
BACKGROUND
Pacemaker pocket infection is a potentially serious problem after permanent pacemaker implantation. Antibiotic prophylaxis is commonly prescribed to reduce the incidence of this complication, but current trial evidence of its efficacy is conflicting. A large prospective randomised trial was therefore performed of antibiotic prophylaxis in permanent pacemaker implantation. The intention was firstly to determine whether antibiotic prophylaxis is efficacious in these patients and secondly to identify which patients are at the highest risk of infection.
METHODS
A prospective randomised open trial of flucloxacillin (clindamycin if the patient was allergic to penicillin) v no antibiotic was performed in a cohort of patients undergoing first implantation of a permanent pacing system over a 17 month period. Intravenous antibiotics were started at the time of implantation and continued for 48 hours. The trial endpoint was a repeat operation for an infective complication.
RESULTS
473 patients were entered into a randomised trial. 224 received antibiotic prophylaxis and 249 received no antibiotics. A further 183 patients were not randomised but were treated according to the operator's preference (64 antibiotics, 119 no antibiotics); these patients are included only in the analysis of predictors of infection. Patients were followed up for a mean (SD) of 19(5) months. Among the patients in the randomised group there were nine infections requiring a repeat operation, all in the group not receiving antibiotic (P = 0.003). In the total patient cohort there were 13 infections, all but one in the non-antibiotic group (P = 0.006). Nine of the infections presented as erosion of the pulse generator or electrode, three as septicaemia secondary to Staphylococcus aureus, and one as a pocket abscess secondary to Staphylococcus epidermidis. Infections were significantly more common when the operator was inexperienced (< or = 100 previous patients), the operation was prolonged, or after a repeat operation for non-infective complications (principally lead displacement). Infection was not significantly more common in patients identified preoperatively as being at high risk (for example patients with diabetes mellitus, patients receiving long term steroid treatment), although there was a trend in this direction.
CONCLUSIONS
Antibiotic prophylaxis significantly reduced the incidence of infective complications requiring a repeat operation after permanent pacemaker implantation. It is suggested that antibiotics should be used routinely.
Topics: Aged; Aged, 80 and over; Cardiac Pacing, Artificial; Clindamycin; Cohort Studies; Female; Floxacillin; Humans; Male; Middle Aged; Premedication; Prospective Studies; Reoperation; Risk Factors; Surgical Wound Infection
PubMed: 7833191
DOI: 10.1136/hrt.72.4.339 -
Indian Pacing and Electrophysiology... Sep 2011There is a general consensus that once a part of an implanted cardiac device becomes infected, it is usually impossible to cure the infection without completely removing...
There is a general consensus that once a part of an implanted cardiac device becomes infected, it is usually impossible to cure the infection without completely removing all prosthetic material from the body. Consequently the Heart Rhythm Society (HRS) included the pocket infection or erosion as a class I indication for pacemaker lead exctraction. However, the procedure still carries a high risk of life-threatening complications due to fibrotic attachments between leads, veins, valves or other endocardial structures, notwithstanding specific tools and techniques that have been developed to assist the lead removal, preventing tissue laceration.
PubMed: 21994472
DOI: No ID Found -
Journal of the American Dental... Jul 2009Exposure to acidic foods and beverages is thought to increase the risk of developing dental erosion. The authors hypothesized that the erosion potential of sour candies... (Comparative Study)
Comparative Study
BACKGROUND
Exposure to acidic foods and beverages is thought to increase the risk of developing dental erosion. The authors hypothesized that the erosion potential of sour candies was greater than the erosion potential of original-flavor versions of the candies.
METHODS
The authors measured the pH and titratable acidity of candies dissolved in artificial saliva or water. They then measured the lesion depths of enamel surfaces exposed to candy slurries for 25 hours. Statistical analyses included two-sample t tests and Wilcoxon rank-sum tests to identify differences between original-flavor and sour candies, as well as correlations to identify relationships between lesion depths, pH and titratable acidity.
RESULTS
The study results show that lesion depths generally were greater after exposure of enamel to sour candies than they were after exposure of enamel to original-flavor candies, as well as for candies dissolved in water compared with those dissolved in artificial saliva. Lesion depths were negatively associated with the initial slurry pH and positively associated with titratable acidity.
CONCLUSIONS
Both original-flavor and sour versions of candies are potentially erosive, with sour candies being of greater concern. Although saliva might protect against the erosive effects of original-flavor candies, it is much less likely to protect against the erosive effects of sour candies.
CLINICAL IMPLICATIONS
People at risk of developing candy-associated erosion, particularly those with a high intake of candy, pocketing behaviors or decreased salivary flow, should receive preventive guidance regarding candy-consuming habits.
Topics: Acids; Candy; Dental Enamel Solubility; Humans; Hydrogen-Ion Concentration; Saliva, Artificial; Statistics, Nonparametric; Tooth Erosion
PubMed: 19571054
DOI: 10.14219/jada.archive.2009.0284 -
Journal of the American College of... Nov 1996The aim of this study was to compare complications in a large cohort of patients undergoing pectoral cardioverter-defibrillator implantation with a subcutaneous or... (Comparative Study)
Comparative Study
OBJECTIVES
The aim of this study was to compare complications in a large cohort of patients undergoing pectoral cardioverter-defibrillator implantation with a subcutaneous or submuscular approach.
BACKGROUND
Pectoral placement of implantable cardioverter-defibrillator (ICD) pulse generators is now routine because of downsizing of these devices. subcutaneous implantation has been advocated by some because it is a simple surgical procedure comparable to pacemaker insertion. Others have favored submuscular insertion to avoid wound complications. These surgical approaches have not been compared previously.
METHODS
The subjects for this study were 1,000 consecutive patients receiving a Medtronic Jewel ICD at 93 centers worldwide. Cumulative follow-up for all patients was 633.7 patient-years, with 64.9% of patients followed up for > or = 6 months. The complications evaluated were erosion, pocket hematoma, seroma, wound infection, dehiscence, device migration, lead fracture and dislodgment.
RESULTS
Subcutaneous implantation was performed in 604 patients and submuscular implantation in the remaining 396. The median procedural times were shorter for subcutaneous implantation (p = 0.014). In addition, the cumulative percentage of patients free from erosion was greater for subcutaneous implantations (p = 0.03, 100% vs. 99.1% at 6 months). However, lead dislodgment was more common with subcutaneous implantations (p = 0.019, 2.3% vs. 0.5% at 6 months) and occurred primarily during the first month postoperatively. Overall, there were no significant differences in cumulative freedom from complications between groups (4.1% vs. 2.5%, p = 0.1836).
CONCLUSIONS
Subcutaneous pectoral implantation of this ICD can be performed safely and has a low complication rate. This approach requires a simple surgical procedure and, compared with the submuscular approach, is associated with shorter procedure times and comparable overall complication rates. However, early follow-up is important in view of the increased lead dislodgment rate.
Topics: Aged; Cohort Studies; Defibrillators, Implantable; Dermatologic Surgical Procedures; Female; Foreign-Body Migration; Humans; Male; Methods; Middle Aged; Pectoralis Muscles; Postoperative Complications; Time Factors
PubMed: 8890827
DOI: 10.1016/s0735-1097(96)00314-2 -
Health Services Research Oct 2012Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to...
BACKGROUND
Given the rapid growth of health care costs, some experts were concerned with erosion of employment-based private insurance (EBPI). This empirical analysis aims to quantify the concern.
METHODS
Using the National Health Account, we generated a cost index to represent state-level annual cost growth. We merged it with the 1996-2003 Medical Expenditure Panel Survey. The unit of analysis is the family. We conducted both bivariate and multivariate logistic analyses.
RESULTS
The bivariate analysis found a significant inverse association between the cost index and the proportion of families receiving an offer of EBPI. The multivariate analysis showed that the cost index was significantly negatively associated with the likelihood of receiving an EBPI offer for the entire sample and for families in the first, second, and third quartiles of income distribution. The cost index was also significantly negatively associated with the proportion of families with EBPI for the entire year for each family member (EBPI-EYEM). The multivariate analysis confirmed significance of the relationship for the entire sample, and for families in the second and third quartiles of income distribution. Among the families with EBPI-EYEM, there was a positive relationship between the cost index and this group's likelihood of having out-of-pocket expenditures exceeding 10 percent of family income. The multivariate analysis confirmed significance of the relationship for the entire group and for families in the second and third quartiles of income distribution.
CONCLUSIONS
Rising health costs reduce EBPI availability and enrollment, and the financial protection provided by it, especially for middle-class families.
Topics: Family; Financing, Personal; Health Benefit Plans, Employee; Health Care Costs; Humans; Income; Logistic Models; Multivariate Analysis; United States
PubMed: 22417314
DOI: 10.1111/j.1475-6773.2012.01397.x