Search

Background The inflammasome modulates the release of key proinflammatory cytokines associated with periodontal disease pathogenesis. The aim of this study was to evaluate the expression of proteins that regulate the inflammasome, namely pyrin domain-only proteins (POPs), caspase activation recruitment domain (CARD)-only proteins, and tripartite motif-containing (TRIM) proteins, in periodontal diseases. Methods A total of 68 participants (34 males and 34 females) were divided into four groups, including periodontal health (H), gingivitis (G), chronic periodontitis (CP), and aggressive periodontitis (AgP) based on clinical parameters. Gingival tissue samples were obtained from all participants for reverse transcription polymerase chain reaction (RT-PCR)-based gene expression analyses of molecules that regulate the inflammasome, including apoptosis-associated speck-like protein (ASC) containing CARD, caspase-1, interleukin-1 beta (IL-1 beta), interleukin-18 (IL-18), nucleotide-binding domain, leucine rich family (NLR) pyrin domain containing 3 (NLRP3), NLR family pyrin domain containing 2 (NLRP2), AIM2 (absent in melanoma 2), POP1, POP2, CARD16, CARD18, TRIM16, and TRIM20 by RT-PCR. Results NLRP3 and IL-1 beta were upregulated in the G, CP, and AgP groups compared with group H (P < 0.05). AIM2 was downregulated in the CP group compared with the H, G, and AgP groups (P < 0.05). TRIM20, TRIM16, and CARD18 were downregulated in the G, CP, and AgP groups compared with the H group (P < 0.05). POP1 and POP2 were downregulated in the CP and AgP, and AgP and G groups, respectively (P < 0.05). Conclusion Active periodontal disease may result in downregulation of inflammasome regulators that may increase the activity of NLRP3 and IL-1 beta in periodontal disease.

IntroductionPressure continues to grow on emergency departments in the UK and throughout the world, with declining performance and adverse effects on patient outcome, safety and experience. One proposed solution is to locate general practitioners to work in or alongside the emergency department (GPED). Several GPED models have been introduced, however, evidence of effectiveness is weak. This study aims to evaluate the impact of GPED on patient care, the primary care and acute hospital team and the wider urgent care system.Methods and analysisThe study will be divided into three work packages (WPs). WP-A; Mapping and Taxonomy: mapping, description and classification of current models of GPED in all emergency departments in England and interviews with key informants to examine the hypotheses that underpin GPED. WP-B; Quantitative Analysis of National Data: measurement of the effectiveness, costs and consequences of the GPED models identified in WP-A, compared with a no-GPED model, using retrospective analysis of Hospital Episode Statistics Data. WP-C; Case Studies: detailed case studies of different GPED models using a mixture of qualitative and quantitative methods including: non-participant observation of clinical care, semistructured interviews with staff, patients and carers; workforce surveys with emergency department staff and analysis of available local routinely collected hospital data. Prospective case study sites will be identified by completing telephone interviews with sites awarded capital funding by the UK government to implement GPED initiatives. The study has a strong patient and public involvement group that has contributed to study design and materials, and which will be closely involved in data interpretation and dissemination.Ethics and disseminationThe study has been approved by the National Health Service East Midlands—Leicester South Research Ethics Committee: 17/EM/0312. The results of the study will be disseminated through peer-reviewed journals, conferences and a planned programme of knowledge mobilisation.Trial registration numberISRCTN51780222.

La investigación titulada "Gestión administrativa del órgano de Control Institucional y su relación con la productividad laboral de los colaboradores en la municipalidad provincial de Moyobamba. 2017", tuvo como objetivo general determinar la relación entre la gestión administrativa del órgano de control institucional y la productividad laboral de los colaboradores en la Municipalidad Provincial de Moyobamba, en el año 2017. El tipo de estudio fue no experimental; el diseño de la investigación fue descriptivo correlacional, asimismo la investigación contó con una muestra de estudio de 30 colaboradores administrativos, las cuales fueron seleccionadas a través de un muestreo no probabilístico, quienes además fueron evaluados mediante la aplicación de cuestionarios con el fin de recolectar información, pudiendo llegar así los siguientes resultados: Mediante la aplicación de los estadísticos se evidencio que la gestión administrativa del órgano de control institucional aplicada en la municipalidad provincial de Moyobamba fue de nivel “Regular” con un 50%, mientras que el 43% de colaboradores administrativos tuvieron una productividad laboral “Aceptable”. Con la aplicación de la prueba estadística de independencia Chi Cuadrado se concluyó, que existe relación significativa entre la gestión administrativa del órgano de control institucional y la productividad laboral de los colaboradores en la municipalidad provincial de Moyobamba, en el año 2017; dado que el Chí Cuadrado de Pearson (22,674) fue notablemente mayor al Chí tabular con 8 grados de libertad (15,507) a un 95 % de confianza, por lo tanto, las variables son dependientes. Tarapoto Escuela de Posgrado Dirección

This paper aims to provide a complete security mechanism for DOS attacks in wireless networks. Various techniques and methodologies were proposed in the earlier studies against DOS attack and their solution in terms of detection and prevention rate is very less. In this paper DAD-(defending against DOS) approach is proposed to provide maximum level of security and DAD shows the efficiency in terms of detection and prevention. DAD has two main phases, such as authentication and monitoring. In authentication phase entire node verification and certification is provided by DAD approach. In monitoring phase the entire traffic flow is monitored with a help of USIP-recording and USIP-marking methods. The simulation result shows that the efficacy of DAD is better than the existing approaches in terms of detection and prevention.

This study provides new insight into guanxi practice and quality differences between business-to-business (B2B) and business-to-government (B2G) ties in China. The results, based on data obtained through structured interviews with 108 Chinese managers across eight cities in China, reveal stark differences between the practices used in developing B2B ties and those used in developing B2G ties. More specifically, these two tie types differ in a variety of guanxi initiation, building, and utilization practices. This study also builds upon the process model of guanxi development by highlighting the dissimilar role of gift giving practices in B2B and B2G ties. Furthermore, this study measures guanxi quality as a separate concept from guanxi process and demonstrates that guanxi quality is a multidimensional concept that is composed of affective attachment and felt obligation, both of which vary across B2B and B2G ties. Implications of these results for theory development and managerial practice in China are also discussed.

Cognitive training or remediation now has multiple studies and meta-analyses supporting its efficacy in improving cognition and functioning in people with schizophrenia. However, relatively little is known about cognitive training outcomes in early psychosis. We conducted a pilot randomized controlled trial of Compensatory Cognitive Training (CCT) compared to Treatment as Usual (TAU) in 27 participants with first-episode psychosis who had received treatment for psychosis for less than six months. Assessments of cognition (MATRICS Consensus Cognitive Battery; MCCB) and functional capacity (UCSD Performance-Based Skills Assessment-Brief; UPSA-B) were administered at baseline and following the 12-week treatment. The CCT condition, compared to TAU, was associated with significant improvements on the MCCB composite score, as well as MCCB subtests measuring processing speed (Trail Making) and social cognition (Mayer-Salovey-Caruso Emotional Intelligence Test), with large effects on these three outcome measures. There were no significant CCT-associated effects on the UPSA-B or on positive, negative, or depressive symptoms. CCT treatment of cognitive impairments in first-episode schizophrenia is feasible and can result in large effect size improvements in global cognition, processing speed, and social cognition.

Knowledge of the product distribution and kinetics of the secondary vapor-phase cracking of biomass tar is crucial for the design and optimization of biomass thermochemical conversion processes, such as fast pyrolysis, gasification, and combustion. In this study, we have examined the distribution of condensable tar products from the vapor-phase cracking of eugenol, a model-fuel compound representative of the lignin structural entities found in biomass. Pyrolysis experiments were investigated at different temperatures (300–900 °C) and residence times (τ = 1 and 3 s) in a non-isothermal laminar-flow reactor operated at atmospheric pressure. Tar products were analyzed using gas chromatography with mass spectrometric detection. Eugenol conversion commenced rapidly above 350 °C at τ = 3 s and above 400 °C at τ = 1 s. Complete conversion was attained at 550 and 600 °C at τ = 3 and 1 s, respectively. A numerical model incorporating laminar-flow, non-isothermal temperature profile and pseudo-unimolecular kinetics...

This study provides new insight into the interplay between partner- and institution-level bases of trustworthy behaviour in international joint ventures (IJVs). The results of the study, based on survey and archival data collected on 144 IJVs across six Asian countries, revealed that host country governance quality directly and positively influences IJV partner trustworthy behaviour. It was also found that weak host country governance undermined the effectiveness of certain partner selection criteria in serving as a tool for establishing an IJV with a trustworthy partner. Furthermore, through distinguishing between two dimensions of trustworthiness (benevolence and competence), it was demonstrated that partner benevolence is facilitated by relationship-oriented criteria, whereas partner competence is facilitated by task-oriented criteria. The implications of these results for the establishment and management of IJVs are discussed.

Objective: To examine factors contributing to variance in functional outcome in first-episode psychosis (FEP) following 1 year of treatment. Method: Naturalistic 1-year follow-up of a FEP cohort (n = 200), from programs in four university centers in Ontario, Canada. Functional recovery was defined by ‘Social and Occupational Functioning Assessment Scale’ (SOFAS) score>60. Regression analysis examined the contribution of independent variables to variance in functional outcome. Results: Twelve-month outcome measures were available for 76.5% of the original cohort. Of these, 70% reported being in school/work and in satisfactory relationships. The functional recovery rate was 51%, compared to 74% attaining symptomatic remission. The greatest contributors to variance in outcome were ongoing symptoms at 6 months and substance abuse comorbidity. Conclusion: After 1 year of treatment, FEP patients show high rates of symptomatic remission and relatively lower rates of functional recovery. Symptoms and substance abuse contribute to variance in outcome.

Albuminuria predicts cardiovascular and end-stage kidney disease in indigenous populations. Early detection in indigenous children may identify those who could benefit from early treatment. Community-based detection of albuminuria needs to be performed using a reliable, inexpensive, and widely available test, such as a proteinuria dipstick. Dipstick accuracy for detecting albuminuria in a community setting has not been evaluated. We assessed the accuracy of Multistix 10 SG dipsticks to detect baseline albuminuria and predict for persistent albuminuria at a 2-year follow-up in a population-based cohort of Australian Aboriginal and non-Aboriginal elementary-school-aged children. Variability in the accuracy of dipsticks in subgroups of higher risk children was analyzed using the relative diagnostic odds ratio (RDOR). Using Multistix 10 SG dipsticks, index-test-positive cases were defined as ≥0.30 g/L (1+) proteinuria and index-test-negative cases as

Background Aboriginal Australians have a 9-fold increased risk of end-stage renal disease. There is no information about the natural history and risk of chronic kidney disease (CKD) in Aboriginal and non-Aboriginal children. Study Design Using a prospective study design, we aimed to determine the prevalence of persistent markers and risk factors for CKD in Australian Aboriginal and non-Aboriginal children and whether Aboriginal children are at increased risk of persistent markers of CKD after accounting for sociodemographic differences. Setting & Participants Children were enrolled from elementary schools throughout New South Wales. Predictor Aboriginal (Aboriginal and Torres Strait Islander Australians) versus non-Aboriginal ethnicity. Outcomes & Measurements Urine analysis, height, weight, blood pressure, birth weight, and sociodemographic status were measured at baseline and 2-year follow-up. Albuminuria was defined as albumin-creatinine ratio of 3.4 mg/mmol or greater, hematuria as 25 or greater red blood cells/μL (≥1+), obesity as body mass index of 2 SDs or greater, and systolic and diastolic hypertension as blood pressure greater than the 90th percentile. Results 2,266 children (55.1% Aboriginal; 51.0% boys; mean age, 8.9 ± 2.0 years [SD] years) were enrolled at baseline. Early markers and predictors of CKD at baseline were frequent: hematuria (5.5%), albuminuria (7.3%), obesity (7.1%), systolic hypertension (7.2%), and diastolic hypertension (5.8%). 1,432 children (63%) were available for retesting at 2-year follow-up (54.0% Aboriginal; 50.5% boys; mean age, 10.5 ± 2.0 years). Persistent obesity (5.3%) was frequent, but persistent markers of CKD were infrequent (systolic hypertension, 1.1%; diastolic hypertension, 0.2%; hematuria, 1.1%; and albuminuria, 1.5%). Although there were more Aboriginal than non-Aboriginal children with baseline hematuria (7.1% versus 3.6%; P = 0.001), after adjustment for age, sex, birth weight, and sociodemographic status, there was no increased risk of persistent hematuria, albuminuria, obesity, or hypertension in Aboriginal children. Limitations Persistent markers of CKD were much less frequent than anticipated, which may have affected study power. The group lost at follow-up was older children, which may have biased results. Conclusions Overall, only 20% of children found to have markers of early CKD had persistent abnormalities (diastolic and systolic hypertension, albuminuria, and hematuria) 2 years later, equivalent to a population point prevalence of 1% to 2% in children with a mean age of 10 years. Aboriginal children had greater rates of baseline and transient hematuria, but no increased risk of persistent markers of CKD, suggesting that adolescence and young adulthood is a critical time for preventative strategies.

Aim: Indigenous people have a two- to tenfold increased risk of premature death from cardiovascular disease. We aimed to determine whether some key risk factors for cardiovascular disease occur more commonly in Aboriginal than non-Aboriginal Australian children. Methods: Children were enrolled from primary schools throughout New South Wales, the state with the highest number of Aboriginal people. Associations between ethnicity, gender, birthweight, socio-demographic status and hypertension, obesity, baseline and persistent albuminuria were determined. Results: A total of 2266 children (55% Aboriginal) were enrolled. Mean age was 8.9 years (±3.8 years). Obesity (body mass index ≥2 standard deviations) was detected in 7.1%, systolic hypertension (blood pressure >90th percentile) in 7.2%, diastolic hypertension in 5.9%, baseline albuminuria (albumin : creatinine ≥3.4 mg/mmol) in 7.3% and persistent albuminuria in 1.5% with no differences between Aboriginal and non-Aboriginal children. Hypertension was less common with increasing social disadvantage (trend P

This study attempts to enhance our understanding of how a host country's legal environment influences international joint venture (IJV) partner selection criteria. Empirical results based on survey data collected on 169 IJVs revealed that host-country rule of law perceptions negatively influence appropriation and coordination cost concerns, which positively influence partner-related criteria. Furthermore, these concerns mediate the relationship between perceptions of host-country rule of law and partner-related criteria. Journal of International Business Studies (2009) 40, 779–801. doi:10.1057/jibs.2008.110

Objective To examine ethnic variations in the pathways to care for persons accessing early intervention (EI) services in Ontario. Method The pathways to care and the duration of untreated psychosis were assessed for first-episode psychosis patients who entered specialized EI services in Ontario. The sample was assigned to the following ethnic classifications: the White (Caucasian), Black (African descent), and Asian (ancestry from the continent) groups, plus all the "other ethnicities" group. Results There were 200 participants: 78% were male; 61% from the White, 15% Black, 13% Asian, and 11% were from the other ethnicities group. At the first point of contact, more participants used nonmedical contacts (12%), such as clergy and naturopathic healers, than psychologists (8%) or psychiatrists (7%). There were no ethnic differences for duration of untreated psychosis (median 22 weeks) or for initiation of help seeking by family/friends (53%), police (15%), or self (33%). After adjusting for relevant clinical and demographic factors, the Asian and other ethnicities groups were 4 and 3 times (respectively) more likely than the White or Black groups (P = .017) to use emergency room services as the first point of contact in the pathways to care. Participants from the Asian group experienced less involuntary hospitalizations (P = .023) than all the other groups. Yet overall, there were many more similarities than significant differences in the pathways to care. Conclusion EI services should monitor the pathways to care for young people of diverse ethnic backgrounds to address any disparities in accessing care.

Structured personal interviews were conducted with 105 senior and mid-level Chinese male and female managers, in which each respondent provided information about their career success network (CSN) ties. Using this data, we tested hypotheses on: (1) the age composition of Chinese managers' CSNs; (2) the face-to-face interaction practices within Chinese managers' CSNs; and (3) the roles of tie sex composition and tie content (position-centred versus person-centred ties) in influencing the age composition of and interaction practices within Chinese managers' CSNs. The results demonstrated that both Chinese male and female managers, while generally preferring to form CSN ties with individuals who are older than themselves, are relatively more reluctant to include middle-aged or elder women in their CSN. The age of those included in the respondents' CSN was also influenced by tie content and whether the tie spans the organizational boundary. With respect to interaction practices within the CSN, tie content mod...

Randomised trials in a highly selected patient population have demonstrated a dramatic reduction in the incidence of in-stent restenosis (ISR) following implantation of sirolimus-eluting (S-E) Cypher™ coronary stents compared with bare metal stents (BMS). The clinical outcome following implantation of S-E stents for treatment of complex, unselected BMS ISR is less well defined. The aim of this study was to assess the safety and efficacy of S-E coronary stents in the treatment of an unselected population of BMS ISR. All patients who received S-E stents for treatment of BMS ISR from May 1 2002–November 30 2003 at a single institution were entered into a prospectively collected database. In-hospital and long-term outcomes were collected. Sixty patients were identified who received S-E stents for the treatment of ISR. Four patients (6%) had undergone previous brachytherapy and 22% were diabetic. The most common target vessel was the left anterior descending coronary artery (40%), and 6% of lesions were in saphenous vein grafts (SVGs). The mean reference diameter was 2.67 ± 0.52 (range 1.75–4.0) mm and the mean lesion length was 16.22 ± 11.46 (range 3–68) mm. There were no procedural or in-hospital major adverse cardiac events (MACE). Long-term follow-up was available in 59 patients (98%). The 12-month MACE rate (cardiac death, myocardial infarction or target lesion revascularisation) was 12% with a 7% percutaneous coronary intervention rate and a 7% coronary artery bypass graft rate. There were no cardiac deaths and two non-cardiac deaths. Of the seven patients who had clinical restenosis at 12 months, four had previously failed brachytherapy and three involved SVGs. In conclusion, the use of S-E stents appears safe and efficacious in the treatment of an unselected population of BMS ISR with results comparing favourably with historical controls. Further randomised studies are needed to delineate the optimal management of this high risk group of patients.

Background:Randomized trials in selected patient populations have demonstrated dramatic reductions in the incidence of in-stent restenosis (ISR) following implantation of paclitaxel-eluting (PE) coronary stents compared with bare metal stents in native coronary disease. The clinical outcome following implantation of PE stents for saphenous vein graft (SVG) stenosis is largely unknown. Aim:To assess the safety and efficacy of PE coronary stents for the treatment of SVG stenosis in an unselected population. Methods:All patients who received PE stents for the treatment of SVG disease from May 1, 2003, to May 1, 2005, were entered into a prospectively collected database. Fifty-five patients were identified with 69 lesions. In-hospital and late major adverse cardiac events (MACE) including death, myocardial infarction (MI), and target lesion revascularization (TLR) were recorded as well as the rate of target vessel revascularization (TVR). Results:Mean follow-up was 13 months with 54 of the 55 patients contacted. The number of stents implanted was 1.12 ± 0.37 per lesion and 1.38 ± 0.59 per patient. Clinically significant procedural MACE was 0%. The late MACE rate was 9% with a 2% clinically driven TLR, a 4% coronary artery bypass graft (CABG), and a 4% TVR rate. There were four deaths, two cardiac and two noncardiac. Conclusion:PE stents appear safe and effective in the treatment of SVG disease at a mean follow-up time of 13 months. Randomized studies are needed to further delineate the optimal management of this high-risk group.

Renal artery stenosis comprises both atherosclerotic renovascular disease and fibromuscular dysplasia, and may be associated with refractory hypertension, acute 'flash' pulmonary oedema and renal failure. The long-term clinical effects of renal artery stenting remain unclear.To assess the procedural and long-term safety and efficacy of renal artery stenting and its effect on blood pressure, antihypertensive medication usage and serum creatinine.All patients referred for renal artery stenting at our institution between September 1997 and December 2003 were entered into a prospectively collected database. Systolic and diastolic blood pressure, number of antihypertensive medications, serum creatinine and estimated glomerular filtration rate (eGFR) were recorded. Patients were followed-up at least six months post-procedure.Eighty-nine patients underwent renal arteriography, with 110 stents deployed in 102 lesions. The procedural success rate was 99% with no procedural mortality. There were two cases of peri-procedural haemorrhage and one of sepsis. One patient developed renal and peripheral atheroemboli.Mean follow-up was 28 months (range 6 months-7 years). Eight patients were lost to follow-up. There were nine deaths with a mean time to death of 20.7 months (range 12 months-3 years). There was a highly statistically significant fall in systolic blood pressure (BP) from 161.7+/-29.5 mmHg pre-procedure to 138.7+/-17.9 mmHg at long-term follow-up post-procedure (p0.0001). The clinical restenosis rate was 6.2%. Renal function and eGFR remained stable and there was a borderline significant decrease in the number of antihypertensive medications used (p=0.05).Renal artery stenting is safe and appears effective for the treatment of clinically significant renal artery stenosis.

This study examined the relationships between culture, individual attributes, and self-rating behavior among 1,786 university students in Canada, Hong Kong, Taiwan, mainland China, and Japan, and in doing so extended and refined the cultural relativity hypothesis. It explored the difference between vertical and horizontal individualists in self-rating behavior, and examined the mediating effects of two individual attributes, self-enhancement propensity and general self-efficacy in the relationship between individualism and self-rating behavior. The results confirmed that individualism is the cultural driver for self-rating leniency, and that the individual-level assessment of individualism is a stronger predictor of self-rating leniency than are culture-level differences. Vertical individualism was found to be positively related to self-enhancement propensity, which in turn was positively related to self-rating. Whereas, horizontal individualism was positively related to general self-efficacy, which in turn had a positive relationship with self-rating. We discuss the implications of the results for academic research and practical management. Copyright © 2006 John Wiley & Sons, Ltd.

Drawing on an institutional perspective, this paper suggests that strategic alliances serve an important legitimating function for firms and that this role, mediated by alliance governance structure and partner selection preferences, has a significant influence on firm and alliance performance. A theoretical framework is proposed that identifies five types of legitimacy associated with strategic alliances and the specific conditions under which legitimation may be an important outcome of strategic alliances. Propositions are developed to explain when firms are most likely to enter into alliances for legitimacy purposes and how the legitimating role of strategic alliances contributes to firm and alliance performance. The paper concludes with a summary and implications of a legitimacy-based view of alliances. Copyright © 2007 John Wiley & Sons, Ltd.

Through structured interviews with 108 senior and middle managers in China, we compared the composition and social exchange practices of Chinese male and female managers' career success networks (CSNs). The results indicated that most of the CSN ties formed by both male and female managers are with men, especially power ties. Male and female managers differed in the extent to which they engaged in instrumental and expressive transactions with same- and opposite-sex CSN alters, reciprocated the help provided by CSN alters, and socialized outside of the workplace with opposite-sex alters. The implications of these results for career success in China are discussed.

Objective: Response to typical antipsychotic medication has been associated with achieving a level of striatal dopamine D2 receptor occupancy in the range of 65% to 70%. We undertook this study to determine whether response to the atypical antipsychotic olanzapine occurs at lower levels of D2 receptor occupancy. Method: Eighteen patients who presented with a first episode of psychosis were randomized to receive olanzapine 5 mg daily or haloperidol 2 mg daily in a double-blind design. We acquired positron emission tomography (PET) scans using the D2 ligand [11C]raclopride within the first 15 days of treatment to determine the percentage of D2 receptors occupied by the medication. According to response, dosage was then adjusted to a maximum dosage of 20 mg daily of either drug. PET scans were repeated after 10 to 12 weeks of treatment. Results: At the first PET scan, the 8 olanzapine-treated patients had significantly lower D2 receptor occupancies (mean 63.4%, SD 7.3) than those observed in the 10 patients treated with haloperidol (mean 73.0%, SD 6.1). When patients were rescanned following dosage adjustment, mean D2 receptor occupancies were greater than 70% in both groups. D2 receptor occupancies did not differ significantly between the olanzapine-treated group (mean 72.0%, SD 5.7) and the haloperidol-treated group (mean 78.7%, SD 7.6). Conclusions: These results suggest that, in patients being treated for a first episode of psychosis, olanzapine has its antipsychotic effect at approximately the same levels of D2 receptor occupancy as are achieved with low dosages of haloperidol.

Background: Carotid stenting was initially proposed as an alternative to surgical endarterectomy for selected high-risk patients. More recently, patients of standard surgical risk are being considered for percutaneous treatment of their carotid disease. Aims: To describe the clinical outcomes of an initial consecutive cohort of patients treated by carotid stenting at one institution. Methods: Between December 1997 and July 2003, 111 patients underwent stenting of 118 carotid arteries. Peri-procedural and long-term outcome data were collected. Results: Most patients (>70%) were high-risk candidates for endarterectomy. Stents were successfully placed in 117/118 carotid arteries (99.2%). Distal protection devices were used in 43/118 (36.4%). The peri-procedural rate of death or disabling stroke was 3/118 (2.5%). Death or any stroke occurred in 11/118 (9.3%). However, only 7/118 (5.9%) procedures resulted in death or any persistent stroke (neurological deficit >1 week post-procedure). No myocardial infarction occurred. Median length of post-procedure hospitalization was 1 day. Long-term follow up was possible for 101 patients (91.0%) over a mean period of 27.1 months. The Kaplan–Meier estimate of survival free of ipsilateral stroke 36 and 66 months after carotid stenting was 77.0 ± 9.5% and 68.2 ± 15.1%, respectively. The estimated survival free of any stroke or stent failure was 70.9 ± 10.7% and 60.7 ± 17.4%, respectively. The majority of late deaths (7/11) were due to cardiac disease. Conclusion: We conclude that stenting of carotid stenoses is feasible, with a high procedural success rate and low complication rate. Carotid stenting should be considered the procedure of choice for high-risk patients. (Intern Med J 2005; 35: 143–150)

The objective of this study was to assess the clinical course of patients undergoing planned percutaneous carotid stenting followed by staged coronary artery bypass grafting (CABG). Coexisting carotid and coronary atherosclerotic disease is relatively common. A combined or staged surgical approach has a composite stroke, myocardial infarction, or death rate of > 10%. We performed a retrospective search of our single-institution database to identify all patients scheduled to undergo staged carotid stenting followed by CABG. Twenty-three such patients (17 males, 6 females) were identified, with 3/23 (13%) requiring bilateral carotid stenting. Most carotid lesions were asymptomatic (18/26; 69.2%) and severe (mean stenosis, 82.9% 6+/- 8.6%). Stents were successfully placed in 26/26 carotid arteries (100%). One stent procedure (1/26; 3.8%) resulted in a minor stroke, but full recovery occurred within 1 week. There were no other peri-stenting complications. Three patents (3/23; 13%), none of whom suffered an adverse event at carotid stenting, elected not to undergo CABG. The mean interval from last carotid stent to CABG was 69.6 6 +/- 39.6 days (range, 8-157 days). Antiplatelet therapy was ceased > 3 days prior to CABG in 10/20 patients (50%), but continued until surgery in the remainder. There were no peri-CABG bleeding or neurological complications, but one myocardial infarction occurred (1/20; 5%). Therefore, of the 20 patients who underwent planned carotid stenting followed by CABG, our overall rate of death, stroke, or myocardial infarction was 10%. However, our rate of death, persistent stroke or myocardial infarction was 5%. Planned carotid stenting followed by staged CABG is a viable method of treatment for patients with coexistent carotid and coronary atherosclerosis.

Objectives: To determine the prevalence and severity of, and risk factors for, daytime urinary incontinence in children starting primary school. Design and setting: Population-based cross-sectional survey of new entrant primary school children in Sydney, Australia. Methods: A random cluster sample of 2020 primary school children was surveyed by using a daytime incontinence questionnaire with known substantial repeatability (mean kappa=0.70). Results: The questionnaire was returned for 1419 (70%) children with a mean age of 5.9 years; 16.5% of children had experienced one or more episodes of wetting in the last 6 months (mild), 2.0% had wet twice or more per week (moderate), and 0.7% were wet every day (severe) (overall prevalence of 19.2%). On multivariate analysis, recent emotional stress (odds ratio 5.7), a history of daytime wetting along the paternal line (odds ratio 9.3), and a history of wetting among male siblings (odds ratio 5.3) were independent risk factors for moderate to severe daytime wetting. Expressed as population attributable risk, 59% and 28% of moderate-severe and mild daytime wetting, respectively, can be attributed to these 3 factors. Only 16% of families with affected children had sought medical help. Conclusions: Daytime urinary incontinence in the first year of primary school is more common than previously reported, and only a small proportion of affected children seek medical help. Emotional stress and family history are likely to be major causal factors. (J Pediatr 2000;137:814-8)

IntroductionUrinary tract infection (UTI) occurs in 2% of boys and 8% of girls by 10 years of age.1 It causes an...

A priming paradigm was used to explore the representation of attitudes about government policies in memory. Participants performed pairs of tasks in quick succession. The focal tasks involved evaluating a policy or thinking of one of its consequences. The results showed that thinking of a consequence of a policy speeded up its subsequent evaluation, regardless of whether the participant held a strong or weak attitude about the policy. Evaluating the policy speeded up thinking of one of its consequences for strong attitudes but not for weak ones. In general, it took participants longer to think of a consequence of a policy than to evaluate it. The implications of these results for existing views of the representation of attitudes in memory are discussed.

Background Thromboembolism after percutaneous balloon mitral valvotomy (PBMV) has been attributed to dislodement of preexisting thrombus during transseptal puncture and instrumentation of the left atrium. The occurrence of thromboembolic events after PBMV in the absence of demonstrable left atrial thrombus before PBMV suggests that thrombus might form during the procedure. Spontaneous echo contrast (SEC) is a swirling pattern of blood echogenicity that is a marker of blood stasis in the left atrium. Exacerbation of left atrial SEC during PBMV may be indicative of an increased thromboembolic risk. Methods Transesophageal echocardiography was performed during PBMV in 20 patients with mitral stenosis. Grades of severity of left atrial SEC [0 (nil) to 4+ (severe)] were allocated before and after each balloon inflation. Results Before PBMV, SEC was present in 17 patients. New SEC or increased severity of SEC was observed during 49 of 56 balloon inflations. SEC was unchanged after six deflations, decreased after 14 deflations, and disappeared after 36 deflations. The mean times to onset and dissipation of SEC after balloon inflation and deflation were 3.1 ± 1.5 and 3.9 ± 1.6 seconds, respectively. After successful PBMV, SEC was unchanged in three patients, decreased in one, and resolved in 13. Conclusions SEC is a dynamic and acutely reversible phenomenon that is highly sensitive to changes in left atrial hemodynamic conditions. Left atrial blood stasis induced by balloon inflation may promote thrombogenesis during PBMV. (Am Heart J 1998;135:609-13.)

In examining how the historical, fur-trading Hudson's Bay Company (HBC) controlled the agency problem, Carlos and Nicholas (1990) concluded that accounting in general was one of the many techniques used. This study expands on the work of Carlos and Nicholas. For the period from 1821 to 1860, it examines original documents in addition to published documents used by Carlos and Nicholas. It uses a specific agency theorytransaction cost economics (TCE). Because of the uncertainty that prevailed through communication lags caused by the great distances, TCE suggests that the HBC would develop extensive directing and monitoring mechanisms and use what is now known as management accounting. The data suggest that the HBC conformed well to the TCE predictions that directing and monitoring mechanisms would be highly developed. The internal accounting had many features comparable to contemporary management accounting.

Infiltration of the kidney by αβ and γδ T cells: Effect on progression in IgA nephropathy. We have studied renal biopsies from three groups of patients to determine if αβ T cells or γδ cells are present, and whether their presence is correlated with disease progression in IgA nephropathy (IgAN). Group one comprised thin basement membrane disease biopsies (non-immunological control, N = 7); group two were patients with IgAN and stable renal function one year following biopsy (stable, N = 7); and group three were IgAN patients with rapidly declining renal function after one year (progressive, N = 7). Immunohistochemical staining using monoclonal antibodies (CD3, TcRβ, TcRδ) and molecular studies utilizing polymerase chain reaction amplification of cDNA transcribed from biopsy RNA, with primers specific for either the αβ TcR or γδ TcR, were undertaken. On immunohistochemistry a significant increase in CD3+cells in progressive biopsies was seen (vs. control P = 0.002, vs. stable P = 0.002). The progressive biopsies infiltrate consisted of both αβ TcR (vs. control P = 0.001, vs. stable P = 0.003) and γδ TcR cells (vs. control P = 0.01). The RNA study demonstrated an increase in TcR Cα transcription in the progressive (vs. control P = 0.003) biopsies. Increased TcR Cδ transcription was seen in the progressive group (vs. control P = 0.01, vs. stable P = 0.02). We confirm that the presence of lymphocytes in IgAN biopsies predicts progressive disease. While αβ T cells are found in both stable and progressive disease, the presence of γδ T cells is only associated with progressive IgAN.