Traumatic and spontaneous carotid and vertebral artery dissection in a level 1 trauma center

This study aimed to compare traumatic and spontaneous carotid artery dissection (CAD) and vertebral artery dissection (VAD) with respect to age, pre-morbid risk factors, and site of dissection. Chart review was performed for 49 patients with CAD and VAD admitted to Westchester Medical Center, a level 1 trauma center, from 1999 to 2007. Presentation was categorized into traumatic (n=28, 57%) or spontaneous dissection (n=21, 43%). Pre-morbid risk factors were analyzed. Location of dissection was identified and categorized into four possible segments. Patients with spontaneous dissection were likely to be over the age of 50 years (p<0.05), and had significantly higher proportions of coronary artery disease (33% compared to 7%, p<0.05), hypertension (57% compared to 18%; p<0.01), and hypercholesterolemia (29% compared to 0%; p<0.01). Of the 49 patients, 42 had imaging studies available for segmental analysis. In both traumatic CAD and VAD, dissection at Segment III (corresponds with the first and second cervical vertebrae), was the most common site (37.5% and 50%, respectively, p<0.05). In contrast, Segment I (origin of the vessel to the fifth cervical vertebrae) was the most common site for spontaneous CAD and VAD (55% and 77%, respectively, p<0.05). This cross-sectional study suggests that etiology plays an important role in the location of dissection. Traumatic CAD and VAD occur most commonly in Segment III. Spontaneous CAD and VAD occur most commonly in Segment I and are associated with increasing age and premorbid cerebrovascular risk factors.

Knot undulator to generate linearly polarized photons with low on-axis power density

Heat load on beamline optics is a serious obstacle for devices designed to generate pure linearly polarized photons in third generation synchrotron radiation facilities. For permanent magnet undulators, this problem can be overcome by implementing a figure-eight design configuration. As yet there has been no good method to tackle this problem for electromagnetic elliptical undulators. Here, a novel design and operational mode is suggested, which can generate pure linearly polarized photons with very low on-axis heat load. Additionally, the minimum photon energy capability of linearly polarized photons can be significantly extended by this method.

Life-threatening hypernatraemic dehydration in breastfed babies

We describe five babies, who were exclusively breast fed, with life-threatening complications of hypernatraemic dehydration secondary to inadequate breast feeding. An increased awareness among health professionals is required so that this potentially devastating condition can be prevented.

Effect of orlistat on cardiovascular disease risk in obese adults

AIM

The aim of this study is to compare the effect of orlistat vs. placebo on the predicted 10-year cardiovascular disease (CVD) risk in obese people with one or more cardiovascular risk factors treated for 12 months, in conjunction with a fat-reduced, but otherwise ad libitum, diet.

METHODS

A double-blind, randomized, placebo-controlled, parallel study was performed in conjunction with a fat-reduced diet and physical activity advice for 1 year. Participants (n = 339) from eight centres in Australia and New Zealand were randomized to either orlistat (120 mg) three times daily (n = 104 women, 66 men; mean +/- s.d. age = 52.0 +/- 7.5 years, body mass index (BMI) = 37.6 +/- 5.1 kg/m(2)) or placebo three times daily (n = 89 women, 80 men; age = 52.5 +/- 7.4 years, BMI = 38.0 +/- 4.9 kg/m(2)). The primary efficacy criterion was the 10-year risk of developing CVD calculated from the Framingham equation. Secondary efficacy criteria were body weight, waist circumference, blood pressure and serum concentrations of triglycerides, cholesterol (total, LDL and HDL), glucose, insulin and glycated haemoglobin and quality of life.

RESULTS

There was no difference in the change in 10-year CVD risk between orlistat and placebo groups over 1 year. The orlistat group, however, had significant favourable changes in many of the individual CVD risk factors (total cholesterol, LDL-cholesterol, glucose, glycated haemoglobin, insulin, body weight and waist circumference) and one of the domains of quality of life measured by means of the SF-36 questionnaire (vitality), compared to the placebo group. Significant reductions in medication use for hypertension and diabetes were observed in the orlistat group, compared to those in placebo, but there were no significant differences in medication use for blood lipids.

CONCLUSIONS

Orlistat may have reduced CVD risk, as judged by the favourable changes in individual risk factors and reductions in medication use, but the method used in order to measure absolute CVD risk in this study (Framingham CVD equation) was not sensitive enough to detect the changes in this relatively low-risk group (approximately 10% of risk of a CVD event over 10 years).

Tuberculosis contact investigation policies, practices, and challenges in 11 U.S. communities

To describe the policies and procedures used by 11 urban tuberculosis control programs to conduct contact investigations, written policies were reviewed and semistructured interviews were conducted with program managers and staff. Qualitative analysis showed that contact investigation policies and procedures vary widely. Most policies address risk factor assessment and contact prioritization; however, none of the policies provide comprehensive guidance for the entire process. Staffing patterns vary, but, overall, staff receive little formal training; informal monitoring practices predominate. Comprehensive guidelines and programmatic support are needed to improve the quality of contact investigation processes.

Variable linear polarization from an X-ray undulator

A new X-ray undulator has been designed and constructed which produces linearly polarized X-rays in which the plane of polarization can be oriented to a user selectable angle, from horizontal to vertical. Based on the Apple-II elliptically polarizing undulator (EPU), the undulator rotates the angle of the linear polarization by a simple longitudinal motion of the undulator magnets. Combined with the circular and elliptical polarization capabilities of the EPU operating in the standard mode, this new undulator produces soft X-ray radiation with versatile polarization control. This paper describes the magnetic structure of the device and presents an analysis of the magnetic field with varying undulator parameters. The variable linear polarization capability is then exhibited by measuring the X-ray absorption spectrum of an oriented polytetrafluoroethylene thin film. This experiment, which measures the linear dichroism of the sample at two peaks near the C 1s absorption edge, demonstrates the continuous polarization rotation capabilities of the undulator.

Posing clinical questions: framing the question for scientific inquiry

Much of nursing practice is (and always has been) based on information generated through inquiry. Finding the best answers quickly and effectively for the questions that arise in the clinical setting facilitates care, increases nursing efficiency, and improves patient outcome and satisfaction. Posing clinical questions also can help nurses identify and fill in gaps in knowledge, keep up with advances in clinical practice, and strengthen interactions with their peers, team members, and patients and their families. Formulating clinical questions that lead to sound, evidence-based answers to resolve clinical problems or direct patient-care decisions takes time and practice. The information in this article will assist nurses to develop the skill of framing clinical questions efficiently and effectively.

Environmentally sensitive plot-scale timber harvesting: impacts on suspended sediment, bedload and bank erosion dynamics

The impact on sediment pollution of environmentally sensitive harvesting of a 15 ha plot (20% of the catchment area) of mature coniferous plantation forest in the 0.89 km2 Afon Tanllwyth catchment, Plynlimon, was investigated for 12 months before harvesting began and a further 18 months after. The results revealed: (a) a steepening of the suspended sediment concentration vs. discharge rating curve resulting in a 39% increase in suspended sediment yield (as compared to the adjacent forested Hafren catchment) during the year in which the harvesting operations took place; (b) a statistically significant increase in main channel bank erosion rates, as compared with the nearby Afon Cyff; main channel banks are estimated to have contributed around 80% of the total catchment suspended sediment yield during the two year period (1995-1996), and (c) no significant change in bedload yields over the duration of the study, though a longer post-harvesting time series of bedload data will be required to properly assess the impact of the harvesting operation upon bedload yields. Forest management implications of these findings are discussed in detail with respect to the existing Forest and Water guidelines.

The role of orlistat in weight management

BACKGROUND

Most antiobesity drugs act centrally to reduce appetite or increase satiety. Orlistat is the first in a new class of drugs targeted at a single dietary component, in this case dietary fat.

OBJECTIVE

To review the clinical actions and efficacy of orlistat and to discuss its place in overall weight management.

DISCUSSION

Orlistat is best used in long term weight management as an adjunct to dietary modification and increased physical activity. The reduction in fat absorption results in a slow but sustained weight reduction and improved metabolic parameters such as reduced total, and LDL cholesterol. Side effects are minimised by maintaining a low fat diet.