Open laparoscopy

Many of the complications of conventional closed, or sharp, laparoscopy result from the use of insufflation needles and sharp trocars. These instruments are not essential elements of the technique as laparoscopy can be easily performed with a small umbilical incision, entering the abdomen under direct vision. This variation is called open laparoscopy. Open laparoscopy eliminates the possibility of insufflation-needle and trocar injuries and lessens the probability of failed laparoscopy attempts and postoperative herniations. Furthermore, physicians performing open laparoscopy can become comfortably proficient in the technique faster than they can in closed laparoscopy because open laparoscopy utilizes standard and familiar surgical technique. Open laparoscopy can be easily performed under local anesthesia, particularly for female sterilization. The technique is suitable for the outpatient setting based on considerations of safety and reliability.     

Advanced techniques in abdominal surgery.

Almost every abdominal organ is now amenable to laparoscopic surgery. Laparoscopic appendicectomy is a routine procedure which also permits identification of other conditions initially confused with an inflamed appendix. However, assessment of appendiceal inflammation is more difficult. Almost all colonic procedures can be performed laparoscopically, at least partly, though resection for colonic cancer is still controversial. For simple patch repair of perforated duodenal ulcers laparoscopy is ideal, and inguinal groin hernia can be repaired satisfactorily with a patch of synthetic mesh. Many upper abdominal procedures, however, still take more time than the open operations. These techniques reduce postoperative pain and the incidence of wound infections and allow a much earlier return to normal activity compared with open surgery. They have also brought new disciplines: surgeons must learn different hand-eye coordination, meticulous haemostasis is needed to maintain picture quality, and delivery of specimens may be problematic. The widespread introduction of laparoscopic techniques has emphasised the need for adequate training (operations that were straight-forward open procedures may require considerable laparoscopic expertise) and has raised questions about trainee surgeons acquiring adequate experience of open procedures.     

Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US

While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its generalizability to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies. We identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. We examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered noncompetitive employment, program retention, and nonvocational outcomes. IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups. The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies (62% vs. 47%). The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence-based practice that may transport well into new settings as long as programs achieve high fidelity to the IPS model, but further research is needed on international adaptations.     

水体沉积物中酸可挥发性硫化物(AVS)研究进展

水体沉积物中酸可挥发性硫化物 (AVS)是总硫含量中活性最高的部分 ,是沉积物中有毒重金属的重要结合形态 ,它的含量在很大程度上影响着沉积物重金属的生物有效性 ,从而作为沉积物中有毒重金属环境污染评价的一个重要指标 ;就十多年来水体沉积物中酸可挥发性硫化物 (AVS)的研究进行了综述。概述了 AVS的测定方法及其影响因素 ;探讨了水体沉积物中 AVS含量时空变化的规律 ;同时就目前“同时可提取重金属”(SEM)与 AVS摩尔浓度比值和水体沉积物重金属生物毒性关系的研究进行了概括和分析。     

Source populations in carnivore management: cougar demography and emigration in a lightly hunted population

Wildlife agencies typically attempt to manage carnivore numbers in localized game management units through hunting, and do not always consider the potential influences of immigration and emigration on the outcome of those hunting practices. However, such a closed population structure may not be an appropriate model for management of carnivore populations where immigration and emigration are important population parameters. The closed population hypothesis predicts that high hunting mortality will reduce numbers and densities of carnivores and that low hunting mortality will increase numbers and densities. By contrast, the open population hypothesis predicts that high hunting mortality may not reduce carnivore densities because of compensatory immigration, and low hunting mortality may not result in more carnivores because of compensatory emigration. Previous research supported the open population hypothesis with high immigration rates in a heavily hunted (hunting mortality rate=0.24) cougar population in northern Washington. We test the open population hypothesis and high emigration rates in a lightly hunted (hunting mortality rate=0.11) cougar population in central Washington by monitoring demography from 2002 to 2007. We used a dual sex survival/fecundity Leslie matrix to estimate closed population growth and annual census counts to estimate open population growth. The observed open population growth rate of 0.98 was lower than the closed survival/fecundity growth rates of 1.13 (deterministic) and 1.10 (stochastic), and suggests a 12–15% annual emigration rate. Our data support the open population hypothesis for lightly hunted populations of carnivores. Low hunting mortality did not result in increased numbers and densities of cougars, as commonly believed because of compensatory emigration.     

Management of insecticides for use in disease vector control: Lessons from six countries in Asia and the Middle East

Interventions to control the vectors of human diseases, notably malaria, leishmaniasis and dengue, have relied mainly on the action of chemical insecticides. However, concerns have been raised regarding the management of insecticides in vector-borne disease-endemic countries. Our study aimed to analyze how vector control insecticides are managed in selected countries to extract lessons learned.A qualitative analysis of the situation of vector control insecticides management was conducted in six countries. Multi-stakeholder meetings and key informer interviews were conducted on aspects covering the pesticide lifecycle. Findings were compared and synthesized to extract lessons learned. Centrally executed guidelines and standards on the management of insecticides offered direction and control in most malaria programs, but were largely lacking from decentralized dengue programs, where practices of procurement, application, safety, storage, and disposal were variable between districts. Decentralized programs were better at facilitating participation of stakeholders and local communities and securing financing from local budgets. However, little coordination existed between malaria, visceral leishmaniasis and dengue programs within countries. Entomological capacity was concentrated in malaria programs at central level, while dengue and visceral leishmaniasis programs were missing out on expertise. Monitoring systems for insecticide resistance in malaria vectors were rarely used for dengue or visceral leishmaniasis vectors. Strategies for insecticide resistance management, where present, did not extend across programs or sectors in most countries. Dengue programs in most countries continued to rely on space spraying which, considering the realities on the ground, call for revision of international guidelines.Vector control programs in the selected countries were confronted with critical shortcomings in the procurement, application, safety measures, storage, and disposal of vector control insecticides, with implications for the efficiency, effectiveness, and safety of vector control. Further international support is needed to assist countries in situation analysis, action planning and development of national guidelines on vector control insecticide management.     

Prospective evaluation of the safety and efficacy of laparoscopic jejunostomy.

We prospectively assessed the safety and efficacy of laparoscopic jejunostomy done by 11 surgeons in 8 medical centers using the T-fastener technique. In all, 23 men and 13 women aged 19 to 84 (mean, 59) years required enteral feeding, but could not undergo gastrostomy and had no contraindication to laparoscopy. Of these patients, 12 had head and neck cancer and 11 had neurologic swallowing dysfunction. The procedure took 25 to 180 minutes (mean, 75). Three (8%) early cases were converted to open jejunostomy because of accidental enterotomies caused by inappropriate techniques that were avoided in later cases. Minor technical problems, such as passing a needle through the back wall of the jejunum, occurred in 7 patients, but they were easily corrected and produced no complications. Feedings were routinely begun within 24 hours of the surgical procedure. All jejunostomy catheters functioned well. This is a safe and effective technique when done by experienced laparoscopic surgeons, and serious complications are rare.     

Seasonal variation of acid volatile sulfide concentration in sediment cores from three northeastern Minnesota lakes

Acid volatile sulfide (AVS) is a natural agent in sediments which complexes some cationic metals and thereby influences the toxicity of these metals to benthic organisms. Because of its influence on metal bioavailability, AVS has been proposed as a key normalization phase for the development of sediment quality criteria for metals. However, studies conducted primarily in marine and estuarine systems have shown that AVS concentrations can vary markedly both temporally and with (sediment) depth. In this study, AVS concentrations were measured monthly for 16 mo in several segments of sediment cores from three freshwater lakes: Caribou Lake, Fish Lake and Pike Lake in northeastern Minnesota, USA. The concentrations of AVS in cores from the three lakes varied inversely with sediment depth. AVS concentrations also varied seasonally by as much as two orders of magnitude and were directly correlated with changes in water temperature. The correlation between AVS and temperature likely was related both to changes in primary productivity and sediment microbial activity.     

Certificate-of-Need regulation in outpatient surgery and specialty care: implications for plastic surgeons

For plastic surgeons, independent development of outpatient surgical centers and specialty facilities is becoming increasingly common. These facilities serve as important avenues not only for increasing access and efficiency but in maintaining a sustainable, competitive specialty advantage. Certificate of Need regulation represents a major hurdle to plastic surgeons who attempt to create autonomy in this fashion. At the state level, Certificate of Need programs were initially established in an effort to reduce health care costs by preventing unnecessary capital outlays for facility expansion (i.e., managing supply of health care resources) in addition to assisting with patient safety and access to care. The purpose of this study was to examine the effect of Certificate of Need regulations on health care costs, patient safety, and access to care and to discuss specific implications of these regulations for plastic surgeons. Within Certificate of Need states, these regulations have done little, if anything, to control health care costs or affect patient safety. Presently, Certificate of Need effects coupled with recent provisions in the Medicare Modernization Act banning development of specialty hospitals may restrict patient access to ambulatory surgical and specialty care. For the plastic surgeon, these effects not only act as an economic barrier to entry but can threaten the efficiencies gained from providing surgical care in an ambulatory setting. An appreciation of these effects is critical to maintaining specialty autonomy and access to fiscal policy.     

Opinion: [on anesthesia for outpatient female sterilization

In actual practice, the choice of anesthesia is more likely to be decided by the personal preference of the surgeon or anesthesiologist rather than by considerations of safety. Most gynecologists in the US and Canada, working in hospitals or surgicenters, choose general anesthesia becaused skilled anesthetists are available, and it is easier for them to operate if their patients are asleep. Most anesthesiologists prefer it that way also, since their services are being fully utilized. During residency training, gynecologists need the benefit of general anesthesia to learn surgical techniques. Because they learned that way, it is the course of least resistance for them to continue to favor general anesthesia. Thus hundreds of thousands of general anesthetics are given each year to suit the convenience and skills of the gynecologist. But minilaparotomy or laparoscopy may be performed with fewer potential complications under local anesthesia, provided the patient receives proper counseling and supportive care, and provided the gynecologist's surgical technique is gentle and precise. Unfortunately, most residency programs do not provide training in such techniques, so they are learned, if at all, during practice years.     

Conservation on International Boundaries: The Impact of Security Barriers on Selected Terrestrial Mammals in Four Protected Areas in Arizona,USA

Several thousand terrestrial protected areas (PAs) lie on international boundaries. Because international boundaries can be focal points for trade, illegal activity and development, such PAs can be vulnerable to a range of anthropogenic threats. There is an increasing trend towards the erection of international boundary infrastructure (including fences, barriers and ditches) in many parts of the world, which may reduce the risk of these anthropogenic threats to some PAs. However this may restrict home range and access to resources for some native species. We sought to understand the impacts of these two different types of threat by using camera traps to measure the activity level of humans, native and invasive mammals in four US PAs on the Mexican international boundary. Comparisons were made between treatment areas with barriers and those without. Results showed that puma and coati were more likely to appear in treatment areas without barriers, whereas humans were not observed more frequently in one treatment area over another. The suggestion is that the intermittent fencing present in this part of the world does affect some native species, but does not necessarily restrict the movement of humans (including illegal migrants), who may negatively impact native species.     

Mild cycles open closed communities to ecological restoration

Species loss is a global issue. With up to a million species at risk and insufficient protected area to maintain the world's biodiversity, humanity will increasingly need to rely on species re‐introductions to locally restore diversity and function. However, such restoration attempts are bound to fail when ecological communities get locked in a closed state that is resistant to recovery. It is presently unknown how to repair these closed systems. We use mathematical models to identify ways out of this problem. We first show how ecological communities may enter a closed state, to then explain how to open them up again for restoration of their original diversity. We find that restoration is often still possible shortly after initial species loss, as (1) the secondary extinctions that produce closure have not happened yet and (2) mild population fluctuations still allow successful repair during a transient postdisturbance phase. However, after this typically short window of opportunity for restoration, the system enters a new equilibrium, which may be a closed state. Our analysis shows how to take ecological communities out of the closed state: Appropriate management of carrying capacities produces a regime of mild population fluctuations that opens a window for successful species re‐introductions. These windows can be perpetually recurring or permanently open. Such opportunities for repair can be absent under regimes of wild cycles or perfect stability. We conclude that mild cycles may open windows of opportunity for the repair of communities that have become resistant to recovery.     

A training primer for Institutional Officials

The laws and policies governing the care and use of animals in research in the US require institutions to establish training programs to assure that personnel are qualified for their roles in animal care and use programs. Few programs define specific training requirements for the Institutional Official (IO), one of the most important roles in an animal care program. In some cases, IOs may have little or no experience in biomedical science. In this article, the author provides an overview of the IO's role in an animal care and use program as defined by US government laws and policies for use in training IOs and chief executive officers. The author outlines the key responsibilities of the IO in an animal care program, the implications of noncompliance with federal requirements and some of the pitfalls in program design.     

Dark butterflies camouflaged from predation in dark tropical forest understories

1. Morphological characteristics, especially coloration, are related to thermoregulation and camouflage, both of which are crucial for species survival and fitness. In cool environments such as the understorey of closed rainforests, darker organisms have thermal advantages and may be able to absorb heat more efficiently. However, such habitats are also suitable for darker organisms with respect to camouflage, making it difficult to elucidate whether the association of dark‐coloured organisms with shady environments is a consequence of thermal stress or predation pressure, or both. 2. In this study, butterfly communities were surveyed and artificial butterflies (mealworms attached to plastic sheeting to mimic adult butterflies) used to test whether differences in wing luminance are related to predation rates within open and closed habitats in monsoonal tropical forests of southwestern China. 3. Using artificial butterflies, significantly lower predation rates were found for dark‐coloured artificial butterflies within closed habitats, whereas such relationships were not found within open habitats. It was found that actual butterfly communities were also significantly darker in closed than in open habitats. 4. These results demonstrate that darker colours may have the effect of reducing predation rates in shady environments and that different habitat types can have contrasting effects on luminance and therefore predation risk.     

Interdomain interactions in hinge-bending transitions.

BACKGROUND: The mechanisms that allow or constrain protein movement have not been understood. Here we study interdomain interactions in proteins to investigate hinge-bending motions. RESULTS: We find a limited number of salt bridges and hydrogen bonds at the interdomain interface, in both the "closed" and the "open" conformations. Consistently, analysis of 222 salt bridges in an independently selected database indicates that most salt bridges form within rather than between independently folding hydrophobic units. Calculations show that these interdomain salt bridges either destabilize or only marginally stabilize the closed conformation in most proteins. In contrast, the nonpolar buried surface area between the moving parts can be extensive in the closed conformations. However, when the nonpolar buried surface area is large, we find that at the interdomain interface in the open conformation it may be as large or larger than in the closed conformation. Hence, the energetic penalty of opening the closed conformation is overcome. Consistently, a large nonpolar surface area buried in the closed interdomain interface accompanies limited opening of the domains, yielding a larger interface. CONCLUSIONS: Short-range electrostatic interactions are largely absent between moving domains. Interdomain nonpolar buried surface area may be large in the closed conformation, but it is largely offset by the area buried in the open conformation. In such cases the opening of the domains appears to be relatively small. This may allow prediction of the extent of domain opening. Such predictions may have implications for the shape and size of the binding pockets in drug/protein design.     

HbA1c standardisation: history, science and politics

Significant analytical improvements have occurred since glycated haemoglobin (GHb), measured as total HbA(1), was first used in routine clinical laboratories around 1977. Following the publication of the Diabetes Control and Complications Trial (DCCT) study in 1993 the issue of international standardisation became an important objective for scientists and clinicians. The lack of international standardisation led several countries to develop national standardisation programs. The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Working Group on Standardisation of HbA(1c) established a true international reference measurement system for HbA(1c) and the successful preparation of pure HbA(1c) calibration material that should lead to further improvements in inter-method and inter-laboratory variability. Reporting of HbA(1c) has been agreed using the units of mmol/mol (IFCC) and percent (National Glycohemoglobin Standardization Program, NGSP).     

Retraction: Open and closed conformations reveal induced fit movements in butyrate kinase 2 activation. J. Diao,Y. D. Ma,and M. S. Hasson.

The following article from Proteins: Structure, Function, and Bioinformatics, “Open and closed conformations reveal induced fit movements in butyrate kinase 2 activation,” by Jiasheng Diao, Yunglin D. Ma, and Miriam S. Hasson, published online on 21 October 2010 in Wiley Online Library (onlinelibrary.wiley.com), has been retracted by agreement between the journal Editor in Chief, Bertrand Garcia‐Moreno, and Wiley Periodicals. The retraction has been agreed because it was established by internal investigation performed by Purdue University that the authors of this article are not the owners of the data and have no right to publication.     

International stem cell collaboration: how disparate policies between the United States and the United Kingdom impact research

As the scientific community globalizes, it is increasingly important to understand the effects of international collaboration on the quality and quantity of research produced. While it is generally assumed that international collaboration enhances the quality of research, this phenomenon is not well examined. Stem cell research is unique in that it is both politically charged and a research area that often generates international collaborations, making it an ideal case through which to examine international collaborations. Furthermore, with promising medical applications, the research area is dynamic and responsive to a globalizing science environment. Thus, studying international collaborations in stem cell research elucidates the role of existing international networks in promoting quality research, as well as the effects that disparate national policies might have on research. This study examined the impact of collaboration on publication significance in the United States and the United Kingdom, world leaders in stem cell research with disparate policies. We reviewed publications by US and UK authors from 2008, along with their citation rates and the political factors that may have contributed to the number of international collaborations. The data demonstrated that international collaborations significantly increased an article's impact for UK and US investigators. While this applied to UK authors whether they were corresponding or secondary, this effect was most significant for US authors who were corresponding authors. While the UK exhibited a higher proportion of international publications than the US, this difference was consistent with overall trends in international scientific collaboration. The findings suggested that national stem cell policy differences and regulatory mechanisms driving international stem cell research in the US and UK did not affect the frequency of international collaborations, or even the countries with which the US and UK most often collaborated. Geographical and traditional collaborative relationships were the predominate considerations in establishing international collaborations.     

Effectiveness of the International Phytosanitary Standard ISPM No. 15 on Reducing Wood Borer Infestation Rates in Wood Packaging Material Entering the United States

Numerous bark- and wood-infesting insects have been introduced to new countries by international trade where some have caused severe environmental and economic damage. Wood packaging material (WPM), such as pallets, is one of the high risk pathways for the introduction of wood pests. International recognition of this risk resulted in adoption of International Standards for Phytosanitary Measures No. 15 (ISPM15) in 2002, which provides treatment standards for WPM used in international trade. ISPM15 was originally developed by members of the International Plant Protection Convention to “practically eliminate” the risk of international transport of most bark and wood pests via WPM. The United States (US) implemented ISPM15 in three phases during 2005–2006. We compared pest interception rates of WPM inspected at US ports before and after US implementation of ISPM15 using the US Department of Agriculture AQIM (Agriculture Quarantine Inspection Monitoring) database. Analyses of records from 2003–2009 indicated that WPM infestation rates declined 36–52% following ISPM15 implementation, with results varying in statistical significance depending on the selected starting parameters. Power analyses of the AQIM data indicated there was at least a 95% chance of detecting a statistically significant reduction in infestation rates if they dropped by 90% post-ISPM15, but the probability fell as the impact of ISPM15 lessened. We discuss several factors that could have reduced the apparent impact of ISPM15 on lowering WPM infestation levels, and suggest ways that ISPM15 could be improved. The paucity of international interception data impeded our ability to conduct more thorough analyses of the impact of ISPM15, and demonstrates the need for well-planned sampling programs before and after implementation of major phytosanitary policies so that their effectiveness can be assessed. We also present summary data for bark- and wood-boring insects intercepted on WPM at US ports during 1984–2008.     

The basics of preclinical drug development for neurodegenerative disease indications

Preclinical development encompasses the activities that link drug discovery in the laboratory to initiation of human clinical trials. Preclinical studies can be designed to identify a lead candidate from several hits; develop the best procedure for new drug scale-up; select the best formulation; determine the route, frequency, and duration of exposure; and ultimately support the intended clinical trial design. The details of each preclinical development package can vary, but all have some common features. Rodent and nonrodent mammalian models are used to delineate the pharmacokinetic profile and general safety, as well as to identify toxicity patterns. One or more species may be used to determine the drug's mean residence time in the body, which depends on inherent absorption, distribution, metabolism, and excretion properties. For drugs intended to treat Alzheimer's disease or other brain-targeted diseases, the ability of a drug to cross the blood brain barrier may be a key issue. Toxicology and safety studies identify potential target organs for adverse effects and define the Therapeutic Index to set the initial starting doses in clinical trials. Pivotal preclinical safety studies generally require regulatory oversight as defined by US Food and Drug Administration (FDA) Good Laboratory Practices and international guidelines, including the International Conference on Harmonisation. Concurrent preclinical development activities include developing the Clinical Plan and preparing the new drug product, including the associated documentation to meet stringent FDA Good Manufacturing Practices regulatory guidelines. A wide range of commercial and government contract options are available for investigators seeking to advance their candidate(s). Government programs such as the Small Business Innovative Research and Small Business Technology Transfer grants and the National Institutes of Health Rapid Access to Interventional Development Pilot Program provide funding and services to assist applicants in preparing the preclinical programs and documentation for their drugs. Increasingly, private foundations are also funding preclinical work. Close interaction with the FDA, including a meeting to prepare for submission of an Investigational New Drug application, is critical to ensure that the preclinical development package properly supports the planned phase I clinical trial.