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Notes: A technique is presented for modifying the Blom-Singer tracheostoma valve housing to improve peristomal skin adherence for hands-free tracheoesophageal speech production following total laryngectomy. The finished product is thin, flexible, and maintains enhanced tear strength. The edges of a standard housing device for the Blom-Singer valve are trimmed to allow for better accommodation to the tissue surface without distortion. A punch biopsy instrument is used to cut uniform holes around the housing device to allow for permeation of the silicone mixture for better mechanical adherence of the materials.

Notes: Abstract  Between 1971 and 1988 left thoracotomy was performed on pump for selected reoperations. Since 1993, 92 patients were operated on with a limited approach and an increased number of cases were done off pump (70 patients). The purpose of this paper is to describe the transition of our operative techniques from on pump to off pump for reoperative coronary patients. From 1995 to 1999, 22 patients (Group 1) were operated on pump and 70 patients (Group II) off pump; 86 of 92 (93.5%) had reoperations. The demographic data were similar in these two groups regarding age, gender, ejection fraction, and total number of grafts performed. In this study 92 patients had a crude mortality of 4.3%. Limited access thoractomy provides safer reoperation than previously (1971–1988) with an improved on or off pump (4.5% vs. 4.3%) mortality, compared to the on pump mortality of 10% between 1971–1988. Off-pump operations are performed with increasing frequency and with the same risk and less postoperative complications.

Notes: Background Research on the impact of parental illness on children is sparse, and it remains unclear what kind of support, if any, families would value. This paper presents findings from the first investigation to explore the experiences of young people who have a parent with inflammatory bowel disease (IBD).Design and methods This qualitative study involved interviews with 23 young people, aged between six and 20 years, who have a parent with IBD. A range of non-verbal techniques was used to facilitate interviews with young children. Data were analysed using the framework approach.Results Participants varied in their understanding and perception of their parent's condition and the extent to which they discussed it with family and friends. Some reported being unaffected by their parent's illness. The main negative effects on everyday life were restrictions on social activities, parents being unable to do housework, children having to be well-behaved and parents becoming withdrawn or irritable. Experiences could lead to feelings of sadness, worry, anger and guilt. The few who reported positive effects described spending time with the parent while ill, being allowed to be more independent and being close as a family. Relatives, friends, neighbours, service providers and young people all played a role in helping to manage the situation, and most participants felt that their family did not need additional support. However, some young people would value advice and information regarding the condition and opportunities to meet others in a similar situation.Conclusion IBD is a highly variable condition, with substantial differences in the extent to which it impinges on the lives of family members. In addition to supporting patients, health professionals have an important role to play in offering advice and information to others affected by the illness, including children.

Notes: This paper reports on an exploratory study concerning the effectiveness of specific design features in talking book software. Talking book software has the potential to complement current approaches to literacy instruction. In addition to common features such as word pronunciations, the implementation included sub-syllabic word pronunciations, hints to encourage independent word identification and activities to reinforce specific reading skills. Two versions of the software were compared using both qualitative and quantitative methodologies. One software version had minimal functionality (‘Basic’) and the other incorporated all design features (‘Enhanced’). Each version of the software was used daily for a period of four weeks by 16 children, aged 5 to 6 years.The findings of the study were complex due to variations in learner preferences and reading abilities. Nevertheless, it seems that electronic books can complement teaching approaches in infant classrooms and can positively affect both cognitive and affective learning outcomes. It is evident that children beginning to recognise words can benefit from common features alone. Those children using the Enhanced software who had already acquired a limited sight vocabulary can benefit from exposure to reinforcement activities. Children with more advanced reading skills may benefit from hints to support independent word identification.

Notes: To assess the effectiveness of a motivational interview among hospitalized psychiatric patients with comorbid substance use disorder in reducing alcohol and other drug (AOD) use.〈section xml:id="abs1-3"〉〈title type="main"〉DesignSubjects were assigned randomly to receive an individual motivational interview (n=79) or a self-help booklet (control condition; n=81).〈section xml:id="abs1-4"〉〈title type="main"〉SettingSubjects were volunteers recruited from a major public psychiatric hospital.〈section xml:id="abs1-5"〉〈title type="main"〉ParticipantsSubjects met abuse or dependence criteria on the structured clinical interview for diagnosis (SCID) for alcohol, cannabis or amphetamine or they reported hazardous use during the last month of one or more of these drug types on the opiate treatment index (OTI).〈section xml:id="abs1-6"〉〈title type="main"〉InterventionEither one 30–45-minute motivational interview or brief advice.〈section xml:id="abs1-7"〉〈title type="main"〉MeasurementsThe SCID and OTI were the main measures.〈section xml:id="abs1-8"〉〈title type="main"〉FindingsThere was a modest short-term effect of the motivational interview on an aggregate index of alcohol and other drug use (polydrug use on the OTI). Cannabis use remained high among the sample over the 12-month follow-up period.〈section xml:id="abs1-9"〉〈title type="main"〉ConclusionAlthough motivational interviewing appears feasible among in-patients in psychiatric hospital with comorbid substance use disorders, more extensive interventions are recommended, continuing on an out-patient basis, particularly for cannabis use.

Notes: abstract The extensive selection–adaptation literature spans diverse theoretical perspectives, but is inconclusive on the role of managerial intentionality in organizational adaptation. Indeed this voluminous literature has more to say about selection and sources and causes of structural inertia than about self-renewing organizations that might counteract such inertia. In this introductory essay, we identify four co-evolutionary generative mechanisms (engines) – naïve selection, managed selection, hierarchical renewal and holistic renewal – which illustrate the extensive range of evolutionary paths that can take place in a population of organizations. In particular, the managed selection engine provides the foundations of the underlying principles of co-evolving self-renewing organizations: managing internal rates of change, optimizing self-organization, and balancing concurrent exploration and exploitation. However, it is altogether clear that empirical co-evolution research represents the next frontier for empirically resolving the adaptation selection debate. The essay concludes with a discussion of requirements for co-evolutionary empirical research and introduces the empirical papers in this Special Research Symposium.

Notes: Abstract The discovery, characterization, and cloning of the calcium-sensing receptor (CaR) in 1993 was soon followed by the creation of a new type of drug, the calcimimetics-NPS R-568 and NPS R-467-which are small phenylalkylamine derivative compounds that act as CaR agonists and increase the sensitivity of the CaR to activation by extracellular calcium (Ca2+). As expected, these compounds turned out to have a significant effect on the Ca2+/parathyroid hormone (PTH) relationship, resulting in a dramatically greater suppression of the PTH level than would otherwise occur at the actual extracellular Ca2+ levels. Renal osteodystrophy (RO) due to secondary hyperparathyroidism (HPT) in chronic renal failure was an obvious target for studying the effects of NPS R-568. In a study on experimental animals, the results clearly showed that this first generation of calcimimetics, NPS R-568, had an acute dose-dependent and short-lived suppressive effect on PTH secretion from the parathyroid glands. A similar effect was found in patients with chronic renal failure and secondary HPT. At the same time, the calcimimetics induced a slight degree of hypocalcemia. Such a significant suppressive effect on PTH secretion would be expected to result in therapeutic potential for a preventive or therapeutic effect on the RO accompanying chronic uremia. Administration would probably be in close concert with present strategies, phosphate binders and vitamin D analogs. A wide distribution of CaRs have now been demonstrated in the body, and an important question is how calcimimetics will affect the function of different tissues and organs when used for long-term treatment or prevention of secondary HPT and RO. Although relatively few experimental and clinical investigations have been completed, they clearly confirm the suppressive effect of calcimimetics on PTH secretion. In rats with experimental chronic renal failure, a significant and beneficial effect on the prevention of RO has been demonstrated. The effect of calcimimetic compounds is presently being evaluated in humans. Besides induction of hypocalcemia, the adverse effects in these mainly short-term studies have been few. Future studies with calcimimetics will further define the physiology and pathophysiology of the CaR and the long-term benefit of calcimimetic compounds in patients with chronic renal failure.

Notes: Abstract Although triacylglycerol stores play the critical role in an organism's ability to withstand fuel deprivation and are strongly associated with such disorders as diabetes, obesity, and atherosclerotic heart disease, information concerning the enzymes of triacylglycerol synthesis, their regulation by hormones, nutrients, and physiological conditions, their mechanisms of action, and the roles of specific isoforms has been limited by a lack of cloned cDNAs and purified proteins. Fortunately, molecular tools for several key enzymes in the synthetic pathway are becoming available. This review summarizes recent studies of these enzymes, their regulation under varying physiological conditions, their purported roles in synthesis of triacylglycerol and related glycerolipids, the possible functions of different isoenzymes, and the evidence for specialized cellular pools of triacylglycerol and glycerolipid intermediates.