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111.
Changing economic, political, environmental, and social conditions continue to have a cumulative impact on Australian regional communities, and in many instances, rural communities are being forced to initiate their own strategies in order to remain economically and socially viable. However, while communities respond in differing ways to similar change events, as do individuals, research examining the change process has largely been undertaken at the individual level. This article reports on an investigation of the characteristics that moderate a community's ability to manage change and the types of collective coping strategies communities employ to deal with change events. A model of community change process was used as the framework to examine the links between community characteristics, appraisal of change events (forest restructuring and tourism), and the use of collective strategies in three communities in Western Australia. Findings suggest that a community's mobilization of strategies is dependent on the collective assessment of the change event, the nature of the event, and the characteristics of the community. The implications for intervention through policy and community development are discussed briefly. © 2004 Wiley Periodicals, Inc. J Comm Psychol 32: 201–216, 2004. 相似文献
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John Fung Dympna Kelly Zakiyah Kadry Kusum Patel-Tom Bijan Eghtesad 《Liver transplantation》2005,11(3):267-280
Although calcineurin inhibitors (CNIs) remain the mainstay of immunosuppression in liver transplantation (LTX), their long-term toxicity significantly contributes to morbidity and mortality. The elucidation of mechanisms of alloimmunity and leukocyte migration have provided novel targets for immunosuppression development. The toxicities of these agents differ from that of the CNI and act additively or synergistically. CNI avoidance protocols in LTX have not been achieved routinely; however, pilot trials have begun to delineate the limitations and promises of such approaches. CNI-sparing protocols appear to be much more promising in balancing the early need for minimizing rejection while tapering doses and minimizing long-term toxicity. 相似文献
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Ralph Madeb Dragan Golijanin Joy Knopf Craig Nicholson Stuart Cramer Frederick Tonetti Kelly Piccone John R. Valvo Louis Eichel 《Journal of robotic surgery》2007,1(2):145-149
Several recent studies have suggested that thought leaders in radical prostatectomy have decreased their own positive margin
rates by switching from open to robot-assisted radical prostatectomy. Theoretically, this improvement is largely attributed
to enhanced visualization of the deep pelvis and precision of dissection afforded by the instrumentation. To date, it has
not been determined if this phenomenon exists amongst non-fellowship-trained urologists in private practice. Herein, we describe
the positive margin rates of two non-fellowship-trained private-practice urologists who converted from open radical retropubic
prostatectomy to robot-assisted radical prostatectomy. The margin positivity data from two non-fellowship-trained private-practice
urologists (surgeon 1 and surgeon 2) were reviewed retrospectively. The last 50 cases of open radical retropubic prostatectomy
from each surgeon were compared with the first 50 robotic prostatectomy cases of surgeons 1 and 2, respectively. A positive
surgical margin was defined as tumor present at the inked margin of the prostate. There was a significant decrease in the
overall and pT2 positive margin rates for both surgeons. The overall positive margin rate and pT2 positive margin rate for
surgeon 1 dropped from 44 to 20% and from 37 to 5.7%, respectively, after changing from open to robotic prostatectomy. For
surgeon 2, the overall positive margin rate changed from 26 to 18% and the pT2 positive margin rate changed from 27.5 to 7%
after converting. Changing from open to robotic-assisted radical prostatectomy may improve the ability of urologists to obtain
negative surgical margins. With proper training this phenomenon does seem to apply to non-fellowship-trained urologists in
private practice and can be realized within the first 50 cases performed. 相似文献
117.
BACKGROUND: We assessed suicide and suicide attempt risk as well as symptom reduction among 3,282 depressed patients participating in duloxetine and escitalopram clinical trials assigned to either an antidepressant or placebo. METHODS: We reviewed the FDA Summary Basis of Approval reports for data regarding safety and efficacy for duloxetine and escitalopram. Furthermore, we compared suicide risk among antidepressant clinical trials in this study with our two previous analyses on seven antidepressant clinical trials. RESULTS: Suicide and suicide attempt risk varied considerably among the three analyses, showing up to ten fold differences. Interestingly, the variability exists across the three reports, rather than between treatments (antidepressants versus placebo). CONCLUSIONS: These findings suggest caution in generalizing suicide risk even from a relatively large number of participants and thus, firm conclusions can only be drawn if the number of participants is overwhelmingly large (approximately two million patients). We also noted similar magnitude of response to placebo and antidepressants among the three studies. 相似文献
118.
Edward D Moloney Jim J Egan Peter Kelly Alfred E Wood Leslie T Cooper 《The Journal of heart and lung transplantation》2005,24(8):1103-1110
Myocarditis is a major cause of end-stage heart failure and is responsible for up to 10% of cases of idiopathic dilated cardiomyopathy (IDC). Worldwide, approximately 45% of all heart transplants are performed for IDC and up to 8% for myocarditis. Early reports suggested that survival after transplantation for myocarditis was poor and patients had an increased risk of rejection. More recently, larger case series suggest that overall survival after transplantation for myocarditis is similar to survival after transplantation for other causes. However, certain disorders, including cardiac sarcoidosis and giant cell myocarditis (GCM), require heightened surveillance for post-transplantation disease recurrence. We present the case of a 42-year-old man with recurrence of GCM 8 years after transplantation and review the literature on the role of cardiac transplantation for patients with myocarditis. 相似文献
119.
Non-selective inhibition of monoamine oxidase (MAO) enzymes (ie, isoforms A and B) in the brain are associated with clinically significant antidepressant effects. In the US, the selegiline transdermal system (STS; EMSAM) is the first antidepressant transdermal delivery system to receive Food and Drug Administration (FDA) approved labeling for the treatment of major depressive disorder (MDD). Currently, the use of orally administered MAO inhibitor antidepressants (eg, phenelzine, tranylcypromine) is limited by the risk of tyramine-provoked events (eg, acute hypertension and headache, also known as the “cheese reaction”) when combined with dietary tyramine. The selegiline transdermal system is the only MAOI available in the US for the treatment of MDD that does not require dietary restriction at the clinically effective dose of 6 mg/24 hours. Delivery of selegiline transdermally (EMSAM®) bypasses hepatic first pass metabolism, thereby avoiding significant inhibition of gastrointestinal and hepatic MAO-A activity (ie, reduced risk of tyramine-provoked events) while still providing sufficient levels of selegiline in the brain to produce an antidepressant effect. At dosages of 6–12 mg/24 hours, EMSAM has been shown to improve symptoms of depression, have good tolerability, and have high rates of medication adherence. However, at higher doses of EMSAM (ie, 9 mg/24 hours or more), dietary restriction of tyramine intake is recommended. The introduction of EMSAM overcomes many of the safety concerns affiliated with the conventional oral MAO inhibitors and EMSAM may be considered another strategy for the treatment of MDD, especially in patients who cannot tolerate oral antidepressants, are poorly adherent, who present with atypical depressive symptoms, or have failed other antidepressants. 相似文献
120.
Richard A. Perugini Steven H. Quarfordt Stephen Baker Donald R. Czerniach Demetrius E. M. Litwin John J. Kelly 《Journal of gastrointestinal surgery》2007,11(9):1083-1090
Introduction Obese individuals may have normal insulin–glucose homeostasis, insulin resistance, or diabetes mellitus. Whereas gastric bypass
cures insulin resistance and diabetes mellitus, its effects on normal physiology have not been described. We studied insulin
resistance and β-cell function for patients undergoing gastric bypass.
Methods One hundred thirty-eight patients undergoing gastric bypass had fasting insulin and glucose levels drawn on days 0, 12, 40,
180, and 365. Thirty-one (22%) patients with diabetes mellitus were excluded from this analysis. Homeostatic model of assessment
was used to estimate insulin resistance, insulin sensitivity, and β-cell function. Based on this model, patients were categorized
as high insulin resistance if their insulin resistance was >2.3.
Results Body mass index did not correlate with insulin resistance. Forty-seven (34%) patients were categorized as high insulin resistance.
Correction of insulin resistance for this group occurred by 12 days postoperatively. Sixty (43%) patients were categorized
as low insulin resistance. They demonstrated an increase of β-cell function by 12 days postoperatively, which returned to
baseline by 6 months. At 1 year postoperatively, the low insulin resistance group had significantly higher β-cell function
per degree of insulin sensitivity.
Conclusions Adipose mass alone cannot explain insulin resistance. Severely obese individuals can be categorized by degree of insulin resistance,
and the effect of gastric bypass depends upon this preoperative physiology. 相似文献