A prospective randomized trial between Euro-Collins and University of Wisconsin solutions as the initial flush in hepatic allograft procurement.

University of Wisconsin solution is currently recognized as the best solution for long-term organ preservation. It is recommended that UW solution be used as the in situ flush prior to organ explantation. The purpose of our study was to determine if hepatic allograft function was impaired by flushing the graft in situ with Euro-Collins and later flushing the graft ex vivo with UW solution, prior to cold storage. Fifty-six donors were randomly assigned to either an EC (n = 24) or UW (n = 32) in situ flush. The livers flushed with EC in situ were later flushed with 1 L of UW on the back table and stored in UW solution. Livers flushed with UW in vivo were similarly flushed and stored in UW on the back table. Concerning the donor allograft, there was no statistical difference (P greater than 0.05) between groups in sex, race, blood type, arterial anatomy, age, prothrombin time (PT), partial thromboplastin time (PTT), total bilirubin (TBR), direct bilirubin (DBR), aspartate amino transferase (AST), or alanine amino transferase (ALT). In addition, the recipients were compared for differences in sex, race, blood type, preoperative status, number of rejections, recipient age, length of surgery, and ischemia time and patient survival. There was no significant difference between groups (P greater than 0.05). There was no significant difference in patient survival (P = 0.238). Values for TBR, AST, ALT, PT, PTT, and AP were collected immediately preoperatively and postoperatively and on postoperative days 1, 3, 7, 14, and 28. There was no difference between groups in these values (P greater than 0.05). In our study there was no difference between the groups with respect to graft performance. This would justify the use of EC as an in situ flush during solid organ procurement and flushing with UW solution on the back table with an estimated savings of $400 to $1200 per procurement.     

Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.

OBJECTIVES: The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. METHODS: Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression. RESULTS: The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. CONCLUSIONS: No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.     

Comparison of fMRI statistical software packages and strategies for analysis of images containing random and stimulus-correlated motion.

The objectives of this study were to use computer-generated phantoms containing real subject motion to: (1) compare the sensitivity of four commonly used fMRI software packages and (2) compare the sensitivity of three statistical analysis strategies with respect to motion correction. The results suggest that all four packages perform similarly in fMRI statistical analysis with SPM2 having slightly higher sensitivity. The most sensitive analysis technique was to perform motion correction and include the realignment parameters as regressors in the general linear model. This approach applies to all four packages examined and can be most beneficial when stimulus-correlated motion is present.     

Managed Migration: The Caribbean Approach to Addressing Nursing Services Capacity

Objective. To (1) provide a contextual analysis of the Caribbean region with respect to forces shaping the current and emerging nursing workforce picture in the region; (2) discuss country-specific case(s) within the Caribbean; and (3) describe the Managed Migration Program as a potential framework for addressing regional and global nurse migration issues.
Principal Findings. The Caribbean is in the midst of a crisis of shortages of nurses with an average vacancy rate of 42 percent. Low pay, poor career prospects, and lack of education opportunities are among the reasons nurses resign. Many of these nurses look outside the region for job opportunities in the United Kingdom, Canada, the United States, and other countries. Compounding the situation is the lack of resources to train nurses to fill the vacancies. The Managed Migration Program of the Caribbean is a multilateral, cross-sector, multi-interventional, long-term strategy for developing and maintaining an adequate supply of nurses for the region.
Conclusions. The Managed Migration Program of the Caribbean has made progress in establishing regional support for addressing the nursing shortage crisis and developing a number of interesting initiatives such as training for export and temporary migration. Recommendations to move the Managed Migration Program of the Caribbean forward focus on advocacy, integration of the program into regional policy decisions, and integration of the program with regional health programming.     

Exposure to pesticides in ambient air

Abstract: Ambient air was monitored for pesticides at four sites in Coffs Harbour, a coastal town (population about 50 000) surrounded by banana plantations. Air was sampled continuously for five consecutive months during the peak agricultural spraying period using vacuum pumps set to sample one litre per minute through ORBO-42 adsorption tubes. Six pesticides were detected: three organochlorines and three organophosphates. The most commonly detected pesticide (14 per cent of all samples) was chlor-pyrifos (maximum detected level 208.0 ng/m³, mean 3.6 ng/m³). Heptachlor was detected in 7.1 per cent of all samples (maximum detected level 133 ng/m³, mean 2.7 ng/m³). Other pesticides were only rarely detected. The only pesticide applied by air in the district (propiconazole) was not detected. If international health guidelines are used as a yardstick, these levels of exposure appear unlikely to present an appreciable health risk. Chlorpyrifos detection was associated with low wind speed (P = 0.012) and high temperature (P = 0.015), and detection at one site was associated with detection at another (P < 0.001). Chlorpyrifos detection was also associated with domestic applications within the town area as reported by pesticide applicators (P = 0.045). Peak agricultural use of chlorpyrifos did not coincide with peak detection periods. None of the detected organochlorines is registered for agricultural use, although at the time, heptachlor was permitted for use as a domestic termiticide. Even in a semirural town with nearby widespread use of agricultural chemicals, community exposures to pesticides in ambient air may largely relate to their nonagricultural use.     

The clinical use of ITI transmucosal implants.

The ITI implant system has a background of research and development of over 15 years. It is distinctive in that the implant fixtures are transmucosal from the time of placement, requiring only a single stage in surgical treatment. In a relatively simplified approach to prosthetic management, standard overdenture components and conventional fixed partial denture techniques are used. In this report the assessment, surgical treatment and post-operative management of patients using ITI Bonefit implants are described and early results from 168 consecutive fixtures placed over a period of 3 years indicated.     

Profession and Professionalisation: Part 1: Role and identity of undergraduate physiotherapy educators

The first part of this paper addresses the issues of profession and professionalisation which affect educators in physiotherapy undergraduate studies. It introduces ‘profession’ and ‘professionalisation’ in isolation, although it is not the intention to simplify discussion, but instead to explore the concepts as they stand from a wider perspective before applying them to physiotherapy education. This is followed by a consideration of the complex issues of physiotherapy itself as an aspiring profession, based upon the elements of a profession previously identified, before introducing the role of physiotherapy education and research within the professionalisation process. Part 2 continues this theme by offering a critical analysis of the overlap between education, research and professional status.The second and concluding part of this article continues the theme of professionalisation within physiotherapy, yet more specifically addresses the issues of professionalisation within academia. It provocatively considers physiotherapy academic educators themselves as jugglers of two values – the producers of future professionals and the aspirational creators of a profession. This theme is then expanded by an analysis of the demands placed upon physiotherapy educators, from the perspective both of promoting the profession, and of identifying physiotherapy educators' values. A summary of the discussion follows, outlining emerging points for future development.This paper finally proposes how physiotherapy educators need to revisit the values that underpin their role, and how the professionalisation of future physiotherapists depends upon both a sound understanding and respect of educational philosophy and educational research. The creation and support of a ‘profession’ of physiotherapy educators is offered as a medium through which they can reflect upon and evaluate their own practice within the discipline of education.