Vulvodynia. Theory and management

Vulvodynia, defined as vulval pain, soreness or burning as opposed to itching or pruritus, is a common and important problem. Although not a sexually transmitted disease, it often presents to physicians working in that field. The main groups of vulvodynia are those where the symptoms are the consequence of an active dermatosis or infection, and those where it is not attributable to such conditions. In the latter group, the patients fall into two main categories: those of dysesthetic vulvidynia, with constant unprovoked pain, and vulval vestibulitis, with pain provoked by attempted vaginal entry. The recent realization that dysesthetic vulvodynia and vulval vestibulitis may be regarded as pain syndromes is proving a fruitful concept as regards both theory and management of these troublesome conditions.     

Cholesterol ester transfer protein: a molecule with three faces?

The pathogenesis of atherosclerosis continues to be a focus of intensive study. One of the more recent players in the atherosclerosis drama is cholesterol ester transfer protein (CETP). CETP is primarily involved in lipid transfer between lipoproteins, for example, from high-density lipoproteins (HDL) to apo B-containing lipoproteins, but CETP has also been found to take up cholesterol directly from cells without the co-participation of lipoproteins, and it is still not clear whether CETP should be classified as a beneficial or as a harmful protein. Some of the important evidence for these conflicting theories is examined here, with special reference to situations where CETP appears to be proatherogenic, instances where CETP seems to assume an antiatherogenic role, and situations where CETP seems to be both proatherogenic and antiatherogenic. In addition, the metabolic context of CETP and the modification of CETP substrates play crucial roles that are not always recognized when judgements about the role of CETP in atherosclerosis are recorded.     

Processing in the Stroop task: Mental set as a determinant of performance.

Examined whether the Stroop effect is inevitable under conditions where the stimuli and overt responses are held constant across 2 instructional conditions, but the mental set given to the Ss is different. 112 Ss responded to the print color of an irrelevant word that spelled a congruent or incongruent color word. In the CLASSIFY condition, Ss were instructed to map 1 color to 1 response button and the other color to another response button. In the DETECT condition, Ss were instructed to signal the presence of a target color with 1 response button, and its absence with another response button. The CLASSIFY instructions produced the standard result: The incongruent condition was slower than the congruent condition. In contrast, there was no Stroop effect given DETECT instructions. Results are discussed in terms of mental set as an important determinant of processing, and contrasted with the received view that reading the irrelevant word is largely "automatic" and virtually always results in a Stroop effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Injection drug users' practices and attitudes toward intervention and potential for reducing the transmission of HIV

Miami is one of the major centers of illegal drug activity and has a significant proportion of AIDS cases among injection drug users (IDUs). Since Needle Exchange Programs (NEP) are illegal and therefore do not exist in the state of Florida, other strategies must play a large role in reducing the transmission of HIV among IDUs. In order to effectively communicate with IDUs about needle safety, it is necessary to understand the practices and culture of IDUs, including where and how the needle/syringes are obtained and used. Data from recent studies conducted in Miami and other local sites indicate that IDUs inject frequently, averaging more than 1,000 per year, per person. While the vast majority of IDUs feel it is very important to clean needles and to use a needle only one time, these sentiments are not always practiced. Furthermore, data indicate that the context where shooting takes place must be considered in the planning of HIV risk reduction interventions. These findings suggest the importance of understanding patterns of drug use, attitudes toward intervention, and the cultural context where risky behaviors occur. Although Needle Exchange Programs are illegal in Florida, intervention programs must still stress the importance of using only new needles, but since new needles cannot always be obtained, IDUs should be taught and motivated not to use contaminated drug paraphernalia.     

Life circumstances, lifestyles and oral health among older Canadians

Nucleation, growth and aggregation are thought to be the most important crystallization processes in stone formation. Since crystallization properties change with urinary dilution, centrifugation and filtration, crystallization should always be studied in freshly voided and not pretreated urine. Recently we developed an automated method where calcium oxalate crystallization is induced in native urine by an exogenous oxalate load and nucleation and growth are monitored by an ion-selective calcium electrode. The method has now been supplemented with the spectrophotometric measurement of crystal aggregation. Repeated experiments in the same urine with different oxalate loads enable the determination of the critical oxalate additionable to induce crystallization (metastable limit) and the calculation of an oxalate load-independent growth rate constant. Preliminary results obtained in the native urine of healthy controls showed an extremely high limit of metastability and a complete absence of crystal aggregation. These findings may explain why, despite frequent urinary calcium oxalate supersaturation, healthy people do not form stones.     

On the use of analytic approximations for describing the macroscopic heat flow during solidification

In this paper both conceptual and numerical analyses of the integral profile method as applied to solidification problems are conducted. Two important examples are considered,viz. a case where the nonsteady state exact solution of the thermal field is known and a thermal analysis of continuous casting. It is shown that the method as it was generalized by Hills may lead in the latter case to serious contradictions with basic thermodynamic principles. It is also shown that the method developed by Tien using a different set of boundary conditions is unsuitable for treating general solidification problems. It is thus concluded that approximate solutions of the thermal field during solidification must be evaluated under rather severe boundary conditions.     

Reaction: In defense of the "artificial."

Much of the analog research in the Journal of Counseling Psychology is accused of being artificial. The present author argues that immediate application of findings is not always a priority. Rather, theoretical understanding may be a legitimate goal, in which validity is not important or meaningful. A preoccupation with immediate application can lead investigators to dismiss important research. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of documented assessment of postoperative pain

Documented assessment of pain does increase patient satisfaction in pain control and treatment but it must be carried out regularly and, more importantly, it must be acted upon. Patients who participate in documented assessment of pain postoperatively may find it easier to communicate their pain levels to the nurse, may feel more informed about their treatment and may be given analgesia more quickly than a control group. Nurses are aware of the importance of pain intensity assessment but do not always assess the effectiveness of the analgesia given. Each individual's perception of pain is unique and the desired amount of relief from pain is infinitely variable. Pain cannot be treated or controlled if it is not accurately assessed. Any information given before surgery decreases anxiety levels and therefore lessens the patient's perception of pain postoperatively, particularly when the information is related to how and where the patient may feel pain. The use of documented pain assessment combined with patient-controlled analgesia systems may be the key to effective postoperative pain control.     

Acquired conditions that lead to osteoarthritis in the dog

There are many acquired arthopathies that will result in some degree of osteoarthritis, even after proper management. Once the articular cartilage is damaged, it is unlikely that the architecture of the original cartilage surface will return to the normal conditions that existed prior to injury. The purpose of timely and meticulous management of traumatic joint events is to stop the progression of osteoarthritic development. When dealing with articular fractures or other forms of trauma to articular cartilage, three important principles to remember are anatomic reduction of the articular surfaces, stable fixation, and limited weight bearing on the affected limb as soon as possible after surgery. Even after strict adherence to these principles, the pet owner should always be warned that the animal will develop some degree of osteoarthritis in the affected joint at some future time; at that time, chronic medical management may be indicated.     

Preventing Disproportionate Collapse

“Disproportionate collapse” is structural collapse disproportionate to the cause; it is often, though not always, progressive, where “progressive collapse” is the collapse of all or a large part of a structure precipitated by damage or failure of a relatively small part of it. There have been many attempts to develop design guidelines and criteria that would reduce or eliminate the susceptibility of buildings to this form of failure. In recent years, the particular focus has been on the prevention of progressive collapse due to deliberate attack. The present study suggests, however, that these guidelines and criteria may be of limited value. Arguably the most important deficiency in the state of the art of design to prevent disproportionate or progressive collapse is uncertainty about the design event: We have the technology now to design for almost anything, but most recent building failures due to explosions and terrorist attacks have involved insults to the building not anticipated in design guidelines and criteria.     

Bioimpedance spectrometry in the determination of body water compartments: accuracy and clinical significance

Bioelectrical impedance analysis (BIA) offers the potential for a simple, portable and relatively inexpensive technique for the in vivo measurement of total body water (TBW). The potential of BIA as a technique of body composition analysis is even greater when one considers that body water can be used as a surrogate measure of lean body mass. However, BIA has not found universal acceptance even with the introduction of multi-frequency BIA (MFBIA) which, potentially, may improve the predictive accuracy of the measurement. There are a number of reasons for this lack of acceptance, although perhaps the major reason is that no single algorithm has been developed which can be applied to all subject groups. This may be due, in part, to the commonly used wrist-to-ankle protocol which is not indicated by the basic theory of bioimpedance, where the body is considered as five interconnecting cylinders. Several workers have suggested the use of segmental BIA measurements to provide a protocol more in keeping with basic theory. However, there are other difficulties associated with the application of BIA, such as effects of hydration and ion status, posture and fluid distribution. A further putative advantage of MFBIA is the independent assessment not only of TBW but also of the extracellular fluid volume (ECW), hence heralding the possibility of being able to assess the fluid distribution between these compartments. Results of studies in this area have been, to date, mixed. Whereas strong relationships of impedance values at low frequencies with ECW, and at high frequencies with TBW, have been reported, changes in impedance are not always well correlated with changes in the size of the fluid compartments (assessed by alternative and more direct means) in pathological conditions. Furthermore, the theoretical advantages of Cole-Cole modelling over selected frequency prediction have not always been apparent. This review will consider the principles, methodology and applications of BIA. The principles and methodology will be considered in relation to the basic theory of BIA and difficulties experienced in its application. The relative merits of single and multiple frequency BIA will be addressed, with particular attention to the latter's role in the assessment of compartmental fluid volumes.     

Viable Cryptosporidium parvum oocysts exposed to chlorine or other oxidising conditions may lack identifying epitopes

The intestinal protozoan parasite Cryptosporidium parvum is a known cause of water-borne disease in humans. The detection of Cryptosporidium oocysts in water samples relies upon the use of fluorescently labelled antibodies, preferably using flow cytometry and epifluorescence microscopy. Here we demonstrate that four commercially available antibodies recognise a similar set of immunodominant epitopes on the oocyst wall. These epitopes appear to be carbohydrate in nature and are labile to chlorine treatment and oxidising conditions. Sodium hypochlorite and sodium meta-periodate reduced the ability of the antibodies to detect Cryptosporidium oocysts. Damage to the epitopes did not necessarily reduce the viability of oocysts. This finding may be important for the water industry, where naturally occurring oxidising conditions or sanitizing treatments could produce viable oocysts that are undetectable using standard protocols.     

Influence of alloying by nitrogen on the strength and austenite stability of X18H10 steel

The strengthening and change in austenite stability when steel of X18H10 type alloyed by nitrogen are investigated, for applications where corrosion-resistant structural steel must operate satisfactorily at both high and cryogenic temperatures. Alloying by nitrogen may be regarded as a promising means of increasing the strength and stability of austenitic stainless steel. Preliminary cold or hot working increases the likelihood of martensite formation under load and consequently limits the working temperature range of the steel. High-strength nonmagnetic nitrogen steel based on X18AH10 steel with up to 0.22% N may be used for undeformable components at cryogenic temperatures. Without nitrogen, deformational martensite is always formed in such steel at temperatures below ?70°C. High strength, plasticity, and ductility may only be ensured in such steel by means of the TRIP effect or reduction in the grain size. Nitrogen effectively strengthens the solid solution in the high-temperature state. The use of combined high-temperature deformation and moderate-temperature deformation permits additional strengthening of the steel during thermomechanical treatment, including strain aging, which is effective where thermostable steel is required.     

Pavlovian conditioning of agonistic behavior in male threespine stickleback (Gasterosteus aculeatus)

The red coloration of male stickleback (Gasterosteus aculeatus) possesses signal value in male-male interactions. Therefore, it was predicted that males would learn to associate a red signal more readily than a green signal with a conspecific rival in a Pavlovian conditioning experiment. Males were presented red and green signal lights where one signal was always paired with presentation of a rival (excitatory conditioned stimulus, CS+) and one signal was never paired with presentation of a rival (nonreinforced stimulus, CS-). Males learned the task rapidly, showing conditioned approach and zigzag responses, but CS+ vs. CS- differentiation persisted, even after a prolonged extinction period. In addition, there were no differences in learning rates between fish trained to the red signal as the CS+ and fish trained to the green signal as the CS+. The results suggest that, although males may rapidly learn about rivals, they are not predisposed to associated red (over green) with the appearance of a rival under the conditions of this experiment. Because males must establish and maintain territories in order to nest and mate, learning about neighboring rivals may be an adaptive mechanism by which males more effectively defend their territories and thereby increase their reproductive fitness.     

Effects of ventilation on hyaluronan and protein concentration in pleural liquid of anesthetized and conscious rabbits

Use of animal power generally enables farmers in sub-Saharan Africa to increase agricultural production and improve the quality of life. Effective use of working animals depends on an understanding of the capabilities of the animals for work, their husbandry requirements and the factors which can influence their performance. These issues are reviewed in this paper in the context of the use of animal power in agriculture in sub-Saharan Africa. The type of animal used for work determines power available to the farmer. The performance of donkeys, horses and cattle have been compared in work tests. Equids are more suited to rapid low draught activities where their faster speed can be used to advantage. At higher draught forces, where speed is less important, the additional weight and power of cattle are an advantage. Use of heart rate recovery after work gives a reasonable indication of fatigue and fitness of equids, when test conditions are standardized. Although feed requirements for work are generally low, feed quality can be so poor that animals are unable to eat enough to meet energy needs for work, and so lose weight during the work season. However, improvements in work performance are not always seen following supplementary feeding in the dry season and the economics need to be considered in each case. Food availability, diseases and heat stress, the major constraints to performance of draught cattle and donkeys working in sub-Saharan Africa, are discussed.     

Roentgenologic symptomatology of cardiomyopathies (author's transl)

In a material of 162 patients with different types of cardiomyopathy it was found that the standard chest radiograms could give important contributions to the diagnosis of the disease. The two main groups hypertrophic and other cardiomyopathy could in most instances be separated from each other. Nearly all patients had an abnormal chest radiogram when first studied. A positive roentgen diagnosis no standard chest examination supports a clinically suspected diagnosis of cardiomyopathy and should be possible in at least 80% of the patients. Angiocardiography can always provide the diagnosis in unclear cases and gives details of anatamy and function of the left and right ventricles in patients where surgical intervention of an intraventricular obstruction is contemplated.     

Uptake and transport by the ovine placenta of neutral nonmetabolizable amino acids with different transport system affinities

In 32 published reports in surgical patients, the preponderance of evidence from standard clinical measures of renal function (BUN and Cr) indicates the absence of renal toxicity following sevoflurane anesthesia. Studies of surgical patients receiving intermediate-duration sevoflurane with high or low fresh gas flow and long-duration sevoflurane with high fresh gas flow included sensitive measures of renal function and/or injury, which also indicate the absence of renal toxicity following sevoflurane anesthesia. Studies of surgical patients receiving long-duration sevoflurane with low fresh gas flow did not include sensitive measures. Seven studies in volunteers are not directly relevant to clinical practice but do raise the issue of whether it is important to apply sensitive measures of renal function and/or injury such as urine concentrations and/or excretion of NAG, beta 2M, alpha 1M, AAP, alpha GST, pi GST, gamma GTP, albumin, protein, and glucose and Cr clearance. Two studies of volunteers receiving prolonged sevoflurane anesthesia with fresh gas flow no greater than 2 L/min concluded that the potential for adverse renal effects of sevoflurane may exist. The other studies of volunteers did not. In 14 published reports of surgical patients in special conditions, the preponderance of evidence from standard clinical measures of renal function indicates the absence of renal toxicity. Studies with sensitive measures have been reported for some conditions where the kidney may be at increased risk (e.g., sevoflurane-induced hypotension, advanced age, and renal insufficiency and failure), are incomplete in others (e.g., hypertension and ischemic heart disease), and are missing in others (e.g., morbid obesity). Studies with sensitive measures of renal function and/or injury are also missing in an important group where the kidney may not be at increased risk--pediatric patients. Studies of other risk conditions, such as temporary ischemia, hemorrhagic hypotension, nephrotoxic antibiotics, kidney transplantation, and diabetes may provide additional information about the renal effects of sevoflurane.     

Detailed Study of Binary Law for Open Channels

This paper presents a generalized version of the binary velocity distribution law, which combines the logarithmic law of the inner region with the parabolic law of the outer region. This combination is extended for cases of flow where the maximum velocity occurs at some distance below the free surface in a vertical. The study uses the data collected at the Indian Institute of Science over a long period for all of the four regimes of turbulent open channel flow, namely, subcritical smooth, supercritical smooth, subcritical rough, and supercritical rough. The various conditions and limitations at the junction point of the inner and outer region are derived and discussed in this paper. It is shown that the velocity distribution for the flows of narrow open channels can be described by the logarithmic law for the inner region and the parabolic law for the outer region, but the conditions at the junction point will not always be the same.     

How to institute and develop a strategic marketing plan for your pediatric dental office

As what may be the most important element in a successful pediatric dental practice, marketing is often misunderstood. It requires careful planning and a long-term commitment. Before implementing your marketing plan, understand the definition of marketing and what it will mean to your practice. To develop your plan, ask yourself several important questions that will help you analyze where you are now, as well as where you want to be. Then, promote your practice by incorporating 12 important qualities into your plan. The plan is the blueprint for your efforts to repeatedly, consistently, and positively communicate with your market for the long term.