Definitions, Criteria and Global Classification of Mast Cell Disorders with Special Reference to Mast Cell Activation Syndromes: A Consensus Proposal

Activation of tissue mast cells (MCs) and their abnormal growth and accumulation in various organs are typically found in primary MC disorders also referred to as mastocytosis. However, increasing numbers of patients are now being informed that their clinical findings are due to MC activation (MCA) that is neither associated with mastocytosis nor with a defined allergic or inflammatory reaction. In other patients with MCA, MCs appear to be clonal cells, but criteria for diagnosing mastocytosis are not met. A working conference was organized in 2010 with the aim to define criteria for diagnosing MCA and related disorders, and to propose a global unifying classification of all MC disorders and pathologic MC reactions. This classification includes three types of `MCA syndromes' (MCASs), namely primary MCAS, secondary MCAS and idiopathic MCAS. MCA is now defined by robust and generally applicable criteria, including (1) typical clinical symptoms, (2) a substantial transient increase in serum total tryptase level or an increase in other MC-derived mediators, such as histamine or prostaglandin D 2, or their urinary metabolites, and (3) a response of clinical symptoms to agents that attenuate the production or activities of MC mediators. These criteria should assist in the identification and diagnosis of patients with MCAS, and in avoiding misdiagnoses or overinterpretation of clinical symptoms in daily practice. Moreover, the MCAS concept should stimulate research in order to identify and exploit new molecular mechanisms and therapeutic targets. Copyright (C) 2011 S. Karger AG, Base

A systematic review of protocol studies on conceptual design cognition

This paper reports the first systematic review and synthesis of protocol studies on conceptual design cognition. 47 protocol studies from the domains of architectural design, engineering design, and product de-sign engineering were reviewed towards answering the following re-search question: What is our current understanding of the cognitive processes involved in conceptual design tasks carried out by individual designers? Studies were found to reflect three viewpoints on the cognitive nature of designing, namely: design as search; design as ex-ploration; and design activities. Synthesising the findings of individual studies yielded a classification of cognitive processes involved in con-ceptual design tasks, described in different terms across different viewpoints. Towards a common terminology, these processes are posi-tioned within the cognitive psychology literature, revealing seven basic types of process that appear to be fundamental to designing across all viewpoints: memory (working and long term); visual perception; men-tal imagery; attention; semantic association; cognitive control; and higher-order processes, e.g. analysis and reasoning. The development of common cognitive models of conceptual design, grounded in a sci-entifically rigorous understanding of design cognition, is identified as an avenue for future research

Modeling of liquid flow in surface discontinuities

Polymer composite and metallic materials have found wide application in various industries such as aviation, rocket, car manufacturing, ship manufacturing, etc. Many design elements need permanent quality control. Ensuring high quality and reliability of products is impossible without effective nondestructive testing methods. One of these methods is penetrant testing using penetrating substances based on liquid penetration into defect cavities. In this paper, we propose a model of liquid flow to determine the rates of filling the defect cavities with various materials and, based on this, to choose optimal control modes

Prevalence of Cervical Dysplasia and Associated Risk Factors among Women Presenting at a Primary Care Clinic in Nigeria

Background: Cervical cancer is a global burden, with increasing incidence and mortality especially in developing countries where there are no clearly define national protocols or guidelines for effective screening and prompt treatment of cervical dysplasia (precancerous condition of the cervix). Most screening facilities are located in the tertiary hospitals, which are mostly not readily accessible to patients because of fear and bureaucracy of accessing services at these tertiary hospitals. In Nigeria, cervical cancer is the second most common female malignancy after breast cancer and national guidelines on effective screening is not readily available. At the general outpatients’ Clinic, University College Hospital, Ibadan, screening is not well‑established and patients are referred to the gynecology clinic for papanicolaou (Pap) smear, which result in poor compliance as a result of the protocol involved.Aim: To asess the prevalence and risk factors for abnormal cervical cancer screening amongst patients of the Primary Care Clinic at UCH, Ibadan, towards justifying expansion of cervical cancer screening service points in tertiary health institutions in Nigeria.Subjects and Methods: A cross‑sectional study using the self‑administered structured questionnaire on questions relating to the socio‑demographic characteristics and lifestyle behavior including sexual history, after which Pap smear and visual inspection of the cervix with acetic acid were performed. Two hundred and eighty consented women aged 20–65 years were interviewed by one of the researchers between June and August 2012 using interviewer‑administered structured questionnaires. The questionnaire sought information on their sociodemographic characteristics, and lifestyle behavior including sexual history, after which Pap smear and visual inspection of the cervix with acetic acid were done, respectively, for all the respondents at no cost. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 11. Cross‑tabulation was used to explore statistical associations between categorical variables. Variables were summarized using frequency distribution, means, proportions, and findings were presented in tables, histograms and pie charts. Chi‑square statistic was used to assess the association between categorical variables. The level of significance was set at P < 0.05. Result: The mean age of the women was 42.5 (11.1) years, and their modal age was 30–39 years. The majority, 92.2% (258/280) of the women were Yoruba. Two hundred and twenty‑eight (81.4%) of the women were married with majority 149 (65.4%) in the monogamous union. Two hundred and thirteen (76.1%) of the women had abnormal cervical cytology. One hundred and sixty‑six (77.9%) of the women with abnormal cytology had inflammatory smears, 33 (15.5%) and 6 (2.8%) had mild and moderate dysplasia, respectively, while the remaining 8 (3.8%) had atypical cells. The prevalence of cervical dysplasia among all the women was 13.9% (39/280), with mild dysplasia accounting for 11.8% (33/280) of the total population. Atypical smears were found in 2.9% (8/280) of them. Histological findings suggestive of human papillomavirus (HPV) were found in 22 of the 33 (66.7%) women who had mild dysplasia and 1 of the 6 (16.7%) women who had moderate dysplasia. There was significant association between abnormal cervical cytology and age (P = 0.03), as well as suggested HPV infection findings (P < 0.001). Visual inspection of the cervix with 5% acetic acid revealed that 46 of the 280 (16.4%) women had an aceto white area, while a prevalence of 47 (16.8%) was found with Pap smear, though visual inspection was found not to be as sensitive in detecting dysplasia. The prevalence of cervical dysplasia among the women was 13.9%, with mild dysplasia accounting for 11.8% of the total population. Atypical smears were found in 2.9% of them. There was a significant association between abnormal cervical cytology and increasing age (P = 0.03), as well as histological findings of HPV infection (P < 0.001).Conclusion: Cervical dysplasia was found to be a common health problem among women attending the primary care clinic. This underscores the need for the provision of screening service at the clinic and effective health education to promote preventive practices and inculcate screening culture among women.KEY WORDS: Cervical dysplasia, Ibadan, Nigeria, risk factors, wome

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Quality of life assessment as a predictor of survival in non-small cell lung cancer

<p>Abstract</p> <p>Background</p> <p>There are conflicting and inconsistent results in the literature on the prognostic role of quality of life (QoL) in cancer. We investigated whether QoL at admission could predict survival in lung cancer patients.</p> <p>Methods</p> <p>The study population consisted of 1194 non-small cell lung cancer patients treated at our institution between Jan 2001 and Dec 2008. QoL was evaluated using EORTC-QLQ-C30 prior to initiation of treatment. Patient survival was defined as the time interval between the date of first patient visit and the date of death from any cause/date of last contact. Univariate and multivariate Cox regression evaluated the prognostic significance of QoL.</p> <p>Results</p> <p>Mean age at presentation was 58.3 years. There were 605 newly diagnosed and 589 previously treated patients; 601 males and 593 females. Stage of disease at diagnosis was I, 100; II, 63; III, 348; IV, 656; and 27 indeterminate. Upon multivariate analyses, global QoL as well as physical function predicted patient survival in the entire study population. Every 10-point increase in physical function was associated with a 10% increase in survival (95% CI = 6% to 14%, p < 0.001). Similarly, every 10-point increase in global QoL was associated with a 9% increase in survival (95% CI = 6% to 11%, p < 0.001). Furthermore, physical function, nausea/vomiting, insomnia, and diarrhea (p < 0.05 for all) in newly diagnosed patients, but only physical function (p < 0.001) in previously treated patients were predictive of survival.</p> <p>Conclusions</p> <p>Baseline global QoL and physical function provide useful prognostic information in non-small cell lung cancer patients.</p

Why caretakers bypass Primary Health Care facilities for child care - a case from rural Tanzania

<p>Abstract</p> <p>Background</p> <p>Research on health care utilization in low income countries suggests that patients frequently bypass PHC facilities in favour of higher-level hospitals - despite substantial additional time and financial costs. There are limited number of studies focusing on user's experiences at such facilities and reasons for bypassing them. This study aimed to identify factors associated with bypassing PHC facilities among caretakers seeking care for their underfive children and to explore experiences at such facilities among those who utilize them.</p> <p>Methods</p> <p>The study employed a mixed-method approach consisting of an interviewer administered questionnaires and in-depth interviews among selected care-takers seeking care for their underfive children at Korogwe and Muheza district hospitals in north-eastern Tanzania.</p> <p>Results</p> <p>The questionnaire survey included 560 caretakers. Of these 30 in-depth interviews were conducted. Fifty nine percent (206/348) of caretakers had not utilized their nearer PHC facilities during the index child's sickness episode. The reasons given for bypassing PHC facilities were lack of possibilities for diagnostic facilities (42.2%), lack of drugs (15.5%), closed health facility (10.2%), poor services (9.7%) and lack of skilled health workers (3.4%). In a regression model, the frequency of bypassing a PHC facility for child care increased significantly with decreasing travel time to the district hospital, shorter duration of symptoms and low disease severity.</p> <p>Findings from the in-depth interviews revealed how the lack of quality services at PHC facilities caused delays in accessing appropriate care and how the experiences of inadequate care caused users to lose trust in them.</p> <p>Conclusion</p> <p>The observation that people are willing to travel long distances to get better quality services calls for health policies that prioritize quality of care before quantity. In a situation with limited resources, utilizing available resources to improve quality of care at available facilities could be more appropriate for improving access to health care than increasing the number of facilities. This would also improve equity in health care access since the poor who can not afford travelling costs will then get access to quality services at their nearer PHC facilities.</p

High Resolution In Vivo Bioluminescent Imaging for the Study of Bacterial Tumour Targeting

The ability to track microbes in real time in vivo is of enormous value for preclinical investigations in infectious disease or gene therapy research. Bacteria present an attractive class of vector for cancer therapy, possessing a natural ability to grow preferentially within tumours following systemic administration. Bioluminescent Imaging (BLI) represents a powerful tool for use with bacteria engineered to express reporter genes such as lux. BLI is traditionally used as a 2D modality resulting in images that are limited in their ability to anatomically locate cell populations. Use of 3D diffuse optical tomography can localize the signals but still need to be combined with an anatomical imaging modality like micro-Computed Tomography (μCT) for interpretation

Evolutionary Substitution and Replacement in N-Species Lotka-Volterra Systems

The successful invasion of a multi-species resident system by mutants has received a great deal of attention in theoretical ecology but less is known about what happens after the successful invasion. Here, in the framework of Lotka-Volterra (LV) systems, we consider the general question where there is one resident phenotype in each species and the evolutionary outcome after invasion remains one phenotype in each species but these include all the mutant phenotypes. In the first case, called evolutionary substitution, a mutant appears in only one species, the resident phenotype in this species dies out and the mutant coexists with the original phenotypes of the other species. In the second case, called evolutionary replacement, a mutant appears in each species, all resident phenotypes die out and the evolutionary outcome is coexistence among all the mutant phenotypes. For general LV systems, we show that dominance of the resident phenotype by the mutant (i.e. the mutant is always more fit) in each species where the mutant appears leads to evolutionary substitution/replacement. However, it is shown by example that, when dominance is weakened to only assuming the average fitness of the mutants is greater than the average for the resident phenotype, the residents may not die out. We also show evolutionary substitution occurs in two-species competitive LV systems when the initial invasion of the resident system (respectively, of the new coexistence system) is successful (respectively, unsuccessful). Moreover, if sequential evolutionary substitution occurs for either order that the two mutant phenotypes appear (called historically independent replacement), then it is shown evolutionar