Transcutaneous electrical nerve stimulation for cancer pain in adults.

Background Cancer-related pain is complex and multi-dimensional but the mainstay of cancer pain management has predominately used a biomedical approach. There is a need for non-pharmacological and innovative approaches. Transcutaneous Electric Nerve Stimulation (TENS) may have a role for a significant number of patients but the effectiveness of TENS is currently unknown. Objectives The aim of this systematic review was to determine the effectiveness of TENS for cancer-related pain in adults. Search strategy We searched The Cochrane Library, MEDLINE, EMBASE, CINAHL, PsychINFO, AMED and PEDRO databases (11/04/08). Selection criteria Only randomised controlled trials (RCTS) investigating the use of TENS for the management of cancer-related pain in adults were included. Data collection and analysis The search strategy identified 37 possible published studies which were divided between two pairs of review authors that decided on study selection. A study eligibility form was used to screen each abstract and where study eligibility could not be determined from the abstract, the full paper was obtained and assessed by one pair of review authors. A standardised data extraction sheet was used to collect information on the studies and the quality of the studies was assessed independently by two review authors using the validated five-point Oxford Quality Scale. Final scores were discussed and agreed between all four review authors. The small sample sizes and differences in patient study populations of the two included studies prevented meta-analysis. Main results Only two RCTs met the eligibility criteria (64 participants). These studies were heterogenous with respect to study population, sample size, study design, methodological quality, mode of TENS, treatment duration, method of administration and outcome measures used. In one RCT, there were no significant differences between TENS and placebo in women with chronic pain secondary to breast cancer treatment. In the other RCT, there were no significant differences between acupuncture-type TENS and sham in palliative care patients; this study was underpowered. Authors' conclusions The results of this systematic review are inconclusive due to a lack of suitable RCTs. Large multi-centre RCTs are required to assess the value of TENS in the management of cancer-related pain in adults

Biochemical diagnosis of ventricular dysfunction in elderly patients in general practice: observational study

Objective: To investigate the usefulness of measuring plasma concentrations of B type natriuretic peptide in the diagnosis of left ventricular systolic dysfunction in an unselected group of elderly people. Design: Observational study. Setting: General practice with four centres in Poole, Dorset. Participants: 155 elderly patients aged 70 to 84 years. Main outcome measures: Diagnostic characteristics of plasma B type natriuretic peptide measured by radioimmunoassay as a test for left ventricular systolic dysfunction assessed by echocardiography. Results: The median plasma concentration of B type natriuretic peptide was 39.3 pmol/l in patients with left ventricular systolic dysfunction and 15.8 pmol/l in those with normal function. The proportional area under the receiver operator curve was 0.85. At a cut-off point of 18.7 pmol/l the test sensitivity was 92% and the predictive value 18%. Conclusions: Plasma concentration of B type natriuretic peptide could be used effectively as an initial test in a community screening programme and, possibly, using a low cut-off point, as a means of ruling out left ventricular systolic dysfunction. It is, however, not a good test to “rule in” the diagnosis, and access to echocardiography remains essential for general practitioners to diagnose heart failure early

Near-infrared and X-ray obscuration to the nucleus of the Seyfert 2 galaxy NGC 3281

We present the results of a near-infrared and X-ray study of the Seyfert 2 galaxy NGC 3281. Emission from the Seyfert nucleus is detected in both regions of the electromagnetic spectrum, allowing us to infer both the equivalent line of sight hydrogen column density, N_H = 71.0(+11.3,-12.3)e26/m^2 and the extinction due to dust, A_V = 22+/-11 magnitudes (90% confidence intervals). We infer a ratio of N_H/A_V which is an order of magnitude larger than that determined along lines of sight in the Milky Way and discuss possible interpretations. We consider the most plausible explanation to be a dense cloud in the foreground of both the X-ray and infrared emitting regions which obscures the entire X-ray source but only a fraction of the much larger infrared source.Comment: 23 pages including 9 figure

Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey

Objective: To assess the prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in the general practice setting by echocardiographic assessment of ventricular function. Design: Cross sectional survey. Setting: Four centre general practice in Poole, Dorset. Subjects: 817 elderly patients aged 70-84 years. Main outcomes: Echocardiographic assessment of left ventricular systolic function including measurement of ejection fraction by biplane summation method where possible, clinical symptoms, and signs of left ventricular dysfunction. Results: The overall prevalence of left ventricular systolic dysfunction was 7.5% (95% confidence interval 5.8% to 9.5%); mild dysfunction (5.0%) was considerably more prevalent than moderate (1.6%) or severe dysfunction (0.7%). Measurement of ejection fraction was possible in 82% of patients (n=667): in patients categorised as having mild, moderate, or severe dysfunction, the mean ejection fraction was 48% (SD 12.0), 38% (8.1), and 26% (7.9) respectively. At all ages the prevalence was much higher in men than in women (odds ratio 5.1, 95% confidence interval 2.6 to 10.1). No clinical symptom or sign was both sensitive and specific. In around half the patients with ventricular dysfunction (52%, 32/61) heart failure had not been previously diagnosed. Conclusions: Unrecognised left ventricular dysfunction is a common problem in elderly patients in the general practice setting. Appropriate treatment with angiotensin converting enzyme inhibitors has the potential to reduce hospitalisation and mortality in these patients, but diagnosis should not be based on clinical history and examination alone. Screening is feasible in general practice, but it should not be implemented until the optimum method of identifying left ventricular dysfunction is clarified, and the cost effectiveness of screening has been shown

Approximate Hermitian-Yang-Mills structures and semistability for Higgs bundles. II: Higgs sheaves and admissible structures

We study the basic properties of Higgs sheaves over compact K\"ahler manifolds and we establish some results concerning the notion of semistability; in particular, we show that any extension of semistable Higgs sheaves with equal slopes is semistable. Then, we use the flattening theorem to construct a regularization of any torsion-free Higgs sheaf and we show that it is in fact a Higgs bundle. Using this, we prove that any Hermitian metric on a regularization of a torsion-free Higgs sheaf induces an admissible structure on the Higgs sheaf. Finally, using admissible structures we proved some properties of semistable Higgs sheaves.Comment: 18 pages; some typos correcte

A simplified picture for Pi electrons in conjugated polymers : from PPP Hamiltonian to an effective molecular crystal approach

An excitonic method proper to study conjugated oligomers and polymers is described and its applicability tested on the ground state and first excited states of trans-polyacetylene, taken as a model. From the Pariser-Parr-Pople Hamiltonian, we derive an effective Hamiltonian based on a local description of the polymer in term of monomers; the relevant electronic configurations are build on a small number of pertinent local excitations. The intuitive and simple microscopic physical picture given by our model supplement recent results, such as the Rice and Garstein ones. Depending of the parameters, the linear absorption appears dominated by an intense excitonic peak.Comment: 41 Pages, 6 postscript figure

Chemical vapor deposition growth

A chemical vapor deposition (CVD) reactor system with a vertical deposition chamber was used for the growth of Si films on glass, glass-ceramic, and polycrystalline ceramic substrates. Silicon vapor was produced by pyrolysis of SiH4 in a H2 or He carrier gas. Preliminary deposition experiments with two of the available glasses were not encouraging. Moderately encouraging results, however, were obtained with fired polycrystalline alumina substrates, which were used for Si deposition at temperatures above 1,000 C. The surfaces of both the substrates and the films were characterized by X-ray diffraction, reflection electron diffraction, scanning electron microscopy optical microscopy, and surface profilometric techniques. Several experiments were conducted to establish baseline performance data for the reactor system, including temperature distributions on the sample pedestal, effects of carrier gas flow rate on temperature and film thickness, and Si film growth rate as a function of temperature

Aircraft requirements for low/medium density markets

A study was conducted to determine the demand for and the economic factors involved in air transportation in a low and medium density market. The subjects investigated are as follows: (1) industry and market structure, (2) aircraft analysis, (3) economic analysis, (4) field surveys, and (5) computer network analysis. Graphs are included to show the economic requirements and the aircraft performance characteristics

Structural insight into the TRIAP1/PRELI-like domain family of mitochondrial phospholipid transfer complexes

The composition of the mitochondrial membrane is important for its architecture and proper function. Mitochondria depend on a tightly regulated supply of phospholipid via intra-mitochondrial synthesis and by direct import from the endoplasmic reticulum. The Ups1/PRELI-like family together with its mitochondrial chaperones (TRIAP1/Mdm35) represent a unique heterodimeric lipid transfer system that is evolutionary conserved from yeast to man. Work presented here provides new atomic resolution insight into the function of a human member of this system. Crystal structures of free TRIAP1 and the TRIAP1–SLMO1 complex reveal how the PRELI domain is chaperoned during import into the intermembrane mitochondrial space. The structural resemblance of PRELI-like domain of SLMO1 with that of mammalian phoshatidylinositol transfer proteins (PITPs) suggest that they share similar lipid transfer mechanisms, in which access to a buried phospholipid-binding cavity is regulated by conformationally adaptable loops

Livestock Producers and Researchers - A Case Study of an Effective Partnership

The Sustainable Grazing Systems Programme (SGS) ran from 1996-2002 with 11 regional producer committees (Regional Producer Network - Simpson et al., 2003) and 6 research sites (National Experiment Andrew & Lodge, 2003) distributed throughout the high rainfall zone of temperate Australia. Each regional committee had a core of producers, with invited scientists and extension practitioners and a paid facilitator. The chair was always a producer and rotated annually. Each regional committee conducted a number of paddock-sized demonstrations of improved grazing management practices on a number of farms within the themes; grazing management and weeds, high input systems, innovative grazing methods for production and the SGS adoption process. Each demonstration was on a producer\u27s property assisted by a local management committee with objective data collected by the regional facilitator. The National research sites investigated the effects of grazing management on sustainable livestock production through five themes; water, nutrients, pastures, animals and biodiversity. Producers had a significant input into the design of the National Experiment and each site had a local advisory committee