Atom probe tomography of a Ti-Si-Al-C-N coating grown on a cemented carbide substrate.

The elemental distribution within a Ti-Si-Al-C-N coating grown by physical vapour deposition on a Cr-doped WC-Co cemented carbide substrate has been investigated by atom probe tomography. Special attention was paid to the coating/substrate interface region. The results indicated a diffusion of substrate binder phase elements into the Ti-N adhesion layer. The composition of this layer, and the Ti-Al-N interlayer present between the adhesion layer and the main Ti-Si-Al-C-N layer, appeared to be sub-stoichiometric. The analysis of the interlayer showed the presence of internal surfaces, possibly grain boundaries, depleted in Al. The composition of the main Ti-Al-Si-C-N layer varied periodically in the growth direction; layers enriched in Ti appeared with a periodicity of around 30 nm. Laser pulsing resulted in a good mass resolution that made it possible to distinguish between N(+) and Si(2+) at 14 Da.

Expressive vocabulary of children with hearing loss in the first 2 years of life: impact of early intervention.

OBJECTIVE: The aim of this study was to determine the expressive vocabulary of children with hearing loss (HL) enrolled in early intervention (EI) ≤ 3 vs >3 months in the first 24 months and to compare with hearing controls. It was hypothesized that the number of words produced would be higher for children with HL enrolled in EI ≤ 3 vs >3 months. STUDY DESIGN: This is a prospective longitudinal matched cohort study. RESULT: The children with HL produced fewer words than the children with hearing. In addition, children with HL enrolled in EI ≤ 3 months had a larger expressive vocabulary percentile score compared with children with HL enrolled >3 months. Children with mild HL enrolled in EI ≤ 3 months had the greatest growth in vocabulary between 12 to 16 and 18 to 24 months. CONCLUSION: Although multiple factors are associated with expressive vocabulary growth of children with HL, enrollment in EI ≤ 3 months has sustained beneficial effects on expressive vocabulary at 18 to 24 months.

Growth patterns and the risk of breast cancer in women.

Adult height and body mass index (BMI) influence the risk of breast cancer in women. Whether these associations reflect growth patterns of the fetus or growth during childhood and adolescence is unknown. We investigated the association between growth during childhood and the risk of breast cancer in a cohort of 117,415 Danish women. Birth weight, age at menarche, and annual measurements of height and weight were obtained from school health records. We used the data to model individual growth curves. Information on vital status, age at first childbirth, parity, and diagnosis of breast cancer was obtained through linkages to national registries. During 3,333,359 person-years of follow-up, 3340 cases of breast cancer were diagnosed. High birth weight, high stature at 14 years of age, low BMI at 14 years of age, and peak growth at an early age were independent risk factors for breast cancer. Height at 8 years of age and the increase in height during puberty (8-14 years of age) were also associated with breast cancer. The attributable risks of birth weight, height at 14 years of age, BMI at 14 years of age, and age at peak growth were 7%, 15%, 15%, and 9%, respectively. No effect of adjusting for age at menarche, age at first childbirth, and parity was observed. Birth weight and growth during childhood and adolescence influence the risk of breast cancer.

Improved synthesis and characterization of 1,3,4,6-tetra-O-acetyl-2-(N-acetylacetamido)-2-deoxy-beta-D-glucopyranose.

A method from the 1960s to synthesize the N,N-diacetyl derivative of peracetylated beta-D-glucosamine was improved by assistance of molecular sieves. The melting point of the title compound was revised and the structure determined by means of X-ray diffraction.

Preparation, crystal structure, and spectroscopic characterization of [(Se(2)SN(2)Cl](2).

The reaction of [(Me(3)Si)(2)N](2)S with an equimolar amount of SeCl(4) in dioxane at 50 degrees C affords [(Se(2)SN(2))Cl](2) (1) in excellent yield. Crystals of 1 are orthorhombic, space group Pbca, with a = 8.5721(7) A, b = 7.8336(6) A, c = 15.228(1) A, and Z = 8. The crystal structure contains two planar Se(2)SN(2)(*)(+) rings which are linked by intermolecular Se.Se interactions [d(Se-Se) = 3.0690(7) A]. The EI mass spectrum shows Se(2)SN(2)(*)(+) as the fragment of highest mass. Both the (14)N and (77)Se NMR spectra show a single resonance (-52 and 1394 ppm, respectively). The solid [(Se(2)SN(2))Cl](2) gives a strong ESR signal indicating the presence of a Se(2)SN(2)(*)(+) radical. The Raman spectrum was assigned through normal coordinate treatment involving a general valence force field. The vibrational analysis yielded a good agreement between the observed and calculated wavenumbers.

Insomnia and depressive symptoms in patients with Parkinson's disease. Relationship to health-related quality of life. An interview study of patients living at home.

The objectives of this study were to describe the prevalence of insomnia and depressive symptoms in patients with Parkinson's disease (PD) and to relate those symptoms to health-related quality of life. A total of 102 patients living at home, most of them moderately to severely disabled, were interviewed. Of them 43 patients were women with a mean age of 70 (range 58-79). The mean age for the men was 71 (range 56-80). Time since diagnosis was <2 years for 57%, 2-10 years for 31% and >10 years for 12%. The geriatric depression scale (GDS) and Livingston's insomnia scale were used. The results were related to quality of life as measured with the SF-36 health survey. The prevalence of insomnia was 80%. Moderate depressive symptoms were found in 47% and severe depressive symptoms in 5%. Patients with insomnia or with depressive symptoms had a significantly impaired quality of life on all eight scales of the SF-36. In a stepwise regression analysis the presence of pain and ache and depressive symptoms were significantly related to insomnia. The variables most related to depressive symptoms were Hoehn and Yahr group and insomnia. Hoehn and Yahr groups (more disability) were significantly related to insomnia and depressive symptoms. Thus, insomnia and depressive symptoms are prevalent in PD and influence quality of life and should, therefore, be considered when evaluating patients with PD.

[Balloon catheter endometrial thermotherapy in menorrhagia. New simple and safe alternative to hysterectomy]. / Värmebehandling av endometriet med ballongkateter vid menorragi. Nytt, enkelt och säkert alternativ till hysterektomi.

Thermal endometrial ablation by means of a silicone balloon catheter is a new form of out-patient treatment for menorrhagia, designed to reduce menstrual blood loss by exerting thermal effects on the endometrium and myometrium without damaging surrounding tissue. Follow-up of 116 of the 117 women who underwent the treatment between August 1993 and December 1996 showed the procedure to be well tolerated, to be without immediate complications, and to be associated with significant reductions in menstrual blood volume and in the reported number of bleeding days (P < 0.001 in both cases). At follow-up after 10-49 months, the success rate was 94 per cent. (This excludes women with uterine cavity changes, or submucosal leiomyomas detected at pretreatment ultrasonography, for whom the treatment is not to be recommended.) In addition to its high success rate, the treatment is safe for the patient and easy for the physician to learn.

Community-based injury prevention: effects on health care utilization.

BACKGROUND: Worldwide, an estimated 78 million people are disabled each year because of unintentional injuries and about 3 million die. The WHO Safe Community model is a framework for community-based injury prevention programmes. The aim of this study is to evaluate the outcome on health care utilization of a Safe Community programme. METHODS: The incidence of injuries treated at health care facilities in an intervention municipality (pop. 41,000) was compared to the injury incidence in a control municipality (pop. 26,000). The incidence was recorded immediately before and one year after programme implementation from registrations made during all first-contact health care visits and from examination of hospital discharge registers. RESULTS: The incidence of health care treated injuries in the intervention area had decreased by 13% (95% CI: 9-16%) from 119 (95% CI: 115-122) per 1000 population-years to 104 (95% CI: 101-107). In the control area, the corresponding injury incidences were 104 (95% CI: 100-108) and 106 (95% CI: 102-109). The hospital-treated injuries in the intervention area decreased by 15% (95% CI: 7-24%) from 19 (95% CI: 17-20) per 1000 population-years to 16 (95% CI: 15-17), while in the control area, the incidences remained at 13 (95% CI: 11-14) per 1000 population-years. Utilization of acute care in the intervention area for reasons other than injuries increased by 8% (95% CI: 6-10%), while in the control area, the number of visits did not show significant change. CONCLUSION: This first controlled evaluation showed that an injury prevention programme based on local action groups can significantly reduce injuries requiring health care in a community. Local prevention can provide a complement to national level campaigns.

Discovery of a Met300Val variant in Shc and studies of its relationship to birth weight and length, impaired insulin secretion, insulin resistance, and type 2 diabetes mellitus.

The Shc adaptor proteins corresponding to the 46-, 52-, and 66-kDa isoforms are key transducers of growth promotion and gene expression, which are being phosphorylated by all known receptor tyrosine kinases after stimulation by growth factors such as insulin and insulin-like growth factor I. Several studies have demonstrated a relationship between intrauterine growth retardation and impaired glucose tolerance or type 2 diabetes later in life. It is unclear whether this finding is partially explained by genetic factors. In this context, abnormalities in Shc proteins are considered to be a plausible candidate. Therefore, the aim of this study was to analyze whether genetic variability of the Shc isoforms causes a decrease in cell growth and cell differentiation that could be manifested by a decrease in birth weight and length, impaired acute insulin secretion after i.v. glucose, insulin resistance, and eventually a higher prevalence of type 2 diabetes. By single strand conformation polymorphism-heteroduplex analysis of 70 patients with diabetes mellitus and subsequent nucleotide sequencing of identified single strand conformation polymorphism variant, we discovered a Met300Val substitution of the 52-kDa isoform. The amino acid variant was predicted to be present in all 3 isoforms of Shc. In a genotype-phenotype study of 360 young healthy subjects, the allelic frequency of the codon 300 polymorphism was 4.2%. In this cohort, no significant differences could be shown between carriers and noncarriers in birth weight and length, the acute insulin response to i.v. glucose, or the insulin sensitivity index, as estimated from an i.v. glucose tolerance test. In an association study of 313 type 2 diabetic patients and 226 matched glucose-tolerant subjects, there was no significant difference in allelic frequency of the Shc variant (5.1% in diabetic patients vs. 3.1% in control subjects; P = 0.11). In conclusion, by itself the Met300Val polymorphism of Shc has no major impact on birth weight and length, insulin sensitivity index, acute glucose-induced insulin secretion, or prevalence of random type 2 diabetes mellitus.

Common amino acid substitutions in insulin receptor substrate-4 are not associated with Type II diabetes mellitus or insulin resistance.

The family of insulin receptor substrates (IRS1-4) is defined by proteins with an overall similar structure. IRS-1 and IRS-2 have been shown to have key roles in cellular transmission of the action of insulin, insulin-like growth factor-1 and various cytokines. We have previously identified amino acid polymorphisms in the human IRS-1 and IRS-2 proteins. Given the documented importance of IRS-1 and -2 in insulin signalling and the implications of distribution of these genes for the pathogenesis of insulin resistance and diabetes, we decided that the most recently identified member of the IRS family, IRS-4, was a relevant candidate to examine for genetic variability which might be associated with subsets of diabetes or insulin resistance. The gene encoding IRS-4 was analysed by the single strand conformation polymorphism technique in 83 Danish Caucasians with Type II (non-insulin-dependent) diabetes mellitus. Five amino acid polymorphisms were identified: Leu34Phe, Arg411Gly, Gly584Cys, His879Asp and Lys883Thr. In an association study of 324 patients with Type II diabetes and 267 control subjects with normal glucose tolerance the polymorphism at codon 34 was found with allelic frequencies of 3.9 and 2.3 %, respectively, the variant at codon 411 with allelic frequencies of 3.9 and 5.6%, respectively, and the variant at codon 879 with frequencies of 19.2 and 18.0%, respectively. Each carrier of the codon 34 polymorphism was also a carrier of the codon 411 and codon 879 variants and similarly, carriers of the variant at codon 411 were also carriers of the polymorphism at codon 879. The variants at codon 584 and 883 were each found in only one Type II diabetic patient. The allelic frequencies of the variants at codon 411 and 879 were also determined in 380 young healthy subjects (4.6 and 18.1 %, respectively). The insulin sensitivity index as estimated by Bergman's minimal model of the young healthy subjects carrying either polymorphism was indistinguishable from the carriers of wild-type IRS-4. Moreover, none of the men were heterozygous for the IRS-4 polymorphisms indicating that the gene is located on the X-chromosome. In conclusion, amino acid polymorphisms in human IRS-4 are common in Caucasians but are not associated with Type II diabetes or with insulin resistance in young healthy subjects.

Thermal conductivity of uterine tissue in vitro.

Thermotherapy of the uterus has emerged as an alternative to hysterectomy in the treatment of menorrhagia, from whence it follows that the thermal properties of uterine tissue have become of importance. This study presents measurements of the thermal conductivity and the water content of uterine tissue in vitro. A steady-state thermal conductivity apparatus, based on the comparison of test samples with a material with known thermal conductivity, is described. Measurements were conducted on tissue samples from eleven patients, directly after hysterectomy. Samples with and without endometrium, as well as coagulated samples, were examined. The thermal conductivity of myometrial tissue was found to be 0.536 +/- 0.012 W m(-1) K(-1) (mean +/- 1 SD) and the corresponding water content was 81.2 +/- 1.5% (mean +/- 1 SD). Measurements on samples with both endometrium and myometrium showed similar thermal conductivity (0.542 +/- 0.008 W m(-1) K(-1), mean +/- 1 SD) and water content (81.6 +/- 0.7%, mean +/- 1 SD). It was also indicated that coagulation causes dehydration, resulting in a lower thermal conductivity.

The source and fate of Pb in contaminated soils at the urban area of Falun in central Sweden.

For centuries the city of Falun in central Sweden has been an important industrial region of copper mining, producing sulphuric acid and paint pigment. The mining and chemical industries have generated vast amounts of wastes which have been deposited around the areas. A large part of the city is now built on the wastes. In the last two decades, significant amounts of work on the waste management have been conducted. Previous investigations showed that the soils of the urban areas have been contaminated by the wastes with a rather high level of lead (Pb). What is the speciation of soil-Pb? How does the Pb reach the biosphere? This paper gives answers toward these environmental problems. This study investigates the distribution of Pb in the urban soils by means of chemical and mineralogical methods the quantity and quality of the fallout particles; and traces the potential sources of contamination. The data indicate that in Falun urban soil-Pb speciation, many mainly be associated with some mineral phases, e.g. Fe and Mn oxides, sulphides, Pb-carbonates, as well as retained by organic matters and clay minerals. The concentrations of water soluble Pb are very low. Because of the properties of the Pb-bearing phases, the high concentrations of soil-Pb in the urban area are not likely to have a significant affect on the blood-Pb levels of pre-school children living in the urban areas. Lead and arsenic are found to be associated with iron oxides in the fallout particles collected in the areas. These fine grained particles may have been distributed through wind-related transportation from the industrial wastes dumped in the areas.

Endometrial thermal coagulation--degree of uterine fibrosis predicts treatment outcome.

OBJECTIVE: To study the uterine cavity after thermal endometrial destruction for the treatment of menorrhagia by means of a balloon catheter, the Cavaterm system. To relate the appearance of the uterine cavity to the outcome of the treatment. METHODS: Fifty-one of the first 60 women treated with balloon endometrial destruction were examined with hysteroscopy and saline infusion sonography 11-28 months after treatment. RESULTS: Patients with minimal or no bleeding after thermal endometrial destruction had more uterine fibrosis than patients bleeding more. CONCLUSION: The greater the degree of fibrosis of the uterine cavity after balloon endometrial destruction by thermal coagulation, the better the effect on menorrhagia.

The WHO safe community program for injury prevention: evaluation of the impact on injury severity.

Despite the fact that injuries consume a considerable amount of health care resources world-wide, 3.5 million people die from unintentional injuries each year. To handle this central public health problem, WHO has introduced the Safe Community accreditation for injury prevention programs. This study was to investigate the impact from a Safe Community program with regard to injury severity. Data were collected in Motala municipality (population = 41,000), Ostergötland county, Sweden, during one year before and one year after program intervention, from two sources: registration of trivial (AIS 1) and non-trivial (AIS 2-6) unintentional injuries from all acute care episodes in the area and recollection of hospital bed days from discharge registers. The incidence of non-trivial injuries treated in health care was found to have decreased by 41% (95% confidence interval, 37-45%), while the trivial injuries increased by 16% (9-22%). The larger decrease of non-trivial injuries was observed in all ages and injury event environments. The total number of bed days at emergency hospitals due to injuries decreased by 39% (37-41%) from 1983-84 to 1989, while the hospital bed utilization for other reasons decreased by 9% (8-9%). The study showed the implementation of a WHO Safe Community program led to the harm from unintentional injuries within the community being considerably more reduced than that of the injury incidence. In future assessments of injury prevention programs, classification of injury severity should be included to increase the validity of inter-program comparisons.

Knowledge discovery and case based reasoning in health promotion: development of a help-desk for prevention of occupational injuries.

This paper presents the concepts, ideas and techniques behind Case Based Reasoning (CBR) in relation to knowledge extraction techniques for health promotion. The ultimate goal is to develop a help-desk service for advice about preventive measures to be taken concerning concrete occupational injury hazards. CBR has been suggested to be a complimentary method to knowledge extraction in order to take direct advantages of large databases for building decision support systems. In this work a database on work injuries is being used to develop a CBR application using a CBR shell-called Recall.

Endometrial destruction by hyperthermia--a possible treatment of menorrhagia. An experimental study.

BACKGROUND: Treatment of menorrhagia by heat-destruction of the endometrium, intended to be an alternative to hysterectomy, was investigated in an experimental study. METHOD: A specially designed catheter (CavatermTM) with a silicone balloon containing a self-regulating containing heating element is inserted into the uterus, filled with glycine to a pressure of around 180 mmHg and heated to about 75 degrees C. We investigated the treatment effect in vitro in five extirpated uteri (series A) and in vivo in three patients treated peroperatively just before hysterectomy, temperatures being monitored in the surrounding tissues (series B). In both series we monitored the following variables: heating-power, balloon-pressure, temperature of the heating element (around 85 degrees C) and the temperatures at five locations from top to bottom of the balloon surface. RESULTS: After 30 min in vitro treatment at 75 degrees C, the endometrium was partly destructed, and condensed. Histological examination showed smooth muscle cells to be destroyed to a depth of 2-5 mm close to the endometrium. With in vivo treatment for 30 min at a heating power of about 20 W (resulting in balloon surface temperatures of 58-65 degrees C), the increases in temperature of the surrounding tissue were too small to measure accurately (+/-1 degree C). Histological examination showed destruction of cells in the corpus uteri to a maximum depth of 8 mm. CONCLUSION: Findings in in vitro and in vivo experiments suggest that 30 min heating of the endometrium to 58-65 degrees C with an intrauterine silicone balloon filled with a liquid to a pressure of 180 mmHg exerts therapeutic effects on both endometrium and uterine cavity smooth muscle cells without damage to surrounding tissues.

Carbon dioxide laser miniconization for treatment of human papillomavirus infection associated with cervical intraepithelial neoplasia.

BACKGROUND: The effect of the carbon dioxide laser miniconization for treatment of cervical intraepithelial neoplasia with concomitant human papillomavirus infection was evaluated. MATERIAL AND METHODS: One hundred and eighteen women with cytologically proven cervical intraepithelial neoplasia stage 1 and/or 2 were investigated with repeat vaginal smear, colposcopy and human papillomavirus DNA sampling. Seventy-five out of 118 women were subjected to laser miniconization or punch biopsy and cervical curettage. RESULTS: Out of 118 patients 37 proved to have positive human papillomavirus DNA with one or more oncogenic types (31.4%). Of these, 32 women were miniconized and five subjected to punch biopsy or cervical curettage. On the first follow-up after miniconization all 32 patients were HPV negative. With follow-up up to five years no recurrences of HPV or dysplasia were seen. CONCLUSION: A miniconization procedure with carbon dioxide laser for treatment of cervical intraepithelial neoplasia proved useful also for simultaneous therapy of concomitant human papillomavirus infection of the uterine cervix.