EP Group Research Articles

Effect of C/N ratios on the performance of earthworm eco-filter for treatment of synthetics domestic sewage

The performances of filter systems that use earthworms and plants, combined with earthworm eco-filter (EE) systems in treating synthetic domestic sewage (SDS) with different C/N ratios, were investigated for a 9-month period. The effects of the combination of filters, earthworms, plants, as well as the combination of earthworms and plants on SDS nutrient removal efficiency were separately investigated to select the optimum system for treating SDS. The results of the current study could be used to determine how treatment performance responds to different C/N ratios and to explain and predict the performance of an operating EE system. EE systems with earthworms and plants (EP groups) consistently performed better than the other types of systems (CK, E, and P; that is, without earthworms and without plants, with earthworms and without plants, and without earthworms and with plants, respectively) under all C/N ratios. The highest removal efficiencies of chemical oxygen demand, total nitrogen, total phosphorus, and total organic carbon were achieved under C/N ratios of 6:1, 6:1, 6:1, and 9:1, respectively. The optimum nutrient removal efficiency was achieved at C/N = 6, and the contribution order for nutrient removal was EP > P > E > CK. Influent C/N ratios, the time of year, and the synergetic effects of earthworm behavior and microorganisms significantly affected nutrient removal efficiencies. Considering the removal of all nutrients, EE systems with plants and earthworms achieved optimum removal effects in July when the influent C/N ratio was controlled at 6. Appropriate control of carbon and nitrogen source concentrations permitted the achievement of optimal nutrient removal effects.

Effect of diisocyanates on the properties and morphology of epoxy/polyurethane interpenetrating polymer networks

The present work investigates the effect of epoxy resin (EP) modification with polyurethanes (PURs) based on polyethylene glycol and two different diisocyanates: 4,4′-diphenylmethane diisocyanate (MDI) and 2,4-toluene diisocyanate (TDI). The impact strength of the material based on 15 wt% PUR with TDI was enhanced by 130%, while the critical stress intensity factor and the flexural strength of epoxy composition based on 5 wt% PUR with MDI increased by approximately 140% in comparison with unmodified EP. Fourier transform infrared spectroscopy confirmed the occurrence of chemical reaction between the hydroxyl groups of EP and isocyanate groups of PUR, explaining the improvement in the mechanical properties of EP. Moreover, scanning electron micrographs showed a rough surface with plastic yielding and several microcracks in the compositions containing TDI-based PUR and deformed leaf-like morphology with more elongated structure for the EP modified with MDI-based PUR.

Prospective Evaluation of Transcatheter Arterial Chemoembolization (TACE) with Multiple Anti-Cancer Drugs (Epirubicin, Cisplatin, Mitomycin C, 5-Fluorouracil) Compared with TACE with Epirubicin for Treatment of Hepatocellular Carcinoma

To compare the efficacy of transcatheter arterial chemoembolization (TACE) using multiple anticancer drugs (epirubicin, cisplatin, mitomycin C, and 5-furuorouracil: Multi group) with TACE using epirubicin (EP group) for hepatocellular carcinoma (HCC). The study design was a single-center, prospective, randomized controlled trial. Patients with unrespectable HCC confined to the liver, unsuitable for radiofrequency ablation, were assigned to the Multi group or the EP group. We assessed radiographic response as the primary endpoint; secondary endpoints were progression-free survival (PFS), safety, and hepatic branch artery abnormality (Grade I, no damage or mild vessel wall irregularity; Grade II, overt stenosis; Grade III, occlusion; Grades II and III indicated significant hepatic artery damage). A total of 51 patients were enrolled: 24 in the Multi group vs. 27 in the EP group. No significant difference in HCC patient background was found between the groups. Radiographic response, PFS, and 1- and 2-year overall survival of the Multi vs. EP group were 54% vs. 48%, 6.1 months vs. 8.7 months, and 95% and 65% vs. 85% and 76%, respectively, with no significant difference. Significantly greater Grade 3 transaminase elevation was found in the Multi group (p=0.023). Hepatic artery abnormality was observed in 34% of the Multi group and in 17.1% of the EP group (p=0.019). TACE with multiple anti-cancer drugs was tolerable but appeared not to contribute to an increase in radiographic response or PFS, and caused significantly more hepatic arterial abnormalities compared with TACE with epirubicin alone.

Effect of Repositioning Maneuver Type and Postmaneuver Restrictions on Vertigo and Dizziness in Benign Positional Paroxysmal Vertigo

Introduction. To compare the efficiency of Epley (Ep) and Sémont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV). Material and Methods. 226 consecutive adult patients with posterior canal BPPV were included. Patients were randomized into 2 different maneuver sequence groups (n = 113): 2 ST then 1 Ep or 2 Ep then 1 ST. Each group of sequence was randomized into 2 subgroups: with or without postmaneuver restrictions. Vertigo and dizziness were assessed from days 0 to 5 by VAS. Results. There was no difference between vertigo scores between Ep and ST groups. Dizziness scores were higher in Ep group during the first 3 days but became similar to those of ST group at days 4 and 5. ST maneuvers induced liberatory signs more frequently than Ep (58% versus 42% resp., P < 0.01, Fisher's test). After repositioning maneuvers, VAS scores decreased similarly in patients with and without liberatory signs. Postmaneuver restrictions did not influence VAS scores. Conclusion. Even if ST showed a higher rate of liberatory signs than Ep in this series, VAS scores were not influenced by these signs.

Subfertile effects of quinestrol and levonorgestrel in male rats

The contraceptive regimen consisting of levonorgestrel and quinestrol (EP-1) has been shown to be effective in several types of wild rodents. In the present study, we investigated the effect of EP-1 and its two components on fertility and spermatogenesis to elucidate the mechanisms underlying its contraceptive effect. Sprague-Dawley rats were treated with 0.33 mgkg(-1) quinestrol (E group), 0.67 mgkg(-1) levonorgestrel (P group) or their combination (EP group) for 7 days and then killed on Days 21 or 42 after treatment for tissue analysis. On Day 21, the weight of the cauda epididymis decreased significantly, while the weight of the adrenal gland increased significantly in the E and EP groups compared with the weights in the control group. In addition, there was a significant decrease in sperm number in the E and EP groups compared with the control group and there was less staining for the androgen receptor and Wilms' tumour nuclear protein 1 in the E and EP groups. The primary defects in E- or EP-treated rats were abnormal spermiogenesis, lack of elongating spermatids, and pachytene spermatocyte arrest. Analysis of MutL homologue 1 revealed that EP treatment inhibited chromosome recombination during meiosis, but did not cause obvious genetic abnormalities. These data demonstrate that quinestrol, alone or in combination with levonorgestrel, induces subfertility in male rats mainly by interfering with germ cell differentiation. Thus, EP-1 or E alone may be effective contraceptive regimens for fertility control in rodents.

A new integrated approach to improve left ventricular electromechanical activation during right ventricular septal pacing

The deleterious effects of apical right ventricular pacing has fostered the utilization of alternative pacing sites. Although right ventricular septal (RVS) sites are commonly used, the results have been controversial because of poor standardization of lead position by fluoroscopy. This study investigated the utility of a new RVS pacing technique based on the combination of fluoroscopy (F), and electrophysiological mapping (F + EP). Left ventricular (LV) electromechanical activation was determined in patients undergoing RVS pacing and the results of the F + EP approach were compared with those derived from standard F alone. Between December 2008 and November 2010 we enrolled 156 consecutive patients undergoing permanent RVS pacing. The standard F approach was used in 93 patients and the F + EP technique was applied to 63 patients. Electromechanical activation was assessed by: (i) electromechanical latency (EML) interval measured from the QRS onset to the mechanical activation of the basal LV and (ii) intra-LV dyssynchrony measured as the interval from the earliest to the latest LV basal motion. Intra-LV dyssynchrony was found in 46.2% patients in the F group compared with 15.9% in the group F + EP (P < 0.001). The F group demonstrated a significantly higher degree of intra-LV dyssynchrony than F + EP group (43.9 ± 24.3 vs. 26.5 ± 15.4 ms; P < 0.001). The F group exhibited a significantly higher EML duration compared with the F + EP group (215.8 ± 25.3 vs. 195.1 ± 17.4 ms; P < 0.001). During RVS pacing, the F + EP approach provides a more physiological LV activation than the standard F technique. The prognostic significance of these short-term findings needs to be correlated with long-term data.

Effects of soy protein on alcoholic liver disease in rats undergoing ethanol withdrawal

ObjectiveThis investigation attempted to clarify the effects of soy protein on alcoholic liver disease (ALD) in rats undergoing ethanol withdrawal. MethodsAlcoholic liver disease was induced in rats by administration of a low-carbohydrate ethanol liquid diet for 12 weeks, after which the ethanol was withdrawn and the rats were divided into two experimental groups: a control group (EC group) and a soy protein group (EP group) for 4 weeks. ResultsAfter the 12-week ALD-inducing period, the ethanol group had significantly higher hepatic lipid accumulation, oxidative stress and inflammation. We found that the EP group had significantly lower hepatic lipids, malondialdehyde, tumor necrosis factor-α, interleukin (IL)-1β, IL-6, hydroxyproline levels and myeloperoxidase activity compared to the EC group. Moreover, the fecal total cholesterol and total lipids were higher in the EP group. Expression of the hepatic cytochrome P450 2E1 (CYP2E1) protein in the EP group was significantly lower than that in the EC group, and the hepatic peroxisome proliferator-activated receptor (PPAR) α and cytochrome P450 4A (CYP4A) protein expressions in the EP group were significantly higher than those in the EC group. In the histopathological analysis, we also found that soy protein ameliorated fat accumulation in the liver. ConclusionThese results suggest that soy protein may improve alcohol-induced lipid accumulation, oxidative stress and inflammation by decreasing proinflammatory cytokines and CYP2E1 protein expression and by increasing PPARα and CYP4A protein expressions and fecal lipid excretion, thereby producing beneficial effects on ALD during ethanol withdrawal.

Las FARC-EP, ¿degradación de la lucha?

This article presents the research results whose aim is to provide elements that report the validity or the support and the justification of the nickname of Terrorist to the FARC - EP group. It is an armed insurgent group in Colombia and main figure of the internal conflict in Colombia for more than 45 years. Not only is it important to see the context in which these nicknames appear, but also to lay the foundations for a rigorous analysis of the case by relying on the data that confirm the theses raised in this study.

Vulnerability of Older Latino and Asian Immigrants with Limited English Proficiency

To explore the implications of limited English proficiency (LEP) for disparities in health status and healthcare service use of older Latino and Asian immigrants. Cross-sectional analysis of existing secondary data. The 2007 California Health Interview Survey. Latino and Asian immigrants aged 60 and older (n=1,745) were divided into three language proficiency groups: older adults who have LEP, are proficient in English but also speak another language at home (EP), and speak English only (EO). Sociodemographic characteristics, health status, health service use, and barriers to service use were compared. Older Latino and Asian immigrants with LEP tended to have poorer self-rated health and higher psychological distress than the EP and EO groups. They were also less likely than the EP and EO groups to use health services and more likely to experience barriers to service use (e.g., difficulty understanding written information at the doctor's office). Older Latinos and Asians with LEP are at higher risk for poor physical and mental health outcomes and inadequate health care. Healthcare systems should consider strategies to address the language needs of older immigrants to reduce the effect of linguistic disparities on access to care and ultimately to improve health status for these vulnerable populations.

Preventing progression of cardiac hypertrophy and development of heart failure by paricalcitol therapy in rats

Vitamin D deficiency is associated with cardiac hypertrophy and heart failure, and vitamin D therapy prevents the progression of cardiac hypertrophy in animal models. Here, we examine whether vitamin D therapy prevents progression of pre-existing cardiac hypertrophy and development of heart failure. When male Dahl salt-sensitive rats were fed a high salt (HS) diet, all rats developed cardiac hypertrophy after 5 weeks. Thereafter, rats were treated with vehicle (V), paricalcitol (PC, an active vitamin D analogue, at 200 ng, IP 3x/week), enalapril (EP, 90 μg/day), and PC + EP. All groups were continued on the HS diet and evaluated after 4 weeks of therapy. The PC and PC + EP groups, but not the V and EP only groups, showed significant prevention of progression of pre-existing cardiac hypertrophy. The signs of decompensated heart failure were evident in the vehicle-treated group; these heart failure parameters significantly improved with PC, EP or PC + EP therapy. The expression of PKCα, which is regulated by Ca(2+)and known to stimulate cardiac hypertrophy, was significantly increased in the vehicle group, and PC, EP or PC + EP effectively decreased PKCα activation. We also observed normalization of genetic alterations during progression to heart failure with PC treatment. PC treatment resulted in both the prevention of progression of pre-existing cardiac hypertrophy and the development of heart failure, compared with improvement in progression to heart failure by EP alone. These beneficial findings in heart were associated with inhibition of PKCα activation and reversal of gene alterations.

The Effect of Dietary Supplementation with Phytase Transgenic Corn on Growth Performance, Phosphorus Utilization and Excretion in Growing Pigs ( Sus scrofa)

Two experiments were conducted to investigate the effect of dietary supplementation with phytase transgenic corn (PTC) on growth performance, phosphorus (P) utilization and excretion in growing pigs. In Exp. 1, 180 pigs (Large White ×Landrace, BW=37.7 kg) were randomly allotted to 4 treatments with 5 replicates of 9 pigs each in order to evaluate the effect of PTC supplementation in low-P diets on growth performance. Four corn soybean meal-based diets consisted of a positive control (PC) diet, a diet containing 500 units (U) of exogenous phytase kg −1 (EP) on the basis of low-P (inorganic P reduced by 0.05% from PC diet) and the low-P+500 (PTC1) or 750 (PTC2) phytase U of PTC kg −1. In Exp. 2, 20 barrows (Large White×Landrace, BW=31 kg, 4 treatments with 5 replicates of 1 pig each) were randomly selected to evaluate the effect of PTC in low-P diets on serum parameters and nutrient utilization. Diets in Exp. 2 were similar to those in Exp. 1 except that the EP group was replaced by a low-P diet without exogenous phytase supplementation as a negative control (NC) group. The results from Exp. 1 showed that the average daily gain (ADG) in the PTC2 group was significantly higher ( P<0.05) than that in the EP group over all periods. On the other hand, the feed:gain (F:G) ratio of the EP group was significantly higher ( P<0.05) than that of the PTC2 group during 1–21 and 1–42 d, respectively. There were no differences in average daily feed intake (ADFI) among all treatments ( P>0.05). The results from Exp. 2 showed that the concentration of serum Ca in the NC group was the highest ( P<0.05), while the concentration of serum P in the PTC2 group was the highest ( P<0.05) among all treatments. There was a significant decrease ( P<0.05) in the P apparent digestibility of the NC group compared with the other groups, and that of PTC2 group was the best. Furthermore, fecal P excretion was reduced ( P<0.05) from 1.80 g d −1 in the PC group to 1.28 g d −1 in the PTC2 group. In conclusion, dietary supplementation with PTC could reduce the application of inorganic P, decrease fecal P excretion, and improve the growth performance of growing pigs.

Nuclear Factor-Kappa B Activity Regulates Brain Expression of P-Glycoprotein in the Kainic Acid-Induced Seizure Rats

This study was aimed to investigate the effect of NF-κB activity on the seizure susceptibility, brain damage, and P-gp expression in kainic acid- (KA-) induced seizure rats. Male SD rats were divided into saline control group (NS group), KA induced epilepsy group (EP group), and epilepsy group intervened with NF-κB inhibitor-pyrrolidine dithiocarbamate salt (PDTC group) or with dexamethasone (DEX group). No seizures were observed in the rats of NS group. Compared with NS group, increased P-gp expression and NF-κB activation in the rat brain of the EP group were observed after KA micro-injection. Both PDTC and DEX pre-treatment significantly increased the latency to grade III or V seizure onset compared to EP group but failed to show neuron-protective effect as the number of survival neurons didn't significantly differ from that in EP group. Furthermore, PDTC pre-treatment significantly decreased P-gp expression along with NF-κB activation in the hippocampus CA3 area and amygdala complex of rats compared with the EP group, implying that NF-κB activation involved in the seizure susceptibility and seizure induced brain P-gp over-expression. Additionally, DEX pre-treatment only decreased P-gp expression level without inhibition of NF-κB activation, suggesting NF-κB independent pathway may also participate in regulating seizure induced P-gp over-expression.

Influence of feed enzymes on the content of mineral elements in sows milk and pigs blood plasma

The aim of this study was to analyze whether and to what extent the addition of enzymes hydrolyzing fractions of non-starch polysaccharides or degrading phytates in pigs feeding in the complete cycle (pregnant and lactating sows, piglets and fatteners) may affect the utilization of mineral elements. The study with pigs in the complete reproductive cycle was accomplished in five periods: pregnant sows, nursing sows, piglets, young fatteners, and fatteners. Four experimental groups were established in the experiment, including two controls: positive control (PC), where dicalcium phosphate additive was used as a source of phosphorus, and negative control (NC), where solely plant-based feed mixtures were the source of phosphorus. The other two groups were as follows: MP – in which pigs received the same feed mixture as in the NC group but supplemented with microbial phytase, and the EP group in which the animals were fed the same feed mixture as in the NC group but with the addition of a multi-enzyme preparation which included both microbial phytase and enzymes participating in the hydrolysis of nonstarch polysaccharide fractions (xylanase, β-glucanase, cellulase). The addition of microbial phytase either alone or with the enzymes hydrolyzing the non-starch polysaccharide fractions contributed to increased contents of phosphorus, copper and zinc in sows’ milk. In contrast, it did not evoke any significant changes in the content of calcium, magnesium, iron, or in that of protein, fat and lactose in the milk of sows. The feed enzymes contributed to a significant increase in the concentrations of minerals (except for magnesium) in blood plasma of piglets and fatteners, whereas so significant changes were observed in the blood plasma of sows.

Reduced methacholine-induced submandibular salivary secretion in rats with experimental periodontitis

ObjectiveSaliva is the first barrier to the entry of bacteria and viruses into the body and is considered a necessary instrument in oral health. Intraperitoneal injection of lipopolysaccharide endotoxins results in submandibular gland (SMG) hyposalivation. The objective of present studies was to assess if periodontitis, a chronic inflammatory disease caused by oral bacteria, alters cholinergic-induced SMG salivary secretion. DesignAn experimental periodontitis model (EP) (cotton thread ligature around the neck of the first lower molars) was used. Male Wistar rats (300–380g) were randomly divided into 3 groups: control, 7 days-bilateral EP and 7 days-unilateral EP (to study if there were different effects at the ipsilateral and contralateral side). The following determinations were performed in SMG: (1) dose–response curves to the cholinergic agonist methacholine, (2) prostaglandin E (PGE) content, (3) inducible nitric oxide synthase (iNOS) activity and (4) histology of gland sections. ResultsThe molars with EP, no matter the group, exhibited significant and similar bone loss (p<0.001). Bilateral EP reduced methacholine-induced salivary secretion (p<0.05, dose 1μg/kg; p<0.001, dose 3–30μg/kg), increased PGE content (p<0.01), stimulated iNOS activity (p<0.05). Ipsilateral glands of unilateral EP animals presented lower methacholine-induced salivary secretion (p<0.05, dose 3μg/kg; p<0.001, dose 10–30μg/kg), and higher PGE content than contralaterals (p<0.001). In turn, at 3 and 10μg/kg of methacholine, contralateral glands showed significantly lower secretion than control animals (p<0.001). Histological studies of glands revealed partial loss of secretor granular material and periductal oedema in the bilateral and unilateral EP groups as compared to controls. ConclusionsAs far as we know, the present results demonstrate for the first time that EP reduces methacholine-induced SMG salivary secretion.

HIV-1 Diversity After a Class Switch Failure

The purpose of this study is to evaluate whether the choice of a PI- or an efavirenz (EFV)-based HAART initial regimen impacts on the viral diversity after failure from a second, class-switch salvage regimen. Sequential HAART failures after a class switch were identified for which the genotypes showed evidence of signature mutations at each failure. Each second failure was required to be from a viral burden <400 RNA c/ml. Thirteen cases of sequential failure from an initial EFV-containing to a PI-containing regimen (EP), and 19 sequential failures from an initial PI-containing to an EFV-containing regimen (PE) were identified. The persistence of signature mutations from the first failure were evaluated at second failure and compared between the EP and PE groups. Phylogenetic trees were constructed for a subgroup of cases from existing genetic sequence information and branch length analysis was used to determine evidence of viral diversity between groups. For EP sequential therapy, 10 of 12 cases carried forward a key non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation in the second failure compared to 5 of 13 cases for PE sequential therapy (p = 0.041). Phylogenetic analysis demonstrated that there was more viral diversity in the PE group as compared to the EP group, consistent with the interpretation that mutations at the second failure added to an ancestral virus closer to baseline rather than to the dominant virus at first failure. The development of HIV viral diversity after multiple HAART failures is determined by the sequence in which the regimens are ordered.

Influence of the implants inclination on the accuracy of the working cast

The aim of this study was to evaluate the influence of the implants inclination on the accuracy of the working cast obtained by two different pouring techniques. A metallic matrix containing two implants, positioned at 90 and 65 degrees in relation to the alveolar ridge, was submitted to the direct transfer impression technique. In CP group (conventional pouring - n=10), the impressions were poured with dental stone type IV using the conventional technique. In EP group (experimental pouring - n=10), the analogs were embraced with latex tubes before the first pouring. After sixty minutes, these tubes were removed and the space was filled with the dental stone. The metallic matrix (control group) and the replicas were evaluated regarding the implant/analog inclination and the vertical misfit between a framework and the implants/analogs. The data were tabulated and analyzed using analysis of variance (ANOVA) and Tukey test at the 0.05 level of significance. Regarding the analog inclination, both experimental groups differed statistically (p&lt;0.05) from the control group only in relation to the leaning analogs. Results demonstrated significant difference (p&lt;0.05) between the control group and the experimental groups when the reading of the vertical misfit was accomplished in the perpendicular implant/analog with the retention screw in the leaning implant/analog and between the control group and the EP group in the opposite situation. Considering the inclination, perpendicular implants produced more accurate casts independently of the plaster pouring technique.

Beneficial effects of sodium or ethyl pyruvate after traumatic brain injury in the rat

Sodium pyruvate (SP) treatment initiated within 5 min post-injury is neuroprotective in a rat model of unilateral cortical contusion injury (CCI). The current studies examined: (1) effects of delayed SP treatments (1000 mg/kg, i.p., at 1, 12 and 24 h), (2) effects of single (1 h) or multiple (1, 12 and 24 h) ethyl pyruvate treatments (EP; at 20 or 40 mg/kg, i.p.), and (3) mechanisms of action for pyruvate effects after CCI. In Experiment 1, both SP and EP treatment(s) significantly reduced the number of dead/dying cells in the ipsilateral hippocampus (dentate hilus + CA3 c and/or CA3 a-b regions) at 72 h post-CCI. Pyruvate treatment(s) attenuated CCI-induced reductions of cerebral cytochrome oxidase activity at 72 h, significantly improving activity in peri-contusional cortex after multiple SP or EP treatments. Optical density measures of ipsilateral CD11b immuno-staining were significantly increased 72 h post-CCI, but these measures of microglia activation were not different from sham injury values in SP and EP groups with three post-CCI treatments. In Experiment 2, three treatments (1, 12 and 24 h) of SP (1000 mg/kg) or EP (40 mg/kg) significantly improved recovery of beam-walking and neurological scores in the first 3 weeks after CCI, and EP treatments significantly improved spatial working memory 1 week post-CCI. Ipsilateral CA3 b neuronal loss, but not cortical tissue loss, was significantly reduced 1 month post-CCI with pyruvate treatments begun 1 h post-CCI. Thus, delayed pyruvate treatments after CCI are neuroprotective and improve neurobehavioral recovery; these effects may be mediated by improved metabolism and reduced inflammation.

Party Policy and Group Affiliation in the European Parliament

Systematic empirical research has yet to explain how national parties join political groups in the European Parliament. This article first demonstrates, using original empirical measures from expert surveys of party positions, that EP party groups consist of national parties sharing similar policy positions. Secondly, using Bayesian/MCMC methods, the paper estimates the policy determinants of group affiliation using a (conditional) multinomial logit model to explain that ‘party group’ choice is largely driven by policy congruence. Finally, predictions from the model identify national parties not in their ‘ideally congruent’ EP groups. The findings suggest that the organization of and switching between EP groups is driven mainly by a concern to minimize policy incongruence between national and transnational levels.

Emergency Physicians’ Risk Attitudes in Acute Decompensated Heart Failure Patients

Despite the existence of various clinical prediction rules, no data exist defining what frequency of death or serious nonfatal outcomes comprises a realistic "low-risk" group for clinicians. This exploratory study sought to identify emergency physicians' (EPs) definition of low-risk acute decompensated heart failure (ADHF) emergency department (ED) patients. Surveys were mailed to full-time physicians (n = 88) in a multihospital EP group in southwestern Pennsylvania between December 2004 and February 2005. Participation was voluntary, and each EP was asked to define low risk (low risk of all-cause 30-day death and low risk of either hospital death or other serious medical complications) and choose a risk threshold at which they might consider outpatient management for those with ADHF. A range of choices was offered (<0.5, <1, <2, <3, <4, and <5%), and demographic data were collected. The response rate was 80%. Physicians defined low risk both for all-cause 30-day death and for hospital death or other serious complications, at <1% (38.8 and 40.3%, respectively). The decision threshold to consider outpatient therapy was <0.5% risk both for all-cause 30-day death (44.6%) and for hospital death or serious medical complications (44.4%). Emergency physicians in this exploratory study define low-risk ADHF patients as having less than a 1% risk of 30-day death or inpatient death or complications. They state a desire to have and use an ADHF clinical prediction rule that can identify low-risk ADHF patients who have less than a 0.5% risk of 30-day death or inpatient death or complications.

A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial

Objective to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women. Design a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group. Setting a 3900-bed medical centre in northern Taiwan with around 3000 births annually. Participants a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre. Interventions the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24–48 hours after birth to six months post partum. Measurements body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support). Findings average gestational weight gain was 14.02, 15.27 and 16.22 kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08 kg in the three groups, respectively. Key conclusions a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention. Implications for practice the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle.