Paramount Factors Research Articles

Spontaneous intracerebral haemorrhage in adults: a literature overview

A large number of reports have analysed epidemiology, pathogenesis, symptomatology, diagnostics and options for medical and surgical treatment of intracerebral haemorrhage. Nevertheless, management still remains controversial. The purpose of the present review is to summarise the clinical data and derive a current updated management concept as a result. The analysis was based on a Medline search to November 2006 for the term "intracerebral haemorrhage" (ICH). The clinical query functions were optimised for aetiology, diagnosis and therapy to limit the results. A total of 103 articles were found eligible for review. Race, age and sex influence the occurrence of ICH. Moreover, hypertension and alcohol consumption are the paramount risk factors. The most frequent pathophysiological mechanism of ICH seems to be a degenerative vessel wall change and, in consequence, rupture of small penetrating arteries and arterioles of 50-200 microm in diameter. The symptomatology depends on the size of ICH, possible rebleeding and the occurrence of hydrocephalus or seizures. The outcome is worse with concomitant occurrence of intraventricular haemorrhage. Treatment with recombinant factor VIIa (rFVIIa) within four hours after the onset of ICH limits the growth of haematoma, reduces mortality and improves functional outcome. Minimally invasive surgery tends to improve functional outcome. A systematic knowledge of currently available data on epidemiology, pathogenesis and symptomatology, the use of diagnostics and the different conservative and surgical treatment options can lead to a balanced management strategy for patients with ICH.

Reproductive performance in high producing dairy cows: practical implications

SummarySeveral studies have clearly demonstrated that the fertility of high yielding dairy cows has declined over the past 25 years. The resumption of ovarian activity post partum has been retarded and conception rates have dropped significantly from 55 to 40%. Accordingly, the calving interval has increased from about 385 days to 417 days. The percentage of cows culled because of infertility has risen from 5 to 8% per year. The “subfertility syndrome” is a multifactorial problem. As the negative energy balance and general health status after calving are known to be paramount factors hampering fertility, it is apparent that avoiding both is among the most important preventive measures to be taken. Improvement of the energy status by achieving a high dry matter intake and the provision of optimal and well balanced nutrition during the transition period as well as during early lactation are key goals in this effort. To achieve these goals, we should not only calculate the rations on paper, but should also check in the stable to determine whether the calculated amount is really being consumed by the cows. Furthermore, veterinarians should use their “clinical eyes” as well as other diagnostic tools to assess the general health status of the cows and to assess at which aspect of the process things are going wrong and need to be adjusted. Besides the control of the negative energy balance and health status, other management factors that need to be maximized include heat detection, cow comfort, insemination technique, time of insemination during estrus and sperm quality. Only if management is on a very high level high milk production and good fertility can be a feasible combination.

Reproductive performance in high producing dairy cows: practical implications

SummarySeveral studies have clearly demonstrated that the fertility of high yielding dairy cows has declined over the past 25 years. The resumption of ovarian activity post partum has been retarded and conception rates have dropped significantly from 55 to 40%. Accordingly, the calving interval has increased from about 385 days to 417 days. The percentage of cows culled because of infertility has risen from 5 to 8% per year. The “subfertility syndrome” is a multifactorial problem. As the negative energy balance and general health status after calving are known to be paramount factors hampering fertility, it is apparent that avoiding both is among the most important preventive measures to be taken. Improvement of the energy status by achieving a high dry matter intake and the provision of optimal and well balanced nutrition during the transition period as well as during early lactation are key goals in this effort. To achieve these goals, we should not only calculate the rations on paper, but should also check in the stable to determine whether the calculated amount is really being consumed by the cows. Furthermore, veterinarians should use their “clinical eyes” as well as other diagnostic tools to assess the general health status of the cows and to assess at which aspect of the process things are going wrong and need to be adjusted. Besides the control of the negative energy balance and health status, other management factors that need to be maximized include heat detection, cow comfort, insemination technique, time of insemination during estrus and sperm quality. Only if management is on a very high level high milk production and good fertility can be a feasible combination.

Improving the adaptability in automated vessel scheduling in container ports using intelligent software agents

Faster turnaround time of vessels and high berth productivity are paramount factors in container terminals for assuring competitive advantage in the shipping industry. An autonomous decision-making capability in the terminal is vital in achieving the required productivity. Vessel scheduling/berthing system in a container terminal is regarded as a very complex dynamic application in today’s business world. The Artificial Intelligence (AI) community has been researching in the field of intelligent (or rational) agents for more than a decade and implementations are found in many commercial applications. The Beliefs, Desires and Intention (BDI) agent architecture is probably the most mature model for many industrial applications in today’s context. However, it is not the best agent model for complex applications that must learn and adapt their behaviours in making rational decisions. We propose a new hybrid BDI framework with an intelligent module to overcome the limitations in the generic BDI model. Learning and the adaptability of the environments are assured with the introduction of the Knowledge Acquisition Module (KAM) in the generic BDI architecture in our proposed framework. The dynamic selection of the intention structures has been improved with a trained neural network. The knowledge required to handle vagueness or uncertainty in the environment has been modelled with an Adaptive Neuro Fuzzy Inference System (ANFIS) in berths. Finally, the benefits and the usability of hybrid BDI model for a vessel berthing application is discussed with experiential results.

Oligarchic family control, social economic outcomes, and the quality of government

Wealthy families, as opposed to small public shareholders, characterize ownership of the large corporate sectors of many countries around the world. This paper shows that greater oligarchic family control over large corporations is associated with worse social economic outcomes. It also correlates with more bureaucratic and more interventionist governments, and less developed financial markets. Further tests show that red tape, price controls, and the lack of shareholder rights protection are the paramount factors relating to the extent of family control of large firms. These results are broadly consistent with Olson and others who argue that economically entrenched wealthy insiders pursue rent-seeking activities to preserve the status quo, and that this increases corruption, and impedes growth.

Comparative Advantage: The Impact of ISO 14001 Environmental Certification on Exports

Relative to the enormous acceptance of the ISO 9000 quality standard, the ISO 14001 environmental management certification has been met with only moderate enthusiasm among industrial facilities. The literature on corporate motivation for ISO 14001 participation is relatively modest considering the enormous number of publications reviewing other aspects of its adoption and implementation. It would seem that the present "marketing" package supporting ISO environmental commitments does not seem to offer sufficiently persuasive incentives for increased sales, either domestically or internationally. While researchers assume that a higher export rate of companies is positively associated with higher ISO participation rates, there have been very few empirical studies that support this inference, and conclusions have not been based on data taken from importing countries orfrom a systematic evaluation of expressed corporate preference for products sold by ISO 14001 certified companies. The present study reports the results of a survey to firms in six countries that are Israel's leading trade partners, importing chemicals, textiles, and produce. The survey results confirm that while the international market still considers price and quality as the paramount factors in selection of suppliers, environmental management systems (EMS) are an important feature that is frequently taken into consideration. EMS certification appears to signify a supplier who is managing the business well and exhibiting ethical responsibility. The European market proved to be more environmentally conscious than those in other industrialized parts of the world. EMS offer a particularly valuable advantage for producers wishing to reach European markets. As policy-makers seek to expand the voluntary adoption of EMS, a clear advantage for exporters should be highlighted among national industries.

Does transmissibility necessarily imply infectivity in spongiform encephalopathy?

The essential biologic properties inherently acquired subsequent to conformational transformation of the α-helical molecular structure of the normal cellular PrPc isoform to the β-sheet molecular tertiary structure of the abnormal PrPsc associated with a rapidly spreading form of neuronal cell death of spongiform encephalopathy are unknown. However, the vacuolization that chiefly characterizes the morphology of neurons in spongiform encephalopathy might constitute a physical disruption with subsequent rapidly progressive impairment of maintenance of homeostatic viability of neurons due to precisely loss of membrane integrity of the plasmalemma and cell organelles. As far as transmission of the prion particle is concerned, it would appear that active incorporation of this agent under the direction of the affected neuronal cell itself would implicate host attributes as paramount factors determining not only susceptibility to the pathologic effects of the prion particle but also to the mode of such infliction as arising in and constituting spongiform encephalopathy beyond its acquisition and progression. As a single set of acquired circumstances determining both transmissibility and also pathologic lesion creation, the spongiform neuronal change might arise directly from a membrane abnormality of water ingress and egress in and out of the neuron. An excess of water ingress intra-neuronally might actually constitute a phenomenon of active lesion induction even in terms simply of biophysical stress intra-neuronally. In simple terms, an understanding of pathogenesis in spongiform encephalopathy might actually implicate aspects of transmissibility as direct attributes of processes of template replication within a system of utilization and elimination of the prion particle. Indeed, susceptibility to spongiform change might constitute one aspect of a biologic process that arises from conformational change of the prion protein molecule that would in turn result from variable polymorphisms in modes of reactive handling of PrPc and PrPsc by the neurons and other constituent cell elements in the central nervous system.

Managing Patients with Diabetes Mellitus and Mental Health Problems

Diabetes mellitus is the subject of a great many case management programs around the world as it is a prevalent disease with modifiable risk factors and potentially preventable severely disabling complications. Diabetes mellitus represents even greater challenges in the context of mental illness. Patients with psychological complications of diabetes mellitus or with psychiatric disease and comorbid diabetes mellitus present a unique set of problems with which the physician and other care providers must contend. These challenges include: problems with treatment regimens; inability to manage self-care programs; difficulties with negotiating appointments, referrals, and follow-up care; confusion over competing care instructions; potential drug interactions and/or complications which exacerbate diabetes mellitus; and many social difficulties which undermine the effective care of diabetes mellitus. Lack of control of either diabetes mellitus or mental health problems may complicate or exacerbate one or the other of these diseases. Case management for these individuals is one potential way of improving care. Management needs to be team based, coordinated between specialties, simplified, and in one location of care when possible. Excellent coordination and communication is paramount and social factors and supports require special attention.

Crippling Capacity of Web Elements with Openings

Commonly used cold-formed steel sections utilized as either wall studs or floor joists contain web holes. The web holes may be factory punched or field cut. Because the Specification for the Design of Cold-Formed Steel Structural Members does not address the potential impact that a web hole can have on the structural integrity of the cold-formed steel member, research was necessary. Researchers at the University of Missouri-Rolla have explored the behavior of a flexural member that possesses a web hole. The scope of the UMR research includes flexure, shear, web crippling, and combinations thereof. The present paper will summarize the findings and design recommendations pertaining to web crippling resulting from either end-one-flange or interior-one-flange loading. The research determined that the paramount factors influencing the web crippling behavior were the relationship between the hole depth and the depth of the web and the relationship between the distance from the edge of the bearing and the flat depth of the web. Easily applied design relationships have been developed.

A stochastic simulation model for Asian elephant Elephas maximus populations and the inheritance of tusks

In the framework of available historical data on population size and human impact on the Asia elephant Elephas maximus Linnaeus, 1758, we developed a stochastic simulation model for elephant populations, which simulates individual elephants and includes their geno- and phenotype regarding the tusk character. The model omits density dependence of reproduction parameters and mortality rates. The model predicts female mortality and mean calving interval to be the paramount factors determining the long-term population trend.

Insulin, insulin sensitivity and hypertension

The sensitivity of tissue to insulin is of physiological, pathophysiological and therapeutic relevance. The quantity of insulin and the response to insulin are paramount complementary factors in the regulation of glucose metabolism, and may, at least under certain pathophysiological conditions, also affect cardiovascular function. Hypertension has a high prevalence among subjects with decreased insulin sensitivity and/or hyperinsulinaemia due to obesity, impaired glucose tolerance, non-insulin-dependent diabetes mellitus, and certain other conditions. There is evidence that, even in the absence of obesity or diabetes mellitus, essential hypertension tends to be associated with insulin resistance. The latter elicits a compensatory increase in insulin secretion. Hyperinsulinaemia also occurs in diabetes type 1 as a consequence of insulin treatment. Considering the acute effects of insulin on sympathetic nervous activity, transmembranous cation transport, renal sodium reabsorption, cellular proliferation and lipid metabolism, insulin resistance and/or hyperinsulinaemia may possibly contribute to the genesis of essential, obesity-associated and diabetes-associated hypertension, and may also promote dyslipidaemia in these disorders.

Forensic Suicides and Attempted Suicides

Forensic suicides and suicide attempts challenge certain premises long held by classical suicidologists. Integration and status or personal loss do not appear to be critical factors when considering forensic suicide behavior. Instead, rage and marginality surface as the paramount factors. Although it is obvious that anomie is a dimension of marginality, it is important to note that marginal members of society fail, for whatever reason, to adequately internalize an acceptable or meaningful normative model from which to assess their successes and/or failures. Consequently “loss,” as it is implied within the classical perspective, does not seem to be a significant factor associated with most forensic suicides. Here, chronic ambiguity and free-floating rage, attributes exacerbated by the jail-like environment of many forensic units, pose a situation whereby either the self or others become convenient targets for aggression release.

Effects of aging on prostate growth in beagles.

Statistical analysis of 82 variables was completed to determine the effects of aging in the male beagle on prostatic growth and function. The results indicate that prostate weight increased to 4 yr and then reached a plateau. Prostatic secretory function (measured as ejaculate volume) followed a course different than the growth of the gland. Prostatic function increased and reached a peak at 4 yr and then declined abruptly. Therefore, there is a separation of the growth and secretory function of the canine prostate after 4 yr of age. Multiple linear regression analysis was performed to determine the mathematical relationship of these variables in predicting prostate weight and therefore benign prostatic hyperplasia, which is correlated with weight. The testicular secretion of testosterone and aging were paramount factors in predicting prostate weight. There appears to be an increased sensitivity of the prostate to testosterone secretion with advancing age.

Cell line and growth site as relevant parameters governing tumor tissue oxygenation.

Tumors commonly exhibit pronounced inter-individual and intra-individual differences in the oxygenation status. Paramount factors contributing to this variability are the tumor growth stage or size, changes in the O2 transport capacity of the arterial blood (e.g., during tumor-induced anemia) as well as inherent properties of the tumor cell line investigated and different tumor growth sites as shown in the present study. In most cases, variations of nutritive tumor blood flow and changes in the amount of arterio-venous shunt perfusion within the tumor tissue have to be considered as basic pathomechanisms for these inter-tumor variations of tissue oxygenation.

Application of high-temperature hyperfiltration to unit textile processes for direct recycle

The recycle of industrial effluents achieves (1) resource recovery, (2) pollution abatement, and (3) control of toxic emissions. The United States textile industry uses about 3.7 × 10 6 m 3/d of water. The water pollution is largely the residual of process chemicals, e.g., detergents, salts, and dyes. About 50% of the energy is discharged as hot water, i.e., 10 14 Btu/yr. High-temperature hyperfiltration and ultrafiltration are being evaluated for recycle of both water and chemicals with operating manufacturing processes: (1) an atmospheric dye beck, (2) a pressure beck, (3) an open-width preparation range, (4) a dye range, and (5) a rope preparation range. The reuse of the (hot) permeate has been demonstrated in every instance. Thus, up to 9 × 10 13 Btu/yr may be conserved in the US textile industry by direct recycle of the hot wastewater. Control of toxic emissions by membranes has been evaluated by examining data existing in the literature. A very limited amount of data with textile wastewaters indicates feasibility of control of organic compounds of molecular weights ≥ 90. The potential economic payout is good with recovery of specific chemicals and energy being paramount factors. A conceptual layout for closed-cycle operation of a continuous range indicates that some chemicals in the waste and a majority of the energy can be conserved by recycle.

The genetics of the mammalian gamete.

The genetics of the mammalian gamete.

Hookworms in the aetiology of tropical iron deficiency anaemia: Radio-isotope studies

1. 1) The relation between hookworm infestation and anaemia was investigated before and after multiple vermifuges by estimating intestinal blood and iron loss with 51Cr. and 59Fe. 2. 2) Maximum blood loss was 180 ml. and iron 33 mg. daily for a worm load of 834 A. duodenale and 249 N. americanus. A loss of 30 ml. daily for a load of only 166 worms was encountered. Augmentation of dietary iron absorption that is associated with increased marrow activity and depleted iron stores, is incapable of meeting these excessive losses. Such losses deplete the iron stores and lead to anaemia. There were great variations in the blood losses in different patients, and in the same patient on different days. 3. 3) The amount of iron lost depended on the haemoglobin level of the patient at the time the loss occurred. 4. 4) The blood loss was correlated with worm loads and species and was greater for A. duodenale. Both A. duodenale and N. americanus are found in Kenya, most patients having both. Loads up to 850 adult A. duodenale and 2,400 N. americanus were recorded by counting adult worms after multiple vermifuges. 5. 5) Removal of worms reduced the blood loss to nil, but did not improve the haemoglobin level unless iron therapy was also given. Iron therapy without removal of worms cured the anaemia, but the haemoglobin fell again once iron therapy was stopped, unless the worms were removed. 6. 6) Patients previously infected with hookworms and who had taken vermifuges, but no iron, presented with gross anaemia but no worms; others taking iron, but no vermifuge, had heavy worm loads but no anaemia. Other factors obscuring the relation between hookworms and anaemia are the migratory habits of the worms leaving few or many bleeding points, the situation of the worms whether over a large or small blood vessel, the rapidity with which bleeding points are sealed, etc. When these factors as well as worm loads and species are taken into consideration, there is always a close correlation between hookworms and anaemia. Failure to make allowances for them has led to the mistaken view that hookworms and anaemia are not related. 7. 7) Even multiple vermifuges will not produce egg-negative stools, but by reducing worm loads will cut blood loss to insignificant amounts. 8. 8) N. americanus was shown to be more resistant to all vermifuges than A. duodenale perhaps because of its small size and its location in the intestinal villi where vermifuges may not easily penetrate. 9. 9) There was little evidence that diet was associated directly with hookworm anaemia; an adequate diet will not diminish the chances of infection or reduce blood loss. Low economic status was, however, closely linked with insanitary habits and the less frequent use of footwear, both paramount factors affecting the risks of infection. 10. 10) The specific deficiency in hookworm anaemia is iron, and it will respond to oral iron provided this is given in sufficient amounts to raise the haemoglobin level to normal and replace the depleted iron stores. Inadequate iron therapy is the commonest cause of failure to respond, but untreated intercurrent infections will also prevent a full remission of the anaemia. Parenteral iron has no advantage over oral iron provided the latter is taken. 11. 11) Other sources of iron loss that may aggravate the iron deficiency anaemia are discussed. 12. 12) Vermifuge campaigns, fortification of diet with iron, the use of footwear and improvement in sanitation, are measures that should be adopted to reduce worm loads and the associated anaemia.