Robbins, Langan P
In pectus excavatum, a developmental chest-wall deformity that affects approximately one in 400 births, the sternum is depressed inward and the ribs protrude anteriorly. This deformity can compromise pulmonary and/or cardiac function. It can also produce a characteristic radiographic appearance on frontal radiographs, which may be mistaken for right-middle-lobe opacification from pneumonia or atelectasis. I present a case of pectus excavatum in a teenage female with characteristic imaging findings, and the disposition of the case.
Pectus excavatum is a condition in which the "breast bone" (sternum) appears sunken and the chest concave. It ... condition (isolated findings). However, some genetic conditions include pectus excavatum.
Wooler, G. H.; Mashhour, Y. A. S.; Garcia, J. B.; Holden, M. P.; Ionescu, M. I.
The deformity of pectus excavatum is caused by a negative pressure in the anterior mediastinum sucking in the body of the sternum. This is usually due to the heart lying on the left side, leaving the mediastinum empty so that the sternum and costal cartilages are sucked in to fill the empty space. The operation consists of excising the deformed cartilages, mobilizing the sternum, and suturing the pericardial sac into a central position which corrects the deformity. Images PMID:5348322
... this page: //medlineplus.gov/ency/presentations/100035.htm Pectus excavatum repair - series—Normal anatomy To use the sharing ... Go to slide 4 out of 4 Overview Pectus excavatum is a deformity of the front of the ...
Gonzalez, Michel; Perentes, Jean Yannis; Abdelnour, Etienne; Wang, Yabo; Ris, Hans-Beat; Krueger, Thorsten
Management of pectus excavatum Congenital chest wall deformities are considered to be anomalies in chest wall growth related to excessive or insufficient growth (aplasia or dysplasia) of the osseous or cartilaginous structures or the rib cage. These deformities are associated in 95% to overgrowth leading into depression (pectus excavatum) or protuberance of the sternum (pectus carinatum). Pectus excavatum may lead to cardiopulmonary disorder or impact on patient's self-esteem. The management of pectus excavatum has evolved this last decade with minimal invasive repair.
Cobben, Jan M; Oostra, Roelof-Jan; van Dijk, Fleur S
Pectus excavatum and carinatum are the most common morphological chest wall abnormalities. For both pectus excavatum and carinatum the pathogenesis is largely unknown although various hypotheses exist. Usually, exclusion of an underlying syndromal or connective tissue disorder is the reason for referral for genetic evaluation. A detailed anamnesis and family history are needed as well as a complete dysmorphological physical examination. If no features of an underlying disorder are detected, then the pectus excavatum/carinatum can be considered as an isolated abnormality and no further genetic studies seem indicated. Although cases of non-syndromal pectus excavatum/carinatum with a positive family history fitting Mendelian inheritance have been described, it is possible that these pedigrees represent multifactorial inheritance, as no genetic cause for familial isolated pectus excavatum/carinatum has been described yet. The recurrence risk for a non-familial iolated pectus excavatum/carinatum is unknown, but thought to be low. If other symptoms are found then appropriate further diagnostic studies are indicated as pectus excavatum/carinatum can be part of many syndromes. However, the most important and most frequently observed monogenic syndromes with pectus excavatum/carinatum are Marfan Syndrome and Noonan Syndrome.
Ravenni, Giacomo; Actis Dato, Guglielmo Mario; Zingarelli, Edoardo; Flocco, Roberto; Casabona, Riccardo
Nowadays the Nuss operation represents the standard surgical choice for pectus excavatum repair in children and teenagers. Some concerns have been raised regarding its applicability in adults, as compared with younger patients, in view of the higher rate of complications after surgery. We describe an easy trick that has been performed on a 36-year old man with a moderate pectus excavatum after an unsatisfactory Nuss procedure. It consisted of a T-shaped partial anterior sternotomy, performed after positioning of the stainless steel bar, in order to promote a hinge mechanism of the sternum to reduce the tension over the reinforcement. This procedure was successful with well-controlled postoperative pain and great patient satisfaction. No complications were recorded at 1-year follow-up. In our opinion, this simple trick could represent a valid surgical option for pectus excavatum repair in late adolescents and adults to obviate the occurrence of major sternal tension.
Demirkaya, Ahmet; Kılıç, Burcu; Kara, Hasan Volkan; Yakşi, Osman; Alizade, Nurlan; Demirhan, Özkan; Sayılgan, Cem; Turna, Akif; Kaynak, Kamil
Introduction The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. Aim To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. Material and methods Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2–45 years). There were 236 adult patients (28.2%) (> 18 years) – 20 female, 216 male. The mean age among the adult patients was 23.2 years (18–45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. Results The MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25–90 min). The median postoperative stay was 4.92 ±2.81 days (3–21 days) in adults and 4.64 ±1.58 (2–13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). Conclusions MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults. PMID:27458490
Underwood, Katherine; Vorsanger, Matthew; Saric, Muhamed; Skolnick, Adam H
Pectus excavatum is one of the most common congenital chest wall deformities. The degree of sternal depression, which may result in compression of the right heart by the chest wall, is variable. While typically asymptomatic, there are various symptoms that can result from severe pectus excavatum. We report on a patient with severe pectus excavatum leading to dynamic obstruction of the right ventricular outflow tract in the seated position.
Puma, Francesco; Vannucci, Jacopo; Santoprete, Stefano
Several techniques exist for the repair of complex pectus excavatum. The placement of retrosternal metal bars improves the results by reducing the recurrence rate, but entails several possible risks, complications and disadvantages. A new method, specifically conceived for the repair of severe, asymmetric forms in adult patients, is reported. The corrected bone is fixed in the proper position by two, patient-customized, titanium struts, externally screwed to the manubrium and sternal body. Any retrosternal bar is thus avoided, reducing possible complications, without hampering the chest wall dynamic. In this particularly difficult issue, this technique provides long-term good functional, mechanical and cosmetic results and does not entail a second surgery for struts removal.
This compares outcome measures of current pectus excavatum (PEx) treatments, namely the Nuss and Ravitch procedures, in pediatric and adult patients. Original investigations that stratified PEx patients based on current treatment and age (pediatric = 0–21; adult 17–99) were considered for inclusion. Outcome measures were: operation duration, analgesia duration, blood loss, length of stay (LOS), outcome ratings, complications, and percentage requiring reoperations. Adult implant patients (18.8%) had higher reoperation rates than adult Nuss or Ravitch patients (5.3% and 3.3% respectively). Adult Nuss patients had longer LOS (7.3 days), more strut/bar displacement (6.1%), and more epidural analgesia (3 days) than adult Ravitch patients (2.9 days, 0%, 0 days). Excluding pectus bar and strut displacements, pediatric and adult Nuss patients tended to have higher complication rates (pediatric - 38%; adult - 21%) compared to pediatric and adult Ravitch patients (12.5%; 8%). Pediatric Ravitch patients clearly had more strut displacements than adult Ravitch patients (0% and 6.4% respectively). These results suggest significantly better results in common PEx surgical repair techniques (i.e. Nuss and Ravitch) than uncommon techniques (i.e. Implants and Robicsek). The results suggest slightly better outcomes in pediatric Nuss procedure patients as compared with all other groups. We recommend that symptomatic pediatric patients with uncomplicated PEx receive the Nuss procedure. We suggest that adult patients receive the Nuss or Ravitch procedure, even though the long-term complication rates of the adult Nuss procedure require more investigation. PMID:24506826
Kocher, Gregor J.; Gstrein, Nathalie; Jaroszewski, Dawn E.; Ewais, Mennatallah M.
Background Recurrence of pectus excavatum (PE) is not an uncommon problem after open repair using the Ravitch technique. The optimal approach for redo surgery is still under debate, especially in adults with less chest wall pliability. Aim of this study was to investigate the usefulness and efficacy of the minimally invasive Nuss technique for repair of recurrent PE after conventional open repair. Methods We performed a retrospective multicentre review of 20 adult patients from University Hospital Bern (n=6) and the US Mayo Clinic (n=14) who underwent minimally invasive repair of recurrent PE after unsuccessful prior Ravitch procedure. Results Mean patient age at primary open correction was 21 years, with recurrence being evident after a mean duration of 10.5 years (range, 0.25–47 years). Mean age at redo surgery using the Nuss technique was 31 years, with a mean Haller index of 4.7 before and 2.5 after final correction. Main reason for redo surgery was recurrent or persistent deformity (100%), followed by chest pain (75%) and exercise intolerance (75%). No major intraoperative or postoperative complications occurred and successful correction was possible in all patients. Conclusions Although the procedure itself is more challenging, the minimally invasive Nuss technique can be safely and successfully used for repair of recurrent PE after failed open surgery. In our series final results were good to excellent in the majority of patients without major complications or recurrence. PMID:27621850
Nuss, Donald; Obermeyer, Robert J; Kelly, Robert E
Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen. We recommend surgical repair at around 12-14 years of age since the chest wall is still typically flexible and because this allows us to keep the bar in place as the patient progresses through puberty which may help decrease growth-related recurrences. Patients with mild to moderate PE are treated with therapeutic deep breathing, posturing, and aerobic exercises, and in appropriately selected patients, the vacuum bell may also be offered. Patients that have severe symptomatic PE are offered Minimally Invasive Repair of Pectus Excavatum (MIRPE). The surgical technique in children is similar to that of adults, except for the higher forces involved that often necessitate sternal elevation and more involved stabilization strategies. Postoperative management includes pain control, deep breathing, and early ambulation. Exercise restriction is mandatory for the first six weeks with slow resumption of normal activity after 12 weeks.
Pectus excavatum is one of the common congenital anomalies, yet there seems to be a suspicious absence of any cases or descriptions of this deformity from antiquity. This could represent a real change in disease prevalence but is more likely just due to an inadequate reporting in medico-historical literature. The current study reviews reports of computed tomography (CT) scans of 217 ancient Egyptian mummies, revealing 3 presumed cases of this deformity. Therefore, pectus excavatum was in fact present already in ancient times, with prevalence roughly similar to the modern one.
Rapuzzi, Giovanni; Torre, Michele; Romanini, Maria Victoria; Viacava, Rosanna; Disma, Nicola; Santi, Pier Luigi; Jasonni, Vincenzo
Pectus excavatum, the most common congenital chest wall malformation, has a higher incidence among men. Since 1987, when Donald Nuss performed his technique for the first time, the minimally invasive approach has become the most widely used technique for treating pectus excavatum. Few reported studies have focused on the repair of female pectus excavatum. Women with pectus excavatum often present with breast asymmetry that may require breast augmentation, either before or after pectus excavatum repair. To the authors' knowledge, no reports on the Nuss procedure after breast implant surgery have been published. This report describes the case of a 26-year-old woman who underwent minimally invasive repair after breast implant surgery. The authors believe that for women with severe pectus excavatum, the Nuss procedure should be the first choice for surgical correction. Moreover, for breast implant patients, this technique is absolutely feasible without major complications.
Park, Hyung Joo; Gu, Ja Hea; Jang, Joon Chul; Dhong, Eun-Sang; Yoon, Eul-Sik
Most women with asymmetric pectus excavatum suffer from hypoplastic breasts. Hence, aesthetic correction of pectus excavatum has to address thoracic wall deformity, breast hypoplasia, and asymmetry.In retrospective series, 21 patients with a diagnosis of pectus excavatum with hypoplastic breasts were corrected using the pectus bar procedure and subpectoral augmentation mammoplasty. Results were assessed by analyzing prospectively collected data and calculating pectus indices from computed tomographic scans. At 12 months postoperatively, cosmetic evaluations were performed by the patients and by an independent, board-certified plastic surgeon using score from 0 (very poor) to 4 (very good).Cosmetic results evaluated by plastic surgeon were good (3.33 ± 0.03) and patient satisfaction was high (3.52 ± 0.03). Furthermore, indices of pectus excavatum were corrected to near normal.The authors consider that the pectus bar procedure with subpectoral augmentation mammoplasty is useful for the aesthetic correction of pectus excavatum with hypoplastic breasts.
Tuncer, Eylem; Vuran, Ali Can; Ozyuksel, Arda; Yeginsu, Ali; Ceyran, Hakan
Although pectus excavatum is a common congenital abnormality of the chest wall, its coexistence with congenital heart defects is rarely encountered. In this report, we present a young adult who was re-operated for pulmonary valve regurgitation and pectus excavatum years after complete repair of tetralogy of Fallot. The surgical challenge and pitfalls are discussed along with a brief review of the literature.
van Klaveren, R J; Morshuis, W J; Lacquet, L K; Cox, A L; Festen, J; Heystraten, F M
Two cases of congenital bronchial atresia with pectus excavatum are reported. Costosternal retraction during the efforts to overcome the airway obstruction due to encroachment on normal lung tissue by the hyperinflated segments may play a part in causing pectus excavatum. Images PMID:1494776
Tedde, Miguel Lia
The correction of deep pectus excavatum, with the Nuss procedure, frequently require a series of maneuvers that is inherently dangerous. Herein we describe 10 technical modifications to prevent potential complications. These modified techniques have certain advantages and according to the authors, with these maneuvers the risk of pericardial sac, cardiac injury, bar displacement and complications during the removal of the bar could be markedly reduced. PMID:27747181
Stefani, Alessandro; Nesci, Jessica; Morandi, Uliano
Open techniques represent a valid repair option for severe asymmetric pectus excavatum in adults. The use of metal supports is recommended to reduce the risk of recurrence. A wide variety of metal supports have been proposed, with pre-, trans- or retrosternal fixation. A novel open technique using titanium bars fixed to the ribs with clips has been recently introduced (STRATOS™ system) for chest wall reconstruction, rib fracture fixation and chest wall malformation repair. We employed this technique in two adult patients with severe asymmetric pectus excavatum: after sternal mobilization, one bar is passed below the body of the sternum and secured with clips bilaterally to two ribs. In the first case, the results remained excellent 5 years after surgery. In the second case, the initial results were satisfying but the bar ruptured after 30 months: removal of the bars and clips was performed and a subsequent recurrence of the deformity occurred. The experiences reported in literature are still too limited to draw firm conclusions about the use of the STRATOS™ system in pectus excavatum repair, but it seems that the use of two bars may reduce the risk of rupture. At present, we are the only ones who reported long-term results.
Obermeyer, Robert J.; Nuss, Donald
Background Recently, technical improvement in the ability to measure lung function and the severity of chest deformity have enabled progress in understanding the mechanism of limitations of lung function in pectus excavatum. Methods After establishing that most patients with pectus excavatum do have symptoms of exercise intolerance, easy fatigability, and shortness of breath with exertion, lung function has been evaluated by a variety of methods in different centers. Spirometry, plethysmography, exercise testing, oculo electronic plethysmography, and imaging methods have been used to assess lung function in pectus excavatum and its response to surgery. Results Not all patients with pectus excavatum have subnormal static pulmonary function testing; some have above-average values. However, in more than 1500 adult and pediatric surgical patients with anatomically severe pectus excavatum at a single center, the bell curve of FVC, FEV1, and FEF 25-75 is shifted to significantly lower values in pectus excavatum. The curve is shifted to higher values after operation by approximately one standard deviation. Previous work has demonstrated that patients with more anatomically severe pectus excavatum are more likely to have diminished PFT’s. A mechanism for this effect is seen by oculo electronic plethysmography, which demonstrates that the depressed portion of the chest does not move on respiration. After Nuss procedure, the chest wall motion used to create suction to draw air into the lungs is indistinguishable from that of persons with a normal chest, and the intrathoracic volume is markedly increased. Conclusions Pectus excavatum is accompanied in most patients by diminished static pulmonary function. Correction by Nuss procedure results in improvement in chest wall motion; this improvement in the thoracic bellows action is accompanied by improvement in pulmonary function testing. PMID:27747180
Kuwata, Toshiyuki; Fukuda, Hirotsugu; Yoshitatsu, Masao; Yamada, Yasuyuki; Shibasaki, Ikuko; Inoue, Yuho; Hori, Takayuki; Ogawa, Hironaga; Tsuchiya, Go; Shimizu, Riha; Takei, Yusuke
Pectus excavatum is generally an isolated abnormality of the chest wall. However, some patients have a concomitant pectus deformity and cardiac & aortic disease. Decisions must be made regarding the operative approach and whether the pectus excavatum should be corrected during the same session. We report 2 patients with acute Stanford type A aortic dissection and pectus excavatum who underwent emergency operation. In case 1, median sternotomy is an unsuitable approach for open heart surgery, since the heart and great vessels are displace into the left hemithorax. But combined sternotomy and left anterior thoracotomy provided excellent surgical exposure. In case 2, we proceeded with a leftsided costotomy of four ribs and place a normal chest retractor providing as excellent exposure as combined sternotomy and left anterior thoracotomy. A left-sided costotomy of four ribs can be performed safely, eliminating the risks of median sternotomy in acute stanford type A aortic dissection with pectus excavatum.
Brochhausen, Christoph; Turial, Salmai; Müller, Felix K P; Schmitt, Volker H; Coerdt, Wiltrud; Wihlm, Jean-Marie; Schier, Felix; Kirkpatrick, C James
Pectus excavatum and pectus carinatum represent the most frequent chest wall deformations. However, the pathogenesis is still poorly understood and research results remain inconsistent. To focus on the recent state of knowledge, we summarize and critically discuss the pathological concepts based on the history of these entities, beginning with the first description in the sixteenth century. Based on the early clinical descriptions, we review and discuss the different pathogenetic hypotheses. To open new perspectives for the potential pathomechanisms, the embryonic and foetal development of the ribs and the sternum is highlighted following the understanding that the origin of these deformities is given by the disruption in the maturation of the parasternal region. In the second, different therapeutical techniques are highlighted and based on the pathogenetic hypotheses and the embryological knowledge potential new biomaterial-based perspectives with interesting insights for tissue engineering-based treatment options are presented.
Mavi, Jagroop; Moore, David L
The technique of choice for surgical correction of pectus excavatum is the Nuss procedure, a minimally invasive technique in which rigid metal bars are placed transthoracically beneath the sternum and costal cartilages until permanent remodeling of the chest wall has occurred. Intraoperatively, anesthesia focuses on three areas: the potential for catastrophic blood loss caused by perforation of large capacitance vessels and the heart, the potential for malignant arrhythmias, and the consequences of bilateral iatrogenic pneumothoraces. Postoperatively, analgesia is institutionally dependent and controversial, based on usage and type of regional anesthesia. The necessity of multimodal analgesic techniques creates a common ground across different hospital systems.
Obermeyer, Robert J.; Kelly, Robert E.
Historically, pectus excavatum (PE) was reported to be congenital, but in our experience only 22% are noticed in the first decade of life. Thus far, genetic studies support an autosomal recessive heritability, which coincides with only 40% of our patients having some positive family history, but is also contradictory given a constant sex ratio of 4:1 in favor of males. This inconsistency may be explained by the effect of more than one pectus disease-associated allele. Once the deformity is noticed, it tends to progress slowly until puberty, when rapid progression is often seen. We recommend surgical repair at around 12–14 years of age since the chest wall is still typically flexible and because this allows us to keep the bar in place as the patient progresses through puberty which may help decrease growth-related recurrences. Patients with mild to moderate PE are treated with therapeutic deep breathing, posturing, and aerobic exercises, and in appropriately selected patients, the vacuum bell may also be offered. Patients that have severe symptomatic PE are offered Minimally Invasive Repair of Pectus Excavatum (MIRPE). The surgical technique in children is similar to that of adults, except for the higher forces involved that often necessitate sternal elevation and more involved stabilization strategies. Postoperative management includes pain control, deep breathing, and early ambulation. Exercise restriction is mandatory for the first six weeks with slow resumption of normal activity after 12 weeks. PMID:27747183
Niedbala, Angela; Adams, Michael; Boswell, William C; Considine, John M
The minimally invasive pectus excavatum repair as described by Nuss et al. is rapidly gaining acceptance as an effective method of repair of severe pectus excavatum deformities in the pediatric population. It potentially offers several advantages over previous techniques. The incidence of major complications of the procedure has been reduced by recent modifications including utilization of video-assisted thoracoscopy during placement of the Lorenz pectus bar as well as utilizing the pectus bar stabilizer that provides more rigid fixation of the strut. We report two cases of acquired thoracic scoliosis following minimally invasive repair of severe pectus excavatum deformity. This particular complication has not been reported in previous literature and warrants concern. In both cases the thoracic scoliosis slowly improved with physical therapy and range-of-motion exercises.
Tocchioni, Francesca; Ghionzoli, Marco; Messineo, Antonio; Romagnoli, Paolo
Pectus excavatum, the most frequent congenital chest wall deformity, may be rarely observed as a sole deformity or as a sign of an underlying connective tissue disorder. To date, only few studies have described correlations between this deformity and heritable connective tissue disorders such as Marfan, Ehlers-Danlos, Poland, MASS (Mitral valve prolapse, not progressive Aortic enlargement, Skeletal and Skin alterations) phenotype among others. When concurring with connective tissue disorder, cardiopulmonary and vascular involvement may be associated to the thoracic defect. Ruling out the concomitance of pectus excavatum and connective tissue disorders, therefore, may have a direct implication both on surgical outcome and long term prognosis. In this review we focused on biological bases of connective tissue disorders which may be relevant to the pathogenesis of pectus excavatum, portraying surgical and clinical implication of their concurrence. PMID:24198927
Tocchioni, Francesca; Ghionzoli, Marco; Messineo, Antonio; Romagnoli, Paolo
Pectus excavatum, the most frequent congenital chest wall deformity, may be rarely observed as a sole deformity or as a sign of an underlying connective tissue disorder. To date, only few studies have described correlations between this deformity and heritable connective tissue disorders such as Marfan, Ehlers-Danlos, Poland, MASS (Mitral valve prolapse, not progressive Aortic enlargement, Skeletal and Skin alterations) phenotype among others. When concurring with connective tissue disorder, cardiopulmonary and vascular involvement may be associated to the thoracic defect. Ruling out the concomitance of pectus excavatum and connective tissue disorders, therefore, may have a direct implication both on surgical outcome and long term prognosis. In this review we focused on biological bases of connective tissue disorders which may be relevant to the pathogenesis of pectus excavatum, portraying surgical and clinical implication of their concurrence.
Glinkowski, Wojciech; Sitnik, Robert; Witkowski, Marcin; Kocoń, Hanna; Bolewicki, Pawel; Górecki, Andrzej
We present an automatic method for assessment of pectus excavatum severity based on an optical 3-D markerless shape measurement. A four-directional measurement system based on a structured light projection method is built to capture the shape of the body surface of the patients. The system setup is described and typical measurement parameters are given. The automated data analysis path is explained. Their main steps are: normalization of trunk model orientation, cutting the model into slices, analysis of each slice shape, selecting the proper slice for the assessment of pectus excavatum of the patient, and calculating its shape parameter. We develop a new shape parameter (I3ds) that shows high correlation with the computed tomography (CT) Haller index widely used for assessment of pectus excavatum. Clinical results and the evaluation of developed indexes are presented.
Winkens, Ron A G; Guldemond, Frank I; Hoppener, Paul F H M; Kragten, Hans A; Knottnerus, J Andre
Objectives. Doctors all over the world consider a pectus excavatum usually as an incidental finding. There is some evidence suggesting that a pectus excavatum may cause symptoms in the elderly. It is not known how often a pectus excavatum occurs and how strong the relation is with symptoms. Methods. In hospitals and general practice data, we searched for evidence of a connection between cardiac symptoms and the presence of a pectus excavatum in a retrospective survey among patients in whom a pectus excavatum was found in a chest X-ray. In radiology reports, we searched for "pectus excavat(∗) " in almost 160000 chest X-rays. The identified X-rays were reviewed by 2 radiologists. Reported symptoms were combined to a severity sum score and the relation with pectus excavatum was assessed through logistic regression. Results. Pectus excavatum was found in 1 to 2 per 1000 chest X-rays. In 32% of patients (N = 117), we found symptoms that might reflect the presence of symptomatic pectus excavatum. We found a significant relation between the SPES sum score and the radiological level of pectus excavatum. Conclusions. A pectus excavatum found when examining the patient should not be neglected and should be considered as a possible explanation for symptoms like dyspnoea, fatigue, or palpitations.
Vilaça, João L.; Moreira, António H. J.; L-Rodrigues, Pedro; Rodrigues, Nuno; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge
Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which several ribs and the sternum grow abnormally. Nowadays, the surgical correction is carried out in children and adults through Nuss technic. This technic has been shown to be safe with major drivers as cosmesis and the prevention of psychological problems and social stress. Nowadays, no application is known to predict the cosmetic outcome of the pectus excavatum surgical correction. Such tool could be used to help the surgeon and the patient in the moment of deciding the need for surgery correction. This work is a first step to predict postsurgical outcome in pectus excavatum surgery correction. Facing this goal, it was firstly determined a point cloud of the skin surface along the thoracic wall using Computed Tomography (before surgical correction) and the Polhemus FastSCAN (after the surgical correction). Then, a surface mesh was reconstructed from the two point clouds using a Radial Basis Function algorithm for further affine registration between the meshes. After registration, one studied the surgical correction influence area (SCIA) of the thoracic wall. This SCIA was used to train, test and validate artificial neural networks in order to predict the surgical outcome of pectus excavatum correction and to determine the degree of convergence of SCIA in different patients. Often, ANN did not converge to a satisfactory solution (each patient had its own deformity characteristics), thus invalidating the creation of a mathematical model capable of estimating, with satisfactory results, the postsurgical outcome.
Iannucci, Glen J; Slesnick, Timothy C; Kogon, Brian; Samai, Cyrus
A previously healthy 11-year-old girl was referred for pediatric cardiology evaluation because of the development of progressive bilateral lower extremity swelling over the course of 2 years. Her prior workup had included a negative result for proteinuria and a negative ultrasound for deep venous thrombosis. On physical examination, in addition to her edema, she was found to have a severe pectus excavatum deformity, which prompted cardiac magnetic resonance imaging. This study demonstrated compression of the inferior vena cava. She underwent uneventful pectus repair with use of a modified Ravitch procedure and experienced complete resolution of her lower extremity edema.
Sun, Yong; Zhu, Peng; Zheng, Shao-Yi
A 8-year-old girl with severe pectus excavatum and an atrial septal defect had simultaneous repair of the both defects, using thransthoracic occlusion for atrial septal defect and improved Nuss technique for the pectus excavatum. Neither cardiopulmonary bypass nor sternotomy was required in this procedure. Details of the procedure and outcome are described.
Awad, Sara F M; Barbosa-Barros, Raimundo; Belem, Lucia de Sousa; Cavalcante, Camila Pinto; Riera, Andrés Ricardo Pérez; Garcia-Niebla, Javier; Anselm, Daniel D; Baranchuk, Adrian
Brugada phenocopies (BrP) have emerged as new clinical entities that are etiologically distinct from true Brugada syndrome (BrS). BrP are characterized by an ECG pattern that is phenotypically identical to true BrS (type 1 or type 2); however, BrP are caused by various other factors such as mechanical mediastinal compression, myocardial ischemia, pericarditis, myocarditis, pulmonary embolism, and metabolic disturbances. We report a case of an electrocardiographic BrP in a patient with pectus excavatum deformity in the absence of true BrS using currently defined BrP diagnostic criteria. A systematic review of ECG manifestations associated with pectus excavatum is also discussed.
Kim, Kyung Soo
Background Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Methods Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t-test or Wilcoxon signed rank tests. Results The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. Conclusions The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair. PMID:27747176
Sarwar, Zahir U; DeFlorio, Robert; O'Connor, Stephen C
Pectus excavatum (PE) is the most common congenital chest wall deformity in children. It affects 1 in every 300-1000 live births with a male to female ratio of 5:1. Most of the patients present in their first year of life. During the teenage years, patients may have exercise intolerance and psychological strain because of their chest wall deformity. The Nuss and Ravitch procedures are established methods of surgical correction of PE. An index of severity known best as the Haller index, typically evaluated with computed tomography scan, when measuring greater than 3.2 is considered to indicate moderate or severe PE and is a prerequisite for third-party insurance reimbursement for these corrective procedures. This article reviews the clinical features of PE, the role of imaging, and the opportunities for radiation dose reduction.
Rha, Eun Young; Kim, Ji-Min; Yoo, Gyeol; Jeong, Jin Yong; Hwang, Duck Ki; Kim, Ki Jun
This study determined the breast volumes of female patients with pectus excavatum that led to asymmetry and hypoplasia compared with normal women. This retrospective study enrolled 13 patients diagnosed with pectus excavatum and 13 normal women, randomly selected from a healthcare centre (n = 26), between January 2012 and December 2014. We measured breast volumes (n = 52) based on chest computed tomography (CT) of all patients using Image J software and divided them into four groups according to the side and presence of pectus excavatum. The mean volumes of the right and left breasts of patients with pectus excavatum were 209 ± 64 mL and 218 ± 67 mL, respectively, with no significant difference between the two groups (P = 0.736). The mean volumes of the right and left breasts of normal women were 415 ± 197 mL and 439 ± 197 mL, respectively, with no significant difference between the two groups (P = 0.754). The breasts of patients with pectus excavatum were significantly smaller than those of normal women (P < 0.001). Both breasts of patients with pectus excavatum were similar in size but were smaller than the breasts of normal women. Skeletal correction for breast asymmetry correction, followed by breast augmentation for breast hypoplasty correction, with a one- or two-step approach may be useful to improve the aesthetics of breast deformities in women with pectus excavatum.
Minimally invasive repair of pectus excavatum (MIRPE) or similar procedures for pectus excavatum (PE) repair, nowadays no longer performed by one single speciality, may not always achieve sufficient aesthetic results, particularly in the infrapectoral or infraxiphoidal region. Reasons for this include the diaphragm inhibiting correct positioning of the bars, as well as asymmetric deformities which may still be present after remodelling attempts. Furthermore, some cases develop a mild recurrence or partial concavity once the correction bar is removed. However, any secondary re-do MIRPE procedure remains risky because of adhesions between the pleura, lung, pericardium, thoracic wall as residuals from the primary intervention. Treatment options as secondary correction for these deformities may include open access surgery, resection or reshaping of deformed costal cartilage. Moreover, augmentation of a residual concave area can be achieved by autologous transplantation of resected over-abundant cartilage, as well as by liposhifting or implantation of customized alloplastics. A physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques in order to provide the best options for a variety of expressions of anterior wall deformities. Among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. An appropriate technique, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be selected carefully based on the heterogeneity of symptoms, severity, expectations and surgical skill in addition to the available equipment. Out of a variety of such ancillary procedures available and based on experience within general plastic reconstructive surgery, some techniques for PE repair are explained and illustrated here with their advantages and disadvantages. PMID:27747184
Schwabegger, Anton H
Minimally invasive repair of pectus excavatum (MIRPE) or similar procedures for pectus excavatum (PE) repair, nowadays no longer performed by one single speciality, may not always achieve sufficient aesthetic results, particularly in the infrapectoral or infraxiphoidal region. Reasons for this include the diaphragm inhibiting correct positioning of the bars, as well as asymmetric deformities which may still be present after remodelling attempts. Furthermore, some cases develop a mild recurrence or partial concavity once the correction bar is removed. However, any secondary re-do MIRPE procedure remains risky because of adhesions between the pleura, lung, pericardium, thoracic wall as residuals from the primary intervention. Treatment options as secondary correction for these deformities may include open access surgery, resection or reshaping of deformed costal cartilage. Moreover, augmentation of a residual concave area can be achieved by autologous transplantation of resected over-abundant cartilage, as well as by liposhifting or implantation of customized alloplastics. A physician dealing with PE corrections should be familiar with various shaping and complementary reconstructive techniques in order to provide the best options for a variety of expressions of anterior wall deformities. Among treating surgeons, there is an awareness that no single method can be applied for every kind of funnel chest deformity. An appropriate technique, either as a single approach for the ordinary deformities or in conjunction with ancillary procedures for the intricate cases, should be selected carefully based on the heterogeneity of symptoms, severity, expectations and surgical skill in addition to the available equipment. Out of a variety of such ancillary procedures available and based on experience within general plastic reconstructive surgery, some techniques for PE repair are explained and illustrated here with their advantages and disadvantages.
Nagasao, Tomohisa; Shimizu, Yusuke; Morotomi, Tadaaki; Takano, Naoki; Jiang, Hua; Kishi, Kazuo
Pectus excavatum-commonly known as funnel chest-is one of the most frequently observed congenital deformities, in which the patients' thoraces present concavity. This paper presents our original hypothesis that the abnormal positioning of the major pectoral muscle can be a potential factor in the occurrence of pectus excavatum, and evaluates the validity of the hypothesis by performing an anatomical and a biomechanical study. An anatomical study on clinical cases revealed that the major pectoral muscle tends to be positioned more superiorly in pectus excavatum patients than in normal persons. The biomechanical study, using three-dimensional finite element dynamic simulation, revealed that the major pectoral muscle functions to elevate the sternum and that the elevating effect is reduced when the muscle is located at superior regions on the thoracic wall. These findings support our hypothesis that the abnormal position of the major pectoral muscle is a potential causative factor for pectus excavatum. This hypothesis suggests that, during surgical correction of pectus excavatum with an open approach, surgeons should reposition the major pectoral muscle to its correct anatomical position to avoid recurrence.
Kılıç, Burcu; Demirkaya, Ahmet; Turna, Akif; Kaynak, Kamil
The Nuss procedure is a minimally invasive surgical repair technique for pectus excavatum with fewer delayed complications compared to open procedures. We report the case of a 22-year-old man with deep pectus excavatum who developed vascular thoracic outlet syndrome after the Nuss procedure. Further evaluation demonstrated that the first rib was causing severe obstruction of the right subclavian artery. The patient showed clinical features of subclavian artery compression. A first rib resection, division of the anterior scalene muscle and fibrous bands provided complete relief of the complaints. The forced structural and spatial changes produced by the elevation of the depressed upper chest might have caused this complication. Vascular thoracic outlet syndrome should be kept in mind as a possible complication in patients who have undergone minimally invasive repair of pectus excavatum, and this complication can be treated by first rib resection.
Bialas, Adam J; Kaczmarski, Jacek; Kozak, Jozef; Kempinska-Miroslawska, Bogumila
Pectus excavatum is one of the most common congenital deformities of the chest wall. The aim of the study was to analyse 621 artefacts (reliefs, sculptures, paintings) from Ancient Egypt in terms of anatomical defects of the chest. The team which analysed artefacts consisted of historians of medicine and thoracic surgeons. The researchers found a relief, depicting a man with an abnormal shape of the chest. The relief was from Niankhkhnum and Khnumhotep mastaba and dates back to circa 2400 BC. The authors think it is possible that the relief may represent a pectus excavatum deformity and believe the image will open up debate on the occurrence of this deformity in ancient times.
Tchantchaleishvili, Vakhtang; Massey, Howard Todd
Pectus excavatum deformity often remains clinically asymptomatic even in cases of a severely diminished thoracic volume and frequently remains uncorrected. In the patient population that requires left ventricular assist device (LVAD) placement, a diminished thoracic volume can be problematic and lead to significant challenges in pump and outflow cannula positioning. Here we present a case of pectus excavatum correction during LVAD placement to show that this deformity can be successfully addressed with minimal, if any, additional operative risk at the time of LVAD implant.
Sinna, Raphaël; Perignon, David; Qassemyar, Quentin; Benhaim, Thomas; Dodreanu, Codrin N.; Berna, Pascal; Delay, Emmanuel
Background: Pectus excavatum is a common congenital deformity involving the anterior thoracic wall. It can be treated with several surgical approaches. Material and methods: To our best of knowledge, this is the first case of pectus excavatum repair via a 2-stage double thoracodorsal artery perforator flap procedure in a 37-year-old patient. Results: We obtained a satisfactory result in which the missing volume was correctly replaced in the absence of dorsal sequelae. The patient was very satisfied despite the dorsal scars. Conclusion: This new approach broadens the surgeon's options for the correction of thoracic deformities. PMID:20458352
Fournier, Tanya E
This is the first published report of a dog with dynamic right ventricular outflow tract (infundibular) stenosis, right ventricular hypertrophy, and pectus excavatum. A juvenile dog presented with a grade V/VI left base systolic heart murmur, tachycardia, and pectus excavatum. Diagnosis of the aforementioned conditions was based on radiography, electrocardiography, and echocardiography. At 9 1/2 wk of age the heart murmur was no longer audible and the right ventricular stenosis and hypertrophy had dissipated and regressed, respectively. Resolution may be associated with growth of the dog. A good prognosis is foreseen.
Yeung, Jonathan C; Marcuzzi, Danny; Peterson, Mark D; Ko, Michael A
We describe the case of a 28-year old man with Marfan's syndrome and severe pectus excavatum who required an aortic root replacement for an ascending aortic aneurysm. There was a near-vertical angulation of the sternum that presented challenges with opening and exposure of the heart during aortic surgery. Furthermore, removal of the sternal retractor after aortic repair resulted in sudden loss of cardiac output. A Ravitch procedure was then performed to successfully close the chest without further cardiovascular compromise. We propose that patients with a severe pectus excavatum and mediastinal displacement seen on preoperative CT scanning should be considered for simultaneous, elective repair.
Tocchioni, Francesca; Ghionzoli, Marco; Calosi, Laura; Guasti, Daniele; Romagnoli, Paolo; Messineo, Antonio
Pectus excavatum (PE) is the most frequent anterior chest deformity which may be frequently associated with connective tissue disorders. We performed microscopic analyses to better understand cartilage behavior and obtain clues on its pathogenesis. In 37 PE patients, none with Marfan syndrome, we analyzed costal cartilage by light microscopy, immunohistochemistry and transmission electron microscopy. Control tissue specimens were harvested from four patients without any connective tissue disease. In both control and PE patients, chondrocytes were on the average <15 µm in diameter and occupied <10% of tissue volume; in most cases the extracellular matrix was stained by alcian blue, instead of safranin; no difference between PE and control samples was significant. All samples showed an uneven collagen type II immunolabeling both within the cells and pericellular matrix, and occasionally of the territorial matrix. In all cases numerous cells underwent apoptosis accompanied by matrix condensation as shown by electron microscopy. Our results suggest that matrix composition and the cell number and size of costal cartilage are dependent on the subject and not on the disease; the microscopic organization of cartilage is correlated with the stabilization of the defective shape rather than with the onset of the deformity.
Kawamura, Tomonori; Fukuda, Ikuo; Minakawa, Masahito; Fukui, Kozo
A 32-year-old female patient with Marfan syndrome was admitted for repair of annuloaortic ectasia and severe pectus excavatum. Because the chest cage deformity was severe, concomitant reparative surgery of the chest wall was performed. Partial median sternotomy and left second-fifth rib division was made to obtain good surgical field. The patient underwent valve-sparing aortic root remodeling successfully. After complete neutralization of heparin, additional division of the right ribs was performed and each rib and the sternum was reshaped. Pectus excavatum was completely repaired by this method. We believe this approach is efficacious for intracardiac repair with severe pectus excavatum.
Kuru, Pinar; Cakiroglu, Aylin; Er, Aynur; Ozbakir, Hincal; Cinel, Ali Emin; Cangut, Busra; Iris, Merve; Canbaz, Berkay; Pıçak, Ebru; Yuksel, Mustafa
Background Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients’ family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. Methods This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution’s ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). Results The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52±0.51 years and the age at the time of operation was 17.89±0.42 years; for PC patients, the corresponding ages were 15.23±0.55 years and 16.77±0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17±0.15 for PE patients and 8.37±0.26 for PC patients. The postoperative pain duration was 51.93±5.18 days for PE patients and 38.5±6.88 days for PC patients. Conclusion In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care. PMID:26889443
Ladenhauf, Hannah Noemi; Stundner, Ottokar; Likar, Rudolf; Schnöll, Jörg; Metzger, Roman P
We present a case of a 25-year-old male patient suffering from severe prolonged pain after uneventful pectus excavatum repair that could be treated successfully by paravertebral nerve radiofrequency thermoablation. The patient was scheduled for a minimally invasive Nuss pectus excavatum repair. Surgical correction was performed under general anesthesia in combination with a thoracic peridural catheter. The immediate postoperative course was uneventful; however, the patient developed severe prolonged bilateral chest wall pain across segments T8 and T9. After failure of conservative treatment options, a specialized interventional anesthesiologist performed paravertebral nerve radiofrequency thermoablation of segment T9 bilaterally, after which the patient was pain free until scheduled removal of the pectus bar 3 years after placement.
Jayaramakrishnan, Kumara; Wotton, Robin; Bradley, Amy; Naidu, Babu
A best evidence topic was written according to a structured protocol. The question addressed was 'Does repair of pectus excavatum (PE) improve cardiopulmonary function?' One hundred and sixty-eight papers were found using the reported search, 19 level III evidence papers and three meta-analyses were relevant. Studies were divided into four groups based on the surgical technique applied and pulmonary and cardiac functions in these groups were analysed. The meta-analyses show conflicting results for improvements in pulmonary and cardiac functions when comparing surgical techniques, while four more recent studies show improved long-term results using the Nuss technique. The best evidence of papers studying the PE repair using the minimally invasive Nuss technique demonstrates a decrease in pulmonary function during the early postoperative period, however, there is a small but significant improvement during the late postoperative period and after bar removal. The best evidence for cardiac function in this group suggests an early improvement that is sustained during further follow-up. The best evidence of papers studying the PE repair using the Ravitch technique shows that pulmonary function decreased during the early postoperative period, however, there is a small but significant improvement during the late postoperative period. The best evidence for cardiac function in this group suggests an early improvement that is sustained during further follow-up. The best evidence of papers studying the PE repair using other techniques (modified Daniel's technique, modified Baronofsky's technique, sterno-costal turn-over technique and sterno-costal elevation technique) or where surgical techniques used were not described (preceding year 1985) suggests that there is no improvement in pulmonary function after surgery. There is some evidence that certain aspects of cardiac function improved after surgery in this group.
Background Pectus excavatum (PE) is the most common anomaly of the anterior chest wall. Prior PE was corrected by a modified Ravitch operation, but since Nuss published his minimal technique in 1998, most surgeons have preferred this technique. Methods Since 2001 the modified Nuss procedure has routinely been used for correction of more than 1,500 patients at Aarhus University Hospital. In the time period between January 1, 2011 and January 31, 2015, 675 patients have been corrected. The median age was 16 years (range, 11-58 years). All patients had preoperatively an epidural catheter and the operations were done in general anaesthesia. The postoperative pain treatment was planned for 4-5 weeks and the patients were routinely seen in the outpatient clinic 6 weeks after surgery and the bars removed after 3 years. Results Four hundred-and-fifty patients had one bar, 216 patients with two bars and nine patients with three bars inserted. The median length of the bar was 10 inch. The median duration of the operation was 29 minutes. The median postoperative stay was 3 days. No death, cardiac perforation or deep infection occurred and only 5% of the patients experienced a complication. Conclusions The Nuss procedure should still be considered in the treatment of PE. To my opinion, it should be the choice for correction of PE. The short bar should be used to achieve the best stability of the system, to obtain a good cosmetic result, a reduced dysfunction motion of the chest wall and an increased cardiac performance. PMID:25984364
Sato, Shinsuke; Nagai, Erina; Hazama, Hiroyuki; Taki, Yusuke; Takahashi, Michiro; Kyoden, Yusuke; Watanabe, Masaya; Ohata, Ko; Kanemoto, Hideyuki; Oba, Noriyuki; Takagi, Masakazu
During thoracic cavity operations, it is difficult to obtain sufficient working space and good operative field visibility in patients with pectus excavatum because the space between the vertebral bodies and sternum is very narrow. Here, we report the successful treatment of esophageal cancer in a patient with pectus excavatum. A 77-year-old man with esophageal cancer was referred to our hospital for further treatment. He was diagnosed with multiple early esophageal squamous cell carcinomas. The patient had pectus excavatum, but because it was asymptomatic, a video-assisted thoracoscopic radical esophagectomy in the left lateral decubitus position without pectus excavatum repair was selected. Despite the patient's unusual anatomy, video-assisted thoracoscopic esophagectomy in the left decubitus position allowed for good operative field visibility, as the videoscope was inserted from the side of the diaphragm. This operative procedure is useful in patients with esophageal cancer who also have pectus excavatum. To the best of our knowledge, this is the second report of video-assisted thoracoscopic esophagectomy in an esophageal cancer patient with pectus excavatum.
Horth, Lisa; Stacey, Michael W; Proud, Virginia K; Segna, Kara; Rutherford, Chelsea; Nuss, Donald; Kelly, Robert E
Pectus excavatum is the most common congenital chest wall abnormality expressed in children, yet its inheritance is poorly understood. Here we present the first comprehensive assessment of the inheritance of this disorder. After evaluating 48 pedigrees and 56 clinical traits of probands and family members, we find strong evidence of autosomal recessive, genetic control for this disorder. Additionally there is likely more than one pectus disease-associated allele, as well as a relatively large number of disease allele carriers in the human population. Some clinical traits appear important and may serve as reliable indicators for predicting the likelihood of pectus excavatum in children before severe symptoms present. Quantifying sex-ratio bias in probands demonstrates a highly significant male bias associated with pectus excavatum. When combined with pedigree data, sex-bias is indicative of sex-linked, sex-limited, and/or epigenetic control such as X-inactivation, reiterating a point made with pedigrees alone, which is that more than one mutation is likely responsible for this disorder.
Background Pectus excavatum (PE) is the most frequent anomaly of the anterior chest wall. Before 2001, all patients in Denmark were referred to the plastic and reconstructive surgeon for implantation of a subcutaneous silicone prosthesis, because the modified Ravitch procedure was not used. Since 2001, all patients have been treated with a modified Nuss procedure, which today has become the gold standard for correction of PE. Methods From September 2001 to March 2016, 1,713 patients have been operated by a modified Nuss procedure using the short bar at Aarhus University Hospital with a male-female ratio 6:1. The median age was 16 years (range 7–58 years). All operations were done in general anesthesia with epidural analgesia and all patients were operated by the same surgeon. All patients were seen routinely 6 weeks after surgery and the bars were removed after 3 years. Results Patients were younger than 18 years in 1,109 cases (65%). The number of bars needed for optimal correction was one in 1,209 patients, two in 486 patients and three in 18 patients. The median length of bar changed from 11 inches to 10 inches during the study period. The annual number of procedures continued to rise during the study period [833 patients during the first 10 years and 880 patients in the last 6 years, though more patients received two bars in the later period, (34%) versus (24%)] and the proportion of patients older than 30 years increased from 7.7% to 10%. The average duration of the operation was 36 minutes (range 12–270 minutes) and did not change significantly during the study period, change in operation time which was around half an hour. The median postoperative hospital stay decreased over time from 6 to 2 days. There was no mortality. Conclusions The modified Nuss procedure with the short bar technique is effective for the correction of PE. The results are stable with a low rate of bar malrotations, and in may most cases can be done in less than an hour in
Zou, Xusen; Lin, Yanqing; Jin, Hui; Cai, Sumei; Xu, Xin; Yin, Weiqiang; Geng, Qingshan; Chen, Jiuhao; Liang, Bing
Objective To carry out pectus excavatum (PEx) screening among primary school students in Dongguan, with an attempt to establish a PEx screening program and provide epidemiological evidences for developing guidelines on the diagnosis and treatment of PEx for young children. Methods A total of 479,402 primary school students who were already in school in 2012 or newly enrolled in 2013 from 422 primary schools in 32 towns in Dongguan, Guangdong Province were screened for PEx. Meanwhile, about 420 medical staff from the infirmaries of 422 primary schools were provided with a serial of training, with an attempt to establish a PEx screening program and network. Results Valid screening results were obtained from 477,627 pupils (99.62%) from 406 primary schools in 31 towns. These students aged 4-15 years (mean: 8.78 years), among whom there were 244,545 males (N1; mean age: 8.22 years) and 233,082 females (N2; mean age: 8.89 years). Totally 257 PEx patients were identified, yielding a prevalence of 0.583%, among whom there were 176 males (N3; mean age: 8.79 years) and 81 females (N4; mean age: 8.77 years). With the PEx patients as the PEx group and the healthy children as the control group, chi square test with gender as the dependent variable showed that the incidence of PEx was significantly different between male and female students (P=0.00) (N3:N4 =2.172:1). In addition, 410 medical staff from the school infirmaries were trained, and a PEx screening program and network was established. Conclusions The screening for PEx was successfully performed among pupils who were already in school in 2012 or newly enrolled in 2013 from 422 primary schools in Dongguan, Guangdong Province. Statistical analysis showed that the incidence of PEx differed between male and female pupils. A stable effective PEx screening program was established, which will provide personal and technical supports for the early diagnosis and treatment of this condition. PMID:26101642
Blickman, J.G.; Rosen, P.R.; Welch, K.J.; Papanicolaou, N.; Treves, S.T.
Regional distribution of pulmonary function was evaluated preoperatively and postoperatively with xenon-133 perfusion and ventilation scintigraphy in 17 patients with pectus excavatum. Ventilatory preoperative studies were abnormal in 12 of 17 patients, resolving in seven of 12 postoperatively. Perfusion scans were abnormal in ten of 17 patients preoperatively; six of ten showed improvement postoperatively. Ventilation-perfusion ratios were abnormal in ten of 17 patients, normalizing postoperatively in six of ten. Symmetry of ventilation-perfusion ratio images improved in six out of nine in the latter group. The distribution of regional lung function in pectus excavatum can be evaluated preoperatively to support indications for surgery. Postoperative improvement can be documented by physiological changes produced by the surgical correction.
Lin, Chieh-Wen; Chen, Ke-Chi; Diau, Guan-Yeu; Chu, Chih-Chun
The Nuss procedure is the most popular technique for correction of pectus excavatum recently. Life-threatening complications associated with the procedure are very rare. We report a 13-year-old boy who developed late-onset bilateral hemothorax with hypovolemic shock 5 months after the Nuss procedure. In literature review, this is the first case of the late-onset life-threatening bilateral hemothorax with hypovolemic shock ever reported.
Jeong, Jin Yong; Suh, Jong Hui; Yoon, Jeong Seob; Park, Chan Beom
The Nuss procedure, which is a minimally invasive approach for treating pectus excavatum, has better functional and cosmetic outcomes than other invasive procedures. Cardiac perforation is the most serious complication and several methods for the prevention of intraoperative events has been developed. Although most cardiac injuries are detected in the operating room, in the case described herein the patient experienced sudden hypovolemic shock during the postoperative recovery period. This indicates that special caution is mandatory even after successful execution of the Nuss procedure.
Rebeis, Eduardo Baldassari; de Campos, Jose Ribas Milanez; Moreira, Luis Felipe Pinho; Pastorino, Antonio Carlos; Pêgo-Fernandes, Paulo Manuel; Jatene, Fabio Biscegli
OBJECTIVES: To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS: Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS: Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11–40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION: In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent. PMID:24141837
Witkowski, Marcin; Glinkowski, Wojciech; Sitnik, Robert; Kocoń, Hanna; Bolewicki, Paweł; Górecki, Andrzej
The paper presents an optical three-dimensional shape measurement system and an automatic method for assessment of pectus excavatum severity based on the measurement results. The measurement system consists of four directional modules utilizing structured light projection method (namely temporal phase shifting TPS and modified Gray code projection) to capture the shape of body surface of the patients. The measurement result is a three-dimensional point cloud representing the skin surface. The system setup is described and the typical measurement parameters are given. The automated data analysis path is explained. Its main stages are: point cloud segmentation, normalization of trunk orientation, cutting the model into slices, analysis of each slice shape, selecting the proper slice for the assessment of pectus excavatum of the patient and calculating its shape parameter. The analysis does not require any initial processing (e.g. surface fitting or mesh building) as it is conducted on raw 3-D point cloud data resulting from the measurement. A new shape parameter (I3ds) was developed that shows correlation with CT Haller Index widely used for assessment of pectus excavatum. Preliminary clinical results are presented.
Soares, Tony R; Henriques-Coelho, Tiago; Vilaça, João; Silva, Ana Raquel; Carvalho, José Luis; Correia-Pinto, Jorge
Pectus Excavatum is the most common congenital deformity of the chest. Although Pectus Excavatum can be associated with heart or lung problems, the main indication for surgical correction of this congenital anomaly is the body image dissatisfaction. The Nuss technique is a minimally invasive procedure that allows the placement of an intrathoracic prosthetic convex bar, previously bended, which mobilize the sternum anteriorly. The aim of this study was to evaluate the degree of satisfaction of the patients and parents after the application of the Nuss technique using the Pectus Excavatum Evaluation Questionnaire. All parameters of psychosocial character - self-image, difficulties in exposing the chest, frustration, sadness, social isolation and ridicule - found a statistically significant improvement after surgical correction of Pectus Excavatum from the perspective of patients and their parents. There was not a marked improvement and consensus regarding the overall physical performance of patients. Which is understandable, since, theoretically, the physical deformity is not responsible for significant limitations on exertion. The current surgical correction of Pectus Excavatum by the Nuss technique allows obtaining aesthetic results of the chest with the resolution of the main problems with body image. Increase awareness of health issues for psychosocial and physical factors which might be involved in this kind of deformities is important, especially when there is a satisfactory solution.
Lu, Tao; Deng, Kaihong
This paper is aimed to evaluate the CT manifestation of congenital pectus excavatum and its effect on the cardiac morphology. CT features of 34 children with pectus excavatum were retrospectively reviewed. The Haller index (HI), CT depression index (CTDI), cardiac rotation angle (CRA), pulmonary vein angle (PVA), cardiac compression index (CCI) and cardiac asymmetry index (CAI) were measured from the images on the PACS system. The relationships among these indexes were evaluated. The HI was 4.12 +/- 1.48, the CTDI was 2.39+/- 0.70, CRA was (53.52 +/- 7.68) degrees, PVA was (66.51 +/- 11.02) degrees, CCI was 2.43 +/- 0.95, and CAI was 1.55 +/- 0.56. There was statistical significance of CCI and CAI between children with severe or slight pectus excavatum. The HI and CTDI were positively related with CCI and CAI respectively, whereas there was no statistical significance of CRA and PVA between children with severe or slight pectus excavatum. There was no statistical significance of HI, CTDI, CRA, PVA, CCI and CAI among different age groups. The morphological change of the heart compressed in children with pectus excavatum can be accurately evaluated by multislice helical CT.
Tardie, Gregory B; Dorsey, David A; Kaeferlein, Bernhard H
Pectus excavatum (PE) is a relatively common congenital deformity of the anterior chest wall associated with reduced exercise capacity. Uncertainty exists over the nature of physiologic impairment in PE. Evidence suggests that myocardial compression exerted by the displaced sternum on the right heart chambers, disables the ability of the heart to augment stroke volume during exercise. This case study describes the evaluation of an athletic 20 year old Caucasian male, lifelong non-smoker, with severe pectus deformity and previous fixation procedure to repair a sternal fracture. The patient performed an incremental cycle ergometer exercise test to determine the etiology of his dyspnea with exertion. The patient demonstrated normal work output and normal aerobic capacity but displayed dynamic hyperinflation. Mechanical restriction of tidal volume expansion appeared to be the major contributors to exercise limitation. These results are compared and contrasted with similar cases reported in the literature. Key PointsPectus excavatum (PE) is a relatively common phenomenon affecting approximately 1 in 300 births, with a 9:1 ratio of male to female rate of incidence.The etiology or exercise limitation is most frequently due to cardiovascular limitation due to the compression of the sternum upon the myocardium, impairing the ability to augment stroke volume.The Pectus Severity Index (PSI) is a useful indicator of pectus severity.Cardiopulmonary exercise testing provides useful data to distinguish between cardiovascular limitation, ventilatory limitation, or deconditioning in the evaluation of PE.In this case study, ventilatory limitation was due to the mechanical restriction of the thoracic cavity.
Ahn, Jinhee; Shim, Jaemin; Lee, Sung Ho; Kim, Young-Hoon
Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS). PMID:28321340
Kondo, Yusuke; Ueda, Marehiko; Winter, Joachim; Nakano, Miyo; Nakano, Masahiro; Ishimura, Masayuki; Miyazawa, Kazuo; Tateno, Kaoru; Kobayashi, Yoshio
The entirely subcutaneous implantable cardioverter-defibrillator (ICD) system was developed to provide a life-saving defibrillation therapy that does not affect the heart and vasculature. The subcutaneous ICD is preferred over the transvenous ICD for patients with a history of recurrent infection presenting major life-threatening rhythms. In this case report, we describe the first successful intermuscular implantation of a completely subcutaneous ICD in a Japanese patient with pectus excavatum. There were no associated complications with the device implantation or lead positioning. Further, the defibrillation threshold testing did not pose any problem with the abnormal anatomy of the patient.
Roberts, Jillian; MacMath, Sheryl; English, Margot; Martin, Joan; Hayashi, Al; Sigalet, David L.
This article takes a comprehensive look at the effects of pectus excavatum, a congenital deformity with psychosocial and physical ramifications, and the Nuss procedure on the quality of life of adolescents. The Nuss procedure is a minimally invasive corrective surgery. Twenty-five participants from Calgary, Alberta were interviewed (10 adolescents…
Moreira, Antonio H. J.; Rodrigues, Pedro L.; Fonseca, Jaime; Pinho, A. C. M.; Rodrigues, Nuno F.; Correia-Pinto, Jorge; Vilaça, João L.
Pectus excavatum is the most common congenital deformity of the anterior chest wall, in which an abnormal formation of the rib cage gives the chest a caved-in or sunken appearance. Today, the surgical correction of this deformity is carried out in children and adults through Nuss technic, which consists in the placement of a prosthetic bar under the sternum and over the ribs. Although this technique has been shown to be safe and reliable, not all patients have achieved adequate cosmetic outcome. This often leads to psychological problems and social stress, before and after the surgical correction. This paper targets this particular problem by presenting a method to predict the patient surgical outcome based on pre-surgical imagiologic information and chest skin dynamic modulation. The proposed approach uses the patient pre-surgical thoracic CT scan and anatomical-surgical references to perform a 3D segmentation of the left ribs, right ribs, sternum and skin. The technique encompasses three steps: a) approximation of the cartilages, between the ribs and the sternum, trough b-spline interpolation; b) a volumetric mass spring model that connects two layers - inner skin layer based on the outer pleura contour and the outer surface skin; and c) displacement of the sternum according to the prosthetic bar position. A dynamic model of the skin around the chest wall region was generated, capable of simulating the effect of the movement of the prosthetic bar along the sternum. The results were compared and validated with patient postsurgical skin surface acquired with Polhemus FastSCAN system.
Stępiński, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szymańska, Anna; Marczak, Jakub; Cichoń, Romuald
A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.
Rodrigues, Pedro L.; Moreira, António H. J.; Rodrigues, Nuno F.; Pinho, ACM; Fonseca, Jaime C.; Correia-Pinto, Jorge; Vilaça, João. L.
Pectus excavatum is the most common deformity of the thorax and usually comprises Computed Tomography (CT) examination for pre-operative diagnosis. Aiming at the elimination of the high amounts of CT radiation exposure, this work presents a new methodology for the replacement of CT by a laser scanner (radiation-free) in the treatment of pectus excavatum using personally modeled prosthesis. The complete elimination of CT involves the determination of ribs external outline, at the maximum sternum depression point for prosthesis placement, based on chest wall skin surface information, acquired by a laser scanner. The developed solution resorts to artificial neural networks trained with data vectors from 165 patients. Scaled Conjugate Gradient, Levenberg-Marquardt, Resilient Back propagation and One Step Secant gradient learning algorithms were used. The training procedure was performed using the soft tissue thicknesses, determined using image processing techniques that automatically segment the skin and rib cage. The developed solution was then used to determine the ribs outline in data from 20 patient scanners. Tests revealed that ribs position can be estimated with an average error of about 6.82+/-5.7 mm for the left and right side of the patient. Such an error range is well below current prosthesis manual modeling (11.7+/-4.01 mm) even without CT imagiology, indicating a considerable step forward towards CT replacement by a 3D scanner for prosthesis personalization.
Vilaça, João L; Rodrigues, Pedro L; Soares, Tony R; Fonseca, Jaime C; Pinho, António C M; Henriques-Coelho, Tiago; Correia-Pinto, Jorge
Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients' sides. It highlighted that the prosthesis bar should be modeled according to each patient's rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.
Yoon, Jee Young; Han, Kook Nam; Choi, Young Ho
Purpose: This study assessed physical development of patients with pectus excavatum and evaluated the effect of the Nuss procedure on physical development. Methods: A total of 146 patients underwent the Nuss procedure; of these, at the time of the study, the bar had been removed from 123 patients (84.9%; male 93, female 30) who were eligible for participation in this study. Heights and body weights of patients were measured prior to surgery and immediately before bar removal. Chest computed tomography (CT) was performed preoperatively and immediately before bar removal. The associations between physical development and chest CT indices were evaluated. Results: The height standard deviation score (SDS) was − 0.66 ± 2.23 preoperatively and 0.04 ± 1.34 immediately before bar removal (p <0.01). The weight SDS was − 0.02 ± 2.59 preoperatively; it increased significantly to 0.56 ± 1.56 immediately before bar removal (p <0.01). The Haller index (3.85 ± 1.18 to 2.99 ± 0.54; p <0.01) and asymmetric index (9.75 ± 6.63 to 7.01 ± 4.77; p <0.01) also showed improvements. Conclusions: The Nuss procedure may contribute positively to the physical development of patients with pectus excavatum. PMID:27629820
Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio
Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques.
Kanagaratnam, Aran; Phan, Steven; Tchantchaleishvilli, Vakhtang
Background Pectus excavatum is the most common congenital chest wall deformity. The two most common surgical techniques for its correction are the modified Ravitch technique and the minimally invasive Nuss technique. Despite both procedures being used widely, data comparing them are scarce. Methods We conducted a systematic review and meta-analysis of comparative studies to evaluate these procedures. A systematic search of the literature was performed from six electronic databases. Pooled meta-analysis was conducted using odds ratio (OR) and weighted mean difference (WMD). Results A total of 13 studies comprising 1,432 pediatric (79.3%) and adult (20.7%) patients were identified, including 912 patients undergoing the Nuss procedure compared to 520 patients undergoing the Ravitch procedure. There was no significant difference found between the Nuss group versus Ravitch group in pediatric patients with regard to overall complications (OR =1.16; 95% CI: 0.61–2.19; I2=56%; P=0.65), reoperations (6.1% vs. 6.4%; OR =1.00; 95% CI: 0.40–2.50; I2=0%; P=1.00), wound infections (OR =0.58; 95% CI: 0.23–1.46; I2=0%; P=0.25), hemothorax (1.6% vs. 1.3%; OR =0.74; 95% CI: 0.21–2.65; I2=12%; P=0.64), pneumothorax (3.4% vs. 1.5%; OR =1.11; 95% CI: 0.42–2.93; I2=0%; P=0.83) or pneumonia (OR =0.15; 95% CI: 0.02–1.48; I2=0%; P=0.10). Adult patients undergoing the Nuss procedure had a higher incidence of overall complications (OR =3.26; 95% CI: 1.01–10.46; I2=0%; P=0.05), though there were far fewer studies that reported data. Conclusions These results suggest no difference between the Nuss and Ravitch procedures for pediatric patients, while in adults the Ravitch procedure resulted in fewer complications. PMID:27747174
Jaroszewski, Dawn; Ewais, MennatAllah; DeValeria, Patrick; Gotway, Michael; Craig Miller, D.
Introduction The Nuss procedure for pectus excavatum (PE) repair has been successfully performed in Marfan syndrome (MFS) patients however there is concern for future risk of aortic dilation/rupture and need for emergent access with support bars in place. Case presentation We present a 45 year-old male with MFS that required descending aortic replacement shortly after modified Nuss repair. Discussion The majority of MFS patients have severe PE and repair with the Nuss procedure is not uncommon. The risk for life threatening aortic dilation, dissection, or rupture in such patients is a concern when utilizing this technique. Our work has been reported in line with the CARE criteria. Conclusion Nuss repair should be considered in MFS patients with technique modifications and careful consideration of future risk of aortic dilation and rupture. PMID:26895112
Jacobsen, Elisabeth Brammer; Thastum, Mikael; Pilegaard, Hans
Background The impact of correction of pectus excavatum (PE) on adolescents’ health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group. Methods Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE. A control group (n=183) consisting of school children comparable in age completed the same measure on one occasion. Results The patients’ level of HRQL before surgery was comparable to the level of the controls except for physical functioning; here boys reported impaired function compared to controls (P<0.0001, d=0.72). Both patients and parents reported improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre- to post-surgery. These improvements were statistically significant (P≤0.001–0.03) and yielded moderate to high effect sizes (ƞ2=0.04–0.22). Conclusions The improvement of physical and psychosocial HRQL reported by both patients and their parents as proxy indicates the psychological implications of the deformity. Patients reported impaired physical function compared to controls. Further, pre-surgery differences in HRQL between the patients and the controls were lacking. However, the improvement in the patients’ HRQL following surgery may justify the correction of pectus excavatum. The effect of the deformity on patients wellbeing compared with controls’ needs to be addressed in further studies. PMID:27747179
... to produce cross-sectional images of the body's internal structure. Electrocardiogram. An electrocardiogram can show whether the heart's rhythm is normal or irregular, and if the electrical signals that control the heartbeat are timed properly. This test is ...
Rodrigues, Pedro L; Rodrigues, Nuno F; Pinho, A C M; Fonseca, Jaime C; Correia-Pinto, Jorge; Vilaça, João L
Pectus excavatum is the most common deformity of the thorax. Pre-operative diagnosis usually includes Computed Tomography (CT) to successfully employ a thoracic prosthesis for anterior chest wall remodeling. Aiming at the elimination of radiation exposure, this paper presents a novel methodology for the replacement of CT by a 3D laser scanner (radiation-free) for prosthesis modeling. The complete elimination of CT is based on an accurate determination of ribs position and prosthesis placement region through skin surface points. The developed solution resorts to a normalized and combined outcome of an artificial neural network (ANN) set. Each ANN model was trained with data vectors from 165 male patients and using soft tissue thicknesses (STT) comprising information from the skin and rib cage (automatically determined by image processing algorithms). Tests revealed that ribs position for prosthesis placement and modeling can be estimated with an average error of 5.0 ± 3.6mm. One also showed that the ANN performance can be improved by introducing a manually determined initial STT value in the ANN normalization procedure (average error of 2.82 ± 0.76 mm). Such error range is well below current prosthesis manual modeling (approximately 11 mm), which can provide a valuable and radiation-free procedure for prosthesis personalization.
Barbosa, Daniel; Queirós, Sandro; Rodrigues, Nuno; Correia-Pinto, Jorge; Vilaça, J.
One of the current frontiers in the clinical management of Pectus Excavatum (PE) patients is the prediction of the surgical outcome prior to the intervention. This can be done through computerized simulation of the Nuss procedure, which requires an anatomically correct representation of the costal cartilage. To this end, we take advantage of the costal cartilage tubular structure to detect it through multi-scale vesselness filtering. This information is then used in an interactive 2D initialization procedure which uses anatomical maximum intensity projections of 3D vesselness feature images to efficiently initialize the 3D segmentation process. We identify the cartilage tissue centerlines in these projected 2D images using a livewire approach. We finally refine the 3D cartilage surface through region-based sparse field level-sets. We have tested the proposed algorithm in 6 noncontrast CT datasets from PE patients. A good segmentation performance was found against reference manual contouring, with an average Dice coefficient of 0.75±0.04 and an average mean surface distance of 1.69+/-0.30mm. The proposed method requires roughly 1 minute for the interactive initialization step, which can positively contribute to an extended use of this tool in clinical practice, since current manual delineation of the costal cartilage can take up to an hour.
Karner, Courtney M; Long, Fanxin; Solnica-Krezel, Lilianna; Monk, Kelly R; Gray, Ryan S
Adolescent idiopathic scoliosis (AIS) and pectus excavatum (PE) are common pediatric musculoskeletal disorders. Little is known about the tissue of origin for either condition, or about their genetic bases. Common variants near GPR126/ADGRG6 (encoding the adhesion G protein-coupled receptor 126/adhesion G protein-coupled receptor G6, hereafter referred to as GPR126) were recently shown to be associated with AIS in humans. Here, we provide genetic evidence that loss of Gpr126 in osteochondroprogenitor cells alters cartilage biology and spinal column development. Microtomographic and x-ray studies revealed several hallmarks of AIS, including postnatal onset of scoliosis without malformations of vertebral units. The mutants also displayed a dorsal-ward deflection of the sternum akin to human PE. At the cellular level, these defects were accompanied by failure of midline fusion within the developing annulus fibrosis of the intervertebral discs and increased apoptosis of chondrocytes in the ribs and vertebrae. Molecularly, we found that loss of Gpr126 upregulated the expression of Gal3st4, a gene implicated in human PE, encoding Galactose-3-O-sulfotransferase 4. Together, these data uncover Gpr126 as a genetic cause for the pathogenesis of AIS and PE in a mouse model.
Betti, Stefano; Ciuti, Gastone; Ricotti, Leonardo; Ghionzoli, Marco; Cavallo, Filippo; Messineo, Antonio; Menciassi, Arianna
Pectus Excavatum is an anatomical deformation characterized by a depression of the anterior chest wall. Nuss technique (representing the current clinical golden standard) consists in the introduction of a corrective metal bar, in order to raise the sternum in its anatomic natural position. Nowadays, the bar plays purely a mechanical/corrective action and is kept implanted for about three years, supporting up to a maximum force of 250 N. Our study aims at optimizing the procedure of correction, in terms of monitoring the bar effect, minimizing the body response, and facilitating the bar removal. The sensorized Nuss bar prototype inserted in a platform for telemedicine described in this article is able to monitor in vitro pressure data variations, with more than 150 discrete measurements during the operating period. This behavior is promising for future clinical applications, in which the device could be exploited to monitor the forces at work, thus, providing a customized therapeutic protocol, which in turn may optimize the period of implant. The sensorized bar was also provided with a polymeric coating, able to influence human dermal fibroblast behavior in vitro. This highlights the possibility to minimize, in future in vivo applications, tissue fibrotic responses. PMID:25268912
Stępiński, Piotr; Aboul-Hassan, Sleiman Sebastian; Szymańska, Anna; Marczak, Jakub; Cichoń, Romuald
A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed. PMID:27516786
Ricotti, Leonardo; Ciuti, Gastone; Ghionzoli, Marco; Messineo, Antonio; Menciassi, Arianna
This study aims at assessing the mechanical behavior of a composite metal/polymer bar to be implanted in the retrosternal position, in order to correct chest wall deformities, such as Pectus Excavatum. A 300-mm-long, 12.7-mm-wide, and 3.5-mm-thick Nuss bar was considered, made of different metals and biodegradable polymers, fixed at its extremities, and with a constant force of 250 N applied on its center. Two different geometries for the metal elements to be embedded in the polymeric matrix were tested: in the former, thin metal sheets and in the latter, cylindrical metal reinforcing rods were considered. Finite element method simulation results are reported, in terms of maximum stress and strain of the bar. Furthermore, the maximum stress values obtained by varying metal sheet thickness or rod diameter (and therefore the volumetric percentage of metal within the matrix) for different material combinations are also shown; optimal configuration for the Pectus Excavatum treatment was finally identified for a composite Nuss bar.
Maagaard, Marie; Heiberg, Johan
Patients with pectus excavatum (PE) often describe improvements in exercise stamina following corrective surgery. Studies have investigated the surgical effect on physiological parameters; still, no consensus has yet been reached. Therefore, the aim of this literature review was to describe the cardiac outcome after surgical correction, both at rest and during exercise. In February 2016, a detailed search of the databases PubMed, Medline, and EMBASE was performed. We assessed clinical studies that described cardiac outcomes both before and after surgical correction of PE. We only included studies reporting either pre-defined echocardiographic or exercise test parameters. No exclusion criteria or statistical analyses were applied. Twenty-one full-text articles, published between 1972 and 2016, were selected, with cohort-ranges of 3-168 patients, mean age-ranges of 5-33 years, and mean follow-up-ranges from immediately to 4 years after surgery. Twelve studies described resting cardiac parameters. Four studies measured cardiac output, where one described 36% immediate increase after surgery, one reported 15% increase after Nuss-bar removal and two found no difference. Three studies demonstrated improvement in mean stroke volume ranges of 22-34% and two studies found no difference. Fifteen studies investigated exercise capacity, with 11 considering peak O2 pr. kg, where five studies demonstrated improvements with the mean ranging from 8% to 15% after surgery, five studies demonstrated no difference, and one saw a decrease of 19% 3 months after Nuss-bar implantation. A measurable increase in exercise capacity exists following surgery, which may be caused by multiple factors. This may be owed to the relief of compressed cardiac chambers with the increased anterior-posterior thoracic dimensions, which could facilitate an improved filling of the heart. With these results, the positive physiological impact of the surgery is emphasized and the potential gain in cardiac
Patients with pectus excavatum (PE) often describe improvements in exercise stamina following corrective surgery. Studies have investigated the surgical effect on physiological parameters; still, no consensus has yet been reached. Therefore, the aim of this literature review was to describe the cardiac outcome after surgical correction, both at rest and during exercise. In February 2016, a detailed search of the databases PubMed, Medline, and EMBASE was performed. We assessed clinical studies that described cardiac outcomes both before and after surgical correction of PE. We only included studies reporting either pre-defined echocardiographic or exercise test parameters. No exclusion criteria or statistical analyses were applied. Twenty-one full-text articles, published between 1972 and 2016, were selected, with cohort-ranges of 3–168 patients, mean age-ranges of 5–33 years, and mean follow-up-ranges from immediately to 4 years after surgery. Twelve studies described resting cardiac parameters. Four studies measured cardiac output, where one described 36% immediate increase after surgery, one reported 15% increase after Nuss-bar removal and two found no difference. Three studies demonstrated improvement in mean stroke volume ranges of 22–34% and two studies found no difference. Fifteen studies investigated exercise capacity, with 11 considering peak O2 pr. kg, where five studies demonstrated improvements with the mean ranging from 8% to 15% after surgery, five studies demonstrated no difference, and one saw a decrease of 19% 3 months after Nuss-bar implantation. A measurable increase in exercise capacity exists following surgery, which may be caused by multiple factors. This may be owed to the relief of compressed cardiac chambers with the increased anterior-posterior thoracic dimensions, which could facilitate an improved filling of the heart. With these results, the positive physiological impact of the surgery is emphasized and the potential gain in cardiac
Zhang, Dong-Kun; Tang, Ji-Ming; Ben, Xiao-Song; Xie, Liang; Zhou, Hai-Yu; Ye, Xiong; Zhou, Zi-Hao; Shi, Rui-Qing; Xiao, Pu
Background To review the clinical experience and short- to middle-term effects of the Nuss procedure for correction of pectus excavatum (PE). Methods From September 2006 to August 2014, 639 patients with PE were treated using the Nuss procedure. Of these, 546 were male and 93 were female. The mean age was 15.3±5.8 years (2.5-49 years). Preoperative chest CT scans Haller index (HI) was 4.3±1.7 (2.9-17.4), with 75 cases of mild PE (HI <3.2), 114 cases of moderate PE (HI 3.2-3.5), 393 cases of severe PE (HI 3.6-6.0), and 57 cases of extremely severe PE (HI >6.0). Results A total of 638 patients successfully completed the surgery, an 11-year-old male patient who died after the surgery had undergone ventricular septal defect closure surgery through a sternal incision 7 years ago. The mean operative time was 64.3±41.7 min (40-310 min). Excluding the patient who died, the average blood loss was 24.5±17.8 mL (10-160 mL). The average length of postoperative hospital stay was 5.2±2.9 days (4-36 days). A total of 484 cases (75.7%) required 1 steel bar insertion, 153 cases (24.0%) required 2 steel bars, and 2 cases (0.3%) required 3 bars. Postoperative evaluation of the surgery outcomes revealed the following: excellent in 504 cases, good in 105, fair in 28 and poor in 2, good quality rate was 95.3%. Conclusions Correction of PE via the Nuss procedure is minimally invasive and simple to perform with good short and mid-term effects, while long-term efficacy remains to be determined. PMID:26543607
Fonseca, João Gomes; Moreira, Antonio H. J.; Rodrigues, Pedro L.; Fonseca, Jaime C.; Pinho, A. C. M.; Correia-Pinto, Jorge; Rodrigues, Nuno F.; Vilaça, João L.
Pectus excavatum is the most common congenital deformity of the anterior thoracic wall. The surgical correction of such deformity, using Nuss procedure, consists in the placement of a personalized convex prosthesis into sub-sternal position to correct the deformity. The aim of this work is the CT-scan substitution by ultrasound imaging for the pre-operative diagnosis and pre-modeling of the prosthesis, in order to avoid patient radiation exposure. To accomplish this, ultrasound images are acquired along an axial plane, followed by a rigid registration method to obtain the spatial transformation between subsequent images. These images are overlapped to reconstruct an axial plane equivalent to a CT-slice. A phantom was used to conduct preliminary experiments and the achieved results were compared with the corresponding CT-data, showing that the proposed methodology can be capable to create a valid approximation of the anterior thoracic wall, which can be used to model/bend the prosthesis.
Becmeur, François; Ferreira, Cindy Gomes; Haecker, Frank-Martin; Schneider, Anne; Lacreuse, Isabelle
We present a new case of cardiac perforation during retrosternal dissection beginning a Nuss procedure for pectus excavatum repair in an 18-year-old boy. The true incidence of life-threatening complications, such as heart injuries during Nuss bar placement for pectus excavatum repair, as well as cardiac lacerations during removal of the bar, remains unknown. Many papers suggest measures to prevent these complications: approaching the retrosternal space through an additional subxiphoid short incision, lifting the sternum during bar placement, or placing the bar extrapleuraly. Nuss procedure is gaining more and more popularity due to its apparent simplicity; however, its operational complications should be well known and discussed to be avoided later on.
Dionyssiou, Dimitrios; Demiri, Efterpi; Batsis, Georgios; Pavlidis, Leonidas
This study aims to present the case of a female patient with Poland's syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland's syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park's classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland's syndrome female patients with chest wall and breast deformities.
Siddiqui, Asad; Tse, Andrew; Paul, James E; Fitzgerald, Peter; Teh, Bernice
Introduction Managing postoperative pain in patients undergoing minimally invasive pectus excavatum repair (Nuss procedure) is challenging but essential in facilitating ambulation and minimizing the length of stay. Although multiple epidural regimens with varying opioids are presently used for pain management, there is currently no clinical consensus regarding which epidural regimen provides the best analgesia outcomes with the fewest side effects. This 10-year retrospective cohort study was performed to compare the quality of analgesia and the incidence of side effects associated with the three most common epidural regimens used at a tertiary care children’s hospital, in patients undergoing the Nuss procedure. Methods Seventy-two pediatric patients were identified as having been treated with one of three epidural regimens for postoperative pain management following the Nuss procedure: Group A (n=12) received 0.125% bupivacaine and 5 µg/mL fentanyl, Group B (n=21) received 0.125% bupivacaine and 10 µg/mL hydromorphone, and Group C (n=39) received 0.1% ropivacaine and 20 µg/mL hydromorphone. Our primary outcome was maximal daily pain scores (numerical rating scale 0–10), with an analytical focus on postoperative day 1 scores. The primary outcome was analyzed using linear regression. The secondary outcomes included the length of stay, side-effect profiles as reflected by the number of treatments for nausea and pruritus, pain scores according to epidural site insertion, occurrence of breakthrough pain, and presence of severe pain throughout their hospital stay. Secondary outcomes were analyzed using linear or logistic regression adjusted for pain scores at baseline. The criterion for statistical significance was set a priori at alpha =0.05. Results Group A had significantly higher day-1 pain scores (score 5.42/10) than Group B (4.52/10; P=0.030) and Group C (4.49/10; P=0.015) after adjusting for baseline pain and age. No significant difference in maximum daily
Du, Xiaojun; Mao, Songsong; Cui, Jianxiu; Ma, Jue; Zhang, Guangyan; Zheng, Yong; Zhou, Haiyu; Xie, Liang; Zhang, Dongkun; Shi, Ruiqing
Background The aim of the present study was to determine the safety and feasibility of the use of laryngeal mask airway (LMA) for non-endotracheal intubated anesthesia for patients with pectus excavatum (PE) undergoing thoracoscopic Nuss procedure. Methods Between July 2015 and December 2015, 30 selected patients with PE were planned to undergo a thoracoscopic Nuss procedure using LMA for non-endotracheal intubated anesthesia in the Guangdong General Hospital. The clinical data were analyzed to evaluate the safety and feasibility of this technique. Results Of the 30 selected patients, two were female, the mean age was 16.04±5.09 years and the average Haller index was 3.37±0.88. A total of 27 cases (90%) succeeded at the first attempt, one patient required conversion to an endotracheal tube (ETT) because of continuous air leak. The peripheral O2 saturation (SpO2), end-tidal carbon dioxide (EtCO2) values, heart rate (HR), and mean arterial blood pressure (MAP) remained stable throughout the procedure in all cases. All of the 30 patients were successfully corrected without requiring conversion to an open surgery. Two patients experienced postoperative nausea and one reported a sore throat. Neither gastro-esophageal reflux nor in-hospital mortality occurred. Conclusions The use of LMA for non-endotracheal intubated anesthesia for selected patients with PE undergoing thoracoscopic Nuss procedure is clinically safe and technically feasible. PMID:27621860
Golden, Eleza T; Alazraki, Adina; Loewen, Jonathan; Braithwaite, Kiery
Sternal cleft anomalies are rare. Associated anomalies include pentalogy of Cantrell and posterior fossa abnormalities, hemangiomas, arteriopathy, cardiac anomalies, eye abnormalities, and sternal defects syndrome. There is only a single report of complete sternal cleft, pectus excavatum, and right clavicular hypoplasia in an adult. Thyroid hemiagenesis is also very rare. To our knowledge, this is the first case of complete sternal cleft, pectus deformity, and right clavicular hypoplasia in a child and the first case with right thyroid hemiagenesis.
Gottlieb LJ, Reid RR, Lee JC. Pediatric chest and trunk defects. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 41. Lumpkins KM, Colombani P, Abdullah F. Repair ...
Gottlieb LJ, Reid RR, Lee JC. Pediatric chest and trunk defects. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier; 2013:chap 41. Lumpkins KM, Colombani P, Abdullah F. Repair ...
Rechowicz, Krzysztof; McKenzie, Frederic; Yan, Zhenzhen; Bawab, Sebastian; Ringleb, Stacie
The cause of pectus excavatum (PE) is unknown and little research has been done to assess the material properties of the PE costal cartilage. One source reported, after studying ex vivo various properties of the costal cartilage in cases of PE that the biomechanical stability of PE cartilage is decreased when compared to that of normals. Building on this idea, it would be beneficial to measure the biomechanical properties of the costal cartilages in vivo to further determine the differences between PE subjects and normals. An approach to doing this would be to use a modified FARO arm, which can read applied loads and resulting deflections. These values can be used to establish a finite element model of the chest area of a person with PE. So far, a validated technique for the registration between a CT based 3D model of the ribcage and a skin surface scan in case of PE has been addressed. On the basis of the data gathered from 10 subjects with normal chests using a robot arm, stylus and 3D laser scanner, we tried to evaluate the influence of inter-measurement respiration of a subject on results accuracy and the possibility of using the stylus for deflection measurement. In addition, we established the best strategy for taking measurements.
Haje, Sydney Abrão; de Podestá Haje, Davi
The authors summarize a 32-year experience in the study and in the non-operative approach of pectus carinatum and pectus excavatum. Data of 4,012 patients with pectus deformities were collected from 1977 to January 2009, allowing evaluation on the etiology, pathogenesis and treatment of these deformities. Growth disturbances of anterior chest wall bones and cartilages were detected in imaging studies. Heredity, and biomechanical factors, like respiratory disturbances and scoliosis were noticed in more than 40% of the patients. The method of dynamic remodeling of the thorax – compressive orthoses simultaneously to exercises practice – was indicated in 2453 patients. Concomitant treatment with bending brace was provided in patients with 20° to 52° scoliosis. Of pectus patients with treatment indication, 1717 returned for re-evaluation: 1632 children and adolescents and 85 adults. Good results were seen in 60.6% of children and adolescents and in 27% of adults treated. No scoliosis patient presented curve worsening, and a case of 52° presented an improvement of 20° in the scoliosis with the treatment. Disturbances in the growth of the sternum and costal arches, as well as biomechanical factors related to the pathogenesis of pectus deformities, demonstrate how these deformities are correlated to orthopaedics. Appropriate evaluation of the anterior chest wall and concomitant treatment with bending brace are recommended in the presence of scoliosis. The dynamic remodeling method of the thorax requires a protocol of medical actions for a successful treatment. PMID:27004171
Ma, Wei; Wang, Jinfeng; Xie, Yuping
The primary etiopathology of pediatric OSAHS includes tonsil or adenoid hypertrophy. Severe OSAHS contributes to or aggravates thoracic deformity, which is rarely reported. In the current report, This children sleep snoring more than 4 years, increasing with thoracic severe depression during sleep 2 days. Clinical examination indicated tonsil and adenoid hypertrophy, and polysomnography revealed OSAHS . The symptoms of OSAHS and severe inhalation-related sternum depression disappeared rapidly after tonsillectomy. Our findings indicated that OSAHS were the major causes underlying funnel chest in children. The rarity of the incidence may result in missed diagnosis or misdiagnosis. Polysomnography was recommended for the child diagnosed with funnel chest accompanied by upper airway stenosis.
Naef, A P
Funnel chest, a congenital hereditary deformity, may lead to impairment of cardiopulmonary function. The predominant motives for operation are psychological and cosmetic. Patients with minor deformities amenable to physiotherapy should not be operated upon, but moderately severe defects justify surgical intervention. Objective photographic documentation is essential. Because of their importance to surgical technique and results, the symmetrical, asymmetrical, localized, and extensive deformities should be distinguished. Ninety operations were performed between 1951 and 1974 according to the various techniques known during that period. Results were irregular until the introduction eight years ago of an operation combining extensive resection according to Ravitch and stabilization by a metal strut as recommended by Adkins and others. Of 24 operations performed during the last eight years, 23 have given excellent long-term results.
Suh, Jee-Won; Joo, Seok; Lee, Geun Dong; Haam, Seok Jin; Lee, Sungsoo
Background We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. Methods Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. Results The mean age of the patients was 24.35±13.20 years (range, 14–57 years), and all patients were male. The percentage of excellent aesthetic results, as rated by the patients, was 37.5%, and the percentage of good results was 56.25%. The preoperative and postoperative Haller Index values were 2.01±0.19 (range, 1.60–2.31), and 2.22±0.19 (range, 1.87–2.50), respectively (p-value=0.01), and the median hospital stay was 7.09±2.91 days (range, 5–15 days). Only one patient experienced postoperative complications. Conclusion Minimally invasive repair is effective for the treatment of pectus carinatum, even in adult patients. PMID:27066432
Temkit, M’hamed; Ewais, MennatAllah M.; Luckritz, Todd C.; Stearns, Joshua D.; Craner, Ryan C.; Gaitan, Brantley D.; Ramakrishna, Harish; Thunberg, Christopher A.; Weis, Ricardo A.; Myers, Kelly M.; Merritt, Marianne V.; Rosenfeld, David M.
Background Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients’ pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q). Methods Patients undergoing MIRPE (modified Nuss) underwent random assignment to TEA or On-Q group. Both groups received intravenous, patient-controlled opioid analgesia, with concomitant delivery of local anesthetic. Primary outcomes were length of stay (LOS), opioid use, and pain scores. Results Of 85 randomly assigned patients, 68 completed the study [52 men, 76.5%; mean (range) age, 32.2 (20.0–58.0) years; Haller index, 5.9 (range, 3.0-26.7)]. The groups were equally matched for preoperative variables; however, the On-Q arm had more patients (60.3%). No significant differences were found between groups in mean daily pain scores (P=0.52), morphine-equivalent opioid usage (P=0.28), or hospital stay 3.5 vs. 3.3 days (TEA vs. On-Q; P=0.55). Thirteen patients randomized to TEA refused the epidural and withdrew from the study because they perceived greater benefit of the On-Q system. Conclusions Postoperative pain management in adults after MIRPE can be difficult. Both continuous local anesthetic delivery by TEA and On-Q catheters with concomitant, intravenous, patient-controlled anesthesia maintained acceptable analgesia with a reasonable LOS. In our cohort, there was preference for the On-Q system for pain management. PMID:27621865
Background Some patients with mild or moderate thoracic scoliosis (Cobb angle <50-60 degrees) suffer disproportionate impairment of pulmonary function associated with deformities in the sagittal plane and reduced flexibility of the spine and chest cage. Long-term improvement in the clinical signs and symptoms of childhood onset scoliosis in an adult, without surgical intervention, has not been documented previously. Case presentation A diagnosis of thoracic scoliosis (Cobb angle 45 degrees) with pectus excavatum and thoracic hypokyphosis in a female patient (DOB 9/17/52) was made in June 1964. Immediate spinal fusion was strongly recommended, but the patient elected a daily home exercise program taught during a 6-week period of training by a physical therapist. This regime was carried out through 1992, with daily aerobic exercise added in 1974. The Cobb angle of the primary thoracic curvature remained unchanged. Ongoing clinical symptoms included dyspnea at rest and recurrent respiratory infections. A period of multimodal treatment with clinical monitoring and treatment by an osteopathic physician was initiated when the patient was 40 years old. This included deep tissue massage (1992-1996); outpatient psychological therapy (1992-1993); a daily home exercise program focused on mobilization of the chest wall (1992-2005); and manipulative medicine (1994-1995, 1999-2000). Progressive improvement in chest wall excursion, increased thoracic kyphosis, and resolution of long-standing respiratory symptoms occurred concomitant with a >10 degree decrease in Cobb angle magnitude of the primary thoracic curvature. Conclusion This report documents improved chest wall function and resolution of respiratory symptoms in response to nonsurgical approaches in an adult female, diagnosed at age eleven years with idiopathic scoliosis. PMID:20003501
... after surgery. Alternative Names Pigeon breast; Pigeon chest Images Ribcage Bowed chest (pigeon breast) References Boas SR. ... urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows ...
... Pectus excavatum References Jones KL, Jones MC, Del Campo M. Moderate short stature, facial and genital. In: Jones KL, Jones MC, Del Campo M, eds. Smith's Recognizable Patterns of Human Malformation . ...
... for couples considering pregnancy if there is a personal or family history of this condition. Alternative Names Brittle bone disease; Congenital disease; OI Images Pectus excavatum References Marini JC. Osteogenesis imperfecta In: ...
Sesia, Sergio B; Holland-Cunz, Stefan; Häcker, Frank-Martin
Background Several nonoperative treatments are currently available for the correction of pectus carinatum (PC). Objective The objective of this study is to report our single center experience with the dynamic compression system (DCS). Materials and Methods The DCS is a rigid aluminum brace. PC is reshaped into a normal appearance through anterior-posterior pressure and lateral expansion of the chest. Patients with chondrogladiolar PC were considered suitable for the nonoperative treatment with DCS. Results In this study, 53 of 68 children (78%) with chondrogladiolar PC were assessed retrospectively: 2 children were corrected by surgery, 12/53 (23%) treated by a conventional orthesis, 11/53 (21%) remained without therapy because of minor PC, and 36/53 (68%) were treated using the DCS. Of these 36 patients, 17 (47%) are already cured with a good (7/17) to excellent (10/17) cosmetic result after a median treatment period of 9 months (range, 2.5-16 months). The mean daily time of wearing of the device for those 17 patients was 9 hours (range, 5-18). None abandoned the treatment and there were almost no complications. Conclusions Lateral expansion of the chest and the possibility to measure the applied pressure seemed to be the key to DCSs success. We propose the DCS as first choice in the treatment of chondrogladiolar PC in children.
Schimmenti, L.A.; Berry, S.A.; Tuchman, M.; Hirsch, B.
The authors report on a male infant with developmental delay, growth failure, hypotonia, dolichocephaly, hypoplastic midface, epicanthal folds, down-slanting palpebral fissures, foveal hypoplasia, tracheomalacia, pectus excavatum, supraventricular tachycardia, gut malrotation, hypospadias, talipes equinovarus, short third metatarsals, capillary hemangiomata, and a de novo terminal deletion at 9q34.3.
... Infections of the skin 7820 Injury: Bladder 7517 Eye, unhealed 6009 Foot 5284 Gall bladder 7317 Lips 7201... diseases 7533 Removal 7500 Transplant 7531 Tuberculosis 7505 Kyphoscoliosis, pectus excavatum / carinatum..., dementia, amnestic and other cognitive disorders Alzheimers 9312 Delirium 9300 Head trauma 9304...
... Infections of the skin 7820 Injury: Bladder 7517 Eye, unhealed 6009 Foot 5284 Gall bladder 7317 Lips 7201... diseases 7533 Removal 7500 Transplant 7531 Tuberculosis 7505 Kyphoscoliosis, pectus excavatum / carinatum..., dementia, amnestic and other cognitive disorders Alzheimers 9312 Delirium 9300 Head trauma 9304...
... Infections of the skin 7820 Injury: Bladder 7517 Eye, unhealed 6009 Foot 5284 Gall bladder 7317 Lips 7201... diseases 7533 Removal 7500 Transplant 7531 Tuberculosis 7505 Kyphoscoliosis, pectus excavatum / carinatum..., dementia, amnestic and other cognitive disorders Alzheimers 9312 Delirium 9300 Head trauma 9304...
... rash is a sign of a similar condition, dermatomyositis . Common symptoms include: Muscle weakness in the shoulders ... in the treatment of refractory adult and juvenile dermatomyositis and adult polymyositis: a randomized, placebo-phase trial. ...
Refresher Center Home FIRST AID, CPR and AED LIFEGUARDING Refresher Putting It All Together: CPRâ€”Adult (2:03) Refresher videos only utilize this player QUICK LINKS Home RedCross.org Purchase Course ...
Bischof, Ledford J.
This volume comprehensively reviews the research on the psychology of the middle aged (ages 40-65). Topics include the concept of maturity and maturation models, the measurement and influences of adult self image; marriage and sexual patterns; intergenerational relationships between and children; vocations and avocations (work, retirement, play,…
Piper, Merisa L; Delrosario, Lawrence; Hoffman, William Y
Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.
BEAL, CATHERINE; AND OTHERS
UNITS ON MIGRANT ADULT EDUCATION, AND A UNIT ON ORGANIZING INFORMAL GROUPS OF MIGRANT WOMEN TO DISCUSS MAINTAINING AND IMPROVING THEIR TEMPORARY HOMES, ARE PRESENTED. THE GOALS OF THE UNIT ON EDUCATION FOR MIGRANT MEN ARE ECONOMIC INDEPENDENCE, BETTER HEALTH AND WELL-BEING, AND BETTER HANDLING OF RESPONSIBILITIES. THE MAIN DIVISIONS OF THE…
Charlesworth, Timothy M; Sturgess, Christopher P
Clinical records made during routine vaccinations were compared between populations of domestic shorthair cats and Bengal kittens. An increased incidence (12/244) of thoracic wall deformity was detected amongst the Bengal kittens. Deformities detected were: pectus excavatum (five), unilateral thoracic wall concavity (six) and scoliosis (one). Five-generation pedigrees were analysed for the affected kittens that showed a high degree of common ancestry indicating the likelihood of a familial cause.
... Autism Spectrum Disorder (ASD) Eating Disorders Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder ... Autism Spectrum Disorder (ASD) Eating Disorders Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder ...
Sleep apnea - obstructive - adults; Apnea - obstructive sleep apnea syndrome - adults; Sleep-disordered breathing - adults; OSA - adults ... When you sleep, all of the muscles in your body become more relaxed. This includes the muscles that help keep your ...
Roberson, Donald N., Jr.
This summary of adult development covers a wide range of authors. Adult development is one way of understanding how the internal and external changes in our lives have an impact on learning. Of particular importance in this work are the developmental issues of older adults. I present various theories of adult development such as linear and…
Manjila, Sunil; Miller, Benjamin R; Rao-Frisch, Anitha; Otvos, Balint; Mitchell, Anna; Bambakidis, Nicholas C; De Georgia, Michael A
Moyamoya disease is a rare cerebrovascular anomaly involving the intracranial carotid arteries that can present clinically with either ischemic or hemorrhagic disease. Moyamoya syndrome, indistinguishable from moyamoya disease at presentation, is associated with multiple clinical conditions including neurofibromatosis type 1, autoimmune disease, prior radiation therapy, Down syndrome, and Turner syndrome. We present the first reported case of an adult patient with previously unrecognized mosaic Turner syndrome with acute subarachnoid and intracerebral hemorrhage as the initial manifestation of moyamoya syndrome. A 52-year-old woman was admitted with a subarachnoid hemorrhage with associated flame-shaped intracerebral hemorrhage in the left frontal lobe. Physical examination revealed short stature, pectus excavatum, small fingers, micrognathia, and mild facial dysmorphism. Cerebral angiography showed features consistent with bilateral moyamoya disease, aberrant intrathoracic vessels, and an unruptured 4-mm right superior hypophyseal aneurysm. Genetic analysis confirmed a diagnosis of mosaic Turner syndrome. Our case report is the first documented presentation of adult moyamoya syndrome with subarachnoid and intracerebral hemorrhage as the initial presentation of mosaic Turner syndrome. It illustrates the utility of genetic evaluation in patients with cerebrovascular disease and dysmorphism.
Grabowski, Stanley M.; And Others
Model programs are described for two areas of adult education--the preparation of adult educators and the training conducted by adult educators. In Chapter One, Phyllis Caldwell reviews the literature concerning the preservice training of adult educators, concentrating on the competencies of adult education administrators and teachers. In Chapter…
... Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults; Cancer - brain tumor (adults) ... Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from brain cells, ...
... Page Resize Text Printer Friendly Online Chat Adult Day Care Adult Day Care Centers are designed to provide care and ... adults who need assistance or supervision during the day. Programs offer relief to family members and caregivers, ...
Still's disease - adult; AOSD ... than 1 out of 100,000 people develop adult-onset Still's disease each year. It affects women more often than men. The cause of adult Still's disease is unknown. No risk factors for ...
Kaufman, Juliet, Ed.; And Others
Findings of an American College Testing Program 1981 survey on college recruitment of adult students are summarized, and 12 articles on adult recruitment are presented. Titles and authors are as follows: "Adult Recruitment Practices: A Report of a National Survey" (Patricia Spratt, Juliet Kaufmann, Lee Noel); "Three Programs for Adults in Shopping…
Charles, John; Morrison, Joanna
Presents a list of adult mystery titles for young adult readers. Includes first titles in a series (for reading in order); new and lesser-known mystery authors' works are the focus. Annotations include plot summary. The rest of each annotation is for professional use (includes date and name of award bestowed). (AEF)
Gill, Sam D.
Argues that young adult literature can play a significant role in the emotional and mental health of an adolescent as well as help young males become more literate. Offers a 19-item annotated list of young adult novels with male protagonists, sorted by themes: nature and adventure stories, sports stories, genre stories, historical stories, and…
Stickle, Fred; Onedera, Jill D.
The purpose of this article is to address selected aspects of depression in older adults. Specifically, symptoms, risk factors, diagnosis, and interventions for depression in older adults are reviewed.
... ACIP Vaccination Recommendations Why Immunize? Vaccines: The Basics Immunization Schedules for Adults in Easy-to-read Formats ... previous immunizations. View or Print a Schedule Recommended Immunizations for Adults (19 Years and Older) by Age ...
Hall, Clyde W.
Summarized are speeches dealing with adult education's stiff-necked adherence to middle-class values; the need for upgraded management skills; and a report of a study of adult education in area vocational schools in Georgia. (Author/AJ)
Miller, Harry; And Others
Folk high schools, study circles, labor market training, union education, and municipal adult schools are the major providers of adult education in Sweden. For the most part, these programs are financed by the government and are tuition free. Folk high schools, which are the oldest type, were founded to provide young adults with a general civic…
The 14 chapters of this textbook chronicle adult development from youth through old age, emphasizing both research and interviews with adults at various stages in their lives. Topics covered include the following: (1) the academic field of adult development; (2) theories and research methods; (3) aging and disease prevention; (4) sexuality and…
Walsko, Gregory M.
The purpose of this instrument is to supplement data from the Adult Basic Learning Examination in assessing the functional level of adults in daily situations. It may also be used as a teaching tool for adults requesting tutoring in specific concepts and skills presented in the instrument. This instrument is an informal assessment instrument and…
Seita, John R.; Brendtro, Larry K.
Kids who distrust adults are highly skilled at hiding their real nature and resisting change. Most adults shun such youths or get mired in conflict with them. Punitive get tough practices as well as traditional flaw-fixing treatment are reactive strategies that often drive these youths further from adult bonds and reinforce oppositional and…
Short, W. Fisher
The impact of urbanization, the main tasks facing the adult educator in an urban context, identifying the casualties of urbanization, recognizing and dealing with social deprivation, and the various agencies involved in adult education are relevant considerations for adult educators. (MW)
Foley, Griff, Ed.
This broad introduction to adult and postcompulsory education offers an overview of the field for students, adult educators and workplace trainers. The book establishes an analytical framework to emphasize the nature of learning and agency of learners; examines the core knowledge and skills that adult educators need; discusses policy, research and…
Sutherland, Peter, Ed.
This book on adult learning is divided into six sections. Section 1, Cognitive Processes, includes the following chapters: "Cognitive Processes: Contemporary Paradigms of Learning" (Jack Mezirow); "Information Processing, Memory, Age and Adult Learning" (Gillian Boulton-Lewis); "Adult Learners' Metacognitive Behaviour in Higher Education" (Barry…
Kirmayer, Paul, Ed.; And Others
This volume contains 13 articles that reflect the development of adult education in Israel during recent years. The material relates to the principal areas with which the Division of Adult Education deals: formal and nonformal education for adults, language and cultural absorption of new immigrants, and training of facilitators for parental…
Notar, Charles E.; Padgett, Sharon
Do adults play a role in bullying? Do parents, teachers, school staff, and community adult leaders influence bullying behavior in children and teenagers? This article will focus on research regarding all adults who have almost daily contact with children and teens and their part in how bullying is identified, addressed, and prevented. This article…
The central aim of this article is to analyse the current situation of adult education in Greece. The article focuses on the following points: (a) the degree of participation in programmes of continuing professional training and general adult education courses, (b) the quality and the outcomes of the adult education provision in Greece, and (c)…
Bureau of Occupational and Adult Education (DHEW/OE), Washington, DC. Div. of Adult Education.
A compilation of abstracts of 120 current Adult Performance Level (APL) and Adult Competency Education (ACE) federally supported projects being conducted in 34 States and the District of Columbia, this project profile was developed for adult and secondary education administrators, teachers, and program developers who are beginning or are currently…
Bureau of Occupational and Adult Education (DHEW/OE), Washington, DC. Div. of Adult Education.
A compilation of brief descriptions of 20 current resources for Adult Performance Level (APL) and Adult Competency Education (ACE) programs, this guide was developed for adult and secondary education administrators, teachers, and program developers who are beginning or are already involved with APL/ACE programs. Each citation contains information…
Cora, Marie T., Ed.; Wood, Nicole R., Ed.
This handbook was written specifically for volunteer tutors but is appropriate for teachers, student interns, coordinators, and others working with Adult Basic Education (ABE) and English-as-a-Second-Language (ESL) adult learners. It presents an overview of adult and non-traditional education models, some principles of reading and writing, a…
Brooke, W. Michael, Comp.
"Trends," a publication of the Canadian Association for Adult Education, is a collection of abstracts on selected subjects affecting adult education; this issue is on adult basic education (ABE). It covers teachers and teacher training, psychological factors relating to the ABE teacher and students, manuals for teachers, instructional…
Boegen, Anne, Ed.
Designed to offer guidelines, ideas and help to those who provide library service to young adults, this manual includes information about the provision of young adult (YA) services in six sections. The first section, which addresses planning and administration, includes a definition of a young adult and a checklist for determining community needs…
Which competences do professional adult educators need? This research note discusses the topic from a comparative perspective, finding that adult educators' required competences are wide-ranging, heterogeneous and complex. They are subject to context in terms of national and cultural environment as well as the kind of adult education concerned…
South Carolina Literacy Resource Center, Columbia.
This curriculum framework for adult literacy was written by 21 South Carolina adult English-as-a-Second-Language (ESL) instructors, as submitted to the South Carolina Literacy Resource Center. It is based on current theories in the fields of adult education and second language acquisition and is designed to be flexible so that it may be adapted to…
... Autism Spectrum Disorder (ASD) Eating Disorders Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder ... Autism Spectrum Disorder (ASD) Eating Disorders Among Adults - Anorexia Nervosa Eating Disorders Among Adults - Binge Eating Disorder ...
Neuville, M; Jondeau, G; Crestani, B; Taillé, C
Marfan's syndrome is a rare genetic disorder caused by a mutation of the gene FBN1, coding for the protein fibrillin-1. Cardiovascular, musculoskeletal and ophthalmic manifestations are the most commonly observed, but minor diagnostic criteria also include pulmonary manifestations. Pneumothorax, frequently relapsing, affects 5 to 11% of patients. Rib cage abnormalities (pectus excavatum or pectus carinatum) and apical blebs may contribute to their occurrence. Treatment does not require any specific procedure but there is an increased risk of recurrence. Pectus excavatum affects up to 60% of the patients, without any functional impairment in most cases. Surgery may be required (using the Nuss procedure) in case of cardiovascular or psychological symptoms. Marfan's syndrome is frequently associated with obstructive sleep apnoea, which may itself contribute to aortic dilatation. Some studies suggest a potential role of craniofacial abnormalities in the pathogenesis of sleep apnea in these patients. Pulmonologists should consider Marfan's syndrome when treating patients for recurrent spontaneous pneumothorax or rib cage abnormalities, since early detection of cardiac abnormalities improves the prognosis significantly.
California Community Colleges, Chancellor's Office, 2015
For more than one hundred and fifty years, until 2008, California was an undisputed national leader in its commitment to adult education. The state's investment in adult learners topped $750 million, a sum greater than the combined total of every other state in the nation. However, for the past several years recession and fiscal crisis have left…
The Bookmark, 1985
Eight articles in this Spring 1985 issue of The Bookmark focus on young adult library services. In addition to these thematic articles, an introduction and three reports are presented. The issue contains: (1) "In Perspective" (E. J. Josey); (2) "Young Adult Literature in the 1980's--Awesome!" (Ellin Chu); (3) "Young Adult…
As a foundation for discussing transpersonal adult development, the author traces her trajectory, involvement in, and contribution to the modern transpersonal movement and her introduction of it to the adult learning literature, beginning during the early 1980s. Highlighted are the transpersonal domain and a differentiation between transpersonal…
A Smart Choice Adult Day Services Comparison At-a-Glance 1 Adult Day Services Assisted Living Home Care Nursing Homes Live at home with family ... supervision Nursing care available as needed during the day Flexibility to receive care only on days when ...
For over 2 years, Blak Hawk College (Illinois) has provided high school equivalency (GED) candidates and recipients, older returning students, and underprepared high school graduates with a Tech Prep curriculum to give them the skills to make the transition from adult basic education to college or work. The Adult Tech Prep (ATP) core curriculum…
This paper is concerned with the relationship between authenticity and adult learning and prompted by some studies in which adult "authentic learning" is a central concept. The implication revealed by them is that real-worldness of learning contexts, learning content and learning tasks is perceived as conferring authenticity on learning. Here,…
Rubenson, Kjell, Ed.
As individuals and societies try to respond to fundamental economic and social transformation, the field of adult learning and education is rapidly getting increased attention and new topics for research on adult learning have emerged. This collection of articles from the International Encyclopedia of Education 3e offers practitioners and…
Who are the adult students in career and technical education (CTE) today? There is not one simple answer to that question. Some are young with little life experience, while others are returning to the workforce and learning new skills to reinvent themselves. Whatever the case, educating adult students is an integral part of ACTE's mission, and the…
Saadat, Ahmed H.
The philosophy behind adult literacy in Zanzibar is that adult literacy is a process whereby the illiterate is empowered to become aware of his or her potential. Literacy activities emphasize a relation to work, sometimes known as functional literacy. Specific objectives of literacy programs are to improve living conditions, impart self-reliant…
Proposes a "spatial-temporal" model conceiving adult vocational development as a complex and constant readjustment in always changing perception of personal space-time, based on interviews of 786 adults. Presents two propositions of this model: the continuous alternation between states of instability and interaction of influences.…
This review presents various resources about working with adult adoptees in order to inform counselors in their practice. Topics covered include basics of adoption, including types of adoption and adoption statistics; possible issues adult adoptees may face; and suggestions and implications for counselors. The article addresses some of the serious…
Flint, Thomas A.; Frey, Ruth
The Council for Adult and Experiential Learning is currently cataloguing alternative programming features that are most effective with adult students in a best practices inventory organized around a framework of high-level descriptive principles of effectiveness. This chapter identifies a few interesting features from a quick survey of this…
Hinzen, Heribert, Ed.
This document contains 19 papers on adult education and development worldwide. The following papers are included: "Editorial" (Heribert Hinzen); "Lifelong Learning in Europe: Moving towards EFA (Dakar Framework for Action on Education for All) Goals and the CONFINTEA V Agenda" (Sofia Conference on Adult Education);…
Ever since the first ideas of national independence appeared in Finland, adult education has played an essential role in shaping the destiny of the Finns. With a history of almost 130 years, during which it has continuously increased in quality and quantity, the Finnish adult education system has ensured that Finland stays among the most…
The 2008 EFA Global Monitoring Report recognises adult literacy as the most neglected of the EFA goals. It is neglected most obviously in respect of the financial allocations made by governments and donors. This shortage of financing creates a dangerous situation in which adult educators seek to convince politicians to invest, based on false…
Zucker, Kenneth J; Lawrence, Anne A; Kreukels, Baudewijntje P C
Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.
Fiske, Amy; Wetherell, Julie Loebach; Gatz, Margaret
Depression is less prevalent among older adults than among younger adults but can have serious consequences. Over half of cases represent a first onset in later life. Although suicide rates in the elderly are declining, they are still higher than in younger adults and more closely associated with depression. Depressed older adults are less likely to endorse affective symptoms and more likely to display cognitive changes, somatic symptoms, and loss of interest than are younger adults. Risk factors leading to the development of late life depression likely comprise complex interactions among genetic vulnerabilities, cognitive diathesis, age-associated neurobiological changes, and stressful events. Insomnia is an often overlooked risk factor for late life depression. We suggest that a common pathway to depression in older adults, regardless of which predisposing risks are most prominent, may be curtailment of daily activities. Accompanying self-critical thinking may exacerbate and maintain a depressed state. Offsetting the increasing prevalence of certain risk factors in late life are age-related increases in psychological resilience. Other protective factors include higher education and socioeconomic status, engagement in valued activities, and religious or spiritual involvement. Treatments including behavioral therapy, cognitive behavioral therapy, cognitive bibliotherapy, problem-solving therapy, brief psychodynamic therapy, and life review/reminiscence therapy are effective but too infrequently used with older adults. Preventive interventions including education for individuals with chronic illness, behavioral activation, cognitive restructuring, problem-solving skills training, group support, and life review have also received support. PMID:19327033
Turturro, Francesco; Calderaro, Cosma; Montanaro, Antonello; Labianca, Luca; Argento, Giuseppe; Ferretti, Andrea
Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process) in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature. PMID:25143854
Spiegel, Ronen; Horovitz, Yoseph; Peters, Hartmut; Erdogan, Fikret; Chervinsky, Ilana; Shalev, Stavit A
We report on three individuals of Muslim Arab origin from a village located in Northern Israel affected by an apparent autosomal recessive syndrome characterized by distinctive facial phenotype of which the most prominent feature is ocular hypertelorism. The other clinical features of the syndrome include variable degree of mental retardation, genital abnormalities dominated by short penis, and skeletal abnormalities including chest deformity (combination of upper pectus carinatum with lower pectus excavatum), and short palms with broad short fingers. Affected individuals displayed distinctive facial features including upslanting palpebral fissures, thick eyebrows, long philtrum, wide mouth with thin upper lip and upturned corners of the mouth, widow's peak, broad nasal bridge, and simple ears with fleshy overfolded helices. This phenotype does not fully meet typical diagnostic features of any known condition.
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The paper examines the role of adult education and the contribution it can make to the solution of current problems in developing countries, particularly the problems of economic under-development and over-population. (Author/AG)
Taylor, J. Rodney
The author reviews theories of human motivation: Lewin's force field analysis, Skinner's operant reinforcement theory, and Maslow's hierarchy of needs. He then extracts the implications of these theories for adult learning. SK)
... find more information? Reprints Share Older Adults and Depression Download PDF Download ePub Order a free hardcopy ... depression need treatment to feel better. Types of Depression There are several types of depression. The most ...
Epstein, Connie C.
Considers the similarities between science fiction writing and young adult literature, and points out that several well-known authors, such as Robert Heinlein and Jane Yolen, write in both genres. (NKA)
This book approaches adult cardiac disease from the correlative imaging perspective. It includes chest X-rays and angiographs, 2-dimensional echocardiograms with explanatory diagrams for clarity, plus details on digital radiology, nuclear medicine techniques, CT and MRI. It also covers the normal heart, valvular heart disease, myocardial disease, pericardial disease, bacterial endocarditis, aortic aneurysm, cardiac tumors, and congenital heart disease of the adult. It points out those aspects where one imaging technique has significant superiority.
Which competences do professional adult educators need? This research note discusses the topic from a comparative perspective, finding that adult educators' required competences are wide-ranging, heterogeneous and complex. They are subject to context in terms of national and cultural environment as well as the kind of adult education concerned (e.g. basic education, work-related education etc.). However, it seems that it is possible to identify certain competence requirements which transcend national, cultural and functional boundaries. This research note summarises these common or "core" requirements, organising them into four thematic subcategories: (1) communicating subject knowledge; (2) taking students' prior learning into account; (3) supporting a learning environment; and (4) the adult educator's reflection on his or her own performance. At the end of his analysis of different competence profiles, the author notes that adult educators' ability to train adult learners in a way which then enables them to apply and use what they have learned in practice (thus performing knowledge transfer) still seems to be overlooked.
Kuitert, R B
The number of adults undergoing orthodontic treatment has increased strongly and the average age that adult patients undergo orthodontic treatment increased steadily although 3/4 is still younger than 27 years. In adults the facial skeletal pattern can only be changed in a very confined way, consequently in case of an abnormal skeletal pattern one has to choose between a combined orthodontic-surgical approach (which is the case in 18% of the patients) and a compromised orthodontic treatment, if necessary combined with other disciplines. It is still controversial whether tooth movement in adults is slower and more difficult than in adolescents. The same holds true for the risk for loss of periodontal support, for root resorption, for gnathologic problems and for relapse. As related to these variables there appears to be a large individual variation. Many adults show one or more problems in their dentition that may influence their orthodontic treatment. About 60% of the adult patients need a multidisciplinary approach. The development of implantology and of bone regeneration and bone grafting has lead to more combined treatments. The risks of such complex treatment plans are generally larger than those for more simple kinds of treatment. A very careful treatment planning and good communication between the different specialists is essential. Moreover the treatment plan with all its (dis)advantages has to be extensively discussed with the patient.
Wang, C; Maynard, S; Glover, T W; Biesecker, L G
A 28 month old girl with dysmorphic features was found to have an interstitial deletion of the short arm of chromosome 7p15.3-7p21.2. The patient had ptosis, dacryostenosis, pectus excavatum, short hands, and her development was normal or mildly delayed. Craniosynostosis and growth retardation, which were present in two other patients with similar deletions, were not present. Because of the mild manifestations, this case expands the clinical spectrum of the 7p15-7p21 deletion phenotype. Images PMID:8411039
In this paper, the author looks at the state of adult education in Ireland. He is suggesting that the state here means both the condition in which one now finds adult education and the role of the Irish State in adult education. He briefly outlines some recent developments in adult education, makes some critical comments on the state of adult…
According to the 2003 National Assessment of Adult Literacy, it is estimated that 93 million adults in the United States have basic or below basic literacy skills. Those individuals found most lacking in literacy skills were adults living in poverty, adults lacking a high school diploma, seniors and the elderly aged 65 and older, the more than one…
Intended for planners of adult education curriculums, this literature review explains the concepts involved in designing an adult education program, provides information about the roles of the people involved in the adult education process, cites some program planning models, and applies the program planning principles to an Adult Basic Education…
Lucas, John A., Ed.
Topics concerning the adult learner that are relevant to institutional researchers are addressed in four articles: marketing, predicting success for adult students, enrollment projection, and follow-up studies of adult learners. In "Institutional Research in Support of Marketing the Adult Student," Lydia Jurand notes the importance of…
Unaware of the messages a bare adult learning environment sends and its effect on adult learners, a trainer attends an intensive Reggio Emilia course and learns that the physical environment is the "third teacher"--for adults as well as for children. Using principles of Reggio, she offers suggestions for enhancing adult learning spaces and…
Kanwar, Amrinder Jit
Adult-onset atopic dermatitis is still an under recognized condition as there are only few studies regarding this entity. As compared to childhood onset atopic dermatitis, clinical features of adult onset atopic dermatitis are still not categorized. Adult atopic dermatitis can present for the first time in adult age with atypical morphology or may progress from childhood onset. This article reviews the characteristic clinical features of adult atopic dermatitis, associated risk factors and management. PMID:27904186
Sengupta, Sabyasachi; Pan, Utsab; Khetan, Vikas
Retinoblastoma (RB) is the most common primary malignant intraocular tumor of childhood presenting usually before 5 years of age. RB in adults older than 20 years is extremely rare. A literature search using PubMed/PubMed Central, Scopus, Google Scholar, EMBASE, and Cochrane databases revealed only 45 cases till date. Over the past decade, there has been a significant increase in the number of such reports, indicating heightened level of suspicion among ophthalmologists. Compared to its pediatric counterpart, adult onset RB poses unique challenges in diagnosis and treatment. This article summarizes available literature on adult onset RB and its clinical and pathologic profile, genetics, association with retinocytoma, diagnostics, treatment, and outcomes. PMID:27609158
Seborrheic dermatitis is a common chronic-recurrent inflammatory disorder that most commonly affects adults; however, a more transient infantile form also occurs. The definitive cause of seborrheic dermatitis is unknown. However, proliferation of Malassezia species has been described as a contributing factor. The adult form of seborrheic dermatitis affects up to approximately five percent of the general population. The disorder commonly affects the scalp, face, and periauricular region, with the central chest, axillae, and genital region also involved in some cases. Pruritus is not always present and is relatively common, especially with scalp disease. A variety of treatments are available including topical corticosteroids, topical antifungal agents, topical calcineurin inhibitors, and more recently, a nonsteroidal “device ”cream. This article reviews the practical topical management of seborrheic dermatitis in the United States, focusing on the adult population. PMID:21607192
Rao, N Madhusudhana; Rambabu, K Murali; Rao, S Harinarayana
We generated transient transgenic zebrafish by applying electrical pulses subsequent to injection of DNA into muscle tissue of 3-6-month old adult zebrafish. Electroporation parameters, such as number of pulses, voltage, and amount of plasmid DNA, were optimized and found that 6 pulses of 40 V/cm at 15 mug/fish increased the luciferase expression by 10-fold compared with those in controls. By measuring the expression of luciferase, in vivo by electroporation in adult zebrafish and in vitro using fish cell line (Xiphophorus xiphidium A2 cells), the strength of three promoters (CMV, human EF-1alpha, and Xenopus EF-1alpha) was compared. Subsequent to electroporation after injecting DNA in the mid region of zebrafish, expression of green fluorescent protein was found far away from the site of injection in the head and the tail sections. Thus, electroporation in adult zebrafish provides a rapid way of testing the behavior of gene sequences in the whole organism.
Becker, Jonathan A; Stumbo, Jessica R
This article provides a summary of the many causes of back pain in adults. There is an overview of the history and physical examination with attention paid to red flags that alert the clinician to more worrisome causes of low back pain. An extensive differential diagnosis for back pain in adults is provided along with key historical and physical examination findings. The various therapeutic options are summarized with an emphasis on evidence-based findings. These reviewed treatments include medication, physical therapy, topical treatments, injections, and complementary and alternative medicine. The indications for surgery and specialty referral are also discussed.
Cabral Rodríguez, R; Arrieta Blanco, F J; Vicente Sánchez, F; Cordobés Martín, F J; Moreno Caballero, B
Coeliac disease is a chronic pathology of the small intestine. The pathogenic mechanism is caused by gluten intolerance. This disease present a characteristic and unspecific injury that causes nutrients and vitamins malabsorption. In adults is an underdiagnosed entity due to atypical forms. To make a premature diagnosis is basic because gluten-free diet prevent the complications after long-term like the intestinal T lymphoma and other digestives malignancies, and decrease the mortality of these patients. We present a case of adult oligosymptomatic coeliac disease in a patient with iron deficiency anaemia and vaginal bleeding. We study the clinic-nutrition and the alterations evolution of the patient.
Adults Learning, 2009
The Campaigning Alliance for Lifelong Learning is to lobby parliament for the restoration of the 1.5 million adult learning places lost over the past two years. The campaign has attracted supporters from an astonishingly wide range of backgrounds. In this article, Gordon Marsden, Caroline Biggins, Beth Walker, Mike Chaney, Peter Davies, Sian…
Taking an autobiographical approach, I tell the story of my experiences facilitating adult development, in a polytechnic and as a management consultant. I relate these to a developmental framework of Modes of Being and Learning that I created and elaborated with colleagues. I connect this picture with a number of related models, theories,…
House, John W.
This article discusses hearing loss in adults. It begins with an explanation of the anatomy of the ear and then explains the three types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed conductive-sensorineural hearing loss. Tinnitus, hearing aids, and cochlear implants are also addressed. (CR)
In an effort to improve the quality of life for area senior citizens, De Anza College has established an older adult education program which combines adaptive physical education with holistic health care principles to instruct students in relaxation, nutrition, and physical activity. Classes are held in convalescent hospitals, retirement homes,…
Ministerio da Educacao e Cultura, Rio de Janeiro (Brazil).
The status and goals of adult education programs in Brazil are discussed in this report. Supplemental systems such as the Brazilian Literacy Movement (Mobral) and their results are described and evaluated. Charts detailing the evolution of literacy are shown and priorities in education are suggested. The progress of other educational entities is…
Massachusetts Career Development Inst., Springfield.
This booklet, aimed at adult basic education students, pinpoints and summarizes a few common spelling rules to help make spelling easier, and includes a component on using the dictionary. In the text, each rule is presented with many examples. Exercises follow each spelling rule, allowing students the opportunity to apply the rule to specific…
The literature on adult education for police is reviewed and criticized. Among the publications that have been influential in debating the need for police education are Charles B. Saunder's "The Challenge of Crime in a Free Society" (1976), which endorses the Presidential Commission on Law Enforcement's recommendations regarding the vital…
Pruett, Diane Milhan, Ed.; And Others
Dance programs for older adults that encourage exercise and socializing are described in six articles. Program guidelines of the American Alliance Committee on Aging are explained, and other articles emphasize a movement education approach that may involve intergenerational contact. A dance program held in a worship setting is also discussed. (PP)
The objective of this paper is to highlight the role of adult education as a tool in addressing labour migration issues, specifically those concerning the protection of migrant workers' rights and the transformation of the impact of migration into positive holistic developmental gains. The view of labour migration as a means to forge the economic…
Rogers, Alan; Illeris, Knud
This dialog between Alan Rogers and Knud Illeris debates arguments Rogers made in a previous article about the differences between adult and child learning. Rogers emphasizes differences in teacher-learner relationships. Illeris believes the differences result from different motivations for learning. (SK)
Kastenbaum, Robert, Ed.
This encyclopedia contains 106 articles on adult development that were written by more than 75 specialists in such diverse fields as anthropology, communication, education, health sciences, history, and psychology. In a guide to related topics that is presented at the beginning of the encyclopedia, the 106 articles are grouped under the following…
This book presents a range of strategies for adult literacy tutors and offers a wealth of practical advice on teaching spelling within the context of writing. Chapters 1-3 offer basic information on talking with the student about spelling, finding out how the student spells and helping the student to see himself/herself as a "good" speller, and…
Rumbaut, Ruben G.; Komaie, Golnaz
Almost 30 percent of the more than 68 million young adults aged eighteen to thirty-four in the United States today are either foreign born or of foreign parentage. As these newcomers make their transitions to adulthood, say Ruben Rumbaut and Golnaz Komaie, they differ significantly not only from one another but also from their native-parentage…
Illinois State Library, Springfield.
Since January 1986, when the Illinois Secretary of State Literacy Grant Program began funding a wide variety of adult literacy programs, more than 30,000 students have sought help with reading. They have been matched with 25,000 tutors who have provided more than 2 million hours of volunteer instruction. The profiles in this booklet are stories of…
Taylor, Maurice C., Ed.; Draper, James A., Ed.
This book, intended to serve as a professional reference work, proposes to define the field of Adult Basic Education in its evolution, its contribution to professional education, and the principal problems and issues. The volume contains the following treatises: "Definitions and Evolution of the Concepts" (Thomas); "Selected…
... slowly than in younger adults. To better manage depression at home: Exercise regularly, if the provider says it is OK. Surround yourself with caring, positive people and do fun activities. ... signs of depression, and know how to react if these occur. ...
MILLER, JUSTIN H.
TRENDS EVIDENT IN ADULT READING DURING THE 1960'S IN THE AREAS OF ADMINISTRATION, PROGRAMS, TEACHING, TECHNIQUES, RESEARCH PROJECTS, AND METHODS OF PROMOTION OF READING PROGRAMS ARE DISCUSSED. TWO INSTANCES OF COMMERCIAL EXPLOITATION BASED ON INTENSE AND OFTEN FALLACIOUS ADVERTISING AND ON PUBLIC IGNORANCE ARE CITED. A POSITIVE TREND IN THE AREA…
... Children Newly Diagnosed: Older Adults Related Topics on AIDS.gov Aging with HIV/AIDS National HIV/AIDS ... an Emerging Challenge Last revised: 07/10/2015 AIDS.gov HIV/AIDS Basics • Federal Resources • Using New ...
Utah State Board of Education, Salt Lake City.
Major purposes for the preparation of this report on public school adult education in Utah were: to provide the public with a description of achievements, trends, and needs, and with meaningful cost accounting information; to make comparisons and analyses of adult education by program, school district, and year; and to provide the adult education…
Crowe, Chris, Ed.
Outlines some of the many confusions about young adult literature. Sheds some light on what young adult literature is (defining it as all genres of literature published since 1967 that are written for and marketed to young adults). Discusses briefly how it can be used in schools. Offers a list of the author's 20 favorite books for teenagers. (SR)
Chen, Joseph C.
As the USA experiences rapid growth of nontraditional adult students in higher education, educators and institutions will increasingly need to look beyond the traditional youth-centric educational models to better address adult learning needs. To date, no research has been conducted examining the learning experiences of adult students enrolled in…
... and genetics may play a role. Why congenital heart disease resurfaces in adulthood Some adults may find that ... in following adults with congenital heart disease. Congenital heart disease and pregnancy Women with congenital heart disease who ...
Suggests some ideas that could stimulate and be incentives for defining programs of adult education in the future. These involve changing priorities, developing a framework which allows adult education programs to be established, and managing decision-making processes. (CT)
... Adolescent Brain Comorbidity College-Age & Young Adults Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ... Age & Young Adults College Addiction Studies Programs Criminal Justice Drugged Driving Drug Testing Drugs and the Brain ...
... Resources for Healthcare Professionals Renal Disease and Adult Vaccination Recommend on Facebook Tweet Share Compartir Vaccines are ... have immunity to this disease Learn about adult vaccination and other health conditions Asplenia Diabetes Type 1 ...
... Vaccination Recommendations Adult Vaccination Resources for Healthcare Professionals Liver Disease and Adult Vaccination Recommend on Facebook Tweet ... critical for people with health conditions such as liver disease. If you have chronic liver disease, talk ...
Kemper, Susan; And Others
Investigates older adults' reading comprehension skills through syntactic measures and measures of sentence content. Analyzes the apparent reading difficulties of older adults. Provides guidelines for the preparation of prose materials for older readers. (HB)
Heffernan, James M.
Little attention has been given to how adults develop through their lifetimes and what roles their workplace environments play in that development. Research and theory regarding adult psychosocial development have confirmed the developmental life-cycle phases of adulthood. These are: leaving the family (ages 16-22), getting into the adult world…
Tsai, Kuan Chen
Creativity in education research has received increasing attention, although the major focus of this research has been on children. Despite pleas by several adult educators for promoting creativity, very few studies have focused on adult learners, leaving to it to be explored what approaches are useful for adult educators to facilitate creativity…
National Languages and Literacy Inst. of Australia, Melbourne. Adult Education Resource and Information Service.
This information sheet provides a summary of general observations regarding adult learners. Adults from different walks of life may seek out learning at different times in their lives, for different reasons, and for vastly different purposes. Adult learning groups may include students of different ages, cultures, and educational and socioeconomic…
Shefrin, Carol; Shafer, Dehra; Forlizzi, Lori
The Assessment Tools for Adult Education project was designed to provide training and support to staff of the Pennsylvania Bureau of Adult Basic and Literacy Education (ABLE) funded programs to help them use assessment tools and procedures to document the learning gains of the adult students they serve. The following candidate assessment…
All educational levels have been attacked by politicians and haunted by suspicion, and adult education has drawn more than its share. Interest groups have had a large effect on adult education. The construction of a theoretical model of the politics of adult education is suggested. (DS)
Costanzo, Meg Ryback
In the Adult Multiple Intelligences (AMI) study, 10 teachers of adults from the northeastern region of the United States explored for 18 months the ways that multiple intelligences (MI) theory could support instruction and assessment in various adult learning contexts. The results of this research were published in a book by Julie Viens called MI…
Worthington, Robert M.
The Associate Commissioner of the Bureau of Adult, Vocational, and Technical Education is responsible for two broad and important programs, career education and broader and better services in adult education. Career education is a lifelong educational process beginning in kindergarten and extending through adult and continuing education. Career…
Adult Education and Development, 1994
The publication is a half-yearly journal for adult education in Africa, Asia, and Latin America. Issue 42 includes the following: "Adult Education for Self-Reliance in Community Health Education Programmes" (Kweka); "Promoting Good Nutrition" (Mangvwat); "Incorporating Health-Improvement Activities in Adult Education…
This symposium on adult learning and human resource development consists of three presentations. "Adult Learning Principles and Concepts in the Workplace: Implications for Training in HRD" (Margot B. Weinstein) reports on findings from interviews with restaurant employees who reported that training practices using adult learning…
Cassara, Beverly Benner, Ed.
This book contains the following papers about development/delivery of adult education through the efforts of multinational and bilateral government donors and the International Council for Adult Education (ICAE): "Preface" (Beverly Benner Cassara); "Introduction: Adult Education and Democracy" (Francisco Vio Grossi);…
Introduction An estimated 4.6 billion cases of diarrhoea occurred worldwide in 2004, resulting in 2.2 million deaths. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for acute diarrhoea in adults living in resource-rich countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults from resource-rich countries travelling to resource-poor countries? What are the effects of treatments for acute mild-to-moderate diarrhoea in adults living in resource-poor countries? What are the effects of treatments for acute severe diarrhoea in adults living in resource-poor countries? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 72 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, antimotility agents, antisecretory agents, bismuth subsalicylate, diet, intravenous rehydration, nasogastric tube rehydration, oral rehydration solutions (amino acid oral rehydration solution, bicarbonate oral rehydration solution, reduced osmolarity oral rehydration solution, rice-based oral rehydration solution, standard oral rehydration solution), vitamin A supplementation, and zinc supplementation. PMID:21718555
... Problem More adults with disabilities need to get physical activity. Adults with disabilities who get no physical activity ... Adults with disabilities are more likely to get physical activity if doctors recommend it. Only 44% of adults ...
Williams, Robert B.
An aspect of an undergraduate psychology course on adult development was the preparation of case records on adults who consented to be studied. Participants (1) developed their abilities to observe and accurately record adult behavior across a variety of ages and contexts; (2) withheld judgments about behavior when evidence was lacking; (3)…
Osawa, Hisayoshi; Mawatari, Tohru; Watanabe, Atsushi; Abe, Tomio
The Nuss procedure for pectus excavatum repair has been considered an acceptable method in terms of its decreased invasiveness and excellent cosmetic results. Although a steel bar is usually used for elevating the sternum, we used a titanium alloy plate for pectus excavatum repair for the first time. The characteristics of this plate are that 1) it comes out translucently on X-rays, 2) MRI examination is possible because titanium will not be magnetized, and 3) it is possible to go through the security checkpoint at the airport without setting off the metal detector. Furthermore, the titanium alloy is highly elastic, which reduces complications such as dislocation, and it excels in the conformity to organization. Patients who have received the Nuss operation are forced to somewhat limit their daily life for two or three years until the bar is removed. A plate made from titanium alloy resolves this problem because of its material and it is thought to be an ideal candidate for elevating the sternum during the Nuss operation.
Zhao, Qian; Safdar, Nabile; Yu, Glenna; Myers, Emmarie; Sandler, Anthony; Linguraru, Marius George
Pectus excavatum is a posterior depression of the sternum and adjacent costal cartilages and is the most common congenital deformity of the anterior chest wall. Its surgical repair can be performed via minimally invasive procedures that involve sternum and cartilage relocation and benefit from adequate surgical planning. In this study, we propose a method to estimate the cartilage regions in thoracic CT scans, which is the first step of statistical modeling of the osseous and cartilaginous structures for the rib cage. The ribs and sternum are first segmented by using interactive region growing and removing the vertebral column with morphological operations. The entire chest wall is also segmented to estimate the skin surface. After the segmentation, surface meshes are generated from the volumetric data and the skeleton of the ribs is extracted using surface contraction method. Then the cartilage surface is approximated via contracting the skin surface to the osseous structure. The ribs' skeleton is projected to the cartilage surface and the cartilages are estimated using cubic interpolation given the joints with the sternum. The final cartilage regions are formed by the cartilage surface inside the convex hull of the estimated cartilages. The method was validated with the CT scans of two pectus excavatum patients and three healthy subjects. The average distance between the estimated cartilage surface and the ground truth is 2.89 mm. The promising results indicate the effectiveness of cartilage surface estimation using the skin surface.
Adult scoliosis is defined as a spinal deformity in a skeletally mature patient with a Cobb angle of more than 10 degrees in the coronal plain. Adult scoliosis can be separated into four major groups: Type 1: Primary degenerative scoliosis, mostly on the basis of a disc and/or facet joint arthritis, affecting those structures asymmetrically with predominantly back pain symptoms, often accompanied either by signs of spinal stenosis (central as well as lateral stenosis) or without. These curves are often classified as "de novo" scoliosis. Type 2: Idiopathic adolescent scoliosis of the thoracic and/or lumbar spine which progresses in adult life and is usually combined with secondary degeneration and/or imbalance. Some patients had either no surgical treatment or a surgical correction and fusion in adolescence in either the thoracic or thoracolumbar spine. Those patients may develop secondary degeneration and progression of the adjacent curve; in this case those curves belong to the type 3a. Type 3: Secondary adult curves: (a) In the context of an oblique pelvis, for instance, due to a leg length discrepancy or hip pathology or as a secondary curve in idiopathic, neuromuscular and congenital scoliosis, or asymmetrical anomalies at the lumbosacral junction; (b) In the context of a metabolic bone disease (mostly osteoporosis) combined with asymmetric arthritic disease and/or vertebral fractures. Sometimes it is difficult to decide, what exactly the primary cause of the curve was, once it has significantly progressed. However, once an asymmetric load or degeneration occurs, the pathomorphology and pathomechanism in adult scoliosis predominantly located in the lumbar or thoracolumbar spine is quite predictable. Asymmetric degeneration leads to increased asymmetric load and therefore to a progression of the degeneration and deformity, as either scoliosis and/or kyphosis. The progression of a curve is further supported by osteoporosis, particularly in post-menopausal female
Cutts, S; Talboys, R; Paspula, C; Prempeh, E M; Fanous, R; Ail, D
Adult respiratory distress syndrome (ARDS) has now been described as a sequela to such diverse conditions as burns, amniotic fluid embolism, acute pancreatitis, trauma, sepsis and damage as a result of elective surgery in general. Patients with ARDS require immediate intubation, with the average patient now being ventilated for between 8 and 11 days. While the acute management of ARDS is conducted by the critical care team, almost any surgical patient can be affected by the condition and we believe that it is important that a broader spectrum of hospital doctors gain an understanding of the nature of the pathology and its current treatment.
Burmeister, L A; Valdivia, T; Nuttall, F Q
Hereditary fructose intolerance was diagnosed in a 69-year-old man on the basis of his medical history and the response to an intravenous fructose tolerance test. Three men of the same age as our patient were used as control subjects. Since the severity may vary and affected individuals self-impose fructose and sucrose restriction, they are essentially symptom free. The diagnosis can only be suspected by taking a careful dietary history. The prevalence of this condition in adults is unknown. It is rare but is likely to be more common than data in the literature would indicate.
Freeman, Hugh James; Nimmo, Michael
Intestinal lymphangiectasia in the adult may be characterized as a disorder with dilated intestinal lacteals causing loss of lymph into the lumen of the small intestine and resultant hypoproteinemia, hypogammaglobulinemia, hypoalbuminemia and reduced number of circulating lymphocytes or lymphopenia. Most often, intestinal lymphangiectasia has been recorded in children, often in neonates, usually with other congenital abnormalities but initial definition in adults including the elderly has become increasingly more common. Shared clinical features with the pediatric population such as bilateral lower limb edema, sometimes with lymphedema, pleural effusion and chylous ascites may occur but these reflect the severe end of the clinical spectrum. In some, diarrhea occurs with steatorrhea along with increased fecal loss of protein, reflected in increased fecal alpha-1-antitrypsin levels, while others may present with iron deficiency anemia, sometimes associated with occult small intestinal bleeding. Most lymphangiectasia in adults detected in recent years, however, appears to have few or no clinical features of malabsorption. Diagnosis remains dependent on endoscopic changes confirmed by small bowel biopsy showing histological evidence of intestinal lymphangiectasia. In some, video capsule endoscopy and enteroscopy have revealed more extensive changes along the length of the small intestine. A critical diagnostic element in adults with lymphangiectasia is the exclusion of entities (e.g. malignancies including lymphoma) that might lead to obstruction of the lymphatic system and "secondary" changes in the small bowel biopsy. In addition, occult infectious (e.g. Whipple's disease from Tropheryma whipplei) or inflammatory disorders (e.g. Crohn's disease) may also present with profound changes in intestinal permeability and protein-losing enteropathy that also require exclusion. Conversely, rare B-cell type lymphomas have also been described even decades following initial
Rumbaut, Rubén G; Komaie, Golnaz
Almost 30 percent of the more than 68 million young adults aged eighteen to thirty-four in the United States today are either foreign born or of foreign parentage. As these newcomers make their transitions to adulthood, say Rubén Rumbaut and Golnaz Komaie, they differ significantly not only from one another but also from their native-parentage counterparts, including blacks and whites. The authors document the demographic changes in the United States over the past forty years and describe the ways in which generation and national origin shape the experiences of these newcomers as they become adults. Rumbaut and Komaie point out that immigrant groups experience gaps in social, economic, and legal status that are even greater than the gaps between native whites and blacks. By far the most-educated (Indians) and the least-educated (Mexicans) groups in the United States today are first-generation immigrants, as are the groups with the lowest poverty rate (Filipinos) and the highest poverty rate (Dominicans). These social and economic divides reflect three very different ways immigrants enter the country: through regular immigration channels, without legal authorization, or as state-sponsored refugees. For many ethnic groups, significant progress takes place from the first to the second generation. But, say the authors, for millions of young immigrants, a lack of legal permanent residency status blocks their prospects for social mobility. Having an undocumented status has become all the more consequential with the failure of Congress to pass comprehensive federal immigration reforms. In the coming two decades, as the U.S. native-parentage labor force continues to shrink, immigrants and their children are expected to account for most of the growth of the nation's labor force, with the fastest-growing occupations requiring college degrees. Rumbaut and Komaie stress that one key to the nation's future will be how it incorporates young adults of immigrant origin in its
Eshraghi, Adrien A; Frachet, Bruno; Van De Water, Tom R; Eter, Elias
The management of hearing loss in adults depends of etiology and its severity. It can be as simple as treating an external otitis, removing an impacted cerumen or a more complex one such as a surgery for otosclerosis. The hearing loss is managed mainly by new advances in hearing aids technology and implantable hearing devices which include BAHA, middle ear implant and cochlear implants. The research is focused on developing new molecules for intracochlear drug therapy to treat noise induced hearing loss, drug ototoxicity as well as hearing loss related to cochlear implant insertion trauma. Antioxidant molecules, molecules against apoptosis are at this time the most promising molecules than need further investigations.
Miller, Hayley J
Dehydration affects 20% to 30% of older adults. It has a greater negative outcome in this population than in younger adults and increases mortality, morbidity, and disability. Dehydration is often caused by water deprivation in older adults, although excess water loss may also be a cause. Traditional markers for dehydration do not take into consideration many of the physiological differences present in older adults. Clinical assessment of dehydration in older adults poses different findings, yet is not always diagnostic. Treatment of dehydration should focus on prevention and early diagnosis before it negatively effects health and gives rise to comorbidities. The current article discusses what has most thoroughly been studied; the best strategies and assessment tools for evaluation, diagnosis, and treatment of dehydration in older adults; and what needs to be researched further. [Journal of Gerontological Nursing, 41(9), 8-13.].
Corazza, G R; Gasbarrini, G
Coeliac disease is a chronic disease characterized by small bowel villous atrophy which impairs nutrient absorption and improves on withdrawal of wheat gliadins and barley, rye and oat prolamins from the diet. Knowledge of the adult form of coeliac disease has greatly improved in recent years. Although this knowledge is not yet sufficiently widespread among referring clinicians, it has, over the past few years, allowed an increasing number of patients to be diagnosed with subclinical forms characterized by minor, transient or apparently unrelated symptoms. As a consequence, our views on the clinical and epidemiological aspects of this condition, the prevalence of which in the general population is believed to be close to 1 in 300, have changed and are still changing. Since it has been demonstrated that a strict gluten-free diet is protective against the complications of adult coeliac disease, it is important that even subclinical and silent forms are diagnosed and treated as early as possible. Non-invasive screening tests, such as anti-gliadin and anti-endomysium antibody estimation, should therefore be used systematically in groups considered to be at risk of coeliac disease. These include first-degree relatives of coeliac patients and patients with insulin-dependent diabetes mellitus, iron-deficiency anaemia, epilepsy with cerebral calcification, recurrent aphthous stomatitis and dental enamel hypoplasia. Other conditions will probably be identified in the near future.
Haas, Lenneke E M; Thijsen, Steven F T; van Elden, Leontine; Heemstra, Karen A
Human metapneumovirus (HMPV) is a relative newly described virus. It was first isolated in 2001 and currently appears to be one of the most significant and common human viral infections. Retrospective serologic studies demonstrated the presence of HMPV antibodies in humans more than 50 years earlier. Although the virus was primarily known as causative agent of respiratory tract infections in children, HMPV is an important cause of respiratory infections in adults as well. Almost all children are infected by HMPV below the age of five; the repeated infections throughout life indicate transient immunity. HMPV infections usually are mild and self-limiting, but in the frail elderly and the immunocompromised patients, the clinical course can be complicated. Since culturing the virus is relatively difficult, diagnosis is mostly based on a nucleic acid amplification test, such as reverse transcriptase polymerase chain reaction. To date, no vaccine is available and treatment is supportive. However, ongoing research shows encouraging results. The aim of this paper is to review the current literature concerning HMPV infections in adults, and discuss recent development in treatment and vaccination.
Gordon-Messer, Deborah; Bauermeister, Jose Arturo; Grodzinski, Alison; Zimmerman, Marc
Purpose Sexting has stirred debate over its legality and safety, but few researchers have documented the relationship between sexting and health. We describe the sexting behavior of young adults in the United States, and examine its association with sexual behavior and psychological well-being. Methods Using an adapted web version of Respondent-Driven Sampling (webRDS) we recruited a sample of U.S. young adults (ages 18 to 24; N=3447). We examined participant sexting behavior using 4 categories of sexting: 1) Non-Sexters, 2) Receivers, 3) Senders, and 4) Two-way Sexters. We then assessed the relationships between sexting categories and sociodemographic characteristics, sexual behavior and psychological well-being. Results Over half (57%) of respondents were Non-Sexters, 28.2% of the sample were Two-way Sexters, 12.6% were Receivers, and 2% were Senders. Males were more likely to be Receivers than females. Sexually active respondents were more likely to be Two-way Sexters than non-sexually active respondents. Among participants who were sexually active in the past 30 days, we found no differences across sexting groups in number of sexual partners, or number of unprotected sex partners in the past 30 days. We also found no relationship between sexting and psychological well-being. Conclusions Our results suggest that sexting is not related to sexual risk behavior or psychological well-being. We discuss the findings of this study and propose directions for further research on sexting. PMID:23299018
Atkinson, K.; Wells, D. G.; Clink, H. McD.; Kay, H. E. M.; Powles, R.; McElwain, T. J.
Seventy-eight adult patients with acute leukaemia were classified cytologically into 3 categories: acute lymphoblastic leukaemia (ALL), acute myelogenous leukaemia (AML) or acute undifferentiated leukaemia (AUL). The periodic acid-Schiff stain was of little value in differentiating the 3 groups. The treatment response in each group was different: 94% of patients with ALL (16/17) achieved complete remission with prednisone, vincristine and other drugs in standard use in childhood ALL; 59% of patients with AML (27/46) achieved complete remission with cytosine arabinoside and daunorubicin (22 patients), or 6-thioguanine and cyclophosphamide (2 patients), 6-thioguanine, cyclophosphamide and Adriamycin (1 patient), and cytosine and Adriamycin (1 patient); only 2 out of 14 patients (14%) with acute undifferentiated leukaemia achieved complete remission using cytosine and daunorubicin after an initial trial of prednisone and vincristine had failed. Prednisone and vincristine would seem to be of no value in acute undifferentiated leukaemia. It would seem also that no benefit is obtained by classifying all patients with acute leukaemia over 20 years of age as “adult acute leukaemia” and treating them with the same polypharmaceutical regimen. The problems posed by each disease are different and such a policy serves only to obscure them. ImagesFig. 1Fig. 2Fig. 3 PMID:4141625
Haas, Lenneke E. M.; Thijsen, Steven F. T.; van Elden, Leontine; Heemstra, Karen A.
Human metapneumovirus (HMPV) is a relative newly described virus. It was first isolated in 2001 and currently appears to be one of the most significant and common human viral infections. Retrospective serologic studies demonstrated the presence of HMPV antibodies in humans more than 50 years earlier. Although the virus was primarily known as causative agent of respiratory tract infections in children, HMPV is an important cause of respiratory infections in adults as well. Almost all children are infected by HMPV below the age of five; the repeated infections throughout life indicate transient immunity. HMPV infections usually are mild and self-limiting, but in the frail elderly and the immunocompromised patients, the clinical course can be complicated. Since culturing the virus is relatively difficult, diagnosis is mostly based on a nucleic acid amplification test, such as reverse transcriptase polymerase chain reaction. To date, no vaccine is available and treatment is supportive. However, ongoing research shows encouraging results. The aim of this paper is to review the current literature concerning HMPV infections in adults, and discuss recent development in treatment and vaccination. PMID:23299785
Tariq, Syed H
Fecal incontinence is an underreported and underappreciated problem in older adults. Although fecal incontinence is more common in women than in men, this difference narrows with aging. Risk factors that lead to the development of fecal incontinence include dementia, physical disability, and fecal impaction. Treatment options include medical or conservative therapy for older adults who have mild incontinence, and surgical options can be explored in selected older adults if surgical expertise is available.
Munoz, Linda; Wrigley, Heide Spruck
Civic engagement, or the practice of democratic deliberation in adult education and learning, asks that adults use their experiences to cooperatively build solutions to the difficult social, economic, and political problems that affect their lives and communities now and into the future. The articles presented in this issue look at the…
Monseau, Virginia R.
This book focuses on how readers respond to the power of young adult literature--negating the assumption that because such literature appeals to adolescents it cannot possibly be worthy of a place in the language arts curriculum. The book serves two purposes: it describes and discusses the oral and written response of adolescents and adults to…
Purcell-Gates, Victoria; Degener, Sophie C.; Jacobson, Erik; Soler, Marta
Investigates relationships between two dimensions of adult literacy instruction and change in the literacy practices of adult literacy students. Finds that authenticity of class literacy activities and texts had a statistically significant effect on change in student literacy practices; and increases in types of texts involved reading and writing…
Radebaugh, Muriel Rogie
Presents an annotated bibliography of 20 recent young adult novels that are also appropriate for use with adult readers in community college reading programs. Suggests ways of helping such students improve their reading comprehension by analyzing the novels' themes, conflicts, settings, characterization, and symbolism. (AEA)
Cumming, J. Joy, Ed.; van Kraayenoord, Christina E., Ed.
This document contains eight papers from an action research program to foster good practice in adult literacy provision and policy. "Introduction" (J. Joy Cumming, Christina E. van Kraayenoord) presents an overview of the action research project and individual reports. "Assessment: Making a Difference in Adult Literacy and Numeracy…
Many adult poor readers do not organize what they read in a way that best facilitates good comprehension. To help students overcome this problem, the Adult Day and Evening School in Oakland, California, organized a reading laboratory for their mostly low-income, educationally disadvantaged students with a diverse range of needs. Instruction in the…
Liberal adult education in Victoria, Australia, takes its ideals, if not its form, from the pre-war university and Workers Education Association (WEA) partnerships: the university providing tutors and content, the WEA providing contact with unions and workers. Unique to Victoria is the level to which community-based adult education has been…
Durell, Todd; Adler, Lenard; Wilens, Timothy; Paczkowski, Martin; Schuh, Kory
Objective: Atomoxetine is a nonstimulant medication for treating child, adolescent, and adult ADHD. This meta-analysis compared the effects in younger and older adults. Method: A post hoc analysis was conducted using data from two double-blind, placebo-controlled clinical trials. Data from patients aged 18-25 years were compared with data from…
California State Dept. of Education, Sacramento.
To assist adult educators in finding meaningful ways to measure the effectiveness of instruction, this monograph provides selected illustrations of specific methods used by adult education instructors to verify student learning. Obtained from teachers in the field, the examples are from programs in (1) dental assisting, (2) instrument pilot ground…
Because of changes in welfare eligibility, the education system, and employment and training opportunities, it has become more likely that young people who have had difficulty with the mainstream schooling system and who face a lack of employment options will end up in adult education. Educators in the adult education classroom have an opportunity…
Müller, A; Zimmermann, R; Krause, S W
The erythrocyte lifespan in haemolytic anemia is shortened while erythropoesis is increased. Important labaratory findings are increased reticulocytes, LDH, indirect bilirubin and a decreased haptoglobin level. The most important diagnostic tool for further work up of hemolytic anemia is the direct antiglobulin test (DAT, Coombs test) to differentiate autoimmune hemolytic anemia (AIHA) from other causes. Another important group are fragmentation syndroms (hemolytic uremic syndrome and thrombotic thrombocytopenic purpura). In these forms of haemolytic anemia fragmented red blood cells can be found in the blood smear together with thrombocytopenia. A severe problem in paroxysmal nocturnal hematuria is the incidence of thrombosis. The following review describes the most important forms of hemolytic anemia in the adult and the diagnostic and therapeutic strategies.
Bouccara, D; Mosnier, I; Bernardeschi, D; Ferrary, E; Sterkers, O
Cochlear implant in adults is a procedure, dedicated to rehabilitate severe to profound hearing loss. Because of technological progresses and their applications for signal strategies, new devices can improve hearing, even in noise conditions. Binaural stimulation, cochlear implant and hearing aid or bilateral cochlear implants are the best opportunities to access to better level of comprehension in all conditions and space localisation. By now minimally invasive surgery is possible to preserve residual hearing and use a double stimulation modality for the same ear: electrical for high frequencies and acoustic for low frequencies. In several conditions, cochlear implant is not possible due to cochlear nerve tumour or major malformations of the inner ear. In these cases, a brainstem implantation can be considered. Clinical data demonstrate that improvement in daily communication, for both cochlear and brainstem implants, is correlated with cerebral activation of auditory cortex.
Czerwinski, B S
Adult feminine hygiene practices are the focus of this exploratory descriptive study. In a sample of 193 women, the typical respondent lived in the Southeast and was a single student who was 23 years of age, and White. Body cleansing, feminine hygiene, and menses management practices were examined. It was found that handwashing varied according to bodily involvement or specific feminine hygiene practices. Assorted menses management products were used for menses management and were used when the woman was not menstruating. The results of this study suggest that it might be possible for health care providers to teach women safe and economical health care practices, such as not douching and handwashing before and after use of menses management products to prevent infections.
Puar, Troy Hai Kiat; Mok, Yingjuan; Debajyoti, Roy; Khoo, Joan; How, Choon How; Ng, Alvin Kok Heong
Secondary hypertension occurs in a significant proportion of adult patients (~10%). In young patients, renal causes (glomerulonephritis) and coarctation of the aorta should be considered. In older patients, primary aldosteronism, obstructive sleep apnoea and renal artery stenosis are more prevalent than previously thought. Primary aldosteronism can be screened by taking morning aldosterone and renin levels, and should be considered in patients with severe, resistant or hypokalaemia-associated hypertension. Symptoms of obstructive sleep apnoea should be sought. Worsening of renal function after starting an angiotensin-converting enzyme inhibitor suggests the possibility of renal artery stenosis. Recognition, diagnosis and treatment of secondary causes of hypertension lead to good clinical outcomes and the possible reversal of end-organ damage, in addition to blood pressure control. As most patients with hypertension are managed at the primary care level, it is important for primary care physicians to recognise these conditions and refer patients appropriately. PMID:27211205
Rollino, Cristiana; D'Urso, Leonardo; Beltrame, Giulietta; Ferro, Michela; Quattrocchio, Giacomo; Quarello, Francesco
Vesicoureteral reflux (VUR) may be congenital or acquired. The most frequent form of congenital VUR is primary VUR. Its prevalence in adults is not exactly known, but it is higher in women, whose greater propensity for urinary tract infections increases the likelihood of an instrumental examination leading to the diagnosis of less severe cases. In men, even severe VUR may go undiagnosed for a long time. Primary VUR is due to a defect in the valve mechanism of the ureterovesical junction. In physiological conditions, the terminal ureter enters the bladder wall obliquely and bladder contraction leads to compression of this intravesical portion. Abnormal length of the intravesical portion of the ureter due to a genetic mutation (whose location is yet to be established) leads to VUR. In its less severe forms VUR may be asymptomatic, but in 50-70% of cases it manifests with recurrent cystitis or pyelonephritis. The manifestations leading to a diagnosis of VUR in adults, besides urinary tract infections, are proteinuria, renal failure and hypertension. The gold-standard diagnostic examination is a micturating cystourethrogram. Reflux nephropathy develops as a result of a pathogenetic mechanism unrelated to high cavity pressure or urinary tract infections but due to reduced formation of the normal renal parenchyma (hypoplasia or dysplasia). Abnormal renal parenchyma development is attributable to the same genes that control the development of the ureters and ureterovesical junction. VUR is considered only a marker of this abnormal development, playing no role in scar formation. There is no conclusive evidence regarding the indications for VUR correction. However, the risk that VUR leads to recurrent pyelonephritis and reflux nephropathy must be kept in mind. VUR certainly has to be corrected in women who contemplate pregnancy.
Russell, Sally S
Part of being an effective instructor involves understanding how adults learn best. Theories of adult education are based on valuing the prior learning and experience of adults. Adult learners have different learning styles which must be assessed prior to initiating any educational session. Health care providers can maximize teaching moments by incorporating specific adult-learning principles and learning styles into their teaching strategies.
King, Lovern Root, Ed.
Aspects of Native American history and culture as well as issues and concerns of American Indians are presented in the twelve short articles in this reader for adults. Intended for use in an adult basic education/GED program, the reader features simply written stories (for grades 0-3), illustrations, vocabulary lists and student study questions.…
Jones, Elaine G.; Ouellette, Sue E.; Kang, Youngmi
The Present Article describes the effectiveness of stress management classes in decreasing perceived stress among Deaf adults. Deaf adults may experience unique stressors, in addition to circumstances associated with increased stress in the general population. The Perceived Stress Scale (S. Cohen, Kamarck, & Mermelstein, 1983) was used as a…
Ater, E. Carolyn, Ed.
This manual is intended for use by senior adult peer advisors (age 60 and over) engaged in helping relationships in providing consumer education to other senior adults. The advisory procedures are based on a problem solving approach which incorporates the development of a self-help concept. Chapter 1 provides information on consumer advising. It…
Isserlis, Janet; And Others
This handbook is for volunteer tutors, student interns, and VISTA volunteers working with adult basic education (ABE) and English-as-a-Second-Language (ESL) learners. The community-based handbook contains information about adult literacy and tutoring--what tutors do, who the learners are, and how the literacy learning process works. Introductory…
This document, which examines the use of educational technologies for distance education for adults in Canada, consists of five narrative sections and a bibliography. The first section introduces the topic and the document's objectives (to describe those technologies used in Canadian adult distance education, paying particular attention to those…
Describes market segmentation and how the principles of segmentation can be applied to the adult education market. Indicates that applying segmentation techniques to adult education programs results in programs that are educationally and financially satisfying and serve an appropriate population. (JOW)
Southampton Univ. (England).
This collection of working papers deals with the relationship among women, social class, and adult education. In her paper entitled "Women and University Extension," Pat Usher argues that by sustaining the dominant cultural, ideological, and social relationships of production in capitalist Britain, university adult education contributes…
Moore, Matthew S.
Defines book display as an adult service as choosing and positioning adult books from the library collection to increase their circulation. The author contrasts bookstore arrangement for sales versus library arrangement for access, including contrasting missions, genre grouping, weeding, problems, and dimensions. (Author/LRW)
In this article, the author describes her journey to international adult education and shares some lessons learned from her journey. The author developed her interest in international adult education through the Scientific Research Institute of International and Comparative Education (SRIICE) at Beijing Normal University and discovered its…
This book describes several curriculum models currently used in the field of adult education in an effort to assist adult educators who develop curricula as a routine part of their jobs. The book is divided into 14 chapters that are grouped into 7 sections. Each section covers a type of educational program, and each chapter describes a specific…
Art Ellison is longtime advocate for adult education, having managed numerous advocacy campaigns over the past forty years on the state and national levels. Prior to his employment in 1980 as the NH State Director of Adult Education he worked for many years as a high school teacher and as a community organizer. In this article, Ellison offers some…
Draper, James A.
A study was conducted to examine the literature on literacy and adult basic education and to identify various issues, trends, problems, possible solutions, and basic principles that might guide programs and policies in adult literacy and basic education in Canada. More than 120 documents were examined, raising such issues as what is literacy and…
Regan, Timothy F.
Problems of adult basic education in the United States, symptomatic of the connection between poverty, poor education, and unemployment, have forged for the disadvantaged adult most of the links in the unbreakable chain of deprivation, frustration, and despair. The problem of ESOL (English for Speakers of Other Languages) instruction is…
Conti, Gary J., Ed.; Fellenz, Robert A., Ed.
Five projects are reported that examined factors related to adult learning in nontraditional environments. "Conrad, Montana: A Community of Memories" (Janice Counter, Lynn Paul, and Gary Conti) reports on a group of adults who for over 40 years have been active in building a better community for friends, relatives, and themselves. A…
Regmi, Krishna; Regmi, Sharada
This paper presents the initial findings from a study of education system in Nepal. This paper examines the adult learning opportunities within the educational and cultural contexts by reviewing available literature relevant to Nepal. Findings show that there are wider opportunities for adult learning than those considered from education and…
Harris, Dolores M.
Adult basic education programs must teach the "social living skills" disadvantaged adults need, as well as basic literacy skills. In creating an ABE program, one must first assess the needs of the target population--through surveys, group meetings, an advisory council of members of the target population, demographic studies, and consideration of…
Marceau, Roger; Meghani, Rehana; Reddon, John R.
This report is primarily concerned with reporting on the normative results obtained on a large sample of serious adult offenders. An expanded Halstead-Reitan Neuropsychological Test Battery was administered to 584 adult offenders (OF), 132 normal controls (NC), and 494 acute psychiatric patients (PP). Subjects were between 18 and 44 years of age.…
Kreitlow, Burton W.; And Others
Controversies over adult education purposes, methods, audiences, and procedures are examined. After outlining a procedure for reviewing competing positions on controversial topics, the book pairs the contrasting views of two authors on each of 10 key issues facing adult education. Chapters cover: philosophies at issue (David L. Boggs); identifying…
Lindner, Charles L.
The current economic crisis, a growing workforce, the increasing lifespan of workers, and demanding, complex jobs have made organizations highly selective in employee recruitment and retention. It is therefore important, to the adult educator, to develop models of learning that better prepare adult learners for the workplace. The purpose of…
Lindstrom, Steven K.
This phenomenological research study examines the lived experience of individual adult transformation in the context of travel. Adults throughout history have experienced profound personal and perception changes as a result of significant travel events. Transformative learning occurs through experience, crisis, and reflection, all of which are…
Best practices in adult transition special education for moderate to severe students suggest student-centered planning that maximizes independence in adult life. Based on the above sources, school districts and governing boards would best serve moderate to severe transition special education students with increasing integration into the community…
Snow, Ellen; And Others
This handbook was developed to provide adult educators in Texas with sufficient background in assessment models to ensure confidence in recognizing and/or selecting appropriate measurement techniques and in using evaluation results to individualize and improve instruction for adult students. The handbook is based on information derived from a…
Donelson, Kenneth L.; Nilsen, Alleen Pace
Defining young adult literature to include any book freely chosen for reading by a person between the ages of 12 and 20, this book is intended to help educate professionals in related fields about the growing body of such literature. The first section of the book provides an introduction to young adult literature, including a discussion of the…
Hudson, J. W.
Beginning with such movements as the eighteenth century moral reformation societies and Welsh Sunday schools, and the first adult schools for both men and women in the early 1800's, this historical review traces British adult education up to 1850. Emphasis is on the extensive and widespread programs of the Mechanics' (workingmen's) Institutes and…
Texas Univ., Austin. Div. of Extension.
The Adult Performance Level (APL) project summary specifies the competencies which are functional to economic and educational success in society and describes devices developed for assessing those competencies. The APL theory of functional competency identifies adult needs in general knowledge areas (consumer economics, occupational knowledge,…
Roy, Nikhil Ranjan
A survey is made of various aspects of adult education in India since 1947, together with comparative accounts of the origin, development, and notable features of adult education in Denmark, Great Britain, the Soviet Union, and the United States. Needs and objectives in India, largely in the eradication of illiteracy, are set forth, and pertinent…
Adult learners, long the stepchildren of colleges and universities, have nearly become the norm, and they spend billions of dollars each year on education. This chapter takes a customer-oriented approach to recruiting and retaining adult students in higher education. (GCP)
Foley, Griff, Ed.
This book introduces readers to issues, debates and literatures related to a number of central areas of practice in adult education and training, especially in Australia. It is intended as a first attempt to define the field of adult education in Australia in an analytical and theoretical, as opposed to a theoretical and practical sense. Written…
Wolf, Lorraine E., Ed.; Schreiber, Hope E., Ed.; Wasserstein, Jeanette, Ed.
Recent advances in neuroimaging and genetics technologies have enhanced our understanding of neurodevelopmental disorders in adults. The authors in this volume not only discuss such advances as they apply to adults with learning disorders, but also address their translation into clinical practice. One cluster of chapters addresses developmental…
Baskett, Linda Musun
This study attempted to determine what expectations or beliefs adults might hold about a child based on his or her sibling status alone. Ratings on 50 adjective pairs for each of three sibling status types, only, oldest, and youngest child, were assessed in relation to adult expectations, birth order, and parental status of rater. (Author/DST)
O'Brien, Roberta Luther, Comp.
This document is an annotated bibliography of recommended print materials for English-speaking adults reading at the seventh grade level or below. (Sixty percent of the titles are at fifth grade level or below). The titles were selected for their broad appeal to the average adult new reader. In the selection, special consideration was given to…
Adult learners comprise almost 50 percent of all students enrolled in higher Education. Some argue they are pioneering change in today's higher educational landscape. This book is designed to assist faculty members and administrators who want to understand how the impact of adult learning programs has and is helping to transform the academy and…
Adult learning programs are becoming increasingly important. This book is designed to serve as a wake-up call for members of the academy who prefer to work with traditional students. It provides practical advice for adult learning programs with insights drawn from case studies and the author's experience. Part 1, "Context and Overview," contains:…
Garrison, D. Randy, Ed.
This book focuses on understanding the epistemological foundation of adult education, the research process, policy issues, and directions for the future. "An Epistemological Overview of the Field" (Garrison) provides an overview of adult education research: the historical development, issues, the scope of the knowledge base, and approaches to…
Mohlman, Jan; Sirota, Karen Gainer; Papp, Laszlo A.; Staples, Alison M.; King, Arlene; Gorenstein, Ethan E.
Over the next few decades the older adult population will increase dramatically, and prevalence rates of psychiatric disorders are also expected to increase in the elderly cohort. These demographic projections highlight the need for diagnostic instruments and methods that are specifically tailored to older adults. The current paper discusses the…
Draper, Thomas W; Holman, Thomas B; White, Whitney; Grandy, Shannon
Attachment scores for 658 young adults living in the U.S.A. were obtained using the Experiences in Close Relationships scale. The participants came from a subsample of the RELATE data set, who had also filled out the adult attachment measure. Those young adults living in Utah County, Utah, an area of the country with a higher than normal birthrate (88% members of the Church of Jesus Christ of Latter-day Saints), also had higher than average adult attachment scores. While the methodology was not sufficient to assess causal direction nor eliminate the possibility of unidentified influences, an undiscussed psychological factor, adult attachment, may play a role in the numerical declines observed among nonimmigrant communities in the USA and Europe.
Discusses young adult novels and presents a bibliography to acquaint librarians with titles and authors that are suitable for emerging young adult readers in grades five through nine. Subject categories include realistic fiction, in the news, historical fiction, short stories, legendary characters, mysteries, science fiction/fantasy/horror, and…
Same-day surgery - adult; Ambulatory surgery - adult; Surgical procedure - adult; Preoperative care - day of surgery ... meet with them at an appointment before the day of surgery or on the same day of ...
Wax, Dorothy M.; Wertheim, Judith
This chapter focuses on the use of coaching for adult learners, the specific characteristics adults bring to the learning environment, and strategies for dealing with the obstacles adult learners may face.
Adler, Lenard A; Faraone, Stephen V; Spencer, Thomas J; Berglund, Patricia; Alperin, Samuel; Kessler, Ronald C
Although DSM-5 stipulates that symptoms of attention-deficit hyperactivity disorder (ADHD) are the same for adults as children, clinical observations suggest that adults have more diverse deficits than children in higher-level executive functioning and emotional control. Previous psychometric analyses to evaluate these observations have been limited in ways addressed in the current study, which analyzes the structure of an expanded set of adult ADHD symptoms in three pooled US samples: a national household sample, a sample of health plan members, and a sample of adults referred for evaluation at an adult ADHD clinic. Exploratory factor analysis found four factors representing executive dysfunction/inattention (including, but not limited to, all the DSM-5 inattentive symptoms, with non-DSM symptoms having factor loadings comparable to those of DSM symptoms), hyperactivity, impulsivity, and emotional dyscontrol. Empirically-derived multivariate symptom profiles were broadly consistent with the DSM-5 inattentive-only, hyperactive/impulsive-only, and combined presentations, but with inattention including executive dysfunction/inattention and hyperactivity-only limited to hyperactivity without high symptoms of impulsivity. These results show that executive dysfunction is as central as DSM-5 symptoms to adult ADHD, while emotional dyscontrol is more distinct but nonetheless part of the combined presentation of adult ADHD.
Zoicas, Flavius; Schöfl, Christof
Craniopharyngiomas are slow growing benign tumors of the sellar and parasellar region with an overall incidence rate of approximately 1.3 per million. During adulthood there is a peak incidence between 40 and 44 years. There are two histopathological types, the adamantinomatous and the papillary type. The later type occurs almost exclusively in adult patients. The presenting symptoms develop over years and display a wide spectrum comprising visual, endocrine, hypothalamic, neurological, and neuropsychological manifestations. Currently, the main treatment option consists in surgical excision followed by radiation therapy in case of residual tumor. Whether gross total or partial resection should be preferred has to be balanced on an individual basis considering the extent of the tumor (e.g., hypothalamic invasion). Although the overall long-term survival is good it is often associated with substantial morbidity. Preexisting disorders are often permanent or even exacerbated by treatment. Endocrine disturbances need careful replacement and metabolic sequelae should be effectively treated. Regular follow-up by a multidisciplinary team is a prerequisite for optimal outcome of these patients. PMID:22654868
Yasawy, Mohamed Ismail; Folsch, Ulrich Richard; Schmidt, Wolfgang Eckhard; Schwend, Michael
Hereditary fructose intolerance (HFI) is an under-recognized, preventable life-threatening condition. It is an autosomal recessive disorder with subnormal activity of aldolase B in the liver, kidney and small bowel. Symptoms are present only after the ingestion of fructose, which leads to brisk hypoglycemia, and an individual with continued ingestion will exhibit vomiting, abdominal pain, failure to thrive, and renal and liver failure. A diagnosis of HFI was made in a 50-year-old woman on the basis of medical history, response to IV fructose intolerance test, demonstration of aldolase B activity reduction in duodenal biopsy, and molecular analysis of leukocyte DNA by PCR showed homozygosity for two doses of mutant gene. HFI may remain undiagnosed until adult life and may lead to disastrous complications following inadvertent fructose or sorbitol infusion. Several lethal episodes of HFI following sorbitol and fructose infusion have been reported. The diagnosis can only be suspected by taking a careful dietary history, and this can present serious complications.
Vitalistic thinking has traditionally been associated with reasoning about biological phenomena. The current research aimed to investigate a broader range of vitalistic thinking than previously studied. Esoteric notions of 'energy' are frequently used by individuals when making causal attributions for strange occurrences, and previous literature has linked such thinking with paranormal, magical, and superstitious beliefs. Two experiments are described that aim to investigate whether adults are vitalistic when asked to make causal judgments, and whether this can be predicted by thinking styles and prior paranormal belief. Experiment 1 asked participants to rate three causal options (one of which was vitalistic) for six vignettes. Scores on one dimension of paranormal belief (New Age Philosophy) and analytical thinking significantly predicted vitalism, but scores on intuitive thinking and Traditional Paranormal Beliefs did not. Experiment 2 extended the findings by asking participants to generate their own causal responses. Again, paranormal belief was found to be the best predictor of vitalism, but this time Traditional Paranormal Beliefs were associated with vitalistic responses whilst both intuitive and analytical thinking were unable to significantly predict classification. Results challenge previous findings, suggesting that vitalistic thinking may operate differently when applied to everyday causal reasoning.
Carozza, S E; Wrensch, M; Miike, R; Newman, B; Olshan, A F; Savitz, D A; Yost, M; Lee, M
Lifetime job histories from a population-based, case-control study of gliomas diagnosed among adults in the San Francisco Bay area between August 1991 and April 1994 were evaluated to assess occupational risk factors. Occupational data for 476 cases and 462 controls were analyzed, with adjustment for age, gender, education, and race. Imprecise increased risks were observed for physicians and surgeons (odds ratio (OR) = 3.5, 95% confidence interval (CI): 0.7, 17.6), artists (OR = 1.9, 95% CI: 0.5, 6.5), foundry and smelter workers (OR = 2.6, 95% CI: 0.5, 13.1), petroleum and gas workers (OR = 4.9, 95% CI: 0.6, 42.2), and painters (OR = 1.6, 95% CI: 0.5, 4.9). Legal and social service workers, shippers, janitors, motor vehicle operators, and aircraft operators had increased odds ratios only with longer duration of employment. Physicians and surgeons, foundry and smelter workers, petroleum and gas workers, and painters showed increased risk for both astrocytic and nonastrocytic tumors. Artists and firemen had increased risk for astrocytic tumors only, while messengers, textile workers, aircraft operators, and vehicle manufacturing workers showed increased risk only for nonastrocytic tumors. Despite study limitations, including small numbers for many of the occupational groups, a high percentage of proxy respondents among cases, and lack of specific exposure information, associations were observed for several occupations previously reported to be at higher risk for brain tumors generally and gliomas specifically.
Charles, John; Morrison, Joanna
This annotated bibliography includes adult mysteries that appeal to teen readers under the categories of Sherlock Holmes; reference sources; private investigators; amateur sleuths; historical sleuths; suspense and thrillers; police procedurals; mystery blends; and anthologies. (LRW)
The survivors of the initial years of neonatal intensive care of preterm infants reached adulthood during the last decade. Reports of their adult outcomes examined have included neurodevelopmental, behavioral and health outcomes as well as social functioning and reproduction. Despite statistically significant differences between preterm young adults and controls in most outcomes studied, the majority of preterm survivors do well and live fairly normal lives. The two major predictors of adult outcomes are lower gestational age that reflect perinatal injury and family sociodemographic status which reflects both genetic and environmental effects.
Cecchi, Guillermo A.; Magnasco, Marcelo O.
Experimental results in recent years have shown that adult neurogenesis is a significant phenomenon in the mammalian brain. Little is known, however, about the functional role played by the generation and destruction of neurons in the context of an adult brain. Here, we propose two models where new projection neurons are incorporated. We show that in both models, using incorporation and removal of neurons as a computational tool, it is possible to achieve a higher computational efficiency that in purely static, synapse-learning-driven networks. We also discuss the implication for understanding the role of adult neurogenesis in specific brain areas like the olfactory bulb and the dentate gyrus.
Dugbartey, A T
There are few empirical studies of the adult outcomes of nonverbal learning disability (NLD). An overwhelming majority of NLD studies has been devoted to the nature of academic difficulties of school children, whereas the few follow-up studies have tended to be limited to college-age young adults. Herein, it is argued that the problems of adults with NLD do not fall solely in academic areas, and that early academic remediation programs might do well to include intervention in emotional and social skills enhancement.
Promotional materials and activities for Australia's Adult Learners Week, which are shaped by a variety of stakeholders , include media strategies and a website. Activities are evaluated using a market research company and website and telephone hotline statistics. (SK)
Therapeutic recreation is a means of empowering individuals with disabilities through arts or sports. The field has developed differently in the United States and the United Kingdom; the former emphasizes professionalization and the latter the right to adult education. (SK)
... lung disease Pulmonary alveolar proteinosis Rheumatoid lung disease Sarcoidosis Patient Instructions Eating extra calories when sick - adults ... team. Related MedlinePlus Health Topics Interstitial Lung Diseases Sarcoidosis Browse the Encyclopedia A.D.A.M., Inc. ...
Vaccinations for Adults with Diabetes The table below shows which vaccinations you should have to protect your health if ... sure you and your healthcare provider keep your vaccinations up to date. Vaccine Do you need it? ...
Hashimoto, Koji; Fujiki, Masato; Quintini, Cristiano; Aucejo, Federico N; Uso, Teresa Diago; Kelly, Dympna M; Eghtesad, Bijan; Fung, John J; Miller, Charles M
Split liver transplantation (SLT), while widely accepted in pediatrics, remains underutilized in adults. Advancements in surgical techniques and donor-recipient matching, however, have allowed expansion of SLT from utilization of the right trisegment graft to now include use of the hemiliver graft as well. Despite less favorable outcomes in the early experience, better outcomes have been reported by experienced centers and have further validated the feasibility of SLT. Importantly, more than two decades of experience have identified key requirements for successful SLT in adults. When these requirements are met, SLT can achieve outcomes equivalent to those achieved with other types of liver transplantation for adults. However, substantial challenges, such as surgical techniques, logistics, and ethics, persist as ongoing barriers to further expansion of this highly complex procedure. This review outlines the current state of SLT in adults, focusing on donor and recipient selection based on physiology, surgical techniques, surgical outcomes, and ethical issues. PMID:27672272
Fay, Francis A.
Author discussed American public's shifts in values and priorities" and suggests that adult educators become involved in 'real politique'" in order to help form public policy in the future. (Author/SP)
... training for health care providers. Learn More Hip Fractures Among Older Adults Recommend on Facebook Tweet Share ... older. What You Can Do to Prevent Hip Fractures You can prevent hip fractures by taking steps ...
Hadley, Lee; Irwin, Annabelle
Presents a dialogue between the authors on what it is like to collaborate in writing young adult fiction. Discusses their writing processes, how they come up with ideas for their books, and how they get the books published. (RS)
... Stroke Urinary Incontinence Related Documents PDF Choosing Wisely: Diabetes Tests and Treatments Download Related Video Join our e-newsletter! Aging & Health A to Z Diabetes Unique to Older Adults This section provides information ...
Davis, C. Amelia
This chapter considers how transitions to adulthood have been historically represented and presents alternative ways of thinking about transitions to adulthood through the context of adult basic education programs.
... of fractures if needed annual flu shots. Protein-Calorie Malnutrition Many older adults living at home eat ... so serious that a condition known as protein-calorie malnutrition (PCM) develops. Sometimes, PCM occurs after a ...
... and Resources Clinical Trials Share Older Adults and Mental Health Overview It’s just as important for an older ... this helpline, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), to receive immediate counseling. Calling ...
Ogino, Yoichiro; Ayukawa, Yasunori; Tomita, Yoko; Koyano, Kiyoshi
Osteopetrosis (OP) is a rare condition characterized by skeletal sclerosis caused by dysfunctional osteoclasts. Though many reports have described severe infantile-malignant autosomal recessive OP, few have described the prosthetic management of adult OP. This report discusses the prosthetic treatment of adult OP. Although prosthodontists should try to reconstruct occlusal function as much as possible, a conservative prosthodontic approach may be a reasonable and recommended treatment option for minimizing the risk of further osteomyelitis and osteonecrosis.
The Adult Learning Program Service (ALPS) aims to reach eight and a half million adults between ages 25 and 44 and teach them reading and math skills they can use at home and on the job. ALPS proposes to reach those who have never finished high school but do have at least a sixth-grade reading level. They could use their new skills to prepare for…
Umberger, Reba; Callen, Bonnie; Brown, Mary Lynn
Severe sepsis may be underrecognized in older adults. Therefore, the purpose of this article is to review special considerations related to early detection of severe sepsis in older adults. Normal organ changes attributed to aging may delay early detection of sepsis at the time when interventions have the greatest potential to improve patient outcomes. Systems are reviewed for changes. For example, the cardiovascular system may have a limited or absent compensatory response to inflammation after an infectious insult, and the febrile response and recruitment of white blood cells may be blunted because of immunosenescence in aging. Three of the 4 hallmark responses (temperature, heart rate, and white blood cell count) to systemic inflammation may be diminished in older adults as compared with younger adults. It is important to consider that older adults may not always manifest the typical systemic inflammatory response syndrome. Atypical signs such as confusion, decreased appetite, and unsteady gait may occur before sepsis related organ failure. Systemic inflammatory response syndrome criteria and a comparison of organ failure criteria were reviewed. Mortality rates in sepsis and severe sepsis remain high and are often complicated by multiple organ failures. As the numbers of older adults increase, early identification and prompt treatment is crucial in improving patient outcomes.
Zelinski, Elizabeth M.; Miura, Shari A.
Evaluated adult age differences in language comprehension with groups of young adults (age 20-35), young old adults (age 55-69), and old old adults (age 70-87). The results suggest that speed of comprehension processes required to match related terms in sentence pairs is not impaired with age as long as terms do not have to be remembered.…
Adult Education and Development, 1996
This serial issue contains a total of 26 articles grouped under five headings: "Adult Learning: A Key for the Twenty-First Century (Fifth International Conference on Adult Education (Confintea V))"; "Trends in Adult Education Policy" (Belanger); "Adult Education in Modern Times" (Geissler); "From Criticism to…
Dobmeier, Robert; Moran, Joseph
The adult education literature on disruptive behavior of adult learners was reviewed and a survey on disruptive behavior of adult learners was conducted with adult educators. The findings are synthesized in a conceptual framework for understanding the types and causes of disruptive behavior, which fall into the categories of inattention,…
Bureau of Occupational and Adult Education (DHEW/OE), Washington, DC. Div. of Adult Education.
This resource guide for adult education personnel describes programs and publications on APL (Adult Performance Level) and Competency-Based Adult Education (CBAE). Includes: (1) Descriptions of APL examination programs developed by the American College Testing Program, (2) brief description of Missouri project on the identification of adult basic…
Theories and studies of adult development are largely confined to adult male career development and ignore a moral or faith dimension of adult development. To determine the faith and moral dimension of adult couples, three hypotheses were examined, i.e.,: (1) religion is a significant dimension in their consciousness; (2) the family is integrally…
Wurster, Susann L., Ed.
Describes training and adult education resources available from ERIC: "Applications of an Adult Motivational Instructional Design Model"; "Visual and Digital Technologies for Adult Learning"; "Applications of Computer-Aided Instruction in Adult Education and Literacy"; and "The San Diego CWELL Project. Report of…
Adult basic education programs, sometimes called adult basic and secondary education programs, typically serve adults over the age of sixteen who do not have a high school diploma and are no longer eligible for traditional secondary education programs. Although adult basic education (ABE) is situated apart from the elementary, secondary, and…
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Adult education. 18.438 Section 18.438 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... Adult Education § 18.438 Adult education. A recipient that provides adult education may not, on...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Adult education. 18.438 Section 18.438 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... Adult Education § 18.438 Adult education. A recipient that provides adult education may not, on...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Adult education. 18.438 Section 18.438 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... Adult Education § 18.438 Adult education. A recipient that provides adult education may not, on...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Adult education. 18.438 Section 18.438 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... Adult Education § 18.438 Adult education. A recipient that provides adult education may not, on...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Adult education. 18.438 Section 18.438 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED... Adult Education § 18.438 Adult education. A recipient that provides adult education may not, on...
Pary, Robert J.
Examination of the records of 240 inpatients with mental retardation and 7 with autism discharged from a university hospital indicated that elderly adults had more medical problems than did adults, more elderly adults were transferred to a state hospital, and the most common diagnosis in both adults and elderly adults was chronic schizophrenia,…
Gill, Lydia E.; Bartels, Stephen J.; Batsis, John A.
As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality is lost), the increase risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults, the dangers and benefits of weight loss in this population, and provides an overview of the new Medicare Obesity Benefit. In addition we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice. PMID:26627496
Wooten, James M
Life expectancy for Americans has increased dramatically since 1900, as have the available pharmacotherapeutic options. Unfortunately, pharmacotherapy mishaps occur commonly in the older adult population. This problem greatly affects the morbidity and mortality of elderly patients and greatly increases healthcare costs. To improve patient care among elderly adults, healthcare practitioners must consider several issues when developing a pharmacotherapy plan. A thorough understanding of pharmacokinetics, pharmacodynamics, adverse drug reactions, drug interactions, and several other factors is necessary for practitioners to develop a safe and effective drug therapy plan for older adults. This review provides a general but comprehensive review of the issues pertaining to pharmacotherapy in elderly people and offers several suggestions for improving their pharmaceutical care.
The prevalence of food allergy is increasing in both the pediatric and adult populations. While symptom onset occurs mostly during childhood, there are a considerable number of patients whose symptoms first begin to appear after the age of 18 years. The majority of patients with adult-onset food allergy suffer from the pollen-plant allergy syndromes. Many of them manifest their allergy after exercise and consuming food to which they are allergic. Eosinophilic esophagitis, an eosinophilic inflammation of the esophagus affecting individuals of all ages, recently emerged as another allergic manifestation, with both immediate and late response to the ingested food. This review provides a condensed update of the current data in the literature on adult-onset allergy.
Fernandez-Sola, J.; Casademont, J.; Grau, J. M.; Graus, F.; Cardellach, F.; Pedrol, E.; Urbano-Marquez, A.
Mitochondrial diseases are polymorphic entities which may affect many organs and systems. Skeletal muscle involvement is frequent in the context of systemic mitochondrial disease, but adult-onset pure mitochondrial myopathy appears to be rare. We report 3 patients with progressive skeletal mitochondrial myopathy starting in adult age. In all cases, the proximal myopathy was the only clinical feature. Mitochondrial pathology was confirmed by evidence of ragged-red fibres in muscle histochemistry, an abnormal mitochondrial morphology in electron microscopy and by exclusion of other underlying diseases. No deletions of mitochondrial DNA were found. We emphasize the need to look for a mitochondrial disorder in some non-specific myopathies starting in adult life. Images Figure 1 Figure 2 PMID:1589382
Chesser, Amy K.; Keene Woods, Nikki; Smothers, Kyle; Rogers, Nicole
Objective: The objective of this review was to assess published literature relating to health literacy and older adults. Method: The current review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses. Results: Eight articles met inclusion criteria. All studies were conducted in urban settings in the United States. Study sample size ranged from 33 to 3,000 participants. Two studies evaluated health-related outcomes and reported significant associations between low health literacy and poorer health outcomes. Two other studies investigated the impact of health literacy on medication management, reporting mixed findings. Discussion: The findings of this review highlight the importance of working to improve health care strategies for older adults with low health literacy and highlight the need for a standardized and validated clinical health literacy screening tool for older adults. PMID:28138488
Schoenfeld, Timothy J; Cameron, Heather A
Several lines of evidence suggest that adult neurogenesis, the production of new neurons in adulthood, may play a role in psychiatric disorders, including depression, anxiety, and schizophrenia. Medications and other treatments for mental disorders often promote the proliferation of new neurons; the time course for maturation and integration of new neurons in circuitry parallels the delayed efficacy of psychiatric therapies; adverse and beneficial experiences similarly affect development of mental illness and neurogenesis; and ablation of new neurons in adulthood alters the behavioral impact of drugs in animal models. At present, the links between adult neurogenesis and depression seem stronger than those suggesting a relationship between new neurons and anxiety or schizophrenia. Yet, even in the case of depression there is currently no direct evidence for a causative role. This article reviews the data relating adult neurogenesis to mental illness and discusses where research needs to head in the future. PMID:25178407
Cloyd, Elizabeth; Dyer, Carmel B
The plight of older adults during catastrophic events is a societal concern. Older persons have an increased prevalence of cognitive disorders, chronic illnesses, and mobility problems that limit their ability to cope. These disorders may result in a lack of mental capacity and the ability to discern when they should evacuate or resolve problems encountered during a catastrophe. Some older persons may have limited transportation options, and many of the elderly survivors are at increased risk for abuse, neglect, and exploitation. Recommendations for future catastrophic events include the development of a federal tracking system for elders and other vulnerable adults, the designation of separate shelter areas for elders and other vulnerable adults, and involvement of gerontological professionals in all aspects of emergency preparedness and care delivery, including training of frontline workers. Preparation through preevent planning that includes region-specific social services, medical and public health resources, volunteers, and facilities for elders and vulnerable adults is critical. Elders need to be protected from abuse and fraud during catastrophic events. A public health triage system for elders and other vulnerable populations in pre- and postdisaster situations is useful, and disaster preparedness is paramount. Communities and members of safety and rescue teams must address ethical issues before an event. When older adults are involved, consideration needs to be given to triage decision making, transporting those who are immobile, the care of older adults who receive palliative care, and the equitable distribution of resources. Nurses are perfectly equipped with the skills, knowledge, and training needed to plan and implement disaster preparedness programs. In keeping with the tradition of Florence Nightingale, nurses can assume several crucial roles in disaster preparedness for older adults. Nurses possess the ability to participate and lead community
Kawahara, Naoya; Ofuji, Sosuke; Abe, Sakae; Tanaka, Ai; Uematsu, Masami; Ogata, Yoshimi
Water intoxication is a common disorder in calves and is usually characterized by transient hemoglobinuria. In contrast, the condition is very rare in adult cattle, with few reports on naturally occurring cases. In the present report, four female Japanese Black cattle, aged 16-25 months, showed neurological signs when they drank water following a water outage. Hemoglobinuria was not grossly observed, while severe hyponatremia was revealed by laboratory tests. Autopsy indicated cerebral edema with accumulation of serous fluid in expanded Virchow-Robin spaces. These results indicate the possibility of water intoxication associated with cerebral edema due to severe dilutional hyponatremia in adult cattle.
Hooks, William Michael; Nelson, Floride
Since its foundation in 1968, the Adult Literacy League of Orlando, Florida, has dedicated itself to eradicating the educational handicaps of more than 2,575 local residents. The League, which in 1975 became part of the Open Campus of Valencia Community College (VCC), offers two courses: (1) a Literacy Tutor Training Workshop, a 10-hour program to…
Charles, John; Morrison, Joanna
Presents an annual list of adult mystery titles (in print as of September 1999) to recommend to teenagers, as well as recently published mystery readers advisory sources or nonfiction mystery-related titles that school and public libraries may want for their collections. (AEF)
van der Kamp, Max
By the year 2000, at least 20 percent of Europeans will be over 60 years old. As the labor force ages, older employees will have to contribute more to the productivity of organizations. Due to rapid technological changes, more retraining will be required. Education can fulfill important functions for older adults, but their learning style must be…
Ali, Adel Ben; Bagnis, Corinne Isnard
Urinary tract infections in adults are frequent and can induce several septic situations. Their economic cost (drugs, microbiologic samples, consultations and/or hospitalizations and stop working) and ecologic cost (second reasons of antibiotic prescription in winter and first in the rest of the year) are important. A better respect of recommendations can improve the outcome of this different infections and decrease their cost.
Emonet, Stéphane; Harbarth, Stephan; van Delden, Christian
Urinary tract infections are commonly seen by general practitioners. Quinolones are frequently prescribed in this setting. The emergence of resistance to these antibiotics has led to new guidelines for the management of uncomplicated UTI, based on the use of fosfomycin and furadantine. This article reviews the epidemiology, pathogenesis, diagnostic and treatment of urinary tract infections in adults.
Rothes, Ana; Lemos, Marina S.; Gonçalves, Teresa
This study investigated profiles of autonomous and controlled motivation and their effects in a sample of 188 adult learners from two Portuguese urban areas. Using a person-centered approach, results of cluster analysis and multivariate analysis of covariance revealed four motivational groups with different effects in self-efficacy, engagement,…
... the most ppular form of exercise among older adults and it's a great choice. What can walking do for you? strengthen muscles help prevent weight gain lower risks of heart disease, stroke, diabetes, and osteoporosis improve balance lower the likelihood of falling If ...
Riga, Peter J.
The compulsory medical treatment of adults is discussed with regard to the legal authority relevant to the problem. Attention is directed toward the "right to die" issue, the public interest and individual freedom of conscious or religion, and the courts' dealing with the freedom of the individual to control his own body. (LBH)
Leikin, Mark; Hagit, Even Zur
This study employed the masked-priming paradigm [Forster and Davis (J Exp Psychol bearn Mem Cogn 10: 680-698, 1984).], along with traditional methods of evaluation of morphological awareness and phonological processing, to obtain a finer-grained picture of the relationship between morphological abilities and reading in adult dyslexic readers.…
BOZZOLI, CARLOS; DEATON, ANGUS; QUINTANA-DOMEQUE, CLIMENT
Taller populations are typically richer populations, and taller individuals live longer and earn more. In consequence, adult height has recently become a focus in understanding the relationship between health and wealth. We investigate the childhood determinants of population adult height, focusing on the respective roles of income and of disease. Across a range of European countries and the United States, we find a strong inverse relationship between postneonatal (ages 1 month to 1 year) mortality, interpreted as a measure of the disease and nutritional burden in childhood, and the mean height of those children as adults. Consistent with these findings, we develop a model of selection and stunting in which the early-life burden of undernutrition and disease not only is responsible for mortality in childhood but also leaves a residue of long-term health risks for survivors, risks that express themselves in adult height and in late-life disease. The model predicts that at sufficiently high mortality levels, selection can dominate scarring, leaving a taller population of survivors. We find evidence of this effect in the poorest and highest-mortality countries of the world, supplementing recent findings on the effects of the Great Chinese Famine. PMID:20084823
Traditionally, vaccines have been associated with childhood. Historically, many of the most-feared communicable diseases attacked infants and toddlers, and those who survived were generally protected from those diseases as adults. During the past century tremendous advances in vaccination spared millions the morbidity and mortality associated with…
Many practices in higher education evolved significantly from 1985 to 2005. The presence of adult degree completion programs in colleges and universities of all types proliferated, with satellite campuses for this purpose in metropolitan areas often far removed from the "home campus." MBA programs multiplied during this same time, as did online…
This is a fascinating time for adult learning in the UK. With a plethora of reviews reaching report stage alongside ongoing discussion about funding, qualifications and quality and the review of post-16 planning and funding in Wales, there is a real sense that things are about to change after a decade of well-meant but often misfocused reform.…
Vansickle, Timothy R.; Russell, Mary T.
Provides an overview of five assessment instruments and discusses their contribution to adult career development: (1) California Personality Inventory; (2) Myers-Briggs Type Indicator; (3) Personality Research Form; (4) Occupational Stress Inventory; and (5) Personal Career Development Profile. Includes information about publishers, intended…
Darkenwald, Gordon G.
The Adult Classroom Environment Scale measures seven dimensions of teacher behaviors or style: involvement, affiliation, teacher support, task orientation, personal goal attainment, organization and clarity, and student influence. Comparison of profiles of students' actual and ideal environments showed that students most wanted involvement,…
Metis Associates, Inc., New York, NY.
A study was conducted to find out about the people who conduct and work in adult literacy programs in New York City (NYC). Through a questionnaire distributed to NYC literacy practitioners working in programs operated by public libraries, the City University of New York, the New York City Board of Education, and community-based organizations, the…
LANYON, RICHARD I.; SCHWARTZ, MILTON M.
TWO PAPERS ARE INCLUDED IN THIS BULLETIN. THE MILTON SCHWARTZ PAPER, "THEORIES OF MOTIVATION AND THEIR APPLICATION TO ADULT EDUCATION," SURVEYS THE THINKING, RESEARCH, AND CONCLUSIONS OF SOME OF THE LEADING FIGURES CONCERNED WITH SOCIAL MOTIVATION. THE AUTHOR ATTEMPTS TO CLASSIFY THESE THEORIES BY GENERATING A TWO-DIMENSIONAL SCHEMA OF…
Bloesch, Emily K.; Abrams, Richard A.
Action integration is the process through which actions performed on a stimulus and perceptual aspects of the stimulus become bound as a unitary object. This process appears to be controlled by the dopaminergic system in the prefrontal cortex, an area that is known to decrease in volume and dopamine functioning in older adults. Although the…
Gawrilow, Caterina; Merkt, Julia; Goossens-Merkt, Heinrich; Bodenburg, Sebastian; Wendt, Mike
Adults with ADHD have problems in everyday multitasking situations presumably because of deficits in executive functions. The present study aims to find out (a) whether adults with ADHD show deficient multitasking performance in a standardized task, (b) how they perceive the multitasking situation, and (c) which task structure might be beneficial for them as compared with adults without ADHD. Therefore, we experimentally compared task performance, mood, and motivation in a group of 45 men with ADHD (M-age = 34.47, SD = 9.95) with a comparison group of 42 men without ADHD (M-age = 31.12, SD = 10.59) in three conditions: (a) a multitasking paradigm, (b) an interleaving condition in which tasks had to be performed without planning or monitoring, and (c) a non-interleaving condition. Our results showed no impaired multitasking performance in adults with ADHD. However, they showed better mood and more motivation in the non-interleaving condition.
Due to the effects of global warming, writes Field, everyone now lives in times of plague, floods, and famine. While the UK government's track record on green issues is not all bad, still it is vulnerable to criticism. In this article, the author discusses what adult education has to offer to the environmental movement, despite existing…
Kidd, J. R.
The book's emphasis is on learning during the years of adulthood and examines present-day practice of adult education for practitioners. This revised edition brings up to date advances in such areas of learning as controversial theory; the effects of environment; sensory processes; intellectual capacities; motivation and attitude; transactional…
... Quitting Smoking for Older Adults Quitting When You’re Older If you’re older, you may wonder if it’s too late ... it can be challenging to quit when you're older, there are proven ways to do it. ...
As the "Hamburg Declaration" makes clear, adult education (AE) is a key component of development strategies that seek to ensure the long-term well-being of nations. Yet, with few exceptions most countries systematically underinvest in AE. Of course, it is no easy task to achieve adequate investment levels that reflect an appropriate balance…
Since 2000, the only serious attempt to mobilise new resources for education has been the World Bank's co-ordinated "Fast Track Initiative (FTI)." However, the FTI only raises funds for achieving universal completion of primary school and it does not address early childhood education or adult literacy. To date the Global Campaign for Education has…
Wingfield, Sarah A; Heflin, Mitchell T
Cancer screening is an important tool for reducing morbidity and mortality in the elderly. In this article, performance characteristics of commonly used screening tests for colorectal, lung, prostate, breast, and cervical cancers are discussed. Guidelines are emphasized and key issues to consider in screening older adults are highlighted.
Abad, Francisco J.; Colom, Robert; Juan-Espinosa, Manuel; Garcia, Luis F.
Results for 3,340 participants taking a battery of cognitive tests and an analysis of the Spanish standardization of the Wechsler Adult Intelligence Scale-III support the differentiation of intelligence across the range of ability, with WAIS-III results more supportive of the differentiation theory. (SLD)
Sticht, Thomas G.; And Others
Recently, several industrialized nations have engaged in extensive and expensive assessments of adult literacy using door-to-door surveys and tests of "functional" reading. A study examined the use of simple checklists of author's names, magazine titles, famous people's names, and vocabulary works used earlier by West, Stanovich and Miller (1993)…
Slider, Patty; Hodges, Kathy; Carter, Cea; White, Barbara
This publication provides materials to help adult educators use computer technology in their teaching. Section 1, Computer Basics, contains activities and materials on these topics: increasing computer literacy, computer glossary, parts of a computer, keyboard, disk care, highlighting text, scrolling and wrap-around text, setting up text,…
According to recent census figures, 10% of today's population are over 65 years old. It has often been stated that individual learning needs and capabilities decline with age. To challenge this idea, a study was conducted to gather information about older adults, their learning interests, activities, and obstacles. Four hypotheses were tested…
Schopfer, David W; Forman, Daniel E
The biology of aging and the pathophysiology of cardiovascular disease (CVD) overlap, with the effect that CVD is endemic in the growing population of older adults. Moreover, CVD in older adults is usually complicated by age-related complexities, including multimorbidity, polypharmacy, frailty, and other intricacies that add to the risks of ambiguous symptoms, deconditioning, iatrogenesis, falls, disability, and other challenges. Cardiac rehabilitation (CR) is a comprehensive lifestyle program that can have particular benefit for older patients with cardiovascular conditions. Although CR was originally designed primarily as an exercise training program for younger adults after a myocardial infarction or coronary artery bypass surgery, it has evolved as a comprehensive lifestyle program (promoting physical activity as well as education, diet, risk reduction, and adherence) for a broader range of CVD (coronary heart disease, heart failure, and valvular heart disease). It provides a valuable opportunity to address and moderate many of the challenges pertinent for the large and growing population of older adults with CVD. Cardiac rehabilitation promotes physical function (cardiorespiratory fitness as well as strength and balance) that helps overcome disease and deconditioning as well as related vulnerabilities such as disability, frailty, and falls. Similarly, CR facilitates education, monitoring, and guidance to reduce iatrogenesis and promote adherence. Furthermore, CR fosters cognition, socialization, and independence in older patients. Yet despite all its conceptual benefits, CR is significantly underused in older populations. This review discusses benefits and the paradoxical underuse of CR, as well as evolving models of care that may achieve greater application and efficacy.
The outline for an adult education colloquim states 17 discussion questions. Under each question, the outline refers to appropriate items on an eight page, 81-item, annotated bibliography. The first of three topical areas, ideas about people, considers: all people's desire to learn and their rough equality in intelligence; common people's ability…
Stoller, Eleanor Palo
Explored the impact of employment and familial responsibilities on the assistance provided to elderly parents (N=153) by adult children (N=502). Results showed hours of assistance varied with the level of parental impairment, the presence of the older parents' spouse, and competing demands on the helpers' time. (JAC)
Too many of Britain's workforce lack the skills needed for a knowledge-based economy. To remedy this will require the commitment, in time and resources, of individuals, employers, the education and training infrastructure and the state. Adults with the lowest qualifications have the least access to employer-funded training, especially in small…
Conrad, Jo Ann; Reinecke, Hank
This student workbook is designed to help Micronesian adults learn everyday English. Its ten chapters move from simple one-word picture labeling to more abstract ideas in a spiraled fashion, reiterating the essential elements of the English language in different, more complicated ways. Subjects covered include names for everyday objects and…
Rest, James R.
This study describes moral dilemmas that young adults (ages 18-24) formulate spontaneously and examines the relationship between these dilemmas and the subjects' environment and scores on a standardized test. Fifty-two subjects were tested both in 1976 and 1978, creating 104 subject-oriented dilemmas. Thirty-two were in college, 17 were not, and…
Paris, Scott; Parecki, Andrea
This report considers the various facets of metacognition and their relation to adult literacy. The first section provides definitions of literacy and discusses the issue of single versus multiple factor hypotheses. The second section looks at the foundation of research on metacognition and literacy development in children. It examines whether…
President's Council on Physical Fitness and Sports Newsletter, 1973
This report of a personal interview research survey conducted for the President's Council on Physical Fitness and Sports in 1972 presents the following findings: (a) 45 percent of all adult Americans do not engage in any form of exercise; (b) walking is the most popular form of exercise, followed by bicycle riding, swimming, calisthenics, bowling,…
Walz, Garry R.; Benjamin, Libby
Adult counseling is assuming increasing importance in counselor education and training. Most important is the developmental aspect of growth all through life, since adulthood is not a static period but can be as fraught with conflict and choice as childhood or adolescence. Outlines describe some important differences between young people and…
Shulik, Richard N.
Introduces the faith development paradigm of James Fowler, describing six stages of faith development: intuitive-projective faith, mythic-literal faith, synthetic-conventional faith, individuating-reflective faith, conjunctive faith, and universalizing faith. Reviews one research project in which Fowler's paradigm was applied to older adults.…
Keep, Ewart; Rogers, David; Hunt, Sally; Walden, Christopher; Fryer, Bob; Gorard, Stephen; Williams, Ceri; Jones, Wendy; Hartley, Ralph
With 6 billion British pounds of public spending reductions already on the table, and far deeper cuts inevitable, what are the prospects for adult learning in the new Parliament? Some of the regular contributors of this journal were asked what they expected and what they would like to see. Ewart Keep warns that the coalition parties' commitments…
Journal of Adolescent & Adult Literacy, 2008
This article presents annotations of 30 trade books on the 2008 list of Young Adults' Choices that are the result of voting by students in five different regions of the United States. Trade books (books other than textbooks) published in 2006 were submitted by more than 50 publishers. Each book had to have at least two positive reviews from…
Word's Worth: A Quarterly Newsletter of the Lifelong Learning Network, 1998
This issue of a quarterly newsletter on lifelong learning focuses on the theme of the arts and humanities in adult literacy education. The following articles are included: (1) "In Defense of a Practical Education" (Earl Shorris); (2) "From the Program Director" (Elizabeth Bryant McCrary); (3) "Vermont Council on the Humanities: Book Discussion…
Hinzen, Heribert, Ed.
These two issues of a half-yearly journal for adult education cover Africa, Asia, and Latin America. Number 40 consists of 35 articles on 4 themes: Multicultural dimensions; environmental learning; cooperation and partnership with Eastern Europe; and women and training. Articles include: "It Is Time to Understand that the World Belongs to All…
Myers, Jane E.
This book was developed to assist counselors and other caregivers in working with adult children and their aging parents. The first chapter addresses normative developmental issues in later life. This includes the demography of aging, theories of aging, and attitudes toward older persons, along with suggestions for identifying at-risk populations,…
... state's health department . Some states have registries (Immunization Information Systems) that include adult vaccines. Unfortunately, there is no national organization that maintains vaccination records. The Centers for Disease ... (CDC) does not have this information. What To Do If You Can't Find ...
Chester County Opportunities Industrialization Center, West Chester, PA.
An evening adult literacy program was developed to provide pre-General Educational Development (GED) instruction to residents of a men's shelter who desired to become dry cleaners pressers. Because an intake assessment of the 32 enrollees revealed that only 34% of them were high school dropouts and more than 50% had some college background, the…
Goetsch, David L.
The metric education program developed at Okaloosa-Walton Junior College, Niceville, Florida, for students and the community in general consists of three components: a metric measurement course; multimedia labor for independent study; and metric signs located throughout the campus. Instructional approaches for adult students are noted. (MF)
Missouri State Dept. of Education, Jefferson City.
This publication is an administrative guide for Missouri school administrators and local adult basic education supervisors. First, general information is given as to legislative authority, standards for approval, procedures for implementation, expenditures and reimbursement, teacher qualifications, program administration, student eligibility and…
Beresford, B; Stuttard, L
Awareness is growing that young adults may have distinctive experiences of adult healthcare and that their needs may differ from those of other adult users. In addition, the role of adult health teams in supporting positive transitions from paediatrics is increasingly under discussion. This paper contributes to these debates. It reports a qualitative study of the experiences of young adults - all with complex chronic health conditions - as users of adult health services. Key findings from the study are reported, including an exploration of factors that help to explain interviewees' experiences. Study findings are discussed in the context of existing evidence from young adults in adult healthcare settings and theories of 'young adulthood'. Implications for training and practice are considered, and priorities for future research are identified.
Lin, Frank R; Chien, Wade W; Li, Lingsheng; Clarrett, Danisa M; Niparko, John K; Francis, Howard W
Cochlear implants allow individuals with severe to profound hearing loss access to sound and spoken language. The number of older adults in the United States who are potential candidates for cochlear implantation (CI) is approximately 150,000 and will continue to increase with the aging of the population. Should CI be routinely recommended for these older adults, and do these individuals benefit from CI? We reviewed our 12-year experience with CI in adults aged ≥60 years (n = 445) at Johns Hopkins Medical Institutions to investigate the impact of CI on speech understanding and to identify factors associated with speech performance. Complete data on speech outcomes at baseline and 1 year post-CI were available for 83 individuals. Our results demonstrate that CI in adults aged ≥60 years consistently improved speech understanding scores, with a mean increase of 60.0% (SD 24.1) on HINT (Hearing in Noise Test) sentences in quiet. The magnitude of the gain in speech scores was negatively associated with age at implantation, such that for every increasing year of age at CI the gain in speech scores was 1.3 percentage points less (95% confidence interval [95% CI], 0.6-1.9) after adjusting for age at hearing loss onset. Conversely, individuals with higher pre-CI speech scores (HINT scores between 40% and 60%) had significantly greater post-CI speech scores by a mean of 10.0 percentage points (95% CI, 0.4-19.6) than those with lower pre-CI speech scores (HINT <40%) after adjusting for age at CI and age at hearing loss onset. These results suggest that older adult CI candidates who are younger at implantation and with higher preoperative speech scores obtain the highest speech understanding scores after CI, with possible implications for current United States Medicare policy. Finally, we provide an extended discussion of the epidemiology and impact of hearing loss in older adults. Future research of CI in older adults should expand beyond simple speech outcomes to take
Obermeyer, Robert J.; Kelly, Robert E.
Repair of pectus excavatum began at the beginning of the 20th century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support. The wide resection resulted in a very rigid anterior chest wall, and in some instances, the development of asphyxiating chondrodystrophy. The primary care physicians therefore became reluctant to refer the patients for repair. In 1987, Nuss developed a minimally invasive technique that required no cartilage or sternal resection and relied only on internal bracing by means of a sub-sternal bar, which is inserted into the chest through two lateral thoracic incisions and guided across the mediastinum with the help of thoracoscopy. After publication of the procedure in 1998, it became widely accepted and a flood of new patients suddenly started to appear, which allowed for rapid improvements and modifications of the technique. New instruments were developed specifically for the procedure, complications were recognized, and the steps taken to prevent them included the development of a stabilizer and the use of pericostal sutures to prevent bar displacement. Various options were developed for sternal elevation prior to mediastinal dissection to prevent injury to the mediastinal structures, allergy testing was implemented, and pain management improved. The increased number of patients coming for repair permitted studies of cardiopulmonary
Thompson, Ashley E; O'Sullivan, Lucia F; Byers, E Sandra; Shaughnessy, Krystelle
Sexual interest and capacity can extend far into later life and result in many positive health outcomes. Yet there is little support for sexual expression in later life, particularly among young adults. This study assessed and compared young adults' explicit and implicit attitudes towards older adult sexuality. A sample of 120 participants (18-24 years; 58% female) completed a self-report (explicit) measure and a series of Implicit Association Tests capturing attitudes towards sexuality among older adults. Despite reporting positive explicit attitudes, young people revealed an implicit bias against the sexual lives of older adults. In particular, young adults demonstrated implicit biases favouring general, as compared to sexual, activities and young adults as compared to older adults. Moreover, the bias favouring general activities was amplified with regard to older adults as compared to younger adults. Our findings challenge the validity of research relying on self-reports of attitudes about older adult sexuality.
Polo, Blanca R., Comp.
Adult education is an umbrella concept under which come various dimensions, including adult literacy, adult basic education, continued education, continued professional education, and adult vocational education. To be effective, an adult educator must realize that: (1) adults learn differently than children do; (2) adult education must develop…
Solid Tumors; Leukemia, Lymphocytic, Acute, Pediatric; Leukemia, Lymphocytic, Acute, Adult; Leukemia, Myelocytic, Acute, Pediatric; Leukemia, Myelocytic, Acute, Adult; Myelodysplastic Syndromes, Adult
... Talk to your doctor about whether you have osteoporosis. Read More "Preventing Falls" Articles Preventing Falls / Great Help for Older Adults / How Can Older Adults Prevent Falls? / Home Improvements ...
Richman, Lynn C.; Harper, Dennis C.
Different forms of chronic observable disability may have differing impacts on adult personality adjustment. Young adults with cleft lip/palate display fewer personality adjustment problems than those with orthopedic impairment. (Author)
A life history approach can give better understanding of adult motivation to participate in education than quantitative surveys can. Interviews with 30 adults entering higher education illustrate the technique but also raise methodological questions about this form of research. (SK)
... will have serious permanent disabilities like brain damage, hearing loss, and limb amputations. FACT: While some adults are at increased risk and need vaccination, adolescents and young adults generally have a higher risk ...
Draper, James A.
Outlines basic assumptions and principles underlying adult education and describes today's challenges: maintaining democracy, technological changes, explosion of information, global competition/cooperation, environment, and universal human rights. Advocates a holistic world view of adult education. (SK)
... Task Force learned about the potential benefits and harms of screening: (1) Adults at high risk for ... C Virus Infection in Adults Potential Benefits and Harms of Screening and Treatment The Task Force reviewed ...
... for Healthcare Professionals Weakened Immune System and Adult Vaccination Recommend on Facebook Tweet Share Compartir Vaccines are ... up to age 26 years Learn about adult vaccination and other health conditions Asplenia Diabetes Type 1 ...
... Healthcare Professionals Lung Disease including Asthma and Adult Vaccination Language: English Español (Spanish) Recommend on Facebook Tweet ... more about health insurance options. Learn about adult vaccination and other health conditions Asplenia Diabetes Heart Disease, ...
What to ask your doctor about epilepsy - adult; Seizures - what to ask your doctor - adult; Seizure - what to ask your doctor ... or someone else, every time I have a seizure? What safety measures do I need to take ...
This second article in a two-part series reviews the literature in the Educational Resources Information Center (ERIC) on the Adult Performance Level (APL) project and other programs for adult education. (See CS 710 176) (KS)
An established set of criteria for developing adult basic education programs for black adults in urban areas is needed. A reported Delphi study resulted in twelve recommended criteria which are described. (MS)
Isaacowitz, Derek M; Vaillant, George E; Seligman, Martin E P
Positive psychology has recently developed a classification of human strengths (Peterson & Seligman, in press). We aimed to evaluate these strengths by investigating the strengths and life satisfaction in three adult samples recruited from the community (young adult, middle-aged, and older adult), as well as in the surviving men of the Grant study of Harvard graduates. In general, older adults had higher levels of interpersonal and self-regulatory strengths, whereas younger adults reported higher levels of strengths related to exploring the world. Grant study men tended to report lower strength levels than older adults from the community. Among the young adults, only hope significantly predicted life satisfaction, whereas among the middle-aged individuals, the capacity for loving relationships was the only predictor. Among community-dwelling older adults, hope, citizenship, and loving relationships all positively and uniquely predicted life satisfaction, compared with loving relationships and appreciation of beauty in the Grant sample.
... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...
... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...
... Cancer Prevention Liver Cancer Screening Research Adult Primary Liver Cancer Treatment (PDQ®)–Patient Version General Information About Adult Primary Liver Cancer Go to Health Professional Version Key Points ...
Moraleda, Jose M; Blanquer, Miguel; Bleda, Patricia; Iniesta, Paqui; Ruiz, Francisco; Bonilla, Sonia; Cabanes, Carmen; Tabares, Lucía; Martinez, Salvador
Adult stem cells may be an invaluable source of plastic cells for tissue regeneration. The bone marrow contains different subpopulations of adult stem cells easily accessible for transplantation. However the therapeutic value of adult stem cell is a question of debate in the scientific community. We have investigated the potential benefits of adult hematopoietic stem cell transplantation in animal models of demyelinating and motor neuron diseases. Our results suggest that transplantation of HSC have direct and indirect neuroregenerative and neuroprotective effects.
Leith, Karen Pezza
Malcolm Knowles, in his theory of adult learning (1972, revised 1980), presents adults as motivated, self-directed learners. Basically, once a person starts seeing himself or herself as an adult, he or she has an expectation of being independent in decision-making, valuing personal experience, and desiring respect. Courses, curriculum, and…
Adult learners often face barriers to participation in traditional classroom instruction. As technology access grows and adults naturally incorporate technology into their daily lives, adult education programs are finding innovative ways to blend technology with instruction through quality online learning opportunities. This article highlights the…
Jakacki, Pola Christina
The purpose of this study was to determine if there was a significant relationship between mentoring and adult resilience, specifically adults that were mentored as adolescents. The study sample comprised of 657 adults from various locations across the country. For this quantitative study, they completed a two-part questionnaire made up of the…
Burt, Diana B.; Primeaux-Hart, Sharon; Loveland, Katherine A.; Cleveland, Lynne A.; Lewis, Kay R.; Lesser, Jary; Pearson, Pamela L.
A cross-sequential design was used to examine changes related to aging in adults with and without Down syndrome (ns = 55 and 75, respectively). Adults received yearly neuropsychological and medical evaluations. Support for precocious aging in adults with Down syndrome was evident only on a test of verbal fluency, with weaker support obtained on a…
This compilation of program materials serves as an introduction to Florida's Brevard Community College's (BCC's) Competency-Based Adult High School Completion Project, a multi-year project designed to teach adult administrators, counselors, and teachers how to organize and implement a competency-based adult education (CBAE) program; to critique…
This paper uses the social cognitive theory model to review the literature on older adult gambling, and related personal and environment characteristics. Results show that lottery is the kind of gambling most frequently played by older adults, followed by casino games. Older adults take trips to casinos to socialize, find excitement, and win…
Skalski, John M.; Baratta, Anthony N.
A 4-phase project, this study was conducted to determine the feasibility of a bilingual vocational skill training program for out-of-school youth and adults of the Perth Amboy Hispanic community. Sampled were 494 out-of-school youth and adults in the area. Findings include: (1) There is a significant need for an adult vocational skills training…
Building on narratives of students in adult education in Sweden, where the majority of the students are young adults, this paper argues that adult education has both negative and positive aspects in helping individuals to be recognised as valuable. Students, often part of the precariat class, have not always been able to survive in the job market…
Horwath, Caroline C.
Discusses specific goals of nutrition education for older adults and high-risk groups within the elderly population through review of three crucial areas: current knowledge of eating patterns, nutrient intake, and supplement use of older adults; existing information on multiple influences on eating habits of older adults; and potential benefits…
Morgan, Ronald R.; Ponticell, Judith A.; Gordon, Edward E.
This book, which is designed to prepare individuals to become workplace consultants, examines the theory and practice of enhancing learning in training and adult education. The following are among the topics discussed: putting cognition theory into practice in instruction; cognitive science perspective on adult learning (adults as learners, three…
Ross, Catherine Sheldrick
Examination of a subset of books popular with young adults--problem novels or young adult realism--is based on deductions concerning nature of reading response that text invites. Young adult realism as formula of popular culture, changes in conventions, narrators and narratees, and identification and distance are discussed. (34 references) (EJS)
Alrwaily, Muhammad; Whitney, Susan L
The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
Kirmayer, Paul, Ed.; Pinnes, Noy, Ed.
This is the second booklet in English that deals with adult education in Israel. The following papers are included: "Editors' Notes" (Paul Kirmayer, Noy Pinnes); "Introduction" (Meir Peretz); "Defining 'Adult Education'" (Yehezkel Cohen); "Planning Study Programs for Adults" (Rachel Tokatli); "The Role…
Waddington, Sue; Tuckett, Alan; Boucher, Fiona
The National Institute of Adult Continuing Education (NIACE) is the UK national coordinator for the European Agenda for Adult Learning, with the challenge of creating a coherent message across the four countries to inform European cooperation on adult learning. To start the debate, the journal staff asked Sue Waddington, Alan Tuckett, and Fiona…
Aldridge, Fiona; Iain Murray; Berry, Caroline
The National Institute of Adult Continuing Education (NIACE) Adult Participation in Learning Survey 10 years ago showed that two-fifths of the adult population said that they had taken part in learning in the last three years. A decade later, the 2012 survey shows that little has changed--active participation in learning remains a minority…
A fundamental aspect of adult education is engaging adults in becoming lifelong learners. More often than not, this requires removing barriers to learning, especially those relating to the actual organisational or institutional learning process. This article explores some of the main barriers to adult learning discussed in the literature and…
van Wieringen, Fons, Ed.; Attwell, Graham, Ed.
This book contains 25 papers on vocational and adult education in Europe and the United States. The following papers are included: "Vocational and Adult Education in Europe: Introduction to the Volume" (Fons van Wieringen, Graham Attwell); "Introduction to Section 1: Markets and Institutions in Vocational and Adult Education"…
Smith, Ann F. V., Ed.; Strong, Gregory, Ed.
"Adult Language Learners: Context and Innovation" presents instructional practices that are particularly successful with adults. Adult language learners are goal oriented and direct their learning to fulfill particular needs or demands: to advance their studies, to progress up the career ladder, to follow business opportunities, to pass…
Seay, Sandra E.
Having stressful workdays is not the sole prerogative of adult students enrolled in educational leadership programs. According to a report released by the American Institute of Stress in 2002, 80% of adult workers felt stress in the workplace. From this it can be assumed that a certain amount of stress accompanies every adult who enters an evening…
Papers relating to using both knowledge and action in adult education programs are presented. The titles and authors of the papers are as follows: "Toward a Theory of Practice in Adult Education" by Jack Mezirow; "Action Seminars" by Alan Knox; The Case-Study Approach--Alternation between Knowledge and Action in Adult Education: (a) "Prepare Case…
Center on Urban Poverty and Community Development (NJ1), 2010
There are no direct measures of adult literacy in Cuyahoga County. Instead, this report uses estimates based on a statistical model derived from the National Survey of Adult Literacy. Adult literacy levels range from Level 1 (the most basic) to Level 5 (the most complex). People with Level 1 literacy are at a severe disadvantage in the sense that…
Maher, Patricia A.; Passmore, Denise
A study conducted life history interviews with long-time adult educators regarding their career paths and choices, philosophical perspectives, influences in professional careers, changes witnessed in the field, and predictions about future trends in adult education. A literature review focused on the history of adult education in the United States…
ASPBAE Courier, 1986
This journal issue contains a series of papers concerned with exploring the role that adult education can play in developing communities. The first paper, "Major Challenges and Prospect of Adult Education for the Year 2000" (T. M. Sakya), provides an overview of adult education in Asia and the Pacific, emphasizing the vastness of the…
Bortner, Rayman W., Ed.; And Others
The proceedings consist of 11 papers grouped in two major categories: the context of adult learning (social significance and fact and fiction about adult learning) and the utilization of learning models for adult instruction. Contributors are Floyd B. Fischer, George L. Maddox, Rolf H. Monge, Eric F. Gardner, Arthur W. Combs, William J. Hoyer,…
Sogunro, Olusegun A.
Evaluation anxiety can have a significant impact on adult learning, and it is a generally inescapable part of teaching-learning transactions. Too much evaluation anxiety can be devastating. This paper examines the effects of evaluation anxiety on adult learning, discussing the causes, the control measures, and the implications for adult educators.…
Gonzales, Ernest; Morrow-Howell, Nancy; Gilbert, Pat
Given the growth in the number of older adults and the ageist attitudes many in the health care profession hold, interventions aimed at improving health professionals' attitudes toward older adults are imperative. Vital Visionaries is an intergenerational art program designed to improve medical students' attitudes toward older adults. Participants…
The development of learning environments especially for adults has been neglected and research in planning such environments is fragmented and minimal. There is general agreement that facilities for adults should have an aura of adulthood to contribute to an adult's feeling of ease, confidence, and capability; that they should be flexible in room…
Effective immunization in adults is a desired health outcome, however it is not mandatory. Immunization of adults must be undertaken in accordance with a patient's real and informed consent. This paper discusses requirements for the lawful administration of an immunization to both capable and incapable adults. PMID:26619268
Chadwick, Alan, Ed.; Stannett, Annette, Ed.
This book, which is intended for individuals involved in the education of adults and museum education, explores the potential role of museums in creation of a learning society, possibilities for collaboration between museums and adult education providers, access to museum resources by adult learners, and training and staff development. The…
A project identified and established components related to adult basic education's role in school-to-work (STW) transition. It focused on developing a cognitive framework for competency-based adult employability classes, integrating adult basic and literacy education (ABLE)-funded programs into the Erie Area STW partnership, and establishing a…
Barer-Stein, Thelma, Ed.; Kompf, Michael, Ed.
This book, which is intended as a text for future and experienced adult educators, examines current theories and best practices in adult education. The book consists of 20 chapters written by prominent practitioners in the field of adult education. The chapter titles and authors are as follows: "Teachers Sharing Experiences" (James A. Draper);…
Caminotti, Enzo; Gray, Jeremy
Purpose: As two doctoral students and adult learners, the authors strongly believe that story telling can be a great tool for educators working with adult learners. The purpose of this paper is to increase awareness of how effective storytelling can be for adult learners. Design/methodology/approach: The approach of this paper is one of gathering…
Designed for use in a 1968 study of why adults learn, this interview schedule contains situation-description and question sheets for use by the interviewer and subject for examining thirteen reasons why adults begin and why they continue a learning project. (The study, "Why Adults Learn: A Study of the Major Reasons for Beginning and Continuing a…
... ADHD symptoms may not be as clear as ADHD symptoms in children. In adults, hyperactivity may decrease, but struggles with ... similar to treatment for childhood ADHD, though some ADHD medications approved for children are not approved for adult use. Adult ADHD ...
Barker, Thomas S.; Sturdivant, V. Ann; Smith, Howard W., Jr.
This paper examines what is known (and not known) about adult college students. It reports on a study which compared different age groups in different types of institutions and reviews the research about how adults learn and methodologies for teaching adults. The study compared age distributions at four Texas institutions: the University of North…
In 1999 we proposed a Modified Food Guide Pyramid for 70+ Adults. It has been extensively used in a variety of settings and formats to highlight the unique dietary challenges of older adults. We now propose a Modified MyPyramid for Older Adults in a format consistent with the MyPyramid graphic. I...
Groenke, Susan; Maples, Joellen; Henderson, Jill
While young adult literature increases adolescents' motivation to read, and adolescents choose to read young adult novels over more canonical works when given opportunities to choose, the authors present yet another reason for teaching young adult literature in the middle school classroom: it provides a medium through which adolescents and their…
Angiama, R. O.
Teaching Adult Students Mathematical Investigation is based on the continuing research work carried out for the last ten years of teaching on the Foundation Course in Mathematics at Goldsmiths, University of London. Teaching Mathematical Investigation to adult students is a very challenging and often rewarding experience for adult educators as…
de Cos, Patricia L.
Assembly member Carol Liu, Chair of the Assembly Select Committee on Adult Education, requested that the California Research Bureau prepare a report on adult education. The legislative request specified that the following topics be covered: (1) a definition of adult education; (2) recent information on student enrollment, funding sources and…
Elias, John L.; Merriam, Sharan B.
This book examines the philosophical foundations of adult education (AE). The following topics are discussed: philosophy of AE (philosophy and action in theory and practice and philosophy for adult educators); liberal AE (historical development, liberal education and the educated person, broad scope, process, liberal education of adults, Great…
Adult learning happens in many places and forms, and is paid for by a complex mix of public, employer and private funds. National Institute of Adult Continuing Education's recent survey of public attitudes to paying for lifelong learning shows clearly that people have not convinced the general public that adult learning deserves more public…
Polson, Cheryl J.
Although adult learners are similar to their younger classmates in many ways, they have some particular characteristics that have implications for teaching them. For example, adults have multiple roles, and classes sometimes cannot be their first priority. Adults also have more life experiences, which can provide foundations for learning or create…
Kedney, R. J., Ed.
This collection of papers is intended to provide adult educators and administrators information that will assist in making decisions about, initiating, financing, and evaluating adult literacy programs in England. Papers in the first part of the book focus on definitions of adult literacy, examining the dimensions of the problem, the potential…
This review of adult vocational education in Canada includes an introduction, highlights in the history of adult vocational education in Canada, and a summary. The introduction considers what adult vocational education is and explains the relationship between Canada's constitution and education. The highlights section covers these periods: before…
In this article I will use an example of current adult education practice, the Glory and Dismay Football Literacies Programme (GDFLP) to appraise the value of critical discourse analysis (CDA) for adult learners, both individually and collectively, and for adult education practitioners with an interest in developing critical literacy skills. The…
Hutson, Barbara A.; Liebermann, Jo
Measures of syntactic knowledge and reading achievement were obtained for 41 students in an adult basic education center. Adults reading at or below fourth-grade level showed significantly less knowledge of syntax than adults at higher levels, even though the language test involved neither reading nor writing. (Author/CT)
Sticht, Thomas G.
This paper provides adult educators with information they can use to produce perspectives for the future of adult education (AE). Part 1 provides a perspective on the past and present of AE that falls under the aegis of the Federal Adult Education Act of 1966 and subsequent amendments. It paints a picture of AE from the mid-1960s to the present…
Hawk, William B.
Many adult English-as-a-Second-Language (ESL) teachers and tutors, paid and volunteer alike, often have great difficulty finding the time, opportunity, and resources to get training in areas vital to adult instruction, such as principles of adult education and learning, second language acquisition theory, teaching methodology, and the use of…
Roberts, Bette H.; Russell, Sheldon Noel
In order to identify the reading behavior and instructional needs of functionally illiterate adults reading below fourth grade level, 50 adults were identified and diagnosed on the Durrell Analysis of Reading Difficulty test and the Slosson Intelligence Test for Children and Adults. In addition, a questionnaire was administered to Oklahoma City…
Loucks, Torrey; Chon, HeeCheong; Han, Woojae
Background: Altered auditory feedback can facilitate speech fluency in adults who stutter. However, other findings suggest that adults who stutter show anomalies in "audiovocal integration", such as longer phonation reaction times to auditory stimuli and less effective pitch tracking. Aims: To study audiovocal integration in adults who stutter…
Eyring, Janet L.
This article discusses the state of the art in the field of "adult ESL" in the US. It identifies the size, characteristics, and settings of adult education and discusses relevant professional standards, assessment procedures, and teacher preparation. Three approaches to noncredit adult ESL education will be presented (Functional…
Mauch, Werner, Ed.; Papen, Uta, Ed.
This book highlights examples of innovative educational practices in the field of organized adult learning. Fifteen chapters present outcomes of collective research in the Innovations in Nonformal and Adult Education (INNAE) project. "Common Learning--Collective Research: Innovating Adult Education" (Werner Mauch, Uta Papen) describes the…
McCallister, Mike; Newsom, Ron
Analysis of 228 magazine articles indexed by adult education in "Reader's Guide" (1970-87) indicated that, although accurately portraying the field for the most part, articles largely ignore self-directed learning, adult education as a field of university study, and the existence of professional adult educators. (SK)
Globalisation, transnational policies and adult education--This paper examines policy documents produced by the United Nations Educational, Scientific and Cultural Organization (UNESCO) and the European Union (EU) in the field of adult education and learning. Both these entities address adult education as an explicit object of policy. This paper…
Writing recently in this journal, two of Canada's veteran adult educators contemplated the "death" of the Canadian adult education movement. I disagree and argue that adult education in Canada is as vital an activity as ever and one that still fully justifies being called a movement. Specifically, Selman and Selman (2009) list five…
In this paper, we control the intention theory of Fishbein and Ajzen (1980) for the participation in an adult education course. Based on the Flemish Eurostat Adult Education Survey, we reveal that participants in adult education have a more positive attitude towards learning and that within the group of non-participants, those who formulate an…
Worthington, Robert M.
Federal regulations for the Adult Education Act and the Carl D. Perkins Vocational Education Act were revised in 1985. The following are the major changes to the Adult Education Act regulations: (1) the definition of "adult" was changed to permit services to persons under the age of 16 in some cases; (2) the definition of…
Schor, Nina F
As it is currently configured, completion of child neurology residency requires performance of 12 months of training in adult neurology. Exploration of whether or not this duration of training in adult neurology is appropriate for what child neurology is today must take into account the initial reasons for this requirement and the goals of adult neurology training during child neurology residency.
El-Bashary, Ahmed, Comp.
The directory of Adult Education Agencies in Egypt is a listing of six different types of organizations: national bodies and central agencies; teachers' training institutes and research institutions; adult education institutions (governmental); adult education institutions (non-governmental); central libraries and documentation centers; and…
Maine Department of Education, 2004
The Maine Adult Education Directors' Handbook offers a basic overview of the Adult and Community Education system in Maine. The information is general and intended to provide a background to the person initially becoming involved in adult education--director, teacher, school board member, advisory council member or superintendent. The Handbook is…
Isaacowitz, Derek M.; Vaillant, George E.; Seligman, Martin E. P.
Positive psychology has recently developed a classification of human strengths (Peterson & Seligman, in press). We aimed to evaluate these strengths by investigating the strengths and life satisfaction in three adult samples recruited from the community (young adult, middle-aged, and older adult), as well as in the surviving men of the Grant study…
Fogarty, Robin J.; Pete, Brian M.
This book addresses the "warrior" who rises to the challenge of teaching the adult learner. The discussion is designed as a catalyst for dialogue about the adult learner and to uncover the complexities of teaching this rare and riveting species. This book is organized around three interlocking themes: some things we know about the adult learner;…
This article focuses on the issue of policy development for adult learning in Mali, West Africa. On January 2007, the Malian government adopted the "Adult Non-formal Education Policy Document," which was intended to regulate the adult learning sector and federate the actions of policy makers, adult education providers, and adult…
de Anda, Diane; Smith, Melanie A.
Examined data on 165 adolescents, 65 young adults, and 175 adults who called 2 suicide help lines. Adults and young adults reported depression as primary reason for contemplating suicide; adolescents reported interpersonal problems. Although callers reported suicide ideation, very small percentage fell into high-risk categories with regard to…
Lindeman, Eduard C.
Adult education is so named not because it is confined to adults but because adulthood defines its limits. As a process, adult education revolves around nonvocational ideals. Its approach is via the route of situations rather than subjects. Adult education attempts to discover new methods and create new incentive for learning. It attempts to serve…
Central tenets of Freirean philosophy and pedagogy are explored and applied to the emerging field of older adults' learning (educational gerontology), a sub-field of adult education. I argue that many of Freire's concepts and principles have direct applicability to the tasks of adult educators working alongside marginalized older adults. In…
Adult education efforts in Africa are dominated by Western models. One aspect of this domination is a presumption that Western models of adult development can be applied to African contexts. As perspectives on adult development affect adult education programmes, this presumption may negatively impact these programmes in Africa. This manuscript…
Hock, Michael F.
Adults with learning disabilities (LD) attending adult basic education, GED programs, or community colleges are among the lowest performers on measures of literacy. For example, on multiple measures of reading comprehension, adults with LD had a mean reading score at the third grade level, whereas adults without LD read at the fifth grade level.…
Fein, George; McGillivray, Shannon; Finn, Peter
This study tested the hypotheses that older adults make less advantageous decisions than younger adults on the Iowa gambling task (IGT). Less advantageous decisions, as measured by the IGT, are characterized by choices that favor larger versus smaller immediate rewards, even though such choices may result in long-term negative consequences. The IGT, and measures of neuropsychological function, personality, and psychopathology were administered to 164 healthy adults 18–85 years of age. Older adults performed less advantageously on the IGT compared with younger adults. Additionally, a greater number of older adult’s IGT performances were classified as ‘impaired’ when compared to younger adults. Less advantageous decisions were associated with obsessive symptoms in older adults and with antisocial symptoms in younger adults. Performance on the IGT was positively associated with auditory working memory and psychomotor function in young adults, and in immediate memory in older adults. PMID:17445297
Davis, Sara D; Meade, Michelle L
In the present study, we examined the impacts of participant age and confederate age on social memory processes. During a collaborative recall phase, young and older adult participants were exposed to the erroneous memory reports of a young or an older adult confederate. On a subsequent individual recall test, young and older adult participants were equally likely to incorporate the confederates' erroneous suggestions into their memory reports, suggesting that participant age had a minimal effect on social memory processes. However, confederate age did have a marked effect: Young adult participants were less likely to incorporate misleading suggestions from older adult confederates and less likely to report "remembering" items suggested by older adult confederates. Critically, older adult participants were also less likely to incorporate misleading information from fellow older adult confederates. Both young and older adult participants discounted older adult confederates' contributions to a memory test.
Congenital adrenal hyperplasia is a life-long disease requiring an integrated therapy. It may negatively influence the quality of life. In childhood, the main problems of the care of these patients involve sex determination and ensuring optimum growth and puberty. The therapeutic goals for adults are the prevention of Addisonian crisis and ensuring the best possible quality of life, including fertility.Key words: androgens - cardiovascular risk - congenital adrenal hyperplasia - bone density - testicular rest tumors.
Olatayo, Adeoti Adekunle; Kubwa, Ojo Osaze; Adekunle, Ajayi Ebenezer
Introduction Oftentimes the older adults are assumed to be asexual as few studies explore into the sexuality of this age group worldwide and even in Nigeria. It is an important aspect of quality of life which is often neglected by people in this age group, attending physicians and the society as a whole. The study was aimed at determining the perception of older adults about sexuality, identify the factors that could militate against sexuality and fill any void in information in this regard. Methods Descriptive study conducted in one hundred older adults. A semi-structured questionnaire was administered to consenting participants between 1st of September 2013 and 31st of March 2014. Results Mean age of respondents was 66.42± 5.77 years. Seventy-eight percent of the male respondents considered engaging in sexual activity as safe compared to 45.8% of the female respondents. More of the women (33.3%) regarded sexuality in the older adults as a taboo when compared to the men (5.4%). However, the men were more favourably disposed to discussing sexual problems than the women with their spouses (42% vs 20%) and Physicians (23.2% vs 0.0%). Major factors responsible for sexual inactivity were participants’ medical ailments (65%), partners’ failing health (15%) as well as anxiety about sexual performance (25%) in the men and dyspareunia (25%) in women. Conclusion There is an urgent need to correct the misconception about sexuality in this age group especially among the women and for the physicians to explore the sexual history of every patient. PMID:26977224
The ideal weight given on the USAF standard weight table was found to have a correlation coefficient of only .672 with calculated percent body fat....volume from height and weight revealed the chart to be biased for adult men. Body volume was found to correlate well with body weight ( correlation ... coefficient of .996). Body volume of men in liters, V, may be estimated from body weight in kilograms, W, by using the formula: V = -4.7573 + 1.0153 W
family categories. 12 A. PSYCHOLOGICAL THEORIES OF DEVELOPMENT In Childhood and Society Erik Erikson broke new ground by proposing that development...a description of the mid-life crisis as any. The idea that adults may have stages in their life de- velopment was given formal legitimacy by Erik ... Erikson in his 7 book, Childhood and Society, first published in 1950. In that work Erikson proposed that there are eight stages in life, three of them in
Powell, C S; Sawyers, J L; Reynolds, V H
A review of the English literature reveals a total of 1,337 patients with choledochal cysts. Improved diagnostic techniques to visualize the biliary system are demonstrating an increasing number of unsuspected choledochal cysts in adult patients. Either choledochal cysts remain clinically silent until adulthood or may develop in later life. Experience is reported with adult patients having type I, II, III, and IV choledochal cysts. Type I cysts are preferably managed by excision but cyst anatomy may necessitate choledochoenteric drainage. Type II cysts are treated by excision except for those located within the pancreatic portion of the common bile duct. These are best managed by transduodenal cystoduodenostomy. The type III cyst (choledochocele) should be excised carefully, identifying and preserving the common bile and pancreatic ducts. Type IV cysts include a combination of any one of the first three types of cyst plus the presence of intrahepatic cyst or cysts. Treatment of these cysts is dictated by the type and location of the extrahepatic cyst. Since choledochal cysts are being recognized with increased frequency in adults, surgeons need to be aware of the diagnostic and treatment modalities available for each type of biliary cyst. Images Fig. 3. Fig. 4. Fig. 6. Fig. 7. Fig. 9. Fig. 10. PMID:7235770
Pfliegler, György; Kovács, Erzsébet; Kovács, György; Urbán, Krisztián; Nagy, Valéria; Brúgós, Boglárka
The present paper is focusing on rare diseases manifesting in late childhood or adulthood. A part of these syndromes are not of genetic origin, such as relatively or absolutely rare infections, autoimmune diseases, tumours, or diseases due to rare environmental toxic agents. In addition, even a large proportion of genetic disorders may develop in adulthood or may have adult forms as well, affecting are almost each medical specialization. Examples are storage disorders (e.g. adult form of Tay-Sachs disease, Gaucher-disease), enzyme deficiencies (e.g. ornithin-transcarbamylase deficiency of the urea cycle disorders), rare thrombophilias (e.g. homozygous factor V. Leiden mutation, antithrombin deficiency), or some rare monogenic disorders such as Huntington-chorea and many others. It is now generally accepted that at least half of the 6-8000 "rare diseases" belong either to the scope of adult-care (e.g. internal medicine, neurology), or to "age-neutral" specialities such as ophtalmology, dermatology etc.).
van Samkar, Anusha; Brouwer, Matthijs C.; van der Ende, Arie; van de Beek, Diederik
Abstract The zoonotic pathogen Campylobacter fetus is a rare cause of bacterial meningitis. Little is known about the clinical characteristics, predisposing factors and outcome of C fetus meningitis in adults. We report cases of C fetus meningitis in a nationwide cohort study of adult bacterial meningitis patients in the Netherlands and performed a review of the literature. Two patients with C fetus meningitis were identified from January 2006 through May 2015. The calculated annual incidence was 0.02 per million adults. Combined with the literature, we identified 22 patients with a median age of 48 years. An immunocompromised state was present in 16 patients (73%), mostly due to alcoholism (41%) and diabetes mellitus (27%). The source of infection was identified in 13 out of 19 patients (68%), consisting of regular contact with domestic animals in 5 and working on a farm in 4. Recurrent fever and illness was reported in 4 patients (18%), requiring prolonged antibiotic treatment. Two patients died (9%) and 3 survivors (15%) had neurological sequelae. C fetus is a rare cause of bacterial meningitis and is associated with an immunocompromised state. Based on the apparent slow clinical response seen in this limited number of cases, the authors of this study recommend a prolonged course of antimicrobial therapy when C fetus is identified as a causative agent of bacterial meningitis. Cases appeared to do best with carbapenem therapy. PMID:26937916
Fagan, P J; Meyer, J K; Schmidt, C W
The focus of this paper is on the adult who has adequately mastered the oedipal stage of psychosexual development and who presents with a sexual dysfunction. Drawing on the developmental sequence of Erik Erikson, the authors suggest that failure to address adequately an adult psychosocial crisis may result in sexual dysfunction. There may be both adult developmental deficits and regression to adolescent and adult stages previously negotiated. Both may be symptomatically represented by sexual dysfunction. The authors urge that the sexual and marital problems be evaluated within an adult developmental framework and that the therapy address the psychosocial issues which are appropriate to the developmental stage of the patient.