The randomized controlled trial of Head Start REDI: Sustained effects on developmental trajectories of social-emotional functioning.

PubMed

Nix, Robert L; Bierman, Karen L; Heinrichs, Brenda S; Gest, Scott D; Welsh, Janet A; Domitrovich, Celene E

2016-04-01

This study assessed the sustained effects of Head Start REDI (Research-based, Developmentally Informed), a randomized controlled preschool preventive intervention, on children's developmental trajectories of social-emotional functioning into elementary school. Twenty-five Head Start centers with 44 classrooms were randomly assigned to deliver Head Start REDI or Head Start as usual. Head Start REDI featured an integrated language-emergent literacy and social-emotional skills curriculum and enhanced support for positive teaching practices. The 356 4-year-old children (54% girls; 25% African American; 17% Latino; 70% living in poverty) in those centers and classrooms were followed for 5 years (from preschool through third grade; 91% retention rate). Each year, teachers rated multiple domains of social-emotional functioning. Person-oriented latent class growth models were used to identify the different developmental trajectories of social-emotional functioning that children followed. Tests of proportions revealed that children who had been in the Head Start REDI intervention were statistically significantly more likely than children in the control condition to follow the most optimal developmental trajectories of social competence, aggressive-oppositional behavior, learning engagement, attention problems, student-teacher closeness, and peer rejection (odds ratio = 1.60-1.93). These findings suggest that enriching Head Start with evidence-based curriculum components and teaching practices can have long-lasting benefits for children's social-emotional functioning. These findings elucidate how high-quality preschool experiences promote core competencies that are critical to the school success of children living in poverty. (c) 2016 APA, all rights reserved).

Atomoxetine could improve intra-individual variability in drug-naïve adults with attention-deficit/hyperactivity disorder comparably with methylphenidate: A head-to-head randomized clinical trial.

PubMed

Ni, Hsing-Chang; Hwang Gu, Shoou-Lian; Lin, Hsiang-Yuan; Lin, Yu-Ju; Yang, Li-Kuang; Huang, Hui-Chun; Gau, Susan Shur-Fen

2016-05-01

Intra-individual variability in reaction time (IIV-RT) is common in individuals with attention-deficit/hyperactivity disorder (ADHD). It can be improved by stimulants. However, the effects of atomoxetine on IIV-RT are inconclusive. We aimed to investigate the effects of atomoxetine on IIV-RT, and directly compared its efficacy with methylphenidate in adults with ADHD. An 8-10 week, open-label, head-to-head, randomized clinical trial was conducted in 52 drug-naïve adults with ADHD, who were randomly assigned to two treatment groups: immediate-release methylphenidate (n=26) thrice daily (10-20 mg per dose) and atomoxetine once daily (n=26) (0.5-1.2 mg/kg/day). IIV-RT, derived from the Conners' continuous performance test (CCPT), was represented by the Gaussian (reaction time standard error, RTSE) and ex-Gaussian models (sigma and tau). Other neuropsychological functions, including response errors and mean of reaction time, were also measured. Participants received CCPT assessments at baseline and week 8-10 (60.4±6.3 days). We found comparable improvements in performances of CCPT between the immediate-release methylphenidate- and atomoxetine-treated groups. Both medications significantly improved IIV-RT in terms of reducing tau values with comparable efficacy. In addition, both medications significantly improved inhibitory control by reducing commission errors. Our results provide evidence to support that atomoxetine could improve IIV-RT and inhibitory control, of comparable efficacy with immediate-release methylphenidate, in drug-naïve adults with ADHD. Shared and unique mechanisms underpinning these medication effects on IIV-RT awaits further investigation. © The Author(s) 2016.

Normalcy of food intake in patients with head and neck cancer supported by combined dietary counseling and swallowing therapy: A randomized clinical trial.

PubMed

van den Berg, Manon G A; Kalf, Johanna G; Hendriks, Jan C M; Takes, Robert P; van Herpen, Carla M L; Wanten, Geert J A; Drenth, Joost P H; Kaanders, Johannes H A M; Merkx, Matthias A W

2016-04-01

Dysphagia resulting in altered food intake is common among patients with head and neck cancer. This randomized trial investigated the effect of combined individual dietary counseling with individualized swallowing therapy (intervention) compared to individual dietary counseling (control) on normalcy of food intake (NFI). Patients with stage II to IV head and neck cancer treated with postoperative (chemo)radiation were randomly assigned to this study. NFI, dysphagia severity, social eating, and nutritional status were measured at the start of treatment and in weeks 6, 10, 18, and 30. One hundred twenty patients, 60 in each group, were recruited. No overall estimated difference was detected for NFI, dysphagia severity, social eating, or nutritional status. At week 10, the intervention group slightly improved dysphagia recovery 0.6 (95% confidence interval [CI] = 0.1-1.1). This difference diminished by week 30. Adding individualized swallowing therapy to individual dietary counseling did not improve NFI but slightly accelerate swallowing recovery. © 2015 Wiley Periodicals, Inc. Head Neck 38: E198-E206, 2016. © 2015 Wiley Periodicals, Inc.

Implementation Quality: Lessons Learned in the Context of the Head Start REDI Trial

ERIC Educational Resources Information Center

Domitrovich, Celene E.; Gest, Scott D.; Jones, Damon; Gill, Sukhdeep; Sanford DeRousie, Rebecca M.

2010-01-01

This study uses data collected in the intervention classrooms (N = 22) of Head Start REDI (Research-based, Developmentally Informed), a randomized clinical trial testing the efficacy of a comprehensive preschool curriculum targeting children's social-emotional competence, language, and emergent literacy skills delivered by teachers who received…

Minimally Displaced, Isolated Radial Head and Neck Fractures Do Not Require Formal Physical Therapy: Results of a Prospective Randomized Trial.

PubMed

Egol, Kenneth A; Haglin, Jack M; Lott, Ariana; Fisher, Nina; Konda, Sanjit R

2018-04-18

Nondisplaced and minimally displaced fractures of the radial head and neck are common injuries, yet the role of physical therapy (PT) in their treatment is unclear. The aim of this trial was to assess the need for formal PT following a simple fracture of the radial head or neck. Patients who had a nondisplaced or minimally displaced fracture of the radial head or neck and presented to 1 of 2 providers were enrolled prospectively between January 2014 and August 2016. Patients were randomized to receive outpatient PT or perform self-directed home exercise. The follow-up intervals were 6 weeks, 3 months, 6 months, and at least 1 year. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores; pain; time to clinical healing; and range of motion. Demographic data were analyzed using the Mann-Whitney U test and Fisher exact test. Independent-samples t tests were utilized to compare outcome measures. Fifty-one patients were enrolled in the study. The average follow-up was 16.6 months. Twenty-five patients were randomized to a home-exercise cohort, and 26 patients were randomized to a formal-outpatient-PT cohort. There were no significant differences in demographics between cohorts. At 6 weeks, the home-exercise cohort had better function as indicated by a significantly lower mean DASH score compared with the PT cohort (p = 0.021). At 3 months, 6 months, and final follow-up, there were no significant differences between cohorts for any outcome measure. Patients who performed home exercises after sustaining a nondisplaced or minimally displaced fracture of the radial head or neck demonstrated better early function at 6 weeks compared with patients who received formal PT. After 6 weeks, there were no significant differences in outcomes. These data suggest that prescribing PT for patients who have an isolated nondisplaced or minimally displaced fracture of the radial head or neck is not cost-effective and that instructing the patient to perform self

Heading in football. Part 3: Effect of ball properties on head response

PubMed Central

Shewchenko, N; Withnall, C; Keown, M; Gittens, R; Dvorak, J

2005-01-01

Objectives: Head impacts from footballs are an essential part of the game but have been implicated in mild and acute neuropsychological impairment. Ball characteristics have been noted in literature to affect the impact response of the head; however, the biomechanics are not well understood. The present study determined whether ball mass, pressure, and construction characteristics help reduce head and neck can impact response. Methods: Head responses under ball impact (6–7 m/s) were measured with a biofidelic numerical human model and controlled human subject trials (n = 3). Three ball masses and four ball pressures were investigated for frontal heading. Further, the effect of ball construction in wet/dry conditions was studied with the numerical model. The dynamic ball characteristics were determined experimentally. Head linear and angular accelerations were measured and compared with injury assessment functions comprising peak values and head impact power. Neck responses were assessed with the numerical model. Results: Ball mass reductions up to 35% resulted in decreased head responses up to 23–35% for the numerical and subject trials. Similar decreases in neck axial and shear responses were observed. Ball pressure reductions of 50% resulted in head and neck response reductions up to 10–31% for the subject trials and numerical model. Head response reductions up to 15% were observed between different ball constructions. The wet condition generally resulted in greater head and neck responses of up to 20%. Conclusion: Ball mass, pressure, and construction can reduce the impact severity to the head and neck. It is foreseeable that the benefits can be extended to players of all ages and skill levels. PMID:16046354

Circle of Security–Parenting: A randomized controlled trial in Head Start

PubMed Central

CASSIDY, JUDE; BRETT, BONNIE E.; GROSS, JACQUELYN T.; STERN, JESSICA A.; MARTIN, DAVID R.; MOHR, JONATHAN J.; WOODHOUSE, SUSAN S.

2017-01-01

Although evidence shows that attachment insecurity and disorganization increase risk for the development of psychopathology (Fearon, Bakermans-Kranenburg, van IJzendoorn, Lapsley, & Roisman, 2010; Groh, Roisman, van IJzendoorn, Bakermans-Kranenburg, & Fearon, 2012), implementation challenges have precluded dissemination of attachment interventions on the broad scale at which they are needed. The Circle of Security–Parenting Intervention (COS-P; Cooper, Hoffman, & Powell, 2009), designed with broad implementation in mind, addresses this gap by training community service providers to use a manualized, video-based program to help caregivers provide a secure base and a safe haven for their children. The present study is a randomized controlled trial of COS-P in a low-income sample of Head Start enrolled children and their mothers. Mothers (N = 141; 75 intervention, 66 waitlist control) completed a baseline assessment and returned with their children after the 10-week intervention for the outcome assessment, which included the Strange Situation. Intent to treat analyses revealed a main effect for maternal response to child distress, with mothers assigned to COS-P reporting fewer unsupportive (but not more supportive) responses to distress than control group mothers, and a main effect for one dimension of child executive functioning (inhibitory control but not cognitive flexibility when maternal age and marital status were controlled), with intervention group children showing greater control. There were, however, no main effects of intervention for child attachment or behavior problems. Exploratory follow-up analyses suggested intervention effects were moderated by maternal attachment style or depressive symptoms, with moderated intervention effects emerging for child attachment security and disorganization, but not avoidance; for inhibitory control but not cognitive flexibility; and for child internalizing but not externalizing behavior problems. This initial

A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children.

PubMed

Braun, P A; Quissell, D O; Henderson, W G; Bryant, L L; Gregorich, S E; George, C; Toledo, N; Cudeii, D; Smith, V; Johs, N; Cheng, J; Rasmussen, M; Cheng, N F; Santo, W; Batliner, T; Wilson, A; Brega, A; Roan, R; Lind, K; Tiwari, T; Shain, S; Schaffer, G; Harper, M; Manson, S M; Albino, J

2016-10-01

The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health-focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health-related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to

Clinical Trials in Head Injury

PubMed Central

NARAYAN, RAJ K.; MICHEL, MARY ELLEN; Ansell, Beth; Baethmann, Alex; Biegon, Anat; Bracken, Michael B.; Bullock, M. Ross; Choi, Sung C.; Clifton, Guy L.; Contant, Charles F.; Coplin, William M.; Dietrich, W. Dalton; Ghajar, Jamshid; Grady, Sean M.; Grossman, Robert G.; Hall, Edward D.; Heetderks, William; Hovda, David A.; Jallo, Jack; Katz, Russell L.; Knoller, Nachshon; Kochanek, Patrick M.; Maas, Andrew I.; Majde, Jeannine; Marion, Donald W.; Marmarou, Anthony; Marshall, Lawrence F.; McIntosh, Tracy K.; Miller, Emmy; Mohberg, Noel; Muizelaar, J. Paul; Pitts, Lawrence H.; Quinn, Peter; Riesenfeld, Gad; Robertson, Claudia S.; Strauss, Kenneth I.; Teasdale, Graham; Temkin, Nancy; Tuma, Ronald; Wade, Charles; Walker, Michael D.; Weinrich, Michael; Whyte, John; Wilberger, Jack; Young, A. Byron; Yurkewicz, Lorraine

2006-01-01

Traumatic brain injury (TBI) remains a major public health problem globally. In the United States the incidence of closed head injuries admitted to hospitals is conservatively estimated to be 200 per 100,000 population, and the incidence of penetrating head injury is estimated to be 12 per 100,000, the highest of any developed country in the world. This yields an approximate number of 500,000 new cases each year, a sizeable proportion of which demonstrate signficant long-term disabilities. Unfortunately, there is a paucity of proven therapies for this disease. For a variety of reasons, clinical trials for this condition have been difficult to design and perform. Despite promising pre-clinical data, most of the trials that have been performed in recent years have failed to demonstrate any significant improvement in outcomes. The reasons for these failures have not always been apparent and any insights gained were not always shared. It was therefore feared that we were running the risk of repeating our mistakes. Recognizing the importance of TBI, the National Institute of Neurological Disorders and Stroke (NINDS) sponsored a workshop that brought together experts from clinical, research, and pharmaceutical backgrounds. This workshop proved to be very informative and yielded many insights into previous and future TBI trials. This paper is an attempt to summarize the key points made at the workshop. It is hoped that these lessons will enhance the planning and design of future efforts in this important field of research. PMID:12042091

Integrative medicine in head and neck cancer

PubMed Central

Matovina, Chloe; Birkeland, Andrew C.; Zick, Suzanna; Shuman, Andrew G.

2017-01-01

Objective Complementary and alternative medicine (CAM), or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this manuscript is to use recent data to outline the decision-making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers’ understanding of integrative medicine. Data Sources Randomized controlled trials involving integrative medicine or CAM treatment for cancer patients. Review Methods Trials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management. Conclusions Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine. Implications for Practice In the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information in order to effectively counsel their patients. PMID:27729559

Integrative Medicine in Head and Neck Cancer.

PubMed

Matovina, Chloe; Birkeland, Andrew C; Zick, Suzanna; Shuman, Andrew G

2017-02-01

Objective Complementary and alternative medicine, or integrative medicine, has become increasingly popular among patients with head and neck cancer. Despite its increasing prevalence, many patients feel uncomfortable discussing such therapies with their physicians, and many physicians are unaware and underequipped to evaluate or discuss their use with patients. The aim of this article is to use recent data to outline the decision making inherent to integrative medicine utilization among patients with head and neck cancer, to discuss the ethical implications inherent to balancing integrative and conventional approaches to treatment, and to highlight available resources to enhance head and neck cancer providers' understanding of integrative medicine. Data Sources Randomized controlled trials involving integrative medicine or complementary and alternative medicine treatment for cancer patients. Review Methods Trials were drawn from a systematic PubMed database search categorized into cancer prevention, treatment, and symptom management. Conclusions Integrative medicine is gaining popularity for the management of cancer and is most commonly used for symptom management. A number of randomized controlled trials provide data to support integrative therapies, yet physicians who treat head and neck cancer may be faced with ethical dilemmas and practical barriers surrounding incorporation of integrative medicine. Implications for Practice In the management of head and neck cancer, there is an increasing demand for awareness of, dialogue about, and research evaluating integrative medicine therapies. It is important for otolaryngologists to become aware of integrative therapy options, their risks and benefits, and resources for further information to effectively counsel their patients.

The MRC CRASH trial--a large, simple randomised trial of steroids in head injury.

PubMed

Wasserberg, J

2004-01-01

CRASH (Corticosteroid randomisation after significant head injury) is a prospective multi-centre randomised double blind study of methylprednisolone versus placebo in mild, moderate and severe head injury. Patients are eligible up to 8 hours from injury. To date the CRASH trial has recruited 9000 patients. The trial is recruiting from 200 hospitals in 50 countries with another 100 centres planning to join the trial. The target for recruitment is 20,000 patients by 2006. The trial is wholly funded by the Medical Research Council of Great Britain and is multidisciplinary, involving doctors and nurses from a range of specialities. A recent systematic review of corticosteroids in head injury demonstrated a risk of death in the corticosteroid treated group 2% lower than in the control group. The 95% confidence interval ranges from a 60%, lower mortality to a 2% higher mortality. This result is compatible with there being no real benefit, but it is also compatible with there being a small benefit of a few percent. An improvement in mortality of 2% would theoretically save 10,000 lives per 500,000 patients treated. The global impact of such a treatment effect would be significant as the number of head injuries world-wide continues to rise.

Study protocol for a randomized controlled trial: tongue strengthening exercises in head and neck cancer patients, does exercise load matter?

PubMed

Van Nuffelen, Gwen; Van den Steen, Leen; Vanderveken, Olivier; Specenier, Pol; Van Laer, Carl; Van Rompaey, Diane; Guns, Cindy; Mariën, Steven; Peeters, Marc; Van de Heyning, Paul; Vanderwegen, Jan; De Bodt, Marc

2015-09-04

Reduced tongue strength is an important factor contributing to early and late dysphagia in head and neck cancer patients previously treated with chemoradiotherapy. The evidence is growing that tongue strengthening exercises can improve tongue strength and swallowing function in both healthy and dysphagic subjects. However, little is known about the impact of specific features of an exercise protocol for tongue strength on the actual outcome (strength or swallowing function). Previous research originating in the fields of sports medicine and physical rehabilitation shows that the degree of exercise load is an influential factor for increasing muscle strength in the limb skeletal muscles. Since the tongue is considered a muscular hydrostat, it remains to be proven whether the same concepts will apply. This ongoing randomized controlled trial in chemoradiotherapy-treated patients with head and neck cancer investigates the effect of three tongue strengthening exercise protocols, with different degrees of exercise load, on tongue strength and swallowing. At enrollment, 51 patients whose dysphagia is primarily related to reduced tongue strength are randomly assigned to a training schedule of 60, 80, or 100% of their maximal tongue strength. Patients are treated three times a week for 8 weeks, executing 120 repetitions of the assigned exercise once per training day. Exercise load is progressively adjusted every 2 weeks. Patients are evaluated before, during and after treatment by means of tongue strength measurements, fiber-optic endoscopic evaluation of swallowing and quality-of-life questionnaires. This randomized controlled trial is the first to systematically investigate the effect of different exercise loads in tongue strengthening exercise protocols. The results will allow the development of more efficacious protocols. Current Controlled Trials ISRCTN14447678.

Functional outcomes from a head-to-head, randomized, double-blind trial of lisdexamfetamine dimesylate and atomoxetine in children and adolescents with attention-deficit/hyperactivity disorder and an inadequate response to methylphenidate.

PubMed

Nagy, Peter; Häge, Alexander; Coghill, David R; Caballero, Beatriz; Adeyi, Ben; Anderson, Colleen S; Sikirica, Vanja; Cardo, Esther

2016-02-01

Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in multiple domains of patients' lives. A secondary objective of this randomized, active-controlled, head-to-head, double-blind, dose-optimized clinical trial was to compare the effects of lisdexamfetamine dimesylate (LDX) and atomoxetine (ATX) on functional impairment in children and adolescents with ADHD. Patients aged 6-17 years with an ADHD Rating Scale IV total score ≥ 28 and an inadequate response to methylphenidate treatment (judged by investigators) were randomized (1:1) to once-daily LDX or ATX for 9 weeks. Parents/guardians completed the Weiss Functional Impairment Rating Scale-Parent Report (WFIRS-P) at baseline and at week 9 or early termination. p values were nominal and not corrected for multiple comparisons. Of 267 randomized patients, 200 completed the study (LDX 99, ATX 101). At baseline, mean WFIRS-P total score in the LDX group was 0.95 [standard deviation (SD) 0.474; 95% confidence interval (CI) 0.87, 1.03] and in the ATX group was 0.91 (0.513; 0.82, 1.00). Scores in all WFIRS-P domains improved from baseline to endpoint in both groups, with least-squares mean changes in total score of -0.35 (95% CI -0.42, -0.29) for LDX and -0.27 (-0.33, -0.20) for ATX. The difference between LDX and ATX was statistically significant (p < 0.05) for the Learning and School (effect size of LDX vs ATX, 0.43) and Social Activities (0.34) domains and for total score (0.27). Both treatments reduced functional impairment in children and adolescents with ADHD; LDX was statistically significantly more effective than ATX in two of six domains and in total score.

The Randomized-Controlled Trial of Head Start REDI: Sustained Effects on Developmental Trajectories of Social-Emotional Functioning

PubMed Central

Nix, Robert L.; Bierman, Karen L.; Heinrichs, Brenda S.; Gest, Scott D.; Welsh, Janet A.; Domitrovich, Celene E.

2015-01-01

Objective This study assessed the sustained effects of Head Start REDI (Research-based, Developmentally-Informed), a randomized-controlled preschool preventive intervention, on children’s developmental trajectories of social-emotional functioning into elementary school. Method Twenty-five Head Start centers with 44 classrooms were randomly assigned to deliver Head Start REDI, which featured an integrated language-emergent literacy and social-emotional skills curriculum and enhanced support for positive teaching practices, or Head Start “as usual.” The 356 4-year old children (54% girls; 25% African American; 17% Latino; 70% living in poverty) in those centers and classrooms were followed for five years (from preschool through third grade; 91% retention rate). Each year teachers rated multiple domains of social-emotional functioning. Person-oriented latent class growth models were used to identify the different developmental trajectories of social-emotional functioning that children followed. Results Tests of proportions revealed that children who had been in the Head Start REDI intervention were statistically significantly more likely than children in the control condition to exhibit the most optimal developmental trajectories of social competence, aggressive-oppositional behavior, learning engagement, attention problems, student-teacher closeness, and peer rejection (odds ratios = 1.60 – 1.93). Conclusions These findings suggest that enriching Head Start with evidence-based curriculum components and teaching practices can have long-lasting benefits for children’s social-emotional functioning. These findings elucidate how high-quality preschool experiences promote core competencies that are critical to the school success of children living in poverty. Public health significance statement When children participated in the enriched preschool program Head Start REDI, they were more likely to follow optimal developmental trajectories of social

The Effect of Head Positioning and Head Tilting on the Incidence of Intraventricular Hemorrhage in Very Preterm Infants: A Systematic Review.

PubMed

de Bijl-Marcus, Karen A; Brouwer, Annemieke J; de Vries, Linda S; van Wezel-Meijler, Gerda

2017-01-01

Despite advances in neonatal intensive care, germinal matrix-intraventricular hemorrhage (GMH-IVH) remains a frequent, serious complication of premature birth. Neutral head position and head tilting have been suggested to reduce the risk of GMH-IVH in preterm infants during the first 72 h of life. The aim of this study was to provide a systematic review of the effect of neutral head positioning and head tilting on the incidence of GMH-IVH in very preterm infants (gestational age ≤30 weeks). In addition, we reviewed their effect on cerebral hemodynamics and oxygenation. Literature was searched (June 2016) in the following electronic databases: CINAHL, Embase, Medline, SCOPUS, and several trial registers. One underpowered trial studied the effect of head positioning on the incidence of GMH-IVH. This randomized controlled trial enrolled 48 preterm infants and found no effect on the occurrence of GMH-IVH. Three observational studies investigated the effect of head rotation and/or tilting on cerebral oxygenation in 68 preterm infants in total. Their results suggest that cerebral oxygenation is not significantly affected by changes in head positioning. The effect of head positioning and/or tilting on cerebral hemodynamics was described in 2 observational studies of 28 preterm infants and found no significant effect. There is insufficient evidence regarding the effect of head positioning and tilting on the incidence of GMH-IVH and cerebral hemodynamics and oxygenation in preterm infants. We recommend further research in this field, especially in extremely preterm and clinically unstable infants during the first postnatal days. © 2016 S. Karger AG, Basel.

Academic Performance of Subsequent Schools and Impacts of Early Interventions: Evidence from a Randomized Controlled Trial in Head Start Settings

PubMed Central

Zhai, Fuhua; Raver, C. Cybele; Jones, Stephanie M.

2012-01-01

The role of subsequent school contexts in the long-term effects of early childhood interventions has received increasing attention, but has been understudied in the literature. Using data from the Chicago School Readiness Project (CSRP), a cluster-randomized controlled trial conducted in Head Start programs, we investigate whether the intervention had differential effects on academic and behavioral outcomes in kindergarten if children attended high- or low-performing schools subsequent to the preschool intervention year. To address the issue of selection bias, we adopt an innovative method, principal score matching, and control for a set of child, mother, and classroom covariates. We find that exposure to the CSRP intervention in the Head Start year had significant effects on academic and behavioral outcomes in kindergarten for children who subsequently attended high-performing schools, but no significant effects on children attending low-performing schools. Policy implications of the findings are discussed. PMID:22773872

A Pilot Study of Randomized, Head-to-Head of Metformin Versus Topiramate in Obese People With Schizophrenia.

PubMed

Peng, Po-Jui; Ho, Pei-Shen; Tsai, Chia-Kuang; Huang, San-Yuan; Liang, Chih-Sung

A number of research studies support the weight loss effects of metformin and topiramate for obese people with schizophrenia. However, only a few studies have addressed the sustainability of the body weight reduction after discontinuation of these drugs. Moreover, head-to-head studies are still lacking. The study aims to evaluate and compare the efficacy of metformin and topiramate in weight reduction and weight maintenance after discontinuation of these drugs in obese people with schizophrenia. Twenty-two obese inpatients with schizophrenia were recruited and randomized into the metformin group (n = 11; daily dose, 1000 mg) and the topiramate group (n = 11; daily dose, 100 mg). A head-to-head, fixed-dose, and single-blinded design was used. Ten obese patients with schizophrenia of similar sex as that of the treated group were included as the control group. After a 4-month treatment, the metformin group showed a body weight reduction of 3.8 kg, and the topiramate group showed a reduction of 2.7 kg. However, the reduction could be sustained only in the metformin group at 3 and 9 months after metformin discontinuation. Interestingly, 3 months after treatment discontinuation, leptin levels showed a reduction in both metformin (baseline, 25.3 ± 14.7, week 7: 5.7 ± 3.7 ng/mL) and topiramate (baseline: 28.4 ± 16.1, week 7: 9.2 ± 15.5 ng/mL) groups. The trend of weight changes supports the superiority of metformin at 1000 mg/d over topiramate at 100 mg/d in weight reduction and weight maintenance.

Quantifying Variation in Head Start Effects on Young Children's Cognitive and Socio-Emotional Skills Using Data from the National Head Start Impact Study

ERIC Educational Resources Information Center

Bloom, Howard S.; Weiland, Christina

2015-01-01

This paper uses data from the Head Start Impact Study (HSIS), a nationally representative multisite randomized trial, to quantify variation in effects of Head Start during 2002-2003 on children's cognitive and socio-emotional outcomes relative to the effects of other local alternatives, including parent care. We find that (1) treatment and control…

'Pharyngocise': Randomized Controlled Trial of Preventative Exercises to Maintain Muscle Structure and Swallowing Function During Head-and-Neck Chemoradiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Carnaby-Mann, Giselle, E-mail: gmann@phhp.ufl.edu; Crary, Michael A.; Schmalfuss, Ilona

2012-05-01

Purpose: Dysphagia after chemoradiotherapy is common. The present randomized clinical trial studied the effectiveness of preventative behavioral intervention for dysphagia compared with the 'usual care.' Methods and Materials: A total of 58 head-and-neck cancer patients treated with chemoradiotherapy were randomly assigned to usual care, sham swallowing intervention, or active swallowing exercises (pharyngocise). The intervention arms were treated daily during chemoradiotherapy. The primary outcome measure was muscle size and composition (determined by T{sub 2}-weighted magnetic resonance imaging). The secondary outcomes included functional swallowing ability, dietary intake, chemosensory function, salivation, nutritional status, and the occurrence of dysphagia-related complications. Results: The swallowing musculaturemore » (genioglossus, hyoglossuss, and mylohyoid) demonstrated less structural deterioration in the active treatment arm. The functional swallowing, mouth opening, chemosensory acuity, and salivation rate deteriorated less in the pharyngocise group. Conclusion: Patients completing a program of swallowing exercises during cancer treatment demonstrated superior muscle maintenance and functional swallowing ability.« less

A systematic review of the quality of randomized controlled trials in head and neck oncology surgery.

PubMed

Carlton, Daniel A; Kocherginsky, Masha; Langerman, Alexander J

2015-01-01

To determine the quality of randomized controlled trials (RCTs) in head and neck surgery in which surgery was a primary intervention. Potential articles were identified in PubMed without publication date restrictions. Articles were scored using the CONSORT checklist and the relationship between the checklist score and whether the first and/or last authors were surgeons was investigated. Differences in the checklist score based on how many surgeons were among the first and last authors of the study were analyzed using the Kruskal-Wallis test. Fisher's exact test was used to examine if there was a significant difference of the reporting of individual items from the checklist between surgeons and nonsurgeons. A nonparametric trend test was used to determine whether there was a difference in the reporting of individual items based on whether there were none, one, or two surgeons among first and last authors. A total of 38 publications satisfied the inclusion criteria. There was a trend toward lower quality for studies in which surgeons were either first, last, or both first and last authors compared to studies that were first-authored and last-authored by nonsurgeons (P = 0.068). Nonsurgeons were more likely to report on critical elements regarding hypothesis, sample size determination, randomization, and eligibility of centers (P = 0.023-0.058). The quality of RCTs in head and neck surgery is poor. Improved training in conducting and reporting clinical research is needed in otolaryngology residencies. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

School Readiness in Children Living in Non-Parental Care: Impacts of Head Start

ERIC Educational Resources Information Center

Lipscomb, Shannon T.; Pratt, Megan E.; Schmitt, Sara A.; Pears, Katherine C.; Kim, Hyoun K.

2013-01-01

The current study examines the effects of Head Start on the development of school readiness outcomes for children living in non-parental care. Data were obtained from the Head Start Impact Study, a randomized controlled trial of Head Start conducted with a nationally representative sample of Head Start programs and families. The sample included…

Immunotherapy of Head and Neck Cancer: Emerging Clinical Trials From a National Cancer Institute Head and Neck Cancer Steering Committee Planning Meeting

PubMed Central

Bauman, Julie E.; Cohen, Ezra; Ferris, Robert L.; Adelstein, David J.; Brizel, David M.; Ridge, John A.; O’Sullivan, Brian; Burtness, Barbara A.; Butterfield, Lisa H.; Carson, William E.; Disis, Mary L.; Fox, Bernard A.; Gajewski, Thomas F.; Gillison, Maura L.; Hodge, James W.; Le, Quynh-Thu; Raben, David; Strome, Scott E.; Lynn, Jean; Malik, Shakun

2017-01-01

Recent advances have permitted successful therapeutic targeting of the immune system in head and neck squamous cell carcinoma (HNSCC). These new immunotherapeutic targets and agents are being rapidly adopted by the oncologic community and hold considerable promise. The National Cancer Institute sponsored a Clinical Trials Planning Meeting to address the issue of how to further investigate the use of immunotherapy in patients with HNSCC. The goals of the meeting were to consider phase 2 or 3 trial designs primarily in 3 different patient populations: those with previously untreated, human papillomavirus-initiated oropharyngeal cancers; those with previously untreated, human papillomavirus-negative HNSCC; and those with recurrent/metastatic HNSCC. In addition, a separate committee was formed to develop integrative biomarkers for the clinical trials. The meeting started with an overview of key immune components and principles related to HNSCC, including immunosurveillance and immune escape. Four clinical trial concepts were developed at the meeting integrating different immunotherapies with existing standards of care. These designs were presented for implementation by the head and neck committees of the National Cancer Institute-funded National Clinical Trials Network. This article summarizes the proceedings of this Clinical Trials Planning Meeting, the purpose of which was to facilitate the rigorous development and design of randomized phase 2 and 3 immunotherapeutic trials in patients with HNSCC. Although reviews usually are published immediately after the meeting is held, this report is unique because there are now tangible clinical trial designs that have been funded and put into practice and the studies are being activated to accrual. PMID:27906454

Household-wide ivermectin treatment for head lice in an impoverished community: randomized observer-blinded controlled trial

PubMed Central

Pilger, Daniel; Heukelbach, Jorg; Khakban, Adak; Oliveira, Fabiola Araujo; Fengler, Gernot

2010-01-01

Abstract Objective To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis (head lice) in resource-poor communities. Methods We studied 132 children without head lice who lived in a slum in north-eastern Brazil. We randomized the households of the study participants into an intervention and a control group and prospectively calculated the incidence of infestation with head lice among the children in each group. In the intervention group, all of the children’s family members who lived in the household were treated with ivermectin; in the control group, no family member was treated. We used the χ² test with continuity correction or Fisher’s exact test to compare proportions. We performed survival analysis using Kaplan–Meier estimates with log rank testing and the Mann–Whitney U test to analyse the length of lice-free periods among sentinel children, and we used Cox regression to analyse survival data on a multivariate level. We also carried out a subgroup analysis based on gender. Findings Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group. The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11–45), as compared to 14 days (IQR: 11–25) in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005). After treatment with ivermectin, the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys. Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period. Conclusion In an impoverished community, girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation. To decrease the number of head lice episodes per unit of

Household-wide ivermectin treatment for head lice in an impoverished community: randomized observer-blinded controlled trial.

PubMed

Pilger, Daniel; Heukelbach, Jorg; Khakban, Adak; Oliveira, Fabiola Araujo; Fengler, Gernot; Feldmeier, Hermann

2010-02-01

To generate evidence on the effectiveness of household-wide treatment for preventing the transmission of pediculosis capitis (head lice) in resource-poor communities. We studied 132 children without head lice who lived in a slum in north-eastern Brazil. We randomized the households of the study participants into an intervention and a control group and prospectively calculated the incidence of infestation with head lice among the children in each group. In the intervention group, all of the children's family members who lived in the household were treated with ivermectin; in the control group, no family member was treated. We used the chi(2) test with continuity correction or Fisher's exact test to compare proportions. We performed survival analysis using Kaplan-Meier estimates with log rank testing and the Mann-Whitney U test to analyse the length of lice-free periods among sentinel children, and we used Cox regression to analyse survival data on a multivariate level. We also carried out a subgroup analysis based on gender. Children in the intervention group remained free from infestation with head lice significantly longer than children in the control group. The median infestation-free period in the intervention group was 24 days (interquartile range, IQR: 11-45), as compared to 14 days (IQR: 11-25) in the control group (P = 0.01). Household-wide treatment with ivermectin proved significantly more effective among boys than among girls (P = 0.005). After treatment with ivermectin, the estimated number of annual episodes of head lice infestation was reduced from 19 to 14 in girls and from 15 to 5 in boys. Female sex and extreme poverty were independent risk factors associated with a shortened disease-free period. In an impoverished community, girls and the poorest of the poor are the population groups that are most vulnerable for head lice infestation. To decrease the number of head lice episodes per unit of time, control measures should include the treatment of all

Progressive resistance training in head and neck cancer patients during concomitant chemoradiotherapy -- design of the DAHANCA 31 randomized trial.

PubMed

Lonkvist, Camilla K; Lønbro, Simon; Vinther, Anders; Zerahn, Bo; Rosenbom, Eva; Primdahl, Hanne; Hojman, Pernille; Gehl, Julie

2017-06-03

Head and neck cancer patients undergoing concomitant chemoradiotherapy (CCRT) frequently experience loss of muscle mass and reduced functional performance. Positive effects of exercise training are reported for many cancer types but biological mechanisms need further elucidation. This randomized study investigates whether progressive resistance training (PRT) may attenuate loss of muscle mass and functional performance. Furthermore, biochemical markers and muscle biopsies will be investigated trying to link biological mechanisms to training effects. At the Departments of Oncology at Herlev and Aarhus University Hospitals, patients with stage III/IV squamous cell carcinoma of the head and neck, scheduled for CCRT are randomized 1:1 to either a 12-week PRT program or control group, both with 1 year follow-up. Planned enrollment is 72 patients, and stratification variables are study site, sex, p16-status, and body mass index. Primary endpoint is difference in change in lean body mass (LBM) after 12 weeks of PRT, assessed by dual-energy X-ray absorptiometry (DXA). The hypothesis is that 12 weeks of PRT can attenuate the loss of LBM by at least 25%. Secondary endpoints include training adherence, changes in body composition, muscle strength, functional performance, weight, adverse events, dietary intake, self-reported physical activity, quality of life, labor market affiliation, blood biochemistry, plasma cytokine concentrations, NK-cell frequency in blood, sarcomeric protein content in muscles, as well as muscle fiber type and fiber size in muscle biopsies. Muscle biopsies are optional. This randomized study investigates the impact of a 12-week progressive resistance training program on lean body mass and several other physiological endpoints, as well as impact on adverse events and quality of life. Furthermore, a translational approach is integrated with extensive biological sampling and exploration into cytokines and mechanisms involved. The current paper discusses

Immunotherapy of head and neck cancer: Emerging clinical trials from a National Cancer Institute Head and Neck Cancer Steering Committee Planning Meeting.

PubMed

Bauman, Julie E; Cohen, Ezra; Ferris, Robert L; Adelstein, David J; Brizel, David M; Ridge, John A; O'Sullivan, Brian; Burtness, Barbara A; Butterfield, Lisa H; Carson, William E; Disis, Mary L; Fox, Bernard A; Gajewski, Thomas F; Gillison, Maura L; Hodge, James W; Le, Quynh-Thu; Raben, David; Strome, Scott E; Lynn, Jean; Malik, Shakun

2017-04-01

Recent advances have permitted successful therapeutic targeting of the immune system in head and neck squamous cell carcinoma (HNSCC). These new immunotherapeutic targets and agents are being rapidly adopted by the oncologic community and hold considerable promise. The National Cancer Institute sponsored a Clinical Trials Planning Meeting to address the issue of how to further investigate the use of immunotherapy in patients with HNSCC. The goals of the meeting were to consider phase 2 or 3 trial designs primarily in 3 different patient populations: those with previously untreated, human papillomavirus-initiated oropharyngeal cancers; those with previously untreated, human papillomavirus-negative HNSCC; and those with recurrent/metastatic HNSCC. In addition, a separate committee was formed to develop integrative biomarkers for the clinical trials. The meeting started with an overview of key immune components and principles related to HNSCC, including immunosurveillance and immune escape. Four clinical trial concepts were developed at the meeting integrating different immunotherapies with existing standards of care. These designs were presented for implementation by the head and neck committees of the National Cancer Institute-funded National Clinical Trials Network. This article summarizes the proceedings of this Clinical Trials Planning Meeting, the purpose of which was to facilitate the rigorous development and design of randomized phase 2 and 3 immunotherapeutic trials in patients with HNSCC. Although reviews usually are published immediately after the meeting is held, this report is unique because there are now tangible clinical trial designs that have been funded and put into practice and the studies are being activated to accrual. Cancer 2017;123:1259-1271. © 2016 American Cancer Society. © 2016 American Cancer Society.

Quality assurance in head and neck surgical oncology: EORTC 24954 trial on larynx preservation.

PubMed

Leemans, C R; Tijink, B M; Langendijk, J A; Andry, G; Hamoir, M; Lefebvre, J L

2013-09-01

The Head and Neck Cancer Group (HNCG) of the EORTC conducted a quality assurance program in the EORTC 24954 trial on larynx preservation. In this multicentre study, patients with resectable advanced squamous cell carcinoma of the larynx or hypopharynx were randomly assigned for treatment with sequential or alternating chemoradiation. The need for a quality assurance program is the evaluation and prevention of differences in treatments between centres in this multidisciplinary study. The surgical subcommittee of the HNCG prepared a questionnaire, and clinical records of all patients were verified during audits of independent teams. Data relating institutional practices were collected during a face to face interview with members of the local team. 271 clinical records from the nine main contributing centres were reviewed. The main difference between centres was the time interval between first consultation and treatment initiation, with a mean of 45 days. On the pathology report the nodal involvement was described by level in 36% of the cases according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Extranodal spread was not always described in neck dissection specimens. The EORTC 24954 trial on larynx preservation was the first prospective trial with a quality assurance program in head and neck surgical oncology. The analysis shows similarities in practices, but also points out some important differences between centres. Operation reports were fairly complete, but uniformity in pathology reports should be improved. Copyright © 2013 Elsevier Ltd. All rights reserved.

Enteral glutamine supplementation in surgical patients with head and neck malignancy: A randomized controlled trial.

PubMed

Azman, Mawaddah; Mohd Yunus, Mohd Razif; Sulaiman, Suhaina; Syed Omar, Syed Nabil

2015-12-01

Glutamine supplementation is a novel approach to perioperative nutritional management. This study was a prospective randomized clinical trial of effects of enteral glutamine supplementation in surgical patients with head and neck malignancy in a tertiary center. This study measured the effects of supplementation within 4 weeks of the postoncologic surgical period in relation to fat-free mass, serum albumin, and quality of life scores. The study population consisted of 44 patients. There was significant difference in serum albumin (p < .001), fat-free mass (p < .001), and quality of life scores (p < .05) between control and interventional groups. Significant correlation exists between fat-free mass and quality of life score difference in our study population (p < .05). Enteral glutamine supplementation significantly improves fat-free mass, serum albumin, and quality of life scores postoperatively and maintenance of lean body mass correlated with improved postoperative outcomes in terms of the patient's quality of life. © 2014 Wiley Periodicals, Inc.

Influence of ultrasound determination of fetal head position on mode of delivery: a pragmatic randomized trial.

PubMed

Popowski, T; Porcher, R; Fort, J; Javoise, S; Rozenberg, P

2015-11-01

To evaluate the influence of ultrasound determination of fetal head position on mode of delivery. This was a pragmatic open-label randomized controlled trial that included women with a singleton pregnancy in the vertex presentation at ≥ 37 weeks' gestation, cervical dilation ≥ 8 cm and who received epidural anesthesia. Women were assigned randomly to undergo either digital vaginal examination (VE group) or both digital vaginal and ultrasound examinations (VE+US group) to determine fetal head position. When the ultrasound and digital vaginal findings were inconsistent in the VE+US group, the ultrasound result was used for clinical management. The primary outcome assessed was operative delivery (Cesarean or instrumental vaginal delivery), and maternal and fetal morbidity were also assessed. The VE and VE+US groups included 959 and 944 women, respectively. The overall rate of operative delivery was significantly higher in the VE+US group than in the VE group: 33.7% vs 27.1%, respectively (relative risk (RR), 1.24 (95% CI, 1.08-1.43)), as was the rate of Cesarean delivery: 7.8% vs 4.9%, respectively (RR, 1.60 (95% CI, 1.12-2.28)). The rate of instrumental vaginal delivery was also higher, albeit not significantly: 25.8% in the VE+US group vs 22.2% in the VE group (RR, 1.16 (95% CI, 0.99-1.37)). Neonatal outcomes did not differ between the two groups. When analysis was restricted to instrumental vaginal deliveries only, maternal and neonatal morbidity outcomes were similar in both groups. Correction of fetal occiput position, determined initially by digital vaginal examination, using systematic ultrasound examination did not improve management of labor and increased the rate of operative delivery without decreasing maternal and neonatal morbidity. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Safety and efficacy of pharmacologic thromboprophylaxis following blunt head injury: a systematic review.

PubMed

Reeves, Fairleigh; Batty, Lachlan; Pitt, Veronica; Chau, Marisa; Pattuwage, Loyal; Gruen, Russell L

2013-10-01

Patients with blunt head injury are at high risk of venous thromboembolism. However, pharmacologic thromboprophylaxis (PTP) may cause progression of intracranial hemorrhage, and clinicians must often weigh up the risks and benefits. This review aimed to determine whether adding PTP to mechanical prophylaxis confers net benefit or harm and the optimal timing, dose, and agent for PTP in patients with blunt head injury. We searched MEDLINE, EMBASE, The Cochrane Library Central Register of Controlled Trials (CENTRAL), and www.clinicaltrials.gov on April 24, 2013, to identify controlled studies and ongoing trials that assessed the efficacy or safety of thromboprophylaxis interventions in the early management of head-injured patients. Studies were classified based on types of interventions and comparisons, and the quality of included studies was assessed using Cochrane risk-of-bias tool and the Newcastle-Ottawa Quality Assessment Scale. We intended to undertake a meta-analysis if studies were sufficiently similar. Sixteen studies met the inclusion criteria, including four randomized controlled trials. At least two randomized controlled trials were at high risk of bias owing to inadequate randomization and concealment of allocation, and observational studies were potentially confounded by substantial differences between comparison groups. Heterogeneity of included studies precluded meta-analysis. Results were mixed, with some studies supporting and others refuting addition of PTP to mechanical interventions. Little evidence was available about dose or choice of agent. The safety and efficacy of early PTP in patients without early progression of hemorrhage is unclear. There is currently insufficient evidence to guide thromboprophylaxis in patients with blunt head injury. Standardized definitions and outcome measurements would facilitate comparison of outcomes across future studies. Studies in mixed populations should report head-injured specific subgroup data. Future

Protocol for a randomised control trial of bisphosphonate (zoledronic acid) treatment in childhood femoral head avascular necrosis due to Perthes disease

PubMed Central

Zacharin, Margaret; Foster, Bruce; Donald, Geoffrey; Hassall, Timothy; Siafarikas, Aris; Johnson, Michael; Tham, Elaine; Whitewood, Colin; Gebski, Val; Cowell, Chris T; Little, David Graham; Munns, Craig Frank

2017-01-01

Introduction Perthes disease (PD) is an idiopathic disorder presenting with avascular necrosis to the femoral head, which frequently results in flattening. Long-term function is directly related to the subsequent femoral head sphericity. Current treatment includes mechanical modalities and surgical procedures, which are therapeutic but are not uniformly able to prevent collapse. The use of the nitrogen-containing bisphosphonate zoledronic acid (ZA) to inhibit osteoclastic bone resorption is aimed at preserving femoral head strength, reducing collapse and thus maintaining shape. The proposed multicentre, prospective, randomised controlled trial intends to evaluate the efficacy of ZA treatment in PD. Methods and analysis An open-label randomised control trial recruiting 100 children (50 each treatment arm) 5 to 16 years old with unilateral PD. Subjects are randomly assigned to either (a) ZA and standard care or (b) Standard care. The primary outcome measure is deformity index (DI), a radiographic parameter of femoral head roundness assessed at 24 months, following 12 months of ZA treatment (3-monthly doses of ZA 0.025 mg/kg at baseline, 3, 6, 9 and 12 months) plus 12 months observation (group A) or 24 months of observation (group B). Secondary outcome measures are femoral head subluxation, Faces Pain scale, Harris hip score and quality of life. Assessments are made at baseline, 3 monthly during the first year of follow-up and then 6 monthly, until the 24th month. Ethics and dissemination The study commenced following the written approval from the Human Research Ethics Committee. Safety considerations regarding the effects of ZA are monitored which include the subject’s symptomatology, mineral status, bone mass and turnover activity, and metaphyseal modelling. Data handling plan requires that all documents, clinical information, biological samples and investigation results will be held in strict confidence by study investigators to preserve its safety and

Effect of Random Thermal Spikes on Stirling Convertor Heater Head Reliability

NASA Technical Reports Server (NTRS)

Shah, Ashwin R.; Korovaichuk, Igor; Halford, Gary R.

2004-01-01

Onboard radioisotope power systems being developed to support future NASA exploration missions require reliable design lifetimes of up to 14 yr and beyond. The structurally critical heater head of the high-efficiency developmental Stirling power convertor has undergone extensive computational analysis of operating temperatures (up to 650 C), stresses, and creep resistance of the thin-walled Inconel 718 bill of material. Additionally, assessment of the effect of uncertainties in the creep behavior of the thin-walled heater head, the variation in the manufactured thickness, variation in control temperature, and variation in pressure on the durability and reliability were performed. However, it is possible for the heater head to experience rare incidences of random temperature spikes (excursions) of short duration. These incidences could occur randomly with random magnitude and duration during the desired mission life. These rare incidences could affect the creep strain rate and therefore the life. The paper accounts for these uncertainties and includes the effect of such rare incidences, random in nature, on the reliability. The sensitivities of variables affecting the reliability are quantified and guidelines developed to improve the reliability are outlined. Furthermore, the quantified reliability is being verified with test data from the accelerated benchmark tests being conducted at the NASA Glenn Research Center.

Matching the oculomotor drive during head-restrained and head-unrestrained gaze shifts in monkey.

PubMed

Bechara, Bernard P; Gandhi, Neeraj J

2010-08-01

High-frequency burst neurons in the pons provide the eye velocity command (equivalently, the primary oculomotor drive) to the abducens nucleus for generation of the horizontal component of both head-restrained (HR) and head-unrestrained (HU) gaze shifts. We sought to characterize how gaze and its eye-in-head component differ when an "identical" oculomotor drive is used to produce HR and HU movements. To address this objective, the activities of pontine burst neurons were recorded during horizontal HR and HU gaze shifts. The burst profile recorded on each HU trial was compared with the burst waveform of every HR trial obtained for the same neuron. The oculomotor drive was assumed to be comparable for the pair yielding the lowest root-mean-squared error. For matched pairs of HR and HU trials, the peak eye-in-head velocity was substantially smaller in the HU condition, and the reduction was usually greater than the peak head velocity of the HU trial. A time-varying attenuation index, defined as the difference in HR and HU eye velocity waveforms divided by head velocity [alpha = (H(hr) - E(hu))/H] was computed. The index was variable at the onset of the gaze shift, but it settled at values several times greater than 1. The index then decreased gradually during the movement and stabilized at 1 around the end of gaze shift. These results imply that substantial attenuation in eye velocity occurs, at least partially, downstream of the burst neurons. We speculate on the potential roles of burst-tonic neurons in the neural integrator and various cell types in the vestibular nuclei in mediating the attenuation in eye velocity in the presence of head movements.

Randomized Trial of Vitamin C/E Complex for Prevention of Radiation-Induced Xerostomia in Patients with Head and Neck Cancer.

PubMed

Chung, Man Ki; Kim, Do Hun; Ahn, Yong Chan; Choi, Joon Young; Kim, Eun Hye; Son, Young-Ik

2016-09-01

The present study was conducted to determine the preventive efficacy of vitamin C/E complex supplementation for radiotherapy (RT)-induced xerostomia in patients with head and neck cancer. Prospective, double-blinded, randomized, placebo-controlled study. A single tertiary referral institution. The trial group (n = 25) received antioxidant supplements (100 IU of vitamin E + 500 mg of vitamin C) twice per day during RT, while the control group (n = 20) received an identical placebo. Pre-RT and 1 and 6 months post-RT, patient-reported xerostomia questionnaires, observer-rated xerostomia score, and salivary scintigraphy were serially obtained to compare xerostomia severity between the 2 groups. The trial group showed greater improvements in xerostomia questionnaire and score at 6 months post-RT when compared with those at 1 month post-RT (P = .007 and .008, respectively). In contrast, the control group showed no changes between 1 and 6 months post-RT. By salivary scintigraphy, there was no difference in maximal accumulation or ejection fraction between the 2 groups. However, the trial group maintained significantly better oral indices at the prestimulatory (P = .01) and poststimulatory (P = .009) stages at 1 month post-RT, compared with the control group. At the final follow-up, there was no difference in overall survival and disease-free survival between the 2 groups. Our data suggest that short-term supplementation with an antioxidant vitamin E/C complex exerts a protective effect against RT-induced xerostomia. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Enhanced upper respiratory tract airflow and head fanning reduce brain temperature in brain-injured, mechanically ventilated patients: a randomized, crossover, factorial trial.

PubMed

Harris, B A; Andrews, P J D; Murray, G D

2007-01-01

Heat loss from the upper airways and through the skull are physiological mechanisms of brain cooling which have not been fully explored clinically. This randomized, crossover, factorial trial in 12 brain-injured, orally intubated patients investigated the effect of enhanced nasal airflow (high flow unhumidified air with 20 p.p.m. nitric oxide gas) and bilateral head fanning on frontal lobe brain temperature and selective brain cooling. After a 30 min baseline, each patient received the four possible combinations of the interventions--airflow, fanning, both together, no intervention--in randomized order. Each combination was delivered for 30 min and followed by a 30 min washout, the last 5 min of which provided the baseline for the next intervention. The difference in mean brain temperature over the last 5 min of the preceding washout minus the mean over the last 5 min of intervention, was 0.15 degrees C with nasal airflow (P=0.001, 95% CI 0.06-0.23 degrees C) and 0.26 degrees C with head fanning (P<0.001, 95% CI 0.17-0.34 degrees C). The estimate of the combined effect of airflow and fanning on brain temperature was 0.41 degrees C. Selective brain cooling did not occur. Physiologically, this study demonstrates that heat loss through the upper airways and through the skull can reduce parenchymal brain temperature in brain-injured humans and the onset of temperature reduction is rapid. Clinically, in ischaemic stroke, a temperature decrease of 0.27 degrees C may reduce the relative risk of poor outcome by 10-20%. Head fanning may have the potential to achieve a temperature decrease of this order.

Is investigator background related to outcome in head to head trials of psychotherapy and pharmacotherapy for adult depression? A systematic review and meta-analysis

PubMed Central

Gentili, Claudio; Pietrini, Pietro; Cuijpers, Pim

2017-01-01

Background The influence of factors related to the background of investigators conducting trials comparing psychotherapy and pharmacotherapy has remained largely unstudied. Specializations emphasizing biological determinants of mental disorders, like psychiatry, might favor pharmacotherapy, while others stressing psychosocial factors, like psychology, could promote psychotherapy. Yet financial conflict of interest (COI) could be a confounding factor as authors with a medical specialization might receive more sponsoring from the pharmaceutical industry. Method We conducted a meta-analysis with subgroup and meta-regression analysis examining whether the specialization and affiliation of trial authors were associated to outcomes in the direct comparison of psychotherapy and pharmacotherapy for the acute treatment of depression. Meta-regression analysis also included trial risk of bias and author conflict of interest in relationship to the pharmaceutical industry. Results We included 45 trials. In half, the first author was psychologist. The last author was psychiatrist/MD in half of the trials, and a psychologist or statistician/other technical in the rest. Most lead authors had medical affiliations. Subgroup analysis indicated that studies with last authors statisticians favored pharmacotherapy. Univariate analysis showed a negative relationship between the presence of statisticians and outcomes favoring psychotherapy. Multivariate analysis showed that trials including authors with financial COI reported findings more favorable to pharmacotherapy. Discussion We report the first detailed overview of the background of authors conducting head to head trials for depression. Trials co-authored by statisticians appear to subtly favor pharmacotherapy. Receiving funding from the industry is more closely related to finding better outcomes for the industry’s elective treatment than are factors related to authors’ background. Limitations For a minority of authors we could

Coordinates of Human Visual and Inertial Heading Perception.

PubMed

Crane, Benjamin Thomas

2015-01-01

Heading estimation involves both inertial and visual cues. Inertial motion is sensed by the labyrinth, somatic sensation by the body, and optic flow by the retina. Because the eye and head are mobile these stimuli are sensed relative to different reference frames and it remains unclear if a perception occurs in a common reference frame. Recent neurophysiologic evidence has suggested the reference frames remain separate even at higher levels of processing but has not addressed the resulting perception. Seven human subjects experienced a 2s, 16 cm/s translation and/or a visual stimulus corresponding with this translation. For each condition 72 stimuli (360° in 5° increments) were delivered in random order. After each stimulus the subject identified the perceived heading using a mechanical dial. Some trial blocks included interleaved conditions in which the influence of ±28° of gaze and/or head position were examined. The observations were fit using a two degree-of-freedom population vector decoder (PVD) model which considered the relative sensitivity to lateral motion and coordinate system offset. For visual stimuli gaze shifts caused shifts in perceived head estimates in the direction opposite the gaze shift in all subjects. These perceptual shifts averaged 13 ± 2° for eye only gaze shifts and 17 ± 2° for eye-head gaze shifts. This finding indicates visual headings are biased towards retina coordinates. Similar gaze and head direction shifts prior to inertial headings had no significant influence on heading direction. Thus inertial headings are perceived in body-centered coordinates. Combined visual and inertial stimuli yielded intermediate results.

Coordinates of Human Visual and Inertial Heading Perception

PubMed Central

Crane, Benjamin Thomas

2015-01-01

Heading estimation involves both inertial and visual cues. Inertial motion is sensed by the labyrinth, somatic sensation by the body, and optic flow by the retina. Because the eye and head are mobile these stimuli are sensed relative to different reference frames and it remains unclear if a perception occurs in a common reference frame. Recent neurophysiologic evidence has suggested the reference frames remain separate even at higher levels of processing but has not addressed the resulting perception. Seven human subjects experienced a 2s, 16 cm/s translation and/or a visual stimulus corresponding with this translation. For each condition 72 stimuli (360° in 5° increments) were delivered in random order. After each stimulus the subject identified the perceived heading using a mechanical dial. Some trial blocks included interleaved conditions in which the influence of ±28° of gaze and/or head position were examined. The observations were fit using a two degree-of-freedom population vector decoder (PVD) model which considered the relative sensitivity to lateral motion and coordinate system offset. For visual stimuli gaze shifts caused shifts in perceived head estimates in the direction opposite the gaze shift in all subjects. These perceptual shifts averaged 13 ± 2° for eye only gaze shifts and 17 ± 2° for eye-head gaze shifts. This finding indicates visual headings are biased towards retina coordinates. Similar gaze and head direction shifts prior to inertial headings had no significant influence on heading direction. Thus inertial headings are perceived in body-centered coordinates. Combined visual and inertial stimuli yielded intermediate results. PMID:26267865

Training Head Start Teachers to Conduct Trial-Based Functional Analysis of Challenging Behavior

ERIC Educational Resources Information Center

Rispoli, Mandy; Burke, Mack D.; Hatton, Heather; Ninci, Jennifer; Zaini, Samar; Sanchez, Lisa

2015-01-01

Trial-based functional analysis (TBFA) is a procedure for experimentally identifying the function of challenging behavior within applied settings. The purpose of this study was to examine the effects of a TBFA teacher-training package in the context of two Head Start centers implementing programwide positive behavior support (PWPBS). Four Head…

To What Extent Do Head Start's Effects on Children's Language, Literacy, Mathematics, and Socio-Emotional Skills Vary across Individuals, Subgroups, and Centers?

ERIC Educational Resources Information Center

Bloom, Howard S.; Weiland, Christina

2014-01-01

Head Start is the largest publicly funded preschool program in the U.S., and one of its primary goals is to improve the school readiness of low-income children. As has been widely reported, the first randomized trial of Head Start in the program's history found some evidence that it is achieving this goal. Receiving one year of Head Start had…

The influence of the utilization time of brush heads from different types of power toothbrushes on oral hygiene assessed over a 6-month observation period: A randomized clinical trial.

PubMed

Schmickler, Jan; Wurbs, Sabine; Wurbs, Susanne; Kramer, Katharina; Rinke, Sven; Hornecker, Else; Mausberg, Rainer F; Ziebolz, Dirk

2016-12-01

This randomized clinical trial investigated the influence of the utilization time of brush heads from different types of power toothbrushes [oscillating rotating (OR) and sonic action (SA)93; on oral hygiene (plaque accumulation and gingival inflammation) over a 6-month observation period. 49 participants were randomly allocated into two groups: use of the same brush head over 6 months (NR: non-replacement) or replacement of brush head every 4 weeks over 6 months (R: replacement). Each group was subdivided into two subgroups according to kind of toothbrush (TB) used (OR and SA). Modified Quigley-Hein plaque index (QHI), papilla bleeding index (PBI), and gingival index (GI) were recorded at baseline and 2, 8, 12, 16, and 24 weeks after baseline. After 24 weeks, participants of both groups (R and NR) received a new brush head. At week 26, final QHI, PBI, and GI were recorded. QHI decreased between baseline and follow-up visits in R groups (P< 0.05), with the exception of week 12 (P= 0.26). In NR groups, no significant decrease was detected (P> 0.05). There was no significant effect of time on PBI or GI in any of R subgroups (P> 0.05). In NR oscillating/rotating TB: significant increase in PBI and GI was detected 24 weeks after baseline (PBI: P= 0.02, GI: P= 0.03); sonic action TBs showed significant decrease in PBI at every follow-up visit (P< 0.05), except at 24 weeks after baseline (P= 0.73). GI was significantly decreased at 2 weeks after baseline only (P< 0.01). Six-month use of the same brush head reduced effectiveness in removing plaque, and gingival inflammation appeared to increase after a utilization time of over 4 months. Replacing brush heads is advised after 4 months.

Comparative efficacy and safety of methylphenidate and atomoxetine for attention-deficit hyperactivity disorder in children and adolescents: Meta-analysis based on head-to-head trials.

PubMed

Liu, Qiang; Zhang, Hong; Fang, Qingqing; Qin, Lili

2017-11-01

Comparative efficacy and safety are important issues for appropriate drug selection for attention-deficit hyperactivity disorder (ADHD) treatment. Therefore we conducted a meta-analysis, where we compared atomoxetine (ATX) and methylphenidate (MPH) for ADHD treatment in children and adolescents. Literature retrieval was conducted in relevant databases from their inception to April 2016 to select head-to-head trials that compared ATX and MPH in children and adolescents. Outcomes like response rate, ADHD Rating Scale (ADHD-RS) score, and adverse events were compared between ATX and MPH treatments. The standardized mean difference (SMD) and risk ratio (RR) with their corresponding 95% confidence intervals (CIs) were used as the effect size for continuous data or dichotomous data, respectively. Eleven eligible randomized-controlled trials were included, and two of them were double-blind, while the remaining were open-label. Compared to ATX, MPH showed a higher response rate (RR = 1.14, 95% CI [1. 09, 1.20]), decreased inattention (SMD = -0.13, 95% CI [-0.25, -0.01]) and lower risk of adverse events (drowsiness: RR = 0.17, 95% CI [0.11, 0.26; nausea: RR = 0.49; 95% CI [0.29, 0.85; vomiting: RR = 0.41, 95% CI [0.27, 0.63]). However, MPH presented a higher risk of insomnia than ATX (RR = 2.27, 95% CI [1.63, 3.15], p < .01). Results of the meta-analysis add additional evidence of the effectiveness of both ATX and MPH and suggest that MPH should be a first treatment option in most patients with ADHD.

Heading and head injuries in soccer.

PubMed

Kirkendall, D T; Jordan, S E; Garrett, W E

2001-01-01

In the world of sports, soccer is unique because of the purposeful use of the unprotected head for controlling and advancing the ball. This skill obviously places the player at risk of head injury and the game does carry some risk. Head injury can be a result of contact of the head with another head (or other body parts), ground, goal post, other unknown objects or even the ball. Such impacts can lead to contusions, fractures, eye injuries, concussions or even, in rare cases, death. Coaches, players, parents and physicians are rightly concerned about the risk of head injury in soccer. Current research shows that selected soccer players have some degree of cognitive dysfunction. It is important to determine the reasons behind such deficits. Purposeful heading has been blamed, but a closer look at the studies that focus on heading has revealed methodological concerns that question the validity of blaming purposeful heading of the ball. The player's history and age (did they play when the ball was leather and could absorb significant amounts of water), alcohol intake, drug intake, learning disabilities, concussion definition and control group use/composition are all factors that cloud the ability to blame purposeful heading. What does seem clear is that a player's history of concussive episodes is a more likely explanation for cognitive deficits. While it is likely that the subconcussive impact of purposeful heading is a doubtful factor in the noted deficits, it is unknown whether multiple subconcussive impacts might have some lingering effects. In addition, it is unknown whether the noted deficits have any affect on daily life. Proper instruction in the technique is critical because if the ball contacts an unprepared head (as in accidental head-ball contacts), the potential for serious injury is possible. To further our understanding of the relationship of heading, head injury and cognitive deficits, we need to: learn more about the actual impact of a ball on the

Randomized, placebo-controlled window trial of EGFR, Src, or combined blockade in head and neck cancer.

PubMed

Bauman, Julie E; Duvvuri, Umamaheswar; Gooding, William E; Rath, Tanya J; Gross, Neil D; Song, John; Jimeno, Antonio; Yarbrough, Wendell G; Johnson, Faye M; Wang, Lin; Chiosea, Simion; Sen, Malabika; Kass, Jason; Johnson, Jonas T; Ferris, Robert L; Kim, Seungwon; Hirsch, Fred R; Ellison, Kimberly; Flaherty, John T; Mills, Gordon B; Grandis, Jennifer R

2017-03-23

BACKGROUND. EGFR and Src family kinases are upregulated in head and neck squamous cell carcinoma (HNSCC). EGFR interacts with Src to activate STAT3 signaling, and dual EGFR-Src targeting is synergistic in HNSCC preclinical models. pSrc overexpression predicted resistance to the EGFR inhibitor, erlotinib, in a prior window trial. We conducted a 4-arm window trial to identify biomarkers associated with response to EGFR and/or Src inhibition. METHODS. Patients with operable stage II-IVa HNSCC were randomized to 7-21 days of neoadjuvant erlotinib, the Src inhibitor dasatinib, the combination of both, or placebo. Paired tumor specimens were collected before and after treatment. Pharmacodynamic expression of EGFR and Src pathway components was evaluated by IHC of tissue microarrays and reverse-phase protein array of tissue lysates. Candidate biomarkers were assessed for correlation with change in tumor size. RESULTS. From April 2009 to December 2012, 58 patients were randomized and 55 were treated. There was a significant decrease in tumor size in both erlotinib arms ( P = 0.0014); however, no effect was seen with dasatinib alone ( P = 0.24). High baseline pMAPK expression was associated with response to erlotinib ( P = 0.03). High baseline pSTAT3 was associated with resistance to dasatinib ( P = 0.099). CONCLUSIONS. Brief exposure to erlotinib significantly decreased tumor size in operable HNSCC, with no additive effect from dasatinib. Baseline pMAPK expression warrants further study as a response biomarker for anti-EGFR therapy. Basal expression of pSTAT3 may be independent of Src, explain therapeutic resistance, and preclude development of dasatinib in biomarker-unselected cohorts. TRIAL REGISTRATION. NCT00779389. FUNDING. National Cancer Institute, American Cancer Society, Pennsylvania Department of Health, V Foundation for Cancer Research, Bristol-Myers Squibb, and Astellas Pharma.

Randomized, placebo-controlled window trial of EGFR, Src, or combined blockade in head and neck cancer

PubMed Central

Bauman, Julie E.; Duvvuri, Umamaheswar; Gooding, William E.; Rath, Tanya J.; Gross, Neil D.; Song, John; Jimeno, Antonio; Yarbrough, Wendell G.; Johnson, Faye M.; Wang, Lin; Chiosea, Simion; Sen, Malabika; Kass, Jason; Johnson, Jonas T.; Ferris, Robert L.; Kim, Seungwon; Hirsch, Fred R.; Ellison, Kimberly; Flaherty, John T.; Mills, Gordon B.

2017-01-01

BACKGROUND. EGFR and Src family kinases are upregulated in head and neck squamous cell carcinoma (HNSCC). EGFR interacts with Src to activate STAT3 signaling, and dual EGFR-Src targeting is synergistic in HNSCC preclinical models. pSrc overexpression predicted resistance to the EGFR inhibitor, erlotinib, in a prior window trial. We conducted a 4-arm window trial to identify biomarkers associated with response to EGFR and/or Src inhibition. METHODS. Patients with operable stage II–IVa HNSCC were randomized to 7–21 days of neoadjuvant erlotinib, the Src inhibitor dasatinib, the combination of both, or placebo. Paired tumor specimens were collected before and after treatment. Pharmacodynamic expression of EGFR and Src pathway components was evaluated by IHC of tissue microarrays and reverse-phase protein array of tissue lysates. Candidate biomarkers were assessed for correlation with change in tumor size. RESULTS. From April 2009 to December 2012, 58 patients were randomized and 55 were treated. There was a significant decrease in tumor size in both erlotinib arms (P = 0.0014); however, no effect was seen with dasatinib alone (P = 0.24). High baseline pMAPK expression was associated with response to erlotinib (P = 0.03). High baseline pSTAT3 was associated with resistance to dasatinib (P = 0.099). CONCLUSIONS. Brief exposure to erlotinib significantly decreased tumor size in operable HNSCC, with no additive effect from dasatinib. Baseline pMAPK expression warrants further study as a response biomarker for anti-EGFR therapy. Basal expression of pSTAT3 may be independent of Src, explain therapeutic resistance, and preclude development of dasatinib in biomarker-unselected cohorts. TRIAL REGISTRATION. NCT00779389. FUNDING. National Cancer Institute, American Cancer Society, Pennsylvania Department of Health, V Foundation for Cancer Research, Bristol-Myers Squibb, and Astellas Pharma. PMID:28352657

Thermoregulatory response to intraoperative head-down tilt.

PubMed

Nakajima, Yasufumi; Mizobe, Toshiki; Matsukawa, Takashi; Sessler, Daniel I; Kitamura, Yoshihiro; Tanaka, Yoshifumi

2002-01-01

Thermoregulation interacts with cardiovascular regulation within the central nervous system. We therefore evaluated the effects of head-down tilt on intraoperative thermal and cardiovascular regulation. Thirty-two patients undergoing lower-abdominal surgery were randomly assigned to the 1) supine, 2) 15 degrees -20 degrees head-down tilt, 3) leg-up, or 4) combination of leg-up and head-down tilt position. Core temperature and forearm minus fingertip skin-temperature gradients (an index of peripheral vasoconstriction) were monitored for 3 h after the induction of combined general and lumbar epidural anesthesia. We also determined cardiac output and central-venous and esophageal pressures. Neither right atrial transmural pressure nor cardiac index was altered in the Head-Down Tilt group, but both increased significantly in the Leg-Up groups. The vasoconstriction threshold was reduced in both leg-up positions but was not significantly decreased by head-down tilt. Final core temperatures were 35.2 degrees C +/- 0.2 degrees C (mean +/- SEM) in the Supine group, 35.0 degrees C +/- 0.2 degrees C in the Head-Down Tilt group, 34.2 degrees C +/- 0.2 degrees C in the Leg-Up group (P < 0.05 compared with supine), and 34.3 degrees C +/- 0.2 degrees C when leg-up and head-down tilt were combined (P < 0.05 compared with supine). These results confirm that elevating the legs increases right atrial transmural pressure, reduces the vasoconstriction threshold, and aggravates intraoperative hypothermia. Surprisingly, maintaining a head-down tilt did not increase right atrial pressure. Intraoperative hypothermia is exaggerated when patients are maintained in the leg-up position because the vasoconstriction threshold is reduced. However, head-down tilt (Trendelenburg position) does not reduce the vasoconstriction threshold or aggravate hypothermia. The head-down tilt position thus does not require special perioperative thermal precautions or management unless the leg-up position is used

Clinical Decision Support for a Multicenter Trial of Pediatric Head Trauma

PubMed Central

Swietlik, Marguerite; Deakyne, Sara; Hoffman, Jeffrey M.; Grundmeier, Robert W.; Paterno, Marilyn D.; Rocha, Beatriz H.; Schaeffer, Molly H; Pabbathi, Deepika; Alessandrini, Evaline; Ballard, Dustin; Goldberg, Howard S.; Kuppermann, Nathan; Dayan, Peter S.

2016-01-01

Summary Introduction For children who present to emergency departments (EDs) due to blunt head trauma, ED clinicians must decide who requires computed tomography (CT) scanning to evaluate for traumatic brain injury (TBI). The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated two age-based prediction rules to identify children at very low risk of clinically-important traumatic brain injuries (ciTBIs) who do not typically require CT scans. In this case report, we describe the strategy used to implement the PECARN TBI prediction rules via electronic health record (EHR) clinical decision support (CDS) as the intervention in a multicenter clinical trial. Methods Thirteen EDs participated in this trial. The 10 sites receiving the CDS intervention used the Epic® EHR. All sites implementing EHR-based CDS built the rules by using the vendor’s CDS engine. Based on a sociotechnical analysis, we designed the CDS so that recommendations could be displayed immediately after any provider entered prediction rule data. One central site developed and tested the intervention package to be exported to other sites. The intervention package included a clinical trial alert, an electronic data collection form, the CDS rules and the format for recommendations. Results The original PECARN head trauma prediction rules were derived from physician documentation while this pragmatic trial led each site to customize their workflows and allow multiple different providers to complete the head trauma assessments. These differences in workflows led to varying completion rates across sites as well as differences in the types of providers completing the electronic data form. Site variation in internal change management processes made it challenging to maintain the same rigor across all sites. This led to downstream effects when data reports were developed. Conclusions The process of a centralized build and export of a CDS system in one commercial EHR system

Tackler’s head position relative to the ball carrier is highly correlated with head and neck injuries in rugby

PubMed Central

Hasegawa, Yoshinori; Shiota, Yuki; Ota, Chihiro; Yoneda, Takeshi; Tahara, Shigeyuki; Maki, Nobukazu; Matsuura, Takahiro; Sekiguchi, Masahiro; Itoigawa, Yoshiaki; Tateishi, Tomohiko; Kaneko, Kazuo

2018-01-01

Objectives To characterise the tackler’s head position during one-on-one tackling in rugby and to determine the incidence of head, neck and shoulder injuries through analysis of game videos, injury records and a questionnaire completed by the tacklers themselves. Methods We randomly selected 28 game videos featuring two university teams in competitions held in 2015 and 2016. Tackles were categorised according to tackler’s head position. The ‘pre-contact phase’ was defined; its duration and the number of steps taken by the ball carrier prior to a tackle were evaluated. Results In total, 3970 tackles, including 317 (8.0%) with the tackler’s head incorrectly positioned (ie, in front of the ball carrier) were examined. Thirty-two head, neck or shoulder injuries occurred for an injury incidence of 0.8% (32/3970). The incidence of injury in tackles with incorrect head positioning was 69.4/1000 tackles; the injury incidence with correct head positioning (ie, behind or to one side of the ball carrier) was 2.7/1000 tackles. Concussions, neck injuries, ‘stingers’ and nasal fractures occurred significantly more often during tackles with incorrect head positioning than during tackles with correct head positioning. Significantly fewer steps were taken before tackles with incorrect head positioning that resulted in injury than before tackles that did not result in injury. Conclusion Tackling with incorrect head position relative to the ball carrier resulted in a significantly higher incidence of concussions, neck injuries, stingers and nasal fractures than tackling with correct head position. Tackles with shorter duration and distance before contact resulted in more injuries. PMID:29162618

Do oxidized zirconium femoral heads reduce polyethylene wear in cemented THAs? A blinded randomized clinical trial.

PubMed

Zaoui, Amine; Hage, Samer El; Langlois, Jean; Scemama, Caroline; Courpied, Jean Pierre; Hamadouche, Moussa

2015-12-01

Charnley low-friction torque total hip arthroplasty (THA) remains the gold standard in THA. The main cause for failure is wear of the socket. Highly crosslinked polyethylene (HXLPE) has been associated with reduced wear rates. Also, oxidized zirconium has shown in vitro reduced wear rates. However, to our knowledge, there are no data comparing oxidized zirconium femoral heads with metal heads against HXLPE or ultrahigh-molecular-weight polyethylene (UHMWPE) when 22.25-mm bearings were used, which was the same size that performed so well in Charnley-type THAs. We hypothesized that after a minimal 4-year followup (1) use of HXLPE would result in lower radiographic wear than UHMWPE when articulating with a stainless steel head or with an oxidized zirconium head; (2) use of oxidized zirconium would result in lower radiographic wear than stainless steel when articulating with UHMWPE and HXLPE; and (3) there would be no difference in terms of Merle d'Aubigné scores between the bearing couple combinations. One hundred patients were randomized to receive cemented THA with either oxidized zirconium or a stainless steel femoral head. UHMWPE was used in the first 50 patients, whereas HXLPE was used in the next 50 patients. There were 25 patients in each of the four bearing couple combinations. All other parameters were identical in both groups. Complete followup was available in 86 of these patients. Femoral head penetration was measured using a validated computer-assisted method dedicated to all-polyethylene sockets. Clinical results were compared between the groups using the Merle d'Aubigné score. In the UHMWPE series, the median steady-state penetration rate from 1 year onward was 0.03 mm/year (range, 0.003-0.25 mm/year) in the oxidized zirconium group versus 0.11 mm/year (range, 0.03-0.29 mm/year) in the metal group (difference of medians 0.08, p < 0.001). In the HXLPE series, the median steady-state penetration rate from 1 year onward was 0.02 mm/year (range, -0.32 to

Improving Self-Regulation for Obesity Prevention in Head Start: A Randomized Controlled Trial.

PubMed

Lumeng, Julie C; Miller, Alison L; Horodynski, Mildred A; Brophy-Herb, Holly E; Contreras, Dawn; Lee, Hannah; Sturza, Julie; Kaciroti, Niko; Peterson, Karen E

2017-05-01

To determine the effect of an intervention to improve emotional and behavioral self-regulation in combination with an obesity-prevention program on the prevalence of obesity and obesity-related behaviors in preschoolers. This was a cluster-randomized intervention trial in Head Start (HS) classrooms conducted in each of 4 academic years from 2011 to 2015. Participants (697 children; 49% boys; mean age: 4.1 ± 0.5 years; 48% white, 30% African American, 12% Hispanic) were randomly assigned by classroom to 1 of 3 intervention arms: (1) HS + Preschool Obesity Prevention Series (POPS) + Incredible Years Series (IYS) (HS enhanced by the POPS [program targeting evidence-based obesity-prevention behaviors] and the IYS [program to improve children's self-regulation]), (2) HS+POPS, or (3) HS. Primary outcomes were changes in prevalence of obesity, overweight/obesity, BMI z score, and teacher-reported child emotional and behavioral self-regulation; secondary outcomes were dietary intake, outdoor play, screen time, and parent nutrition knowledge and nutrition self-efficacy. HS+POPS+IYS improved teacher-reported self-regulation compared with HS+POPS ( P < .001) and HS ( P < .001), but there was no effect on the prevalence of obesity (16.4% preintervention to 14.3% postintervention in HS+POPS+IYS versus 17.3% to 14.4% in HS+POPS [ P = .54] versus 12.2% to 13.0% in HS [ P = .33]). There was no effect of HS+POPS compared with HS alone ( P = .16). There was no effect on other outcomes except for sugar-sweetened beverage intake (HS+POPS+IYS resulted in a greater decline than HS; P = .005). An intervention for parents and children to improve HS preschoolers' emotional and behavioral self-regulation in combination with an obesity-prevention curriculum did not reduce obesity prevalence or most obesity-related behaviors. Copyright © 2017 by the American Academy of Pediatrics.

Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies.

PubMed

Coghill, David; Banaschewski, Tobias; Zuddas, Alessandro; Pelaz, Antonio; Gagliano, Antonella; Doepfner, Manfred

2013-09-27

The stimulant methylphenidate (MPH) has been a mainstay of treatment for attention-deficit/hyperactivity disorder (ADHD) for many years. Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations, a new generation of long-acting MPH formulations has emerged. Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy; however, to date, relatively few head-to-head studies have been performed.The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection. A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms: attention deficit disorder with hyperactivity/drug therapy; methylphenidate/therapeutic use and All Fields: Concerta; Ritalin LA; OROS and ADHD; Medikinet; Equasym XL and ADHD; long-acting methylphenidate; Diffucaps and ADHD; SODAS and methylphenidate. No filters were applied and no language, publication date or publication status limitations were imposed. Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age; non-systematic review articles and unpublished data were not included. Of 15,295 references returned in the literature search and screened by title, 34 articles were identified for inclusion: nine articles from pharmacokinetic studies (nine studies); nine articles from laboratory school studies (six studies); two articles from randomized controlled trials (two studies); three articles from switching studies (two studies) and three articles from one observational study. Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available. At a group level, efficacy across the day generally follows the

Assessment of the effectiveness of head only and back-of-the-head electrical stunning of chickens

PubMed Central

Gibson, T. J.; Taylor, A. H.; Gregory, N. G.

2016-01-01

Abstract The study assesses the effectiveness of reversible head-only and back-of-the-head electrical stunning of chickens using 130–950 mA per bird at 50 Hz AC.Three trials were conducted to compare both stunning systems: (a) behavioural assessment of return of consciousness, (b) insensibility to thermal pain, and (c) assessment of return of brain activity with visually evoked potentials (VEPs).Assessment of behaviour suggested that the period of unconsciousness following head-only electrical stunning was shorter in hens compared to broilers.Stunning across the back-of-the-head delayed the time to return of brainstem function compared to stunning with standard head-only electrodes. Additionally, back-of-the-head stunning produced a more prolonged period of electroanalgesia compared to head-only.Based on examination of return of brain function with VEPs in hens, back-of-the-head stunning produced a shorter-lasting stun than standard head-only. However, even for standard head-only, the stun was notably shorter than previously reported. In some birds, brain function had returned within 9 s after the end of stunning.The results suggest that some birds may recover consciousness prior to or during the neck cut. Based on these findings, back-of-the-head stunning and standard head-only stunning of hens should not be recommended without further development. PMID:27023411

Randomized trial of standard pain control with or without gabapentin for pain related to radiation-induced mucositis in head and neck cancer.

PubMed

Kataoka, Tomoko; Kiyota, Naomi; Shimada, Takanobu; Funakoshi, Yohei; Chayahara, Naoko; Toyoda, Masanori; Fujiwara, Yutaka; Nibu, Ken-Ichi; Komori, Takahide; Sasaki, Ryohei; Mukohara, Toru; Minami, Hironobu

2016-12-01

Radiation-induced mucositis (RIM) in chemoradiotherapy (CRT) for head and neck cancer (HNC) causes severe pain and worsens CRT compliance, QOL and outcome. Following retrospective reports, we conducted a randomized trial of the safety and efficacy of gabapentin for RIM-associated pain during CRT. HNC patients (pts) receiving CRT were randomized to standard pain control (SPC) with acetaminophen and opioids, or SPC plus gabapentin (SPC+G). Gabapentin was maintained at 900mg/day for 4 weeks after CRT. Primary endpoint was maximum visual analogue scale (VAS) score during CRT, and secondary endpoints were total opioid dose, changes in QOL (EORTC QLQ-C30 and QLQ-HN 35) from baseline to 4 weeks after CRT, and adverse events. Twenty-two eligible Stage III or IV pts were randomly assigned to SPC or SPC+G (n=11 each). Twelve were treated in a locally advanced setting and 10 in a postoperative setting. Median maximum VAS scores, median total dose of opioids at maximum VAS and total dose of opioids at 4 weeks after CRT tended to be higher in the SPC+G arm (47 in SPC vs. 74 in SPC+G, p=0.517; 215mg vs. 745.3mg, p=0.880; and 1260mg vs. 1537.5mg, p=0.9438, respectively), without significance. QOL analysis showed significantly worse scores in the SPC+G arm for weight gain (p=0.005). Adverse events related to gabapentin were manageable. This pilot study is the first prospective randomized trial of gabapentin for RIM-related pain. Gabapentin had no apparent beneficial effect. Further research into agents for RIM-related pain is warranted. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Clinical and Radiographic Outcomes of Unipolar and Bipolar Radial Head Prosthesis in Patients with Radial Head Fracture: A Systemic Review and Meta-Analysis.

PubMed

Chen, Hongwei; Wang, Ziyang; Shang, Yongjun

2018-06-01

To compare clinical outcomes of unipolar and bipolar radial head prosthesis in the treatment of patients with radial head fracture. Medline, Cochrane, EMBASE, Google Scholar databases were searched until April 18, 2016 using the following search terms: radial head fracture, elbow fracture, radial head arthroplasty, implants, prosthesis, unipolar, bipolar, cemented, and press-fit. Randomized controlled trials, retrospective, and cohort studies were included. The Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, radiologic assessment, ROM, and grip strength following elbow replacement were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head arthroplasty, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prosthesis were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups, with both groups have comparable risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values <0.001 for both unipolar and bipolar prosthesis). However, bipolar radial head prosthesis was associated with an increased chance of heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis was not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039). Unipolar and bipolar radial head prostheses were similar with respect to clinical outcomes. Additional comparative studies are necessary to further compare different radial head prostheses used to treat radial head fracture.

Characterization of the Head Stabilization Response to a Lateral Perturbation During Walking in Older Adults

NASA Technical Reports Server (NTRS)

Buccello-Stout, Regina R.; Cromwell, Ronita L.; Bloomberg, Jacob J.

2009-01-01

A main contributor of fractures in older adults is from a lateral fall. The decline in sensory systems results in difficulty maintaining balance stability. Head stabilization contributes to postural control by serving as a stable platform for the sensory systems. The purpose of this study was to characterize the head stabilization response to a lateral perturbation while walking. A total of 16 healthy older adults, aged 66-81 years, walked across a foam pathway 6 times. One piece of the foam pathway covered a movable platform that translated to the left when the subject stepped on the foam. Three trials were randomized in which the platform shifted. Angular rate sensors placed on the center of mass of the head and trunk collected head and trunk movement in all three planes of motion. The roll plane was analyzed to examine motion in the plane of the perturbation. Subjects stepped onto the platform with the right foot. Recovery step time and distance were recorded. The first trial was analyzed to capture the novelty of the perturbation. Results indicate a significant difference in footfall distance t=0.004, p<0.05, as well as the speed of foot recovery t=0.001, p<0.05, between natural and perturbed walking. Results indicate that the head t=0.005, p<0.05, and trunk t=0.0001, p<0.05, velocities increase during perturbed compared to natural walking. Older adults place their recovery foot down faster when perturbed to re-establish their base of support. Head and trunk segments are less stable and move with greater velocities to reestablish stability when perturbed.

Changes in Head Stability Control in Response to a Lateral Perturbation while Walking in Older Adults

NASA Technical Reports Server (NTRS)

Buccello, Regina R.; Cromwell, Ronita L.; Bloomberg, Jacob J.

2008-01-01

Falling is a main contributor of injury in older adults. The decline in sensory systems associated with aging limits information needed to successfully compensate for unexpected perturbations. Therefore, sensory changes result in older adults having problems maintaining balance stability when experiencing an unexpected lateral perturbation (e.g. slip) in the environment. The goal of this study was to determine head stability movement strategies used by older adults when experiencing an unexpected lateral perturbation during walking. A total of 16 healthy adults, aged 66-81 years, walked across a foam pathway 6 times. One piece of the foam pathway covered a movable platform that translated to the left when the subject stepped on the foam. Three trials were randomized in which the platform shifted. Angular rate sensors were placed on the center of mass for the head and trunk segments to collect head and trunk movement in all three planes of motion. The predominant movement strategies for maintaining head stability were determined from the results of the cross-correlation analyses between the head and trunk segments. The Chi square test of independence was used to evaluate the movement pattern distributions of head-trunk coordination during perturbed and non-perturbed walking. When perturbed, head stabilization was significantly challenged in the yaw and roll planes of motion. Subjects demonstrated a movement pattern of the head leading the trunk in an effort to stabilize the head. The older adult subjects used this head stabilization movement pattern to compensate for sensory changes when experiencing the unexpected lateral perturbation.

Infant head circumference growth is saltatory and coupled to length growth.

PubMed

Lampl, Michelle; Johnson, Michael L

2011-05-01

Rapid growth rates of head circumference and body size during infancy have been reported to predict developmental pathologies that emerge during childhood. This study investigated whether growth in head circumference was concordant with growth in body length. Forty infants (16 males) were followed between the ages of 2 days and 21 months for durations ranging from 4 to 21 months (2616 measurements). Longitudinal anthropometric measurements were assessed weekly (n=12), semi-weekly (n=24) and daily (n=4) during home visits. Individual head circumference growth was investigated for the presence of saltatory patterns. Coincident analysis tested the null hypothesis that head growth was randomly coupled to length growth. Head circumference growth during infancy is saltatory (p<0.05), characterized by median increments of 0.20 cm (95% confidence interval, 0.10-0.30 cm) in 24-h, separated by intervals of no growth ranging from 1 to 21 days. Daily assessments identified that head growth saltations were coupled to length growth saltations within a median time frame of 2 days (interquartile 0-4, range 1-8 days). Assessed at semi-weekly and weekly intervals, an average 82% (SD 0.13) of head growth saltations was non-randomly concordant with length growth (p≤0.006). Normal infant head circumference grows by intermittent, episodic saltations that are temporally coupled to growth in total body length by a process of integrated physiology that remains to be described. Copyright © 2011 Elsevier Ltd. All rights reserved.

Long-acting methylphenidate formulations in the treatment of attention-deficit/hyperactivity disorder: a systematic review of head-to-head studies

PubMed Central

2013-01-01

Background The stimulant methylphenidate (MPH) has been a mainstay of treatment for attention-deficit/hyperactivity disorder (ADHD) for many years. Owing to the short half-life and the issues associated with multiple daily dosing of immediate-release MPH formulations, a new generation of long-acting MPH formulations has emerged. Direct head-to-head studies of these long-acting MPH formulations are important to facilitate an evaluation of their comparative pharmacokinetics and efficacy; however, to date, relatively few head-to-head studies have been performed. The objective of this systematic review was to compare the evidence available from head-to-head studies of long-acting MPH formulations and provide information that can guide treatment selection. Methods A systematic literature search was conducted in MEDLINE and PsycINFO in March 2012 using the MeSH terms: attention deficit disorder with hyperactivity/drug therapy; methylphenidate/therapeutic use and All Fields: Concerta; Ritalin LA; OROS and ADHD; Medikinet; Equasym XL and ADHD; long-acting methylphenidate; Diffucaps and ADHD; SODAS and methylphenidate. No filters were applied and no language, publication date or publication status limitations were imposed. Articles were selected if the title indicated a comparison of two or more long-acting MPH preparations in human subjects of any age; non-systematic review articles and unpublished data were not included. Results Of 15,295 references returned in the literature search and screened by title, 34 articles were identified for inclusion: nine articles from pharmacokinetic studies (nine studies); nine articles from laboratory school studies (six studies); two articles from randomized controlled trials (two studies); three articles from switching studies (two studies) and three articles from one observational study. Conclusions Emerging head-to-head studies provide important data on the comparative efficacy of the formulations available. At a group level, efficacy

Assessment of parental tooth-brushing following instruction with single-headed and triple-headed toothbrushes.

PubMed

Telishevesky, Yoel S; Levin, Liran; Ashkenazi, Malka

2012-01-01

The purpose of this study was to evaluate the effect of toothbrush design on the ability of parents to effectively brush their children's teeth. Parents of children (mean age=5.1±0.75 years old) from 4 kindergarten schools were randomly assigned to receive instruction in brushing their children's teeth using a manual single-headed toothbrush (2 schools) or a triple-headed toothbrush (2 schools). The parents' ability to brush their children's teeth was evaluated according to a novel toothbrush performing skill index (Ashkenazi Index), based on 2 criteria: (1) placement of the toothbrush on each tooth segment to be brushed ("reach"); and (2) completion of enough strokes on each segment ("stay"). One month after instruction, tooth-brushing ability was re-evaluated and plaque index of the children's teeth was assessed. One month after instruction, parents using the triple-headed toothbrush received significantly higher scores on the tooth-brushing performance index (~86%), than did those in the single-headed group (~61%; P=.001). The plaque index was significantly higher in the single-headed group (0.97±0.38) vs the triple-headed group (0.72±0.29; P<.01). The tooth-brushing performance index correlated negatively with the plaque index (P<.01). A triple-headed toothbrush promotes more consistent tooth-brushing by parents than does a single-headed toothbrush.

Adapted head- and eye-movement responses to added-head inertia

NASA Technical Reports Server (NTRS)

Gauthier, G. M.; Martin, B. J.; Stark, L. W.

1986-01-01

Adaptation to inertia added to the head was studied in men by mounting masses on a rigidly attached helmet until two- to ten-fold increases of inertia were produced, while an overhead suspension compensated for the weights. The observed changes in the eye and head movement coordination included increased head movement latencies, as well as changes in the eye movement amplitude, and later stabilizing alternate contractions of the neck muscles. Oscillopsia, or continual displacement or instability of the visual world, which is a symptom of a breakdown of space constancy, was prominent and consistent in the perceptual reports of the subjects. Although adaptation resulting from adding inertia to the head occurred much faster than that induced by adding prisms or lenses, it has similar perceptual and motor components that may be objectively studied in detail.

Rate of Hanger Reflex Occurrence: Unexpected Head Rotation on Fronto-temporal Head Compression

PubMed Central

ASAHI, Takashi; SATO, Michi; KAJIMOTO, Hiroyuki; KOH, Masaki; KASHIWAZAKI, Daina; KURODA, Satoshi

When the head is encircled with a wire clothes hanger and the unilateral fronto-temporal region is compressed, the head rotates unexpectedly. As the mechanism is unclear, however, we have temporarily named this phenomenon as the “hanger reflex.” We previously reported a case wherein this phenomenon was applied to treat cervical dystonia. Because little is known about this phenomenon, we determined how often this phenomenon is observed in healthy subjects. Study participants were 120 healthy Japanese adults (60 men and 60 women) aged 19–65 years. A wire clothes hanger was applied to each subject’s head. The longer side of the hanger was attached over the volunteer’s fronto-temporal regions on both sides of the head in succession (i.e., two applications per volunteer). We evaluated whether the subjects felt the sensation of head rotation by using a questionnaire. The sensation of head rotation was observed in 95.8% of subjects. There were five non-responders (4.2%). In 85.4% of the trials, head rotation was observed in the direction that coincided with the side compressed by the hanger. There were no differences in responses between genders. The incident rate of the hanger reflex was remarkably high and most likely represents a prevalent phenomenon in humans. The mechanism underlying the reflex remains unknown. Further research should be performed to elucidate the underlying causes of the hanger reflex, which represents a potential treatment for cervical dystonia. PMID:26119894

Stride-Cycle Influences on Goal-Directed Head Movements Made During Walking

NASA Technical Reports Server (NTRS)

Peters, Brian T.; vanEmmerik, Richard E. A.; Bloomberg, Jacob J.

2006-01-01

Horizontal head movements were studied in six subjects as they made rapid horizontal gaze adjustments while walking. The aim of the present research was to determine if gait-cycle events alter the head movement response to a visual target acquisition task. Gaze shifts of approximately 40deg were elicited by a step change in the position of a visual target from a central location to a second location in the left or right horizontal periphery. The timing of the target position change was constrained to occur at 25,50,75 and 100% of the stride cycle. The trials were randomly presented as the subjects walked on a treadmill at their preferred speed (range: 1.25 to 1.48 m/s, mean: 1.39 +/- 0.09 m/s ) . Analyses focused on the movement onset latencies of the head and eyes and on the peak velocity and saccade amplitude of the head movement response. A comparison of the group means indicated that the head movement onset lagged the eye onset (262 ms versus 252 ms). The head and eye movement onset latencies were not affected by either the direction of the target change nor the point in the gait cycle during which the target relocation occurred. However, the presence of an interaction between the gait cycle events and the direction of the visual target shift indicates that the peak head saccade velocity and head saccade amplitude are affected by the natural head oscillations that occur while walking.

Procedures for Behavioral Experiments in Head-Fixed Mice

PubMed Central

Guo, Zengcai V.; Hires, S. Andrew; Li, Nuo; O'Connor, Daniel H.; Komiyama, Takaki; Ophir, Eran; Huber, Daniel; Bonardi, Claudia; Morandell, Karin; Gutnisky, Diego; Peron, Simon; Xu, Ning-long; Cox, James; Svoboda, Karel

2014-01-01

The mouse is an increasingly prominent model for the analysis of mammalian neuronal circuits. Neural circuits ultimately have to be probed during behaviors that engage the circuits. Linking circuit dynamics to behavior requires precise control of sensory stimuli and measurement of body movements. Head-fixation has been used for behavioral research, particularly in non-human primates, to facilitate precise stimulus control, behavioral monitoring and neural recording. However, choice-based, perceptual decision tasks by head-fixed mice have only recently been introduced. Training mice relies on motivating mice using water restriction. Here we describe procedures for head-fixation, water restriction and behavioral training for head-fixed mice, with a focus on active, whisker-based tactile behaviors. In these experiments mice had restricted access to water (typically 1 ml/day). After ten days of water restriction, body weight stabilized at approximately 80% of initial weight. At that point mice were trained to discriminate sensory stimuli using operant conditioning. Head-fixed mice reported stimuli by licking in go/no-go tasks and also using a forced choice paradigm using a dual lickport. In some cases mice learned to discriminate sensory stimuli in a few trials within the first behavioral session. Delay epochs lasting a second or more were used to separate sensation (e.g. tactile exploration) and action (i.e. licking). Mice performed a variety of perceptual decision tasks with high performance for hundreds of trials per behavioral session. Up to four months of continuous water restriction showed no adverse health effects. Behavioral performance correlated with the degree of water restriction, supporting the importance of controlling access to water. These behavioral paradigms can be combined with cellular resolution imaging, random access photostimulation, and whole cell recordings. PMID:24520413

Are head-to-head trials of biologics needed? The role of value of information methods in arthritis research.

PubMed

Welton, Nicky J; Madan, Jason; Ades, Anthony E

2011-09-01

Reimbursement decisions are typically based on cost-effectiveness analyses. While a cost-effectiveness analysis can identify the optimum strategy, there is usually some degree of uncertainty around this decision. Sources of uncertainty include statistical sampling error in treatment efficacy measures, underlying baseline risk, utility measures and costs, as well as uncertainty in the structure of the model. The optimal strategy is therefore only optimal on average, and a decision to adopt this strategy might still be the wrong decision if all uncertainty could be eliminated. This means that there is a quantifiable expected (average) loss attaching to decisions made under uncertainty, and hence a value in collecting information to reduce that uncertainty. Value of information (VOI) analyses can be used to provide guidance on whether more research would be cost-effective, which particular model inputs (parameters) have the most bearing on decision uncertainty, and can also help with the design and sample size of further research. Here, we introduce the key concepts in VOI analyses, and highlight the inputs required to calculate it. The adoption of the new biologic treatments for RA and PsA tends to be based on placebo-controlled trials. We discuss the possible role of VOI analyses in deciding whether head-to-head comparisons of the biologic therapies should be carried out, illustrating with examples from other fields. We emphasize the need for a model of the natural history of RA and PsA, which reflects a consensus view.

Translation and Rotation Trade Off in Human Visual Heading Estimation

NASA Technical Reports Server (NTRS)

Stone, Leland S.; Perrone, John A.; Null, Cynthia H. (Technical Monitor)

1996-01-01

We have previously shown that, during simulated curvilinear motion, humans can make reasonably accurate and precise heading judgments from optic flow without either oculomotor or static-depth cues about rotation. We now systematically investigate the effect of varying the parameters of self-motion. We visually simulated 400 ms of self-motion along curved paths (constant rotation and translation rates, fixed retinocentric heading) towards two planes of random dots at 10.3 m and 22.3 m at mid-trial. Retinocentric heading judgments of 4 observers (2 naive) were measured for 12 different combinations of translation (T between 4 and 16 m/s) and rotation (R either 8 or 16 deg/s). In the range tested, heading bias and uncertainty decrease quasilinearly with T/R, but the bias also appears to depend on R. If depth is held constant, the ratio T/R can account for much of the variation in the accuracy and precision of human visual heading estimation, although further experiments are needed to resolve whether absolute rotation rate, total flow rate, or some other factor can account for the observed -2 deg shift between the bias curves.

Quality Assurance and Improvement in Head and Neck Cancer Surgery: From Clinical Trials to National Healthcare Initiatives.

PubMed

Simon, Christian; Caballero, Carmela

2018-05-24

It is without question in the best interest of our patients, if we can identify ways to improve the quality of care we deliver to them. Great progress has been made within the last 25 years in terms of development and implementation of quality-assurance (QA) platforms and quality improvement programs for surgery in general, and within this context for head and neck surgery. As of now, we have successfully identified process indicators that impact outcome of our patients and the quality of care we deliver as surgeons. We have developed risk calculators to determine the risk for complications of individual surgical patients. We have created perioperative guidelines for complex head and neck procedures. We have in Europe and North America created audit registries that can gather and analyze data from institutions across the world to better understand which processes need change to obtain good outcomes and improve quality of care. QA platforms can be tested within the clearly defined environment of prospective clinical trials. If positive, such programs could be rolled out within national healthcare systems, if feasible. Testing quality programs in clinical trials could be a versatile tool to help head neck cancer patients benefit directly from such initiatives on a global level.

Active head rotations and eye-head coordination

NASA Technical Reports Server (NTRS)

Zangemeister, W. H.; Stark, L.

1981-01-01

It is pointed out that head movements play an important role in gaze. The interaction between eye and head movements involves both their shared role in directing gaze and the compensatory vestibular ocular reflex. The dynamics of head trajectories are discussed, taking into account the use of parameterization to obtain the peak velocity, peak accelerations, the times of these extrema, and the duration of the movement. Attention is given to the main sequence, neck muscle EMG and details of the head-movement trajectory, types of head model accelerations, the latency of eye and head movement in coordinated gaze, gaze latency as a function of various factors, and coordinated gaze types. Clinical examples of gaze-plane analysis are considered along with the instantaneous change of compensatory eye movement (CEM) gain, and aspects of variability.

Effectiveness of a handwriting readiness program in head start: a two-group controlled trial.

PubMed

Lust, Carol A; Donica, Denise K

2011-01-01

This study measured skill improvement in prewriting skills, kindergarten readiness, first-name writing, and handwriting-nonspecific fine motor skills of students at Head Start who participated in Handwriting Without Tears-Get Set for School (HWT-GSS) programming. We conducted a two-group, nonrandomized controlled trial using a pretest-posttest design at a rural Head Start. The effectiveness of adding the HWT-GSS curriculum in one preschool classroom was compared with a control classroom. On posttesting, the experimental group made significant improvements compared with the control group in prewriting, kindergarten readiness, and fine motor skills. Both groups made significant improvements between pretesting and posttesting in prewriting, first name writing, and school readiness. Adding HWT-GSS to the Head Start program would be beneficial in improving handwriting readiness skills.

Do Head Start Impacts Vary by Neighborhood Context?

ERIC Educational Resources Information Center

Morris, Pamela A.; Connors, Maia C.; McCoy, Dana Charles; Gomez, Celia J.; Yoshikawa, Hiro; Aber, J. Lawrence

2014-01-01

This paper capitalizes on the addition of geocodes for Head Start centers in which children were randomly assigned to address questions about the role of neighborhood characteristics in moderating impacts of assignment to the Head Start program. Researchers explore the extent to which impacts of assignment to Head Start on outcomes for children…

Head lice

MedlinePlus

Pediculosis capitis - head lice ... Head lice infect hair on the head. Tiny eggs on the hair look like flakes of dandruff . However, ... flaking off the scalp, they stay in place. Head lice can live up to 30 days on a ...

Head Lice

MedlinePlus

What are head lice? Head lice are tiny insects that live on people's heads. Adult lice are about the size of sesame seeds. The eggs, called ... often at the neckline and behind the ears. Head lice are parasites, and they need to feed on ...

Differences in highly cross-linked polyethylene wear between zirconia and cobalt-chromium femoral heads in Japanese patients: a prospective, randomized study.

PubMed

Kawate, Kenji; Ohmura, Tetsuji; Kawahara, Ikuo; Tamai, Katsuya; Ueha, Tomoyuki; Takemura, Kazuo

2009-12-01

The purpose of this study was to compare highly cross-linked polyethylene wear between the zirconia head and the cobalt-chromium head in Japanese patients. A prospective, randomized study was performed to evaluate the outcomes in 32 hips that had zirconia heads and in 30 hips that had cobalt-chromium heads. The mean follow-up periods of both groups were same (5 years). There were no significant differences between the zirconia head and the cobalt-chromium head in the mean polyethylene linear wear per year and the mean volumetric polyethylene wear per year in the steady phase. This study indicates that zirconia head offers no benefits over metal head in terms of wear reduction at 5 years in Japanese patients who have lightweight and thin polyethylene liners.

Detection of Sound Image Movement During Horizontal Head Rotation

PubMed Central

Ohba, Kagesho; Iwaya, Yukio; Suzuki, Yôiti

2016-01-01

Movement detection for a virtual sound source was measured during the listener’s horizontal head rotation. Listeners were instructed to do head rotation at a given speed. A trial consisted of two intervals. During an interval, a virtual sound source was presented 60° to the right or left of the listener, who was instructed to rotate the head to face the sound image position. Then in one of a pair of intervals, the sound position was moved slightly in the middle of the rotation. Listeners were asked to judge the interval in a trial during which the sound stimuli moved. Results suggest that detection thresholds are higher when listeners do head rotation. Moreover, this effect was found to be independent of the rotation velocity. PMID:27698993

The temporal dynamics of heading perception in the presence of moving objects

PubMed Central

Fajen, Brett R.

2015-01-01

Many forms of locomotion rely on the ability to accurately perceive one's direction of locomotion (i.e., heading) based on optic flow. Although accurate in rigid environments, heading judgments may be biased when independently moving objects are present. The aim of this study was to systematically investigate the conditions in which moving objects influence heading perception, with a focus on the temporal dynamics and the mechanisms underlying this bias. Subjects viewed stimuli simulating linear self-motion in the presence of a moving object and judged their direction of heading. Experiments 1 and 2 revealed that heading perception is biased when the object crosses or almost crosses the observer's future path toward the end of the trial, but not when the object crosses earlier in the trial. Nonetheless, heading perception is not based entirely on the instantaneous optic flow toward the end of the trial. This was demonstrated in Experiment 3 by varying the portion of the earlier part of the trial leading up to the last frame that was presented to subjects. When the stimulus duration was long enough to include the part of the trial before the moving object crossed the observer's path, heading judgments were less biased. The findings suggest that heading perception is affected by the temporal evolution of optic flow. The time course of dorsal medial superior temporal area (MSTd) neuron responses may play a crucial role in perceiving heading in the presence of moving objects, a property not captured by many existing models. PMID:26510765

Heading Frequency Is More Strongly Related to Cognitive Performance Than Unintentional Head Impacts in Amateur Soccer Players.

PubMed

Stewart, Walter F; Kim, Namhee; Ifrah, Chloe; Sliwinski, Martin; Zimmerman, Molly E; Kim, Mimi; Lipton, Richard B; Lipton, Michael L

2018-01-01

Compared to heading, unintentional head impacts (e.g., elbow to head, head to head, head to goalpost) in soccer are more strongly related to risk of moderate to very severe Central Nervous System (CNS) symptoms. But, most head impacts associated with CNS symptoms that occur in soccer are mild and are more strongly related to heading. We tested for a differential relation of heading and unintentional head impacts with neuropsychological (NP) test performance. Active adult amateur soccer players were recruited in New York City and the surrounding areas for this repeated measures longitudinal study of individuals who were enrolled if they had 5+ years of soccer play and were active playing soccer 6+ months/year. All participants completed a baseline validated questionnaire ("HeadCount-2w"), reporting 2-week recall of soccer activity, heading and unintentional head impacts. In addition, participants also completed NP tests of verbal learning, verbal memory, psychomotor speed, attention, and working memory. Most participants also completed one or more identical follow-up protocols (i.e., HeadCount-2w and NP tests) at 3- to 6-month intervals over a 2-year period. Repeated measures General Estimating Equations (GEE) linear models were used to determine if variation in NP tests at each visit was related to variation in either heading or unintentional head impacts in the 2-week period before testing. 308 players (78% male) completed 741 HeadCount-2w. Mean (median) heading/2-weeks was 50 (17) for men and 26 (7) for women. Heading was significantly associated with poorer performance on psychomotor speed ( p  < 0.001) and attention ( p  = 0.02) tasks and was borderline significant with poorer performance on the working memory ( p  = 0.06) task. Unintentional head impacts were not significantly associated with any NP test. Results did not differ after excluding 22 HeadCount-2w with reported concussive or borderline concussive symptoms. Poorer NP test performance was

Spinosad for the treatment of head lice infestations.

PubMed

Villegas, S C

2012-09-01

Head lice infestations continue to be an issue in today's society, with an increase in economic cost and resistance. Spinosad 0.9% topical suspension was recently introduced in the U.S. market as a novel agent with both pediculicidal and ovicidal activity, approved in children 4 years of age and older for the treatment of head lice infestations. In clinical trials, it has demonstrated effectiveness against head lice with permethrin resistance. In two clinical trials comparing spinosad to permethrin, efficacy was observed in the spinosad-treated groups at 84.6% and 86.7%, respectively, when compared to the permethrin-treated groups (respective values of 44.9% and 42.9%; P < 0.001). Overall, spinosad was well tolerated in clinical trials. Copyright 2012 Prous Science, S.A.U. or its licensors. All rights reserved.

Firing properties of rat lateral mammillary single units: head direction, head pitch, and angular head velocity.

PubMed

Stackman, R W; Taube, J S

1998-11-01

Many neurons in the rat anterodorsal thalamus (ADN) and postsubiculum (PoS) fire selectively when the rat points its head in a specific direction in the horizontal plane, independent of the animal's location and ongoing behavior. The lateral mammillary nuclei (LMN) are interconnected with both the ADN and PoS and, therefore, are in a pivotal position to influence ADN/PoS neurophysiology. To further understand how the head direction (HD) cell signal is generated, we recorded single neurons from the LMN of freely moving rats. The majority of cells discharged as a function of one of three types of spatial correlates: (1) directional heading, (2) head pitch, or (3) angular head velocity (AHV). LMN HD cells exhibited higher peak firing rates and greater range of directional firing than that of ADN and PoS HD cells. LMN HD cells were modulated by angular head velocity, turning direction, and anticipated the rat's future HD by a greater amount of time (approximately 95 msec) than that previously reported for ADN HD cells (approximately 25 msec). Most head pitch cells discharged when the rostrocaudal axis of the rat's head was orthogonal to the horizontal plane. Head pitch cell firing was independent of the rat's location, directional heading, and its body orientation (i.e., the cell discharged whenever the rat pointed its head up, whether standing on all four limbs or rearing). AHV cells were categorized as fast or slow AHV cells depending on whether their firing rate increased or decreased in proportion to angular head velocity. These data demonstrate that LMN neurons code direction and angular motion of the head in both horizontal and vertical planes and support the hypothesis that the LMN play an important role in processing both egocentric and allocentric spatial information.

A Randomized Double-Blind Placebo-Controlled Trial of Fruit and Vegetable Concentrates on Intermediate Biomarkers in Head and Neck Cancer

PubMed Central

Datta, Mridul; Shaw, Edward G.; Lesser, Glenn J.; Case, L. Douglas; Vitolins, Mara Z.; Schneider, Charles; Frizzell, Bart; Sullivan, Christopher; Lively, Mark; Franzmann, Elizabeth; Hu, Jennifer J.

2017-01-01

Background. Head and neck cancer (HNC) patients are at an increased risk for developing second primary tumors (SPTs). Diets rich in fruits and vegetables (FVs) may lower HNC risk. FV concentrates may offer a potential alternative to increasing FV intake. Methods. We conducted a randomized, double-blind, placebo-controlled trial to evaluate whether Juice PLUS+ (JP; a commercial product with multiple FV concentrates) has an effect on p27 and Ki-67, biomarkers associated with the risk of SPTs. During 2004-2008, we randomized 134 HNC patients to 12 weeks of JP (n = 72) or placebo (n = 62). Oral cavity mucosal biopsies and whole blood were obtained at baseline and after 12 weeks. All participants were given the opportunity to receive JP for 5 years following the end of the intervention period, and they were followed yearly for the development of SPTs. Results. After 12 weeks, patients on JP had significantly higher serum α-carotene (P = .009), β-carotene (P < .0001), and lutein (P = .003) but did not differ significantly in p27 (P = .23) or Ki-67 (P = .95). JP use following the initial 12-week trial was not significantly associated with SPT prevention. Conclusions. Despite increased serum micronutrient levels, our results do not suggest a clinical benefit of JP in HNC patients. Future studies should focus on longer intervention periods and/or modified supplement formulations with demonstrated chemopreventive properties. PMID:28102098

Ice hockey shoulder pad design and the effect on head response during shoulder-to-head impacts.

PubMed

Richards, Darrin; Ivarsson, B Johan; Scher, Irving; Hoover, Ryan; Rodowicz, Kathleen; Cripton, Peter

2016-11-01

Ice hockey body checks involving direct shoulder-to-head contact frequently result in head injury. In the current study, we examined the effect of shoulder pad style on the likelihood of head injury from a shoulder-to-head check. Shoulder-to-head body checks were simulated by swinging a modified Hybrid-III anthropomorphic test device (ATD) with and without shoulder pads into a stationary Hybrid-III ATD at 21 km/h. Tests were conducted with three different styles of shoulder pads (traditional, integrated and tethered) and without shoulder pads for the purpose of control. Head response kinematics for the stationary ATD were measured. Compared to the case of no shoulder pads, the three different pad styles significantly (p < 0.05) reduced peak resultant linear head accelerations of the stationary ATD by 35-56%. The integrated shoulder pads reduced linear head accelerations by an additional 18-21% beyond the other two styles of shoulder pads. The data presented here suggest that shoulder pads can be designed to help protect the head of the struck player in a shoulder-to-head check.

Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players

PubMed Central

Swartz, Erik E.; Broglio, Steven P.; Cook, Summer B.; Cantu, Robert C.; Ferrara, Michael S.; Guskiewicz, Kevin M.; Myers, Jay L.

2015-01-01

Objective To test a helmetless-tackling behavioral intervention for reducing head impacts in National Collegiate Athletic Association Division I football players. Design Randomized controlled clinical trial. Setting Football field. Patients or Other Participants Fifty collegiate football players (intervention = 25, control = 25). Intervention(s) The intervention group participated in a 5-minute tackling drill without their helmets and shoulder pads twice per week in the preseason and once per week through the season. During this time, the control group performed noncontact football skills. Main Outcome Measure(s) Frequency of head impacts was recorded by an impact sensor for each athlete-exposure (AE). Data were tested with a 2 × 3 (group and time) repeated-measures analysis of variance. Significant interactions and main effects (P < .05) were followed with t tests. Results Head impacts/AE decreased for the intervention group compared with the control group by the end of the season (9.99 ± 6.10 versus 13.84 ± 7.27, respectively). The intervention group had 30% fewer impacts/AE than the control group by season's end (9.99 ± 6.10 versus 14.32 ± 8.45, respectively). Conclusion A helmetless-tackling training intervention reduced head impacts in collegiate football players within 1 season. PMID:26651278

Fetal head detection and measurement in ultrasound images by a direct inverse randomized Hough transform

NASA Astrophysics Data System (ADS)

Lu, Wei; Tan, Jinglu; Floyd, Randall C.

2005-04-01

Object detection in ultrasound fetal images is a challenging task for the relatively low resolution and low signal-to-noise ratio. A direct inverse randomized Hough transform (DIRHT) is developed for filtering and detecting incomplete curves in images with strong noise. The DIRHT combines the advantages of both the inverse and the randomized Hough transforms. In the reverse image, curves are highlighted while a large number of unrelated pixels are removed, demonstrating a "curve-pass filtering" effect. Curves are detected by iteratively applying the DIRHT to the filtered image. The DIRHT was applied to head detection and measurement of the biparietal diameter (BPD) and head circumference (HC). No user input or geometric properties of the head were required for the detection. The detection and measurement took 2 seconds for each image on a PC. The inter-run variations and the differences between the automatic measurements and sonographers" manual measurements were small compared with published inter-observer variations. The results demonstrated that the automatic measurements were consistent and accurate. This method provides a valuable tool for fetal examinations.

AHNS Series: Do you know your guidelines? Perioperative antithrombotic management in head and neck surgery.

PubMed

Meyer, Annika; Gross, Neil; Teng, Marita

2018-01-01

Head and neck surgeons are commonly faced with surgical patients who have underlying medical problems requiring antithrombotic therapy. It is difficult to achieve a balance between minimizing the risk of thromboembolism and hemorrhage in the perioperative period. Data from randomized, controlled trials are limited, and procedure-specific bleed rates are also difficult to pinpoint. The decision is made more difficult when patients with moderate-to-high risk for thromboembolic events undergo procedures that are high risk for bleeding. This is true for many head and neck oncologic surgeries. Furthermore, although elective procedures may be delayed for optimization of antithrombotic medication, emergent procedures cannot. Head and neck surgery often represents the most challenging of all these circumstances, given the potential risk of airway compromise from bleeding after head and neck surgery. © 2017 Wiley Periodicals, Inc.

Changes in maximum bite force related to extension of the head.

PubMed

Hellsing, E; Hagberg, C

1990-05-01

The maximum bite force and position of the hyoid bone during natural and extended head posture were studied in 15 adults. All participants had normal occlusions and full dentitions. In addition, there were no signs or symptoms of craniomandibular disorders. The bite force was measured with a bite force sensor placed between the first molars. Six registrations of gradually increasing bite force up to a maximum were made with randomized natural and extended head postures. With one exception, the mean maximum bite force value was found to be higher for every subject with extended head posture compared to natural head posture. The sample mean was 271.6 Newton in natural head posture and 321.5 Newton with 20 degrees extension. With changed head posture, the cephalometric measurements pointed towards a changed position of the hyoid bone in relation to the mandible and pharyngeal airway. The cephalometric changes in the position of the hyoid bone could be due to a changed interplay between the elevator and depressor muscle groups. This was one factor which could have influenced the registered maximum bite force.

Multidimensional Assessment of Functional Outcomes in Schizophrenia: Results From QUALIFY, a Head-to-Head Trial of Aripiprazole Once-Monthly and Paliperidone Palmitate.

PubMed

Potkin, Steven G; Loze, Jean-Yves; Forray, Carlos; Baker, Ross A; Sapin, Christophe; Peters-Strickland, Timothy; Beillat, Maud; Nylander, Anna-Greta; Hertel, Peter; Nitschky Schmidt, Simon; Eramo, Anna; Hansen, Karina; Naber, Dieter

2017-01-01

QUALIFY was a 28-week, randomized, open-label, head-to-head trial that assessed improvements across multiple measures in stable patients with schizophrenia with aripiprazole once-monthly 400 mg vs paliperidone palmitate. Secondary effectiveness assessments included physician-rated readiness for work using the Work Readiness Questionnaire, the Clinical Global Impression-Severity and Clinical Global Impression-Improvement scales, and quality of life with the rater-blinded Heinrichs-Carpenter Quality of Life Scale. Patients assessed their treatment satisfaction and quality of life with Subjective Well-Being under Neuroleptic Treatment-short version and Tolerability and Quality of Life questionnaires. Odds of being ready for work at week 28 were significantly higher with aripiprazole once-monthly 400 mg vs paliperidone palmitate (adjusted odds ratio, 2.67; 95% CI, 1.39-5.14; P=.003). Aripiprazole once-monthly 400 mg produced numerically or significantly greater improvements from baseline vs paliperidone palmitate in all Quality of Life Scale items. With aripiprazole once-monthly 400 mg vs paliperidone palmitate at week 28, there were significantly more Clinical Global Impression-Severity and Clinical Global Impression-Improvement responders (adjusted odds ratio, 2.26; P=.010, and 2.51; P=.0032) and significantly better Clinical Global Impression-Improvement scores (least squares mean treatment difference, -0.326; 95% CI, -0.60 to -0.05; P=.020). Numerically larger improvements with aripiprazole once-monthly 400 mg vs paliperidone palmitate were observed for patient-rated scales Subjective Well-Being under Neuroleptic Treatment-short version and Tolerability and Quality of Life. Partial correlations were strongest among clinician-rated and among patient-rated scales but poorest between clinician and patient-rated scales. Consistently greater improvements were observed with aripiprazole once-monthly 400 mg vs paliperidone palmitate across all measures. Partial

Classroom-based Interventions and Teachers’ Perceived Job Stressors and Confidence: Evidence from a Randomized Trial in Head Start Settings

PubMed Central

Zhai, Fuhua; Raver, C. Cybele; Li-Grining, Christine

2011-01-01

Preschool teachers’ job stressors have received increasing attention but have been understudied in the literature. We investigated the impacts of a classroom-based intervention, the Chicago School Readiness Project (CSRP), on teachers’ perceived job stressors and confidence, as indexed by their perceptions of job control, job resources, job demands, and confidence in behavior management. Using a clustered randomized controlled trial (RCT) design, the CSRP provided multifaceted services to the treatment group, including teacher training and mental health consultation, which were accompanied by stress-reduction services and workshops. Overall, 90 teachers in 35 classrooms at 18 Head Start sites participated in the study. After adjusting for teacher and classroom factors and site fixed effects, we found that the CSRP had significant effects on the improvement of teachers’ perceived job control and work-related resources. We also found that the CSRP decreased teachers’ confidence in behavior management and had no statistically significant effects on job demands. Overall, we did not find significant moderation effects of teacher race/ethnicity, education, teaching experience, or teacher type. The implications for research and policy are discussed. PMID:21927538

Classroom-based Interventions and Teachers' Perceived Job Stressors and Confidence: Evidence from a Randomized Trial in Head Start Settings.

PubMed

Zhai, Fuhua; Raver, C Cybele; Li-Grining, Christine

2011-09-01

Preschool teachers' job stressors have received increasing attention but have been understudied in the literature. We investigated the impacts of a classroom-based intervention, the Chicago School Readiness Project (CSRP), on teachers' perceived job stressors and confidence, as indexed by their perceptions of job control, job resources, job demands, and confidence in behavior management. Using a clustered randomized controlled trial (RCT) design, the CSRP provided multifaceted services to the treatment group, including teacher training and mental health consultation, which were accompanied by stress-reduction services and workshops. Overall, 90 teachers in 35 classrooms at 18 Head Start sites participated in the study. After adjusting for teacher and classroom factors and site fixed effects, we found that the CSRP had significant effects on the improvement of teachers' perceived job control and work-related resources. We also found that the CSRP decreased teachers' confidence in behavior management and had no statistically significant effects on job demands. Overall, we did not find significant moderation effects of teacher race/ethnicity, education, teaching experience, or teacher type. The implications for research and policy are discussed.

The effectiveness of thyme honey for the management of treatment-induced xerostomia in head and neck cancer patients: A feasibility randomized control trial.

PubMed

Charalambous, Andreas; Lambrinou, Ekaterini; Katodritis, Nicos; Vomvas, Dimitrios; Raftopoulos, Vasilios; Georgiou, Morpho; Paikousis, Lefkios; Charalambous, Melanie

2017-04-01

Radiation-induced xerostomia is one of the most common side effects that head and neck cancer patients experience during and after treatment. Despite the various methods for the prevention and treatment of radiation-induced xerostomia, it remains highly prevalent among patients treated for head and neck cancers negatively influencing their lives. The purpose of this study was to evaluate the effectiveness of thyme honey as a means for managing radiation-induced xerostomia. This was a parallel randomised controlled trial with two equal arms, the experimental arm (thyme honey) and the control arm (saline). 72 head and neck cancer patients receiving radiotherapy or/and chemotherapy or/and surgery were recruited in a specialised cancer centre. Patients in both arms followed the same administration protocol with thyme honey and saline respectively. Identical assessments at baseline, 1 month and 6 months following completion of the intervention were performed in both arms including the National Cancer Institute (NCI) xerostomia scale and the Xerostomia Questionnaire (XQ) additionally to weekly oral clinical assessments. The ClinicalTrials.gov Identifier for this study is NCT01465308. Linear Mixed Models revealed the statistically significant effect of the intervention on xerostomia (F = 8.474 p < 0.001) and overall quality of life (F = 13.158 p < 0.001). Moreover, Generalised Estimating Equations revealed a statistically significant effect on strong and unbearable pain (F = 10.524 p < 0.001) and dysphagia (F = 4.525 p = 0.033). The study has demonstrated the safety and efficacy findings of Thyme honey in head and neck cancer patients for the management of treatment induced xerostomia. Copyright © 2017 Elsevier Ltd. All rights reserved.

What Makes a Difference: Early Head Start Evaluation Findings in a Developmental Context

ERIC Educational Resources Information Center

Love, John M.; Chazan-Cohen, Rachel; Raikes, Helen; Brooks-Gunn, Jeanne

2013-01-01

The federal Early Head Start (EHS) program began in 1995, and a randomized trial was conducted to evaluate the efficacy of 17 EHS programs. In all, 3,001 low-income families (35% African American, 24% Hispanic, and 37% White) with a pregnant women or an infant under the age of 12 months were randomly assigned to a treatment or control group (with…

Reducing the risk of ventilator-acquired pneumonia through head of bed elevation.

PubMed

Keeley, Libby

2007-01-01

It has been suggested that placing critically ill ventilated patients in a semirecumbent position minimizes the likelihood of nosocomial pneumonia. This pilot study explores whether the incidence of ventilator-acquired pneumonia (VAP) can be reduced by elevating the head of the bed to 45 degrees. The design is quantitative in nature, using a randomized controlled trial. The method involves adult ventilated patients being randomly assigned to one of two positions, i.e. 45 degrees raised head of bed (treatment group) or 25 degrees raised head of bed (control group). Data collection relied upon the diagnosis of clinically suspected and microbiologically confirmed pneumonia defined by the Consensus Conference on VAP. Thirty patients were included in the study--17 in the treatment group and 13 in the control group. Results showed that 29% (five) in the treatment group and 54% (seven) in the control group contracted VAP (P < 0.176). There was a trend towards a reduction in VAP in the patients nursed at 45 degrees. However, because of the sample size this difference did not reach statistical significance.

Treatment of head louse infestation with 4% dimeticone lotion: randomised controlled equivalence trial

PubMed Central

Burgess, Ian F; Brown, Christine M; Lee, Peter N

2005-01-01

Objective To evaluate the efficacy and safety of 4% dimeticone lotion for treatment of head louse infestation. Design Randomised controlled equivalence trial. Setting Community, with home visits. Participants 214 young people aged 4 to 18 years and 39 adults with active head louse infestation. Interventions Two applications seven days apart of either 4.0% dimeticone lotion, applied for eight hours or overnight, or 0.5% phenothrin liquid, applied for 12 hours or overnight. Outcome measures Cure of infestation (no evidence of head lice after second treatment) or reinfestation after cure. Results Cure or reinfestation after cure occurred in 89 of 127 (70%) participants treated with dimeticone and 94 of 125 (75%) treated with phenothrin (difference -5%, 95% confidence interval -16% to 6%). Per protocol analysis showed that 84 of 121 (69%) participants were cured with dimeticone and 90 of 116 (78%) were cured with phenothrin. Irritant reactions occurred significantly less with dimeticone (3/127, 2%) than with phenothrin (11/125, 9%; difference -6%, -12% to -1%). Per protocol this was 3 of 121 (3%) participants treated with dimeticone and 10 of 116 (9%) treated with phenothrin (difference -6%, -12% to -0.3%). Conclusion Dimeticone lotion cures head louse infestation. Dimeticone seems less irritant than existing treatments and has a physical action on lice that should not be affected by resistance to neurotoxic insecticides. PMID:15951310

Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial.

PubMed

Roberts, Ian; Yates, David; Sandercock, Peter; Farrell, Barbara; Wasserberg, Jonathan; Lomas, Gabrielle; Cottingham, Rowland; Svoboda, Petr; Brayley, Nigel; Mazairac, Guy; Laloë, Véronique; Muñoz-Sánchez, Angeles; Arango, Miguel; Hartzenberg, Bennie; Khamis, Hussein; Yutthakasemsunt, Surakrant; Komolafe, Edward; Olldashi, Fatos; Yadav, Yadram; Murillo-Cabezas, Francisco; Shakur, Haleema; Edwards, Phil

Corticosteroids have been used to treat head injuries for more than 30 years. In 1997, findings of a systematic review suggested that these drugs reduce risk of death by 1-2%. The CRASH trial--a multicentre international collaboration--aimed to confirm or refute such an effect by recruiting 20000 patients. In May, 2004, the data monitoring committee disclosed the unmasked results to the steering committee, which stopped recruitment. 10008 adults with head injury and a Glasgow coma score (GCS) of 14 or less within 8 h of injury were randomly allocated 48 h infusion of corticosteroids (methylprednisolone) or placebo. Primary outcomes were death within 2 weeks of injury and death or disability at 6 months. Prespecified subgroup analyses were based on injury severity (GCS) at randomisation and on time from injury to randomisation. Analysis was by intention to treat. Effects on outcomes within 2 weeks of randomisation are presented in this report. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN74459797. Compared with placebo, the risk of death from all causes within 2 weeks was higher in the group allocated corticosteroids (1052 [21.1%] vs 893 [17.9%] deaths; relative risk 1.18 [95% CI 1.09-1.27]; p=0.0001). The relative increase in deaths due to corticosteroids did not differ by injury severity (p=0.22) or time since injury (p=0.05). Our results show there is no reduction in mortality with methylprednisolone in the 2 weeks after head injury. The cause of the rise in risk of death within 2 weeks is unclear.

Cumulative cisplatin dose in concurrent chemoradiotherapy for head and neck cancer: A systematic review.

PubMed

Strojan, Primož; Vermorken, Jan B; Beitler, Jonathan J; Saba, Nabil F; Haigentz, Missak; Bossi, Paolo; Worden, Francis P; Langendijk, Johannes A; Eisbruch, Avraham; Mendenhall, William M; Lee, Anne W M; Harrison, Louis B; Bradford, Carol R; Smee, Robert; Silver, Carl E; Rinaldo, Alessandra; Ferlito, Alfio

2016-04-01

The optimal cumulative dose and timing of cisplatin administration in various concurrent chemoradiotherapy protocols for nonmetastatic head and neck squamous cell carcinoma (HNSCC) has not been determined. The absolute survival benefit at 5 years of concurrent chemoradiotherapy protocols versus radiotherapy alone observed in prospective randomized trials reporting on the use of cisplatin monochemotherapy for nonnasopharyngeal HNSCC was extracted. In the case of nonrandomized studies, the outcome results at 2 years were compared between groups of patients receiving different cumulative cisplatin doses. Eleven randomized trials and 7 nonrandomized studies were identified. In 6 definitive radiotherapy phase III trials, a statistically significant association (p = .027) between cumulative cisplatin dose, independent of the schedule, and overall survival benefit was observed for higher doses. Results support the conclusion that the cumulative dose of cisplatin in concurrent chemoradiation protocols for HNSCC has a significant positive correlation with survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E2151-E2158, 2016. © 2015 Wiley Periodicals, Inc.

Similar range of motion and function after resurfacing large–head or standard total hip arthroplasty

PubMed Central

2013-01-01

Background and purpose Large–size hip articulations may improve range of motion (ROM) and function compared to a 28–mm THA, and the low risk of dislocation allows the patients more activity postoperatively. On the other hand, the greater extent of surgery for resurfacing hip arthroplasty (RHA) could impair rehabilitation. We investigated the effect of head size and surgical procedure on postoperative rehabilitation in a randomized clinical trial (RCT). Methods We followed randomized groups of RHAs, large–head THAs and standard THAs at 2 months, 6 months, 1 and 2 years postoperatively, recording clinical rehabilitation parameters. Results Large articulations increased the mean total range of motion by 13° during the first 6 postoperative months. The increase was not statistically significant and was transient. The 2–year total ROM (SD) for RHA, standard THA, and large–head THA was 221° (35), 232° (36), and 225° (30) respectively, but the differences were not statistically significant. The 3 groups were similar regarding Harris hip score, UCLA activity score, step rate, and sick leave. Interpretation Head size had no influence on range of motion. The lack of restriction allowed for large articulations did not improve the clinical and patient–perceived outcomes. The more extensive surgical procedure of RHA did not impair the rehabilitation. This project is registered at ClinicalTrials.gov under # NCT01113762. PMID:23530872

[Acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages:a clinical randomized controlled trial].

PubMed

Wang, Zhanyou; Zhou, Xuelong; Xie, Lishuang; Liang, Dongyue; Wang, Ying; Zhang, Hong-An; Zheng, Jinghong

2016-10-12

To compare the efficacy difference between acupotomy and acupuncture in the treatment of avascular necrosis of femoral head at the early and middle stages. The randomized controlled prospective study method was adopted. Sixty cases of avascular necrosis of femoral head at Ficat-ArletⅠto Ⅱ stages were randomized into an acupotomy group (32 cases) and an acupuncture group (28 cases) by the third part. In the acupotomy group, the acupotomy was adopted for the loose solution at the treatment sites of hip joint, once every two weeks, totally for 3 times. In the acupuncture group, ashi points around the hip joint were selected and stimulated with warm acupuncture therapy, once every day, for 6 weeks. Harris hip score was observed before and after treatment. The efficacy was evaluated in the two groups. Harris hip score was improved significantly after treatment in the two groups (both P <0.05). The result in acupotomy group was better than that in the acupuncture group ( P <0.05). The effective rate was 90.6% (29/32) in the acupotomy group, better than 75.0% (21/28) in the acupuncture group after treatment ( P <0.05). Harris hip score and the effective rate in the acupotomy group are better than those in the treatment with routine acupuncture for avascular necrosis of femoral head at the early and middle stages.

A pilot study of the use of oral ivermectin to treat head lice in primary school students in Australia.

PubMed

Currie, Marian J; Reynolds, Graham J; Glasgow, Nicholas J; Bowden, Francis J

2010-01-01

Head lice are a common, costly public health problem worldwide. We aimed to determine the feasibility of an ivermectin intervention program. Consenting students in two schools were screened for head lice. Infested students and siblings at one school were offered a head lice fact sheet and two doses of oral ivermectin, 7 days apart. Parents of infested students in the other school were given the same fact sheet and asked to treat the child and siblings using their preferred topical treatment. Seven hundred two of 754 (93.1%) students enrolled in the two schools were screened; 40 (5.3%; 95% CI 3.7-6.9) had head lice; 31 (9.4%; 95% CI 6.1-12.2) in the intervention school and nine (2.5%; 95% CI 1.1-3.8) in the control school. Subsequently 93.6% of children in the intervention school were treated with oral ivermectin. No adverse events were reported. At 6 months the reduction in the head lice infestation rates for the intervention and control schools were 87% and 56%, respectively. This pilot study suggests that school wide screening for head lice and the administration of oral ivermectin is feasible and acceptable. A randomized controlled trial at 20 schools is planned. © 2010 Wiley Periodicals, Inc.

Preventive Effect of Glycyrrhiza Glabra Extract on Oral Mucositis in Patients Under Head and Neck Radiotherapy: A Randomized Clinical Trial

PubMed Central

Najafi, Shamsolmolok; Koujan, Soraiya Ebrahimpour; Manifar, Soheila; Kharazifard, Mohammad Javad; Kidi, Saba

2017-01-01

Objectives: About two-thirds of cancer patients undergo radiotherapy. Oral mucositis represents a major complication of radiotherapy, causing morbidity and mortality and decreasing the quality of life of patients. This study aimed to assess the preventive effect of Glycyrrhiza aqueous extract on oral mucositis in cancer patients under head and neck radiotherapy. Materials and Methods: In this double-blind clinical trial, 37 head and neck cancer patients were divided into intervention (n=19) group receiving Glycyrrhiza aqueous extract and control (n=18) group receiving placebo. Patients in the test group used Glycyrrhiza aqueous extract topically twice a day from the first day of starting radiotherapy until the end of the second week. Patients were examined in the first day of radiotherapy for any type of wound before treatment and those with oral ulcers before radiotherapy were excluded from the study. The grade of mucositis was determined using the classification by the World Health Organization. ANCOVA was performed to assess any difference between the two groups with regard to oral mucosal irritation and wound size after the intervention while controlling for the covariates such as sex and age. Results: Significant differences were found in the maximum grade of mucositis and oral mucosal irritation between the intervention and control groups (P<0.001). Conclusions: This study showed that aqueous extract of Glycyrrhiza can be effective for decreasing the severity of oral mucositis in head and neck cancer patients undergoing radiotherapy. PMID:29296112

RESPONSE LATENCIES OF NORMAL AND FOCAL-HEAD IRRADIATED MONKEYS

DOE Office of Scientific and Technical Information (OSTI.GOV)

McDowell, A.A.; Brown, W.L.

1963-12-01

This study was designed to determine whether focal-head irradiated rhesus monkeys differ from normal monkeys in a manner analogous to that previously found in whole-body irradiated monkeys with respect to response latencies under both familiar and novel stimulus conditions. Five control and four focal-head irradiated rhesus monkeys with nearly identical training histories were used; the latter were survivors of a focal-head irradiation study conducted four years earlier. They had received 3000 r x radiation to the inferior parietal lobule and posterior aspect of the temporal lobe of the brain, and 30 days later the same dosage to the same areamore » of the brain. The testing was conducted in a modified version of the Wisconsin General Test Apparatus, with 24 trials per day for two days, on response latency to a single food-rewarded wooden block placed randomly over either of the two extreme food-well positions. Then, 24 trials were conducted per day for two days on response latency to either the same food-rewarded wooden block or to a novel nonrewarded wooden block presented simultaneously. On the single-block condition, median response latencies of the two groups were comparable and the groups improved in a similar manner with practice. Optimal performance latencies were also comparable for the two groups. When the novel nonrewarded stimulus block was introduced, both groups manifested comparable disruption of median response latencies, but disruption of optimal response latencies was shown only by the focalhead irradiated group. The findings show that monkeys with previous focal-head irradiation of the posterior association areas, unlike relatively high-dose whole-body irradiated monkeys, manifest median response latencies comparable to those of controls. These data indicate the lasting effects of focal-head irradiation with x rays, and suggest that the sites of permanent damage for monkeys given sublethal whole-body radiation exposure differ from the sites

Allocentric-heading recall and its relation to self-reported sense-of-direction.

PubMed

Sholl, M Jeanne; Kenny, Ryan J; DellaPorta, Katherine A

2006-05-01

A sense of direction (SOD) computes the body's facing direction relative to a reference frame grounded in the environment. The authors report on three experiments in which they used a heading-recall task to tap the functioning of a SOD system and then correlated task performance with self-reported SOD as a convergent test of the task's construct validity. On each heading-recall trial, the participant judged the photographer's allocentric heading when photographing a pictured outdoor scene. Participants were tested over the full range of SOD ratings in Experiment 1, and in Experiments 2 and 3 heading-recall at the SOD extremes was tested. In all experiments, there was wide variability in heading-recall accuracy that covaried with self-rated SOD. Parametric manipulation of various task parameters revealed some likely functional properties of the SOD system. The results support the psychological reality of a SOD system and further indicate that there are large individual differences in the efficacy with which the system functions.

Statistical analysis plan of the head position in acute ischemic stroke trial pilot (HEADPOST pilot).

PubMed

Olavarría, Verónica V; Arima, Hisatomi; Anderson, Craig S; Brunser, Alejandro; Muñoz-Venturelli, Paula; Billot, Laurent; Lavados, Pablo M

2017-02-01

Background The HEADPOST Pilot is a proof-of-concept, open, prospective, multicenter, international, cluster randomized, phase IIb controlled trial, with masked outcome assessment. The trial will test if lying flat head position initiated in patients within 12 h of onset of acute ischemic stroke involving the anterior circulation increases cerebral blood flow in the middle cerebral arteries, as measured by transcranial Doppler. The study will also assess the safety and feasibility of patients lying flat for ≥24 h. The trial was conducted in centers in three countries, with ability to perform early transcranial Doppler. A feature of this trial was that patients were randomized to a certain position according to the month of admission to hospital. Objective To outline in detail the predetermined statistical analysis plan for HEADPOST Pilot study. Methods All data collected by participating researchers will be reviewed and formally assessed. Information pertaining to the baseline characteristics of patients, their process of care, and the delivery of treatments will be classified, and for each item, appropriate descriptive statistical analyses are planned with comparisons made between randomized groups. For the outcomes, statistical comparisons to be made between groups are planned and described. Results This statistical analysis plan was developed for the analysis of the results of the HEADPOST Pilot study to be transparent, available, verifiable, and predetermined before data lock. Conclusions We have developed a statistical analysis plan for the HEADPOST Pilot study which is to be followed to avoid analysis bias arising from prior knowledge of the study findings. Trial registration The study is registered under HEADPOST-Pilot, ClinicalTrials.gov Identifier NCT01706094.

Trial of Postoperative Radiation, Cisplatin, and Panitumumab in Locally Advanced Head and Neck Cancer

ClinicalTrials.gov

2017-09-04

Cancer of Head; Cancer of Head and Neck; Cancer of Neck; Cancer of the Head; Cancer of the Head and Neck; Cancer of the Neck; Head and Neck Cancer; Head Cancer; Head Neoplasms; Head, Neck Neoplasms; Neck Cancer; Neck Neoplasms; Neoplasms, Head; Neoplasms, Head and Neck; Neoplasms, Neck; Neoplasms, Upper Aerodigestive Tract; UADT Neoplasms; Upper Aerodigestive Tract Neoplasms

Neck Strength Imbalance Correlates With Increased Head Acceleration in Soccer Heading

PubMed Central

Dezman, Zachary D.W.; Ledet, Eric H.; Kerr, Hamish A.

2013-01-01

Background: Soccer heading is using the head to directly contact the ball, often to advance the ball down the field or score. It is a skill fundamental to the game, yet it has come under scrutiny. Repeated subclinical effects of heading may compound over time, resulting in neurologic deficits. Greater head accelerations are linked to brain injury. Developing an understanding of how the neck muscles help stabilize and reduce head acceleration during impact may help prevent brain injury. Hypothesis: Neck strength imbalance correlates to increasing head acceleration during impact while heading a soccer ball. Study Design: Observational laboratory investigation. Methods: Sixteen Division I and II collegiate soccer players headed a ball in a controlled indoor laboratory setting while player motions were recorded by a 14-camera Vicon MX motion capture system. Neck flexor and extensor strength of each player was measured using a spring-type clinical dynamometer. Results: Players were served soccer balls by hand at a mean velocity of 4.29 m/s (±0.74 m/s). Players returned the ball to the server using a heading maneuver at a mean velocity of 5.48 m/s (±1.18 m/s). Mean neck strength difference was positively correlated with angular head acceleration (rho = 0.497; P = 0.05), with a trend toward significance for linear head acceleration (rho = 0.485; P = 0.057). Conclusion: This study suggests that symmetrical strength in neck flexors and extensors reduces head acceleration experienced during low-velocity heading in experienced collegiate players. Clinical Relevance: Balanced neck strength may reduce head acceleration cumulative subclinical injury. Since neck strength is a measureable and amenable strength training intervention, this may represent a modifiable intrinsic risk factor for injury. PMID:24459547

Head circumference

MedlinePlus

... a child's head circumference. Normal ranges for a child's sex and age (weeks, months), based on values that experts have obtained for normal growth rates of infants' and children's heads. Measurement of the head circumference is an ...

Gender differences in head-neck segment dynamic stabilization during head acceleration.

PubMed

Tierney, Ryan T; Sitler, Michael R; Swanik, C Buz; Swanik, Kathleen A; Higgins, Michael; Torg, Joseph

2005-02-01

Recent epidemiological research has revealed that gender differences exist in concussion incidence but no study has investigated why females may be at greater risk of concussion. Our purpose was to determine whether gender differences existed in head-neck segment kinematic and neuromuscular control variables responses to an external force application with and without neck muscle preactivation. Forty (20 females and 20 males) physically active volunteers participated in the study. The independent variables were gender, force application (known vs unknown), and force direction (forced flexion vs forced extension). The dependent variables were kinematic and EMG variables, head-neck segment stiffness, and head-neck segment flexor and extensor isometric strength. Statistical analyses consisted of multiple multivariate and univariate analyses of variance, follow-up univariate analyses of variance, and t-tests (P < or = 0.05). Gender differences existed in head-neck segment dynamic stabilization during head angular acceleration. Females exhibited significantly greater head-neck segment peak angular acceleration (50%) and displacement (39%) than males despite initiating muscle activity significantly earlier (SCM only) and using a greater percentage of their maximum head-neck segment muscle activity (79% peak activity and 117% muscle activity area). The head-neck segment angular acceleration differences may be because females exhibited significantly less isometric strength (49%), neck girth (30%), and head mass (43%), resulting in lower levels of head-neck segment stiffness (29%). For our subject demographic, the results revealed gender differences in head-neck segment dynamic stabilization during head acceleration in response to an external force application. Females exhibited significantly greater head-neck segment peak angular acceleration and displacement than males despite initiating muscle activity earlier (SCM only) and using a greater percentage of their maximum

Head Lice (For Parents)

MedlinePlus

... Videos for Educators Search English Español First Aid: Head Lice KidsHealth / For Parents / First Aid: Head Lice Print A head louse is a tiny, wingless ... Prevention! You can help protect your kids from head lice by teaching them to: avoid head-to-head ...

Head movements and postures as pain behavior

PubMed Central

Al-Hamadi, Ayoub; Limbrecht-Ecklundt, Kerstin; Walter, Steffen; Traue, Harald C.

2018-01-01

Pain assessment can benefit from observation of pain behaviors, such as guarding or facial expression, and observational pain scales are widely used in clinical practice with nonverbal patients. However, little is known about head movements and postures in the context of pain. In this regard, we analyze videos of three publically available datasets. The BioVid dataset was recorded with healthy participants subjected to painful heat stimuli. In the BP4D dataset, healthy participants performed a cold-pressor test and several other tasks (meant to elicit emotion). The UNBC dataset videos show shoulder pain patients during range-of-motion tests to their affected and unaffected limbs. In all videos, participants were sitting in an upright position. We studied head movements and postures that occurred during the painful and control trials by measuring head orientation from video over time, followed by analyzing posture and movement summary statistics and occurrence frequencies of typical postures and movements. We found significant differences between pain and control trials with analyses of variance and binomial tests. In BioVid and BP4D, pain was accompanied by head movements and postures that tend to be oriented downwards or towards the pain site. We also found differences in movement range and speed in all three datasets. The results suggest that head movements and postures should be considered for pain assessment and research. As additional pain indicators, they possibly might improve pain management whenever behavior is assessed, especially in nonverbal individuals such as infants or patients with dementia. However, in advance more research is needed to identify specific head movements and postures in pain patients. PMID:29444153

Assessment of a head support system to prevent pediatric out-of-position: an observational study.

PubMed

Lopez-Valdes, Francisco J; Forman, Jason L; Ash, Joseph H; Kent, Richard; Alba, Juan J; Segui-Gomez, Maria

Head injuries are the most common severe injuries sustained by pediatric occupants in road traffic crashes. Preventing children from adopting positions that can result in an increased injury risk due to unfavorable interactions with the restraints is fundamental. The objective of this paper was to assess the effect of a head support system (SS) on the lateral position of the head, the vertical position of the sternum and the shoulder belt fit. Thirty pediatric rear-seat passengers were exposed to two 75-minute trials. Volunteers were restrained by a three-point belt and, if needed, used the appropriate child restraint system for their anthropometry (high-back booster, low-back booster, no booster). A case crossover study was designed in which the volunteers used the head support system (SS) during one of the trials, acting as their own controls (No SS) in the other. Compared to the control group, the head support reduced significantly the 90(th) percentile value of the absolute value of the relative lateral motion of the head, regardless of the restraint used. The system also reduced the maximum downward position of the sternal notch within the low-back booster group. As for the belt fit, the use of the head support improved significantly the position of the shoulder belt on the occupant in the low-back booster and in the no booster groups.

Assessment of a head support system to prevent pediatric out-of-position: an observational study

PubMed Central

Lopez-Valdes, Francisco J.; Forman, Jason L.; Ash, Joseph H.; Kent, Richard; Alba, Juan J.; Segui-Gomez, Maria

2013-01-01

Head injuries are the most common severe injuries sustained by pediatric occupants in road traffic crashes. Preventing children from adopting positions that can result in an increased injury risk due to unfavorable interactions with the restraints is fundamental. The objective of this paper was to assess the effect of a head support system (SS) on the lateral position of the head, the vertical position of the sternum and the shoulder belt fit. Thirty pediatric rear-seat passengers were exposed to two 75-minute trials. Volunteers were restrained by a three-point belt and, if needed, used the appropriate child restraint system for their anthropometry (high-back booster, low-back booster, no booster). A case crossover study was designed in which the volunteers used the head support system (SS) during one of the trials, acting as their own controls (No SS) in the other. Compared to the control group, the head support reduced significantly the 90th percentile value of the absolute value of the relative lateral motion of the head, regardless of the restraint used. The system also reduced the maximum downward position of the sternal notch within the low-back booster group. As for the belt fit, the use of the head support improved significantly the position of the shoulder belt on the occupant in the low-back booster and in the no booster groups. PMID:24406966

Oral ivermectin for the treatment of head lice infestation.

PubMed

Sanchezruiz, Wendy L; Nuzum, Donald S; Kouzi, Samir A

2018-05-22

Published literature describing the use of oral ivermectin for the treatment of head lice infestation is reviewed. In the United States and globally, head lice infestation, or pediculosis capitis, remains a public health issue with both social and medical implications. Treatment with oral or topical medications is typically required for head lice eradication. Resistance to traditional topical therapies for head lice infestation is increasing, creating a need for consideration of additional treatment options. A growing body of data describing the potential role of oral ivermectin for the treatment or prevention of head lice infestation is available. A literature search identified 5 clinical trials that evaluated safety and/or effectiveness outcomes of oral ivermectin use as an alternative to malathion, other topical prescription medications, and traditional, nonprescription remedies; those studies were conducted in various parts of the world (e.g., Australia, Brazil, Mexico, Egypt) and likely involved varying types and degrees of lice resistance. Clinical research findings to date, while not consistently robust, suggest that oral ivermectin is comparable or superior in effectiveness to other topical treatment options for head lice infestation while being well tolerated and favorably perceived by patients and caretakers. Oral ivermectin is an option for the treatment of head lice infestation, especially in individuals who have experienced a treatment failure. Published evidence from clinical trials indicates that oral ivermectin is as effective as currently available topical treatments. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Smartphone Application WeChat for Clinical Follow-up of Discharged Patients with Head and Neck Tumors: A Randomized Controlled Trial

PubMed Central

Lyu, Ke-Xing; Zhao, Jing; Wang, Bin; Xiong, Guan-Xia; Yang, Wei-Qiang; Liu, Qi-Hong; Zhu, Xiao-Lin; Sun, Wei; Jiang, Ai-Yun; Wen, Wei-Ping; Lei, Wen-Bin

2016-01-01

Background: Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods: A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up (WFU) group or telephone follow-up (TFU) group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results: Time consumption in WFU group for each patient (23.36 ± 6.16 min) was significantly shorter than that in TFU group (42.89 ± 7.15 min) (P < 0.001); total economic cost in WFU group (RMB 90 Yuan) was much lower than that in TFU group (RMB 196 Yuan). Lost-to-follow-up rate in the WFU group was 7.02% (4/57) compared with TFU group, 9.80% (5/51), while no significance was observed (95% confidence interval [CI]: 0.176–2.740; P = 0.732). The overall satisfaction rate in WFU group was 94.34% (50/53) compared with 80.43% (37/46) in TFU group (95% CI: 0.057–0.067; P = 0.034). Conclusions: The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions. Trial Registration: Chinese Clinical Trial Registry, Chi

Selection of head and whisker coordination strategies during goal-oriented active touch.

PubMed

Schroeder, Joseph B; Ritt, Jason T

2016-04-01

In the rodent whisker system, a key model for neural processing and behavioral choices during active sensing, whisker motion is increasingly recognized as only part of a broader motor repertoire employed by rodents during active touch. In particular, recent studies suggest whisker and head motions are tightly coordinated. However, conditions governing the selection and temporal organization of such coordinated sensing strategies remain poorly understood. We videographically reconstructed head and whisker motions of freely moving mice searching for a randomly located rewarded aperture, focusing on trials in which animals appeared to rapidly "correct" their trajectory under tactile guidance. Mice orienting after unilateral contact repositioned their whiskers similarly to previously reported head-turning asymmetry. However, whisker repositioning preceded head turn onsets and was not bilaterally symmetric. Moreover, mice selectively employed a strategy we term contact maintenance, with whisking modulated to counteract head motion and facilitate repeated contacts on subsequent whisks. Significantly, contact maintenance was not observed following initial contact with an aperture boundary, when the mouse needed to make a large corrective head motion to the front of the aperture, but only following contact by the same whisker field with the opposite aperture boundary, when the mouse needed to precisely align its head with the reward spout. Together these results suggest that mice can select from a diverse range of sensing strategies incorporating both knowledge of the task and whisk-by-whisk sensory information and, moreover, suggest the existence of high level control (not solely reflexive) of sensing motions coordinated between multiple body parts. Copyright © 2016 the American Physiological Society.

Selection of head and whisker coordination strategies during goal-oriented active touch

PubMed Central

2016-01-01

In the rodent whisker system, a key model for neural processing and behavioral choices during active sensing, whisker motion is increasingly recognized as only part of a broader motor repertoire employed by rodents during active touch. In particular, recent studies suggest whisker and head motions are tightly coordinated. However, conditions governing the selection and temporal organization of such coordinated sensing strategies remain poorly understood. We videographically reconstructed head and whisker motions of freely moving mice searching for a randomly located rewarded aperture, focusing on trials in which animals appeared to rapidly “correct” their trajectory under tactile guidance. Mice orienting after unilateral contact repositioned their whiskers similarly to previously reported head-turning asymmetry. However, whisker repositioning preceded head turn onsets and was not bilaterally symmetric. Moreover, mice selectively employed a strategy we term contact maintenance, with whisking modulated to counteract head motion and facilitate repeated contacts on subsequent whisks. Significantly, contact maintenance was not observed following initial contact with an aperture boundary, when the mouse needed to make a large corrective head motion to the front of the aperture, but only following contact by the same whisker field with the opposite aperture boundary, when the mouse needed to precisely align its head with the reward spout. Together these results suggest that mice can select from a diverse range of sensing strategies incorporating both knowledge of the task and whisk-by-whisk sensory information and, moreover, suggest the existence of high level control (not solely reflexive) of sensing motions coordinated between multiple body parts. PMID:26792880

Promoting Parents' Social Capital to Increase Children's Attendance in Head Start: Evidence from an Experimental Intervention

ERIC Educational Resources Information Center

Sommer, Teresa Eckrich; Sabol, Terri J.; Chase-Lansdale, P. Lindsay; Small, Mario; Wilde, Henry; Brown, Sean; Huang, Zong Yang

2017-01-01

Improving children's attendance is a high priority for Head Start and other early childhood education programs serving low-income children. We conducted a randomized control trial in a major northern city to evaluate the impact of a low-cost intervention designed to promote parents' social capital as a potential influence on children's attendance…

Otitis media with effusion after radiotherapy of the head and neck: a systematic review.

PubMed

Christensen, J G; Wessel, I; Gothelf, A B; Homøe, P

2018-04-26

Otitis media (OM) and associated hearing problems may be side effects to radiotherapy of the head and neck region and affect patient quality of life. The condition is associated with the tumor location. To perform a systematic review concerning the present knowledge of the risk of OM after radiotherapy of the head and neck. A comprehensive search of PubMed and Embase was carried out between 1 October 2015 and 6 February 2017. The search strategy followed the PRISMA guideline for systematic reviews. Of 597 articles 11 fulfilled the inclusion criteria. Seven were retrospective and four prospective. There were no randomized controlled trials. Eight studies concerned nasopharyngeal cancer. One study concerned cancer of the parotid gland and two studies concerned other locations of head and neck cancer. Meta-analysis could not be done due to heterogeneity between the studies. The incidence of OM varied considerably (range 8-29%). The incidence of OM is high after radiotherapy of cancer of the upper head and neck area and the Eustachian tube (ET) irradiation dosage seems associated with development of OM, but the literature is poor. Research is needed to designate patients at risk of developing OM after radiotherapy. Preferably through analysis of dosage relationships between the ET and middle ear, and development of OM. Reporting of OM should be per ear and follow standardized protocols of middle ear assessment before and after radiotherapy. Furthermore, there is a need to find new ways to prevent and treat radiation-induced OME, preferably through randomized controlled trials.

Testing maternal depression and attachment style as moderators of Early Head Start's effects on parenting.

PubMed

Berlin, Lisa J; Whiteside-Mansell, Leanne; Roggman, Lori A; Green, Beth L; Robinson, JoAnn; Spieker, Susan

2011-01-01

This study examined maternal depression, attachment avoidance, and attachment anxiety as moderators of Early Head Start's effects on four parenting outcomes assessed at age three. Participants (N = 947) were drawn from six sites of the Early Head Start National Research and Evaluation Project, a multi-site randomized trial. Findings suggest more positive program effects for mothers with less initial attachment avoidance or attachment anxiety. First, baseline attachment avoidance moderated Early Head Start program effects on observed maternal supportiveness, such that program mothers with lower baseline attachment avoidance were rated as more supportive of their three-year-olds than program mothers with higher baseline attachment avoidance. Second, program effects on spanking varied depending on mothers' baseline attachment anxiety.

An evaluation of flight path formats head-up and head-down

NASA Technical Reports Server (NTRS)

Sexton, George A.; Moody, Laura E.; Evans, Joanne; Williams, Kenneth E.

1988-01-01

Flight path primary flight display formats were incorporated on head-up and head-down electronic displays and integrated into an Advanced Concepts Flight Simulator. Objective and subjective data were collected while ten airline pilots evaluated the formats by flying an approach and landing task under various ceiling, visibility and wind conditions. Deviations from referenced/commanded airspeed, horizontal track, vertical track and touchdown point were smaller using the head-up display (HUD) format than the head-down display (HDD) format, but not significantly smaller. Subjectively, the pilots overwhelmingly preferred (1) flight path formats over attitude formats used in current aircraft, and (2) the head-up presentation over the head-down, primarily because it eliminated the head-down to head-up transition during low visibility landing approaches. This report describes the simulator, the flight displays, the format evaluation, and the results of the objective and subjective data.

The efficacy of Australian essential oils for the treatment of head lice infestation in children: A randomised controlled trial.

PubMed

Greive, Kerryn A; Barnes, Tanya M

2018-05-01

The increase in resistance of head lice to neurotoxic pediculicides and public concern over their safety has led to an increase in alternative treatments, many of which are poorly researched or even untested. A multicentre, randomised, assessor-blind, parallel-group trial (Trial 1) was conducted to compare the safety and efficacy of a head lice treatment containing Australian eucalyptus oil and Leptospermum petersonii (EO/LP solution; applied thrice with 7-day intervals between applications) with a neurotoxic treatment containing pyrethrins and piperonyl butoxide (P/PB mousse; applied twice with a 7-day interval) in children. A single-blind, open trial (Trial 2) was conducted to assess the efficacy of EO/LP solution following a single application. In addition, skin irritancy and sensitisation tests using EO/LP solution were performed in adults and children. In vitro tests were performed to further assess the ovicidal and pediculicidal efficacy of EO/LP solution. EO/LP solution was found to be more than twice as effective in curing head lice infestation as P/PB mousse in per-protocol participants (Trial 1; 83% vs 36%, P < 0.0001), and was also found to be 100% pediculicidal following a single application (Trial 2). Adverse events were limited to transient itching, burning or stinging. Further skin testing with the EO/LP solution reported no irritation or sensitisation in adults, or irritation in children. In vitro exposure of lice and eggs to the EO/LP solution resulted in 100% mortality. The efficacy, safety and relative ease of use of the EO/LP solution make it a viable alternative in treating head lice. © 2017 Ego Pharmaceuticals Pty Ltd. Australasian Journal of Dermatology published by John Wiley & Sons, Ltd. on behalf of The Australasian College of Dermatologists.

Head lice.

PubMed

Devore, Cynthia D; Schutze, Gordon E

2015-05-01

Head lice infestation is associated with limited morbidity but causes a high level of anxiety among parents of school-aged children. Since the 2010 clinical report on head lice was published by the American Academy of Pediatrics, newer medications have been approved for the treatment of head lice. This revised clinical report clarifies current diagnosis and treatment protocols and provides guidance for the management of children with head lice in the school setting. Copyright © 2015 by the American Academy of Pediatrics.

Prevalence of head lice infestation and pediculicidal effect of permethrine shampoo in primary school girls in a low-income area in southeast of Iran.

PubMed

Soleimani-Ahmadi, Moussa; Jaberhashemi, Seyed Aghil; Zare, Mehdi; Sanei-Dehkordi, Alireza

2017-07-24

Head lice infestation is a common public health problem that is most prevalent in primary school children throughout the world, especially in developing countries including different parts of Iran. This study aimed to determine the prevalence and risk factors associated with head lice infestation and pediculicidal effect of 1% permethrin shampoo in primary schools girls of Bashagard County, one of the low socioeconomic areas in southeast of Iran. In this interventional study six villages with similar demographical situations were selected and randomly assigned into intervention and control areas. In each area 150 girl students aged 7-12 years were selected randomly and screened for head lice infestation by visual scalp examination. In intervention area, treatment efficacy of 1% permethrin shampoo was evaluated via re-examination for infestation after one, two, and three weeks. Pre-tested structured questionnaire was used to collect data on socio-demographic and associated factors of head lice infestation. The prevalence of head lice infestation was 67.3%. There was significant association between head lice infestation and school grade, family size, parents' literacy, bathing facilities, frequency of hair washing, and use of shared articles (p < 0.05). The effectiveness of 1% permethrin shampoo for head lice treatment was 29.2, 68.9, and 90.3% after the first, second, and third weeks, respectively. The head lice infestation is a health problem in primary school girls of Bashagard County. Improvement of socioeconomic status and providing appropriate educational programs about head lice risk factors and prevention can be effective for reduction of infestation in this area. This trial has been registered and approved by Hormozgan University of Medical Sciences ethical committee (Trial No.764). Trial registration date: March 17 2014.

Reirradiation of head and neck cancer using modern highly conformal techniques.

PubMed

Ho, Jennifer C; Phan, Jack

2018-04-23

Locoregional disease recurrence or development of a second primary cancer after definitive radiotherapy for head and neck cancers remains a treatment challenge. Reirradiation utilizing traditional techniques has been limited by concern for serious toxicity. With the advent of newer, more precise radiotherapy techniques, such as intensity-modulated radiotherapy (IMRT), proton radiotherapy, and stereotactic body radiotherapy (SBRT), there has been renewed interest in curative-intent head and neck reirradiation. However, as most studies were retrospective, single-institutional experiences, the optimal modality is not clear. We provide a comprehensive review of the outcomes of relevant studies using these 3 head and neck reirradiation techniques, followed by an analysis and comparison of the toxicity, tumor control, concurrent systemic therapy, and prognostic factors. Overall, there is evidence that IMRT, proton therapy, and SBRT reirradiation are feasible treatment options that offer a chance for durable local control and survival. Prospective studies, particularly randomized trials, are needed. © 2018 Wiley Periodicals, Inc.

Bottom head assembly

DOEpatents

Fife, A.B.

1998-09-01

A bottom head dome assembly is described which includes, in one embodiment, a bottom head dome and a liner configured to be positioned proximate the bottom head dome. The bottom head dome has a plurality of openings extending there through. The liner also has a plurality of openings extending there through, and each liner opening aligns with a respective bottom head dome opening. A seal is formed, such as by welding, between the liner and the bottom head dome to resist entry of water between the liner and the bottom head dome at the edge of the liner. In the one embodiment, a plurality of stub tubes are secured to the liner. Each stub tube has a bore extending there through, and each stub tube bore is coaxially aligned with a respective liner opening. A seat portion is formed by each liner opening for receiving a portion of the respective stub tube. The assembly also includes a plurality of support shims positioned between the bottom head dome and the liner for supporting the liner. In one embodiment, each support shim includes a support stub having a bore there through, and each support stub bore aligns with a respective bottom head dome opening. 2 figs.

Reduced head-neck offset in nontraumatic osteonecrosis of the femoral head.

PubMed

Fraitzl, Christian R; Kappe, Thomas; Brugger, Annina; Billich, Christian; Reichel, Heiko

2013-08-01

Risk factors for nontraumatic osteonecrosis of the femoral head have in common that they trigger intravascular coagulation and thus lead to devascularization of the femoral head. In part of the patients, however, no risk factors seem to be evident. Mechanical reasons contributing to nontraumatic osteonecrosis have not been discussed so far. We hypothesized that recurrent traumatization of the vessels supplying the femoral head by a cam-type mechanism as in femoroacetabular impingement could add to intravascular coagulation. We, therefore, asked whether structural abnormalities at the femoral head-neck junction indicative of such a mechanism could be observed in radiographs of patients with osteonecrosis of the femoral head. The preoperative anteroposterior and lateral radiographs of 77 patients who underwent surgery because of osteonecrosis of the femoral head were retrospectively screened for a reduced head-neck offset by measuring the α-angle. For comparison, the α-angle was measured on anteroposterior and lateral radiographs of 339 control subjects without evident underlying hip pathology. The mean α-angle was 62.8° (SD 18.7°) for anteroposterior and 67.6° (SD 13.2°) for lateral radiographs in patients with nontraumatic osteonecrosis of the femoral head, whereas in control subjects, the mean α-angle was 47.2° (SD 9.6°) (p < 0.0001) and 47.6° (SD 10.3°) (p < 0.0001), respectively. A reduced head-neck offset in patients with nontraumatic osteonecrosis of the femoral head may act as a mechanical (co-)factor in developing osteonecrosis of the femoral head.

Effect of trunk-to-head bathing on physiological responses in newborns.

PubMed

So, Hyun-Sook; You, Mi-Ae; Mun, Je-Yung; Hwang, Myeong-Jin; Kim, Hyun-Kyung; Pyeon, Suk-Jin; Shin, Mi-Young; Chang, Bong-Hee

2014-01-01

To determine the effect of trunk-to-head bathing versus the traditional head-to-trunk bathing on newborns' body temperature, heart rate, and oxygen saturation. A prospective, two-group, quasi-experimental repeated measures design. A newborn nursery in an urban university hospital. Sixty-two healthy full-term newborns. Newborns were randomly assigned to two groups. The newborns in the experimental group were bathed from trunk to head; those in the control group were bathed from head to trunk. Measurements of body temperature, heart rate, and oxygen saturation were obtained at four time points: before the bath, immediately after the bath, 30 minutes after the bath, and 60 minutes after the bath. No significant differences in body temperature, heart rate, or oxygen saturation were observed between groups. However, body temperature was significantly different across measurement times, and there was a significant interaction between group and measurement time. The mean body temperature dropped 0.2°C after bathing in both groups, but the experimental group returned to their initial body temperature more rapidly than the control group. These findings suggest that newborns who were bathed from trunk to head and whose heads were wet for shorter periods of time benefited with a more rapid recovery of body temperature and decreased heat loss due to evaporation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: A randomized controlled study.

PubMed

Axelsson, Lars; Silander, Ewa; Nyman, Jan; Bove, Mogens; Johansson, Leif; Hammerlid, Eva

2017-05-01

Dysphagia is common in head and neck cancer. A percutaneous endoscopic gastrostomy (PEG) tube is used to facilitate nutrition; however, some retrospective studies have indicated that the PEG tube causes dysphagia. A randomized study of patients with head and neck cancer was conducted with up to 10 years of follow-up. Patients were randomized to either the prophylactic PEG tube group (study group) or the common clinical nutritional support group (control group). At each follow-up, a dietician assessed the oral intake, noted the patients' weight, and if the patients used a PEG tube. Dysphagia was also assessed by the quality of life questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 Head and Neck 35-questions (EORTC-QLQ-H&N35). One hundred thirty-four patients were included in this study. There was no significant difference in swallowing function between the groups after 12 months, 24 months, and 8 years based on the EORTC-QLQ-H&N35, the oral intake scale, tube dependence, esophageal intervention, weight, body mass index (BMI), and overall survival. A prophylactic PEG tube can be used without an increased risk of long-term dysphagia in patients with head and neck cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 908-915, 2017. © 2017 Wiley Periodicals, Inc.

Effects of scalp block with bupivacaine versus levobupivacaine on haemodynamic response to head pinning and comparative efficacies in postoperative analgesia: A randomized controlled trial.

PubMed

Can, Banu O; Bilgin, Hülya

2017-04-01

Objective This study was performed to determine the effects of scalp blocks with bupivacaine versus levobupivacaine on the haemodynamic response during craniotomy and the efficacies and analgesic requirements of these drugs postoperatively. Methods This randomized, prospective, placebo-controlled, double-blind study included 90 patients (age, 18-85 years; American Society of Anesthesiologists physical status, I or II). The patients were randomly divided into three groups: those who received 20 mL of 0.5% bupivacaine (Group B, n = 30), 20 mL of 0.5% levobupivacaine (Group L, n = 30), or saline as a placebo (Group C, n = 30). Scalp blocks were performed 5 min before head pinning. The primary outcome was the mean arterial pressure (MAP), and the secondary outcomes were the heart rate (HR), visual analogue scale (VAS) scores, and additional intraoperative and postoperative drug use. Postoperative pain was evaluated using a 10-cm VAS. Results During head pinning and incision, the MAP and HR were significantly higher in Group C. The additional drug requirement for intraoperative hypertension and tachycardia was significantly higher in Group C. There were no significant differences in MAP, HR, or VAS scores between Groups B and L. Conclusion Both bupivacaine and levobupivacaine can be effectively and safely used for scalp blocks to control haemodynamic responses and postoperative pain.

What are Head Cavities? - A History of Studies on Vertebrate Head Segmentation.

PubMed

Kuratani, Shigeru; Adachi, Noritaka

2016-06-01

Motivated by the discovery of segmental epithelial coeloms, or "head cavities," in elasmobranch embryos toward the end of the 19th century, the debate over the presence of mesodermal segments in the vertebrate head became a central problem in comparative embryology. The classical segmental view assumed only one type of metamerism in the vertebrate head, in which each metamere was thought to contain one head somite and one pharyngeal arch, innervated by a set of cranial nerves serially homologous to dorsal and ventral roots of spinal nerves. The non-segmental view, on the other hand, rejected the somite-like properties of head cavities. A series of small mesodermal cysts in early Torpedo embryos, which were thought to represent true somite homologs, provided a third possible view on the nature of the vertebrate head. Recent molecular developmental data have shed new light on the vertebrate head problem, explaining that head mesoderm evolved, not by the modification of rostral somites of an amphioxus-like ancestor, but through the polarization of unspecified paraxial mesoderm into head mesoderm anteriorly and trunk somites posteriorly.

Early intensive postural and movement training advances head control in very young infants.

PubMed

Lee, Hui-Min; Galloway, James Cole

2012-07-01

Daily experiences are thought to play an important role in motor development during infancy. There are limited studies on the effect of postural and movement experiences on head control. The purpose of this study was to quantify the effects of postural and movement experiences on head control through a comprehensive set of measurements beginning when infants were 1 month old. This was a prospective, longitudinal, 2-cohort study. Twenty-two full-term infants who were healthy were randomly assigned to either a training group or a control group. Infants were observed every other week from 1 to 4 months of age. Head control was assessed using a standardized developmental assessment tool, the Test of Infant Motor Performance (TIMP), as well as behavioral coding and kinematics of infants' head postures and movements in a supported sitting position. Caregivers performed at least 20 minutes of daily postural and movement activities (training group), or social interaction (control group) for 4 weeks. The training group had higher TIMP scores on head control-related items during the training period and after training stopped compared with the control group. Starting from the during training phase, the training group infants had their heads in a vertical and midline position longer compared with the control group infants. After training stopped, the training group infants actively moved their heads forward more often and for larger distances. The experiences outside daily training were not monitored, and the results may be specific to the experimental setup for infants with typical development. Young infants are able to take advantage of postural and movement experiences to rapidly advance their head control as early as 4 to 6 weeks of postnatal life. Infant positioning, caregiver handling, and caregiver-infant interactions were likely contributing factors. This database of comprehensive measures may be useful in future trials focused on head control in infants with special

Thromboprophylaxis in Head and Neck Microvascular Reconstruction.

PubMed

Abraham, Manoj; Badhey, Arvind; Hu, Shirley; Kadakia, Sameep; Rasamny, J K; Moscatello, Augustine; Ducic, Yadranko

2018-06-01

Head and neck patients undergoing microvascular reconstruction are at high risk for thromboembolism. While the prevention of thromboembolism has become an essential aspect of care, within the field of microsurgery, concern for anastomotic complications have hindered the creation of an accepted regimen. The aim of this review was to evaluate the risks and benefits of prophylactic agents for thromboprophylaxis. A literature search was conducted in MEDLINE, Cochrane Library, and PubMed/NCBI databases. Articles discussing thromboprophylaxis in otolaryngology, head and neck surgery, or microvascular reconstruction were considered in the review from the past 30 years. The majority of patients undergoing microvascular surgery have multiple risk factors for thrombus formation. Several consensus guidelines exist for the prophylaxis in patients who are critically ill, undergoing surgery, or with malignancy. Significant evidence supports the routine use of mechanical means, such as early mobilization and pneumatic compression along with subcutaneous heparin. Low-molecular-weight heparin is also frequently utilized, although results are largely divided. Data on aspirin remain equivocal. Studies on microvascular failure and flap loss have demonstrated little to no association with chemoprophylaxis. The evidence for postoperative thromboprophylaxis regimens in patients undergoing head and neck free tissue transfer is variable. Multiple studies have supported the use of unfractionated heparin or low-molecular-weight heparin. There appears to be an expert consensus for the combined use of mechanical prophylactic methods and chemical prophylaxis. Prospective randomized trials are required to validate the most effective combination of chemoprophylaxis agents.

Erlotinib, erlotinib-sulindac versus placebo: a randomized, double-blind, placebo-controlled window trial in operable head and neck cancer.

PubMed

Gross, Neil D; Bauman, Julie E; Gooding, William E; Denq, William; Thomas, Sufi M; Wang, Lin; Chiosea, Simion; Hood, Brian L; Flint, Melanie S; Sun, Mai; Conrads, Thomas P; Ferris, Robert L; Johnson, Jonas T; Kim, Seungwon; Argiris, Athanassios; Wirth, Lori; Nikiforova, Marina N; Siegfried, Jill M; Grandis, Jennifer R

2014-06-15

The EGF receptor (EGFR) and COX2 pathways are upregulated in head and neck squamous cell carcinoma (HNSCC). Preclinical models indicate synergistic antitumor activity from dual blockade. We conducted a randomized, double-blind, placebo-controlled window trial of erlotinib, an EGFR inhibitor; erlotinib plus sulindac, a nonselective COX inhibitor; versus placebo. Patients with untreated, operable stage II-IVb HNSCC were randomized 5:5:3 to erlotinib, erlotinib-sulindac, or placebo. Tumor specimens were collected before and after seven to 14 days of treatment. The primary endpoint was change in Ki67 proliferation index. We hypothesized an ordering effect in Ki67 reduction: erlotinib-sulindac > erlotinib > placebo. We evaluated tissue microarrays by immunohistochemistry for pharmacodynamic modulation of EGFR and COX2 signaling intermediates. From 2005-2009, 47 patients were randomized for the target 39 evaluable patients. Thirty-four tumor pairs were of sufficient quality to assess biomarker modulation. Ki67 was significantly decreased by erlotinib or erlotinib-sulindac (omnibus comparison, two-sided Kruskal-Wallis, P = 0.04). Wilcoxon pairwise contrasts confirmed greater Ki67 effect in both erlotinib groups (erlotinib-sulindac vs. placebo, P = 0.043; erlotinib vs. placebo, P = 0.027). There was a significant trend in ordering of Ki67 reduction: erlotinib-sulindac > erlotinib > placebo (two-sided exact Jonckheere-Terpstra, P = 0.0185). Low baseline pSrc correlated with greater Ki67 reduction (R(2) = 0.312, P = 0.024). Brief treatment with erlotinib significantly decreased proliferation in HNSCC, with additive effect from sulindac. Efficacy studies of dual EGFR-COX inhibition are justified. pSrc is a potential resistance biomarker for anti-EGFR therapy, and warrants investigation as a molecular target. ©2014 American Association for Cancer Research.

Efficacy and safety of tofacitinib monotherapy, tofacitinib with methotrexate, and adalimumab with methotrexate in patients with rheumatoid arthritis (ORAL Strategy): a phase 3b/4, double-blind, head-to-head, randomised controlled trial.

PubMed

Fleischmann, Roy; Mysler, Eduardo; Hall, Stephen; Kivitz, Alan J; Moots, Robert J; Luo, Zhen; DeMasi, Ryan; Soma, Koshika; Zhang, Richard; Takiya, Liza; Tatulych, Svitlana; Mojcik, Christopher; Krishnaswami, Sriram; Menon, Sujatha; Smolen, Josef S

2017-07-29

Tofacitinib is an oral Janus kinase inhibitor for the treatment of rheumatoid arthritis. The Oral Rheumatoid Arthritis triaL (ORAL) Strategy aimed to assess the comparative efficacy of tofacitinib monotherapy, tofacitinib plus methotrexate, and adalimumab plus methotrexate for the treatment of rheumatoid arthritis in patients with a previous inadequate response to methotrexate. ORAL Strategy was a 1 year, double-blind, phase 3b/4, head-to-head, non-inferiority, randomised controlled trial in patients aged 18 years or older with active rheumatoid arthritis despite methotrexate therapy. Patients were randomly assigned (1:1:1) to receive oral tofacitinib (5 mg twice daily) monotherapy, oral tofacitinib (5 mg twice daily) plus methotrexate, or subcutaneous adalimumab (40 mg every other week) plus methotrexate at 194 centres in 25 countries. Eligible patients received live zoster vaccine at investigators' discretion. The primary endpoint was the proportion of patients who attained an American College of Rheumatology response of at least 50% (ACR50) at month 6 in the full analysis set (patients who were randomly assigned to a group and received at least one dose of the study treatment). Non-inferiority between groups was shown if the lower bound of the 98·34% CI of the difference between comparators was larger than -13·0%. This trial is registered with ClinicalTrials.gov, number NCT02187055. 1146 patients received treatment (384 had tofacitinib monotherapy; 376 had tofacitinib and methotrexate; and 386 had adalimumab and methotrexate). At 6 months, ACR50 response was attained in 147 (38%) of 384 patients with tofacitinib monotherapy, 173 (46%) of 376 patients with tofacitinib and methotrexate, and 169 (44%) of 386 patients with adalimumab and methotrexate. Non-inferiority was declared for tofacitinib and methotrexate versus adalimumab and methotrexate (difference 2% [98·34% CI -6 to 11]) but not for tofacitinib monotherapy versus either adalimumab and methotrexate (-6

Impacts of Social-Emotional Curricula on Three-Year-Olds: Exploratory Findings from the Head Start CARES Demonstration. Research Snapshot. OPRE Report 2014-78

ERIC Educational Resources Information Center

Hsueh, JoAnn; Lowenstein, Amy E.; Morris, Pamela; Mattera, Shira K.; Bangser, Michael

2014-01-01

This report presents exploratory impact findings for 3-year-olds from the Head Start CARES demonstration, a large-scale randomized controlled trial implemented in Head Start centers for one academic year across the country. The study was designed primarily to test the effects of the enhancements on 4-year-olds, but it also provides an opportunity…

Cetuximab in the treatment of head and neck cancer: preliminary results outside clinical trials

PubMed Central

Dequanter, Didier; Shahla, Mohammad; Paulus, Pascal; Lothaire, Phillippe

2010-01-01

Introduction: The purpose of this study was to evaluate the clinical efficacy in our daily practice, outside clinical trials, of cetuximab plus radiotherapy in a majority of treatment-naive patients with locoregionally advanced head and neck squamous cell carcinomas. Methods: A retrospective study was performed to evaluate outcomes in patients who were treated definitively with cetuximab and radiotherapy (ExRT). Patients with stage III or IV, nonmetastatic, measurable squamous cell carcinoma of the head and neck (SCCHN) were eligible. Results: There were 18 males and two females. The median age was 61 years (range from 49 to 87 years old). Concurrent radiotherapy and cetuximab was used, in first line, in 17 patients with locally advanced disease; two patients with recurrent SCCHN, who were intolerant of Cisplatin-based regimens, were treated with radiotherapy combined with weekly cetuximab; and 1 patient received cetuximab and radiotherapy postoperatively. The median time of response was 10 months (range from 2 to 24 months). A partial response was observed in 11 cases; a complete response in nine cases. The occurrence of grade 2–3 skin toxicity was observed in 11 cases. Skin toxicity was clearly correlated with a better response and the duration of the response to the treatment. The use of cetuximab in combination with radiotherapy does not increase the side effects of radiotherapy. At the end of the follow-up, 17 patients died. Conclusion: Cetuximab, with its highly targeted mechanism of action and synergistic activity with current treatment modalities, is a valuable treatment option in head and neck patients. The effect of the epidermal growth factor receptor antagonist occurs without any change in the pattern and the severity of toxicity usually associated with head and neck radiation. Cetuximab seems not to provide the most benefit for patients with oropharyngeal cancers but will in patients with T4 tumors. However, the median duration of local control was

Head-to-head comparison of H2-receptor antagonists and proton pump inhibitors in the treatment of erosive esophagitis: A meta-analysis

PubMed Central

Wang, Wei-Hong; Huang, Jia-Qing; Zheng, Ge-Fan; Xia, Harry Hua-Xiang; Wong, Wai-Man; Lam, Shiu-Kum; Wong, Benjamin Chun-Yu

2005-01-01

AIM: To systematically evaluate the efficacy of H2-receptor antagonists (H2RAs) and proton pump inhibitors in healing erosive esophagitis (EE). METHODS: A meta-analysis was performed. A literature search was conducted in PubMed, Medline, Embase, and Cochrane databases to include randomized controlled head-to-head comparative trials evaluating the efficacy of H2RAs or proton pump inhibitors in healing EE. Relative risk (RR) and 95% confidence interval (CI) were calculated under a random-effects model. RESULTS: RRs of cumulative healing rates for each comparison at 8 wk were: high dose vs standard dose H2RAs, 1.17 (95%CI, 1.02-1.33); standard dose proton pump inhibitors vs standard dose H2RAs, 1.59 (95%CI, 1.44-1.75); standard dose other proton pump inhibitors vs standard dose omeprazole, 1.06 (95%CI, 0.98-1.06). Proton pump inhibitors produced consistently greater healing rates than H2RAs of all doses across all grades of esophagitis, including patients refractory to H2RAs. Healing rates achieved with standard dose omeprazole were similar to those with other proton pump inhibitors in all grades of esophagitis. CONCLUSION: H2RAs are less effective for treating patients with erosive esophagitis, especially in those with severe forms of esophagitis. Standard dose proton pump inhibitors are significantly more effective than H2RAs in healing esophagitis of all grades. Proton pump inhibitors given at the recommended dose are equally effective for healing esophagitis. PMID:15996033

Head Tilt Posturography to Enhance Balance Control Assessment for Astronauts: A Case Study

NASA Technical Reports Server (NTRS)

Hwang, E. Y.; Paloski, W. H.

2006-01-01

For many years, we have used a standard clinical computerized dynamic posturography (CDP) protocol to assess recovery of integrated sensory-motor function in astronauts returning from space flight. The most reliable indications of postflight crew performance capabilities have been obtained from the sensory organization tests (SOTs) within the CDP protocol, particularly SOTs 5 (eyes closed, surface support sway referenced) and 6 (eyes open, surface support and visual surround sway referenced), which are sensitive to changes in availability and/or utilization of vestibular cues. We have observed, however, that some astronauts exhibiting visible signs of incomplete sensory-motor recovery are able to score within clinical norms on standard SOTs 5 and 6 trials, perhaps as a result of cognitive strategies driven by their naturally competitive natures. To improve the sensitivity of the CDP protocol for assessing recovery of integrated sensory-motor function and fitness to return to duties and/or activities of daily living, we have introduced pitch plane head tilt SOT trials to our protocol. In a preliminary study of 5 short duration (11day missions) astronauts, we showed that they were unable to maintain balance on landing day when performing dynamic head tilt trials, despite scoring within the clinically normal range on the standard SOT trials. The present case report illustrates the advantages of including head tilt trials for assessing sensory-motor recovery in long duration crewmembers.

Heads Up to High School Sports

MedlinePlus

... submit" value="Submit" /> HEADS UP to School Sports Recommend on Facebook Tweet Share Compartir To help ... organizations, developed the HEADS UP: Concussion in School Sports initiative and materials. Specific Concussion Information for... Coaches ...

Randomized phase III trial of postoperative radiochemotherapy +/- amifostine in head and neck cancer. Is there evidence for radioprotection?

PubMed

Vacha, Peter; Fehlauer, Fabian; Mahlmann, Birgit; Marx, Meinolf; Hinke, Axel; Sommer, Konrad; Richter, Eckart; Feyerabend, Thomas

2003-06-01

Experimental and clinical data suggest a reduction of radiation-induced acute toxicity by amifostine (A). We investigated this issue in a randomized trial comparing radiochemotherapy (RT + CT) versus radiochemotherapy plus amifostine (RC + CT + A) in patients with head and neck cancer. 56 patients with oro-/hypopharynx or larynx cancer (T1-2 N1-2 G3, T3-4 N0-2 G1-3) were randomized to receive RC + CT alone or RC + CT + A. Patients were irradiated up to 60 Gy (R0) or 70 Gy (R1/2) and received chemotherapy (70 mg/m(2) carboplatin, day 1-5 in week 1 and 5 of radiotherapy). 250 mg amifostine were applied daily before each radiotherapy session. Acute toxicity was evaluated according to the Common Toxicity Criteria (CTC). As for acute xerostomia, patients with laryngeal cancer were excluded from evaluation. 50 patients were evaluable (25 patients in the RC + CT, 25 patients in the RC + CT + A group). Clinical characteristics were well balanced in both treatment groups. Amifostine provided reduction in acute xerostomia and mucositis but had no obvious influence on Karnofsky performance status, body weight, cutaneous side effects, and alopecia. The differences between both groups were statistically significant for acute xerostomia and nonsignificant, but with a trend for mucositis. According to our results, there is a radioprotective effect on salivary glands and a potential effect on oral mucosa by amifostine in postoperative radiotherapy combined with carboplatin. To improve the radio- and chemoprotective effects of amifostine in clinical practice, the application of a higher dose (> 250 mg) seems to be necessary.

Quantifying Head Impacts in Collegiate Lacrosse.

PubMed

Reynolds, Bryson B; Patrie, James; Henry, Erich J; Goodkin, Howard P; Broshek, Donna K; Wintermark, Max; Druzgal, T Jason

2016-11-01

Concussion and repetitive head impact in sports has increased interest and concern for clinicians, scientists, and athletes. Lacrosse is the fastest growing sport in the United States, but the burden of head impact in lacrosse is unknown. The goal of this pilot study was to quantify head impact associated with practicing and playing collegiate lacrosse while subjects were fitted with wearable accelerometers. Descriptive epidemiology study. In a single year, a collegiate cohort of 14 women's and 15 men's lacrosse players wore mastoid-patch accelerometers to measure the frequency and severity of head impacts during official practices and games. Average impact severity, mean number of impacts, and cumulative acceleration were evaluated, stratified by sport and event type. Men's and women's collegiate lacrosse players did not significantly differ in the number of head impacts received during games (11.5 for men vs 9.2 for women) or practices (3.1 vs 3.1). Men's lacrosse players had significantly higher average head acceleration per impact during games compared with women (21.1g vs 14.7g) but not during practices (21.3g vs 18.1g). For both men and women, more impacts occurred during games than during practices (men, 11.5 vs 3.1; women, 9.2 vs 3.1), but impact severity did not significantly differ between events for either sport (men, 21.1g vs 21.3g; women, 14.7g vs 18.1g). The study data suggest a higher impact burden during games compared with practices, but this effect is driven by the quantity rather than severity of impacts. In contrast, sex-based effects in impact burden are driven by average impact severity rather than quantity. Data collected from larger multisite trials and/or different age groups could be used to inform ongoing debates, including headgear and practice regulations, that might appreciably affect the burden of head impacts in lacrosse. While most head impacts do not result in a clinical diagnosis of concussion, evidence indicates that

A Randomized Study Comparing the Sniffing Position with Simple Head Extension for Glottis Visualization and Difficulty in Intubation during Direct Laryngoscopy.

PubMed

Akhtar, Mehmooda; Ali, Zulfiqar; Hassan, Nelofar; Mehdi, Saqib; Wani, Gh Mohammad; Mir, Aabid Hussain

2017-01-01

Proper positioning of the head and neck is important for an optimal laryngeal visualization. Traditionally, sniffing position (SP) is recommended to provide a superior glottic visualization, during direct laryngoscopy, enhancing the ease of intubation. Various studies in the last decade of this belief have challenged the need for sniffing position during intubation. We conducted a prospective study comparing the sniffing head position with simple head extension to study the laryngoscopic view and intubation difficulty during direct laryngoscopy. Five-hundred patients were included in this study and randomly distributed to SP or simple head extension. In the sniffing group, an incompressible head ring was placed under the head to raise its height by 7 cm from the neutral plane followed by maximal extension of the head. In the simple extension group, no headrest was placed under the head; however, maximal head extension was given at the time of laryngoscopy. Various factors as ability to mask ventilate, laryngoscopic visualization, intubation difficulty, and posture of the anesthesiologist during laryngoscopy and tracheal intubation were noted. In the incidence of difficult laryngoscopy (Cormack Grade III and IV), Intubation Difficulty Scale (IDS score) was compared between the two groups. There was no significant difference between two groups in Cormack grades. The IDS score differed significantly between sniffing group and simple extension group ( P = 0.000) with an increased difficulty during intubation in the simple head extension. Patients with simple head extension needed more lifting force, increased use of external laryngeal manipulation, and an increased use of alternate techniques during intubation when compared to SP. We conclude that compared to the simple head extension position, the SP should be used as a standard head position for intubation attempts under general anesthesia.

Heading in the right direction? An innovative approach toward proper patient head positioning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grush, William H.; Steffen, Gary A

2002-12-31

An in-house-manufactured modification of the standard A-F foam rubber head-neck supports (aka. Timo Supports) was designed to eliminate clinical setup problems with head immobilization and instability during treatment, thus providing for a more comfortable head rest for the patient. The custom design of this head holder seeks to eliminate superior-to-inferior shift, and minimize the lateral right-to-left rotational movement of the head when coupled with an AquaPlast casting system. By focusing attention to the seating of the occipital portion of the head and contour of the patient's neck, the aforementioned problems of movement were addressed, while adhering to the interests ofmore » patient comfort in this modified head support system.« less

Heading-vector navigation based on head-direction cells and path integration.

PubMed

Kubie, John L; Fenton, André A

2009-05-01

Insect navigation is guided by heading vectors that are computed by path integration. Mammalian navigation models, on the other hand, are typically based on map-like place representations provided by hippocampal place cells. Such models compute optimal routes as a continuous series of locations that connect the current location to a goal. We propose a "heading-vector" model in which head-direction cells or their derivatives serve both as key elements in constructing the optimal route and as the straight-line guidance during route execution. The model is based on a memory structure termed the "shortcut matrix," which is constructed during the initial exploration of an environment when a set of shortcut vectors between sequential pairs of visited waypoint locations is stored. A mechanism is proposed for calculating and storing these vectors that relies on a hypothesized cell type termed an "accumulating head-direction cell." Following exploration, shortcut vectors connecting all pairs of waypoint locations are computed by vector arithmetic and stored in the shortcut matrix. On re-entry, when local view or place representations query the shortcut matrix with a current waypoint and goal, a shortcut trajectory is retrieved. Since the trajectory direction is in head-direction compass coordinates, navigation is accomplished by tracking the firing of head-direction cells that are tuned to the heading angle. Section 1 of the manuscript describes the properties of accumulating head-direction cells. It then shows how accumulating head-direction cells can store local vectors and perform vector arithmetic to perform path-integration-based homing. Section 2 describes the construction and use of the shortcut matrix for computing direct paths between any pair of locations that have been registered in the shortcut matrix. In the discussion, we analyze the advantages of heading-based navigation over map-based navigation. Finally, we survey behavioral evidence that nonhippocampal

Head circumference (image)

MedlinePlus

Head circumference is a measurement of the circumference of the child's head at its largest area, above the eyebrows and ears and around the back of the head. During routine check-ups, the distance is ...

Posture, head stability, and orientation recovery during vestibular regeneration in pigeons.

PubMed

Dickman, J David; Lim, Insook

2004-09-01

Compensatory behavior such as oculomotor, gaze, and postural responses that occur during movement largely depend upon a functioning vestibular system. In the present study, the initial loss and subsequent recovery of postural and head stability in pigeons undergoing vestibular regeneration were examined. Adult pigeons were trained to manipulate a straight run chamber to peck an illuminated key for fluid reward. Six behavioral measures assessing performance, posture, and head stability were quantified. These included run latency, steps (walking), path negotiation (lane changes), gaze saccades, head bobs, and head shakes. Once normative values were obtained for four birds, complete lesion of all receptor cells and denervation of the epithelia in the vestibular endorgans were produced using a single intralabyrinthine application of streptomycin sulfate. Each bird was then tested at specific times during regeneration and the same behavioral measures examined. At 7 days post-streptomycin treatment (PST), all birds exhibited severe postural and head instability, with tremors, head shakes, staggering, and circling predominating. No normal trial runs, walking, gaze saccades, or head bobs were present. Many of these dysfunctions persisted through 3-4 weeks PST. Gradually, tremor and head shakes diminished and were replaced with an increasing number of normal head bobs during steps and gaze saccades. Beginning at 4 weeks PST, but largely inaccurate, was the observed initiation of directed steps, less staggering, and some successful path negotiation. As regeneration progressed, spatial orientation and navigation ability increased and, by 49 days PST, most trials were successful. By 70 days PST, all birds had recovered to pretreatment levels. Thus, it was observed that ataxia must subside, coincident with normalized head and postural stability prior to the recovery of spatial orientation and path navigation recovery. Parallels in recovery were drawn to hair cell regeneration

Ceramic Heads Decrease Metal Release Caused by Head-taper Fretting and Corrosion.

PubMed

Kocagoz, Sevi B; Underwood, Richard J; MacDonald, Daniel W; Gilbert, Jeremy L; Kurtz, Steven M

2016-04-01

Metal release resulting from taper fretting and corrosion is a clinical concern, because wear and corrosion products may stimulate adverse local tissue reactions. Unimodular hip arthroplasties have a conical taper between the femoral head (head bore taper) and the femoral stem (stem cone taper). The use of ceramic heads has been suggested as a way of reducing the generation of wear and corrosion products from the head bore/stem cone taper junction. A previous semiquantitative study found that ceramic heads had less visual evidence of fretting-corrosion damage compared with CoCr heads; but, to our knowledge, no studies have quantified the volumetric material loss from the head bore and stem cone tapers of a matched cohort of ceramic and metal heads. We asked: (1) Do ceramic heads result in less volume of material loss at the head-stem junction compared with CoCr heads; (2) do stem cone tapers have less volumetric material loss compared with CoCr head bore tapers; (3) do visual fretting-corrosion scores correlate with volumetric material loss; and (4) are device, patient, or intraoperative factors associated with volumetric material loss? A quantitative method was developed to estimate volumetric material loss from the head and stem taper in previously matched cohorts of 50 ceramic and 50 CoCr head-stem pairs retrieved during revision surgery for causes not related to adverse reactions to metal particles. The cohorts were matched according to (1) implantation time, (2) stem flexural rigidity, and (3) lateral offset. Fretting corrosion was assessed visually using a previously published four-point, semiquantitative scoring system. The volumetric loss was measured using a precision roundness machine. Using 24 equally spaced axial traces, the volumetric loss was estimated using a linear least squares fit to interpolate the as-manufactured surfaces. The results of this analysis were considered in the context of device (taper angle clearance, head size, head offset

Anti-cancer effects of curcumin on head and neck cancers.

PubMed

Gao, Wei; Chan, Jimmy Yu-Wai; Wei, William Ignance; Wong, Thian-Sze

2012-11-01

Head and neck cancer is the sixth large type of cancer in the world. The treatment regimens for head and neck cancer encompass surgery, radiotherapy and chemotherapy. However, all current treatment regimens for head and neck cancer have adverse effects. Therefore, continuing investigations have been undertaken to seek less toxic therapies to reduce treatment morbidity for head and neck cancer. Substantial evidence has demonstrated that curcumin inhibited proliferation, migration, invasion and metastasis and induced apoptosis via modulating multiple signaling pathways in head and neck cancer. Curcumin also suppressed the growth of xenograft derived from head and neck cancer in vivo in animal models. This review summarizes the evidence demonstrating potential use of curcumin as a single chemotherapeutic agent or in combination with other chemotherapeutic agents and radiation to minimize their toxicity in head and neck cancer. Although curcumin has been shown to be safe at doses of 8 g/d in both phase I and phase II clinical trials, its bioavailability is poor. Overcoming the poor bioavailability of curcumin in the near future would facilitate its clinical use.

Spurious group differences due to head motion in a diffusion MRI study

PubMed Central

Yendiki, Anastasia; Koldewyn, Kami; Kakunoori, Sita; Kanwisher, Nancy; Fischl, Bruce

2014-01-01

Diffusion-weighted MRI (DW-MRI) has become a popular imaging modality for probing the microstructural properties of white matter and comparing them between populations in vivo. However, the contrast in DW-MRI arises from the microscopic random motion of water molecules in brain tissues, which makes it particularly sensitive to macroscopic head motion. Although this has been known since the introduction of DW-MRI, most studies that use this modality for group comparisons do not report measures of head motion for each group and rely on registration-based correction methods that cannot eliminate the full effects of head motion on the DW-MRI contrast. In this work we use data from children with autism and typically developing children to investigate the effects of head motion on differences in anisotropy and diffusivity measures between groups. We show that group differences in head motion can induce group differences in DW-MRI measures, and that this is the case even when comparing groups that include control subjects only, where no anisotropy or diffusivity differences are expected. We also show that such effects can be more prominent in some white-matter pathways than others, and that they can be ameliorated by including motion as a nuisance regressor in the analyses. Our results demonstrate the importance of taking head motion into account in any population study where one group might exhibit more head motion than the other. PMID:24269273

The effect of the use of thyme honey in minimizing radiation - induced oral mucositis in head and neck cancer patients: A randomized controlled trial.

PubMed

Charalambous, Melanie; Raftopoulos, Vasilios; Paikousis, Lefkios; Katodritis, Nicos; Lambrinou, Ekaterini; Vomvas, Dimitrios; Georgiou, Morpho; Charalambous, Andreas

2018-06-01

Radiation-induced oral mucositis is one of the main side effects during and after the treatment of head and neck cancer patients. The study was designed to provide evidence on the effectiveness of thyme honey on oral mucositis management. This was a randomised controlled trial (RCT) with 72 head and neck cancer patients who were divided either to the intervention group (thyme honey rinses) or to the control group (saline rinses). Oral mucositis was assessed according to the Radiation Therapy Oncology Group (RTOC criteria), and assessments were performed weekly starting at the 4th week of the radiotherapy for seven weeks and repeated once 6 months later. Additionally, the Oral Mucositis Weekly Questionnaire (OMWQ) was given at 4th week of radiotherapy, 1 month after the completion of radiotherapy and 6 months later. The ClinicalTrials.gov Identifier for this study is NCT01465308. This paper reports on the findings regarding thyme honey's effectiveness on oral mucositis. Generalized estimating equations revealed that patients in the intervention group were graded lower in the objective assessment of oral mucositis (p < 0,001), maintained their body weight (p < 0,001) and showed an improvement in their global health (p = 0.001) compared to the control group. Quality of life of the patients in the same group was also statistically significantly higher than that of the patients of the control group (p < 0,001). The study provided evidence on the positive effect of thyme honey on the management of radiation-induced oral mucositis and quality of life in head and neck cancer patients. Copyright © 2018 Elsevier Ltd. All rights reserved.

Fetal head detection and measurement in ultrasound images by an iterative randomized Hough transform

NASA Astrophysics Data System (ADS)

Lu, Wei; Tan, Jinglu; Floyd, Randall C.

2004-05-01

This paper describes an automatic method for measuring the biparietal diameter (BPD) and head circumference (HC) in ultrasound fetal images. A total of 217 ultrasound images were segmented by using a K-Mean classifier, and the head skull was detected in 214 of the 217 cases by an iterative randomized Hough transform developed for detection of incomplete curves in images with strong noise without user intervention. The automatic measurements were compared with conventional manual measurements by sonographers and a trained panel. The inter-run variations and differences between the automatic and conventional measurements were small compared with published inter-observer variations. The results showed that the automated measurements were as reliable as the expert measurements and more consistent. This method has great potential in clinical applications.

Non-intrusive head movement analysis of videotaped seizures of epileptic origin.

PubMed

Mandal, Bappaditya; Eng, How-Lung; Lu, Haiping; Chan, Derrick W S; Ng, Yen-Ling

2012-01-01

In this work we propose a non-intrusive video analytic system for patient's body parts movement analysis in Epilepsy Monitoring Unit. The system utilizes skin color modeling, head/face pose template matching and face detection to analyze and quantify the head movements. Epileptic patients' heads are analyzed holistically to infer seizure and normal random movements. The patient does not require to wear any special clothing, markers or sensors, hence it is totally non-intrusive. The user initializes the person-specific skin color and selects few face/head poses in the initial few frames. The system then tracks the head/face and extracts spatio-temporal features. Support vector machines are then used on these features to classify seizure-like movements from normal random movements. Experiments are performed on numerous long hour video sequences captured in an Epilepsy Monitoring Unit at a local hospital. The results demonstrate the feasibility of the proposed system in pediatric epilepsy monitoring and seizure detection.

Pivoting-Head Wrench

NASA Technical Reports Server (NTRS)

Bradley, Glen L.

1993-01-01

Wrench ends pivot so it can be used to loosen or tighten nuts or bolts in confined spaces. One end equipped with open-end socket; other end, with double-hexagon socket. Heads pivot on pins. Pins fit tightly so heads do not flop; friction on pins sufficient to hold heads in positions until rotated intentionally.

Head MRI

MedlinePlus

... the head; MRI - cranial; NMR - cranial; Cranial MRI; Brain MRI; MRI - brain; MRI - head ... the test, tell your provider if you have: Brain aneurysm clips An artificial heart valves Heart defibrillator ...

Effects of head tilt on visual field testing with a head-mounted perimeter imo

PubMed Central

Matsumoto, Chota; Nomoto, Hiroki; Numata, Takuya; Eura, Mariko; Yamashita, Marika; Hashimoto, Shigeki; Okuyama, Sachiko; Kimura, Shinji; Yamanaka, Kenzo; Chiba, Yasutaka; Aihara, Makoto; Shimomura, Yoshikazu

2017-01-01

Purpose A newly developed head-mounted perimeter termed “imo” enables visual field (VF) testing without a fixed head position. Because the positional relationship between the subject’s head and the imo is fixed, the effects of head position changes on the test results are small compared with those obtained using a stationary perimeter. However, only ocular counter-roll (OCR) induced by head tilt might affect VF testing. To quantitatively reveal the effects of head tilt and OCR on the VF test results, we investigated the associations among the head-tilt angle, OCR amplitude and VF testing results. Subjects and methods For 20 healthy subjects, we binocularly recorded static OCR (s-OCR) while tilting the subject’s head at an arbitrary angle ranging from 0° to 60° rightward or leftward in 10° increments. By monitoring iris patterns, we evaluated the s-OCR amplitude. We also performed blind spot detection while tilting the subject’s head by an arbitrary angle ranging from 0° to 50° rightward or leftward in 10° increments to calculate the angle by which the blind spot rotates because of head tilt. Results The association between s-OCR amplitude and head-tilt angle showed a sinusoidal relationship. In blind spot detection, the blind spot rotated to the opposite direction of the head tilt, and the association between the rotation angle of the blind spot and the head-tilt angle also showed a sinusoidal relationship. The rotation angle of the blind spot was strongly correlated with the s-OCR amplitude (R2≥0.94, p<0.0001). A head tilt greater than 20° with imo causes interference between adjacent test areas. Conclusions Both the s-OCR amplitude and the rotation angle of the blind spot were correlated with the head-tilt angle by sinusoidal regression. The rotated VF was correlated with the s-OCR amplitude. During perimetry using imo, the change in the subject’s head tilt should be limited to 20°. PMID:28945777

Erlotinib, erlotinib-sulindac vs. placebo: a randomized, double-blind, placebo-controlled window trial in operable head and neck cancer

PubMed Central

Gross, Neil D.; Bauman, Julie E.; Gooding, William E.; Denq, William; Thomas, Sufi M.; Wang, Lin; Chiosea, Simion; Hood, Brian L.; Flint, Melanie S.; Sun, Mai; Conrads, Thomas P.; Ferris, Robert L.; Johnson, Jonas T.; Kim, Seungwon; Argiris, Athanassios; Wirth, Lori; Nikiforova, Marina N.; Siegfried, Jill M.; Grandis, Jennifer R.

2014-01-01

Purpose The epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) pathways are upregulated in head and neck squamous cell carcinoma (HNSCC). Preclinical models indicate synergistic anti-tumor activity from dual blockade. We conducted a randomized, double-blind, placebo-controlled window trial of erlotinib, an EGFR inhibitor; erlotinib plus sulindac, a non-selective COX inhibitor, vs. placebo. Experimental Design Patients with untreated, operable Stage II-IVb HNSCC were randomized 5:5:3 to erlotinib, erlotinib-sulindac, or placebo. Tumor specimens were collected before and after 7-14 days of treatment. The primary endpoint was change in Ki-67 proliferation index. We hypothesized an ordering effect in Ki-67 reduction: erlotinib-sulindac > erlotinib > placebo. We evaluated tissue microarrays by immunohistochemistry for pharmacodynamic modulation of EGFR and COX-2 signaling intermediates. Results From 2005-2009, 47 patients were randomized for the target 39 evaluable patients. Thirty-four tumor pairs were of sufficient quality to assess biomarker modulation. Ki-67 was significantly decreased by erlotinib or erlotinib-sulindac (omnibus comparison, two-sided Kruskal-Wallis, p=0.04). Wilcoxon pairwise contrasts confirmed greater Ki-67 effect in both erlotinib groups (erlotinib-sulindac vs. placebo p=0.043; erlobinib vs. placebo, p=0.027). There was a significant trend in ordering of Ki-67 reduction: erlotinib-sulindac > erlotinib > placebo (two-sided exact Jonckheere-Terpstra, p =0.0185). Low baseline pSrc correlated with greater Ki-67 reduction (R2 = .312, p = 0.024). Conclusions Brief treatment with erlotinib significantly decreased proliferation in HNSCC, with additive effect from sulindac. Efficacy studies of dual EGFR-COX inhibition are justified. pSrc is a potential resistance biomarker for anti-EGFR therapy, and warrants investigation as a molecular target. PMID:24727329

Eye and head motion during head turns in spaceflight

NASA Technical Reports Server (NTRS)

Thornton, William E.; Uri, John J.; Moore, Thomas P.; Pool, Sam L.

1988-01-01

Eye-head motion was studied pre-, in- and postflight during single voluntary head turns. A transient increase in vestibulo-ocular reflex (VOR) gain occurred early in the flight, but later trended toward normal. This increased gain was produced by a relative increase in eye counterrotation velocity. Asymmetries in gain with right and left turns also occurred, caused by asymmetries in eye counterrotation velocities. These findings were remarkably similar to those from Soviet primate studies using gaze fixation targets, except the human study trended more rapidly toward normal. These findings differ substantially from those measuring VOR gain by head oscillation, in which no significant changes were found inflight. No visual disturbances were noted in either test condition or in normal activities. These head turn studies are the only ones to date documenting any functional change in VOR in weightlessness.

The Cognitive Effects of Antidepressants in Major Depressive Disorder: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

PubMed Central

Rosenblat, Joshua D; Kakar, Ron

2016-01-01

Background: Cognitive dysfunction is often present in major depressive disorder (MDD). Several clinical trials have noted a pro-cognitive effect of antidepressants in MDD. The objective of the current systematic review and meta-analysis was to assess the pooled efficacy of antidepressants on various domains of cognition in MDD. Methods: Trials published prior to April 15, 2015, were identified through searching the Cochrane Central Register of Controlled Trials, PubMed, Embase, PsychINFO, Clinicaltrials.gov, and relevant review articles. Data from randomized clinical trials assessing the cognitive effects of antidepressants were pooled to determine standard mean differences (SMD) using a random-effects model. Results: Nine placebo-controlled randomized trials (2 550 participants) evaluating the cognitive effects of vortioxetine (n = 728), duloxetine (n = 714), paroxetine (n = 23), citalopram (n = 84), phenelzine (n = 28), nortryptiline (n = 32), and sertraline (n = 49) were identified. Antidepressants had a positive effect on psychomotor speed (SMD 0.16; 95% confidence interval [CI] 0.05–0.27; I2 = 46%) and delayed recall (SMD 0.24; 95% CI 0.15–0.34; I2 = 0%). The effect on cognitive control and executive function did not reach statistical significance. Of note, after removal of vortioxetine from the analysis, statistical significance was lost for psychomotor speed. Eight head-to-head randomized trials comparing the effects of selective serotonin reuptake inhibitors (SSRIs; n = 371), selective serotonin and norepinephrine reuptake inhibitors (SNRIs; n = 25), tricyclic antidepressants (TCAs; n = 138), and norepinephrine and dopamine reuptake inhibitors (NDRIs; n = 46) were identified. No statistically significant difference in cognitive effects was found when pooling results from head-to-head trials of SSRIs, SNRIs, TCAs, and NDRIs. Significant limitations were the heterogeneity of results, limited number of studies, and small sample sizes. Conclusions

The Role of Access to Head Start and Quality Ratings for Spanish-Speaking Dual Language Learners’ (DLLs) Participation in Early Childhood Education

PubMed Central

2014-01-01

Data from the Head Start Impact Study (N = 4,442) were used to test for differences between Spanish-speaking Dual Language Learners (DLLs) and monolingual English-speaking children in: (1) Head Start attendance rates when randomly assigned admission; and (2) quality ratings of other early childhood education (ECE) programs attended when not randomly assigned admission to Head Start. Logistic regressions showed that Spanish-speaking DLL children randomly assigned a spot in Head Start were more likely than monolingual-English learners to attend. Further, Spanish-speaking DLLs not randomly assigned a spot in Head Start were more likely to attend higher-quality ECE centers than non-DLL children. Policy implications are discussed, suggesting that, if given access, Spanish-speaking DLL families will take advantage of quality ECE programs. PMID:25018585

Head Start’s Impact is Contingent on Alternative Type of Care in Comparison Group

PubMed Central

Brooks-Gunn, Jeanne; Waldfogel, Jane

2014-01-01

Using data (n = 3,790 with 2,119 in the 3-year-old cohort and 1,671 in the 4-year-old cohort) from 353 Head Start centers in the Head Start Impact Study, the only large-scale randomized experiment in Head Start history, this paper examined the impact of Head Start on children’s cognitive and parent-reported social-behavioral outcomes through first grade contingent on the child care arrangements used by children who were randomly assigned to the control group (i.e., parental care, relative/non-relative care, another Head Start program, or other center-based care). A principal score matching approach was adopted to identify children assigned to Head Start who were similar to children in the control group with a specific care arrangement. Overall, the results showed that the effects of Head Start varied substantially contingent on the alternative child care arrangements. Compared to children in parental care and relative/non-relative care, Head Start participants generally had better cognitive and parent-reported behavioral development, with some benefits of Head Start persisting through first grade; in contrast, few differences were found between Head Start and other center-based care. The results have implications regarding the children for whom Head Start is most beneficial as well as how well Head Start compares to other center-based programs. PMID:25329552

Clinical staging and operative reporting for multi-institutional trials in head and neck squamous cell carcinoma.

PubMed

Weymuller, E A

1997-12-01

A Strategic Planning Conference (jointly supported by NCI and NIDCD) was convened to consider potential improvements in surgical patient data for multi-institutional trials. The thesis underlying this project is that inadequacies in staging, pretreatment patient stratification, and the details of surgical resection may have obscured the detection of treatment effect. The goals of this project were multiple: (1) to consider the utility of new clinical stratification variables, (2) to increase the precision of tumor staging, and (3) to improve operative reporting for multi-institutional trials in head and neck cancer. The conference attendees came to a number of important conclusions: (1) TNM status is inadequate for describing head and neck cancer in a multi-institutional trial setting. A detailed anatomic reporting scheme is proposed; (2) comorbidity measures should be included as patient descriptors, especially those that meet the criteria "definitely important and easy to obtain"; (3) surgical reporting in multi-institutional trials should use a format that is compatible with computer analysis and use the same items as the revised (anatomic) staging system; (4) the surgeon should be personally responsible for data coding and should interact directly with the pathologist in marking the surgical specimen; (5) pathologic reporting should use an anatomic template identical to the staging and operative reporting formats.

Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: A randomized, placebo-controlled clinical trial

PubMed Central

Moraska, Albert F.; Stenerson, Lea; Butryn, Nathan; Krutsch, Jason P.; Schmiege, Sarah J.; Mann, J. Douglas

2014-01-01

Objective Myofascial trigger points (MTrPs) are focal disruptions in skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type headache (TTH). The present study applied massage focused on MTrPs of subjects with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache pain. Methods Fifty-six subjects with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over six weeks, or to wait-list. Trigger point release (TPR) massage focused on MTrPs in cervical musculature. Headache pain (frequency, intensity and duration) was recorded in a daily headache diary. Additional outcome measures included self-report of perceived clinical change in headache pain and pressure-pain threshold (PPT) at MTrPs in the upper trapezius and sub-occipital muscles. Results From diary recordings, group differences across time were detected in headache frequency (p=0.026), but not for intensity or duration. Post hoc analysis indicated headache frequency decreased from baseline for both massage (p<0.0003) and placebo (p=0.013), but no difference was detected between massage and placebo. Subject report of perceived clinical change was a greater reduction in headache pain for massage than placebo or wait-list groups (p=0.002). PPT improved in all muscles tested for massage only (all p's<0.002). Discussion Two findings from this study are apparent: 1) MTrPs are important components in the treatment of TTH, and 2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on headache that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention. PMID:25329141

Myofascial trigger point-focused head and neck massage for recurrent tension-type headache: a randomized, placebo-controlled clinical trial.

PubMed

Moraska, Albert F; Stenerson, Lea; Butryn, Nathan; Krutsch, Jason P; Schmiege, Sarah J; Mann, John D

2015-02-01

Myofascial trigger points (MTrPs) are focal disruptions in the skeletal muscle that can refer pain to the head and reproduce the pain patterns of tension-type HA (TTH). The present study applied massage focused on MTrPs of patients with TTH in a placebo-controlled, clinical trial to assess efficacy on reducing headache (HA) pain. Fifty-six patients with TTH were randomized to receive 12 massage or placebo (detuned ultrasound) sessions over 6 weeks, or to wait-list. Trigger point release massage focused on MTrPs in cervical musculature. HA pain (frequency, intensity, and duration) was recorded in a daily HA diary. Additional outcome measures included self-report of perceived clinical change in HA pain and pressure-pain threshold at MTrPs in the upper trapezius and suboccipital muscles. From diary recordings, group differences across time were detected in HA frequency (P=0.026), but not for intensity or duration. Post hoc analysis indicated that HA frequency decreased from baseline for both massage (P<0.0003) and placebo (P=0.013), but no difference was detected between massage and placebo. Patient report of perceived clinical change was greater reduction in HA pain for massage than placebo or wait-list groups (P=0.002). Pressure-pain threshold improved in all muscles tested for massage only (all P's<0.002). Two findings from this study are apparent: (1) MTrPs are important components in the treatment of TTH, and (2) TTH, like other chronic conditions, is responsive to placebo. Clinical trials on HA that do not include a placebo group are at risk for overestimating the specific contribution from the active intervention.

A comparative study of restricted randomization procedures for multiarm trials with equal or unequal treatment allocation ratios.

PubMed

Ryeznik, Yevgen; Sverdlov, Oleksandr

2018-06-04

Randomization designs for multiarm clinical trials are increasingly used in practice, especially in phase II dose-ranging studies. Many new methods have been proposed in the literature; however, there is lack of systematic, head-to-head comparison of the competing designs. In this paper, we systematically investigate statistical properties of various restricted randomization procedures for multiarm trials with fixed and possibly unequal allocation ratios. The design operating characteristics include measures of allocation balance, randomness of treatment assignments, variations in the allocation ratio, and statistical characteristics such as type I error rate and power. The results from the current paper should help clinical investigators select an appropriate randomization procedure for their clinical trial. We also provide a web-based R shiny application that can be used to reproduce all results in this paper and run simulations under additional user-defined experimental scenarios. Copyright © 2018 John Wiley & Sons, Ltd.

Rat Cardiovascular Responses to Whole Body Suspension: Head-down and Non-Head-Down Tilt

NASA Technical Reports Server (NTRS)

Musacchia, X. J.; Steffen, Joseph M.; Dombrowski, Judy

1992-01-01

The rat whole body suspension technique mimics responses seen during exposure to microgravity and was evaluated as a model for cardiovascular responses with two series of experiments. In one series, changes were monitored in chronically catheterized rats during 7 days of Head-Down Tilt (HDT) or Non-Head-Down Tilt (N-HDT) and after several hours of recovery. Elevations of mean arterial (MAP), systolic, and diastolic pressures of approx. 20 % (P less than 0.05) in HDT rats began as early as day 1 and were maintained for the duration of suspension. Pulse pressures were relatively unaffected, but heart rates were elevated approx. 10 %. During postsuspension (2-7 h), most cardiovascular parameters returned to presuspension levels. N-HDT rats exhibited elevations chiefly on days 3 and 7. In the second series, blood pressure was monitored in 1- and 3-day HDT and N-HDT rats to evaluate responses to rapid head-up tilt. MAP, systolic and diastolic pressures, and HR were elevated (P less than 0.05) in HDT and N-HDT rats during head-up tilt after 1 day of suspension, while pulse pressures remained un changed. HDT rats exhibited elevated pretilt MAP and failed to respond to rapid head-up tilt with further increase of MAP on day 3, indicating some degree of deconditioning. The whole body suspended rat may be useful as a model to better understand responses of rats exposed to microgravity.

Do the Effects of Head Start Vary by Parental Preacademic Stimulation?

PubMed Central

Miller, Elizabeth B.; Farkas, George; Vandell, Deborah Lowe; Duncan, Greg J.

2014-01-01

Data from the Head Start Impact Study (N=3,185, age = 3–4 years) were used to determine whether one year of Head Start differentially benefited children from homes with high, middle, and low levels of parental preacademic stimulation on three academic outcome domains – early math, early literacy, and receptive vocabulary. Results from residualized growth models showed positive impacts of random assignment to Head Start on all three outcomes, and positive associations between parental preacademic stimulation and academic performance. Two moderated effects were also found. Head Start boosted early math skills the most for children receiving low parental preacademic stimulation. Effects of Head Start on early literacy skills were largest for children receiving moderate levels of parental preacademic stimulation. Implications for Head Start are discussed. PMID:24597729

Head Lice.

PubMed

Meister, Laura; Ochsendorf, Falk

2016-11-11

Conflicting information about the proper treatment of head lice has given rise to uncertainty among patients and treating personnel. For example, the reported efficacy of permethrin fell from 97% in the 1990s to 30% in 2010. Review of the literature based on a selective search of PubMed. In Germany, outbreaks of head lice mainly occur among 5- to 13-year-olds returning to school after the summer vacation. Nymphs hatch from eggs after an average of 8 days and become sexually mature lice over the ensuing 9 days. The main route of transmission is direct head-to-head contact; transmission via inanimate objects is of no relevance. Symptoms arise 4-6 weeks after an initial infestation; many affected persons have no symptoms at all. Wet combing is the most sensitive method of establishing the diagnosis and monitoring treatment. Resistance to neurotoxic pediculocidal drugs is increasing around the world. Dimethicones are the treatment of choice, with 97% efficacy. Outbreaks must be managed with the synchronous treatment of all infested persons to break the chain of infestation. If the agent used is not ovicidal, the treatment must be repeated in 8-10 days and sometimes in a further 7 days as well. Outbreaks of head lice can be successfully terminated by synchronous treatment with ovicidal dimethicones.

Migration from full-head mask to "open-face" mask for immobilization of patients with head and neck cancer.

PubMed

Li, Guang; Lovelock, D Michael; Mechalakos, James; Rao, Shyam; Della-Biancia, Cesar; Amols, Howard; Lee, Nancy

2013-09-06

To provide an alternative device for immobilization of the head while easing claustrophobia and improving comfort, an "open-face" thermoplastic mask was evaluated using video-based optical surface imaging (OSI) and kilovoltage (kV) X-ray radiography. A three-point thermoplastic head mask with a precut opening and reinforced strips was developed. After molding, it provided sufficient visible facial area as the region of interest for OSI. Using real-time OSI, the head motion of ten volunteers in the new mask was evaluated during mask locking and 15minutes lying on the treatment couch. Using a nose mark with reference to room lasers, forced head movement in open-face and full-head masks (with a nose hole) was compared. Five patients with claustrophobia were immobilized with open-face masks, set up using OSI and kV, and treated in 121 fractions, in which 61 fractions were monitored during treatment using real-time OSI. With the open-face mask, head motion was found to be 1.0 ± 0.6 mm and 0.4° ± 0.2° in volunteers during the experiment, and 0.8 ± 0.3 mm and 0.4° ± 0.2° in patients during treatment. These agree with patient motion calculated from pre-/post-treatment OSI and kV data using different anatomical landmarks. In volunteers, the head shift induced by mask-locking was 2.3 ± 1.7 mm and 1.8° ± 0.6°, and the range of forced movements in the open-face and full-head masks were found to be similar. Most (80%) of the volunteers preferred the open-face mask to the full-head mask, while claustrophobic patients could only tolerate the open-face mask. The open-face mask is characterized for its immobilization capability and can immobilize patients sufficiently (< 2 mm) during radiotherapy. It provides a clinical solution to the immobilization of patients with head and neck (HN) cancer undergoing radiotherapy, and is particularly beneficial for claustrophobic patients. This new open-face mask is readily adopted in radiotherapy clinic as a superior alternative

Nanomedicines for Inflammatory Arthritis: Head-To-Head Comparison of Glucocorticoid-Containing Polymers, Micelles and Liposomes

PubMed Central

Crielaard, Bart J.; Dusad, Anand; Lele, Subodh M.; Rijcken, Cristianne J. F.; Metselaar, Josbert M; Kostková, Hana; Etrych, Tomáš; Ulbrich, Karel; Kiessling, Fabian; Mikuls, Ted R.; Hennink, Wim E.; Storm, Gert; Lammers, Twan; Wang, Dong

2014-01-01

As an emerging research direction, nanomedicine has been increasingly utilized to treat inflammatory diseases. In this head-to-head comparison study, four established nanomedicine formulations of dexamethasone, including liposomes (L-Dex), core-crosslinked micelles (M-Dex), slow releasing polymeric prodrugs (P-Dex-slow) and fast releasing polymeric prodrugs (P-Dex-fast), were evaluated in an adjuvant-induced arthritis rat model with an equivalent dose treatment design. It was found that after a single i.v. injection, the formulations with the slower drug release kinetics (i.e. M-Dex and P-Dex-slow) maintained longer duration of therapeutic activity than those with relatively faster drug release kinetics, resulting in better joint protection. This finding will be instructional in the future development and optimization of nanomedicines for the clinical management of rheumatoid arthritis. The outcome of this study also illustrates the value of such head-to-head comparison studies in translational nanomedicine research. PMID:24341611

Effect of neck flexor muscle activation on impact velocity of the head during backward falls in young adults.

PubMed

Choi, W J; Robinovitch, S N; Ross, S A; Phan, J; Cipriani, D

2017-11-01

Falls are a common cause of traumatic brain injuries (TBI) across the lifespan. A proposed but untested hypothesis is that neck muscle activation influences impact severity and risk for TBI during a fall. We conducted backward falling experiments to test whether activation of the neck flexor muscles facilitates the avoidance of head impact, and reduces impact velocity if the head contacts the ground. Young adults (n=8) fell from standing onto a 30cm thick gymnastics mat while wearing a helmet. Participants were instructed to fall backward and (a) prevent their head from impacting the mat ("no head impact" trials); (b) allow their head to impact the mat, but with minimal impact severity ("soft impact" trials); and (c) allow their head to impact the mat, while inhibiting efforts to reduce impact severity ("hard impact" trials). Trial type associated with peak magnitude of electromyographic activity of the sternocleidomastoid (SCM) muscles (p<0.017), and with the vertical and horizontal velocity of the head at impact (p<0.001). Peak SCM activations, expressed as percent maximal voluntary isometric contraction (%MVIC), averaged 75.3, 67.5, and 44.5%MVIC in "no head impact", "soft impact", and "hard impact" trials, respectively. When compared to "soft impact" trials, vertical impact velocities in "hard impact" trials averaged 87% greater (3.23 versus 1.73m/s) and horizontal velocities averaged 83% greater (2.74 versus 1.50m/s). For every 10% increase in SCM %MVIC, vertical impact velocity decreased 0.24m/s and horizontal velocity decreased 0.22m/s. We conclude that SCM activation contributes to the prevention and modulation of head impact severity during backward falls. Copyright © 2017 Elsevier Ltd. All rights reserved.

Physiological responses to the Coriolis illusion: effects of head position and vision.

PubMed

Westmoreland, David; Krell, Robert W; Self, Brian P

2007-10-01

Changes in sympathetic outflow during Type II spatial disorientation are well documented. In this study we investigated the influences of head position and eye state (open or closed) on sympathetic activation. There were 11 naive subjects (6 men, 5 women) who were tested in a General Aviation Trainer that accelerated at a subthreshold rate for 60 s until a constant angular velocity of 90 degrees x s(-1) was reached. Approximately 40 s later, subjects were instructed to tilt their heads along either the pitch or roll axis, stimulating a Coriolis illusion. Subjects reported the perceived intensity and duration of disorientation. Heart rate, heart rate variability, and electrodermal responses were recorded before, during, and after the period of disorientation. Each subject completed four trials, which were crossed combinations of head position and eye state. There were significant increases in heart rate and the electrodermal response during disorientation, but no significant change in heart rate variability. Head position had no significant effect on any physiological parameters or on the perceived intensity of disorientation; subjects reported a shorter duration of disorientation when the head was tilted into the roll versus the pitch axis. Eye state had no effect on heart rate, heart rate variability, or the intensity of disorientation, but the electrodermal response was somewhat greater, and the duration of disorientation shorter when eyes were open. The results suggest that head position and eye state (open or closed) do not need to be included as factors when investigating sympathetic outflow during a mild Coriolis illusion.

Hydra multiple head star sensor and its in-flight self-calibration of optical heads alignment

NASA Astrophysics Data System (ADS)

Majewski, L.; Blarre, L.; Perrimon, N.; Kocher, Y.; Martinez, P. E.; Dussy, S.

2017-11-01

HYDRA is EADS SODERN new product line of APS-based autonomous star trackers. The baseline is a multiple head sensor made of three separated optical heads and one electronic unit. Actually the concept which was chosen offers more than three single-head star trackers working independently. Since HYDRA merges all fields of view the result is a more accurate, more robust and completely autonomous multiple-head sensor, releasing the AOCS from the need to manage the outputs of independent single-head star trackers. Specific to the multiple head architecture and the underlying data fusion, is the calibration of the relative alignments between the sensor optical heads. The performance of the sensor is related to its estimation of such alignments. HYDRA design is first reminded in this paper along with simplification it can bring at system level (AOCS). Then self-calibration of optical heads alignment is highlighted through descriptions and simulation results, thus demonstrating the performances of a key part of HYDRA multiple-head concept.

Safety and efficacy of a non-pesticide-based head lice treatment: results of a randomised comparative trial in children.

PubMed

Greive, Kerryn A; Lui, Ada H; Barnes, Tanya M; Oppenheim, V M Jane

2012-11-01

Increasing resistance to pesticide-based head lice treatments has resulted in the need for alternative products to treat head lice infestations, but there are few clinical studies that have adequately tested these products. This multicentre, randomised, assessor-blind, parallel-group phase IV trial compared the safety and efficacy of a non-pesticide-based head lice shampoo with malathion foam in children. This trial used strict entry criteria, standardised treatment and assessment regimes, sibling control and a primary efficacy end-point defined as the absence of live head lice 21 days after initiating treatment. Repeat insult patch tests were performed to further assess the safety of the non-pesticide-based shampoo. In vitro tests were used to assess its ovicidal and pediculicidal efficacy. A total of 216 children were enrolled, of whom 172 were per-protocol. The non-pesticide-based shampoo was significantly more effective than malathion foam for the intent-to-treat population (62.3 vs 40.4% louse-free, unadjusted P = 0.002; adjusted P = 0.003), as well as for the per-protocol population (67.8 vs 43.0% louse-free, unadjusted P = 0.001; adjusted P = 0.004). Adverse events were limited to itching or stinging. Patch testing with the non-pesticide-based shampoo resulted in no adverse reactions. In vitro tests using body lice demonstrated that the non-pesticide-based shampoo is ovicidal and pediculicidal. The non-pesticide-based shampoo is significantly more effective in eliminating head lice than malathion foam in children, while being associated with a low incidence of mild, transient adverse events. © 2012 Ego Pharmaceuticals Pty Ltd Australasian Journal of Dermatology © 2012 The Australasian College of Dermatologists.

Encoding of head direction by hippocampal place cells in bats.

PubMed

Rubin, Alon; Yartsev, Michael M; Ulanovsky, Nachum

2014-01-15

Most theories of navigation rely on the concept of a mental map and compass. Hippocampal place cells are neurons thought to be important for representing the mental map; these neurons become active when the animal traverses a specific location in the environment (the "place field"). Head-direction cells are found outside the hippocampus, and encode the animal's head orientation, thus implementing a neural compass. The prevailing view is that the activity of head-direction cells is not tuned to a single place, while place cells do not encode head direction. However, little work has been done to investigate in detail the possible head-directional tuning of hippocampal place cells across species. Here we addressed this by recording the activity of single neurons in the hippocampus of two evolutionarily distant bat species, Egyptian fruit bat and big brown bat, which crawled randomly in three different open-field arenas. We found that a large fraction of hippocampal neurons, in both bat species, showed conjunctive sensitivity to the animal's spatial position (place field) and to its head direction. We introduced analytical methods to demonstrate that the head-direction tuning was significant even after controlling for the behavioral coupling between position and head direction. Surprisingly, some hippocampal neurons preserved their head direction tuning even outside the neuron's place field, suggesting that "spontaneous" extra-field spikes are not noise, but in fact carry head-direction information. Overall, these findings suggest that bat hippocampal neurons can convey both map information and compass information.

Head Lice to Dead Lice: Safe Solutions for Frantic Families. A New Treatment Program To Address Persistent Head Lice Infestations. [Videotape].

ERIC Educational Resources Information Center

Sawyer Mac Productions, Weston, MA.

Head lice affect over 10 million Americans each year. Noting that head lice are becoming resistant to conventional pediculicide (insecticide) treatments, this video combines live action and animation to education parents, children, and health professionals about the use of olive oil for successfully preventing and getting rid of head lice. The…

Grandparent Headed Families and Head Start: Developing Effective Services.

ERIC Educational Resources Information Center

Dannison, Linda L.; Smith, Andrea B.

Numerous challenges face the growing number of grandparent-headed households, including isolation from friends and social supports, and difficulties in caring for grandchildren exhibiting multiple needs. This paper describes a pilot program in which a university and a large county-wide Head Start program formed a partnership to focus on serving…

The head-mounted microscope.

PubMed

Chen, Ting; Dailey, Seth H; Naze, Sawyer A; Jiang, Jack J

2012-04-01

Microsurgical equipment has greatly advanced since the inception of the microscope into the operating room. These advancements have allowed for superior surgical precision and better post-operative results. This study focuses on the use of the Leica HM500 head-mounted microscope for the operating phonosurgeon. The head-mounted microscope has an optical zoom from 2× to 9× and provides a working distance from 300 mm to 700 mm. The headpiece, with its articulated eyepieces, adjusts easily to head shape and circumference, and offers a focus function, which is either automatic or manually controlled. We performed five microlaryngoscopic operations utilizing the head-mounted microscope with successful results. By creating a more ergonomically favorable operating posture, a surgeon may be able to obtain greater precision and success in phonomicrosurgery. Phonomicrosurgery requires the precise manipulation of long-handled cantilevered instruments through the narrow bore of a laryngoscope. The head-mounted microscope shortens the working distance compared with a stand microscope, thereby increasing arm stability, which may improve surgical precision. Also, the head-mounted design permits flexibility in head position, enabling operator comfort, and delaying musculoskeletal fatigue. A head-mounted microscope decreases the working distance and provides better ergonomics in laryngoscopic microsurgery. These advances provide the potential to promote precision in phonomicrosurgery. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Does Head Start differentially benefit children with risks targeted by the program’s service model?☆

PubMed Central

Miller, Elizabeth B.; Farkas, George; Duncan, Greg J.

2015-01-01

Data from the Head Start Impact Study (N = 3540) were used to test for differential benefits of Head Start after one program year and after kindergarten on pre-academic and behavior outcomes for children at risk in the domains targeted by the program’s comprehensive services. Although random assignment to Head Start produced positive treatment main effects on children’s pre-academic skills and behavior problems, residualized growth models showed that random assignment to Head Start did not differentially benefit the pre-academic skills of children with risk factors targeted by the Head Start service model. The models showed detrimental impacts of Head Start for maternal-reported behavior problems of high-risk children, but slightly more positive impacts for teacher-reported behavior. Policy implications for Head Start are discussed. PMID:26379369

A computerized photographic method to evaluate changes in head posture and scapular position following rapid palatal expansion: a pilot study.

PubMed

Cerruto, Carmen; Di Vece, Luca; Doldo, Tiziana; Giovannetti, Agostino; Polimeni, Antonella; Goracci, Cecilia

2012-01-01

To assess the applicability of a computerized method to measure on digital photographs the changes in head and scapular posture following rapid palatal expansion (RPE) treatment. Randomized controlled trial. Twenty-three children (age 9.2 +/- 70.88 years) diagnosed with maxillary constriction were randomly divided into two groups: 1. Study group (n = 12): patients receiving RPE treatment; 2. Untreated controls (n = 11). Postural measurements were taken on frontal, lateral, and dorsal views of each subject. In the study group measurements were taken at T0 (the day orthodontic records were taken), T1 (end of RPE active phase), and T2 (RPE removal). In controls the same observations were conducted at T0 and T1(98.18 +/- 36.01 days after T0). Measurements were statistically analyzed (Intraclass Correlation Coefficient, t-tests, Signed Rank test, One-Way Repeated Measures Analysis of Variance, Tukey test; p < 0.05). In the study group a significant reduction in forward head posture (FHP) occurred between T0 and T1. Forward shoulder posture (FSP) decreased significantly between T1 and T2. At T1 treated patients exhibited significantly lower values of the measurements indicating FHP and FSP than controls. Changes in head and scapular posture following RPE treatment can be documented with computerized measurements on digital photographs.

Random Positional Variation Among the Skull, Mandible, and Cervical Spine With Treatment Progression During Head-and-Neck Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahn, Peter H.; Ahn, Andrew I.; Lee, C. Joe

2009-02-01

Purpose: With 54{sup o} of freedom from the skull to mandible to C7, ensuring adequate immobilization for head-and-neck radiotherapy (RT) is complex. We quantify variations in skull, mandible, and cervical spine movement between RT sessions. Methods and Materials: Twenty-three sequential head-and-neck RT patients underwent serial computed tomography. Patients underwent planned rescanning at 11, 22, and 33 fractions for a total of 93 scans. Coordinates of multiple bony elements of the skull, mandible, and cervical spine were used to calculate rotational and translational changes of bony anatomy compared with the original planning scan. Results: Mean translational and rotational variations on rescanningmore » were negligible, but showed a wide range. Changes in scoliosis and lordosis of the cervical spine between fractions showed similar variability. There was no correlation between positional variation and fraction number and no strong correlation with weight loss or skin separation. Semi-independent rotational and translation movement of the skull in relation to the lower cervical spine was shown. Positioning variability measured by means of vector displacement was largest in the mandible and lower cervical spine. Conclusions: Although only small overall variations in position between head-and-neck RT sessions exist on average, there is significant random variation in patient positioning of the skull, mandible, and cervical spine elements. Such variation is accentuated in the mandible and lower cervical spine. These random semirigid variations in positioning of the skull and spine point to a need for improved immobilization and/or confirmation of patient positioning in RT of the head and neck.« less

The Potential for Tumor Suppressor Gene Therapy in Head and Neck Cancer

PubMed Central

Birkeland, Andrew C.; Ludwig, Megan L.; Spector, Matthew E.; Brenner, J. Chad

2016-01-01

Head and neck squamous cell carcinoma remains a highly morbid and fatal disease. Importantly, genomic sequencing of head and neck cancers has identified frequent mutations in tumor suppressor genes. While targeted therapeutics increasingly are being investigated in head and neck cancer, the majority of these agents are against overactive/overexpressed oncogenes. Therapy to restore lost tumor suppressor gene function remains a key and under-addressed niche in trials for head and neck cancer. Recent advances in gene editing have captured the interest of both the scientific community and the public. As our technology for gene editing and gene expression modulation improves, addressing lost tumor suppressor gene function in head and neck cancers is becoming a reality. This review will summarize new techniques, challenges to implementation, future directions, and ethical ramifications of gene therapy in head and neck cancer. PMID:26896601

Development of the head and trunk mesoderm in the dogfish, Scyliorhinus torazame: II. Comparison of gene expression between the head mesoderm and somites with reference to the origin of the vertebrate head.

PubMed

Adachi, Noritaka; Takechi, Masaki; Hirai, Tamami; Kuratani, Shigeru

2012-01-01

The vertebrate mesoderm differs distinctly between the head and trunk, and the evolutionary origin of the head mesoderm remains enigmatic. Although the presence of somite-like segmentation in the head mesoderm of model animals is generally denied at molecular developmental levels, the appearance of head cavities in elasmobranch embryos has not been explained, and the possibility that they may represent vestigial head somites once present in an amphioxus-like ancestor has not been ruled out entirely. To examine whether the head cavities in the shark embryo exhibit any molecular signatures reminiscent of trunk somites, we isolated several developmentally key genes, including Pax1, Pax3, Pax7, Pax9, Myf5, Sonic hedgehog, and Patched2, which are involved in myogenic and chondrogenic differentiation in somites, and Pitx2, Tbx1, and Engrailed2, which are related to the patterning of the head mesoderm, from an elasmobranch species, Scyliorhinus torazame. Observation of the expression patterns of these genes revealed that most were expressed in patterns that resembled those found in amniote embryos. In addition, the head cavities did not exhibit an overt similarity to somites; that is, the similarity was no greater than that of the unsegmented head mesoderm in other vertebrates. Moreover, the shark head mesoderm showed an amniote-like somatic/visceral distinction according to the expression of Pitx2, Tbx1, and Engrailed2. We conclude that the head cavities do not represent a manifestation of ancestral head somites; rather, they are more likely to represent a derived trait obtained in the lineage of gnathostomes. © 2012 Wiley Periodicals, Inc.

Radiation Therapy Intensification for Solid Tumors: A Systematic Review of Randomized Trials

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamoah, Kosj; Showalter, Timothy N.; Ohri, Nitin, E-mail: ohri.nitin@gmail.com

Purpose: To systematically review the outcomes of randomized trials testing radiation therapy (RT) intensification, including both dose escalation and/or the use of altered fractionation, as a strategy to improve disease control for a number of malignancies. Methods and Materials: We performed a literature search to identify randomized trials testing RT intensification for cancers of the central nervous system, head and neck, breast, lung, esophagus, rectum, and prostate. Findings were described qualitatively. Where adequate data were available, pooled estimates for the effect of RT intensification on local control (LC) or overall survival (OS) were obtained using the inverse variance method. Results: Inmore » primary central nervous system tumors, esophageal cancer, and rectal cancer, randomized trials have not demonstrated that RT intensification improves clinical outcomes. In breast cancer and prostate cancer, dose escalation has been shown to improve LC or biochemical disease control but not OS. Radiation therapy intensification may improve LC and OS in head and neck and lung cancers, but these benefits have generally been limited to studies that did not incorporate concurrent chemotherapy. Conclusions: In randomized trials, the benefits of RT intensification have largely been restricted to trials in which concurrent chemotherapy was not used. Novel strategies to optimize the incorporation of RT in the multimodality treatment of solid tumors should be explored.« less

Axis of Eye Rotation Changes with Head-Pitch Orientation during Head Impulses about Earth-Vertical

PubMed Central

Schubert, Michael C.; Clendaniel, Richard A.; Carey, John P.; Della Santina, Charles C.; Minor, Lloyd B.; Zee, David S.

2006-01-01

The goal of this study was to assess how the axis of head rotation, Listing's law, and eye position influence the axis of eye rotation during brief, rapid head rotations. We specifically asked how the axis of eye rotation during the initial angular vestibuloocular reflex (VOR) changed when the pitch orientation of the head relative to Earth-vertical was varied, but the initial position of the eye in the orbit and the orientation of Listing's plane with respect to the head were fixed. We measured three-dimensional eye and head rotation axes in eight normal humans using the search coil technique during head-and-trunk (whole-body) and head-on-trunk (head-only) “impulses” about an Earth-vertical axis. The head was initially oriented at one of five pitch angles (30° nose down, 15° nose down, 0°, 15° nose up, 30° nose up). The fixation target was always aligned with the nasooccipital axis. Whole-body impulses were passive, unpredictable, manual, rotations with peak-amplitude of ∼20°, peak-velocity of ∼80°/s, and peak-acceleration of ∼1000°/s2. Head-only impulses were also passive, unpredictable, manual, rotations with peak-amplitude of ∼20°, peak-velocity of ∼150°/s, and peak-acceleration of ∼3000°/s2. During whole-body impulses, the axis of eye rotation tilted in the same direction, and by an amount proportional (0.51 ± 0.09), to the starting pitch head orientation (P < 0.05). This proportionality constant decreased slightly to 0.39 ± 0.08 (P < 0.05) during head-only impulses. Using the head-only impulse data, with the head pitched up, we showed that only 50% of the tilt in the axis of eye rotation could be predicted from vectorial summation of the gains (eye velocity/head velocity) obtained for rotations about the pure yaw and roll head axes. Thus, even when the orientation of Listing's plane and eye position in the orbit are fixed, the axis of eye rotation during the VOR reflects a compromise between the requirements of Listing's law and a

Smartphone Application WeChat for Clinical Follow-up of Discharged Patients with Head and Neck Tumors: A Randomized Controlled Trial.

PubMed

Lyu, Ke-Xing; Zhao, Jing; Wang, Bin; Xiong, Guan-Xia; Yang, Wei-Qiang; Liu, Qi-Hong; Zhu, Xiao-Lin; Sun, Wei; Jiang, Ai-Yun; Wen, Wei-Ping; Lei, Wen-Bin

2016-12-05

Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up (WFU) group or telephone follow-up (TFU) group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Time consumption in WFU group for each patient (23.36 ± 6.16 min) was significantly shorter than that in TFU group (42.89 ± 7.15 min) (P < 0.001); total economic cost in WFU group (RMB 90 Yuan) was much lower than that in TFU group (RMB 196 Yuan). Lost-to-follow-up rate in the WFU group was 7.02% (4/57) compared with TFU group, 9.80% (5/51), while no significance was observed (95% confidence interval [CI]: 0.176-2.740; P = 0.732). The overall satisfaction rate in WFU group was 94.34% (50/53) compared with 80.43% (37/46) in TFU group (95% CI: 0.057-0.067; P = 0.034). The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions. Chinese Clinical Trial Registry, ChiCTR-IOR-15007498; http://www.chictr.org.cn/ showproj.aspx?proj=12613.

Porcine head response to blast.

PubMed

Shridharani, Jay K; Wood, Garrett W; Panzer, Matthew B; Capehart, Bruce P; Nyein, Michelle K; Radovitzky, Raul A; Bass, Cameron R 'dale'

2012-01-01

Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740 kPa peak incident overpressure with scaled durations from 1.3 to 6.9 ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30 s and the remaining two recovered within 8 min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390 kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300-2830 kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G's and were well correlated with peak incident overpressure (R(2) = 0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are

Porcine Head Response to Blast

PubMed Central

Shridharani, Jay K.; Wood, Garrett W.; Panzer, Matthew B.; Capehart, Bruce P.; Nyein, Michelle K.; Radovitzky, Raul A.; Bass, Cameron R. ‘Dale’

2012-01-01

Recent studies have shown an increase in the frequency of traumatic brain injuries related to blast exposure. However, the mechanisms that cause blast neurotrauma are unknown. Blast neurotrauma research using computational models has been one method to elucidate that response of the brain in blast, and to identify possible mechanical correlates of injury. However, model validation against experimental data is required to ensure that the model output is representative of in vivo biomechanical response. This study exposes porcine subjects to primary blast overpressures generated using a compressed-gas shock tube. Shock tube blasts were directed to the unprotected head of each animal while the lungs and thorax were protected using ballistic protective vests similar to those employed in theater. The test conditions ranged from 110 to 740 kPa peak incident overpressure with scaled durations from 1.3 to 6.9 ms and correspond approximately with a 50% injury risk for brain bleeding and apnea in a ferret model scaled to porcine exposure. Instrumentation was placed on the porcine head to measure bulk acceleration, pressure at the surface of the head, and pressure inside the cranial cavity. Immediately after the blast, 5 of the 20 animals tested were apneic. Three subjects recovered without intervention within 30 s and the remaining two recovered within 8 min following respiratory assistance and administration of the respiratory stimulant doxapram. Gross examination of the brain revealed no indication of bleeding. Intracranial pressures ranged from 80 to 390 kPa as a result of the blast and were notably lower than the shock tube reflected pressures of 300–2830 kPa, indicating pressure attenuation by the skull up to a factor of 8.4. Peak head accelerations were measured from 385 to 3845 G’s and were well correlated with peak incident overpressure (R2 = 0.90). One SD corridors for the surface pressure, intracranial pressure (ICP), and head acceleration are

Increased head circumference

MedlinePlus

... page: //medlineplus.gov/ency/article/003305.htm Increased head circumference To use the sharing features on this page, please enable JavaScript. Increased head circumference is when the measured distance around the widest ...

Missouri: Early Head Start Initiative

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

Missouri's Early Head Start/Child Care Partnership Project expands access to Early Head Start (EHS) services for children birth to age 3 by developing partnerships between federal Head Start, EHS contractors, and child care providers. Head Start and EHS contractors that participate in the initiative provide services through community child care…

Comparing the Efficacy of Commercially Available Insecticide and Dimeticone based Solutions on Head Lice, Pediculus capitis: in vitro Trials.

PubMed

Balcıoğlu, I Cüneyt; Karakuş, Mehmet; Arserim, Suha K; Limoncu, M Emin; Töz, Seray; Baştemur, Serkan; Öncel, Koray; Özbel, Yusuf

2015-12-01

Head lice infestation is a public health and social problem for almost all countries worldwide. For its treatment, insecticide and dimeticone-based solutions are currently available in the markets in many countries. We aimed to compare the efficacy of commercially available anti-head lice shampoos containing insecticide and physically effective products with different percentages of dimeticone using an in vitro technique. Head lice specimens were collected from primary school children using special plastic and metal combs. Anti-head lice products were commercially purchased and used directly. The specimens were placed one by one in 5-cm Petri dishes containing a slightly wet filter paper and were kept in a plastic cage at 28±2°C and 50%±20% relative humidity. A standardized protocol was used for testing all the products, and mortality data were obtained after 24 h. Two control tests were performed with each batch of trials. For each product and control, 10-20 head lice specimens were used, and the results were statistically analyzed. Our study demonstrated that among all the tested products, two products containing mineral oils [5.5% dimeticone & silicone (patented product) and dimeticone (no percentage mentioned in the prospectus) & cyclopentasiloxane] were found to be more effective for killing head lice in vitro. Physically effective products can be repetitively used because they are non-toxic and resistance to them is not expected. To control the infestation at a public level, the use of these products needs to be encouraged with respect to their cost price.

Does padded headgear prevent head injury in rugby union football?

PubMed

McIntosh, Andrew S; McCrory, Paul; Finch, Caroline F; Best, John P; Chalmers, David J; Wolfe, Rory

2009-02-01

Concussion is a serious problem in many contact sports, including rugby union football. The study's primary aim was to measure the efficacy of padded headgear in reducing the rates of head injury or concussion. A cluster randomized controlled trial with three arms was conducted with rugby union football teams as the unit of randomization. Teams consisted of males participating in under 13-, 15-, 18-, and 20-yr age group competitions. The interventions were "standard" and "modified" padded headgear. Headgear wearing and injury were measured for each study team at each game over two seasons. Eighty-two teams participated in year 1 and 87 in year 2. A total of 1493 participants (10,040 player hours) were in the control group, 1128 participants (8170 player hours) were assigned to the standard headgear group, and 1474 participants (10,650 player hours) were assigned to the modified headgear group. The compliance rates were low in all groups, but 46% of participants wore standard headgear. An intention-to-treat analysis showed no differences in the rates of head injury or concussion between controls and headgear arms. Incidence rate ratios for standard headgear wearers referenced to controls were 0.95 and 1.02 for game and missed game injuries. Analyses of injury rates based on observed wearing patterns also showed no significant differences. Incidence rate ratios for standard headgear wearers referenced to nonwearers were 1.11 and 1.10 for game and missed game injuries. Padded headgear does not reduce the rate of head injury or concussion. The low compliance rates are a limitation. Although individuals may choose to wear padded headgear, the routine or mandatory use of protective headgear cannot be recommended.

Head injuries in children's football-results from two prospective cohort studies in four European countries.

PubMed

Faude, O; Rössler, R; Junge, A; Aus der Fünten, K; Chomiak, J; Verhagen, E; Beaudouin, F; Dvorak, J; Feddermann-Demont, N

2017-12-01

Head injuries are considered harmful in children. We analyzed head and neck injuries in organized football in 7- to 12-year-old children. Data for this analysis were obtained from a prospective cohort study over two consecutive football seasons in two European countries, and a randomized intervention trial over one season in four European countries. Football exposure and injuries were documented through an online database. Detailed information regarding injury characteristics and medical follow-up was retrieved from coaches, children and parents by phone. Thirty-nine head injuries and one neck injury (5% of all 791 injuries) were documented during 9933 player-seasons (total football exposure 688 045 hours). The incidence was 0.25 [95%CI 0.15, 0.35] head/neck injuries per 1000 match hours (N=23 match injuries) and 0.03 [95%CI 0.02, 0.03] per 1000 training hours. Eleven concussions (27.5%), nine head contusions (22.5%), eight lacerations or abrasions (20%), two nose fractures (2.5%), and two dental injuries (2.5%) occurred. The remaining eight injuries were nose bleeding or other minor injuries. Thirty injuries (75%) resulted from contact with another player, and ten injuries were due to collision with an object, falling or a hit by the ball. Whereas 70% of all head injuries (N=28) were due to frontal impacts, 73% of concussions (N=8) resulted from an impact to the occiput. The incidence and severity of head injuries in children's football are low. Coaches and parents, however, should be sensitized regarding the potential of concussions, particularly after an impact to the occiput. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Human papilloma virus infection in head and neck cancer.

PubMed

Tribius, Silke; Hoffmann, Markus

2013-03-01

The causal link between cervical cancer and human papilloma virus (HPV) is well known. It is now becoming clear that some types of squamous-cell carcinoma of the head and neck, particularly oropharyngeal carcinoma (OPC), are also linked to HPV infection. The development of vaccines against certain HPV genotypes has changed the management strategy for HPV-associated diseases of the uterine cervix. An analogous approach is now being considered for the prevention of HPV-associated diseases of the head and neck. We review pertinent articles retrieved by a selective search of the literature for phase II and III trials providing evidence about a possible effect of HPV status on the survival rates of patients with OPC. Seven trials fulfilled our search criteria: four phase III trials with retrospective HPV analysis and three phase II trials with retrospective and prospective HPV analysis. Patients with HPV-positive OPC survive significantly longer than those with HPV-negative OPC. Tobacco smoking has been identified as a negative prognostic factor in patients with either HPV-negative or HPV-positive disease. The established treatment strategy for OPC in patients with and without the traditional risk factors (tobacco and alcohol consumption) is now being reconsidered in the light of what we have learned about the role of HPV infection. Ongoing and projected clinical trials with risk-factor stratification may soon lead to changes in treatment. Further study is needed to answer the question whether HPV infection in the head and neck region is carcinogenic.

Head Start Facilities Manual.

ERIC Educational Resources Information Center

Research Assessment Management, Inc., Silver Spring, MD.

A quality Head Start facility should provide a physical environment responsive both to the needs of the children and families served and to the needs of staff, volunteers, and community agencies that share space with Head Start. This manual is a tool for Head Start grantees and delegate agencies for assessing existing facilities, making…

Submandibular gland transfer for the prevention of postradiation xerostomia in patients with head and neck cancer: a systematic review and meta-analysis.

PubMed

Wu, Fanglong; Weng, Shengxin; Li, Chunjie; Sun, Jun; Li, Longjiang; Gao, Qinghong

2015-01-01

Submandibular gland transfer has been widely used to prevent postradiation xerostomia in head-and-neck cancers. However, there are still some controversies. Six databases were searched, data extraction was performed and the risk of bias was assessed by 2 reviewers independently. The meta-analysis was performed using Review Manager, version 5.2. A total of 7 trials (12 articles) and 369 participants were included. The present clinical evidence suggests that submandibular gland transfer might be highly effective to prevent postradiation xerostomia in head-and-neck cancers without serious adverse events. However, more randomized controlled trials are still needed to confirm this conclusion. © 2015 S. Karger AG, Basel.

Postural control and head stability during natural gaze behaviour in 6- to 12-year-old children.

PubMed

Schärli, A M; van de Langenberg, R; Murer, K; Müller, R M

2013-06-01

We investigated how the influence of natural exploratory gaze behaviour on postural control develops from childhood into adulthood. In a cross-sectional design, we compared four age groups: 6-, 9-, 12-year-olds and young adults. Two experimental trials were performed: quiet stance with a fixed gaze (fixed) and quiet stance with natural exploratory gaze behaviour (exploratory). The latter was elicited by having participants watch an animated short film on a large screen in front of them. 3D head rotations in space and centre of pressure (COP) excursions on the ground plane were measured. Across conditions, both head rotation and COP displacement decreased with increasing age. Head movement was greater in the exploratory condition in all age groups. In all children-but not in adults-COP displacement was markedly greater in the exploratory condition. Bivariate correlations across groups showed highly significant positive correlations between COP displacement in ML direction and head rotation in yaw, roll, and pitch in both conditions. The regularity of COP displacements did not show a clear developmental trend, which indicates that COP dynamics were qualitatively similar across age groups. Together, the results suggest that the contribution of head movement to eye-head saccades decreases with age and that head instability-in part resulting from such gaze-related head movements-is an important limiting factor in children's postural control. The lack of head stabilisation might particularly affect children in everyday activities in which both postural control and visual exploration are required.

Family Connections: Helping Early Head Start/Head Start Staff and Parents Address Mental Health Challenges

ERIC Educational Resources Information Center

Beardslee, William R.; Avery, Mary Watson; Ayoub, Catherine; Watts, Caroline L.

2009-01-01

Early Head Start/Head Start teachers and staff encounter parents who have wrestled with depression and other adversities every day. This article describes an innovative program of trainings for and consultation to Early Head Start/Head Start staff to help them effectively deal with mental heath challenges faced by parents and children. The program…

Genetic Landscape of Human Papillomavirus–Associated Head and Neck Cancer and Comparison to Tobacco-Related Tumors

PubMed Central

Hayes, D. Neil; Van Waes, Carter; Seiwert, Tanguy Y.

2015-01-01

Head and neck cancer is the fifth most common cancer worldwide. It is often amenable to curative intent therapy when localized to the head and neck region, but it carries a poor prognosis when it is recurrent or metastatic. Therefore, initial treatment decisions are critical to improve patient survival. However, multimodality therapy used with curative intent is toxic. The balance between offering intensive versus tolerable and function-preserving therapy has been thrown into sharp relief with the recently described epidemic of human papillomavirus–associated head and neck squamous cell carcinomas characterized by improved clinical outcomes compared with smoking-associated head and neck tumors. Model systems and clinical trials have been slow to address the clinical questions that face the field to date. With this as a background, a host of translational studies have recently reported the somatic alterations in head and neck cancer and have highlighted the distinct genetic and biologic differences between viral and tobacco-associated tumors. This review seeks to summarize the main findings of studies, including The Cancer Genome Atlas, for the clinician scientist, with a goal of leveraging this new knowledge toward the betterment of patients with head and neck cancer. PMID:26351353

Testing Maternal Depression and Attachment Style as Moderators of Early Head Start's Effects on Parenting

PubMed Central

Berlin, Lisa J.; Whiteside-Mansell, Leanne; Roggman, Lori A.; Green, Beth L.; Robinson, JoAnn; Spieker, Susan

2010-01-01

This study examined maternal depression, attachment avoidance, and attachment anxiety as moderators of Early Head Start's effects on four parenting outcomes assessed at age 3. Participants (N = 947) were drawn from six sites of the Early Head Start National Research and Evaluation Project, a multi-site randomized trial. Findings suggest more positive program effects for mothers with less initial attachment avoidance or attachment anxiety. First, baseline attachment avoidance moderated EHS program effects on observed maternal supportiveness, such that program mothers with lower baseline attachment avoidance were rated as more supportive of their 3-year-olds than program mothers with higher baseline attachment avoidance. Second, program effects on spanking varied depending on mothers’ baseline attachment anxiety. PMID:21240694

Improving Quality of Life With Nabilone During Radiotherapy Treatments for Head and Neck Cancers: A Randomized Double-Blind Placebo-Controlled Trial.

PubMed

Côté, Mathieu; Trudel, Mathieu; Wang, Changshu; Fortin, André

2016-04-01

Patients treated for head and neck carcinomas experience a significant deterioration of their quality of life during treatments because of severe side effects. Nabilone has many properties that could alleviate symptoms caused by radiotherapy and improve patients' quality of life. The aim of the present study was to compare the effects of nabilone versus placebo on the quality of life and side effects during radiotherapy for head and neck carcinomas. Fifty-six patients were randomized to nabilone or placebo. Patients filled the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-H&N35; three independent questionnaires assessing appetite, nausea, and toxicity; and a visual analog scale for pain. These data were collected before radiotherapy, each week during radiotherapy, and 4 weeks after radiotherapy. Patients were weighed every week. Nabilone did not lengthen the time necessary for a 15% deterioration of quality of life (P = .4279), and it was not better than placebo for relieving symptoms like pain (P = .6048), nausea (P = .7105), loss of appetite (P = .3295), weight (P = .1454), mood (P = .3214), and sleep (P = .4438). At the dosage used, nabilone was not potent enough to improve the patients' quality of life over placebo. © The Author(s) 2015.

A review of drugs in development for the personalized treatment of head and neck squamous cell carcinoma

PubMed Central

Birkeland, Andrew C.; Swiecicki, Paul L.; Brenner, J. Chad; Shuman, Andrew G.

2017-01-01

Introduction Head and neck squamous cell carcinoma remains a highly morbid and fatal disease, with poor survival rates among patients with advanced and recurrent disease. Recent advances in next generation sequencing, targeted therapeutics, and precision medicine trials are expanding treatment options for head and neck cancers; thus greater awareness of this rapidly evolving field is important. Areas Covered Recent next-generation sequencing studies in head and neck squamous cell carcinoma, targeted therapy clinical trials involving head and neck squamous cell carcinoma. Expert Commentary This review discusses the current state of head and neck cancer treatment, and considerations and implications for the incorporation of personalized medicine and targeted therapy for head and neck cancers in a dynamic clinical landscape. PMID:28251187

Migration from full‐head mask to “open‐face” mask for immobilization of patients with head and neck cancer

PubMed Central

Lovelock, D. Michael; Mechalakos, James; Rao, Shyam; Della‐Biancia, Cesar; Amols, Howard; Lee, Nancy

2013-01-01

To provide an alternative device for immobilization of the head while easing claustrophobia and improving comfort, an “open‐face” thermoplastic mask was evaluated using video‐based optical surface imaging (OSI) and kilovoltage (kV) X‐ray radiography. A three‐point thermoplastic head mask with a precut opening and reinforced strips was developed. After molding, it provided sufficient visible facial area as the region of interest for OSI. Using real‐time OSI, the head motion of ten volunteers in the new mask was evaluated during mask locking and 15 minutes lying on the treatment couch. Using a nose mark with reference to room lasers, forced head movement in open‐face and full‐head masks (with a nose hole) was compared. Five patients with claustrophobia were immobilized with open‐face masks, set up using OSI and kV, and treated in 121 fractions, in which 61 fractions were monitored during treatment using real‐time OSI. With the open‐face mask, head motion was found to be 1.0 ± 0.6 mm and 0.4° ± 0.2° in volunteers during the experiment, and 0.8 ± 0.3 mm and 0.4° ± 0.2° in patients during treatment. These agree with patient motion calculated from pre‐/post‐treatment OSI and kV data using different anatomical landmarks. In volunteers, the head shift induced by mask‐locking was 2.3 ± 1.7 mm and 1.8° ± 0.6°, and the range of forced movements in the open‐face and full‐head masks were found to be similar. Most (80%) of the volunteers preferred the open‐face mask to the full‐head mask, while claustrophobic patients could only tolerate the open‐face mask. The open‐face mask is characterized for its immobilization capability and can immobilize patients sufficiently (< 2 mm) during radiotherapy. It provides a clinical solution to the immobilization of patients with head and neck (HN) cancer undergoing radiotherapy, and is particularly beneficial for claustrophobic patients. This new open�

Surgical trial in traumatic intracerebral hemorrhage (STITCH(Trauma)): study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Intracranial hemorrhage occurs in over 60% of severe head injuries in one of three types: extradural (EDH); subdural (SDH); and intraparenchymal (TICH). Prompt surgical removal of significant SDH and EDH is established and widely accepted. However, TICH is more common and is found in more than 40% of severe head injuries. It is associated with a worse outcome but the role for surgical removal remains undefined. Surgical practice in the treatment of TICHs differs widely around the world. The aim of early surgery in TICH removal is to prevent secondary brain injury. There have been trials of surgery for spontaneous ICH (including the STICH II trial), but none so far of surgery for TICH. Methods/Design The UK National Institutes of Health Research has funded STITCH(Trauma) to determine whether a policy of early surgery in patients with TICH improves outcome compared to a policy of initial conservative treatment. It will include a health economics component and carry out a subgroup analysis of patients undergoing invasive monitoring. This is an international multicenter pragmatic randomized controlled trial. Patients are eligible if: they are within 48 h of injury; they have evidence of TICH on CT scan with a confluent volume of attenuation significantly raised above that of the background white and grey matter that has a total volume >10 mL; and their treating neurosurgeon is in equipoise. Patients will be ineligible if they have: a significant surface hematoma (EDH or SDH) requiring surgery; a hemorrhage/contusion located in the cerebellum; three or more separate hematomas fulfilling inclusion criteria; or severe pre-existing physical or mental disability or severe co-morbidity which would lead to poor outcome even if the patient made a full recovery from the head injury. Patients will be randomized via an independent service. Patients randomized to surgery receive surgery within 12 h. Both groups will be monitored according to standard neurosurgical

Of lice and math: using models to understand and control populations of head lice.

PubMed

Laguna, María Fabiana; Laguna, Mara Fabiana; Risau-Gusman, Sebastián

2011-01-01

In this paper we use detailed data about the biology of the head louse (pediculus humanus capitis) to build a model of the evolution of head lice colonies. Using theory and computer simulations, we show that the model can be used to assess the impact of the various strategies usually applied to eradicate head lice, both conscious (treatments) and unconscious (grooming). In the case of treatments, we study the difference in performance that arises when they are applied in systematic and non-systematic ways. Using some reasonable simplifying assumptions (as random mixing of human groups and the same mobility for all life stages of head lice other than eggs) we model the contagion of pediculosis using only one additional parameter. It is shown that this parameter can be tuned to obtain collective infestations whose characteristics are compatible with what is given in the literature on real infestations. We analyze two scenarios: One where group members begin treatment when a similar number of lice are present in each head, and another where there is one individual who starts treatment with a much larger threshold ("superspreader"). For both cases we assess the impact of several collective strategies of treatment.

Study protocol. IDUS - Instrumental delivery & ultrasound: a multi-centre randomised controlled trial of ultrasound assessment of the fetal head position versus standard care as an approach to prevent morbidity at instrumental delivery.

PubMed

Murphy, Deirdre J; Burke, Gerard; Montgomery, Alan A; Ramphul, Meenakshi

2012-09-13

Instrumental deliveries are commonly performed in the United Kingdom and Ireland, with rates of 12 - 17% in most centres. Knowing the exact position of the fetal head is a pre-requisite for safe instrumental delivery. Traditionally, diagnosis of the fetal head position is made on transvaginal digital examination by delineating the suture lines of the fetal skull and the fontanelles. However, the accuracy of transvaginal digital examination can be unreliable and varies between 20% and 75%. Failure to identify the correct fetal head position increases the likelihood of failed instrumental delivery with the additional morbidity of sequential use of instruments or second stage caesarean section. The use of ultrasound in determining the position of the fetal head has been explored but is not part of routine clinical practice. A multi-centre randomised controlled trial is proposed. The study will take place in two large maternity units in Ireland with a combined annual birth rate of 13,500 deliveries. It will involve 450 nulliparous women undergoing instrumental delivery after 37 weeks gestation. The main outcome measure will be incorrect diagnosis of the fetal head position. A study involving 450 women will have 80% power to detect a 10% difference in the incidence of inaccurate diagnosis of the fetal head position with two-sided 5% alpha. It is both important and timely to evaluate the use of ultrasound to diagnose the fetal head position prior to instrumental delivery before routine use can be advocated. The overall aim is to reduce the incidence of incorrect diagnosis of the fetal head position prior to instrumental delivery and improve the safety of instrumental deliveries. Current Controlled Trials ISRCTN72230496.

Head temperature modulates thermal behavior in the cold in humans

PubMed Central

Mündel, Toby; Raman, Aaron; Schlader, Zachary J.

2016-01-01

ABSTRACT We tested the hypothesis that skin temperature, specifically of the head, is capable of modulating thermal behavior during exercise in the cold. Following familiarization 8 young, healthy, recreationally active males completed 3 trials, each consisting of 30 minutes of self-paced cycle ergometry in 6°C. Participants were instructed to control their exercise work rate to achieve and maintain thermal comfort. On one occasion participants wore only shorts and shoes (Control) and on the 2 other occasions their head was either warmed (Warming) or cooled (Cooling). Work rate, rate of metabolic heat production, thermal perceptions, rectal, mean weighted skin and head temperatures were measured. Exercise work rate was reduced during Warming and augmented during Cooling after the first and second minutes of exercise, respectively (P ≤ 0.04), with the rate of metabolic heat production mirroring work rate. At this early stage of exercise (≤5 min) the changes over time for rectal temperature were negligible and similar (0.1 ± 0.1°C, P = 0.51), while the decrease in mean skin temperature was not different between all trials (1.7 ± 0.6°C, P = 0.13). Mean head temperature was either decreased (Control: 1.5 ± 1.1°C, Cooling: 2.9 ± 0.8°C, both P < 0.01) or increased (Warming: 1.7 ± 0.9°C, P < 0.01). Head thermal perception was warmer and more comfortable in Warming and cooler and less comfortable in Cooling (P < 0.01). Participants achieved thermal comfort similarly in all trials (P > 0.09) after 10 ± 7 min and this was maintained until the end of exercise. These results indicate that peripheral temperatures modulate thermal behavior in the cold. PMID:27857959

Progressive addition spectacle lenses: Design preferences and head movements while reading

NASA Astrophysics Data System (ADS)

Preston, Julie Lynn

In a subjective preference study, two key progressive addition lens parameters, near zone width and corridor length, were varied in a double-masked, randomized, clinical trial of 49 patients. Each subject received a complete eye examination and a new frame. Each wore 6 pairs of lenses for one week at a time and completed questionnaires relating to vision, adaptation, and satisfaction. The preferred lens was identified from the three near zone width lenses and from the three corridor length lenses. Patient characteristics were analyzed for their effect on design preference. Satisfaction ratings following a brief experience with each design were compared to ratings after one week of wear in order to ascertain the predictability of initial impressions. One lens design appeared twice in the preference trial, providing an assessment of the repeatability of the rating instrument. The lens design with the widest near zone was rated significantly lower than the other near zone width designs for nearly every question relating to vision, adaptation, and satisfaction. This lens was also least preferred of all the designs. Preferences for corridor length were evenly distributed among the three designs. Of patient characteristics, years of progressive addition lens wear and gender significantly affected design preference in this population. Initial impressions were not predictive of satisfaction after a week of wear. The rating instrument was judged to have low repeatability. In the head movement portion of the study, 18 participants from the preference study wore the three near zone width designs while reading three paragraphs of varying print size. From a 20 second recording for each of three different paragraphs with each lens, measures of head rotation and posture were collected. The amplitude of head rotation was significantly affected by print size but not by lens design. The effective zone widths on the lenses scanned by the eyes and the locations of the reading levels

Influence of vision on head stabilization strategies in older adults during walking.

PubMed

Cromwell, Ronita L; Newton, Roberta A; Forrest, Gail

2002-07-01

Maintaining balance during dynamic activities is essential for preventing falls in older adults. Head stabilization contributes to dynamic balance, especially during the functional task of walking. Head stability and the role of vision in this process have not been studied during walking in older adults. Seventeen older adults (76.2 +/- 6.9 years) and 20 young adults (26.0 +/- 3.4 years) walked with their eyes open (EO), with their eyes closed (EC), and with fixed gaze (FG). Participants performed three trials of each condition. Sagittal plane head and trunk angular velocities in space were obtained using an infrared camera system with passive reflective markers. Frequency analyses of head-on-trunk with respect to trunk gains and phases were examined for head-trunk movement strategies used for head stability. Average walking velocity, cadence, and peak head velocity were calculated for each condition. Differences between age groups demonstrated that older adults decreased walking velocity in EO (p =.022). FG (p = .021), and EC (p = .022). and decreased cadence during EC (p = .007). Peak head velocity also decreased across conditions (p < .0001) for older adults. Movement patterns demonstrated increased head stability during EO. diminished head stability with EC, and improved head stability with FG as older adult patterns resembled those of young adults. Increased stability of the lower extremity outcome measures for older adults was indicated by reductions in walking velocity and cadence. Concomitant increases in head stability were related to visual tasks. Increased stability may serve as a protective mechanism to prevent falls. Further, vision facilitates the head stabilization process for older adults to compensate for age-related decrements in other sensory systems subserving dynamic balance.

Twenty-four hours or 10 days? A prospective randomised controlled trial in children comparing head bandages following pinnaplasty.

PubMed

Ramkumar, S; Narayanan, V; Laing, J H E

2006-01-01

The perceived benefits of bandaging for 10 days following pinnaplasty have been questioned by previous studies. The problems arising from these dressings are many [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bartley J. How long should ears be bandaged after otoplasty? J Laryngol Otol 1998;112:531-2. Wong MC, Sylaidis P. Head dressings for pinnaplasty: a tradition not supported by evidence. Br J Plast Surg 2001;54:81-2], including their slippage [Powell BWEM. The value of head dressings in the postoperative management of the prominent ear. Br J Plast Surg 1989;42:692-4. Bradbury ET, Hewison J, Timmons MJ. Psychological and social outcome of prominent ear correction in children. Br J Plast Surg 1992;45:97-100. Jeffery SLA. Complications following correction of prominent ears: an audit review of 122 cases. Br J Plast Surg 1999;52:588-90]. Eighty children were recruited into a prospective randomised controlled trial comparing the use of a head bandage for only 24 h with a standard practise of a 10-day head bandage. A preoperative measurement of the lateral ear projection (LEP) was made. The outcome measures recorded during the two planned postoperative visits at 10 days (visit 1) and 2 months (visit 2) were: patient satisfaction score, LEP, complications and any unscheduled hospital visits associated with the surgery. There was no significant difference in LEP and patient satisfaction between the two groups at both the scheduled postoperative visits. Differences between the groups in the number of unscheduled visits (p=0.21) did not reach statistical significance. The findings indicate that it is safe and effective to use head bandage for only 24 h following surgical correction of prominent ears. This study shows no benefit from the application of a formal head bandage for any longer than 1 day.

Vomiting--is this a good indication for CT head scans in patients with minor head injury?

PubMed

Bainbridge, J; Khirwadkar, H; Hourihan, M D

2012-02-01

The National Institute for Health and Clinical Excellence head injury guidelines advise CT imaging within 1 h if there is more than one episode of vomiting post-head injury in adults and three or more episodes in children. Since the guideline publication, studies have found that, following head injury, vomiting alone is associated with an abnormal CT head scan in 13-45% of cases. CT head scan requests referred from the emergency department between 1 May 2009 and 30 April 2010 were retrospectively reviewed. Patients with vomiting as the sole indication for an "immediate" CT head scan performed within 1 h were included in the study. Reports produced by experienced neuroradiologists were reviewed and the detection of significant head injury was noted. There were 1264 CT head scans performed during our study period. 151 (124 adults, 27 children) were indicated owing to vomiting following head injury. 5 of the 124 adult scans and 1 of the 27 paediatric scans showed an abnormal finding, giving positive predictive values (PPV) of 4% and 3.7%, respectively. None of these patients required either acute or delayed neurosurgical intervention. In our experience, vomiting alone has a PPV of 4% for significant head injury in adults. However, none of these injuries were serious enough to warrant acute or delayed intervention. Given these findings, vomiting following head injury is a reasonable indication for a CT head scan; however, as none of the patients required acute intervention, we suggest that these scans do not usually need to be performed within 1 h of request.

Fatal pediatric head injury due to toppled television: does the injury pattern overlap with abusive head trauma?

PubMed

Kodikara, Sarathchandra; Pollanen, Michael

2012-07-01

Pediatric head injuries can occur from abusive head trauma (AHT) or accidents. Accidental pediatric head injuries caused by cathode-ray tube televisions (CRTT) toppling have become a 'silent epidemic'. Differentiation between a fatal case of AHT and CRTT toppling could be vexing when the historical and scene evidence are subtle. A 2-year-old girl was found unresponsive in her house and could not be resuscitated. A 27" CRTT was found fallen from its stand onto the floor at the scene. The siblings report that the deceased was climbing on the television stand when it toppled. Autopsy revealed a spectrum of head injuries including, contusions, fractures, bilateral acute subdural hemorrhages, subarachnoid hemorrhages, brain contusion-lacerations and corpus callosal hemorrhages. Microscopy of the eyes revealed bilateral acute retinal hemorrhages. The cause of death was given as crushing injuries of head and brain. The skull fracture pattern is compatible with an accident causing crush injury due to the toppled CRTT rather than AHT. The injury pattern reconfirms that the head is the most vulnerable site in case of CRTT tipover. Although there may be an overlap between the injury pattern in AHT and in CRTT tipover cases, a careful evaluation of the history and scene and autopsy findings such as the crushing nature of the skull fractures and distribution of injury, can solve this problem. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

49 CFR 572.112 - Head assembly.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Head assembly. 572.112 Section 572.112... 50th Percentile Male § 572.112 Head assembly. The head assembly consists of the head (drawing 78051-61X...) accelerometers that are mounted in conformance to § 572.36 (c). (a) Test procedure. (1) Soak the head assembly in...

49 CFR 572.112 - Head assembly.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Head assembly. 572.112 Section 572.112... 50th Percentile Male § 572.112 Head assembly. The head assembly consists of the head (drawing 78051-61X...) accelerometers that are mounted in conformance to § 572.36 (c). (a) Test procedure. (1) Soak the head assembly in...

49 CFR 572.112 - Head assembly.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Head assembly. 572.112 Section 572.112... 50th Percentile Male § 572.112 Head assembly. The head assembly consists of the head (drawing 78051-61X...) accelerometers that are mounted in conformance to § 572.36 (c). (a) Test procedure. (1) Soak the head assembly in...

49 CFR 572.112 - Head assembly.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Head assembly. 572.112 Section 572.112... 50th Percentile Male § 572.112 Head assembly. The head assembly consists of the head (drawing 78051-61X...) accelerometers that are mounted in conformance to § 572.36 (c). (a) Test procedure. (1) Soak the head assembly in...

49 CFR 572.112 - Head assembly.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Head assembly. 572.112 Section 572.112... 50th Percentile Male § 572.112 Head assembly. The head assembly consists of the head (drawing 78051-61X...) accelerometers that are mounted in conformance to § 572.36 (c). (a) Test procedure. (1) Soak the head assembly in...

The Metaphorical Department Head: Using Metaphors as Analytic Tools to Investigate the Role of Department Head

ERIC Educational Resources Information Center

Paranosic, Nikola; Riveros, Augusto

2017-01-01

This paper reports the results of a study that examined the ways a group of department heads in Ontario, Canada, describe their role. Despite their ubiquity and importance, department heads have been seldom investigated in the educational leadership literature. The study uses the metaphor as an analytic tool to examine the ways participants talked…

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia.

PubMed

Deribew, Amare; Birhanu, Zewdie; Sena, Lelisa; Dejene, Tariku; Reda, Ayalu A; Sudhakar, Morankar; Alemseged, Fessehaye; Tessema, Fasil; Zeynudin, Ahmed; Biadgilign, Sibhatu; Deribe, Kebede

2012-01-06

Long-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia. A cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings. A total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons. Training of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry

Exploding head syndrome.

PubMed

Sharpless, Brian A

2014-12-01

Exploding head syndrome is characterized by the perception of abrupt, loud noises when going to sleep or waking up. They are usually painless, but associated with fear and distress. In spite of the fact that its characteristic symptomatology was first described approximately 150 y ago, exploding head syndrome has received relatively little empirical and clinical attention. Therefore, a comprehensive review of the scientific literature using Medline, PsycINFO, Google Scholar, and PubMed was undertaken. After first discussing the history, prevalence, and associated features, the available polysomnography data and five main etiological theories for exploding head syndrome are summarized. None of these theories has yet reached dominance in the field. Next, the various methods used to assess and treat exploding head syndrome are discussed, as well as the limited outcome data. Finally, recommendations for future measure construction, treatment options, and differential diagnosis are provided. Copyright © 2014 Elsevier Ltd. All rights reserved.

Using EMG to anticipate head motion for virtual-environment applications

NASA Technical Reports Server (NTRS)

Barniv, Yair; Aguilar, Mario; Hasanbelliu, Erion

2005-01-01

In virtual environment (VE) applications, where virtual objects are presented in a see-through head-mounted display, virtual images must be continuously stabilized in space in response to user's head motion. Time delays in head-motion compensation cause virtual objects to "swim" around instead of being stable in space which results in misalignment errors when overlaying virtual and real objects. Visual update delays are a critical technical obstacle for implementing head-mounted displays in applications such as battlefield simulation/training, telerobotics, and telemedicine. Head motion is currently measurable by a head-mounted 6-degrees-of-freedom inertial measurement unit. However, even given this information, overall VE-system latencies cannot be reduced under about 25 ms. We present a novel approach to eliminating latencies, which is premised on the fact that myoelectric signals from a muscle precede its exertion of force, thereby limb or head acceleration. We thus suggest utilizing neck-muscles' myoelectric signals to anticipate head motion. We trained a neural network to map such signals onto equivalent time-advanced inertial outputs. The resulting network can achieve time advances of up to 70 ms.

Using EMG to anticipate head motion for virtual-environment applications.

PubMed

Barniv, Yair; Aguilar, Mario; Hasanbelliu, Erion

2005-06-01

In virtual environment (VE) applications, where virtual objects are presented in a see-through head-mounted display, virtual images must be continuously stabilized in space in response to user's head motion. Time delays in head-motion compensation cause virtual objects to "swim" around instead of being stable in space which results in misalignment errors when overlaying virtual and real objects. Visual update delays are a critical technical obstacle for implementing head-mounted displays in applications such as battlefield simulation/training, telerobotics, and telemedicine. Head motion is currently measurable by a head-mounted 6-degrees-of-freedom inertial measurement unit. However, even given this information, overall VE-system latencies cannot be reduced under about 25 ms. We present a novel approach to eliminating latencies, which is premised on the fact that myoelectric signals from a muscle precede its exertion of force, thereby limb or head acceleration. We thus suggest utilizing neck-muscles' myoelectric signals to anticipate head motion. We trained a neural network to map such signals onto equivalent time-advanced inertial outputs. The resulting network can achieve time advances of up to 70 ms.

Head Start FACES 2000: A Whole-Child Perspective on Program Performance. Fourth Progress Report.

ERIC Educational Resources Information Center

Zill, Nicholas; Resnick, Gary; Kim, Kwang; O'Donnell, Kevin; Sorongon, Alberto; McKey, Ruth Hubbell; Pai-Samant, Shefali; Clark, Cheryl; O'Brien, Robert; D'Elio, Mary Ann

In 1997, Head Start launched the Family and Child Experiences Survey (FACES), a study of a national random sample of Head Start programs, designed to describe characteristics, experiences, and outcomes for children and families served by Head Start. In 2000, FACES began data collection on a new national cohort of 2,800 children and their families…

Standard (head-down tilt) versus modified (without head-down tilt) postural drainage in infants and young children with cystic fibrosis.

PubMed

Freitas, Diana A; Chaves, Gabriela Ss; Santino, Thayla A; Ribeiro, Cibele Td; Dias, Fernando Al; Guerra, Ricardo O; Mendonça, Karla Mpp

2018-03-09

Postural drainage is used primarily in infants with cystic fibrosis from diagnosis up to the moment when they are mature enough to actively participate in self-administered treatments. However, there is a risk of gastroesophageal reflux associated with this technique.This is an update of a review published in 2015. To compare the effects of standard postural drainage (15º to 45º head-down tilt) with modified postural drainage (15º to 30º head-up tilt) with regard to gastroesophageal reflux in infants and young children up to six years old with cystic fibrosis in terms of safety and efficacy. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Cystic Fibrosis Trials Register. We also searched the reference lists of relevant articles and reviews. Additional searches were conducted on ClinicalTrials.gov and on the WHO International Clinical Trials Registry Platform for any planned, ongoing and unpublished studies.The date of the most recent literature searches: 19 June 2017. We included randomised controlled studies that compared two postural drainage regimens (standard and modified postural drainage) with regard to gastroesophageal reflux in infants and young children (up to and including six years old) with cystic fibrosis. We used standard methodological procedures expected by Cochrane. Two review authors independently identified studies for inclusion, extracted outcome data and assessed risk of bias. We resolved disagreements by consensus or by involving a third review author. We contacted study authors to obtain missing or additional information. The quality of the evidence was assessed using GRADE. Two studies, involving a total of 40 participants, were eligible for inclusion in the review. We included no new studies in the 2018 update. The included studies were different in terms of the age of participants, the angle of tilt, the reported outcomes, the number of sessions and the study duration. The following outcomes were measured

Head CT scan

MedlinePlus

Brain CT; Cranial CT; CT scan - skull; CT scan - head; CT scan - orbits; CT scan - sinuses; Computed tomography - cranial; CAT scan - brain ... conditions: Birth (congenital) defect of the head or brain Brain infection Brain tumor Buildup of fluid inside ...

Development of Gene Therapeutics for Head and Neck Cancer in China: From Bench to Bedside.

PubMed

Guo, Wei; Song, Hao

2018-02-01

Head and neck cancer represents the seventh most common cancer worldwide. Although multidisciplinary sequential treatments have been used, there is still an urgent need for new treatment approaches that can effectively improve the outcomes of patients with advanced stages of head and neck cancer. Gene therapy is a rapidly evolving field in cancer therapy that has been shown to improve the efficacy of antitumor treatment. China is at the forefront in clinical trials and practice of gene therapy. Chinese researchers have mainly focused on gene therapeutics based on oncolytic virus and recombinant adenovirus expressing p53, antiangiogenesis factor or herpes simplex virus-thymidine kinase. Currently, two gene therapy drugs, Gendicine and Oncorine, have been marketed in China, and a number of upcoming gene therapy agents are under development for the treatment of head and neck cancer. Most gene therapy agents have demonstrated excellent tolerance. However, the therapeutic effects need further improvement. With current innovations in tumor biology and knowledge, gene therapy has great potential as a safe and effective anticancer treatment. In recent years, new gene therapy agents with promising effects have been incorporated into clinical trials in China. Thus, gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future.

Anatomic fit of six different radial head plates: comparison of precontoured low-profile radial head plates.

PubMed

Burkhart, Klaus Josef; Nowak, Tobias E; Kim, Yoon-Joo; Rommens, Pol M; Müller, Lars P

2011-04-01

Bulky implants may lead to symptomatic soft tissue irritation after open reduction and internal fixation of radial head and neck fractures. The purpose of our study was to compare the anatomic fit of precontoured radial head plates. We stripped 22 embalmed human cadaveric radiuses of soft tissues. We investigated 6 radial head plates: (1) the Medartis radial head buttress plate (MBP), (2) the Medartis radial head rim plate (MRP), (3) the Synthes radial neck plate (SNP), (4) the Synthes radial head plate (SHP), (5) the Acumed radial head plate (AHP), and (6) the Wright radial head plate (WHP). Each plate was applied to each radial head at the place of best fit within the safe zone. We tested 4 parameters of anatomic fit: (1) plate-to-bone distance, (2) plate contact judged by 3 different observers, (3) pin-subchondral zone distance, and (4) plate-to-bone contact after adjustment of the plates. The MBP and MRP showed the lowest profile by objective measurements, the SNP and AHP had a moderate profile, and the SHP and WHP demonstrated the bulkiest profile. The subjective assessments also demonstrated the best fit for the MBP, a good fit for the SNP, a moderate fit for the MRP and AHP, and a poor fit for the SHP and WHP. The MBP, MRP, and AHP could always provide pin-subchondral zone contact, unlike the SHP, SNP, and WHP. After bending, significant improvement of plate-to-bone distance could only be seen for the MBP, MRP, and WHP. The ranking among plates remained the same except for the WHP, which showed a significantly lower plate-to-bone distance than the SHP. Currently available radial head implants are heterogeneous. The MBP and MRP showed the lowest profile and best anatomic fit. Owing to the complex radial head anatomy, to date there is no one radial head plate that perfectly fits all radial heads. Conformance of existing plates to the radial head and neck is not perfect. Careful plate selection and modification, when necessary, may minimize interference of this

Developmental Changes in the Effect of Active Left and Right Head Rotation on Random Number Generation

PubMed Central

Sosson, Charlotte; Georges, Carrie; Guillaume, Mathieu; Schuller, Anne-Marie; Schiltz, Christine

2018-01-01

Numbers are thought to be spatially organized along a left-to-right horizontal axis with small/large numbers on its left/right respectively. Behavioral evidence for this mental number line (MNL) comes from studies showing that the reallocation of spatial attention by active left/right head rotation facilitated the generation of small/large numbers respectively. While spatial biases in random number generation (RNG) during active movement are well established in adults, comparable evidence in children is lacking and it remains unclear whether and how children’s access to the MNL is affected by active head rotation. To get a better understanding of the development of embodied number processing, we investigated the effect of active head rotation on the mean of generated numbers as well as the mean difference between each number and its immediately preceding response (the first order difference; FOD) not only in adults (n = 24), but also in 7- to 11-year-old elementary school children (n = 70). Since the sign and absolute value of FODs carry distinct information regarding spatial attention shifts along the MNL, namely their direction (left/right) and size (narrow/wide) respectively, we additionally assessed the influence of rotation on the total of negative and positive FODs regardless of their numerical values as well as on their absolute values. In line with previous studies, adults produced on average smaller numbers and generated smaller mean FODs during left than right rotation. More concretely, they produced more negative/positive FODs during left/right rotation respectively and the size of negative FODs was larger (in terms of absolute value) during left than right rotation. Importantly, as opposed to adults, no significant differences in RNG between left and right head rotations were observed in children. Potential explanations for such age-related changes in the effect of active head rotation on RNG are discussed. Altogether, the present study confirms that

Developmental Changes in the Effect of Active Left and Right Head Rotation on Random Number Generation.

PubMed

Sosson, Charlotte; Georges, Carrie; Guillaume, Mathieu; Schuller, Anne-Marie; Schiltz, Christine

2018-01-01

Numbers are thought to be spatially organized along a left-to-right horizontal axis with small/large numbers on its left/right respectively. Behavioral evidence for this mental number line (MNL) comes from studies showing that the reallocation of spatial attention by active left/right head rotation facilitated the generation of small/large numbers respectively. While spatial biases in random number generation (RNG) during active movement are well established in adults, comparable evidence in children is lacking and it remains unclear whether and how children's access to the MNL is affected by active head rotation. To get a better understanding of the development of embodied number processing, we investigated the effect of active head rotation on the mean of generated numbers as well as the mean difference between each number and its immediately preceding response (the first order difference; FOD) not only in adults ( n = 24), but also in 7- to 11-year-old elementary school children ( n = 70). Since the sign and absolute value of FODs carry distinct information regarding spatial attention shifts along the MNL, namely their direction (left/right) and size (narrow/wide) respectively, we additionally assessed the influence of rotation on the total of negative and positive FODs regardless of their numerical values as well as on their absolute values. In line with previous studies, adults produced on average smaller numbers and generated smaller mean FODs during left than right rotation. More concretely, they produced more negative/positive FODs during left/right rotation respectively and the size of negative FODs was larger (in terms of absolute value) during left than right rotation. Importantly, as opposed to adults, no significant differences in RNG between left and right head rotations were observed in children. Potential explanations for such age-related changes in the effect of active head rotation on RNG are discussed. Altogether, the present study confirms that

Head lice and the use of spinosad.

PubMed

Villegas, Susan C; Breitzka, Robin L

2012-01-01

Head lice infestations are responsible for social and economic distress. Despite a reported increase in resistance, permethrin 1% is still the first-line treatment of head lice. Alternative topical pediculicidal agents include malathion and benzyl alcohol, but resistance is of growing concern. In 2011, a new pediculicide, spinosad, was introduced. Our aim was to review the clinical pharmacology, efficacy, tolerability, and current place in therapy of spinosad for the treatment of head lice. Pertinent articles and abstracts were identified through searches of MEDLINE/Ebsco and MEDLINE/Ovid from 1948 to September 2011 and International Pharmaceutical Abstracts from 1966 to September 2011. Two reports described 3 trials of spinosad used for the treatment of head lice. One study (n = 120) demonstrated efficacy of both spinosad 0.5% and spinosad 1% compared with placebo, with 82.5% and 86.1% of patients free of live lice 14 days after treatment, respectively, compared with 25.6% in the placebo group (P < 0.001 for each treatment). The difference between the spinosad 0.5% and 1% treatment groups was not significant. Two trials (n = 1038) comparing spinosad 0.9% with permethrin 1% reported greater efficacy for spinosad with absence of live lice 14 days after 1 or 2 treatments for 84.6% and 86.7%, respectively, of primary cases compared with 44.9% and 42.9% with permethrin (P < 0.001 for both studies). The most common reported adverse events were eye and scalp irritation, but they were not statistically significant (P = 0.329 and P = 0.395, respectively). Only application-site erythema reactions showed statistical significance, with 6.8% in the permethrin group versus 3.1% in the spinosad group (P = 0.007). Although limited, the available literature suggests that spinosad is an effective and well-tolerated agent for the treatment of head lice. In a time of increasing resistance, spinosad has demonstrated superior performance compared with permethrin. A review of the

Afatinib versus methotrexate in older patients with second-line recurrent and/or metastatic head and neck squamous cell carcinoma: subgroup analysis of the LUX-Head & Neck 1 trial.

PubMed

Clement, P M; Gauler, T; Machiels, J P; Haddad, R I; Fayette, J; Licitra, L F; Tahara, M; Cohen, E E W; Cupissol, D; Grau, J J; Guigay, J; Caponigro, F; de Castro, G; de Souza Viana, L; Keilholz, U; Del Campo, J M; Cong, X J; Ehrnrooth, E; Vermorken, J B

2016-08-01

In the phase III LUX-Head & Neck 1 (LHN1) trial, afatinib significantly improved progression-free survival (PFS) versus methotrexate in recurrent and/or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients progressing on/after platinum-based therapy. This report evaluates afatinib efficacy and safety in prespecified subgroups of patients aged ≥65 and <65 years. Patients were randomized (2:1) to 40 mg/day oral afatinib or 40 mg/m(2)/week intravenous methotrexate. PFS was the primary end point; overall survival (OS) was the key secondary end point. Other end points included: objective response rate (ORR), patient-reported outcomes, tumor shrinkage, and safety. Disease control rate (DCR) was also assessed. Of 483 randomized patients, 27% (83 afatinib; 45 methotrexate) were aged ≥65 years (older) and 73% (239 afatinib; 116 methotrexate) <65 years (younger) at study entry. Similar PFS benefit with afatinib versus methotrexate was observed in older {median 2.8 versus 2.3 months, hazard ratio (HR) = 0.68 [95% confidence interval (CI) 0.45-1.03], P = 0.061} and younger patients [2.6 versus 1.6 months, HR = 0.79 (0.62-1.01), P = 0.052]. In older and younger patients, the median OS with afatinib versus methotrexate was 7.3 versus 6.4 months [HR = 0.84 (0.54-1.31)] and 6.7 versus 6.2 months [HR = 0.98 (0.76-1.28)]. ORRs with afatinib versus methotrexate were 10.8% versus 6.7% and 10.0% versus 5.2%; DCRs were 53.0% versus 37.8% and 47.7% versus 38.8% in older and younger patients, respectively. In both subgroups, the most frequent treatment-related adverse events were rash/acne (73%-77%) and diarrhea (70%-80%) with afatinib, and stomatitis (43%) and fatigue (31%-34%) with methotrexate. Fewer treatment-related discontinuations were observed with afatinib (each subgroup 7% versus 16%). A trend toward improved time to deterioration of global health status, pain, and swallowing with afatinib was observed in both subgroups. Advancing age (≥65 years) did not

Anterior approach versus posterior approach for Pipkin I and II femoral head fractures: A systemic review and meta-analysis.

PubMed

Wang, Chen-guang; Li, Yao-min; Zhang, Hua-feng; Li, Hui; Li, Zhi-jun

2016-03-01

We performed a meta-analysis, pooling the results from controlled clinical trials to compare the efficiency of anterior and posterior surgical approaches to Pipkin I and II fractures of the femoral head. Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5) and ScienceDirect (1966-2015.5) databases. Gray studies were identified from the references of the included literature. Pooling of the data was performed and analyzed by RevMan software, version 5.1. Five case-control trials (CCTs) met the inclusion criteria. There were significant differences in the incidence of heterotopic ossification (HO) between the approaches, but no significant differences were found between the two groups regarding functional outcomes of the hip, general postoperative complications, osteonecrosis of the femoral head or post-traumatic arthritis. The present meta-analysis indicated that the posterior approach decreased the risk of heterotopic ossification compared with the anterior approach for the treatment of Pipkin I and II femoral head fractures. No other complications were related to anterior and posterior approaches. Future high-quality randomized, controlled trials (RCTs) are needed to determine the optimal surgical approach and to predict other postoperative complications. III. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

49 CFR 572.192 - Head assembly.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Head assembly. 572.192 Section 572.192... Test Dummy, Small Adult Female § 572.192 Head assembly. (a) The head assembly consists of the head (180...) of this section, the head assembly shall meet performance requirements specified in paragraph (c) of...

49 CFR 572.192 - Head assembly.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Head assembly. 572.192 Section 572.192... Dummy, Small Adult Female § 572.192 Head assembly. (a) The head assembly consists of the head (180-1000...) of this section, the head assembly shall meet performance requirements specified in paragraph (c) of...

49 CFR 572.192 - Head assembly.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Head assembly. 572.192 Section 572.192... Test Dummy, Small Adult Female § 572.192 Head assembly. (a) The head assembly consists of the head (180...) of this section, the head assembly shall meet performance requirements specified in paragraph (c) of...

49 CFR 572.192 - Head assembly.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Head assembly. 572.192 Section 572.192... Dummy, Small Adult Female § 572.192 Head assembly. (a) The head assembly consists of the head (180-1000...) of this section, the head assembly shall meet performance requirements specified in paragraph (c) of...

49 CFR 572.192 - Head assembly.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Head assembly. 572.192 Section 572.192... Dummy, Small Adult Female § 572.192 Head assembly. (a) The head assembly consists of the head (180-1000...) of this section, the head assembly shall meet performance requirements specified in paragraph (c) of...

Executive functions and school readiness intervention: Impact, moderation, and mediation in the Head Start REDI program

PubMed Central

BIERMAN, KAREN L.; NIX, ROBERT L.; GREENBERG, MARK T.; BLAIR, CLANCY; DOMITROVICH, CELENE E.

2011-01-01

Despite their potentially central role in fostering school readiness, executive function (EF) skills have received little explicit attention in the design and evaluation of school readiness interventions for socioeconomically disadvantaged children. The present study examined a set of five EF measures in the context of a randomized-controlled trial of a research-based intervention integrated into Head Start programs (Head Start REDI). Three hundred fifty-six 4-year-old children (17% Hispanic, 25% African American; 54% girls) were followed over the course of the prekindergarten year. Initial EF predicted gains in cognitive and social–emotional skills and moderated the impact of the Head Start REDI intervention on some outcomes. The REDI intervention promoted gains on two EF measures, which partially mediated intervention effects on school readiness. We discuss the importance of further study of the neurobiological bases of school readiness, the implications for intervention design, and the value of incorporating markers of neurobiological processes into school readiness interventions. PMID:18606033

Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry.

PubMed

Kim, Cheol Ki; Ryu, Ju Seok; Song, Sun Hong; Koo, Jung Hoi; Lee, Kyung Duck; Park, Hee Sun; Oh, Yoongul; Min, Kyunghoon

2015-06-01

To observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM). Ten healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture. The maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture. The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx.

Effects of Head Rotation and Head Tilt on Pharyngeal Pressure Events Using High Resolution Manometry

PubMed Central

Kim, Cheol Ki; Song, Sun Hong; Koo, Jung Hoi; Lee, Kyung Duck; Park, Hee Sun; Oh, Yoongul; Min, Kyunghoon

2015-01-01

Objective To observe changes in pharyngeal pressure during the swallowing process according to postures in normal individuals using high-resolution manometry (HRM). Methods Ten healthy volunteers drank 5 mL of water twice while sitting in a neutral posture. Thereafter, they drank the same amount of water twice in the head rotation and head tilting postures. The pressure and time during the deglutition process for each posture were measured with HRM. The data obtained for these two postures were compared with those obtained from the neutral posture. Results The maximum pressure, area, rise time, and duration in velopharynx (VP) and tongue base (TB) were not affected by changes in posture. In comparison, the maximum pressure and the pre-upper esophageal sphincter (UES) maximum pressure of the lower pharynx in the counter-catheter head rotation posture were lower than those in the neutral posture. The lower pharynx pressure in the catheter head tilting posture was higher than that in the counter-catheter head tilting. The changes in the VP peak and epiglottis, VP and TB peaks, and the VP onset and post-UES time intervals were significant in head tilting and head rotation toward the catheter postures, as compared with neutral posture. Conclusion The pharyngeal pressure and time parameter analysis using HRM determined the availability of head rotation as a compensatory technique for safe swallowing. Tilting the head smoothes the progress of food by increasing the pressure in the pharynx. PMID:26161349

Preventing Caries in Preschoolers: Successful Initiation of an Innovative Community-Based Clinical Trial in Navajo Nation Head Start

PubMed Central

Quissell, David O.; Bryant, Lucinda L.; Braun, Patricia A.; Cudeii, Diana; Johs, Nikolas; Smith, Vongphone L.; George, Carmen; Henderson, William G.; Albino, Judith

2014-01-01

Navajo Nation children have the greatest prevalence of early childhood caries in the United States. This protocol describes an innovative combination of community-based participatory research and clinical trial methods to rigorously test a lay native Community Oral Health Specialists-delivered oral health intervention, with the goal of reducing the progression of disease and improving family knowledge and behaviors. Methods/Design This cluster-randomized trial designed by researchers at the Center for Native Oral Health Research at the University of Colorado in conjunction with members of the Navajo Nation community compares outcomes between the manualized 2-year oral health fluoride varnish-oral health promotion intervention and usual care in the community (child-caregiver dyads from 26 Head Start classrooms in each study arm; total of 1016 dyads). Outcome assessment includes annual dental screening and an annual caregiver survey of knowledge, attitudes and behaviors; collection of cost data will support cost-benefit analyses. Discussion The study protocol meets all standards required of randomized clinical trials. Aligned with principles of community-based participatory research, extended interaction between members of the Navajo community and researchers preceded study initiation, and collaboration between project staff and a wide variety of community members informed the study design and implementation. We believe the benefits of adding CBPR methods to those of randomized clinical studies outweigh the barriers and constraints, especially in studies of health disparities and in challenging settings. When done well, this innovative mix of methods will increase the likelihood of valid results that communities can use. PMID:24469238

American Head and Neck Society

MedlinePlus

American Head & Neck Society Mission Statement: Advance Education, Research, and Quality of Care for the head and neck oncology patient. American Head & Neck Society | AHNS The mission of the AHNS is ...

Randomized phase III trial of concurrent chemoradiotherapy vs accelerated hyperfractionation radiotherapy in locally advanced head and neck cancer

PubMed Central

Chitapanarux, Imjai; Tharavichitkul, Ekkasit; Kamnerdsupaphon, Pimkhuan; Pukanhapan, Nantaka; Vongtama, Roy

2013-01-01

The aim of this study was to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) vs accelerated hyperfractionation with concomitant boost (CCB) as a primary treatment for patients with Stage III–IV squamous cell carcinoma of head and neck (SCCHN). A total of 85 non-metastatic advanced SCCHN patients were accrued from January 2003 to December 2007. Of these, 48 and 37 patients received CCRT and CCB, respectively. The patients were randomized to receive either three cycles of carboplatin and 5-fluorouracil plus conventional radiotherapy (CCRT, 66 Gy in 6.5 weeks) or hybrid accelerated radiotherapy (CCB, 70 Gy in 6 weeks). The primary endpoint was determined by locoregional control rate. The secondary endpoints were overall survival and toxicity. With a median follow-up of 43 months (range, 3–102), the 5-year locoregional control rate was 69.6% in the CCRT arm vs 55.0% in the CCB arm (P = 0.184). The 5-year overall survival rate was marginally significantly different (P = 0.05): 76.1% in the CCRT arm vs 63.5% in the CCB arm. Radiotherapy treatment interruptions of more than three days were 60.4% and 40.5% in the CCRT arm and CCB arm, respectively. The median total treatment time was 55.5 days in the CCRT arm and 49 days in the CCB arm. The rate of Grade 3–4 acute mucositis was significantly higher in the CCB arm (67.6% vs 41.7%, P = 0.01), but no high grade hematologic toxicities were found in the CCB arm (27.2% vs 0%). CCRT has shown a trend of improving outcome over CCB irradiation in locoregionally advanced head and neck cancer. PMID:23740894

Cellular resolution functional imaging in behaving rats using voluntary head restraint

PubMed Central

Scott, Benjamin B.; Brody, Carlos D.; Tank, David W.

2013-01-01

SUMMARY High-throughput operant conditioning systems for rodents provide efficient training on sophisticated behavioral tasks. Combining these systems with technologies for cellular resolution functional imaging would provide a powerful approach to study neural dynamics during behavior. Here we describe an integrated two-photon microscope and behavioral apparatus that allows cellular resolution functional imaging of cortical regions during epochs of voluntary head restraint. Rats were trained to initiate periods of restraint up to 8 seconds in duration, which provided the mechanical stability necessary for in vivo imaging while allowing free movement between behavioral trials. A mechanical registration system repositioned the head to within a few microns, allowing the same neuronal populations to be imaged on each trial. In proof-of-principle experiments, calcium dependent fluorescence transients were recorded from GCaMP-labeled cortical neurons. In contrast to previous methods for head restraint, this system can also be incorporated into high-throughput operant conditioning systems. PMID:24055015

The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics.

PubMed

Garner, Alan A; Fearnside, Michael; Gebski, Val

2013-09-14

The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate. This article describes the design and protocol of the Head Injury Retrieval Trial (HIRT) which is a randomised controlled single centre trial of physician prehospital care (delivering advanced interventions such as rapid sequence intubation and blood transfusion) in addition to paramedic care for severe blunt TBI compared with paramedic care alone. Primary endpoint is Glasgow Outcome Scale score at six months post injury. Issues with trial integrity resulting from drop ins from standard care to the treatment arm as the result of policy changes by the local ambulance system are discussed. This randomised controlled trial will contribute to the evaluation of the efficacy of advance prehospital interventions in severe blunt TBI. ClinicalTrials.gov: NCT00112398.

Of Lice and Math: Using Models to Understand and Control Populations of Head Lice

PubMed Central

Laguna, Mara Fabiana; Risau-Gusman, Sebastián

2011-01-01

In this paper we use detailed data about the biology of the head louse (pediculus humanus capitis) to build a model of the evolution of head lice colonies. Using theory and computer simulations, we show that the model can be used to assess the impact of the various strategies usually applied to eradicate head lice, both conscious (treatments) and unconscious (grooming). In the case of treatments, we study the difference in performance that arises when they are applied in systematic and non-systematic ways. Using some reasonable simplifying assumptions (as random mixing of human groups and the same mobility for all life stages of head lice other than eggs) we model the contagion of pediculosis using only one additional parameter. It is shown that this parameter can be tuned to obtain collective infestations whose characteristics are compatible with what is given in the literature on real infestations. We analyze two scenarios: One where group members begin treatment when a similar number of lice are present in each head, and another where there is one individual who starts treatment with a much larger threshold (“superspreader”). For both cases we assess the impact of several collective strategies of treatment. PMID:21799752

[Rare tumors of the head and neck; on behalf of the REFCOR, the French Network of rare head and neck tumors].

PubMed

Baujat, Bertrand; Thariat, Juliette; Baglin, Anne Catherine; Costes, Valérie; Testelin, Sylvie; Reyt, Emile; Janot, François

2014-05-01

Malignant tumors of the upper aerodigestive tract may be rare by their histology (sarcoma, variants of conventional squamous cell carcinomas) and/or location (sinuses, salivary glands, ear, of various histologies themselves). They represent less than 10% of head and neck neoplasms. The confirmation of their diagnosis often requires a medical expertise and sometimes biomolecular techniques complementary to classical histology and immunohistochemistry. Due to their location, their treatment often requires a specific surgical technique. Radiation therapy is indicated based on histoclinical characteristics common to other head and neck neoplasms but also incorporate grade. Further, the technique must often be adapted to take into account the proximity of organs at risk. For most histologies, chemotherapy is relatively inefficient but current molecular advances may allow to consider pharmaceutical developments in the coming years. The REFCOR, the French Network of head and neck cancers aims to organize and promote the optimal management of these rare and heterogeneous diseases, to promote research and clinical trials.

Femoral head epiphysis growth and development among Chinese children aged 0-5 years.

PubMed

Luo, Jiayou; Tang, Jin; Zhou, Libo; Zeng, Rong; Mou, Jinsong; Zhang, Lingli

2009-05-01

The aim of this study was to examine the pattern of femoral head epiphysis growth and development among Chinese children. Between January and December, 2007, we randomly sampled 1,450 healthy Chinese children (0-5 years old) from Hunan Provincial Children's Hospital in Changsha, Hunan, China. The diameter of femoral head epiphysis was measured by pelvic X-ray photography and processed by medical image processing software. The growth of femoral head epiphysis in girls was 2-3 months earlier than that in boys. The diameter of femoral head epiphysis increased with advancing age in both girls and boys, but the diameter of femoral head epiphysis in 2, 3, 4, 6, and 10-month-old girls was significantly larger than that in boys. Cubic regression equations between the diameter of femoral head epiphysis and age were created for boys and girls that could be used to predict the diameter of femoral head epiphysis. In conclusion, there was gender difference in femoral head epiphysis growth and development among Chinese children, and our prediction models will provide the guidance for early diagnosis of diseases related to the growth and development of the femoral head epiphysis.

Moving Toward Bioadjuvant Approaches to Head and Neck Cancer Prevention

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saba, Nabil F.; Hammond, Anthea; Shin, Dong M.

2007-10-01

Head and neck squamous cell carcinoma affects >45,000 Americans annually. Patients who are successfully treated for their primary tumor are at high risk of developing a second primary tumor, making effective preventive strategies highly desirable for this disease. Although a landmark study in 1990 suggested some benefit of high-dose retinoids in head and neck cancer prevention, subsequent trials using more tolerable doses have shown limited clinical success. Newer preventive strategies have included bioadjuvant therapy combining retinoids with interferon and {alpha}-tocopherol, combinations of molecularly targeted agents, and oncolytic viruses. Furthermore, considerable evidence has supported a cancer protective role for several nutrients,more » including green tea and curcumin analogs. Natural compounds such as these with favorable long-term safety profiles might be particularly suited to the cancer prevention setting, in which patients will usually tolerate only moderate risk and toxicity.« less

Second Primary Head and Neck Cancers After Non-Head and Neck Primary Cancers.

PubMed

Schlieve, Thomas; Heidel, R Eric; Carlson, Eric R

2016-12-01

The purpose of the present study was to determine the rate of second primary head and neck cancer development among patients with a primary cancer diagnosed outside the head and neck region, to present the clinical characteristics of this population, and to determine whether any variables are associated with survival. We designed a case series based on a sample of patients diagnosed with head and neck cancer who had previously been diagnosed with cancer located outside the head and neck region. The primary predictor variable was a diagnosis of cancer outside the head and neck region. The primary outcome variable was the diagnosis of a second cancer in the head and neck region. χ 2  Goodness-of-fit tests were used to test for differences between the observed and expected rates. A total of 19,406 cancers were diagnosed at the University of Tennessee Cancer Institute during the study period from July 1, 2004 to June 30, 2014. The rate of second primary head and neck cancer among patients with a non-head and neck primary cancer was 0.2%. These 40 cancers occurred among a total of 849 head and neck squamous cell carcinoma (HNSCC) cases (5%) diagnosed during the study period. The most common location for a second primary HNSCC was the gingiva (27.5%), followed by the oral tongue (17.5%). Significantly more gingival cancers were diagnosed than expected (P < .001) and significantly fewer tongue cancers than expected (P = .01). The most common primary cancer was prostate (27.5%), followed by breast (25%). The median survival was 28.5 months after the second primary diagnosis. A nonsignificant effect was found for age (P = .30), tobacco use (P = .12), gender (P = .60), TNM stage (P = .29), and treatment protocol (P = .96) on survival. The development of a second primary HNSCC in a population of patients with non-head and neck primary cancers is associated with decreased overall survival. The most common presentation of a second primary HNSCC in our study was in

Impact of a telehealth intervention on quality of life and symptom distress in patients with head and neck cancer.

PubMed

Pfeifer, Mark P; Keeney, Cynthia; Bumpous, Jeffrey; Schapmire, Tara J; Studts, Jamie L; Myers, John; Head, Barbara

2015-01-01

Patients undergoing treatment for head and neck cancer commonly experience signi•cant changes in quality of life (QoL) and levels of symptom distress. It is not known if a telehealth intervention would mitigate these changes. To evaluate the impact of a telehealth intervention on QoL and symptom burden in patients undergoing initial treatment for head and neck cancers. A randomized clinical trial comparing the impact on QoL and symptom distress of telehealth intervention and standard care was conducted with 80 patients (45 treatment, 35 control) who had been diagnosed with head or neck cancer and were receiving 1 or more treatment modalities. Treatment group participants responded daily to symptom management algorithms using a simple telehealth messaging device. QoL was evaluated by the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACTHN) and symptom burden by the Memorial Symptom Assessment Scale (MSAS). Control group participants completed assessments while they received routine care. In the posttreatment phase, the telehealth participants had signi•cantly better scores than the controls for physical well-being (20.6 vs 17.0, P = .02) and trial outcome index (59.9 vs. 50.2, P = .04) on the FACT-HN, and total scores on the MSAS (0.9 vs. 1.2, P = .04). The moderate sample size of 80 patients limits the power to measure more subtle impacts of the intervention. Using telehealth to provide support to patients with head and neck cancer during the acute phase of treatment improved some aspects of posttreatment QoL and symptom burden. ©2015 Frontline Medical Communications.

Vestibular Dysfunction after Subconcussive Head Impact

PubMed Central

Ma, Lei; Kawata, Keisuke; Tierney, Ryan; Jeka, John J.

2017-01-01

Abstract Current thinking views mild head impact (i.e., subconcussion) as an underrecognized phenomenon that has the ability to cause significant current and future detrimental neurological effects. Repeated mild impacts to the head, however, often display no observable behavioral deficits based on standard clinical tests, which may lack sensitivity. The current study investigates the effects of subconcussive impacts from soccer heading with innovative measures of vestibular function and walking stability in a pre- 0–2 h, post- 24 h post-heading repeated measures design. The heading group (n = 10) executed 10 headers with soccer balls projected at a velocity of 25 mph (11.2 m/sec) over 10 min. Subjects were evaluated 24 h before, immediately after, and 24 h after soccer heading with: the modified Balance Error Scoring System (mBESS); a walking stability task with visual feedback of trunk movement; and galvanic vestibular stimulation (GVS) while standing with eyes closed on foam. A control group (n = 10) followed the same protocol with no heading. The results showed significant decrease in trunk angle, leg angle gain, and center of mass gain relative to GVS for the heading group compared with controls. Medial-lateral trunk orientation displacement and velocity during treadmill walking increased immediately after mild head impact for the heading group compared with controls. Controls showed an improvement in mBESS scores over time, indicating a learning effect, which was not observed with the heading group. These results suggest that mild head impact leads to a transient dysfunction in vestibular processing, which deters walking stability during task performance. PMID:26885560

Vestibular Dysfunction after Subconcussive Head Impact.

PubMed

Hwang, Sungjae; Ma, Lei; Kawata, Keisuke; Tierney, Ryan; Jeka, John J

2017-01-01

Current thinking views mild head impact (i.e., subconcussion) as an underrecognized phenomenon that has the ability to cause significant current and future detrimental neurological effects. Repeated mild impacts to the head, however, often display no observable behavioral deficits based on standard clinical tests, which may lack sensitivity. The current study investigates the effects of subconcussive impacts from soccer heading with innovative measures of vestibular function and walking stability in a pre- 0-2 h, post- 24 h post-heading repeated measures design. The heading group (n = 10) executed 10 headers with soccer balls projected at a velocity of 25 mph (11.2 m/sec) over 10 min. Subjects were evaluated 24 h before, immediately after, and 24 h after soccer heading with: the modified Balance Error Scoring System (mBESS); a walking stability task with visual feedback of trunk movement; and galvanic vestibular stimulation (GVS) while standing with eyes closed on foam. A control group (n = 10) followed the same protocol with no heading. The results showed significant decrease in trunk angle, leg angle gain, and center of mass gain relative to GVS for the heading group compared with controls. Medial-lateral trunk orientation displacement and velocity during treadmill walking increased immediately after mild head impact for the heading group compared with controls. Controls showed an improvement in mBESS scores over time, indicating a learning effect, which was not observed with the heading group. These results suggest that mild head impact leads to a transient dysfunction in vestibular processing, which deters walking stability during task performance.

Video analysis of head blows leading to concussion in competition Taekwondo.

PubMed

Koh, Jae O; Watkinson, E Jane; Yoon, Yong-Jin

2004-12-01

To analyse the situational and contextual factors surrounding concussions and head blows in Taekwondo. Prospective design. Direct observation, subject interview and videotape recording used. A total of 2328 competitors participated in the 2001 tournament, South Korea. All matches were recorded on videotape. All recipients of head blows were interviewed by athletic therapists and the researcher immediately after the match. The videotapes of concussions and head blows were analysed. A total of 1009 head blows including concussions were analysed. Head blows and concussions were most evident when the attacker was situated in a closed stance and received a single roundhouse kick. The most frequent anatomical site of the head impact was the temporal region. The frequency of head blows and concussions is high in Taekwondo. Development of blocking skills, safety education, rigorous enforcement of the competition rules and improvement of head-gear are recommended.

Head growth and neurocognitive outcomes.

PubMed

Wright, Charlotte M; Emond, Alan

2015-06-01

There is a lack of evidence on the value of head circumference (HC) as a screening measure. We aimed to describe the incidence of head centile shifting and the relationship between extremes of head size and later neurodevelopmental problems in the Avon Longitudinal Study of Parents and Children. HC was measured routinely at 2, 9, and 18 or 24 months and by researchers at ages 4, 8, 12, and 18 months. IQ according to the Wechsler Intelligence Scale for Children was measured in research clinics at age 8 for all. Neurocognitive disorders (NCDs) were identified from chart review. There were 10 851 children with ≥2 head measurements. At each age, 2% to 3% of children had scores that were < -2 or >2 SDs below or above the mean, but for most children this was only found at 1 age. More than 15% of children showed centile shifts, but less than one-third of these were sustained at subsequent measurements. Only 0.5% showed a sustained shift beyond the normal range. Children with consistently small heads were up to 7 times more likely to have an NCD, but 85% of children with small heads had no NCDs, and 93% of children with NCDs had head SD scores within the normal range. Centile shifts within the normal range occur commonly and seem mainly to reflect measurement error. This finding makes robust assessment of the head trajectory difficult and may result in many children being investigated unnecessarily. Extreme head size is neither specific nor sensitive for detecting NCDs, suggesting that routine measurement of HC is unhelpful. Copyright © 2015 by the American Academy of Pediatrics.

CT Perfusion of the Head

MedlinePlus

... News Physician Resources Professions Site Index A-Z CT Perfusion of the Head Computed tomography (CT) perfusion ... of CT Perfusion of the Head? What is CT Perfusion of the Head? Computed tomography (CT) perfusion ...

Minnesota: Early Head Start Initiatiive

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

Minnesota provides supplemental state funding to existing federal Head Start and Early Head Start (EHS) grantees to increase their capacity to serve additional infants, toddlers, and pregnant women. The initiative was started in 1997 when the state legislature earmarked $1 million of the general state Head Start supplemental funds for children…

GETTING READY: RESULTS OF A RANDOMIZED TRIAL OF A RELATIONSHIP-FOCUSED INTERVENTION ON THE PARENT-INFANT RELATIONSHIP IN RURAL EARLY HEAD START.

PubMed

Knoche, Lisa L; Sheridan, Susan M; Clarke, Brandy L; Edwards, Carolyn Pope; Marvin, Christine A; Cline, Keely D; Kupzyk, Kevin A

2012-09-01

The purpose of this study is to investigate the effects of a relational intervention (the Getting Ready intervention) on parenting behaviors supporting the parent-infant relationship for families enrolled in Early Head Start home-based programming. Two-hundred thirty-four parents and their children participated in the randomized study, with 42% of parents reporting education of less than a high-school diploma. Brief, semistructured parent-child interaction tasks were videotaped every 4 months over a16-month intervention period. Observational codes of parent-infant relationship behaviors included quality of three parental behaviors: warmth and sensitivity, support for learning, and encouragement of autonomy; two appropriateness indicators: support for learning and guidance/directives; and one amount indicator: constructive behaviors. Parents who participated in the Getting Ready intervention demonstrated higher quality interactions with their children that included enhanced quality of warmth and sensitivity, and support for their children's autonomy than did parents in the control group. They also were more likely to use appropriate directives with their children and more likely to demonstrate appropriate supports for their young children's learning. Results indicate an added value of the Getting Ready intervention for Early Head Start home-based programming for families of infants and toddlers.

GETTING READY: RESULTS OF A RANDOMIZED TRIAL OF A RELATIONSHIP-FOCUSED INTERVENTION ON THE PARENT–INFANT RELATIONSHIP IN RURAL EARLY HEAD START

PubMed Central

KNOCHE, LISA L.; SHERIDAN, SUSAN M.; CLARKE, BRANDY L.; EDWARDS, CAROLYN POPE; MARVIN, CHRISTINE A.; CLINE, KEELY D.; KUPZYK, KEVIN A.

2014-01-01

The purpose of this study is to investigate the effects of a relational intervention (the Getting Ready intervention) on parenting behaviors supporting the parent–infant relationship for families enrolled in Early Head Start home-based programming. Two-hundred thirty-four parents and their children participated in the randomized study, with 42% of parents reporting education of less than a high-school diploma. Brief, semistructured parent–child interaction tasks were videotaped every 4 months over a16-month intervention period. Observational codes of parent–infant relationship behaviors included quality of three parental behaviors: warmth and sensitivity, support for learning, and encouragement of autonomy; two appropriateness indicators: support for learning and guidance/directives; and one amount indicator: constructive behaviors. Parents who participated in the Getting Ready intervention demonstrated higher quality interactions with their children that included enhanced quality of warmth and sensitivity, and support for their children’s autonomy than did parents in the control group. They also were more likely to use appropriate directives with their children and more likely to demonstrate appropriate supports for their young children’s learning. Results indicate an added value of the Getting Ready intervention for Early Head Start home-based programming for families of infants and toddlers. PMID:24644374

Improving quality of life through the routine use of the patient concerns inventory for head and neck cancer patients: a cluster preference randomized controlled trial.

PubMed

Rogers, Simon N; Lowe, Derek; Lowies, Cher; Yeo, Seow Tien; Allmark, Christine; Mcavery, Dominic; Humphris, Gerald M; Flavel, Robert; Semple, Cherith; Thomas, Steven J; Kanatas, Anastasios

2018-04-18

The consequences of treatment for Head and Neck cancer (HNC) patients has profound detrimental impacts such as impaired QOL, emotional distress, delayed recovery and frequent use of healthcare. The aim of this trial is to determine if the routine use of the Patients Concerns Inventory (PCI) package in review clinics during the first year following treatment can improve overall quality of life, reduce the social-emotional impact of cancer and reduce levels of distress. Furthermore, we aim to describe the economic costs and benefits of using the PCI. This will be a cluster preference randomised control trial with consultants either 'using' or 'not using' the PCI package at clinic. It will involve two centres Leeds and Liverpool. 416 eligible patients from at least 10 consultant clusters are required to show a clinically meaningful difference in the primary outcome. The primary outcome is the percentage of participants with less than good overall quality of life at the final one-year clinic as measured by the University of Washington QOL questionnaire version 4 (UWQOLv4). Secondary outcomes at one-year are the mean social-emotional subscale (UWQOLv4) score, Distress Thermometer (DT) score ≥ 4, and key health economic measures (QALY-EQ-5D-5 L; CSRI). This trial will provide knowledge on the effectiveness of a consultation intervention package based around the PCI used at routine follow-up clinics following treatment of head and neck cancer with curative intent. If this intervention is (cost) effective for patients, the next step will be to promote wider use of this approach as standard care in clinical practice. 32,382. Clinical Trials Identifier, NCT03086629 . Version 3.0, 1st July 2017.

A randomized clinical trial evaluating gingivitis and plaque reduction of an oscillating-rotating power brush with a new brush head with angled bristles versus a marketed sonic brush with self-adjusting technology.

PubMed

Klukowska, Malgorzata; Grender, Julie M; Conde, Erinn; Ccahuana-Vasquez, Renzo Alberto; Ram Goyal, C

2014-08-01

To compare the efficacy of an oscillating-rotating power toothbrush with a novel brush head incorporating angled CrissCross bristles (Oral-B Pro 7000 SmartSeries and Oral-B CrossAction brush head) versus a marketed sonic toothbrush (Colgate ProClinical A1500 with the Triple Clean brush head) in the reduction of gingivitis and plaque over a 6-week period. This was a single center, randomized, open label, examiner-blind, 2-treatment, parallel group study. Study participants who met the entrance criteria were enrolled in the study and randomly assigned to one of the two toothbrush groups. Study participants brushed with their assigned toothbrush and a marketed fluoride dentifrice for 2 minutes twice daily at home for 6 weeks. Gingivitis and plaque were evaluated at baseline and Week 6. Gingivitis was assessed using the Modified Gingival Index (MGI) and Gingival Bleeding Index (GBI) and plaque was assessed using the Rustogi Modified Navy Plaque Index (RMNPI). Data was analyzed using the ANCOVA with baseline as the covariate. In total, 130 study participants were randomized to treatment resulting in 64 study participants per group completing the study. Both brushes produced statistically significant (P < 0.001) reductions in gingivitis and plaque measures relative to baseline. The oscillating-rotating,brush with the novel brush head demonstrated statistically significantly (P < 0.05) greater reductions in all gingivitis measures, as well as whole mouth and interproximal plaque measures, compared to the sonic toothbrush. The benefit for the oscillating- rotating brush over the sonic brush was 21.3% for gingivitis, 35.7% for gingival bleeding, 34.7% for number of bleeding sites, 17.4% for whole mouth plaque, and 21.2% for interproximal plaque. There were no adverse events reported or observed for either brush.

Hip-Hop to Health Jr. Randomized Effectiveness Trial

PubMed Central

Kong, Angela; Buscemi, Joanna; Stolley, Melinda R.; Schiffer, Linda A.; Kim, Yoonsang; Braunschweig, Carol L.; Gomez-Perez, Sandra L.; Blumstein, Lara B.; Van Horn, Linda; Dyer, Alan R.; Fitzgibbon, Marian L.

2015-01-01

Introduction The preschool years provide a unique window of opportunity to intervene on obesity-related lifestyle risk factors during the formative years of a child’s life. The purpose of this study was to assess the impact of a preschool-based obesity prevention effectiveness trial at 1-year follow-up. Design RCT. Settings/participants Primarily African American children (aged 3–5 years, N=618) attending Head Start preschool programs administered by Chicago Public Schools. Methods Eighteen preschools were randomly assigned in 2007–2008 to receive either: (1) a 14-week teacher-delivered intervention focused on healthy lifestyle behaviors; or (2) a 14-week teacher-delivered general health curriculum (control group). Main outcome measures The primary outcome, BMI, was measured at baseline, post-intervention, and 1-year follow-up. Diet and screen time behaviors were also assessed at these time points. Multilevel mixed effects models were used to test for between-group differences. Data were analyzed in 2014. Results Significant between-group differences were observed in diet, but not in BMI z-score or screen time at 1-year follow-up. Diet differences favored the intervention arm over controls in overall diet quality (p=0.02) and in subcomponents of diet quality, as measured by the Healthy Eating Index-2005, and in fruit intake (servings/day, excludes juice) (p=0.02). Diet quality worsened more among controls than the intervention group at 1-year follow-up. Conclusions The adaptation of Hip-Hop to Health Jr. produced modest benefits in diet quality, but did not significantly impact weight gain trajectory. Not unlike other effectiveness trials, this real-world version delivered by Head Start teachers produced fewer benefits than the more rigorous efficacy trial. It is important to understand and build upon the lessons learned from these types of trials so that we can design, implement, and disseminate successful evidence-based programs more widely and effectively

Biomechanical investigation of head impacts in football

PubMed Central

Withnall, C; Shewchenko, N; Gittens, R; Dvorak, J

2005-01-01

Objectives: This study sought to measure the head accelerations induced from upper extremity to head and head to head impact during the game of football and relate this to the risk of mild traumatic brain injury using the Head Impact Power (HIP) index. Furthermore, measurement of upper neck forces and torques will indicate the potential for serious neck injury. More stringent rules or punitive sanctions may be warranted for intentional impact by the upper extremity or head during game play. Methods: Game video of 62 cases of head impact (38% caused by the upper extremity and 30% by the head of the opposing player) was provided by F-MARC. Video analysis revealed the typical impact configurations and representative impact speeds. Upper extremity impacts of elbow strike and lateral hand strike were re-enacted in the laboratory by five volunteer football players striking an instrumented Hybrid III pedestrian model crash test manikin. Head to head impacts were re-enacted using two instrumented test manikins. Results: Elbow to head impacts (1.7–4.6 m/s) and lateral hand strikes (5.2–9.3 m/s) resulted in low risk of concussion (<5%) and severe neck injury (<5%). Head to head impacts (1.5–3.0 m/s) resulted in high concussion risk (up to 67%) but low risk of severe neck injury (<5%). Conclusion: The laboratory simulations suggest little risk of concussion based on head accelerations and maximum HIP. There is no biomechanical justification for harsher penalties in this regard. However, deliberate use of the head to impact another player's head poses a high risk of concussion, and justifies a harsher position by regulatory bodies. In either case the risk of serious neck injury is very low. PMID:16046356

Brush head composition, wear profile, and cleaning efficacy: an assessment of three electric brush heads using in vitro methods.

PubMed

Kaiser, Eva; Meyners, Michael; Markgraf, Dirk; Stoerkel, Ulrich; von Koppenfels, Roxana; Adam, Ralf; Soukup, Martin; Wehrbein, Heinrich; Erbe, Christina

2014-01-01

The objective of this research was to evaluate a current store brand (SB) brush head for composition/physical characteristics, Wear Index (WI), and cleaning efficacy versus the previous SB brush head refill design (SB control) and the Oral-B Precision Clean brush head (positive control, PC). This research consisted of three parts: 1) Analytical analysis using Fourier Transform Infrared (FT-IR) spectrometry to evaluate the chemical composition of the current SB brush head bristles relative to the SB control. In addition, physical parameters such as bristle count and diameter were determined. 2) Wear Index (WI) investigation to determine the Wear Index scores of in vitro-aged brush heads at four weeks (one month) and 13 weeks (three months) by a trained investigator. To "age" the brush heads, a robot system was used as a new alternative in vitro method to simulate aging by consumer use. 3) Robot testing to determine the cleaning performance of in vitro-aged brush heads, comparing one month-aged current SB brush heads with the SB control (one and three months-aged) and the PC brush heads (three months-aged) in a standardized fashion. 1) FT-IR analysis revealed that the chemical composition of the current and control SB refill brush heads is identical. In terms of physical parameters, the current SB brush head has 12% more bristles and a slightly oval brush head compared to the round brush head of the SB control. 2) Wear Index analysis showed there was no difference in the one month-aged current SB brush head versus the one month-aged SB control (1.67 vs. 1.50, p = 0.65) or versus the three months-aged PC brush head (1.67 vs. 1.50, p = 0.65). The one month-aged current SB brush head demonstrated statistically significantly less wear than the three months-aged SB control (1.67 vs. 2.67, p = 0.01). 3) Analysis of cleaning efficacy shows that the one month-aged current SB brush head had improved cleaning performance over the one month-aged SB control brush head (p < 0

The effect of long and short head biceps loading on glenohumeral joint rotational range of motion and humeral head position.

PubMed

McGarry, Michelle H; Nguyen, Michael L; Quigley, Ryan J; Hanypsiak, Bryan; Gupta, Ranjan; Lee, Thay Q

2016-06-01

To evaluate the effect of loading the long and short heads of the biceps on glenohumeral range of motion and humeral head position. Eight cadaveric shoulders were tested in 60° abduction in the scapula and coronal plane. Muscle loading was applied based on cross-sectional area ratios. The short and long head of the biceps were loaded individually followed by combined loading. Range of motion was measured with 2.2 Nm torque, and the humeral head apex position was measured using a MicroScribe. A paired t test with Bonferroni correction was used for statistics. Long head loading decreased internal rotation in both the scapular (17.9 %) and coronal planes (5.7 %) and external rotation in the scapular plane (2.6 %) (P < 0.04). With only short head loading, maximum internal rotation was significantly increased in the scapular and coronal plane. Long head and short head loading shifted the humeral head apex posteriorly in maximum internal rotation in both planes with the long head shift being significantly greater than the short head. Long head loading also shifted the humeral apex inferiorly in internal rotation and inferiorly posteriorly in neutral rotation in the scapular plane. With the long head unloaded, there was a significant superior shift with short head loading in both planes. Loading the long head of the biceps had a much greater effect on glenohumeral range of motion and humeral head shift than the short head of the biceps; however, in the absence of long head loading, with the short head loaded, maximum internal rotation increases and the humeral head shifts superiorly, which may contribute to impingement following tenodesis of the long head of the biceps. These small changes in rotational range of motion and humeral head position with biceps tenodesis may not lead to pathologic conditions in low-demand patients; however, in throwers, biceps tenodesis may lead to increased contact pressures in late-cocking and deceleration that will likely translate

Is Heading in Youth Soccer Dangerous Play?

PubMed

O'Kane, John W

2016-01-01

Soccer is among the most popular youth sports with over 3 million youth players registered in the U.S. Soccer is unique in that players intentionally use their head to strike the ball, leading to concerns that heading could cause acute or chronic brain injury, especially in the immature brains of children. Pub Med search without date restriction was conducted in November 2014 and August 2015 using the terms soccer and concussion, heading and concussion, and youth soccer and concussion. 310 articles were identified and reviewed for applicable content specifically relating to youth athletes, heading, and/or acute or chronic brain injury from soccer. Soccer is a low-risk sport for catastrophic head injury, but concussions are relatively common and heading often plays a role. At all levels of play, concussions are more likely to occur in the act of heading than with other facets of the game. While concussion from heading the ball without other contact to the head appears rare in adult players, some data suggests children are more susceptible to concussion from heading primarily in game situations. Contributing factors include biomechanical forces, less developed technique, and the immature brain's susceptibility to injury. There is no evidence that heading in youth soccer causes any permanent brain injury and there is limited evidence that heading in youth soccer can cause concussion. A reasonable approach based on U.S. Youth Soccer recommendations is to teach heading after age 10 in controlled settings, and heading in games should be delayed until skill acquisition and physical maturity allow the youth player to head correctly with confidence.

Head injury - first aid

MedlinePlus

... medlineplus.gov/ency/article/000028.htm Head injury - first aid To use the sharing features on this page, ... a concussion can range from mild to severe. First Aid Learning to recognize a serious head injury and ...

Mortality prediction of head Abbreviated Injury Score and Glasgow Coma Scale: analysis of 7,764 head injuries.

PubMed

Demetriades, Demetrios; Kuncir, Eric; Murray, James; Velmahos, George C; Rhee, Peter; Chan, Linda

2004-08-01

We assessed the prognostic value and limitations of Glasgow Coma Scale (GCS) and head Abbreviated Injury Score (AIS) and correlated head AIS with GCS. We studied 7,764 patients with head injuries. Bivariate analysis was performed to examine the relationship of GCS, head AIS, age, gender, and mechanism of injury with mortality. Stepwise logistic regression analysis was used to identify the independent risk factors associated with mortality. The overall mortality in the group of head injury patients with no other major extracranial injuries and no hypotension on admission was 9.3%. Logistic regression analysis identified head AIS, GCS, age, and mechanism of injury as significant independent risk factors of death. The prognostic value of GCS and head AIS was significantly affected by the mechanism of injury and the age of the patient. Patients with similar GCS or head AIS but different mechanisms of injury or ages had significantly different outcomes. The adjusted odds ratio of death in penetrating trauma was 5.2 (3.9, 7.0), p < 0.0001, and in the age group > or = 55 years the adjusted odds ratio was 3.4 (2.6, 4.6), p < 0.0001. There was no correlation between head AIS and GCS (correlation coefficient -0.31). Mechanism of injury and age have a major effect in the predictive value of GCS and head AIS. There is no good correlation between GCS and head AIS.

The study protocol for the Head Injury Retrieval Trial (HIRT): a single centre randomised controlled trial of physician prehospital management of severe blunt head injury compared with management by paramedics

PubMed Central

2013-01-01

Background The utility of advanced prehospital interventions for severe blunt traumatic brain injury (BTI) remains controversial. Of all trauma patient subgroups it has been anticipated that this patient group would most benefit from advanced prehospital interventions as hypoxia and hypotension have been demonstrated to be associated with poor outcomes and these factors may be amenable to prehospital intervention. Supporting evidence is largely lacking however. In particular the efficacy of early anaesthesia/muscle relaxant assisted intubation has proved difficult to substantiate. Methods This article describes the design and protocol of the Head Injury Retrieval Trial (HIRT) which is a randomised controlled single centre trial of physician prehospital care (delivering advanced interventions such as rapid sequence intubation and blood transfusion) in addition to paramedic care for severe blunt TBI compared with paramedic care alone. Results Primary endpoint is Glasgow Outcome Scale score at six months post injury. Issues with trial integrity resulting from drop ins from standard care to the treatment arm as the result of policy changes by the local ambulance system are discussed. Conclusion This randomised controlled trial will contribute to the evaluation of the efficacy of advance prehospital interventions in severe blunt TBI. Trial Registration ClinicalTrials.gov: NCT00112398 PMID:24034628

A head-to-head comparison of hydrogen peroxide vapor and aerosol room decontamination systems.

PubMed

Holmdahl, T; Lanbeck, P; Wullt, M; Walder, M H

2011-09-01

New technologies have emerged in recent years for the disinfection of hospital rooms and equipment that may not be disinfected adequately using conventional methods. There are several hydrogen peroxide-based area decontamination technologies on the market, but no head-to-head studies have been performed. We conducted a head-to-head in vitro comparison of a hydrogen peroxide vapor (HPV) system (Bioquell) and an aerosolized hydrogen peroxide (aHP) system (Sterinis). The tests were conducted in a purpose-built 136-m(3) test room. One HPV generator and 2 aHP machines were used, following recommendations of the manufacturers. Three repeated tests were performed for each system. The microbiological efficacy of the 2 systems was tested using 6-log Tyvek-pouched Geobacillus stearothermophilus biological indicators (BIs). The indicators were placed at 20 locations in the first test and 14 locations in the subsequent 2 tests for each system. All BIs were inactivated for the 3 HPV tests, compared with only 10% in the first aHP test and 79% in the other 2 aHP tests. The peak hydrogen peroxide concentration was 338 ppm for HPV and 160 ppm for aHP. The total cycle time (including aeration) was 3 and 3.5 hours for the 3 HPV tests and the 3 aHP tests, respectively. Monitoring around the perimeter of the enclosure with a handheld sensor during tests of both systems did not identify leakage. One HPV generator was more effective than 2 aHP machines for the inactivation of G. stearothermophilus BIs, and cycle times were faster for the HPV system.

Maryland Early Head Start Initiative

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2012

2012-01-01

Since 2000, Maryland has provided state supplemental funds to Head Start and Early Head Start (EHS) programs to improve access. Local EHS programs may use funds, through child care partnerships, to extend the EHS day or year. Maryland's approach to building on EHS includes: (1) Increase the capacity of existing Head Start and EHS programs to…

Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: a systematic review and meta-analysis

PubMed Central

Rummel-Kluge, Christine; Komossa, Katja; Schwarz, Sandra; Hunger, Heike; Schmid, Franziska; Lobos, Claudia Asenjo; Kissling, Werner; Davis, John M; Leucht, Stefan

2010-01-01

Objective The metabolic side effects of second-generation antipsychotics (SGA) are serious and have not been compared head to head in a meta-analysis. We conducted a meta-analysis of studies comparing the metabolic side effects of the following SGAs head-to-head: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone, sertindole, ziprasidone, zotepine. Method We searched the register of the Cochrane schizophrenia group (last search May 2007), supplemented by MEDLINE and EMBASE (last search January 2009) for randomized, blinded studies comparing the above mentioned SGA in the treatment of schizophrenia or related disorders. At least three reviewers extracted the data independently. The primary outcome was weight change. We also assessed changes of cholesterol and glucose. The results were combined in a meta-analysis. Results We included 48 studies with 105 relevant arms. Olanzapine produced more weight gain than all other second-generation antipsychotics except for clozapine where no difference was found. Clozapine produced more weight gain than risperidone, risperidone more than amisulpride, and sertindole more than risperidone. Olanzapine produced more cholesterol increase than aripiprazole, risperidone and ziprasidone. (No differences with amisulpride, clozapine and quetiapine were found). Quetiapine produced more cholesterol increase than risperidone and ziprasidone. Olanzapine produced more increase in glucose than amisulpride, aripiprazole, quetiapine, risperidone and ziprasidone; no difference was found with clozapine. Conclusions Some SGAs lead to substantially more metabolic side effects than other SGAs. When choosing an SGA for an individual patient these side effects with their potential cause of secondary diseases must be weighed against efficacy and characteristics of the individual patient. PMID:20692814

Cybersickness Onset With Reflexive Head Movements During Land and Shipboard Head-Mounted Display Flight Simulation

DTIC Science & Technology

2010-09-09

provoked a predictable OKCR coronal head tilt (p < 0.001) whenever aircraft angle of bank (AOB) increased (Fig. 2). With 90º of simulated AOB, land... head pitch were –3.3 ± 3.8 to 6.8 ± 5.9 on land, and –4.0º ± 5.6 to 7.6º ± 9.7 at sea (Fig. 3). 7 Combined Coronal OKCR ( Head Tilt ) Data for...Land OKCR Figure 2: Coronal OKCR ( head tilt ) vs. angle of bank, during both land based and shipboard HMD/VR flight simulation. Combined

Adjustment of saccade characteristics during head movements.

NASA Technical Reports Server (NTRS)

Morasso, P.; Bizzi, E.; Dichgans, J.

1973-01-01

Saccade characteristics have been studied during coordinated eye-head movements in monkeys. Amplitude, duration, and peak velocity of saccades with head turning were compared with saccades executed while the head was artificially restrained. The results indicate that the saccade characteristics are modulated as a function of head movement, hence the gaze movement (eye+head) exactly matches saccades with head fixed. Saccade modulation is achieved by way of negative vestibulo-ocular feedback. The neck proprioceptors, because of their longer latency, are effective only if the head starts moving prior to the onset of saccade. It is concluded that saccades make with head turning are not 'ballistic' movements because their trajectory is not entirely predetermined by a central command.

Pigeons (C. livia) Follow Their Head during Turning Flight: Head Stabilization Underlies the Visual Control of Flight.

PubMed

Ros, Ivo G; Biewener, Andrew A

2017-01-01

Similar flight control principles operate across insect and vertebrate fliers. These principles indicate that robust solutions have evolved to meet complex behavioral challenges. Following from studies of visual and cervical feedback control of flight in insects, we investigate the role of head stabilization in providing feedback cues for controlling turning flight in pigeons. Based on previous observations that the eyes of pigeons remain at relatively fixed orientations within the head during flight, we test potential sensory control inputs derived from head and body movements during 90° aerial turns. We observe that periods of angular head stabilization alternate with rapid head repositioning movements (head saccades), and confirm that control of head motion is decoupled from aerodynamic and inertial forces acting on the bird's continuously rotating body during turning flapping flight. Visual cues inferred from head saccades correlate with changes in flight trajectory; whereas the magnitude of neck bending predicts angular changes in body position. The control of head motion to stabilize a pigeon's gaze may therefore facilitate extraction of important motion cues, in addition to offering mechanisms for controlling body and wing movements. Strong similarities between the sensory flight control of birds and insects may also inspire novel designs of robust controllers for human-engineered autonomous aerial vehicles.

Pigeons (C. livia) Follow Their Head during Turning Flight: Head Stabilization Underlies the Visual Control of Flight

PubMed Central

Ros, Ivo G.; Biewener, Andrew A.

2017-01-01

Similar flight control principles operate across insect and vertebrate fliers. These principles indicate that robust solutions have evolved to meet complex behavioral challenges. Following from studies of visual and cervical feedback control of flight in insects, we investigate the role of head stabilization in providing feedback cues for controlling turning flight in pigeons. Based on previous observations that the eyes of pigeons remain at relatively fixed orientations within the head during flight, we test potential sensory control inputs derived from head and body movements during 90° aerial turns. We observe that periods of angular head stabilization alternate with rapid head repositioning movements (head saccades), and confirm that control of head motion is decoupled from aerodynamic and inertial forces acting on the bird's continuously rotating body during turning flapping flight. Visual cues inferred from head saccades correlate with changes in flight trajectory; whereas the magnitude of neck bending predicts angular changes in body position. The control of head motion to stabilize a pigeon's gaze may therefore facilitate extraction of important motion cues, in addition to offering mechanisms for controlling body and wing movements. Strong similarities between the sensory flight control of birds and insects may also inspire novel designs of robust controllers for human-engineered autonomous aerial vehicles. PMID:29249929

Head circumferences of children born to HIV-infected and HIV-uninfected mothers in Zimbabwe during the preantiretroviral therapy era

PubMed Central

Evans, Ceri; Chasekwa, Bernard; Ntozini, Robert; Humphrey, Jean H.; Prendergast, Andrew J.

2016-01-01

Objectives: To describe the head growth of children according to maternal and child HIV infection status. Design: Longitudinal analysis of head circumference data from 13 647 children followed from birth in the ZVITAMBO trial, undertaken in Harare, Zimbabwe, between 1997 and 2001, prior to availability of antiretroviral therapy (ART) or cotrimoxazole prophylaxis. Methods: Head circumference was measured at birth, then at regular intervals through 24 months of age. Mean head circumference-for-age Z-scores (HCZ) and prevalence of microcephaly (HCZ < −2) were compared between HIV-unexposed children, HIV-exposed uninfected (HEU) children and children infected with HIV in utero (IU), intrapartum (IP) and postnatally (PN). Results: Children infected with HIV in utero had head growth restriction at birth. Head circumference Z-scores remained low throughout follow-up in IP children, whereas they progressively declined in IU children. During the second year of life, HCZ in the PN group declined, reaching a similar mean as IP-infected children by 21 months of age. Microcephaly was more common among IU and IP children than HIV-uninfected children through 24 months. HEU children had significantly lower head circumferences than HIV-unexposed children through 12 months. Conclusion: HIV-infected children had lower head circumferences and more microcephaly than HIV-uninfected children. Timing of HIV acquisition; influenced HCZ, with those infected before birth having particularly poor head growth. HEU children had poorer head growth until 12 months of age. Correlations between head growth and neurodevelopment in the context of maternal/infant HIV infection, and further studies from the current ART era, will help determine the predictive value of routine head circumference measurement. PMID:27428746

Effect of relative head position on the anesthetic efficacy of inferior alveolar nerve block during endodontic treatment of patients with irreversible pulpitis.

PubMed

Aggarwal, Vivek; Singla, Mamta; Miglani, Sanjay

2018-02-01

The purpose of this prospective randomized single-blind clinical trial was to evaluate the effect of tilting the head on the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Ninety-two patients were divided into two groups: the first group received IANB and the head was tilted in the direction of the block for 15 min, whereas the second group received IANB and the head was tilted to the opposite side. Access cavity preparation was initiated after 15 min. Success was defined as no pain or faint/weak/mild pain during endodontic access preparation and instrumentation. The anesthetic success rates were analyzed by Pearson chi-square test at 5% significance levels. The same side position and opposite side position yielded 41% and 30% anesthetic success rates, respectively; there was no significant difference between the two sides. Relative head position has no effect on the anesthetic success rate of IANB.

Effect of relative head position on the anesthetic efficacy of inferior alveolar nerve block during endodontic treatment of patients with irreversible pulpitis

PubMed Central

2018-01-01

Background The purpose of this prospective randomized single-blind clinical trial was to evaluate the effect of tilting the head on the anesthetic efficacy of inferior alveolar nerve block (IANB) in patients with symptomatic irreversible pulpitis. Methods Ninety-two patients were divided into two groups: the first group received IANB and the head was tilted in the direction of the block for 15 min, whereas the second group received IANB and the head was tilted to the opposite side. Access cavity preparation was initiated after 15 min. Success was defined as no pain or faint/weak/mild pain during endodontic access preparation and instrumentation. The anesthetic success rates were analyzed by Pearson chi-square test at 5% significance levels. Results The same side position and opposite side position yielded 41% and 30% anesthetic success rates, respectively; there was no significant difference between the two sides. Conclusions Relative head position has no effect on the anesthetic success rate of IANB. PMID:29556558

Head tilt during driving.

PubMed

Zikovitz, D C; Harris, L R

1999-05-01

In order to distinguish between the use of visual and gravito-inertial force reference frames, the head tilt of drivers and passengers were measured as they went around corners at various speeds. The visual curvature of the corners were thus dissociated from the magnitude of the centripetal forces (0.30-0.77 g). Drivers' head tilts were highly correlated with the visually-available estimate of the curvature of the road (r2=0.86) but not with the centripetal force (r2<0.1). Passengers' head tilts were inversely correlated with the lateral forces (r2=0.3-0.7) and seem to reflect a passive sway. The strong correlation of the tilt of drivers' heads with a visual aspect of the road ahead, supports the use of a predominantly visual reference frame for the driving task.

Validation and calibration of HeadCount, a self-report measure for quantifying heading exposure in soccer players.

PubMed

Catenaccio, E; Caccese, J; Wakschlag, N; Fleysher, R; Kim, N; Kim, M; Buckley, T A; Stewart, W F; Lipton, R B; Kaminski, T; Lipton, M L

2016-01-01

The long-term effects of repetitive head impacts due to heading are an area of increasing concern, and exposure must be accurately measured; however, the validity of self-report of cumulative soccer heading is not known. In order to validate HeadCount, a 2-week recall questionnaire, the number of player-reported headers was compared to the number of headers observed by trained raters for a men's and a women's collegiate soccer teams during an entire season of competitive play using Spearman's correlations and intraclass correlation coefficients (ICCs), and calibrated using a generalized estimating equation. The average Spearman's rho was 0.85 for men and 0.79 for women. The average ICC was 0.75 in men and 0.38 in women. The calibration analysis demonstrated that men tend to report heading accurately while women tend to overestimate. HeadCount is a valid instrument for tracking heading behaviour, but may have to be calibrated in women.

Head Circumference and Height in Autism

PubMed Central

Lainhart, Janet E.; Bigler, Erin D.; Bocian, Maureen; Coon, Hilary; Dinh, Elena; Dawson, Geraldine; Deutsch, Curtis K.; Dunn, Michelle; Estes, Annette; Tager-Flusberg, Helen; Folstein, Susan; Hepburn, Susan; Hyman, Susan; McMahon, William; Minshew, Nancy; Munson, Jeff; Osann, Kathy; Ozonoff, Sally; Rodier, Patricia; Rogers, Sally; Sigman, Marian; Spence, M. Anne; Stodgell, Christopher J.; Volkmar, Fred

2016-01-01

Data from 10 sites of the NICHD/NIDCD Collaborative Programs of Excellence in Autism were combined to study the distribution of head circumference and relationship to demographic and clinical variables. Three hundred thirty-eight probands with autism-spectrum disorder (ASD) including 208 probands with autism were studied along with 147 parents, 149 siblings, and typically developing controls. ASDs were diagnosed, and head circumference and clinical variables measured in a standardized manner across all sites. All subjects with autism met ADI-R, ADOS-G, DSM-IV, and ICD-10 criteria. The results show the distribution of standardized head circumference in autism is normal in shape, and the mean, variance, and rate of macrocephaly but not microcephaly are increased. Head circumference tends to be large relative to height in autism. No site, gender, age, SES, verbal, or non-verbal IQ effects were present in the autism sample. In addition to autism itself, standardized height and average parental head circumference were the most important factors predicting head circumference in individuals with autism. Mean standardized head circumference and rates of macrocephaly were similar in probands with autism and their parents. Increased head circumference was associated with a higher (more severe) ADI-R social algorithm score. Macrocephaly is associated with delayed onset of language. Although mean head circumference and rates of macrocephaly are increased in autism, a high degree of variability is present, underscoring the complex clinical heterogeneity of the disorder. The wide distribution of head circumference in autism has major implications for genetic, neuroimaging, and other neurobiological research. PMID:17022081

Head Lice - Multiple Languages

MedlinePlus

... Are Here: Home → Multiple Languages → All Health Topics → Head Lice URL of this page: https://medlineplus.gov/languages/ ... V W XYZ List of All Topics All Head Lice - Multiple Languages To use the sharing features on ...

[Duodenum-preserving total pancreatic head resection and pancreatic head resection with segmental duodenostomy].

PubMed

Takada, Tadahiro; Yasuda, Hideki; Nagashima, Ikuo; Amano, Hodaka; Yoshiada, Masahiro; Toyota, Naoyuki

2003-06-01

A duodenum-preserving pancreatic head resection (DPPHR) was first reported by Beger et al. in 1980. However, its application has been limited to chronic pancreatitis because of it is a subtotal pancreatic head resection. In 1990, we reported duodenum-preserving total pancreatic head resection (DPTPHR) in 26 cases. This opened the way for total pancreatic head resection, expanding the application of this approach to tumorigenic morbidities such as intraductal papillary mucinous tumor (IMPT), other benign tumors, and small pancreatic cancers. On the other hand, Nakao et al. reported pancreatic head resection with segmental duodenectomy (PHRSD) as an alternative pylorus-preserving pancreatoduodenectomy technique in 24 cases. Hirata et al. also reported this technique as a new pylorus-preserving pancreatoduodenostomy with increased vessel preservation. When performing DPTPHR, the surgeon should ensure adequate duodenal blood supply. Avoidance of duodenal ischemia is very important in this operation, and thus it is necessary to maintain blood flow in the posterior pancreatoduodenal artery and to preserve the mesoduodenal vessels. Postoperative pancreatic functional tests reveal that DPTPHR is superior to PPPD, including PHSRD, because the entire duodenum and duodenal integrity is very important for postoperative pancreatic function.

A Review of Instrumented Equipment to Investigate Head Impacts in Sport

PubMed Central

2016-01-01

Contact, collision, and combat sports have more head impacts as compared to noncontact sports; therefore, such sports are uniquely suited to the investigation of head impact biomechanics. Recent advances in technology have enabled the development of instrumented equipment, which can estimate the head impact kinematics of human subjects in vivo. Literature pertaining to head impact measurement devices was reviewed and usage, in terms of validation and field studies, of such devices was discussed. Over the past decade, instrumented equipment has recorded millions of impacts in the laboratory, on the field, in the ring, and on the ice. Instrumented equipment is not without limitations; however, in vivo head impact data is crucial to investigate head injury mechanisms and further the understanding of concussion. PMID:27594780

Patient-reported outcomes, body composition, and nutrition status in patients with head and neck cancer: Results from an exploratory randomized controlled exercise trial.

PubMed

Capozzi, Lauren C; McNeely, Margaret L; Lau, Harold Y; Reimer, Raylene A; Giese-Davis, Janine; Fung, Tak S; Culos-Reed, S Nicole

2016-04-15

Patients with head and neck cancer experience loss of weight and muscle mass, decreased functioning, malnutrition, depression, and declines in quality of life during and after treatment. The purpose of this exploratory randomized study was to determine the optimal timing for the initiation of a lifestyle and progressive resistance exercise training intervention (during or after radiation therapy), as determined by intervention adherence and by comparing between-group outcomes across 24 weeks. Sixty patients with head and neck cancer were randomized to engage in a 12-week lifestyle intervention and progressive resistance-training program either during radiation treatment or immediately after completion. The primary outcome of body composition--specifically, lean body mass, body mass index, and body fat--as well as secondary outcomes of fitness, quality of life, depression, and nutrition status were evaluated. The progressive resistance-training intervention carried out during treatment did not significantly influence the primary outcome of body composition, despite a significant increase in weekly physical activity reported by the intervention group. A small-to-medium intervention effect was noted for some secondary outcomes, including fitness, quality of life, and nutrition status. Regardless of whether patients received the immediate or delayed progressive resistance-training intervention, the analysis revealed a main effect of time on body composition, fitness, quality of life, depression, and nutritional scores. Although the intervention during treatment did not reduce the loss of lean body mass, delaying the exercise program until after treatment completion was associated with improved intervention adherence, a finding with important clinical implications. © 2016 American Cancer Society.

Merkel cell carcinoma of the head and neck: poorer prognosis than non-head and neck sites.

PubMed

Morand, G B; Madana, J; Da Silva, S D; Hier, M P; Mlynarek, A M; Black, M J

2016-04-01

Merkel cell carcinoma is a rare, aggressive neurocutaneous malignancy. This study investigated whether patients with Merkel cell carcinoma in the head and neck had poorer outcomes than patients with Merkel cell carcinoma located elsewhere. A retrospective study was performed of patients with Merkel cell carcinoma treated at the Jewish General Hospital in Montréal, Canada, from 1993 to 2013. Associations between clinicopathological characteristics and disease-free and disease-specific survival rates were examined according to the Kaplan-Meier method. Twenty-seven patients were identified. Although basic clinicopathological characteristics and treatments were similar between head and neck and non-head and neck Merkel cell carcinoma groups, disease-free and disease-specific survival rates were significantly lower in the head and neck Merkel cell carcinoma group (log-rank test; p = 0.043 and p = 0.001, respectively). Mortality was mainly due to distant metastasis. Patients with head and neck Merkel cell carcinoma had poorer survival rates than patients with non-head and neck Merkel cell carcinoma in our study. The tendency to obtain close margins, a less predictable metastatic pattern, and/or intrinsic tumour factors related to the head and neck may explain this discrepancy.

Can Functional Movement Assessment Predict Football Head Impact Biomechanics?

PubMed

Ford, Julia M; Campbell, Kody R; Ford, Cassie B; Boyd, Kenneth E; Padua, Darin A; Mihalik, Jason P

2018-06-01

The purposes of this study was to determine functional movement assessments' ability to predict head impact biomechanics in college football players and to determine whether head impact biomechanics could explain preseason to postseason changes in functional movement performance. Participants (N = 44; mass, 109.0 ± 20.8 kg; age, 20.0 ± 1.3 yr) underwent two preseason and postseason functional movement assessment screenings: 1) Fusionetics Movement Efficiency Test and 2) Landing Error Scoring System (LESS). Fusionetics is scored 0 to 100, and participants were categorized into the following movement quality groups as previously published: good (≥75), moderate (50-75), and poor (<50). The LESS is scored 0 to 17, and participants were categorized into the following previously published movement quality groups: good (≤5 errors), moderate (6-7 errors), and poor (>7 errors). The Head Impact Telemetry (HIT) System measured head impact frequency and magnitude (linear acceleration and rotational acceleration). An encoder with six single-axis accelerometers was inserted between the padding of a commercially available Riddell football helmet. We used random intercepts general linear-mixed models to analyze our data. There were no effects of preseason movement assessment group on the two Head Impact Telemetry System impact outcomes: linear acceleration and rotational acceleration. Head impact frequency did not significantly predict preseason to postseason score changes obtained from the Fusionetics (F1,36 = 0.22, P = 0.643, R = 0.006) or the LESS (F1,36 < 0.01, P = 0.988, R < 0.001) assessments. Previous research has demonstrated an association between concussion and musculoskeletal injury, as well as functional movement assessment performance and musculoskeletal injury. The functional movement assessments chosen may not be sensitive enough to detect neurological and neuromuscular differences within the sample and subtle changes after sustaining head impacts.

Fostering High-Quality Teaching with an Enriched Curriculum and Professional Development Support: The Head Start REDI Program

PubMed Central

Domitrovich, Celene E.; Gest, Scott D.; Gill, Sukhdeep; Bierman, Karen L.; Welsh, Janet; Jones, Damon

2017-01-01

This randomized controlled trial tested whether teaching quality in Head Start classrooms could be improved with the addition of evidence-based curriculum components targeting emergent language/literacy and social-emotional development and the provision of associated professional development support. Participants were lead and assistant teachers in 44 Head Start classrooms. Teachers received 4 days of workshop training along with weekly in-class support from a mentor teacher. End-of-year observations indicated that, compared to the control group, intervention teachers talked with children more frequently and in more cognitively complex ways, established a more positive classroom climate, and used more preventive behavior management strategies. Results supported the conclusion that enriched curriculum components and professional development support can produce improvements in multiple domains of teaching quality. PMID:29081534

Head Rotation Movement Times.

PubMed

Hoffmann, Errol R; Chan, Alan H S; Heung, P T

2017-09-01

The aim of this study was to measure head rotation movement times in a Fitts' paradigm and to investigate the transition region from ballistic movements to visually controlled movements as the task index of difficulty (ID) increases. For head rotation, there are gaps in the knowledge of the effects of movement amplitude and task difficulty around the critical transition region from ballistic movements to visually controlled movements. Under the conditions of 11 ID values (from 1.0 to 6.0) and five movement amplitudes (20° to 60°), participants performed a head rotation task, and movement times were measured. Both the movement amplitude and task difficulty have effects on movement times at low IDs, but movement times are dependent only on ID at higher ID values. Movement times of participants are higher than for arm/hand movements, for both ballistic and visually controlled movements. The information-processing rate of head rotational movements, at high ID values, is about half that of arm movements. As an input mode, head rotations are not as efficient as the arm system either in ability to use rapid ballistic movements or in the rate at which information may be processed. The data of this study add to those in the review of Hoffmann for the critical IDs of different body motions. The data also allow design for the best arrangement of display that is under the design constraints of limited display area and difficulty of head-controlled movements in a data-inputting task.

Head Circumference Charts for Turkish Children Aged Five to Eighteen Years.

PubMed

Kara, Bülent; Etiler, Nilay; Aydoğan Uncuoğlu, Ayşen; Maraş Genç, Hülya; Ulak Gümüşlü, Esen; Gökçay, Gülbin; Furman, Andrezej

2016-03-01

Most head circumference growth references are useful during the first years of life, but they are also useful for older children when screening for developmental, neurological, and genetic disorders. We aimed to develop head circumference growth reference charts for age, height, and waist circumference for Turkish children aged 5-18 years. Head circumference, height, and waist circumference measurements were obtained from 5079 students aged 5-18 years from İzmit, Kocaeli Province, Turkey. The LMS method was used to construct reference centile curves. Head circumference measurements were strongly correlated with height (r=0.74), weight (r=0.76), and waist circumference (r=0.68). The mean head circumference values for boys were larger than those for girls at all ages. Compared with data from the United States, the World Health Organization, and other studies from Turkey, our data showed a decrease in head circumference at all ages for both sexes. Local growth charts can be used to evaluate head circumference growth in older Turkish children and adolescents.

49 CFR 572.182 - Head assembly.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Head assembly. 572.182 Section 572.182... Test Dummy, 50th Percentile Adult Male § 572.182 Head assembly. (a) The head assembly consists of the..., the head assembly shall meet performance requirements specified in paragraph (c) of this section. (b...

49 CFR 572.182 - Head assembly.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 7 2010-10-01 2010-10-01 false Head assembly. 572.182 Section 572.182... Dummy, 50th Percentile Adult Male § 572.182 Head assembly. (a) The head assembly consists of the head... assembly shall meet performance requirements specified in paragraph (c) of this section. (b) Test procedure...

49 CFR 572.182 - Head assembly.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Head assembly. 572.182 Section 572.182... Dummy, 50th Percentile Adult Male § 572.182 Head assembly. (a) The head assembly consists of the head... assembly shall meet performance requirements specified in paragraph (c) of this section. (b) Test procedure...

49 CFR 572.182 - Head assembly.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Head assembly. 572.182 Section 572.182... Dummy, 50th Percentile Adult Male § 572.182 Head assembly. (a) The head assembly consists of the head... assembly shall meet performance requirements specified in paragraph (c) of this section. (b) Test procedure...

49 CFR 572.182 - Head assembly.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Head assembly. 572.182 Section 572.182... Test Dummy, 50th Percentile Adult Male § 572.182 Head assembly. (a) The head assembly consists of the..., the head assembly shall meet performance requirements specified in paragraph (c) of this section. (b...

Shivering heat production and core cooling during head-in and head-out immersion in 17 degrees C water.

PubMed

Pretorius, Thea; Cahill, Farrell; Kocay, Sheila; Giesbrecht, Gordon G

2008-05-01

Many cold-water scenarios cause the head to be partially or fully immersed (e.g., ship wreck survival, scuba diving, cold-water adventure swim racing, cold-water drowning, etc.). However, the specific effects of head cold exposure are minimally understood. This study isolated the effect of whole-head submersion in cold water on surface heat loss and body core cooling when the protective shivering mechanism was intact. Eight healthy men were studied in 17 degrees C water under four conditions: the body was either insulated or exposed, with the head either out of the water or completely submersed under the water within each insulated/exposed subcondition. Submersion of the head (7% of the body surface area) in the body-exposed condition increased total heat loss by 11% (P < 0.05). After 45 min, head-submersion increased core cooling by 343% in the body-insulated subcondition (head-out: 0.13 +/- 0.2 degree C, head-in: 0.47 +/- 0.3 degree C; P < 0.05) and by 56% in the body-exposed subcondition (head-out: 0.40 +/- 0.3 degree C and head-in: 0.73 +/- 0.6 degree C; P < 0.05). In both body-exposed and body-insulated subconditions, head submersion increased the rate of core cooling disproportionally more than the relative increase in total heat loss. This exaggerated core-cooling effect is consistent with a head cooling induced reduction of the thermal core, which could be stimulated by cooling of thermosensitive and/or trigeminal receptors in the scalp, neck, and face. These cooling effects of head submersion are not prevented by shivering heat production.

Aviation spatial orientation in relationship to head position and attitude interpretation.

PubMed

Patterson, F R; Cacioppo, A J; Gallimore, J J; Hinman, G E; Nalepka, J P

1997-06-01

Conventional wisdom describing aviation spatial awareness assumes that pilots view a moving horizon through the windscreen. This assumption presupposes head alignment with the cockpit "Z" axis during both visual (VMC) and instrument (IMC) maneuvers. Even though this visual paradigm is widely accepted, its accuracy has not been verified. The purpose of this research was to determine if a visually induced neck reflex causes pilots to align their heads toward the horizon, rather than the cockpit vertical axis. Based on literature describing reflexive head orientation in terrestrial environments it was hypothesized that during simulated VMC aircraft maneuvers, pilots would align their heads toward the horizon. Some 14 military pilots completed two simulated flights in a stationary dome simulator. The flight profile consisted of five separate tasks, four of which evaluated head tilt during exposure to unique visual conditions and one examined occurrences of disorientation during unusual attitude recovery. During simulated visual flight maneuvers, pilots tilted their heads toward the horizon (p < 0.0001). Under IMC, pilots maintained head alignment with the vertical axis of the aircraft. During VMC maneuvers pilots reflexively tilt their heads toward the horizon, away from the Gz axis of the cockpit. Presumably, this behavior stabilizes the retinal image of the horizon (1 degree visual-spatial cue), against which peripheral images of the cockpit (2 degrees visual-spatial cue) appear to move. Spatial disorientation, airsickness, and control reversal error may be related to shifts in visual-vestibular sensory alignment during visual transitions between VMC (head tilt) and IMC (Gz head stabilized) conditions.

45 CFR 79.39 - Appeal to authority head.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 1 2010-10-01 2010-10-01 false Appeal to authority head. 79.39 Section 79.39 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION PROGRAM FRAUD CIVIL REMEDIES § 79.39 Appeal to authority head. (a) Any defendant who has filed a timely answer and who is...

6 CFR 13.39 - Appeal to Authority Head.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 6 Domestic Security 1 2010-01-01 2010-01-01 false Appeal to Authority Head. 13.39 Section 13.39 Domestic Security DEPARTMENT OF HOMELAND SECURITY, OFFICE OF THE SECRETARY PROGRAM FRAUD CIVIL REMEDIES § 13.39 Appeal to Authority Head. (a) Any Defendant who has served a timely answer and who is...

Head control: volitional aspects of rehabilitation training in patients with multiple sclerosis compared with healthy subjects.

PubMed

Cattaneo, Davide; Ferrarin, Maurizio; Frasson, William; Casiraghi, Anna

2005-07-01

To investigate the role of voluntary mechanisms and motor learning in head stability and the impact of longitudinal biofeedback training in head control. Crossover trial and single-subject research design. Neurorehabilitation research institute. Head stability during treadmill gait was measured in healthy subjects and patients with multiple sclerosis (MS). The experimental condition in which subjects walked on the treadmill was compared with that in which the head was voluntarily stabilized. In another experimental condition, augmented feedback of head displacement was provided by means of a laser mounted on the head that projected a laser beam on a screen. The motor learning was investigated with biofeedback training sessions. Positional feedback was represented by the laser beam, with subjects having to stabilize the beam while walking on the treadmill. Head angular oscillation in the sagittal and frontal planes. Results showed that on verbal request, healthy subjects and patients further stabilized the head during gait, especially in the sagittal plane. Short-term feedback of head displacement was no better than self-stabilization at improving head control. Conversely, the motor learning was evident in the rehabilitation protocol: after 10 to 15 training sessions, patients with MS showed a clinically relevant decrease of head angular oscillations. Voluntary mechanisms play a role in head stabilization during gait. Augmented biofeedback of head displacement may be effective in reducing head oscillations.

[Robot-assisted surgery in the head and neck region].

PubMed

Hoffmann, T K; Friedrich, D T; Schuler, P J

2016-09-01

Robot-assisted surgery (RAS) in the head and neck region is believed to have a large potential for the improvement of patient care. Several systems with a master-slave setup are already in routine clinical use, particularly for oncologic surgery. Although specific patient groups may benefit from RAS, there is a lack of randomized clinical studies validating the advantages of these new technological systems in comparison to the existing standard procedures. On the other hand, RAS in the head and neck region is being constantly developed. Currently, the main limitations are the technical miniaturization of the tools and the loss of haptic feedback, as well as the high costs for acquisition and maintenance without financial reimbursement. In any case, the current generation of head and neck surgeons will face the technical, scientific, and ethical challenges of RAS.

Head-up and head-down displays integration in automobiles

NASA Astrophysics Data System (ADS)

Betancur, J. Alejandro; Osorio-Gómez, Gilberto; Agudelo, J. David

2014-06-01

In automotive industry, the dashboard has been ergonomically developed in order to keep the driver focused on the horizon while driving, but the possibility to access external electronic devices constraints the driver to turn away his face, generating dangerous situations in spite of the short periods of time. Therefore, this work explores the integration of Head-Up Displays and Head-Down Displays in automobiles, proposing configurations that give to drivers the facility to driving focused. In this way, some of the main ergonomic comments about those configurations are proposed; and also, some technical comments regarding the implemented arrangements are given.

Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer.

PubMed

Cohen, Ezra E W; Karrison, Theodore G; Kocherginsky, Masha; Mueller, Jeffrey; Egan, Robyn; Huang, Chao H; Brockstein, Bruce E; Agulnik, Mark B; Mittal, Bharat B; Yunus, Furhan; Samant, Sandeep; Raez, Luis E; Mehra, Ranee; Kumar, Priya; Ondrey, Frank; Marchand, Patrice; Braegas, Bettina; Seiwert, Tanguy Y; Villaflor, Victoria M; Haraf, Daniel J; Vokes, Everett E

2014-09-01

Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN. © 2014 by American Society of Clinical Oncology.

Phase III Randomized Trial of Induction Chemotherapy in Patients With N2 or N3 Locally Advanced Head and Neck Cancer

PubMed Central

Cohen, Ezra E.W.; Karrison, Theodore G.; Kocherginsky, Masha; Mueller, Jeffrey; Egan, Robyn; Huang, Chao H.; Brockstein, Bruce E.; Agulnik, Mark B.; Mittal, Bharat B.; Yunus, Furhan; Samant, Sandeep; Raez, Luis E.; Mehra, Ranee; Kumar, Priya; Ondrey, Frank; Marchand, Patrice; Braegas, Bettina; Seiwert, Tanguy Y.; Villaflor, Victoria M.; Haraf, Daniel J.; Vokes, Everett E.

2014-01-01

Purpose Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. Patients and Methods Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and fluorouracil 750 mg/m2 on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). Results A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. Conclusion IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN. PMID:25049329

Quality Disparities in Child Care for At-Risk Children: Comparing Head Start and Non-Head Start Settings

PubMed Central

Hillemeier, Marianne M.; Morgan, Paul L.; Farkas, George; Maczuga, Steven A.

2012-01-01

The study objectives are to describe child care type and quality experienced by developmentally at-risk children, examine quality differences between Head Start and non-Head Start settings, and identify factors associated with receiving higher-quality child care. Data are analyzed from the Early Childhood Longitudinal Survey, Birth Cohort, a prospective study of a nationally representative sample of US children born in 2001. The sample consisted of 7,500 children who were assessed at 48 months of age. The outcome of interest is child care quality, measured by the Early Childhood Environmental Rating Scale (center care) and the Family Day Care Rating Scale (family day care). Results of descriptive and multivariate regression analyses are presented. Less than one-third of poor children were in Head Start. Child care quality was higher in Head Start centers than other centers, particularly among poor children (4.75 vs. 4.28, p < 0.001), Hispanics (4.90 vs. 4.45, p < 0.001), and whites (4.89 vs. 4.51, p < 0.001). African Americans experienced the lowest quality care in both Head Start and non-Head Start centers. Quality disadvantage was associated with Head Start family care settings, especially for low birthweight children (2.04 in Head Start vs. 3.58 in non-Head Start, p < 0.001). Lower family day care quality was associated with less maternal education and African American and Hispanic ethnicity. Center-based Head Start provides higher quality child care for at-risk children, and expansion of these services will likely facilitate school readiness in these populations. Quality disadvantages in Head Start family day care settings are worrisome and warrant investigation. PMID:22392601

Maneuvering impact boring head

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zollinger, W.T.; Reutzel, E.W.

An impact boring head may comprise a main body having an internal cavity with a front end and a rear end. A striker having a head end and a tail end is slidably mounted in the internal cavity of the main body so that the striker can be reciprocated between a forward position and an aft position in response to hydraulic pressure. A compressible gas contained in the internal cavity between the head end of the striker and the front end of the internal cavity returns the striker to the aft position upon removal of the hydraulic pressure. 8 figs.

Maneuvering impact boring head

DOEpatents

Zollinger, W.T.; Reutzel, E.W.

1998-08-18

An impact boring head may comprise a main body having an internal cavity with a front end and a rear end. A striker having a head end and a tail end is slidably mounted in the internal cavity of the main body so that the striker can be reciprocated between a forward position and an aft position in response to hydraulic pressure. A compressible gas contained in the internal cavity between the head end of the striker and the front end of the internal cavity returns the striker to the aft position upon removal of the hydraulic pressure. 8 figs.

Maneuvering impact boring head

DOEpatents

Zollinger, W. Thor; Reutzel, Edward W.

1998-01-01

An impact boring head may comprise a main body having an internal cavity with a front end and a rear end. A striker having a head end and a tail end is slidably mounted in the internal cavity of the main body so that the striker can be reciprocated between a forward position and an aft position in response to hydraulic pressure. A compressible gas contained in the internal cavity between the head end of the striker and the front end of the internal cavity returns the striker to the aft position upon removal of the hydraulic pressure.

Multispectral image-fused head-tracked vision system (HTVS) for driving applications

NASA Astrophysics Data System (ADS)

Reese, Colin E.; Bender, Edward J.

2001-08-01

Current military thermal driver vision systems consist of a single Long Wave Infrared (LWIR) sensor mounted on a manually operated gimbal, which is normally locked forward during driving. The sensor video imagery is presented on a large area flat panel display for direct view. The Night Vision and Electronics Sensors Directorate and Kaiser Electronics are cooperatively working to develop a driver's Head Tracked Vision System (HTVS) which directs dual waveband sensors in a more natural head-slewed imaging mode. The HTVS consists of LWIR and image intensified sensors, a high-speed gimbal, a head mounted display, and a head tracker. The first prototype systems have been delivered and have undergone preliminary field trials to characterize the operational benefits of a head tracked sensor system for tactical military ground applications. This investigation will address the advantages of head tracked vs. fixed sensor systems regarding peripheral sightings of threats, road hazards, and nearby vehicles. An additional thrust will investigate the degree to which additive (A+B) fusion of LWIR and image intensified sensors enhances overall driving performance. Typically, LWIR sensors are better for detecting threats, while image intensified sensors provide more natural scene cues, such as shadows and texture. This investigation will examine the degree to which the fusion of these two sensors enhances the driver's overall situational awareness.

Acupuncture in Treating Dry Mouth Caused By Radiation Therapy in Patients With Head and Neck Cancer | Division of Cancer Prevention

Cancer.gov

RATIONALE: Acupuncture may help relieve dry mouth caused by radiation therapy. PURPOSE: This randomized phase III trial is studying to see how well one set of acupuncture points work in comparison to a different set of acupuncture points or standard therapy in treating dry mouth caused by radiation therapy in patients with head and neck cancer. |

Visual perception of axes of head rotation

PubMed Central

Arnoldussen, D. M.; Goossens, J.; van den Berg, A. V.

2013-01-01

Registration of ego-motion is important to accurately navigate through space. Movements of the head and eye relative to space are registered through the vestibular system and optical flow, respectively. Here, we address three questions concerning the visual registration of self-rotation. (1) Eye-in-head movements provide a link between the motion signals received by sensors in the moving eye and sensors in the moving head. How are these signals combined into an ego-rotation percept? We combined optic flow of simulated forward and rotational motion of the eye with different levels of eye-in-head rotation for a stationary head. We dissociated simulated gaze rotation and head rotation by different levels of eye-in-head pursuit. We found that perceived rotation matches simulated head- not gaze-rotation. This rejects a model for perceived self-rotation that relies on the rotation of the gaze line. Rather, eye-in-head signals serve to transform the optic flow's rotation information, that specifies rotation of the scene relative to the eye, into a rotation relative to the head. This suggests that transformed visual self-rotation signals may combine with vestibular signals. (2) Do transformed visual self-rotation signals reflect the arrangement of the semi-circular canals (SCC)? Previously, we found sub-regions within MST and V6+ that respond to the speed of the simulated head rotation. Here, we re-analyzed those Blood oxygenated level-dependent (BOLD) signals for the presence of a spatial dissociation related to the axes of visually simulated head rotation, such as have been found in sub-cortical regions of various animals. Contrary, we found a rather uniform BOLD response to simulated rotation along the three SCC axes. (3) We investigated if subject's sensitivity to the direction of the head rotation axis shows SCC axes specifcity. We found that sensitivity to head rotation is rather uniformly distributed, suggesting that in human cortex, visuo-vestibular integration is

Thermal effects of whole head submersion in cold water on nonshivering humans.

PubMed

Pretorius, Thea; Bristow, Gerald K; Steinman, Alan M; Giesbrecht, Gordon G

2006-08-01

This study isolated the effect of whole head submersion in cold water, on surface heat loss and body core cooling, when the confounding effect of shivering heat production was pharmacologically eliminated. Eight healthy male subjects were studied in 17 degrees C water under four conditions: the body was either insulated or uninsulated, with the head either above the water or completely submersed in each body-insulation subcondition. Shivering was abolished with buspirone (30 mg) and meperidine (2.5 mg/kg), and subjects breathed compressed air throughout all trials. Over the first 30 min of immersion, exposure of the head increased core cooling both in the body-insulated conditions (head out: 0.47 +/- 0.2 degrees C, head in: 0.77 +/- 0.2 degrees C; P < 0.05) and the body-exposed conditions (head out: 0.84 +/- 0.2 degrees C and head in: 1.17 +/- 0.5 degrees C; P < 0.02). Submersion of the head (7% of the body surface area) in the body-exposed conditions increased total heat loss by only 10%. In both body-exposed and body-insulated conditions, head submersion increased core cooling rate much more (average of 42%) than it increased total heat loss. This may be explained by a redistribution of blood flow in response to stimulation of thermosensitive and/or trigeminal receptors in the scalp, neck and face, where a given amount of heat loss would have a greater cooling effect on a smaller perfused body mass. In 17 degrees C water, the head does not contribute relatively more than the rest of the body to surface heat loss; however, a cold-induced reduction of perfused body mass may allow this small increase in heat loss to cause a relatively larger cooling of the body core.

Self-organization of head-centered visual responses under ecological training conditions.

PubMed

Mender, Bedeho M W; Stringer, Simon M

2014-01-01

We have studied the development of head-centered visual responses in an unsupervised self-organizing neural network model which was trained under ecological training conditions. Four independent spatio-temporal characteristics of the training stimuli were explored to investigate the feasibility of the self-organization under more ecological conditions. First, the number of head-centered visual training locations was varied over a broad range. Model performance improved as the number of training locations approached the continuous sampling of head-centered space. Second, the model depended on periods of time where visual targets remained stationary in head-centered space while it performed saccades around the scene, and the severity of this constraint was explored by introducing increasing levels of random eye movement and stimulus dynamics. Model performance was robust over a range of randomization. Third, the model was trained on visual scenes where multiple simultaneous targets where always visible. Model self-organization was successful, despite never being exposed to a visual target in isolation. Fourth, the duration of fixations during training were made stochastic. With suitable changes to the learning rule, it self-organized successfully. These findings suggest that the fundamental learning mechanism upon which the model rests is robust to the many forms of stimulus variability under ecological training conditions.

The internal representation of head orientation differs for conscious perception and balance control.

PubMed

Dalton, Brian H; Rasman, Brandon G; Inglis, J Timothy; Blouin, Jean-Sébastien

2017-04-15

We tested perceived head-on-feet orientation and the direction of vestibular-evoked balance responses in passively and actively held head-turned postures. The direction of vestibular-evoked balance responses was not aligned with perceived head-on-feet orientation while maintaining prolonged passively held head-turned postures. Furthermore, static visual cues of head-on-feet orientation did not update the estimate of head posture for the balance controller. A prolonged actively held head-turned posture did not elicit a rotation in the direction of the vestibular-evoked balance response despite a significant rotation in perceived angular head posture. It is proposed that conscious perception of head posture and the transformation of vestibular signals for standing balance relying on this head posture are not dependent on the same internal representation. Rather, the balance system may operate under its own sensorimotor principles, which are partly independent from perception. Vestibular signals used for balance control must be integrated with other sensorimotor cues to allow transformation of descending signals according to an internal representation of body configuration. We explored two alternative models of sensorimotor integration that propose (1) a single internal representation of head-on-feet orientation is responsible for perceived postural orientation and standing balance or (2) conscious perception and balance control are driven by separate internal representations. During three experiments, participants stood quietly while passively or actively maintaining a prolonged head-turned posture (>10 min). Throughout the trials, participants intermittently reported their perceived head angular position, and subsequently electrical vestibular stimuli were delivered to elicit whole-body balance responses. Visual recalibration of head-on-feet posture was used to determine whether static visual cues are used to update the internal representation of body configuration