New reference charts for testicular volume in Dutch children and adolescents allow the calculation of standard deviation scores.

PubMed

Joustra, Sjoerd D; van der Plas, Evelyn M; Goede, Joery; Oostdijk, Wilma; Delemarre-van de Waal, Henriette A; Hack, Wilfried W M; van Buuren, Stef; Wit, Jan M

2015-06-01

Accurate calculations of testicular volume standard deviation (SD) scores are not currently available. We constructed LMS-smoothed age-reference charts for testicular volume in healthy boys. The LMS method was used to calculate reference data, based on testicular volumes from ultrasonography and Prader orchidometer of 769 healthy Dutch boys aged 6 months to 19 years. We also explored the association between testicular growth and pubic hair development, and data were compared to orchidometric testicular volumes from the 1997 Dutch nationwide growth study. The LMS-smoothed reference charts showed that no revision of the definition of normal onset of male puberty - from nine to 14 years of age - was warranted. In healthy boys, the pubic hair stage SD scores corresponded with testicular volume SD scores (r = 0.394). However, testes were relatively small for pubic hair stage in Klinefelter's syndrome and relatively large in immunoglobulin superfamily member 1 deficiency syndrome. The age-corrected SD scores for testicular volume will aid in the diagnosis and follow-up of abnormalities in the timing and progression of male puberty and in research evaluations. The SD scores can be compared with pubic hair SD scores to identify discrepancies between cell functions that result in relative microorchidism or macroorchidism. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Diagnostic Consistency and Relation Between Optical Coherence Tomography and Standard Automated Perimetry in Primary Open-Angle Glaucoma.

PubMed

Toprak, Ibrahim; Yaylalı, Volkan; Yildirim, Cem

2017-01-01

To assess diagnostic consistency and relation between spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP) in patients with primary open-angle glaucoma (POAG). This retrospective study comprised 51 eyes of 51 patients with a confirmed diagnosis of POAG. The qualitative and quantitative SD-OCT parameters (retinal nerve fiber layer thicknesses [RNFL; average, superior, inferior, nasal and temporal], RNFL symmetry, rim area, disc area, average and vertical cup/disc [C/D] ratio and cup volume) were compared with parameters of SAP (mean deviation, pattern standard deviation, visual field index, and glaucoma hemifield test reports). Fifty-one eyes of 51 patients with POAG were recruited. Twenty-nine eyes (56.9%) had consistent RNFL and visual field (VF) damage. However, nine patients (17.6%) showed isolated RNFL damage on SD-OCT and 13 patients (25.5%) had abnormal VF test with normal RNFL. In patients with VF defect, age, average C/D ratio, vertical C/D ratio, and cup volume were significantly higher and rim area was lower when compared to those of the patients with normal VF. In addition to these parameters, worsening in average, superior, inferior, and temporal RNFL thicknesses and RNFL symmetry was significantly associated with consistent SD-OCT and SAP outcomes. In routine practice, patients with POAG can be manifested with inconsistent reports between SD-OCT and SAP. An older age, higher C/D ratio, larger cup volume, and lower rim area on SD-OCT appears to be associated with detectable VF damage. Moreover, additional worsening in RNFL parameters might reinforce diagnostic consistency between SD-OCT and SAP.

Autonomic cardiovascular control recovery in quadriplegics after handcycle training.

PubMed

Abreu, Elizângela Márcia de Carvalho; Alves, Rani de Souza; Borges, Ana Carolina Lacerda; Lima, Fernanda Pupio Silva; Júnior, Alderico Rodrigues de Paula; Lima, Mário Oliveira

2016-07-01

The aim of this study was to investigate the cardiovascular autonomic acute response, during recovery after handcycle training, in quadriplegics with spinal cord injury (SCI). [Subjects and Methods] Seven quadriplegics (SCIG -level C6-C7, male, age 28.00 ± 6.97 years) and eight healthy subjects (CG -male, age 25.00 ± 7.38 years) were studied. Their heart rate variability (HRV) was assessed before and after one handcycle training. [Results] After the training, the SCIG showed significantly reduced: intervals between R waves of the electrocardiogram (RR), standard deviation of the NN intervals (SDNN), square root of the mean squares differences of sucessive NN intervals (rMSSD), low frequency power (LF), high frequency power (HF), and Poincaré plot (standard deviation of short-term HRV -SD1 and standard deviation of long-term HRV -SD2). The SDNN, LF, and SD2 remained decreased during the recovery time. The CG showed significantly reduced: RR, rMSSD, number of pairs of adjacent NN intervals differing by more than 50 ms (pNN50), LF, HF, SD1, and sample entropy (SampEn). Among these parameters, only RR remained decreased during recovery time. Comparisons of the means of HRV parameters evaluated between the CG and SCIG showed that the SCIG had significantly lower pNN50, LF, HF, and SampEn before training, while immediately after training, the SCIG had significantly lower SDNN, LF, HF, and SD2. The rMSSD30s of the SCIG significantly reduced in the windows 180 and 330 seconds and between the windows 300 seconds in the CG. [Conclusion] There was a reduction of sympathetic and parasympathetic activity in the recovery period after the training in both groups; however, the CG showed a higher HRV. The parasympathetic activity also gradually increased after training, and in the SCIG, this activity remained reduced even at three minutes after the end of training, which suggests a deficiency in parasympathetic reactivation in quadriplegics after SCI.

Analysis of vertical distributions and effective flight layers of insects: three-dimensional simulation of flying insects and catch at trap heights

USDA-ARS?s Scientific Manuscript database

The mean height and standard deviation (SD) of flight is calculated for over 100 insect species from their catches on trap heights reported in the literature. The iterative equations for calculating mean height and SD are presented. The mean flight height for 95% of the studies varied from 0.17 to 5...

Biological Interactions of Nanomaterials

DTIC Science & Technology

2008-12-01

reagent contains the tetrazolium compound MTS and an electron coupling reagent ( phenazine ethosulfate; PES). The quantity of formazan product as...PES Phenazine ethosulfate PS Polysaccharide RET Rearranged during transfection ROS Reactive oxygen species SD Standard deviation SEM Scanning

Improved differentiation between hepatic hemangioma and metastases on diffusion-weighted MRI by measurement of standard deviation of apparent diffusion coefficient.

PubMed

Hardie, Andrew D; Egbert, Robert E; Rissing, Michael S

2015-01-01

Diffusion-weighted magnetic resonance imaging (DW-MR) can be useful in the differentiation of hemangiomata from liver metastasis, but improved methods other than by mean apparent diffusion coefficient (mADC) are needed. A retrospective review identified 109 metastatic liver lesions and 86 hemangiomata in 128 patients who had undergone DW-MR. For each lesion, mADC and the standard deviation of the mean ADC (sdADC) were recorded and compared by receiver operating characteristic analysis. Mean mADC was higher in benign hemangiomata (1.52±0.12 mm(2)/s) than in liver metastases (1.33±0.18 mm(2)/s), but there was significant overlap in values. The mean sdADC was lower in hemangiomata (101±17 mm(2)/s) than metastases (245±25 mm(2)/s) and demonstrated no overlap in values, which was significantly different (P<.0001). Hemangiomata may be better able to be differentiated from liver metastases on the basis of sdADC than by mADC, although further studies are needed. Copyright © 2015 Elsevier Inc. All rights reserved.

Poincaré plot analysis of autocorrelation function of RR intervals in patients with acute myocardial infarction.

PubMed

Chuang, Shin-Shin; Wu, Kung-Tai; Lin, Chen-Yang; Lee, Steven; Chen, Gau-Yang; Kuo, Cheng-Deng

2014-08-01

The Poincaré plot of RR intervals (RRI) is obtained by plotting RRIn+1 against RRIn. The Pearson correlation coefficient (ρRRI), slope (SRRI), Y-intercept (YRRI), standard deviation of instantaneous beat-to-beat RRI variability (SD1RR), and standard deviation of continuous long-term RRI variability (SD2RR) can be defined to characterize the plot. Similarly, the Poincaré plot of autocorrelation function (ACF) of RRI can be obtained by plotting ACFk+1 against ACFk. The corresponding Pearson correlation coefficient (ρACF), slope (SACF), Y-intercept (YACF), SD1ACF, and SD2ACF can be defined similarly to characterize the plot. By comparing the indices of Poincaré plots of RRI and ACF between patients with acute myocardial infarction (AMI) and patients with patent coronary artery (PCA), we found that the ρACF and SACF were significantly larger, whereas the RMSSDACF/SDACF and SD1ACF/SD2ACF were significantly smaller in AMI patients. The ρACF and SACF correlated significantly and negatively with normalized high-frequency power (nHFP), and significantly and positively with normalized very low-frequency power (nVLFP) of heart rate variability in both groups of patients. On the contrary, the RMSSDACF/SDACF and SD1ACF/SD2ACF correlated significantly and positively with nHFP, and significantly and negatively with nVLFP and low-/high-frequency power ratio (LHR) in both groups of patients. We concluded that the ρACF, SACF, RMSSDACF/SDACF, and SD1ACF/SD2ACF, among many other indices of ACF Poincaré plot, can be used to differentiate between patients with AMI and patients with PCA, and that the increase in ρACF and SACF and the decrease in RMSSDACF/SDACF and SD1ACF/SD2ACF suggest an increased sympathetic and decreased vagal modulations in both groups of patients.

Caution regarding the choice of standard deviations to guide sample size calculations in clinical trials.

PubMed

Chen, Henian; Zhang, Nanhua; Lu, Xiaosun; Chen, Sophie

2013-08-01

The method used to determine choice of standard deviation (SD) is inadequately reported in clinical trials. Underestimations of the population SD may result in underpowered clinical trials. This study demonstrates how using the wrong method to determine population SD can lead to inaccurate sample sizes and underpowered studies, and offers recommendations to maximize the likelihood of achieving adequate statistical power. We review the practice of reporting sample size and its effect on the power of trials published in major journals. Simulated clinical trials were used to compare the effects of different methods of determining SD on power and sample size calculations. Prior to 1996, sample size calculations were reported in just 1%-42% of clinical trials. This proportion increased from 38% to 54% after the initial Consolidated Standards of Reporting Trials (CONSORT) was published in 1996, and from 64% to 95% after the revised CONSORT was published in 2001. Nevertheless, underpowered clinical trials are still common. Our simulated data showed that all minimal and 25th-percentile SDs fell below 44 (the population SD), regardless of sample size (from 5 to 50). For sample sizes 5 and 50, the minimum sample SDs underestimated the population SD by 90.7% and 29.3%, respectively. If only one sample was available, there was less than 50% chance that the actual power equaled or exceeded the planned power of 80% for detecting a median effect size (Cohen's d = 0.5) when using the sample SD to calculate the sample size. The proportions of studies with actual power of at least 80% were about 95%, 90%, 85%, and 80% when we used the larger SD, 80% upper confidence limit (UCL) of SD, 70% UCL of SD, and 60% UCL of SD to calculate the sample size, respectively. When more than one sample was available, the weighted average SD resulted in about 50% of trials being underpowered; the proportion of trials with power of 80% increased from 90% to 100% when the 75th percentile and the maximum SD from 10 samples were used. Greater sample size is needed to achieve a higher proportion of studies having actual power of 80%. This study only addressed sample size calculation for continuous outcome variables. We recommend using the 60% UCL of SD, maximum SD, 80th-percentile SD, and 75th-percentile SD to calculate sample size when 1 or 2 samples, 3 samples, 4-5 samples, and more than 5 samples of data are available, respectively. Using the sample SD or average SD to calculate sample size should be avoided.

Comparing biomarker measurements to a normal range: when to use standard error of the mean (SEM) or standard deviation (SD) confidence intervals tests

EPA Science Inventory

This commentary is the second of a series outlining one specific concept in interpreting biomarkers data. In the first, an observational method was presented for assessing the distribution of measurements before making parametric calculations. Here, the discussion revolves around...

Instructor/Operator Display Evaluation Methods

DTIC Science & Technology

1981-03-01

14 IV. Experimental Desln.n ........ .................... ... 16 V. Procedure ............................................. 18 VI, Results...plies and thus the length of time during which the information must be retained. 16 ...... Nu -n4- (0 4-)~ R IW~~ IH I CDWC * I t I’ CI I~ _ _ I _ _17...standard deviation (S.D.) of 3.0 years. Total flight hours averaged 2248 (S.D. = 858). Current equipment for 16 pilots was the C-130 in which they

Period variability of coupled noisy oscillators

NASA Astrophysics Data System (ADS)

Mori, Fumito; Kori, Hiroshi

2013-03-01

Period variability, quantified by the standard deviation (SD) of the cycle-to-cycle period, is investigated for noisy phase oscillators. We define the checkpoint phase as the beginning or end point of one oscillation cycle and derive an expression for the SD as a function of this phase. We find that the SD is dependent on the checkpoint phase only when oscillators are coupled. The applicability of our theory is verified using a realistic model. Our work clarifies the relationship between period variability and synchronization from which valuable information regarding coupling can be inferred.

Evaluation of Two New Indices of Blood Pressure Variability Using Postural Change in Older Fallers.

PubMed

Goh, Choon-Hian; Ng, Siew-Cheok; Kamaruzzaman, Shahrul B; Chin, Ai-Vyrn; Poi, Philip J H; Chee, Kok Han; Imran, Z Abidin; Tan, Maw Pin

2016-05-01

To evaluate the utility of blood pressure variability (BPV) calculated using previously published and newly introduced indices using the variables falls and age as comparators.While postural hypotension has long been considered a risk factor for falls, there is currently no documented evidence on the relationship between BPV and falls.A case-controlled study involving 25 fallers and 25 nonfallers was conducted. Systolic (SBPV) and diastolic blood pressure variability (DBPV) were assessed using 5 indices: standard deviation (SD), standard deviation of most stable continuous 120 beats (staSD), average real variability (ARV), root mean square of real variability (RMSRV), and standard deviation of real variability (SDRV). Continuous beat-to-beat blood pressure was recorded during 10 minutes' supine rest and 3 minutes' standing.Standing SBPV was significantly higher than supine SBPV using 4 indices in both groups. The standing-to-supine-BPV ratio (SSR) was then computed for each subject (staSD, ARV, RMSRV, and SDRV). Standing-to-supine ratio for SBPV was significantly higher among fallers compared to nonfallers using RMSRV and SDRV (P = 0.034 and P = 0.025). Using linear discriminant analysis (LDA), 3 indices (ARV, RMSRV, and SDRV) of SSR SBPV provided accuracies of 61.6%, 61.2%, and 60.0% for the prediction of falls which is comparable with timed-up and go (TUG), 64.4%.This study suggests that SSR SBPV using RMSRV and SDRV is a potential predictor for falls among older patients, and deserves further evaluation in larger prospective studies.

Multiplicative surrogate standard deviation: a group metric for the glycemic variability of individual hospitalized patients.

PubMed

Braithwaite, Susan S; Umpierrez, Guillermo E; Chase, J Geoffrey

2013-09-01

Group metrics are described to quantify blood glucose (BG) variability of hospitalized patients. The "multiplicative surrogate standard deviation" (MSSD) is the reverse-transformed group mean of the standard deviations (SDs) of the logarithmically transformed BG data set of each patient. The "geometric group mean" (GGM) is the reverse-transformed group mean of the means of the logarithmically transformed BG data set of each patient. Before reverse transformation is performed, the mean of means and mean of SDs each has its own SD, which becomes a multiplicative standard deviation (MSD) after reverse transformation. Statistical predictions and comparisons of parametric or nonparametric tests remain valid after reverse transformation. A subset of a previously published BG data set of 20 critically ill patients from the first 72 h of treatment under the SPRINT protocol was transformed logarithmically. After rank ordering according to the SD of the logarithmically transformed BG data of each patient, the cohort was divided into two equal groups, those having lower or higher variability. For the entire cohort, the GGM was 106 (÷/× 1.07) mg/dl, and MSSD was 1.24 (÷/× 1.07). For the subgroups having lower and higher variability, respectively, the GGM did not differ, 104 (÷/× 1.07) versus 109 (÷/× 1.07) mg/dl, but the MSSD differed, 1.17 (÷/× 1.03) versus 1.31 (÷/× 1.05), p = .00004. By using the MSSD with its MSD, groups can be characterized and compared according to glycemic variability of individual patient members. © 2013 Diabetes Technology Society.

Prognostic implications of mutation-specific QTc standard deviation in congenital long QT syndrome.

PubMed

Mathias, Andrew; Moss, Arthur J; Lopes, Coeli M; Barsheshet, Alon; McNitt, Scott; Zareba, Wojciech; Robinson, Jennifer L; Locati, Emanuela H; Ackerman, Michael J; Benhorin, Jesaia; Kaufman, Elizabeth S; Platonov, Pyotr G; Qi, Ming; Shimizu, Wataru; Towbin, Jeffrey A; Michael Vincent, G; Wilde, Arthur A M; Zhang, Li; Goldenberg, Ilan

2013-05-01

Individual corrected QT interval (QTc) may vary widely among carriers of the same long QT syndrome (LQTS) mutation. Currently, neither the mechanism nor the implications of this variable penetrance are well understood. To hypothesize that the assessment of QTc variance in patients with congenital LQTS who carry the same mutation provides incremental prognostic information on the patient-specific QTc. The study population comprised 1206 patients with LQTS with 95 different mutations and ≥ 5 individuals who carry the same mutation. Multivariate Cox proportional hazards regression analysis was used to assess the effect of mutation-specific standard deviation of QTc (QTcSD) on the risk of cardiac events (comprising syncope, aborted cardiac arrest, and sudden cardiac death) from birth through age 40 years in the total population and by genotype. Assessment of mutation-specific QTcSD showed large differences among carriers of the same mutations (median QTcSD 45 ms). Multivariate analysis showed that each 20 ms increment in QTcSD was associated with a significant 33% (P = .002) increase in the risk of cardiac events after adjustment for the patient-specific QTc duration and the family effect on QTc. The risk associated with QTcSD was pronounced among patients with long QT syndrome type 1 (hazard ratio 1.55 per 20 ms increment; P<.001), whereas among patients with long QT syndrome type 2, the risk associated with QTcSD was not statistically significant (hazard ratio 0.99; P = .95; P value for QTcSD-by-genotype interaction = .002). Our findings suggest that mutations with a wider variation in QTc duration are associated with increased risk of cardiac events. These findings appear to be genotype-specific, with a pronounced effect among patients with the long QT syndrome type 1 genotype. Copyright © 2013. Published by Elsevier Inc.

The recursive combination filter approach of pre-processing for the estimation of standard deviation of RR series.

PubMed

Mishra, Alok; Swati, D

2015-09-01

Variation in the interval between the R-R peaks of the electrocardiogram represents the modulation of the cardiac oscillations by the autonomic nervous system. This variation is contaminated by anomalous signals called ectopic beats, artefacts or noise which mask the true behaviour of heart rate variability. In this paper, we have proposed a combination filter of recursive impulse rejection filter and recursive 20% filter, with recursive application and preference of replacement over removal of abnormal beats to improve the pre-processing of the inter-beat intervals. We have tested this novel recursive combinational method with median method replacement to estimate the standard deviation of normal to normal (SDNN) beat intervals of congestive heart failure (CHF) and normal sinus rhythm subjects. This work discusses the improvement in pre-processing over single use of impulse rejection filter and removal of abnormal beats for heart rate variability for the estimation of SDNN and Poncaré plot descriptors (SD1, SD2, and SD1/SD2) in detail. We have found the 22 ms value of SDNN and 36 ms value of SD2 descriptor of Poincaré plot as clinical indicators in discriminating the normal cases from CHF cases. The pre-processing is also useful in calculation of Lyapunov exponent which is a nonlinear index as Lyapunov exponents calculated after proposed pre-processing modified in a way that it start following the notion of less complex behaviour of diseased states.

Scanning laser polarimetry in eyes with exfoliation syndrome.

PubMed

Dimopoulos, Antonios T; Katsanos, Andreas; Mikropoulos, Dimitrios G; Giannopoulos, Theodoros; Empeslidis, Theodoros; Teus, Miguel A; Holló, Gábor; Konstas, Anastasios G P

2013-01-01

To compare retinal nerve fiber layer thickness (RNFLT) of normotensive eyes with exfoliation syndrome (XFS) and healthy eyes.
 Sixty-four consecutive individuals with XFS and normal office-time intraocular pressure (IOP) and 72 consecutive healthy controls were prospectively enrolled for a cross-sectional analysis in this hospital-based observational study. The GDx-VCC parameters (temporal-superior-nasal-inferior-temporal [TSNIT] average, superior average, inferior average, TSNIT standard deviation (SD), and nerve fiber indicator [NFI]) were compared between groups. Correlation between various clinical parameters and RNFLT parameters was investigated with Spearman coefficient. 
 The NFI, although within normal limits for both groups, was significantly greater in the XFS group compared to controls: the respective median and interquartile range (IQR) values were 25.1 (22.0-29.0) vs 15.0 (12.0-20.0), p<0.001. In the XFS group, all RNFLT values were significantly lower compared to controls (p<0.001). However, they were all within the normal clinical ranges for both groups: TSNIT average median (IQR): 52.8 (49.7-55.7) vs 56.0 (53.0-59.3) µm; superior average mean (SD): 62.3 (6.7) vs 68.8 (8.2) µm; inferior average mean (SD): 58.0 (7.2) vs 64.8 (7.7) µm, respectively. TSNIT SD was significantly lower in the XFS group, median (IQR): 18.1 (15.4-20.4) vs 21.0 (18.4-23.8), p<0.001. There was no systematic relationship between RNFLT and visual acuity, cup-to-disc ratio, IOP, central corneal thickness, Humphrey mean deviation, and pattern standard deviation in either group. 
 Compared to control eyes, polarimetry-determined RNFLT was lower in XFS eyes with normal IOP. Therefore, close monitoring of RNFLT may facilitate early identification of those XFS eyes that convert to exfoliative glaucoma.

Verification of calculated skin doses in postmastectomy helical tomotherapy.

PubMed

Ito, Shima; Parker, Brent C; Levine, Renee; Sanders, Mary Ella; Fontenot, Jonas; Gibbons, John; Hogstrom, Kenneth

2011-10-01

To verify the accuracy of calculated skin doses in helical tomotherapy for postmastectomy radiation therapy (PMRT). In vivo thermoluminescent dosimeters (TLDs) were used to measure the skin dose at multiple points in each of 14 patients throughout the course of treatment on a TomoTherapy Hi·Art II system, for a total of 420 TLD measurements. Five patients were evaluated near the location of the mastectomy scar, whereas 9 patients were evaluated throughout the treatment volume. The measured dose at each location was compared with calculations from the treatment planning system. The mean difference and standard error of the mean difference between measurement and calculation for the scar measurements was -1.8% ± 0.2% (standard deviation [SD], 4.3%; range, -11.1% to 10.6%). The mean difference and standard error of the mean difference between measurement and calculation for measurements throughout the treatment volume was -3.0% ± 0.4% (SD, 4.7%; range, -18.4% to 12.6%). The mean difference and standard error of the mean difference between measurement and calculation for all measurements was -2.1% ± 0.2% (standard deviation, 4.5%: range, -18.4% to 12.6%). The mean difference between measured and calculated TLD doses was statistically significant at two standard deviations of the mean, but was not clinically significant (i.e., was <5%). However, 23% of the measured TLD doses differed from the calculated TLD doses by more than 5%. The mean of the measured TLD doses agreed with TomoTherapy calculated TLD doses within our clinical criterion of 5%. Copyright © 2011 Elsevier Inc. All rights reserved.

Verification of Calculated Skin Doses in Postmastectomy Helical Tomotherapy

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

Ito, Shima; Parker, Brent C., E-mail: bcparker@marybird.com; Mary Bird Perkins Cancer Center, Baton Rouge, LA

2011-10-01

Purpose: To verify the accuracy of calculated skin doses in helical tomotherapy for postmastectomy radiation therapy (PMRT). Methods and Materials: In vivo thermoluminescent dosimeters (TLDs) were used to measure the skin dose at multiple points in each of 14 patients throughout the course of treatment on a TomoTherapy Hi.Art II system, for a total of 420 TLD measurements. Five patients were evaluated near the location of the mastectomy scar, whereas 9 patients were evaluated throughout the treatment volume. The measured dose at each location was compared with calculations from the treatment planning system. Results: The mean difference and standard errormore » of the mean difference between measurement and calculation for the scar measurements was -1.8% {+-} 0.2% (standard deviation [SD], 4.3%; range, -11.1% to 10.6%). The mean difference and standard error of the mean difference between measurement and calculation for measurements throughout the treatment volume was -3.0% {+-} 0.4% (SD, 4.7%; range, -18.4% to 12.6%). The mean difference and standard error of the mean difference between measurement and calculation for all measurements was -2.1% {+-} 0.2% (standard deviation, 4.5%: range, -18.4% to 12.6%). The mean difference between measured and calculated TLD doses was statistically significant at two standard deviations of the mean, but was not clinically significant (i.e., was <5%). However, 23% of the measured TLD doses differed from the calculated TLD doses by more than 5%. Conclusions: The mean of the measured TLD doses agreed with TomoTherapy calculated TLD doses within our clinical criterion of 5%.« less

The standard deviation of extracellular water/intracellular water is associated with all-cause mortality and technique failure in peritoneal dialysis patients.

PubMed

Tian, Jun-Ping; Wang, Hong; Du, Feng-He; Wang, Tao

2016-09-01

The mortality rate of peritoneal dialysis (PD) patients is still high, and the predicting factors for PD patient mortality remain to be determined. This study aimed to explore the relationship between the standard deviation (SD) of extracellular water/intracellular water (E/I) and all-cause mortality and technique failure in continuous ambulatory PD (CAPD) patients. All 152 patients came from the PD Center between January 1st 2006 and December 31st 2007. Clinical data and at least five-visit E/I ratio defined by bioelectrical impedance analysis were collected. The patients were followed up till December 31st 2010. The primary outcomes were death from any cause and technique failure. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors for mortality and technique failure in CAPD patients. All patients were followed up for 59.6 ± 23.0 months. The patients were divided into two groups according to their SD of E/I values: lower SD of E/I group (≤0.126) and higher SD of E/I group (>0.126). The patients with higher SD of E/I showed a higher all-cause mortality (log-rank χ (2) = 10.719, P = 0.001) and technique failure (log-rank χ (2) = 9.724, P = 0.002) than those with lower SD of E/I. Cox regression analysis found that SD of E/I independently predicted all-cause mortality (HR  3.551, 95 % CI 1.442-8.746, P = 0.006) and technique failure (HR  2.487, 95 % CI 1.093-5.659, P = 0.030) in CAPD patients after adjustment for confounders except when sensitive C-reactive protein was added into the model. The SD of E/I was a strong independent predictor of all-cause mortality and technique failure in CAPD patients.

Novel CO2 laser robotic controller outperforms experienced laser operators in tasks of accuracy and performance repeatability.

PubMed

Wong, Yu-Tung; Finley, Charles C; Giallo, Joseph F; Buckmire, Robert A

2011-08-01

To introduce a novel method of combining robotics and the CO(2) laser micromanipulator to provide excellent precision and performance repeatability designed for surgical applications. Pilot feasibility study. We developed a portable robotic controller that appends to a standard CO(2) laser micromanipulator. The robotic accuracy and laser beam path repeatability were compared to six experienced users of the industry standard micromanipulator performing the same simulated surgical tasks. Helium-neon laser beam video tracking techniques were employed. The robotic controller demonstrated superiority over experienced human manual micromanipulator control in accuracy (laser path within 1 mm of idealized centerline), 97.42% (standard deviation [SD] 2.65%), versus 85.11% (SD 14.51%), P = .018; and laser beam path repeatability (area of laser path divergence on successive trials), 21.42 mm(2) (SD 4.35 mm(2) ) versus 65.84 mm(2) (SD 11.93 mm(2) ), P = .006. Robotic micromanipulator control enhances accuracy and repeatability for specific laser tasks. Computerized control opens opportunity for alternative user interfaces and additional safety features. Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.

Estimating insect flight densities from attractive trap catches and flight height distributions

USDA-ARS?s Scientific Manuscript database

Insect species often exhibit a specific mean flight height and vertical flight distribution that approximates a normal distribution with a characteristic standard deviation (SD). Many studies in the literature report catches on passive (non-attractive) traps at several heights. These catches were us...

Parenting Styles and Life Satisfaction of Turkish Adolescents

ERIC Educational Resources Information Center

Cenkseven-Onder, Fulya

2012-01-01

This study examined adolescents' perception of satisfaction from various life domains according to gender and parenting styles among 562 Turkish adolescents [53.2% girls; Mean (M) age = 14.1, Standard Deviation (SD) = 0.85]. The participants completed the multidimensional students' life satisfaction scale and the parenting style inventory. The…

Microorganisms as an Indicator of Hygiene Status Among Migrant Food Handlers in Peninsular Malaysia.

PubMed

Woh, Pei Yee; Thong, Kwai Lin; Lim, Yvonne Ai Lian; Behnke, Jerzy Marian; Lewis, John Watkin; Mohd Zain, Siti Nursheena

2017-10-01

This study used microbial indicators to assess the hygiene status of 383 migrant food handlers from 3 urban cities in Peninsular Malaysia. Microbiological analysis revealed that all the hand swabs tested 99.5% positive for aerobic plate counts (mean [M] ± standard deviation [SD] = 3.57 ± 0.83 log 10 CFU [colony forming unit]), 20.8% positive for total coliform/ Escherichia coli (M ± SD = 0.30 ± 0.67 log 10 CFU), and 63.4% positive for Staphylococcus aureus (M ± SD = 1.38 ± 1.26 log 10 CFU). In addition, aerobic plate counts and Staphylococcus aureus counts exceeded the acceptable standard levels. Bacterial counts were found to be significantly associated with subjects' country of origin ( P = .019) and working responsibilities ( P = .001). Our findings indicate high probability of transmission of pathogenic bacteria from the food handlers' hands to customers during meal preparation and serving. This calls for improvements in personal hygiene and sanitation standards by the relevant health authorities among migrant food handlers.

Characterizing Accuracy and Precision of Glucose Sensors and Meters

PubMed Central

2014-01-01

There is need for a method to describe precision and accuracy of glucose measurement as a smooth continuous function of glucose level rather than as a step function for a few discrete ranges of glucose. We propose and illustrate a method to generate a “Glucose Precision Profile” showing absolute relative deviation (ARD) and /or %CV versus glucose level to better characterize measurement errors at any glucose level. We examine the relationship between glucose measured by test and comparator methods using linear regression. We examine bias by plotting deviation = (test – comparator method) versus glucose level. We compute the deviation, absolute deviation (AD), ARD, and standard deviation (SD) for each data pair. We utilize curve smoothing procedures to minimize the effects of random sampling variability to facilitate identification and display of the underlying relationships between ARD or %CV and glucose level. AD, ARD, SD, and %CV display smooth continuous relationships versus glucose level. Estimates of MARD and %CV are subject to relatively large errors in the hypoglycemic range due in part to a markedly nonlinear relationship with glucose level and in part to the limited number of observations in the hypoglycemic range. The curvilinear relationships of ARD and %CV versus glucose level are helpful when characterizing and comparing the precision and accuracy of glucose sensors and meters. PMID:25037194

Frequency of Bolton tooth-size discrepancies among orthodontic patients.

PubMed

Freeman, J E; Maskeroni, A J; Lorton, L

1996-07-01

The purpose of this study was to determine the percentage of orthodontic patients who present with an interarch tooth-size discrepancy likely to affect treatment planning or results. The Bolton tooth-size discrepancies of 157 patients accepted for treatment in an orthodontic residency program were evaluated for the frequency and the magnitude of deviation from Bolton's mean. Discrepancies outside of 2 SD were considered as potentially significant with regard to treatment planning and treatment results. Although the mean of the sample was nearly identical to that of Bolton's, the range and standard deviation varied considerably with a large percentage of the orthodontic patients having discrepancies outside of Bolton's 2 SD. With such a high frequency of significant discrepancies it would seem prudent to routinely perform a tooth-size analysis and incorporate the findings into orthodontic treatment planning.

ARFI cut-off values and significance of standard deviation for liver fibrosis staging in patients with chronic liver disease.

PubMed

Goertz, Ruediger S; Sturm, Joerg; Pfeifer, Lukas; Wildner, Dane; Wachter, David L; Neurath, Markus F; Strobel, Deike

2013-01-01

Acoustic radiation force impulse (ARFI) elastometry quantifies hepatic stiffness, and thus degree of fibrosis, non-invasively. Our aim was to analyse the diagnostic accuracy of ARFI cut-off values, and the significance of a defined limit of standard deviation (SD) as a potential quality parameter for liver fibrosis staging in patients with chronic liver diseases (CLD). 153 patients with CLD (various aetiologies) undergoing liver biopsy, and an additional 25 patients with known liver cirrhosis, were investigated. ARFI measurements were performed in the right hepatic lobe, and correlated with the histopathological Ludwig fibrosis score (inclusion criteria: at least 6 portal tracts). The diagnostic accuracy of cut-off values was analysed with respect to an SD limit of 30% of the mean ARFI value. The mean ARFI elastometry showed 1.95 ± 0.87 m/s (range 0.79-4.40) in 178 patients (80 female, 98 male, mean age: 52 years). The cut-offs were 1.25 m/s for F ≥ 2, 1.72 m/s for F ≥ 3 and 1.75 m/s for F = 4, and the corresponding AUROC 80.7%, 86.2% and 88.7%, respectively. Exclusion of 31 patients (17.4%) with an SD higher than 30% of the mean ARFI improved the diagnostic accuracy: The AUROC for F ≥ 2, F ≥ 3 and F = 4 were 86.1%, 91.2% and 91.5%, respectively. The diagnostic accuracy of ARFI can be improved by applying a maximum SD of 30% of the mean ARFI as a quality parameter--which however leads to an exclusion of a relevant number of patients. ARFI results with a high SD should be interpreted with caution.

Impact of heterozygosity and heterogeneity on cotton lint yield stability: II. Lint yield components

USDA-ARS?s Scientific Manuscript database

In order to determine which yield components may contribute to yield stability, an 18-environment field study was undertaken to observe the mean, standard deviation (SD), and coefficient of variation (CV) for cotton lint yield components in population types that differed for lint yield stability. Th...

Diurnal Dynamics of Standard Deviations of Three Wind Velocity Components in the Atmospheric Boundary Layer

NASA Astrophysics Data System (ADS)

Shamanaeva, L. G.; Krasnenko, N. P.; Kapegesheva, O. F.

2018-04-01

Diurnal dynamics of the standard deviation (SD) of three wind velocity components measured with a minisodar in the atmospheric boundary layer is analyzed. Statistical analysis of measurement data demonstrates that the SDs for x- and y-components σx and σy lie in the range from 0.2 to 4 m/s, and σz = 0.1-1.2 m/s. The increase of σx and σy with the altitude is described sufficiently well by a power law with exponent changing from 0.22 to 1.3 depending on time of day, and σz increases by a linear law. Approximation constants are determined and errors of their application are estimated. It is found that the maximal diurnal spread of SD values is 56% for σx and σy and 94% for σz. The established physical laws and the obtained approximation constants allow the diurnal dynamics of the SDs for three wind velocity components in the atmospheric boundary layer to be determined and can be recommended for application in models of the atmospheric boundary layer.

Preliminary Investigations of Biofouling of Ships’ Hulls: Non-Indigenous Species Investigations in the Columbia River

DTIC Science & Technology

2006-04-01

Oregon P Primary S Secondary SD Standard Deviation SE Standard Error TBT Tributyltin U.S. United States WA Washington WHOI Woods Hole...reasons hull biofouling was considered less important as a vector of organisms than ballast water (Carlton, 1985). In the early 1970s, tributyltin ... TBT ) became the dominant antifouling paint applied to 9 vessels because it was hugely successful in preventing biofouling accumulation

Teratology Studies of Lewisite and Sulfur Mustard Agents: Effects of Lewisite in Rats and Rabbits

DTIC Science & Technology

1987-12-31

virus of mice (PCM), rat corona virus /sialodacryoadenitis virus (RCV/SDA), H-1 virus and Kilham rat virus (KRV) by Microbiological Associates...Pneumonia virus of mice RCV/SDA = Rat corona virus /sialodacryoadenitis virus RH = Relative humidity SC = Subcutaneous SD = Standard deviation SE = Standard... cat , rabbit and human but apparently did not cross the placental membranes readily. The accumulation of a sufficient quantity of arsenate to induce a

Anthropometry and renal size of children suffering under sustained conflict in Sri Lanka.

PubMed

Whitehall, John

2008-11-01

To measure anthropometry, blood pressure and renal lengths of children in a war torn region of Sri Lanka and compare results with local and international standards. Measurements of 147 Tamil children in Kilinochchi, north-east Sri Lanka, were compared with the World Health Organization standards using Anthro 2005 software in a period of relative peace in December 2005. Renal lengths were measured by ultrasound and compared with Australian and Indian data. 1 2-5 years of age. The weight-to-height ratio for combined sexes revealed 13.9% were <-3 standard deviations (SD) and 33.3% <-2 SD. The height-to-age ratio revealed 5.6% <-3 SD and 22.2% <-2 SD. The weight-to-age ratio revealed 13.9% <-3 SD and 38.9% <-2 SD. The body mass index of 13.9% of children was <-3 SD, of 25% it was <-2 SD. Stunting and wasting is prevalent, and worse than in other areas of Sri Lanka, except in tea estates. 2 5-12 years. The height-to-age ratio for combined sexes revealed 15.7% were <-3 SD and 38.5% <-2 SD. The weight-to-age ratio revealed 6.1% were <-3 SD and 47.3% <-2 SD. The body mass index of 64.0% of children was <5th percentile. More children are stunted and wasted in this older group. Girls are more affected than boys. 3 Renal lengths fell progressively below -2 SD for both age and height when compared with Australian and Indian children. Tamil children in Kilinochchi are more stunted and wasted than others in Sri Lanka, except those in the tea estates. Progressive renal stunting because of under-nutrition may be a mechanism for later disease. The loss of potential for human development can only be addressed by long-term improvement in access to nutrition.

Home-made temperature monitoring system from four-channel K-type thermocouples via internet of thing technology platform

NASA Astrophysics Data System (ADS)

Detmod, Thitaporn; Özmen, Yiǧiter; Songkaitiwong, Kittiphot; Saenyot, Khanuengchat; Locharoenrat, Kitsakorn; Lekchaum, Sarai

2018-06-01

This paper is aimed to design and construct the home-made temperature monitoring system from four-channel K-type thermocouples in order to improve the temperature measurement based on standard evaluation measurements guidance. The temperature monitoring system was capable to record the temperature on SD card and to display the realtime temperature on Internet of Thing Technology platform. The temperature monitoring system was tested in terms of the temperature measurement accuracy and delay response time. It was found that a standard deviation was acceptable as compared to the Instrument Society of America. The response time of the microcontroller to SD card was 2 sec faster than that of the microcontroller to Thingspeak.

Auditory stimulation with music influences the geometric indices of heart rate variability in response to the postural change maneuver.

PubMed

de Castro, Bianca C R; Guida, Heraldo L; Roque, Adriano L; de Abreu, Luiz Carlos; Ferreira, Celso; Marcomini, Renata S; Monteiro, Carlos B M; Adami, Fernando; Ribeiro, Viviane F; Fonseca, Fernando L A; Santos, Vilma N S; Valenti, Vitor E

2014-01-01

It is poor in the literature the behavior of the geometric indices of heart rate variability (HRV) during the musical auditory stimulation. The objective is to investigate the acute effects of classic musical auditory stimulation on the geometric indexes of HRV in women in response to the postural change maneuver (PCM). We evaluated 11 healthy women between 18 and 25 years old. We analyzed the following indices: Triangular index, Triangular interpolation of RR intervals and Poincarι plot (standard deviation of the instantaneous variability of the beat-to beat heart rate [SD1], standard deviation of long-term continuous RR interval variability and Ratio between the short - and long-term variations of RR intervals [SD1/SD2] ratio). HRV was recorded at seated rest for 10 min. The women quickly stood up from a seated position in up to 3 s and remained standing still for 15 min. HRV was recorded at the following periods: Rest, 0-5 min, 5-10 min and 10-15 min during standing. In the second protocol, the subject was exposed to auditory musical stimulation (Pachelbel-Canon in D) for 10 min at seated position before standing position. Shapiro-Wilk to verify normality of data and ANOVA for repeated measures followed by the Bonferroni test for parametric variables and Friedman's followed by the Dunn's posttest for non-parametric distributions. In the first protocol, all indices were reduced at 10-15 min after the volunteers stood up. In the protocol musical auditory stimulation, the SD1 index was reduced at 5-10 min after the volunteers stood up compared with the music period. The SD1/SD2 ratio was decreased at control and music period compared with 5-10 min after the volunteers stood up. Musical auditory stimulation attenuates the cardiac autonomic responses to the PCM.

Psychometric evaluation of the Polish adaptation of the Hill-Bone Compliance to High Blood Pressure Therapy Scale.

PubMed

Uchmanowicz, Izabella; Jankowska-Polańska, Beata; Chudiak, Anna; Szymańska-Chabowska, Anna; Mazur, Grzegorz

2016-05-10

Development of simple instruments for the determination of the level of adherence in patients with high blood pressure is the subject of ongoing research. One such instrument, gaining growing popularity worldwide, is the Hill-Bone Compliance to High Blood Pressure Therapy. The aim of this study was to adapt and to test the reliability of the Polish version of Hill-Bone Compliance to High Blood Pressure Therapy Scale. A standard guideline was used for the translation and cultural adaptation of the English version of the Hill-Bone Compliance to High Blood Pressure Therapy Scale into Polish. The study included 117 Polish patients with hypertension aged between 27 and 90 years, among them 53 men and 64 women. Cronbach's alpha was used for analysing the internal consistency of the scale. The mean score in the reduced sodium intake subscale was M = 5.7 points (standard deviation SD = 1.6 points). The mean score in the appointment-keeping subscale was M = 3.4 points (standard deviation SD = 1.4 points). The mean score in the medication-taking subscale was M = 11.6 points (standard deviation SD = 3.3 points). In the principal component analysis, the three-factor system (1 - medication-taking, 2 - appointment-keeping, 3 - reduced sodium intake) accounted for 53 % of total variance. All questions had factor loadings > 0.4. The medication-taking subscale: most questions (6 out of 9) had the highest loadings with Factor 1. The appointment-keeping subscale: all questions (2 out of 2) had the highest loadings with Factor 2. The reduced sodium intake subscale: most questions (2 out of 3) had the highest loadings with Factor 3. Goodness of fit was tested at chi(2) = 248.87; p < 0.001. The Cronbach's alpha score for the entire questionnaire was 0.851. The Hill-Bone Compliance to High Blood Pressure Therapy Scale proved to be suitable for use in the Polish population. Use of this screening tool for the assessment of adherence to BP treatment is recommended.

Student-Related Variables as Predictors of Academic Achievement among Some Undergraduate Psychology Students in Barbados

ERIC Educational Resources Information Center

Fayombo, Grace Adebisi

2011-01-01

This study examined some student-related variables (interest in higher education, psychological resilience and study habit) as predictors of academic achievement among 131 (M (mean) = 28.17, SD (standard deviation) = 1.61) first year psychology students in the Introduction to Developmental Psychology class in UWI (The University of the West…

Child and Informant Influences on Behavioral Ratings of Preschool Children

ERIC Educational Resources Information Center

Phillips, Beth M.; Lonigan, Christopher J.

2010-01-01

This study investigated relationships among teacher, parent, and observer behavioral ratings of 3- and 4-year-old children using intra-class correlations and analysis of variance. Comparisons within and across children from middle-income (MI; N = 166; mean age = 54.25 months, standard deviation [SD] = 8.74) and low-income (LI; N = 199; mean age =…

QUANTITATIVE PCR ANALYSIS OF MOLDS IN THE DUST FROM HOMES OF ASTHMATIC CHILDREN IN NORTH CAROLINA

EPA Science Inventory

The vacuum bag (VB) dust was analyzed by mold specific quantitative PCR. These results were compared to the analysis survey calculated for each of the homes. The mean and standard deviation (SD) of the ERMI values in the homes of the NC asthmatic children was 16.4 (6.77), compa...

Behavioural and Emotional Problems in Children and Educational Outcomes: A Dynamic Panel Data Analysis.

PubMed

Khanam, Rasheda; Nghiem, Son

2018-05-01

This study investigates the effects of behavioural and emotional problems in children on their educational outcomes using data from the Longitudinal Survey of Australian Children (LSAC). We contribute to the extant literature using a dynamic specification to test the hypothesis of knowledge accumulation. Further, we apply the system generalised method of moments (GMM) estimator to minimise biases due to unobserved factors. We find that mental disorders in children has a negative effect on the National Assessment Program-Literacy and Numeracy (NAPLAN) test scores. Among all mental disorders, having emotional problems is found to be the most influential with one standard deviation (SD) increase in emotional problems being associated with 0.05 SD reduction in NAPLAN reading, writing and spelling; 0.04 SD reduction in matrix reasoning and grammar; and 0.03 SD reduction in NAPLAN numeracy.

Conventional multi-slice computed tomography (CT) and cone-beam CT (CBCT) for computer-aided implant placement. Part II: reliability of mucosa-supported stereolithographic guides.

PubMed

Arisan, Volkan; Karabuda, Zihni Cüneyt; Pişkin, Bülent; Özdemir, Tayfun

2013-12-01

Deviations of implants that were placed by conventional computed tomography (CT)- or cone beam CT (CBCT)-derived mucosa-supported stereolithographic (SLA) surgical guides were analyzed in this study. Eleven patients were randomly scanned by a multi-slice CT (CT group) or a CBCT scanner (CBCT group). A total of 108 implants were planned on the software and placed using SLA guides. A new CT or CBCT scan was obtained and merged with the planning data to identify the deviations between the planned and placed implants. Results were analyzed by Mann-Whitney U test and multiple regressions (p < .05). Mean angular and linear deviations in the CT group were 3.30° (SD 0.36), and 0.75 (SD 0.32) and 0.80 mm (SD 0.35) at the implant shoulder and tip, respectively. In the CBCT group, mean angular and linear deviations were 3.47° (SD 0.37), and 0.81 (SD 0.32) and 0.87 mm (SD 0.32) at the implant shoulder and tip, respectively. No statistically significant differences were detected between the CT and CBCT groups (p = .169 and p = .551, p = .113 for angular and linear deviations, respectively). Implant placement via CT- or CBCT-derived mucosa-supported SLA guides yielded similar deviation values. Results should be confirmed on alternative CBCT scanners. © 2012 Wiley Periodicals, Inc.

Design of ultraviolet wavelength and standard solution concentrations in relative response factors for simultaneous determination of multi-components with single reference standard in herbal medicines.

PubMed

Yang, Ting-Wen; Zhao, Chao; Fan, Yong; Qi, Lian-Wen; Li, Ping

2015-10-10

Single standard to determine multi-components (SSDMC) is a practical pattern for quality evaluation of herbal medicines (HMs). However, it remains challenging because of potential inconsistency of relative response factors (RRF) on different instruments. In this work, the effects of two key roles, i.e., ultraviolet (UV) wavelength and standard solution concentrations, on reproducibility of RRF were investigated. The effect of UV wavelength on reproducibility of RRF was studied by plotting the relationship of the peak area ratios (internal standard vs analyte) to wavelengths. The preferable wavelength should be set at the flat parts of the curve. Optimized 300 nm produced a 0.38% RSD for emodin/emodin-8-O-β-D-glucopyranoside on five instruments, much lower than 2.80% obtained from the maximum wavelength at 290 nm. Next, the effects of standard solution concentrations of emodin on its response factor (RF) were investigated. For one single point method, low concentration less than 49 b/k resulted in significant variations in RF. For emodin, when the concentration is higher than 7.00 μg mL(-1), a low standard deviation (SD) value at 0.13 was obtained, while lower than 7.00 μg mL(-1), a high SD at 3.71 was obtained. The developed SSDMC method was then applied to determination of target components in 10 Polygonum cuspidatum samples and showed comparable accuracy to conventional calibration methods with deviation less than 1%. Copyright © 2015 Elsevier B.V. All rights reserved.

Outpatient Combined Group and Individual Cognitive-Behavioral Treatment for Patients With Migraine and Tension-Type Headache in a Routine Clinical Setting.

PubMed

Christiansen, Sandra; Jürgens, Tim P; Klinger, Regine

2015-09-01

To test the long-term clinical effectiveness (follow-up at 3, 6 and 12 months) of an outpatient combined group and individual cognitive-behavioral treatment (CBT) for headache patients following standard medical care. A decrease in headache intensity, frequency, headache-specific impairment, depression, and change of pain-related cognitions was expected. The efficacy of CBT for primary headaches has been confirmed in research, yet the translation into clinical practice has remained untested thus far. In this single-group outcome study, 87 headache patients diagnosed with migraine and/or tension-type headache received (1) headache-specific medication for 10 weeks and (2) a subsequent CBT treatment made up of 13 individual and 12 group sessions consisting of psychoeducation, progressive muscle relaxation, coping strategies for pain and stress, and goal setting skills. Booster group sessions after 3 and 6 months were implemented to stimulate individual goal attainment, and follow-up measures were recorded up to 12 months. A significant decrease was found for all primary and secondary outcome criteria, ie, average headache intensity (prae M: 6.0, standard deviation [SD]: 1.5 vs follow-up [FU] 1 year M: 5.1, SD: 1.9), headache frequency (prae M: 16.0, SD: 9.5 vs FU 1 year M: 13.4, SD: 9.9), and catastrophizing (prae M: 3.4, SD: 1.0 vs FU 1 year M: 2.6, SD: 1.1). Coping strategies were increased (prae M: 3.4, SD: .9 vs FU 1 year M: 4.0, SD: 1.0). CBT treatment is a useful component within a routine clinical setting and can improve standard medical care thereby helping patients in managing their headache pain. © 2015 American Headache Society.

Comparative study of Poincaré plot analysis using short electroencephalogram signals during anaesthesia with spectral edge frequency 95 and bispectral index.

PubMed

Hayashi, K; Yamada, T; Sawa, T

2015-03-01

The return or Poincaré plot is a non-linear analytical approach in a two-dimensional plane, where a timed signal is plotted against itself after a time delay. Its scatter pattern reflects the randomness and variability in the signals. Quantification of a Poincaré plot of the electroencephalogram has potential to determine anaesthesia depth. We quantified the degree of dispersion (i.e. standard deviation, SD) along the diagonal line of the electroencephalogram-Poincaré plot (named as SD1/SD2), and compared SD1/SD2 values with spectral edge frequency 95 (SEF95) and bispectral index values. The regression analysis showed a tight linear regression equation with a coefficient of determination (R(2) ) value of 0.904 (p < 0.0001) between the Poincaré index (SD1/SD2) and SEF95, and a moderate linear regression equation between SD1/SD2 and bispectral index (R(2)  = 0.346, p < 0.0001). Quantification of the Poincaré plot tightly correlates with SEF95, reflecting anaesthesia-dependent changes in electroencephalogram oscillation. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

Relationship between LiDAR-derived forest canopy height and Landsat images

Treesearch

Cristina Pascual; Antonio Garcia-Abril; Warren B. Cohen; Susana Martin-Fernandez

2010-01-01

The mean and standard deviation (SD) of light detection and ranging (LiDAR)-derived canopy height are related to forest structure. However, LiDAR data typically cover a limited area and have a high economic cost compared with satellite optical imagery. Optical images may be required to extrapolate LiDAR height measurements across a broad landscape. Different spectral...

The Portuguese adaptation of the Gudjonsson Suggestibility Scale (GSS1) in a sample of inmates.

PubMed

Pires, Rute; Silva, Danilo R; Ferreira, Ana Sousa

2014-01-01

This paper comprises two studies which address the validity of the Portuguese adaptation of the Gudjonsson Suggestibility Scale, GSS1. In study 1, the means and standard deviations for the suggestibility results of a sample of Portuguese inmates (N=40, Mage=37.5 years, SD=8.1) were compared to those of a sample of Icelandic inmates (Gudjonsson, 1997; Gudjonsson & Sigurdsson, 1996). Portuguese inmates' results were in line with the original results. In study 2, the means and standard deviations for the suggestibility results of the sample of Portuguese inmates were compared to those of a general Portuguese population sample (N=57, Mage=36.1 years, SD=12.7). The forensic sample obtained significantly higher scores in suggestibility measures than the general population sample. ANOVA confirmed that the increased suggestibility in the inmates sample was due to the limited memory capacity of this latter group. Given that the results of both studies 1 and 2 are in keeping with the author's original results (Gudjonsson, 1997), this may be regarded as a confirmation of the validity of the Portuguese GSS1. Copyright © 2013 Elsevier Ltd. All rights reserved.

Impaired memory is more closely associated with brain beta-amyloid than leukoaraiosis in hypertensive patients with cognitive symptoms.

PubMed

Smith, Eric E; Muzikansky, Alona; McCreary, Cheryl R; Batool, Saima; Viswanathan, Anand; Dickerson, Bradford C; Johnson, Keith; Greenberg, Steven M; Blacker, Deborah

2018-01-01

Hypertension is the strongest modifiable risk factor for subcortical ischemic changes and is also a risk factor for Alzheimer's dementia. We used neuroimaging to investigate the pathological basis of early cognitive symptoms in patients with hypertension. In this cross-sectional cohort study 67 patients age >60 years with hypertension and Clinical Dementia Rating scale score of 0.5 without dementia, and without history of symptomatic stroke, underwent MRI for measurement of subcortical vascular changes and positron emission tomography (PET) scan with Pittsburgh Compound B (PiB-PET) to detect beta-amyloid deposition. These imaging measures were related to neuropsychological tests of memory, executive function and processing speed. Mean age was 75.0 (standard deviation, SD, 7.3). Mean neuropsychological Z scores were: episodic memory -0.63 (SD 1.23), executive function -0.40 (SD 1.10), processing speed -0.24 (SD 0.88); 22 of the 67 subjects met criteria for mild cognitive impairment (MCI) and the remaining 45 subjects had subjective cognitive concerns only. In multivariable models adjusting for age and years of education, each 0.1 unit increase in mean cortical PiB-PET binding was associated with 0.14 lower mean Z score for episodic memory (95% CI -0.28 to -0.01). This means that for every 0.1 unit increase in mean cortical PiB-PET, episodic memory was 0.14 standard deviations lower. White matter hyperintensity volume, silent brain infarcts and microbleeds were not associated with neuropsychological test scores. Episodic memory was prominently affected in hypertensive participants with MCI or subjective cognitive concerns, and was associated with PiB-PET binding. This suggests a prominent role for Alzheimer pathology in cognitive impairment even in hypertensive participants at elevated risk for vascular cognitive impairment.

Changes in cortisol release and heart rate and heart rate variability during the initial training of 3-year-old sport horses.

PubMed

Schmidt, Alice; Aurich, Jörg; Möstl, Erich; Müller, Jürgen; Aurich, Christine

2010-09-01

Based on cortisol release, a variety of situations to which domestic horses are exposed have been classified as stressors but studies on the stress during equestrian training are limited. In the present study, Warmblood stallions (n=9) and mares (n=7) were followed through a 9 respective 12-week initial training program in order to determine potentially stressful training steps. Salivary cortisol concentrations, beat-to-beat (RR) interval and heart rate variability (HRV) were determined. The HRV variables standard deviation of the RR interval (SDRR), RMSSD (root mean square of successive RR differences) and the geometric means standard deviation 1 (SD1) and 2 (SD2) were calculated. Nearly each training unit was associated with an increase in salivary cortisol concentrations (p<0.01). Cortisol release varied between training units and occasionally was more pronounced in mares than in stallions (p<0.05). The RR interval decreased slightly in response to lunging before mounting of the rider. A pronounced decrease occurred when the rider was mounting, but before the horse showed physical activity (p<0.001). The HRV variables SDRR, RMSSD and SD1 decreased in response to training and lowest values were reached during mounting of a rider (p<0.001). Thereafter RR interval and HRV variables increased again. In contrast, SD2 increased with the beginning of lunging (p<0.05) and no changes in response to mounting were detectable. In conclusion, initial training is a stressor for horses. The most pronounced reaction occurred in response to mounting by a rider, a situation resembling a potentially lethal threat under natural conditions. Copyright (c) 2010 Elsevier Inc. All rights reserved.

A simulation study of the effects of alcohol on driving performance in a Chinese population.

PubMed

Li, Y C; Sze, N N; Wong, S C; Yan, Wei; Tsui, K L; So, F L

2016-10-01

Driving under the influence of alcohol (DUIA) is a significant factor contributing to road traffic crashes, injuries, and fatalities. Although the effects of alcohol on driving performance are widely acknowledged, studies of the effects of alcohol impairment on driving performance and particularly on the control system of Chinese adults are rare. This study attempts to evaluate the effects of alcohol on the driving performance of Chinese adults using a driving simulator. A double-blind experimental study was conducted to evaluate the effects of alcohol impairment on the driving performance of 52 Chinese participants using a driving simulator. A series of simulated driving tests covering two driving modules, including emergency braking (EB) and following braking (FB), at 50km/h and 80km/h were performed. Linear mixed models were established to evaluate driving performance in terms of braking reaction time (BRT), the standard deviation of lateral position (SD-LANE), and the standard deviation of speed (SD-SPEED). Driving performance in terms of BRT and SD-LANE was highly correlated with the level of alcohol consumption, with a one-unit increase in breath alcohol concentration (BrAC) degrading BRT and SD-LANE by 0.3% and 0.2%, respectively. Frequent drinkers generally reacted faster in their BRT than less-frequent drinkers and non-drinkers by 10.2% and 30.6%, respectively. Moreover, alcohol impairment had varying effects on certain aspects of the human control system, and automatic action was less likely to be affected than voluntary action from a psychological viewpoint. The findings should be useful for planning and developing effective measures to combat drink driving in Chinese communities. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reduction of metal artifacts due to dental hardware in computed tomography angiography: assessment of the utility of model-based iterative reconstruction.

PubMed

Kuya, Keita; Shinohara, Yuki; Kato, Ayumi; Sakamoto, Makoto; Kurosaki, Masamichi; Ogawa, Toshihide

2017-03-01

The aim of this study is to assess the value of adaptive statistical iterative reconstruction (ASIR) and model-based iterative reconstruction (MBIR) for reduction of metal artifacts due to dental hardware in carotid CT angiography (CTA). Thirty-seven patients with dental hardware who underwent carotid CTA were included. CTA was performed with a GE Discovery CT750 HD scanner and reconstructed with filtered back projection (FBP), ASIR, and MBIR. We measured the standard deviation at the cervical segment of the internal carotid artery that was affected most by dental metal artifacts (SD 1 ) and the standard deviation at the common carotid artery that was not affected by the artifact (SD 2 ). We calculated the artifact index (AI) as follows: AI = [(SD 1 )2 - (SD 2 )2]1/2 and compared each AI for FBP, ASIR, and MBIR. Visual assessment of the internal carotid artery was also performed by two neuroradiologists using a five-point scale for each axial and reconstructed sagittal image. The inter-observer agreement was analyzed using weighted kappa analysis. MBIR significantly improved AI compared with FBP and ASIR (p < 0.001, each). We found no significant difference in AI between FBP and ASIR (p = 0.502). The visual score of MBIR was significantly better than those of FBP and ASIR (p < 0.001, each), whereas the scores of ASIR were the same as those of FBP. Kappa values indicated good inter-observer agreements in all reconstructed images (0.747-0.778). MBIR resulted in a significant reduction in artifact from dental hardware in carotid CTA.

Erratic tacrolimus exposure, assessed using the standard deviation of trough blood levels, predicts chronic lung allograft dysfunction and survival.

PubMed

Gallagher, Harry M; Sarwar, Ghulam; Tse, Tracy; Sladden, Timothy M; Hii, Esmond; Yerkovich, Stephanie T; Hopkins, Peter M; Chambers, Daniel C

2015-11-01

Erratic tacrolimus blood levels are associated with liver and kidney graft failure. We hypothesized that erratic tacrolimus exposure would similarly compromise lung transplant outcomes. This study assessed the effect of tacrolimus mean and standard deviation (SD) levels on the risk of chronic lung allograft dysfunction (CLAD) and death after lung transplantation. We retrospectively reviewed 110 lung transplant recipients who received tacrolimus-based immunosuppression. Cox proportional hazard modeling was used to investigate the effect of tacrolimus mean and SD levels on survival and CLAD. At census, 48 patients (44%) had developed CLAD and 37 (34%) had died. Tacrolimus SD was highest for the first 6 post-transplant months (median, 4.01; interquartile range [IQR], 3.04-4.98 months) before stabilizing at 2.84 μg/liter (IQR, 2.16-4.13 μg/liter) between 6 and 12 months. The SD then remained the same (median, 2.85; IQR, 2.00-3.77 μg/liter) between 12 and 24 months. A high mean tacrolimus level 6 to 12 months post-transplant independently reduced the risk of CLAD (hazard ratio [HR], 0.74; 95% confidence interval [CI], 0.63-0.86; p < 0.001) but not death (HR, 0.96; 95% CI, 0.83-1.12; p = 0.65). In contrast, a high tacrolimus SD between 6 and 12 months independently increased the risk of CLAD (HR, 1.46; 95% CI, 1.23-1.73; p < 0.001) and death (HR, 1.27; 95% CI, 1.08-1.51; p = 0.005). Erratic tacrolimus levels are a risk factor for poor lung transplant outcomes. Identifying and modifying factors that contribute to this variability may significantly improve outcomes. Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Adult height in patients with familial male-limited precocious puberty and the role of an aromatase inhibitor in patient management.

PubMed

Lane, Laura C; Flowers, Josephine; Johnstone, Helen; Cheetham, Tim

2018-04-25

There is little adult height data in patients with familial male-limited precocious puberty (FMPP) and no management consensus. We assessed the treatment and adult height in local patients with FMPP and those reported in the literature. Growth data were obtained on four local patients with FMPP and a search performed to obtain management details and adult height data on cases in the literature. UK (90) population standards were used to calculate standard deviation scores (SDS). Adult height data were available on 25 men with FMPP of whom 21 were treated. Median adult height SDS of patients was -1.5 SD with a mid-parental target of -0.6 SD (p=0.1). Eight patients (32%) had an adult height above the mid-parental target and seven patients (28%) had a height >2 SD below the mean. The median height SD was -0.03 in untreated patients and +0.5 SD in those receiving an aromatase inhibitor. There was no relationship between height and age at presentation. Aromatase inhibitor therapy is associated with a positive height outcome in FMPP but the outcome with and without intervention is unpredictable. Clinicians need to be cautious when counselling families about the potential height outcome in FMPP.

Physical dose of therapeutic exercises in institutional neck rehabilitation.

PubMed

Wasenius, Niko; Karapalo, Teppo; Sjögren, Tuulikki; Pekkonen, Mika; Mälkiä, Esko

2013-03-01

To determine the intensity and volume of therapeutic exercises during a standard 13-day inpatient neck rehabilitation course in relation to overall physical activity in rehabilitation and everyday life. Cross-sectional study. Subjects (n = 19; 16 women and 3 men; mean age 48.6 years, standard deviation (SD) 6.6) with chronic non-specific neck pain were recruited from two inpatient neck rehabilitation courses. Intensity and volume of therapeutic exercises and physical activity were measured in metabolic equivalents (METs) with an objective measurement device and all-time recall questionnaire. Maximum oxygen uptake was determined in METs (METc) by direct maximal cycle ergometer. Subjects' mean METc was 7.2 METs (SD 1.4) or 25.3 ml/kg/min (SD 4.8). Intensity of all therapeutic exercises was 1.9 METs or 27 %METc (SD 5.1) and volume 7.7 MET-hours/week. Intensity of specific neck and shoulder exercises was 2.0 METs or 28 %METc (SD 5.4) and volume 2.5 MET-hours/week. In addition, subjects were more active in everyday life than in inpatient rehabilitation. The therapeutic exercise dose failed to reach previously reported target values for pain relief. The dose of therapeutic exercises and confounding physical activity should be carefully controlled in pain rehabilitation programmes.

Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men.

PubMed

Veale, David; Miles, Sarah; Bramley, Sally; Muir, Gordon; Hodsoll, John

2015-06-01

To systematically review and create nomograms of flaccid and erect penile size measurements. Study key eligibility criteria: measurement of penis size by a health professional using a standard procedure; a minimum of 50 participants per sample. samples with a congenital or acquired penile abnormality, previous surgery, complaint of small penis size or erectile dysfunction. Synthesis methods: calculation of a weighted mean and pooled standard deviation (SD) and simulation of 20,000 observations from the normal distribution to generate nomograms of penis size. Nomograms for flaccid pendulous [n = 10,704, mean (SD) 9.16 (1.57) cm] and stretched length [n = 14,160, mean (SD) 13.24 (1.89) cm], erect length [n = 692, mean (SD) 13.12 (1.66) cm], flaccid circumference [n = 9407, mean (SD) 9.31 (0.90) cm], and erect circumference [n = 381, mean (SD) 11.66 (1.10) cm] were constructed. Consistent and strongest significant correlation was between flaccid stretched or erect length and height, which ranged from r = 0.2 to 0.6. relatively few erect measurements were conducted in a clinical setting and the greatest variability between studies was seen with flaccid stretched length. Penis size nomograms may be useful in clinical and therapeutic settings to counsel men and for academic research. © 2014 The Authors. BJU International © 2014 BJU International.

Seismic zoning (first approximation) using data of the main geomagnetic field

NASA Astrophysics Data System (ADS)

Khachikyan, Galina; Zhumabayev, Beibit; Toyshiev, Nursultan; Kairatkyzy, Dina; Seraliyev, Alibek; Khassanov, Eldar

2017-04-01

Seismic zoning is among the most complicated and extremely important problems of modern seismology. In solving this problem, a very important parameter is maximal possible earthquake magnitude (Mmax) which is believed at present depends on horizontal size of geoblocks. At the same time, it was found by Khachikyan et al. [2012, IJG, doi: 10.4236/ijg.2012.35109] that Mmax value in any seismic region may be determined using Z_GSM value that is geomagnetic Z-component in this region estimated in geocentric solar-magnetosphere coordinate system (GSM). On the base of the global seismological catalog NEIC with M≥4.5 for 1973-2010 years, and the International Geomagnetic Reference Field (IGRF) model, an empirical relation was obtained as follows: Mmax= a + b {log[abs(Z_GSM)]}. For the case of the whole planet, obtained empirical coefficients are as follows: a = (5,22 ± 0,17), and b = (0,78 ± 0,06) with correlation coefficient R=0.91, standard deviation SD=0.56, and probability 95%. Further investigations showed that the coefficients of the regression equation are different for different seismically active regions of the planet. For example, to the territory of the San Andreas Fault, defined by the coordinates 30-45N, 105-135W obtained values are as follows: a = (4,04 ± 0.38) and b = (0.7 ± 0.13) with correlation coefficient R = 0.91, standard deviation SD = 0.34, and probability of 95%. For territory of inland seismicity in Eurasia defined by the coordinates 30-45N, 0-110E, a = (12.44 ± 0.48) and b = (1,15 ± 0.2) with correlation coefficient R = 0.87, standard deviation SD = 0.98, and probability of 95%, and for the territory of the strongest seismicity in the world defined by the coordinates 20S-20N, 90-150E, obtained values of a = (- 17.5 ± 1,5) and b = (5,7 ± 0.4) with correlation coefficient R = 0.97, standard deviation SD = 0.4, and probability of 95%. The relationship between the intensity of the main geomagnetic field and released seismic energy is expectable, because both the main geomagnetic field and the tectonic activity of the planet originate from the same source - the convection in the Earth's liquid core. The relationship between earthquake magnitude and geomagnetic Z - component expressed namely in geocentric solar magnetosphere coordinate system (GSM), in which the interaction of the solar wind magnetic field with the geomagnetic field is better ordered, indicates at the external (triggering) earthquake occurrence in the extremely stressed tectonic area. Above empirical relationships may be used (in first approximation) for global seismic zoning and for prediction of possible Mmax, when a place and time of earthquake occurrence are predicted. In report we present global maps of Z_GSM and Mmax estimated for different seasons and different times.

Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning.

PubMed

Yuan, Peng; Mai, Huaming; Li, Jianfu; Ho, Dennis Chun-Yu; Lai, Yingying; Liu, Siting; Kim, Daeseung; Xiong, Zixiang; Alfi, David M; Teichgraeber, John F; Gateno, Jaime; Xia, James J

2017-12-01

There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities.

Design, development and clinical validation of computer-aided surgical simulation system for streamlined orthognathic surgical planning

PubMed Central

Yuan, Peng; Mai, Huaming; Li, Jianfu; Ho, Dennis Chun-Yu; Lai, Yingying; Liu, Siting; Kim, Daeseung; Xiong, Zixiang; Alfi, David M.; Teichgraeber, John F.; Gateno, Jaime

2017-01-01

Purpose There are many proven problems associated with traditional surgical planning methods for orthognathic surgery. To address these problems, we developed a computer-aided surgical simulation (CASS) system, the AnatomicAligner, to plan orthognathic surgery following our streamlined clinical protocol. Methods The system includes six modules: image segmentation and three-dimensional (3D) reconstruction, registration and reorientation of models to neutral head posture, 3D cephalometric analysis, virtual osteotomy, surgical simulation, and surgical splint generation. The accuracy of the system was validated in a stepwise fashion: first to evaluate the accuracy of AnatomicAligner using 30 sets of patient data, then to evaluate the fitting of splints generated by AnatomicAligner using 10 sets of patient data. The industrial gold standard system, Mimics, was used as the reference. Result When comparing the results of segmentation, virtual osteotomy and transformation achieved with AnatomicAligner to the ones achieved with Mimics, the absolute deviation between the two systems was clinically insignificant. The average surface deviation between the two models after 3D model reconstruction in AnatomicAligner and Mimics was 0.3 mm with a standard deviation (SD) of 0.03 mm. All the average surface deviations between the two models after virtual osteotomy and transformations were smaller than 0.01 mm with a SD of 0.01 mm. In addition, the fitting of splints generated by AnatomicAligner was at least as good as the ones generated by Mimics. Conclusion We successfully developed a CASS system, the AnatomicAligner, for planning orthognathic surgery following the streamlined planning protocol. The system has been proven accurate. AnatomicAligner will soon be available freely to the boarder clinical and research communities. PMID:28432489

Reconstruction of the lateral tibia plateau fracture with a third triangular support screw: A biomechanical study.

PubMed

Moran, Eduardo; Zderic, Ivan; Klos, Kajetan; Simons, Paul; Triana, Miguel; Richards, R Geoff; Gueorguiev, Boyko; Lenz, Mark

2017-10-01

Split fractures of the lateral tibia plateau in young patients with good bone quality are commonly treated using two minimally invasive percutaneous lag screws, followed by unloading of the knee joint. Improved stability could be achieved with the use of a third screw inserted either in the jail-technique fashion or with a triangular support screw configuration. The aim of this study was to investigate under cyclic loading the compliance and endurance of the triangular support fixation in comparison with the standard two lag-screw fixation and the jail technique. Lateral split fractures of type AO/OTA 41-B1 were created on 21 synthetic tibiae and subsequently fixed with one of the following three techniques for seven specimens: standard fixation by inserting two partially threaded 6.5 mm cannulated lag screws parallel to each other and orthogonal to the fracture plane; triangular support fixation-standard fixation with one additional support screw at the distal end of the fracture at 30° proximal inclination; and jail fixation-standard fixation with one additional orthogonal support screw inserted in the medial nonfractured part of the bone. Mechanical testing was performed under progressively increasing cyclic compression loading. Fragment displacement was registered via triggered radiographic imaging. Mean construct compliance was 3.847 × 10 -3  mm/N [standard deviation (SD) 0.784] for standard fixation, 3.838 × 10 -3  mm/N (SD 0.242) for triangular fixation, and 3.563 × 10 -3  mm/N (SD 0.383) for jail fixation, with no significant differences between the groups ( p  = 0.525). The mean numbers of cycles to 2 mm fragment dislocation, defined as a failure criterion, were 12,384 (SD 2267) for standard fixation, 17,708 (SD 2193) for triangular fixation, and 14,629 (SD 5194) for jail fixation. Triangular fixation revealed significantly longer endurance than the standard one ( p  = 0.047). Triangular support fixation enhanced interfragmentary stability at the ultimate stage of dynamic loading. However, the level of improvement seems to be limited and may not legitimate the intervention with an additional third screw.

Role of dispersion corrected hybrid GGA class in accurately calculating the bond dissociation energy of carbon halogen bond: A benchmark study

NASA Astrophysics Data System (ADS)

Kosar, Naveen; Mahmood, Tariq; Ayub, Khurshid

2017-12-01

Benchmark study has been carried out to find a cost effective and accurate method for bond dissociation energy (BDE) of carbon halogen (Csbnd X) bond. BDE of C-X bond plays a vital role in chemical reactions, particularly for kinetic barrier and thermochemistry etc. The compounds (1-16, Fig. 1) with Csbnd X bond used for current benchmark study are important reactants in organic, inorganic and bioorganic chemistry. Experimental data of Csbnd X bond dissociation energy is compared with theoretical results. The statistical analysis tools such as root mean square deviation (RMSD), standard deviation (SD), Pearson's correlation (R) and mean absolute error (MAE) are used for comparison. Overall, thirty-one density functionals from eight different classes of density functional theory (DFT) along with Pople and Dunning basis sets are evaluated. Among different classes of DFT, the dispersion corrected range separated hybrid GGA class along with 6-31G(d), 6-311G(d), aug-cc-pVDZ and aug-cc-pVTZ basis sets performed best for bond dissociation energy calculation of C-X bond. ωB97XD show the best performance with less deviations (RMSD, SD), mean absolute error (MAE) and a significant Pearson's correlation (R) when compared to experimental data. ωB97XD along with Pople basis set 6-311g(d) has RMSD, SD, R and MAE of 3.14 kcal mol-1, 3.05 kcal mol-1, 0.97 and -1.07 kcal mol-1, respectively.

Behavioral Ecology of Deep Diving Odontocetes in The Bahamas

DTIC Science & Technology

2015-10-19

was prepared under contract to the Department of Defense Strategic Environmental Research and Development Program (SERDP). The publication of this...stratum SD – standard deviation SERDP – Strategic Environmental Research and Development Program SGBA – South Grand Bahama stratum SIs – Stable... Environmental Research and Development Program (SERDP) and we are grateful to Dr. John Hall, Program Manager for the Resource Conservation and Climate

A Maximal Graded Exercise Test to Accurately Predict VO2max in 18-65-Year-Old Adults

ERIC Educational Resources Information Center

George, James D.; Bradshaw, Danielle I.; Hyde, Annette; Vehrs, Pat R.; Hager, Ronald L.; Yanowitz, Frank G.

2007-01-01

The purpose of this study was to develop an age-generalized regression model to predict maximal oxygen uptake (VO sub 2 max) based on a maximal treadmill graded exercise test (GXT; George, 1996). Participants (N = 100), ages 18-65 years, reached a maximal level of exertion (mean plus or minus standard deviation [SD]; maximal heart rate [HR sub…

SU-G-IeP3-11: On the Utility of Pixel Variance to Characterize Noise for Image Receptors of Digital Radiography Systems

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

Finley, C; Dave, J

Purpose: To characterize noise for image receptors of digital radiography systems based on pixel variance. Methods: Nine calibrated digital image receptors associated with nine new portable digital radiography systems (Carestream Health, Inc., Rochester, NY) were used in this study. For each image receptor, thirteen images were acquired with RQA5 beam conditions for input detector air kerma ranging from 0 to 110 µGy, and linearized ‘For Processing’ images were extracted. Mean pixel value (MPV), standard deviation (SD) and relative noise (SD/MPV) were obtained from each image using ROI sizes varying from 2.5×2.5 to 20×20 mm{sup 2}. Variance (SD{sup 2}) was plottedmore » as a function of input detector air kerma and the coefficients of the quadratic fit were used to derive structured, quantum and electronic noise coefficients. Relative noise was also fitted as a function of input detector air kerma to identify noise sources. The fitting functions used least-squares approach. Results: The coefficient of variation values obtained using different ROI sizes was less than 1% for all the images. The structured, quantum and electronic coefficients obtained from the quadratic fit of variance (r>0.97) were 0.43±0.10, 3.95±0.27 and 2.89±0.74 (mean ± standard deviation), respectively, indicating that overall the quantum noise was the dominant noise source. However, for one system electronic noise coefficient (3.91) was greater than quantum noise coefficient (3.56) indicating electronic noise to be dominant. Using relative noise values, the power parameter of the fitting equation (|r|>0.93) showed a mean and standard deviation of 0.46±0.02. A 0.50 value for this power parameter indicates quantum noise to be the dominant noise source whereas values around 0.50 indicate presence of other noise sources. Conclusion: Characterizing noise from pixel variance assists in identifying contributions from various noise sources that, eventually, may affect image quality. This approach may be integrated during periodic quality assessments of digital image receptors.« less

Predicting Functional Capacity From Measures of Muscle Mass in Postmenopausal Women.

PubMed

Orsatti, Fábio Lera; Nunes, Paulo Ricardo Prado; Souza, Aletéia de Paula; Martins, Fernanda Maria; de Oliveira, Anselmo Alves; Nomelini, Rosekeila Simões; Michelin, Márcia Antoniazi; Murta, Eddie Fernando Cândido

2017-06-01

Menopause increases body fat and decreases muscle mass and strength, which contribute to sarcopenia. The amount of appendicular muscle mass has been frequently used to diagnose sarcopenia. Different measures of appendicular muscle mass have been proposed. However, no studies have compared the most salient measure (appendicular muscle mass corrected by body fat) of the appendicular muscle mass to physical function in postmenopausal women. To examine the association of 3 different measurements of appendicular muscle mass (absolute, corrected by stature, and corrected by body fat) with physical function in postmenopausal women. Cross-sectional descriptive study. Outpatient geriatric and gynecological clinic. Forty-eight postmenopausal women with a mean age (standard deviation [SD]) of 62.1 ± 8.2 years, with mean (SD) length of menopause of 15.7 ± 9.8 years and mean (SD) body fat of 43.6% ± 9.8%. Not applicable. Appendicular muscle mass measure was measured with dual-energy x-ray absorptiometry. Physical function was measured by a functional capacity questionnaire, a short physical performance battery, and a 6 minute-walk test. Muscle quality (leg extensor strength to lower-body mineral-free lean mass ratio) and sum of z scores (sum of each physical function tests z score) were performed to provide a global index of physical function. The regression analysis showed that appendicular muscle mass corrected by body fat was the strongest predictor of physical function. Each increase in the standard deviation of appendicular muscle mass corrected by body fat was associated with a mean sum of z score increase of 59% (standard deviation), whereas each increase in absolute appendicular muscle mass and appendicular muscle mass corrected by stature were associated with a mean sum of z scores decrease of 23% and 36%, respectively. Muscle quality was associated with appendicular muscle mass corrected by body fat. These findings indicate that appendicular muscle mass corrected by body fat is a better predictor of physical function than the other measures of appendicular muscle mass in postmenopausal women. I. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Reduction in mean deviation values in automated perimetry in eyes with multifocal compared to monofocal intraocular lens implants.

PubMed

Farid, Marjan; Chak, Garrick; Garg, Sumit; Steinert, Roger F

2014-08-01

To evaluate differences in mean deviation values in automated perimetry in healthy eyes with multifocal compared to monofocal intraocular lens (IOL) implants. Prospective, age-matched, comparative analysis. Single-center, tertiary referral academic practice. A total of 37 healthy eyes in 37 patients with bilateral multifocal (n=22) or monofocal (n=15) IOL implants were studied. INTERVENTION/OBSERVATION PROCEDURE: Humphrey Visual Field 10-2 testing was performed on all patients. Mean deviation (MD) and pattern standard deviation (PSD) numerical values were evaluated and compared between groups. The average MD was -2.84 dB (SD 2.32) for the multifocal IOL group and -0.97 dB (SD 1.58) for the monofocal IOL group (P=.006). There was no significant difference in PSD between the 2 groups (P=.99). Eyes that had the visual field 10-2 testing≥6 months from time of IOL placement showed no improvement in MD when compared to eyes that were tested within 6 months from IOL placement. Multifocal IOL implants cause significant nonspecific reduction in MD values on Humphrey Visual Field 10-2 testing that does not improve with time or neuroadaptation. Multifocal IOL implants may be inadvisable in patients where central visual field reduction may not be tolerated, such as macular degeneration, retinal pigment epithelium changes, and glaucoma. Copyright © 2014 Elsevier Inc. All rights reserved.

Clinical outcomes of proximal row carpectomy versus four-corner arthrodesis for post-traumatic wrist arthropathy: a systematic review.

PubMed

Saltzman, B M; Frank, J M; Slikker, W; Fernandez, J J; Cohen, M S; Wysocki, R W

2015-06-01

We conducted a systematic review of studies reporting clinical outcomes after proximal row carpectomy or to four-corner arthrodesis for scaphoid non-union advanced collapse or scapholunate advanced collapse arthritis. Seven studies (Levels I-III; 240 patients, 242 wrists) were evaluated. Significantly different post-operative values were as follows for four-corner arthrodesis versus proximal row carpectomy groups: wrist extension, 39 (SD 11º) versus 43 (SD 11º); wrist flexion, 32 (SD 10º) versus 36 (SD 11º); flexion-extension arc, 62 (SD 14º) versus 75 (SD 10º); radial deviation, 14 (SD 5º) versus 10 (SD 5º); hand grip strength as a percentage of contralateral side, 74% (SD 13) versus 67% (SD 16); overall complication rate, 29% versus 14%. The most common post-operative complications were non-union (grouped incidence, 7%) after four-corner arthrodesis and synovitis and clinically significant oedema (3.1%) after proximal row carpectomy. Radial deviation and post-operative hand grip strength (as a percentage of the contralateral side) were significantly better after four-corner arthrodesis. Four-corner arthrodesis gave significantly greater post-operative radial deviation and grip strength as a percentage of the opposite side. Wrist flexion, extension, and the flexion-extension arc were better after proximal row carpectomy, which also had a lower overall complication rate. © The Author(s) 2014.

Effectiveness of autologous fibrin tissue adhesive in reducing postoperative blood loss during total hip arthroplasty: a prospective randomised study of 100 cases.

PubMed

Mawatari, M; Higo, T; Tsutsumi, Y; Shigematsu, M; Hotokebuchi, T

2006-08-01

To evaluate the effectiveness of autologous fibrin tissue adhesive (auto-FTA) in reducing blood loss during cementless total hip arthroplasty (THA). From September 2000 to August 2001, 100 patients who predonated 400 ml of autologous blood were randomised to undergo either standard treatment with auto-FTA (auto-FTA group) or standard treatment alone (control group). The volume of postoperative blood loss and the decrease in haemoglobin level were measured. All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification. The mean postoperative blood loss was 580 ml (standard deviation [SD], 240 ml) in the auto-FTA group and 810 ml (SD, 341 ml) in the control group; the difference was significant (230 ml, p<0.001). The decrease in haemoglobin concentration was 17 g/l (SD, 11 g/l) in the auto-FTA group and 22 g/l (SD, 12 g/l) in the control group. The difference was significant (5 g/l, p=0.03). The percentage of total blood loss of >1200 ml in any single patient was significantly lower in the auto-FTA group (4%) than in the control group (20%) [p=0.01]. Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA.

Symptom Burden among Latino Patients with End-Stage Renal Disease and Access to Standard or Emergency-Only Hemodialysis.

PubMed

Cervantes, Lilia; Hull, Madelyne; Keniston, Angela; Chonchol, Michel; Hasnain-Wynia, Romana; Fischer, Stacy

2018-05-30

Patients with end-stage renal disease (ESRD) have a high symptom burden and this negatively impacts health-related quality of life. Little is known about the symptom burden of Latinos with ESRD and variable access to hemodialysis. To estimate the symptom burden of Latinos with ESRD and access to standard or emergency-only hemodialysis. Observational descriptive study of Latino adults with ESRD receiving standard or emergency-only hemodialysis. Patients completed the Edmonton Symptom Assessment System Revised: Renal (ESAS-r:Renal). We used descriptive statistics and propensity score adjustment to conduct the analysis. ESAS-r:Renal. Participants (N = 67) had a mean age of 58 years (standard deviation [SD] ±13) and a mean Charlson Comorbidity Index of 6.6 ± 2.5, and had been on hemodialysis a mean of 42 months (SD ±43). On average, Latinos with ESRD experienced 7 (SD ±3) symptoms with a mean of 5 ± 3 symptoms reported as moderate or severe. After adjusting for propensity score, emergency-only hemodialysis patients reported experiencing more nausea compared to standard hemodialysis patients (odds ratio 8.95, 95% confidence interval: 1.17-68.31, p = 0.03). Latinos with ESRD have a high symptom burden and compared to patients with standard hemodialysis, patients who rely on emergency-only hemodialysis report more nausea. A national treatment strategy that provides standard hemodialysis for undocumented immigrants with ESRD is an important next step.

Training labels for hippocampal segmentation based on the EADC-ADNI harmonized hippocampal protocol.

PubMed

Boccardi, Marina; Bocchetta, Martina; Morency, Félix C; Collins, D Louis; Nishikawa, Masami; Ganzola, Rossana; Grothe, Michel J; Wolf, Dominik; Redolfi, Alberto; Pievani, Michela; Antelmi, Luigi; Fellgiebel, Andreas; Matsuda, Hiroshi; Teipel, Stefan; Duchesne, Simon; Jack, Clifford R; Frisoni, Giovanni B

2015-02-01

The European Alzheimer's Disease Consortium and Alzheimer's Disease Neuroimaging Initiative (ADNI) Harmonized Protocol (HarP) is a Delphi definition of manual hippocampal segmentation from magnetic resonance imaging (MRI) that can be used as the standard of truth to train new tracers, and to validate automated segmentation algorithms. Training requires large and representative data sets of segmented hippocampi. This work aims to produce a set of HarP labels for the proper training and certification of tracers and algorithms. Sixty-eight 1.5 T and 67 3 T volumetric structural ADNI scans from different subjects, balanced by age, medial temporal atrophy, and scanner manufacturer, were segmented by five qualified HarP tracers whose absolute interrater intraclass correlation coefficients were 0.953 and 0.975 (left and right). Labels were validated as HarP compliant through centralized quality check and correction. Hippocampal volumes (mm(3)) were as follows: controls: left = 3060 (standard deviation [SD], 502), right = 3120 (SD, 897); mild cognitive impairment (MCI): left = 2596 (SD, 447), right = 2686 (SD, 473); and Alzheimer's disease (AD): left = 2301 (SD, 492), right = 2445 (SD, 525). Volumes significantly correlated with atrophy severity at Scheltens' scale (Spearman's ρ = <-0.468, P = <.0005). Cerebrospinal fluid spaces (mm(3)) were as follows: controls: left = 23 (32), right = 25 (25); MCI: left = 15 (13), right = 22 (16); and AD: left = 11 (13), right = 20 (25). Five subjects (3.7%) presented with unusual anatomy. This work provides reference hippocampal labels for the training and certification of automated segmentation algorithms. The publicly released labels will allow the widespread implementation of the standard segmentation protocol. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Dietary Influences on Alpha-Methylacyl-CoA Racemase (AMACR) Expression in the Prostate

DTIC Science & Technology

2011-04-01

levels and individual dairy products and ruminant meats (milk, cheese, yogurt , cream, butter, beef, lamb) 2) Evaluation of associations between dietary... yogurt , cream, butter, beef, lamb) • Evaluation of associations between: 1) dietary intake of red meat / dairy products and phytanic acid...1 Adjusted for vitamin supplement use, current alcohol use, smoking status, and calories 2 SD = standard deviation 3 Daily servings of milk, yogurt

Computer-Based Algorithmic Determination of Muscle Movement Onset Using M-Mode Ultrasonography

DTIC Science & Technology

2017-05-01

contraction images were analyzed visually and with three different classes of algorithms: pixel standard deviation (SD), high-pass filter and Teager Kaiser...Linear relationships and agreements between computed and visual muscle onset were calculated. The top algorithms were high-pass filtered with a 30 Hz...suggest that computer automated determination using high-pass filtering is a potential objective alternative to visual determination in human

An Assessment of the Condition of Coral Reefs off the Former Navy Bombing Ranges at Isla De Culebra and Isla De Vieques, Puerto Rico

DTIC Science & Technology

2005-04-01

Bray-Curtis distance measure with an Unweighted Pair Group Method with Arithmetic Averages ( UPGMA ) linkage method to perform a cluster analysis of the...59 35 Comparison of reef condition indicators clustering by UPGMA analysis...Polyvinyl Chloride RBD Red-band Disease SACEX Supporting Arms Coordination Exercise SAV Submerged Aquatic Vegetation SD Standard Deviation UPGMA

Mediating Pathways in the Socio-Economic Gradient of Child Development: Evidence from Children 6-42 Months in Bogota

ERIC Educational Resources Information Center

Rubio-Codina, Marta; Attanasio, Orazio; Grantham-McGregor, Sally

2016-01-01

Research has previously shown a gap of near 0.5 of a standard deviation (SD) in cognition and language development between the top and bottom household wealth quartile in children aged 6-42 months in a large representative sample of low- and middle-income families in Bogota, using the Bayley Scales of Infant and Toddler Development. The gaps in…

Ordovician Jeleniów Claystone Formation of the Holy Cross Mountains, Poland - Reconstruction of Redox Conditions Using Pyrite Framboid Study

NASA Astrophysics Data System (ADS)

Smolarek, Justyna; Marynowski, Leszek; Trela, Wiesław

2014-09-01

The aim of this research is to reconstruct palaeoredox conditions during sedimentation of the Jeleniów Claystone Formation deposits, using framboid pyrite diameter measurements. Analysis of pyrite framboids diameter distribution is an effective method in the palaeoenvironmental interpretation which allow for a more detailed insight into the redox conditions, and thus the distinction between euxinic, dysoxic and anoxic conditions. Most of the samples is characterized by framboid indicators typical for anoxic/euxinic conditions in the water column, with average (mean) values ranging from 5.29 to 6.02 urn and quite low standard deviation (SD) values ranging from 1.49 to 3.0. The remaining samples have shown slightly higher values of framboid diameter typical for upper dysoxic conditions, with average values (6.37 to 7.20 um) and low standard deviation (SD) values (1.88 to 2.88). From the depth of 75.5 m till the shallowest part of the Jeleniów Claystone Formation, two samples have been examined and no framboids has been detected. Because secondary weathering should be excluded, the lack of framboids possibly indicates oxic conditions in the water column. Oxic conditions continue within the Wólka Formation based on the lack of framboids in the ZB 51.6 sample.

Ordovician Jeleniów Claystone Formation of the Holy Cross Mountains, Poland - Reconstruction of redox conditions using pyrite framboid study

NASA Astrophysics Data System (ADS)

Smolarek, Justyna; Marynowski, Leszek; Trela, Wiesław

2014-09-01

The aim of this research is to reconstruct palaeoredox conditions during sedimentation of the Jeleniów Claystone Formation deposits, using framboid pyrite diameter measurements. Analysis of pyrite framboids diameter distribution is an effective method in the palaeoenvironmental interpretation which allow for a more detailed insight into the redox conditions, and thus the distinction between euxinic, dysoxic and anoxic conditions. Most of the samples is characterized by framboid indicators typical for anoxic/euxinic conditions in the water column, with average (mean) values ranging from 5.29 to 6.02 μm and quite low standard deviation (SD) values ranging from 1.49 to 3.0. The remaining samples have shown slightly higher values of framboid diameter typical for upper dysoxic conditions, with average values (6.37 to 7.20 μm) and low standard deviation (SD) values (1.88 to 2.88). From the depth of 75.5 m till the shallowest part of the Jeleniów Claystone Formation, two samples have been examined and no framboids has been detected. Because secondary weathering should be excluded, the lack of framboids possibly indicates oxic conditions in the water column. Oxic conditions continue within the Wólka Formation based on the lack of framboids in the ZB 51.6 sample

Successful treatment of open jaw and jaw deviation dystonia with botulinum toxin using a simple intraoral approach.

PubMed

Moscovich, Mariana; Chen, Zhongxing Peng; Rodriguez, Ramon

2015-03-01

Oromandibular dystonia (OMD) is a focal dystonia that involves the mouth, jaw, and/or tongue. It can be classified as idiopathic, tardive dystonia or secondary to other neurological disorders and subdivided into jaw opening, jaw closing, jaw deviation and lip pursing. The muscles involved in jaw opening dystonia are usually the digastrics and lateral pterygoids. It is known that the lateral pterygoids may be approached both internally and externally. The external approach is the most common; however neurologists experienced in treating patients with botulinum toxin can safely and with no extra cost perform the intraoral procedure. We report our experience in the treatment of jaw opening and jaw deviation dystonia using the intraoral injection approach. Eight patients were selected from the University of Florida with a clinical diagnosis of open jaw/jaw deviation dystonia. All of them were injected with onabotulinum toxin A using the internal approach and the clinical global impression scale was applied. The mean age of the patients was 67 (standard deviation [SD] 10.2) years, with a disease duration of 10.2 (SD 7.7) years and the mean distance they traveled to our institution was 448 km (278 miles). After treatment, six patients scored as very much improved in the clinical global impression scale and two patients scored as much improved. Only one patient reported an adverse event of nasal speech following one of the injections that improved after 4 weeks. Botulinum toxin injections for open jaw/jaw deviation dystonia can be safely performed with the intraoral approach without the need of special devices other than electromyography. Copyright © 2014 Elsevier Ltd. All rights reserved.

Active video games as a form of exercise and the effect of gaming experience: a preliminary study in healthy young adults.

PubMed

O'Donovan, C; Hussey, J

2012-09-01

To examine the energy expenditure and heart rate response while playing active video games, and the effect of gaming experience on energy expenditure. Cross-sectional study. Twenty-eight healthy participants (18 male, age 19 to 27 years) played either Wii Sports Boxing, Tennis and Baseball, or Wii Sports Boxing and Wii Fit Free Jogging. Percentage maximal heart rate (%HRmax) and metabolic equivalents (METs) were measured during 15 minutes of rest and during each game. Mean %HRmax and METs while playing each of the four games were as follows: Wii Fit Free Jogging 71% [standard deviation (SD) 13%], 5.9 (SD 1.8); Wii Sports Boxing 58% (SD 13%), 3.2 (SD 1.1); Wii Sports Baseball 42% (SD 6%), 2.0 (SD 0.5); and Wii Sports Tennis 42% (SD 7%), 2.0 (SD 0.4). Subjects with gaming experience achieved a lower heart rate playing Wii Sports Tennis compared with subjects without gaming experience. Wii Sports Boxing, Tennis and Baseball are light-intensity activities, and Wii Fit Free Jogging is a moderate-intensity activity. Experience of gaming may affect the exercise intensity of games requiring controller skill. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Asthma, inhaled corticosteroid treatment, and growth.

PubMed

Ninan, T K; Russell, G

1992-06-01

To evaluate the effects on growth of inhaled corticosteroid treatment (ICT) and of the quality of control of asthma, height velocity was studied in 58 prepubertal children attending a specialist asthma clinic because of chronic asthma that was difficult to control. The height velocity standard deviation (SD) score was maximal when the asthma was well controlled both before (0.01) and after (-0.07) starting ICT. It was least when the asthma was poorly controlled both before (-1.50) and after (-1.55) starting ICT. The effectiveness of control correlated significantly with the height velocity SD score, both before and after ICT was started. No evidence was found that the administration of ICT has an adverse effect on growth.

Variability of medial and posterior offset in patients with fourth-generation stemmed shoulder arthroplasty.

PubMed

Irlenbusch, Ulrich; Berth, Alexander; Blatter, Georges; Zenz, Peter

2012-03-01

Most anthropometric data on the proximal humerus has been obtained from deceased healthy individuals with no deformities. Endoprostheses are implanted for primary and secondary osteoarthritis, rheumatoid arthritis,humeral-head necrosis, fracture sequelae and other humeral-head deformities. This indicates that pathologicoanatomical variability may be greater than previously assumed. We therefore investigated a group of patients with typical shoulder replacement diagnoses, including posttraumatic and rheumatic deformities. One hundred and twenty-two patients with a double eccentrically adjustable shaft endoprosthesis served as a specific dimension gauge to determine in vivo the individual humeral-head rotation centres from the position of the adjustable prosthesis taper and the eccentric head. All prosthesis heads were positioned eccentrically.The entire adjustment range of the prosthesis of 12 mm medial/lateral and 6 mm dorsal/ventral was required. Mean values for effective offset were 5.84 mm mediolaterally[standard deviation (SD) 1.95, minimum +2, maximum +11]and 1.71 mm anteroposteriorly (SD 1.71, minimum −3,maximum 3 mm), averaging 5.16 mm (SD 1.76, minimum +2,maximum + 10). The posterior offset averaged 1.85 mm(SD 1.85, minimum −1, maximum + 6 mm). In summary, variability of the combined medial and dorsal offset of the humeral-head rotational centre determined in patients with typical underlying diagnoses in shoulder replacement was not greater than that recorded in the literature for healthy deceased patients.The range of deviation is substantial and shows the need for an adjustable prosthetic system.

New clinical validation method for automated sphygmomanometer: a proposal by Japan ISO-WG for sphygmomanometer standard.

PubMed

Shirasaki, Osamu; Asou, Yosuke; Takahashi, Yukio

2007-12-01

Owing to fast or stepwise cuff deflation, or measuring at places other than the upper arm, the clinical accuracy of most recent automated sphygmomanometers (auto-BPMs) cannot be validated by one-arm simultaneous comparison, which would be the only accurate validation method based on auscultation. Two main alternative methods are provided by current standards, that is, two-arm simultaneous comparison (method 1) and one-arm sequential comparison (method 2); however, the accuracy of these validation methods might not be sufficient to compensate for the suspicious accuracy in lateral blood pressure (BP) differences (LD) and/or BP variations (BPV) between the device and reference readings. Thus, the Japan ISO-WG for sphygmomanometer standards has been studying a new method that might improve validation accuracy (method 3). The purpose of this study is to determine the appropriateness of method 3 by comparing immunity to LD and BPV with those of the current validation methods (methods 1 and 2). The validation accuracy of the above three methods was assessed in human participants [N=120, 45+/-15.3 years (mean+/-SD)]. An oscillometric automated monitor, Omron HEM-762, was used as the tested device. When compared with the others, methods 1 and 3 showed a smaller intra-individual standard deviation of device error (SD1), suggesting their higher reproducibility of validation. The SD1 by method 2 (P=0.004) significantly correlated with the participant's BP, supporting our hypothesis that the increased SD of device error by method 2 is at least partially caused by essential BPV. Method 3 showed a significantly (P=0.0044) smaller interparticipant SD of device error (SD2), suggesting its higher interparticipant consistency of validation. Among the methods of validation of the clinical accuracy of auto-BPMs, method 3, which showed the highest reproducibility and highest interparticipant consistency, can be proposed as being the most appropriate.

Mapping tissue inhomogeneity in acute myocarditis: a novel analytical approach to quantitative myocardial edema imaging by T2-mapping.

PubMed

Baeßler, Bettina; Schaarschmidt, Frank; Dick, Anastasia; Stehning, Christian; Schnackenburg, Bernhard; Michels, Guido; Maintz, David; Bunck, Alexander C

2015-12-23

The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection. Cardiovascular magnetic resonance (CMR) data of 31 patients with ACM were retrospectively analyzed. 30 healthy volunteers (HV) served as a control. Additionally to the routine CMR protocol, T2-mapping data were acquired at 1.5 T using a breathhold Gradient-Spin-Echo T2-mapping sequence in six short axis slices. T2-maps were segmented according to the 16-segments AHA-model and segmental T2 values as well as the segmental pixel-standard deviation (SD) were analyzed. Mean differences of global myocardial T2 or pixel-SD between HV and ACM patients were only small, lying in the normal range of HV. In contrast, variation of segmental T2 values and pixel-SD was much larger in ACM patients compared to HV. In random forests and multiple logistic regression analyses, the combination of the highest segmental T2 value within each patient (maxT2) and the mean absolute deviation (MAD) of log-transformed pixel-SD (madSD) over all 16 segments within each patient proved to be the best discriminators between HV and ACM patients with an AUC of 0.85 in ROC-analysis. In classification trees, a combined cut-off of 0.22 for madSD and of 68 ms for maxT2 resulted in 83% specificity and 81% sensitivity for detection of ACM. The proposed cut-off values for maxT2 and madSD in the setting of ACM allow edema detection with high sensitivity and specificity and therefore have the potential to overcome the hurdles of T2-mapping for its integration into clinical routine.

Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique.

PubMed

Meermans, G; Doorn, J Van; Kats, J-J

2016-12-01

One goal of total hip arthroplasty is to restore normal hip anatomy. The aim of this study was to compare displacement of the centre of rotation (COR) using a standard reaming technique with a technique in which the acetabulum was reamed immediately peripherally and referenced off the rim. In the first cohort the acetabulum was reamed to the floor followed by sequentially larger reamers. In the second cohort the acetabulum was only reamed peripherally, starting with a reamer the same size as the native femoral head. Anteroposterior pelvic radiographs were analysed for acetabular floor depth and vertical and horizontal position of the COR. Horizontally, the mean medial displacement of the COR was 0.8 mm (standard deviation (sd) 1.4) in the peripheral remaing group and 5.0 mm (sd 3.30) in the standard reaming group (p < 0.001). Vertically, the mean superior displacement of the COR was 0.7 mm (sd 1.3) in the peripheral reaming group and 3.7 mm (sd 2.6) in the standard reaming group (p < 0.001). In the standard reaming group, there was a strong correlation between the pre-operative acetabular floor depth and displacement of the COR (p < 0.001). Reaming the acetabulum to the floor can lead to significant displacement of the COR medially and superiorly. This displacement is related to the pre-operative acetabular floor depth and cannot always be compensated by using a high offset stem. Cite this article: Bone Joint J 2016;98-B:1597-603. ©2016 The British Editorial Society of Bone & Joint Surgery.

Patients with Parkinson disease present high ambulatory blood pressure variability.

PubMed

Kanegusuku, Hélcio; Silva-Batista, Carla; Peçanha, Tiago; Silva-Junior, Natan; Queiroz, Andreia; Costa, Luiz; Mello, Marco; Piemonte, Maria; Ugrinowitsch, Carlos; Forjaz, Cláudia

2017-09-01

Patients with Parkinson disease (PD) present blunted nocturnal blood pressure fall and similar ambulatory blood pressure variability (ABPV) measured by standard deviation (SD) and coefficient of variation (CV) compared with healthy subjects. However, these classical indices of ABPV have limited validity in individuals with circadian blood pressure alterations. New indices, such as the average of daytime and night-time standard deviation weighted by the duration of the daytime and night-time intervals (SD dn ) and the average real variability (ARV), remove the influence of the daytime and the night-time periods on ABPV. This study assessed ABPV by SD dn and ARV in PD. Twenty-one patients with PD (11 men, 66 ± 2 years, stages 2-3 of modified Hoehn & Yahr) and 21 matched controls without Parkinson disease (9 men, 64 ± 1 years old) underwent blood pressure monitoring for 24 h. ABPV was analysed by 24 h, daytime and night-time SD and CV, and by the SD dn and ARV. Systolic/diastolic 24-h and night-time SD and CV were similar between the patients with PD and the controls. The patients with PD presented higher daytime systolic/diastolic CV and SD than the controls (10·4 ± 0·9/12·3 ± 0·8 versus 7·0 ± 0·3/9·9 ± 0·5%, P<0·05; 12·6 ± 1·0/9·1 ± 0·5 versus 8·6 ± 0·4/7·5 ± 0·3 mmHg, P<0·05, respectively) as well as higher systolic/diastolic SD dn (10·9 ± 0·8/8·2 ± 0·5 versus 8·2 ± 0·3/7·1 ± 0·2 mmHg, P<0·05, respectively) and ARV (8·8 ± 0·6/6·9 ± 0·3 versus 7·2 ± 0·2/6·0 ± 0·2 mmHg, P<0·05, respectively). In conclusion, patients with PD have higher ABPV than control subjects as assessed by SD d , CV d , SD dn and AVR. © 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Low-dose CT for quantitative analysis in acute respiratory distress syndrome

DTIC Science & Technology

2013-08-31

noise of scans performed at 140, 60, 15 and 7.5 mAs corresponded to 10, 16, 38 and 74 Hounsfield Units , respectively. Conclusions: A reduction of...slice of a series, total lung volume, total lung tissue mass and frequency distribution of lung CT numbers expressed in Hounsfield Units (HU) were...tomography; HU: Hounsfield units ; CTDIvol: volumetric computed tomography dose index; DLP: dose length product; E: effective dose; SD: standard deviation

Antibacterial activity of oregano (Origanum vulgare Linn.) against gram positive bacteria.

PubMed

Saeed, Sabahat; Tariq, Perween

2009-10-01

The present investigation is focused on antibacterial potential of infusion, decoction and essential oil of oregano (Origanum vulgare) against 111 Gram-positive bacterial isolates belonging to 23 different species related to 3 genera. Infusion and essential oil exhibited antibacterial activity against Staphylococcus saprophyticus, S. aureus, Micrococcus roseus, M. kristinae, M. nishinomiyaensis, M. lylae, M. luteus, M. sedentarius, M. varians, Bacillus megaterium, B. thuringiensis, B. alvei, B. circulans, B. brevis, B. coagulans, B. pumilus, B. laterosporus, B. polymyxa, B. macerans, B. subtilis, B. firmus, B. cereus and B. lichiniformis. The infusion exhibited maximum activity against B. laterosporus (17.5 mm mean zone of inhibition+/-1.5 Standard deviation) followed by B. polymyxa (17.0 mm+/-2.0 SD) and essential oil of oregano exhibited maximum activity against S. saprophyticus (16.8 mm+/-1.8 SD) followed by B. circulans (14.5 mm+/-0.5 SD). While all these tested isolates were found resistant to decoction of oregano.

Pattern of Visits to Older Family Physicians in Taiwan.

PubMed

Liu, Hao-Yen; Liu, Cheng-Chieh; Shen, Tzu-Hsiang; Wang, Yi-Jen; Liu, Jui-Yao; Chen, Tzeng-Ji; Chou, Li-Fang; Hwang, Shinn-Jang

2017-05-08

Many family physicians still practice at an old age. Nevertheless, their practice patterns have scarcely been studied. To address this lack of research, the current study analyzed claims data for a total of 2,018,440 visits to 171 family physicians in 2011 sourced from Taiwan's National Health Insurance Research Database. Family physicians aged 65 years and over had fewer patients (mean: 2330, standard deviation (SD): 2019) and visits (mean: 9220, SD: 8600) than younger physicians had. Furthermore, the average age of the patients who visited physicians aged 65 years and over was 51.9 (SD: 21.5) years, significantly higher than that of patients who visited younger physicians. However, the proportions of visits for upper respiratory tract infections, hypertension, diabetes mellitus, and dyslipidemia did not differ significantly among different age groups of physicians. In the future, the manpower planning of physicians should take into consideration the age structure and work profile of physicians.

Quantifying the Influence of Climate on Human Conflict

NASA Astrophysics Data System (ADS)

Hsiang, S. M.; Burke, M.; Miguel, E.

2014-12-01

A rapidly growing body of research examines whether human conflict can be affected by climatic changes. Drawing from archaeology, criminology, economics, geography, history, political science, and psychology, we assemble and analyze the most rigorous quantitative studies and document, for the first time, a striking convergence of results. We find strong causal evidence linking climatic events to human conflict across a range of spatial and temporal scales and across all major regions of the world. The magnitude of climate's influence is substantial: for each one standard deviation (1sd) change in climate toward warmer temperatures or more extreme rainfall, median estimates indicate that the frequency of interpersonal violence rises 4% and the frequency of intergroup conflict rises 14%. Because locations throughout the inhabited world are expected to warm 2sd to 4sd by 2050, amplified rates of human conflict could represent a large and critical impact of anthropogenic climate change.

Postprandial Glucose Surges after Extremely Low Carbohydrate Diet in Healthy Adults.

PubMed

Kanamori, Koji; Ihana-Sugiyama, Noriko; Yamamoto-Honda, Ritsuko; Nakamura, Tomoka; Sobe, Chie; Kamiya, Shigemi; Kishimoto, Miyako; Kajio, Hiroshi; Kawano, Kimiko; Noda, Mitsuhiko

2017-09-01

Carbohydrate-restricted diets are prevalent not only in obese people but also in the general population to maintain appropriate body weight. Here, we report that extreme carbohydrate restriction for one day affects the subsequent blood glucose levels in healthy adults. Ten subjects (median age 30.5 years, BMI 21.1 kg/m 2 , and HbA1c 5.5%), wearing with a continuous glucose monitoring device, were given isoenergetic test meals for 4 consecutive days. On day 1, day 2 (D2), and day 4 (D4), they consumed normal-carbohydrate (63-66% carbohydrate) diet, while on day 3, they took low-carbohydrate/high-fat (5% carbohydrate) diet. The daily energy intake was 2,200 kcal for males and 1,700 kcal for females. On D2 and D4, we calculated the mean 24-hr blood glucose level (MEAN/24h) and its standard deviation (SD/24h), the area under the curve (AUC) for glucose over 140 mg/dL within 4 hours after each meal (AUC/4h/140), the mean amplitude of the glycemic excursions (MAGE), the incremental AUC of 24-hr blood glucose level above the mean plus one standard deviation (iAUC/MEAN+SD). Indexes for glucose fluctuation on D4 were significantly greater than those on D2 (SD/24h; p = 0.009, MAGE; p = 0.013, AUC/4h/140 after breakfast and dinner; p = 0.006 and 0.005, and iAUC/MEAN+SD; p = 0.007). The value of MEAN/24h and AUC/4h/140 after lunch on D4 were greater than those on D2, but those differences were not statistically significant. In conclusion, consumption of low-carbohydrate/high-fat diet appears to cause higher postprandial blood glucose on subsequent normal-carbohydrate diet particularly after breakfast and dinner in healthy adults.

Metal implants on CT: comparison of iterative reconstruction algorithms for reduction of metal artifacts with single energy and spectral CT scanning in a phantom model.

PubMed

Fang, Jieming; Zhang, Da; Wilcox, Carol; Heidinger, Benedikt; Raptopoulos, Vassilios; Brook, Alexander; Brook, Olga R

2017-03-01

To assess single energy metal artifact reduction (SEMAR) and spectral energy metal artifact reduction (MARS) algorithms in reducing artifacts generated by different metal implants. Phantom was scanned with and without SEMAR (Aquilion One, Toshiba) and MARS (Discovery CT750 HD, GE), with various metal implants. Images were evaluated objectively by measuring standard deviation in regions of interests and subjectively by two independent reviewers grading on a scale of 0 (no artifact) to 4 (severe artifact). Reviewers also graded new artifacts introduced by metal artifact reduction algorithms. SEMAR and MARS significantly decreased variability of the density measurement adjacent to the metal implant, with median SD (standard deviation of density measurement) of 52.1 HU without SEMAR, vs. 12.3 HU with SEMAR, p < 0.001. Median SD without MARS of 63.1 HU decreased to 25.9 HU with MARS, p < 0.001. Median SD with SEMAR is significantly lower than median SD with MARS (p = 0.0011). SEMAR improved subjective image quality with reduction in overall artifacts grading from 3.2 ± 0.7 to 1.4 ± 0.9, p < 0.001. Improvement of overall image quality by MARS has not reached statistical significance (3.2 ± 0.6 to 2.6 ± 0.8, p = 0.088). There was a significant introduction of artifacts introduced by metal artifact reduction algorithm for MARS with 2.4 ± 1.0, but minimal with SEMAR 0.4 ± 0.7, p < 0.001. CT iterative reconstruction algorithms with single and spectral energy are both effective in reduction of metal artifacts. Single energy-based algorithm provides better overall image quality than spectral CT-based algorithm. Spectral metal artifact reduction algorithm introduces mild to moderate artifacts in the far field.

Deep versus periventricular white matter lesions and cognitive function in a community sample of middle-aged participants.

PubMed

Soriano-Raya, Juan José; Miralbell, Júlia; López-Cancio, Elena; Bargalló, Núria; Arenillas, Juan Francisco; Barrios, Maite; Cáceres, Cynthia; Toran, Pere; Alzamora, Maite; Dávalos, Antoni; Mataró, Maria

2012-09-01

The association of cerebral white matter lesions (WMLs) with cognitive status is not well understood in middle-aged individuals. Our aim was to determine the specific contribution of periventricular hyperintensities (PVHs) and deep white matter hyperintensities (DWMHs) to cognitive function in a community sample of asymptomatic participants aged 50 to 65 years. One hundred stroke- and dementia-free adults completed a comprehensive neuropsychological battery and brain MRI protocol. Participants were classified according to PVH and DWMH scores (Fazekas scale). We dichotomized our sample into low grade WMLs (participants without or with mild lesions) and high grade WMLs (participants with moderate or severe lesions). Analyses were performed separately in PVH and DWMH groups. High grade DWMHs were associated with significantly lower scores in executive functioning (-0.45 standard deviations [SD]), attention (-0.42 SD), verbal fluency (-0.68 SD), visual memory (-0.52 SD), visuospatial skills (-0.79 SD), and psychomotor speed (-0.46 SD). Further analyses revealed that high grade DWMHs were also associated with a three- to fourfold increased risk of impaired scores (i.e.,<1.5 SD) in executive functioning, verbal fluency, visuospatial skills, and psychomotor speed. Our findings suggest that only DWMHs, not PVHs, are related to diminished cognitive function in middle-aged individuals. (JINS, 2012, 18, 1-12).

Myocardial infarct sizing by late gadolinium-enhanced MRI: Comparison of manual, full-width at half-maximum, and n-standard deviation methods.

PubMed

Zhang, Lin; Huttin, Olivier; Marie, Pierre-Yves; Felblinger, Jacques; Beaumont, Marine; Chillou, Christian DE; Girerd, Nicolas; Mandry, Damien

2016-11-01

To compare three widely used methods for myocardial infarct (MI) sizing on late gadolinium-enhanced (LGE) magnetic resonance (MR) images: manual delineation and two semiautomated techniques (full-width at half-maximum [FWHM] and n-standard deviation [SD]). 3T phase-sensitive inversion-recovery (PSIR) LGE images of 114 patients after an acute MI (2-4 days and 6 months) were analyzed by two independent observers to determine both total and core infarct sizes (TIS/CIS). Manual delineation served as the reference for determination of optimal thresholds for semiautomated methods after thresholding at multiple values. Reproducibility and accuracy were expressed as overall bias ± 95% limits of agreement. Mean infarct sizes by manual methods were 39.0%/24.4% for the acute MI group (TIS/CIS) and 29.7%/17.3% for the chronic MI group. The optimal thresholds (ie, providing the closest mean value to the manual method) were FWHM30% and 3SD for the TIS measurement and FWHM45% and 6SD for the CIS measurement (paired t-test; all P > 0.05). The best reproducibility was obtained using FWHM. For TIS measurement in the acute MI group, intra-/interobserver agreements, from Bland-Altman analysis, with FWHM30%, 3SD, and manual were -0.02 ± 7.74%/-0.74 ± 5.52%, 0.31 ± 9.78%/2.96 ± 16.62% and -2.12 ± 8.86%/0.18 ± 16.12, respectively; in the chronic MI group, the corresponding values were 0.23 ± 3.5%/-2.28 ± 15.06, -0.29 ± 10.46%/3.12 ± 13.06% and 1.68 ± 6.52%/-2.88 ± 9.62%, respectively. A similar trend for reproducibility was obtained for CIS measurement. However, semiautomated methods produced inconsistent results (variabilities of 24-46%) compared to manual delineation. The FWHM technique was the most reproducible method for infarct sizing both in acute and chronic MI. However, both FWHM and n-SD methods showed limited accuracy compared to manual delineation. J. Magn. Reson. Imaging 2016;44:1206-1217. © 2016 International Society for Magnetic Resonance in Medicine.

Free-breathing conformal irradiation of pancreatic cancer.

PubMed

Solla, Ignazio; Zucca, Sergio; Possanzini, Marco; Piras, Sara; Pusceddu, Claudio; Porru, Sergio; Meleddu, Gianfranco; Farace, Paolo

2013-07-08

The purpose of this study was to assess treatment margins in free-breathing irradiation of pancreatic cancer after bone alignment, and evaluate their impact on conformal radiotherapy. Fifteen patients with adenocarcinoma of the head of the pancreas underwent implantation of single fiducial marker. Intrafraction uncertainties were assessed on simulation four-dimensional computed tomography (4D CT) by calculating maximal intrafraction fiducial excursion (MIFE). In the first ten patients, after bony alignment, the position of the fiducial was identified on weekly acquired megavolt cone-beam CT (MV-CBCT). The interfraction residual uncertainties were estimated by measuring the fiducial displacements with respect to the position in the first session. Patient mean (pM) and patient standard deviation (pSD) of fiducial displacement, mean (μM) and standard deviation (μSD) of pM, and root-mean-square of pSD (σ(res)) were calculated. In the other five patients, MIFE was added to the residual component to obtain personalized margin. In these patients, conformal kidney sparing (CONKISS) irradiation was planned prescribing 54/45 Gy to PTV1/PTV2. The organ-at-risk limits were set according to current NCCN recommendation. No morbidity related to the fiducial marker implantation was recorded. In the first ten patients, along right-left, anterior-posterior, and inferior-superior directions, MIFE was variable (mean ± std = 0.24 ± 0.13 cm, 0.31 ± 0.14 cm, 0.83 ± 0.35 cm, respectively) and was at most 0.51, 0.53, and 1.56 cm, respectively. Along the same directions, μM were 0.09, -0.05, -0.05 cm, μSD were 0.30, 0.17, 0.33 cm, and σ(res) were 0.35, 0.26, and 0.30 cm, respectively. MIFE was not correlated with pM and pSD. In the five additional patients, it was possible to satisfy recommended dose limits, with the exception of slightly higher doses to small bowel. After bony alignment, the margins for target expansion can be obtained by adding personalized MIFE to the residual interfraction term. Using these margins, conformal free-breathing irradiation is a reliable option for the treatment of pancreatic cancer.

Free‐breathing conformal irradiation of pancreatic cancer

PubMed Central

Solla, Ignazio; Zucca, Sergio; Possanzini, Marco; Piras, Sara; Pusceddu, Claudio; Porru, Sergio; Meleddu, Gianfranco

2013-01-01

The purpose of this study was to assess treatment margins in free‐breathing irradiation of pancreatic cancer after bone alignment, and evaluate their impact on conformal radiotherapy. Fifteen patients with adenocarcinoma of the head of the pancreas underwent implantation of single fiducial marker. Intrafraction uncertainties were assessed on simulation four‐dimensional computed tomography (4D CT) by calculating maximal intrafraction fiducial excursion (MIFE). In the first ten patients, after bony alignment, the position of the fiducial was identified on weekly acquired megavolt cone‐beam CT (MV‐CBCT). The interfraction residual uncertainties were estimated by measuring the fiducial displacements with respect to the position in the first session. Patient mean (pM) and patient standard deviation (pSD) of fiducial displacement, mean (μM) and standard deviation (μSD) of pM, and root‐mean‐square of pSD (σres) were calculated. In the other five patients, MIFE was added to the residual component to obtain personalized margin. In these patients, conformal kidney sparing (CONKISS) irradiation was planned prescribing 54/45 Gy to PTV1/PTV2. The organ‐at‐risk limits were set according to current NCCN recommendation. No morbidity related to the fiducial marker implantation was recorded. In the first ten patients, along right–left, anterior–posterior, and inferior–superior directions, MIFE was variable (mean±std=0.24±0.13cm,0.31±0.14cm,0.83±0.35cm, respectively) and was at most 0.51, 0.53, and 1.56 cm, respectively. Along the same directions, μM were 0.09,−0.05,−0.05cm,μSD were 0.30, 0.17, 0.33 cm, and σres were 0.35, 0.26, and 0.30 cm, respectively. MIFE was not correlated with pM and pSD. In the five additional patients, it was possible to satisfy recommended dose limits, with the exception of slightly higher doses to small bowel. After bony alignment, the margins for target expansion can be obtained by adding personalized MIFE to the residual interfraction term. Using these margins, conformal free‐breathing irradiation is a reliable option for the treatment of pancreatic cancer. PACS number: 87.55.D‐ PMID:23835380

Effects of extensor synovectomy and excision of the distal ulna in rheumatoid arthritis on long-term function.

PubMed

Jain, Abhilash; Ball, Cathy; Freidin, Andrew J; Nanchahal, Jagdeep

2010-09-01

Objective outcomes data after excision of the distal ulna in rheumatoid arthritis are lacking. The aim of this study was to evaluate the functional results of this surgery in the long term. We prospectively collected data on range of motion (22 wrists), visual analog pain scores (14 wrists), and grip strength measured using a Jamar dynamometer (20 hands) in a group of 23 patients (26 wrists) preoperatively and at 3 months, 12 months, and a minimum of 5 years postoperatively (range, 5.3-10.4 y). The Jebsen-Taylor hand function test was administered to 9 patients at the same time points. A subgroup of patients also underwent extensor carpi radialis longus to extensor carpi ulnaris tendon transfer (11 wrists). At one year, there were improvements in wrist pronation and supination, which were maintained at final follow-up. Active radial deviation decreased significantly at 3 months (p = .01) and one year (p = .02); this remained reduced at final follow-up (not significant). Wrist extension and active ulnar deviation showed slight improvements by one year, but reduced to levels below that measured preoperatively by final follow-up. Wrist flexion was significantly reduced at all time points postoperatively. Grip strength showed improvement from 10.0 kg (standard deviation [SD] 4.1 kg) preoperatively to 12.5 kg (SD 4.6 kg) 1 year after surgery and returned to preoperative levels (9.5 kg, SD 5.6 kg) by final follow-up. Wrist pain was significantly reduced from a mean score of 5 (SD 4) preoperatively to 2 (SD 2) postoperatively (p = .01). The Jebsen-Taylor hand function test showed improvements in writing and card turning. In the long term, excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function. There is a significant (p = .01) reduction in wrist pain but a reduction of wrist flexion. Therapeutic IV. Copyright 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Hypertonic saline in paediatric traumatic brain injury: a review of nine years' experience with 23.4% hypertonic saline as standard hyperosmolar therapy.

PubMed

Piper, B J; Harrigan, P W

2015-03-01

We describe the protocolised use of 23.4% hypertonic saline solution (HTS) for intracranial hypertension in the context of traumatic brain injury in the paediatric population. This study represents the largest published data on the use of 23.4% HTS in the paediatric population. In this retrospective cohort, we focus on the efficacy, biochemical and metabolic consequences of 23.4% HTS administration in a Level 1 paediatric trauma centre. Mortality in the first seven days was 6% (2/32) with a mean intensive care unit length-of-stay of ten days (range 2 to 25, standard deviation [SD] 6). All-cause hospital mortality was 6%, with no deaths after the seven-day study period. Mean intracranial pressure (ICP) response to HTS was 10 mmHg (range 1 to 30, SD 8). For biochemistry data, the mean highest daily serum sodium was 148 mmol/l (139 to 161, SD 6), mean highest serum chloride was 115 mmol/l (range 101 to 132, SD 8) with matched mean serum base excess of -1.5 mmol/l (range 2 to -8, SD 3) and mean peak serum creatinine was 73 mmol/l (range 32 to 104, SD 32). Glasgow outcome scores of >3 (independent function) were achieved in 74% of patients. We describe the use of 23.4% HTS, demonstrating it to be a practical and efficacious method of delivering osmoles and may be advantageous in minimising total fluid volume. Thus, the bolus versus infusion debate may best be served via combining both approaches.

The evaluation of 3 diets for rearing Hyalella azteca and the influence of diet on acute ammonia toxicity.

PubMed

Kennedy, Lisa M; Watson-Leung, Trudy L; Poirier, David G

2016-10-01

Three Hyalella azteca cultures were reared on different diets since birth, reflecting the recommended diets of various investigators. The 3 diets consisted of fish flakes (FF), a mixture of fish flakes supplemented with the diatom Thalassiosira weissflogii (FF-D), and a mixture of fish flakes supplemented with yeast, cereal grass media, and trout chow (FF-YCT). The 3 diets were evaluated by comparing 20 wk of culturing data, along with the organism's response to standard 96-h toxicity testing with ammonium chloride over a range of pH and temperature. Hyalella azteca fed the FF-D diet had the highest overall survival rate (96.6%, standard deviation [SD] 4.3%) compared to those fed the FF diet (92.0%, SD 12.7%), or the FF-YCT diet (91.1%, SD 14.8%), although difference in survival was not statistically significant. Organisms fed the FF-D diet produced a higher number of young per week per adult (6.1, SD 2.8) than the FF diet (5.1, SD 2.2), or the FF-YCT diet (4.0, SD 1.2), although differences were not statistically significant. Of the diets evaluated, H. azteca reared on the FF-D diet were often significantly more resistant to total and un-ionized ammonia toxicity in acute 96-h testing than those reared on the other 2 diets across the 2 temperatures and 5 pHs tested, suggesting this may be the most optimal diet for this species. Environ Toxicol Chem 2016;35:2416-2424. © 2016 SETAC. © 2016 SETAC.

Investigation of the reproducibility and reliability of sagittal vertebral inclination measurements from MR images of the spine.

PubMed

Vrtovec, Tomaž; Pernuš, Franjo; Likar, Boštjan

2014-10-01

In this study, sagittal vertebral inclination (SVI) was systematically evaluated for 28 vertebrae (segments between T4 and L5) in magnetic resonance (MR) images of one normal and one scoliotic subject to compare the performance of manual and computerized measurements, and identify the most reproducible and reliable measurements. Manual measurements were performed by three observers, who identified on two occasions the distinctive anatomical landmarks required to evaluate SVI by six measurement methods, i.e. the superior tangents, inferior tangents, anterior tangents, posterior tangents, mid-endplate lines and mid-wall lines. Computerized measurements were performed by automatically evaluating SVI from the symmetry of vertebral anatomical structures in two-dimensional (2D) sagittal cross-sections and in three-dimensional (3D) volumetric images. The mid-wall lines and posterior tangents proved to be the manual measurements with the lowest intra-observer (standard deviation, SD, of 1.4° and 1.7°, respectively) and inter-observer variability (SD of 1.9° and 2.4°, respectively). The strongest inter-method agreement was found between the mid-wall lines and posterior tangents (SD of 2.0°). Computerized measurements in 2D and in 3D resulted in intra-observer (SD of 2.8° and 3.1°, respectively) and inter-observer variability (SD of 3.8° and 5.2°, respectively) that were comparable to those of the superior tangents (SD of 2.6° and 3.7°) and inferior tangents (SD of 3.2° and 4.5°), which represent standard Cobb angle measurements. It can be concluded that computerized measurements of SVI should be based on the inclination of vertebral body walls. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sci—Fri PM: Topics — 04: What if bystander effects influence cell kill within a target volume? Potential consequences of dose heterogeneity on TCP and EUD on intermediate risk prostate patients

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

Balderson, M.J.; Kirkby, C.; Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta

In vitro evidence has suggested that radiation induced bystander effects may enhance non-local cell killing which may influence radiotherapy treatment planning paradigms. This work applies a bystander effect model, which has been derived from published in vitro data, to calculate equivalent uniform dose (EUD) and tumour control probability (TCP) and compare them with predictions from standard linear quadratic (LQ) models that assume a response due only to local absorbed dose. Comparisons between the models were made under increasing dose heterogeneity scenarios. Dose throughout the CTV was modeled with normal distributions, where the degree of heterogeneity was then dictated by changingmore » the standard deviation (SD). The broad assumptions applied in the bystander effect model are intended to place an upper limit on the extent of the results in a clinical context. The bystander model suggests a moderate degree of dose heterogeneity yields as good or better outcome compared to a uniform dose in terms of EUD and TCP. Intermediate risk prostate prescriptions of 78 Gy over 39 fractions had maximum EUD and TCP values at SD of around 5Gy. The plots only dropped below the uniform dose values for SD ∼ 10 Gy, almost 13% of the prescribed dose. The bystander model demonstrates the potential to deviate from the common local LQ model predictions as dose heterogeneity through a prostate CTV is varies. The results suggest the potential for allowing some degree of dose heterogeneity within a CTV, although further investigations of the assumptions of the bystander model are warranted.« less

Moving standard deviation and moving sum of outliers as quality tools for monitoring analytical precision.

PubMed

Liu, Jiakai; Tan, Chin Hon; Badrick, Tony; Loh, Tze Ping

2018-02-01

An increase in analytical imprecision (expressed as CV a ) can introduce additional variability (i.e. noise) to the patient results, which poses a challenge to the optimal management of patients. Relatively little work has been done to address the need for continuous monitoring of analytical imprecision. Through numerical simulations, we describe the use of moving standard deviation (movSD) and a recently described moving sum of outlier (movSO) patient results as means for detecting increased analytical imprecision, and compare their performances against internal quality control (QC) and the average of normal (AoN) approaches. The power of detecting an increase in CV a is suboptimal under routine internal QC procedures. The AoN technique almost always had the highest average number of patient results affected before error detection (ANPed), indicating that it had generally the worst capability for detecting an increased CV a . On the other hand, the movSD and movSO approaches were able to detect an increased CV a at significantly lower ANPed, particularly for measurands that displayed a relatively small ratio of biological variation to CV a. CONCLUSION: The movSD and movSO approaches are effective in detecting an increase in CV a for high-risk measurands with small biological variation. Their performance is relatively poor when the biological variation is large. However, the clinical risks of an increase in analytical imprecision is attenuated for these measurands as an increased analytical imprecision will only add marginally to the total variation and less likely to impact on the clinical care. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Effects of steam inhalation on voice quality-related acoustic measures.

PubMed

Mahalingam, Shenbagavalli; Boominathan, Prakash

2016-10-01

To investigate the effects of steam inhalation using a facial steamer on voice quality-related acoustic measures. Prospective outcome research: single-blinded experimental study. Forty-five vocally healthy female subjects ranging in age from 18 to 30 years (Mean age: 22.41 years; standard deviation [SD]: 8.91) participated in the study. Phonation samples were recorded under three different conditions in triplicate: baseline recording, immediately after mouth breathing (dehydration), and immediately after 3 minutes of steam inhalation via the mouth (rehydration). In the initial voice recording (prior to dehydration), mean jitter (0.42 %; SD: 0.07), shimmer (2.20 dB; SD: 0.45), and harmonics-to-noise ratio (HNR) (21.60; SD: 2.41) values were within normal limits. After short-term mouth breathing (dehydration, approximately 10 minutes), the mean jitter (1.57 %; SD: 1.82) and shimmer (4.73 dB; SD: 1.83) were significantly increased (P < 0.05), and HNR (18.64; SD: 3.16) was reduced (P < 0.05). After steam inhalation (rehydration) for 3 minutes, mean jitter (0.48 %; SD: 0.12) and shimmer (2.70 dB; SD: 0.71) showed significant decrease (P < 0.05), and HNR (20.10; SD: 3.69) showed significant increase (P < 0.05). All parameters statistically significantly improved from post dehydration values. The simple procedure of steam inhalation using a facial steamer displayed positive effects on parameters proposed to reflect voice quality. 4. Laryngoscope, 126:2305-2309, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Using an established telehealth model to train urban primary care providers on hypertension management.

PubMed

Masi, Christopher; Hamlish, Tamara; Davis, Andrew; Bordenave, Kristine; Brown, Stephen; Perea, Brenda; Aduana, Glen; Wolfe, Marcus; Bakris, George; Johnson, Daniel

2012-01-01

The objective of this study was to determine whether a videoconference-based telehealth network can increase hypertension management knowledge and self-assessed competency among primary care providers (PCPs) working in urban Federally Qualified Health Centers (FQHCs). We created a telehealth network among 6 urban FQHCs and our institution to support a 12-session educational program designed to teach state-of-the-art hypertension management. Each 1-hour session included a brief lecture by a university-based hypertension specialist, case presentations by PCPs, and interactive discussions among the specialist and PCPs. Twelve PCPs (9 intervention and 3 controls) were surveyed at baseline and immediately following the curriculum. The mean number of correct answers on the 26-item hypertension knowledge questionnaire increased in the intervention group (13.11 [standard deviation (SD)]=3.06) to 17.44 [SD=1.59], P<.01) but not among controls (14.33 [SD=3.21] to 13.00 [SD=3.46], P=.06). Similarly, the mean score on a 7-item hypertension management self-assessed competency scale increased in the intervention group (4.68 [SD=0.94] to 5.41 [SD=0.89], P<.01) but not among controls (5.28 [SD=0.43] to 5.62 [SD=0.67], P=.64). This model holds promise for enhancing hypertension care provided by urban FQHC providers. © 2011 Wiley Periodicals, Inc.

Effects of Ammonium Dinitramide in Human Liver Slices: An EPR/Spin Trapping Study.

DTIC Science & Technology

1995-09-01

environmentally safe than AP. EPR/spin trapping studies with the spin trap N-tert-butyl-a-phenyl nitrone (PBN lOmM) for 5 min in the presence of ADN yielded...N-tert-butyl-a-phenyl nitrone PBN 17. SECURITY CLASSIFICATION OF REPORT UNCLASSIFIED 18. SECURITY CLASSIFICATION OF THIS PAGE UNCLASSIFIED... nitrone s second SCN- thiocyanate SD standard deviation Vll INTRODUCTION This is a study of the reactions of free radicals formed when ammonium

Do physiotherapy staff record treatment time accurately? An observational study.

PubMed

Bagley, Pam; Hudson, Mary; Green, John; Forster, Anne; Young, John

2009-09-01

To assess the reliability of duration of treatment time measured by physiotherapy staff in early-stage stroke patients. Comparison of physiotherapy staff's recording of treatment sessions and video recording. Rehabilitation stroke unit in a general hospital. Thirty-nine stroke patients without trunk control or who were unable to stand with an erect trunk without the support of two therapists recruited to a randomized trial evaluating the Oswestry Standing Frame. Twenty-six physiotherapy staff who were involved in patient treatment. Contemporaneous recording by physiotherapy staff of treatment time (in minutes) compared with video recording. Intraclass correlation with 95% confidence interval and the Bland and Altman method for assessing agreement by calculating the mean difference (standard deviation; 95% confidence interval), reliability coefficient and 95% limits of agreement for the differences between the measurements. The mean duration (standard deviation, SD) of treatment time recorded by physiotherapy staff was 32 (11) minutes compared with 25 (9) minutes as evidenced in the video recording. The mean difference (SD) was -6 (9) minutes (95% confidence interval (CI) -9 to -3). The reliability coefficient was 18 minutes and the 95% limits of agreement were -24 to 12 minutes. Intraclass correlation coefficient for agreement between the two methods was 0.50 (95% CI 0.12 to 0.73). Physiotherapy staff's recording of duration of treatment time was not reliable and was systematically greater than the video recording.

Attitude and skill levels of graduate health professionals in performing cardiopulmonary resuscitation

PubMed Central

Gebreegziabher Gebremedhn, Endale; Berhe Gebregergs, Gebremedhn; Anderson, Bernard Bradley; Nagaratnam, Vidhya

2017-01-01

Background Cardiopulmonary resuscitation (CPR) is an emergency procedure used to treat victims following cardiopulmonary arrest. Graduate health professionals at the University of Gondar Teaching Hospital manage many trauma and critically ill patients. The chance of survival after cardiopulmonary arrest may be increased with sufficient attitude and skill levels. The study aimed to assess the attitude and skill levels of graduate health professionals in performing CPR. Methods A hospital-based cross-sectional study was conducted from May 1 to 30, 2013, at the University of Gondar Teaching Hospital. The mean attitude and skill scores were compared for sex, original residence, and department of the participants using Student’s t-test and analysis of variance (Scheffe’s test). P-values <0.05 were considered to be statistically significant. Results Of the 506 graduates, 461 were included in this study with a response rate of 91.1%. The mean attitude scores of nurse, interns, health officer, midwifery, anesthesia, and psychiatric nursing graduates were 1.15 (standard deviation [SD] =1.67), 8.21 (SD =1.24), 7.2 (SD =1.49), 6.69 (SD =1.83), 8.19 (SD =1.77), and 7.29 (SD =2.01), respectively, and the mean skill scores were 2.34 (SD =1.95), 3.77 (SD =1.58), 1.18 (SD =1.52), 2.16 (SD =1.93), 3.88 (SD =1.36), and 1.21 (SD =1.77), respectively. Conclusion and recommendations Attitude and skill level of graduate health professionals with regard to CPR were insufficient. Training on CPR for graduate health professionals needs to be given emphasis. PMID:28123315

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

Levegruen, Sabine, E-mail: sabine.levegruen@uni-due.de; Poettgen, Christoph; Abu Jawad, Jehad

Purpose: To evaluate megavoltage computed tomography (MVCT)-based image guidance with helical tomotherapy in patients with vertebral tumors by analyzing factors influencing interobserver variability, considered as quality criterion of image guidance. Methods and Materials: Five radiation oncologists retrospectively registered 103 MVCTs in 10 patients to planning kilovoltage CTs by rigid transformations in 4 df. Interobserver variabilities were quantified using the standard deviations (SDs) of the distributions of the correction vector components about the observers' fraction mean. To assess intraobserver variabilities, registrations were repeated after {>=}4 weeks. Residual deviations after setup correction due to uncorrectable rotational errors and elastic deformations were determinedmore » at 3 craniocaudal target positions. To differentiate observer-related variations in minimizing these residual deviations across the 3-dimensional MVCT from image resolution effects, 2-dimensional registrations were performed in 30 single transverse and sagittal MVCT slices. Axial and longitudinal MVCT image resolutions were quantified. For comparison, image resolution of kilovoltage cone-beam CTs (CBCTs) and interobserver variability in registrations of 43 CBCTs were determined. Results: Axial MVCT image resolution is 3.9 lp/cm. Longitudinal MVCT resolution amounts to 6.3 mm, assessed as full-width at half-maximum of thin objects in MVCTs with finest pitch. Longitudinal CBCT resolution is better (full-width at half-maximum, 2.5 mm for CBCTs with 1-mm slices). In MVCT registrations, interobserver variability in the craniocaudal direction (SD 1.23 mm) is significantly larger than in the lateral and ventrodorsal directions (SD 0.84 and 0.91 mm, respectively) and significantly larger compared with CBCT alignments (SD 1.04 mm). Intraobserver variabilities are significantly smaller than corresponding interobserver variabilities (variance ratio [VR] 1.8-3.1). Compared with 3-dimensional registrations, 2-dimensional registrations have significantly smaller interobserver variability in the lateral and ventrodorsal directions (VR 3.8 and 2.8, respectively) but not in the craniocaudal direction (VR 0.75). Conclusion: Tomotherapy image guidance precision is affected by image resolution and residual deviations after setup correction. Eliminating the effect of residual deviations yields small interobserver variabilities with submillimeter precision in the axial plane. In contrast, interobserver variability in the craniocaudal direction is dominated by the poorer longitudinal MVCT image resolution. Residual deviations after image guidance exist and need to be considered when dose gradients ultimately achievable with image guided radiation therapy techniques are analyzed.« less

Megavoltage computed tomography image guidance with helical tomotherapy in patients with vertebral tumors: analysis of factors influencing interobserver variability.

PubMed

Levegrün, Sabine; Pöttgen, Christoph; Jawad, Jehad Abu; Berkovic, Katharina; Hepp, Rodrigo; Stuschke, Martin

2013-02-01

To evaluate megavoltage computed tomography (MVCT)-based image guidance with helical tomotherapy in patients with vertebral tumors by analyzing factors influencing interobserver variability, considered as quality criterion of image guidance. Five radiation oncologists retrospectively registered 103 MVCTs in 10 patients to planning kilovoltage CTs by rigid transformations in 4 df. Interobserver variabilities were quantified using the standard deviations (SDs) of the distributions of the correction vector components about the observers' fraction mean. To assess intraobserver variabilities, registrations were repeated after ≥4 weeks. Residual deviations after setup correction due to uncorrectable rotational errors and elastic deformations were determined at 3 craniocaudal target positions. To differentiate observer-related variations in minimizing these residual deviations across the 3-dimensional MVCT from image resolution effects, 2-dimensional registrations were performed in 30 single transverse and sagittal MVCT slices. Axial and longitudinal MVCT image resolutions were quantified. For comparison, image resolution of kilovoltage cone-beam CTs (CBCTs) and interobserver variability in registrations of 43 CBCTs were determined. Axial MVCT image resolution is 3.9 lp/cm. Longitudinal MVCT resolution amounts to 6.3 mm, assessed as full-width at half-maximum of thin objects in MVCTs with finest pitch. Longitudinal CBCT resolution is better (full-width at half-maximum, 2.5 mm for CBCTs with 1-mm slices). In MVCT registrations, interobserver variability in the craniocaudal direction (SD 1.23 mm) is significantly larger than in the lateral and ventrodorsal directions (SD 0.84 and 0.91 mm, respectively) and significantly larger compared with CBCT alignments (SD 1.04 mm). Intraobserver variabilities are significantly smaller than corresponding interobserver variabilities (variance ratio [VR] 1.8-3.1). Compared with 3-dimensional registrations, 2-dimensional registrations have significantly smaller interobserver variability in the lateral and ventrodorsal directions (VR 3.8 and 2.8, respectively) but not in the craniocaudal direction (VR 0.75). Tomotherapy image guidance precision is affected by image resolution and residual deviations after setup correction. Eliminating the effect of residual deviations yields small interobserver variabilities with submillimeter precision in the axial plane. In contrast, interobserver variability in the craniocaudal direction is dominated by the poorer longitudinal MVCT image resolution. Residual deviations after image guidance exist and need to be considered when dose gradients ultimately achievable with image guided radiation therapy techniques are analyzed. Copyright © 2013 Elsevier Inc. All rights reserved.

Memory training interventions for older adults: a meta-analysis.

PubMed

Gross, Alden L; Parisi, Jeanine M; Spira, Adam P; Kueider, Alexandra M; Ko, Jean Y; Saczynski, Jane S; Samus, Quincy M; Rebok, George W

2012-01-01

A systematic review and meta-analysis of memory training research was conducted to characterize the effect of memory strategies on memory performance among cognitively intact, community-dwelling older adults, and to identify characteristics of individuals and of programs associated with improved memory. The review identified 402 publications, of which 35 studies met criteria for inclusion. The overall effect size estimate, representing the mean standardized difference in pre-post change between memory-trained and control groups, was 0.31 standard deviations (SD; 95% confidence interval (CI): 0.22, 0.39). The pre-post training effect for memory-trained interventions was 0.43 SD (95% CI: 0.29, 0.57) and the practice effect for control groups was 0.06 SD (95% CI: 0.05, 0.16). Among 10 distinct memory strategies identified in studies, meta-analytic methods revealed that training multiple strategies was associated with larger training gains (p=0.04), although this association did not reach statistical significance after adjusting for multiple comparisons. Treatment gains among memory-trained individuals were not better after training in any particular strategy, or by the average age of participants, session length, or type of control condition. These findings can inform the design of future memory training programs for older adults.

Problems with Using the Normal Distribution – and Ways to Improve Quality and Efficiency of Data Analysis

PubMed Central

Limpert, Eckhard; Stahel, Werner A.

2011-01-01

Background The Gaussian or normal distribution is the most established model to characterize quantitative variation of original data. Accordingly, data are summarized using the arithmetic mean and the standard deviation, by ± SD, or with the standard error of the mean, ± SEM. This, together with corresponding bars in graphical displays has become the standard to characterize variation. Methodology/Principal Findings Here we question the adequacy of this characterization, and of the model. The published literature provides numerous examples for which such descriptions appear inappropriate because, based on the “95% range check”, their distributions are obviously skewed. In these cases, the symmetric characterization is a poor description and may trigger wrong conclusions. To solve the problem, it is enlightening to regard causes of variation. Multiplicative causes are by far more important than additive ones, in general, and benefit from a multiplicative (or log-) normal approach. Fortunately, quite similar to the normal, the log-normal distribution can now be handled easily and characterized at the level of the original data with the help of both, a new sign, x/, times-divide, and notation. Analogous to ± SD, it connects the multiplicative (or geometric) mean * and the multiplicative standard deviation s* in the form * x/s*, that is advantageous and recommended. Conclusions/Significance The corresponding shift from the symmetric to the asymmetric view will substantially increase both, recognition of data distributions, and interpretation quality. It will allow for savings in sample size that can be considerable. Moreover, this is in line with ethical responsibility. Adequate models will improve concepts and theories, and provide deeper insight into science and life. PMID:21779325

Problems with using the normal distribution--and ways to improve quality and efficiency of data analysis.

PubMed

Limpert, Eckhard; Stahel, Werner A

2011-01-01

The gaussian or normal distribution is the most established model to characterize quantitative variation of original data. Accordingly, data are summarized using the arithmetic mean and the standard deviation, by mean ± SD, or with the standard error of the mean, mean ± SEM. This, together with corresponding bars in graphical displays has become the standard to characterize variation. Here we question the adequacy of this characterization, and of the model. The published literature provides numerous examples for which such descriptions appear inappropriate because, based on the "95% range check", their distributions are obviously skewed. In these cases, the symmetric characterization is a poor description and may trigger wrong conclusions. To solve the problem, it is enlightening to regard causes of variation. Multiplicative causes are by far more important than additive ones, in general, and benefit from a multiplicative (or log-) normal approach. Fortunately, quite similar to the normal, the log-normal distribution can now be handled easily and characterized at the level of the original data with the help of both, a new sign, x/, times-divide, and notation. Analogous to mean ± SD, it connects the multiplicative (or geometric) mean mean * and the multiplicative standard deviation s* in the form mean * x/s*, that is advantageous and recommended. The corresponding shift from the symmetric to the asymmetric view will substantially increase both, recognition of data distributions, and interpretation quality. It will allow for savings in sample size that can be considerable. Moreover, this is in line with ethical responsibility. Adequate models will improve concepts and theories, and provide deeper insight into science and life.

Breakdown in the temporal and spatial organization of spontaneous brain activity during general anesthesia.

PubMed

Zhang, Jianfeng; Huang, Zirui; Chen, Yali; Zhang, Jun; Ghinda, Diana; Nikolova, Yuliya; Wu, Jinsong; Xu, Jianghui; Bai, Wenjie; Mao, Ying; Yang, Zhong; Duncan, Niall; Qin, Pengmin; Wang, Hao; Chen, Bing; Weng, Xuchu; Northoff, Georg

2018-05-01

Which temporal features that can characterize different brain states (i.e., consciousness or unconsciousness) is a fundamental question in the neuroscience of consciousness. Using resting-state functional magnetic resonance imaging (rs-fMRI), we investigated the spatial patterns of two temporal features: the long-range temporal correlations (LRTCs), measured by power-law exponent (PLE), and temporal variability, measured by standard deviation (SD) during wakefulness and anesthetic-induced unconsciousness. We found that both PLE and SD showed global reductions across the whole brain during anesthetic state comparing to wakefulness. Importantly, the relationship between PLE and SD was altered in anesthetic state, in terms of a spatial "decoupling." This decoupling was mainly driven by a spatial pattern alteration of the PLE, rather than the SD, in the anesthetic state. Our results suggest differential physiological grounds of PLE and SD and highlight the functional importance of the topographical organization of LRTCs in maintaining an optimal spatiotemporal configuration of the neural dynamics during normal level of consciousness. The central role of the spatial distribution of LRTCs, reflecting temporo-spatial nestedness, may support the recently introduced temporo-spatial theory of consciousness (TTC). © 2018 Wiley Periodicals, Inc.

Burden of salmonellosis, campylobacteriosis and listeriosis: a time series analysis, Belgium, 2012 to 2020

PubMed Central

Maertens de Noordhout, Charline; Devleesschauwer, Brecht; Haagsma, Juanita A; Havelaar, Arie H; Bertrand, Sophie; Vandenberg, Olivier; Quoilin, Sophie; Brandt, Patrick T; Speybroeck, Niko

2017-01-01

Salmonellosis, campylobacteriosis and listeriosis are food-borne diseases. We estimated and forecasted the number of cases of these three diseases in Belgium from 2012 to 2020, and calculated the corresponding number of disability-adjusted life years (DALYs). The salmonellosis time series was fitted with a Bai and Perron two-breakpoint model, while a dynamic linear model was used for campylobacteriosis and a Poisson autoregressive model for listeriosis. The average monthly number of cases of salmonellosis was 264 (standard deviation (SD): 86) in 2012 and predicted to be 212 (SD: 87) in 2020; campylobacteriosis case numbers were 633 (SD: 81) and 1,081 (SD: 311); listeriosis case numbers were 5 (SD: 2) in 2012 and 6 (SD: 3) in 2014. After applying correction factors, the estimated DALYs for salmonellosis were 102 (95% uncertainty interval (UI): 8–376) in 2012 and predicted to be 82 (95% UI: 6–310) in 2020; campylobacteriosis DALYs were 1,019 (95% UI: 137–3,181) and 1,736 (95% UI: 178–5,874); listeriosis DALYs were 208 (95% UI: 192–226) in 2012 and 252 (95% UI: 200–307) in 2014. New actions are needed to reduce the risk of food-borne infection with Campylobacter spp. because campylobacteriosis incidence may almost double through 2020. PMID:28935025

The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency.

PubMed

Sim, Julius; Lewis, Martyn

2012-03-01

To investigate methods to determine the size of a pilot study to inform a power calculation for a randomized controlled trial (RCT) using an interval/ratio outcome measure. Calculations based on confidence intervals (CIs) for the sample standard deviation (SD). Based on CIs for the sample SD, methods are demonstrated whereby (1) the observed SD can be adjusted to secure the desired level of statistical power in the main study with a specified level of confidence; (2) the sample for the main study, if calculated using the observed SD, can be adjusted, again to obtain the desired level of statistical power in the main study; (3) the power of the main study can be calculated for the situation in which the SD in the pilot study proves to be an underestimate of the true SD; and (4) an "efficient" pilot size can be determined to minimize the combined size of the pilot and main RCT. Trialists should calculate the appropriate size of a pilot study, just as they should the size of the main RCT, taking into account the twin needs to demonstrate efficiency in terms of recruitment and to produce precise estimates of treatment effect. Copyright © 2012 Elsevier Inc. All rights reserved.

Burden of salmonellosis, campylobacteriosis and listeriosis: a time series analysis, Belgium, 2012 to 2020.

PubMed

Maertens de Noordhout, Charline; Devleesschauwer, Brecht; Haagsma, Juanita A; Havelaar, Arie H; Bertrand, Sophie; Vandenberg, Olivier; Quoilin, Sophie; Brandt, Patrick T; Speybroeck, Niko

2017-09-21

Salmonellosis, campylobacteriosis and listeriosis are food-borne diseases. We estimated and forecasted the number of cases of these three diseases in Belgium from 2012 to 2020, and calculated the corresponding number of disability-adjusted life years (DALYs). The salmonellosis time series was fitted with a Bai and Perron two-breakpoint model, while a dynamic linear model was used for campylobacteriosis and a Poisson autoregressive model for listeriosis. The average monthly number of cases of salmonellosis was 264 (standard deviation (SD): 86) in 2012 and predicted to be 212 (SD: 87) in 2020; campylobacteriosis case numbers were 633 (SD: 81) and 1,081 (SD: 311); listeriosis case numbers were 5 (SD: 2) in 2012 and 6 (SD: 3) in 2014. After applying correction factors, the estimated DALYs for salmonellosis were 102 (95% uncertainty interval (UI): 8-376) in 2012 and predicted to be 82 (95% UI: 6-310) in 2020; campylobacteriosis DALYs were 1,019 (95% UI: 137-3,181) and 1,736 (95% UI: 178-5,874); listeriosis DALYs were 208 (95% UI: 192-226) in 2012 and 252 (95% UI: 200-307) in 2014. New actions are needed to reduce the risk of food-borne infection with Campylobacter spp. because campylobacteriosis incidence may almost double through 2020. This article is copyright of The Authors, 2017.

Effects of push-off ability and handcycle type on handcycling performance in able-bodied participants.

PubMed

Kouwijzer, Ingrid; Nooijen, Carla F J; Breukelen, Kees van; Janssen, Thomas W J; de Groot, Sonja

2018-05-14

To assess the effects on handcycling performance and physiological responses, of: (i) making a closed chain by comparing handcycling in a recumbent bike with 2-feet footrest (closed chain) with handcycling with 1 footrest (partial closed chain) and without a footrest (no closed chain); (ii) equipment by comparing handcycling in a recumbent bike with a kneeling bike. Ten able-bodied participants performed submaximal exercise and sprint tests, once in a knee-ling bike and 3 times on a recumbent: 2-feet support, 1-foot support and without foot support. Physical strain (submaximal oxygen uptake and heart rate), peak (POpeak) and mean power output (POmean) were measured. Significantly higher POpeak and POmean were found with 2-feet support (mean 415 W (standard deviation (SD) 163) and mean 281 W (SD 96)) and higher POmean with 1-foot support (mean 279 W (SD 104)) compared with no foot support (mean 332 W (SD 127) and mean 254 W (SD 101)), p < 0.05. No differences were found for physical strain. In the kneeling bike, POpeak and POmean were significantly higher (mean 628 W (SD 231) and 391 W (SD 121)) than in the recumbent (mean 415 W (SD 163) and 281 W (SD 96)), p = 0.001. The ability to make a closed chain has a significant positive effect on handcycling sprint performance; therefore, this ability may be a discriminating factor. Sprint performance was significantly higher in kneeling compared with recumbent handcycling.

Impact of sleep deprivation and obstructive sleep apnea syndrome on daytime vigilance and driving performance: a laboratory perspective.

PubMed

Pizza, F; Contardi, S; Mondini, S; Cirignotta, F

2012-01-01

To study the impact of sleepiness, a well-established cause of car accidents, on driving ability, we designed a 30-min monotonous simulated driving task. Our simulated driving task encompasses both primary vehicle control (standard deviation of lane position, crash occurrence) and secondary tasks (type and reaction times to divided attention tasks). Driving simulator data were correlated to subjective (state/trait) and objective (MSLT/MWT) sleepiness measures in healthy subjects undergoing sleep deprivation (SD) and in obstructive sleep apnea (OSAS) patients. SD induced severe sleepiness during nighttime, when state sleepiness increased while primary vehicle control ability worsened. After SD, driving ability decreased and was inversely correlated to subjective and objective sleepiness at MSLT. OSAS patients driving ability was well correlated to objective sleepiness, with inverse correlation to sleep propensity at the MSLT and even more strict relation with the ability to maintain wakefulness at the MWT. Sleepiness worsens driving ability in healthy subjects after SD and in OSAS patients. Driving ability correlates with subjective and objective sleepiness measures, in particular to the ability to maintain wakefulness.

Brain networks governing the golf swing in professional golfers.

PubMed

Kim, Jin Hyun; Han, Joung Kyue; Kim, Bung-Nyun; Han, Doug Hyun

2015-01-01

Golf, as with most complex motor skills, requires multiple different brain functions, including attention, motor planning, coordination, calculation of timing, and emotional control. In this study we assessed the correlation between swing components and brain connectivity from the cerebellum to the cerebrum. Ten female golf players and 10 age-matched female controls were recruited. In order to determine swing consistency among participants, the standard deviation (SD) of the mean swing speed time and the SD of the mean swing angle were assessed over 30 swings. Functional brain connectivity was assessed by resting state functional MRI. Pro-golfers showed greater positive left cerebellum connectivity to the occipital lobe, temporal lobe, parietal lobe and both frontal lobes compared to controls. The SD of play scores was positively correlated with the SD of the impact angle. Constant swing speed and back swing angle in professional golfers were associated with functional connectivity (FC) between the cerebellum and parietal and frontal lobes. In addition, the constant impact angle in professional golfers was associated with improved golf scores and additional FC of the thalamus.

Evaluation of USEPA method 1622 for detection of Cryptosporidium oocysts in stream waters

USGS Publications Warehouse

Simmons, O. D.; Sobsey, M.D.; Schaefer, F. W.; Francy, D.S.; Nally, R.A.; Heaney, C.D.

2001-01-01

To improve surveillance for Cryptosporidium oocysts in water, the US Environmental Protection Agency developed method 1622, which consists of filtration, concentration, immunomagnetic separation, fluorescent antibody and 4, 6-diamidino-2-phenylindole (DAPI) counter-staining, and microscopic evaluation. Two filters were compared for analysis of 11 stream water samples collected throughout the United States. Replicate 10-L stream water samples (unspiked and spiked with 100-250 oocysts) were tested to evaluate matrix effects. Oocyst recoveries from the stream water samples averaged 22% (standard deviation [SD] = ??17%) with a membrane disk and 12% (SD = ??6%) with a capsule filter. Oocyst recoveries from reagent water precision and recovery samples averaged 39% (SD = ??13%) with a membrane disk and 47% (SD = ??19%) with a capsule filter. These results demonstrate that Cryptosporidium oocysts can be recovered from stream waters using method 1622, but recoveries are lower than those from reagent-grade water. This research also evaluated concentrations of indicator bacteria in the stream water samples. Because few samples were oocyst-positive, relationships between detections of oocysts and concentrations of indicator organisms could not be determined.

Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12).

PubMed

Selim, Alfredo J; Rogers, William; Fleishman, John A; Qian, Shirley X; Fincke, Benjamin G; Rothendler, James A; Kazis, Lewis E

2009-02-01

The purpose of this project was to develop an updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). We used a well-defined and nationally representative sample of the U.S. population from 52,425 responses to the Medical Expenditure Panel Survey (MEPS) collected between 2000 and 2002. We applied modified regression estimates to update the non-proprietary 1990 scoring algorithms. We applied the updated standard to the Medicare Health Outcomes Survey (HOS) to compute the VR-12 physical (PCS((MEPS standard))) and mental (MCS((MEPS standard))) component summaries based on the MEPS. We compared these scores to PCS and MCS based on the 1990 U.S. population standard. Using the updated U.S. population standard, the average VR-12 PCS((MEPS standard)) and MCS((MEPS standard)) scores in the Medicare HOS were 39.82 (standard deviation [SD] = 12.2) and 50.08 (SD = 11.4), respectively. For the same Medicare HOS, the average PCS and MCS scores based on the 1990 standard were 1.40 points higher and 0.99 points lower in comparison to VR-12 PCS and MCS, respectively. Changes in the U.S. population between 1990 and today make the old standard obsolete for the VR-12, so the updated standard developed here is widely available to serve as such a contemporary standard for future applications for health-related quality of life (HRQoL) assessments.

Use of the Teager-Kaiser Energy Operator for Muscle Activity Detection in Children

PubMed Central

Lauer, Richard T.; Prosser, Laura A.

2009-01-01

The purpose of this study was to demonstrate the usefulness of the Teager-Kaiser Energy (TKE) operator to assess surface electromyographic (sEMG) activity from the hip and trunk muscles during pediatric gait in children with and without cerebral palsy (CP). Muscle activity was recorded from the trapezius, erector spinae, rectus abdominus, external oblique, gluteus maximus and medius, rectus femoris, and semitendinosus bilaterally in ten children with typical development (TD) and five children with CP ages 44.4 ± 18.6 months. Duration of muscle activity was calculated as a percentage of the gait cycle, and compared to two common onset detection methods, a standard deviation (SD) amplitude threshold method, and the visual inspection from two raters (R1, R2). Relative and absolute agreement was determined using intraclass correlation coefficients (ICCs) and Bland-Altman plots. Of the two automated methods, the TKE method demonstrated better agreement with visual inspection (0.45–0.89) than the SD (0.11–0.76) method. The Bland-Altman plots indicated a smaller bias and 95% confidence interval for the TKE method in comparison to the raters (TKE to R1: −5, 113%; TKE to R2: 4, 95%; SD to R1: −24, 170%; SD to R2: −15, 151%). The use of the TKE operator may better detect sEMG activity in children than the standard amplitude method. PMID:19484385

Toward a microfluidic-based rapid amylase assay system.

PubMed

Holmes, Richard J; Summersgil, Philip; Ryan, Timothy; Brown, Bernard J Treves; Mockbil, Amal; Grieve, Bruce D; Fielden, Peter R

2009-08-01

This article describes work into a prototype system for the assay of amylase, using microfludic technologies. The new system has a significantly shorter cycle time than the current laboratory methods, which generally use microtitre plates, yet is capable of generating significantly superior results. As such, we have shown that sensitivity is enhanced by a factor of 10 in the standard assay trials, and by a factor of 2 in the real-sample lab trials. In both assays, the use of a microreactor system reduced the reaction time by a factor of 6.2, from 20 min incubation to 3.2 min. Basing the conclusion on the Megazyme Cerealpha Standard Method, and using the Cerealpha units as a measure of assay efficiency, the typical response for the microfluidic assay was shown to be 1.0 x 10(-3) CU/mL (standard deviation [SD] 2.5 x 10(-4) CU/mL), compared to 2.56 x 10(-4) CU/mL (SD 5.94 x 10(-5) CU/mL) for the standard macroassay. It is believed that this improvement in the reaction schematics is due to the inherent advantages of microfluidic devices such as superior mixing, higher thermal efficiency, and enhanced reaction kinetics.

Progressive decline of decision-making performances during multiple sclerosis.

PubMed

Simioni, Samanta; Ruffieux, Christiane; Kleeberg, Joerg; Bruggimann, Laure; du Pasquier, Renaud A; Annoni, Jean-Marie; Schluep, Myriam

2009-03-01

The purpose of this study was to evaluate longitudinally, using the Iowa Gambling Task (IGT), the dynamics of decision-making capacity at a two-year interval (median: 2.1 years) in a group of patients with multiple sclerosis (MS) (n = 70) and minor neurological disability [Expanded Disability Status Scale (EDSS) < or = 2.5 at baseline]. Cognition (memory, executive functions, attention), behavior, handicap, and perceived health status were also investigated. Standardized change scores [(score at retest-score at baseline)/standard deviation of baseline score] were computed. Results showed that IGT performances decreased from baseline to retest (from 0.3, SD = 0.4 to 0.1, SD = 0.3, p = .005). MS patients who worsened in the IGT were more likely to show a decreased perceived health status and emotional well-being (SEP-59; p = .05 for both). Relapsing rate, disability progression, cognitive, and behavioral changes were not associated with decreased IGT performances. In conclusion, decline in decision making can appear as an isolated deficit in MS.

Trends in New U.S. Marine Corps Accessions During the Recent Conflicts in Iraq and Afghanistan

DTIC Science & Technology

2014-01-01

modest changes over the study period. Favorable trends included recent (2009-2010) improvernents in body mass index and physical activity levels...height, body mass index (BMI) in kg/m^ was calculated. Frequency of physical activity before service entry was assessed from self-report. Initial run...Test; BMI, body mass index; mph, miles per hour; SD, standard deviation. "Numbers (n) may not add up to 131,961 because of missing self-reported data for

68Ga Bombesin PET/MRI in Patients with Biochemically Recurrent Prostate Cancer and Noncontributory Conventional Imaging

DTIC Science & Technology

2017-10-01

REPORT DATE: October 2017 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702...AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 11. SPONSOR...prostate cancer (PCa). Methods : We enrolled 15 men with biochemically recurrent PCa from May to Sep 2017, 63-79 year-old (mean±standard deviation (SD

Visual field changes after cataract extraction: the AGIS experience.

PubMed

Koucheki, Behrooz; Nouri-Mahdavi, Kouros; Patel, Gitane; Gaasterland, Douglas; Caprioli, Joseph

2004-12-01

To test the hypothesis that cataract extraction in glaucomatous eyes improves overall sensitivity of visual function without affecting the size or depth of glaucomatous scotomas. Experimental study with no control group. One hundred fifty-eight eyes (of 140 patients) from the Advanced Glaucoma Intervention Study with at least two reliable visual fields within a year both before and after cataract surgery were included. Average mean deviation (MD), pattern standard deviation (PSD), and corrected pattern standard deviation (CPSD) were compared before and after cataract extraction. To evaluate changes in scotoma size, the number of abnormal points (P < .05) on the pattern deviation plot was compared before and after surgery. We described an index ("scotoma depth index") to investigate changes of scotoma depth after surgery. Mean values for MD, PSD, and CPSD were -13.2, 6.4, and 5.9 dB before and -11.9, 6.8, and 6.2 dB after cataract surgery (P < or = .001 for all comparisons). Mean (+/- SD) number of abnormal points on pattern deviation plot was 26.7 +/- 9.4 and 27.5 +/- 9.0 before and after cataract surgery, respectively (P = .02). Scotoma depth index did not change after cataract extraction (-19.3 vs -19.2 dB, P = .90). Cataract extraction caused generalized improvement of the visual field, which was most marked in eyes with less advanced glaucomatous damage. Although the enlargement of scotomas was statistically significant, it was not clinically meaningful. No improvement of sensitivity was observed in the deepest part of the scotomas.

Temporal and bi-directional associations between sleep duration and physical activity/sedentary time in children: An international comparison.

PubMed

Lin, Yingyi; Tremblay, Mark S; Katzmarzyk, Peter T; Fogelholm, Mikael; Hu, Gang; Lambert, Estelle V; Maher, Carol; Maia, Jose; Olds, Timothy; Sarmiento, Olga L; Standage, Martyn; Tudor-Locke, Catrine; Chaput, Jean-Philippe

2018-06-01

The purpose of this multinational and cross-sectional study was to investigate whether nighttime sleep duration was associated with physical activity (PA) and sedentary time (SED) the following day, whether daytime PA/SED were associated with sleep duration the subsequent night, and whether the associations were modified by sex and study sites. Data from 5779 children aged 9-11years were analyzed. A waist-worn Actigraph GT3X+ accelerometer was used to assess children's 24-h movement behaviours for 7days, i.e. sleep duration, total SED, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA). Multilevel linear regression models were used to account for the repeated measures nested within participants (there were up to 7 sleep→PA/SED and PA/SED→sleep pairings per participant) and schools, and adjusted for covariates. To facilitate interpretation, all sleep and PA/SED variables were standardized. Results showed that the relationship between sleep and PA/SED is bi-directional in this international sample of children. Specifically, for each one standard deviation (SD) unit increase in sleep duration, SED the following day decreased by 0.04 SD units, while LPA and MVPA increased by 0.04 and 0.02 SD units, respectively. Sleep duration decreased by 0.02 SD units and increased by 0.04 SD units for each one SD unit increase in SED and MVPA, respectively. Sleep duration was not affected by changes in LPA. These associations differed across sex and study sites in both directions. However, since the observed effect sizes are subtle, public health initiatives should consider the clinical and practical relevance of these findings. Copyright © 2017 Elsevier Inc. All rights reserved.

Performance of non-neurological older adults on the Wisconsin Card Sorting Test and the Stroop Color-Word Test: normal variability or cognitive impairment?

PubMed

Gunner, Jessica H; Miele, Andrea S; Lynch, Julie K; McCaffrey, Robert J

2012-06-01

There is currently no standard criterion for determining abnormal test scores in neuropsychology; thus, a number of different criteria are commonly used. We investigated base rates of abnormal scores in healthy older adults using raw and T-scores from indices of the Wisconsin Card Sorting Test and Stroop Color-Word Test. Abnormal scores were examined cumulatively at seven cutoffs including >1.0, >1.5, >2.0, >2.5, and >3.0 standard deviations (SD) from the mean as well as those below the 10th and 5th percentiles. In addition, the number of abnormal scores at each of the seven cutoffs was also examined. Results showed when considering raw scores, ∼15% of individuals obtained scores>1.0 SD from the mean, around 10% were less than the 10th percentile, and 5% fell >1.5 SD or <5th percentile from the mean. Using T-scores, approximately 15%-20% and 5%-10% of scores were >1.0 and >1.5 SD from the mean, respectively. Roughly 15% and 5% fell at the <10th and <5th percentiles, respectively. Both raw and T-scores>2.0 SD from the mean were infrequent. Although the presence of a single abnormal score at 1.0 and 1.5 SD from the mean or at the 10th and 5th percentiles was not unusual, the presence of ≥2 abnormal scores using any criteria was uncommon. Consideration of base rate data regarding the percentage of healthy individuals scoring in the abnormal range should help avoid classifying normal variability as neuropsychological impairment.

Evaluation of nuclear chromatin using grayscale intensity and thresholded percentage area in liquid-based cervical cytology.

PubMed

Lee, Hyekyung; Han, Myungein; Yoo, Taejo; Jung, Chanho; Son, Hyun-Jin; Cho, Migyung

2018-05-01

Development of computerized image analysis techniques has opened up the possibility for the quantitative analysis of nuclear chromatin in pathology. We hypothesized that the features extracted from digital images could be used to determine specific cytomorphological findings for nuclear chromatin that may be applicable for establishing a medical diagnosis. Three parameters were evaluated from nuclear chromatin images obtained from the liquid-based cervical cytology samples of patients with biopsy-proven high-grade squamous intraepithelial lesion (HGSIL), and compared between non-neoplastic squamous epithelia and dysplastic epithelia groups: (1) standard deviation (SD) of the grayscale intensity; (2) difference between the maximum and minimum grayscale intensity (M-M); and (3) thresholded area percentage. Each parameter was evaluated at the mean, mean-1SD, and mean-2SD thresholding intensity levels. Between the mean and mean-1SD levels, the thresholded nuclear chromatin pattern was most similar to the chromatin granularity of the unthresholded grayscale images. The SD of the gray intensity and the thresholded area percentage differed significantly between the non-neoplastic squamous epithelia and dysplastic epithelia of HGSIL images at all three thresholding intensity levels (mean, mean-1SD, and mean-2SD). However, the M-M significantly differed between the two sample types for only two of the thresholding intensity levels (mean-1SD and mean-2SD). The digital parameters SD and M-M of the grayscale intensity, along with the thresholded area percentage could be useful in automated cytological evaluations. Further studies are needed to identify more valuable parameters for clinical application. © 2018 Wiley Periodicals, Inc.

Patient-specific positioning guides for total knee arthroplasty: no significant difference between final component alignment and pre-operative digital plan except for tibial rotation.

PubMed

Boonen, Bert; Schotanus, Martijn G M; Kerens, Bart; Hulsmans, Frans-Jan; Tuinebreijer, Wim E; Kort, Nanne P

2017-09-01

To assess whether there is a significant difference between the alignment of the individual femoral and tibial components (in the frontal, sagittal and horizontal planes) as calculated pre-operatively (digital plan) and the actually achieved alignment in vivo obtained with the use of patient-specific positioning guides (PSPGs) for TKA. It was hypothesised that there would be no difference between post-op implant position and pre-op digital plan. Twenty-six patients were included in this non-inferiority trial. Software permitted matching of the pre-operative MRI scan (and therefore calculated prosthesis position) to a pre-operative CT scan and then to a post-operative full-leg CT scan to determine deviations from pre-op planning in all three anatomical planes. For the femoral component, mean absolute deviations from planning were 1.8° (SD 1.3), 2.5° (SD 1.6) and 1.6° (SD 1.4) in the frontal, sagittal and transverse planes, respectively. For the tibial component, mean absolute deviations from planning were 1.7° (SD 1.2), 1.7° (SD 1.5) and 3.2° (SD 3.6) in the frontal, sagittal and transverse planes, respectively. Absolute mean deviation from planned mechanical axis was 1.9°. The a priori specified null hypothesis for equivalence testing: the difference from planning is >3 or <-3 was rejected for all comparisons except for the tibial transverse plane. PSPG was able to adequately reproduce the pre-op plan in all planes, except for the tibial rotation in the transverse plane. Possible explanations for outliers are discussed and highlight the importance for adequate training surgeons before they start using PSPG in their day-by-day practise. Prospective cohort study, Level II.

Do Individuals with High-Functioning Autism Who Speak a Tone Language Show Intonation Deficits?

PubMed

Chan, Kary K L; To, Carol K S

2016-05-01

This study investigated whether intonation deficits were observed in 19 Cantonese-speaking adults with high-functioning autism (HFA) when compared to 19 matched neurotypical (NT) controls. This study also investigated the use of sentence-final particles (SFPs) and their relationship with intonation in both groups. Standard deviations (SDs) of the fundamental frequency (F0), the total number and the type of SFPs were calculated based on narrative samples. The HFA group demonstrated significantly higher SD of F0 and a positive correlation between the type of SFPs and SD of F0. Both groups produced a similar total number and type of SFPs. The results supported the universality of atypical intonation in ASD. The relationship between intonation and SFPs could be further explored by focusing on sentences containing SFPs.

Insulinlike growth factor I affects ocular development: a study of untreated and treated patients with Laron syndrome.

PubMed

Bourla, Dan Haim; Laron, Zvi; Snir, Moshe; Lilos, Pearl; Weinberger, Dov; Axer-Siegel, Ruth

2006-07-01

To evaluate the ocular dimensions in patients with primary growth hormone receptor insensitivity (Laron syndrome [LS]) and to study the effect of supplemental insulinlike growth factor I (IGF-I) on ocular growth. Retrospective case series. Twelve patients with LS, 8 untreated (LS group) and 4 treated (LS-T group) with supplemental IGF-I, and 30 healthy controls. Ocular dimensions and refraction were measured, and a full ophthalmologic examination was performed. Differences in the average ocular dimension data among IGF-I-treated patients, untreated ones, and controls. The average axial length of eyes in the LS group was 21.94 mm (standard deviation [SD], 0.81). Corresponding values for the LS-T and control group eyes were 22.53 mm (SD, 1.74) and 23.20 mm (SD, 1.35) respectively. The average anterior chamber depth of eyes in the LS group was 2.55 mm (SD, 0.26). Corresponding values for eyes in the LS-T and control groups were 3.48 mm (SD, 0.09) and 3.84 mm (SD, 0.16) respectively. The average lens thickness of eyes in the LS group was 4.56 mm (SD, 0.36). Corresponding values for the LS-T and control groups were 3.77 mm (SD, 0.23) and 3.51 mm (SD, 0.25), respectively. The average corneal curvature of eyes in the LS group was 46.9 diopters (D) (SD, 2.32). Corresponding values for the LS-T and control groups were 47.6 D (SD, 2.83) and 44.4 D (SD, 1.5), respectively. Insulinlike growth factor I seems to be an important regulator of ocular growth as documented in patients with primary growth hormone insensitivity. The mechanism of this observation should be investigated further.

Comparison of polyurethane with cyanoacrylate in hemostasis of vascular injury in guinea pigs.

PubMed

Kubrusly, Luiz Fernando; Formighieri, Marina Simões; Lago, José Vitor Martins; Graça, Yorgos Luiz Santos de Salles; Sobral, Ana Cristina Lira; Lago, Marianna Martins

2015-01-01

To evaluate the behavior of castor oil-derived polyurethane as a hemostatic agent and tissue response after abdominal aortic injury and to compare it with 2-octyl-cyanoacrylate. Twenty-four Guinea Pigs were randomly divided into three groups of eight animals (I, II, and III). The infrarenal abdominal aorta was dissected, clamped proximally and distally to the vascular puncture site. In group I (control), hemostasis was achieved with digital pressure; in group II (polyurethane) castor oil-derived polyurethane was applied, and in group III (cyanoacrylate), 2-octyl-cyanoacrylate was used. Group II was subdivided into IIA and IIB according to the time of preparation of the hemostatic agent. Mean blood loss in groups IIA, IIB and III was 0.002 grams (g), 0.008 g, and 0.170 g, with standard deviation of 0.005 g, 0.005 g, and 0.424 g, respectively (P=0.069). The drying time for cyanoacrylate averaged 81.5 seconds (s) (standard deviation: 51.5 seconds) and 126.1 s (standard deviation: 23.0 s) for polyurethane B (P=0.046). However, there was a trend (P=0.069) for cyanoacrylate to dry more slowly than polyurethane A (mean: 40.5 s; SD: 8.6 s). Furthermore, polyurethane A had a shorter drying time than polyurethane B (P=0.003), mean IIA of 40.5 s (standard deviation: 8.6 s). In group III, 100% of the animals had mild/severe fibrosis, while in group II only 12.5% showed this degree of fibrosis (P=0.001). Polyurethane derived from castor oil showed similar hemostatic behavior to octyl-2-cyanoacrylate. There was less perivascular tissue response with polyurethane when compared with cyanoacrylate.

Comparison of polyurethane with cyanoacrylate in hemostasis of vascular injury in guinea pigs

PubMed Central

Kubrusly, Luiz Fernando; Formighieri, Marina Simões; Lago, José Vitor Martins; Graça, Yorgos Luiz Santos de Salles; Sobral, Ana Cristina Lira; Lago, Marianna Martins

2015-01-01

Objective To evaluate the behavior of castor oil-derived polyurethane as a hemostatic agent and tissue response after abdominal aortic injury and to compare it with 2-octyl-cyanoacrylate. Methods Twenty-four Guinea Pigs were randomly divided into three groups of eight animals (I, II, and III). The infrarenal abdominal aorta was dissected, clamped proximally and distally to the vascular puncture site. In group I (control), hemostasis was achieved with digital pressure; in group II (polyurethane) castor oil-derived polyurethane was applied, and in group III (cyanoacrylate), 2-octyl-cyanoacrylate was used. Group II was subdivided into IIA and IIB according to the time of preparation of the hemostatic agent. Results Mean blood loss in groups IIA, IIB and III was 0.002 grams (g), 0.008 g, and 0.170 g, with standard deviation of 0.005 g, 0.005 g, and 0.424 g, respectively (P=0.069). The drying time for cyanoacrylate averaged 81.5 seconds (s) (standard deviation: 51.5 seconds) and 126.1 s (standard deviation: 23.0 s) for polyurethane B (P=0.046). However, there was a trend (P=0.069) for cyanoacrylate to dry more slowly than polyurethane A (mean: 40.5 s; SD: 8.6 s). Furthermore, polyurethane A had a shorter drying time than polyurethane B (P=0.003), mean IIA of 40.5 s (standard deviation: 8.6 s). In group III, 100% of the animals had mild/severe fibrosis, while in group II only 12.5% showed this degree of fibrosis (P=0.001). Conclusion Polyurethane derived from castor oil showed similar hemostatic behavior to octyl-2-cyanoacrylate. There was less perivascular tissue response with polyurethane when compared with cyanoacrylate. PMID:25859876

Assessment of β-zone peripapillary atrophy by optical coherence tomography and scanning laser ophthalmoscopy imaging in glaucoma patients

PubMed Central

Seidensticker, Florian; Reznicek, Lukas; Mann, Thomas; Hübert, Irene; Kampik, Anselm; Ulbig, Michael; Hirneiss, Christoph; Neubauer, Aljoscha S; Kernt, Marcus

2014-01-01

Purpose To assess β-zone peripapillary atrophy (β-PPA) using spectral domain optical coherence tomography (SD-OCT), scanning laser ophthalmoscopy (SLO), and fundus auto-fluorescence (FAF) imaging in patients with primary open-angle glaucoma with advanced glaucomatous visual field defects. Methods A consecutive, prospective series of 82 study eyes with primary open-angle glaucoma were included in this study. All study participants underwent a full ophthalmic examination followed by SD-OCT, wide-field SLO, and FAF imaging of the optic nerve head and the peripapillary region. Results Eighty-four glaucomatous eyes were included in our prospective study. Correlation analyses for horizontally and vertically obtained β-PPA for all three imaging modalities (color SLO, FAF, and SD-OCT) revealed highest correlations between FAF and color SLO (Pearson correlation coefficient: 0.904 [P<0.001] for horizontal β-PPA and 0.786 [P<0.001] for vertical β-PPA). Bland–Altman plotting revealed highest agreements between color SLO and FAF, with −2.1 pixels ±1.96 standard deviation (SD) for horizontal β-PPA, SD: 10.5 pixels and 2.4 pixels ±1.96 SD for vertical β-PPA. Conclusion β-PPA can be assessed using en-face SLO and cross-sectional SD-OCT imaging. Correlation analyses revealed highest correlations between color SLO and FAF imaging, while correlations between SLO and SD-OCT were weak. A more precise structural definition of β-PPA is needed. PMID:25061270

Visual and Quantitative Analysis Methods of Respiratory Patterns for Respiratory Gated PET/CT.

PubMed

Son, Hye Joo; Jeong, Young Jin; Yoon, Hyun Jin; Park, Jong-Hwan; Kang, Do-Young

2016-01-01

We integrated visual and quantitative methods for analyzing the stability of respiration using four methods: phase space diagrams, Fourier spectra, Poincaré maps, and Lyapunov exponents. Respiratory patterns of 139 patients were grouped based on the combination of the regularity of amplitude, period, and baseline positions. Visual grading was done by inspecting the shape of diagram and classified into two states: regular and irregular. Quantitation was done by measuring standard deviation of x and v coordinates of Poincaré map (SD x , SD v ) or the height of the fundamental peak ( A 1 ) in Fourier spectrum or calculating the difference between maximal upward and downward drift. Each group showed characteristic pattern on visual analysis. There was difference of quantitative parameters (SD x , SD v , A 1 , and MUD-MDD) among four groups (one way ANOVA, p = 0.0001 for MUD-MDD, SD x , and SD v , p = 0.0002 for A 1 ). In ROC analysis, the cutoff values were 0.11 for SD x (AUC: 0.982, p < 0.0001), 0.062 for SD v (AUC: 0.847, p < 0.0001), 0.117 for A 1 (AUC: 0.876, p < 0.0001), and 0.349 for MUD-MDD (AUC: 0.948, p < 0.0001). This is the first study to analyze multiple aspects of respiration using various mathematical constructs and provides quantitative indices of respiratory stability and determining quantitative cutoff value for differentiating regular and irregular respiration.

High SNR Acquisitions Improve the Repeatability of Liver Fat Quantification Using Confounder-corrected Chemical Shift-encoded MR Imaging

PubMed Central

Motosugi, Utaroh; Hernando, Diego; Wiens, Curtis; Bannas, Peter; Reeder, Scott. B

2017-01-01

Purpose: To determine whether high signal-to-noise ratio (SNR) acquisitions improve the repeatability of liver proton density fat fraction (PDFF) measurements using confounder-corrected chemical shift-encoded magnetic resonance (MR) imaging (CSE-MRI). Materials and Methods: Eleven fat-water phantoms were scanned with 8 different protocols with varying SNR. After repositioning the phantoms, the same scans were repeated to evaluate the test-retest repeatability. Next, an in vivo study was performed with 20 volunteers and 28 patients scheduled for liver magnetic resonance imaging (MRI). Two CSE-MRI protocols with standard- and high-SNR were repeated to assess test-retest repeatability. MR spectroscopy (MRS)-based PDFF was acquired as a standard of reference. The standard deviation (SD) of the difference (Δ) of PDFF measured in the two repeated scans was defined to ascertain repeatability. The correlation between PDFF of CSE-MRI and MRS was calculated to assess accuracy. The SD of Δ and correlation coefficients of the two protocols (standard- and high-SNR) were compared using F-test and t-test, respectively. Two reconstruction algorithms (complex-based and magnitude-based) were used for both the phantom and in vivo experiments. Results: The phantom study demonstrated that higher SNR improved the repeatability for both complex- and magnitude-based reconstruction. Similarly, the in vivo study demonstrated that the repeatability of the high-SNR protocol (SD of Δ = 0.53 for complex- and = 0.85 for magnitude-based fit) was significantly higher than using the standard-SNR protocol (0.77 for complex, P < 0.001; and 0.94 for magnitude-based fit, P = 0.003). No significant difference was observed in the accuracy between standard- and high-SNR protocols. Conclusion: Higher SNR improves the repeatability of fat quantification using confounder-corrected CSE-MRI. PMID:28190853

Formulae Based on Biomathematics to Estimate the Standard Value of Fetal Growth of Japanese.

PubMed

Miyagi, Yasunari; Tada, Katsuhiko; Takayoshi, Riko; Oguni, Nobutsugu; Sato, Yasushi; Shibata, Maki; Kiyokawa, Machiko; Hashimoto, Tadashi; Takada, Tomoyoshi; Oda, Takashi; Miyake, Takahito

2018-04-01

We devised biomathematics-based formulae to estimate the standard values of fetal growth of Japanese after 22 weeks' gestation. The growth rates of bi-parietal diameter (BPD), abdominal circumference (AC), femur length (FL), and estimated fetal body weight (EFBW) at the time of gestation were assumed to be proportional to the product of the value at the time and the rest value of an unknown maximum value, respectively. The EFBW was also assumed to follow a multiple logistic function of BPD, AC and FL to fit the standard values of Japanese fetuses published by the Japan Society of Ultrasonics in Medicine. The Mann-Whitney test was used for statistical analysis. The values as a function of gestational day, t, were as follows: BPD(t)=99.6/(1+exp (2.725-0.01837＊t)) (mm); AC(t)=39.7/(1+exp (2.454-0.01379＊t)) (cm); FL(t)=79.6/(1+exp (2.851-0.01710＊t)) (mm); EFBW(t)=8045.1/(1+exp (6.028-0.06582＊BPD(t)-0.1469＊AC(t)+ 0.07377＊FL(t))) (g). EFBW as a function of BPD, AC and FL was as follows: EFBW=8045.1/(1+exp (4.747+ 0.02584＊BPD+0.1010＊AC-0.1416＊FL)) (g). When the BPD, AC and FL were at -2 standard deviation (SD), -1SD, mean and + 2SD, the EFBW values calculated by the formula were statistically closer to the standard values than conventional formulas with p-values of 4.871×10-7, 4.228×10-7, 9.777×10-7 and 0.028, respectively. The formulae based on biomathematics might be useful to estimate the fetal growth standard values.

The personal shopper – a pilot randomized trial of grocery store-based dietary advice

PubMed Central

Lewis, K H; Roblin, D W; Leo, M; Block, J P

2015-01-01

The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index – 2005 [0–100 points] ), and nutritional knowledge (0–65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. PMID:25873139

Mechanical evaluation of aluminum alloy ring fixator.

PubMed

Tosborvorn, Somboon; Cheechareon, Sukrom; Ruttanuchun, Kittiput; Sirivedin, Suparerk; Rhienumporn, Chaitawat

2006-11-01

To test the homemade ring fixator as a tool for correction of bony deformity. The authors developed an aluminum alloy ring fixator and tested it to find out the accuracy of manufacturing and strength of the ring systems under axial load with the Roundness Testing Machine and Lloyd Universal Testing Machine. The mean diameter of the twenty five-drill holes was 6.5843872 +/- 0.0521594 mm (mean +/- SD). Distance between particular drill holes, which reflected the precision of drilling, had a high accuracy with standard deviation from 0.1138 to 0.1870 mm. The roundness of the rings was 0.2421376 +/- 0.12437977 mm (mean +/- SD). The system structure had minimal permanent deformity at breaking point, mean yield strength of the system was 4786.9 +/- 14.353 N (mean +/- SD). This was caused by the failure of the wire. Mean stiffness of the system was 127 N./mm. The aluminum alloy ring fixator was strong enough and well tolerated for clinical usage

The personal shopper--a pilot randomized trial of grocery store-based dietary advice.

PubMed

Lewis, K H; Roblin, D W; Leo, M; Block, J P

2015-06-01

The objective of this study was to test the feasibility and preliminary efficacy of a store-based dietary education intervention against traditional clinic-based advice. Patients with obesity (n = 55, mean [standard deviation, SD] age 44.3[9.2] years, 64% women, 87% non-Hispanic Black) were randomized to receive dietary counselling either in a grocery store or a clinic. Change between groups (analysis of covariance) was assessed for outcomes including: dietary quality (Healthy Eating Index--2005 [0-100 points]), and nutritional knowledge (0-65-point knowledge scale). Both groups reported improved diet quality at the end of the study. Grocery participants had greater increases in knowledge (mean [SD] change = 5.7 [6.1] points) than clinic participants (mean [SD] change = 3.2 [4.0] points) (P = 0.04). Participants enjoyed the store-based sessions. Grocery store-based visits offer a promising approach for dietary counselling. © 2015 The Authors. Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity.

Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty.

PubMed

Johnson, Jeremiah D; Nessler, Joseph M; Horazdovsky, Ryan D; Vang, Sandy; Thomas, Avis J; Marston, Scott B

2017-03-01

Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA. Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure. All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds. VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection. Copyright © 2015 Elsevier Inc. All rights reserved.

Relations of circulating GDF-15, soluble ST2, and troponin-I concentrations with vascular function in the community: The Framingham Heart Study.

PubMed

Andersson, Charlotte; Enserro, Danielle; Sullivan, Lisa; Wang, Thomas J; Januzzi, James L; Benjamin, Emelia J; Vita, Joseph A; Hamburg, Naomi M; Larson, Martin G; Mitchell, Gary F; Vasan, Ramachandran S

2016-05-01

Growth differentiation factor-15 (GDF-15), soluble (s)ST2, and high-sensitivity troponin-I (hs-TnI) are associated with incident cardiovascular disease (CVD) including heart failure, yet the underlying mechanisms are not fully understood. We investigated if GDF-15, sST2, and hs-TnI are related to subclinical vascular dysfunction in the community, which may explain the relations of these biomarkers with CVD. We evaluated 1823 Framingham Study participants (mean age 61 ± 10 years, 54% women) who underwent routine assessment of vascular function. We related circulating GDF-15, sST2, and hs-TnI concentrations to measures of arterial stiffness (carotid-femoral pulse wave velocity, CFPWV; augmentation index; and forward pressure wave amplitude, FW), endothelial-dependent vasodilation (flow-mediated dilation, FMD), and baseline and hyperemic brachial flow velocities using linear regression adjusting for standard risk factors. After multivariable adjustment, GDF-15 levels were positively associated with CFPWV (0.044 [95% confidence interval 0.007-0.081] standard deviation [SD] change per SD increase in loge[GDF-15], p = 0.02) and FW (0.076 [0.026-0.126] SD change per SD increase in loge[GDF-15], p = 0.003) and inversely related to FMD (-0.051 [-0.101-0.0003] SD change per SD increase in loge[GDF-15], p = 0.048). sST2 was positively associated with CFPWV (0.032 [0.0005-0.063] SD change per SD increase in loge[sST2], p = 0.046), and hs-TnI inversely associated with hyperemic flow velocity (-0.041 [-0.082-0.0004] SD change per SD increase in loge[hs-TnI], p = 0.048). In our community-based investigation, individual cardiac stress biomarkers were differentially related to select aspects of vascular function. These findings may contribute to the associations of circulating GDF-15, sST2, and hs-TnI with incident CVD and heart failure. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Intra-individual reaction time variability and all-cause mortality over 17 years: a community-based cohort study.

PubMed

Batterham, Philip J; Bunce, David; Mackinnon, Andrew J; Christensen, Helen

2014-01-01

very few studies have examined the association between intra-individual reaction time variability and subsequent mortality. Furthermore, the ability of simple measures of variability to predict mortality has not been compared with more complex measures. a prospective cohort study of 896 community-based Australian adults aged 70+ were interviewed up to four times from 1990 to 2002, with vital status assessed until June 2007. From this cohort, 770-790 participants were included in Cox proportional hazards regression models of survival. Vital status and time in study were used to conduct survival analyses. The mean reaction time and three measures of intra-individual reaction time variability were calculated separately across 20 trials of simple and choice reaction time tasks. Models were adjusted for a range of demographic, physical health and mental health measures. greater intra-individual simple reaction time variability, as assessed by the raw standard deviation (raw SD), coefficient of variation (CV) or the intra-individual standard deviation (ISD), was strongly associated with an increased hazard of all-cause mortality in adjusted Cox regression models. The mean reaction time had no significant association with mortality. intra-individual variability in simple reaction time appears to have a robust association with mortality over 17 years. Health professionals such as neuropsychologists may benefit in their detection of neuropathology by supplementing neuropsychiatric testing with the straightforward process of testing simple reaction time and calculating raw SD or CV.

Improved Measurement of Blood Pressure by Extraction of Characteristic Features from the Cuff Oscillometric Waveform

PubMed Central

Lim, Pooi Khoon; Ng, Siew-Cheok; Jassim, Wissam A.; Redmond, Stephen J.; Zilany, Mohammad; Avolio, Alberto; Lim, Einly; Tan, Maw Pin; Lovell, Nigel H.

2015-01-01

We present a novel approach to improve the estimation of systolic (SBP) and diastolic blood pressure (DBP) from oscillometric waveform data using variable characteristic ratios between SBP and DBP with mean arterial pressure (MAP). This was verified in 25 healthy subjects, aged 28 ± 5 years. The multiple linear regression (MLR) and support vector regression (SVR) models were used to examine the relationship between the SBP and the DBP ratio with ten features extracted from the oscillometric waveform envelope (OWE). An automatic algorithm based on relative changes in the cuff pressure and neighbouring oscillometric pulses was proposed to remove outlier points caused by movement artifacts. Substantial reduction in the mean and standard deviation of the blood pressure estimation errors were obtained upon artifact removal. Using the sequential forward floating selection (SFFS) approach, we were able to achieve a significant reduction in the mean and standard deviation of differences between the estimated SBP values and the reference scoring (MLR: mean ± SD = −0.3 ± 5.8 mmHg; SVR and −0.6 ± 5.4 mmHg) with only two features, i.e., Ratio2 and Area3, as compared to the conventional maximum amplitude algorithm (MAA) method (mean ± SD = −1.6 ± 8.6 mmHg). Comparing the performance of both MLR and SVR models, our results showed that the MLR model was able to achieve comparable performance to that of the SVR model despite its simplicity. PMID:26087370

Evaluation of Free Breathing Versus Breath Hold Diffusion Weighted Imaging in Terms Apparent Diffusion Coefficient (ADC) and Signal-to-Noise Ratio (SNR) Values for Solid Abdominal Organs.

PubMed

Herek, Duygu; Karabulut, Nevzat; Kocyıgıt, Ali; Yagcı, Ahmet Baki

2016-01-01

Our aim was to compare the apparent diffusion coefficient (ADC) values of normal abdominal parenchymal organs and signal-to-noise ratio (SNR) measurements in the same patients with breath hold (BH) and free breathing (FB) diffusion weighted imaging (DWI). Forty-eight patients underwent both BH and FB DWI. Spherical region of interest (ROI) was placed on the right hepatic lobe, spleen, pancreas, and renal cortices. ADC values were calculated for each organ on each sequence using an automated software. Image noise, defined as the standard deviation (SD) of the signal intensities in the most artifact-free area of the image background was measured by placing the largest possible ROI on either the left or the right side of the body outside the object in the recorded field of view. SNR was calculated using the formula: SNR=signal intensity (SI) (organ) /standard deviation (SD) (noise) . There were no statistically significant differences in ADC values of the abdominal organs between BH and FB DWI sequences ( p >0.05). There were statistically significant differences between SNR values of organs on BH and FB DWIs. SNRs were found to be better on FB DWI than BH DWI ( p <0.001). Free breathing DWI technique reduces image noise and increases SNR for abdominal examinations. Free breathing technique is therefore preferable to BH DWI in the evaluation of abdominal organs by DWI.

Monty Roberts' Public Demonstrations: Preliminary Report on the Heart Rate and Heart Rate Variability of Horses Undergoing Training during Live Audience Events.

PubMed

Loftus, Loni; Marks, Kelly; Jones-McVey, Rosie; Gonzales, Jose L; Fowler, Veronica L

2016-09-09

Effective training of horses relies on the trainer's awareness of learning theory and equine ethology, and should be undertaken with skill and time. Some trainers, such as Monty Roberts, share their methods through the medium of public demonstrations. This paper describes the opportunistic analysis of beat-to-beat (RR) intervals and heart rate variability (HRV) of ten horses being used in Monty Roberts' public demonstrations within the United Kingdom. RR and HRV was measured in the stable before training and during training. The HRV variables standard deviation of the RR interval (SDRR), root mean square of successive RR differences (RMSSD), geometric means standard deviation 1 (SD1) and 2 (SD2), along with the low and high frequency ratio (LF/HF ratio) were calculated. The minimum, average and maximum RR intervals were significantly lower in training (indicative of an increase in heart rate as measured in beats-per-minute) than in the stable ( p = 0.0006; p = 0.01; p = 0.03). SDRR, RMSSD, SD1, SD2 and the LF/HF ratio were all significantly lower in training than in the stable ( p = 0.001; p = 0.049; p = 0.049; p = 0.001; p = 0.01). When comparing the HR and HRV of horses during Join-up (®) to overall training, there were no significant differences in any variable with the exception of maximum RR which was significantly lower ( p = 0.007) during Join-up (®) , indicative of short increases in physical exertion (canter) associated with this training exercise. In conclusion, training of horses during public demonstrations is a low-moderate physiological, rather than psychological stressor for horses. The physiological stress responses observed within this study were comparable or less to those previously reported in the literature for horses being trained outside of public audience events. Furthermore, there is no evidence that the use of Join-up (®) alters HR and HRV in a way to suggest that this training method negatively affects the psychological welfare of horses.

SU-E-T-625: Robustness Evaluation and Robust Optimization of IMPT Plans Based on Per-Voxel Standard Deviation of Dose Distributions.

PubMed

Liu, W; Mohan, R

2012-06-01

Proton dose distributions, IMPT in particular, are highly sensitive to setup and range uncertainties. We report a novel method, based on per-voxel standard deviation (SD) of dose distributions, to evaluate the robustness of proton plans and to robustly optimize IMPT plans to render them less sensitive to uncertainties. For each optimization iteration, nine dose distributions are computed - the nominal one, and one each for ± setup uncertainties along x, y and z axes and for ± range uncertainty. SD of dose in each voxel is used to create SD-volume histogram (SVH) for each structure. SVH may be considered a quantitative representation of the robustness of the dose distribution. For optimization, the desired robustness may be specified in terms of an SD-volume (SV) constraint on the CTV and incorporated as a term in the objective function. Results of optimization with and without this constraint were compared in terms of plan optimality and robustness using the so called'worst case' dose distributions; which are obtained by assigning the lowest among the nine doses to each voxel in the clinical target volume (CTV) and the highest to normal tissue voxels outside the CTV. The SVH curve and the area under it for each structure were used as quantitative measures of robustness. Penalty parameter of SV constraint may be varied to control the tradeoff between robustness and plan optimality. We applied these methods to one case each of H&N and lung. In both cases, we found that imposing SV constraint improved plan robustness but at the cost of normal tissue sparing. SVH-based optimization and evaluation is an effective tool for robustness evaluation and robust optimization of IMPT plans. Studies need to be conducted to test the methods for larger cohorts of patients and for other sites. This research is supported by National Cancer Institute (NCI) grant P01CA021239, the University Cancer Foundation via the Institutional Research Grant program at the University of Texas MD Anderson Cancer Center, and MD Anderson’s cancer center support grant CA016672. © 2012 American Association of Physicists in Medicine.

Bromelain and cardiovascular risk factors in diabetes: An exploratory randomized, placebo controlled, double blind clinical trial.

PubMed

Ley, Chit Moy; Ni, Qing; Liao, Xing; Gao, Huai-Lin; Robinson, Nicola

2016-10-01

To assess whether the dietary supplement (bromelain) has the potential to reduce plasma fibrinogen and other cardiovascular disease (CVD) risk factors in patients with diabetes. This randomized placebo controlled, double blind, parallel design, efficacy study was carried out in China and investigated the effect of 12 weeks of bromelain (1,050 mg/day) on plasma fibrinogen. This randomized controlled trial (RCT) recruited 68 Chinese diabetic patients [32 males and 36 females; Han origin, mean age of 61.26 years (standard deviation (SD), 12.62 years)] with at least one CVD risk factor. Patients were randomized into either bromelain or placebo group. While bromelain group received bromelain capsule, the placebo group received placebo capsule which consisted inert ingredient and has no treatment effect. Subjects were required to take 1,050 mg (3×350 mg) of either bromelain or starch-filled placebo capsules, two to be taken (2×350 mg) after breakfast and another (350 mg) after dinner, daily for 12 weeks. Plasma fibrinogen, CVD risk factors and anthropometric indicators were determined at baseline and at 12 weeks. The change in the fibrinogen level in the bromelain group at the end of the study showed a mean reduction of 0.13 g/L (standard deviation (SD) 0.86g/L) compared with the mean reduction of 0.36 g/L (SD 0.96 g/L) for the placebo group. However, there was no significant difference in the mean change in fibrinogen between the placebo and bromelain groups (mean difference=0.23g/L (SD 0.22 g/L), =0.291). Similarly, the difference in mean change in other CVD risk factors (blood lipids, blood pressure), blood glucose, C-reactive protein and anthropometric measures between the bromelain and placebo groups was also not statistically significant. Statistical differences in fibrinogen between bromelain and placebo groups before the trial despite randomization may have influenced the results of this study. This RCT failed to show a beneficial effect in reducing fibrinogen or influencing other selected CVD risk factors but suggests other avenues for subsequent research on bromelain.

Poisson regression models outperform the geometrical model in estimating the peak-to-trough ratio of seasonal variation: a simulation study.

PubMed

Christensen, A L; Lundbye-Christensen, S; Dethlefsen, C

2011-12-01

Several statistical methods of assessing seasonal variation are available. Brookhart and Rothman [3] proposed a second-order moment-based estimator based on the geometrical model derived by Edwards [1], and reported that this estimator is superior in estimating the peak-to-trough ratio of seasonal variation compared with Edwards' estimator with respect to bias and mean squared error. Alternatively, seasonal variation may be modelled using a Poisson regression model, which provides flexibility in modelling the pattern of seasonal variation and adjustments for covariates. Based on a Monte Carlo simulation study three estimators, one based on the geometrical model, and two based on log-linear Poisson regression models, were evaluated in regards to bias and standard deviation (SD). We evaluated the estimators on data simulated according to schemes varying in seasonal variation and presence of a secular trend. All methods and analyses in this paper are available in the R package Peak2Trough[13]. Applying a Poisson regression model resulted in lower absolute bias and SD for data simulated according to the corresponding model assumptions. Poisson regression models had lower bias and SD for data simulated to deviate from the corresponding model assumptions than the geometrical model. This simulation study encourages the use of Poisson regression models in estimating the peak-to-trough ratio of seasonal variation as opposed to the geometrical model. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Memory training interventions for older adults: A meta-analysis

PubMed Central

Gross, Alden L.; Parisi, Jeanine M.; Spira, Adam P.; Kueider, Alexandra M.; Ko, Jean Y.; Saczynski, Jane S.; Samus, Quincy M.; Rebok, George W.

2012-01-01

A systematic review and meta-analysis of memory training research was conducted to characterize the effect of memory strategies on memory performance among cognitively intact, community-dwelling older adults, and to identify characteristics of individuals and of programs associated with improved memory. The review identified 402 publications, of which 35 studies met criteria for inclusion. The overall effect size estimate, representing the mean standardized difference in pre-post change between memory-trained and control groups, was 0.31 standard deviations (SD; 95% confidence interval (CI): 0.22, 0.39). The pre-post training effect for memory-trained interventions was 0.43 SD (95% CI: 0.29, 0.57) and the practice effect for control groups was 0.06 SD (95% CI: -0.05, 0.16). Among 10 distinct memory strategies identified in studies, meta-analytic methods revealed that training multiple strategies was associated with larger training gains (p=0.04), although this association did not reach statistical significance after adjusting for multiple comparisons. Treatment gains among memory-trained individuals were not better after training in any particular strategy, or by the average age of participants, session length, or type of control condition. These findings can inform the design of future memory training programs for older adults. PMID:22423647

Comparison of expert and nonexpert swimmers' opinions about the value, potency, and activity of four standard swimming strokes and underwater undulatory swimming.

PubMed

Collard, L; Oboeuf, A

2009-04-01

Underwater undulatory swimming (UUS) is often perceived to be a nonessential aspect of aquatic propulsion. Given their solid theoretical and practical training in swimming, physical education students should be capable of judging the true value of the "fifth stroke," since it appears to be the most efficient technique in high level, competitive swimming. To compare opinions and connotations associated with the stroke and the four official strokes (butterfly, backstroke, breaststroke, and crawl), 198 students (32 of whom were expert swimmers; M age = 20.6 yr., SD = 1.2), were surveyed using the semantic differential of Osgood, Suci, and Tannenbaum. Although answers of expert and nonexpert swimmers differed significantly (p < .01, except for the breaststroke), participants considered overall that undulatory stroke was less attractive, less powerful, and less rapid than the four surface strokes (d = 2.88 for the expert swimmers). Putting one arm in front of the other and repeating the sequence still remains the most solidly held representation of "the right way" to swim. However, the high observed standard deviations for the underwater undulatory stimulus (SD > or = 1.1 with SD max = 3 for the expert swimmers) attests to the view being less strongly held by swimming specialists.

24-hour aortic blood pressure variability showed a stronger association with carotid damage than 24-hour brachial blood pressure variability: The SAFAR study.

PubMed

Yu, Shikai; Chi, Chen; Protogerou, Athanase D; Safar, Michel E; Blacher, Jacques; Argyris, Antonis A; Nasothimiou, Efthimia G; Sfikakis, Petros P; Papaioannou, Theodore G; Xu, Henry; Zhang, Yi; Xu, Yawei

2018-03-01

We aim to compare 24-hour aortic blood pressure variability (BPV) with brachial BPV in relation to carotid damage as estimated by carotid intima-media thickness (CIMT) and cross-sectional area (CCSA). Four hundred and forty five individuals received brachial and aortic 24-hour ambulatory BP monitoring with a validated device (Mobil-O-Graph). Systolic BPV was estimated by average real variability (ARV) and time-weighted standard deviation (wSD). In multiple logistic regression analysis, CIMT > 900 μm was significantly and independently associated with aortic ARV (OR = 1.38; 95% CI: 1.04-1.84), aortic wSD (OR = 1.65; 95% CI: 1.19-2.29) and brachial ARV (OR = 1.53; 95% CI: 1.07-2.18), but not with brachial wSD. CCSA > 90th percentile was significantly and independently associated with aortic ARV (OR = 1.50; 95% CI: 1.07-2.10) and wSD (OR = 1.70; 95% CI: 1.12-2.56), but not with brachial BPVs. In receiver operator characteristics curve analysis, aortic wSD identified CCSA > 90th percentile better than brachial wSD (AUC: 0.73 vs 0.68, P < .01). In conclusion, aortic 24-hour systolic BPV showed a slightly stronger association with carotid damage than brachial BPV. ©2018 Wiley Periodicals, Inc.

CPAP Adherence is Associated With Attentional Improvements in a Group of Primarily Male Patients With Moderate to Severe OSA.

PubMed

Deering, Sean; Liu, Lin; Zamora, Tania; Hamilton, Joanne; Stepnowsky, Carl

2017-12-15

Obstructive sleep apnea (OSA) is a widespread condition that adversely affects physical health and cognitive functioning. The prevailing treatment for OSA is continuous positive airway pressure (CPAP), but therapeutic benefits are dependent on consistent use. Our goal was to investigate the relationship between CPAP adherence and measures of sustained attention in patients with OSA. Our hypothesis was that the Psychomotor Vigilance Task (PVT) would be sensitive to attention-related improvements resulting from CPAP use. This study was a secondary analysis of a larger clinical trial. Treatment adherence was determined from CPAP use data. Validated sleep-related questionnaires and a sustained-attention and alertness test (PVT) were administered to participants at baseline and at the 6-month time point. Over a 6-month time period, the average CPAP adherence was 3.32 h/night (standard deviation [SD] = 2.53), average improvement in PVT minor lapses was -4.77 (SD = 13.2), and average improvement in PVT reaction time was -73.1 milliseconds (standard deviation = 211). Multiple linear regression analysis showed that higher CPAP adherence was significantly associated with a greater reduction in minor lapses in attention after 6 months of continuous treatment with CPAP therapy (β = -0.72, standard error = 0.34, P = .037). The results of this study showed that higher levels of CPAP adherence were associated with significant improvements in vigilance. Because the PVT is a performance-based measure that is not influenced by prior learning and is not subjective, it may be an important supplement to patient self-reported assessments. Name: Effect of Self-Management on Improving Sleep Apnea Outcomes, URL: https://clinicaltrials.gov/ct2/show/NCT00310310, Identifier: NCT00310310. © 2017 American Academy of Sleep Medicine

Software-assisted small bowel motility analysis using free-breathing MRI: feasibility study.

PubMed

Bickelhaupt, Sebastian; Froehlich, Johannes M; Cattin, Roger; Raible, Stephan; Bouquet, Hanspeter; Bill, Urs; Patak, Michael A

2014-01-01

To validate a software prototype allowing for small bowel motility analysis in free breathing by comparing it to manual measurements. In all, 25 patients (15 male, 10 female; mean age 39 years) were included in this Institutional Review Board-approved, retrospective study. Magnetic resonance imaging (MRI) was performed on a 1.5T system after standardized preparation acquiring motility sequences in free breathing over 69-84 seconds. Small bowel motility was analyzed manually and with the software. Functional parameters, measurement time, and reproducibility were compared using the coefficient of variance and paired Student's t-test. Correlation was analyzed using Pearson's correlation coefficient and linear regression. The 25 segments were analyzed twice both by hand and using the software with automatic breathing correction. All assessed parameters significantly correlated between the methods (P < 0.01), but the scattering of repeated measurements was significantly (P < 0.01) lower using the software (3.90%, standard deviation [SD] ± 5.69) than manual examinations (9.77%, SD ± 11.08). The time needed was significantly less (P < 0.001) with the software (4.52 minutes, SD ± 1.58) compared to manual measurement, lasting 17.48 minutes for manual (SD ± 1.75 minutes). The use of the software proves reliable and faster small bowel motility measurements in free-breathing MRI compared to manual analyses. The new technique allows for analyses of prolonged sequences acquired in free breathing, improving the informative value of the examinations by amplifying the evaluable data. Copyright © 2013 Wiley Periodicals, Inc.

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

Arbique, G; Anderson, J; Guild, J

Purpose: The National Lung Screening Trial mandated manual low dose CT technique factors, where up to a doubling of radiation output could be used over a regular to large patient size range. Recent guidance from the AAPM and ACR for lung cancer CT screening recommends radiation output adjustment for patient size either through AEC or a manual technique chart. This study evaluated the use of AEC for output control and dose reduction. Methods: The study was performed on a multidetector helical CT scanner (Aquillion ONE, Toshiba Medical) equipped with iterative reconstruction (ADIR-3D), AEC was adjusted with a standard deviation (SD)more » image quality noise index. The protocol SD parameter was incrementally increased to reduce patient population dose while image quality was evaluated by radiologist readers scoring the clinical utility of images on a Likert scale. Results: Plots of effective dose vs. body size (water cylinder diameter reported by the scanner) demonstrate monotonic increase in patient dose with increasing patient size. At the initial SD setting of 19 the average CTDIvol for a standard size patient was ∼ 2.0 mGy (1.2 mSv effective dose). This was reduced to ∼1.0 mGy (0.5 mSv) at an SD of 25 with no noticeable reduction in clinical utility of images as demonstrated by Likert scoring. Plots of effective patient diameter and BMI vs body size indicate that these metrics could also be used for manual technique charts. Conclusion: AEC offered consistent and reliable control of radiation output in this study. Dose for a standard size patient was reduced to one-third of the 3 mGy CTDIvol limit required for ACR accreditation of lung cancer CT screening. Gary Arbique: Research Grant, Toshiba America Medical Systems; Cecelia Brewington: Research Grant, Toshiba America Medical Systems; Di Zhang: Employee, Toshiba America Medical Systems.« less

Inappropriate use of standard error of the mean when reporting variability of study samples: a critical evaluation of four selected journals of obstetrics and gynecology.

PubMed

Ko, Wen-Ru; Hung, Wei-Te; Chang, Hui-Chin; Lin, Long-Yau

2014-03-01

The study was designed to investigate the frequency of misusing standard error of the mean (SEM) in place of standard deviation (SD) to describe study samples in four selected journals published in 2011. Citation counts of articles and the relationship between the misuse rate and impact factor, immediacy index, or cited half-life were also evaluated. All original articles in the four selected journals published in 2011 were searched for descriptive statistics reporting with either mean ± SD or mean ± SEM. The impact factor, immediacy index, and cited half-life of the journals were gathered from Journal Citation Reports Science edition 2011. Scopus was used to search for citations of individual articles. The difference in citation counts between the SD group and SEM group was tested by the Mann-Whitney U test. The relationship between the misuse rate and impact factor, immediacy index, or cited half-life was also evaluated. The frequency of inappropriate reporting of SEM was 13.60% for all four journals. For individual journals, the misuse rate was from 2.9% in Acta Obstetricia et Gynecologica Scandinavica to 22.68% in American Journal of Obstetrics & Gynecology. Articles using SEM were cited more frequently than those using SD (p = 0.025). An approximate positive correlation between the misuse rate and cited half-life was observed. Inappropriate reporting of SEM is common in medical journals. Authors of biomedical papers should be responsible for maintaining an integrated statistical presentation because valuable articles are in danger of being wasted through the misuse of statistics. Copyright © 2014. Published by Elsevier B.V.

Reference Ranges for Head Circumference in Ethiopian Children 0-2 Years of Age.

PubMed

Amare, Ephrem Bililigne; Idsøe, Mari; Wiksnes, Miriam; Moss, Thomas; Roelants, Mathieu; Shimelis, Damte; Júlíusson, Pétur B; Kiserud, Torvid; Wester, Knut

2015-12-01

Head circumference (HC) charts are important for early detection of hydrocephalus during childhood. In low-income countries where population-based HC charts are rarely available, hydrocephalus occurs more commonly than in developed countries, and is usually not diagnosed early enough to prevent severe brain damage. This applies to Ethiopia as well. The World Health Organization (WHO) has provided standard HC charts advocated for global use, but recent studies cast doubts whether these charts are equally applicable in various populations. The aim of the study was therefore to establish reference ranges for early childhood HC in Ethiopia. In this prospective, observational cross-sectional study, measurements of HC were collected from healthy children of different ethnicities between birth and 24 months, in health centers situated in 5 Ethiopian cities. Reference ranges for HC were estimated using the LMS method and compared with those recommended by WHO. A total of 4019 children were included. Overall, 6.7% of boys and 7.1% of girls were above the +2 standard deviation (SD) of the WHO reference ranges, whereas the corresponding figures below -2 SD were 2.8% and 2.1%. Similarly, the +2 SD lines of the Ethiopian reference curves were considerably higher than those of the WHO growth standards, whereas the median and -2 SD lines were more comparable. Ethiopian HC reference ranges for children from birth to 24 months of age were found to differ significantly from those established by WHO and should correspondingly be considered as the first choice for screening for hydrocephalus in that population. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Ankle passive and active movement training in children with acute brain injury using a wearable robot.

PubMed

Chen, Kai; Xiong, Bo; Ren, Yupeng; Dvorkin, Assaf Y; Gaebler-Spira, Deboah; Sisung, Charles E; Zhang, Li-Qun

2018-01-10

To evaluate the feasibility and effectiveness of a wearable robotic device in guiding isometric torque generation and passive-active movement training for ankle motor recovery in children with acute brain injury. Ten inpatient children with acute brain injury being treated in a rehabilitation hospital. Daily robot-guided ankle passive-active movement therapy for 15 sessions, including isometric torque generation under real-time feedback, stretch-ing, and active movement training with motivating games using a wearable ankle rehabilitation robot. Ankle biomechanical improvements induced by each training session including ankle range of motion (ROM), muscle strength, and clinical (Fugl-Meyer Lower-Extremity (FMLE), Pediatric Balance Scale (PBS)) and biomechanical (ankle ROM and muscle strength) outcomes over 15 training sessions. As training progressed, improvements in biomechanical performance measures followed logarithmic curves. Each training session increased median dorsiflexion active range of motion (AROM) 2.73° (standard deviation (SD) 1.14), dorsiflexion strength 0.87 Nm (SD 0.90), and plantarflexion strength 0.60 Nm (SD 1.19). After 15 training sessions the median FMLE score had increased from 14.0 (SD 10.11) to 23.0 (SD 11.4), PBS had increased from 33.0 (SD 19.99) to 50.0 (SD 23.13) (p < 0.05), median dorsiflexion and plantarflexion strength had improved from 0.21 Nm (SD 4.45) to 4.0 Nm (SD 7.63) and 8.33 Nm (SD 10.18) to 18.45 Nm (SD 14.41), respectively, median dorsiflexion AROM had improved from -10.45° (SD 12.01) to 11.87° (SD 20.69), and median dorsiflexion PROM increased from 20.0° (SD 9.04) to 25.0° (SD 8.03). Isometric torque generation with real-time feedback, stretching and active movement training helped promote neuroplasticity and improve motor performance in children with acute brain injury.

Mindfulness Meditation for Alcohol Relapse Prevention: A Feasibility Pilot Study

PubMed Central

Zgierska, Aleksandra; Rabago, David; Zuelsdorff, Megan; Coe, Christopher; Miller, Michael; Fleming, Michael

2014-01-01

Objectives Meditation is a promising treatment for alcohol dependence. This 16-week prospective case series was designed to gather preliminary data about the efficacy of meditation for relapse prevention and to evaluate study methods feasibility. Methods Nineteen adult alcohol-dependent graduates of an intensive outpatient program were enrolled. Fifteen subjects completed the 8-week meditation course supplemented by at-home meditation and “standard of care” therapy. Outcome measures included surveys and 2 stress-responsive biomarkers. Results Subjects (N = 19, 38.4 standard deviation [SD] = 8.6-year-old) were abstinent for 30.9 (SD = 22.2) days at enrollment. Completers (N = 15) attended 82% of meditation course sessions and meditated on average 4.6 (SD = 1.1) days per week; they were abstinent on 94.5% (SD = 7.4) of study days, with 47% reporting complete abstinence and 47% reporting 1 or more heavy drinking days. Their severity of depression, anxiety, stress (P < 0.05), and craving (P < 0.08), documented relapse triggers, decreased, and the degree of mindfulness increased (P < 0.05). The meditation course was rated as a “very important” (8.7/10, SD = 1.8) and “useful relapse prevention tool” (8.5/10, SD = 2.1); participants reported being “very likely” to continue meditating (9.0/10, SD = 1.5). “Gaining skills to reduce stress,” “coping with craving,” and “good group support” were the most common qualitative comments about the course value. Compared with baseline, at 16 weeks, interleukin-6 levels decreased (N = 12, P = 0.05); cortisol levels (N = 10) were reduced but not significantly. There were no adverse events or side effects. Conclusions Meditation may be an effective adjunctive therapy for relapse prevention in alcohol dependence, worthy of investigation in a larger trial. The study methods are appropriate for such a trial. PMID:21768988

Suomi-NPP VIIRS Solar Diffuser Stability Monitor Performance

NASA Technical Reports Server (NTRS)

Fulbright, Jon; Lei, Ning; Efremova, Boryana; Xiong, Xiaoxiong

2015-01-01

When illuminated by the Sun, the onboard solar diffuser (SD) panel provides a known spectral radiance source to calibrate the reflective solar bands of the Visible Infrared Imaging Radiometer Suite on the Suomi-NPP satellite. The SD bidirectional reflectance distribution function (BRDF) degrades over time due to solar exposure, and this degradation is measured using the SD stability monitor (SDSM). The SDSM acts as a ratioing radiometer, comparing solar irradiance measurements off the SD panel to those from a direct Sun view. We discuss the design and operations of the SDSM, the SDSM data analysis, including improvements incorporated since launch, and present the results through 1000 days after launch. After 1000 days, the band-dependent H-factors, a quantity describing the relative degradation of the BRDF of the SD panel since launch, range from 0.716 at 412 nanometers to 0.989 at 926 nanometers. The random uncertainty of these H-factors is about 0.1 percent, which is confirmed by the similar standard deviation values computed from the residuals of quadratic exponential fits to the H-factor time trends. The SDSM detector gains have temperature sensitivity of up to about 0.36 percent per kelvin, but this does not affect the derived H-factors. An initial error in the solar vector caused a seasonal bias to the H-factors of up to 0.5 percent. The total exposure of the SD panel to UV light after 1000 orbits is equivalent to about 100 hours of direct sunlight illumination perpendicular to the SD panel surface.

LB02.03: EVALUATION OF DAY-BY-DAY BLOOD PRESSURE VARIABILITY IN CLINIC (DO WE STILL NEED STANDARD DEVIATION?).

PubMed

Ryuzaki, M; Nakamoto, H; Hosoya, K; Komatsu, M; Hibino, Y

2015-06-01

Blood pressure (BP) variability correlates with cardio-vascular disease as BP level itself. There is not known easy way to evaluate the BP variability in clinic.To evaluate the usefulness of maximum-minimum difference (MMD) of BP in a month compared to standard deviation (SD), as an index of BP variability. Study-1: Twelve patients (age 65.9 ± 12.1 y/o) were enrolled. Measurements of home systolic (S) BP were required in the morning. The 12 months consecutive data and at least 3 times measurements a month were required for including. (Mean 29.0 ± 4.5 times/month in the morning). We checked the correlation between MMD and SD. Study-2: Six hemodialized patients monitored with i-TECHO system (J of Hypertens 2007: 25: 2353-2358) for longer than one year were analyzed. As in study-1, we analyzed the correlation between SD and MMD of SBP. 17.4 ± 11.9 times per month. Study-3: The data from our previous study (FUJIYAM study Clin. Exp Hypertens 2014: 36:508-16) were extracted. 1524 patient-month morning BP data were calculated as in study-1. Picking up data measuring more than 24 times a month, 517 patient-month BP data were analyzed. We compared the ratio to 25 times measured data of SD and MMD, in the setting 5, 10, 15, 20 times measured data. Study-1: SBP, MMD was correlated very well to SD (p < 0.0001, R=0.923). Equation of SBPSD = 1.275+ 0.208xMMD. Study-2: R = 0.884 (P < 0.0001) SBPSD = 2.17+ 0.22xMMD. Study-3: R = 0.842(P < 0.0001), if we used all data measurements > 2 times. If data were extracted (measurements>24 times), correlation was 0.927 (P < 0.0001). The equation of SBPSD = 1.520+ 0.201xMMD. The ratios of SD to 25 times were as follows; 0.956 in 5 times, 0.956 in 10, 0.979 in 15, 0.991 in 20 times. The ratios of MMD to 25 times were as follows; 0.558 in 5, 0.761 in 10, 0.874 in 15, 0.944 in 20. We can assume SD easily by measuring MMD as an index of day-by-day BP variability of a month. The equation formulas were very similar though the patients' groups were different. But we have to be careful how many times patients measure in a month.

High-frequency daily temperature variability in China and its relationship to large-scale circulation

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

Wu, Fu-Ting; Fu, Congbin; Qian, Yun

Two measures of intra-seasonal variability, indicated respectively by standard deviations (SD) and day-to-day (DTD) fluctuations denoted by absolute differences between adjacent 2-day periods, as well as their relationships with large-scale circulation patterns were investigated in China during 1962–2008 on the basis of homogenized daily temperature records from 549 local stations and reanalysis data. Our results show that both the SD and DTD of daily minimum temperatures (Tmin) in summer as well as the minimum and maximum temperatures in winter have been decreasing, while the daily maximum temperature (Tmax) variability in summer is fluctuating more, especially over southern China. In summer,more » an attribution analysis indicates that the intensity of the Western Pacific Subtropical High (WPSH) and high-level East Asian Subtropical Jet stream (EASJ) are positively correlated with both SD and DTD, but the correlation coefficients are generally greater with the SD than with the DTD of the daily maximum temperature, Tmax. In contrast, the location of the EASJ shows the opposite correlation pattern, with intensity regarding the correlation with both SD and DTD. In winter, the Arctic Oscillation (AO) is negatively correlated with both the SD and DTD of the daily minimum temperature, but its intra-seasonal variability exhibits good agreement with the SD of the Tmin. The Siberian High acts differently with respect to the SD and DTD of the Tmin, demonstrating a regionally consistent positive correlation with the SD. Overall, the large-scale circulation can well explain the intra-seasonal SD, but DTD fluctuations may be more local and impacted by local conditions, such as changes in the temperature itself, the land surface, and so on.« less

Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models.

PubMed

Breimer, Gerben E; Haji, Faizal A; Bodani, Vivek; Cunningham, Melissa S; Lopez-Rios, Adriana-Lucia; Okrainec, Allan; Drake, James M

2017-02-01

The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head." To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training. Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items. The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P = .04) and the third ventricle floor (4.4, SD = 0.6 vs 4.0, SD = 0.9; P = .03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P = .11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P < .001 and 3.9; SD = 0.8 vs 4.2, SD = 0.6; P = .02, respectively). Overall task fidelity across the 2 simulators was not perceived as significantly different. Simulation model selection should be based on educational objectives. Training focused on learning anatomy or decision-making for anatomic cues may be aided with the VR simulation model. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model. Copyright © 2016 by the Congress of Neurological Surgeons

New radiological parameters for the assessment of atlantoaxial instability in children with Down syndrome: the normal values and the risk of spinal cord injury.

PubMed

Nakamura, N; Inaba, Y; Aota, Y; Oba, M; Machida, J; N Aida; Kurosawa, K; Saito, T

2016-12-01

To determine the normal values and usefulness of the C1/4 space available for spinal cord (SAC) ratio and C1 inclination angle, which are new radiological parameters for assessing atlantoaxial instability in children with Down syndrome. We recruited 272 children with Down syndrome (including 14 who underwent surgical treatment), and 141 children in the control group. All were aged between two and 11 years. The C1/4 SAC ratio, C1 inclination angle, atlas-dens interval (ADI), and SAC were measured in those with Down syndrome, and the C1/4 SAC ratio and C1 inclination angle were measured in the control group. The mean C1/4 SAC ratio in those requiring surgery with Down syndrome, those with Down syndrome not requiring surgery and controls were 0.63 (standard deviation (sd) 0.1), 1.15 (sd 0.13) and 1.29 (sd 0.14), respectively, and the mean C1 inclination angles were -3.1° (sd 10.7°), 15.8° (sd 7.3) and 17.2° (sd 7.3), in these three groups, respectively. The mean ADI and SAC in those with Down syndrome requiring surgery and those with Down syndrome not requiring surgery were 9.8 mm (sd 2.8) and 4.3 mm (sd 1.0), and 11.1 mm (sd 2.6) and 18.5 mm (sd 2.4), respectively. The normal values of the C1/4 SAC ratio and the C1 inclination angle were found to be about 1.2° and 15º, respectively. Cite this article: Bone Joint J 2016;98-B:1704-10. ©2016 The British Editorial Society of Bone & Joint Surgery.

The effectiveness of a cognitive task analysis informed curriculum to increase self-efficacy and improve performance for an open cricothyrotomy.

PubMed

Campbell, Julia; Tirapelle, Leslie; Yates, Kenneth; Clark, Richard; Inaba, Kenji; Green, Donald; Plurad, David; Lam, Lydia; Tang, Andrew; Cestero, Ramon; Sullivan, Maura

2011-01-01

This study explored the effects of a cognitive task analysis (CTA)-informed curriculum to increase surgical skills performance and self-efficacy beliefs for medical students and postgraduate surgical residents learning how to perform an open cricothyrotomy. Third-year medical students and postgraduate year 2 and 3 surgery residents were assigned randomly to either the CTA group (n = 12) or the control group (n = 14). The CTA group learned the open cricothyrotomy procedure using the CTA curriculum. The control group received the traditional curriculum. The CTA group outperformed the control group significantly based on a 19-point checklist score (CTA mean score: 17.75, standard deviation [SD] = 2.34; control mean score: 15.14, SD = 2.48; p = 0.006). The CTA group also reported significantly higher self-efficacy scores based on a 140-point self-appraisal inventory (CTA mean score: 126.10, SD = 16.90; control: 110.67, SD = 16.8; p = 0.029). The CTA curriculum was effective in increasing the performance and self-efficacy scores for postgraduate surgical residents and medical students performing an open cricothyrotomy. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Effectiveness of training intervention to improve medical student's information literacy skills.

PubMed

Abdekhoda, Mohammadhiwa; Dehnad, Afsaneh; Yousefi, Mahmood

2016-12-01

This study aimed to assess the efficiency of delivering a 4-month course of "effective literature search" among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students' attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student's attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students' familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students' competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students' ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student's information literacy skills.

Effectiveness of training intervention to improve medical student’s information literacy skills

PubMed Central

2016-01-01

This study aimed to assess the efficiency of delivering a 4-month course of “effective literature search” among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students’ attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student’s attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students’ familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students’ competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students’ ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student’s information literacy skills. PMID:27907985

Olfactory function and neurocognitive outcomes in old age: The Atherosclerosis Risk in Communities Neurocognitive Study.

PubMed

Palta, Priya; Chen, Honglei; Deal, Jennifer A; Sharrett, A Richey; Gross, Alden; Knopman, David; Griswold, Michael; Heiss, Gerardo; Mosley, Thomas H

2018-03-30

We tested the hypothesis that poor sense of smell is associated with lower cognitive function and higher mild cognitive impairment (MCI) prevalence. Olfaction, measured by the Sniffin' Sticks test, was categorized as olfactory impairment (OI) (score ≤6) or no OI (score >6). MCI was adjudicated based on review of a neuropsychological examination. Linear regression estimated the mean difference in cognitive factor scores, and log-binomial regression quantified MCI prevalence among participants with versus without OI. Participants with OI had lower mean factor scores (memory: -0.27 standard deviation [SD], 95% confidence interval [CI]: -0.35 to -0.19; language: -0.24 SD, 95% CI: -0.30 to -0.17; executive function/processing speed: -0.09 SD, 95% CI: -0.12 to -0.06; and general cognitive performance: -0.25 SD, 95% CI: -0.30 to -0.20). OI was also associated with MCI (n = 204; prevalence ratio = 1.56, 95% CI: 1.37, 1.78). An impaired sense of smell may serve as a readily accessible early marker of neurodegeneration and improve upon the prevailing delayed diagnoses and underascertainment of MCI/dementia. Copyright © 2018 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Standing postural reaction to visual and proprioceptive stimulation in chronic acquired demyelinating polyneuropathy.

PubMed

Provost, Clement P; Tasseel-Ponche, Sophie; Lozeron, Pierre; Piccinini, Giulia; Quintaine, Victorine; Arnulf, Bertrand; Kubis, Nathalie; Yelnik, Alain P

2018-02-28

To investigate the weight of visual and proprioceptive inputs, measured indirectly in standing position control, in patients with chronic acquired demyelinating polyneuropathy (CADP). Prospective case study. Twenty-five patients with CADP and 25 healthy controls. Posture was recorded on a double force platform. Stimulations were optokinetic (60°/s) for visual input and vibration (50 Hz) for proprioceptive input. Visual stimulation involved 4 tests (upward, downward, rightward and leftward) and proprioceptive stimulation 2 tests (triceps surae and tibialis anterior). A composite score, previously published and slightly modified, was used for the recorded postural signals from the different stimulations. Despite their sensitivity deficits, patients with CADP were more sensitive to proprioceptive stimuli than were healthy controls (mean composite score 13.9 ((standard deviation; SD) 4.8) vs 18.4 (SD 4.8), p = 0.002). As expected, they were also more sensitive to visual stimuli (mean composite score 10.5 (SD 8.7) vs 22.9 (SD 7.5), p <0.0001). These results encourage balance rehabilitation of patients with CADP, aimed at promoting the use of proprioceptive information, thereby reducing too-early development of visual compensation while proprioception is still available.

Dealing with missing standard deviation and mean values in meta-analysis of continuous outcomes: a systematic review.

PubMed

Weir, Christopher J; Butcher, Isabella; Assi, Valentina; Lewis, Stephanie C; Murray, Gordon D; Langhorne, Peter; Brady, Marian C

2018-03-07

Rigorous, informative meta-analyses rely on availability of appropriate summary statistics or individual participant data. For continuous outcomes, especially those with naturally skewed distributions, summary information on the mean or variability often goes unreported. While full reporting of original trial data is the ideal, we sought to identify methods for handling unreported mean or variability summary statistics in meta-analysis. We undertook two systematic literature reviews to identify methodological approaches used to deal with missing mean or variability summary statistics. Five electronic databases were searched, in addition to the Cochrane Colloquium abstract books and the Cochrane Statistics Methods Group mailing list archive. We also conducted cited reference searching and emailed topic experts to identify recent methodological developments. Details recorded included the description of the method, the information required to implement the method, any underlying assumptions and whether the method could be readily applied in standard statistical software. We provided a summary description of the methods identified, illustrating selected methods in example meta-analysis scenarios. For missing standard deviations (SDs), following screening of 503 articles, fifteen methods were identified in addition to those reported in a previous review. These included Bayesian hierarchical modelling at the meta-analysis level; summary statistic level imputation based on observed SD values from other trials in the meta-analysis; a practical approximation based on the range; and algebraic estimation of the SD based on other summary statistics. Following screening of 1124 articles for methods estimating the mean, one approximate Bayesian computation approach and three papers based on alternative summary statistics were identified. Illustrative meta-analyses showed that when replacing a missing SD the approximation using the range minimised loss of precision and generally performed better than omitting trials. When estimating missing means, a formula using the median, lower quartile and upper quartile performed best in preserving the precision of the meta-analysis findings, although in some scenarios, omitting trials gave superior results. Methods based on summary statistics (minimum, maximum, lower quartile, upper quartile, median) reported in the literature facilitate more comprehensive inclusion of randomised controlled trials with missing mean or variability summary statistics within meta-analyses.

Influence of supine sleep positioning on early motor milestone acquisition.

PubMed

Majnemer, Annette; Barr, Ronald G

2005-06-01

This study aimed to determine whether supine sleep-positioned infants have delayed motor skills at age 4 and 6 months, and if delays are associated with decreased exposure to prone position. One 4 and one 6-month-old sample of healthy infants born at term were recruited. Motor assessments included the Peabody Developmental Motor Scale (PDMS) and Alberta Infant Motor Scale (AIMS). Parents completed an infant behavior diary for 3 consecutive days. Seventy-one 4-month-old infants were assessed (38 males; mean age 4.4 mo, standard deviation [SD] 0.2). Mean motor scores were close to normative standards (AIMS 47.7, SD 19.6; PDMS gross motor quotient [GMQ] 96.3, SD 6.5; PDMS fine motor quotient [FMQ] 99.2, SD 4.8). No infant scored below cut-off values used to identify motor delay. Milestones less likely to be achieved included extended arm support in prone, hands to feet in supine, and sitting with arm support. Exposure to 'tummy time' while awake was correlated with AIMS scores (r = 0.38, p < 0.01). F i fty 6-month-old infants were assessed (21 males; mean age 6.4 mo, SD 0.4). Mean scores were shifted down for all scales, and as much as 1 SD for PDMS (AIMS 44.5, SD 21.6; PDMS GMQ 85.7, SD 7.6; PDMS FMQ 88.9, SD 9.0). Only 22% of 6-month-olds could sit without arm support versus 50% expected in a normative sample. Remarkably, 22% of our sample exhibited gross motor delays (quotient <78). Tummy time (awake) was significantly associated with the AIMS (r = 0.64) and PDMS GMQ (r = 0.55) and FMQ (r = 0.33) quotients, even after adjusting for confounders. Typically developing infants who were sleep-positioned in supine had delayed motor development by age 6 months, and this was significantly associated with limited exposure to awake prone positioning. This has important implications for interpreting motor assessments of infants at risk and for preventing inappropriate referrals.

How Many Subjects are Needed for a Visual Field Normative Database? A Comparison of Ground Truth and Bootstrapped Statistics.

PubMed

Phu, Jack; Bui, Bang V; Kalloniatis, Michael; Khuu, Sieu K

2018-03-01

The number of subjects needed to establish the normative limits for visual field (VF) testing is not known. Using bootstrap resampling, we determined whether the ground truth mean, distribution limits, and standard deviation (SD) could be approximated using different set size ( x ) levels, in order to provide guidance for the number of healthy subjects required to obtain robust VF normative data. We analyzed the 500 Humphrey Field Analyzer (HFA) SITA-Standard results of 116 healthy subjects and 100 HFA full threshold results of 100 psychophysically experienced healthy subjects. These VFs were resampled (bootstrapped) to determine mean sensitivity, distribution limits (5th and 95th percentiles), and SD for different ' x ' and numbers of resamples. We also used the VF results of 122 glaucoma patients to determine the performance of ground truth and bootstrapped results in identifying and quantifying VF defects. An x of 150 (for SITA-Standard) and 60 (for full threshold) produced bootstrapped descriptive statistics that were no longer different to the original distribution limits and SD. Removing outliers produced similar results. Differences between original and bootstrapped limits in detecting glaucomatous defects were minimized at x = 250. Ground truth statistics of VF sensitivities could be approximated using set sizes that are significantly smaller than the original cohort. Outlier removal facilitates the use of Gaussian statistics and does not significantly affect the distribution limits. We provide guidance for choosing the cohort size for different levels of error when performing normative comparisons with glaucoma patients.

Determinants of ocular deviation in esotropic subjects under general anesthesia.

PubMed

Daien, Vincent; Turpin, Chloé; Lignereux, François; Belghobsi, Riadh; Le Meur, Guylene; Lebranchu, Pierre; Pechereau, Alain

2013-01-01

The authors attempted to identify the determinants of ocular deviation in a population of patients with esotropia under general anesthesia. Forty-one patients with esotropia were included. Horizontal ocular deviation was evaluated by the photographic Hirschberg test both in the awakened state and under general anesthesia before surgery. Changes in ocular deviation were measured and a multivariate analysis was used to assess its clinical determinants. The mean age (± standard deviation [SD]) of study subjects was 13 ± 11 years and 51% were females. The mean spherical equivalent refraction of the right eye was 2.44 ± 2.50 diopters (D), with no significant difference between eyes (P = .26). The mean ocular deviation changed significantly, from 33.5 ± 12.5 prism diopters (PD) at preoperative examination to 8.8 ± 11.4 PD under general anesthesia (P = .0001). The changes in ocular deviation positively correlated with the pre-operative ocular deviation (correlation coefficient r = 0.59, P = .0001) and negatively correlated with patient age (correlation coefficient r = -0.53, P = .0001). These two determinants remained significant after multivariate adjustment of the following variables: preoperative ocular deviation; age; gender; spherical equivalent refraction; and number of previous strabismus surgeries (model r(2) = 0.49, P = .0001). The ocular position under general anesthesia was reported as a key factor in the surgical treatment of subjects with esotropia; therefore, its clinical determinants were assessed. The authors observed that preoperative ocular deviation and patient age were the main factors that influenced the ocular position under general anesthesia. Copyright 2013, SLACK Incorporated.

Suturing training in Augmented Reality: gaining proficiency in suturing skills faster.

PubMed

Botden, S M B I; de Hingh, I H J T; Jakimowicz, J J

2009-09-01

Providing informative feedback and setting goals tends to motivate trainees to practice more extensively. Augmented Reality simulators retain the benefit of realistic haptic feedback and additionally generate objective assessment and informative feedback during the training. This study researched the performance curve of the adapted suturing module on the ProMIS Augmented Reality simulator. Eighteen novice participants were pretrained on the MIST-VR to become acquainted with laparoscopy. Subsequently, they practiced 16 knots on the suturing module, of which the assessment scores were recorded to evaluate the gain in laparoscopic suturing skills. The scoring of the assessment method was calculated from the "time spent in the correct area" during the knot tying and the quality of the knot. Both the baseline knot and the knot at the top of the performance curve were assessed by two independent objective observers, by means of a standardized evaluation form, to objectify the gain in suturing skills. There was a statistically significant difference between the scores of the second knot (mean 72.59, standard deviation (SD) 16.28) and the top of the performance curve (mean 95.82, SD 3.05; p < 0.001, paired t-test). The scoring of the objective observers also differed significantly (mean 11.83 and 22.11, respectively; SD 3.37 and 3.89, respectively; p < 0.001) (interobserver reliability Cronbach's alpha = 0.96). The median amount of repetitions to reach the top of the performance curve was eight, which also showed significant differences between both the assessment score (mean 88.14, SD 13.53, p < 0.001) and scoring of the objective observers of the second knot (mean 20.51, SD 4.14; p < 0.001). This adapted suturing module on the ProMIS Augmented Reality laparoscopic simulator is a potent tool for gaining laparoscopic suturing skills.

Development of a Smartphone-based reading system for lateral flow immunoassay.

PubMed

Lee, Sangdae; Kim, Giyoung; Moon, Jihea

2014-11-01

This study was conducted to develop and evaluate the performance of the Smartphone-based reading system for the lateral flow immunoassay (LFIA). Smartphone-based reading system consists of a Samsung Galaxy S2 Smartphone, Smartphone application, and a LFIA reader. LFIA reader is composed of the close-up lens with a focal length up to 30 mm, white LED light, lithium polymer battery, and main body. The Smartphone application for image acquisition and data analysis was developed on the Android platform. The standard curve was obtained by plotting the measured P(T)/P(c) or A(T)/A(c) ratio versus Salmonella standard concentration. The mean, standard deviation (SD), recovery, and relative standard deviation (RSD) were also calculated using additional experimental results. These data were compared with that obtained from the benchtop LFIA reader. The LOD in both systems was observed with 10(6) CFU/mL. The results show high accuracy and good reproducibility with a RSD less than 10% in the range of 10(6) to 10(9) CFU/mL. Due to the simple structure, good sensitivity, and high accuracy of the Smartphone-based reading system, this system can be substituted for the benchtop LFIA reader for point-of-care medical diagnostics.

The Myocardial Ischemia Evaluated by Real-Time Contrast Echocardiography May Predict the Response to Cardiac Resynchronization Therapy: A Large Animal Study

PubMed Central

Chen, Yongle; Cheng, Leilei; Yao, Haohua; Chen, Haiyan; Wang, Yongshi; Zhao, Weipeng; Pan, Cuizhen; Shu, Xianhong

2014-01-01

Evidence-based criteria for applying cardiac resynchronization therapy (CRT) in patients with ischemic cardiomyopathy are still scarce. The aim of the present study was to evaluate the predictive value of real-time myocardial contrast echocardiography (RT-MCE) in a preclinical canine model of ischemic cardiomyopathy who received CRT. Ischemic cardiomyopathy was produced by ligating the first diagonal branch in 20 beagles. Dogs were subsequently divided into two groups that were either treated with bi-ventricular pacing (CRT group) or left untreated (control group). RT-MCE was performed at baseline, before CRT, and 4 weeks after CRT. Two-dimensional speckle tracking imaging was used to evaluate the standard deviation of circumferential (Cir12SD), radial (R12SD), and longitudinal (L12SD) strains of left ventricular segments at basal as well as middle levels. Four weeks later, the Cir12SD, R12SD, and myocardial blood flow (MBF) of the treated group were significantly improved compared to their non-CRT counterparts. Furthermore, MBF values measured before CRT were significantly higher in responders than in non-responders to bi-ventricular pacing. Meanwhile, no significant differences were observed between the responder and non-responder groups in terms of Cir12SD, R12SD, and L12SD. A high degree of correlation was found between MBF values before CRT and LVEF after CRT. When MBF value>24.9 dB/s was defined as a cut-off point before CRT, the sensitivity and specificity of RT-MCE in predicting the response to CRT were 83.3% and 100%, respectively. Besides, MBF values increased significantly in the CRT group compared with the control group after 4 weeks of pacing (49.8±15.5 dB/s vs. 28.5±4.6 dB/s, p<0.05). Therefore, we considered that myocardial perfusion may be superior to standard metrics of LV synchrony in selecting appropriate candidates for CRT. In addition, CRT can improve myocardial perfusion in addition to cardiac synchrony, especially in the setting of ischemic cardiomyopathy. PMID:25469632

Prognostic factors of hydrops fetalis with pleural effusion.

PubMed

Nakayama, Atsushi; Oshiro, Makoto; Yamada, Yasumasa; Hattori, Tetsuo; Wakano, Yasuhiro; Hayashi, Seiji; Kokubo, Minoru; Takemoto, Koji; Honda, Shigeru; Ieda, Kuniko; Yamamoto, Hikaru; Kouwaki, Masanori; Yokoi, Kyoko; Shinohara, Osamu; Kato, Takenori; Miyata, Masafumi; Tanaka, Taihei; Hayakawa, Masahiro

2017-10-01

Hydrops fetalis (HF) has a low survival rate, particularly in the case of preterm birth. In addition, the severity index of HF has not been fully investigated yet. The aim of this study was to clarify the prognostic factors of HF with pleural effusion. All live-born HF patients with pleural effusion, except for chromosomal abnormality or complex congenital heart disease, born from 2009 to 2013 in Aichi Prefecture in Japan were included. Prenatal, perinatal, and postnatal information was obtained from the medical records and was retrospectively analyzed. Forty-one HF patients with pleural effusion were included, and 28 patients (68%) survived. On multivariate logistic stepwise analysis, gestational birth week (OR, 0.71; 95% CI: 0.52-0.96, P = 0.027) and standard deviation (SD) score of the birthweight (OR, 1.74; 95% CI: 1.01-2.99, P = 0.045) were significant factors for postnatal death. All patients with both ≥32 gestational weeks and <3.0 birthweight SD score survived. Combined with the gestational weeks data, birthweight SD score may be useful to estimate the prognosis of HF with pleural effusion. © 2017 Japan Pediatric Society.

Infant lung function tests as endpoints in the ISIS multicenter clinical trial in cystic fibrosis.

PubMed

Davis, Stephanie D; Ratjen, Felix; Brumback, Lyndia C; Johnson, Robin C; Filbrun, Amy G; Kerby, Gwendolyn S; Panitch, Howard B; Donaldson, Scott H; Rosenfeld, Margaret

2016-05-01

The Infant Study of Inhaled Saline (ISIS) in CF was the first multicenter clinical trial to utilize infant pulmonary function tests (iPFTs) as an endpoint. Secondary analysis of ISIS data was conducted in order to assess feasibility of iPFT measures and their associations with respiratory symptoms. Standard deviations were calculated to aid in power calculations for future clinical trials. Seventy-three participants enrolled, 70 returned for the final visit; 62 (89%) and 45 (64%) had acceptable paired functional residual capacity (FRC) and raised volume measurements, respectively. Mean baseline FEV0.5, FEF75 and FRC z-scores were 0.3 (SD: 1.2), -0.2 (SD: 2.0), and 1.8 (SD: 2.0). iPFTs are not appropriate primary endpoints for multicenter clinical trials due to challenges of obtaining acceptable data and near-normal average raised volume measurements. Raised volume measures have potential to serve as secondary endpoints in future clinical CF trials. Copyright © 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

[Comparative study of the biometric measurements made by immersion and contact techniques].

PubMed

Kronbauer, Airton Leite; Kronbauer, Fernando Leite; Kronbauer, Cláudia Leite

2006-01-01

To compare clinical biometric findings between measurements of immersion technique and contact technique. Axial length was measured by A-scan in 120 medical examinations in 60 patients with cataract using a non-contact (immersion) and a contact technique in paired-samples by ultrasound. The mean axial length was found to be 23.19 mm (SD 1.32) with the immersion technique and 22.93 mm (SD 1.32) with the contact technique, using the same transducer probe. The difference of 0.255 mm (SD 0.3) was significant at the 0.01 level. The difference should be taken into account when evaluating the accuracy of IOL calculation. The mean standard deviation between recurrent measures in same eye was found to be 0.04 with the immersion technique and 0.19 with the contact technique. The difference of 0.15 was significant at the 0.01 level. The difference should be taken into account when evaluating the accuracy of reproductivity of technique examination. These data provide benchmark information that can be used to monitor clinical practice and to perform others studies.

A height-for-age growth reference for children with achondroplasia: Expanded applications and comparison with original reference data.

PubMed

Hoover-Fong, Julie; McGready, John; Schulze, Kerry; Alade, Adekemi Yewande; Scott, Charles I

2017-05-01

The height-for-age (HA) reference currently used for children with achondroplasia is not adaptable for electronic records or calculation of HA Z-scores. We report new HA curves and tables of mean and standard deviation (SD) HA, for calculating Z-scores, from birth-16 years in achondroplasia. Mixed longitudinal data were abstracted from medical records of achondroplasia patients from a single clinical practice (CIS, 1967-2004). Gender-specific height percentiles (5, 25, 50, 75, 95th) were estimated across the age continuum, using a 2 month window per time point smoothed by a quadratic smoothing algorithm. HA curves were constructed for 0-36 months and 2-16 years to optimize resolution for younger children. Mean monthly height (SD) was tabulated. These novel HA curves were compared to reference data currently in use for children with achondroplasia. 293 subjects (162 male/131 female) contributed 1,005 and 932 height measures, with greater data paucity with age. Mean HA tracked with original achondroplasia norms, particularly through mid-childhood (2-9 years), but with no evidence of a pubertal growth spurt. Standard deviation of height at each month interval increased from birth through 16 years. Birth length was lower in achondroplasia than average stature and, as expected, height deficits increased with age. A new HA reference is available for longitudinal growth assessment in achondroplasia, taking advantage of statistical modeling techniques and allowing for Z-score calculations. This is an important contribution to clinical care and research endeavors for the achondroplasia population. © 2017 Wiley Periodicals, Inc.

Reduced exposure using asymmetric cone beam processing for wide area detector cardiac CT

PubMed Central

Bedayat, Arash; Kumamaru, Kanako; Powers, Sara L.; Signorelli, Jason; Steigner, Michael L.; Steveson, Chloe; Soga, Shigeyoshi; Adams, Kimberly; Mitsouras, Dimitrios; Clouse, Melvin; Mather, Richard T.

2011-01-01

The purpose of this study was to estimate dose reduction after implementation of asymmetrical cone beam processing using exposure differences measured in a water phantom and a small cohort of clinical coronary CTA patients. Two separate 320 × 0.5 mm detector row scans of a water phantom used identical cardiac acquisition parameters before and after software modifications from symmetric to asymmetric cone beam acquisition and processing. Exposure was measured at the phantom surface with Optically Stimulated Luminescence (OSL) dosimeters at 12 equally spaced angular locations. Mean HU and standard deviation (SD) for both approaches were compared using ROI measurements obtained at the center plus four peripheral locations in the water phantom. To assess image quality, mean HU and standard deviation (SD) for both approaches were compared using ROI measurements obtained at five points within the water phantom. Retrospective evaluation of 64 patients (37 symmetric; 27 asymmetric acquisition) included clinical data, scanning parameters, quantitative plus qualitative image assessment, and estimated radiation dose. In the water phantom, the asymmetric cone beam processing reduces exposure by approximately 20% with no change in image quality. The clinical coronary CTA patient groups had comparable demographics. The estimated dose reduction after implementation of the asymmetric approach was roughly 24% with no significant difference between the symmetric and asymmetric approach with respect to objective measures of image quality or subjective assessment using a four point scale. When compared to a symmetric approach, the decreased exposure, subsequent lower patient radiation dose, and similar image quality from asymmetric cone beam processing supports its routine clinical use. PMID:21336552

Reduced exposure using asymmetric cone beam processing for wide area detector cardiac CT.

PubMed

Bedayat, Arash; Rybicki, Frank J; Kumamaru, Kanako; Powers, Sara L; Signorelli, Jason; Steigner, Michael L; Steveson, Chloe; Soga, Shigeyoshi; Adams, Kimberly; Mitsouras, Dimitrios; Clouse, Melvin; Mather, Richard T

2012-02-01

The purpose of this study was to estimate dose reduction after implementation of asymmetrical cone beam processing using exposure differences measured in a water phantom and a small cohort of clinical coronary CTA patients. Two separate 320 × 0.5 mm detector row scans of a water phantom used identical cardiac acquisition parameters before and after software modifications from symmetric to asymmetric cone beam acquisition and processing. Exposure was measured at the phantom surface with Optically Stimulated Luminescence (OSL) dosimeters at 12 equally spaced angular locations. Mean HU and standard deviation (SD) for both approaches were compared using ROI measurements obtained at the center plus four peripheral locations in the water phantom. To assess image quality, mean HU and standard deviation (SD) for both approaches were compared using ROI measurements obtained at five points within the water phantom. Retrospective evaluation of 64 patients (37 symmetric; 27 asymmetric acquisition) included clinical data, scanning parameters, quantitative plus qualitative image assessment, and estimated radiation dose. In the water phantom, the asymmetric cone beam processing reduces exposure by approximately 20% with no change in image quality. The clinical coronary CTA patient groups had comparable demographics. The estimated dose reduction after implementation of the asymmetric approach was roughly 24% with no significant difference between the symmetric and asymmetric approach with respect to objective measures of image quality or subjective assessment using a four point scale. When compared to a symmetric approach, the decreased exposure, subsequent lower patient radiation dose, and similar image quality from asymmetric cone beam processing supports its routine clinical use.

Early results after laparoscopic Roux-en-Y gastric bypass: effect of the learning curve

PubMed Central

Andrew, Christopher G.; Hanna, Wael; Look, Didier; McLean, Alexander P.H.; Christou, Nicolas V.

2006-01-01

Introduction This study was performed to evaluate the safety and short-term efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity and to describe the relation between learning curve and short-term outcomes. Methods We collected a prospective database on the first 201 consecutive patients who underwent LRYGB by a single university-based, experienced bariatric surgeon over 24 months. We divided patients into 3 consecutive groups of 67 patients for analysis (Group 1, Group 2 and Group 3). Results The mean patient age was 37 (standard deviation [SD] 9) years; mean body mass index (BMI) was 49.2 (SD 8.3) kg/m2. BMI was similar in Groups 1 and 2 (mean 47.1, SD 5.9 and mean 48.7, SD 8.9 kg/m2) but increased in Group 3 (mean 52, SD 9.7 kg/m2, p < 0.01). Operative time decreased from 145 (SD 30) minutes in Group 1 to 114 (SD 24) minutes in Group 2 (p < 0.01) and was maintained at 119 (SD 23) minutes in Group 3. Early and late complication rates were 14.9% and 12.4%, respectively. Leak rates decreased from 6.0% in the first group to 1.5% in Groups 2 and 3, but they did not reach statistical significance. Anastomotic stricture rates decreased from 11.9% in Group 1 to 3.0% in Group 2 (p < 0.01). Overall excess weight loss for the entire series was 31.5% (SD 11.9%), 54.5% (SD 14.1%), 77.1% (SD 18.5%) and 82.1% (SD 17.5%) at 3, 6, 12 and 18 months, respectively. Conclusion LRYGB can be performed with acceptable morbidity and short-term results during the learning curve. In our series, operative time and anastomotic stricture rates decreased with experience, despite an increase in mean BMI. PMID:17234071

Optimized point dose measurement for monitor unit verification in intensity modulated radiation therapy using 6 MV photons by three different methodologies with different detector-phantom combinations: A comparative study

PubMed Central

Sarkar, Biplab; Ghosh, Bhaswar; Sriramprasath; Mahendramohan, Sukumaran; Basu, Ayan; Goswami, Jyotirup; Ray, Amitabh

2010-01-01

The study was aimed to compare accuracy of monitor unit verification in intensity modulated radiation therapy (IMRT) using 6 MV photons by three different methodologies with different detector phantom combinations. Sixty patients were randomly chosen. Zero degree couch and gantry angle plans were generated in a plastic universal IMRT verification phantom and 30×30×30 cc water phantom and measured using 0.125 cc and 0.6 cc chambers, respectively. Actual gantry and couch angle plans were also measured in water phantom using 0.6 cc chamber. A suitable point of measurement was chosen from the beam profile for each field. When the zero-degree gantry, couch angle plans and actual gantry, couch angle plans were measured by 0.6 cc chamber in water phantom, the percentage mean difference (MD) was 1.35%, 2.94 % and Standard Deviation (SD) was 2.99%, 5.22%, respectively. The plastic phantom measurements with 0.125 cc chamber Semiflex ionisation chamber (SIC) showed an MD=4.21% and SD=2.73 %, but when corrected for chamber-medium response, they showed an improvement, with MD=3.38 % and SD=2.59 %. It was found that measurements with water phantom and 0.6cc chamber at gantry angle zero degree showed better conformity than other measurements of medium-detector combinations. Correction in plastic phantom measurement improved the result only marginally, and actual gantry angle measurement in a flat- water phantom showed higher deviation. PMID:20927221

Multimedia telehomecare system using standard TV set.

PubMed

Guillén, S; Arredondo, M T; Traver, V; García, J M; Fernández, C

2002-12-01

Nowadays, there are a very large number of patients that need specific health support at home. The deployment of broadband communication networks is making feasible the provision of home care services with a proper quality of service. This paper presents a telehomecare multimedia platform that runs over integrated services digital network and internet protocol using videoconferencing standards H.320 and H.323, and standard TV set for patient interaction. This platform allows online remote monitoring: ECG, heart sound, blood pressure. Usability, affordability, and interoperability were considered for the design and development of its hardware and software components. A first evaluation of technical and usability aspects were carried forward with 52 patients of a private clinic and 10 students in the University. Results show a high rate (mean = 4.33, standard deviation--SD = 1.63 in a five-points Likert scale) in the global perception of users on the quality of images, voice, and feeling of virtual presence.

Pelvic position and movement during hip replacement.

PubMed

Grammatopoulos, G; Pandit, H G; da Assunção, R; Taylor, A; McLardy-Smith, P; De Smet, K A; Murray, D W; Gill, H S

2014-07-01

The orientation of the acetabular component is influenced not only by the orientation at which the surgeon implants the component, but also the orientation of the pelvis at the time of implantation. Hence, the orientation of the pelvis at set-up and its movement during the operation, are important. During 67 hip replacements, using a validated photogrammetric technique, we measured how three surgeons orientated the patient's pelvis, how much the pelvis moved during surgery, and what effect these had on the final orientation of the acetabular component. Pelvic orientation at set-up, varied widely (mean (± 2, standard deviation (sd))): tilt 8° (2sd ± 32), obliquity -4° (2sd ± 12), rotation -8° (2sd ± 14). Significant differences in pelvic positioning were detected between surgeons (p < 0.001). The mean angular movement of the pelvis between set-up and component implantation was 9° (sd 6). Factors influencing pelvic movement included surgeon, approach (posterior > lateral), procedure (hip resurfacing > total hip replacement) and type of support (p < 0.001). Although, on average, surgeons achieved their desired acetabular component orientation, there was considerable variability (2sd ± 16) in component orientation. We conclude that inconsistency in positioning the patient at set-up and movement of the pelvis during the operation account for much of the variation in acetabular component orientation. Improved methods of positioning and holding the pelvis are required. ©2014 The British Editorial Society of Bone & Joint Surgery.

Retinopathy of prematurity: postmenstrual age at threshold in a transitional economy is similar to that in developed countries.

PubMed

Carden, Susan Mary; Luu, Lan Ngoc; Nguyen, Tinh Xuan; Huynh, Tess; Good, William Vance

2008-03-01

To analyse the timing of threshold disease in infants requiring treatment for retinopathy of prematurity in a transitional economy. Retrospective, observational, cohort study. National Hospital of Paediatrics, Hanoi, Vietnam. Premature infants in the Neonatal ward requiring laser treatment for threshold retinopathy of prematurity. Chronological age and postmenstrual age at treatment. From January 2002 to November 2004, 42 infants from the National Hospital of Paediatrics required laser surgery for threshold retinopathy of prematurity. The mean +/- standard deviation (SD) of birth weight was 1369 +/- 184 g (range 1000-1700); the mean +/- SD of gestation at birth was 30 +/- 1.8 weeks (range 27-34); and the mean +/- SD of postmenstrual age at which treatment occurred in these infants was 36.2 +/- 2.5 weeks (range 31.4-42). A further 58 infants were transferred from other hospitals for laser surgery between January 2004 and October 2004. The mean +/- SD of birth weight was 1325.5 +/- 237.2 g (range 800-1900); the mean +/- SD of gestation at birth was 30 +/- 1.7 weeks (range 28-35); and the mean +/- SD of postmenstrual age at which treatment was given in these infants was 36.3 +/- 2.3 weeks (range 32.71-44.3). Despite the relative maturity of the gestation of these infants compared with infants in developed countries who develop severe retinopathy of prematurity, the timing of treatment for threshold disease appears to be related to postmenstrual age.

Arthroscopic Revision Surgery for Failure of Open Latarjet Technique.

PubMed

Cuéllar, Adrián; Cuéllar, Ricardo; de Heredia, Pablo Beltrán

2017-05-01

To evaluate the efficacy in treating pain, limited range of motion, and continued instability of the Latarjet open technique via the use of arthroscopy. A retrospective review of patients who underwent arthroscopic capsule plication after failure of an open Latarjet technique was performed. Revision surgery was indicated in cases of recurrent instability and associated pain. Only patients with a glenoid defect <25% were considered. The Constant and Rowe scores were administered, whereas pain was assessed with a visual analog scale before the reoperation and at 24 months after operation. Radiographs, computed tomography, and CT arthrography scans were performed. Twelve patients met the inclusion criteria. All patients had capsular distension and consequently were subjected to a capsuloplasty. Shoulder function, stability, and pain had all improved significantly at 24 months after arthroscopic revision (P < .0001). In particular, the Constant score increased from 44.9 (standard deviation [SD] 7.10) to 89.3 (SD 12.6) points, the Rowe score improved from 49.5 (SD 10.1) to 80.9 (SD 10.9), whereas the visual analog scale pain score decreased from 6.75 (SD 1.17) to 1.38 (SD 1.06). Primary open Latarjet with a glenoid bone defect <25% that failed due to capsular redundancy is amenable to successful treatment with arthroscopic capsuloplasty. Arthroscopic approaches can offer a good solution for treating previously failed open Latarjet procedures. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Course of employment in adults with cerebral palsy over a 14-year period.

PubMed

Benner, Joyce L; Hilberink, Sander R; Veenis, Thessa; van der Slot, Wilma M A; Roebroeck, Marij E

2017-07-01

To explore the course of employment in adults with cerebral palsy (CP) over 14 years, and to identify subgroups at risk for unemployment. Sixty-five adults with CP (33 males, 32 females; baseline age 25y 8mo, standard deviation [SD] 3y 2mo; intellectual impairment 25%; bilateral CP 65%) participated in a prospective cohort study. Self-reports of employment and work hours per week in 1996, 2000, and 2010 were documented. The course of employment (including sheltered work) and work hours per week were analysed, using generalized estimating equations (GEE). Overall, employment rate was stable over time (38-45%, p=0.413), but lower than in the general population (75-86%, p<0.001). Employment rates were specifically low in adults with intellectual impairment, bilateral CP, and in adults with Gross Motor Function Classification System (GMFCS) levels IV and V. Work hours per week declined (35.0 [SD 7.9] to 31.2 [SD 10.3], p=0.033), especially among females (32.3 [SD 6.4] to 23.4 [SD 7.4], p<0.001). Similar to the general population, females often worked part-time. Employment was low compared with the general population, but remained stable in the long term; however, work hours per week decreased. Adults with intellectual impairment, bilateral CP, and GMFCS levels IV and V are subgroups at risk for unemployment. © 2017 Mac Keith Press.

Visually assessed colour overlay features in shear-wave elastography for breast masses: quantification and diagnostic performance.

PubMed

Gweon, Hye Mi; Youk, Ji Hyun; Son, Eun Ju; Kim, Jeong-Ah

2013-03-01

To determine whether colour overlay features can be quantified by the standard deviation (SD) of the elasticity measured in shear-wave elastography (SWE) and to evaluate the diagnostic performance for breast masses. One hundred thirty-three breast lesions in 119 consecutive women who underwent SWE before US-guided core needle biopsy or surgical excision were analysed. SWE colour overlay features were assessed using two different colour overlay pattern classifications. Quantitative SD of the elasticity value was measured with the region of interest including the whole breast lesion. For the four-colour overlay pattern, the area under the ROC curve (Az) was 0.947; with a cutoff point between pattern 2 and 3, sensitivity and specificity were 94.4 % and 81.4 %. According to the homogeneity of the elasticity, the Az was 0.887; with a cutoff point between reasonably homogeneous and heterogeneous, sensitivity and specificity were 86.1 % and 82.5 %. For the SD of the elasticity, the Az was 0.944; with a cutoff point of 12.1, sensitivity and specificity were 88.9 % and 89.7 %. The colour overlay features showed significant correlations with the quantitative SD of the elasticity (P < 0.001). The colour overlay features and the SD of the elasticity in SWE showed excellent diagnostic performance and showed good correlations between them.

Hyperosmolarity response of ocular standing potential as a clinical test for retinal pigment epithelium activity. Chorioretinal dystrophies.

PubMed

Yonemura, D; Kawasaki, K; Madachi-Yamamoto, S

1984-05-30

The hyperosmolarity response of the standing potential was recorded in retinitis pigmentosa (20 eyes), central (pericentral) retinitis pigmentosa (4 eyes), pigmented paravenous retinochoroidal atrophy (2 eyes), fundus albipunctatus (8 eyes), and Stargardt's disease (or fundus flavimaculatus) (14 eyes). The light peak/dark trough ratio (the L/D ratio) and the Diamox response were also determined. The hyperosmolarity response was greatly suppressed (less than M-4SD; M and SD indicate respectively the mean and the standard deviation in normal control subjects) in all examined eyes with retinitis pigmentosa (20 eyes) including retinitis pigmentosa sine pigmento (8 eyes), central (pericentral) retinitis pigmentosa (4 eyes), and pigmented paravenous retinochoroidal atrophy (2 eyes). The L/D ratio was larger than 1.26 (M-2.5 SD) in the half of the eyes with the above-described diseases. The hyperosmolarity response was abnormal (less than M-2 SD) in 4 of 8 eyes with fundus albipunctatus. The L/D ratio was normal in all 8 eyes. The hyperosmolarity response was abnormal (less than M-2 SD) in all 14 eyes with Stargardt's disease or fundus flavimaculatus. The L/D ratio was abnormal in 5 of these 14 eyes. The hyperosmolarity response was more frequently abnormal than the L/D ratio in the chorioretinal dystrophies mentioned above, and hence is useful particularly for early diagnosis of these disorders.

Hyperosmolarity response of ocular standing potential as a clinical test for retinal pigment epithelium activity chorioretinal dystrophies.

PubMed

Yonemura, D; Kawasaki, K; Madachi-Yamamoto, S

1984-05-01

The hyperosmolarity response of the standing potential was recorded in retinitis pigmentosa (20 eyes), central (pericentral) retinitis pigmentosa (4 eyes), pigmented paravenous retinochoroidal atrophy (2 eyes), fundus albipunctatus (8 eyes), and Stargardt's disease (or fundus flavimaculatus) (14 eyes). The light peak/dark trough ratio (the L/D ratio) and the Diamox response were also determined.The hyperosmolarity response was greatly suppressed (less than M-4SD; M and SD indicate respectively the mean and the standard deviation in normal control subjects) in all examined eyes with retinitis pigmentosa (20 eyes) including retinitis pigmentosa sine pigmento (8 eyes), central (pericentral) retinitis pigmentosa (4 eyes), and pigmented paravenous retinochoroidal atrophy (2 eyes). The L/D ratio was larger than 1.26 (M-2.5 SD) in the half of the eyes with the above-described diseases.The hyperosmolarity response was abnormal (less than M-2 SD) in 4 of 8 eyes with fundus albipunctatus. The L/D ratio was normal in all 8 eyes.The hyperosmolarity response was abnormal (less than M-2 SD) in all 14 eyes with Stargardt's disease or fundus flavimaculatus. The L/D ratio was abnormal in 5 of these 14 eyes.The hyperosmolarity response was more frequently abnormal than the L/D ratio in the chorioretinal dystrophies mentioned above, and hence is useful particularly for early diagnosis of these disorders.

Application of 3D and 2D quantitative shear wave elastography (SWE) to differentiate between benign and malignant breast masses.

PubMed

Tian, Jie; Liu, Qianqi; Wang, Xi; Xing, Ping; Yang, Zhuowen; Wu, Changjun

2017-01-20

As breast cancer tissues are stiffer than normal tissues, shear wave elastography (SWE) can locally quantify tissue stiffness and provide histological information. Moreover, tissue stiffness can be observed on three-dimensional (3D) colour-coded elasticity maps. Our objective was to evaluate the diagnostic performances of quantitative features in differentiating breast masses by two-dimensional (2D) and 3D SWE. Two hundred ten consecutive women with 210 breast masses were examined with B-mode ultrasound (US) and SWE. Quantitative features of 3D and 2D SWE were assessed, including elastic modulus standard deviation (E SD E ) measured on SWE mode images and E SD U measured on B-mode images, as well as maximum elasticity (E max ). Adding quantitative features to B-mode US improved the diagnostic performance (p < 0.05) and reduced false-positive biopsies (p < 0.0001). The area under the receiver operating characteristic curve (AUC) of 3D SWE was similar to that of 2D SWE for E SD E (p = 0.026) and E SD U (p = 0.159) but inferior to that of 2D SWE for E max (p = 0.002). Compared with E SD U , E SD E showed a higher AUC on 2D (p = 0.0038) and 3D SWE (p = 0.0057). Our study indicates that quantitative features of 3D and 2D SWE can significantly improve the diagnostic performance of B-mode US, especially 3D SWE E SD E , which shows considerable clinical value.

Assessing the standards of online oral hygiene instructions for patients with fixed orthodontic appliances.

PubMed

Verhoef, Willem A; Livas, Christos; Delli, Konstantina; Ren, Yijin

2015-05-01

The authors conducted this study to assess the quality of the information available on the Web about oral hygiene for patients with fixed orthodontic appliances. The authors entered the search terms "cleaning braces," "brushing braces," and "oral hygiene and braces" into Google, Yahoo, and Bing search engines. They analyzed Web sites satisfying the inclusion criteria from the first 20 hits of each search for accessibility, usability, and reliability by using the LIDA instrument; for readability by using the Flesch Reading Ease (FRE) score; and for the completeness of oral hygiene instructions. Sixty-two Web sites met the inclusion criteria. The mean total LIDA score of 71.2 indicated the moderate quality of the design of the reviewed Web sites. The mean (standard deviation [SD]) values of LIDA scores for accessibility, usability, and reliability were 85.9 (7.0), 63.4 (16.1), and 48.0 (10.4), respectively. The mean (SD) FRE Score of 68.6 (9.7) applied to standard reading skills. The completeness of information (mean [SD] = 67.1 [27.8]) presented the highest variability. Overall, the authors found that the standards of online oral hygiene materials for orthodontic patients with fixed appliances exhibited modest scores. Readability appeared to be appropriate for young adolescents, whereas the comprehensiveness of the displayed information was highly variable. Further improvement of the infrastructure of electronic health information (that is, e-health) in orthodontics is necessary to meet patients' needs. Given the moderate quality of oral hygiene instruction available on the Web for patients with fixed appliances, orthodontic patients and caregivers should be cautious when browsing the Internet for relevant information. Dental professionals should refer patients to valid Web-based educational materials. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

[Investigation of radiation dose for lower tube voltage CT using automatic exposure control].

PubMed

Takata, Mitsuo; Matsubara, Kousuke; Koshida, Kichirou; Tarohda, Tohru

2015-04-01

The purpose of our study was to investigate radiation dose for lower tube voltage CT using automatic exposure control (AEC). An acrylic body phantom was used, and volume CT dose indices (CTDIvol) for tube voltages of 80, 100, 120, and 135 kV were investigated with combination of AEC. Average absorbed dose in the abdomen for 100 and 120 kV were also measured using thermoluminescence dosimeters. In addition, we examined noise characteristics under the same absorbed doses. As a result, the exposure dose was not decreased even when the tube voltage was lowered, and the organ absorbed dose value became approximately 30% high. And the noise was increased under the radiographic condition to be an equal absorbed dose. Therefore, radiation dose increases when AEC is used for lower tube voltage CT under the same standard deviation (SD) setting with 120 kV, and the optimization of SD setting is crucial.

A simple method for the fast calculation of charge redistribution of solutes in an implicit solvent model

NASA Astrophysics Data System (ADS)

Dias, L. G.; Shimizu, K.; Farah, J. P. S.; Chaimovich, H.

2002-09-01

We propose and demonstrate the usefulness of a method, defined as generalized Born electronegativity equalization method (GBEEM) to estimate solvent-induced charge redistribution. The charges obtained by GBEEM, in a representative series of small organic molecules, were compared to PM3-CM1 charges in vacuum and in water. Linear regressions with appropriate correlation coefficients and standard deviations between GBEEM and PM3-CM1 methods were obtained ( R=0.94,SD=0.15, Ftest=234, N=32, in vacuum; R=0.94,SD=0.16, Ftest=218, N=29, in water). In order to test the GBEEM response when intermolecular interactions are involved we calculated a water dimer in dielectric water using both GBEEM and PM3-CM1 and the results were similar. Hence, the method developed here is comparable to established calculation methods.

Incidence and economic burden of acute otitis media in children aged up to 5years in three Middle Eastern countries and Pakistan: A multinational, retrospective, observational study.

PubMed

Mustafa, Ghulam; Al Aidaroos, Amal Y; Al Abaidani, Idris S; Meszaros, Kinga; Gopala, Kusuma; Ceyhan, Mehmet; Al-Tannir, Mohamad; DeAntonio, Rodrigo; Bawikar, Shyam; Schmidt, Johannes E

2017-06-01

Epidemiological data on acute otitis media (AOM), an infectious disease frequently affecting children, are lacking in some countries. This study was undertaken to assess the incidence of AOM in children ≤5years in Saudi Arabia, Oman, Pakistan, and Turkey, as well as the economic burden from a parent/caregiver perspective. Medical records of 4043 children (Saudi Arabia=1023, Oman=998, Pakistan=1022, Turkey=1000) were retrospectively reviewed and the incidence of AOM episodes calculated from suspected and confirmed cases. Using a standardized Health Economics Questionnaire, parents recorded resource use and expenses incurred per AOM episode [in local currency and converted to US dollars (USD)]. The overall incidence of AOM episodes per 1000 person-years was: Saudi Arabia, 207 [95% confidence interval (CI): 178-238]; Oman, 105 (95% CI: 85-127); Pakistan, 138 (95% CI: 116-163); and Turkey, 99 (95% CI: 79-123). The mean total out-of-pocket healthcare expense incurred by parents/caregivers per episode was: Saudi Arabia USD67.1 [standard deviation (SD)=93.0], Oman USD16.1 (SD=16.4), Pakistan USD22.1 (SD=20.5), and Turkey USD33.6 (SD=44.9). The incidence of AOM episodes varied across all four countries, probably due to different diagnostic and management practices. Nevertheless, our results confirm that AOM causes a substantial burden to public health, reinforcing the need for cost-effective prevention strategies. Copyright © 2017 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

Accuracy of body mass index for age to diagnose obesity in Mexican schoolchildren.

PubMed

Mendoza Pablo, Pedro A; Valdés, Jesús; Ortiz-Hernández, Luis

2015-06-01

To compare the accuracy of three BMI-forage references (World Health Organization reference, WHO; the updated International Obesity Task Force reference, IOTF; and Centers for Disease Control and Prevention (CDC) growth charts) to diagnose obesity in Mexican children. A convenience sample of Mexican schoolchildren (n = 218) was assessed. The gold standard was the percentage of body fat estimated by deuterium dilution technique. Sensitivity and specificity of the classical cutoff point of BMI-for-age to identify obesity (i.e. > 2.00 standard deviation, SD) were estimated. The accuracy (i.e. area under the curve, AUC) of three BMI-for-age references for the diagnosis of obesity was estimated with the receiver operating characteristic (ROC) curves method. The optimal cutoff point (OCP) was determined. The cutoff points to identify obesity had low (WHO reference: 57.6%, CDC: 53.5%) to very low (IOTF reference: 40.4%) sensitivities, but adequate specificities (91.6%, 95.0%, and, 97.5%, respectively). The AUC of the three references were adequate (0.89). For the IOTF reference, the AUC was lower among the older children. The OCP for the CDC reference (1.24 SD) was lower than the OCP for WHO (1.53 SD) and IOTF charts (1.47 SD). The classical cutoff point for obesity has low sensitivity--especially for the IOTF reference. The accuracy of the three references was similar. However, to obtain comparable diagnosis of obesity different cutoff points should be used depending of the reference. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Dosimetric characterization of small fields using a plastic scintillator detector: A large multicenter study.

PubMed

Mancosu, Pietro; Pasquino, Massimo; Reggiori, Giacomo; Masi, Laura; Russo, Serenella; Stasi, Michele

2017-09-01

In modern radiation therapy accurate small fields dosimetry is a challenge and its standardization is fundamental to harmonize delivered dose in different institutions. This study presents a multicenter characterization of MLC-defined small field for Elekta and Varian linear accelerators. Measurements were performed using the Exradin W1 plastic scintillator detector. The project enrolled 24 Italian centers. Each center performed Tissue Phantom Ratio (TPR), in-plane and cross-plane dose profiles of 0.8×0.8cm 2 field, and Output Factor (OF) measurements for square field sizes ranging from 0.8 to 10cm. Set-up conditions were 10cm depth in water phantom at SSD 90cm. Measurements were performed using two twin Exradin W1 plastic scintillator detectors (PSD) correcting for the Cerenkov effect as proposed by the manufacturer. Data analysis from 12 Varian and 12 Elekta centers was performed. Measurements of 7 centers were not included due to cable problems. TPR measurements showed standard deviations (SD)<1%; SD<0.4mm for the profile penumbra was obtained, while FWHM measurements showed SD<0.5mm. OF measurements showed SD<1.5% for field size greater than 2×2cm 2 . Median OFs values were in agreement with the recent bibliography. High degree of consistency was registered for all the considered parameters. This work confirmed the importance of multicenter dosimetric intercomparison. W1 PSD could be considered as a good candidate for small field measurements. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

The transmissibility estimation of influenza with early stage data of small-scale outbreaks in Changsha, China, 2005-2013.

PubMed

Chen, T M; Chen, Q P; Liu, R C; Szot, A; Chen, S L; Zhao, J; Zhou, S S

2017-02-01

Hundreds of small-scale influenza outbreaks in schools are reported in mainland China every year, leading to a heavy disease burden which seriously impacts the operation of affected schools. Knowing the transmissibility of each outbreak in the early stage has become a major concern for public health policy-makers and primary healthcare providers. In this study, we collected all the small-scale outbreaks in Changsha (a large city in south central China with ~7·04 million population) from January 2005 to December 2013. Four simple and popularly used models were employed to calculate the reproduction number (R) of these outbreaks. Given that the duration of a generation interval Tc = 2·7 and the standard deviation (s.d.) σ = 1·1, the mean R estimated by an epidemic model, normal distribution and delta distribution were 2·51 (s.d. = 0·73), 4·11 (s.d. = 2·20) and 5·88 (s.d. = 5·00), respectively. When Tc = 2·9 and σ = 1·4, the mean R estimated by the three models were 2·62 (s.d. = 0·78), 4·72 (s.d. = 2·82) and 6·86 (s.d. = 6·34), respectively. The mean R estimated by gamma distribution was 4·32 (s.d. = 2·47). We found that the values of R in small-scale outbreaks in schools were higher than in large-scale outbreaks in a neighbourhood, city or province. Normal distribution, delta distribution, and gamma distribution models seem to more easily overestimate the R of influenza outbreaks compared to the epidemic model.

Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space.

PubMed

Lemos-Rodriguez, Ana M; Sreenath, Satyan B; Rawal, Rounak B; Overton, Lewis J; Farzal, Zainab; Zanation, Adam M

2017-03-01

To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm. Anatomical study. Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented. The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA. Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure. N/A. Laryngoscope, 127:585-591, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Mobility histories of 7th-9th century AD people buried at early medieval Bamburgh, Northumberland, England.

PubMed

Groves, S E; Roberts, C A; Lucy, S; Pearson, G; Gröcke, D R; Nowell, G; Macpherson, C G; Young, G

2013-07-01

Early Medieval England is described historically as a time when people migrated from the Continent to English shores. This study tests the hypothesis that those buried in the Bowl Hole cemetery, Bamburgh, Northumberland were nonlocally born, because of its royal status. Ninety-one male and female adult, and nonadult, skeletons were studied. Isotope ratios of strontium ((87) Sr/(86) Sr) and oxygen (δ(18) O) were generated for 78 individuals (28 females, 27 males, five "adults," 18 nonadults). The mean Sr value for human enamel was 0.71044, standard deviation (sd) 0.001, and the mean O (δw) value is -5.9‰, sd 1.6‰. Additionally, animal tooth enamel (mean Sr value 0.710587, sd 0.001; mean O value -6.5‰, sd 1.5‰), local soil (mean Sr value 0.709184, sd 0.0006), snail shells (mean Sr value 0.708888, sd 0.0001), and soil samples from a 5 km transect heading inland (mean Sr value 0.709121, sd 0.0003), were analyzed for an indication of the isotopic composition of bioavailable Sr in the modern environment and to assess the impact of sea-spray; water samples from a well, local rivers, and standing water were analyzed for local δ(18) O values (mean O value -6.4‰, relative to VSMOW, sd 2.8‰). Over 50% of those buried at Bamburgh were nonlocal. All ages and both sexes produced "nonlocal" signatures; some suggested childhood origins in Scandinavia, the southern Mediterranean or North Africa. Stature and other indicators of health status indicated differences in quality of life between local and migrant groups. These differences did not extend to burial practices. Copyright © 2013 Wiley Periodicals, Inc.

Burnout Among Otolaryngology Residents in Saudi Arabia: A Multicenter Study.

PubMed

Aldrees, Turki; Badri, Motasim; Islam, Tahera; Alqahtani, Khalid

2015-01-01

Determine the prevalence of, and associated risk factors for, burnout among otolaryngologist residents in Saudi Arabia. A cross-section study of multicenter hospitals in Saudi Arabia conducted in March 2013. Registered residents in Saudi Otolaryngology Board Program. The Maslach Burnout Inventory was used to measure burnout status. Questions supplementary to the Maslach Burnout Inventory were also included to identify associated potential risk factors such as demographic data, resident satisfaction, and work conditions. Of the initial 123 questionnaires that were distributed, 85 yielded responses, a rate of 69%. The mean age (standard deviation [SD]) of respondents was 29 (2.3) years. Of those, 67% (57/85) were men and 66% (55/85) were married. Resident levels were delineated: level 2, 19%; level 3, 33%; level 4, 29%; and level 5, 19%. The mean number of on-call days/month (SD) was 7 (2), clinics/week (SD) was 3 (1), sleep hours/day (SD) was 6 (1), and operations/week (SD) was 2 (1). The mean emotional exhaustion (EE) and depersonalization scores were high at 29.5 (SD = 9.6) and 10.7 (SD = 6), respectively. The mean personal accomplishment was low at 32.33 (SD = 6). The mean of all subscales did not differ by sex (EE p = 0.5; depersonalization p = 0.09; personal accomplishment p = 0.4). Mean EE differed by marital status, which was 31.2, 31.3, and 25.6 for married, divorced, and single, respectively, analysis of variance test p = 0.045. Burnout prevalence was found to be high among otolaryngologist residents in Saudi Arabia. The associated variables examined in this study should be addressed to decrease this level of burnout and provide residents with a less stressful work environment. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Dynamic locking screw improves fixation strength in osteoporotic bone: an in vitro study on an artificial bone model.

PubMed

Pohlemann, Tim; Gueorguiev, Boyko; Agarwal, Yash; Wahl, Dieter; Sprecher, Christoph; Schwieger, Karsten; Lenz, Mark

2015-04-01

The novel dynamic locking screw (DLS) was developed to improve bone healing with locked-plate osteosynthesis by equalising construct stiffness at both cortices. Due to a theoretical damping effect, this modulated stiffness could be beneficial for fracture fixation in osteoporotic bone. Therefore, the mechanical behaviour of the DLS at the screw-bone interface was investigated in an artificial osteoporotic bone model and compared with conventional locking screws (LHS). Osteoporotic surrogate bones were plated with either a DLS or a LHS construct consisting of two screws and cyclically axially loaded (8,500 cycles, amplitude 420 N, increase 2 mN/cycle). Construct stiffness, relative movement, axial screw migration, proximal (P) and distal (D) screw pullout force and loosening at the bone interface were determined and statistically evaluated. DLS constructs exhibited a higher screw pullout force of P 85 N [standard deviation (SD) 21] and D 93 N (SD 12) compared with LHS (P 62 N, SD 28, p = 0.1; D 57 N, SD 25, p < 0.01) and a significantly lower axial migration over cycles compared with LHS (p = 0.01). DLS constructs showed significantly lower axial construct stiffness (403 N/mm, SD 21, p < 0.01) and a significantly higher relative movement (1.1 mm, SD 0.05, p < 0.01) compared with LHS (529 N/mm, SD 27; 0.8 mm, SD 0.04). Based on the model data, the DLS principle might also improve in vivo plate fixation in osteoporotic bone, providing enhanced residual holding strength and reducing screw cutout. The influence of pin-sleeve abutment still needs to be investigated.

Correlation between Decreased Parasympathetic Activity and Reduced Cerebrovascular Reactivity in Patients with Lacunar Infarct.

PubMed

Intharakham, Kannakorn; Suwanprasert, Kesorn; Muengtaweepongsa, Sombat

2017-01-01

Reduced cerebrovascular reactivity (CVR) was found in patients with recent lacunar infarct. However, its mechanisms were controversial. The breath holding maneuver as a vasodilatory stimulus is clinically useful for an estimation of cerebrovasomotor reactivity in well co-operative patients. Patients with lacunar infarct have no higher cortical dysfunction and remain well co-operation. The breath holding maneuver is feasible and safe to perform in patients with lacunar infarct. Autonomic nervous system regulates systemic vascular activity. Regulation of autonomic function to cerebrovascular reactivity has been reported in the literature. We examined the correlation between autonomic functions with frequency and nonlinear heart rate variability (HRV) and cerebrovascular reactivity in patients with lacunar infarct by application of breath holding maneuver. Fifteen patients with lacunar infarct (8 women, age 65.6 ± 13.61) and 16 healthy controls (11 women, age 27.33 ± 3.85) were continuously monitored at baseline before maneuver (basal phase), during CVR induction (experimental phase) with breath holding maneuver and after maneuver (recovery phase), for arterial blood pressure (ABP), electrocardiography (EKG), mean cerebral blood flow velocity (mCBFV) of middle cerebral arteries (MCA) by transcranial doppler (TCD). The short term-one minute HRV was analyzed from EKG signals for low frequency (LF)/ high frequency (HF) ratio, nonlinear of standard deviation 1 (SD1), standard deviation 2 (SD2), cardiac Sample Entropy (SampEn) and Shannon Entropy. Significant increasing in mCBFV, LF/HF ratio, SD2/SD1, Shannon Entropy and inversely decreasing SampEn during breath holding maneuver compared with baseline were found in both groups (p<0.05). The trend of cerebrovascular reactivity is similar in both groups. However, there were differences of mCBFV, systolic blood pressure (SysBP) in the whole phases (basal, experiment and recovery) between patients and controls (p<0.05). Less scattered signals of SD1 with low value in patient group were illustrated from Poincaré (p<0.05). This indicated less degree of parasympathetic drive in the patients compared to the controls. Moreover, significant positive correlation between systolic bloods pressure and mCBFV in patients suggests impact of autonomic control and cerebral blood flow on the patho-physiological mechanism of vasodilatation, triggered by hypercapnia from breath holding maneuver in patients with lacunar infarct. Reduction of cerebrovascular reactivity in patients with lacunar infarct may relate with decreased parasympathetic activity. Further study is required to demonstrate whether these findings mean mechanisms of lacunar infarct or the effect of hypertensive response. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Overcoming preconceptions and perceived barriers to medical communication using a 'dual role-play' training course.

PubMed

Lim, E C H; Oh, V M S; Seet, R C S

2008-09-01

Communication is a core component of clinical competence. We introduced a dual role-play (DRP) course, in which participants role-played both the doctor-candidate and the standardized patient. The aim of the study was to assess the usefulness of a DRP communication course for physicians and to identify factors that inhibit effective medical communication. We conducted four medical communication skills courses from 2004 to 2006. A questionnaire was administered before and after completion of each course. We assessed respondents' confidence levels before and after the course and sought to identify perceived barriers to effective communication among medical trainees in Singapore. Finally, we asked if they found participation in the course and its DRP nature to be useful. Twenty-six participants, 20 men, 6 women, of mean age 30.2 years (standard deviation (SD) 2.01) completed the survey. The pre-course confidence levels (rated on a scale of 1-10) of 6.23 (SD 1.18) rose significantly to 7.58 (SD 0.95) on completion of the course (P = 0.001, Wilcoxon signed rank test). All respondents felt that they had benefited from participation in the medical communication skills course. 24 (92.3%) respondents deemed it useful to have role-played both the doctor and standardized patient in the exercise. We identified respondents with language difficulties to have benefited the most from the course (P = 0.031, odds ratio 2.906 (95%CI 0.292-5.519), linear regression analysis). DRP is an effective way to train doctors in medical communication.

The value of quantitative shear wave elastography in differentiating the cervical lymph nodes in patients with thyroid nodules.

PubMed

You, Jun; Chen, Juan; Xiang, Feixiang; Song, Yue; Khamis, Simai; Lu, Chengfa; Lv, Qing; Zhang, Yanrong; Xie, Mingxing

2018-04-01

This study aimed at evaluating the diagnostic performance of quantitative shear wave elastography (SWE) in differentiating metastatic cervical lymph nodes from benign nodes in patients with thyroid nodules. One hundred and forty-one cervical lymph nodes from 39 patients with thyroid nodules that were diagnosed as papillary thyroid cancer had been imaged with SWE. The shear elasticity modulus, which indicates the stiffness of the lymph nodes, was measured in terms of maximum shear elasticity modulus (maxSM), minimum shear elasticity modulus (minSM), mean shear elasticity modulus (meanSM), and standard deviation (SD) of the shear elasticity modulus. All the patients underwent thyroid surgery, 50 of the suspicious lymph nodes were resected, and 91 lymph nodes were followed up for 6 months. The maxSM value, minSM value, meanSM value, and SD value of the metastatic lymph nodes were significantly higher than those of the benign nodes. The area under the curve of the maxSM value, minSM value, meanSM value, and SD value were 0.918, 0.606, 0.865, and 0.915, respectively. SWE can differentiate metastasis from benign cervical lymph nodes in patients with thyroid nodules, and the maxSM, meanSM, and SD may be valuable quantitative indicators for characterizing cervical lymph nodes.

Birth Trends among Female Physicians in Taiwan: A Nationwide Survey from 1996 to 2013.

PubMed

Wang, Yi-Jen; Chiang, Shu-Chiung; Chen, Tzeng-Ji; Chou, Li-Fang; Hwang, Shinn-Jang; Liu, Jui-Yao

2017-07-09

Background : Although more and more women are becoming physicians, their decisions regarding pregnancy may be affected by the lengthy period of medical education and postgraduate training. The aim of this study was to explore the birth trends among female physicians in Taiwan; Methods: Retrospective analyses of maternal ages at delivery from 1996 to 2013, both for physicians and the general population, were conducted using a nationwide dataset called National Health Insurance Research Database; Results : During the study period, 8540 female physicians were identified. The physicians delivered a total of 4940 births in that time, with a rise from 210 in 1996 to 440 in 2013. In addition, the mean maternal age of the physicians at delivery increased from 32.19 years (standard deviations (SD) 2.80) in 1996 to 33.61 (SD 3.21) in 2013, values significantly higher than those for non-physicians of 27.81 (SD 4.74) in 1996 ( p < 0.001) and 31.36 (SD 4.78) in 2013 ( p < 0.001); Conclusion : Female physicians usually gave birth at an older age than non-physicians, but the discrepancy between the two groups gradually declined over the 18-year course of the study. The establishment of a maternity-friendly environment for female physicians should be considered by those who determine healthcare system policies.

Clostridium difficile PCR ribotypes 001 and 176 - the common denominator of C. difficile infection epidemiology in the Czech Republic, 2014.

PubMed

Krutova, Marcela; Matejkova, Jana; Kuijper, Ed J; Drevinek, Pavel; Nyc, Otakar

2016-07-21

In 2014, 18 hospitals in the Czech Republic participated in a survey of the incidence of Clostridium difficile infections (CDI) in the country. The mean CDI incidence was 6.1 (standard deviation (SD):7.2) cases per 10,000 patient bed-days and 37.8 cases (SD: 41.4) per 10,000 admissions. The mean CDI testing frequency was 39.5 tests (SD: 25.4) per 10,000 patient bed-days and 255.8 tests (SD: 164.0) per 10,000 admissions. A total of 774 C. difficile isolates were investigated, of which 225 (29%) belonged to PCR ribotype 176, and 184 isolates (24%) belonged to PCR ribotype 001. Multilocus variable-number tandem repeat analysis (MLVA) revealed 27 clonal complexes formed by 84% (190/225) of PCR ribotype 176 isolates, and 14 clonal complexes formed by 77% (141/184) of PCR ribotype 001 isolates. Clonal clusters of PCR ribotypes 176 and 001 were observed in 11 and 7 hospitals, respectively. Our data demonstrate the spread of two C. difficile PCR ribotypes within 18 hospitals in the Czech Republic, stressing the importance of standardising CDI testing protocols and implementing mandatory CDI surveillance in the country. This article is copyright of The Authors, 2016.

[Impact to Z-score Mapping of Hyperacute Stroke Images by Computed Tomography in Adaptive Statistical Iterative Reconstruction].

PubMed

Watanabe, Shota; Sakaguchi, Kenta; Hosono, Makoto; Ishii, Kazunari; Murakami, Takamichi; Ichikawa, Katsuhiro

The purpose of this study was to evaluate the effect of a hybrid-type iterative reconstruction method on Z-score mapping of hyperacute stroke in unenhanced computed tomography (CT) images. We used a hybrid-type iterative reconstruction [adaptive statistical iterative reconstruction (ASiR)] implemented in a CT system (Optima CT660 Pro advance, GE Healthcare). With 15 normal brain cases, we reconstructed CT images with a filtered back projection (FBP) and ASiR with a blending factor of 100% (ASiR100%). Two standardized normal brain data were created from normal databases of FBP images (FBP-NDB) and ASiR100% images (ASiR-NDB), and standard deviation (SD) values in basal ganglia were measured. The Z-score mapping was performed for 12 hyperacute stroke cases by using FBP-NDB and ASiR-NDB, and compared Z-score value on hyperacute stroke area and normal area between FBP-NDB and ASiR-NDB. By using ASiR-NDB, the SD value of standardized brain was decreased by 16%. The Z-score value of ASiR-NDB on hyperacute stroke area was significantly higher than FBP-NDB (p<0.05). Therefore, the use of images reconstructed with ASiR100% for Z-score mapping had potential to improve the accuracy of Z-score mapping.

Simultaneous Administration of 2-Aminoethyl Diphenylborinate and Chloroquine Reverses Chloroquine Resistance in Malaria Parasites

PubMed Central

Mossaad, Ehab; Furuyama, Wakako; Enomoto, Masahiro; Kawai, Satoru; Mikoshiba, Katsuhiko

2015-01-01

A nearly complete reversal of chloroquine (CQ) resistance in the CQ-resistant Plasmodium falciparum K-1 strain, with a significant decrease in the mean ± standard deviation (SD) 50% inhibitory concentration (IC50) from 1,050 ± 95 nM to 14 ± 2 nM, was achieved in vitro by the simultaneous administration of 2-aminoethyl diphenylborinate (2-APB). The CQ resistance-reversing activity of 2-APB, which showed the same efficacy as verapamil, was also observed in an in vivo mouse infection model with the CQ-resistant Plasmodium chabaudi AS(30CQ) strain. PMID:25691631

Technical performance of lactate biosensors and a test-strip device during labour.

PubMed

Luttkus, A K; Fotopoulou, C; Sehouli, J; Stupin, J; Dudenhausen, J W

2010-04-01

Lactate in fetal blood has a high diagnostic power to detect fetal compromise due to hypoxia, as lactate allows an estimation of duration and intensity of metabolic acidemia. Biosensor technology allows an instantaneous diagnosis of fetal compromise in the delivery room. The goal of the current investigation is to define the preanalytical and analytical biases of this technology under routine conditions in a labour ward in comparison to test-strip technology, which allows measurement of lactate alone. Three lactate biosensors (RapidLab 865, Siemens Medical Solutions Diagnostics, Bad Nauheim, Germany; Radiometer ABL625 and ABL 700, Radiometer Copenhagen, Denmark) and one test-strip device (Lactate Pro, Oxford Instruments, UK) were evaluated regarding precision in serial and repetitive measurements in over 1350 samples of fetal whole blood. The coefficient of variation (CV) and the standard deviation (SD) were calculated. The average value of all three biosensors was defined as an artificial reference value (refval). Blood tonometry was performed in order to test the quality of respiratory parameters and to simulate conditions of fetal hypoxia (pO (2): 10 and 20 mmHg). The precision of serial measurements of all biosensors indicated a coefficient of variation (CV) between 1.55 and 3.16% with an SD from 0.042 to 0.053 mmol/L. The test-strip device (Lactate Pro) mounted to 0.117 mmol/L and 3.99% (SD, CV). When compared to our reference value (refval) ABL 625 showed the closest correlation of -0.1%, while Siemens RapidLab 865 showed an overestimation of +8.9%, ABL700 an underestimation of -6.2% and Lactate Pro of -3.7%. For routine use all tested biosensors show sufficient precision. The test-strip device shows a slightly higher standard deviation. A direct comparison of measured lactate values from the various devices needs to be interpreted with caution as each method detects different lactate concentrations. Furthermore, the 40 min process of tonometry led to an increase of SD and coefficient of variation in all devices. This results in the important preanalytical finding that the precision of replicated measurements worsens significantly with time. The clinician should be aware of the type of analyser used and of preanalytical biases before making clinical decisions on the basis of lactate values.

Digital vs. conventional full-arch implant impressions: a comparative study.

PubMed

Amin, Sarah; Weber, Hans Peter; Finkelman, Matthew; El Rafie, Khaled; Kudara, Yukio; Papaspyridakos, Panos

2017-11-01

To test whether or not digital full-arch implant impressions with two different intra-oral scanners (CEREC Omnicam and True Definition) have the same accuracy as conventional ones. The hypothesis was that the splinted open-tray impressions would be more accurate than digital full-arch impressions. A stone master cast representing an edentulous mandible using five internal connection implant analogs (Straumann Bone Level RC, Basel, Switzerland) was fabricated. The three median implants were parallel to each other, the far left implant had 10°, and the far right had 15° distal angulation. A splinted open-tray technique was used for the conventional polyether impressions (n = 10) for Group 1. Digital impressions (n = 10) were taken with two intra-oral optical scanners (CEREC Omnicam and 3M True Definition) after connecting polymer scan bodies to the master cast for groups 2 and 3. Master cast and conventional impression test casts were digitized with a high-resolution reference scanner (Activity 880 scanner; Smart Optics, Bochum, Germany) to obtain digital files. Standard tessellation language (STL) datasets from the three test groups of digital and conventional impressions were superimposed with the STL dataset from the master cast to assess the 3D deviations. Deviations were recorded as root-mean-square error. To compare the master cast with conventional and digital impressions at the implant level, Welch's F-test was used together with Games-Howell post hoc test. Group I had a mean value of 167.93 μm (SD 50.37); Group II (Omnicam) had a mean value of 46.41 μm (SD 7.34); Group III (True Definition) had a mean value of 19.32 μm (SD 2.77). Welch's F-test was used together with the Games-Howell test for post hoc comparisons. Welch's F-test showed a significant difference between the groups (P < 0.001). The Games-Howell test showed statistically significant 3D deviations for all three groups (P < 0.001). Full-arch digital implant impressions using True Definition scanner and Omnicam were significantly more accurate than the conventional impressions with the splinted open-tray technique. Additionally, the digital impressions with the True Definition scanner had significantly less 3D deviations when compared with the Omnicam. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Differential effects of phosphate binders on pre-dialysis serum bicarbonate in end-stage kidney disease patients on maintenance haemodialysis

PubMed Central

2013-01-01

Background Phosphate binders’ constituents have alkalotic or acidotic properties and may contribute to acid base balance in haemodialysis patients. This study aimed to investigate the differential effects of phosphate binders on pre-dialysis serum bicarbonate in End Stage Kidney Disease patients on maintenance haemodialysis. Methods Stable out-patients having satellite haemodialysis for at least 3 months were retrospectively studied for 18 months, excluding those with other medical causes for metabolic acidosis. Blood results were censored for inpatient episodes, at the time of death, renal transplant or dialysis modality change. Multivariable multilevel mixed-effects linear regression was used and five groups of phosphate binders were compared: Group A(Calcium (Ca) and/or Aluminium (Al) binders); B(Sevelamer hydrochloride (SH) alone); C(lanthanum carbonate (LC) alone); D(SH and Ca/Al), E(LC and Ca/Al). Results Of 320 patients, 292 were eligible for analysis with a mean follow-up of 15.54 (standard deviation, SD 3.98) months. Similar mean pre-dialysis serum levels of bicarbonate were observed at all 6 month-interval analyses. At 18th months, observed mean serum bicarbonate levels in mmol/L were Group B: 21.58 (SD 2.82, P<0.001), C: 23.29 (SD 2.80, P=0.02), D: 21.56 (SD 3.00, P<0.001), and E: 21.29 (SD 3.62, P=0.92) compared with Group A: 22.98 (SD 2.77). Mean serum bicarbonate was related to total SH dose in mmol/L: 22.34 (SD 2.56) for SH <2.5 g/day, 21.61 (SD 2.62) for SH 2.5-4.8 g/day, 21.04 (SD 3.31) for SH >4.8 g/day compared with 22.85 (SD 2.91) for non-users; P-trend<0.001. Conclusions Phosphate binders’ constituents may contribute to/protect against a predisposition to pre-dialysis metabolic acidosis. This may be dose dependant in patients taking Sevelamer Hydrochloride. PMID:24079654

Trabectome-Initiated Gonioscopy-Assisted Transluminal Trabeculotomy.

PubMed

Smith, Brett L; Ellyson, Austin C; Kim, Won I

2018-03-01

To introduce a trabectome-initiated gonioscopy-assisted transluminal trabeculotomy (TIGATT) procedure and to report preliminary results. A preliminary case series of eight patients who have undergone the newly proposed TIGATT procedure is presented. TIGATT is a new concept that modifies established techniques by replacing the initial goniotomy incision of gonioscopy-assisted transluminal trabeculotomy (GATT) with an ab interno trabeculectomy ablation utilizing the trabectome. All surgeries were performed by a single surgeon (W.I.K.) between November 2014 and October 2015 in adults with primary open-angle glaucoma. Recorded outcome measures were intraocular pressure (IOP), number of medications, and complications. Eight patients with an age range of 63-93 yr underwent TIGATT with at least 3 mo of follow-up. Five of the eight initial patients had follow-up to 2 yr. The mean pre-operative IOP was 25 mmHg (standard deviation [SD] 7.0) on four medications (SD 1.1). The mean post-operative IOP at 3 mo was 14 mmHg (SD 1.8) on two medications (SD 1.3). The average decrease in IOP was 9.9 mmHg (SD 7.5) with an average decrease in medications of two (SD 1.4) at 3 mo. At 2 yr, the mean post-operative IOP was 14 mmHg (SD 3.2) on one medication (SD 1.1). The average decrease in IOP was 7.8 mmHg (SD 3.1) with an average decrease in medications of two (SD 1.8). There were two treatment failures that required further glaucoma surgery and one patient was lost to follow-up. The preliminary results and safety profile for TIGATT are promising and appear at least comparable with previously published results for both GATT and trabectome. Initiating the transluminal trabeculotomy with trabectome clearly exposes Schlemm's canal and facilitates threading the microcatheter into the canal. Additionally, if the 360-degree trabeculotomy cannot be completed because of an incompletely patent Schlemm's canal, the patient will at least have a trabectome ablation that can serve as their glaucoma surgery.

Shear-wave elastography for breast masses: local shear wave speed (m/sec) versus Young modulus (kPa).

PubMed

Youk, Ji Hyun; Son, Eun Ju; Park, Ah Young; Kim, Jeong-Ah

2014-01-01

To evaluate and compare the performance of shear-wave elastography (SWE) for breast masses using the local shear wave speed (m/sec) vs. Young modulus (kPa). A total of 130 breast lesions in 123 women who underwent SWE before ultrasound- guided core needle biopsy or surgical excision were included. With the region-of-interest placed over the stiffest areas of the lesion on SWE, the quantitative mean, maximum, and standard deviation (SD) of the elasticity values were measured in kPa and m/sec for each lesion. The SD was also measured with the region-of-interest including the whole breast lesion (wSD). The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of each elasticity value measured in kPa and m/sec were compared. Of the 130 lesions, 49 (37.7%) were malignant and 81 (62.3%) were benign. The AUCs for the mean, maximum, and SD of the elasticity values using kPa and m/sec did not differ significantly: mean, 0.974 vs. 0.974; maximum, 0.960 vs. 0.976; SD, 0.916 vs. 0.916. However, the AUC for wSD showed a significant difference: 0.964 (kPa) vs. 0.960 (m/sec) (P=0.036). There was no significant difference in the sensitivity and specificity of the mean, maximum, and wSD of the elasticity values. However, the specificity of the SD was significantly different between the two different measurements: 95.1% (kPa) vs. 87.7% (m/sec) (P=0.031). The quantitative elasticity values measured in kPa and m/sec on SWE showed good diagnostic performance. The specificity of the SD and AUC of the wSD measured in kPa were significantly higher than those measured in m/sec.

Use of computed tomography to assess volume change after endoscopic orbital decompression for Graves' ophthalmopathy.

PubMed

Schiff, Bradley A; McMullen, Caitlin P; Farinhas, Joaquim; Jackman, Alexis H; Hagiwara, Mari; McKellop, Jason; Lui, Yvonne W

2015-01-01

Orbital decompression is frequently performed in the management of patients with sight-threatening and disfiguring Graves' ophthalmopathy. The quantitative measurements of the change in orbital volume after orbital decompression procedures are not definitively known. Furthermore, the quantitative effect of septal deviation on volume change has not been previously analyzed. To provide quantitative measurement of orbital volume change after medial and inferior endoscopic decompression and describe a straightforward method of measuring this change using open-source technologies. A secondary objective was to assess the effect of septal deviation on orbital volume change. A retrospective review was performed on all patients undergoing medial and inferior endoscopic orbital decompression for Graves' ophthalmopathy at a tertiary care academic medical center. Pre-operative and post-operative orbital volumes were calculated from computed tomography (CT) data using a semi-automated segmenting technique and Osirix™, an open-source DICOM reader. Data were collected for pre-operative and post-operative orbital volumes, degree of septal deviation, time to follow-up scan, and individual patient Hertel scores. Nine patients (12 orbits) were imaged before and after decompression. Mean pre-operative orbital volume was 26.99 cm(3) (SD=2.86 cm(3)). Mean post-operative volume was 33.07 cm(3) (SD=3.96 cm(3)). The mean change in volume was 6.08 cm(3) (SD=2.31 cm(3)). The mean change in Hertel score was 4.83 (SD=0.75). Regression analysis of change in volume versus follow-up time to imaging indicates that follow-up time to imaging has little effect on change in volume (R=-0.2), and overall mean maximal septal deviation toward the operative side was -0.5mm. Negative values were attributed to deviation away form the operative site. A significant correlation was demonstrated between change in orbital volume and septal deviation distance site (R=0.66), as well as between change in orbital volume and septal deviation angle (R=0.67). Greater volume changes were associated with greater degree of septal deviation away from the surgical site, whereas smaller volume changes were associated with greater degree of septal deviation toward the surgical site. A straightforward, semi-automated segmenting technique for measuring change in volume following endoscopic orbital decompression is described. This method proved useful in determining that a mean increase of approximately 6 cm in volume was achieved in this group of patients undergoing medial and inferior orbital decompression. Septal deviation appears to have an effect on the surgical outcome and should be considered during operative planning. Copyright © 2015 Elsevier Inc. All rights reserved.

A multifaceted approach to improving the quality of ENT Emergency Clinic referrals.

PubMed

Swords, Chloe; Leach, Laura; Kasbekar, Anand; Jani, Piyush

2017-01-01

It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient. We conducted a Quality Improvement Project to improve the efficiency of the referral process. A prospective evaluation of referrals was collected continuously over a two-month period. Overall, 5 domains were deemed crucial to enable timely and accurate booking of patients to clinic: booking date, urgency, legibility, patient identification and appropriateness. Our proposed standard set for this project was 100% compliance over the 5 domains. Three separate interventions were instigated following the first cycle. The main components of the intervention were the phased development of an electronic referral system and an educational initiative for junior doctors. 20 referral forms were analysed during the initial 3-week period. No referrals met the recommended overall compliance standard of 100% (mean number of domains achieved: 3.38; standard deviation (SD): 0.637). Legibility and patient information were included in 21% and 30% of referrals, respectively. There was a trend of improvement following initiation of interventions. The mean number of domains achieved was 4.27 (SD 0.647; n=13) in the second data collection period, 4.53 (SD 0.514; n=16) in the third, and 4.75 (SD 0.452; n=24) in the fourth. Using linear regression, this change demonstrates a statistically significant improvement (p<0.001). An e-Proforma referral system represents a safe and efficient communication technology. When implementing policy change, it is crucial to acquire managerial and consultant support.

A multifaceted approach to improving the quality of ENT Emergency Clinic referrals

PubMed Central

Swords, Chloe; Leach, Laura; Kasbekar, Anand; Jani, Piyush

2017-01-01

It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient. We conducted a Quality Improvement Project to improve the efficiency of the referral process. A prospective evaluation of referrals was collected continuously over a two-month period. Overall, 5 domains were deemed crucial to enable timely and accurate booking of patients to clinic: booking date, urgency, legibility, patient identification and appropriateness. Our proposed standard set for this project was 100% compliance over the 5 domains. Three separate interventions were instigated following the first cycle. The main components of the intervention were the phased development of an electronic referral system and an educational initiative for junior doctors. 20 referral forms were analysed during the initial 3-week period. No referrals met the recommended overall compliance standard of 100% (mean number of domains achieved: 3.38; standard deviation (SD): 0.637). Legibility and patient information were included in 21% and 30% of referrals, respectively. There was a trend of improvement following initiation of interventions. The mean number of domains achieved was 4.27 (SD 0.647; n=13) in the second data collection period, 4.53 (SD 0.514; n=16) in the third, and 4.75 (SD 0.452; n=24) in the fourth. Using linear regression, this change demonstrates a statistically significant improvement (p<0.001). An e-Proforma referral system represents a safe and efficient communication technology. When implementing policy change, it is crucial to acquire managerial and consultant support. PMID:28352465

MAGNETIC FIELD STRENGTH FLUCTUATIONS IN THE HELIOSHEATH: VOYAGER 1 OBSERVATIONS DURING 2009

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

Burlaga, L. F.; Ness, N. F., E-mail: lburlagahsp@verizon.net, E-mail: nfnudel@yahoo.com

2012-01-01

We analyze the ''microscale fluctuations'' of the magnetic field strength B on a scale of several hours observed by Voyager1 (V1) in the heliosheath during 2009. The microscale fluctuations of B range from coherent to stochastic structures. The amplitude of microscale fluctuations of B during 1 day is measured by the standard deviation (SD) of 48 s averages of B. The distribution of the daily values of SD is lognormal. SD(t) from day of year (DOY) 1 to 331, 2009, is very intermittent. SD(t) has a 1/f or 'pink noise' spectrum on scales from 1 to 100 days, and itmore » has a broad multifractal spectrum f({alpha}) with 0.57 {<=} {alpha} {<=} 1.39. The time series of increments SD(t + {tau}) - SD(t) has a pink noise spectrum with {alpha}' = 0.88 {+-} 0.14 on scales from 1 to 100 days. The increments have a Tsallis (q-Gaussian) distribution on scales from 1 to 165 days, with an average q = 1.75 {+-} 0.12. The skewness S and kurtosis K have Gaussian and lognormal distributions, respectively. The largest spikes in K(t) and S(t) are often associated with a change in B across a data gap and with identifiable physical structures. The 'turbulence' observed by V1 during 2009 was weakly compressible on average but still very intermittent, highly variable, and highly compressible at times. The turbulence observed just behind the termination shock by Voyager 2 was twice as strong. These observations place strong constraints on any model of 'turbulence' in the heliosheath.« less

[Growth hormone treatment in small for gestational age children in Spain].

PubMed

Rial Rodríguez, José Manuel; de Arriba Muñoz, Antonio; Bosch Muñoz, Jordi; Cabanas Rodríguez, Paloma; Cañete Estrada, Ramón; Díez López, Ignacio; Hawkins Solís, María Magdalena; Martínez-Aedo Ollero, María José; Rodríguez Dehli, Ana Cristina; Ibáñez Toda, Lourdes

2017-05-01

Since its approval by the European Medicines Agency, a great number of patients born small for gestational date have received recombinant growth hormone treatment in Spain. The aim of this study is to analyse its outcome in the setting of ordinary clinical practice. Information was gathered from the registers of the assessment boards that authorise all growth hormone treatments prescribed in public hospitals in six autonomic communities (regions). Valid data from 974 patients was obtained. All of them complied with criteria established by the European Medicines Agency. Patients in the sample were smaller in length than weight at birth, with their median target height being below 1 standard deviation (SD), and 23% of them had been delivered prematurely. Treatment was started at 7.2±2.8 years (mean±SD). The mean patient height at start was -3.1±0.8 SD. They gained 0.7±0.2 SD in the first year, and 1.2±0.8 SD after two years. Final height was attained by 8% of the sample, reaching -1.4±0.7 SD. These results are similar to other Spanish and international published studies, and are representative of the current practice in Spain. Despite treatment being started at a late age, adequate growth is observed in the short term and in the final height. Up to a 24% of patients show a poor response in the first year. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Angiographic assessment of atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy.

PubMed

Çildağ, Mehmet B; Ertuğrul, Bülent M; Köseoğlu, Ömer Fk; Çildağ, Songül; Armstrong, David G

2018-06-01

The aim of this study was to investigate atherosclerotic load at the lower extremity in patients with diabetic foot and charcot neuro-arthropathy and compare them with patients with diabetic foot without charcot neuro-arthropathy. This retrospective study consists of 78 patients with diabetic foot who had lower extremity angiography with antegrade approach. All patients were classified into two groups; neuro ischemic wounds with charcot neuro-arthropathy (30/78) and without charcot neuro-arthropathy (48/78).Atherosclerotic load at the side of diabetic foot was determined by using the Bollinger angiogram scoring method. Comparison of atherosclerotic load between the two groups was performed. The mean of total and infrapopliteal level angiogram scoring of all patients was 33.3 (standard deviation, sd:±17.2) and 29.3 (sd:±15.6), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds with charcot neuro-arthropathy group was 18.1 (sd:±11.6) and 15.7 (sd:±10.4), respectively. The mean of total and infrapopliteal level angiogram scoring of neuroischemic wounds without charcot neuro-arthropathy group was 42.8 (sd:±12.7) and 37.7 (sd:±12.0), respectively. There was a statistically significant difference between the two groups of mean total and infrapopliteal angiogram scoring (p < 0.01). This angiographic study confirms that the atherosclerotic load in patients with diabetic foot and chronic charcot neuro-arthropathy is significantly less than in patients with neuroischemic diabetic foot wounds without chronic charcot neuro-arthropathy. Copyright © 2017. Published by Elsevier Taiwan LLC.

Choline intake during pregnancy and child cognition at age 7 years.

PubMed

Boeke, Caroline E; Gillman, Matthew W; Hughes, Michael D; Rifas-Shiman, Sheryl L; Villamor, Eduardo; Oken, Emily

2013-06-15

Animal models indicate that exposure to choline in utero improves visual memory through cholinergic transmission and/or epigenetic mechanisms. Among 895 mothers in Project Viva (eastern Massachusetts, 1999-2002 to 2008-2011), we estimated the associations between intakes of choline, vitamin B12, betaine, and folate during the first and second trimesters of pregnancy and offspring visual memory (measured by the Wide Range Assessment of Memory and Learning, Second Edition (WRAML2), Design and Picture Memory subtests) and intelligence (measured using the Kaufman Brief Intelligence Test, Second Edition (KBIT-2)) at age 7 years. Mean second-trimester intakes were 328 (standard deviation (SD), 63) mg/day for choline, 10.5 (SD, 5.1) µg/day for vitamin B12, 240 (SD, 104) mg/day for betaine, and 1,268 (SD, 381) µg/day for folate. Mean age 7 test scores were 17.2 (SD, 4.4) points on the WRAML 2 Design and Picture Memory subtests, 114.3 (SD, 13.9) points on the verbal KBIT-2, and 107.8 (SD, 16.5) points on the nonverbal KBIT-2. In a model adjusting for maternal characteristics, the other nutrients, and child's age and sex, the top quartile of second-trimester choline intake was associated with a child WRAML2 score 1.4 points higher (95% confidence interval: 0.5, 2.4) than the bottom quartile (P-trend = 0.003). Results for first-trimester intake were in the same direction but weaker. Intake of the other nutrients was not associated with the cognitive tests administered. Higher gestational choline intake was associated with modestly better child visual memory at age 7 years.

Personality Traits of Hospital Pharmacists: Toward a Better Understanding of Factors Influencing Pharmacy Practice Change

PubMed Central

Hall, Jill; Rosenthal, Meagen; Family, Hannah; Sutton, Jane; Hall, Kevin; Tsuyuki, Ross T

2013-01-01

Background The profession of pharmacy has adopted a mandate to become more patient-centred; however, significant change in this direction has not been achieved. Objective: To characterize the personality traits of hospital pharmacists in one Canadian province, to provide insights into potential barriers to practice change. Methods: A cross-sectional survey of hospital pharmacists was conducted in Alberta, Canada. An invitation to participate was sent to all 766 hospital pharmacists practising in the province’s 2 health service organizations. The survey was based on the Big Five Inventory, a validated, reliable instrument that uses a 5-point Likert scale to measure the traits of extraversion, agreeableness, conscientiousness, neuroticism, and openness. Results: Of the 347 pharmacists who completed the survey (45% response rate), the majority (297 [86%]) were staff pharmacists working full time in an urban setting. The average age of respondents was 41 years (standard deviation [SD] 11 years), and the average period in practice was 17 years (SD 11 years). Respondents’ mean scores were 3.2 (SD 0.7) on extraversion, 3.8 (SD 0.4) on agreeableness, 4.0 (SD 0.4) on conscientiousness, 2.5 (SD 0.7) on neuroticism, and 3.5 (SD 0.6) on openness. Total frequency counts revealed that respondents tended toward stronger expression of extraversion, agreeableness, conscientiousness, and openness and low levels of neuroticism (with the latter indicating stability). Conclusion: The Big Five Inventory represents a novel approach to examining pharmacists’ change-related behaviours. Improving understanding of hospital pharmacists’ personality traits will provide insights for the development of training and support programs tailored specifically to this group. PMID:24159231

Sensitivity and specificity of machine learning classifiers and spectral domain OCT for the diagnosis of glaucoma.

PubMed

Vidotti, Vanessa G; Costa, Vital P; Silva, Fabrício R; Resende, Graziela M; Cremasco, Fernanda; Dias, Marcelo; Gomi, Edson S

2012-06-15

Purpose. To investigate the sensitivity and specificity of machine learning classifiers (MLC) and spectral domain optical coherence tomography (SD-OCT) for the diagnosis of glaucoma. Methods. Sixty-two patients with early to moderate glaucomatous visual field damage and 48 healthy individuals were included. All subjects underwent a complete ophthalmologic examination, achromatic standard automated perimetry, and RNFL imaging with SD-OCT (Cirrus HD-OCT; Carl Zeiss Meditec, Inc., Dublin, California, USA). Receiver operating characteristic (ROC) curves were obtained for all SD-OCT parameters. Subsequently, the following MLCs were tested: Classification Tree (CTREE), Random Forest (RAN), Bagging (BAG), AdaBoost M1 (ADA), Ensemble Selection (ENS), Multilayer Perceptron (MLP), Radial Basis Function (RBF), Naive-Bayes (NB), and Support Vector Machine (SVM). Areas under the ROC curves (aROCs) obtained for each parameter and each MLC were compared. Results. The mean age was 57.0±9.2 years for healthy individuals and 59.9±9.0 years for glaucoma patients (p=0.103). Mean deviation values were -4.1±2.4 dB for glaucoma patients and -1.5±1.6 dB for healthy individuals (p<0.001). The SD-OCT parameters with the greater aROCs were inferior quadrant (0.813), average thickness (0.807), 7 o'clock position (0.765), and 6 o'clock position (0.754). The aROCs from classifiers varied from 0.785 (ADA) to 0.818 (BAG). The aROC obtained with BAG was not significantly different from the aROC obtained with the best single SD-OCT parameter (p=0.93). Conclusions. The SD-OCT showed good diagnostic accuracy in a group of patients with early glaucoma. In this series, MLCs did not improve the sensitivity and specificity of SD-OCT for the diagnosis of glaucoma.

Accuracy of Acoustic Analysis Measurements in the Evaluation of Patients With Different Laryngeal Diagnoses.

PubMed

Lopes, Leonardo Wanderley; Batista Simões, Layssa; Delfino da Silva, Jocélio; da Silva Evangelista, Deyverson; da Nóbrega E Ugulino, Ana Celiane; Oliveira Costa Silva, Priscila; Jefferson Dias Vieira, Vinícius

2017-05-01

This study aims to investigate the accuracy of acoustic measures in discriminating between patients with different laryngeal diagnoses. The study design is descriptive, cross-sectional, and retrospective. A total of 279 female patients participated in the research. Acoustic measures of the mean and standard deviation (SD) values of the fundamental frequency (F 0 ), jitter, shimmer, and glottal to noise excitation (GNE) were extracted from the emission of the vowel /ε/. Isolated acoustic measures do not demonstrate adequate performance in discriminating patients with and without laryngeal alteration. The combination of GNE, SD of the F 0 , jitter, and shimmer improved the ability to classify patients with and without laryngeal alteration. In isolation, the SD of the F 0 , shimmer, and GNE presented acceptable performance in discriminating individuals with different laryngeal diagnoses. The combination of acoustic measurements caused discrete improvement in performance of the classifier to discriminate healthy larynx vs vocal polyp (SD of the F 0 , shimmer, and GNE), healthy larynx vs unilateral vocal fold paralysis (SD of the F 0 and jitter), healthy larynx vs vocal nodules (SD of the F 0 and jitter), healthy larynx vs sulcus vocalis (SD of the F 0 and shimmer), and healthy larynx vs voice disorder due to gastroesophageal reflux (F 0 mean, jitter, and shimmer). Isolated acoustic measures do not demonstrate adequate performance in discriminating patients with and without laryngeal alteration, although they present acceptable performance in classifying different laryngeal diagnoses. Combined acoustic measures present an acceptable capacity to discriminate between the presence and the absence of laryngeal alteration and to differentiate several laryngeal diagnoses. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Acoustic properties of healthy and reconstructed cleft lip

NASA Astrophysics Data System (ADS)

Thijssen, Johan M.; van Hees, Nancy J.; Weijers, Gert G.; Huyskens, Rinske W.; Nillesen, Maartje; Katsaros, Christos; de Korte, Chris L.

2006-03-01

The feasibility of echographic imaging of the tissues in healthy lip and in reconstructed cleft lip and estimating the dimensions and the normalized echo level of these tissues is investigated. Echographic images of the upper lip were made with commercial medical ultrasound equipment, using a linear array transducer (7-11 MHz bandwidth) and a non-contact gel coupling. Tissue dimensions were measured by means of software calipers. Echo levels were calibrated and corrected for beam characteristics, gel path and tissue attenuation by using a tissue-mimicking phantom. At central position of philtrum, mean thickness (and standard deviation) of lip loose connective tissue layer, orbicularis oris muscle and dense connective layer was 4.0 (sd 0.1) mm, 2.3 (sd 0.7) mm, 2.2 (sd 0.7) mm, respectively, in healthy lip at rest. Mean (sd) echo level of muscle and dense connective tissue layer with respect to echo level of lip loose connective tissue layer was in relaxed condition: - 19.3 (sd 0.6) dB and - 10.7 (sd 4.0) dB, respectively. Echo level of loose connective tissue layer was +25.6 (sd 4.2) dB relative to phantom echo level obtained in the focus of the transducer. Color mode echo images were calculated, after adaptive filtering of the images, which show the tissues in separate colors and highlight the details of healthy lip and reconstructed cleft lip. Quantitative assessment of thickness and echo level of various lip tissues is feasible after proper calibration of the echographic equipment. Diagnostic potentials of the developed quantitative echographic techniques for non-invasive evaluation of the outcome of cleft lip reconstruction are promising.

Choline Intake During Pregnancy and Child Cognition at Age 7 Years

PubMed Central

Boeke, Caroline E.; Gillman, Matthew W.; Hughes, Michael D.; Rifas-Shiman, Sheryl L.; Villamor, Eduardo; Oken, Emily

2013-01-01

Animal models indicate that exposure to choline in utero improves visual memory through cholinergic transmission and/or epigenetic mechanisms. Among 895 mothers in Project Viva (eastern Massachusetts, 1999–2002 to 2008–2011), we estimated the associations between intakes of choline, vitamin B12, betaine, and folate during the first and second trimesters of pregnancy and offspring visual memory (measured by the Wide Range Assessment of Memory and Learning, Second Edition (WRAML2), Design and Picture Memory subtests) and intelligence (measured using the Kaufman Brief Intelligence Test, Second Edition (KBIT-2)) at age 7 years. Mean second-trimester intakes were 328 (standard deviation (SD), 63) mg/day for choline, 10.5 (SD, 5.1) µg/day for vitamin B12, 240 (SD, 104) mg/day for betaine, and 1,268 (SD, 381) µg/day for folate. Mean age 7 test scores were 17.2 (SD, 4.4) points on the WRAML 2 Design and Picture Memory subtests, 114.3 (SD, 13.9) points on the verbal KBIT-2, and 107.8 (SD, 16.5) points on the nonverbal KBIT-2. In a model adjusting for maternal characteristics, the other nutrients, and child's age and sex, the top quartile of second-trimester choline intake was associated with a child WRAML2 score 1.4 points higher (95% confidence interval: 0.5, 2.4) than the bottom quartile (P-trend = 0.003). Results for first-trimester intake were in the same direction but weaker. Intake of the other nutrients was not associated with the cognitive tests administered. Higher gestational choline intake was associated with modestly better child visual memory at age 7 years. PMID:23425631

Clinical voice analysis of Carnatic singers.

PubMed

Arunachalam, Ravikumar; Boominathan, Prakash; Mahalingam, Shenbagavalli

2014-01-01

Carnatic singing is a classical South Indian style of music that involves rigorous training to produce an "open throated" loud, predominantly low-pitched singing, embedded with vocal nuances in higher pitches. Voice problems in singers are not uncommon. The objective was to report the nature of voice problems and apply a routine protocol to assess the voice. Forty-five trained performing singers (females: 36 and males: 9) who reported to a tertiary care hospital with voice problems underwent voice assessment. The study analyzed their problems and the clinical findings. Voice change, difficulty in singing higher pitches, and voice fatigue were major complaints. Most of the singers suffered laryngopharyngeal reflux that coexisted with muscle tension dysphonia and chronic laryngitis. Speaking voices were rated predominantly as "moderate deviation" on GRBAS (Grade, Rough, Breathy, Asthenia, and Strain). Maximum phonation time ranged from 4 to 29 seconds (females: 10.2, standard deviation [SD]: 5.28 and males: 15.7, SD: 5.79). Singing frequency range was reduced (females: 21.3 Semitones and males: 23.99 Semitones). Dysphonia severity index (DSI) scores ranged from -3.5 to 4.91 (females: 0.075 and males: 0.64). Singing frequency range and DSI did not show significant difference between sex and across clinical diagnosis. Self-perception using voice disorder outcome profile revealed overall severity score of 5.1 (SD: 2.7). Findings are discussed from a clinical intervention perspective. Study highlighted the nature of voice problems (hyperfunctional) and required modifications in assessment protocol for Carnatic singers. Need for regular assessments and vocal hygiene education to maintain good vocal health are emphasized as outcomes. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Can Ultrasound Accurately Assess Ischiofemoral Space Dimensions? A Validation Study.

PubMed

Finnoff, Jonathan T; Johnson, Adam C; Hollman, John H

2017-04-01

Ischiofemoral impingement is a potential cause of hip and buttock pain. It is evaluated commonly with magnetic resonance imaging (MRI). To our knowledge, no study previously has evaluated the ability of ultrasound to measure the ischiofemoral space (IFS) dimensions reliably. To determine whether ultrasound could accurately measure the IFS dimensions when compared with the gold standard imaging modality of MRI. A methods comparison study. Sports medicine center within a tertiary-care institution. A total of 5 male and 5 female asymptomatic adult subjects (age mean = 29.2 years, range = 23-35 years; body mass index mean = 23.5, range = 19.5-26.6) were recruited to participate in the study. Subjects were secured in a prone position on a MRI table with their hips in a neutral position. Their IFS dimensions were then acquired in a randomized order using diagnostic ultrasound and MRI. The main outcome measurements were the IFS dimensions acquired with ultrasound and MRI. The mean IFS dimensions measured with ultrasound was 29.5 mm (standard deviation [SD] 4.99 mm, standard error mean 1.12 mm), whereas those obtained with MRI were 28.25 mm (SD 5.91 mm, standard error mean 1.32 mm). The mean difference between the ultrasound and MRI measurements was 1.25 mm, which was not statistically significant (SD 3.71 mm, standard error mean 3.71 mm, 95% confidence interval -0.49 mm to 2.98 mm, t 19 = 1.506, P = .15). The Bland-Altman analysis indicated that the 95% limits of agreement between the 2 measurement was -6.0 to 8.5 mm, indicating that there was no systematic bias between the ultrasound and MRI measurements. Our findings suggest that the IFS measurements obtained with ultrasound are very similar to those obtained with MRI. Therefore, when evaluating individuals with suspected ischiofemoral impingement, one could consider using ultrasound to measure their IFS dimensions. III. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Urinary growth hormone level and insulin-like growth factor-1 standard deviation score (IGF-SDS) can discriminate adult patients with severe growth hormone deficiency.

PubMed

Hirohata, Toshio; Saito, Nobuhito; Takano, Koji; Yamada, So; Son, Jae-Hyun; Yamada, Shoko M; Nakaguchi, Hiroshi; Hoya, Katsumi; Murakami, Mineko; Mizutani, Akiko; Okinaga, Hiroko; Matsuno, Akira

2013-01-01

Adult growth hormone (GH) deficiency (AGHD) in Japan is diagnosed based on peak GH concentrations during GH provocative tests such as GHRP-2 stimulation test. In this study, we aimed to evaluate the ability of serum insulin-like growth factor-1 (sIGF-1) and urinary GH (uGH) at the time of awakening to diagnose AGHD. Fifty-nine patients with pituitary disease (32 men and 27 women; age 20-85 y (57.5 ± 15.5, mean ± SD) underwent GHRP-2 stimulation and sIGF-1 testing. Thirty-six and 23 patients were diagnosed with and without severe AGHD, respectively based on a peak GH response of <9 ng/mL to GHRP-2 stimulation. Serum IGF-1 was evaluated as a standard deviation score (IGF-1 SDS) based on age and sex. We determined whether uGH levels in urine samples from 42 of the 59 patients at awakening were above or below the sensitivity limit. We evaluated IGF-1 SDS and uGH levels in a control group of 15 healthy volunteers. Values for IGF-1 SDS were significantly lower in patients with, than without (-2.07 ± 1.77 vs.-0.03 ± 0.92, mean ± SD; p < 0.001) AGHD whereas the range of IGF-1 SDS substantially overlapped at > -1.4. IGF-1 SDS discriminated AGHD more effectively in patients aged ≤60 years. The χ2 test revealed a statistical relationship between uGH and AGHD (test statistic: 7.0104 ≥ χ2 (1; 0.01) = 6.6349). When IGF-1 SDS is < -1.4 or uGH is below the sensitivity limit, AGHD can be detected with high sensitivity.

Early anthropometric indices predict short stature and overweight status in a cohort of Peruvians in early adolescence

PubMed Central

Sterling, Robie; Miranda, J Jaime; Gilman, Robert H; Cabrera, Lilia; Sterling, Charles R; Bern, Caryn; Checkley, William

2014-01-01

While childhood malnutrition is associated with increased morbidity and mortality, less well understood is how early childhood growth influences height and body composition later in life. We revisited 152 Peruvian children who participated in a birth cohort study between 1995 and 1998, and obtained anthropometric and bioimpedance measurements 11 to 14 years later. We used multivariable regression models to study the effects of childhood anthropometric indices on height and body composition in early adolescence. Each standard deviation decrease in length-for-age at birth was associated with a decrease in adolescent height-for-age of 0.7 SD in both boys and girls (all p<0.001) and 9.7 greater odds of stunting (95% CI 3.3 to 28.6). Each SD decrease in length-for-age in the first 30 months of life was associated with a decrease in adolescent height-for-age of 0.4 in boys and 0.6 standard deviation in girls (all p<0.001) and with 5.8 greater odds of stunting (95% CI 2.6 to 13.5). The effect of weight gain during early childhood on weight in early adolescence was more complex to understand. Weight-for-length at birth and rate of change in weight-for-length in early childhood were positively associated with age- and sex-adjusted body mass index and a greater risk of being overweight in early adolescence. Linear growth retardation in early childhood is a strong determinant of adolescent stature, indicating that, in developing countries, growth failure in height during early childhood persists through early adolescence. Interventions addressing linear growth retardation in childhood are likely to improve adolescent stature and related-health outcomes in adulthood. PMID:22552904

Early anthropometric indices predict short stature and overweight status in a cohort of Peruvians in early adolescence.

PubMed

Sterling, Robie; Miranda, J Jaime; Gilman, Robert H; Cabrera, Lilia; Sterling, Charles R; Bern, Caryn; Checkley, William

2012-07-01

While childhood malnutrition is associated with increased morbidity and mortality, less well understood is how early childhood growth influences height and body composition later in life. We revisited 152 Peruvian children who participated in a birth cohort study between 1995 and 1998, and obtained anthropometric and bioimpedance measurements 11-14 years later. We used multivariable regression models to study the effects of childhood anthropometric indices on height and body composition in early adolescence. Each standard deviation decrease in length-for-age at birth was associated with a decrease in adolescent height-for-age of 0.7 SD in both boys and girls (all P < 0.001) and 9.7 greater odds of stunting (95% CI 3.3-28.6). Each SD decrease in length-for-age in the first 30 months of life was associated with a decrease in adolescent height-for-age of 0.4 in boys and 0.6 standard deviation in girls (all P < 0.001) and with 5.8 greater odds of stunting (95% CI 2.6-13.5). The effect of weight gain during early childhood on weight in early adolescence was more complex to understand. Weight-for-length at birth and rate of change in weight-for-length in early childhood were positively associated with age- and sex-adjusted body mass index and a greater risk of being overweight in early adolescence. Linear growth retardation in early childhood is a strong determinant of adolescent stature, indicating that, in developing countries, growth failure in height during early childhood persists through early adolescence. Interventions addressing linear growth retardation in childhood are likely to improve adolescent stature and related-health outcomes in adulthood. Copyright © 2012 Wiley Periodicals, Inc.

Identification of "ever-cropped" land (1984-2010) using Landsat annual maximum NDVI image composites: Southwestern Kansas case study.

PubMed

Maxwell, Susan K; Sylvester, Kenneth M

2012-06-01

A time series of 230 intra- and inter-annual Landsat Thematic Mapper images was used to identify land that was ever cropped during the years 1984 through 2010 for a five county region in southwestern Kansas. Annual maximum Normalized Difference Vegetation Index (NDVI) image composites (NDVI(ann-max)) were used to evaluate the inter-annual dynamics of cropped and non-cropped land. Three feature images were derived from the 27-year NDVI(ann-max) image time series and used in the classification: 1) maximum NDVI value that occurred over the entire 27 year time span (NDVI(max)), 2) standard deviation of the annual maximum NDVI values for all years (NDVI(sd)), and 3) standard deviation of the annual maximum NDVI values for years 1984-1986 (NDVI(sd84-86)) to improve Conservation Reserve Program land discrimination.Results of the classification were compared to three reference data sets: County-level USDA Census records (1982-2007) and two digital land cover maps (Kansas 2005 and USGS Trends Program maps (1986-2000)). Area of ever-cropped land for the five counties was on average 11.8 % higher than the area estimated from Census records. Overall agreement between the ever-cropped land map and the 2005 Kansas map was 91.9% and 97.2% for the Trends maps. Converting the intra-annual Landsat data set to a single annual maximum NDVI image composite considerably reduced the data set size, eliminated clouds and cloud-shadow affects, yet maintained information important for discriminating cropped land. Our results suggest that Landsat annual maximum NDVI image composites will be useful for characterizing land use and land cover change for many applications.

Foot clearance and variability in mono- and multifocal intraocular lens users during stair navigation.

PubMed

Renz, Erik; Hackney, Madeleine; Hall, Courtney

2016-01-01

Intraocular lenses (IOLs) provide distance and near refraction and are becoming the standard for cataract surgery. Multifocal glasses increase variability of toe clearance in older adults navigating stairs and increase fall risk; however, little is known about the biomechanics of stair navigation in individuals with multifocal IOLs. This study compared clearance while ascending and descending stairs in individuals with monofocal versus multifocal IOLs. Eight participants with multifocal IOLs (4 men, 4 women; mean age = 66.5 yr, standard deviation [SD] = 6.26) and fifteen male participants with monofocal IOLs (mean age = 69.9 yr, SD = 6.9) underwent vision and mobility testing. Motion analysis recorded kinematic and custom software-calculated clearances in three-dimensional space. No significant differences were found between groups on minimum clearance or variability. Clearance differed for ascending versus descending stairs: the first step onto the stair had the greatest toe clearance during ascent, whereas the final step to the floor had the greatest heel clearance during descent. This preliminary study indicates that multifocal IOLs have similar biomechanic characteristics to monofocal IOLs. Given that step characteristics are related to fall risk, we can tentatively speculate that multifocal IOLs may carry no additional fall risk.

The metabolic syndrome in black hypertensive women--waist circumference more strongly related than body mass index.

PubMed

Rheeder, P; Stolk, R P; Veenhouwer, J F; Grobbee, D E

2002-08-01

To examine the association between measures of obesity and features of the metabolic syndrome in treated black female hypertensive subjects. Cross-sectional study. An urban primary health care centre in Mamelodi, Pretoria. Women with hypertension and without known diabetes mellitus or secondary causes of hypertension. In total 124 women participated, with a mean age of 56.9 years (standard deviation (SD) 11.0) and mean body mass index (BMI) of 34.1 kg/m2 (SD 8.1). Blood pressure, glucose, insulin and lipid levels. Waist circumference and waist-hip ratio were more strongly associated with insulin, uric acid, glucose and triglycerides than was BMI. Statistically significant associations were found between waist circumference and low high-density lipoprotein HDL cholesterol (standardised regression coefficient -0.006, standard error of the mean (SEM) 0.002), log triglycerides (0.007, SEM 0.003), uric acid (0.002, SEM 0.001) and log insulin (0.012, SEM 0.003). BMI was only significantly associated with uric acid (0.002, SEM 0.002) and log insulin (0.009, SEM 0.004). In a group of black hypertensive women measures of central obesity were more strongly associated with components of the metabolic syndrome than BMI.

The repeatability of mean defect with size III and size V standard automated perimetry.

PubMed

Wall, Michael; Doyle, Carrie K; Zamba, K D; Artes, Paul; Johnson, Chris A

2013-02-15

The mean defect (MD) of the visual field is a global statistical index used to monitor overall visual field change over time. Our goal was to investigate the relationship of MD and its variability for two clinically used strategies (Swedish Interactive Threshold Algorithm [SITA] standard size III and full threshold size V) in glaucoma patients and controls. We tested one eye, at random, for 46 glaucoma patients and 28 ocularly healthy subjects with Humphrey program 24-2 SITA standard for size III and full threshold for size V each five times over a 5-week period. The standard deviation of MD was regressed against the MD for the five repeated tests, and quantile regression was used to show the relationship of variability and MD. A Wilcoxon test was used to compare the standard deviations of the two testing methods following quantile regression. Both types of regression analysis showed increasing variability with increasing visual field damage. Quantile regression showed modestly smaller MD confidence limits. There was a 15% decrease in SD with size V in glaucoma patients (P = 0.10) and a 12% decrease in ocularly healthy subjects (P = 0.08). The repeatability of size V MD appears to be slightly better than size III SITA testing. When using MD to determine visual field progression, a change of 1.5 to 4 decibels (dB) is needed to be outside the normal 95% confidence limits, depending on the size of the stimulus and the amount of visual field damage.

Kinematic variability, fractal dynamics and local dynamic stability of treadmill walking

PubMed Central

2011-01-01

Background Motorized treadmills are widely used in research or in clinical therapy. Small kinematics, kinetics and energetics changes induced by Treadmill Walking (TW) as compared to Overground Walking (OW) have been reported in literature. The purpose of the present study was to characterize the differences between OW and TW in terms of stride-to-stride variability. Classical (Standard Deviation, SD) and non-linear (fractal dynamics, local dynamic stability) methods were used. In addition, the correlations between the different variability indexes were analyzed. Methods Twenty healthy subjects performed 10 min TW and OW in a random sequence. A triaxial accelerometer recorded trunk accelerations. Kinematic variability was computed as the average SD (MeanSD) of acceleration patterns among standardized strides. Fractal dynamics (scaling exponent α) was assessed by Detrended Fluctuation Analysis (DFA) of stride intervals. Short-term and long-term dynamic stability were estimated by computing the maximal Lyapunov exponents of acceleration signals. Results TW did not modify kinematic gait variability as compared to OW (multivariate T2, p = 0.87). Conversely, TW significantly modified fractal dynamics (t-test, p = 0.01), and both short and long term local dynamic stability (T2 p = 0.0002). No relationship was observed between variability indexes with the exception of significant negative correlation between MeanSD and dynamic stability in TW (3 × 6 canonical correlation, r = 0.94). Conclusions Treadmill induced a less correlated pattern in the stride intervals and increased gait stability, but did not modify kinematic variability in healthy subjects. This could be due to changes in perceptual information induced by treadmill walking that would affect locomotor control of the gait and hence specifically alter non-linear dependencies among consecutive strides. Consequently, the type of walking (i.e. treadmill or overground) is important to consider in each protocol design. PMID:21345241

Stepwise introduction of the 'Best Care Always' central-line-associated bloodstream infection prevention bundle in a network of South African hospitals.

PubMed

Richards, G A; Brink, A J; Messina, A P; Feldman, C; Swart, K; van den Bergh, D

2017-09-01

Healthcare-associated infection (HCAI) remains a major international problem. The 'Best Care Always!' (BCA) campaign was launched in South Africa to reduce preventable HCAI, including central-line-associated bloodstream infection (CLABSI). The intervention took place in 43 Netcare Private Hospitals, increasing later to 49 with 958 intensive care units (ICUs) and 439 high-care (HC) beds and 1207 ICUs and 493 HC beds, respectively. Phase 1, April 2010 to March 2011, ICU infection prevention and control (IPC) nurse-driven change: commitment from management and doctors and training of IPC nurses. Bundle compliance and infections per 1000 central-line-days were incorporated as standard IPC measures and captured monthly. Phase 2, April 2011 to March 2012, breakthrough collaborative method: multiple regional learning sessions for nursing leaders, IPC nurses and unit managers. Phase 3, April 2012 to May 2016: sustained goal-setting, benchmarks, ongoing audits. A total of 1,119,558 central-line-days were recorded. Bundle compliance improved significantly from a mean of 73.1% [standard deviation (SD): 11.2; range: 40.6-81.7%] in Phase 1 to a mean of 90.5% (SD: 4.7; range: 76.5-97.2%) in Phase 3 (P = 0.0004). The CLABSI rate declined significantly from a mean of 3.55 (SD: 0.82; range: 2.54-5.78) per 1000 central-line-days in Phase 1 to a mean of 0.13 (SD: 0.09; range: 0-0.33) (P < 0.0001). This intervention, the first of its kind in South Africa, through considerable motivation and education, and through competition between hospitals resulted in significant decreases in CLABSI. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Prepregnancy body mass index, gestational weight gain, and birth weight in the BRISA cohort.

PubMed

Lima, Raina Jansen Cutrim Propp; Batista, Rosângela Fernandes Lucena; Ribeiro, Marizélia Rodrigues Costa; Ribeiro, Cecília Cláudia Costa; Simões, Vanda Maria Ferreira; Lima Neto, Pedro Martins; Silva, Antônio Augusto Moura da; Bettiol, Heloisa

2018-01-01

OBJECTIVE To analyze the effects of maternal pre-pregnancy body mass index and weight gain during pregnancy on the baby's birth weight. METHODS We conducted a cross-sectional study with 5,024 mothers and their newborns using a Brazilian birth cohort study. In the proposed model, estimated by structural equation modeling, we tested socioeconomic status, age, marital status, pre-pregnancy body mass index, smoking habit and alcohol consumption during pregnancy, hypertension and gestational diabetes, gestational weight gain, and type of delivery as determinants of the baby's birth weight. RESULTS For a gain of 4 kg/m2 (1 Standard Deviation [SD]) in pre-pregnancy body mass index, there was a 0.126 SD increase in birth weight, corresponding to 68 grams (p < 0.001). A 6 kg increase (1 SD) in gestational weight gain represented a 0.280 SD increase in newborn weight, correponding to 151.2 grams (p < 0.001). The positive effect of pre-pregnancy body mass index on birth weight was direct (standardized coefficient [SC] = 0.202; p < 0.001), but the negative indirect effect was small (SC = -0.076, p < 0.001) and partially mediated by the lower weight gain during pregnancy (SC = -0.070, p < 0.001). The positive effect of weight gain during pregnany on birth weight was predominantly direct (SC = 0.269, p < 0.001), with a small indirect effect of cesarean delivery (SC = 0.011; p < 0.001). Women with a higher pre-pregnancy body mass index gained less weight during pregnancy (p < 0.001). CONCLUSIONS The effect of gestational weight gain on the increase in birth weight was greater than that of pre-pregnancy body mass index.

Reconstruction of a quadriceps tendon tear using Polyvinylidene fluoride sutures and patellar screw fixation: A biomechanical study.

PubMed

Sellei, R M; Bauer, E; Hofman, M; Kobbe, P; Lichte, P; Garrison, R L; Pape, H C; Horst, K

2015-12-01

Acute quadriceps tendon tears are infrequent injuries requiring surgical treatment. Improved stability after surgical repair may allow for earlier weight-bearing and range of motion. Therefore, a new implant was tested and compared with the "gold standard", using transosseous sutures. Quadriceps tendon tears were constructed using a cadaveric model of 12 fresh matched-pair specimens (aged 61-97; mean age: 82 years). The biomechanical testing compared non-absorbable suture anchors (Polyvinylidene fluoride) versus transosseous absorbable sutures (Polydioxanon). Following anatomic reconstruction, the repaired specimens were loaded until they failed (testing machine: Hounsfield H10KM, Redhill, United Kingdom; maximum force: 1000 N; load speed: 25 mm/min; maximum test length: 150 mm; pre-load: 5 N). Values for load until tear displacement, maximum load until complete failure of the construct (pullout or breakage of the sutures or anchors) and stiffness of the reconstruction were recorded. The stiffness found in the Polyvinylidene fluoride reconstruction (mean 9.83 N/mm) (standard deviation (SD) 7.75) showed a significant increase compared to the Polydioxanon reconstruction (mean 6.66 N/mm (SD 3.32); P=0.045). Transosseous fixation showed comparable results to the suture anchor system. There was no significant difference found in the maximum load to tear displacement (PVDF: 290.88 N (SD 106.01) vs. PDS: 266.75 N (SD 82.61); P=0.358). Using the Polyvinylidene fluoride thread showed comparable results to the established method in reconstruction of ruptured quadriceps tendon. Stiffness of the Polyvinylidene fluoride thread reconstruction was even greater than Polydioxanon thread. Improved stiffness may facilitate healing and is suggested as clinical relevance in reconstruction. Copyright © 2015 Elsevier B.V. All rights reserved.

Death before disco: the effectiveness of a musical metronome in layperson cardiopulmonary resuscitation training.

PubMed

Hafner, John W; Jou, Andrew C; Wang, Huaping; Bleess, Brandon B; Tham, Stephanie K

2015-01-01

A novel musical memory aid has been proposed for aiding laypersons in complying with the American Heart Association (AHA) cardiopulmonary resuscitation (CPR) guidelines of 100 compressions per minute (cpm). This study tested usefulness of such a memory aid to improve layperson long-term compliance with CPR compression rate guidelines. A prospective randomized controlled trial was conducted using CPR-untrained laypersons. Subjects received either a standard CPR educational experience (AHA Heartsaver® CPR class) or an experimental CPR educational experience (AHA Heartsaver® CPR class augmented with a musical metronome). Experimental group subjects were taught to perform compressions to the cadence of a pop music song (The Bee Gees "Stayin' Alive"; Saturday Night Fever, The Original Movie Soundtrack; Polygram International Music, 1977) with a tempo of 100 beats/min. Compression rates, depth of compressions, and correct compressions were measured initially and upon retesting ≥6 weeks post-training. Control subjects had a higher mean compression rate both immediately (121 [standard deviation {SD} = 21] vs. 109 [SD = 15] cpm; 95% confidence interval [CI] of mean difference 4-19; p = 0.002) and at follow-up (120 [SD = 20] vs. 111 [SD = 13] cpm; 95% CI of mean difference 2-16; p = 0.014). Compression rates stratified to 100-120 cpm demonstrated no difference between groups initially (39% vs. 48%; p = 0.382), but more experimental subjects maintained these rates at follow-up (43% vs. 74%; p = 0.003). Subjects trained to use a musical metronome more often maintained a compression rate of 100-120 cpm at ≥6-week follow-up, suggesting the memory aid may improve long-term guideline adherence. Copyright © 2015 Elsevier Inc. All rights reserved.

Effects of voice-sparing cricotracheal resection on phonation in women.

PubMed

Tanner, Kristine; Dromey, Christopher; Berardi, Mark L; Mattei, Lisa M; Pierce, Jenny L; Wisco, Jonathan J; Hunter, Eric J; Smith, Marshall E

2017-09-01

Individuals with idiopathic subglottic stenosis (SGS) are at risk for voice disorders prior to and following surgical management. This study examined the nature and severity of voice disorders in patients with SGS before and after a revised cricotracheal resection (CTR) procedure designed to minimize adverse effects on voice function. Eleven women with idiopathic SGS provided presurgical and postsurgical audio recordings. Voice Handicap Index (VHI) scores were also collected. Cepstral, signal-to-noise, periodicity, and fundamental frequency (F 0 ) analyses were undertaken for connected speech and sustained vowel samples. Listeners made auditory-perceptual ratings of overall quality and monotonicity. Paired samples statistical analyses revealed that mean F 0 decreased from 215 Hz (standard deviation [SD] = 40 Hz) to 201 Hz (SD = 65 Hz) following surgery. In general, VHI scores decreased after surgery. Voice disorder severity based on the Cepstral Spectral Index of Dysphonia (KayPentax, Montvale, NJ) for sustained vowels decreased (improved) from 41 (SD = 41) to 25 (SD = 21) points; no change was observed for connected speech. Semitone SD (2.2 semitones) did not change from pre- to posttreatment. Auditory-perceptual ratings demonstrated similar results. These preliminary results indicate that this revised CTR procedure is promising in minimizing adverse voice effects while offering a longer-term surgical outcome for SGS. Further research is needed to determine causal factors for pretreatment voice disorders, as well as to optimize treatments in this population. 4. Laryngoscope, 127:2085-2092, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

A Comparison of Solo and Multiplayer Active Videogame Play in Children with Unilateral Cerebral Palsy.

PubMed

Howcroft, Jennifer; Fehlings, Darcy; Wright, Virginia; Zabjek, Karl; Andrysek, Jan; Biddiss, Elaine

2012-08-01

Active videogames (AVGs) have potential in terms of physical activity and therapy for children with cerebral palsy. However, the effect of social interaction on AVG play has not yet been assessed. The objective of this study is to determine if multiplayer AVG versus solo affects levels of energy expenditure and movement patterns. Fifteen children (9.77 [standard deviation (SD) 1.78] years old) with hemiplegic cerebral palsy (Gross Motor Function Classification System Level I) participated in solo and multiplayer Nintendo(®) "Wii™ Boxing" (Nintendo, Inc., Redmond, WA) AVG play while energy expenditure and punching frequency were monitored. Moderate levels of physical activity were achieved with no significant differences in energy measures during multiplayer and solo play. Dominant arm punching frequency increased during the multiplayer session from 95.75 (SD 37.93) punches/minute to 107.77 (SD 36.99) punches/minute. Conversely, hemiplegic arm punching frequency decreased from 39.05 (SD 29.57) punches/minutes to 30.73 (SD 24.74) punches/minutes during multiplayer game play. Children enjoyed multiplayer more than solo play. Opportunities to play AVGs with friends and family may translate to more frequent participation in this moderate physical activity. Conversely, increased hemiplegic limb use during solo play may have therapeutic advantages. As such, new strategies are recommended to promote use of the hemiplegic hand during multiplayer AVG play and to optimize commercial AVG systems for applications in virtual reality therapy.

Diagnostic ability of macular ganglion cell inner plexiform layer measurements in glaucoma using swept source and spectral domain optical coherence tomography.

PubMed

Yang, Zhiyong; Tatham, Andrew J; Weinreb, Robert N; Medeiros, Felipe A; Liu, Ting; Zangwill, Linda M

2015-01-01

To evaluate the diagnostic ability of macular ganglion cell and inner plexiform layer measurements in glaucoma, obtained using swept source (SS) and spectral domain (SD) optical coherence tomography (OCT) and to compare to circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements. The study included 106 glaucomatous eyes of 80 subjects and 41 eyes of 22 healthy subjects from the Diagnostic Innovations in Glaucoma Study. Macular ganglion cell and inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) and cpRNFL thickness were assessed using SS-OCT and SD-OCT, and area under the receiver operating characteristic curves (AUCs) were calculated to determine ability to differentiate glaucomatous and healthy eyes and between early glaucomatous and healthy eyes. Mean (± standard deviation) mGCIPL and mGCC thickness were thinner in both healthy and glaucomatous eyes using SS-OCT compared to using SD-OCT. Fixed and proportional biases were detected between SS-OCT and SD-OCT measures. Diagnostic accuracy (AUCs) for differentiating between healthy and glaucomatous eyes for average and sectoral mGCIPL was similar in SS-OCT (0.65 to 0.81) and SD-OCT (0.63 to 0.83). AUCs for average cpRNFL acquired using SS-OCT and SD-OCT tended to be higher (0.83 and 0.85, respectively) than for average mGCC (0.82 and 0.78, respectively), and mGCIPL (0.73 and 0.75, respectively) but these differences did not consistently reach statistical significance. Minimum SD-OCT mGCIPL and mGCC thickness (unavailable in SS-OCT) had the highest AUC (0.86) among macular measurements. Assessment of mGCIPL thickness using SS-OCT or SD-OCT is useful for detecting glaucomatous damage, but measurements are not interchangeable for patient management decisions. Diagnostic accuracies of mGCIPL and mGCC from both SS-OCT and SD-OCT were similar to that of cpRNFL for glaucoma detection.

Diagnostic Ability of Macular Ganglion Cell Inner Plexiform Layer Measurements in Glaucoma Using Swept Source and Spectral Domain Optical Coherence Tomography

PubMed Central

Yang, Zhiyong; Tatham, Andrew J.; Weinreb, Robert N.; Medeiros, Felipe A.; Liu, Ting; Zangwill, Linda M.

2015-01-01

Purpose To evaluate the diagnostic ability of macular ganglion cell and inner plexiform layer measurements in glaucoma, obtained using swept source (SS) and spectral domain (SD) optical coherence tomography (OCT) and to compare to circumpapillary retinal nerve fiber layer (cpRNFL) thickness measurements. Methods The study included 106 glaucomatous eyes of 80 subjects and 41 eyes of 22 healthy subjects from the Diagnostic Innovations in Glaucoma Study. Macular ganglion cell and inner plexiform layer (mGCIPL), macular ganglion cell complex (mGCC) and cpRNFL thickness were assessed using SS-OCT and SD-OCT, and area under the receiver operating characteristic curves (AUCs) were calculated to determine ability to differentiate glaucomatous and healthy eyes and between early glaucomatous and healthy eyes. Results Mean (± standard deviation) mGCIPL and mGCC thickness were thinner in both healthy and glaucomatous eyes using SS-OCT compared to using SD-OCT. Fixed and proportional biases were detected between SS-OCT and SD-OCT measures. Diagnostic accuracy (AUCs) for differentiating between healthy and glaucomatous eyes for average and sectoral mGCIPL was similar in SS-OCT (0.65 to 0.81) and SD-OCT (0.63 to 0.83). AUCs for average cpRNFL acquired using SS-OCT and SD-OCT tended to be higher (0.83 and 0.85, respectively) than for average mGCC (0.82 and 0.78, respectively), and mGCIPL (0.73 and 0.75, respectively) but these differences did not consistently reach statistical significance. Minimum SD-OCT mGCIPL and mGCC thickness (unavailable in SS-OCT) had the highest AUC (0.86) among macular measurements. Conclusion Assessment of mGCIPL thickness using SS-OCT or SD-OCT is useful for detecting glaucomatous damage, but measurements are not interchangeable for patient management decisions. Diagnostic accuracies of mGCIPL and mGCC from both SS-OCT and SD-OCT were similar to that of cpRNFL for glaucoma detection. PMID:25978420

Biophysics of cochlear implant/MRI interactions emphasizing bone biomechanical properties.

PubMed

Sonnenburg, Robert E; Wackym, Phillip A; Yoganandan, Narayan; Firszt, Jill B; Prost, Robert W; Pintar, Frank A

2002-10-01

The forces exerted during a 1.5-Tesla MRI evaluation on the internal magnet of a cochlear implant (CI) raise concern about the safety for CI recipients. This study determines the magnitude of force required to fracture the floor of a CI receiver bed. Recessed CI beds were drilled to maximum uniform thinness into formalin-fixed and fresh-frozen human calvaria specimens. A Med-El stainless steel CI template mounted to the piston of an electrohydraulic testing device was used to fracture the floor of the implant beds. Force and displacement were measured as a function of time using a digital data acquisition system. Mean force to first failure, displacement to first failure, and minimum thickness, respectively, were: group 1 (formalin-fixed, 0.3-0.4-mm thick [n = 22]), 34.08 N (8.21-59.64 N, standard deviation [SD] 15.41 N), 1.09 mm (0.40-2.16 mm, SD 0.51 mm), 0.36 mm (0.3-0.4 mm, SD 0.05 mm); group 2 (formalin-fixed, 0.5-0.9 mm thick [n = 21]), 52.82 N (20.28-135.53 N, SD 25.29 N), 1.08 mm (0.50-2.28 mm, SD 0.47 mm), 0.58 mm (0.5-0.9 mm, SD 0.12 mm); group 3 (fresh-frozen [n = 9]), 134.13 N (86.44-190.70 N, SD 34.92 N), 1.96 mm (1.47-2.46 mm, SD 0.35 mm), 0.42 mm (0.3-0.6 mm, SD 0.11 mm). The mean magnitude of force required to fracture the floor of a CI bed is significantly greater than those that are generated when a Med-El Combi 40+, CII Bionic Ear CI, or Nucleus Contour CI is placed into a 1.5-Tesla MRI unit.

SSRI and SNRI withdrawal symptoms reported on an internet forum.

PubMed

Stockmann, Tom; Odegbaro, Dolapo; Timimi, Sami; Moncrieff, Joanna

2018-05-09

Antidepressant withdrawal symptoms are well-recognised, but their potential duration remains uncertain. We aimed to describe the characteristics of withdrawal associated with two popular classes of antidepressants, including duration. We analysed the content of a sample of posts on an antidepressant withdrawal website. We compared the characteristics of withdrawal associated with SSRIs and SNRIs, including time of onset, duration and nature of symptoms. 110 posts about SSRI withdrawal, and 63 concerning SNRI withdrawal, were analysed. The mean duration of withdrawal symptoms was significantly longer with SSRIs than SNRIs: 90.5 weeks (standard deviation, SD, 150.0) and 50.8 weeks (SD 76.0) respectively; p = 0.043). Neurological symptoms, such as 'brain zaps,' were more common among SNRI users (p = 0.023). Psychosexual/genitourinary symptoms may be more common among SSRI users (p = 0.054). The website aims to help people with antidepressant withdrawal, and is therefore likely to attract people who have difficulties. Length of prior use of antidepressants was long, with a mean of 252.2 weeks (SD 250.8). People accessing antidepressant withdrawal websites report experiencing protracted withdrawal symptoms. There are some differences in the characteristics of withdrawal associated with different classes of antidepressants.

Chronic effects of temperature on mortality in the Southeastern USA using satellite-based exposure metrics

NASA Astrophysics Data System (ADS)

Shi, Liuhua; Liu, Pengfei; Wang, Yan; Zanobetti, Antonella; Kosheleva, Anna; Koutrakis, Petros; Schwartz, Joel

2016-07-01

Climate change may affect human health, particularly for elderly individuals who are vulnerable to temperature changes. While many studies have investigated the acute effects of heat, only a few have dealt with the chronic ones. We have examined the effects of seasonal temperatures on survival of the elderly in the Southeastern USA, where a large fraction of subpopulation resides. We found that both seasonal mean temperature and its standard deviation (SD) affected long-term survival among the 13 million Medicare beneficiaries (aged 65+) in this region during 2000-2013. A 1 °C increase in summer mean temperature corresponded to an increase of 2.5% in death rate. Whereas, 1 °C increase in winter mean temperature was associated with a decrease of 1.5%. Increases in seasonal temperature SD also influence mortality. We decomposed seasonal mean temperature and its temperature SD into long-term geographic contrasts between ZIP codes and annual anomalies within ZIP code. Effect modifications by different subgroups were also examined to find out whether certain individuals are more vulnerable. Our findings will be critical to future efforts assessing health risks related to the future climate change.

A descriptive study of adherence to lifestyle modificationfactors among hypertensive patients.

PubMed

Alhalaiqa, Fadwa; Al-Nawafleh, Ahmad; Batiha, Abdul-Monim; Masa'deh, Rami; Abd Al-Razek, Aida

2017-02-27

Healthy life style recommendations (e.g., physical activity, healthy diet, and decreased cholesterol levels) play an important role in controlling blood pressure (BP). This study aimed to assess lifestyle modification factors among patients diagnosed with hypertension. A descriptive-survey design was used. Data were collected using four questionnaires; one was the Beliefs about Medication questionnaire (BMQ) and the rest were developed to collect data about demographic and clinical characteristics and lifestyle modification factors. In total 312 questionnaires were completed. The results revealed that our participants did not follow the healthy lifestyle recommendations; for example, the mean blood sugar (BS) level, body mass index (BMI), and cholesterol levels were 155 mg/dL (standard deviation (SD) = 71.9), 29 kg/m2 (SD = 5.4), and 197 mg/dL (SD = 86.6), respectively. A significant correlation was shown between age and BP (P = 0.000). Increase in diastolic BP (DBP) correlated with a significant increase in cholesterol level (P = 0.002) and BMI (P = 0.006). Our study showed that somewhat hypertensive patients in Jordan did not follow a healthy lifestyle. Therefore, urgent action by addressing behavioral risk factors has a positive impact on preventing and controlling hypertension.

An online intervention using information on the mental health-mental illness continuum to reduce stigma.

PubMed

Schomerus, G; Angermeyer, M C; Baumeister, S E; Stolzenburg, S; Link, B G; Phelan, J C

2016-02-01

A core component of stigma is being set apart as a distinct, dichotomously different kind of person. We examine whether information on a continuum from mental health to mental illness reduces stigma. Online survey experiment in a quota sample matching the German population for age, gender and region (n=1679). Participants randomly received information on either (1) a continuum, (2) a strict dichotomy of mental health and mental illness, or (3) no information. We elicited continuity beliefs and stigma toward a person with schizophrenia or depression. The continuum intervention decreased perceived difference by 0.19 standard deviations (SD, P<0.001) and increased social acceptance by 0.18 SD (P=0.003) compared to the no-text condition. These effects were partially mediated by continuity beliefs (proportion mediated, 25% and 26%), which increased by 0.19 SD (P<0.001). The dichotomy intervention, in turn, decreased continuity beliefs and increased notions of difference, but did not affect social acceptance. Attitudes towards a person with mental illness can be improved by providing information on a mental health-mental illness continuum. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Heart rate variability parameters in horses distinguish atrial fibrillation from sinus rhythm before and after successful electrical cardioversion.

PubMed

Broux, B; De Clercq, D; Decloedt, A; Ven, S; Vera, L; van Steenkiste, G; Mitchell, K; Schwarzwald, C; van Loon, G

2017-11-01

Atrial fibrillation (AF) is the most common pathological arrhythmia in horses. After successful treatment, recurrence is common. Heart rate monitors are easily applicable in horses and some devices offer basic heart rate variability (HRV) calculations. If HRV can be used to distinguish between AF and sinus rhythm (SR), this could become a monitoring tool for horses at risk for recurrence of AF. The purpose of this study was to assess whether in horses AF (before cardioversion) and SR (after cardioversion) can be differentiated based upon HRV parameters. Cohort study with internal controls. Six HRV parameters were determined in 20 horses, both in AF and in SR, at rest (2- and 5-min and 1- and 4-h recordings) and during exercise (walk and trot, 2-min recordings). Time-domain (standard deviation of the NN intervals, root mean squared successive differences in NN intervals and triangular index), frequency domain (low/high frequency ratio) and nonlinear parameters (standard deviation of the Poincaré plot [SD]1 and SD2) were used. Statistical analysis was done using paired Wilcoxon signed rank tests and receiver operating characteristic curves. HRV was higher during AF compared to SR. Results for the detection of AF were good (area under the receiver operating characteristic curve [AUC] 0.8-1) for most HRV parameters. Root mean squared successive differences in NN intervals and SD1 yielded the best results (AUC 0.9-1). Sensitivity and specificity were high for all parameters at all recordings, but highest during exercise. Although AUCs improved with longer recordings, short recordings were also good (AUC 0.8-1) for the detection of AF. In horses with frequent second degree atrioventricular block, HRV at rest is increased and recordings at walk or trot are recommended. Animals served as their own controls and there was no long-term follow-up to identify AF recurrence. AF (before cardioversion) and SR (after cardioversion) could be distinguished with HRV. This technique has promise as a monitoring tool in horses at risk for AF development. © 2017 EVJ Ltd.

Normative Data for a User-friendly Paradigm for Pattern Electroretinogram Recording

PubMed Central

Porciatti, Vittorio; Ventura, Lori M.

2009-01-01

Purpose To provide normative data for a user-friendly paradigm for the pattern electroretinogram (PERG) optimized for glaucoma screening (PERGLA). Design Prospective nonrandomized case series. Participants Ninety-three normal subjects ranging in age between 22 and 85 years. Methods A circular black–white grating of 25° visual angle, reversing 16.28 times per second, was presented on a television monitor placed inside a Ganzfeld bowl. The PERG was recorded simultaneously from both eyes with undilated pupils by means of skin cup electrodes taped over the lower eyelids. Reference electrodes were taped on the ipsilateral temples. Electrophysiologic signals were conventionally amplified, filtered, and digitized. Six hundred artifact-free repetitions were averaged. The response component at the reversal frequency was isolated automatically by digital Fourier transforms and was expressed as a deviation from the age-corrected average. The procedure took approximately 4 minutes. Main Outcome Measures Pattern electroretinogram amplitude (μV) and phase (π rad); response variability (coefficient of variation [CV] = standard deviation [SD] / mean × 100) of amplitude and phase of 2 partial averages that build up the PERG waveform; amplitude (μV) of background noise waveform, obtained by multiplying alternate sweeps by +1 and −1; and interocular asymmetry (CV of amplitude and phase of the PERG of the 2 eyes). Results On average, the PERG has a signal-to-noise ratio of more than 13:1. The CVs of intrasession and intersession variabilities in amplitude and phase are lower than 10% and 2%, respectively, and do not depend on the operator. The CV of interocular asymmetries in amplitude and phase are 9.8±8.8% and 1.5±1.4%, respectively. The PERG amplitude and phase decrease with age. Residuals of linear regression lines have normal distribution, with an SD of 0.1 log units for amplitude and 0.019 log units for phase. Age-corrected confidence limits (P<0.05) are defined as ±2 SD of residuals. Conclusions The PERGLA paradigm yields responses as reliable as the best previously reported using standard protocols. The ease of execution and interpretation of results of PERGLA indicate a potential value for objective screening and follow-up of glaucoma. PMID:14711729

Evaluating the short-term effects of a communication skills program for preclinical medical students.

PubMed

Lee, Young-Mee; Lee, Young Hee

2014-09-01

Regardless of the growing importance of communication skills as a core clinical competence, few studies have determined the effects of communication skills courses in undergraduate medical curricula in Asian medical schools. The purpose of this study was to examine the effectiveness of a communication skills program for preclinical medical students. A communication skills course was provided to 111 second-year medical students in a medical college in Korea. Students' self-assessed competency of communication skills was evaluated by a questionnaire survey. To examine the improvement in observed communication skills, the students' encounters with standardized patients (SPs) were assessed at the first session and at the final course assessment. A structured checklist, consisting of 25 communication skills items, was used for the assessment. Students' self-assessed competency of communication skills increased significantly after completion of the course (p<0.001). The observed communication skills scores also improved significantly at the end of the course; the mean scores of the first SPs encounters was 49.6 (standard deviation [SD], 11.1), and those of cases A and B at the final assessment were 61.5 (SD, 8.4) and 69.6 (SD, 7.8), respectively (F₆₁=269.54, p<0.001). Even a short period of medical communication skills course was beneficial in developing and improving communication skills competency in preclinical medical students. Further studies should be followed to examine whether the acquisition of communication skills during preclinical studies can be sustained into clerkship and actual practice.

Iterative outlier removal: A method for identifying outliers in laboratory recalibration studies

PubMed Central

Parrinello, Christina M.; Grams, Morgan E.; Sang, Yingying; Couper, David; Wruck, Lisa M.; Li, Danni; Eckfeldt, John H.; Selvin, Elizabeth; Coresh, Josef

2016-01-01

Background Extreme values that arise for any reason, including through non-laboratory measurement procedure-related processes (inadequate mixing, evaporation, mislabeling), lead to outliers and inflate errors in recalibration studies. We present an approach termed iterative outlier removal (IOR) for identifying such outliers. Methods We previously identified substantial laboratory drift in uric acid measurements in the Atherosclerosis Risk in Communities (ARIC) Study over time. Serum uric acid was originally measured in 1990–92 on a Coulter DACOS instrument using an uricase-based measurement procedure. To recalibrate previous measured concentrations to a newer enzymatic colorimetric measurement procedure, uric acid was re-measured in 200 participants from stored plasma in 2011–13 on a Beckman Olympus 480 autoanalyzer. To conduct IOR, we excluded data points >3 standard deviations (SDs) from the mean difference. We continued this process using the resulting data until no outliers remained. Results IOR detected more outliers and yielded greater precision in simulation. The original mean difference (SD) in uric acid was 1.25 (0.62) mg/dL. After four iterations, 9 outliers were excluded, and the mean difference (SD) was 1.23 (0.45) mg/dL. Conducting only one round of outlier removal (standard approach) would have excluded 4 outliers (mean difference [SD] = 1.22 [0.51] mg/dL). Applying the recalibration (derived from Deming regression) from each approach to the original measurements, the prevalence of hyperuricemia (>7 mg/dL) was 28.5% before IOR and 8.5% after IOR. Conclusion IOR is a useful method for removal of extreme outliers irrelevant to recalibrating laboratory measurements, and identifies more extraneous outliers than the standard approach. PMID:27197675

Simultaneous Validation of Seven Physical Activity Questionnaires Used in Japanese Cohorts for Estimating Energy Expenditure: A Doubly Labeled Water Study.

PubMed

Sasai, Hiroyuki; Nakata, Yoshio; Murakami, Haruka; Kawakami, Ryoko; Nakae, Satoshi; Tanaka, Shigeho; Ishikawa-Takata, Kazuko; Yamada, Yosuke; Miyachi, Motohiko

2018-04-28

Physical activity questionnaires (PAQs) used in large-scale Japanese cohorts have rarely been simultaneously validated against the gold standard doubly labeled water (DLW) method. This study examined the validity of seven PAQs used in Japan for estimating energy expenditure against the DLW method. Twenty healthy Japanese adults (9 men; mean age, 32.4 [standard deviation {SD}, 9.4] years, mainly researchers and students) participated in this study. Fifteen-day daily total energy expenditure (TEE) and basal metabolic rate (BMR) were measured using the DLW method and a metabolic chamber, respectively. Activity energy expenditure (AEE) was calculated as TEE - BMR - 0.1 × TEE. Seven PAQs were self-administered to estimate TEE and AEE. The mean measured values of TEE and AEE were 2,294 (SD, 318) kcal/day and 721 (SD, 161) kcal/day, respectively. All of the PAQs indicated moderate-to-strong correlations with the DLW method in TEE (rho = 0.57-0.84). Two PAQs (Japan Public Health Center Study [JPHC]-PAQ Short and JPHC-PAQ Long) showed significant equivalence in TEE and moderate intra-class correlation coefficients (ICC). None of the PAQs showed significantly equivalent AEE estimates, with differences ranging from -547 to 77 kcal/day. Correlations and ICCs in AEE were mostly weak or fair (rho = 0.02-0.54, and ICC = 0.00-0.44). Only JPHC-PAQ Short provided significant and fair agreement with the DLW method. TEE estimated by the PAQs showed moderate or strong correlations with the results of DLW. Two PAQs showed equivalent TEE and moderate agreement. None of the PAQs showed equivalent AEE estimation to the gold standard, with weak-to-fair correlations and agreements. Further studies with larger sample sizes are needed to confirm these findings.

Establishing the minimal clinically important difference for the Questionnaire of Olfactory Disorders.

PubMed

Mattos, Jose L; Schlosser, Rodney J; Mace, Jess C; Smith, Timothy L; Soler, Zachary M

2018-05-02

Olfactory-specific quality of life (QOL) can be measured using the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS). Changes in the QOD-NS after treatment can be difficult to interpret since there is no standardized definition of clinically meaningful improvement. Patients with chronic rhinosinusitis (CRS) completed the QOD-NS. Four distribution-based methods were used to calculate the minimal clinically important difference (MCID): (1) one-half standard deviation (SD); (2) standard error of the mean (SEM); (3) Cohen's effect size (d) of the smallest unit of change; and (4) minimal detectable change (MDC). We also averaged all 4 of the scores together. Finally, the likelihood of achieving a MCID after sinus surgery using these methods, as well as average QOD-NS scores, was stratified by normal vs abnormal baseline QOD-NS scores. Outcomes were examined on 128 patients. The mean ± SD improvement in QOD-NS score after surgery was 4.3 ± 11.0 for the entire cohort and 9.6 ± 12.9 for those with abnormal baseline scores (p < 0.001). The MCID values using the different techniques were: (1) SD = 6.5; (2) SEM = 3.1; (3) d = 2.6; and (4) MDC = 8.6. The MCID score was 5.2 on average. For the total cohort analysis, the likelihood of reporting a MCID ranged from 26% to 51%, and 49% to 70% for patients reporting preoperative abnormal olfaction. Distribution-based MCID values of the QOD-NS range between 2.6 and 8.6 points, with an average of 5.2. When stratified by preoperative QOD-NS scores the majority of patients reporting abnormal preoperative QOD-NS scores achieved a MCID. © 2018 ARS-AAOA, LLC.

SU-F-T-552: A One-Year Evaluation of the QABeamChecker+ for Use with the CyberKnife System

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

Gersh, J; Spectrum Medical Physics, LLC, Greenville, SC

Purpose: By attaching an adapter plate with fiducial markers to the QA BeamChecker+ (Standard Imaging, Inc., Middleton, WI), the output of the CyberKnife can be accurately, efficiently, and consistently evaluated. The adapter plate, known as the Cutting Board, allows for automated alignment of the QABC+ using the CK’s stereoscopic kV image-based treatment localization system (TLS). Described herein is an evaluation of the system following a year of clinical utilization. Methods: Based on a CT scan of the QABC+ and CB, a treatment plan is generated which delivers a beam to each of the 5 plane-parallel ionization chambers. Following absolute calibrationmore » of the CK, the QA plan is delivered, and baseline measurements are acquired (and automatically corrected for temperature and pressure). This test was performed at the beginning of each treatment day for a year. A calibration evaluation (using a water-equivalent slab and short thimble chamber) is performed every four weeks, or whenever the QABC+ detects a deviation of more than 1.0%. Results: During baseline evaluation, repeat measurements (n=10) were performed, with an average output of 0.25% with an SD of 0.11%. As a test of the reposition of the QABC+ and CB, ten additional measurements were performed where between each acquisition, the entire system was removed and re-positioned using the TLS. The average output deviation was 0.30% with a SD of 0.13%. During the course of the year, 187 QABC+ measurements and 13 slab-based measurements were performed. The output measurements of the QABC+ correlated well with slab-based measurements (R2=0.909). Conclusion: By using the QABC+ and CB, daily output was evaluated accurately, efficiently, and consistently. From setup to break-down (including analysis), this test required 5 minutes instead of approximately 15 using traditional techniques (collimator-mounted ionization chambers). Additionally, by automatically saving resultant output deviation to a database, trend analysis was simplified. Spectrum Medical Physics, LLC of Greenville, SC has a consulting contract with Standard Imaging of Middleton, WI.« less

A Motion Videogame for Opioid Relapse Prevention.

PubMed

Abroms, Lorien C; Leavitt, Leah E; Van Alstyne, Judy M; Schindler-Ruwisch, Jennifer M; Fishman, Marc J; Greenberg, Daniel

2015-12-01

This study examined the feasibility and acceptability of a body motion-activated videogame, targeting the prevention of opioid relapse among youth in the context of outpatient treatment. Participants attended four weekly gameplay sessions. Surveys were conducted at baseline and following each week's gameplay and assessed satisfaction with gameplay, craving intensity, and self-efficacy to refuse opioids. Participants expressed a high level of satisfaction with the videogame throughout the 4 weeks and agreed with the statement that they would be more likely to attend treatment sessions if the game was present (mean=4.6; standard deviation [SD]=0.7) and would recommend the videogame to other people in treatment (mean=4.2; SD=0.8). All participants recommended playing the videogame as part of treatment at least weekly, with a third recommending playing daily. Self-reported cravings declined over the 4-week period from baseline (mean=12.7; SD=8.4) to Week 4 (mean=9.8; SD=8.3), although the decline was not significant. Although participants stated that they liked the game, one-third of participants had dropped out of the study by the fourth session of gameplay. Preliminary evidence indicates that a motion videogame for addiction recovery may be feasible and acceptable within the context of outpatient treatment, although additional efforts are needed to keep youth in treatment. Future studies are needed to assess the impact of the game on long-term abstinence, treatment adherence, and engagement.

Associations of acoustically measured tongue/jaw movements and portion of time speaking with negative symptom severity in patients with schizophrenia in Italy and the United States.

PubMed

Bernardini, Francesco; Lunden, Anya; Covington, Michael; Broussard, Beth; Halpern, Brooke; Alolayan, Yazeed; Crisafio, Anthony; Pauselli, Luca; Balducci, Pierfrancesco M; Capulong, Leslie; Attademo, Luigi; Lucarini, Emanuela; Salierno, Gianfranco; Natalicchi, Luca; Quartesan, Roberto; Compton, Michael T

2016-05-30

This is the first cross-language study of the effect of schizophrenia on speech as measured by analyzing phonetic parameters with sound spectrography. We hypothesized that reduced variability in pitch and formants would be correlated with negative symptom severity in two samples of patients with schizophrenia, one from Italy, and one from the United States. Audio recordings of spontaneous speech were available from 40 patients. From each speech sample, a file of F0 (pitch) and formant values (F1 and F2, resonance bands indicating the moment-by-moment shape of the oral cavity), and the portion of the recording in which there was speaking ("fraction voiced," FV), was created. Correlations between variability in the phonetic indices and negative symptom severity were tested and further examined using regression analyses. Meaningful negative correlations between Scale for the Assessment of Negative Symptoms (SANS) total score and standard deviation (SD) of F2, as well as variability in pitch (SD F0) were observed in the Italian sample. We also found meaningful associations of SANS affective flattening and SANS alogia with SD F0, and of SANS avolition/apathy and SD F2 in the Italian sample. In both samples, FV was meaningfully correlated with SANS total score, avolition/apathy, and anhedonia/asociality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The dynamic nature of alignment and variations in normal knees.

PubMed

Deep, K; Eachempati, K K; Apsingi, S

2015-04-01

The restoration of knee alignment is an important goal during total knee arthroplasty (TKA). In the past surgeons aimed to restore neutral limb alignment during surgery. However, previous studies have demonstrated alignment to be dynamic, varying depending on the position of the limb and the degree of weight-bearing, and between patients. We used a validated computer navigation system to measure the femorotibial mechanical angle (FTMA) in 264 knees in 77 male and 55 female healthy volunteers aged 18 to 35 years (mean 26.2). We found the mean supine alignment to be a varus angle of 1.2° (standard deviation (sd) 4), with few patients having neutral alignment. FTMA differs significantly between males and females (with a mean varus of 1.7° (sd 4) and 0.4° (sd 3.9), respectively; p = 0.008). It changes significantly with posture, the knee hyperextending by a mean of 5.6°, and coronal plane alignment becoming more varus by 2.2° (sd 3.6) on standing compared with supine. Knee alignment is different in different individuals and is dynamic in nature, changing with different postures. This may have implications for the assessment of alignment in TKA, which is achieved in non-weight-bearing conditions and which may not represent the situation observed during weight-bearing. ©2015 The British Editorial Society of Bone & Joint Surgery.

Chemical applicability domain of the Local Lymph Node Assay (LLNA) for skin sensitisation potency. Part 2. The biological variability of the murine Local Lymph Node Assay (LLNA) for skin sensitisation.

PubMed

Roberts, David W; Api, Anne Marie; Aptula, Aynur O

2016-10-01

The Local Lymph Node Assay (LLNA) is the most common in vivo regulatory toxicology test for skin sensitisation, quantifying potency as the EC3, the concentration of chemical giving a threefold increase in thymidine uptake in the local lymph node. Existing LLNA data can, along with clinical data, provide useful comparator information on the potency of sensitisers. Understanding of the biological variability of data from LLNA studies is important for those developing non-animal based risk assessment approaches for skin allergy. Here an existing set of 94 EC3 values for 12 chemicals, all tested at least three times in the same vehicle have been analysed by calculating standard deviations (SD) for logEC3 values. The SDs range from 0.08 to 0.22. The overall SD for the 94 logEC3 values is 0.147. Thus the 95% confidence limits (2xSD) for LLNA EC3 values are within a factor of 2, comparable to those for physico-chemical measurements such as partition coefficients and solubility. The residual SDs of Quantitative Mechanistic Models (QMMs) based on physical organic chemistry parameters are similar to the overall SD of the LLNA, indicating that QMMs of this type are unlikely to be bettered for predictive accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

Growth trajectories and intellectual abilities in young adulthood: The Helsinki Birth Cohort study.

PubMed

Räikkönen, Katri; Forsén, Tom; Henriksson, Markus; Kajantie, Eero; Heinonen, Kati; Pesonen, Anu-Katriina; Leskinen, Jukka T; Laaksonen, Ilmo; Osmond, Clive; Barker, David J P; Eriksson, Johan G

2009-08-15

Slow childhood growth is associated with poorer intellectual ability. The critical periods of growth remain uncertain. Among 2,786 Finnish male military conscripts (1952-1972) born in 1934-1944, the authors tested how specific growth periods from birth to age 20 years predicted verbal, visuospatial, and arithmetic abilities at age 20. Small head circumference at birth predicted poorer verbal, visuospatial, and arithmetic abilities. The latter 2 measures were also associated with lower weight and body mass index (weight (kg)/height (m)(2)) at birth (for a 1-standard-deviation (SD) decrease in test score per SD decrease in body size > or = 0.05, P's < 0.04). Slow linear growth and weight gain between birth and age 6 months, between ages 6 months and 2 years, or both predicted poorer performance on all 3 tests (for a 1-SD decrease in test score per SD decrease in growth > or = 0.05, P's < 0.03). Reduced linear growth between ages 2 and 7 years predicted worse verbal ability, and between age 11 years and conscription it predicted worse performance on all 3 tests. Prenatal brain growth and linear growth up to 2 years after birth form a first critical period for intellectual development. There is a second critical period, specific for verbal development, between ages 2 and 7 years and a third critical period for all 3 tested outcomes during adolescence.

An evaluation of the impact of the ventilator care bundle.

PubMed

Crunden, Eddie; Boyce, Carolyn; Woodman, Helen; Bray, Barbara

2005-01-01

A number of interventions have been shown to improve the outcomes of patients who are invasively ventilated in intensive care units (ICUs). However, significant problems still exist in implementing research findings into clinical practice. The aim of this study was to assess whether the systematic and methodical implementation of evidence-based interventions encapsulated in a care bundle influenced length of ventilation and ICU length of stay (LOS). A ventilator care bundle was introduced within a general ICU and evaluated 1 year later. The care bundle was composed of four protocols that consisted of prophylaxis against peptic ulceration, prophylaxis against deep vein thrombosis, daily cessation of sedation and elevation of the patient's head and chest to at least 30 degrees to the horizontal. Compliance with the bundle was assessed, as was ICU LOS, ICU mortality and ICU/high-dependency unit patient throughput. Mean ICU LOS was reduced from 13-75 [standard deviation (SD) 19.11] days to 8.36 (SD 10.21) days (p<0.05). Mean ventilator days were reduced from 10.8 (SD 15.58) days to 6.1 (SD 8.88) days. Unit patient throughput increased by 30.1% and the number of invasively ventilated patients increased by 39.5%. Care bundles encourage the consistent and systematic application of evidence-based protocols used in particular treatment regimes. Since the introduction of the ventilator care bundle, length of ventilation and ICU LOS have reduced significantly.

Evaluation of Downstream Regulatory Element Antagonistic Modulator Gene in Human Multinodular Goiter

PubMed Central

Shinzato, Amanda; Lerario, Antonio M.; Lin, Chin J.; Danilovic, Debora S.; Marui, Suemi; Trarbach, Ericka B.

2015-01-01

Background DREAM (Downstream Regulatory Element Antagonistic Modulator) is a neuronal calcium sensor that was suggested to modulate TSH receptor activity and whose overexpression provokes an enlargement of the thyroid gland in transgenic mice. The aim of this study was to investigate somatic mutations and DREAM gene expression in human multinodular goiter (MNG). Material/Methods DNA and RNA samples were obtained from hyperplastic thyroid glands of 60 patients (54 females) with benign MNG. DREAM mutations were evaluated by PCR and direct automatic sequencing, whereas relative quantification of mRNA was performed by real-time PCR. Over- and under-expression were defined as a 2-fold increase and decrease in comparison to normal thyroid tissue, respectively. RQ M (relative quantification mean); SD (standard deviation). Results DREAM expression was detected in all nodules evaluated. DREAM mRNA was overexpressed in 31.7% of MNG (RQ M=6.26; SD=5.08), whereas 53.3% and 15% had either normal (RQ M=1.16; SD=0.46) or underexpression (RQ M=0.30; SD=0.10), respectively. Regarding DREAM mutations analysis, only previously described intronic polymorphisms were observed. Conclusions We report DREAM gene expression in the hyperplastic thyroid gland of MNG patients. However, DREAM expression did not vary significantly, and was somewhat underexpressed in most patients, suggesting that DREAM upregulation does not significantly affect nodular development in human goiter. PMID:26319784

Birth Trends among Female Physicians in Taiwan: A Nationwide Survey from 1996 to 2013

PubMed Central

Wang, Yi-Jen; Chiang, Shu-Chiung; Chen, Tzeng-Ji; Chou, Li-Fang; Hwang, Shinn-Jang; Liu, Jui-Yao

2017-01-01

Background: Although more and more women are becoming physicians, their decisions regarding pregnancy may be affected by the lengthy period of medical education and postgraduate training. The aim of this study was to explore the birth trends among female physicians in Taiwan; Methods: Retrospective analyses of maternal ages at delivery from 1996 to 2013, both for physicians and the general population, were conducted using a nationwide dataset called National Health Insurance Research Database; Results: During the study period, 8540 female physicians were identified. The physicians delivered a total of 4940 births in that time, with a rise from 210 in 1996 to 440 in 2013. In addition, the mean maternal age of the physicians at delivery increased from 32.19 years (standard deviations (SD) 2.80) in 1996 to 33.61 (SD 3.21) in 2013, values significantly higher than those for non-physicians of 27.81 (SD 4.74) in 1996 (p < 0.001) and 31.36 (SD 4.78) in 2013 (p < 0.001); Conclusion: Female physicians usually gave birth at an older age than non-physicians, but the discrepancy between the two groups gradually declined over the 18-year course of the study. The establishment of a maternity-friendly environment for female physicians should be considered by those who determine healthcare system policies. PMID:28698490

Readability Assessment of Internet-Based Patient Education Materials Related to Parathyroid Surgery.

PubMed

Patel, Chirag R; Sanghvi, Saurin; Cherla, Deepa V; Baredes, Soly; Eloy, Jean Anderson

2015-07-01

Patient education is critical in obtaining informed consent and reducing preoperative anxiety. Written patient education material (PEM) can supplement verbal communication to improve understanding and satisfaction. Published guidelines recommend that health information be presented at or below a sixth-grade reading level to facilitate comprehension. We investigate the grade level of online PEMs regarding parathyroid surgery. A popular internet search engine was used to identify PEM discussing parathyroid surgery. Four formulas were used to calculate readability scores: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Gunning Frequency of Gobbledygook (GFOG), and Simple Measure of Gobbledygook (SMOG). Thirty web-based articles discussing parathyroid surgery were identified. The average FRE score was 42.8 (±1 standard deviation [SD] 16.3; 95% confidence interval [CI], 36.6-48.8; range, 6.1-71.3). The average FKGL score was 11.7 (±1 SD 3.3; 95% CI, 10.5-12.9; range, 6.1-19.0). The SMOG scores averaged 14.2 (±1 SD 2.6; 95% CI, 13.2-15.2; range, 10.7-21.9), and the GFOG scores averaged 15.0 (±1 SD 3.5; 95% CI, 13.7-16.3; range, 10.6-24.8). Online PEM on parathyroid surgery is written above the recommended sixth-grade reading level. Improving readability of PEM may promote better health education and compliance. © The Author(s) 2015.

Effects of early whole-body vibration treatment on knee neuromuscular function and postural control after anterior cruciate ligament reconstruction: A randomized controlled trial.

PubMed

Pistone, Eugenio Maria; Laudani, Luca; Camillieri, Gianluca; Di Cagno, Alessandra; Tomassi, Gabriele; Macaluso, Andrea; Giombini, Arrigo

2016-11-11

To assess the effects of adding a whole-body vibration protocol at optimal frequency (WBV-OF) to a traditional rehabilitation programme (TRP) early after anterior cruciate ligament reconstruction, on maximal strength and balance, in comparison with a traditional rehabilitation programme. A total of 34 anterior cruciate ligament reconstructed patients with hamstring-tendon graft underwent either 4 weeks of WBV-OF training in addition to a traditional rehabilitation programme, or a traditional rehabilitation programme only, starting from the first month after surgery. Patients were assessed for maximal voluntary isometric strength during both knee extension and flexion and for balance on a force platform before, 1 month after treatment and at 3-month follow-up. Strength symmetry of the knee flexor muscles improved in WBV-OF+TRP patients more than in TRP patients 1 month after treatment (mean 66% (standard deviation (SD) 15) vs 58% SD 13), and also at the 3-month follow-up (mean 77% (SD 15) vs 64% (SD 15)), with no differences in balance improvements between the groups. Adding 4-weeks of WBV-OF to a traditional rehabilitation programme 1 month after surgery is effective in improving muscle strength of the knee flexor muscles. This early intervention may be incorporated into current rehabilitation to facilitate early strength recovery of anterior cruciate ligament reconstructed patients.

Diffusion Tensor Imaging Parameters in Mild Traumatic Brain Injury and Its Correlation with Early Neuropsychological Impairment: A Longitudinal Study.

PubMed

Veeramuthu, Vigneswaran; Narayanan, Vairavan; Kuo, Tan Li; Delano-Wood, Lisa; Chinna, Karuthan; Bondi, Mark William; Waran, Vicknes; Ganesan, Dharmendra; Ramli, Norlisah

2015-10-01

We explored the prognostic value of diffusion tensor imaging (DTI) parameters of selected white matter (WM) tracts in predicting neuropsychological outcome, both at baseline and 6 months later, among well-characterized patients diagnosed with mild traumatic brain injury (mTBI). Sixty-one patients with mTBI (mean age=27.08; standard deviation [SD], 8.55) underwent scanning at an average of 10 h (SD, 4.26) post-trauma along with assessment of their neuropsychological performance at an average of 4.35 h (SD, 7.08) upon full Glasgow Coma Scale recovery. Results were then compared to 19 healthy control participants (mean age=29.05; SD, 5.84), both in the acute stage and 6 months post-trauma. DTI and neuropsychological measures between acute and chronic phases were compared, and significant differences emerged. Specifically, chronic-phase fractional anisotropy and radial diffusivity values showed significant group differences in the corona radiata, anterior limb of internal capsule, cingulum, superior longitudinal fasciculus, optic radiation, and genu of corpus callosum. Findings also demonstrated associations between DTI indices and neuropsychological outcome across two time points. Our results provide new evidence for the use of DTI as an imaging biomarker and indicator of WM damage occurring in the context of mTBI, and they underscore the dynamic nature of brain injury and possible biological basis of chronic neurocognitive alterations.

Femoral pseudoarthrosis and knee stiffness: long-term results of a one-stage surgical approach.

PubMed

Gomes, João L Ellera; Ruthner, Roberto P; Moreira, Luiz

2010-02-01

The objective of this study was to analyze the surgical results of the simultaneous treatment of femoral pseudoarthrosis and knee stiffness using a combined one-stage approach (quadricepsplasty + osteoperiosteal decortications + bone autografting + fracture stabilization). Twelve patients (six men) followed up for a minimum of 10 years and who had undergone surgery for these combined procedures were contacted for evaluation. Their mean age at the time of the surgery was 30 years (standard deviation, SD 15; range 22-65 years), and mean time from initial trauma was 16 months (SD 6, range 10-32 months). Mean range of motion improved from 10 degrees (SD 9) to 112 degrees (SD 13) postoperatively. Fractures healed in all patients, and improvement in their range of motion was statistically significant (Student's t-test = 31; P

Assessment of nutritional status using abridged scored patient-generated subjective global assessment in cancer patient.

PubMed

Shahvazi, Simin; Onvani, Shokouh; Heydari, Marziyeh; Mehrzad, Valiollah; Nadjarzadeh, Azadeh; Fallahzadeh, Hosseyn

2017-01-01

Malnutrition is a common problem among cancer patients, usually occurs due to poor appetite, low food intake, and changes in body metabolism. The aim of this study is to determine the prevalence of malnutrition in patients receiving chemotherapy on an outpatient basis. This cross-sectional study conducted on 300 cancer patients referred to hospital. The prevalence of malnutrition among patients was assessed using the abridged scored patient-generated subjective global assessment (abPG-SGA) standard questionnaire. Moreover, patient's weight and 24 h dietary recall were measured. Descriptive statistics were used to present characteristics of patients and dietary recalls. For revealing the correlation, Spearman correlation was used. The average abPG-SGA score was 7.6 (standard deviation [SD] = 5.4) and 60.7% of patients were malnourished and required nutritional intervention. Patients mean age and mean duration of illness were 54.2 (SD = 14.7(years, 25 months, respectively. The most common complaint of patients included fatigue (51.3%), anorexia (43.3%), and dry mouth (41%). Reduction in food intake in past month was reported by 41.7% of patients. According to the high prevalence of cancers and increasing growth of them in recent years with regard to outpatient treatment development for cancer patients, using the abPG-SGA standard questionnaire by nutritionist or nurses can be effective to detect malnourished patients and reduce complications caused by disease.

TVT-S in the U position--anatomical study.

PubMed

Hubka, Petr; Nanka, Ondrej; Martan, Alois; Grim, Milos; Zvarova, Jana; Masata, Jaromir

2011-02-01

The objective is to describe the anatomical position of tension-free vaginal tape Secur (TVT-S) in the U position regarding possible injury and fixation site. We placed TVT-S inserters bilaterally in 13 embalmed and five fresh frozen female bodies. After dissection, we measured distances from the obturator bundle. In embalmed bodies, the mean distance of TVT-S from the obturator bundle was 2.83 cm (standard deviation (SD) 0.87 cm) on the left, 2.92 cm (SD 1.24 cm) on the right. Perforation of the fascia of obturator internus muscle occurred in 38.5%. In fresh frozen bodies, results were fundamentally similar (p > 0.05). There is a risk of injury to the obturator bundle and urinary bladder during TVT-S; however, there is a significant risk of inserting the TVT-S inserter outside the obturator internus muscle (into the lesser pelvis). The position of TVT-S does not change significantly after legs mal-positioning.

Driving characteristics of teens with attention deficit hyperactivity and autism spectrum disorder.

PubMed

Classen, Sherrilene; Monahan, Miriam; Wang, Yanning

2013-01-01

Vehicle crashes are a leading cause of death among teens. Teens with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or both (ADHD-ASD) may have a greater crash risk. We examined the between-groups demographic, clinical, and predriving performance differences of 22 teens with ADHD-ASD (mean age = 15.05, standard deviation [SD] = 0.95) and 22 healthy control (HC) teens (mean age = 14.32, SD = 0.72). Compared with HC teens, the teens with ADHD-ASD performed more poorly on right-eye visual acuity, selective attention, visual-motor integration, cognition, and motor performance and made more errors on the driving simulator pertaining to visual scanning, speed regulation, lane maintenance, adjustment to stimuli, and total number of driving errors. Teens with ADHD-ASD, compared with HC teens, may have more predriving deficits and as such require the skills of a certified driving rehabilitation specialist to assess readiness to drive. Copyright © 2013 by the American Occupational Therapy Association, Inc.

Reflexology has an acute (immediate) haemodynamic effect in healthy volunteers: a double-blind randomised controlled trial.

PubMed

Jones, Jenny; Thomson, Patricia; Lauder, William; Howie, Kate; Leslie, Stephen J

2012-11-01

Reflexologists claim that massage to specific points of the feet increases blood supply to internal organs. This study measured changes in cardiovascular parameters in subjects receiving reflexology to areas of their feet thought to correspond to the heart (intervention) compared with other areas which are not (control). 16 reflexology-naive healthy volunteers received an active and control reflexology treatment in an RCT, double-blind repeated measures study. 'Beat-to-beat' continuous measurement of selected cardiovascular parameters, State Anxiety Inventory. Cardiac index decreased significantly in the intervention group during left foot treatment (LFT) (baseline mean 2.6; standard deviation (SD) 0.75; 95% CI ± 0.38 vs. LFT mean 2.45; SD 0.68; CI 0.35), effect size (p = 0.035, omega squared effect (w2) = 0.002; w = 0.045). Reflexology massage applied to the upper part of the left foot may have a modest specific effect on the cardiac index of healthy volunteers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Evaluation of Pacific Islands Early Childhood Caries Prevention Project: Republic of the Marshall Islands.

PubMed

Milgrom, Peter; Tut, Ohnmar K

2009-01-01

This communication reports an outcomes evaluation of the Pacific Islands Early Childhood Caries Prevention Project. The evaluation includes children in three conditions: a) topical fluoride varnish three times per school year; b) varnish plus twice-per-day toothbrushing; and c) intervention 2 plus three-times-per-day xylitol containing gummy bear snacks at school and home visits to encourage parental involvement. For this evaluation, groups 2 and 3 have been combined. One year after project implementation, mean decayed, extracted, or filled primary teeth was 10.3 [standard deviation (SD)= 4.3] teeth for group 1, and 8.2 (SD = 4.0) teeth for the combination of groups 2 and 3 (P < 0.05). Twenty-four percent of group 1 had cavitated lesions in any permanent molar versus 12.8 percent in groups 2 and 3 combined (P > 0.05). Evaluation confirms the outcome of a program including both in-school twice-daily toothbrushing with fluoridated toothpaste and frequent applications of fluoride varnish.

Enhancing Time-Series Detection Algorithms for Automated Biosurveillance

PubMed Central

Burkom, Howard; Xing, Jian; English, Roseanne; Bloom, Steven; Cox, Kenneth; Pavlin, Julie A.

2009-01-01

BioSense is a US national system that uses data from health information systems for automated disease surveillance. We studied 4 time-series algorithm modifications designed to improve sensitivity for detecting artificially added data. To test these modified algorithms, we used reports of daily syndrome visits from 308 Department of Defense (DoD) facilities and 340 hospital emergency departments (EDs). At a constant alert rate of 1%, sensitivity was improved for both datasets by using a minimum standard deviation (SD) of 1.0, a 14–28 day baseline duration for calculating mean and SD, and an adjustment for total clinic visits as a surrogate denominator. Stratifying baseline days into weekdays versus weekends to account for day-of-week effects increased sensitivity for the DoD data but not for the ED data. These enhanced methods may increase sensitivity without increasing the alert rate and may improve the ability to detect outbreaks by using automated surveillance system data. PMID:19331728

Intra- and extra-articular planes of reference for use in total hip arthroplasty: a preliminary study.

PubMed

Hausselle, Jerome; Moreau, Pierre Etienne; Wessely, Loic; de Thomasson, Emmanuel; Assi, Ayman; Parratte, Sebastien; Essig, Jerome; Skalli, Wafa

2012-08-01

Acetabular component malalignment in total hip arthroplasty can lead to potential complications such as dislocation, component impingement and excessive wear. Computer-assisted orthopaedic surgery systems generally use the anterior pelvic plane (APP). Our aim was to investigate the reliability of anatomical landmarks accessible during surgery and to define new potential planes of reference. Three types of palpations were performed: virtual, on dry bones and on two cadaveric specimens. Four landmarks were selected, the reproducibility of their positioning ranging from 0.9 to 2.3 mm. We then defined five planes and tested them during palpations on two cadaveric specimens. Two planes produced a mean orientation error of 5.0° [standard deviation (SD 3.3°)] and 5.6° (SD 2.7°). Even if further studies are needed to test the reliability of such planes on a larger scale in vivo during surgery, these results demonstrated the feasibility of defining a new plane of reference as an alternative to the APP.

Scanning laser polarimetry using variable corneal compensation in the detection of glaucoma with localized visual field defects.

PubMed

Kook, Michael S; Cho, Hyun-soo; Seong, Mincheol; Choi, Jaewan

2005-11-01

To evaluate the ability of scanning laser polarimetry parameters and a novel deviation map algorithm to discriminate between healthy and early glaucomatous eyes with localized visual field (VF) defects confined to one hemifield. Prospective case-control study. Seventy glaucomatous eyes with localized VF defects and 66 normal controls. A Humphrey field analyzer 24-2 full-threshold test and scanning laser polarimetry with variable corneal compensation were used. We assessed the sensitivity and specificity of scanning laser polarimetry parameters, sensitivity and cutoff values for scanning laser polarimetry deviation map algorithms at different specificity values (80%, 90%, and 95%) in the detection of glaucoma, and correlations between the algorithms of scanning laser polarimetry and of the pattern deviation derived from Humphrey field analyzer testing. There were significant differences between the glaucoma group and normal subjects in the mean parametric values of the temporal, superior, nasal, inferior, temporal (TSNIT) average, superior average, inferior average, and TSNIT standard deviation (SD) (P<0.05). The sensitivity and specificity of each scanning laser polarimetry variable was as follows: TSNIT, 44.3% (95% confidence interval [CI], 39.8%-49.8%) and 100% (95.4%-100%); superior average, 30% (25.5%-34.5%) and 97% (93.5%-100%); inferior average, 45.7% (42.2%-49.2%) and 100% (95.8%-100%); and TSNIT SD, 30% (25.9%-34.1%) and 97% (93.2%-100%), respectively (when abnormal was defined as P<0.05). Based on nerve fiber indicator cutoff values of > or =30 and > or =51 to indicate glaucoma, sensitivities were 54.3% (50.1%-58.5%) and 10% (6.4%-13.6%), and specificities were 97% (93.2%-100%) and 100% (95.8%-100%), respectively. The range of areas under the receiver operating characteristic curves using the scanning laser polarimetry deviation map algorithm was 0.790 to 0.879. Overall sensitivities combining each probability scale and severity score at 80%, 90%, and 95% specificities were 90.0% (95% CI, 86.4%-93.6%), 71.4% (67.4%-75.4%), and 60.0% (56.2%-63.8%), respectively. There was a statistically significant correlation between the scanning laser polarimetry severity score and the VF severity score (R2 = 0.360, P<0.001). Scanning laser polarimetry parameters may not be sufficiently sensitive to detect glaucomatous patients with localized VF damage. Our algorithm using the scanning laser polarimetry deviation map may enhance the understanding of scanning laser polarimetry printouts in terms of the locality, deviation size, and severity of localized retinal nerve fiber layer defects in eyes with localized VF loss.

Improved thermal conductivity of TiO2-SiO2 hybrid nanofluid in ethylene glycol and water mixture

NASA Astrophysics Data System (ADS)

Hamid, K. A.; Azmi, W. H.; Nabil, M. F.; Mamat, R.

2017-10-01

The need to study hybrid nanofluid properties such as thermal conductivity has increased recently in order to provide better understanding on nanofluid thermal properties and behaviour. Due to its ability to improve heat transfer compared to conventional heat transfer fluids, nanofluids as a new coolant fluid are widely investigated. This paper presents the thermal conductivity of TiO2-SiO2 nanoparticles dispersed in ethylene glycol (EG)-water. The TiO2-SiO2 hybrid nanofluids is measured for its thermal conductivity using KD2 Pro Thermal Properties Analyzer for concentration ranging from 0.5% to 3.0% and temperature of 30, 50 and 70°C. The results show that the increasing in concentration and temperature lead to enhancement in thermal conductivity at range of concentration studied. The maximum enhancement is found to be 22.1% at concentration 3.0% and temperature 70°C. A new equation is proposed based on the experiment data and found to be in good agreement where the average deviation (AD), standard deviation (SD) and maximum deviation (MD) are 1.67%, 1.66% and 5.13%, respectively.

Exercise-based cardiac rehabilitation increases daily physical activity of patients following myocardial infarction: subanalysis of two randomised controlled trials.

PubMed

Ribeiro, F; Oliveira, N L; Silva, G; Campos, L; Miranda, F; Teixeira, M; Alves, A J; Oliveira, J

2017-03-01

To assess the effects of an exercise-based cardiac rehabilitation programme on daily physical activity levels of patients following myocardial infarction. Subanalysis of two randomised, prospective controlled trials. Outpatient clinic of a secondary hospital. Fifty consecutive patients randomised to the exercise group {n=25; 23 males; mean age 54 [standard deviation (SD) 9] years} or the control group [n=25; 20 males; mean age 58 (SD 9) years]. The exercise group participated in an 8-week aerobic exercise programme plus usual medical care and follow-up. The control group received usual medical care and follow-up. The primary outcome measure was change in time spent undertaking moderate-to-vigorous physical activity per day, assessed by accelerometer over 7 consecutive days. Secondary outcome measures were cardiorespiratory fitness, body mass, and resting blood pressure and heart rate. Moderate-to-vigorous physical activity levels increased significantly in the exercise group [43.2 (SD 36.3) to 53.5 (SD 31.9) minutes/day, P=0.030], and remained unchanged in the control group [40.8 (SD 26.2) to 36.8 (SD 26.5) minutes/day, P=0.241] from baseline to the end of the programme. Cardiorespiratory fitness increased significantly in the exercise group (mean difference 2.8; 95% of the difference 1.3 to 4.4ml/kg/minute, P=0.001) after the 8-week programme. In patients under optimal medication following myocardial infarction, participation in an 8-week exercise-based cardiac rehabilitation programme was found to improve physical activity levels consistent with health-related benefits. Future studies are needed to determine whether the increase in physical activity is maintained in the long term. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Cone Beam CT Imaging Analysis of Interfractional Variations in Bladder Volume and Position During Radiotherapy for Bladder Cancer

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

Yee, Don, E-mail: dony@ualberta.c; Parliament, Matthew; Rathee, Satyapal

2010-03-15

Purpose: To quantify daily bladder size and position variations during bladder cancer radiotherapy. Methods and Materials: Ten bladder cancer patients underwent daily cone beam CT (CBCT) imaging of the bladder during radiotherapy. Bladder and planning target volumes (bladder/PTV) from CBCT and planning CT scans were compared with respect to bladder center-of-mass shifts in the x (lateral), y (anterior-posterior), and z (superior-inferior) coordinates, bladder/PTV size, bladder/PTV margin positions, overlapping areas, and mutually exclusive regions. Results: A total of 262 CBCT images were obtained from 10 bladder cancer patients. Bladder center of mass shifted most in the y coordinate (mean, -0.32 cm).more » The anterior bladder wall shifted the most (mean, -0.58 cm). Mean ratios of CBCT-derived bladder and PTV volumes to planning CT-derived counterparts were 0.83 and 0.88. The mean CBCT-derived bladder volume (+- standard deviation [SD]) outside the planning CT counterpart was 29.24 cm{sup 3} (SD, 29.71 cm{sup 3}). The mean planning CT-derived bladder volume outside the CBCT counterpart was 47.74 cm{sup 3} (SD, 21.64 cm{sup 3}). The mean CBCT PTV outside the planning CT-derived PTV was 47.35 cm{sup 3} (SD, 36.51 cm{sup 3}). The mean planning CT-derived PTV outside the CBCT-derived PTV was 93.16 cm{sup 3} (SD, 50.21). The mean CBCT-derived bladder volume outside the planning PTV was 2.41 cm{sup 3} (SD, 3.97 cm{sup 3}). CBCT bladder/ PTV volumes significantly differed from planning CT counterparts (p = 0.047). Conclusions: Significant variations in bladder and PTV volume and position occurred in patients in this trial.« less

Exaggerated blood pressure variability is associated with memory impairment in very elderly patients.

PubMed

Fujiwara, Takeshi; Hoshide, Satoshi; Kanegae, Hiroshi; Eguchi, Kazuo; Kario, Kazuomi

2018-04-01

We investigated the association between working memory (WM) impairment and blood pressure variability (BPV) in very elderly patients. Japanese outpatients ≥80 years who engaged in normal activities of daily living were the study cohort. WM function was evaluated by a simple visual WM test consisting of 3 figures. We considered the number of figures recalled by the patient his/her test score. We defined the patients with a score of 0 or 1 as those with WM impairment and those with scores of 2 or 3 as those without. To investigate the relative risk of WM impairment, we evaluated each patient's 24 hour ambulatory systolic blood pressure (SBP) and its weighted standard deviation (SD SBP ), office SBP, and the visit-to-visit SD SBP during the 1 year period from the patient's enrollment. A total of 66 patients (mean 84 ± 3.6 years) showed WM impairment, and 431 patients (mean 83 ± 3.1 years) showed no WM impairment. There were no significant differences in 24 hour ambulatory SBP or office SBP between these two groups. However, the WM impairment patients showed significantly higher weighted SD SBP and visit-to-visit SD SBP values compared to the no-impairment group even after adjusting for age. Among these ≥80-year-old patients, those with the highest quartile of both weighted SD SBP (≥21.4 mm Hg) and visit-to-visit SD SBP (≥14.5 mm Hg) showed the highest relative risk (odds ratio 3.52, 95% confidence interval 1.42-8.72) for WM impairment. Exaggerated blood pressure variability parameters were significantly associated with working memory impairment in very elderly individuals. ©2018 Wiley Periodicals, Inc.

Head circumference in untreated and IGF-I treated patients with Laron syndrome: comparison with untreated and hGH-treated children with isolated growth hormone deficiency.

PubMed

Laron, Zvi; Iluz, Moshe; Kauli, Rivka

2012-04-01

Head circumference (HC) is a simple and practical measure of brain size, development and longitudinal measurements of the HC in childhood are an index of brain growth. To determine the effects of long IGF-I deficiency and treatment on HC in patients with Laron syndrome (LS). 20 untreated adult LS patients, aged 48.4±11.2 years and 13 LS patients treated between ages of 5.6±4 to 11.3±3 years were studied. 15 patients with congenital IGHD treated between age 6.1±4 and 13±4 by hGH served as controls. HC was expressed as standard deviation (SD) and Ht as SDS. HC was measured and plotted on Nellhaus charts. Linear height (Ht) was measured by a Harpenden Stadiometer. The mean HC deficit of the adult untreated LS males was -2.9±0.6 SD compared to a Ht deficit of -7.0±1.7 SDS. The HC of the LS adult females was -3.6±1 SD compared to a Ht SDS of -6.9±1.5 (p<0.001). IGF-I treatment (150-200 μg/kg once daily) increased the HC from -3.3±0.9 (m±SD) to normal values (0.87±1.8 SD) (p<0.001) in 11/13 children. The Ht SDS deficit decreased only by 1.5 SDS. hGH treatment of cIGHD children increased the HC from -2.0±1.8 to 0.3±1.2 SD and the Ht SDS from -4.8±1.6 to 1.6±1.0. Copyright © 2012 Elsevier Ltd. All rights reserved.

Costs and utilization of end-stage glaucoma patients receiving visual rehabilitation care: a US multisite retrospective study.

PubMed

Gieser, David K; Tracy Williams, R; O'Connell, William; Pasquale, Louis R; Rosenthal, Bruce P; Walt, John G; Katz, Laura M; Siegartel, Lisa R; Wang, Lujing; Rosenblatt, Lisa C; Stern, Lee S; Doyle, John J

2006-10-01

Glaucoma is a prevalent ophthalmologic disease and leading cause of blindness. A retrospective analysis was conducted to evaluate resources and costs for end-stage glaucoma patients receiving visual rehabilitation care (VRC). A chart review was conducted in 3 United States VRC centers. Charts of patients with primary open-angle glaucoma as the primary cause of vision loss (1998 to 2003) were selected, yielding 81 records. Data were collected from patient-level billing and reimbursement records (ophthalmologist/optometrist visits, glaucoma medications, procedures, and specialized low-vision and glaucoma-related services). Visual rehabilitation services included utilization of low-vision devices, assessment of daily functioning, orientation and mobility training, and patient counseling. Mean age at baseline was 72.7 years [standard deviation (SD)=17.2, range: 29 to 95]. Of those with known sex (n=77), 55.8% were women. Medicare was the payer type for most patients (59.3%), whereas 20% had Medicaid. Mean number of visits was 7.1 (SD=6.1) in year 1 and 3.7 (SD=4.2) in year 2, for an annual mean of 5.4 (SD=5.0) visits overall. Total mean cost per patient in year 1 was greater than year 2 [$2170 (SD=$2252) vs. $1202 (SD=$1080), respectively]; of the total 2-year costs, 15% were VRC, 37% ophthalmology care, and 48% pharmacy. Analysis of nonpharmacy costs revealed that VRC accounted for 28% and ophthalmology for 72%. End-stage glaucoma is associated with appreciable resource utilization and costs, because of both vision rehabilitation and ophthalmology care. Advanced primary open-angle glaucoma has a substantial cost-of-illness, warranting improved management in early stages of disease.

Glucose fluctuations reduce quality of sleep and of life in patients with liver cirrhosis.

PubMed

Haraguchi, Masafumi; Miyaaki, Hisamitsu; Ichikawa, Tatsuki; Shibata, Hidetaka; Honda, Takuya; Ozawa, Eisuke; Miuma, Satoshi; Taura, Naota; Takeshima, Fuminao; Nakao, Kazuhiko

2017-01-01

Sleep disturbance and decreased health-related quality of life (HRQOL) are significant complaints in patients with liver cirrhosis. Although the etiology of these complications is unclear, we propose that glucose intolerance may be a predisposing factor. Therefore, our aim was to investigate the relationship between glucose intolerance and these complications. We assessed continuous glucose monitoring in 43 patients with chronic liver disease. Among these patients, 36 completed the Pittsburgh Sleep Quality Index (PSQI), the 36-Item Short-form Health Survey (SF-36), and the Neuropsychological Test (NPT). We also assessed the change in glucose fluctuations between preoperative periods and 1 year after liver transplantation in 13 patients. Standard deviation (SD) of blood glucose was 24.15 ± 13.52. SD values correlated to glucose metabolism measures, including HbA1c and glycoalbumin. SD values also correlated to markers of liver fibrosis, including type IV collagen. Twenty-one patients (58.3 %) were classified as "poor" sleepers, with a global PSQI score ≥6. Glucose fluctuations correlated with the global PSQI score (r = 0.456, p = 0.008) and the SF-36 score (r = 0.434, p = 0.013). Multivariate regression analysis identified SD values as an independent risk factor for sleep disturbance (r = 0.12, p = 0.039) and decreased HRQOL (r = -0.32, p = 0.024). SD values did not correlate with the NPT. SD values were also improved in 11 (84.6 %) patients 1 year after liver transplantation. Abnormal glucose fluctuations are a risk factor for sleep disturbance and decrease of HRQOL in patients with cirrhosis.

Change in blood pressure variability in patients with acute ischemic stroke and its effect on early neurologic outcome

PubMed Central

Hong, Jeong-Ho; Jang, Min Uk; Choi, Nack Cheon; Lee, Ji Sung; Kim, Beom Joon; Han, Moon-Ku; Bae, Hee-Joon

2017-01-01

Background How short-term blood pressure variability (BPV) is affected in the acute stage of ischemic stroke and whether BPV is associated with early neurologic outcomes remains unclear. Methods Patients who admitted for ischemic stroke within 24 h of symptom onset were consecutively identified between January 2010 and January 2015. BP profiles measured in real-time were summarized into short-term, 24-h time intervals, based on standard deviation (SD) and mean of systolic BP (SBPSD) during the first 3 days. The primary outcome was daily assessment of early neurological deterioration (END). The associations between short-term SBPSD values and the secular trend for primary outcome were examined. Results A total of 2,545 subjects (mean age, 67.1 ± 13.5 years old and median baseline National Institutes of Health Stroke Scale score, 3) arrived at the hospital an average of 6.1 ± 6.6 h after symptom onset. SBPSD values at day 1 (SD#D1), SD#D2, and SD#D3 were 14.4 ± 5.0, 12.5 ± 4.5, and 12.2 ± 4.6 mmHg, respectively. Multivariable analyses showed that SD#D2 was independently associated with onset of END at day 2 (adjusted odds ratio, 1.08; 95% confidence interval, 1.03–1.13), and SD#D3 was independently associated with END#D3 (1.07, 1.01–1.14), with adjustments for predetermined covariates, SBPmean, and interactions with daily SBPSD. Conclusion Short-term BPV changed and stabilized from the first day of ischemic stroke. Daily high BPV may be associated with neurological deterioration independent of BPV on the previous day. PMID:29252991

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

PubMed Central

Rugeles, Saúl-Javier; Rueda, Juan-David; Díaz, Carlos-Eduardo; Rosselli, Diego

2013-01-01

Introduction: Our aim was to evaluate the impact of hyperproteic hypocaloric enteral feeding on clinical outcomes in critically ill patients, particularly on severity of organic failure measured with the Sequential Organ Failure Assessment (SOFA). Materials and Methods: In a double blind clinical trial, 80 critically ill adult patients were randomized to hyperproteic hypocaloric or to isocaloric enteral nutrition; all patients completed follow-up of at least 4 days. Prescribed caloric intake was: Hyperproteic hypocaloric enteral nutrition (15 kcal/kg with 1.7 g/kg of protein) or isocaloric enteral nutrition (25 kcal/kg with 20% of the calories as protein). The main outcome was the differences in delta SOFA at 48 h. Secondary outcomes were intensive care unit (ICU) length of stay, days on ventilator, hyperglycemic events, and insulin requirements. Results: There were no differences in SOFA score at baseline (7.5 (standard deviation (SD) 2.9) vs 6.7 (SD 2.5) P = 0.17). The total amount of calories delivered was similarly low in both groups (12 kcal/kg in intervention group vs 14 kcal/kg in controls), but proteic delivery was significantly different (1.4 vs 0.76 g/kg, respectively P ≤ 0.0001). The intervention group showed an improvement in SOFA score at 48 h (delta SOFA 1.7 (SD 1.9) vs 0.7 (SD 2.8) P = 0.04) and less hyperglycemic episodes per day (1.0 (SD 1.3) vs 1.7 (SD 2.5) P = 0.017). Discussion: Enteral hyperproteic hypocaloric nutrition therapy could be associated with a decrease in multiple organ failure measured with SOFA score. We also found decreased hyperglycemia and a trend towards less mechanical ventilation days and ICU length of stay. PMID:24501485

Oxidised zirconium versus cobalt alloy bearing surfaces in total knee arthroplasty: 3D laser scanning of retrieved polyethylene inserts.

PubMed

Anderson, F L; Koch, C N; Elpers, M E; Wright, T M; Haas, S B; Heyse, T J

2017-06-01

We sought to establish whether an oxidised zirconium (OxZr) femoral component causes less loss of polyethylene volume than a cobalt alloy (CoCr) femoral component in total knee arthroplasty. A total of 20 retrieved tibial inserts that had articulated with OxZr components were matched with 20 inserts from CoCr articulations for patient age, body mass index, length of implantation, and revision diagnosis. Changes in dimensions of the articular surfaces were compared with those of pristine inserts using laser scanning. The differences in volume between the retrieved and pristine surfaces of the two groups were calculated and compared. The loss of polyethylene volume was 122 mm 3 (standard deviation (sd) 87) in the OxZr group and 170 mm 3 (sd 96) in the CoCr group (p = 0.033). The volume loss in the OxZr group was also lower in the medial (72 mm 3 (sd 67) versus 92 mm 3 (sd 60); p = 0.096) and lateral (49 mm 3 (sd 36) versus 79 mm 3 (sd 61); p = 0.096) compartments separately, but these differences were not significant. Our results corroborate earlier findings from in vitro testing and visual retrieval analysis which suggest that polyethylene volume loss is lower with OxZr femoral components. Since both OxZr and CoCr are hard surfaces that would be expected to create comparable amounts of polyethylene creep, the differences in volume loss may reflect differences in the in vivo wear of these inserts. Cite this article: Bone Joint J 2017;99-B:793-8. ©2017 The British Editorial Society of Bone & Joint Surgery.

Realistic sampling of anisotropic correlogram parameters for conditional simulation of daily rainfields

NASA Astrophysics Data System (ADS)

Gyasi-Agyei, Yeboah

2018-01-01

This paper has established a link between the spatial structure of radar rainfall, which more robustly describes the spatial structure, and gauge rainfall for improved daily rainfield simulation conditioned on the limited gauged data for regions with or without radar records. A two-dimensional anisotropic exponential function that has parameters of major and minor axes lengths, and direction, is used to describe the correlogram (spatial structure) of daily rainfall in the Gaussian domain. The link is a copula-based joint distribution of the radar-derived correlogram parameters that uses the gauge-derived correlogram parameters and maximum daily temperature as covariates of the Box-Cox power exponential margins and Gumbel copula. While the gauge-derived, radar-derived and the copula-derived correlogram parameters reproduced the mean estimates similarly using leave-one-out cross-validation of ordinary kriging, the gauge-derived parameters yielded higher standard deviation (SD) of the Gaussian quantile which reflects uncertainty in over 90% of cases. However, the distribution of the SD generated by the radar-derived and the copula-derived parameters could not be distinguished. For the validation case, the percentage of cases of higher SD by the gauge-derived parameter sets decreased to 81.2% and 86.6% for the non-calibration and the calibration periods, respectively. It has been observed that 1% reduction in the Gaussian quantile SD can cause over 39% reduction in the SD of the median rainfall estimate, actual reduction being dependent on the distribution of rainfall of the day. Hence the main advantage of using the most correct radar correlogram parameters is to reduce the uncertainty associated with conditional simulations that rely on SD through kriging.

Temporal ordering of motivational quality and athlete burnout in elite sport.

PubMed

Lonsdale, Chris; Hodge, Ken

2011-05-01

Using self-determination theory as the theoretical framework, we conducted a longitudinal investigation of the relationships between motivation and athlete burnout. We tested four hypotheses: H0: low self-determination (SD) does not precede burnout, and burnout does not precede low SD; H1: low SD precedes burnout; H2: burnout precedes low SD; and H3: burnout and motivation have a reciprocal relationship. We used a two-wave design, with the follow-up assessment 4 months after baseline. Elite New Zealand athletes (n=119, mean age=24.74 yr (standard deviation=8.54 yr); 57.14% of whom were females) completed the Athlete Burnout Questionnaire and the Behavioral Regulation in Sport Questionnaire. Structural equation modeling of cross-lagged panel models was used to test the hypotheses. The relationship between motivation and burnout varied depending on the type of motivation assessed. Analyses related to overall levels of self-determined motivation, amotivation, and controlled forms of extrinsic motivation provided support for H1: low SD precedes burnout. When compared with external regulation, introjected regulation seemed to be a clearer antecedent of athlete burnout. Analyses related to the self-determined forms of extrinsic motivation provided support for H2: burnout precedes low SD. The only analyses in which the null hypothesis could not be rejected were those relating to intrinsic motivation. Finally, there was little support for a reciprocal effects model. Low levels of self-determination may lead to increases in athlete burnout, whereas athlete burnout may precede decrements in self-determined extrinsic motivation. Particular efforts could be made to help support the basic psychological needs of athletes with controlled forms of motivation, thereby leading to an internalization of motivation and decreased risk of burnout. © 2011 by the American College of Sports Medicine

Identification of Patients With Diabetes Who Benefit Most From a Health Coaching Program in Chronic Disease Management, Sydney, Australia, 2013.

PubMed

Delaney, Grace; Newlyn, Neroli; Pamplona, Elline; Hocking, Samantha L; Glastras, Sarah J; McGrath, Rachel T; Fulcher, Gregory R

2017-03-02

Chronic disease management programs (CDMPs) that include health coaching can facilitate and coordinate diabetes management. The aim of this study was to assess changes in patients' general knowledge of diabetes, self-reported health status, diabetes distress, body mass index (BMI), and glycemic control after enrollment in a face-to-face CDMP group health coaching session (with telephone follow-up) compared with participation in telephone-only health coaching, during a 12-month period. Patients with diabetes were enrolled in a health coaching program at Royal North Shore Hospital, Sydney, Australia, in 2013. Questionnaires were administered at baseline and at 3, 6, and 12 months, and the results were compared with baseline. Glycemic control, measured with glycated hemoglobin A 1c (HbA 1c ) and BMI, were measured at baseline and 12 months. Overall, 238 patients attended a face-to-face CDMP session with telephone follow-up (n = 178) or participated in telephone-only health coaching (n = 60). We found no change in BMI in either group; however, HbA 1c levels in patients with baseline above the current recommended target (>7%) decreased significantly from 8.5% (standard deviation [SD], 1.0%) to 7.9% (SD, 1.0%) (P = .03). Patients with the lowest self-reported health status at baseline improved from 4.4 (SD, 0.5) to 3.7 (SD, 0.9) (P = .001). Diabetes knowledge improved in all patients (24.4 [SD, 2.4] to 25.2 [SD, 2.4]; P < .001), and diabetes distress decreased among those with the highest levels of distress at baseline (3.0 [SD, 0.4] vs 3.8 [SD, 0.6]; P = .003). Diabetes health coaching programs can improve glycemic control and reduce diabetes distress in patients with high levels of these at baseline.

Re-evaluation of a novel approach for quantitative myocardial oedema detection by analysing tissue inhomogeneity in acute myocarditis using T2-mapping.

PubMed

Baeßler, Bettina; Schaarschmidt, Frank; Treutlein, Melanie; Stehning, Christian; Schnackenburg, Bernhard; Michels, Guido; Maintz, David; Bunck, Alexander C

2017-12-01

To re-evaluate a recently suggested approach of quantifying myocardial oedema and increased tissue inhomogeneity in myocarditis by T2-mapping. Cardiac magnetic resonance data of 99 patients with myocarditis were retrospectively analysed. Thirthy healthy volunteers served as controls. T2-mapping data were acquired at 1.5 T using a gradient-spin-echo T2-mapping sequence. T2-maps were segmented according to the 16-segments AHA-model. Segmental T2-values, segmental pixel-standard deviation (SD) and the derived parameters maxT2, maxSD and madSD were analysed and compared to the established Lake Louise criteria (LLC). A re-estimation of logistic regression models revealed that all models containing an SD-parameter were superior to any model containing global myocardial T2. Using a combined cut-off of 1.8 ms for madSD + 68 ms for maxT2 resulted in a diagnostic sensitivity of 75% and specificity of 80% and showed a similar diagnostic performance compared to LLC in receiver-operating-curve analyses. Combining madSD, maxT2 and late gadolinium enhancement (LGE) in a model resulted in a superior diagnostic performance compared to LLC (sensitivity 93%, specificity 83%). The results show that the novel T2-mapping-derived parameters exhibit an additional diagnostic value over LGE with the inherent potential to overcome the current limitations of T2-mapping. • A novel quantitative approach to myocardial oedema imaging in myocarditis was re-evaluated. • The T2-mapping-derived parameters maxT2 and madSD were compared to traditional Lake-Louise criteria. • Using maxT2 and madSD with dedicated cut-offs performs similarly to Lake-Louise criteria. • Adding maxT2 and madSD to LGE results in further increased diagnostic performance. • This novel approach has the potential to overcome the limitations of T2-mapping.

Concomitant SLAP repair does not influence the surgical outcome for arthroscopic Bankart repair of traumatic shoulder dislocations.

PubMed

Aydin, Nuri; Unal, Mehmet Bekir; Asansu, Mustafa; Tok, Okan

2017-01-01

Prior studies revealed the presence of superior labrum anterior-to-posterior (SLAP) injury together with Bankart lesions in some patients. The purpose of the study is to compare the clinical results of isolated Bankart repairs with the clinical results of Bankart repairs when performed with concomitant SLAP repairs. The patients who underwent arthroscopic surgery for treatment of anterior glenohumeral instability were evaluated retrospectively. Group 1 consisted of 19 patients who had arthroscopic SLAP repair together with Bankart repair. The mean age of the patients was 23. Group 2 consisted of 38 patients who underwent isolated Bankart repair. The mean age was 24. Knotless anchors were used in both groups. The mean follow-up was 34 months (range: 26-72). In group 1, the mean preoperative Constant score was 84 (range: 74-90, standard deviation (SD): 5.91) and Rowe score was 64.1 (range: 40-70, SD: 8.14). In group 2, the preoperative Constant score was 84.4 (range: 70-96, SD: 5.88) and Rowe score was 60 (range: 45-70, SD: 7.95). In group 1, the postoperative mean Constant score raised to 96.8 (range: 88-100, SD: 2.91) and the mean Rowe score raised to 92.3 (range: 85-100, SD: 5.17). In group 2, the postoperative mean Constant score was 94.9 (range: 88-100, SD: 3.70) and the mean Rowe score was 94.2 (range: 80-100, SD: 4.71). The difference between the scores of two groups was insignificant ( p > 0.05). When the numbers of redislocations and range of motion were compared, no significant difference was found ( p > 0.05). Accompanying SLAP repair in surgical treatment with Bankart repair for shoulder instability does not affect the results negatively. Properly repaired labral tears extending from anterior inferior to the posterior superior of the glenoid in instability treatment have the same outcome in overall results as repaired isolated Bankart lesions.

Air and blood lead levels in lead acid battery recycling and manufacturing plants in Kenya.

PubMed

Were, Faridah H; Kamau, Geoffrey N; Shiundu, Paul M; Wafula, Godfrey A; Moturi, Charles M

2012-01-01

The concentration of airborne and blood lead (Pb) was assessed in a Pb acid battery recycling plant and in a Pb acid battery manufacturing plant in Kenya. In the recycling plant, full-shift area samples taken across 5 days in several production sections showed a mean value ± standard deviation (SD) of 427 ± 124 μg/m(3), while area samples in the office area had a mean ± SD of 59.2 ± 22.7 μg/m(3). In the battery manufacturing plant, full-shift area samples taken across 5 days in several production areas showed a mean value ± SD of 349 ± 107 μg/m(3), while area samples in the office area had a mean ± SD of 55.2 ± 33.2 μg/m(3). All these mean values exceed the U.S. Occupational Safety and Health Administration's permissible exposure limit of 50 μg/m(3) as an 8-hr time-weighted average. In the battery recycling plant, production workers had a mean blood Pb level ± SD of 62.2 ± 12.7 μg/dL, and office workers had a mean blood Pb level ± SD of 43.4 ± 6.6 μg/dL. In the battery manufacturing plant, production workers had a mean blood Pb level ± SD of 59.5 ± 10.1 μg/dL, and office workers had a mean blood Pb level ± SD of 41.6 ± 7.4 μg/dL. All the measured blood Pb levels exceeded 30 μg/dL, which is the maximum blood Pb level recommended by the ACGIH(®). Observations made in these facilities revealed numerous sources of Pb exposure due to inadequacies in engineering controls, work practices, respirator use, and personal hygiene.

Impact of an Automatically Generated Cancer Survivorship Care Plan on Patient-Reported Outcomes in Routine Clinical Practice: Longitudinal Outcomes of a Pragmatic, Cluster Randomized Trial.

PubMed

Nicolaije, Kim A H; Ezendam, Nicole P M; Vos, M Caroline; Pijnenborg, Johanna M A; Boll, Dorry; Boss, Erik A; Hermans, Ralph H M; Engelhart, Karin C M; Haartsen, Joke E; Pijlman, Brenda M; van Loon-Baelemans, Ingrid E A M; Mertens, Helena J M M; Nolting, Willem E; van Beek, Johannes J; Roukema, Jan A; Zijlstra, Wobbe P; Kruitwagen, Roy F P M; van de Poll-Franse, Lonneke V

2015-11-01

This study was conducted to longitudinally assess the impact of an automatically generated survivorship care plan (SCP) on patient-reported outcomes in routine clinical practice. Primary outcomes were patient satisfaction with information and care. Secondary outcomes included illness perceptions and health care use. Twelve hospitals were randomly assigned to SCP care or usual care in a pragmatic, cluster randomized trial. Newly diagnosed patients with endometrial cancer completed questionnaires after diagnosis (n = 221; 75% response), 6 months (n = 158), and 12 months (n = 147). An SCP application was built in the Web-based ROGY (Registration System Oncological Gynecology). By clicking the SCP button, a patient-tailored SCP was generated. In the SCP care arm, 74% of patients received an SCP. They reported receiving more information about their treatment (mean [M] = 57, standard deviation [SD] = 20 v M = 47, SD = 24; P = .03), other services (M = 35, SD = 22 v M = 25, SD = 22; P = .03), and different places of care (M = 27, SD = 25 v M = 23, SD = 26; P = .04) than the usual care arm (scales, 0 to 100). However, there were no differences regarding satisfaction with information or care. Patients in the SCP care arm experienced more symptoms (M = 3.3, SD = 2.0 v M = 2.6, SD = 1.6; P = .03), were more concerned about their illness (M = 4.4, SD = 2.3 v M = 3.9, SD = 2.1; P = .03), were more affected emotionally (M = 4.0, SD = 2.2 v M = 3.7, SD = 2.2; P = .046), and reported more cancer-related contact with their primary care physician (M = 1.8, SD = 2.0 v M = 1.1, SD = 0.9; P = .003) than those in the usual care arm (scale, 1 to 10). These effects did not differ over time. The present trial showed no evidence of a benefit of SCPs on satisfaction with information and care. Furthermore, SCPs increased patients' concerns, emotional impact, experienced symptoms, and the amount of cancer-related contact with the primary care physician. Whether this may ultimately lead to more empowered patients should be investigated further. © 2015 by American Society of Clinical Oncology.

Comparison of Automated Analysis of Cirrus HD-OCT™ Spectral Domain Optical Coherence Tomography with Stereo Photos of the Optic Disc

PubMed Central

Sharma, Ashish; Oakley, Jonathan D.; Schiffman, Joyce C.; Budenz, Donald L.; Anderson, Douglas R.

2010-01-01

OBJECTIVE To evaluate a new automated analysis of optic disc images obtained by spectral domain optical coherence tomography (SD-OCT). Areas of the optic disc, cup, and neural rim in SD-OCT images were compared with these areas from stereoscopic photographs, to represent the current traditional optic nerve evaluation. The repeatability of measurements by each method was determined and compared. DESIGN Evaluation of diagnostic technology. PARTICIPANTS 119 healthy eyes, 23 eyes with glaucoma, and 7 suspect eyes METHODS Optic disc and cup margins were traced from stereoscopic photographs by three individuals independently. Optic disc margins and rim widths were determined automatically in SD-OCT. A subset of photographs was examined and traced a second time, and duplicate SD-OCT images were also analyzed. MAIN OUTCOME MEASUREMENTS Agreement among photograph readers, between duplicate readings, and between SD-OCT and photographs were quantified by the intraclass correlation coefficient (ICC), by the root mean square (RMS), and the standard deviation (SD) of the differences. RESULTS Optic disc areas tended to be slightly larger when judged in photographs than by SD-OCT, while cup areas were similar. Cup and optic disc areas showed good correlation (0.8) between average photographic reading and SD-OCT, but only fair correlation of rim areas (0.4). The SD-OCT was highly reproducible (ICC of 0.96 to 0.99). Each reader was also consistent with himself on duplicate readings of 21 photographs (ICC 0.80 to 0.88 for rim area, 0.95 to 0.98 for all other measurements), but reproducibility was not as good as SD-OCT. Measurements derived from SD-OCT did not differ from photographic readings more than the readings of photographs by different readers differed from each other. CONCLUSIONS Designation of the cup and optic disc boundaries by an automated analysis of SD-OCT was within the range of variable designations by different readers from color stereoscopic photographs, but use of different landmarks typically made the designation of the optic disc size somewhat smaller in the automated analysis. There was better repeatability among measurements from SD-OCT than from among readers of photographs. The repeatability of automated measurement of SD-OCT images is promising for use both in diagnosis and in monitoring of progression. PMID:21397334

Association between air pollution and acute childhood wheezy episodes: prospective observational study.

PubMed Central

Buchdahl, R.; Parker, A.; Stebbings, T.; Babiker, A.

1996-01-01

OBJECTIVE--To examine the association between the air pollutants ozone, sulphur dioxide, and nitrogen dioxide and the incidence of acute childhood wheezy episodes. DESIGN--Prospective observational study over one year. SETTING--District general hospital. SUBJECTS--1025 children attending the accident and emergency department with acute wheezy episodes; 4285 children with other conditions as the control group. MAIN OUTCOME MEASURES--Daily incidence of acute wheezy episodes. RESULTS--After seasonal adjustment, day to day variations in daily average concentrations of ozone and sulphur dioxide were found to have significant associations with the incidence of acute wheezy episodes. The strongest association was with ozone, for which a non-linear U shaped relation was seen. In terms of the incidence rate ratio (1 at a mean 24 hour ozone concentration of 40 microg/m3 (SD=19.1)), children were more likely to attend when the concentration was two standard deviations below the mean (incidence rate ratio=3.01; 95% confidence interval 2.17 to 4.18) or two standard deviations above the mean (1.34; 1.09 to 1.66). Sulphur dioxide had a weaker log-linear relation with incidence (1.12; 1.05 to 1.19 for each standard deviation (14.1) increase in sulphur dioxide concentration). Further adjustment for temperature and wind speed did not significantly alter these associations. CONCLUSIONS--Independent of season, temperature, and wind speed, fluctuations in concentrations of atmospheric ozone and sulphur dioxide are strongly associated with patterns of attendance at accident and emergency departments for acute childhood wheezy episodes. A critical ozone concentration seems to exist in the atmosphere above or below which children are more likely to develop symptoms. PMID:8597731

The Impact of Medical Comorbidities on Primary Total Knee Arthroplasty Reimbursements.

PubMed

Sabeh, Karim G; Rosas, Samuel; Buller, Leonard T; Freiberg, Andrew A; Emory, Cynthia L; Roche, Martin W

2018-05-23

Medical comorbidities have been shown to cause an increase in peri-and postoperative complications following total knee arthroplasty (TKA). However, the increase in cost associated with these complications has yet to be determined. Factors that influence cost have been of great interest particularly after the initiation of bundled payment initiatives. In this study, we present and quantify the influence of common medical comorbidities on the cost of care in patients undergoing primary TKA. A retrospective level of evidence III study was performed using the PearlDiver supercomputer to identify patients who underwent primary TKA between 2007 and 2015. Patients were stratified by medical comorbidities and compared using analysis of variance for reimbursements for the day of surgery and over 90 days postoperatively. A cohort of 137,073 US patients was identified as having undergone primary TKA between 2007 and 2015. The mean entire episode-of-care reimbursement was $23,701 (range: $21,294-26,299; standard deviation [SD] $2,611). The highest reimbursements were seen in patients with chronic obstructive pulmonary disease (mean $26,299; SD $3,030), hepatitis C (mean $25,662; SD $2,766), morbid obesity (mean $25,450; SD $2,154), chronic kidney disease (mean $25,131, $3,361), and cirrhosis (mean $24,890; SD $2,547). Medical comorbidities significantly impact reimbursements, and therefore cost, after primary TKA. Comprehensive preoperative optimization for patients with medical comorbidities undergoing TKA is highly recommended and may reduce perioperative complications, improve patient outcome, and ultimately reduce cost. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Sucrose concentration and pH in liquid oral pediatric medicines of long-term use for children.

PubMed

Passos, Isabela Albuquerque; Sampaio, Fábio Correia; Martínez, Cosme Rafael; Freitas, Cláudia Helena Soares de Morais

2010-02-01

To determine the pH and sucrose concentrations (SC) of pediatric liquid drugs of long-term use by children in order to evaluate the potential risk for dental caries and dental erosion. After assessing the pH, we analyzed 71 aqueous medicine samples for sucrose by the Lane-Eynon general volumetric method. The pH and SC values (mean +/- standard deviation (SD) were calculated according to therapeutic action. The highest and the lowest SC values (mean +/- SD) were found in respiratory (37.75% +/- 17.23%) and endocrine drugs (11.97% +/- 15.16%) (p < 0.01). The values for medicines prescribed for daily ingestion were 47.15% +/- 9.57%, whereas for twice daily and three or four times a day, these numbers were 24.42% +/- 18.03% and 34.43% +/- 14.83%, respectively (p < 0.01). The SC (mean +/- SD)) values were higher in syrups (36.32% +/- 17.62%) than in other formulations (p > 0.05). The overall pH (mean +/- SD) was 5.89 +/- 2.02 (range 2.3 +/- 0.01 to 10.6 +/- 0.02). In products with acidic pH, the SC (mean +/- SD) was significantly lower (22.14% +/- 15.72%) than in nonacidic medicines (39.22% +/- 15.82%) (p < 0.001). It can be concluded that the pediatric medicines studied have a high SC and low pH, which vary according to therapeutic class, daily dose, and brand. Caution about dental caries, dental erosion, and systemic diseases such as diabetes mellitus is warranted when these medicines are ingested frequently.

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth.

PubMed

Basset, Helene; Nusinovici, Simon; Huetz, Noémie; Sentilhes, Loic; Berlie, Isabelle; Flamant, Cyril; Roze, Jean-Christophe; Gascoin, Geraldine

2018-01-01

There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in a large prospective cohort of preterm infants. This study was conducted as a population-based, prospective, multicenter study, including 4,965 infants born between 24 and 33 weeks' gestation and whose status regarding ACT and the measurement of head circumference at birth were available. They were evaluated at 2 years of corrected age to assess neurological outcome. Three approaches were considered to estimate the effect of ACT on neurodevelopment: (i) logistic regression with adjustment on propensity score, (ii) weighted logistic regression using the inverse probability of treatment weighting method, and (iii) 1:1 matching of gestational age, ZS HC, and propensity score between treated and nontreated infants. ACT was documented in 60% of infants. Three groups of infants were considered according to their ZS HC: between -3 and -1 standard deviation (SD), -1 and +1 SD, and +1 and +3 SD, respectively. ACT was associated with a significant improvement of neurodevelopmental outcome only for infants with an ZS HC of between +1 and +3 SD (adjusted OR 1.72; 95% CI 1.06-2.79). Moreover, ORs estimated in the -3 to -1 and +1 to +3 categories were significantly different. We found beneficial effects of ACT on neurodevelopmental outcomes at 2 years of corrected age only in preterm infants with a ZS HC >1 SD. © 2017 S. Karger AG, Basel.

Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations.

PubMed

Blaine, Rachel E; Fisher, Jennifer Orlet; Taveras, Elsie M; Geller, Alan C; Rimm, Eric B; Land, Thomas; Perkins, Meghan; Davison, Kirsten K

2015-07-21

Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012-2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2-12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2-5 years) more snacks to reward behavior (1.9 vs. 1.1, p < 0.001), keep quiet (1.0 vs. 0.5, p < 0.001), and celebrate achievements (1.7 vs. 1.0, p < 0.001) than parents of older children (6-12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70-0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52-0.99), or achievements (OR = 0.82; 95% CI 0.68-0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts.

Effects of type II thyroplasty on adductor spasmodic dysphonia.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji; Minoda, Ryosei; Kodama, Narihiro

2010-04-01

Type II thyroplasty, or laryngeal framework surgery, is based on the hypothesis that the effect of adductor spasmodic dysphonia (AdSD) on the voice is due to excessively tight closure of the glottis, hampering phonation. Most of the previous, partially effective treatments have aimed to relieve this tight closure, including recurrent laryngeal nerve section or avulsion, extirpation of the adductor muscle, and botulinum toxin injection, which is currently the most popular. The aim of this study was to assess the effects of type II thyroplasty on aerodynamic and acoustic findings in patients with AdSD. Case series. University hospital. Ten patients with AdSD underwent type II thyroplasty between August 2006 and December 2008. Aerodynamic and acoustic analyses were performed prior to and six months after surgery. Mean flow rates (MFRs) and voice efficiency were evaluated with a phonation analyzer. Jitter, shimmer, the harmonics-to-noise ratio (HNR), standard deviation of the fundamental frequency (SDF0), and degree of voice breaks (DVB) were measured from each subject's longest sustained phonation sample of the vowel /a/. Voice efficiency improved significantly after surgery. No significant difference was found in the MFRs between before and after surgery. Jitter, shimmer, HNR, SDF0, and DVB improved significantly after surgery. Treatment of AdSD with type II thyroplasty significantly improved aerodynamic and acoustic findings. The results of this study suggest that type II thyroplasty provides relief from voice strangulation in patients with AdSD. Copyright 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. Published by Mosby, Inc. All rights reserved.

Computerised lung sound monitoring to assess effectiveness of chest physiotherapy and secretion removal: a feasibility study.

PubMed

Ntoumenopoulos, G; Glickman, Y

2012-09-01

To explore the feasibility of computerised lung sound monitoring to evaluate secretion removal in intubated and mechanically ventilated adult patients. Before and after observational investigation. Intensive care unit. Fifteen intubated and mechanically ventilated adult patients receiving chest physiotherapy. Chest physiotherapy included combinations of standard closed airway suctioning, saline lavage, postural drainage, chest wall vibrations, manual-assisted cough and/or lung hyperinflation, dependent upon clinical indications. Lung sound amplitude at peak inspiration was assessed using computerised lung sound monitoring. Measurements were performed immediately before and after chest physiotherapy. Data are reported as mean [standard deviation (SD)], mean difference and 95% confidence intervals (CI). Significance testing was not performed due to the small sample size and the exploratory nature of the study. Fifteen patients were included in the study [11 males, four females, mean age 65 (SD 14) years]. The mean total lung sound amplitude at peak inspiration decreased two-fold from 38 (SD 59) units before treatment to 17 (SD 19) units after treatment (mean difference 22, 95% CI of difference -3 to 46). The mean total lung sound amplitude from the lungs of patients with a large amount of secretions (n=9) was over four times 'louder' than the lungs of patients with a moderate or small amount of secretions (n=6) [56 (SD 72) units vs 12 (13) units, respectively; mean difference -44, 95% CI of difference -100 to 11]. The mean total lung sound amplitude decreased in the group of 'loud' right and left lungs (n=15) from 37 (SD 36) units before treatment to 15 (SD 13) units after treatment (mean difference 22, 95% CI of difference 6 to 38). Computerised lung sound monitoring in this small group of patients demonstrated a two-fold decrease in lung sound amplitude following chest physiotherapy. Subgroup analysis also demonstrated decreasing trends in lung sound amplitude in the group of 'loud' lungs following chest physiotherapy. Due to the small sample size and large SDs with high variability in the lung sound amplitude measurements, significance testing was not reported. Further investigation is needed in a larger sample of patients with more accurate measurement of sputum wet weight in order to distinguish between secretion-related effects and changes due to other factors such as airflow rate and pattern. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Comparison of Patient Health History Questionnaires Used in General Internal and Family Medicine, Integrative Medicine, and Complementary and Alternative Medicine Clinics.

PubMed

Laube, Justin G R; Shapiro, Martin F

2017-05-01

Health history questionnaires (HHQs) are a set of self-administered questions completed by patients prior to a clinical encounter. Despite widespread use, minimal research has evaluated the content of HHQs used in general internal medicine and family medicine (GIM/FM), integrative medicine, and complementary and alternative medicine (CAM; chiropractic, naturopathic, and Traditional Chinese Medicine [TCM]) clinics. Integrative medicine and CAM claim greater emphasis on well-being than does GIM/FM. This study investigated whether integrative medicine and CAM clinics' HHQs include more well-being content and otherwise differ from GIM/FM HHQs. HHQs were obtained from GIM/FM (n = 9), integrative medicine (n = 11), naturopathic medicine (n = 5), chiropractic (n = 4), and TCM (n = 7) clinics in California. HHQs were coded for presence of medical history (chief complaint, past medical history, social history, family history, surgeries, hospitalizations, medications, allergies, review of systems), health maintenance procedures (immunization, screenings), and well-being components (nutrition, exercise, stress, sleep, spirituality). In HHQs of GIM/FM clinics, the average number of well-being components was 1.4 (standard deviation [SD], 1.4) compared with 4.0 (SD, 1.1) for integrative medicine (p < 0.01), 3.2 (SD, 2.1) for naturopathic medicine (p = 0.04), 2.0 (SD, 1.4) for chiropractic (p = 0.54), and 2.0 (SD, 1.5) for TCM (p = 0.47). In HHQs of GIM/FM clinics, the average number of medical history components was 6.4 (SD, 1.9) compared with 8.3 (SD, 1.2) for integrative medicine (p = 0.01), 9.0 (SD, 0) for naturopathic medicine (p = 0.01), 7.1 (SD, 2.8) for chiropractic (p = 0.58), and 7.1 (SD, 1.7) for TCM (p = 0.41). Integrative and naturopathic medicine HHQs included significantly more well-being and medical history components than did GIM/FM HHQs. Further investigation is warranted to determine the optimal HHQ content to support the clinical and preventive health goals of general internal medicine, family medicine, integrative medicine, and CAM practices.

Hearing results using the SMart piston prosthesis.

PubMed

Fayad, Jose N; Semaan, Maroun T; Meier, Josh C; House, John W

2009-12-01

SMart, a newly introduced piston prosthesis for stapedotomy, is a nitinol-based, heat-activated, self-crimping prosthesis. We review our hearing results and postoperative complications using this self-crimped piston prosthesis and compare them with those obtained using stainless steel or platinum piston prostheses. Audiometric results using the SMart piston are identical to those obtained using a conventional piston prosthesis. Retrospective chart review. Private neurotologic tertiary referral center. The 416 ears reviewed included 306 with a SMart prosthesis and 110 conventional prostheses. 61% were women. Mean follow-up time was 5.6 (standard deviation [SD], 6.3 mo) and 6.9 months (SD, 7.0 mo) for the 2 groups, respectively. Stapedotomy using the SMart or a conventional (non-SMart) prosthesis. Audiometric hearing results, including pure-tone average (PTA) and air-bone gap (ABG), and prevalence of postoperative complications. Mean postoperative PTA was 32.6 (SD, 16.8) dB for the SMart group and 29.4 (SD, 13.5) dB for the non-SMart group, with ABGs of 7.6 (SD, 8.9) and 6.0 (SD, 5.2) dB, respectively. Mean change (decrease) in ABG was 18.7 (SD, 13.1) dB for the SMart group and 19.9 (SD, 10.3) dB for the non-SMart group. High-frequency bone PTAs showed overclosure of 2.0 (SD, 7.9) dB for the SMart group and 3.6 (SD, 8.6) dB for the non-SMart group. Postoperative vertigo and tinnitus were infrequent. No significant differences in these audiometric outcomes or complication rates were noted between groups. There was no significant difference in rate of gap closure to within 10 dB (78.3 versus 84.2%, SMart and non-SMart, respectively) or 20 dB (94.2 and 98.0%). Compared with conventional stapes prostheses, the nitinol-based SMart is a safe and reliable stapes prosthesis that eliminates manual crimping without significantly altering the audiometric outcome. Complications are rare, but longer follow-up is needed before establishing long-term stability.

Three-dimensional high-speed optical coherence tomography imaging of lamina cribrosa in glaucoma.

PubMed

Inoue, Ryo; Hangai, Masanori; Kotera, Yuriko; Nakanishi, Hideo; Mori, Satoshi; Morishita, Shiho; Yoshimura, Nagahisa

2009-02-01

To evaluate the appearance of the optic nerve head and lamina cribrosa in patients with glaucoma using spectral/Fourier-domain optical coherence tomography (SD-OCT) and to test for a correlation between lamina cribrosa thickness measured on SD-OCT images and visual field loss. Observational case series. We evaluated 52 eyes of 30 patients with glaucoma or ocular hypertension. The high-speed SD-OCT equipment used was a prototype system developed for 3-dimensional (3D) imaging. It had a sensitivity of 98 decibels (dB), a tissue axial resolution of 4.3 mum, and an acquisition rate of approximately 18,700 axial scans per second. For 3D analyses, a raster scan protocol of 256 x 256 axial scans covering a 2.8 x 2.8 mm disc area was used. Lamina cribrosa thickness was measured on 3D images using 3D image processing software. Correlation between lamina cribrosa thickness and mean deviation (MD) values obtained using static automatic perimetry were tested for statistical significance. Clarity of lamina cribrosa features, lamina cribrosa thickness, and MD values on static automatic perimetry. On 3D images, the lamina cribrosa appeared clearly as a highly reflective plate that was bowed posteriorly and contained many circular areas of low reflectivity. The dots of low reflectivity visible just beneath the anterior surface of the lamina cribrosa in en face cross-sections corresponded with dots representing lamina pores in color fundus photographs. The mean (+/-1 standard deviation) thickness of the lamina cribrosa was 190.5+/-52.7 mum (range, 80.5-329.0). Spearman rank testing and linear regression analysis showed that lamina cribrosa thickness correlated significantly with MD (Spearman sigma = 0.744; P<0.001; r(2) = 0.493; P<0.001). Different observers performed measurements of the lamina cribrosa thickness in SD-OCT cross-sectional images with high reproducibility (intraclass correlation coefficient = 0.784). These 3D SD-OCT imaging clearly demonstrated the 3D structure of the lamina cribrosa and allowed measurement of its thickness, which correlated significantly with visual field loss, in living patients with glaucoma. This noninvasive imaging technique should facilitate investigations of structural changes in the optic nerve head lamina cribrosa in eyes with optic nerve damage due to glaucoma. The authors have no proprietary or commercial interest in any materials discussed in this article.

Safety and efficacy of at-home robotic locomotion therapy in individuals with chronic incomplete spinal cord injury: a prospective, pre-post intervention, proof-of-concept study.

PubMed

Rupp, Rüdiger; Schließmann, Daniel; Plewa, Harry; Schuld, Christian; Gerner, Hans Jürgen; Weidner, Norbert; Hofer, Eberhard P; Knestel, Markus

2015-01-01

The compact Motorized orthosis for home rehabilitation of Gait (MoreGait) was developed for continuation of locomotion training at home. MoreGait generates afferent stimuli of walking with the user in a semi-supine position and provides feedback about deviations from the reference walking pattern. Prospective, pre-post intervention, proof-of-concept study to test the feasibility of an unsupervised home-based application of five MoreGait prototypes in subjects with incomplete spinal cord injury (iSCI). Twenty-five (5 tetraplegia, 20 paraplegia) participants with chronic (mean time since injury: 5.8 ± 5.4 (standard deviation, SD) years) sensorimotor iSCI (7 ASIA Impairment Scale (AIS) C, 18 AIS D; Walking Index for Spinal Cord Injury (WISCI II): Interquartile range 9 to 16) completed the training (45 minutes / day, at least 4 days / week, 8 weeks). Baseline status was documented 4 and 2 weeks before and at training onset. Training effects were assessed after 4 and 8 weeks of therapy. After therapy, 9 of 25 study participants improved with respect to the dependency on walking aids assessed by the WISCI II. For all individuals, the short-distance walking velocity measured by the 10-Meter Walk Test showed significant improvements compared to baseline (100%) for both self-selected (Mean 139.4% ± 35.5% (SD)) and maximum (Mean 143.1% ± 40.6% (SD)) speed conditions as well as the endurance estimated with the six-minute walk test (Mean 166.6% ± 72.1% (SD)). One device-related adverse event (pressure sore on the big toe) occurred in over 800 training sessions. Home-based robotic locomotion training with MoreGait is feasible and safe. The magnitude of functional improvements achieved by MoreGait in individuals with iSCI is well within the range of complex locomotion robots used in hospitals. Thus, unsupervised MoreGait training potentially represents an option to prolong effective training aiming at recovery of locomotor function beyond in-patient rehabilitation. German Clinical Trials Register (DKRS) DRKS00005587.

Effect of breastfeeding on weight retention from one pregnancy to the next: results from the North Carolina WIC program.

PubMed

Østbye, Truls; Krause, Katrina M; Swamy, Geeta K; Lovelady, Cheryl A

2010-11-01

Pregnancy-related weight retention can contribute to obesity, and breastfeeding may facilitate postpartum weight loss. We investigated the effect of breastfeeding on long-term postpartum weight retention. Using data from the North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; 1996-2004), weight retention was assessed in women aged 18 years or older who had more than one pregnancy available for analysis (n=32,920). Using multivariable linear regression, the relationship between duration of breastfeeding after the first pregnancy and change in pre-pregnancy weight from the first pregnancy to the second pregnancy was estimated, controlling for demographic and weight-related covariates. Mean time between pregnancies was 2.8 years (standard deviation (SD) 1.5), and mean weight retention from the first to the second pregnancy was 4.9kg (SD 8.7). In covariate-adjusted analyses, breastfeeding for 20 weeks or more resulted in 0.39kg (standard error (SE) 0.18) less weight retention at the beginning of the second pregnancy relative to no breastfeeding (p=0.025). In this large, racially diverse sample of low-income women, long-term weight retention was lower among those who breastfed for at least 20 weeks. Copyright © 2010 Elsevier Inc. All rights reserved.

Effect of therapeutic exercises on pregnancy-related low back pain and pelvic girdle pain: Secondary analysis of a randomized controlled trial.

PubMed

Sklempe Kokic, Iva; Ivanisevic, Marina; Uremovic, Melita; Kokic, Tomislav; Pisot, Rado; Simunic, Bostjan

2017-03-06

To investigate the effect of a supervised, structured exercise programme on the occurrence and severity of pregnancy-related lumbopelvic pain. Randomized controlled trial. A total of 45 pregnant women were randomly assigned to 2 groups: an experimental group (n = 20; mean age 32.8 (standard deviation (SD) 3.6) years) and a control group (n = 22; mean age 32.2 years (SD 4.9)). Exercise intervention for the experimental group consisted of aerobic and resistance exercises performed bi-weekly from the date of inclusion into the study until the end of pregnancy, together with at least 30 min of brisk daily walks. A numeric rating scale, Roland-Morris Disability Questionnaire (RMDQ), and Pelvic Girdle Questionnaire (PGQ) were used to measure outcomes. The control group received only standard antenatal care. There were significant differences between the 2 groups on the numeric rating scale, PGQ and RMDQ scores in the 36th week of pregnancy (p = 0.017; p = 0.005; p < 0.001, respectively) in favour of the experimental group. The exercise programme had a beneficial effect on the severity of lumbopelvic pain in pregnancy, reducing the intensity of pain and the level of disability experienced as a result.

Economic Burden of Dengue Virus Infection at the Household Level among Residents of Puerto Maldonado, Peru

PubMed Central

Salmon-Mulanovich, Gabriela; Blazes, David L.; Lescano, Andres G.; Bausch, Daniel G.; Montgomery, Joel M.; Pan, William K.

2015-01-01

Dengue virus (DENV) was reintroduced to Peru in the 1990s and has been reported in Puerto Maldonado (population ~65,000) in the Peruvian southern Amazon basin since 2000. This region also has the highest human migration rate in the country, mainly from areas not endemic for DENV. The objective of this study was to assess the proportion of household income that is diverted to costs incurred because of dengue illness and to compare these expenses between recent migrants (RMs) and long-term residents (LTRs). We administered a standardized questionnaire to persons diagnosed with dengue illness at Hospital Santa Rosa in Puerto Maldonado from December 2012 to March 2013. We compared direct and indirect medical costs between RMs and LTRs. A total of 80 participants completed the survey, of whom 28 (35%) were RMs and 52 (65%) were LTRs. Each dengue illness episode cost the household an average of US$105 (standard deviation [SD] = 107), representing 24% of their monthly income. Indirect costs were the greatest expense (US$56, SD = 87), especially lost wages. The proportion of household income diverted to dengue illness did not differ significantly between RM and LTR households. The study highlights the significant financial burden incurred by households when a family member suffers dengue illness. PMID:26217040

EFFECTS OF FLUID AND COMPUTED TOMOGRAPHIC TECHNICAL FACTORS ON CONSPICUITY OF CANINE AND FELINE NASAL TURBINATES

PubMed Central

Uosyte, Raimonda; Shaw, Darren J; Gunn-Moore, Danielle A; Fraga-Manteiga, Eduardo; Schwarz, Tobias

2015-01-01

Turbinate destruction is an important diagnostic criterion in canine and feline nasal computed tomography (CT). However decreased turbinate visibility may also be caused by technical CT settings and nasal fluid. The purpose of this experimental, crossover study was to determine whether fluid reduces conspicuity of canine and feline nasal turbinates in CT and if so, whether CT settings can maximize conspicuity. Three canine and three feline cadaver heads were used. Nasal slabs were CT-scanned before and after submerging them in a water bath; using sequential, helical, and ultrahigh resolution modes; with images in low, medium, and high frequency image reconstruction kernels; and with application of additional posterior fossa optimization and high contrast enhancing filters. Visible turbinate length was measured by a single observer using manual tracing. Nasal density heterogeneity was measured using the standard deviation (SD) of mean nasal density from a region of interest in each nasal cavity. Linear mixed-effect models using the R package ‘nlme’, multivariable models and standard post hoc Tukey pair-wise comparisons were performed to investigate the effect of several variables (nasal content, scanning mode, image reconstruction kernel, application of post reconstruction filters) on measured visible total turbinate length and SD of mean nasal density. All canine and feline water-filled nasal slabs showed significantly decreased visibility of nasal turbinates (P < 0.001). High frequency kernels provided the best turbinate visibility and highest SD of aerated nasal slabs, whereas medium frequency kernels were optimal for water-filled nasal slabs. Scanning mode and filter application had no effect on turbinate visibility. PMID:25867935

The Moderating Effect of Frequent Singing on Voice Aging.

PubMed

Lortie, Catherine L; Rivard, Julie; Thibeault, Mélanie; Tremblay, Pascale

2017-01-01

The effects of aging on voice production are well documented, including changes in loudness, pitch, and voice quality. However, one important and clinically relevant question that remains concerns the possibility that the aging of voice can be prevented or at least delayed through noninvasive methods. Indeed, discovering natural means to preserve the integrity of the human voice throughout aging could have a major impact on the quality of life of elderly adults. The objective of this study was therefore to examine the potentially positive effect of singing on voice production. To this aim, a group of 72 healthy nonsmoking adults (20-93 years old) was recruited and separated into three groups based on their singing habits. Several voice parameters were assessed (fundamental frequency [f0] mean, f0 standard deviation [SD], f0 minimum and f0 maximum, mean amplitude and amplitude SD, jitter, shimmer, and harmonic-to-noise ratio) during the sustained production of vowel /a/. Other parameters were assessed during standardized reading passage (speaking f0, speaking f0 SD). As was expected, age effects were found on most acoustic parameters with significant sex differences. Importantly, moderation analyses revealed that frequent singing moderates the effect of aging on most acoustic parameters. Specifically, in frequent singers, there was no decrease in the stability of pitch and amplitude with age, suggesting that the voice of frequent singers remains more stable in aging than the voice of non-singers, and more generally, providing empirical evidence for a positive effect of singing on voice in aging. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Statistical validation of reagent lot change in the clinical chemistry laboratory can confer insights on good clinical laboratory practice.

PubMed

Cho, Min-Chul; Kim, So Young; Jeong, Tae-Dong; Lee, Woochang; Chun, Sail; Min, Won-Ki

2014-11-01

Verification of new lot reagent's suitability is necessary to ensure that results for patients' samples are consistent before and after reagent lot changes. A typical procedure is to measure results of some patients' samples along with quality control (QC) materials. In this study, the results of patients' samples and QC materials in reagent lot changes were analysed. In addition, the opinion regarding QC target range adjustment along with reagent lot changes was proposed. Patients' sample and QC material results of 360 reagent lot change events involving 61 analytes and eight instrument platforms were analysed. The between-lot differences for the patients' samples (ΔP) and the QC materials (ΔQC) were tested by Mann-Whitney U tests. The size of the between-lot differences in the QC data was calculated as multiples of standard deviation (SD). The ΔP and ΔQC values only differed significantly in 7.8% of the reagent lot change events. This frequency was not affected by the assay principle or the QC material source. One SD was proposed for the cutoff for maintaining pre-existing target range after reagent lot change. While non-commutable QC material results were infrequent in the present study, our data confirmed that QC materials have limited usefulness when assessing new reagent lots. Also a 1 SD standard for establishing a new QC target range after reagent lot change event was proposed. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Resistance Training Increases the Variability of Strength Test Scores

DTIC Science & Technology

2009-06-08

standard deviations for pretest and posttest strength measurements. This information was recorded for every strength test used in a total of 377 samples...significant if the posttest standard deviation consistently was larger than the pretest standard deviation. This condition could be satisfied even if...the difference in the standard deviations was small. For example, the posttest standard deviation might be 1% larger than the pretest standard

A Joyful Heart is Good Medicine: Positive Affect Predicts Memory Complaints.

PubMed

Lee, Pai-Lin

2016-08-01

Positive affect (PA) systematically improves cognitive performance on a wide range of cognitive tasks, but the link between PA and subjective memory complaints (SMCs) is unclear. The aim of this study was to investigate the associations between PA (level and change) and SMCs over a 10-year span. Current data included participants who completed all measures in the Midlife in the US Study (N = 2,214; age range: 50-84 years; mean: 62.81; standard deviation [SD]: 8.98). The level (mean of Time 1 and Time 2) and change (Time 2 minus Time 1) of PA was examined longitudinally to determine if PA predicts SMCs. The long-term level and change of PA predicted SMCs. No age and education differences were found for the effects of PA (PA × age and PA × education) on SMCs. Additional comparison analysis found high PA (+1 SD) differs from low PA (-1 SD) on age, financial condition and depression, and physical activity. This study provides longitudinal evidence that further supports PA is associated with a key cognitive aging outcome, SMCs. Effective cognitive-health programs may need to pay more attention to PA intervention. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Evaluation of variations in absorbed dose and image noise according to patient forms in X-ray computed tomography.

PubMed

Matsubara, Kosuke; Koshida, Kichiro; Suzuki, Masayuki; Hayakawa, Mayumi; Tsujii, Hideo; Yamamoto, Tomoyuki

2005-12-20

Excessive radiation exposure in pediatric computed tomography (CT) scanning has become a serious problem, and it is difficult to select scan parameters for the scanning of small patients such as children. We investigated differences in absorbed dose and standard deviation (SD) in Hounsfield unit (HU) caused by differences in the form of the subject using a body-type phantom with removable body parts. Using four X-ray CT scanners, measurements were made with values from 50 mAs to 300 mAs, with slices of 50 mAs, using scan protocols that were assumed to perform thorough examinations. The results showed that the mAs values and absorbed doses were almost proportional, and the absorbed doses in the phantom without body parts were about 1.1-2.2-fold higher than those of the phantom with body parts at the same points. The SD values obtained indicated that the absorbed doses in the phantom with body parts were 0.3-0.6 times those of the phantom without body parts when the mAs values used were adjusted so that both SD values were the same. The absorbed doses in various patient forms can be estimated from these results, and they will become critical data for the selection of appropriate scan protocols.

Patient Satisfaction With Pharmacist-Led Chronic Disease State Management Programs.

PubMed

Schuessler, Tyler J; Ruisinger, Janelle F; Hare, Sarah E; Prohaska, Emily S; Melton, Brittany L

2016-10-01

To assess patient satisfaction, perception of self-management, and perception of disease state knowledge with pharmacist-led diabetes and cardiovascular disease state management (DSM) programs. A self-insured chain of grocery store pharmacies in the Kansas City metropolitan area administers pharmacist-led diabetes and cardiovascular DSM programs for eligible employees and dependents. A modified version of the Diabetes Disease State Management Questionnaire was used to assess patient satisfaction with the DSM programs. Demographic information was also collected. Survey items were based on a 5-point Likert scale (1 = strongly disagree and 5 = strongly agree). Patients were eligible to complete the survey if he or she had been in at least 1 DSM program for 6 months. Data were assessed using descriptive statistics and analysis of variance. Across 20 pharmacies, 281 eligible participants were identified, and 46% (n = 128) completed a survey. Means for summed items relating to overall satisfaction (8 items), self-management (5 items), and knowledge (4 items) were 36.6/40 (standard deviation [SD] = 3.9), 20.9/25 (SD = 3.4), and 17.6/20 (SD = 2.1), respectively. Participant comments further indicated that the program and pharmacists are helpful and increase motivation and accountability. Positive patient responses to the program support use of pharmacist-led DSM programs. © The Author(s) 2015.

Does psychosocial stress explain socioeconomic inequities in 9-year weight gain among young women?

PubMed

Ball, Kylie; Schoenaker, Danielle A J M; Mishra, Gita D

2017-06-01

This study investigated the contribution of psychosocial stress to mediating inequities in weight gain by educational status in a large cohort of young Australian women over a 9-year follow-up. This observational cohort study used survey data drawn from 4,806 women, aged 22 to 27 years at baseline (2000), participating in the Australian Longitudinal Study on Women's Health, who reported their education level (2000), perceived stress (2003), and weight (2003 and 2012). Using a causal inference framework based on counterfactuals for mediation analysis, we fitted linear or logistic regression models to examine the total effect, decomposed into natural direct and indirect effects via perceived stress, of education level (highest qualification completed: up to year 12/trade or diploma vs. university) on weight change. Women with lower education gained more weight over 9 years (6.1 kg, standard deviation [SD] 9.5) than women with higher education (3.8 kg, SD 7.7; P < 0.0001) and were more likely to be very or extremely stressed. The higher weight gain associated with low education was not mediated through perceived stress (per SD increase, percent mediated: 1.0%). Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels. © 2017 The Obesity Society.

Diffusion measurements in the ischemic human brain with a steady-state sequence.

PubMed

Brüning, R; Wu, R H; Deimling, M; Porn, U; Haberl, R L; Reiser, M

1996-11-01

The authors evaluate the clinical usefulness of a diffusion-weighted steady-state free-precession (SSFP) sequence to detect acute and subacute ischemic changes. Twenty-four patients were examined on a 1.5-tesla scanner, using a SSFP-sequence (repetition time [TR]/ echo time [TE] = 22/3-8 mseconds). The slice thickness was 5 mm, 10 averages, 57 seconds per slice. The diffusion gradient strength was 23 millitesla/m, with b-values from 165 to 598 seconds/mm2. Diffusion-weighted images (DWI) were compared with T2-weighted images. The diffusion-weighted SSFP sequence produced diagnostic quality images in 23 of 24 patients. Diffusion depicted (group 1: 0-12 hours) more acute lesions (3 of 6) than T2-weighted images (2 of 6); the mean lesion diameter depicted by diffusion was 10.9 mm (standard deviation [SD], 12.3) and in T2-weighted images was 4.7 mm (SD 6.8). A significant correlation (P < 0.017) in subacute lesions was found when diffusion was compared with turbo spin echo (mean size difference/T2 = 18.5/17.5 mm, SD 13.2/12.2). The diffusion-weighted SSFP-sequence is more sensitive in acute ischemia and delineates likewise in subacute ischemia, when compared with T2-weighted imaging.

Effect of Clothing on Measurement of Bone Mineral Density.

PubMed

McNamara, Elizabeth A; Feldman, Anna Z; Malabanan, Alan O; Abate, Ejigayehu G; Whittaker, LaTarsha G; Yano-Litwin, Amanda; Dorazio, Jolene; Rosen, Harold N

2016-01-01

It is unknown whether allowing patients to have BMD (bone mineral density) studies acquired while wearing radiolucent clothing adlib contributes appreciably to the measurement error seen. To examine this question, a spine phantom was scanned 30 times without any clothing, while draped with a gown, and while draped with heavy winter clothing. The effect on mean BMD and on SD (standard deviation) was assessed. The effect of clothing on mean or SD of the area was not significant. The effect of clothing on mean and SD for BMD was small but significant and was around 1.6% for the mean. However, the effect on BMD precision was much more clinically important. Without clothing the spine phantom had an least significant change of 0.0077 gm/cm(2), while when introducing variability of clothing the least significant change rose as high as 0.0305 gm/cm(2). We conclude that, adding clothing to the spine phantom had a small but statistically significant effect on the mean BMD and on variance of the measurement. It is unlikely that the effect on mean BMD has any clinical significance, but the effect on the reproducibility (precision) of the result is likely clinically significant. Copyright © 2016 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

AUTONOMIC CONTROL OF HEART RATE AFTER EXERCISE IN TRAINED WRESTLERS

PubMed Central

Báez, San Martín E.; Von Oetinger, A.; Cañas, Jamett R.; Ramírez, Campillo R.

2013-01-01

The objective of this study was to establish differences in vagal reactivation, through heart rate recovery and heart rate variability post exercise, in Brazilian jiu-jitsu wrestlers (BJJW). A total of 18 male athletes were evaluated, ten highly trained (HT) and eight moderately trained (MT), who performed a maximum incremental test. At the end of the exercise, the R-R intervals were recorded during the first minute of recovery. We calculated heart rate recovery (HRR60s), and performed linear and non-linear (standard deviation of instantaneous beat-to-beat R-R interval variability – SD1) analysis of heart rate variability (HRV), using the tachogram of the first minute of recovery divided into four segments of 15 s each (0-15 s, 15-30 s, 30-45 s, 45-60 s). Between HT and MT individuals, there were statistically significant differences in HRR60s (p <0.05) and in the non linear analysis of HRV from SD130-45s (p <0.05) and SD145-60s (p <0.05). The results of this research suggest that heart rate kinetics during the first minute after exercise are related to training level and can be used as an index for autonomic cardiovascular control in BJJW. PMID:24744476

Reducing adolescent clients' anger in a residential substance abuse treatment facility.

PubMed

Adelman, Robert; McGee, Patricia; Power, Robert; Hanson, Cathy

2005-06-01

Sundown Ranch, a residential behavioral health care treatment facility for adolescents, tracked the progress and results of treatment by selecting performance measures from a psychosocial screening inventory. The temper scale was one of the two highest scales at admission and the highest scale at discharge. A clinical performance improvement (PI) project was conducted to assess improvements in clients' ability to manage anger after the incorporation of Rational Emotive Behavior Therapy (REBT) into treatment. Eighteen months of baseline data (July 1, 1999 - February 1, 2001) were collected, and 20 months of data (May 1, 2001 - December 31, 2002) were collected after the introduction of the PI activity. In all, data were collected for 541 consecutive admissions. A comparison of five successive quarterly reviews indicated average scores of 1.4 standard deviations (SDs) above the mean on the temper scale before the PI activity and .45 SD above the mean after. The performance threshold of reduction of the average temper scale score to < or =1 SD was met for 17 of 20 months. The fact that the PI activity reduced the temper scale elevations by almost one full SD is highly suggestive of the efficacy of REBT with the treatment population. After the project was completed, REBT was promoted as an additional therapeutic modality within the treatment program.

Accelerometer-based method for correcting signal baseline changes caused by motion artifacts in medical near-infrared spectroscopy

NASA Astrophysics Data System (ADS)

Virtanen, Jaakko; Noponen, Tommi; Kotilahti, Kalle; Virtanen, Juha; Ilmoniemi, Risto J.

2011-08-01

In medical near-infrared spectroscopy (NIRS), movements of the subject often cause large step changes in the baselines of the measured light attenuation signals. This prevents comparison of hemoglobin concentration levels before and after movement. We present an accelerometer-based motion artifact removal (ABAMAR) algorithm for correcting such baseline motion artifacts (BMAs). ABAMAR can be easily adapted to various long-term monitoring applications of NIRS. We applied ABAMAR to NIRS data collected in 23 all-night sleep measurements and containing BMAs from involuntary movements during sleep. For reference, three NIRS researchers independently identified BMAs from the data. To determine whether the use of an accelerometer improves BMA detection accuracy, we compared ABAMAR to motion detection based on peaks in the moving standard deviation (SD) of NIRS data. The number of BMAs identified by ABAMAR was similar to the number detected by the humans, and 79% of the artifacts identified by ABAMAR were confirmed by at least two humans. While the moving SD of NIRS data could also be used for motion detection, on average 2 out of the 10 largest SD peaks in NIRS data each night occurred without the presence of movement. Thus, using an accelerometer improves BMA detection accuracy in NIRS.

Impact of adding artificially generated alert sound to hybrid electric vehicles on their detectability by pedestrians who are blind.

PubMed

Kim, Dae Shik; Emerson, Robert Wall; Naghshineh, Koorosh; Pliskow, Jay; Myers, Kyle

2012-01-01

A repeated-measures design with block randomization was used for the study, in which 14 adults with visual impairments attempted to detect three different vehicles: a hybrid electric vehicle (HEV) with an artificially generated sound (Vehicle Sound for Pedestrians [VSP]), an HEV without the VSP, and a comparable internal combustion engine (ICE) vehicle. The VSP vehicle (mean +/- standard deviation [SD] = 38.3 +/- 14.8 m) was detected at a significantly farther distance than the HEV (mean +/- SD = 27.5 +/- 11.5 m), t = 4.823, p < 0.001, but no significant difference existed between the VSP and ICE vehicles (mean +/- SD = 34.5 +/- 14.3 m), t = 1.787, p = 0.10. Despite the overall sound level difference between the two test sites (parking lot = 48.7 dBA, roadway = 55.1 dBA), no significant difference in detection distance between the test sites was observed, F(1, 13) = 0.025, p = 0.88. No significant interaction was found between the vehicle type and test site, F(1.31, 16.98) = 0.272, p = 0.67. The findings of the study may help us understand how adding an artificially generated sound to an HEV could affect some of the orientation and mobility tasks performed by blind pedestrians.

Theoretical repeatability assessment without repetitive measurements in gradient high-performance liquid chromatography.

PubMed

Kotani, Akira; Tsutsumi, Risa; Shoji, Asaki; Hayashi, Yuzuru; Kusu, Fumiyo; Yamamoto, Kazuhiro; Hakamata, Hideki

2016-07-08

This paper puts forward a time and material-saving method for evaluating the repeatability of area measurements in gradient HPLC with UV detection (HPLC-UV), based on the function of mutual information (FUMI) theory which can theoretically provide the measurement standard deviation (SD) and detection limits through the stochastic properties of baseline noise with no recourse to repetitive measurements of real samples. The chromatographic determination of terbinafine hydrochloride and enalapril maleate is taken as an example. The best choice of the number of noise data points, inevitable for the theoretical evaluation, is shown to be 512 data points (10.24s at 50 point/s sampling rate of an A/D converter). Coupled with the relative SD (RSD) of sample injection variability in the instrument used, the theoretical evaluation is proved to give identical values of area measurement RSDs to those estimated by the usual repetitive method (n=6) over a wide concentration range of the analytes within the 95% confidence intervals of the latter RSD. The FUMI theory is not a statistical one, but the "statistical" reliability of its SD estimates (n=1) is observed to be as high as that attained by thirty-one measurements of the same samples (n=31). Copyright © 2016 Elsevier B.V. All rights reserved.

Pre-analytical phase: The automated ProTube device supports quality assurance in the phlebotomy process.

PubMed

Piva, Elisa; Tosato, Francesca; Plebani, Mario

2015-12-07

Most errors in laboratory medicine occur in the pre-analytical phase of the total testing process. Phlebotomy, a crucial step in the pre-analytical phase influencing laboratory results and patient outcome, calls for quality assurance procedures and automation in order to prevent errors and ensure patient safety. We compared the performance of a new small, automated device, the ProTube Inpeco, designed for use in phlebotomy with a complete traceability of the process, with a centralized automated system, BC ROBO. ProTube was used for 15,010 patients undergoing phlebotomy with 48,776 tubes being labeled. The mean time and standard deviation (SD) for blood sampling was 3:03 (min:sec; SD ± 1:24) when using ProTube, against 5:40 (min:sec; SD ± 1:57) when using BC ROBO. The mean number of patients per hour managed at each phlebotomy point was 16 ± 3 with ProTube, and 10 ± 2 with BC ROBO. No tubes were labeled erroneously or incorrectly, even if process failure occurred in 2.8% of cases when ProTube was used. Thanks to its cutting edge technology, the ProTube has many advantages over BC ROBO, above all in verifying patient identity, and in allowing a reduction in both identification error and tube mislabeling.

Autonomic control of heart rate after exercise in trained wrestlers.

PubMed

Henríquez, Olguín C; Báez, San Martín E; Von Oetinger, A; Cañas, Jamett R; Ramírez, Campillo R

2013-06-01

The objective of this study was to establish differences in vagal reactivation, through heart rate recovery and heart rate variability post exercise, in Brazilian jiu-jitsu wrestlers (BJJW). A total of 18 male athletes were evaluated, ten highly trained (HT) and eight moderately trained (MT), who performed a maximum incremental test. At the end of the exercise, the R-R intervals were recorded during the first minute of recovery. We calculated heart rate recovery (HRR60s), and performed linear and non-linear (standard deviation of instantaneous beat-to-beat R-R interval variability - SD1) analysis of heart rate variability (HRV), using the tachogram of the first minute of recovery divided into four segments of 15 s each (0-15 s, 15-30 s, 30-45 s, 45-60 s). Between HT and MT individuals, there were statistically significant differences in HRR60s (p <0.05) and in the non linear analysis of HRV from SD130-45s (p <0.05) and SD145-60s (p <0.05). The results of this research suggest that heart rate kinetics during the first minute after exercise are related to training level and can be used as an index for autonomic cardiovascular control in BJJW.

An Improved Method for Determination of Cyanide Content in Bitter Almond Oil.

PubMed

Chen, Jia; Liu, Lei; Li, Mengjun; Yu, Xiuzhu; Zhang, Rui

2018-01-01

An improved colorimetric method for determination of cyanide content in bitter almond oil was developed. The optimal determination parameters were as follows: volume ratio of hydrochloric acid to bitter almond oil (v/v), 1.5:1; holding time for hydrolysis, 120 min; and volume ratio of distillation solution to bitter almond oil (v/v), 8:1. Analytical results showed that the relative standard deviations (SDs) of determinations were less than 10%, which satisfies the test requirements. The results of high-performance liquid chromatography and measurements exhibited a significant correlation (R = 0.9888, SD = 0.2015). Therefore, the improved colorimetric method can be used to determine cyanide content in bitter almond oil.

Estimate of standard deviation for a log-transformed variable using arithmetic means and standard deviations.

PubMed

Quan, Hui; Zhang, Ji

2003-09-15

Analyses of study variables are frequently based on log transformations. To calculate the power for detecting the between-treatment difference in the log scale, we need an estimate of the standard deviation of the log-transformed variable. However, in many situations a literature search only provides the arithmetic means and the corresponding standard deviations. Without individual log-transformed data to directly calculate the sample standard deviation, we need alternative methods to estimate it. This paper presents methods for estimating and constructing confidence intervals for the standard deviation of a log-transformed variable given the mean and standard deviation of the untransformed variable. It also presents methods for estimating the standard deviation of change from baseline in the log scale given the means and standard deviations of the untransformed baseline value, on-treatment value and change from baseline. Simulations and examples are provided to assess the performance of these estimates. Copyright 2003 John Wiley & Sons, Ltd.

Salovum egg yolk containing antisecretory factor as an adjunct therapy in severe cholera in adult males: a pilot study.

PubMed

Alam, Nur H; Ashraf, Hasan; Olesen, Maryam; Salam, Mohammed A; Gyr, Niklaus; Meier, Remy

2011-08-01

Cholera involves stimulation of intestinal secretory process in response to cholera toxin leading to profuse watery diarrhoea that might cause death due to dehydration unless timely rehydration therapy is initiated. Efforts to identify and test potential antisecretory agents are ongoing. Antisecretory factor (AF) is a naturally-occurring protein produced in the human secretory organs, including the intestine, with antisectory properties demonstrated in animal and human models of secretory diarrhoea. Salovum egg yolk powder contains antisecretory proteins in a much higher (500 times) concentration than that of normal hen eggs. This is achieved by feeding hens with specially-processed cereals, capable of inducing antisecretory proteins in the yolk. The aim of the study was to examine the effect of Salovum egg yolk powder containing AF in the treatment of adult cholera patients. In an open, randomized controlled trial (pilot study), 40 adult male patients with severe cholera were studied: 20 received standard treatment (oral rehydration solution, antibiotic, and usual hospital diet) plus Salovum egg yolk powder (study group) and 20 received standard treatment alone (control group). All the patients received tablet doxycycline (300 mg) once immediately after randomization. Written informed consent was obtained from each subject before enrollment. The main outcome measures were stool weight and duration of diarrhoea. The demographic and baseline clinical characteristics of the study patients were comparable between the groups. No significant differences were found in the mean stool weight, g/kg of body-weight during the first 24 hours [study vs control group, mean +/- standard deviation (SD), 218 +/- 119 vs 195 +/- 136], second 24 hours (mean +/- SD, 23 +/- 39 vs 22 +/- 34), and cumulative up to 72 hours (mean +/- SD, 245 +/- 152 vs 218 +/- 169). The duration (hours) of diarrhoea after admission in the hospital was also similar in both the groups (mean +/- SD, 33 +/- 14 vs 32 +/- 10). No adverse effect was observed. Salovum egg powder containing AF as an adjunct therapy in the treatment of severe cholera could not demonstrate any beneficial effect. Further studies with higher doses of Salovum egg yolk powder might be considered in future to establish its antisecretory effect.

Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial.

PubMed

Vidal-Petiot, Emmanuelle; Stebbins, Amanda; Chiswell, Karen; Ardissino, Diego; Aylward, Philip E; Cannon, Christopher P; Ramos Corrales, Marco A; Held, Claes; López-Sendón, José Luis; Stewart, Ralph A H; Wallentin, Lars; White, Harvey D; Steg, Philippe Gabriel

2017-10-01

To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Development of Refractive Errors-What Can We Learn From Inherited Retinal Dystrophies?

PubMed

Hendriks, Michelle; Verhoeven, Virginie J M; Buitendijk, Gabriëlle H S; Polling, Jan Roelof; Meester-Smoor, Magda A; Hofman, Albert; Kamermans, Maarten; Ingeborgh van den Born, L; Klaver, Caroline C W

2017-10-01

It is unknown which retinal cells are involved in the retina-to-sclera signaling cascade causing myopia. As inherited retinal dystrophies (IRD) are characterized by dysfunction of a single retinal cell type and have a high risk of refractive errors, a study investigating the affected cell type, causal gene, and refractive error in IRDs may provide insight herein. Case-control study. Study Population: Total of 302 patients with IRD from 2 ophthalmogenetic centers in the Netherlands. Reference Population: Population-based Rotterdam Study-III and Erasmus Rucphen Family Study (N = 5550). Distributions and mean spherical equivalent (SE) were calculated for main affected cell type and causal gene; and risks of myopia and hyperopia were evaluated using logistic regression. Bipolar cell-related dystrophies were associated with the highest risk of SE high myopia 239.7; odds ratio (OR) mild hyperopia 263.2, both P < .0001; SE -6.86 diopters (D) (standard deviation [SD] 6.38), followed by cone-dominated dystrophies (OR high myopia 19.5, P < .0001; OR high hyperopia 10.7, P = .033; SE -3.10 D [SD 4.49]); rod dominated dystrophies (OR high myopia 10.1, P < .0001; OR high hyperopia 9.7, P = .001; SE -2.27 D [SD 4.65]), and retinal pigment epithelium (RPE)-related dystrophies (OR low myopia 2.7; P = .001; OR high hyperopia 5.8; P = .025; SE -0.10 D [SD 3.09]). Mutations in RPGR (SE -7.63 D [SD 3.31]) and CACNA1F (SE -5.33 D [SD 3.10]) coincided with the highest degree of myopia and in CABP4 (SE 4.81 D [SD 0.35]) with the highest degree of hyperopia. Refractive errors, in particular myopia, are common in IRD. The bipolar synapse and the inner and outer segments of the photoreceptor may serve as critical sites for myopia development. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Li, K; John R Marsh Cancer Center

Purpose: To evaluate the clinical rationale for Truebeam and Trilogy Linac machines from Varian Medical System as exchangeable treatment modalities in the same radiation oncology department. Methods: Intensity Modulated Radiotherapy (IMRT) plans for different diseases were selected for this study. These disease sites included brain, head and neck, breast, lung, and prostate. The parameters selected for this study were the energy amount, Monitor Unit (MU); dose coverage of target reflected by prescription isodose volume(PIV); dose spillage described by the volume of 50% isodoseline of the prescription; and dose homogeneities represented by the maximum dose (MaxD) and the minimum dose (MinD)more » of target volume (TV) and critical structure (CS). Each percentage difference between the values of these parameters formed an element of a matrix, which was called Similarity Comparison Matrix(SCM). The elements of the SCM were then simplified by dimensional conversion algorithm, which was used to determine clinical similarity between two machines through a single value. Results: For the selected clinical cases in this study, the average percentage differences between Trilogy and Truebeam in MU was 0.28% with standard deviation(SD) 0.66%, PIV was 0.23% with SD 0.20%, Volume at 50% prescription dose was 0.31% with SD at 0.78%, MaxD at TV is 0.26% with SD 0.35%, MinD at TV is −0.04% with SD 0.51%, MaxD in CS is −0.53% with SD 0.92%, and MinD in CS 3.31%, with SD at 2.89%. The sum, product, geometric and harmonic mean for the matrix elements were 19.0%, 0.00%, 0.19%, and 0.00%. Conclusion: A method to compare two machines in clinical level was developed and some reference values were calculated for decision-making in clinical practice, and this strategy could be expanded to different clinical applications.« less

Variation of normal tissue complication probability (NTCP) estimates of radiation-induced hypothyroidism in relation to changes in delineation of the thyroid gland.

PubMed

Rønjom, Marianne F; Brink, Carsten; Lorenzen, Ebbe L; Hegedüs, Laszlo; Johansen, Jørgen

2015-01-01

To examine the variations of risk-estimates of radiation-induced hypothyroidism (HT) from our previously developed normal tissue complication probability (NTCP) model in patients with head and neck squamous cell carcinoma (HNSCC) in relation to variability of delineation of the thyroid gland. In a previous study for development of an NTCP model for HT, the thyroid gland was delineated in 246 treatment plans of patients with HNSCC. Fifty of these plans were randomly chosen for re-delineation for a study of the intra- and inter-observer variability of thyroid volume, Dmean and estimated risk of HT. Bland-Altman plots were used for assessment of the systematic (mean) and random [standard deviation (SD)] variability of the three parameters, and a method for displaying the spatial variation in delineation differences was developed. Intra-observer variability resulted in a mean difference in thyroid volume and Dmean of 0.4 cm(3) (SD ± 1.6) and -0.5 Gy (SD ± 1.0), respectively, and 0.3 cm(3) (SD ± 1.8) and 0.0 Gy (SD ± 1.3) for inter-observer variability. The corresponding mean differences of NTCP values for radiation-induced HT due to intra- and inter-observer variations were insignificantly small, -0.4% (SD ± 6.0) and -0.7% (SD ± 4.8), respectively, but as the SDs show, for some patients the difference in estimated NTCP was large. For the entire study population, the variation in predicted risk of radiation-induced HT in head and neck cancer was small and our NTCP model was robust against observer variations in delineation of the thyroid gland. However, for the individual patient, there may be large differences in estimated risk which calls for precise delineation of the thyroid gland to obtain correct dose and NTCP estimates for optimized treatment planning in the individual patient.

NRG Oncology medical physicists' manpower survey quantifying support demands for multi-institutional clinical trials.

PubMed

Monroe, James I; Boparai, Karan; Xiao, Ying; Followill, David; Galvin, James M; Klein, Eric E; Low, Daniel A; Moran, Jean M; Zhong, Haoyu; Sohn, Jason W

2018-02-04

A survey was created by NRG to assess a medical physicists' percent full time equivalent (FTE) contribution to multi-institutional clinical trials. A 2012 American Society for Radiation Oncology report, "Safety Is No Accident," quantified medical physics staffing contributions in FTE factors for clinical departments. No quantification of FTE effort associated with clinical trials was included. To address this lack of information, the NRG Medical Physics Subcommittee decided to obtain manpower data from the medical physics community to quantify the amount of time medical physicists spent supporting clinical trials. A survey, consisting of 16 questions, was designed to obtain information regarding physicists' time spent supporting clinical trials. The survey was distributed to medical physicists at 1996 radiation therapy institutions included on the membership rosters of the 5 National Clinical Trials Network clinical trial groups. Of the 451 institutions who responded, 50% (226) reported currently participating in radiation therapy trials. On average, the designated physicist at each institution spent 2.4 hours (standard deviation [SD], 5.5) per week supervising or interacting with clinical trial staff. On average, 1.2 hours (SD, 3.1), 1.8 hours (SD, 3.9), and 0.6 hours (SD, 1.1) per week were spent on trial patient simulations, treatment plan reviews, and maintaining a Digital Imaging and Communications in Medicine server, respectively. For all trial credentialing activities, physicists spent an average of 32 hours (SD, 57.2) yearly. Reading protocols and supporting dosimetrists, clinicians, and therapists took an average of 2.1 hours (SD, 3.4) per week. Physicists also attended clinical trial meetings, on average, 1.2 hours (SD, 1.9) per month. On average, physicist spent a nontrivial total of 9 hours per week (0.21 FTE) supporting an average of 10 active clinical trials. This time commitment indicates the complexity of radiation therapy clinical trials and should be taken into account when staffing radiation therapy institutions. Copyright © 2018 Elsevier Inc. All rights reserved.

Cardiac rehabilitation for women with breast cancer and treatment-related heart failure compared with coronary artery disease: A retrospective study.

PubMed

Bonsignore, Alis; Marzolini, Susan; Oh, Paul

2017-03-06

To examine clinical outcomes and completion rates of cardiac rehabilitation in women with breast cancer and treatment-related heart failure. Data for women with breast cancer and treatment-related heart failure were compared with those for age-matched women with coronary artery disease. Retrospective data were obtained from the Toronto Rehabilitation Institute database for dates between 1998 and 2011, for cardiopulmonary exercise test results at baseline and 6 months, body composition measures, and cardiac rehabilitation completion rates. A total of 29 women with breast cancer and treatment-related heart failure (mean 57 years (standard deviation (SD) 9.4)) and 29 age-matched women with coronary artery disease were identified. There was no significant difference between the proportion of women with breast cancer and treatment-related heart failure and those with coronary artery disease who completed the programme. Peak aerobic power (VO2peak) increased in the breast cancer and treatment-related heart failure group (mean 16.2 ml-1.kg-1.min-1 (SD 3.4) to mean 18.5 ml-1.kg-1.min-1 (SD 4.5) ; p = 0.002) and in the coronary artery disease group (mean 18.9 ml-1.kg-1.min-1 (SD 4.5) to mean 20.8 ml-1.kg-1.min-1 (SD 4.9); p = 0.01). Body fat percentage increased in the breast cancer and treatment-related heart failure group (mean 34.8% (SD 8.5) to mean 36.3% (SD 6.9); p = 0.04). Women with breast cancer and treatment-related heart failure participating in cardiac rehabilitation demonstrate similar significant gains in VO2peak and similar completion rates to those of age-matched women with coronary artery disease. Further research is needed to determine interventions that improve body composition in women with breast cancer and treatment-related heart failure.

Contribution of vertebral deformities to chronic back pain and disability. The Study of Osteoporotic Fractures Research Group

NASA Technical Reports Server (NTRS)

Ettinger, B.; Black, D. M.; Nevitt, M. C.; Rundle, A. C.; Cauley, J. A.; Cummings, S. R.; Genant, H. K.

1992-01-01

Among 2992 white women aged 65-70 years recruited from population-based listings, we measured radiographic vertebral dimensions of T5-L4 and calculated ratios of heights: anterior/posterior, mid/posterior, and posterior/posterior of either adjacent vertebra. The degree of deformity for each vertebra was analyzed in terms of the number of standard deviations (SD) that ratio differed from the mean ratio calculated for the same vertebral level in this population. We correlated the severity of each woman's worst vertebral deformity with back pain, back disability in six activities of daily living, and height loss since age 25. Only 39.4% of the cohort had no vertebral deformity; 10.2% had a deformity greater than or equal to 4 SD. Vertebral deformities less than 4 SD below the mean were not associated with increased back pain, disability, or loss of height. In contrast, women whose deformity was greater than or equal to 4 SD had a 1.9 (95% CI, 1.5-2.4) times higher risk of moderate to severe back pain and a 2.6 (95% CI, 1.7-3.9) times higher risk of disability involving the back; they were also 2.5 (95% CI, 2.0-3.2) times more likely to have lost greater than or equal to 4 cm in height. All three types of vertebral deformity (wedge, end plate, and crush) were equally associated with these outcomes. Multiple deformities less than 4 SD did not increase the likelihood of these three outcomes, but multiple deformities greater than or equal to 4 SD tended to be associated with increased back pain, disability, and height loss. This large cross-sectional study suggests that vertebral deformities cause substantial pain, disability, or loss of height only if vertebral height ratios fall 4 SD below the normal mean. Much back pain could not be attributed to vertebral deformities, suggesting other causes.

Comparison of the effects of friction varnish and electroforming on the retention of telescopic crowns.

PubMed

Özyemişci-Cebeci, Nuran; Yavuzyilmaz, Hüsnü

2013-06-01

Methods to improve the retention of telescopic crowns, including the application of friction varnish and electroforming, are available. However, information about their efficiency is limited. The purpose of this study was to compare the influence of 2 different friction varnishes and an electroforming method on the retention of telescopic crowns. Thirty inner and outer crowns were fabricated from cobalt-chromium-molybdenum alloy having lengths and cervical diameters of 6 mm, 2-degree tapers, and shoulder margins of 1 mm. Fifty-μm thick layers were removed from the internal surfaces of the outer crowns with a vertical machining center to simulate wear. The retentive forces of these specimens were measured with a testing machine. FGP friction varnish (FGP Friction-Fit-System), SD friction varnish (Servo-dental), and an electroforming method (GES\\Gold Electroforming System) were applied to the specimens. After the application of the 3 methods, retention values were measured, and the results analyzed with 1-way ANOVA, paired sample t test (α=.05). The increase in the retentive forces of all specimens was statistically significant (P<.01). The mean retentive forces increased from 3.6 N to 9.8 N for group FGP, 3.6 N to 4.6 N for group SD, and 3.7 N to 6.0 N for group EF. Group FGP was significantly different from group SD and group EF (P<.05), and no significant difference was observed between group SD and group EF. Mean standard deviation values of retentive forces for group FGP before, FGP after, SD before, SD after, EF before and EF after is 0.5, 2.7, 0.6, 1.3, 0.8, 2.3, respectively. Group FGP showed the maximum retention values. Group EF showed higher retention values than group SD. Copyright © 2013 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

A Motion Videogame for Opioid Relapse Prevention

PubMed Central

Leavitt, Leah E.; Van Alstyne, Judy M.; Schindler-Ruwisch, Jennifer M.; Fishman, Marc J.; Greenberg, Daniel

2015-01-01

Abstract Objective: This study examined the feasibility and acceptability of a body motion–activated videogame, targeting the prevention of opioid relapse among youth in the context of outpatient treatment. Materials and Methods: Participants attended four weekly gameplay sessions. Surveys were conducted at baseline and following each week's gameplay and assessed satisfaction with gameplay, craving intensity, and self-efficacy to refuse opioids. Results: Participants expressed a high level of satisfaction with the videogame throughout the 4 weeks and agreed with the statement that they would be more likely to attend treatment sessions if the game was present (mean=4.6; standard deviation [SD]=0.7) and would recommend the videogame to other people in treatment (mean=4.2; SD=0.8). All participants recommended playing the videogame as part of treatment at least weekly, with a third recommending playing daily. Self-reported cravings declined over the 4-week period from baseline (mean=12.7; SD=8.4) to Week 4 (mean=9.8; SD=8.3), although the decline was not significant. Although participants stated that they liked the game, one-third of participants had dropped out of the study by the fourth session of gameplay. Conclusions: Preliminary evidence indicates that a motion videogame for addiction recovery may be feasible and acceptable within the context of outpatient treatment, although additional efforts are needed to keep youth in treatment. Future studies are needed to assess the impact of the game on long-term abstinence, treatment adherence, and engagement. PMID:26213838

Professional Burnout and Concurrent Health Complaints in Neonatal Nursing.

PubMed

Skorobogatova, Natalija; Žemaitienė, Nida; Šmigelskas, Kastytis; Tamelienė, Rasa

2017-01-01

The aim of this study was to analyze nurses' professional burnout and health complaints and the relationship between the two components. The anonymous survey included 94 neonatal intensive care nurses from two centers of perinatology. The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to evaluate professional burnout; it consisted of 3 components, Emotional Exhaustion, Depersonalization, and Personal Accomplishments, with 22 items in total. Health complaints were evaluated by 21 items, where nurses were asked to report the occurrence of symptoms within the last year. Scale means were presented with standard deviations (SD). Inferential analysis was conducted with multivariate logistic regression, adjusting for age, residence, and work experience. The mean score of professional burnout on the Emotional Exhaustion subscale was 14.4 (SD=7.91), Depersonalization 3.8 (SD=4.75), and Personal Accomplishment 29.1 (SD=10.12). The health assessment revealed that sleeplessness, lack of rest, nervousness, and tiredness were the most common complaints. The regression analysis revealed that tiredness was independently associated with significantly increased odds of professional burnout (OR=4.1). In our study, more than half of the nurses in neonatal intensive care had moderate or high levels of emotional exhaustion, while levels of depersonalization were significantly lower. In contrast, the level of personal accomplishment was low in more than half of the nurses. The most common health complaints were sleep disturbances, nervousness, and tiredness. Tiredness was most strongly associated with professional burnout.

Effects of education of the head of the household on the prevalence of malnutrition in children.

PubMed

El-Mouzan, Mohammad I; Al-Salloum, Abdullah A; Al-Herbish, Abdullah S; Qurachi, Mansour M; Al-Omar, Ahmad A

2010-03-01

To explore the effect of the educational level of the head of household on the prevalence of malnutrition in Saudi children. The study was conducted over 2 years in 2004 and 2005 in all regions of the Kingdom of Saudi Arabia (KSA). The design consisted of a stratified multistage probability random sampling of the population of the KSA. The educational level of the heads of the household, and measurements of weight and height of the children were obtained during house visits. Nutritional indicators in the form of weight for age, height for age, and weight for height for children below 5 years of age were determined, and the prevalence of each indicator below -2 standard deviations (SD) was calculated for each level of education. The sample size was 7390 in the weight for age, 7275 height for age, and 7335 for weight for height. The prevalence of underweight (weight for age below -2 SD) increased from 7.4% for the university level to 15.2% in the children of illiterate heads of household. Similar patterns were found for the prevalence of stunting (height for age below -2 SD) and wasting (weight for height below -2 SD). This study demonstrates that the higher the education level of the heads of the household, the lower the prevalence of malnutrition in their children, suggesting that completing at least 9-12 years of education (intermediate and secondary school) is needed for better improvement in the nutritional status of the children.

Maternal postnatal depression and child growth: a European cohort study

PubMed Central

2010-01-01

Background Previous studies have reported postpartum depression to be associated with both positive and negative effects on early infant growth. This study examined the hypothesis that maternal postnatal depression may be a risk factor for later child growth faltering or overweight. Methods A total of 929 women and their children participating in a European multicenter study were included at a median age of 14 days. Mothers completed the Edinburgh postnatal depression scale (EPDS) at 2, 3 and 6 months after delivery. EPDS scores of 13 and above at any time were defined as maternal depression. Weight, length, triceps and subscapular skinfold thicknesses were measured, and body mass index (BMI) were calculated when the children were two years old and converted to standard deviation scores based on the WHO Multicentre Growth Reference Study (MGRS). Results Z-scores for weight-for-length at inclusion of infants of mothers with high EPDS scores (-0.55, SD 0.74) were lower than of those with normal scores (-0.36, SD 0.74; p = 0.013). BMI at age 24 months did not differ in the high (16.3 kg/m2, SD 1.3) and in the normal EPDS groups (16.2 kg/m2, SD 1.3; p = 0.48). All other anthropometric indices also did not differ between groups, with no change by multivariate adjustment. Conclusions We conclude that a high maternal postnatal depression score does not have any major effects on offspring growth in high income countries. PMID:20226021

Translation and validation of the Brown attention-deficit disorder scale for use in Brazil: identifying cases of attention-deficit/hyperactivity disorder among samples of substance users and non-users. Cross-cultural validation study.

PubMed

Kakubo, Simone Mayumi; Mendez, Mariel; Silveira, Juliana Doering; Maringolo, Leonardo; Nitta, Conrado; Silveira, Dartiu Xavier da; Fidalgo, Thiago Marques

2018-04-23

The Brown Attention-Deficit Disorder Scale (BADDS) was developed as a self-report assessment that was designed to screen for presence of symptoms of attention deficit hyperactivity disorder (ADHD). The objective here was to translate and validate the adult self-report BADDS for use in Brazil. Cross-cultural validation study conducted in an addiction unit at a public university hospital. This study included a control group (n = 100) and a drug-user group (n = 100). Both groups included subjects aged 18 to 60 years old. The control group had no prior diagnosis of drug addiction and the drug-user group included participants with a diagnosis of addiction. Each participant answered Brazilian Portuguese translations of both the BADDS and the Adult Attention Deficit Hyperactivity Disorder Self-Report Scale (ASRS) questionnaires, in paper-and-pencil format. The drug-user group scored higher than the control group on both scales. The mean scores on ASRS were 27.26 (standard deviation, SD: 11.99) and 25.85 (SD: 8.65) respectively (P > 0.05). The mean scores on BADDS were 79.56 (SD: 29.61) and 79.31 (SD: 18.09), respectively (P > 0.05). Cronbach's alpha for BADDS was 0.95. BADDS presented fair sensitivity (72% accuracy) and fair specificity (88% accuracy). This study provides discriminative validity evidence for use of BADDS among Brazilian adults with substance-use disorders.

Out of Pocket Payment for Obstetrical Complications: A Cost Analysis Study in Iran

PubMed Central

Yavangi, Mahnaz; Sohrabi, Mohammad Reza; Riazi, Sahand

2013-01-01

Background: This study was conducted to determine the total expenditure and out of pocket payment on pregnancy complications in Tehran, the capital of Iran. Methods: A cross-sectional study conducted on 1172 patients who admitted in two general teaching referral Hospitals in Tehran. In this study, we calculated total and out of pocket inpatient costs for seven pregnancy complications including preeclampsia, intrauterine growth restriction (IUGR), abortion, ante-partum hemorrhage, preterm delivery, premature rupture of membranes and post-dated pregnancy. We used descriptive analysis and analysis of variance test to compare these pregnancy complications. Results: The average duration of hospitalization was 3.28 days and the number of visits by physicians for a patient was 9.79 on average. The average total cost for these pregnancy complications was 735.22 Unites States Dollars (USD) (standard deviation [SD] = 650.53). The average out of packet share was 277.08 USD (SD = 350.74), which was 37.69% of total expenditure. IUGR with payment of 398.76 USD (SD = 418.54) (52.06% of total expenditure) had the greatest amount of out of pocket expenditure in all complications. While, abortion had the minimum out of pocket amount that was 148.77 USD (SD = 244.05). Conclusions: Obstetrics complications had no catastrophic effect on families, but IUGR cost was about 30% of monthly household non-food costs in Tehran so more financial protection plans and insurances are recommended for these patients. PMID:24404365

Sweet taste preferences before and after an intensive medical weight loss intervention.

PubMed

Asao, K; Rothberg, A E; Arcori, L; Kaur, M; Fowler, C E; Herman, W H

2016-06-01

Medical weight loss could change sweet taste threshold and preferences. The decrease in sweet taste preferences may, in turn, help in the maintenance of weight loss. This study examined the association between sweet taste preferences at baseline and weight change during a medical weight management programme and the impact of diet-induced weight loss on sweet taste preferences. Adult patients with body mass index ≥32 kg m -2 were recruited from a medical weight management clinic. Sweet taste preference was assessed using a forced-choice, paired-comparison tracking method before and after a very-low-calorie diet (VLCD). Twenty participants were included in the analysis: mean age was 53.1 (standard deviation [SD]: 11.4) years, and 14 were female. The mean body mass index was 41.4 (SD: 7.5) kg m -2 . The median preferred sucrose concentration before VLCD was 0.45 M. Following VLCD, mean change in weight was -13.3 (SD: 6.6) kg, and percentage weight change was -11.3% (SD: 5.9%). Based on mixed models with and without adjustment for demographic factors, diabetes status and smoking history, preferred sucrose concentration at baseline did not predict change in longer-term body weight. The change of preferred sucrose concentration following 12 weeks of VLCD was not significant ( P -value 0.95). Change in weight during and after VLCD was not associated with sweet taste preferences at baseline. After diet-induced weight loss, sweet taste preferences did not change.

Seismic structure of the crust and uppermost mantle of north America and adjacent oceanic basins: A synthesis

USGS Publications Warehouse

Chulick, G.S.; Mooney, W.D.

2002-01-01

We present a new set of contour maps of the seismic structure of North America and the surrounding ocean basins. These maps include the crustal thickness, whole-crustal average P-wave and S-wave velocity, and seismic velocity of the uppermost mantle, that is, Pn and Sn. We found the following: (1) The average thickness of the crust under North America is 36.7 km (standard deviation [s.d.] ??8.4 km), which is 2.5 km thinner than the world average of 39.2 km (s.d. ?? 8.5) for continental crust; (2) Histograms of whole-crustal P- and S-wave velocities for the North American crust are bimodal, with the lower peak occurring for crust without a high-velocity (6.9-7.3 km/sec) lower crustal layer; (3) Regions with anomalously high average crustal P-wave velocities correlate with Precambrian and Paleozoic orogens; low average crustal velocities are correlated with modern extensional regimes; (4) The average Pn velocity beneath North America is 8.03 km/sec (s.d. ?? 0.19 km/sec); (5) the well-known thin crust beneath the western United States extends into northwest Canada; (6) the average P-wave velocity of layer 3 of oceanic crust is 6.61 km/ sec (s.d. ?? 0.47 km/sec). However, the average crustal P-wave velocity under the eastern Pacific seafloor is higher than the western Atlantic seafloor due to the thicker sediment layer on the older Atlantic seafloor.

Changes in smoking habit among patients with a history of oral squamous cell carcinoma (OSCC).

PubMed

Poveda-Roda, Rafael; Bagán, José V; Jiménez-Soriano, Yolanda; Margaix-Muñoz, Maria; Sarrión-Pérez, Gracia

2010-09-01

To determine the changes in smoking habit among patients with oral squamous cell carcinoma (OSCC) diagnosed and treated in the Service of Stomatology (Valencia University General Hospital. Valencia, Spain). The study involved 123 patients with a history of OSCC interviewed by telephone on their smoking habits at the time of the diagnosis and modifications in habits subsequently. The mean age at diagnosis was 60 years and 9 months (standard deviation, SD +/- 12 years and 2 months). Males predominated (61.8%) over females (38.2%). The mean time from the diagnosis of OSCC to the survey was 4 years and 6 months (SD +/- 3 years and 6 months). Almost one-half of the patients (45.5%) were active smokers at the time of the diagnosis, with a mean duration of the habit of 34.9 years (SD +/- 12 years and 7 months). In turn, 19.5% of the patients were ex-smokers at diagnosis, with an average of 13 years and 9 months (SD +/- 9 years and 4 months) from smoking cessation to the development of cancer. A total of 57.1% of the smokers abandoned the habit at diagnosis, 8.9% continued to smoke to the same extent as before, and 33.9% reduced smoking. A full 44.4 % of our patients diagnosed with OSCC continued to smoke despite warnings of the risks, and although the majority claimed to have reduced their smoking habit, interventional strategies would be indicated to help ensure complete smoking cessation.

Volume-outcome associations after major hepatectomy for hepatocellular carcinoma: a nationwide Taiwan study.

PubMed

Lu, Chih-Cheng; Chiu, Chong-Chi; Wang, Jhi-Joung; Chiu, Yu-Hsien; Shi, Hon-Yi

2014-06-01

The objective of this study was to explore volume-outcome associations after major hepatectomy for hepatocellular carcinoma (HCC). This population-based cohort study retrospectively analyzed 23,107 major hepatectomies for HCC patients from 1998 to 2009. Relationships between hospital/surgeon volume and patient outcome were analyzed by propensity score matching (PSM). Five-year overall survival (OS) was estimated by Kaplan-Meier method, and differences were compared by log-rank test. The mean length of stay (LOS) after major hepatectomy was 18.1 days, and the mean hospital cost was US$5,088.2. After PSM, the mean OS in high- and low-volume hospitals was 71.1 months (standard deviation (SD) 0.7 months) and 68.6 months (SD 0.6 months), respectively; the mean OS in high- and low-volume surgeons was 78.5 months (SD 0.7 months) and 66.9 months (SD 0.7 months), respectively. The PSM analysis showed that treatment by high-volume hospitals and treatment by high-volume surgeons were both associated with significantly shorter LOS, lower hospital cost, and longer survival compared to their low-volume counterparts (P < 0.001). The results of this nationwide study support the regionalization of HCC treatment by hospital volume and by surgeon volume. High surgeon volume revealed both short- and long-term benefits. The applicability of PSM in volume-outcome analysis may also be confirmed.

Born Small for Gestational Age and Poor School Performance - How Small Is Too Small?

PubMed

Lindström, Linda; Wikström, Anna-Karin; Bergman, Eva; Lundgren, Maria

2017-01-01

To assess the relationship between severity of small for gestational age (SGA) and the risk of poor school performance, and to investigate whether adult stature modifies this risk. 1,088,980 Swedish children born at term between 1973 and 1988 were categorized into severe SGA (less than -3 standard deviations (SD) of expected birth weight), moderate SGA (-2.01 to -3 SD), mild SGA (-1.01 to -2 SD), and appropriate for gestational age (-1 to 0.99 SD). The risk of poor school performance at the time of graduation from compulsory school (grades <10th percentile) was calculated using unconditional logistic regression models and adjusted for socio-economic factors. In a sub-analysis, we stratified boys by adult stature, and adjusted for maternal but not paternal height. All SGA groups were significantly associated with an increased risk of poor school performance, with adjusted odds ratios and 95% confidence intervals ranging from 1.85 (1.65-2.07) for severe SGA to 1.25 (1.22-1.28) for mild SGA. In the sub-analysis, all birth weight groups were associated with an increased risk of poor school performance among boys with short stature compared to those with non-short stature. Mild SGA is associated with a significantly increased risk of poor school performance, and the risk increases with severity of SGA. Further, this risk diminishes after adequate catch-up growth. © 2017 S. Karger AG, Basel.

Personality and diabetes mellitus incidence in a national sample.

PubMed

Cukić, Iva; Weiss, Alexander

2014-09-01

To test whether personality traits were prospectively associated with type 2 diabetes incidence. The sample (n=6798) was derived from the National Health and Nutrition Examination Survey Epidemiological Follow-up Study cohort. We fit four logistic regression models to test whether neuroticism, extraversion, openness to experience, or the Type A behavior pattern predicted type 2 diabetes incidence. Model 1 included sex, age, and race/ethnicity. Model 2 added personality traits, Model 3 added depressive symptoms, and Model 4 added body mass index (BMI), hypertension, and cigarette smoking status as predictors. In Model 1 age was associated with increased risk of diabetes (2% per year); being black as opposed to white was associated with a three-fold increase in risk. In Model 2 age and being black were still significant and extraversion was associated with decreased risk (17% per standard deviation [SD]). In Model 3 age, being black, and extraversion were still significant. In addition, neuroticism was associated with decreased risk (26% per SD) and depressive symptoms were associated with increased risk (28% per SD). In Model 4 age, being black, neuroticism, and depressive symptoms were still significant. BMI was associated with increased risk (14% per SD) and extraversion was no longer significant. Higher neuroticism was associated with reduced type 2 diabetes risk even after controlling for race/ethnicity, age, depressive symptoms, and BMI. Extraversion and Type A behavior were not significant after including covariates. Copyright © 2014 Elsevier Inc. All rights reserved.

Effect of active arm swing to local dynamic stability during walking.

PubMed

Wu, Yu; Li, Yue; Liu, An-Min; Xiao, Fei; Wang, Yin-Zhi; Hu, Fei; Chen, Jin-Ling; Dai, Ke-Rong; Gu, Dong-Yun

2016-02-01

Arm swing is an essential component in regulating dynamic stability of the whole body during walking, while the contribution of active arm swing to local dynamic stability of different motion segments remains unclear. This study investigated the effects of arm swing under natural arm swing condition and active arm swing condition on local dynamic stability and gait variability of the trunk segments (C7 and T10 joint) and lower extremity joints (hip, knee and ankle joint). The local divergence exponents (λs) and mean standard deviation over strides (MeanSD) of 24 young healthy adults were calculated while they were walking on treadmill with two arm swing conditions at their preferred walking speed (PWS). We found that in medial-lateral direction, both λs and MeanSD values of the trunk segments (C7 and T10 joint) in active arm swing condition were significantly lower than those in natural arm swing condition (p<0.05), while no significant difference of λs or MeanSD in lower extremity joints (hip, knee and ankle joint) was found between two arm swing conditions (p>0.05, respectively). In anterior-posterior and vertical direction, neither λs nor MeanSD values of all body segments showed significant difference between two arm swing conditions (p>0.05, respectively). These findings indicate that active arm swing may help to improve the local dynamic stability of the trunk segments in medial-lateral direction. Copyright © 2015 Elsevier B.V. All rights reserved.

Longitudinal study of sperm DNA fragmentation as measured by terminal uridine nick end-labelling assay.

PubMed

Sergerie, M; Laforest, G; Boulanger, K; Bissonnette, F; Bleau, G

2005-07-01

One major limitation in the use of sperm DNA fragmentation as measured by the TdT (terminal deoxynucleotidyl transferase)-mediated dUTP nick-end labelling (TUNEL) assay is the paucity of solid data on the stability of this parameter. The objective of our study was to evaluate variations in the degree of sperm DNA fragmentation, as measured by the TUNEL assay, over a 6 month period. Five donors provided semen samples (total 107) on the average three times per month, and 10 infertility patients provided semen samples every 4 weeks (total 58). The mean percentage of sperm DNA fragmentation for donors was 13.18%, the within-donor standard deviation (SD(W) = 3.79%) was small compared to between-donor (SD(B) = 17.56%). For the group of patients, the mean percentage of sperm DNA fragmentation was 22.44%, with SD(W) of 4.43% within patients and SD(B) of 29.48% between patients. No seasonal rhythm was observed during the study. The intra-class correlation coefficient for all subjects combined was 0.83. Compared to sperm concentration, individual coefficients of variation for sperm DNA fragmentation indicated less variability in four subjects, but were similar in the others. This longitudinal study shows that sperm DNA fragmentation is a parameter with good stability (repeatability) over time; it can be taken as a baseline both in healthy fertile men and in patients from infertility couples.

[A self-report study of sexual victimization in Spanish community adolescents and at-risk groups].

PubMed

Pereda, Noemí; Abad, Judit; Guilera, Georgina; Arch, Mila

2015-01-01

To determine the extent of sexual victimization in four groups of Spanish adolescents based on their own reports. An observational, cross-sectional, multicenter study was conducted. Sexual victimization was assessed by seven questions included in the Juvenile Victimization Questionnaire. The samples were composed of 1,105 adolescents (mean age [M]=14.52, standard deviation [SD]=1.76) from seven secondary schools; 149 adolescents (M=14.28; SD=1.45) from 14 child and adolescent mental health centers; 129 adolescents (M=14.59, SD=1.62) institutionalized in 18 long-term (78.3%) and short-term (21.7%) residential centers belonging to the child protection system; and 101 adolescents (M=16.08, SD=0.99) recruited from three detention centers (77.2%) and five open regime teams or follow-up services for court orders for minors not requiring loss of freedom (22.8%). The extent of lifetime sexual victimization ranged from 14.7% of the adolescents in the community sample to 23.5% of youths attended in mental health services, 35.6% of youths involved in the juvenile justice system, and 36.4% of children protected by the child welfare system. Most of the victims were female, the only exception being the group of male victims from the juvenile justice system. Sexual victimization of children is widespread in Spain and its distribution differs depending on the group of children under study. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Long-term voice handicap index after type II thyroplasty using titanium bridges for adductor spasmodic dysphonia.

PubMed

Sanuki, Tetsuji; Yumoto, Eiji; Kodama, Narihiro; Minoda, Ryosei; Kumai, Yoshihiko

2014-06-01

To determine the long-term functional outcomes of type II thyroplasty using titanium bridges for adductor spasmodic dysphonia (AdSD) by perceptual analysis using the Voice Handicap Index-10 (VHI-10) and by acoustic analysis. Fifteen patients with AdSD underwent type II thyroplasty using titanium brides between August 2006 and February 2011. VHI-10 scores, a patient-based survey that quantifies a patient's perception of his or her vocal handicap, were determined before and at least 2 years after surgery. Concurrent with the VHI-10 evaluation, acoustic parameters were assessed, including jitter, shimmer, harmonic-to-noise ratio (HNR), standard deviation of F0 (SDF0), and degree of voice breaks (DVB). The average follow-up interval was 30.1 months. No patient had strangulation of the voice, and all were satisfied with the voice postoperatively. In the perceptual analysis, the mean VHI-10 score improved significantly, from 26.7 to 4.1 two years after surgery. All patients had significantly improved each score of three different aspects of VHI-10, representing improved functional, physical, and emotional well-being. All acoustic parameters improved significantly 2 years after surgery. The treatment of AdSD with type II thyroplasty significantly improved the voice-related quality of life and acoustic parameters 2 years after surgery. The results of the study suggest that type II thyroplasty using titanium bridges provides long-term relief of vocal symptoms in patients with AdSD. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Tc-99m tilmanocept versus Tc-99m sulfur colloid in breast cancer sentinel lymph node identification: Results from a randomized, blinded clinical trial.

PubMed

Unkart, Jonathan T; Hosseini, Ava; Wallace, Anne M

2017-12-01

No prior trials have compared sentinel lymph node (SLN) identification outcomes between Tc-99m tilmanocept (TcTM) and Tc-99m sulfur colloid (TcSC) in breast cancer (BC). We report on the secondary outcomes from a randomized, double-blinded, single surgeon clinical trial comparing post-injection site pain between TcTM and TcSC. Patients were randomized to receive a preoperative single, peritumoral intradermal injection of TcTM or TcSC. The number of total, "hot", and blue nodes detected and removed were compared between groups. Fifty-two (27-TcSC and 25-TcTM) patients were enrolled and underwent definitive surgical treatment. At least one "hot" SLN was detected in all patients. Three (5.8%) patients had a disease positive-SLN. The total number of SLNs removed was 61 (mean 2.26 (standard deviation (SD) 0.90)) in the TcSC group and 54 (mean 2.16 (SD 0.90)) in the TcTM group, P = 0.69. The total number of "hot" nodes in the TcSC group was 1.96 (SD 0.76) compared to 2.04 (SD 0.73) in the TcTM group, P = 0.71. The number of identified SLNs did not differ significantly between TcTM and TcSC. Given that no significant technical advantages exist between the two agents, surgeons should choose a radiopharmaceutical based on cost and side effect profile. © 2017 Wiley Periodicals, Inc.

Validation of a visual analogue score (LRTI-VAS) in non-CF bronchiectasis.

PubMed

Altenburg, Josje; Wortel, Kim; de Graaff, Casper S; van der Werf, Tjip S; Boersma, Wim G

2016-03-01

Quality of life in patients with non-cystic fibrosis (non-CF) bronchiectasis is largely defined by respiratory symptoms. To date, no disease-specific tool for symptom measurement in this patient group was available. We developed the lower respiratory tract infections - visual analogue scale (LRTI-VAS) in order to quickly and conveniently quantify symptoms in non-CF bronchiectasis. This study aimed to validate LRTI-VAS for use in non-CF bronchiectasis. This study included outpatients with radiologically proven bronchiectasis and no evidence of CF. Results of LRTI-VAS were compared with other markers of disease activity {lung function parameters, oxygen saturation and three health-related quality of life questionnaires [Medical Outcomes Study Short-Form 36 Health Survey (SF-36), St Georges Respiratory Questionnaire (SGRQ) and Leicester Cough Questionnaire (LCQ)]} and validity, reliability and responsiveness were assessed. Thirty stable and 30 exacerbating participants completed the LRTI-VAS questionnaire. When testing for repeatability on two separate occasions, no statistically significant difference between total scores was found {1.4 [standard deviation (SD)] 5.3}, P = 0.16). Internal consistency was high across items (Cronbach's alpha 0.86). Correlation with SGRQ, SF-36 and LCQ total scores was high. Following antibiotic treatment, mean (SD) LRTI-VAS total score improved from 18.1 (SD 9.9) to 26.1 (SD 6.6) (P < 0.001). LRTI-VAS showed excellent validity, reliability and responsiveness to change and therefore appears a reliable tool for symptom measurement in non-CF bronchiectasis. © 2014 John Wiley & Sons Ltd.

Childhood Obstructive Sleep Apnea Associates with Neuropsychological Deficits and Neuronal Brain Injury

PubMed Central

Halbower, Ann C; Degaonkar, Mahaveer; Barker, Peter B; Earley, Christopher J; Marcus, Carole L; Smith, Philip L; Prahme, M. Cristine; Mahone, E. Mark

2006-01-01

Background Childhood obstructive sleep apnea (OSA) is associated with neuropsychological deficits of memory, learning, and executive function. There is no evidence of neuronal brain injury in children with OSA. We hypothesized that childhood OSA is associated with neuropsychological performance dysfunction, and with neuronal metabolite alterations in the brain, indicative of neuronal injury in areas corresponding to neuropsychological function. Methods and Findings We conducted a cross-sectional study of 31 children (19 with OSA and 12 healthy controls, aged 6–16 y) group-matched by age, ethnicity, gender, and socioeconomic status. Participants underwent polysomnography and neuropsychological assessments. Proton magnetic resonance spectroscopic imaging was performed on a subset of children with OSA and on matched controls. Neuropsychological test scores and mean neuronal metabolite ratios of target brain areas were compared. Relative to controls, children with severe OSA had significant deficits in IQ and executive functions (verbal working memory and verbal fluency). Children with OSA demonstrated decreases of the mean neuronal metabolite ratio N-acetyl aspartate/choline in the left hippocampus (controls: 1.29, standard deviation [SD] 0.21; OSA: 0.91, SD 0.05; p = 0.001) and right frontal cortex (controls: 2.2, SD 0.4; OSA: 1.6, SD 0.4; p = 0.03). Conclusions Childhood OSA is associated with deficits of IQ and executive function and also with possible neuronal injury in the hippocampus and frontal cortex. We speculate that untreated childhood OSA could permanently alter a developing child's cognitive potential. PMID:16933960

Performance and evaluation of small construction safety training simulations.

PubMed

Wojcik, S M; Kidd, P S; Parshall, M B; Struttmann, T W

2003-06-01

Back- and fall-related injuries occur frequently in construction and are costly in terms of workers' compensation claims and lost productivity. Interventions are needed that address the susceptibility to these injuries. The purpose of this study was to develop and test a safety training intervention for small construction companies (

Correlation between Macular Thickness and Visual Field in Early Open Angle Glaucoma: A Cross-Sectional Study.

PubMed

Fallahi Motlagh, Behzad; Sadeghi, Ali

2017-01-01

The aim of this study was to correlate macular thickness and visual field parameters in early glaucoma. A total of 104 eyes affected with early glaucoma were examined in a cross-sectional, prospective study. Visual field testing using both standard automated perimetry (SAP) and shortwave automated perimetry (SWAP) was performed. Global visual field parameters, including mean deviation (MD) and pattern standard deviation (PSD), were recorded and correlated with spectral domain optical coherence tomography (SD-OCT)-measured macular thickness and asymmetry. Average macular thickness correlated significantly with all measures of visual field including MD-SWAP (r = 0.42), MD-SAP (r = 0.41), PSD-SWAP (r = -0.23), and PSD-SAP (r = -0.21), with P-values <0.001 for all correlations. The mean MD scores (using both SWAP and SAP) were significantly higher in the eyes with thin than in those with intermediate average macular thickness. Intraeye (superior macula thickness - inferior macula thickness) asymmetries correlated significantly with both PSD-SWAP (r = 0.63, P < 0.001) and PSD-SAP (r = 0.26, P = 0.01) scores. This study revealed a significant correlation between macular thickness and visual field parameters in early glaucoma. The results of this study should make macular thickness measurements even more meaningful to glaucoma specialists.

Prevalence of alterations in the characteristics of smile symmetry in an adult population from southern Europe.

PubMed

Jiménez-Castellanos, Emilio; Orozco-Varo, Ana; Arroyo-Cruz, Gema; Iglesias-Linares, Alejandro

2016-06-01

Deviation from the facial midline and inclination of the dental midline or occlusal plane has been described as extremely influential in the layperson's perceptions of the overall esthetics of the smile. The purpose of this study was to determine the prevalence of deviation from the facial midline and inclination of the dental midline or occlusal plane in a selected sample. White participants from a European population (N=158; 93 women, 65 men) who met specific inclusion criteria were selected for the present study. Standardized 1:1 scale frontal photographs were made, and 3 variables of all participants were measured: midline deviation, midline inclination, and inclination of the occlusal plane. Software was used to measure midline deviation and inclination, taking the bipupillary line and the facial midline as references. Tests for normality of the sample were explored and descriptive statistics (means ±SD) were calculated. The chi-square test was used to evaluate differences in midline deviation, midline inclination, and occlusion plane (α=.05) RESULTS: Frequencies of midline deviation (>2 mm), midline inclination (>3.5 degrees), and occlusal plane inclination (>2 degrees) were 31.64% (mean 2.7±1.23 mm), 10.75% (mean 7.9 degrees ±3.57), and 25.9% (mean 9.07 degrees ±3.16), respectively. No statistically significant differences (P>.05) were found between sex and any of the esthetic smile values. The incidence of alterations with at least 1 altered parameter that affected smile esthetics was 51.9% in a population from southern Europe. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis.

PubMed

McKendy, Katherine M; Lee, Lawrence F; Boulva, Kerianne; Deckelbaum, Dan L; Mulder, David S; Razek, Tarek S; Grushka, Jeremy R

2017-06-15

The optimal method of pain control for patients with traumatic rib fractures is unknown. The aim of this study was to determine the effect of epidural analgesia on respiratory complications and in-hospital mortality in patients with rib fractures. Adult patients at a level I trauma center with ≥1 rib fracture from blunt trauma were included (2004-2013). Those with a blunt-penetrating mechanism, traumatic brain injury, or underwent a laparotomy or thoracotomy were excluded. Patients who were treated with epidural analgesia (EPI) were compared with those were not treated with epidural analgesia (NEPI) using coarsened exact matching. Primary outcomes were respiratory complications (pneumonia, deep vein thrombosis/pulmonary embolus, and respiratory failure) and 30-d in-hospital mortality. Secondary outcomes were total hospital and intensive care unit length of stay, and duration of ventilator support. About 1360 patients (EPI: 329 and NEPI: 1031) met inclusion criteria (mean age: 54.2 y; standard deviation [SD]: 19.7; 68% male). The mean number of rib fractures was 4.8 (SD: 3.3; 21% bilateral) with a high total burden of injury (mean Injury Severity Score: 19.9 [SD: 8.9]). The overall incidence of respiratory complications was 13% and mortality was 4%. After matching, 204 EPI patients were compared with 204 NEPI patients, with no differences in baseline characteristics. EPI patients experienced more respiratory complications (19% versus 10%, P = 0.009), but no differences in 30-d mortality (5% versus 2%, P = 0.159), duration of mechanical ventilation (EPI: 148 h [SD: 167] versus NEPI: 117 h [SD: 187], P = 0.434), or duration of intensive care unit length of stay (6.5 d [SD: 7.6] versus 5.8 d [SD: 9.1], P = 0.626). Hospital stay was higher in the EPI group (16.6 d [SD: 19.6] vs 12.7 d [SD: 15.2], P = 0.026). Epidural analgesia is associated with increased respiratory complications without providing mortality benefit after traumatic rib fractures. Alternate analgesic strategies should be investigated to treat these severely injured patients. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of the VERSANT HCV RNA 3.0 assay for quantification of hepatitis C virus RNA in serum.

PubMed

Trimoulet, Pascale; Halfon, Philippe; Pohier, Eric; Khiri, Hacène; Chêne, Geneviève; Fleury, Hervé

2002-06-01

We assessed the performance of a new assay (VERSANT HCV RNA 3.0 [bDNA 3.0] assay [Bayer Diagnostics]) to quantitate HCV RNA levels and compared the results of the bDNA 3.0 assay to results of the Quantiplex HCV RNA 2.0 (bDNA 2.0) assay. Samples used in this study included 211 serum specimens from hepatitis C virus (HCV)-infected persons from two sites (Bordeaux and Marseille, France) with different genotypes; 383 serum specimens from HCV antibody-negative, HCV RNA-negative persons; and serial dilutions of World Health Organization (WHO) HCV RNA standard at a titer of 100,000 IU/ml. The specificity of the bDNA 3.0 assay was 98.2%. A high correlation was observed between expected and observed values in all dilutions of WHO standard (r = 0.9982), in serial dilutions of pooled samples (r = 0.9996), and in diluted sera from different HCV genotypes (r = 0.9930 to 0.9995). The standard deviations (SD) for the within-run and between-run reproducibility of the bDNA 3.0 assay were

Evaluation of the VERSANT HCV RNA 3.0 Assay for Quantification of Hepatitis C Virus RNA in Serum

PubMed Central

Trimoulet, Pascale; Halfon, Philippe; Pohier, Eric; Khiri, Hacène; Chêne, Geneviève; Fleury, Hervé

2002-01-01

We assessed the performance of a new assay (VERSANT HCV RNA 3.0 [bDNA 3.0] assay [Bayer Diagnostics]) to quantitate HCV RNA levels and compared the results of the bDNA 3.0 assay to results of the Quantiplex HCV RNA 2.0 (bDNA 2.0) assay. Samples used in this study included 211 serum specimens from hepatitis C virus (HCV)-infected persons from two sites (Bordeaux and Marseille, France) with different genotypes; 383 serum specimens from HCV antibody-negative, HCV RNA-negative persons; and serial dilutions of World Health Organization (WHO) HCV RNA standard at a titer of 100,000 IU/ml. The specificity of the bDNA 3.0 assay was 98.2%. A high correlation was observed between expected and observed values in all dilutions of WHO standard (r = 0.9982), in serial dilutions of pooled samples (r = 0.9996), and in diluted sera from different HCV genotypes (r = 0.9930 to 0.9995). The standard deviations (SD) for the within-run and between-run reproducibility of the bDNA 3.0 assay were ≤0.2 and ≤0.14, respectively. The intersite SD ranged from 0.03 to 0.14. The bDNA 3.0 assay results were positively correlated with the bDNA 2.0 assay results (r = 0.9533). Taking in account the overall performance, this assay could be used as a routine tool for the HCV RNA quantification. PMID:12037059

Analysis of VIIRS TEB noise using solar diffuser measurements

NASA Astrophysics Data System (ADS)

Choi, Taeyoung; Cao, Changyong; Weng, Fuzhong

2015-09-01

The Soumi-NPP Visible Infrared Imaging Radiometer Suite (VIIRS) was launched on October 28th, 2011 and its Sensor Data Record (SDR) product reached maturity status in March of 2014. Although the VIIRS SDR products are declared at the validated maturity level, there remain issues such as residual stripings in some thermal bands along with the scan direction. These horizontal striping issues in the Thermal Emissive Bands (TEB) were reflected in the sea surface temperature (SST) products. The observed striping magnitude can reach to 0.2 K, especially at the band M14 and M15. As an independent source of calibration, the Solar Diffuser (SD) is utilized in this study. The SD is originally designed for the Reflective Solar Band (RSB), however, it is assumed to be thermally stable at the time of SD observation. For each detector, a linear slope is developed by Integrated Calibration and Validation System (ICVS), which is applied on converting digital number (DN) to radiance unit. After the conversion, detector based noise analyses in VIIRS band M15 and M16 are performed on in-scan and scan-by-scan SD responses. Since SD radiance varies within an orbit, the noise calculation must be derived from the neighborhood Allan deviation. The noise derived Allan deviation shows that detector 1 and 2 in band M15 and detector 9 in band M16 have higher noise content compared to other detectors.

7 CFR 400.204 - Notification of deviation from standards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Notification of deviation from standards. 400.204... Contract-Standards for Approval § 400.204 Notification of deviation from standards. A Contractor shall advise the Corporation immediately if the Contractor deviates from the requirements of these standards...

Student- and faculty-reported importance of science prerequisites for osteopathic medical school: a survey-based study.

PubMed

Binstock, Judith; Junsanto-Bahri, Tipsuda

2014-04-01

The relevance of current standard medical school science prerequisites is being reexamined. (1) To identify which science prerequisites are perceived to best prepare osteopathic medical students for their basic science and osteopathic manipulative medicine (OMM) coursework and (2) to determine whether science prerequisites for osteopathic medical school should be modified. Preclinical osteopathic medical students and their basic science and OMM faculty from 3 colleges of osteopathic medicine were surveyed about the importance of specific science concepts, laboratories, and research techniques to medical school coursework. Participants chose responses on a 5-point scale, with 1 indicating "strongly disagree" or "not important" and 5 indicating "strongly agree" or "extremely important." Participants were also surveryed on possible prerequisite modifications. Student responses (N=264) to the general statement regarding prerequisites were "neutral" for basic science coursework and "disagree" for OMM coursework, with mean (standard deviation [SD]) scores of 3.37 (1.1) and 2.68 (1.2), respectively. Faculty responses (N=49) were similar, with mean (SD) scores of 3.18 (1.1) for basic science coursework and 2.67 (1.2) for OMM coursework. Student mean (SD) scores were highest for general biology for basic science coursework (3.93 [1.1]) and physics for OMM coursework (2.5 [1.1]). Student mean (SD) scores were lowest for physics for basic science coursework (1.79 [1.2]) and organic chemistry for OMM coursework (1.2 [0.7]). Both basic science and OMM faculty rated general biology highest in importance (mean [SD] scores, 3.73 [0.9] and 4.22 [1.0], respectively). Students and faculty rated biochemistry high in importance for basic science coursework (mean [SD] scores of 3.66 [1.2] and 3.32 [1.2], respectively). For basic science coursework, students and faculty rated most laboratories as "important," with the highest mean (SD) ratings for general anatomy (students, 3.66 [1.5]; faculty, 3.72 [1.1]) and physiology (students, 3.56 [1.7]; faculty, 3.61 [1.1]). For their OMM coursework, students rated only general anatomy and physiology laboratories as "important" (mean [SD] scores, 3.22 [1.8] and 2.61 [1.6], respectively), whereas OMM faculty rated all laboratories as "important" (mean scores, >3). Both student and faculty respondents rated research techniques higher in importance for basic science coursework than for OMM coursework. For prerequisite modifications, all respondents indicated "no change" for biology and "reduce content" for organic chemistry and physics. All respondents favored adding physiology and biochemistry as prerequisites. General biology and laboratory were the only standard prerequisites rated as "important." Research techniques were rated as "important" for basic science coursework only. Physiology and biochemistry were identified as possible additions to prerequisites. It may be necessary for colleges of osteopathic medicine to modify science prerequisites to reflect information that is pertinent to their curricula.

Validation of the Calypso Surface Beacon Transponder.

PubMed

Belanger, Maxwell; Saleh, Ziad; Volpe, Tom; Margiasso, Rich; Li, Xiang; Chan, Maria; Zhu, Xiaofeng; Tang, Xiaoli

2016-07-08

Calypso L-shaped Surface Beacon transponder has recently become available for clinical applications. We herein conduct studies to validate the Surface Beacon transponder in terms of stability, reproducibility, orientation sensitivity, cycle rate dependence, and respiratory waveform tracking accuracy. The Surface Beacon was placed on a Quasar respiratory phantom and positioned at the isocenter with its two arms aligned with the lasers. Breathing waveforms were simulated, and the motion of the transponder was tracked. Stability and drift analysis: sinusoidal waveforms (200 cycles) were produced, and the amplitudes of phases 0% (inhale) and 50% (exhale) were recorded at each breathing cycle. The mean and standard deviation (SD) of the amplitudes were calculated. Linear least-squares fitting was performed to access the possible amplitude drift over the breathing cycles. Reproducibility: similar setting to stability and drift analysis, and the phantom generated 100 cycles of the sinusoidal waveform per run. The Calypso system's was re-setup for each run. Recorded amplitude and SD of 0% and 50% phase were compared between runs to assess contribution of Calypso electromagnetic array setup variation. Beacon orientation sensitivity: the Calypso tracks sinusoidal phantom motion with a defined angular offset of the beacon to assess its effect on SD and peak-to-peak amplitude. Rate dependence: sinusoidal motion was generated at cycle rates of 1 Hz, .33 Hz, and .2 Hz. Peak-to-peak displacement and SDs were assessed. Respiratory waveform tracking accuracy: the phantom reproduced recorded breathing cycles (by volunteers and patients) were tracked by the Calypso system. Deviation in tracking position from produced waveform was used to calculate SD throughout entire breathing cycle. Stability and drift analysis: Mean amplitude ± SD of phase 0% or 50% were 20.01 ± 0.04 mm and -19.65 ± 0.08 mm, respectively. No clinically significant drift was detected with drift measured as 5.1 × 10-5 mm/s at phase 0% and -6.0 × 10-5 mm/s at phase 50%. Reproducibility: The SD of the setup was 0.06 mm and 0.02 mm for phases 0% and 50%, respectively. The combined SDs, including both setup and intrarun error of all runs at phases 0% and 50%, were 0.07mm and 0.11 mm, respectively. Beacon orientation: SD ranged from 0.032mm to 0.039 mm at phase 0% and from 0.084 mm to 0.096 mm at phase 50%. The SD was found not to vary linearly with Beacon angle in the range of 0° and 15°. A positive systematic error was observed with amplitude 0.07 mm/degree at phase 0% and 0.05 mm/degree at phase 50%. Rate dependence: SD and displacement amplitudes did not vary significantly between 0.2 Hz and 0.33 Hz. At 1 Hz, both 0% and 50% amplitude measurements shifted up appreciably, by 0.72 mm and 0.78mm, respectively. As compared with the 0.33 Hz data, SD at phase 0% was 1.6 times higher and 5.4 times higher at phase 50%. Respiratory waveform tracking accuracy: SD of 0.233 mm with approximately normal distribution in over 134 min of tracking (201468 data points). The Surface Beacon transponder appears to be stable, accurate, and reproducible. Submillimeter resolution is achieved throughout breathing and sinusoidal waveforms. © 2016 The Authors

Validation of the Calypso Surface Beacon Transponder

PubMed Central

Saleh, Ziad; Volpe, Tom; Margiasso, Rich; Li, Xiang; Chan, Maria; Zhu, Xiaofeng; Tang, Xiaoli

2016-01-01

Calypso L‐shaped Surface Beacon transponder has recently become available for clinical applications. We herein conduct studies to validate the Surface Beacon transponder in terms of stability, reproducibility, orientation sensitivity, cycle rate dependence, and respiratory waveform tracking accuracy. The Surface Beacon was placed on a Quasar respiratory phantom and positioned at the isocenter with its two arms aligned with the lasers. Breathing waveforms were simulated, and the motion of the transponder was tracked. Stability and drift analysis: sinusoidal waveforms (200 cycles) were produced, and the amplitudes of phases 0% (inhale) and 50% (exhale) were recorded at each breathing cycle. The mean and standard deviation (SD) of the amplitudes were calculated. Linear least‐squares fitting was performed to access the possible amplitude drift over the breathing cycles. Reproducibility: similar setting to stability and drift analysis, and the phantom generated 100 cycles of the sinusoidal waveform per run. The Calypso system's was re‐setup for each run. Recorded amplitude and SD of 0% and 50% phase were compared between runs to assess contribution of Calypso electromagnetic array setup variation. Beacon orientation sensitivity: the Calypso tracks sinusoidal phantom motion with a defined angular offset of the beacon to assess its effect on SD and peak‐to‐peak amplitude. Rate dependence: sinusoidal motion was generated at cycle rates of 1 Hz, .33 Hz, and .2 Hz. Peak‐to‐peak displacement and SDs were assessed. Respiratory waveform tracking accuracy: the phantom reproduced recorded breathing cycles (by volunteers and patients) were tracked by the Calypso system. Deviation in tracking position from produced waveform was used to calculate SD throughout entire breathing cycle. Stability and drift analysis: Mean amplitude ± SD of phase 0% or 50% were 20.01±0.04 mm and ‐19.65±0.08 mm, respectively. No clinically significant drift was detected with drift measured as 5.1×10‐5 mm/s at phase 0% and ‐6.0×10‐5 mm/s at phase 50%. Reproducibility: The SD of the setup was 0.06 mm and 0.02 mm for phases 0% and 50%, respectively. The combined SDs, including both setup and intrarun error of all runs at phases 0% and 50%, were 0.07 mm and 0.11 mm, respectively. Beacon orientation: SD ranged from 0.032 mm to 0.039 mm at phase 0% and from 0.084 mm to 0.096 mm at phase 50%. The SD was found not to vary linearly with Beacon angle in the range of 0° and 15°. A positive systematic error was observed with amplitude 0.07 mm/degree at phase 0% and 0.05 mm/degree at phase 50%. Rate dependence: SD and displacement amplitudes did not vary significantly between 0.2 Hz and 0.33 Hz. At 1 Hz, both 0% and 50% amplitude measurements shifted up appreciably, by 0.72 mm and 0.78 mm, respectively. As compared with the 0.33 Hz data, SD at phase 0% was 1.6 times higher and 5.4 times higher at phase 50%. Respiratory waveform tracking accuracy: SD of 0.233 mm with approximately normal distribution in over 134 min of tracking (201468 data points). The Surface Beacon transponder appears to be stable, accurate, and reproducible. Submillimeter resolution is achieved throughout breathing and sinusoidal waveforms. PACS number(s): 87.50.ct, 87.50.st, 87.50.ux, 87.50.wp, 87.50.yt PMID:27455489

SU-E-T-586: Optimal Determination of Tolerance Level for Radiation Dose Delivery Verification in An in Vivo Dosimetry System

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

Chen, Y; Souri, S; Gill, G

Purpose: To statistically determine the optimal tolerance level in the verification of delivery dose compared to the planned dose in an in vivo dosimetry system in radiotherapy. Methods: The LANDAUER MicroSTARii dosimetry system with screened nanoDots (optically stimulated luminescence dosimeters) was used for in vivo dose measurements. Ideally, the measured dose should match with the planned dose and falls within a normal distribution. Any deviation from the normal distribution may be redeemed as a mismatch, therefore a potential sign of the dose misadministration. Randomly mis-positioned nanoDots can yield a continuum background distribution. A percentage difference of the measured dose tomore » its corresponding planned dose (ΔD) can be used to analyze combined data sets for different patients. A model of a Gaussian plus a flat function was used to fit the ΔD distribution. Results: Total 434 nanoDot measurements for breast cancer patients were collected across a period of three months. The fit yields a Gaussian mean of 2.9% and a standard deviation (SD) of 5.3%. The observed shift of the mean from zero is attributed to the machine output bias and calibration of the dosimetry system. A pass interval of −2SD to +2SD was applied and a mismatch background was estimated to be 4.8%. With such a tolerance level, one can expect that 99.99% of patients should pass the verification and at most 0.011% might have a potential dose misadministration that may not be detected after 3 times of repeated measurements. After implementation, a number of new start breast cancer patients were monitored and the measured pass rate is consistent with the model prediction. Conclusion: It is feasible to implement an optimal tolerance level in order to maintain a low limit of potential dose misadministration while still to keep a relatively high pass rate in radiotherapy delivery verification.« less

Factors influencing endometrial thickness in postmenopausal women.

PubMed

Hebbar, S; Chaya, V; Rai, L; Ramachandran, A

2014-07-01

Cut-off values for endometrial thickness (ET) in asymptomatic postmenopausal woman have been standardized. However, there are no comprehensive studies to document how various factors can influence the ET after the age of menopause. To study the various factors influencing the ET in postmenopausal women. This was a prospective observational study. A total of 110 postmenopausal women underwent detailed history taking, clinical examination, and transvaginal scan for uterine volume and ovarian volume. The volumes were calculated by using ellipsoid formula: Width × thickness × height × 0.523. The variation in ET with respect to the influencing factors such as age, duration of menopause, parity, body mass index (BMI), medical illness like diabetes/hypertension, drugs like tamoxifen, presence of myoma, uterine volume, ovarian volume, and serum estradiol (in selected patients) were measured. Descriptive analysis was performed using SPSS software (version 16, Chicago II, USA) to obtain mean, standard deviation (SD), 95% confidence intervals (CIs) and inter quartile ranges. Comparison of means was carried out using analysis of variance. The mean (SD) age of the patients was 55.4 (6.91) years (95% CI, 54.1, 56.7). The mean (SD) age at menopause was 47.95 (3.90) years (95% CI, 47.2, 48.7) and the mean (SD) duration of menopause was 7.27 (6.65) years (95% CI, 6.01, 8.53). The mean (SD) ET was 3.8 (2.3) mm (95% CI, 3.36, 4.23). Medical illness like diabetes and hypertension did not alter the ET. ET increased as BMI increased and it was statistically significant. The presence of myoma increased uterine volume significantly and was associated with thick endometrial stripe. Similarly, whenever the ovaries were visualized and as the ovarian volume increased, there was an increase in ET. When ET was > 4 mm (n = 37), they were offered endocel, of which 16 agreed to undergo the procedure. None were found to have endometrial cancer. This study suggests that parity, BMI, presence of myoma, tamoxifen usage, uterine volume, ovarian volume and serum estradiol influence the ET in postmenopausal women.

Reference intervals of aortic pulse wave velocity assessed with an oscillometric device in healthy children and adolescents from Argentina.

PubMed

Alejandro, Díaz; Yanina, Zócalo; Daniel, Bia; Franco, Sabino; Victoria, Rodríguez; Edmundo, Cabrera FIscher

2018-03-09

Age-related reference intervals (RIs) of aortic pulse wave velocity (Ao-PWV) obtained from a large healthy population are lacking in South America. The aims of this study were to determine Ao-PWV RIs in a cohort of healthy children and adolescents from Argentina and to generate year-to-year percentile curves. Ao-PWV was measured in 1000 healthy subjects non-exposed to traditional cardiovascular risk factors (Age: 10-22 y. o., 56% males). First, we evaluated if RIs for males and females were necessaries (correlation and covariate analysis). Second, mean (M) and standard deviation (SD) age-related equations were obtained for cf-PWV, using parametric regression methods based on fractional polynomials. Third, age-specific (year to year) percentiles curves (for all, males and females children and adolescents) were generated using the standard normal distribution. They were, age-specific 1st, 2.5th, 5th, 10th, 25th, 50th, 75th, 90th, 95th, 97.5th and 99th percentile curves and values. After covariate analysis (i.e., adjusting by age, jugulum-symphysis distance, body weight and height), specific RIs for males and females of children and adolescents were evidenced as necessaries. The equations were For all subjects: Ao-PWV_Mean = 4.98 + 12.86x10 -5 Age 3 . Ao-PWV_SD = 0.47 + 21.00x10 -6 Age 3 . For girls: Ao-PWV_Mean = 5.07 + 10.23x10 -5 Age 3 . Ao-PWV_SD = 0.50 + 10.00x10 -6 Age 3 . For boys: Ao-PWV_Mean = 4.87 + 15.81x10 -5 Age 3 . Ao-PWV_SD = 0.46 + 22.34x10 -6 Age 3 . Our study provides the largest database to-date concerning Ao-PWV in healthy children and adolescents in Argentina. Age-related equations (M and SD values) for Ao-PWV are reported by the first time. Specific RIs and percentiles of Ao-PWV are now available according to age and sex for an Argentinian population.

Response assessment of stereotactic body radiation therapy using dynamic contrast-enhanced integrated MR-PET in non-small cell lung cancer patients.

PubMed

Huang, Yu-Sen; Chen, Jenny Ling-Yu; Hsu, Feng-Ming; Huang, Jei-Yie; Ko, Wei-Chun; Chen, Yi-Chang; Jaw, Fu-Shan; Yen, Ruoh-Fang; Chang, Yeun-Chung

2018-01-01

To evaluate the response in patients undergoing SBRT using dynamic contrast-enhanced (DCE) integrated magnetic resonance positron emission tomography (MR-PET). Stereotactic body radiation therapy (SBRT) is efficacious as a front-line local treatment for non-small cell lung cancer (NSCLC). We prospectively enrolled 19 lung tumors in 17 nonmetastatic NSCLC patients who were receiving SBRT as a primary treatment. They underwent DCE-integrated 3T MR-PET before and 6 weeks after SBRT. The following image parameters were analyzed: tumor size, standardized uptake value (SUV), apparent diffusion coefficient, K trans , k ep , v e , v p , and iAUC 60 . Chest computed tomography (CT) was performed at 3 months after SBRT. SBRT treatment led to tumor changes including significant decreases in the SUV max (-61%, P < 0.001), K trans mean (-72%, P = 0.005), K trans standard deviation (SD; -85%, P = 0.046), k ep mean (-53%, P = 0.014), k ep SD (-63%, P = 0.001), and v p SD (-58%, P = 0.002). The PET SUV max was correlated with the MR k ep mean (P = 0.002) and k ep SD (P < 0.001). The percentage reduction in K trans mean (P < 0.001) and k ep mean (P = 0.034) at 6 weeks post-SBRT were significantly correlated with the percentage reduction in tumor size, as measured using CT at 3 months after SBRT. Univariate analyses revealed a trend toward disease progression when the initial SUV max > 10 (P = 0.083). In patients with NSCLC who are receiving SBRT, DCE-integrated MR-PET can be used to evaluate the response after SBRT and to predict the local treatment outcome. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:191-199. © 2017 International Society for Magnetic Resonance in Medicine.

Head restraint backset during routine automobile driving: drivers usually exceed the recommended guidelines.

PubMed

Shugg, Jarrod A J; Vernest, Kyle; Dickey, James P

2011-04-01

Although several previous studies have evaluated horizontal head restraint backset distances, few studies have evaluated them during driving. The purpose of this study was to measure this backset during routine automobile driving and to specifically evaluate the backset during individual driving tasks such as turning, stopping, starting, and lane changes. Fourteen subjects drove around a specified route through the city of Guelph, Ontario, Canada, that included residential, thruway, and highway driving; additional minor driving tasks, such as lane changes, were evaluated. The distance of head restraint to posterior aspect of the head was measured continuously throughout the drive using an ultrasonic measurement system. The timing of specific tasks was documented using a video camera. The average head-to-restraint distance throughout the driving route was 78.1 mm (standard deviation [SD] 24.8 mm); this distance did not vary significantly between the global measures during various driving areas (residential, thruway, and highway). We observed that the head restraint backsets during right turns (93.6 mm; SD 34.8 mm) were significantly larger compared to the other driving tasks (p < .001). The 7 males and 7 females showed similar backset distances: 84.52 mm (SD 12.08) and 71.68 mm (SD 5.53), respectively (p = .0785). We observed that most subjects maintain a relatively consistent head-to-restraint distance throughout their driving route; 2 subjects adopted very large head restraint backset distances throughout their drive and 2 others adopted very small head restraint backset distances-this appears to reflect driver posture. Twelve of 14 subjects had average backset distances that exceed the National Highway Traffic Safety Administration and the Federal Motor Vehicle Safety Standard guidelines, indicating that most drivers may be at risk for whiplash-like disorders if exposed to a rear impact while driving. Of the monitored driving tasks, turning, especially right turns, caused drivers to increase their head-to-restraint backset distance.

Erect penile dimensions in a cohort of 778 Middle Eastern men: establishment of a nomogram.

PubMed

Habous, Mohamad; Tealab, Alaa; Williamson, Ben; Binsaleh, Saleh; El Dawy, Sherif; Mahmoud, Saad; Abdelwahab, Osama; Nassar, Mohammed; Mulhall, John P; Veale, David; Muir, Gordon

2015-06-01

Accurate data regarding the size of the erect penis are of great importance to several disciplines working with male patients, but little high-quality research exists on the subject, particularly in different ethnic groups and for erect penis size. The aim of this study was to create a nomogram of erect penile dimensions in a large sample of Middle Eastern men. A retrospective cohort study of 778 men (mean age 43.7; range 20-82) attending urological outpatient clinics in Saudi Arabia was conducted. Exclusion criteria were age under 18 years, a presenting complaint of small or short penis, Peyronie's disease or complaint of congenital curvature, clinical hypogonadism, and previous penile surgery or trauma. Three erect penile dimensions following induction of erection using intracavernosal injection of Quadrimix. Mean patient body mass index (BMI) was 29.09 (standard deviation [SD] 5.76). The mean suprapubic skin-to-penile tip erect length was 12.53 cm (SD 1.93); the mean erect length from the symphysis pubis to the penile tip was 14.34 cm (SD 1.86); and the mean erect shaft circumference was 11.50 cm (SD 1.74). A nomogram was constructed and statistical analysis performed, demonstrating a weak negative correlation between BMI and erect penile length measured from the suprapubic skin (r = -0.283, P < 0.000) but not from bone to tip, and a weak negative correlation between age and both erect penile length measurements (skin to tip r = -0.177, P < 0.0005; bone to tip r = -0.099, P = 0.006). A nomogram for Middle Eastern men can be used as a standard when advising men with small penis anxiety. The importance of measuring erect size and allowing for infra-pubic fat interference in measurement is emphasized. We envisage that this tool can be used to educate and reassure concerned men about the size of their penises. © 2015 International Society for Sexual Medicine.

Effectiveness of first-aid training on school students in Singur Block of Hooghly District, West Bengal.

PubMed

Bandyopadhyay, Lina; Manjula, M; Paul, Bobby; Dasgupta, Aparajita

2017-01-01

First aid is the helping behavior and initial care provided for an acute illness or injury. Students have the potential for changing the health scenario of the society if properly groomed and educated. The objective of the study is to evaluate the effectiveness of educational intervention on the first aid among middle school students of a rural school in West Bengal. A total of 230, 6 th and 7 th standard students were given a self-administered questionnaire for assessing their baseline knowledge about management of common injuries followed by educational intervention with a systematically devised teaching module during February to March 2016. Post intervention evaluation of their knowledge acquisition was done after 2 weeks with same questionnaire. The baseline knowledge on the management of selected injuries was found to be insufficient among the study subjects. Paired t -test was performed to compare the pre- and post-test scores of knowledge and attitude of the students about first aid, and there was a significant change in knowledge from pretest score (mean = 1.50, standard deviation [SD] =0.47) to posttest score (mean = 6.53, SD = 1.30). To quantify the effectiveness of health education, effect size (Cohen's d) was derived. For knowledge score, Cohen's d was 5.14 with large effect size indicating highly effective impact of the training program. Significant change was also noticed regarding attitude regarding first aid as evident from increase in pretest score (mean = 1.19, SD = 0.96) to posttest score (mean = 3.17, SD = 1.03); Cohen's d was 1.88 with medium effect size. Inculcating first-aid training in the school curriculum can be a fruitful investment in ensuring proper and timely management of illnesses and injuries not only for the school children but also for the community at large.

T2-weighted images are superior to other MR image types for the determination of diffuse intrinsic pontine glioma intratumoral heterogeneity.

PubMed

Harward, Stephen; Harrison Farber, S; Malinzak, Michael; Becher, Oren; Thompson, Eric M

2018-03-01

Diffuse intrinsic pontine glioma (DIPG) remains the main cause of death in children with brain tumors. Given the inefficacy of numerous peripherally delivered agents to treat DIPG, convection enhanced delivery (CED) of therapeutic agents is a promising treatment modality. The purpose of this study was to determine which MR imaging type provides the best discrimination of intratumoral heterogeneity to guide future stereotactic implantation of CED catheters into the most cellular tumor regions. Patients ages 18 years or younger with a diagnosis of DIPG from 2000 to 2015 were included. Radiographic heterogeneity index (HI) of the tumor was calculated by measuring the standard deviation of signal intensity of the tumor (SD Tumor ) normalized to the genu of the corpus callosum (SD Corpus Callosum ). Four MR image types (T2-weighted, contrast-enhanced T1-weighted, FLAIR, and ADC) were analyzed at several time points both before and after radiotherapy and chemotherapy. HI values across these MR image types were compared and correlated with patient survival. MR images from 18 patients with DIPG were evaluated. The mean survival ± standard deviation was 13.8 ± 13.7 months. T2-weighted images had the highest HI (mean ± SD, 5.1 ± 2.5) followed by contrast-enhanced T1-weighted images (3.7 ± 1.5), FLAIR images (3.0 ± 1.1), and ADC maps (1.6 ± 0.4). ANOVA demonstrated that HI values were significantly higher for T2-weighted images than FLAIR (p < 0.01) and ADC (p < 0.0001). Following radiotherapy, T2-weighted and contrast-enhanced T1-weighted image HI values increased, while FLAIR and ADC HI values decreased. Univariate and multivariate analyses did not reveal a relationship between HI values and patient survival (p > 0.05). For children with DIPG, T2-weighted MRI demonstrates the greatest signal intensity variance suggesting tumor heterogeneity. Within this heterogeneity, T2-weighted signal hypointensity is known to correlate with increased cellularity and thus may represent a putative target for CED catheter placement in future clinical trials.

The Standard Deviation of Launch Vehicle Environments

NASA Technical Reports Server (NTRS)

Yunis, Isam

2005-01-01

Statistical analysis is used in the development of the launch vehicle environments of acoustics, vibrations, and shock. The standard deviation of these environments is critical to accurate statistical extrema. However, often very little data exists to define the standard deviation and it is better to use a typical standard deviation than one derived from a few measurements. This paper uses Space Shuttle and expendable launch vehicle flight data to define a typical standard deviation for acoustics and vibrations. The results suggest that 3dB is a conservative and reasonable standard deviation for the source environment and the payload environment.

Early growth patterns are associated with intelligence quotient scores in children born small-for-gestational age.

PubMed

Varella, Marcia H; Moss, William J

2015-08-01

To assess whether patterns of growth trajectory during infancy are associated with intelligence quotient (IQ) scores at 4 years of age in children born small-for-gestational age (SGA). Children in the Collaborative Perinatal Project born SGA were eligible for analysis. The primary outcome was the Stanford-Binet IQ score at 4 years of age. Growth patterns were defined based on changes in weight-for-age z-scores from birth to 4 months and 4 to 12 months of age and consisted of steady, early catch-up, late catch-up, constant catch-up, early catch-down, late catch-down, constant catch-down, early catch-up & late catch-down, and early catch-down & late catch-up. Multivariate linear regression was used to assess associations between patterns of growth and IQ. We evaluated patterns of growth and IQ in 5640 children. Compared with children with steady growth, IQ scores were 2.9 [standard deviation (SD)=0.54], 1.5 (SD=0.63), and 2.2 (SD=0.9) higher in children with early catch-up, early catch-up and later catch-down, and constant catch-up growth patterns, respectively, and 4.4 (SD=1.4) and 3.9 (SD=1.5) lower in children with early catch-down & late catch-up, and early catch-down growth patterns, respectively. Patterns in weight gain before 4 months of age were associated with differences in IQ scores at 4 years of age, with children with early catch-up having slightly higher IQ scores than children with steady growth and children with early catch-down having slightly lower IQ scores. These findings have implications for early infant nutrition in children born SGA. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Thermal performance trials on the habitability of private bushfire shelters: part 2

NASA Astrophysics Data System (ADS)

Taylor, Nigel A. S.; Haberley, Benjamin J.

2015-08-01

In the preceding communication, an investigation was described in which the thermal specifications for the design of private bushfire shelters were evaluated. Since those trials were undertaken with the thermal characteristics of the air clamped, survival uncertainty persisted if the internal ambient conditions were progressively changing, as would occur within an air-tight shelter. Therefore, two further investigations were performed. In the first, changes in the physical properties of air within an air-tight shelter simulator (1.2 m3), initially equilibrated to 43.7 °C and 42.3 % relative humidity, were studied when pre-heated, well-hydrated males were sealed inside ( N = 16; 60 min; experimental series 2). Air temperature and humidity moved sigmoidally to 40.5 °C (standard deviation (SD), 0.5) and 90.1 % (SD, 2.1). Oxygen and carbon dioxide fractional concentrations changed reciprocally, with respective terminal averages of 16.7 % (SD, 0.8) and 3.94 % (SD, 0.72). Deep-body temperature rose beyond the tenth minute to a terminal mean of 39.3 °C (SD, 0.2). In the third experimental series, these air temperature and humidity changes were reproduced in trials commencing at two different thermal states (40 °C and 70 % relative humidity; 45 °C and 50 % relative humidity). Sixteen pre-heated and slightly dehydrated men and women were investigated. In neither condition did the auditory canal temperature of any individual change by more than 2 °C or exceed 40 °C. It may be concluded, within the limits of these experiments, that the recommended thermal and dimensional specifications for bushfire shelters can provide tenable conditions for healthy, young adults.

Reasons Low-Income Parents Offer Snacks to Children: How Feeding Rationale Influences Snack Frequency and Adherence to Dietary Recommendations

PubMed Central

Blaine, Rachel E.; Fisher, Jennifer Orlet; Taveras, Elsie M.; Geller, Alan C.; Rimm, Eric B.; Land, Thomas; Perkins, Meghan; Davison, Kirsten K.

2015-01-01

Although American children snack more than ever before, the parental role in promoting snacking is not well understood. In 2012–2013 at baseline in an intervention study to prevent childhood obesity in low-income Massachusetts communities, n = 271 parents of children aged 2–12 years completed surveys regarding nutritive and non-nutritive reasons they offered children snacks, demographics, and dietary factors. An analysis of variance demonstrated that parents reported offering snacks (mean/week; standard deviation (SD)) for nutritive reasons like promoting growth (x̄ = 2.5; SD 2.2) or satisfying hunger (x̄ = 2.4; SD 2.1) almost twice as often as non-nutritive reasons like keeping a child quiet (x̄ = 0.7; SD 1.5) or celebrating events/holidays (x̄ = 0.8; SD 1.1). Parents reported giving young children (2–5 years) more snacks to reward behavior (1.9 vs. 1.1, p < 0.001), keep quiet (1.0 vs. 0.5, p < 0.001), and celebrate achievements (1.7 vs. 1.0, p < 0.001) than parents of older children (6–12 years). Multivariable logistic regression models were used to obtain adjusted odds ratios, which indicated reduced child adherence to dietary recommendations when parents offered snacks to reward behavior (Odds Ratio (OR) = 0.83; 95% Confidence Interval (CI) 0.70–0.99), celebrate events/holidays (OR = 0.72; 95% CI 0.52–0.99), or achievements (OR = 0.82; 95% CI 0.68–0.98). Parental intentions around child snacking are likely important targets for obesity prevention efforts. PMID:26197335

Left ventricular dyssynchrony in patients with normal ventricular systolic function referred for exercise echocardiography.

PubMed

Bernheim, Alain M; Nakajima, Yoshie; Pellikka, Patricia A

2008-10-01

Exercise testing is often normal despite the presence of exertional symptoms. We hypothesized that left ventricular (LV) dyssynchrony might occur in some patients in the absence of ischemia, LV dysfunction, or wide QRS, and might contribute to exertional symptoms and diminished exercise capacity. Echocardiographic parameters were assessed before and with exercise in 40 patients (age 62 +/- 8 years, 27 with exertional symptoms). All had normal clinically indicated exercise echocardiograms and narrow QRS. The time to peak systolic velocity (Ts) was measured in 12 segments to calculate the standard deviation (Ts-SD) and the maximal difference (Ts-diff). At rest, 25 patients (63%) had dyssynchrony by Ts-SD. With exercise, mean Ts-SD did not increase significantly (34.9 +/- 19.3 ms vs 39.5 +/- 27.2 ms, P = .28). However, Ts-SD increased by greater than 40% in 15 patients (37.5%), remained stable in 19 patients (47.5%), and decreased by greater than 40% in 6 patients (15%). Similar responses were observed for Ts-diff. Patients with exercise-induced dyssynchrony were not more likely to have symptoms. Exercise capacity was inversely correlated with resting Ts-SD (r = -0.37, P = .02) and resting Ts-diff (r = -0.38, P = .02), but not with exercise-induced changes in dyssynchrony. Patients with resting dyssynchrony had higher resting heart rate (73 +/- 12 vs 63 +/- 11 beats/min, P = .02). LV dyssynchrony may occur more frequently than previously thought and may develop with exercise in the absence of ischemia. Exercise-induced LV dyssynchrony was not related to exertional symptoms or exercise capacity. Patients with dyssynchrony at rest had a higher resting heart rate and achieved a lower workload; this may indicate early myocardial impairment.

Nonnative Cattle Ownership, Diet, and Child Height-for-Age: Evidence from the 2011 Uganda Demographic and Health Survey.

PubMed

Fierstein, Jamie L; Eliasziw, Misha; Rogers, Beatrice Lorge; Forrester, Janet E

2017-01-11

In underresourced settings where domestic animals and children often cohabitate, there is limited evidence about the net impact of domestic animal ownership on child health. We analyzed the 2011 Uganda Demographic and Health Survey to determine whether household ownership of native cattle, goats, sheep, chickens, pigs, and nonnative cattle was associated with child height-for-age z-scores (HAZ), and to assess the influence of diet on this association in rural and urban environments. Using weighted multivariable linear regression, we found that nonnative cattle ownership was positively associated with HAZ in rural children 0 to < 2 years of age (+1.32 standard deviations [SD], 95% confidence interval [CI] = 0.2-2.5) and 2 to < 5 years of age (+0.58 SD, 95% CI = 0.003-1.2), and urban children 2 to < 5 years of age (+1.08 SD, 95% CI = 0.38-1.8). Sheep ownership was positively associated with HAZ in rural children 2 to < 5 years of age (+0.29 SD, 95% CI = 0.002-0.58) and goat ownership was positively associated with HAZ in rural children 0 to < 2 years of age (+0.27 SD, 95% CI = 0.003-0.55). We observed no other significant associations. Children who lived in households that owned nonnative cattle consumed dairy more frequently; however, the relationship between child HAZ and nonnative cattle ownership was not mediated by child dairy consumption. These findings suggest that domestic animal ownership may not be detrimental to child HAZ, and that nonnative cattle ownership is beneficial for child HAZ through pathways other than dairy consumption. © The American Society of Tropical Medicine and Hygiene.

Characteristics of patients with fibromyalgia in France and Germany.

PubMed

Perrot, S; Winkelmann, A; Dukes, E; Xu, X; Schaefer, C; Ryan, K; Chandran, A; Sadosky, A; Zlateva, G

2010-07-01

Few studies have comprehensively assessed the burden associated with fibromyalgia (FM). This cross-sectional, observational study evaluates the impact of FM on patients in France and Germany. A total of 299 FM patients were recruited from 33 physician offices in France and Germany during routine visits. Patients completed a survey that included the Brief Pain Inventory-Short Form (BPI-sf), Fibromyalgia Impact Questionnaire (FIQ), EuroQol 5D (EQ-5D) and the Hospital Anxiety and Depression Scale (HADS) to describe their pain, FM and health-related quality of life (HRQOL). FM severity was defined using patients' FIQ total scores with 0 to < 39, 39 to < 59 and 59-100, representing mild, moderate and severe FM, respectively. Site staff completed case report forms using patients' medical records. Mean (standard deviation, SD) age was 54.2 (12.6); 81% of patients were women. The mean (SD) FIQ total score was 53.3 (19.6); 33% and 44% of patients reported moderate and severe FM, respectively. Most patients (91%) were receiving prescription medications for FM during the study. Patients reported a mean (SD) EQ-5D health state valuation of 0.44 (0.33) and a mean (SD) BPI-sf Pain Severity Index score of 4.9 (1.8). Forty-one percent of patients reported some level of disruption in their employment because of FM; employed patients missed a mean (SD) of 2.2 (4.6) workdays during the past 4 weeks. An increase in FM severity was significantly associated with increased pain severity, productivity loss, sleep disturbance and higher anxiety and depression (p < 0.0001). There is a substantial burden of illness including treatment limitations for FM patients in France and Germany.

Are all temperate lakes eutrophying in a warmer world?

NASA Astrophysics Data System (ADS)

Paltsev, A.; Creed, I. F.

2017-12-01

Freshwater lakes are at risk of eutrophication due to climate change and intensification of human activities on the planet. In relatively undisturbed areas of the temperate forest biome, lakes are "sentinels" of the effects of rising temperatures. We hypothesise that rising temperatures are driving a shift from nutrient-poor oligotrophic states to nutrient-rich eutrophic states. To test this hypothesis, we examined a time series of satellite based chlorophyll-a (a proxy of algal biomass) of 12,000+ lakes over 30 years in the Canadian portion of the Laurentian Great Lakes basin. From the time series, non-stationary trends (detected by Mann-Kendall analysis) and stationary cycles (revealed through Morlet wavelet analysis) were removed, and the standard deviation (SD) of the remaining residuals was used as an indicator of lake stability. Four classes of lake stability were identified: (1) stable (SD is consistently low); (2) destabilizing (SD increases over time); (3) unstable (SD is consistently high); and (4) stabilizing lakes (SD decreases over time). Stable lakes were either oligotrophic or eutrophic indicating the presence of two stable states in the region. Destabilizing lakes were shifting from oligotrophic to lakes with a higher trophic status (indicating eutrophication), unstable lakes were mostly mesotrophic, and stabilizing lakes were shifting from eutrophic to the lakes with lower trophic status (indicating oligotrophication). In contrast to common expectations, while many lakes (2142) were shifting from oligotrophic to eutrophic states, more lakes (3199) were showing the opposite trend and shifting from eutrophic to oligotrophic states. This finding reveals a complexity of lake responses to rising temperatures and the need to improve understanding of why some lakes shift while others do not. Future work is focused on exploring the interactive effects of global, regional, and local drivers of lake trophic states.

Thermal performance trials on the habitability of private bushfire shelters: part 2.

PubMed

Taylor, Nigel A S; Haberley, Benjamin J

2015-08-01

In the preceding communication, an investigation was described in which the thermal specifications for the design of private bushfire shelters were evaluated. Since those trials were undertaken with the thermal characteristics of the air clamped, survival uncertainty persisted if the internal ambient conditions were progressively changing, as would occur within an air-tight shelter. Therefore, two further investigations were performed. In the first, changes in the physical properties of air within an air-tight shelter simulator (1.2 m(3)), initially equilibrated to 43.7 °C and 42.3 % relative humidity, were studied when pre-heated, well-hydrated males were sealed inside (N = 16; 60 min; experimental series 2). Air temperature and humidity moved sigmoidally to 40.5 °C (standard deviation (SD), 0.5) and 90.1 % (SD, 2.1). Oxygen and carbon dioxide fractional concentrations changed reciprocally, with respective terminal averages of 16.7 % (SD, 0.8) and 3.94 % (SD, 0.72). Deep-body temperature rose beyond the tenth minute to a terminal mean of 39.3 °C (SD, 0.2). In the third experimental series, these air temperature and humidity changes were reproduced in trials commencing at two different thermal states (40 °C and 70 % relative humidity; 45 °C and 50 % relative humidity). Sixteen pre-heated and slightly dehydrated men and women were investigated. In neither condition did the auditory canal temperature of any individual change by more than 2 °C or exceed 40 °C. It may be concluded, within the limits of these experiments, that the recommended thermal and dimensional specifications for bushfire shelters can provide tenable conditions for healthy, young adults.

Growth hormone for short children--whom should we be treating and why?

PubMed

Kelnar, C J

2012-03-01

The objective of this paper was to determine systematically the impact of growth hormone (GH)therapy on adult height of children with (so-called) 'idiopathic short stature' (ISS) using the Cochrane Central Register of Controlled Trials, Medline, and the bibliographic references from retrieved articles of randomised controlled trials (RCTs) and non-RCTs from 1985 to April 2010. Inclusion criteria were initial short stature (defined as height >2 standard deviation[SD] below the mean), peak growth hormone responses>10 micrograms per litre (μg/L), prepuberty, no previous growth hormone therapy, and no comorbid conditions that would impair growth. Data extracted were adult height and overall gain in height from baseline measurement in childhood.Three RCTs (115 children) met the inclusion criteria.The adult height of the GH treated children exceeded that of the controls by 0.65 SD score (~4 cm). The mean height gain in treated children was 1.2 SD score compared with 0.34 SD score in untreated children. A difference of ~1.2 cm in adult height was observed between two GH dose regimens. In the seven non-RCTs, adult height of the GH-treated group exceeded that of controls by 0.45 SD score (~3 cm).The authors conclude that 1) GH therapy in children with ISS seems effective in partially reducing the deficit in height as adults, although less so than in other conditions for which GH is licensed; treated individuals remain relatively short compared with normal height peers. 2)Individual responses to therapy are highly variable; further studies are needed to identify responders. 3) High quality evidence from long-term RCTs of GH therapy that continue until adult height is necessary to determine the ideal dosage and long-term safety.

Changes in sodium levels in chain restaurant foods in Canada (2010−2013): a longitudinal study

PubMed Central

Scourboutakos, Mary J.

2014-01-01

Background Several restaurant chains have committed to reducing sodium levels in their foods; however, how much sodium levels have changed over the past few years is unknown. The objective was to measure changes in sodium in restaurant foods from 2010 to 2013. Methods Data for the serving size, calorie and sodium level of 3878 foods were collected from the websites of 61 Canadian restaurant chains in 2010 and 2013. A longitudinal study of changes in sodium levels in foods available from the restaurants in 2010 and 2013 (n = 2198) was conducted. Levels in newly reported and discontinued foods were also investigated. Results Sodium levels (mg/serving) decreased in 30.1% of foods, increased in 16.3% and were unchanged in 53.6%. The average change in foods with a decrease in sodium was –220 (standard deviation [SD] ± 303) mg/serving (a decline of 19% [SD ± 17%]), whereas the average change in foods with an increase in sodium was 251 (SD ± 349) mg/serving (a 44% [SD ± 104%] increase). The prevalence and magnitude of change varied depending on the restaurant and food category. Overall, there was a small, yet significant, decrease in sodium per serving (–25 [SD ± 268] mg, p < 0.001); however, the percentage of foods exceeding the daily sodium adequate intake (1500 mg) and tolerable upper intake level (2300 mg) remained unchanged. Interpretation The observed increases and decreases in sodium show that industry efforts to voluntarily decrease sodium levels in Canadian restaurant foods have produced inconsistent results. Although the lower levels in some foods show that sodium reduction is possible, the simultaneous increase in other foods demonstrates the need for targets and timelines for sodium reduction in restaurants. PMID:25553327

Quality of Life of Pregnant Women Living with HIV/AIDS.

PubMed

Silveira, Marysabel Pinto Telis; Silveira, Mariângela Freitas; Müller, Cristina Heloisa

2016-05-01

Objective to evaluate the quality of life of HIV positive (HIV+) pregnant women using the HIV/AIDS Target Quality of Life (HAT-QoL) instrument. Methods cross-sectional study, conducted between May 2014 and November 2015, with HIV+ pregnant women selected by convenience sampling. Sociodemographic and behavioral data were collected through interviews, and the HAT-QoL questionnaire was applied. Clinical and laboratorial data were collected from medical records. Results twenty-seven pregnant women participated in the study. Their mean age was 27 years (standard deviation - SD: 7.3). The majority (59%) had up to 8 years of education, 52% identified themselves as white, 56% were unemployed, and 59% had a household income higher than the minimum wage. The mean infection time by the virus was 68.4 months (5.7 years). The majority (74%) were contaminated with HIV through sexual intercourse, and 67% declared not having a HIV+ relative. Regarding the use of condoms, 41% reported using them sporadically, and the same number did not have proper knowledge about them. Only 23 patients (85%) reported having been prescribed antiretrovirals. Fourteen (64%) had a CD4 count higher than 500 cells/mm(3), and 13 pregnant women (59%) had an undetectable viral load. The scores from the quality of life questionnaire dimensions that were more affected are: infection "disclosure concerns" (mean: 39.8; SD: 27.1), followed by "financial concerns" (mean: 49.1; SD: 36), and "HIV acceptance" (mean: 49.1; SD: 35.8). The dimension with the best score was "medication concerns" (mean: 80.8; SD: 26.5). Conclusion quality of life has been increasingly used as a clinical outcome evaluation parameter. The results of this study contribute to the establishment of interventions based on the needs of HIV+ pregnant women. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Sex differences in baroreflex sensitivity, heart rate variability, and end organ damage in the TGR(mRen2)27 rat.

PubMed

Johnson, Megan S; DeMarco, Vincent G; Heesch, Cheryl M; Whaley-Connell, Adam T; Schneider, Rebecca I; Rehmer, Nathan T; Tilmon, Roger D; Ferrario, Carlos M; Sowers, James R

2011-10-01

The aim of this investigation was to evaluate sex differences in baroreflex and heart rate variability (HRV) dysfunction and indexes of end-organ damage in the TG(mRen2)27 (Ren2) rat, a model of renin overexpression and tissue renin-angiotensin-aldosterone system overactivation. Blood pressure (via telemetric monitoring), blood pressure variability [BPV; SD of systolic blood pressure (SBP)], spontaneous baroreflex sensitivity, HRV [HRV Triangular Index (HRV-TI), standard deviation of the average NN interval (SDNN), low and high frequency power (LF and HF, respectively), and Poincaré plot analysis (SD1, SD2)], and cardiovascular function (pressure-volume loop analysis and proteinuria) were evaluated in male and female 10-wk-old Ren2 and Sprague Dawley rats. The severity of hypertension was greater in Ren2 males (R2-M) than in Ren2 females (R2-F). Increased BPV, suppression of baroreflex gain, decreased HRV, and associated end-organ damage manifested as cardiac dysfunction, myocardial remodeling, elevated proteinuria, and tissue oxidative stress were more pronounced in R2-M compared with R2-F. During the dark cycle, HRV-TI and SDNN were negatively correlated with SBP within R2-M and positively correlated within R2-F; within R2-M, these indexes were also negatively correlated with end-organ damage [left ventricular hypertrophy (LVH)]. Furthermore, within R2-M only, LVH was strongly correlated with indexes of HRV representing predominantly vagal (HF, SD1), but not sympathetic (LF, SD2), variability. These data demonstrated relative protection in females from autonomic dysfunction and end-organ damage associated with elevated blood pressure in the Ren2 model of hypertension.

The effect of boundary shape and minima selection on single limb stance postural stability.

PubMed

Cobb, Stephen C; Joshi, Mukta N; Bazett-Jones, David M; Earl-Boehm, Jennifer E

2012-11-01

The effect of time-to-boundary minima selection and stability limit definition was investigated during eyes open and eyes closed condition single-limb stance postural stability. Anteroposterior and mediolateral time-to-boundary were computed using the mean and standard deviation (SD) of all time-to-boundary minima during a trial, and the mean and SD of only the 10 absolute time-to-boundary minima. Time-to-boundary with rectangular, trapezoidal, and multisegmented polygon defined stability limits were also calculated. Spearman's rank correlation coefficient test results revealed significant medium-large correlations between anteroposterior and mediolateral time-to-boundary scores calculated using both the mean and SD of the 10 absolute time-to-boundary minima and of all the time-to-boundary minima. Friedman test results revealed significant mediolateral time-to-boundary differences between boundary shape definitions. Follow-up Wilcoxon signed rank test results revealed significant differences between the rectangular boundary shape and both the trapezoidal and multisegmented polygon shapes during the eyes open and eyes closed conditions when both the mean and the SD of the time-to-boundary minima were used to represent postural stability. Significant differences were also revealed between the trapezoidal and multisegmented polygon definitions during the eyes open condition when the SD of the time-to-boundary minima was used to represent postural stability. Based on these findings, the overall results (i.e., stable versus unstable participants or groups) of studies computing postural stability using different minima selection can be compared. With respect to boundary shape, the trapezoid or multisegmented polygon shapes may be more appropriate than the rectangular shape as they more closely represent the anatomical shape of the stance foot.

Separating the Wheat From the Chaff: An Evaluation of Readability, Quality, and Accuracy of Online Health Information for Treatment of Peyronie Disease.

PubMed

Bompastore, Nicholas J; Cisu, Theodore; Holoch, Peter

2018-04-30

To characterize available information about Peyronie disease online and evaluate its readability, quality, accuracy, and respective associations with HONcode certification and website category. The search term "Peyronie disease" was queried on 3 major search engines (Google, Bing, and Yahoo) and the first 50 search results on each search engine were assessed. All websites were categorized as institutional or reference, commercial, charitable, personal or patient support, or alternative medicine, and cross-referenced with the Health on the Net (HON) Foundation. Websites that met the inclusion criteria were analyzed for readability using 3 validated algorithms, for quality using the DISCERN instrument, and for accuracy by a fellowship-trained urologist. On average, online health information about treatment of Peyronie disease is written at or above the 11th grade level, exceeding the current reading guidelines of 6th-8th grade. The mean total DISCERN score for all website categories was 50.44 (standard deviation [SD] 11.94), the upper range of "fair" quality. The mean accuracy score of all online Peyronie treatment information was 2.76 (SD 1.23), corresponding to only 25%-50% accurate information. Both institutional or reference and HONcode-certified websites were of "good" quality (53.44, SD 11.64 and 60.86, SD 8.74, respectively). Institutional or reference websites were 50%-75% accurate (3.13, SD 1.20). Most of the online Peyronie disease treatment information is of mediocre quality and accuracy. The information from institutional or reference websites is of better quality and accuracy, and the information from HONcode-certified websites is of better quality. The mean readability of all websites exceeds the reading ability of most US adults by several grade levels. Copyright © 2018 Elsevier Inc. All rights reserved.

Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women: A randomized controlled trial.

PubMed

Haakstad, Lene A H; Bø, Kari

2015-03-01

To determine whether participation in a group fitness class for pregnant women can prevent and treat pelvic girdle pain and low back pain. An observer-blinded randomized controlled trial. A total of 105 sedentary, nulliparous pregnant women, mean age 30.7 years (standard deviation (SD) 4.0), mean pre-pregnancy body mass index (BMI) 23.8 (SD 4.3), were assigned to either control or exercise groups at mean gestation week 17.7 (SD 4.2). The exercise intervention followed the guidelines of American College of Obstetricians and Gynecologists and included a 60 min general fitness class, with 40 min of endurance training and 20 min of strength training including stretching, performed at least twice per week for a minimum of 12 weeks. Outcome measures were number of women reporting pelvic girdle pain and low back pain after the intervention (mean pregnancy week 36.6 (SD 0.9)) and postpartum (mean 7.7 (SD 1.7)). There were no statistically significant differences between the exercisers and controls in numbers reporting the 2 conditions after the intervention (pelvic girdle pain: odds ratio (OR) = 1.34, CI = 0.56-3.20 or low back pain: OR = 1.10, CI = 0.47-2.60) or postpartum (pelvic girdle pain: OR = 0.38, CI = 0.13-1.10 or low back pain: OR = 1.45, CI = 0.54-3.94). A comparison of the women who had attended at least 80% of the weekly exercise classes with the control participants did not change the results. Participation in regular group fitness classes during pregnancy did not alter the proportion of women reporting pelvic girdle pain or low back pain during pregnancy or after childbirth.

Nonnative Cattle Ownership, Diet, and Child Height-for-Age: Evidence from the 2011 Uganda Demographic and Health Survey

PubMed Central

Fierstein, Jamie L.; Eliasziw, Misha; Rogers, Beatrice Lorge; Forrester, Janet E.

2017-01-01

In underresourced settings where domestic animals and children often cohabitate, there is limited evidence about the net impact of domestic animal ownership on child health. We analyzed the 2011 Uganda Demographic and Health Survey to determine whether household ownership of native cattle, goats, sheep, chickens, pigs, and nonnative cattle was associated with child height-for-age z-scores (HAZ), and to assess the influence of diet on this association in rural and urban environments. Using weighted multivariable linear regression, we found that nonnative cattle ownership was positively associated with HAZ in rural children 0 to < 2 years of age (+1.32 standard deviations [SD], 95% confidence interval [CI] = 0.2–2.5) and 2 to < 5 years of age (+0.58 SD, 95% CI = 0.003–1.2), and urban children 2 to < 5 years of age (+1.08 SD, 95% CI = 0.38–1.8). Sheep ownership was positively associated with HAZ in rural children 2 to < 5 years of age (+0.29 SD, 95% CI = 0.002–0.58) and goat ownership was positively associated with HAZ in rural children 0 to < 2 years of age (+0.27 SD, 95% CI = 0.003–0.55). We observed no other significant associations. Children who lived in households that owned nonnative cattle consumed dairy more frequently; however, the relationship between child HAZ and nonnative cattle ownership was not mediated by child dairy consumption. These findings suggest that domestic animal ownership may not be detrimental to child HAZ, and that nonnative cattle ownership is beneficial for child HAZ through pathways other than dairy consumption. PMID:27821693

Unique features of esophagogastric junction pressure topography in hiatus hernia patients with dysphagia.

PubMed

Pandolfino, John E; Kwiatek, Monika A; Ho, Kim; Scherer, John R; Kahrilas, Peter J

2010-01-01

Our aim was to assess pressure dynamics within the esophagogastric junction (EGJ) in sliding hiatus hernia (HH) during normal peristalsis and to compare the pressure profiles of HH patients with gastroesophageal reflux disease (GERD) symptoms (HH-GERD) to HH patients with dysphagia (HH-dysphagia). High-resolution manometry studies in 230 consecutive patients and 68 controls were reviewed. HH patients were defined by a >or=1.5 cm separation between the lower esophageal sphincter (LES) and crural diaphragm (CD) on pressure topography plots. The HH population was further culled to eliminate those patients with motor disorders or stricture. The study groups were composed of 18 HH patients with only reflux symptoms and 10 HH patients with only dysphagia. Analysis of the pressure dynamics within the EGJ was performed at rest and after swallowing to independently quantify the LES and CD contributions to residual EGJ pressure, as well as the magnitude and genesis of distal esophageal intrabolus pressure (IBP). Differences among study groups were analyzed with analysis of variance. After swallows, HH-dysphagia patients had greater residual CD pressure (9 mmHg; standard deviation [SD], 4) and IBP pressure (19 mmHg; SD, 4) compared to HH-GERD patients (5 mmHg; SD, 2; and 12 mmHg; SD, 2, respectively; P<.001) or normal subjects (NA; 11 mmHg; SD, 3; P<.001). Sliding HH alters the pressure dynamics through the EGJ and can lead to a functional obstruction. Patients with HH and dysphagia have greater pressures through the CD compared to HH patients with GERD symptoms, supporting the hypothesis that sliding HH in and of itself may be responsible for dysphagia. Copyright (c) 2010 Mosby, Inc. All rights reserved.

The relationship between adiposity-associated inflammation and coronary artery and abdominal aortic calcium differs by strata of central adiposity: The Multi-Ethnic Study of Atherosclerosis (MESA).

PubMed

Hughes-Austin, Jan M; Wassel, Christina L; Jiménez, Jessica; Criqui, Michael H; Ix, Joachim H; Rasmussen-Torvik, Laura J; Budoff, Matthew J; Jenny, Nancy S; Allison, Matthew A

2014-08-01

Adipokines regulate metabolic processes linked to coronary artery (CAC) and abdominal aorta calcification (AAC). Because adipokine and other adiposity-associated inflammatory marker (AAIM) secretions differ between visceral and subcutaneous adipose tissue, we hypothesized that central adiposity modifies associations between AAIMs and CAC and AAC. We evaluated 1878 MESA participants with complete measures of AAIMs, anthropometry, CAC, and AAC. Associations of AAIMs with CAC and AAC prevalence and severity were analyzed per standard deviation of predictors (SD) using log binomial and linear regression models. The waist-to-hip ratio (WHR) was dichotomized at median WHR values based on sex/ethnicity. CAC and AAC prevalence were defined as any calcium (Agatston score >0). Severity was defined as ln (Agatston score). Analyses examined interactions with WHR and were adjusted for traditional cardiovascular disease risk factors. Each SD higher interleukin-6 (IL-6), fibrinogen and CRP was associated with 5% higher CAC prevalence; and each SD higher IL-6 and fibrinogen was associated with 4% higher AAC prevalence. Associations of IL-6 and fibrinogen with CAC severity, but not CAC prevalence, were significantly different among WHR strata. Median-and-above WHR: each SD higher IL-6 was associated with 24.8% higher CAC severity. Below-median WHR: no association (p interaction =0.012). Median-and-above WHR: each SD higher fibrinogen was associated with 19.6% higher CAC severity. Below-median WHR: no association (p interaction =0.034). Adiponectin, leptin, resistin, and tumor necrosis factor-alpha were not associated with CAC or AAC prevalence or severity. These results support findings that adiposity-associated inflammation is associated with arterial calcification, and further add that central adiposity may modify this association. © The Author(s) 2014.

Farmers’ Cohort for Agricultural Work-Related Musculoskeletal Disorders (FARM) Study: Study Design, Methods, and Baseline Characteristics of Enrolled Subjects

PubMed Central

Jo, Hannae; Baek, Sora; Park, Hee-won; Lee, Sang-Ah; Moon, Jiyoung; Yang, Jae E.; Kim, Ki Sung; Kim, Jee Yong; Kang, Eun Kyoung

2016-01-01

Background The ongoing Farmers’ Cohort for Agricultural Work-related Musculoskeletal Disorders (FARM) study was developed to evaluate health status and related factors in farmers. Methods Farmers in Kangwon Province, South Korea, were recruited. Baseline characteristics were determined using questionnaires about sociodemographic and health characteristics and agricultural work-related factors. In addition, laboratory examinations (lumbar spinal radiography and serologic testing) were conducted. Results The FARM study covers eight rural areas and recruited 1013 subjects (534 women; mean [standard deviation {SD}] age, 57.2 [7.5] years). Musculoskeletal pain in multiple areas was reported by 925 subjects (91.3%), and low back pain (63.8%) was the most frequent site of pain. Farmer’s Stress Inventory (mean [SD], 77.7 [10.2]; range, 28–112] and subjective stress index (mean [SD], 5.3 [2.4]; range, 0–10) were above median scale values, reflecting a stressful condition, while the EuroQol-5D-3L index and the EuroQol-Visual Analog Scale scores were high (mean [SD], 0.9 [0.1]; range −0.171–1 and mean [SD], 67.7 [18.7]; range 0–100, respectively), reflecting good life quality. In total, 53% of participants had worked in farming for more than 30 years, and workers involved in dry-field farming comprised the largest subgroup (41.5%). Most participants (94.3%) had no more than a high school education, and families with annual income below 20 million won constituted the largest subgroup (36.3%). Conclusions The FARM study may provide data on the current health status and related sociodemographic and agricultural work-related risk factors in Korean farmers, with the goal of providing a scientific basis for developing coping interventions and preventive strategies. PMID:26235456

Spiritual coping of older people in Malta and Australia (part 1).

PubMed

Baldacchino, Donia R; Bonello, Lilian; Debattista, Clifford J

This descriptive sequential explanatory study, which forms part of a larger study, investigated the use of spiritual coping strategies by three cohort groups of Maltese older residents in three phases. The theoretical model of causal pathway for mental health based on monotheistic religions (Christianity, Judaism, and Islam) guided the study. Participants were recruited from four private homes: two in Australia (n=30), two in Malta (n=43) and two state residences also in Malta (n=64). The residents (n=137; men n=103, women n=34), mean (M) age 72.8 years, were all Roman Catholics, mobile and with a minimum residence of 6 months. The quantitative data (phase I) were collected by the Maltese version of the Spiritual Coping Strategies scale ( Baldacchino and Buhagiar, 2003 ). The qualitative findings in phase II derived from the face-to-face interviews and focus groups explain the use of spiritual coping strategies and how they contributed toward coping with institutionalisation. Significant differences were found in spiritual coping (F=11.434; p=0.001; degree of freedom (df)=2) whereby the cohort in Australia scored the highest scores in the total spiritual coping (M=48.60; standard deviation (SD)=6.251), religious coping (M=23.47; SD=2.145) and existential coping (M=25.13; SD=6.033). No significant differences were found in the total spiritual coping between subgroups of mobility and demographic characteristics except by gender (Student's t-test (t)=2.455; p=0.015) whereby women (M=22.09; SD=4.325) scored higher than the men (M=19.67; SD=4.508). Australian private homes reported the highest (significant) mean scores in total spiritual coping, religious coping and existential coping. Recommendations were set for clinical practice and management, nursing education, and further research.

Implementation of Neurocritical Care Is Associated With Improved Outcomes in Traumatic Brain Injury.

PubMed

Sekhon, Mypinder S; Gooderham, Peter; Toyota, Brian; Kherzi, Navid; Hu, Vivien; Dhingra, Vinay K; Hameed, Morad S; Chittock, Dean R; Griesdale, Donald E

2017-07-01

Background Traditionally, the delivery of dedicated neurocritical care (NCC) occurs in distinct NCC units and is associated with improved outcomes. Institution-specific logistical challenges pose barriers to the development of distinct NCC units; therefore, we developed a consultancy NCC service coupled with the implementation of invasive multimodal neuromonitoring, within a medical-surgical intensive care unit. Our objective was to evaluate the effect of a consultancy NCC program on neurologic outcomes in severe traumatic brain injury patients. We conducted a single-center quasi-experimental uncontrolled pre- and post-NCC study in severe traumatic brain injury patients (Glasgow Coma Scale ≤8). The NCC program includes consultation with a neurointensivist and neurosurgeon and multimodal neuromonitoring. Demographic, injury severity metrics, neurophysiologic data, and therapeutic interventions were collected. Glasgow Outcome Scale (GOS) at 6 months was the primary outcome. Multivariable ordinal logistic regression was used to model the association between NCC implementation and GOS at 6 months. A total of 113 patients were identified: 76 pre-NCC and 37 post-NCC. Mean age was 39 years (standard deviation [SD], 2) and 87 of 113 (77%) patients were male. Median admission motor score was 3 (interquartile ratio, 1-4). Daily mean arterial pressure was higher (95 mmHg [SD, 10]) versus (88 mmHg [SD, 10], p<0.001) and daily mean core body temperature was lower (36.6°C [SD, 0.90]) versus (37.2°C [SD, 1.0], p=0.001) post-NCC compared with pre-NCC, respectively. Multivariable regression modelling revealed the NCC program was associated with a 2.5 increased odds (odds ratios, 2.5; 95% confidence interval, 1.1-5.3; p=0.022) of improved 6-month GOS. Implementation of a NCC program is associated with improved 6 month GOS in severe TBI patients.

Dental Age Estimation (DAE): Data management for tooth development stages including the third molar. Appropriate censoring of Stage H, the final stage of tooth development.

PubMed

Roberts, Graham J; McDonald, Fraser; Andiappan, Manoharan; Lucas, Victoria S

2015-11-01

The final stage of dental development of third molars is usually helpful to indicate whether or not a subject is aged over 18 years. A complexity is that the final stage of development is unlimited in its upper border. Investigators usually select an inappropriate upper age limit or censor point for this tooth development stage. The literature was searched for appropriate data sets for dental age estimation and those that provided the count (n), the mean (x¯), and the standard deviation (sd) for each of the tooth development stages. The Demirjian G and Demirjian H were used for this study. Upper and lower limits of the Stage G and Stage H data were calculated limiting the data to plus or minus three standard deviations from the mean. The upper border of Stage H was limited by appropriate censoring at the maximum value for Stage G. The maximum age at attainment from published data, for Stage H, ranged from 22.60 years to 34.50 years. These data were explored to demonstrate how censoring provides an estimate for the correct maximum age for the final stage of Stage H as 21.64 years for UK Caucasians. This study shows that confining the data array of individual tooth developments stages to ± 3sd provides a reliable and logical way of censoring the data for tooth development stages with a Normal distribution of data. For Stage H this is inappropriate as it is unbounded in its upper limit. The use of a censored data array for Stage H using Percentile values is appropriate. This increases the reliability of using third molar Stage H alone to determine whether or not an individual is over 18 years old. For Stage H, individual ancestral groups should be censored using the same technique. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Variability in developmental timings of the knee in young American children as assessed through Pyle and Hoerr's radiographic atlas.

PubMed

Schaefer, Maureen; Hackman, Lucina; Gallagher, John

2016-03-01

This study examines the accuracy of the Pyle and Hoerr radiographic atlas technique in an effort to document the extent of normal variation associated with developmental timings in the knee for purposes of age estimation. The atlas has been previously tested; however, accuracy rates were produced from a dataset, which spread in age from mostly 7-16 years. This study took a closer look at the younger age groups, examining radiographs from 297 children (147 female and 150 male) from birth to 6 years. Standard deviations representing the difference between the skeletal and chronological age were calculated according to two groupings. Each group represents episodes, or time periods, of differential developmental rates as expressed through the number of plates within the atlas dedicated to documenting each year of life. The beginning year of life is characterized by the most rapid of development as represented by the numerous image plates used to depict this time period. Individuals assigned to plates with a skeletal age between birth and 1 year were grouped collectively to document the variation associated with such rapidly changing morphology (SD = 2.5 months in female children; 2.3 months in male children). Years 1-3.8 years (female) and 1-4.5 years (male) were represented by two or three images within the atlas, and therefore, individuals assigned to plates with a skeletal age falling within this range were placed within a second grouping (SD = 5.2 months in female children; 7.0 months in male children). As expected, variation was observed to decrease as developmental processes accelerated in the younger children. The newly calculated standard deviations offer tighter predictions for estimating age in young children while at the same time maintaining an acceptable width that accounts for normal variation in developmental timings.

Predicting Accommodative Response Using Paraxial Schematic Eye Models

PubMed Central

Ramasubramanian, Viswanathan; Glasser, Adrian

2016-01-01

Purpose Prior ultrasound biomicroscopy (UBM) studies showed that accommodative optical response (AOR) can be predicted from accommodative biometric changes in a young and a pre-presbyopic population from linear relationships between accommodative optical and biometric changes, with a standard deviation of less than 0.55D. Here, paraxial schematic eyes (SE) were constructed from measured accommodative ocular biometry parameters to see if predictions are improved. Methods Measured ocular biometry (OCT, A-scan and UBM) parameters from 24 young and 24 pre-presbyopic subjects were used to construct paraxial SEs for each individual subject (individual SEs) for three different lens equivalent refractive index methods. Refraction and AOR calculated from the individual SEs were compared with Grand Seiko (GS) autorefractor measured refraction and AOR. Refraction and AOR were also calculated from individual SEs constructed using the average population accommodative change in UBM measured parameters (average SEs). Results Schematic eye calculated and GS measured AOR were linearly related (young subjects: slope = 0.77; r2 = 0.86; pre-presbyopic subjects: slope = 0.64; r2 = 0.55). The mean difference in AOR (GS - individual SEs) for the young subjects was −0.27D and for the pre-presbyopic subjects was 0.33D. For individual SEs, the mean ± SD of the absolute differences in AOR between the GS and SEs was 0.50 ± 0.39D for the young subjects and 0.50 ± 0.37D for the pre-presbyopic subjects. For average SEs, the mean ± SD of the absolute differences in AOR between the GS and the SEs was 0.77 ± 0.88D for the young subjects and 0.51 ± 0.49D for the pre-presbyopic subjects. Conclusions Individual paraxial SEs predict AOR, on average, with a standard deviation of 0.50D in young and pre-presbyopic subject populations. Although this prediction is only marginally better than from individual linear regressions, it does consider all the ocular biometric parameters. PMID:27092928

Airborne Evaluation and Demonstration of a Time-Based Airborne Inter-Arrival Spacing Tool

NASA Technical Reports Server (NTRS)

Lohr, Gary W.; Oseguera-Lohr, Rosa M.; Abbott, Terence S.; Capron, William R.; Howell, Charles T.

2005-01-01

An airborne tool has been developed that allows an aircraft to obtain a precise inter-arrival time-based spacing interval from the preceding aircraft. The Advanced Terminal Area Approach Spacing (ATAAS) tool uses Automatic Dependent Surveillance-Broadcast (ADS-B) data to compute speed commands for the ATAAS-equipped aircraft to obtain this inter-arrival spacing behind another aircraft. The tool was evaluated in an operational environment at the Chicago O'Hare International Airport and in the surrounding terminal area with three participating aircraft flying fixed route area navigation (RNAV) paths and vector scenarios. Both manual and autothrottle speed management were included in the scenarios to demonstrate the ability to use ATAAS with either method of speed management. The results on the overall delivery precision of the tool, based on a target spacing of 90 seconds, were a mean of 90.8 seconds with a standard deviation of 7.7 seconds. The results for the RNAV and vector cases were, respectively, M=89.3, SD=4.9 and M=91.7, SD=9.0.

ELF-MF Occupational Exposure in Die-casting and Electroplating Workers in Korea.

PubMed

Rajitha Kawshalya, Mailan Arachchige Don; Jung, Joon-Sig; Lee, Yun-Jin; Hong, Seung-Cheol

2018-04-26

A 24-h exposure assessment was performed in two groups of blue-collar workers from a die-casting and an electroplating plant to investigate levels of exposure to extremely low-frequency magnetic fields (ELF-MF), using EMDEX Lite. ELF-MF exposure of workers from the die-casting plant AM±SD (AM=arithmetic mean, SD=standard deviation) (0.649±1.343µT)] is higher than in electroplating workers (0.138±0.045µT). Higher ELF-MF exposure was found among workers living in same building as their workplace compared to that among other workers. This study suggests that ELF-MF exposure levels should be taken into consideration when providing dormitories for workers to minimize the levels of residential ELF-MF exposure due to emission from plants. The study recommends that blue-collar workers should be made aware of measures to minimize their exposure to environmental agents such as ELF-MF and electromagnetic field (EMF) during work, such as maintaining a safe distance between machines and avoiding undesirable behavior with equipment.

Perceived physical appearance and life satisfaction: a moderated mediation model of self-esteem and life experience of deaf and hearing adolescents.

PubMed

Lu, Aitao; Hong, Xiuxiu; Yu, Yanping; Ling, Hong; Tian, Haiping; Yu, Zuwei; Chang, Lei

2015-02-01

In this study, we investigated the relationship between perceived physical appearance and life satisfaction, and the role of self-esteem as mediator and life experience as moderator of the relationship in deaf and hearing adolescents. 118 Chinese deaf adolescents (55.1% male; mean age = 15.12 years, standard deviation [SD] = 2.13) from 5 special education schools and 132 Chinese hearing adolescents (53.8% male; mean age = 13.11 years, SD = .85) completed anonymous questionnaires regarding perceived physical appearance, self-esteem, and life satisfaction. Perceived physical appearance, self-esteem, and life satisfaction were significantly and positively associated with each other. Moreover, self-esteem partially mediated the relationship between perceived physical appearance and life satisfaction; however, this indirect link was weaker for deaf adolescents than it was for hearing adolescents. Implications of the findings and future research directions are discussed, as are potential interventions that can be applied to increase subjective well-being in deaf adolescents. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

[Nutritional status and risk in hospitalized children].

PubMed

Hankard, R; Bloch, J; Martin, P; Randrianasolo, H; Bannier, M F; Machinot, S; Cézard, J P

2001-11-01

A few studies report malnutrition in hospitalized patients. This one-day cross-sectional survey performed in January 1999 assessed nutritional status and protein-energy intake in a pediatric population hospitalized in medicine or surgery units. Every child older than six months, hospitalized for more than 48 h and free of nutritional support (parenteral, enteral, or special regimens for metabolic diseases) was included. Fifty-eight children among the 183 present the day of the study met the inclusion criteria and were included in the statistical analysis. They were hospitalized in medicine (48%), psychiatry (31%) and surgery (21%). The body mass index (BMI) was below -2 standard deviations (DS) in 21% of them. Excluding patients with anorexia nervosa, BMI was < -2 SD, > +2 SD, or in between these limits in respectively 12, 14 and 74%. Energy intake measured at the hospital was below 75% of the recommended dietary allowances in two-thirds of the children whether malnourished or not. Fifty percent of the malnourished children had been referred to a dietician the day of the study. Malnutrition is frequent in a population of hospitalized children. Energy intake and referral to a dietician are insufficient.

Is a Perceived Activity-Friendly Environment Associated with More Physical Activity and Fewer Screen-Based Activities in Adolescents?

PubMed

Kopcakova, Jaroslava; Dankulincova Veselska, Zuzana; Madarasova Geckova, Andrea; Bucksch, Jens; Nalecz, Hanna; Sigmundova, Dagmar; van Dijk, Jitse P; Reijneveld, Sijmen A

2017-01-03

Background: The aim of this study is to explore if perception of an activity-friendly environment is associated with more physical activity and fewer screen-based activities among adolescents. Methods: We collected self-reported data in 2014 via the Health Behavior in School-aged Children cross-sectional study from four European countries ( n = 13,800, mean age = 14.4, 49.4% boys). We explored the association of perceived environment (e.g., "There are other children nearby home to go out and play with") with physical activity and screen-based activities using a binary logistic regression model adjusted for age, gender, family affluence and country. Results: An environment perceived as activity-friendly was associated with higher odds that adolescents meet recommendations for physical activity (odds ratio (OR) for one standard deviation (SD) change = 1.11, 95% confidence interval (CI) 1.05-1.18) and lower odds for excessive screen-based activities (OR for 1 SD better = 0.93, 95% CI 0.88-0.98). Conclusions: Investment into an activity-friendly environment may support the promotion of active life styles in adolescence.

Smart device-based testing for medical students in Korea: satisfaction, convenience, and advantages.

PubMed

Lim, Eun Young; Yim, Mi Kyoung; Huh, Sun

2017-01-01

The aim of this study was to investigate respondents' satisfaction with smart device-based testing (SBT), as well as its convenience and advantages, in order to improve its implementation. The survey was conducted among 108 junior medical students at Kyungpook National University School of Medicine, Korea, who took a practice licensing examination using SBT in September 2015. The survey contained 28 items scored using a 5-point Likert scale. The items were divided into the following three categories: satisfaction with SBT administration, convenience of SBT features, and advantages of SBT compared to paper-and-pencil testing or computer-based testing. The reliability of the survey was 0.95. Of the three categories, the convenience of the SBT features received the highest mean (M) score (M= 3.75, standard deviation [SD]= 0.69), while the category of satisfaction with SBT received the lowest (M= 3.13, SD= 1.07). No statistically significant differences across these categories with respect to sex, age, or experience were observed. These results indicate that SBT was practical and effective to take and to administer.

Ability to Pay for Future National Health Financing Scheme among Malaysian Households.

PubMed

Aizuddin, Azimatun Noor; Aljunid, Syed Mohamed

Malaysia is no exception to the challenging health care financing phenomenon of globalization. The objective of the present study was to assess the ability to pay among Malaysian households as preparation for a future national health financing scheme. This was a cross-sectional study involving representative samples of 774 households in Peninsular Malaysia. A majority of households were found to have the ability to pay for their health care. Household expenditure on health care per month was between MYR1 and MYR2000 with a mean (standard deviation [SD]) of 73.54 (142.66), or in a percentage of per-month income between 0.05% and 50% with mean (SD) 2.74 (5.20). The final analysis indicated that ability to pay was significantly higher among younger and higher-income households. Sociodemographic and socioeconomic statuses are important eligibility factors to be considered in planning the proposed national health care financing scheme to shield the needed group from catastrophic health expenditures. Copyright © 2017 Icahn School of Medicine at Mount Sinai. Published by Elsevier Inc. All rights reserved.

Sex differences in the association of childhood socioeconomic status with adult blood pressure change: the CARDIA study.

PubMed

Janicki-Deverts, Denise; Cohen, Sheldon; Matthews, Karen A; Jacobs, David R

2012-09-01

To examine sex differences in the relation of childhood socioeconomic status (CSES) to systolic (SBP) and diastolic blood pressure (DBP) trajectories during 15 years, spanning young (mean [M] [standard deviation {SD}] = 30 [3] years) and middle (M [SD] = 45 [3] years) adulthood, independent of adult SES. A total of 4077 adult participants reported father's and mother's educational attainments at study enrollment (Year 0) and own educational attainment at enrollment and at all follow-up examinations. Resting BP also was measured at all examinations. Data from examination Years 5 (when participant M [SD] age = 30 [3] years), 7, 10, 15, and 20 are examined here. Associations of own adult (Year 5), mother's, and father's educations with 15-year BP trajectories were examined in separate multilevel models. Fully controlled models included time-invariant covariates (age, sex, race, recruitment center) and time-varying covariates that were measured at each examination (marital status, body mass, cholesterol, oral contraceptives/hormones, and antihypertensive drugs). Analyses of parental education controlled for own education. When examined without covariates, higher education - own (SBP γ = -0.03, DBP γ = -0.03), mother's (SBP γ = -0.02, DBP γ = -0.02), and father's (SBP γ = -0.02, DBP γ = -0.01) - were associated with attenuated 15-year increases in BP (p < .001). Associations of own (but not either parent's) education with BP trajectories remained independent of standard controls. Sex moderated the apparent null effects of parental education, such that higher parental education-especially mother's, predicted attenuated BP trajectories independent of standard covariates among women (SBP γ = -0.02, p = .02; DBP γ = -0.01, p = .04) but not men (SBP γ = 0.02, p = .06; DBP γ = 0.005, p = .47; p interaction SBP < .001, p interaction DBP = .01). Childhood socioeconomic status may influence women's health independent of their own adult status.

ExacTrac Snap Verification: A New Tool for Ensuring Quality Control for Lung Stereotactic Body Radiation Therapy

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

Udrescu, Corina; Mornex, Francoise, E-mail: francoise.mornex@chu-lyon.fr; Tanguy, Ronan

2013-01-01

Purpose: The intrafraction verification provided by ExacTrac X-ray 6D Snap Verification (ET-SV) allows the tracking of potential isocenter displacements throughout patient position and treatment. The aims of this study were (1) to measure the intrafraction variations of the isocenter position (random errors); (2) to study the amplitude of the variation related to the fraction duration; and (3) to assess the impact of the table movement on positioning uncertainties. Methods and Materials: ET-SV uses images acquired before or during treatment delivery or both to detect isocenter displacement. Twenty patients treated with stereotactic body radiation therapy (SBRT) for lung tumors underwent SVmore » before or during each beam. Noncoplanar beams were sometimes necessary. The time between the setup of the patient and each SV was noted, and values of deviations were compiled for 3 SV time groups: SV performed at {<=}10 min (group 1), between 11 and 20 min (group 2), and {>=}21 min (group 3). Random errors in positioning during the use of noncoplanar fields were noted. Results: The mean isocenter deviation {+-}SD was 2 {+-} 0.5 mm (range, 1-8 mm). The average deviations {+-}SD increased significantly from 1.6 {+-} 0.5 mm to 2.1 {+-} 0.8 mm and 2.2 {+-} 0.6 mm for groups 1, 2, and 3 (P=.002), respectively. Percentages of deviation {>=}3 mm were 7.06%, 22.83%, and 28.07% and 1.08%, 4.15%, and 8.4% for {>=}5 mm (P<.0001). For 11 patients, table rotation was necessary. The mean isocenter deviation {+-}SD increased significantly from 1.9 {+-} 0.5 mm before table rotation to 2.7 {+-} 0.5 mm (P=.001) for the first beam treated after rotation. Conclusions: SV detects isocenter deviations, which increase in amplitude and frequency with the fraction duration, and enables intrafraction verification for SBRT (taking into account clinical condition and technical issues). SV gives accurate targeting at any time during irradiation and may raise confidence to escalate the dose. SV appears to be an important tool for ensuring the quality control of SBRT.« less

Promoting Mental Health Resource Use on Campus by "Trying Something New".

PubMed

Champlin, Sara; Nisbett, Gwendelyn

2018-05-01

To design and test a persuasive health promotion campaign that aligns with the qualities of trying something new for the first time. Given that a majority of students have not previously sought/considered professional mental health assistance before, the hypothesis tested in this study asked whether a campaign that takes this into account is effective with this audience. Participants viewed an online informational message (n = 84), information message plus first-time experience banner (n = 99), or 1 of 4 full campaigns, each depicting a student story and photo about a first-time experience (moving from home [n = 48], skydiving [n = 52], acting in a play [n = 48], and exercising with personal trainer [n = 48]). Visual poster items: appeal (visually pleasing, 7 items, α = .92), support (value of poster, 5 items, α = .86) and behavioral intention items: engagement (participant seek help/pay attention, 3 items, α = .86), relevance (content as relevant, 3 items, α = .84), and judgment (judgment of others for not seeking help, 2 items, α = .87). College students (N = 380). In comparison to information-only messages, framing mental health help seeking as a first-time experience was linked with increased appeal, support, and engagement (M informationonly = 2.79 [standard deviation, SD = 1.34], M informationplusbanner = 3.25 [SD = 1.23], M fullcampaign = 4.07 [SD = 1.28], P < .001, M informationonly = 4.38 [SD = 1.47], M informationplusbanner = 4.92 [SD = 1.21], M fullcampaign = 4.57 [SD = 1.26], P = .014, and M informationonly = 3.13 [SD = 1.76], M informationplusbanner = 3.56 [SD = 1.48], M fullcampaign = 4.02 [SD = 1.42], P < .001, respectively). As anticipated, the full campaign garnered the highest affect and engagement scores. When comparing the 4 first-time experiences, there were main effects on support and engagement (M train = 5.06 [SD = 1.17], M plane = 4.27 [SD = 1.28], M home = 4.59 [SD = 1.19], M play = 4.38 [SD = 1.29], P = .009 and M train = 4.50 [SD = 1.27], M plane = 3.75 [SD = 1.43], M home = 4.01 [SD = 1.49], M play = 3.84 [SD = 1.39], P = .042, respectively), with the novel experience of "working with a personal trainer" rated highest. Findings from this study have implications for the design of health promotion materials on college campuses. Specifically, campaigns that frame seeking help for mental health as a new experience potentially increase student engagement in this behavior. A key finding from the present study is that a campaign in which this behavior is linked to a familiar form of interpersonal help seeking (personal training) can create receptivity to the stigmatized issue of mental health help seeking.

Do body mass index trajectories affect the risk of type 2 diabetes? A case-control study.

PubMed

Mano, Yoshihiko; Yokomichi, Hiroshi; Suzuki, Kohta; Takahashi, Atsunori; Yoda, Yoshioki; Tsuji, Masahiro; Sato, Miri; Shinohara, Ryoji; Mizorogi, Sonoko; Mochizuki, Mie; Yamagata, Zentaro

2015-07-28

Although obesity is a well-studied risk factor for diabetes, there remains an interest in whether "increasing body mass index (BMI)," "high BMI per se," or both are the actual risk factors for diabetes. The present study aimed to retrospectively compare BMI trajectories of individuals with and without diabetes in a case-control design and to assess whether increasing BMI alone would be a risk factor. Using comprehensive health check-up data measured over ten years, we conducted a case-control study and graphically drew the trajectories of BMIs among diabetic patients and healthy subjects, based on coefficients in fitted linear mixed-effects models. Patient group was matched with healthy control group at the onset of diabetes with an optimal matching method in a 1:10 ratio. Simple fixed-effects models assessed the differences in increasing BMIs over 10 years between patient and control groups. At the time of matching, the mean ages in male patients and controls were 59.3 years [standard deviation (SD) = 9.2] and 57.7 years (SD = 11.2), whereas the mean BMIs were 25.0 kg/m(2) (SD = 3.1) and 25.2 kg/m(2) (SD = 2.9), respectively. In female patients and controls, the mean ages were 61.4 years (SD = 7.9) and 60.1 years (SD = 9.6), whereas the mean BMIs were 24.8 kg/m(2) (SD = 3.5) and 24.9 kg/m(2) (SD = 3.4), respectively. The simple fixed-effects models detected no statistical significance for the differences of increasing BMIs between patient and control groups in males (P = 0.19) and females (P = 0.67). Sudden increases in BMI were observed in both male and female patients when compared with BMIs 1 year prior to diabetes onset. The present study suggested that the pace of increasing BMIs is similar between Japanese diabetic patients and healthy individuals. The increasing BMI was not detected to independently affect the onset of type 2 diabetes.

Reverse shoulder arthroplasty for the treatment of acute complex proximal humeral fractures: Influence of greater tuberosity healing on the functional outcomes.

PubMed

Torrens, Carlos; Alentorn-Geli, Eduard; Mingo, Felipe; Gamba, Carlo; Santana, Fernando

2018-01-01

To investigate the influence of greater tuberosity healing on the functional outcomes of reverse shoulder arthroplasty (RSA) for the treatment of acute complex proximal humeral fractures (PHFs), and to investigate the influence of patient- and surgery-related factors in the healing of the greater tuberosity. Retrospective study including 41 consecutive PHFs treated using RSA with minimum 2-year follow-up. In all the cases, tuberosities were reattached with a standardized technique. All the patients were assessed at the last follow-up with constant score. Body mass index, surgery delay, comorbidities, polyethylene size, glenosphere size, overhanging of glenosphere, and scapular notch were recorded, and their influence in final constant score and in greater tuberosity healing was analyzed. Mean final constant score was of 60.7 points (standard deviation (SD) = 9.9). Greater tuberosity healed in proper position in 68% of the cases. There were no significant differences in constant score between patients with (mean = 61; SD = 9.5) and without (mean = 61; SD = 11.3) the healing of greater tuberosity. All patients scored above 90° in forward elevation. Scapular notch was reported in 14.6% of the cases. Age significantly affected the constant score ( p = 0.008). Comorbidities significantly interfered with greater tuberosity healing ( p = 0.03). There was one reoperation after dislocation. In spite of expecting good functional outcome with low complication rate after RSA for acute PHFs, the influence of greater tuberosity healing on shoulder function could not be demonstrated. The presence of comorbidities, but not age or gender, negatively influenced the healing of the greater tuberosity.

IGFBP-1 and IGF-I as markers for advanced fibrosis in NAFLD - a pilot study.

PubMed

Hagström, Hannes; Stål, Per; Hultcrantz, Rolf; Brismar, Kerstin; Ansurudeen, Ishrath

2017-12-01

Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease globally. Advanced fibrosis (stage 3-4) is the most robust marker for future mortality, but diagnosis requires liver biopsy. Current non-invasive scoring systems aimed to identify advanced fibrosis are imperfect. Insulin-like growth factor I (IGF-I) and its binding protein IGFBP-1 are liver derived proteins, that are involved in various liver disorders. The aim of this study was to examine the possible association between advanced fibrosis and IGF-I and IGFBP-1 in NAFLD. Fasting blood samples were obtained from 52 patients diagnosed with NAFLD by liver biopsy. Total IGF-I and IGFBP-1 concentrations were determined in serum by in-house radio-immuno-assays. IGF-I levels were age-standardized (IGF-SD). A logistic regression model was used to investigate the association of IGF-SD and IGFBP-1 with advanced fibrosis (stage 3-4). Patients with advanced fibrosis (stage 3-4 vs. 0-2) had lower IGF-SD (-1.17 vs. 0.11, p = .01) and higher mean levels of IGFBP-1 (29.9 vs. 18.8 µg/l, p = .02). IGFBP-1 was associated with presence of advanced fibrosis (OR 1.04 per unit increase, 95%CI 1.0-1.07, p = .05), while IGF-1 was negatively associated with advanced fibrosis (OR 0.63 per standard deviation, 95%CI 0.44-0.92, p = .02). This pilot study suggests an association between serum IGFBP-1 and IGF-I levels with advanced fibrosis in NAFLD patients. IGFBP1 and IGF-1 could be of interest as future biomarkers. Similar studies in larger cohorts are needed.

Language, learning, and memory in children with and without single-suture craniosynostosis.

PubMed

Kapp-Simon, Kathleen A; Wallace, Erin; Collett, Brent R; Cradock, Mary Michaeleen; Crerand, Canice E; Speltz, Matthew L

2016-05-01

OBJECTIVE The language and memory functions of children with and without single-suture craniosynostosis (SSC) were compared at school age (mean 7.45 years, standard deviation [SD] 0.54 years). The children in this cohort were originally recruited in infancy and prior to cranial surgery for those with SSC. METHODS Individual evaluations of 179 school-aged children with SSC and 183 controls were conducted (70% of the original cohort) using standardized measures of language, learning, and memory. Parents participated in an interview about specialized education interventions and school progress. Parents and teachers completed questionnaires about language development. RESULTS Children with SSC (cases) obtained lower scores than controls on all measures. The adjusted differences in language, learning, and memory scores were modest, with SD ranging from 0.0 to -0.4 (p values ranged from 0.001 to 0.99). Censored normal regression was used to account for intervention services received prior to the school-age evaluation; this increased case-control differences (SD range 0.1 to -0.5, p value range 0.001 to 0.50). Mean scores for cases in each SSC diagnostic group were lower than those for controls, with the greatest differences observed among children with unilateral coronal craniosynostosis. CONCLUSIONS Children with SSC continue to show poorer performance than controls on language, learning, and memory tasks at early elementary school age, even when controlling for known confounders, although mean differences are small. Multidisciplinary care, including direct psychological assessment, for children with SSC should extend through school age with a specific focus on language and conceptual learning, as these are areas of potential risk. Future research is needed to investigate language, memory, and learning for this population during the middle to high school years.

Patent ductus arteriosus closure using Occlutech® Duct Occluder, experience in Port Elizabeth, South Africa

PubMed Central

Pepeta, Lungile; Greyling, Adele; Nxele, Mahlubandile Fintan; Makrexeni, Zongezile Masonwabe

2017-01-01

Background: Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. Methods: Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. Results: From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1–454 months) and the median weight was 8.5 kg (range 2.5–78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12–100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1–7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. Conclusion: The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients. PMID:28566820

Patent ductus arteriosus closure using Occlutech® Duct Occluder, experience in Port Elizabeth, South Africa.

PubMed

Pepeta, Lungile; Greyling, Adele; Nxele, Mahlubandile Fintan; Makrexeni, Zongezile Masonwabe

2017-01-01

Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1-454 months) and the median weight was 8.5 kg (range 2.5-78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12-100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1-7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients.

Micro-CT evaluation of bone defects: applications to osteolytic bone metastases, bone cysts, and fracture.

PubMed

Buie, Helen R; Bosma, Nick A; Downey, Charlene M; Jirik, Frank R; Boyd, Steven K

2013-11-01

Bone defects can occur in various forms and present challenges to performing a standard micro-CT evaluation of bone quality because most measures are suited to homogeneous structures rather than ones with spatially focal abnormalities. Such defects are commonly associated with pain and fragility. Research involving bone defects requires quantitative approaches to be developed if micro-CT is to be employed. In this study, we demonstrate that measures of inter-microarchitectural bone spacing are sensitive to the presence of focal defects in the proximal tibia of two distinctly different mouse models: a burr-hole model for fracture healing research, and a model of osteolytic bone metastases. In these models, the cortical and trabecular bone compartments were both affected by the defect and were, therefore, evaluated as a single unit to avoid splitting the defects into multiple analysis regions. The burr-hole defect increased mean spacing (Sp) by 27.6%, spacing standard deviation (SpSD) by 113%, and maximum spacing (Spmax) by 72.8%. Regression modeling revealed SpSD (β=0.974, p<0.0001) to be a significant predictor of the defect volume (R(2)=0.949) and Spmax (β=0.712, p<0.0001) and SpSD (β=0.271, p=0.022) to be significant predictors of the defect diameter (R(2)=0.954). In the mice with osteolytic bone metastases, spacing parameters followed similar patterns of change as reflected by other imaging technologies, specifically bioluminescence data which is indicative of tumor burden. These data highlight the sensitivity of spacing measurements to bone architectural abnormalities from 3D micro-CT data and provide a tool for quantitative evaluation of defects within a bone. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

7 CFR 400.174 - Notification of deviation from financial standards.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 6 2010-01-01 2010-01-01 false Notification of deviation from financial standards... Agreement-Standards for Approval; Regulations for the 1997 and Subsequent Reinsurance Years § 400.174 Notification of deviation from financial standards. An insurer must immediately advise FCIC if it deviates from...

Degrees of Freedom for Allan Deviation Estimates of Multiple Clocks

DTIC Science & Technology

2016-04-01

Allan deviation . Allan deviation will be represented by σ and standard deviation will be represented by δ. In practice, when the Allan deviation of a...the Allan deviation of standard noise types. Once the number of degrees of freedom is known, an approximate confidence interval can be assigned by...measurement errors from paired difference data. We extend this approach by using the Allan deviation to estimate the error in a frequency standard

Potential for Osseous Regeneration of Platelet-Rich Fibrin-A Comparative Study in Mandibular Third Molar Impaction Sockets.

PubMed

Varghese, Mathew P; Manuel, Suvy; Kumar L K, Surej

2017-07-01

This study investigated the potential of platelet-rich fibrin (PRF) for osseous regeneration and soft tissue healing in mandibular third molar impaction sockets. A prospective in vivo study was performed. Randomization was performed after extraction. On one side, the socket was sutured primarily (control site); on the other side, autologous PRF gel was placed and then the socket was sutured (test site). Postoperatively, grid periapical radiographs were obtained at periodic intervals (weeks 1, 4, and 16) and digitalized. Gray-level values were measured at 3 different regions of the socket (for regions of newly formed bone) compared with the natural bone area using HL Image++ software, and the percentage bone fill was measured. Clinical evaluation of soft tissue healing was performed using the healing index of Landry et al (J Periodontol 60:212, 1994) at the specific intervals. Thirty healthy men and women (age range, 18 to 35 yr) with bilaterally impacted mandibular third molars were enrolled in this study. In general, there was markedly greater bone formation in sockets treated with PRF (P < .05). In the PRF group, the average gray-level values at the cervical, middle, and apical regions were 61.85 (standard deviation [SD], ±25.186), 64.54 (SD, ±24.831), and 67.80 (SD, ±23.946), respectively, with a mean value of 64.73 (SD, ±24.411). In the control group, these values were 51.58 (SD, ±15.286), 54.30 (SD, ±16.274), and 57.53 (SD, ±16.187), respectively, with a mean of 53.67 (SD, ±16.528). The average percentage of bone fill in the PRF group was 57.90 (SD, ±26.789) and that of the non-PRF group was 46.74 (SD, ±17.713; P < .05). Soft tissue healing as evaluated by the healing index of Landry et al also was found to be better at the PRF test site and it was statistically significant (P < .05). There was evidence for better osseous regeneration and soft tissue healing in response to PRF. Further investigations to evaluate the application of PRF in other areas of oral and maxillofacial surgery are imperative. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Interference with work in fibromyalgia - effect of treatment with pregabalin and relation to pain response

PubMed Central

2011-01-01

Background Clinical trials in chronic pain often collect information about interference with work as answers to component questions of commonly used questionnaires but these data are not normally analysed separately. Methods We performed a meta-analysis of individual patient data from four large trials of pregabalin for fibromyalgia lasting 8-14 weeks. We analysed data on interference with work, inferred from answers to component questions of Fibromyalgia Impact Questionnaire (FIQ), Short Form 36 Health Survey, Sheehan Disability Scale, and Multidimensional Assessment of Fatigue, including "How many days in the past week did you miss work, including housework, because of fibromyalgia?" from FIQ. Analyses were performed according to randomised treatment group (pregabalin 150-600 mg daily or placebo), pain improvement (0-10 numerical pain rating scale scores at trial beginning vs. end), and end of trial pain state (100 mm visual analogue pain scale [VAS]). Results Comparing treatment group average outcomes revealed modest improvement over the duration of the trials, more so with active treatment than with placebo. For the 'work missed' question from FIQ the change for patients on placebo was from 2.2 (standard deviation [SD] 2.3) days of work lost per week at trial beginning to 1.9 (SD 2.1) days lost at trial end (p < 0.01). For patients on 600 mg pregabalin the change was from 2.1 (SD 2.2) days to 1.6 (SD 2.0) days (p < 0.001). However, the change in days of work lost was substantial in patients with a good pain response: from 2.0 (SD 2.2) days to 0.97 (SD 1.6) days (p < 0.0001) for those experiencing >/= 50% pain improvement and from 1.9 (SD 2.2) days to 0.73 (SD 1.4) days (p < 0.0001) for those achieving a low level of pain at trial end (<30 mm on the VAS). Patients achieving both >/= 50% pain improvement and a pain score <30 mm on the VAS had the largest improvement, from 2.0 (SD 2.2) days to 0.60 (SD 1.3) days (p < 0.0001). Analysing answers to the other questions yielded qualitatively similar results. Conclusions Effective pain treatment goes along with benefit regarding work. A reduction in time off work >1 day per week can be achieved in patients with good pain responses. PMID:21639874

Interference with work in fibromyalgia: effect of treatment with pregabalin and relation to pain response.

PubMed

Straube, Sebastian; Moore, R Andrew; Paine, Jocelyn; Derry, Sheena; Phillips, Ceri J; Hallier, Ernst; McQuay, Henry J

2011-06-03

Clinical trials in chronic pain often collect information about interference with work as answers to component questions of commonly used questionnaires but these data are not normally analysed separately. We performed a meta-analysis of individual patient data from four large trials of pregabalin for fibromyalgia lasting 8-14 weeks. We analysed data on interference with work, inferred from answers to component questions of Fibromyalgia Impact Questionnaire (FIQ), Short Form 36 Health Survey, Sheehan Disability Scale, and Multidimensional Assessment of Fatigue, including "How many days in the past week did you miss work, including housework, because of fibromyalgia?" from FIQ. Analyses were performed according to randomised treatment group (pregabalin 150-600 mg daily or placebo), pain improvement (0-10 numerical pain rating scale scores at trial beginning vs. end), and end of trial pain state (100 mm visual analogue pain scale [VAS]). Comparing treatment group average outcomes revealed modest improvement over the duration of the trials, more so with active treatment than with placebo. For the 'work missed' question from FIQ the change for patients on placebo was from 2.2 (standard deviation [SD] 2.3) days of work lost per week at trial beginning to 1.9 (SD 2.1) days lost at trial end (p < 0.01). For patients on 600 mg pregabalin the change was from 2.1 (SD 2.2) days to 1.6 (SD 2.0) days (p < 0.001). However, the change in days of work lost was substantial in patients with a good pain response: from 2.0 (SD 2.2) days to 0.97 (SD 1.6) days (p < 0.0001) for those experiencing >/= 50% pain improvement and from 1.9 (SD 2.2) days to 0.73 (SD 1.4) days (p < 0.0001) for those achieving a low level of pain at trial end (<30 mm on the VAS). Patients achieving both >/= 50% pain improvement and a pain score <30 mm on the VAS had the largest improvement, from 2.0 (SD 2.2) days to 0.60 (SD 1.3) days (p < 0.0001). Analysing answers to the other questions yielded qualitatively similar results. Effective pain treatment goes along with benefit regarding work. A reduction in time off work >1 day per week can be achieved in patients with good pain responses.

Interobserver delineation variation in lung tumour stereotactic body radiotherapy

PubMed Central

Persson, G F; Nygaard, D E; Hollensen, C; Munck af Rosenschöld, P; Mouritsen, L S; Due, A K; Berthelsen, A K; Nyman, J; Markova, E; Roed, A P; Roed, H; Korreman, S; Specht, L

2012-01-01

Objectives In radiotherapy, delineation uncertainties are important as they contribute to systematic errors and can lead to geographical miss of the target. For margin computation, standard deviations (SDs) of all uncertainties must be included as SDs. The aim of this study was to quantify the interobserver delineation variation for stereotactic body radiotherapy (SBRT) of peripheral lung tumours using a cross-sectional study design. Methods 22 consecutive patients with 26 tumours were included. Positron emission tomography/CT scans were acquired for planning of SBRT. Three oncologists and three radiologists independently delineated the gross tumour volume. The interobserver variation was calculated as a mean of multiple SDs of distances to a reference contour, and calculated for the transversal plane (SDtrans) and craniocaudal (CC) direction (SDcc) separately. Concordance indexes and volume deviations were also calculated. Results Median tumour volume was 13.0 cm3, ranging from 0.3 to 60.4 cm3. The mean SDtrans was 0.15 cm (SD 0.08 cm) and the overall mean SDcc was 0.26 cm (SD 0.15 cm). Tumours with pleural contact had a significantly larger SDtrans than tumours surrounded by lung tissue. Conclusions The interobserver delineation variation was very small in this systematic cross-sectional analysis, although significantly larger in the CC direction than in the transversal plane, stressing that anisotropic margins should be applied. This study is the first to make a systematic cross-sectional analysis of delineation variation for peripheral lung tumours referred for SBRT, establishing the evidence that interobserver variation is very small for these tumours. PMID:22919015

Pharmacokinetic behaviour of phenylglyoxal bis(guanylhydrazone) (PGBG) after intravenous administration in rabbits.

PubMed

Rodríguez, C; San Andrés, M I; San Andrés, M D; Encinas, T; González, F; Ballesteros, E

2001-04-01

Phenylglyoxal bis(guanylhydrazone) (PGBG) is a synthesized analogue of methylglyoxal bis(guanylhydrazone) (MGBG), which has demonstrated anti-parasitic activity in rabbits. The pharmacokinetic behaviour of PGBG after intravenous administration (10 mg/kg bodyweight) was studied in five rabbits. Plasma concentrations of PGBG were measured by high-performance liquid chromatography. Plasma PGBG concentrations decreased rapidly and were not detectable beyond 90 min after treatment. The mean [+/- standard deviation (SD)] volume of distribution at steady state (Vdss) was 2.19 +/- 0.47 l/kg and the mean plasma clearance value (Cl) was 29.99 +/- 3.98 ml/min kg. This drug is rapidly eliminated from the body in rabbits, having a short elimination half-life (0.93 h) and mean residence time (1.21 h).

Do you hear the noise? The German matrix sentence test with a fixed noise level in subjects with normal hearing and hearing impairment.

PubMed

Wardenga, Nina; Batsoulis, Cornelia; Wagener, Kirsten C; Brand, Thomas; Lenarz, Thomas; Maier, Hannes

2015-01-01

The aim of this study was to determine the relationship between hearing loss and speech reception threshold (SRT) in a fixed noise condition using the German Oldenburg sentence test (OLSA). After training with two easily-audible lists of the OLSA, SRTs were determined monaurally with headphones at a fixed noise level of 65 dB SPL using a standard adaptive procedure, converging to 50% speech intelligibility. Data was obtained from 315 ears of 177 subjects with hearing losses ranging from -5 to 90 dB HL pure-tone average (PTA, 0.5, 1, 2, 3 kHz). Two domains were identified with a linear dependence of SRT on PTA. The SRT increased with a slope of 0.094 ± 0.006 dB SNR/dB HL (standard deviation (SD) of residuals = 1.17 dB) for PTAs < 47 dB HL and with a slope of 0.811 ± 0.049 dB SNR/dB HL (SD of residuals = 5.54 dB) for higher PTAs. The OLSA can be applied to subjects with a wide range of hearing losses. With 65 dB SPL fixed noise presentation level the SRT is determined by listening in noise for PTAs < ∼47 dB HL, and above it is determined by listening in quiet.

Venous leg ulcer healing with electric stimulation therapy: a pilot randomised controlled trial.

PubMed

Miller, C; McGuiness, W; Wilson, S; Cooper, K; Swanson, T; Rooney, D; Piller, N; Woodward, M

2017-03-02

Compression therapy is a gold standard treatment to promote venous leg ulcer (VLU) healing. Concordance with compression therapy is, however, often sub-optimal. The aim of this study was to evaluate the effectiveness of electric stimulation therapy (EST) to facilitate healing of VLUs among people who do not use moderate-to-high levels of compression (>25 mmHg). A pilot multicentre, single-blinded randomised controlled trial was conducted. Participants were randomised (2:1) to the intervention group or a control group where EST or a sham device was used 4 times daily for 20 minutes per session. Participants were monitored fortnightly for eight weeks. The primary outcome measure was percentage of area (wound size) change. In the 23 patients recruited, an average redution in wound size of 23.15% (standard deviation [SD]: 61.23) was observed for the control group compared with 32.67 % (SD: 42.54) for the intervention. A moderate effect size favouring the intervention group was detected from univariate [F(1,18)=1.588, p=0.224, partial eta squared=0.081] and multivariate repeated measures [F(1,18)=2.053, p=0.169, partial eta squared=0.102] analyses. The pilot study was not powered to detect statistical significance, however, the difference in healing outcomes are encouraging. EST may be an effective adjunct treatment among patients who have experienced difficulty adhering to moderate-to-high levels of compression therapy.

Economic Burden of Dengue Virus Infection at the Household Level Among Residents of Puerto Maldonado, Peru.

PubMed

Salmon-Mulanovich, Gabriela; Blazes, David L; Lescano, Andres G; Bausch, Daniel G; Montgomery, Joel M; Pan, William K

2015-10-01

Dengue virus (DENV) was reintroduced to Peru in the 1990s and has been reported in Puerto Maldonado (population ~65,000) in the Peruvian southern Amazon basin since 2000. This region also has the highest human migration rate in the country, mainly from areas not endemic for DENV. The objective of this study was to assess the proportion of household income that is diverted to costs incurred because of dengue illness and to compare these expenses between recent migrants (RMs) and long-term residents (LTRs). We administered a standardized questionnaire to persons diagnosed with dengue illness at Hospital Santa Rosa in Puerto Maldonado from December 2012 to March 2013. We compared direct and indirect medical costs between RMs and LTRs. A total of 80 participants completed the survey, of whom 28 (35%) were RMs and 52 (65%) were LTRs. Each dengue illness episode cost the household an average of US$105 (standard deviation [SD] = 107), representing 24% of their monthly income. Indirect costs were the greatest expense (US$56, SD = 87), especially lost wages. The proportion of household income diverted to dengue illness did not differ significantly between RM and LTR households. The study highlights the significant financial burden incurred by households when a family member suffers dengue illness. © The American Society of Tropical Medicine and Hygiene.

Measuring acetabular component position on lateral radiographs - ischio-lateral method.

PubMed

Pulos, Nicholas; Tiberi Iii, John V; Schmalzried, Thomas P

2011-01-01

The standard method for the evaluation of arthritis and postoperative assessment of arthroplasty treatment is observation and measurement from plain films, using the flm edge for orientation. A more recent employment of an anatomical landmark, the ischial tuberosity, has come into use as orientation for evaluation and is called the ischio-lateral method. In this study, the use of this method was evaluated as a first report to the literature on acetabular component measurement using a skeletal reference with lateral radiographs. Postoperative radiographs of 52 hips, with at least three true lateral radiographs taken at different time periods, were analyzed. Component position was measured with the historical method (using the flm edge for orientation) and with the new method using the ischio-lateral method. The mean standard deviation (SD) for the historical approach was 3.7° and for the ischio-lateral method, 2.2° (p < 0.001). With the historical method, 19 (36.5%) hips had a SD greater than ± 4°, compared to six hips (11.5%) with the ischio-lateral method. By using a skeletal reference, the ischio-lateral method provides a more consistent measurement of acetabular component position. The high intra-class correlation coefficients for both intra- and inter-observer reliability indicate that the angle measured with this simple method, which employs no further technology, increased time, or cost, is consistent and reproducible for multiple observers.

Crossing the North Sea seems to make DCD disappear: cross-validation of Movement Assessment Battery for Children-2 norms.

PubMed

Niemeijer, Anuschka S; van Waelvelde, Hilde; Smits-Engelsman, Bouwien C M

2015-02-01

The Movement Assessment Battery for Children has been revised as the Movement ABC-2 (Henderson, Sugden, & Barnett, 2007). In Europe, the 15th percentile score on this test is recommended for one of the DSM-IV diagnostic criteria for Developmental Coordination Disorder (DCD). A representative sample of Dutch and Flemish children was tested to cross-validate the UK standard scores, including the 15th percentile score. First, the mean, SD and percentile scores of Dutch children were compared to those of UK normative samples. Item standard scores of Dutch speaking children deviated from the UK reference values suggesting necessary adjustments. Except for very young children, the Dutch-speaking samples performed better. Second, based on the mean and SD and clinical relevant cut-off scores (5th and 15th percentile), norms were adjusted for the Dutch population. For diagnostic use, researchers and clinicians should use the reference norms that are valid for the group of children they are testing. The results indicate that there possibly is an effect of testing procedure in other countries that validated the UK norms and/or cultural influence on the age norms of the Movement ABC-2. It is suggested to formulate criterion-based norms for age groups in addition to statistical norms. Copyright © 2014 Elsevier B.V. All rights reserved.

Rapid and Cost-Effective Quantification of Glucosinolates and Total Phenolic Content in Rocket Leaves by Visible/Near-Infrared Spectroscopy.

PubMed

Toledo-Martín, Eva María; Font, Rafael; Obregón-Cano, Sara; De Haro-Bailón, Antonio; Villatoro-Pulido, Myriam; Del Río-Celestino, Mercedes

2017-05-20

The potential of visible-near infrared spectroscopy to predict glucosinolates and total phenolic content in rocket ( Eruca vesicaria ) leaves has been evaluated. Accessions of the E. vesicaria species were scanned by NIRS as ground leaf, and their reference values regressed against different spectral transformations by modified partial least squares (MPLS) regression. The coefficients of determination in the external validation (R²VAL) for the different quality components analyzed in rocket ranged from 0.59 to 0.84, which characterize those equations as having from good to excellent quantitative information. These results show that the total glucosinolates, glucosativin and glucoerucin equations obtained, can be used to identify those samples with low and high contents. The glucoraphanin equation obtained can be used for rough predictions of samples and in case of total phenolic content, the equation showed good correlation. The standard deviation (SD) to standard error of prediction ratio (RPD) and SD to range (RER) were variable for the different quality compounds and showed values that were characteristic of equations suitable for screening purposes or to perform accurate analyses. From the study of the MPLS loadings of the first three terms of the different equations, it can be concluded that some major cell components such as protein and cellulose, highly participated in modelling the equations for glucosinolates.

Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection.

PubMed

Shea, Katherine M; Hobbs, Athena L V; Jaso, Theresa C; Bissett, Jack D; Cruz, Christopher M; Douglass, Elizabeth T; Garey, Kevin W

2017-06-01

Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P = 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P < 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly ( P = 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%]; P < 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%]; P < 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273; P = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system. Copyright © 2017 American Society for Microbiology.

Pediatric palliative care consultation services in California hospitals.

PubMed

Reid, Thomas; O'Riordan, David L; Mazzini, Andrea; Bruno, Kelly A; Pantilat, Steven Z

2014-12-01

The American Academy of Pediatrics recommends that palliative care be available to seriously ill hospitalized children, yet little is known about how these services are structured. The study's aim is to report the prevalence of pediatric palliative care services (PCS) and compare the structure of pediatric PCS to adult PCS within California hospitals. We surveyed 377 hospitals to assess the prevalence, structure, and characteristics of pediatric and adult PCS. Hospitals were categorized as children's hospitals with a pediatric-only PCS, mixed hospitals with pediatric and adult PCS, and hospitals with adult-only PCS. All 8 children's hospitals in the state reported having a pediatric PCS, and 36 pediatric PCSs were in mixed hospitals. Mixed hospitals saw fewer (p=0.0001) children per year (mean=5.6, standard deviation [SD]=3.6) than pediatric-only PCSs (mean=168, SD=73). Pediatric-only PCSs treated more patients for noncancer-related illness (82.5%) than pediatric PCSs in mixed hospitals (34.5%, p=0.03) or adult-only PCSs (52.4%, p=0.001). All PCSs were universally available (100%) during weekday business hours and half were available during weekend business hours. Pediatric-only PCSs had a mean total full-time equivalent (FTE) of 1.9, which was not significantly different (p=0.3) from the total FTE for pediatric PCSs in mixed hospitals (mean=1.1, SD=1.4) or for adult-only PCSs (mean=2.7, SD=2.0). However, in mixed hospitals the adult PCS had a significantly higher (p=0.005) total FTE (mean=2.4, SD=1.3) than the pediatric PCS (mean=1.1, SD=1.4). All children's hospital and a few mixed hospitals offer pediatric PCS. Better understanding of the palliative care needs of seriously ill children in mixed hospitals and assessment of the quality of care provided will help ensure that children seen in these hospitals receive necessary care.

Do prices reflect the costs of cardiac surgery in the elderly?

PubMed

Coelho, Pedro; Rodrigues, Vanessa; Miranda, Luís; Fragata, José; Pita Barros, Pedro

2017-01-01

Payment for cardiac surgery in Portugal is based on a contract agreement between hospitals and the health ministry. Our aim was to compare the prices paid according to this contract agreement with calculated costs in a population of patients aged ≥65 years undergoing cardiac surgery in one hospital department. Data on 250 patients operated between September 2011 and September 2012 were prospectively collected. The procedures studied were coronary artery bypass graft surgery (CABG) (n=67), valve surgery (n=156) and combined CABG and valve surgery (n=27). Costs were calculated by two methods: micro-costing when feasible and mean length of stay otherwise. Price information was provided by the hospital administration and calculated using the hospital's mean case-mix. Thirty-day mortality was 3.2%. Mean EuroSCORE I was 5.97 (standard deviation [SD] 4.5%), significantly lower for CABG (p<0.01). Mean intensive care unit stay was 3.27 days (SD 4.7) and mean hospital stay was 9.92 days (SD 6.30), both significantly shorter for CABG. Calculated costs for CABG were €6539.17 (SD 3990.26), for valve surgery €8289.72 (SD 3319.93) and for combined CABG and valve surgery €11 498.24 (SD 10 470.57). The payment for each patient was €4732.38 in 2011 and €4678.66 in 2012 based on the case-mix index of the hospital group, which was 2.06 in 2011 and 2.21 in 2012; however, the case-mix in our sample was 6.48 in 2011 and 6.26 in 2012. The price paid for each patient was lower than the calculated costs. Prices would be higher than costs if the case-mix of the sample had been used. Costs were significantly lower for CABG. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Impact of growth hormone therapy on adult height of children with idiopathic short stature: systematic review.

PubMed

Deodati, Annalisa; Cianfarani, Stefano

2011-03-11

To systematically determine the impact of growth hormone therapy on adult height of children with idiopathic short stature. Systematic review. Cochrane Central Register of Controlled Trials, Medline, and the bibliographic references from retrieved articles of randomised and non-randomised controlled trials from 1985 to April 2010. Height in adulthood (standard deviation score) and overall gain in height (SD score) from baseline measurement in childhood. Randomised and non-randomised controlled trials with height measurements for adults. Inclusion criteria were initial short stature (defined as height >2 SD score below the mean), peak growth hormone responses >10 μg/L, prepubertal stage, no previous growth hormone therapy, and no comorbid conditions that would impair growth. Adult height was considered achieved when growth rate was <1.5 cm/year or bone age was 15 years in females and 16 years in males. Three randomised controlled trials (115 children) met the inclusion criteria. The adult height of the growth hormone treated children exceeded that of the controls by 0.65 SD score (about 4 cm). The mean height gain in treated children was 1.2 SD score compared with 0.34 SD score in untreated children. A slight difference of about 1.2 cm in adult height was observed between the two growth hormone dose regimens. In the seven non-randomised controlled trials the adult height of the growth hormone treated group exceeded that of the controls by 0.45 SD score (about 3 cm). Growth hormone therapy in children with idiopathic short stature seems to be effective in partially reducing the deficit in height as adults, although the magnitude of effectiveness is on average less than that achieved in other conditions for which growth hormone is licensed. The individual response to therapy is highly variable, and additional studies are needed to identify the responders.

Mental health and wellbeing in spouses of persons with dementia: the Nord-Trøndelag Health Study.

PubMed

Ask, Helga; Langballe, Ellen Melbye; Holmen, Jostein; Selbæk, Geir; Saltvedt, Ingvild; Tambs, Kristian

2014-05-01

Caring for a spouse diagnosed with dementia can be a stressful situation and can put the caregiving partner at risk of loss of mental health and wellbeing. The main aim of this study was to investigate the relationship between dementia and spousal mental health in a population-based sample of married couples older than 55 years of age. The association was investigated for individuals living together with their demented partner, as well as for individuals whose demented partner was living in an institution. Data on dementia were collected from hospitals and nursing homes in the county of Nord-Trøndelag, Norway. These data were combined with data on spousal mental health, which were collected in a population-based health screening: the Nord-Trøndelag Health Study (HUNT). Of 6,951 participating couples (>55 years), 131 included one partner that had been diagnosed with dementia. Our results indicate that after adjustment for covariates, having a partner with dementia is associated with lower levels of life satisfaction and more symptoms of anxiety and depression than reported by spouses of elderly individuals without dementia. Spouses living together with a partner diagnosed with dementia experienced moderately lower levels of life satisfaction (0.35 standard deviation [SD]) and more symptoms of depression (0.38 SD) and anxiety (0.23 SD) than did their non-caregiving counterparts. Having a partner with dementia that resided in a nursing home was associated with clearly lower life satisfaction. Compared with non-caregivers, these spouses reported lower levels of life satisfaction (1.16 SD), and also more symptoms of depression (0.38 SD), and more symptoms of anxiety (0.42 SD). Having a partner with dementia is associated with loss of mental health and reduced life satisfaction. The risk of adverse mental health outcomes is greatest after the partner's nursing home admission.

Automated Smartphone Threshold Audiometry: Validity and Time Efficiency.

PubMed

van Tonder, Jessica; Swanepoel, De Wet; Mahomed-Asmail, Faheema; Myburgh, Hermanus; Eikelboom, Robert H

2017-03-01

Smartphone-based threshold audiometry with automated testing has the potential to provide affordable access to audiometry in underserved contexts. To validate the threshold version (hearTest) of the validated hearScreen™ smartphone-based application using inexpensive smartphones (Android operating system) and calibrated supra-aural headphones. A repeated measures within-participant study design was employed to compare air-conduction thresholds (0.5-8 kHz) obtained through automated smartphone audiometry to thresholds obtained through conventional audiometry. A total of 95 participants were included in the study. Of these, 30 were adults, who had known bilateral hearing losses of varying degrees (mean age = 59 yr, standard deviation [SD] = 21.8; 56.7% female), and 65 were adolescents (mean age = 16.5 yr, SD = 1.2; 70.8% female), of which 61 had normal hearing and the remaining 4 had mild hearing losses. Threshold comparisons were made between the two test procedures. The Wilcoxon signed-ranked test was used for comparison of threshold correspondence between manual and smartphone thresholds and the paired samples t test was used to compare test time. Within the adult sample, 94.4% of thresholds obtained through smartphone and conventional audiometry corresponded within 10 dB or less. There was no significant difference between smartphone (6.75-min average, SD = 1.5) and conventional audiometry test duration (6.65-min average, SD = 2.5). Within the adolescent sample, 84.7% of thresholds obtained at 0.5, 2, and 4 kHz with hearTest and conventional audiometry corresponded within ≤5 dB. At 1 kHz, 79.3% of the thresholds differed by ≤10 dB. There was a significant difference (p < 0.01) between smartphone (7.09 min, SD = 1.2) and conventional audiometry test duration (3.23 min, SD = 0.6). The hearTest application with calibrated supra-aural headphones provides a cost-effective option to determine valid air-conduction hearing thresholds. American Academy of Audiology

Biofeedback training effects on minimum toe clearance variability during treadmill walking.

PubMed

Tirosh, Oren; Cambell, Amity; Begg, Rezaul K; Sparrow, W A

2013-08-01

A number of variability analysis techniques, including Poincaré plots and detrended fluctuation analysis (DFA) were used to investigate minimum toe clearance (MTC) control during walking. Ten young adults walked on a treadmill for 10 min at preferred speed in three conditions: (i) no-intervention baseline, (ii) with biofeedback of MTC within a target range, and (iii) no-biofeedback retention. Mean, median, standard deviation (SD), and inter quartile range of MTC during biofeedback (45.57 ± 11.65, 44.98 ± 11.57, 7.08 ± 2.61, 8.58 ± 2.77 mm, respectively) and retention (56.95 ± 20.31, 56.69 ± 20.94, 10.68 ± 5.41, 15.38 ± 10.19 mm) were significantly greater than baseline (30.77 ± 9.49, 30.51 ± 9.49, 3.04 ± 0.77, 3.66 ± 0.91 mm). Relative to baseline, skewness was reduced in biofeedback and retention but only significantly for retention (0.88 ± 0.51, 0.63 ± 0.55, and 0.40 ± 0.40, respectively). Baseline Poincaré measures (SD1 = 0.25, SD2 = 0.34) and DFA (α1 = 0.72 and α2 = 0.64) were lower than biofeedback (SD1 = 0.58, SD2 = 0.83, DFA α1 = 0.76 and α2 = 0.92) with significantly greater variability in retention compared to biofeedback only in the long-term SD2 and α2 analyses. Increased DFA longer-term correlations α2 in retention confirm that a novel gait pattern was acquired with a longer-term variability structure. Short- and long-term variability analyses were both useful in quantifying gait adaptations with biofeedback. The findings provide evidence that MTC can be modified with feedback, suggesting future applications in gait training procedures for impaired populations designed to reduce tripping risk.

Automated Quantification of Volumetric Optic Disc Swelling in Papilledema Using Spectral-Domain Optical Coherence Tomography

PubMed Central

Wang, Jui-Kai; Kardon, Randy H.; Kupersmith, Mark J.; Garvin, Mona K.

2012-01-01

Purpose. To develop an automated method for the quantification of volumetric optic disc swelling in papilledema subjects using spectral-domain optical coherence tomography (SD-OCT) and to determine the extent that such volumetric measurements correlate with Frisén scale grades (from fundus photographs) and two-dimensional (2-D) peripapillary retinal nerve fiber layer (RNFL) and total retinal (TR) thickness measurements from SD-OCT. Methods. A custom image-analysis algorithm was developed to obtain peripapillary circular RNFL thickness, TR thickness, and TR volume measurements from SD-OCT volumes of subjects with papilledema. In addition, peripapillary RNFL thickness measures from the commercially available Zeiss SD-OCT machine were obtained. Expert Frisén scale grades were independently obtained from corresponding fundus photographs. Results. In 71 SD-OCT scans, the mean (± standard deviation) resulting TR volumes for Frisén scale 0 to scale 4 were 11.36 ± 0.56, 12.53 ± 1.21, 14.42 ± 2.11, 17.48 ± 2.63, and 21.81 ± 3.16 mm3, respectively. The Spearman's rank correlation coefficient was 0.737. Using 55 eyes with valid Zeiss RNFL measurements, Pearson's correlation coefficient (r) between the TR volume and the custom algorithm's TR thickness, the custom algorithm's RNFL thickness, and Zeiss' RNFL thickness was 0.980, 0.929, and 0.946, respectively. Between Zeiss' RNFL and the custom algorithm's RNFL, and the study's TR thickness, r was 0.901 and 0.961, respectively. Conclusions. Volumetric measurements of the degree of disc swelling in subjects with papilledema can be obtained from SD-OCT volumes, with the mean volume appearing to be roughly linearly related to the Frisén scale grade. Using such an approach can provide a more continuous, objective, and robust means for assessing the degree of disc swelling compared with presently available approaches. PMID:22599584

Cross-Cultural Interprofessional Faculty Development in Japan: Results of an Integrated Workshop for Clinical Teachers.

PubMed

Wong, Jeffrey G; Son, Daisuke; Miura, Wakako

2017-12-01

Faculty development programs, studied both home and abroad, have been shown to be helpful for enhancing the scholarly and academic work of nonacademic clinicians. Interprofessional education and faculty development efforts have been less well studied. This project investigated the effect of a well-studied faculty development program applied in an interprofessional fashion across health profession educators in medicine and nursing. A faculty cohort of nurse and physician educators at The University of Tokyo underwent training in the Stanford Faculty Development Center (SFDC) model of clinical teaching through a sequence of 7 workshops. The workshops were performed in English with all materials translated into Japanese. A validated, retrospective pretest and posttest instrument was used to measure study outcomes on global assessment of teaching abilities and specific teaching behaviors (STBs) at 1 and 12 months after intervention. Successful completion of Commitment to Change statements were also assessed at 12 months. In total, 19 faculty participants completed the study. All participants found the workshops valuable. For global assessment, significant improvement in self-reported teaching abilities was seen comparing the mean pretest scores of 27.26 (maximum score = 55, standard deviation [SD] = 8.61) with mean scores at both 1 month (36.81, SD = 7.48, P < 0.001) and at 1 year (34.67, SD = 7.32, P < 0.001). For STBs, significant improvement was also seen comparing the mean group pretest score of 82.11 (maximum score = 145, SD = 15.72), to the posttest mean score of 111.11 (SD = 14.48, P < 0.001) and the 1-year mean score of 103.76 (SD = 12.87, P < 0.001). In total, 27/42 Commitment to Change statements were successfully completed at 1 year. Faculty development for improving clinical teaching can be performed across the cultures of medicine and nursing, as well as across the cultures of the United States and Japan. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

1 CFR 21.14 - Deviations from standard organization of the Code of Federal Regulations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 1 General Provisions 1 2010-01-01 2010-01-01 false Deviations from standard organization of the... CODIFICATION General Numbering § 21.14 Deviations from standard organization of the Code of Federal Regulations. (a) Any deviation from standard Code of Federal Regulations designations must be approved in advance...

Silver Clear Nylon Dressing is Effective in Preventing Radiation-Induced Dermatitis in Patients With Lower Gastrointestinal Cancer: Results From a Phase III Study

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

Niazi, Tamim M.; Vuong, Te, E-mail: tvuong@jgh.mcgill.ca; Azoulay, Laurant

2012-11-01

Purpose: For patients with anal canal and advanced rectal cancer, chemoradiation therapy is a curative modality or an important adjunct to surgery. Nearly all patients treated with chemoradiation experience some degree of radiation-induced dermatitis (RID). Prevention and effective treatment of RID, therefore, is of considerable clinical relevance. The present phase III randomized trial compared the efficacy of silver clear nylon dressing (SCND) with that of standard skin care for these patients. Methods and Materials: A total of 42 rectal or anal canal cancer patients were randomized to either a SCND or standard skin care group. SCND was applied from Daymore » 1 of radiation therapy (RT) until 2 weeks after treatment completion. In the control arm, sulfadiazine cream was applied at the time of skin dermatitis. Printed digital photographs taken 2 weeks prior to, on the last day, and two weeks after the treatment completion were scored by 10 blinded readers, who used the common toxicity scoring system for skin dermatitis. Results: The radiation dose ranged from 50.4 to 59.4 Gy, and there were no differences between the 2 groups. On the last day of RT, when the most severe RID occurs, the mean dermatitis score was 2.53 (standard deviation [SD], 1.17) for the standard and 1.67 (SD, 1.2; P=.01) for the SCND arm. At 2 weeks after RT, the difference was 0.39 points in favor of SCND (P=.39). There was considerable intraclass correlation among the 10 observers. Conclusions: Silver clear nylon dressing is effective in reducing RID in patients with lower gastrointestinal cancer treated with combined chemotherapy and radiation treatment.« less

Implementation of hospital governing boards: views from the field.

PubMed

McNatt, Zahirah; Thompson, Jennifer W; Mengistu, Abraham; Tatek, Dawit; Linnander, Erika; Ageze, Leulseged; Lawson, Ruth; Berhanu, Negalign; Bradley, Elizabeth H

2014-04-17

Decentralization through the establishment of hospital governing boards has been touted as an effective way to improve the quality and efficiency of hospitals in low-income countries. Although several studies have examined the process of decentralization, few have quantitatively assessed the implementation of hospital governing boards and their impact on hospital performance. Therefore, we sought to describe the functioning of governing boards and to determine the association between governing board functioning and hospital performance. We conducted a cross-sectional study with governing board chairpersons to assess board (1) structure, (2) roles and responsibilities and (3) training and orientation practices. Using bivariate analysis and multivariable regression, we examined the association between governing board functioning and hospital performance. Hospital performance indicators: 1) percent of hospital management standards met, measured with the Ethiopian Hospital Reform Implementation Guidelines and 2) patient experience, measured with the Inpatient and Outpatient Assessment of Healthcare surveys. A total of 92 boards responded to the survey (96% response rate). The average percentage of EHRIG standards met was 58.1% (standard deviation (SD) 21.7 percentage points), and the mean overall patient experience score was 7.2 (SD 2.2). Hospitals with greater hospital management standards met had governing boards that paid members, reviewed performance in several domains quarterly or more frequently, developed new revenue sources, determined services to be outsourced, reviewed patient complaints, and had members with knowledge in business and financial management (all P-values < 0.05). Hospitals with more positive patient experience had governing boards that developed new revenue sources, determined services to be outsourced, and reviewed patient complaints (all P-values < 0.05). These cross-sectional data suggest that strengthening governing boards to perform essential responsibilities may result in improved hospital performance.

Quality of Life among Patients Undergoing Hemodialysis in Penang, Malaysia.

PubMed

Ramatillah, Diana Laila; Syed Sulaiman, Syed Azhar; Khan, Amer Hayat; Meng, Ong Loke

2017-01-01

Quality of life is one of the parameters to check the improvement of hemodialysis treatment among hemodialysed patients. Those patients will be dealing with this treatment in long term if this treatment is the only way for them to replace their kidney function and this thing will affect their quality of life. To evaluate the quality of life patients on hemodialysis using kidney disease quality of life-short term 24 (KDQoL-SF24) Malaysian Version. Cohort observational study was conducted in this study. The study included 78 hemodialysed patients in HD center Penang, Malaysia. There were 9 components which had the lower of the mean and standard deviation (SD) than the standard form; work status (15.01 ± 35.57), cognitive function (75.66 ± 13.75), quality of life social interaction (76.32 ± 16.11), sleep (55.86 ± 15.30), social support (59.61 ± 22.08), patient satisfaction (43.24 ± 15.32), physical functioning (50.06 ± 42.81), general health (29.62 ± 25.56), and role emotional (54.27 ± 49.92). In this HD center, the group of patient's age who had the lower mean ± SD from the KDQoL-SF Manual Standard were the first and the sixth groups of patient's age (≤20 and 61-70). The study conducted in HD center, Penang, Malaysia showed that the scoring of work status, cognitive function, quality of social interaction, sleep, social support, patient satisfaction, physical functioning, general health, and role emotional were low than standard form.

Nutritional supplementation in HIV-infected individuals in South India: a prospective interventional study.

PubMed

Swaminathan, S; Padmapriyadarsini, C; Yoojin, L; Sukumar, B; Iliayas, S; Karthipriya, J; Sakthivel, R; Gomathy, P; Thomas, B E; Mathew, M; Wanke, C A; Narayanan, P R

2010-07-01

Malnutrition in human immunodeficiency virus (HIV)-infected individuals is associated with faster disease progression, higher mortality rates, and suboptimal response to antiretroviral therapy (ART). We conducted a prospective interventional study to evaluate the effects of an oral macronutrient supplement among HIV-infected adults in South India. Patients attending Tuberculosis Research Centre clinics from June 2005 through December 2007 had baseline nutritional assessment and laboratory investigations performed. Patients at 1 center received nutritional counseling and standard care, whereas patients at 2 centers additionally received a macronutrient providing 400 cal and 15 g of protein daily. Study outcomes were changes in anthropometry, body composition, blood chemistry, and immune status at 6 months. In total, 636 ART-naive patients were enrolled in the study; 361 completed 6 months of follow-up (282 received supplements and 79 received standard care). Mean age +/- standard deviation (SD) was 31 +/- 7 years, mean weight +/- SD was 50 +/- 10 kg, and 42% were male. Significant increases in body weight, body mass index, midarm circumference, fat-free mass, and body cell mass were observed in the supplement group but not in the control group at 6 months; gains were greater in patients with CD4 cell counts <200 cells/microL. No changes were observed in lipid levels, whereas the CD4 cell count decreased in the control group. However, after adjusting for baseline differences, these changes were not statistically significantly different between the groups. Macronutrient supplementation did not result in significantly increased weight gain compared with standard care (including nutritional counseling) among patients with moderately advanced HIV disease. The effect of supplementation on specific subsets of patients and on preserving immune function needs further research.

Medicine authentication technology as a counterfeit medicine-detection tool: a Delphi method study to establish expert opinion on manual medicine authentication technology in secondary care

PubMed Central

Naughton, Bernard; Roberts, Lindsey; Dopson, Sue; Brindley, David; Chapman, Stephen

2017-01-01

Objectives This study aims to establish expert opinion and potential improvements for the Falsified Medicines Directive mandated medicines authentication technology. Design and intervention A two-round Delphi method study using an online questionnaire. Setting Large National Health Service (NHS) foundation trust teaching hospital. Participants Secondary care pharmacists and accredited checking technicians. Primary outcome measures Seven-point rating scale answers which reached a consensus of 70–80% with a standard deviation (SD) of <1.0. Likert scale questions which reached a consensus of 70–80%, a SD of <1.0 and classified as important according to study criteria. Results Consensus expert opinion has described database cross-checking technology as quick and user friendly and suggested the inclusion of an audio signal to further support the detection of counterfeit medicines in secondary care (70% consensus, 0.9 SD); other important consensus with a SD of <1.0 included reviewing the colour and information in warning pop up screens to ensure they were not mistaken for the ‘already dispensed here’ pop up, encouraging the dispenser/checker to act on the warnings and making it mandatory to complete an ‘action taken’ documentation process to improve the quarantine of potentially counterfeit, expired or recalled medicines. Conclusions This paper informs key opinion leaders and decision makers as to the positives and negatives of medicines authentication technology from an operator's perspective and suggests the adjustments which may be required to improve operator compliance and the detection of counterfeit medicines in the secondary care sector. PMID:28478398

Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair

PubMed Central

Islam, Anowarul; Bohl, Michael S.; Tsai, Andrew G; Younesi, Mousa; Gillespie, Robert; Akkus, Ozan

2015-01-01

Background Currently, there are no well-established suture protocols to attach fully load-bearing scaffolds which span tendon defects between bone and muscle for repair of critical sized tendon tears. Methods to attach load-bearing tissue repair scaffolds could enable functional repair of tendon injuries. Methods Sixteen rabbit shoulders were dissected (New Zealand white rabbits, 1 yr. old, female) to isolate the humeral-infraspinatus muscle complex. A unique suture technique was developed to allow for a 5 mm segmental defect in infraspinatus tendon to be replaced with a mechanically strong bioscaffold woven from pure collagen threads. The suturing pattern resulted in a fully load-bearing scaffold. The tensile stiffness and strength of scaffold repair was compared with intact infraspinatus and regular direct repair. Findings The failure load and displacement at failure of the scaffold repair group were 59.9 N (Standard Deviation, SD = 10.7) and 10.3 mm (SD = 2.9), respectively and matched those obtained by direct repair group which were 57.5 N (SD = 15.3) and 8.6 mm (SD = 1.5), (p > 0.05). Failure load, displacement at failure and stiffness of both of the repair groups were half of the intact infraspinatus shoulder group. Interpretation With the developed suture technique, scaffolds repair showed similar failure load, displacement at failure and stiffness to the direct repair. This novel suturing pattern and the mechanical robustness of the scaffold at time zero indicates that the proposed model is mechanically viable for future in vivo studies which has a higher potential to translate into clinical uses. PMID:26009492

Differences in body temperature variability between subjects with and without diabetes and predictive value for cardiovascular events.

PubMed

Amiya, Eisuke; Watanabe, Masafumi; Takata, Munenori; Watanabe, Shogo; Ozeki, Atsuko; Watanabe, Aya; Kawarasaki, Shuichi; Nakao, Tomoko; Hosoya, Yumiko; Omori, Kazuko; Maemura, Koji; Hirata, Yasunobu; Nagai, Ryozo; Komuro, Issei

2013-01-01

Differences in regulating factors and the clinical implications of body temperature variability (BTV) between subjects with and without diabetes have not been clarified to date. In 66 subjects with ischemic heart disease (33 with diabetes and 33 without diabetes), BTV, the difference between the highest and lowest temperature measurements, and body temperature standard deviation (BT SD) were measured from axillary body temperature (ABT) records of 3 consecutive days and followed for 16.4±8.4 months. In subjects without diabetes BTV and BT SD were closely associated with endothelial function as evaluated on flow-mediated dilation (BTV, R=0.33, P=0.026; BT SD, R=0.41, P=0.029), whereas there was a poor association in subjects with diabetes. In the absence of an interrelationship between vascular function and thermoregulation, the contribution of inflammation to BTV was increased in subjects with diabetes (BTV, 0.59±0.21°C for C-reactive protein [CRP] <0.08 mg/dl vs. 0.79±0.28°C for CRP >0.08 mg/dl, P=0.014). Event-free survival analysis showed that in subjects with diabetes higher BT SD was associated with shorter event-free survival (log-rank P=0.012), but this relationship was not found in subjects without diabetes. In subjects with diabetes, the interrelationship between thermoregulation and vascular function was disrupted and the effect of inflammation on thermoregulation was enhanced, so that BTV had a sufficient predictive value for cardiovascular events in diabetic subjects.

Inter-examination Precision of Magnitude-based Magnetic Resonance Imaging for Estimation of Segmental Hepatic Proton Density Fat Fraction (PDFF) in Obese Subjects

PubMed Central

Negrete, Lindsey M.; Middleton, Michael S.; Clark, Lisa; Wolfson, Tanya; Gamst, Anthony C.; Lam, Jessica; Changchien, Chris; Deyoung-Dominguez, Ivan M.; Hamilton, Gavin; Loomba, Rohit; Schwimmer, Jeffrey; Sirlin, Claude B.

2013-01-01

Purpose To prospectively describe magnitude-based multi-echo gradient-echo hepatic proton density fat fraction (PDFF) inter-examination precision at 3T. Materials and Methods In this prospective, IRB approved, HIPAA compliant study, written informed consent was obtained from 29 subjects (body mass indexes > 30kg/m2). Three 3T magnetic resonance imaging (MRI) examinations were obtained over 75-90 minutes. Segmental, lobar, and whole liver PDFF were estimated (using three, four, five, or six echoes) by magnitude-based multi-echo MRI in co-localized regions of interest (ROIs). For estimate (using three, four, five, or six echoes), at each anatomic level (segmental, lobar, whole liver), three inter-examination precision metrics were computed: intra-class correlation coefficient (ICC), standard deviation (SD), and range. Results Magnitude-based PDFF estimates using each reconstruction method showed excellent inter-examination precision for each segment (ICC ≥ 0.992; SD ≤ 0.66%; range ≤ 1.24%), lobe (ICC ≥ 0.998; SD ≤ 0.34%; range ≤ 0.64%), and the whole liver (ICC = 0.999; SD ≤ 0.24%; range ≤ 0.45%). Inter-examination precision was unaffected by whether PDFF was estimated using three, four, five, or six echoes. Conclusion Magnitude-based PDFF estimation shows high inter-examination precision at segmental, lobar, and whole liver anatomic levels, supporting its use in clinical care or clinical trials. The results of this study suggest that longitudinal hepatic PDFF change greater than 1.6% is likely to represent signal rather than noise. PMID:24136736

Characteristics of palliative care consultation services in California hospitals.

PubMed

Pantilat, Steven Z; Kerr, Kathleen M; Billings, J Andrew; Bruno, Kelly A; O'Riordan, David L

2012-05-01

Although hospital palliative care consultation services (PCCS) can improve a variety of clinical and nonclinical outcomes, little is known about how these services are structured. We surveyed all 351 acute care hospitals in California to examine the structure and characteristics of those hospitals with PCCS. We achieved a 92% response rate. Thirty-one percent (n=107) of hospitals reported having a PCCS. Teams commonly included physicians (87%), social workers (80%), spiritual care professionals (77%), and registered nurses (71%). Nearly all PCCS were available on-site during weekday business hours; 50% were available on-site or by phone in the weekday evenings and 54% were available during weekend daytime hours. The PCCS saw an average of 347 patients annually (median=310, standard deviation [SD]=217), or 258 patients per clinical full-time equivalent (FTE; median=250, SD=150.3). Overall, 60% of consultation services reported they are struggling to cope with the workload. On average, patients were in the hospital 5.9 days (median=5.5, SD=3.3) prior to referral to PCCS, and remained in the hospital for 6 days (median=4, SD=7.9) following the initial consultation. Patient and family meetings were an aspect of the consultation in 74% of cases. Overall, 21% of consultation patients were discharged home with hospice services and 25% died in the hospital. There is variation in how PCCS in California hospitals are structured and in the ways they engage with patients. Ultimately, linking PCCS characteristics and practices to patient and family outcomes will identify best practices that PCCS can use to maximize quality.

[Alcohol and driving: attitudes and habits of students after an intervention].

PubMed

Ponce-Blandón, Jose Antonio; Romero-Martín, Macarena; Romero-Brioso, Concepción; Paredes-Jiménez, Antonio de Padua

2016-01-01

Knowing and contrasting attitudes and habits toward alcohol when it comes to driving among nursing students and to analyze the effectiveness of an educational intervention with testimonies in order to modify them. Analytical and quasiexperimental design with pre-test and post-test. The study population consists of students of nursing degree of the Red Cross from Sevilla. The intervention is based on attending an educational activity from people directly and personally experienced on car accidents, narrating their own lived facts. A specific questionnaire was used to measure attitudes and trends of behaviors towards alcohol drinking and driving. The mean of the responses related to the false beliefs of students in first course is 2.73 (standard deviation [SD]=0.14) versus 2.29 (SD=0.27) in fourth. For questions regarding the intentions of risky behavior, first course have a mean of 2.01 (SD=0.51) versus 1.76 (SD=1.76) in fourth. These differences were not found to be significant. No differences were found before and after the intervention on the two global dimensions studied. The disaggregated results per item show that the intervention significantly reduced the belief that alcohol does not affect safety (p=.001) and intention not to drink to accompany friends with your car (p=.026), among others. The analyzed intervention has a positive but limited influence. It is recommended to repeat it several times to improve a healthy lifestyle and also to improve the health habits of the general population in the future. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Concentration and Detection of Cryptosporidium Oocysts in Surface Water Samples by Method 1622 Using Ultrafiltration and Capsule Filtration

USGS Publications Warehouse

Simmons, O. D.; Sobsey, M.D.; Heaney, C.D.; Schaefer, F. W.; Francy, D.S.

2001-01-01

The protozoan parasite Cryptosporidium parvum is known to occur widely in both source and drinking water and has caused waterborne outbreaks of gastroenteritis. To improve monitoring, the U.S. Environmental Protection Agency developed method 1622 for isolation and detection of Cryptosporidium oocysts in water. Method 1622 is performance based and involves filtration, concentration, immunomagnetic separation, fluorescent-antibody staining and 4???,6-diamidino-2-phenylindole (DAPI) counterstaining, and microscopic evaluation. The capsule filter system currently recommended for method 1622 was compared to a hollow-fiber ultrafilter system for primary concentration of C. parvum oocysts in seeded reagent water and untreated surface waters. Samples were otherwise processed according to method 1622. Rates of C. parvum oocyst recovery from seeded 10-liter volumes of reagent water in precision and recovery experiments with filter pairs were 42% (standard deviation [SD], 24%) and 46% (SD, 18%) for hollow-fiber ultrafilters and capsule filters, respectively. Mean oocyst recovery rates in experiments testing both filters on seeded surface water samples were 42% (SD, 27%) and 15% (SD, 12%) for hollow-fiber ultrafilters and capsule filters, respectively. Although C. parvum oocysts were recovered from surface waters by using the approved filter of method 1622, the recovery rates were significantly lower and more variable than those from reagent grade water. In contrast, the disposable hollow-fiber ultrafilter system was compatible with subsequent method 1622 processing steps, and it recovered C. parvum oocysts from seeded surface waters with significantly greater efficiency and reliability than the filter suggested for use in the version of method 1622 tested.

Changes in right ventricular function assessed by echocardiography in dog models of mild RV pressure overload.

PubMed

Morita, Tomoya; Nakamura, Kensuke; Osuga, Tatsuyuki; Yokoyama, Nozomu; Morishita, Keitaro; Sasaki, Noboru; Ohta, Hiroshi; Takiguchi, Mitsuyoshi

2017-07-01

The assessment of hemodynamic change by echocardiography is clinically useful in patients with pulmonary hypertension. Recently, mild elevation of the mean pulmonary arterial pressure (PAP) has been shown to be associated with increased mortality. However, changes in the echocardiographic indices of right ventricular (RV) function are still unknown. The objective of this study was to validate the relationship between echocardiographic indices of RV function and right heart catheterization variables under a mild RV pressure overload condition. Echocardiography and right heart catheterization were performed in dog models of mild RV pressure overload induced by thromboxane A 2 analog (U46619) (n=7). The mean PAP was mildly increased (19.3±1.1 mm Hg), and the cardiac index was decreased. Most echocardiographic indices of RV function were significantly impaired even under a mild RV pressure overload condition. Multivariate analysis revealed that the RV free wall longitudinal strain (RVLS), standard deviation of the time-to-peak longitudinal strain of RV six segments (RV-SD) by speckle-tracking echocardiography, and Tei index were independent echocardiographic predictors of the mean PAP (free wall RVLS, β=-0.60, P<.001; RV-SD, β=0.40, P=.011), pulmonary vascular resistance (free wall RVLS, β=-0.39, P=.020; RV-SD, β=0.47, P=.0086; Tei index, β=0.34, P=.047), and cardiac index (Tei index, β=-0.65, P<.001). Free wall RVLS, RV-SD, and Tei index are useful for assessing the hemodynamic change under a mild RV pressure overload condition. © 2017, Wiley Periodicals, Inc.

Lung function comparison between two decades in cystic fibrosis children: A single centre study.

PubMed

Tridello, Gloria; Volpi, Sonia; Assael, Baroukh M; Meneghelli, Ilaria; Passiu, Marianna; Circelli, Maria

2015-12-01

The purpose of this study was to compare two cohorts of cystic fibrosis (CF) patients born and treated in two different decades, diagnosed through a CF neonatal screening program. We compared pulmonary function decline from 10 to 15 years of age in patients with cystic fibrosis born between 1979 and 1984 (Cohort 1) and between 1991 and 1996 (Cohort 2). Forced expiratory volume in 1 sec (FEV1%) and forced expiratory flow from 25% to 75% (FEF 25-75%) were analyzed by a linear mixed model approach. The differences between the two cohorts were estimated and the overall cohort effect was tested. Ninety-two patients (51 males, 41 females) fulfilled the selection criteria. Pancreatic insufficiency and CF related diabetes were present in 91% and 20% of patients, respectively. The mean absolute decrement of FEV1% was 9.2 (standard deviation [SD] 11.2) in Cohort 1 and 0.6 (SD 10.4) in Cohort 2 (P < 0.001). The mean decrement of FEF 25-75% was 16.3 (SD 19.5) in Cohort 1 and 1.3 (SD 16.8) in Cohort 2 (P < 0.001) and the Pseudomonas aeruginosa (Pa) colonization was 28% and 15% respectively (P = 0.1). Our results show that pulmonary function has clearly ameliorated over a decade in young CF patients, in a period during which several significant therapeutic changes have been introduced, such as dornase alfa, tobramycin and hypertonic saline. To our knowledge this is the first study showing a cohort effect in patients diagnosed after neonatal screening. © 2015 Wiley Periodicals, Inc.

Determination of the SNPP VIIRS SDSM Screen Relative Transmittance From Both Yaw Maneuver and Regular On-Orbit Data

NASA Technical Reports Server (NTRS)

Lei, Ning; Chen, Xuexia; Xiong, Xiaoxiong

2015-01-01

The Visible Infrared Imaging Radiometer Suiteaboard the Suomi National Polar-orbiting Partnership (SNPP) satellite performs radiometric calibration of its reflective solar bands primarily through observing a sunlit onboard solar diffuser (SD). The SD bidirectional reflectance distribution function(BRDF) degradation factor is determined by an onboard SD stability monitor (SDSM), which observes the Sun through a pinhole screen and the sunlit SD. The transmittance of the SDSM pinhole screen over a range of solar angles was determined prelaunch and used initially to determine the BRDF degradation factor.The degradation-factor-versus-time curves were found to have a number of very large unphysical undulations likely due to the inaccuracy in the prelaunch determined SDSM screen transmittance.To refine the SDSM screen transmittance, satellite yaw maneuvers were carried out. With the SDSM screen relative transmittance determined from the yaw maneuver data, the computed BRDFdegradation factor curves still have large unphysical ripples, indicating that the projected solar horizontal angular step size in the yaw maneuver data is too large to resolve the transmittance at a fine angular scale. We develop a methodology to use both the yaw maneuver and a small portion of regular on-orbit data to determine the SDSM screen relative transmittance at a fine angular scale. We determine that the error standard deviation of the calculated relative transmittance ranges from 0.00030 (672 nm) to 0.00092 (926 nm). With the newly determined SDSM screen relative transmittance, the computed BRDF degradation factor behaves much more smoothly over time.

Abdominal aortic atherosclerosis at MR imaging is associated with cardiovascular events: the Dallas heart study.

PubMed

Maroules, Christopher D; Rosero, Eric; Ayers, Colby; Peshock, Ronald M; Khera, Amit

2013-10-01

To determine the value of two abdominal aortic atherosclerosis measurements at magnetic resonance (MR) imaging for predicting future cardiovascular events. This study was approved by the institutional review board and complied with HIPAA regulations. The study consisted of 2122 participants from the multiethnic, population-based Dallas Heart Study who underwent abdominal aortic MR imaging at 1.5 T. Aortic atherosclerosis was measured by quantifying mean aortic wall thickness (MAWT) and aortic plaque burden. Participants were monitored for cardiovascular death, nonfatal cardiac events, and nonfatal extracardiac vascular events over a mean period of 7.8 years ± 1.5 (standard deviation [SD]). Cox proportional hazards regression was used to assess independent associations of aortic atherosclerosis and cardiovascular events. Increasing MAWT was positively associated with male sex (odds ratio, 3.66; P < .0001), current smoking (odds ratio, 2.53; P < .0001), 10-year increase in age (odds ratio, 2.24; P < .0001), and hypertension (odds ratio, 1.66; P = .0001). A total of 143 participants (6.7%) experienced a cardiovascular event. MAWT conferred an increased risk for composite events (hazard ratio, 1.28 per 1 SD; P = .001). Aortic plaque was not associated with increased risk for composite events. Increasing MAWT and aortic plaque burden both conferred an increased risk for nonfatal extracardiac events (hazard ratio of 1.52 per 1 SD [P < .001] and hazard ratio of 1.46 per 1 SD [P = .03], respectively). MR imaging measures of aortic atherosclerosis are predictive of future adverse cardiovascular events. © RSNA, 2013.

Perspectives of paediatric and adult gastroenterologists on transfer and transition care of adolescents with inflammatory bowel disease.

PubMed

Wright, E K; Williams, J; Andrews, J M; Day, A S; Gearry, R B; Bampton, P; Moore, D; Lemberg, D; Ravikumaran, R; Wilson, J; Lewindon, P; Radford-Smith, G; Rosenbaum, J; Catto-Smith, A; Desmond, P V; Connell, W R; Cameron, D; Alex, G; Bell, S J; De Cruz, P

2014-05-01

Programmes specific to inflammatory bowel disease (IBD) that facilitate transition from paediatric to adult care are currently lacking. We aimed to explore the perceived needs of adolescents with IBD among paediatric and adult gastroenterologists and to identify barriers to effective transition. A web-based survey of paediatric and adult gastroenterologists in Australia and New Zealand employed both ranked items (Likert scale; from 1 not important to 5 very important) and forced choice items regarding the importance of various factors in facilitating effective transition of adolescents from paediatric to adult care. Response rate among 178 clinicians was 41%. Only 23% of respondents felt that adolescents with IBD were adequately prepared for transition to adult care. Psychological maturity (Mean = 4.3, standard deviation (SD) = 0.70) and readiness as assessed by adult caregiver (Mean = 4, SD = 0.72) were prioritised as the most important factors in determining timing of transfer. Self-efficacy and readiness as assessed by adult caregiver were considered the two most important factors to determine timing of transition by both groups of gastroenterologists. Poor medical and surgical handover (Mean = 4.10, SD = 0.8) and patients' lack of responsibility for their own care (Mean= 4.10, SD = 0.82) were perceived as major barriers to successful transition by both paediatric and adult gastroenterologists. Deficiencies exist in current transition care of adolescents with IBD in Australia and New Zealand. Standardising transition care practices with strategies aimed at optimising communication, patient education, self-efficacy and adherence may improve outcomes. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Creation of Consistent Burn Wounds: A Rat Model

PubMed Central

Cai, Elijah Zhengyang; Ang, Chuan Han; Raju, Ashvin; Tan, Kong Bing; Hing, Eileen Chor Hoong; Loo, Yihua; Wong, Yong Chiat; Lee, Hanjing; Lim, Jane; Moochhala, Shabbir M; Hauser, Charlotte AE

2014-01-01

Background Burn infliction techniques are poorly described in rat models. An accurate study can only be achieved with wounds that are uniform in size and depth. We describe a simple reproducible method for creating consistent burn wounds in rats. Methods Ten male Sprague-Dawley rats were anesthetized and dorsum shaved. A 100 g cylindrical stainless-steel rod (1 cm diameter) was heated to 100℃ in boiling water. Temperature was monitored using a thermocouple. We performed two consecutive toe-pinch tests on different limbs to assess the depth of sedation. Burn infliction was limited to the loin. The skin was pulled upwards, away from the underlying viscera, creating a flat surface. The rod rested on its own weight for 5, 10, and 20 seconds at three different sites on each rat. Wounds were evaluated for size, morphology and depth. Results Average wound size was 0.9957 cm2 (standard deviation [SD] 0.1845) (n=30). Wounds created with duration of 5 seconds were pale, with an indistinct margin of erythema. Wounds of 10 and 20 seconds were well-defined, uniformly brown with a rim of erythema. Average depths of tissue damage were 1.30 mm (SD 0.424), 2.35 mm (SD 0.071), and 2.60 mm (SD 0.283) for duration of 5, 10, 20 seconds respectively. Burn duration of 5 seconds resulted in full-thickness damage. Burn duration of 10 seconds and 20 seconds resulted in full-thickness damage, involving subjacent skeletal muscle. Conclusions This is a simple reproducible method for creating burn wounds consistent in size and depth in a rat burn model. PMID:25075351

Decomposing Intra-Subject Variability in Children with Attention-Deficit/Hyperactivity Disorder

PubMed Central

Di Martino, Adriana; Ghaffari, Manely; Curchack, Jocelyn; Reiss, Philip; Hyde, Christopher; Vannucci, Marina; Petkova, Eva; Klein, Donald F.; Castellanos, F. Xavier

2009-01-01

Background Increased intra-subject response time standard deviations (RT-SD) discriminate children with Attention-Deficit/Hyperactivity Disorder (ADHD) from healthy controls. RT-SD is averaged over time, thus it does not provide information about the temporal structure of response time variability. We previously hypothesized that such increased variability may be related to slow spontaneous fluctuations in brain activity occurring with periods between 15s and 40s. Here, we investigated whether these slow response time fluctuations add unique differentiating information beyond the global increase in RT-SD. Methods We recorded RT at 3s intervals for 15 minutes during an Eriksen flanker task for 29 children with ADHD and 26 age-matched typically developing controls (TDC) (mean ages 12.5 ± 2.4 and 11.6 ± 2.5; 26 and 12 boys, respectively). The primary outcome was the magnitude of the spectral component in the frequency range between 0.027 and 0.073 Hz measured with continuous Morlet wavelet transform. Results The magnitude of the low frequency fluctuation was greater for children with ADHD compared to TDC (p=0.02, d= 0.69). After modeling ADHD diagnosis as a function of RT-SD, adding this specific frequency range significantly improved the model fit (p=0.03; odds ratio= 2.58). Conclusions Fluctuations in low frequency response time variability predict the diagnosis of ADHD beyond the effect associated with global differences in variability. Future studies will examine whether such spectrally specific fluctuations in behavioral responses are linked to intrinsic regional cerebral hemodynamic oscillations which occur at similar frequencies. PMID:18423424

Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial.

PubMed

Tamaoki, Marcel Jun Sugawara; Faloppa, Flavio; Wajnsztejn, André; Archetti Netto, Nicola; Matsumoto, Marcelo Hide; Belloti, João Carlos

2012-01-01

Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp). From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group. Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. ISRCTN27127703.

Web-based training on weapons of mass destruction response for emergency medical services personnel.

PubMed

Gershon, Robyn R M; Canton, Allison N; Magda, Lori A; DiMaggio, Charles; Gonzalez, Dario; Dul, Mitchell W

2009-01-01

To develop, implement, and assess a web-based simulation training program for emergency medical services (EMS) personnel on recognition and treatment of ocular injuries resulting from weapons of mass destruction (WMD) attacks. The training program consisted of six modules: WMD knowledge and event detection, ocular anatomy, ocular first aid (ie, flushing, cupping, and patching), and three WMD simulations (ie, sarin gas release, anthrax release, and radioactive dispersal device). Pretest, post-test, and 1-month follow-up test and a program evaluation were used to measure knowledge gain and retention and to assess the effectiveness of the program. New York State EMS. Four hundred and sixty-four individuals participated in the training program and all waves of the testing (86 percent retention rate). The effectiveness of the training intervention was measured using pretest and post-test questionnaires and analyzed using dependent t-tests. Assessment scores for overall knowledge increased from the pretest (mean = 15.7, standard deviation [SD] = 2.1) to the post-test (mean = 17.8, SD = 1.3), p < 0.001, and from pretest (mean = 15.7, SD = 2.1) to 1-month follow-up test (mean = 16.6, SD = 2.0), p < 0.001. Ninety-two percent of respondents indicated that the program reinforced understanding of WMDs. This training method provides an effective and low-cost approach to educate and evaluate EMS personnel on emergency treatment of eye trauma associated with the use of WMD. Online training should also be supplemented with hands-on practice and refresher trainings.

Cue-induced craving in pathological buying: empirical evidence and clinical implications.

PubMed

Trotzke, Patrick; Starcke, Katrin; Pedersen, Anya; Brand, Matthias

2014-01-01

Pathological buying is associated with marked distress and impaired functioning in important life domains. It is currently under debate whether pathological buying can be considered a behavioral addiction. In analogy to results reported in addicted individuals, craving reactions elicited by addiction-related cues might be an underlying mechanism for the etiology and pathogenesis of pathological buying. In the present study, 30 pathological buyers and 30 matched control participants were examined with a cue-reactivity paradigm consisting of shopping and control cues. Skin conductance responses, as well as subjective ratings for arousal, valence, and urge to buy, were assessed. Subjective craving reactions were measured before and after the cue-reactivity paradigm. On a physiological level, skin conductance responses toward shopping cues were higher in pathological buyers (mean [M; standard deviation {SD}] = 0.26 [0.13]) compared with control participants (M [SD] = 0.19 [0.09]; t(58) = 2.29, p = .025, d = 0.60). On a behavioral level, the individuals with pathological buying rated the shopping cues as more arousing and more positive, and reported a greater urge to buy compared with control participants and with control cues. An increase in subjective craving after completing the cue-reactivity paradigm was observed only in the pathological buyers (Mpre [SD] = 1.95 [1.47], Mpost [SD] = 2.87 [1.79]; t(29) = 5.07, p < .001, d = 0.97). Cue-reactivity and craving might be potential correlates for the development and maintenance of pathological buying. The results demonstrate similarities between pathological buying and substance or behavioral addictions and provide implications for clinical treatment.

Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in Nepal

PubMed Central

Gautam, Om Prasad; Schmidt, Wolf-Peter; Cairncross, Sandy; Cavill, Sue; Curtis, Valerie

2017-01-01

In this study, we report on the results of a trial of an intervention to improve five food hygiene behaviors among mothers of young children in rural Nepal. This novel intervention targeted five behaviors; cleanliness of serving utensils, handwashing with soap before feeding, proper storage of cooked food, and thorough reheating and water treatment. Based on formative research and a creative process using the Behavior-Centered Design approach, an innovative intervention package was designed and delivered over a period of 3 months. The intervention activities included local rallies, games, rewards, storytelling, drama, competitions linking with emotional drivers of behavior, and “kitchen makeovers” to disrupt behavior settings. The effect of the package on behavior was evaluated via a cluster-randomized before–after study in four villages with four villages serving as controls. The primary outcome was the difference in the mean cluster level proportions of mothers directly observed practicing all five food hygiene behaviors. The five targeted food hygiene behaviors were rare at baseline (composite performance of all five behaviors in intervention 1% [standard deviation (SD) = 2%] and in control groups 2% [SD = 2%]). Six weeks after the intervention, the target behaviors were more common in the intervention than in the control group (43% [SD = 14%] versus 2% [SD = 2%], P = 0.02) during follow-up. The intervention appeared to be equally effective in improving all five behaviors in all intervention clusters. This study shows that a theory-driven, systematic approach employing emotional motivators and modifying behavior settings was capable of substantially improving multiple food hygiene behaviors in Nepal. PMID:28719285

Effect of vitamin C supplementation on stroke recovery: a case-control study.

PubMed

Rabadi, Meheroz H; Kristal, Bruce S

2007-01-01

Epidemiological studies have associated increased dietary intake of antioxidants (vitamin C, E, and beta-carotene) in preventing and decreasing the extent of ischemic brain injury. The effect of vitamin C supplementation on functional recovery after stroke has not been studied. In this retrospective, case-control study of 23 patients with ischemic stroke taking vitamin C were identified and matched for age, sex, onset to admission, and admission total functional independence measure (TFIM) with 23 patients with ischemic stroke not taking Vitamin C supplementation. Vitamin C 1000 mg daily was prescribed on admission to our unit mainly to patients who were undernourished (defined as significant weight loss and/or 90% or less ideal body weight for age and sex) and those with pressure sores. The outcome measures were: change in the TFIM, FIM-Cognition (FIM-Cog), and FIM-Motor sub-scores, discharge disposition, and length of stay (LOS). The change in TFIM (20 +/- 13 standard deviation [SD] vs. 26 +/- 6, p = 0.20), FIM-Cog (3 +/- 3 SD vs. 4 +/- 5, p = 0.41), FIM-Motor (15 +/- 11 SD vs. 20 +/- 13, p = 0.21) sub-scores were less in the vitamin C treated group, but these differences did not reach statistical significance. Similarly, no significant differences were found in LOS (21 +/- 9 SD vs. 23 +/- 9, p = 0.59), and discharge disposition (home/institution) (9/10 vs. 13/9, p = 0.60) between the vitamin C and the control groups. This study suggests vitamin C supplementation did not enhance functional recovery in undernourished ischemic stroke patients.

Inhibitory Control and Impulsivity Levels in Women Crack Users.

PubMed

Hess, Adriana Raquel Binsfeld; Menezes, Carolina B; de Almeida, Rosa Maria Martins

2018-05-12

investigate impulsivity levels and inhibitory control in women crack users and explore the relationships between impulsivity and inhibitory control. 52 healthy women (M = 32.83 years; SD = 9.54) and 46 crack cocaine users (M = 31.02 years; SD = 7.73), in abstinence, performed the assessment protocol included a Sociodemographic Data Questionnaire, Mini-Mental State Examination (MMSE), a GO/No-Go Task and the Barratt Impulsiveness Scale-11 (BIS-11). It was a quantitative research with cross-sectional design and control group. crack group showed higher levels of impulsivity in all domains when compared to the control group (crack group M = 76.39, SD = 11.39, control group M = 58.53, SD = 10.76, p <.01). Participants from the crack group presented a significantly higher total reaction time in the Go-NoGo task (F(1,93) = 9.93, p =.002; effect size =.09, observed power =.87) and significantly more commission (F(1,93) = 7.20, p =.009; effect size =.07, observed power =.75) and omission errors (F(1,93) = 6.04, p =.01; effect size =.06, observed power =.68), in Go/NoGo Task. Groups did also significantly differ on total standard deviations suggesting that variability in total reaction time was significantly greater in the crack group. Results showed that only in the crack group there were significant correlations between Go-NoGo parameters and Barratt Impulsiveness Scale. Our findings are consistent that impulsivity and inhibitory control are closely linked to crack use in women. Future studies should consider to evaluate crack users in different withdrawal times, controlling the impact of abstinence time in the variables studied.

Trial of a Novel Intervention to Improve Multiple Food Hygiene Behaviors in Nepal.

PubMed

Gautam, Om Prasad; Schmidt, Wolf-Peter; Cairncross, Sandy; Cavill, Sue; Curtis, Valerie

2017-06-01

AbstractIn this study, we report on the results of a trial of an intervention to improve five food hygiene behaviors among mothers of young children in rural Nepal. This novel intervention targeted five behaviors; cleanliness of serving utensils, handwashing with soap before feeding, proper storage of cooked food, and thorough reheating and water treatment. Based on formative research and a creative process using the Behavior-Centered Design approach, an innovative intervention package was designed and delivered over a period of 3 months. The intervention activities included local rallies, games, rewards, storytelling, drama, competitions linking with emotional drivers of behavior, and "kitchen makeovers" to disrupt behavior settings. The effect of the package on behavior was evaluated via a cluster-randomized before-after study in four villages with four villages serving as controls. The primary outcome was the difference in the mean cluster level proportions of mothers directly observed practicing all five food hygiene behaviors. The five targeted food hygiene behaviors were rare at baseline (composite performance of all five behaviors in intervention 1% [standard deviation (SD) = 2%] and in control groups 2% [SD = 2%]). Six weeks after the intervention, the target behaviors were more common in the intervention than in the control group (43% [SD = 14%] versus 2% [SD = 2%], P = 0.02) during follow-up. The intervention appeared to be equally effective in improving all five behaviors in all intervention clusters. This study shows that a theory-driven, systematic approach employing emotional motivators and modifying behavior settings was capable of substantially improving multiple food hygiene behaviors in Nepal.

Reliability and validity of a brief questionnaire to assess television viewing and computer use by middle school children.

PubMed

Schmitz, Kathryn H; Harnack, Lisa; Fulton, Janet E; Jacobs, David R; Gao, Shujun; Lytle, Leslie A; Van Coevering, Pam

2004-11-01

Sedentary behaviors, like television viewing, are positively associated with overweight among young people. To monitor national health objectives for sedentary behaviors in young adolescents, this project developed and assessed the reliability and validity of a brief questionnaire to measure weekly television viewing, usual television viewing, and computer use by middle school children. Reliability and validity of the Youth Risk Behavior Survey (YRBS) question on weekday television viewing also were examined. A brief, five-item television and computer use questionnaire was completed twice by 245 middle school children with one week apart. To concurrently assess validity, students also completed television and computer use logs for seven days. Among all students, Spearman correlations for test-retest reliability for television viewing and computer use ranged from 0.55 to 0.68. Spearman correlations between the first questionnaire and the seven-day log produced the following results: YRBS question for weekday television viewing (0.46), weekend television viewing (0.37), average television viewing over the week (0.47), and computer use (0.39). Methods comparison analysis showed a mean difference (hours/week) between answers to questionnaire items and the log of -0.04 (1.70 standard deviation [SD]) hours for weekday television, -0.21 (2.54 SD) for weekend television, -0.09 (1.75 SD) for average television over the week, and 0.68 (1.26 SD) for computer use. The YRBS weekday television viewing question, and the newly developed questions to assess weekend television viewing, average television viewing, and computer use, produced adequate reliability and validity for surveillance of middle school students.

Current versus lifetime depression, APOE variation, and their interaction on cognitive performance in younger and older adults.

PubMed

Luciano, Michelle; Pujals, Ana Maria Fernández; Marioni, Riccardo E; Campbell, Archie; Hayward, Caroline; MacIntyre, Donald J; Porteous, David J; McIntosh, Andrew M; Deary, Ian J

2015-06-01

An interaction effect of depressive symptoms and APOE e4 allele status on cognitive decline has been shown in old age: e4 allele carriers with more depressive symptoms have faster cognitive decline than those with either depression or the e4 allele. We test this interaction effect on four cognitive domains, using a clinical depression measure comparing current versus lifetime depression. 14,379 individuals aged 18 to 59 years, and 3944 individuals aged 60 to 94 years from the Generation Scotland: Scottish Family Health Study participated. Linear-mixed models-accounting for participant relatedness and demographic and health indices-tested for effects of depression and APOE on cognitive abilities. There was no interaction between depression and APOE on cognition (p > .05). Current depression was associated with poorer speed (in both groups) and memory (18- to 59-year-olds); differences ranged from 0.01 to 0.03 standard deviation [SD]. For lifetime depression, cognitive performance was lower for digit symbol in younger adults, but higher for vocabulary in both younger (0.03 SD) and older (0.05 SD) adults. A negative effect of the APOE e4 allele on speed and memory was found in the group 60 years and older (effect sizes of 0.04 SD). The absence of a depression by APOE interaction on cognitive abilities suggests that these synergistic effects only operate at the level of cognitive decline. This implies that it is those biological pathways especially affected by aging that become compromised further by the combined presence of depression and APOE e4 in an individual.

Study Behaviors and USMLE Step 1 Performance: Implications of a Student Self-Directed Parallel Curriculum.

PubMed

Burk-Rafel, Jesse; Santen, Sally A; Purkiss, Joel

2017-11-01

To determine medical students' study behaviors when preparing for the United States Medical Licensing Examination (USMLE) Step 1, and how these behaviors are associated with Step 1 scores when controlling for likely covariates. The authors distributed a study-behaviors survey in 2014 and 2015 at their institution to two cohorts of medical students who had recently taken Step 1. Demographic and academic data were linked to responses. Descriptive statistics, bivariate correlations, and multiple linear regression analyses were performed. Of 332 medical students, 274 (82.5%) participated. Most students (n = 211; 77.0%) began studying for Step 1 during their preclinical curriculum, increasing their intensity during a protected study period during which they averaged 11.0 hours studying per day (standard deviation [SD] 2.1) over a period of 35.3 days (SD 6.2). Students used numerous third-party resources, including reading an exam-specific 700-page review book on average 2.1 times (SD 0.8) and completing an average of 3,597 practice multiple-choice questions (SD 1,611). Initiating study prior to the designated study period, increased review book usage, and attempting more practice questions were all associated with higher Step 1 scores, even when controlling for Medical College Admission Test scores, preclinical exam performance, and self-identified score goal (adjusted R = 0.56, P < .001). Medical students at one public institution engaged in a self-directed, "parallel" Step 1 curriculum using third-party study resources. Several study behaviors were associated with improved USMLE Step 1 performance, informing both institutional- and student-directed preparation for this high-stakes exam.

Comorbidity in chronic obstructive pulmonary disease. Related to disease severity?

PubMed

Echave-Sustaeta, Jose M; Comeche Casanova, Lorena; Cosio, Borja G; Soler-Cataluña, Juan Jose; Garcia-Lujan, Ricardo; Ribera, Xavier

2014-01-01

Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients. In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated. Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage. COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity.

Changes in the perception of alcohol-related stigma in Germany over the last two decades.

PubMed

Schomerus, Georg; Matschinger, Herbert; Lucht, Michael J; Angermeyer, Matthias C

2014-10-01

Alcohol dependence is a severely stigmatized disorder. Perceived stigma may deter help-seeking and is associated with higher co-morbidity and self-stigma in persons with alcohol dependence. We assess changes in the perception of alcohol-related stigma over 21 years in the general population. Two representative population surveys using identical methodology were conducted in Germany in 1990 and 2011 (n=1022 and n=967), eliciting the perceived discrimination and devaluation of someone with a history of alcohol problems as measured with an adoption of Link's Perceived Discrimination and Devaluation Scale (aPDDS), and perceived negative stereotypes of an "alcoholic." Both on item level and using factor scores, attitudes changed significantly between 1990 and 2011. Perceived discrimination and devaluation of someone with a history of alcohol dependence decreased considerably by 0.44 standard deviations (SD). Perceived negative stereotypes related to unpredictability of an "alcoholic" increased slightly by 0.15 SD, while perceived stereotypes related to strangeness decreased (-0.23 SD). Our findings suggest that particularly the image of someone who has received treatment for alcohol dependence has improved in Germany. This parallels increasing acceptance of professional treatment for alcohol dependence among the general population over the last twenty years, and contrasts with overall unchanged negative attitudes toward persons who actually suffer from alcohol problems. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Crustal structure of Precambrian terranes in the southern African subcontinent with implications for secular variation in crustal genesis

NASA Astrophysics Data System (ADS)

Kachingwe, Marsella; Nyblade, Andrew; Julià, Jordi

2015-07-01

New estimates of crustal thickness, Poisson's ratio and crustal shear wave velocity have been obtained for 39 stations in Angola, Botswana, the Democratic Republic of Congo, Malawi, Mozambique, Namibia, Rwanda, Tanzania and Zambia by modelling P-wave receiver functions using the H-κ stacking method and jointly inverting the receiver functions with Rayleigh-wave phase and group velocities. These estimates, combined with similar results from previous studies, have been examined for secular trends in Precambrian crustal structure within the southern African subcontinent. In both Archean and Proterozoic terranes we find similar Moho depths [38-39 ± 3 km SD (standard deviation)], crustal Poisson's ratio (0.26 ± 0.01 SD), mean crustal shear wave velocity (3.7 ± 0.1 km s-1 SD), and amounts of heterogeneity in the thickness of the mafic lower crust, as defined by shear wave velocities ≥4.0 km s-1. In addition, the amount of variability in these crustal parameters is similar within each individual age grouping as between age groupings. Thus, the results provide little evidence for secular variation in Precambrian crustal structure, including between Meso- and Neoarchean crust. This finding suggests that (1) continental crustal has been generated by similar processes since the Mesoarchean or (2) plate tectonic processes have reworked and modified the crust through time, erasing variations in structure resulting from crustal genesis.

Presence of PSA auto-antibodies in men with prostate abnormalities (prostate cancer/benign prostatic hyperplasia/prostatitis).

PubMed

Lokant, M T; Naz, R K

2015-04-01

Prostate-specific antigen (PSA), produced by the prostate, liquefies post-ejaculate semen. PSA is detected in semen and blood. Increased circulating PSA levels indicate prostate abnormality [prostate cancer (PC), benign prostatic hyperplasia (BPH), prostatitis (PTIS)], with variance among individuals. As the prostate has been proposed as an immune organ, we hypothesise that variation in PSA levels among men may be due to presence of auto-antibodies against PSA. Sera from healthy men (n = 28) and men having prostatitis (n = 25), BPH (n = 30) or PC (n = 29) were tested for PSA antibody presence using enzyme-linked immunosorbent assay (ELISA) values converted to standard deviation (SD) units, and Western blotting. Taking ≥2 SD units as cut-off for positive immunoreactivity, 0% of normal men, 0% with prostatitis, 33% with BPH and 3.45% with PC demonstrated PSA antibodies. One-way analysis of variance (anova) performed on the mean absorbance values and SD units of each group showed BPH as significantly different (P < 0.01) compared with PC and prostatitis. All others were nonsignificant (P < 0.05). Men (33%) with BPH had PSA antibodies by ELISA and Western blot. These discoveries may find clinical application in differential diagnosis among prostate abnormalities, especially differentiating BPH from prostate cancer and prostatitis. © 2014 Blackwell Verlag GmbH.

Children with congenital colorectal malformations often require special education or remedial teaching, despite normal intelligence.

PubMed

van den Hondel, Desiree; Aarsen, Femke K; Wijnen, Rene M H; Sloots, Cornelius E J; IJsselstijn, Hanneke

2016-02-01

This study prospectively evaluated neuropsychological functioning in 8-year-old patients with anorectal malformation (ARM) and Hirschsprung's disease (HD). School functioning and behaviour were assessed in a standardised interview. Intelligence, attention, self-esteem and quality of life were evaluated with validated tests and questionnaires. The following predictors were assessed: socio-economic status, number of episodes of general anaesthesia, laxative treatment and premature birth. Severely intellectually disabled patients were excluded. In total, twelve of the 23 (52%) patients with ARM and 11 (55%) of the 20 patients with HD received special education or remedial teaching. The intelligence quotient was normal: mean (standard deviation or SD) was 98 (17) and 96 (17), respectively. However, sustained attention was below the norm: mean (SD) Z-score was -1.90 (1.94) and -1.43 (1.98) for ARM and HD patients; both p < 0.01. Self-esteem was normal: mean (SD) Z-score was 0.10 (1.29) and -0.20 (1.11) for ARM and HD patients. Quality of life was normal in ARM patients and slightly impaired in HD patients. No predictors for neuropsychological outcome were identified. Despite normal intelligence, more than half of these patients received special education or remedial teaching. In addition, problems with sustained attention were found. These findings are important for long-term care. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Development of preschool and academic skills in children born very preterm.

PubMed

Aarnoudse-Moens, Cornelieke Sandrine Hanan; Oosterlaan, Jaap; Duivenvoorden, Hugo Joseph; van Goudoever, Johannes Bernard; Weisglas-Kuperus, Nynke

2011-01-01

To examine performance in preschool and academic skills in very preterm (gestational age ≤ 30 weeks) and term-born comparison children aged 4 to 12 years. Very preterm children (n = 200; mean age, 8.2 ± 2.5 years) born between 1996 and 2004 were compared with 230 term-born children (mean age, 8.3 ± 2.3). The Dutch National Pupil Monitoring System was used to measure preschool numerical reasoning and early linguistics, and primary school simple and complex word reading, reading comprehension, spelling, and mathematics/arithmetic. With univariate analyses of variance, we assessed the effects of preterm birth on performance across grades and on grade retention. In preschool, very preterm children performed comparably with term-born children in early linguistics, but perform more poorly (0.7 standard deviation [SD]) in numerical reasoning skills. In primary school, very preterm children scored 0.3 SD lower in complex word reading and 0.6 SD lower in mathematics/arithmetic, but performed comparably with peers in reading comprehension and spelling. They had a higher grade repeat rate (25.5%), although grade repeat did not improve their academic skills. Very preterm children do well in early linguistics, reading comprehension, and spelling, but have clinically significant deficits in numerical reasoning skills and mathematics/arithmetic, which persist with time. Copyright © 2011 Mosby, Inc. All rights reserved.

Impact of adding artificially generated alert sound to hybrid electric vehicles on their detectability by pedestrians who are blind

PubMed Central

Kim, Dae Shik; Emerson, Robert Wall; Naghshineh, Koorosh; Pliskow, Jay; Myers, Kyle

2012-01-01

A repeated-measures design with block randomization was used for the study, in which 14 adults with visual impairments attempted to detect three different vehicles: a hybrid electric vehicle (HEV) with an artificially generated sound (Vehicle Sound for Pedestrians [VSP]), an HEV without the VSP, and a comparable internal combustion engine (ICE) vehicle. The VSP vehicle (mean +/− standard deviation [SD] = 38.3 +/− 14.8 m) was detected at a significantly farther distance than the HEV (mean +/− SD = 27.5 +/− 11.5 m), t = 4.823, p < 0.001, but no significant difference existed between the VSP and ICE vehicles (mean +/− SD = 34.5 +/− 14.3 m), t = 1.787, p = 0.10. Despite the overall sound level difference between the two test sites (parking lot = 48.7 dBA, roadway = 55.1 dBA), no significant difference in detection distance between the test sites was observed, F(1, 13) = 0.025, p = 0.88. No significant interaction was found between the vehicle type and test site, F(1.31, 16.98) = 0.272, p = 0.67. The findings of the study may help us understand how adding an artificially generated sound to an HEV could affect some of the orientation and mobility tasks performed by blind pedestrians. PMID:22773198

Malnutrition among vaccinated children aged 0-5 years in Batouri, Republic of Cameroon.

PubMed

Nagahori, Chikako; Kinjo, Yoshihide; Tchuani, Jean Paul; Yamauchi, Taro

2017-12-01

Malnutrition continues to contribute to a high infant mortality rate. This study aimed to determine the prevalence of malnutrition and its potential association with the time at which complementary feeding was introduced among children aged 0-5 years in Batouri, Republic of Cameroon. Mothers (n=212) were interviewed using a structured questionnaire. Child height or length, and weight measurements were determined and the appropriate Z -scores calculated. Multiple regression analysis was performed with the values of all nutritional status indicators as dependent variables and the time of commencing complementary feeding, and the child's age and sex, as independent variables. The prevalence of stunting (height/length for age<-2 standard deviation [SD]), underweight (weight for age<-2SD), and wasting (weight for height/length<-2SD) was 45.8%, 30.2%, and 11.3%, respectively. Even taking into consideration the biological variables, there was a significant association in the effects of time of starting complementary foods on the nutritional status indicators. Furthermore, adding socio-economic variables did not produce a rise in adjusted R 2 values for all age group models concerned. Approximately 30% of the children in the study region were underweight, and approximately half of the children exhibited stunting, indicating chronic malnutrition. Commencing complementary feeding at an appropriate time had a positive effect on nutritional status from approximately 2 years of age.

A cybernetic approach to osteoporosis in anorexia nervosa.

PubMed

Fricke, O; Tutlewski, B; Stabrey, A; Lehmkuhl, G; Schöenau, E

2005-06-01

A group of 25 female individuals, who had been admitted to the University Hospital with the diagnosis of anorexia nervosa (AN) 3 to 10 years before, was seen for a follow-up visit in the hospital. These women got a psychiatric exploration to detect a present eating disorder. Moreover, parameters of the muskuloskeletal interaction were determined on the non-dominant forearm. Bone mineral content (BMC) of the radius was measured by pQCT and maximal grip force was evaluated by the use of a dynamometer. Eating disorders were present in 12 females. The mean of BMC standard deviation (SD) score was significantly reduced in comparison with reference values. Furthermore, the mean of BMC SD score was also significantly lower than the mean of grip force in SD score. These results gave the suggestion that the adaptation of bone mass to biomechanical forces is disturbed in AN. The linear regression analyses between the parameters grip force and BMC were compared between the study and the reference group. The comparison delivered a significantly lower constant in the regression equation of the study group. This result can be interpreted on the background of the mechanostat theory. The affection with an eating disorder decreases the set point in the feedback loop of bone modeling. The results offer for the first time the possibility to analyse osteoporosis in anorexic females under the paradigm of muskuloskeletal interaction.

Value of shear wave arrival time contour display in shear wave elastography for breast masses diagnosis.

PubMed

Zhou, Bang-Guo; Wang, Dan; Ren, Wei-Wei; Li, Xiao-Long; He, Ya-Ping; Liu, Bo-Ji; Wang, Qiao; Chen, Shi-Gao; Alizad, Azra; Xu, Hui-Xiong

2017-08-01

To evaluate the diagnostic performance of shear wave arrival time contour (SWATC) display for the diagnosis of breast lesions and to identify factors associated with the quality of shear wave propagation (QSWP) in breast lesions. This study included 277 pathologically confirmed breast lesions. Conventional B-mode ultrasound characteristics and shear wave elastography parameters were computed. Using the SWATC display, the QSWP of each lesion was assigned to a two-point scale: score 1 (low quality) and score 2 (high quality). Binary logistic regression analysis was performed to identify factors associated with QSWP. The area under the receiver operating characteristic curve (AUROC) for QSWP to differentiate benign from malignant lesions was 0.913, with a sensitivity of 91.9%, a specificity of 90.7%, a positive predictive value (PPV) of 74.0%, and a negative predictive value (NPV) of 97.5%. Compared with using the standard deviation of shear wave speed (SWS SD ) alone, SWS SD combined with QSWP increased the sensitivity from 75.8% to 93.5%, but decreased the specificity from 95.8% to 89.3% (P < 0.05). SWS SD was identified to be the strongest factor associated with the QSWP, followed by tumor malignancy and the depth of the lesion. In conclusion, SWATC display may be useful for characterization of breast lesions.

[Food intake in indigenous and non-indigenous Chilean schoolchildren of different social vulnerability].

PubMed

García, Vanessa; Amigo, Hugo; Bustos, Patricia

2002-12-01

The study was based on a cross-sectional design of children from six to nine year olds. Indigenous children were those whose parents had all surnames of this ethnic origin. Non-indigenous children were those with Hispanic surnames. Participants belonged to one of the three social vulnerability groups: high vulnerability (extreme poverty) living in rural communities in a southern region of the country (n = 184); medium vulnerability living in urbanized settings in the same region (n = 248); low vulnerability living in Santiago of Chile (n = 336). Food intake was estimated using a 24-hours recall questionnaire. Total energy intake was similar in the two ethnic groups in all vulnerabilities. It was observed that energy and macronutrient intake increased with the improvement of the social vulnerability: High 1679 kcal. with a standard deviation (SD) of 461, Medium 1878 (SD 484), Low 1894 (SD 495). Children in the high social vulnerability group had a total energy intake below the WHO/FAO recommendations. Consumption of milk, meat, vegetables and fruits was insufficient in all social vulnerability levels but it was closer to the recommendation in the low vulnerability group. Bread accounted for almost 50% of the total energy intake in the high and medium vulnerability groups. It is concluded that differences in the access to an adequate feeding are related to social vulnerability and not ethnicity.

Quantitative assessment of colorectal cancer tumor vascular parameters by using perfusion CT: influence of tumor region of interest.

PubMed

Goh, Vicky; Halligan, Steve; Gharpuray, Anita; Wellsted, David; Sundin, Josefin; Bartram, Clive I

2008-06-01

To prospectively determine whether position and size of tumor region of interest (ROI) influence estimates of colorectal cancer vascular parameters at computed tomography (CT). After institutional review board approval and informed consent, 25 men and 22 women (mean age, 65.8 years) with colorectal adenocarcinoma underwent 65-second CT perfusion study. Blood volume, blood flow, and permeability-surface area product were determined for 40- or 120-mm(2) circular ROIs placed at the tumor edge and center and around (outlining) visible tumor. ROI analysis was repeated by two observers in different subsets of patients to assess intra- and interobserver variation. Measurements were compared by using analysis of variance; a difference with P = .002 was significant. Blood volume, blood flow, and permeability-surface area product measurements were substantially higher at the edge than at the center for both 40- and 120-mm(2) ROIs. For 40-mm(2) ROI, means of the three measurements were 6.9 mL/100 g (standard deviation [SD], 1.4), 108.7 mL/100 g per minute (SD, 39.2), and 16.9 mL/100 g per minute (SD, 4.2), respectively, at the edge versus 5.1 mL/100 g (SD, 1.5), 56.3 mL/100 g per minute (SD, 33.1), and 13.9 mL/100 g per minute (SD, 4.6), respectively, at the center. For 120-mm(2) ROI, means of the three measurements were 6.6 mL/100 g (SD, 1.3), 96.7 mL/100 g per minute (SD, 42.5), and 16.3 mL/100 g per minute (SD, 5.6), respectively, at the edge versus 5.1 mL/100 g (SD, 1.4), 58.3 mL/100 g per minute (SD, 32.5), and 13.4 mL/100 g per minute (SD, 4.3) at the center (P < .0001). Measurements varied substantially depending on the ROI size; values for the ROI for outlined tumor were intermediate between those at the tumor edge and center. Inter- and intraobserver agreement was poor for both 40- and 120-mm(2) ROIs. Position and size of tumor ROI and observer variation substantially influence ultimate perfusion values. ROI for outlined entire tumor is more reliable for perfusion measurements and more appropriate clinically than use of arbitrarily determined smaller ROIs. (c) RSNA, 2008.

Comparison of Accuracy Between a Conventional and Two Digital Intraoral Impression Techniques.

PubMed

Malik, Junaid; Rodriguez, Jose; Weisbloom, Michael; Petridis, Haralampos

To compare the accuracy (ie, precision and trueness) of full-arch impressions fabricated using either a conventional polyvinyl siloxane (PVS) material or one of two intraoral optical scanners. Full-arch impressions of a reference model were obtained using addition silicone impression material (Aquasil Ultra; Dentsply Caulk) and two optical scanners (Trios, 3Shape, and CEREC Omnicam, Sirona). Surface matching software (Geomagic Control, 3D Systems) was used to superimpose the scans within groups to determine the mean deviations in precision and trueness (μm) between the scans, which were calculated for each group and compared statistically using one-way analysis of variance with post hoc Bonferroni (trueness) and Games-Howell (precision) tests (IBM SPSS ver 24, IBM UK). Qualitative analysis was also carried out from three-dimensional maps of differences between scans. Means and standard deviations (SD) of deviations in precision for conventional, Trios, and Omnicam groups were 21.7 (± 5.4), 49.9 (± 18.3), and 36.5 (± 11.12) μm, respectively. Means and SDs for deviations in trueness were 24.3 (± 5.7), 87.1 (± 7.9), and 80.3 (± 12.1) μm, respectively. The conventional impression showed statistically significantly improved mean precision (P < .006) and mean trueness (P < .001) compared to both digital impression procedures. There were no statistically significant differences in precision (P = .153) or trueness (P = .757) between the digital impressions. The qualitative analysis revealed local deviations along the palatal surfaces of the molars and incisal edges of the anterior teeth of < 100 μm. Conventional full-arch PVS impressions exhibited improved mean accuracy compared to two direct optical scanners. No significant differences were found between the two digital impression methods.

Upgraded FAA Airfield Capacity Model. Volume 1. Supplemental User’s Guide

DTIC Science & Technology

1981-02-01

SIGMAR (P4.0) cc 1-4 -standard deviation, in seconds, of arrival runway occupancy time (R.O.T.). SIGMAA (F4.0) cc 5-8 -standard deviation, in seconds...iI SI GMAC - The standard deviation of the time from departure clearance to start of roll. SIGMAR - The standard deviation of the arrival runway

Glaucoma progression detection with frequency doubling technology (FDT) compared to standard automated perimetry (SAP) in the Groningen Longitudinal Glaucoma Study.

PubMed

Wesselink, Christiaan; Jansonius, Nomdo M

2017-09-01

To determine the usefulness of frequency doubling perimetry (FDT) for progression detection in glaucoma, compared to standard automated perimetry (SAP). Data were used from 150 eyes of 150 glaucoma patients from the Groningen Longitudinal Glaucoma Study. After baseline, SAP was performed approximately yearly; FDT every other year. First and last visit had to contain both tests. Using linear regression, progression velocities were calculated for SAP (Humphrey Field Analyzer) mean deviation (MD) and FDT MD and the number of test locations with a total deviation probability below p < 0.01 (TD). Progression velocity tertiles were determined and eyes were classified as slowly, intermediately, or fast progressing for both techniques. Comparison between SAP and FDT classifications were made using a Mantel Haenszel chi-square test. Longitudinal signal-to-noise ratios (LSNRs) were calculated, per patient and per technique, defined as progression velocity divided by the standard deviation of the residuals. Mean (SD) follow-up was 6.4 (1.7) years; median (interquartile range [IQR]) baseline SAP MD -6.6 (-14.2 to -3.6) dB. On average 8.2 and 4.5 tests were performed for SAP and FDT, respectively. Median (IQR) MD slope was -0.16 (-0.46 to +0.02) dB/year for SAP and -0.05 (-0.39 to +0.17) dB/year for FDT. Mantel Haenszel chi-squares of SAP MD vs FDT MD and TD were 12.5 (p < 0.001) and 15.8 (p < 0.001), respectively. LSNRs for SAP MD (median -0.17 yr -1 ) were better than those for FDT MD (-0.04 yr -1 ; p = 0.010). FDT may be a useful technique for monitoring glaucoma progression in patients who cannot perform SAP reliably. © 2017 The Authors Ophthalmic & Physiological Optics © 2017 The College of Optometrists.