Among extracorporeal liver support devices, liver dialysis is cleared by the U.S. Food and Drug Administration to be used for the management of fulminant hepatic failure (FHF). The outcomes of patients following liver dialysis need to be clearly evaluated. Among the 25 patients with FHF admitted to the Liver ICU between May 2000 and November 2002, 12 underwent liver dialysis, including 6 men and 6 women, of mean age 32 years. The causes of FHF were identified as acetaminophen (n = 10), herbal medications (n = 1) and autoimmune disease (n = 1). At presentation, the mean total bilirubin was 9.35 mg/dL (range, 0 to 1.3), mean ALT 3015 U/L (range, 0 to 48), mean AST 3457 (range, 0 to 42), mean ammonia 98 micromol/L (range, 10 to 60) and mean INR 1.88. A control group including 13 patients (2 men and 11 women), of mean age 27.8 years mean total bilirubin 5.66, mean ALT 3494, mean AST 3528, mean ammonia 113 and mean INR 3, were not treated with liver dialysis, due to the lack of machine availability or physician's choice. The causes of FHF were acute hepatitis B (n = 1), acetaminophen (n = 10) or unknown (n = 2). There was no statistically significant difference in the baseline characteristics of the two groups (P >.05). Among the liver dialysis group, 1 patient died, 2 underwent OLTx, and 9 were discharged home. Among the control group; 4 patients died, 2 underwent OLTx, and 7 were discharged home. Preliminary results seem to support survival benefit among patients who underwent liver dialysis compared to non-liver dialysis; however, further randomized control trials are warranted to verify this observation.

Adolescent↗

PubMedDate not supplied

Intonation and dialog context as constraints for speech recognition.

This paper describes a way of using intonation and dialog context to improve the performance of an automatic speech recognition (ASR) system. Our experiments were run on the DCIEM Maptask corpus, a corpus of spontaneous task-oriented dialog speech. This corpus has been tagged according to a dialog analysis scheme that assigns each utterance to one of 12 "move types," such as "acknowledge," "query-yes/no" or "instruct." Most ASR systems use a bigram language model to constrain the possible sequences of words that might be recognized. Here we use a separate bigram language model for each move type. We show that when the "correct" move-specific language model is used for each utterance in the test set, the word error rate of the recognizer drops. Of course when the recognizer is run on previously unseen data, it cannot know in advance what move type the speaker has just produced. To determine the move type we use an intonation model combined with a dialog model that puts constraints on possible sequences of move types, as well as the speech recognizer likelihoods for the different move-specific models. In the full recognition system, the combination of automatic move type recognition with the move specific language models reduces the overall word error rate by a small but significant amount when compared with a baseline system that does not take intonation or dialog acts into account. Interestingly, the word error improvement is restricted to "initiating" move types, where word recognition is important. In "response" move types, where the important information is conveyed by the move type itself--for example, positive versus negative response--there is no word error improvement, but recognition of the response types themselves is good. The paper discusses the intonation model, the language models, and the dialog model in detail and describes the architecture in which they are combined.

Humans↗

PubMedDate not supplied

Prostate-specific antigen levels among cirrhotic patients.

PURPOSE: The aim of this study was to determine serum prostate-specific antigen (PSA) levels in patients with liver cirrhosis. PATIENTS AND METHODS: Between January 1995 and August 2001, 216 men with cirrhosis were evaluated. The extent of their liver disease was classified according to the Child-Pugh classification. Serum PSA levels were measured with the Hybritech Tandem-R RIA method and matched with age-related reference PSA levels. Digital rectal examination (DRE) was performed in all patients. Patients with elevated PSA levels and/or abnormal DRE were recommended to undergo further assessment including transrectal ultrasonography (TRUS) and biopsy performed by an urologist. RESULTS: Two hundred and sixteen men (mean age 54.09 +/- 9.09 years, range 25-76) with cirrhosis were examined. Their mean PSA value was 0.57 +/- 0.84 ng/mL and tended to be lower than in the normal population. The degree of PSA decrease was found to parallel the severity of the liver disease (p=0.002). The mean serum PSA level increased with each age decade in a statistically significant manner (p<0.001). Four patients (three with elevated PSA values) underwent prostate biopsy. Three biopsies were positive for prostate cancer, the other showed evidence of benign prostatic hyperplasia (BPH). CONCLUSION: Serum PSA is influenced by the severity of liver disease and its levels tend to be lower in cirrhotic patients than in the normal population. However, serum PSA can still be considered a reliable marker in the clinical management of prostatic disease in patients with cirrhosis.

Adult↗

PubMedDate not supplied

Evaluation study of the exploratory visit: an innovative outreach activity of the ILGWU's friendly visiting program.

The exploratory visit to recent retirees, an outreach component of the International Ladies Garment Workers Union Friendly Visiting Program, was evaluated during a ten month period beginning in September 1973. An operations analysis found that need identifying activities of Friendly Vistors by type of service need. A post-test only control group effect study revealed exploratory visits were effective in establishing a link between the program and the retiree although they had no significant impact on the retirees' service needs.

Aged↗

PubMedDate not supplied

A visual fuzzy cluster system for patient analysis.

A visual fuzzy cluster (VFC) system is developed to assist physicians in interactively detecting and refining cluster partitions for patients with acute upper respiratory infections. The VFC system assists physicians in discovering relationships among patients by applying a fuzzy cluster algorithm to analyse a case base of patient findings. The algorithm discovers similarities among patients, while at the same time identifying atypical patients. The system visually presents the fuzzy cluster solutions on a three-dimensional animated display. Physicians then interactively manipulate icons representing patients to explore and refine the fuzzy cluster solution. Initial experiences with the VFC prototype are encouraging and support the claims that the system improves physician understanding and allows physicians to take advantage of visual recognition and manipulation skills to define and label patient groupings. The resulting labels and cluster centres or prototypes offer insight into the set of patient features that best discriminate between groups.

Algorithms↗

PubMedDate not supplied

Psychodynamic experience in the community.

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Anxiety↗

PubMedDate not supplied

Characteristics of non-cobalamin deficient patients who receive regular cyanocobalamin injections.

For decades Vitamin B12 injections have been administered to patients with no documented deficiency. A previous study identified a cohort of patients who described vitamin B12-responsive symptoms despite lack of cobalamin deficiency as measured by conventional laboratory tests. These patients have been studied further and, when compared with controls, were found to have had more prescriptions for psychoactive drugs (P less than .001) and to have had more hospitalizations related to symptoms suggestive of neuropsychiatric problems (P less than .01). To confirm these findings and to determine national estimates for vitamin B12 use, an analysis of the 1985 National Ambulatory Medical Care Survey (NAMCS) was conducted. This analysis supports a significantly higher frequency of neuropsychiatric complaints among patients who received vitamin B12 injections (P less than .001). In addition, the NAMCS analysis indicates that of the calculated 2,516,564 vitamin B12 injections given in 1985, only 376,488 were for a diagnosis compatible with a cobalamin deficiency state (a 7:1 observed over expected ratio). According to the national data set analysis, vitamin B12 injections are given most frequently in the rural south by a doctor of osteopathy in solo practice.

Aged↗

PubMedDate not supplied

[Esophageal lesions caused by human papillomaviruses (HPV)].

Twenty two patients are presented with histologic lesions on esophageal biopsy compatible with infection by human papillomavirus. Symptoms were uncharacteristic, there was no sex difference and the mean age was 40 years. Upper GI endoscopy showed the following: a) multiple ulcers in the middle esophagus, most of less than 10 mm in diameter, rounded or oval in shape, separated by normal appearing mucosa, well delimited erythematous margins, with a smooth white base; b) In five patients, multiple white elevated lesions were found in the middle esophagus, separated by normal appearing mucosa. One patient had 2 papillomas; c) In two cases there was an epidermoid carcinoma at 25 and 28 cm from the dental arcade. Biopsy taken at the border of the lesions were compatible with papilloma virus infection. The possible relation of the lesions with papillomavirus infection was established only on histologic criteria. The described lesions regress without treatment or with nonspecific treatment, some cases of our series have responded to empiric antiviral medication.

Adult↗

PubMedDate not supplied

[Vascular ectasias of the colon].

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Colon↗

PubMedDate not supplied

Cancer mortality and the method of chlorination of public drinking water: St. Louis City and St. Louis County, Missouri.

St. Louis City and St. Louis County, Missouri share the same public drinking water source, namely the Missouri River. The 'all cancer' and most organ specific cancer mortality rates have been consistently and considerably higher for St. Louis City than for St. Louis County for the period 1960 through 1972. A change in the St. Louis County water treatment process, which included increasing the chlorine dosage and delaying the addition of ammonia to form chloramines until just prior to distribution, was instituted in 1955. St. Louis City has, by contrast, continued the lower chlorine level and early ammoniation. Trend analysis using the period 1960-67 and 1972-76 showed higher percentage as well as net cancer mortality rate per million increases for large bowel, liver and bladder cancers for St. Louis County. An apparent association between a probable increase in trihalomethane production in the St. Louis County water since 1955 and an increase in these specific cancer rates which exceed the increases in the St. Louis City rates appears to have been shown. This does not imply causality but is in general agreement with other studies which have examined water chlorination and cancer mortality.

Adult↗