Uvulectomy--the making of a ritual.
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Africa↗
Biomedical subjects
L Hunter
Publications and source records attributed to L Hunter.
Laband syndrome. Report of two cases, review of the literature, and identification of additional manifestations.
Twenty-six persons with Laband syndrome have been reported in the literature to date. We report two further unrelated cases and suggest that a skeletal anterior open bite and symmetric soft tissue swelling of the vault of the palate be added to the variable features associated with the syndrome. There is clear evidence in the literature of autosomal dominant inheritance but our analysis indicates that in some cases recessive transmission is likely.
Abnormalities, Multiple↗
A study of a pre-brushing mouthrinse as an adjunct to oral hygiene.
A previous clinical screening study demonstrated that a cetylpyridinium chloride (CPC) essential oil mouthrinse inhibited plaque regrowth to a significantly greater extent than a negative control or a triclosan/copolymer rinse when used without toothbrushing. The purpose of this study was to evaluate the same ingredient combination as a pre-brushing rinse over a 6-week period. The study employed a 4 group parallel design with a minimum of 50 subjects per group. Subjects with a minimum baseline plaque index of 1.95 were recruited. The formulations employed were two variations of a CPC/essential oil rinse, a triclosan/copolymer product, and a hydroalcohol negative control. Subjects were rendered plaque free at baseline and then rinsed twice daily before toothbrushing with their allocated product. Plaque was scored at 6 days and 6 weeks. Plaque scores were reduced at 6 days compared to baseline but there were no significant differences between any of the groups. At 6 weeks, plaque scores were significantly lower in both CPC/essential oil groups compared to control. Although both CPC/essential oil groups showed plaque scores which were lower than the triclosan group, in only one of the groups was the difference significant. The triclosan product was not significantly different from control. The results support the previous findings that a CPC/essential oil rinse could be a useful adjunct to oral hygiene when used prior to normal toothbrushing.
Adolescent↗
Speakers and listeners: some problems of generalising from a common speech pathology research design.
Experimental studies of speech and language behaviour often have difficulty measuring the phenomena that they seek to investigate. A common solution has been to collect data in the form of listeners' judgements of the speech of members of a clinical group of interest. If the speakers are taken to be a random sample of the clinical group and the listeners a random sample of those who they may communicate with, it is tempting to believe that results from such studies may be generalised to both other speakers and listeners, thus allowing a general statement about the communicative abilities of the clinical group to be made. Two related problems with this form of design are discussed. Both lead to the conclusion that greater caution is required in the interpretation of studies in which listeners' judgements of speakers are analysed. Potential solutions to the problem are offered.
Communication Disorders↗
Waiting for coronary revascularization in Toronto: 2 years' experience with a regional referral office.
OBJECTIVES: To determine the frequency of major adverse events among patients awaiting coronary revascularization; to assess the match between referring physicians' estimates of urgency, a computer-generated multifactorial urgency rating score and actual waiting times; to determine the changes in waiting times as capacity for bypass surgery increased; and to evaluate the influence of choice of procedure or operator on waiting times. DESIGN: Consecutive case series. SETTING: Greater Toronto region. SUBJECTS: All 571 patients referred to an organized referral office by cardiologists at hospitals without on-site revascularization facilities between Jan. 3, 1989, and June 30, 1991. MAIN OUTCOME MEASURES: Preoperative fatal or nonfatal myocardial infarction; proportions of patients waiting longer than the maximum period recommended for their urgency rating; mean waiting times for various subgroups; and correlations among referring physicians' urgency ratings, computer-generated multifactorial urgency scores and waiting times. RESULTS: Of the 496 patients accepted for a procedure 5 had fatal cardiac events and 3 nonfatal myocardial infarction. Events occurred three times more often in patients with left mainstem disease than in those in other anatomic categories (relative risk [RR] 3.05, 95% confidence interval [CI] 1.48 to 6.27, p = 0.03). Both the computer-generated scores and the referring physicians' scores were correlated with the actual waiting time (r = 0.46 and 0.57 respectively). Waiting times and the proportion of patients with excessive waiting times fell during the study period (p < 0.0001). However, urgent cases were much less likely to be done "on time" than those with a recommended waiting time of more than 2 weeks (RR 0.16, 95% CI 0.11 to 0.25, p < 0.0001). The mean wait for coronary artery bypass grafting (CABG) was 22.73 days if the referral office was allowed to find a surgeon or interventional cardiologist and 35.31 days if one was requested (p = 0.002 after adjustment for urgency scores). CONCLUSIONS: Death of a patient on the waiting list is uncommon in an organized referral system. Patients with left main-stem disease are at higher risk of death than those in other anatomic categories. There were significant correlations between referring physicians' ratings of urgency, multifactorial urgency scores and actual waiting times. Expansion of capacity for CABG led to shorter waiting times, but patients with unstable symptoms continued to wait longer than recommended. Requests for a specific surgeon caused significantly longer delays.
Aged↗
Queueing for coronary surgery during severe supply-demand mismatch in a Canadian referral centre: a case study of implicit rationing.
Queues for in-patient surgery are commonplace in universal health care systems. Clinicians and hospitals usually manage these waiting lists with informal criteria for determining patient priority--a form of implicit rationing. To understand the workings of implicit rationing by queue, we took advantage of a natural experiment in the Canadian province of Ontario. Unprecedentedly severe supply-demand mismatch led to long waiting lists for coronary surgery [CABS] in Ontario during 1987-88. The crisis was resolved by increased funding and widespread adoption of a multifactorial clinical index for patient priority that was developed by an expert panel in 1989. Thus, we audited randomly chosen charts of patients who underwent coronary angiography at four Toronto hospitals during the crisis period, and calculated urgency scores for each case based on the multifactorial index. From 413 charts, 193 eligible patients were identified who proceeded to CABS. Waiting times did correlate with urgency ratings (r = 0.42, P < 0.0001). However, mean wait from catheterization to CABS varied among hospitals by as much as 8 weeks (P < 0.0001 after controlling for urgency scores). At the hospital with shortest queues, waiting times were twice as long for patients catheterized by cardiologists off-site vs those referred by on-site practitioners (P < 0.0001, after controlling for urgency scores); a similar form of bias was found at a second coronary surgery centre (P = 0.056, after controlling for urgency scores). Over half the patients waited longer than the maximum suggested for their category by the expert panel.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiology Service, Hospital↗
Finding relevant biomolecular features.
Many methods for analyzing biological problems are constrained by problem size. The ability to distinguish between relevant and irrelevant features of a problem may allow a problem to be reduced in size sufficiently to make it tractable. The issue of learning in the presence of large numbers of irrelevant features is an important one in machine learning, and recently, several methods have been proposed to address this issue. A combination of machine learning approaches and statistical analysis methods can be used to identify a set of relevant attributes for currently intractable biological problems. We call our framework F/I/E (Focus-Induce-Extract). As an example of this methodology, this paper reports on the identification of the features of mutations in collagen that are likely to be relevant in the bone disease Osteogenesis imperfecta.
Amino Acid Sequence↗
Computationally efficient cluster representation in molecular sequence megaclassification.
Molecular sequence megaclassification is a technique for automated protein sequence analysis and annotation. Implementation of the method has been limited by the need to store and randomly access a database of all the sequence pair similarities. More than 80,000 protein sequences are now present in the public databases, and the pair similarity data table for the full protein sequence database requires over 1 gigabyte of storage. In this paper we present a computationally efficient representation of groups based on a graph theory approach where sequence clusters are described by a minimal spanning tree of highest scoring similarity pairs. This representation allows a classification of N proteins to be stored in order(N) memory. The use of this minimal spanning tree representation simplifies analysis of groups, the description of group characteristics and the manual correction of artifacts resulting from false hits. The new tree representation also introduces new possibilities for artifact generation in sequence classification. Methods for detecting and removing these artifacts are discussed.
Algorithms↗
Indexing of health literature in sub-Saharan countries.
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Abstracting and Indexing↗
Physical therapy assessment and treatment protocol for nursing home residents.
This article describes a standard protocol for assessing physical function in elderly nursing home residents. Major physical dimensions that are measured with the protocol include range of motion, muscle force, muscle reflex activity, sensation, soft tissue status, balance/coordination, and posture. A practical, functionally prioritized treatment model based on the assessment is also presented. The standardized assessment and treatment plan may be useful to the physical therapist in (1) planning and prioritizing treatment, (2) identifying when goals have been met, (3) recognizing when there is a need for treatment plan modification, and (4) educating physical therapy students in applying problem-solving skills in their treatment sessions.
Activities of Daily Living↗
The team approach to managing an LIS.
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Clinical Laboratory Information Systems↗
Perceptual characteristics of vowel and prosody production in apraxic, aphasic, and dysarthric speakers.
Narrow phonetic transcriptions and prosodic judgments were made of single-word imitations by apraxic (AOS), conduction aphasic (CA), and ataxic dysarthric (AD) speakers. AOS and AD subjects showed similar vowel error patterns, particularly predominant errors in low, tense, and back vowels, more distortions than other types of vowel errors, and predominant errors in initial position of words and in monosyllabic words. The CA subjects displayed a different vowel error pattern, notably more substitutions than distortions, more errors in polysyllabic than monosyllabic words, and more errors in noninitial than initial positions of words. Analysis of prosodic features identifiable at the single-word level (e.g., syllabic stress, juncture, and struggles to initiate or complete productions) indicated that syllabic stress errors and more difficulty initiating than completing word production were characteristic of AOS and AD but not CA subjects.
Adult↗
Effect of visual display unit use on blink rate and tear stability.
In the literature, there is evidence supporting the notion that visual display unit (VDU) use decreases the blink rate and possibly reduces the stability of the precorneal tear film. In this investigation the blink rate and tear stability were measured using noninvasive techniques, in relation to VDU use. In normal healthy subjects, the results show an average 5-fold drop in blink rate during VDU use but tear stability appears to be unaffected. During VDU use a significant relation was found to exist between the interval between blinks and the stability of the precorneal tear film.
Adolescent↗
The use of strategies to increase speech intelligibility in cerebral palsy: an experimental evaluation.
The effects of strategies on the intelligibility of cerebral-palsied speech were experimentally evaluated. Listeners were asked to identify words in sentences spoken by subjects whose dysarthria was rated to be either moderate or severe. Results indicated that strategies increased intelligibility and that different strategies were appropriate at different levels of severity. Use of initial letter cueing achieved the greatest gains for the more severely impaired speakers but, for the less severely impaired, the gains achieved by providing visual cues were the same as those achieved by letter cueing and could not be improved upon by repetition. Listeners' experience of dysarthric speech and the redundancy of the test sentences were also manipulated. Previous experience did not influence recognition and redundancy only appeared to have an influence at higher levels of intelligibility. The role of strategies in improving intelligibility is discussed. The results suggest that many speakers will be unable to use simple strategies to improve intelligibility to levels that may be needed for adequate information transfer.
Adolescent↗
A community cholesterol screen: five days, 8,656 tests.
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Cholesterol↗
Assessing linearity the easy way.
Laboratories can comply with new Federal regulations for linearity verification by applying simple calculations and graphs to materials that are readily at hand.
Autoanalysis↗
Balance function test correlates of the Dizziness Handicap Inventory.
Balance Function test data alone cannot capture the reaction that a patient has to balance system disease. The present investigation examined the relations among components of the balance function examination (electronystagmography, rotational testing, and platform posturography) and self-perceived dizziness handicap, as quantified by the Dizziness Handicap Inventory (DHI). The DHI is a 25-item self-assessment scale designed to quantify the functional, emotional, and physical effects of dizziness and unsteadiness. The DHI was administered to 367 patients seen consecutively for balance function evaluations. The results indicated that the largest proportion of significant correlations existed between DHI and the sensory organization subtests of platform posturography. Further, greater perceived handicap was documented for patients with (1) spontaneous nystagmus and (2) decreased postural stability quantified by evaluating the inter-relations among vestibular, visual, and proprioceptive systems (posturography).
Activities of Daily Living↗
Perceptual characteristics of consonant production by apraxic speakers.
Single-word repetitions by 4 brain-damaged adults with apraxia of speech (AOS) but without concomitant aphasia were transcribed using a standard narrow phonetic transcription system. Analysis of consonant productions yielded a profile of AOS slightly different from the traditionally accepted one. Among the results was the atypical finding that consonant distortions exceeded all other error types including sound substitutions. In addition, errors predominated in the medial position of words, and monosyllabic words had approximately the same error rate per number of consonants as did multisyllabic words. Results are discussed with reference to previous perceptual descriptions of AOS and in relationship to Broca's aphasia. Results are also interpreted relative to linguistic and motoric components of speech production models.
Aged↗