Biomedical subjects
S King
Publications and source records attributed to S King.
The concordance between symptom information gathered from remitted schizophrenic patients and their relatives.
The concordance between symptom information gathered from remitted schizophrenic out-patients and the relatives with whom they live was assessed for different schizophrenic symptom clusters. It was hypothesized that the positive symptoms would show the greatest patient-relative concordance. Patients and relatives were also compared for levels of overall symptom reporting. It was hypothesized that long-term memory problems, anosognosia, and underreporting in order to appear healthy, would cause patients to report fewer symptoms than their relatives. An alternative hypothesis was that relatives would under report symptoms to avoid "blame" for their relatives' illness, and because they did not have direct experience of the symptomatology. The 24-item version of the Brief Psychiatric Rating Scale (BPRS) was administered to 41 schizophrenic patients (chart diagnoses were validated by a DSM-III-R diagnostic checklist). Fourteen of the BPRS items were then used to glean information about patients' symptomatology from 41 relatives of the patients. Interviews with patients revealed significantly more symptomatology than interviews with patients' relatives for total and non-positive symptoms (both p-values < .01), but not positive symptoms. Intraclass correlations (ICC) between patients' and relatives' assessments were moderate for positive symptoms (ICC = .54, p < .01), low for total symptoms (ICC = .26, p = .05) and negligible for non-positive symptoms (.13, ns). Despite the potential for underreporting due to factors like anosognosia and long-term memory problems, patients are still the best source of information for schizophrenic symptomatology.
Cognitive and motor development in children with vertically transmitted HIV infection.
This study was designed to examine mental and motor development in infants with vertically transmitted human immunodeficiency virus (HIV) infection. Early neurodevelopment was examined in 25 young children with HIV infection acquired through vertical transmission. Compared with 25 children born to HIV-positive mothers but not infected with the virus, and after controlling for developmental risk factors, the HIV-infected group showed impairments in mental and motor development. Mental and motor development were assessed using the Bayley Scales of Infant Development. On the mental scale (MDI), the HIV-infected infants obtained significantly lower scores than the uninfected infants. On the performace scale (PDI), the HIV-infected infants obtained significantly lower standard scores than the uninfected infants. CT scan results were available for 20 of the HIV-infected children. CT abnormalities were associated with developmental delays, particularly for motor development. The results point to the importance of early abnormalities in myelination and of subcortical lesions of cognitive and motor development.
[A new vacuum extraction system with a ball joint and detachment warning--in vitro studies and clinical use].
BACKGROUND: The vacuum extractor is used in about 5% of deliveries. It is associated with a lower maternal morbidity than is forceps extraction. On the other hand, cephalhematomas, hyperbilirubinemia and cerebral hemorrhages in the baby are observed more frequently. The sudden detachment of the vacuum extractor with appreciable fluctuations in intracranial pressure in the baby is especially dangerous. In order to improve the conventional Malmström system, we have developed a new vacuum extractor and investigated its handling in vitro and in clinical application. PATIENTS AND METHODS: The essential constructional principle of the new vacuum extractor consists in a pivot lowered by ball bearings and a volume reduction of one third. Moreover, in two-chamber vacuum it is possible to give a warning of sudden detachment. The possible tractional force in kiloponds was determined at various angles (0 degree, 15 degrees, 30 degrees und 45 degrees) comparing the Malmström extractor with the new one and two-chamber system in a standardized apparatus. In addition, the new vacuum extractor was also used clinically in 43 women; besides the obstetric parameters, the handling was also appraised. RESULTS: In the in-vitro experiments, a distinct decrease of the possible tractional force with increasing angles was shown for the Malmström extractor (0 degree--15.7 kp, 15 degrees--12.7 kp, 30 degrees--8.6 kp, 45 degrees--7.3 kp). The values for the new one-chamber system were significantly greater from a tractional angle of 15 degrees (0 degree--15.6 kp, 15 degrees--14.4 kp, 30 degrees--14.0 kp, 45 degrees--13.8). The clinical application of the new vacuum system was unproblematic and confirmed the feasibility of good traction. A very much smaller caput succedaneum was found in the baby. Especially in the training situation, the warning system enables a good surveillance before sudden detachment, but reduces the possible tractional force. CONCLUSIONS: The new vacuum system appears to enable the vaginal surgical delivery to be improved compared to the conventional Malmström extractor. After these promising approaches, a multicenter study was commenced in order to enable better evaluation of their clinical significance.
Transforming negative work cultures: a practical strategy.
At a time of unprecedented turbulence and challenge for healthcare organizations, maintaining healthy work environments is of paramount importance. Such environments support the day-to-day work of an organization and link its mission to customer service strategies and goals. We describe an unhealthy work culture and outline a practical approach that healthcare managers and clinical leaders can use to facilitate and sustain cultural transformation. The model is built on the core principles of ownership and investment in service outcomes as well as the life of the organization.
Occupational therapy and physiotherapy for the patient with burns: principles and management guidelines.
Clinical practice guidelines are a tool to assist with clinical decision making. They provide information about the care for a condition and make recommendations based on research evidence, which can be adapted locally. A focus group within the Allied Health Interest Group of the Australian and New Zealand Burn Association has compiled the "Occupational Therapy and Physiotherapy for the Patient with Burns--Principles and Management Guidelines." These guidelines are designed as a practical guide to the relevant clinical knowledge and therapy intervention techniques required for effective patient management. Content areas include respiratory management, edema management, splinting and positioning, physical function (mobility, function, exercise), scar management, and psychosocial and mutual elements. The document has undergone extensive review by members of the Australian and New Zealand Burn Association to ensure clarity, internal consistency, and acceptability. The guidelines have been endorsed by the Australian and New Zealand Burn Association. An abridged version of the guidelines is included in this article, with the full document available from www.anzba.org.au.
Expression profile of ovarian tumors: distinct signature of Sertoli-Leydig cell tumor.
Epithelial ovarian tumors are the most common subtype of ovarian cancer. In this study, we reveal distinct expression signatures of previously uncharacterized ovarian carcinoma subtypes, including endometrioid component of mixed ovarian tumor and Sertoli-Leydig tumor. Both subtypes were compared to the most common and well-characterized ovarian epithelial carcinoma of the serous type. These comparisons were performed by complementaryDNA (cDNA) microarrays allowing high-fidelity measurements of the expression levels of 39,360 human individual cDNA species representing both known and unknown human genes. Functional analysis of differentially expressed genes in Sertoli-Leydig tumor revealed an upregulation in sonic hedgehog pathway, deregulation of several metabolic pathways especially in amino acid metabolism and overexpression of genes associated with protein synthesis, including ribosomal genes.
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.
Use of biodegradable dissolved organic carbon to assess treatment process performance in relation to solids retention time.
A biodegradable dissolved organic carbon (BDOC) method has been developed and used to analyze secondary- and advanced-treated wastewater effluents and to investigate correlations between residual organic content and the solids retention time (SRT). Conventional biochemical oxygen demand (BOD) bottles and a 28-day incubation period were used. Secondary wastewater effluents from Hawaii were found to contain between 9.0 and 14.0 mg/L of dissolved organic carbon (DOC), of which 23 to 35% was biodegradable in the 28-day BDOC test (from a survey of nine treatment plants). Bench-scale, continuous-flow activated-sludge biological reactors treating synthetic wastewater were operated at SRTs between 2 and 15 days, and effluent BDOCs were determined. A good BDOC prediction equation was developed that incorporates the initial DOC, the DOC remaining after 5 days, and the SRT of the system from which the sample originated. This equation can be used to determine the BDOC value using data that can be obtained during a conventional 5-day BOD test. The determined equation was found to be appropriate for some of the full-scale wastewater effluent survey data.
Decontamination of equipment and the environment.
This article explains the various ways decontamination of equipment and the environment can be carried out and highlights the importance of nurses being familiar with such methods so to reduce the possibility of infection.
Waiting for a diagnosis after an abnormal screening mammogram. SMPBC diagnostic process workgroup. Screening Mammography Program of British Columbia.
BACKGROUND: Women with abnormal screening mammograms require diagnostic assessment and experience anxiety until a diagnosis is established. This report evaluated the timeliness of diagnosis after an abnormal screening mammogram in the Screening Mammography Program of British Columbia (SMPBC). METHODS: Information on diagnostic interventions following an abnormal screen (N = 10,314) provided through 11 regional SMPBC services between January 1, 1993 and June 30, 1994 were abstracted and analyzed. RESULTS: The median time from abnormal screen to diagnosis was 3.4 weeks with regional variation of 2.0 to 4.7 weeks; 10% waited 8.7 weeks or longer. For the 19% of women proceeding to open biopsy, the median diagnostic interval was 7.1 weeks with regional variation of 4.6 to 9.3 weeks; 10% waited 13.1 weeks or longer. INTERPRETATION: After an abnormal screening mammogram, women waited many weeks for a definitive diagnosis, especially those proceeding to open biopsy. Opportunities for process improvement were identified.
Hand hygiene for patients with rheumatic diseases.
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Indices of apoptosis and proliferation as potential prognostic markers in non-functioning pituitary adenomas.
OBJECTIVE: Non-functioning pituitary adenomas (NFAs) are a distinct group of pituitary adenomas, which comprise approximately 20% of pituitary adenomas. Although most pituitary adenomas are benign, there is a subset of adenomas that behaves in an aggressive fashion, with either invasion of the surrounding structures or recurrence. The aim of this study was to investigate whether the behaviour of NFAs can be predicted using immunohistochemical markers that label proliferating and apoptotic cells, including a new marker for apoptosis (M30 CytoDEATH). This is the first study to analyse both the proliferation labelling index (LI) and the apoptotic index (AI) in NFAs and to correlate the labelling indices of these histological markers with tumor growth rate as measured by 2 postoperative MRI scans. MATERIAL AND METHODS: 40 patients in total were included in the study. 20 patients with high growth rate and percentage change in the pituitary adenoma volume as assessed on 2 postoperative MRI scans were age/sex matched to 20 patients with low growth rate or percentage change. RESULTS: There is no significant statistical difference of the histological and immunohistochemical indices assessed between cases and controls. CONCLUSION: The routine assessment of the proliferation and the apoptotic markers used in this study in NFAs has no prognostic value.
Interviewer training and supervision.
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Delta8- and Delta9-tetrahydrocannabinol: effects on cultured human leucocytes.
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Caring and sharing. The friendly group.
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The story of a convert.
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Spotlight on children. Please be patient!
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