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At least 469 records · Page 26Linked to original sources
PubMed2003

The Periotest in traumatology. Part II. The Periotest as a special test for assessing the periodontal status of teeth in children that have suffered trauma.

The research was carried out on the upper permanent incisor teeth of 101 children aged 8-12 years attending the trauma clinic at the University Dental Hospital, Manchester, UK. The double blind, cross-over study involved Periotest readings being taken by one examiner and traditional special tests being carried out by another examiner. The traditional special tests chosen were mobility testing, percussion sounds and radiographs. The Periotest readings and special tests were then repeated at the child's recall appointment. The results revealed that there was a significant difference (P < 0.001) between the number of abnormalities detected by the Periotest and those detected by the traditional special tests. There was also found to be a significant difference (P < 0.001) in the detection of undesirable sequelae between the Periotest and the traditional special tests.

Chi-Square Distribution↗
PubMed2006

Precursors to melanoma and their mimics: nevi of special sites.

Melanocytic nevi, which are benign tumors of melanocytes, may have occasional cosmetic significance but, for the most part, they are important only in relation to melanoma. Nevi are the most important simulants of melanoma, both clinically and histologically, and can usually be reliably distinguished from melanomas using published criteria. Some lesions are characterized by greater degrees of atypia and may be more difficult to diagnose. Dysplastic nevi are among the most important simulants of melanoma. Nevi may also be important as potential precursors of melanoma; however, most nevi are stable and will not progress to malignancy. Nevi are vastly more common than melanomas and the rate of progression of individual lesions is very low. Therefore, nevi are not as a rule managed by wholesale excision to prevent melanoma. Nevi are also important as risk markers, identifying individuals at greater risk of developing melanoma in the future. Dysplastic nevi and, to a lesser extent, common acquired and congenital nevi are among the most important melanoma risk markers. Nevi of special sites have been identified as nevi that may show atypical features suggestive of a dysplastic nevus or of a melanoma. However, they are not risk markers and they are not malignancies. Nevi of genital skin, acral skin, and flexural skin are among the most important 'nevi of special sites'. It is important, in considering the differential diagnosis of a lesion in a special site, to avoid overcalling such a lesion as a melanoma or a dysplastic nevus because this could lead to excessive treatment. Conversely, it is important to avoid undercalling a lesion that is a dysplastic nevus or a melanoma as a nevus of special sites, because in this circumstance a patient could lose the opportunity either for surveillance to recognize a developing melanoma at an early, curable stage, or for definitive treatment of an established malignancy. In this monograph, dysplastic nevi and nevi of special sites are compared and contrasted in relation to melanoma.

Diagnosis, Differential↗
PubMed2000

Influence of a specialized leg ulcer service on management and outcome.

BACKGROUND: The organization of leg ulcer care is poorly defined in the community. This study assessed the overall influence of a specialized community service on management and outcome of chronic leg ulcers, irrespective of aetiology. METHODS: Assessment and outcome of ulcers were compared in patient samples (n = 200) from East and West Gloucestershire, before and after the introduction of specialized clinics into East Gloucestershire. In clinics, vascular disease was routinely assessed by duplex scanning and determination of the ankle : brachial pressure index. RESULTS: There was no coordinated community structure for the care of patients with leg ulcers before the service was introduced, and 74 and 67 per cent of limbs in East and West Gloucestershire respectively had aetiology undiagnosed. After introduction of the clinics, the 12-week healing rate increased from 12 to 22 per cent in East Gloucestershire (P = 0. 05) and to 47 per cent in the specialized East Gloucestershire clinics (P < 0.001). The 12-month recurrence rate decreased from 50 to 41 per cent in East Gloucestershire and to 17 per cent in the East clinics (P < 0.001). The West Gloucestershire control showed no significant changes. CONCLUSION: A specialized leg ulcer service with defined protocols provides an improved management structure for treating patients with leg ulcers in the community. Accurate diagnosis of chronic leg ulcers and improved outcome may be achieved within this specialized service.

Ambulatory Care↗
PubMed1999

Disclosing special needs to parents. Have we got it right yet?

Parents' perceptions of how they were told that their child has special needs were examined. Thirty-nine families on the Isle of Wight completed a structured interview. Participants formed two groups. The first group comprised of 23 families who had a child aged from birth to 5 years with special needs. In the second group there were 16 families who had a child aged between 15 and 20 years with special needs. Parents were asked about their perceptions of how their child's special needs were disclosed, their satisfaction with how they were told and what improvements they would have liked. Differences between the two cohorts were examined, and changes in how services were perceived were investigated. Overall, parents in the group with younger children were more satisfied about the way in which they were told that their child had special needs than those with older children. Implications for service delivery and future research are considered.

Adolescent↗
PubMed1993

The treatment and security needs of special-hospital patients: a nursing perspective.

Psychiatric nurses who are key workers or primary nurses within special hospitals are well placed to comment on their patients' needs and the benefits, and shortfalls, of trying to meet these within a maximum-security environment. In this survey, nurse respondents gave information on two groups of special-hospital clients, though they themselves were unaware of any group differentiation. Those who were not seen as requiring continued care within maximum security, as judged by other team investigators, were conceptualized by the researcher as 'leavers'. The survey revealed that in relation to those continuing to require maximum security--the 'stayers'--'leavers' retained exceptionally high levels of deficits related to their potential for community reintegration. Deficits in cognitive, social and life skills were as prevalent among those considered to need lower levels of security, and closer contact with the community, as those remaining within the special-hospital service. It also became clear that the effective management of special-hospital residents demanded a necessary conflict of interests: client-centred flexibility within the constraints of secure custody. There were also inconsistent features between the hospitals, as was shown in the differential provision of parole for patients. Only the survey sample from Broadmoor had access to this important resource. The conclusion is that, with the special hospitals' unequivocal commitment to maintain security, not all treatment and security needs of patients are appropriately met. Certain opportunities should, perhaps, be provided within new, alternative facilities.

England↗
PubMed1999

Suicidal patients and special observation.

Special observation is a nursing practice utilized in in-patient psychiatric facilities for patients who are suicidal. Special observation is carried out by an allocated registered nurse remaining continuously at arms length from, or within sight of (as specified), the patient; or a registered nurse observing the patient within a 30 min interval. In this exploratory study, we investigated the role of the registered nurse when caring for patients on special observation. Semistructured interviews were conducted with 10 randomly selected registered nurses from 4 acute psychiatric wards. The 9 themes that emerged were: 1) Safety; 2) Therapeutic relationships; 3) Supporting patients and carers; 4) Consequences of special observation for nurses; 5) Continuity of care concerns; 6) Peer support; 7) Suicide indicators; 8) Responsibilities and rights: nurses and patients; and 9) Nurses, doctors and the hospital hierarchy. Recommendations for alleviation of the concerns about the practice of special observation are outlined and discussed.

Adolescent↗
PubMed1998

Experiences of special gynaecological services for children and adolescents: a descriptive study.

Gynaecological examination of girls during childhood is undertaken somewhat infrequently. These genital examinations should not be taboo or a frightening experience for the girl, for her parents or for the physician. Studies of children suspected of sexual abuse have paid attention to the wide variety of gynaecological conditions already present in childhood. In 1988 we founded a special gynaecological outpatient clinic for girls under 16 y of age at a university hospital to develop the special knowledge and skills needed in children's gynaecology. In this gynaecological clinic for children and adolescents we were able to gain and offer expert knowledge of the problems of this age group. In this special clinic for children, gynaecological examination by special techniques and sonography led to a diagnosis in 71% of the patients without any instrumentation. Children and adolescent girls in need of special gynaecological care should be recognized specifically. Particular attention should be paid to the gynaecological care of victims of child sexual abuse and mentally or physically handicapped girls. In good co-operation with the girl, a gynaecological examination can become a positive experience during the development of female identity.

Adolescent↗
PubMed1985

Arrangement and possible function of actin filament bundles in ectoplasmic specializations of ground squirrel Sertoli cells.

We have investigated the arrangement and function of actin filament bundles in Sertoli cell ectoplasmic specializations found adjacent to junctional networks and in areas of adhesion to spermatogenic cells. Tissue was collected, from ground squirrel (Spermophilus spp.) testes, in three ways: seminiferous tubules were fragmented mechanically; segments of intact epithelium and denuded tubule walls were isolated by using EDTA in a phosphate-buffered salt solution; and isolated epithelia and denuded tubule walls were extracted in glycerol. To determine the arrangement of actin bundles, the tissue was fixed, mounted on slides, treated with cold acetone (-20 degrees C), and then exposed to nitrobenzoxadiazole-phallacidin. Myosin was localized using immunofluorescence. To investigate the hypothesis that ectoplasmic specializations are contractile, glycerinated models were exposed to exogenous ATP and Ca++; then contraction was assessed qualitatively by using nitrobenzoxadiazole-phallacidin as a marker. Actin bundles in ectoplasmic specializations adjacent to junctional networks circumscribe the bases of Sertoli cells. When intact epithelia are viewed from an angle perpendicular to the epithelial base, honeycomb staining patterns are observed. Filament bundles in Sertoli cell regions adjacent to spermatogenic cells dramatically change organization during spermatogenesis. Initially, the bundles circle the region of contact between the developing acrosome and nucleus. They then expand to cover the entire head. As the spermatid flattens, filaments on one side of the now saucer-shaped head orient themselves parallel to the germ cell axis while those on the other align perpendicularly to it. Before sperm release, all filaments course parallel to the rim of the head. Contrary to the results we obtained with myoid cells, we could not convincingly demonstrate myosin in ectoplasmic specializations or induce contraction of glycerinated models. Our data are consistent with the hypothesis that actin in ectoplasmic specializations of Sertoli cells may be more skeletal than contractile.

Actins↗
PubMed2002

The ecology of individuals: incidence and implications of individual specialization.

Most empirical and theoretical studies of resource use and population dynamics treat conspecific individuals as ecologically equivalent. This simplification is only justified if interindividual niche variation is rare, weak, or has a trivial effect on ecological processes. This article reviews the incidence, degree, causes, and implications of individual-level niche variation to challenge these simplifications. Evidence for individual specialization is available for 93 species distributed across a broad range of taxonomic groups. Although few studies have quantified the degree to which individuals are specialized relative to their population, between-individual variation can sometimes comprise the majority of the population's niche width. The degree of individual specialization varies widely among species and among populations, reflecting a diverse array of physiological, behavioral, and ecological mechanisms that can generate intrapopulation variation. Finally, individual specialization has potentially important ecological, evolutionary, and conservation implications. Theory suggests that niche variation facilitates frequency-dependent interactions that can profoundly affect the population's stability, the amount of intraspecific competition, fitness-function shapes, and the population's capacity to diversify and speciate rapidly. Our collection of case studies suggests that individual specialization is a widespread but underappreciated phenomenon that poses many important but unanswered questions.

Animals↗
PubMed2005

Brain state-dependent functional hemispheric specialization in men but not in women.

Hemispheric specialization is reliably demonstrated in patients with unilateral lesions or disconnected hemispheres, but is inconsistent in healthy populations. The reason for this paradox is unclear. We propose that functional hemispheric specialization in healthy participants depends upon functional brain states at stimulus arrival (FBS). Brain activity was recorded from 123 surface electrodes while 22 participants (11 women) performed lateralized lexical decisions (left hemisphere processing) on neutral and emotional (right hemisphere processing) words. We determined two classes of stable FBS, one with right anterior-left posterior orientations (RA-LP maps) and one with left anterior-right posterior orientations (LA-RP maps). Results show that functional hemispheric specialization is dependent upon the class of FBS and gender. Of those with LA-RP maps, only men showed a strong emotional word advantage (EWA) after left visual field (right hemisphere) presentation, but no EWA after right visual field (left hemisphere) presentation. Subsequent to all other brain states, there was an almost equal EWA after presentation to either visual field. Only about half of the FBS in men led to the pattern of functional hemispheric specialization. We suggest that 'split-brain' research may be marginally describable by a model, but only in exceptional situations, while in connected brains this functional hemispheric specialization is only one of many dynamic states.

Adolescent↗
PubMed2003

Special types of invasive breast cancer, with clinical implications.

Analysis of invasive breast cancers by histopathology has generally revolved around the analysis of individual characteristics such as nuclear pleomorphism and/or gland formation (grading) or categorization by specific histologic patterns (special type carcinomas). Recognition of special types of invasive breast carcinoma allows for the identification of women with an extremely good prognosis often approaching or equaling that of the general population of the same age (with unique problems for medullary). The distinguishing features of special types of breast cancer are present in complete or classic form in the pure examples of these cases, and the features recognizing these types may be present in lesser degrees in many carcinomas of no special type or not otherwise specified in which they often have important clinical correlates other than strong indicators of survival, such as recognizing the diffusely invasive feature of lobular and lobular-like cancers. Many other features have been noted as contenders for types of breast cancer (such as squamous, cystic, clear cell, histiocytoid, and lipid rich). These terms are not discussed here because they have no special clinical correlates relevant to diagnosis or prognosis. It should be reemphasized here that combined histologic grade (Nottingham system favored) with nuclear, glandular, and mitotic evaluation is expected by most authorities for clarification of diagnosis in all but rare, pure medullary cancers. (5, 13, 14, 27) The Nottingham grade 11 interacts with nodal status to produce a very strong prognostic index. The mitotic count may be the most important part of the grading system, certainly for prognosis within 5 years of diagnosis. (22, 26)

Adenocarcinoma↗
PubMed1993

Effect of full-time, specialized physician supervision on the success of a large, urban emergency medical services system.

OBJECTIVES: Despite the universal proliferation of emergency medical services programs throughout the United States since 1970, only a few have ever documented a valid lifesaving effect, particularly in large, urban centers. The purpose of this study was to demonstrate the effect of specialized physician supervision on the effectiveness of an emergency medical services system. DESIGN: Prospective, cohort study. SETTING: Large, urban municipality (population 2 million). PATIENTS: Evaluation of victims of out-of-hospital sudden cardiac death cases, before (n = 152) and after (n = 200) the introduction of specialized physician supervision for the emergency medical services system. INTERVENTIONS: The hiring of a full-time, salaried emergency medical services system physician whose principal duties would be to provide intensive individualized training, direct operational supervision, and continuous system monitoring, including frequent on-scene oversight of emergency medical services personnel. MEASUREMENTS AND MAIN RESULTS: Comparison of existing hospital discharge rates for out-of-hospital sudden cardiac death cases to those rates achieved 5 yrs after recruitment of the specialized emergency medical services system physician. A dramatic increase in hospital discharge rates was demonstrated for sudden death patients presenting with ventricular fibrillation, from zero at year 0 (0 of 152 patients survived), to 21% (42 of 200 patients) by year 5 (p < .001). This result was achieved despite the fact that all other related factors (budget, paramedic numbers, response times) significantly worsened during the comparison periods. CONCLUSIONS: The introduction of the new factor into the emergency medical services system (specialized physician supervision) was associated with significantly improved patient outcome. In view of current suboptimal outcome statistics found in most municipal emergency medical services programs across the United States, future goals of medical community leaders should be directed at efforts to properly train, certify, and establish appropriate positions for physicians who specialize in emergency medical services system supervision.

Allied Health Personnel↗
PubMed1994

Reduction of morbidity in interhospital transport by specialized pediatric staff.

OBJECTIVE: We prospectively compared the occurrence of morbidity during high-risk interhospital transport in two types of transport systems: specialized tertiary center-based vs. nonspecialized, referring hospital-based. DESIGN: Concurrent, prospective comparison of morbidity at two pediatric centers that use different types of transport team. SETTING: Two tertiary care pediatric intensive care units (ICU). The specialized team consisted of a pediatric resident, pediatric intensive care nurse, and a pediatric respiratory therapist. Comparison was made with referring institution transports by nonspecialized personnel to a second center. The two centers were similar in size and patient mix, with referral areas of similar population and rural/urban ratio. PATIENTS: One hundred forty-one patients transported to two tertiary pediatric ICUs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Two types of events were assessed: vital signs and other observable clinical events were described as "physiologic deteriorations." Events such as loss of intravenous access, endotracheal tube mishaps, and exhaustion of oxygen supply were described as "intensive care-related adverse events." Pretransport severity of illness and therapy were described by Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores. Only high-risk patients with PRISM scores of > or = 10 were analyzed. Intensive care-related adverse events occurred in one (2%) of 49 transports by the specialized team and 18 (20%) of 92 transports by nonspecialized personnel. The difference is statistically significant (p < .05). Physiologic deterioration was similar in the two groups occurring in five (11%) of 47 specialized team transports and 11 (12%) of 92 transports by the nonspecialized team. CONCLUSION: We conclude that specialized pediatric teams can reduce transport morbidity. This is the first published study to compare two models of pediatric transport using identical definitions of severity and morbidity.

Age Distribution↗
PubMed2025

A widespread Actinobacterial G Protein System regulates production of specialized metabolites in Streptomyces coelicolor.

Actinobacterial G protein systems (AGPSs), also known as conservons, are regulatory systems that are broadly distributed within Actinomycetota. AGPSs are composed of a minimum of four proteins, including a sensor histidine kinase, a small Ras-like GTPase, a roadblock/MglB protein (likely a GTPase activating protein), and protein with a domain of unknown function that likely functions as a guanine-nucleotide exchange factor (GEF). While progress has been made in understanding AGPS function at the mechanistic level, the phylogenetic distribution of individual AGPSs, and the genes and processes they regulate, remain largely unmapped. Previously, the Cvn8 AGPS of Streptomyces coelicolor was found to influence expression of genes in multiple specialized metabolic pathways during interspecies interactions with other actinomycetes. However, the impact of the Cvn8 AGPS on specialized metabolism has not been assessed at the chemical level. Here, we investigated the phylogenetic distribution of the Cvn8 AGPS clade,and assessed the impact of the Cvn8 AGPS on natural product biosynthesis using untargeted metabolomics. In a set of 485 actinobacterial genomes, we found that members of the clade that includes the Cvn8 AGPS from S. coelicolor are widely distributed in the lineages known to produce specialized metabolites. We also found that in S. coelicolor, the pattern of specialized metabolite production varied in mutants lacking specific components of the Cvn8 AGPS. Specifically, normal production of the pigmented antibiotic actinorhodin during interspecies interactions required cvnA8 and cvnF8, while a &#x394;cvnD8 overproduced undecylprodigiosin. Together, these results connect a widespread AGPS to control of specialized metabolism in a model actinomycete.

Journal Article↗
PubMed2006

Special paraunitary matrices, Cayley transform, and multidimensional orthogonal filter banks.

We characterize and design multidimensional (MD) orthogonal filter banks using special paraunitary matrices and the Cayley transform. Orthogonal filter banks are represented by paraunitary matrices in the polyphase domain. We define special paraunitary matrices as paraunitary matrices with unit determinant. We show that every paraunitary matrix can be characterized by a special paraunitary matrix and a phase factor. Therefore, the design of paraunitary matrices (and thus of orthogonal filter banks) becomes the design of special paraunitary matrices, which requires a smaller set of nonlinear equations. Moreover, we provide a complete characterization of special paraunitary matrices in the Cayley domain, which converts nonlinear constraints into linear constraints. Our method greatly simplifies the design of MD orthogonal filter banks and leads to complete characterizations of such filter banks.

Algorithms↗
PubMed2006

Acetic acid-enhanced magnification endoscopy in the diagnosis of specialized intestinal metaplasia, dysplasia and early cancer in Barrett's oesophagus.

BACKGROUND: Barrett's surveillance is prone to sampling error. Aim To determine whether enhanced magnification endoscopy using acetic acid instillation improves diagnostic accuracy of specialized intestinal metaplasia/dysplasia in Barrett's oesophagus. METHODS: We examined the detection rate of the specialized intestinal metaplasia/dysplasia in 64 consecutive patients with Barrett's oesophagus using acetic acid to enhance mucosal pit patterns. Histology was compared with the previous findings at recent conventional surveillance in 62 patients. We also examined the inter-/intra-observer agreement in the assessment of the enhanced magnification endoscopy pit pattern findings. RESULTS: Histology revealed columnar-lined oesophagus in six (9%) patients, specialized intestinal metaplasia in 49 (77%), low-grade dysplasia in five (8%), high-grade dysplasia in one (2%), and adenocarcinoma in three (5%). There was discordance between the histologic findings from conventional surveillance with random biopsy. Fifteen patients (24%) had a histological upgrade with enhanced magnification endoscopy. There was a high detection rate of specialized intestinal metaplasia even in short segment Barrett's oesophagus (74%), and additionally, there were two cancers, one with 2-cm Barrett's oesophagus and one ultra-short (1 cm). The mean kappa values for inter- and intra-observer agreement in assessing the pit patterns were 0.571 (0.041) and 0.709 (0.038), respectively. CONCLUSIONS: Enhanced magnification endoscopy allows clear visualization of the epithelial pit patterns within Barrett's oesophagus, and targeted biopsy results in a high yield of specialized intestinal metaplasia and dysplasia.

Acetic Acid↗
PubMed2004

Effective services to support children in special circumstances.

BACKGROUND: Children living in special circumstances, defined as those who are at risk of achieving poorer outcomes than their peers, have a particular need of good quality, accessible services to promote their health and well-being, yet may be least likely to receive them. AIMS: This review considers the evidence for effective services to support children living in five kinds of special circumstances: (1) those at risk of offending; (2) teenage parents; (3) children whose parents have drug, alcohol or mental health problems; (4) children living with domestic violence; and (5) children who have been abused or neglected. In practice, there is often considerable overlap between these groups, and many children face multiple disadvantage. The review also aims to identify effective strategies for making support services more accessible to hard-to-reach groups. METHODS: Relevant literature was identified through searches of databases and websites, and consultation with experts. Given the broad scope of the topic, the aim was to provide an overview of best evidence rather than to undertake a systematic review. RESULTS: Similar themes underpin the most promising approaches to supporting children in special circumstances. These include: (1) a holistic, multi-agency approach addressing the needs of the whole child rather than compartmentalising children's social, educational, health and care needs; (2) the importance of links between adults' and children's services so that children who are in need because of their parents' circumstances can be identified and supported; and (3) the value of providing children in special circumstances with intensive, targeted support within a framework of universal provision. CONCLUSIONS: Overall, there is a lack of well-designed evaluations of the effectiveness of UK services and programmes for children in special circumstances. The existing evidence base would be strengthened by the development of better outcome measures, by exploring the characteristics of effective services from the perspective of different stakeholders (including children and young people themselves) and by extending the current problem-oriented approach to consider the factors that promote resilience and coping.

Child↗
PubMed1993

Depression and quality of life in the elderly in a special nursing home.

Using a Japanese version of the Self-Rating Depression Scale by Zung (SDS) and the Quality of Life (QOL) rating scale designed by Iida et al. (QOL scale), we compared the QOL and depressive state of special nursing home residents and the elderly in the general community. The QOL scale has four categories: physical functioning, emotional adjustment, interpersonal relationships and attitudes toward life. High scores in either examination indicate a greater impairment. The SDS scores of the residents in the special nursing home were significantly lower than those of the elderly in the community, but the scores in 3 categories and the total score, except for those of physical functioning of the QOL, were significantly higher in the nursing home residents. In the nondepressed elderly rated by the SDS, the physical functioning score of the elderly in the community significantly exceeded that of the special nursing home residents. In the depressed elderly, all the scores including the total score were significantly higher than those in the special nursing home residents. Our results suggest that while the QOL of the depressed elderly in a special nursing home was poorer than that of the elderly in the community, their depression could be treated. However, the QOL cannot be improved by treatment alone.

Activities of Daily Living↗