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PubMed1989

A reappraisal of the terverticillate penicillia using biochemical, physiological and morphological features. II. Identification.

The data from an integrated numerical classification was used to construct identification schemes for some fasciculate penicillia. The identification schemes were presented as a synoptic key and a frequency matrix for computer-assisted identification. Statistical testing of the frequency matrix showed that although character separation values were generally low, only four pairs of taxa showed overlap greater than that expected for a rectangular distribution. The identification schemes were tested practically with 52 previously studied strains and 51 further cultures. A synoptic key based on 10 and 90% cutoff limits was used to correctly identify 44 of the 51 additional strains, although this proved very sensitive to single test discrepancies. The frequency matrix was used to correctly identify 45 of the additional strains with a Willcox probability score and this was compared to identifications based on the modal likelihood fraction.

Numerical Analysis, Computer-Assisted↗
PubMed2001

Real-time gait event detection for paraplegic FES walking.

A real-time method for the detection of gait events that occur during the electrically stimulated locomotion of paraplegic subjects is described. It consists of a two-level algorithm for the processing of sensor signals and the determination of gait event times. Sensor signals and information about the progression of the stimulator though its pre-specified stimulation "pattern" are processed by a machine intelligence (fuzzy logic) algorithm to determine an initial estimate of the patient's current phase of gait. This is then reviewed and modified by a second algorithm that removes spurious gait estimates, and determines gait event times. These gait event times are known to the system within approximately one-half of a gait cycle. The resulting gait event detection system was successfully evaluated on three subjects. Detection accuracy is not adversely affected by day-to-day gait variability. This work resolved technical and practical issues that previously limited the real time application of these methods. In particular, cosmetically acceptable insole force transducers were used. This gait event detector is designed for use in a real time controller for the automatic adjustment of the intensity and timing of stimulation while the subject is walking using functional electrical stimulation (FES).

Adult↗
PubMed1994

Establishing the incidence of myelodysplastic syndrome.

We studied the incidence of myelodysplastic syndrome (MDS) in a population served by one district general hospital over a 10-year period (1981-90). Cases were sought through investigation of individuals presenting with suggestive peripheral blood findings. 279 new cases were diagnosed in a population rising from 203,000 to 226,000 over the study period. The observed incidence rate did not change over the study period. The crude incidence rate was 12.6/100,000/year. Age-specific incidence rates per 100,000 per year were 0.5 for age < 50, 5.3 for age 50-59, 15 for age 60-69, 49 for age 70-79, and 89 for age 80+. A cohort study of one large general practice revealed several previously unknown and asymptomatic cases, indicating that the observed figures for the population overall may still underestimate the real incidence. We conclude that MDS is more common than reported in previous studies and that incidence continues to rise into very old age. Difficulties in case ascertainment hamper reliable estimates of true incidence.

Adult↗
PubMed2004

Perinatal depression among black Caribbean women.

The present paper describes findings from a mixed-method, longitudinal cohort study into perinatal depression among black Caribbean women. Using symptom scores from the Edinburgh Postnatal Depression Scale (EPDS), 101 black Caribbean and 200 white British women accessing maternity services in Manchester, UK, were screened for depressive symptoms in the last trimester of pregnancy and 6 weeks following delivery. The purpose of the study, which was undertaken between February 2000 and February 2001, was to estimate the prevalence of depressive symptoms during and after pregnancy among black Caribbean women compared to white British women in the same geographical area, and to explore black Caribbean women's beliefs about perinatal depression and their attitudes to help-seeking. Despite higher levels of self-reported risk, black Caribbean women were less likely than white British women to score above threshold (EPDS > or = 12) during pregnancy (chi2 = 4.16, d.f. = 1, P = 0.041). Although equally likely to score above threshold postnatally, they were less likely to receive treatment (chi2 = 4.20, d.f. = 1, P = 0.040) and more likely to be referred to secondary care (Fisher's Exact Test, P = 0.049). Qualitative findings suggest important differences between black Caribbean women's beliefs, attitudes and associated help-seeking practices, and those previously reported. Lower rates of depressive symptoms might partly be accounted for by conceptualisations of mental illness which differ from those of white British and South Asian women, and mistrust of the mental health services. This study showed that black Caribbean ethnicity is an important dimension in understanding the social patterning of mental illness. The findings have implications for the equitable provision of primary care services since black Caribbean women experienced depressive symptoms in pregnancy and early motherhood, but were less likely than their white British counterparts to receive treatment.

Adult↗
PubMed2006

Use of systemic glucocorticosteroids in pregnancy: be alert but not alarmed.

SUMMARY Concerns have been raised regarding the use of repeated courses of systemic glucocorticosteroids given to pregnant women with threatened premature labour to improve fetal lung maturity. Most worrying are animal studies showing detrimental effects on the developing brain, though human data to date are conflicting. Additional concerns relate to the fetal origins of adult diseases, particularly vascular diseases such as hypertension and atherosclerosis. It is currently recommended that obstetricians give only a single course of antenatal corticosteroids to pregnant women to enhance lung maturity instead of giving repeated doses, which was previously a common practice. Other clinicians including dermatologists, gastroenterologists and rheumatologists may have reason to provide systemic glucocorticosteroids to pregnant women. Although systemic glucocorticosteroids all cross the placenta to some degree, the extent to which they do so depends on the drug involved. The choice of systemic glucocorticosteroid for the pregnant women in light of this evolving literature is discussed.

Administration, Oral↗
PubMed1994

The Bristol prostate cancer pilot screening study--a 3-year follow-up.

OBJECTIVE: To undertake a follow-up study of 472 men who were screened 3 years previously, in general practice, for prostate cancer, and to investigate the efficacy and patient acceptability of a 3-year screening interval. SUBJECTS AND METHODS: Eligible men (n = 472) were sent postal invitations to attend their Health Centre in North Bristol. Serum prostate-specific antigen (PSA) was the initial screening test. Men with PSA > 4 ng/ml (Hybritech) were referred to the Department of Urology for digital rectal examination and transrectal ultrasound +/- biopsy. RESULTS: A total of 132 (28%) men were excluded because of intercurrent illness, death and migration. Two hundred of 340 (59%) men were re-screened. Thirty-seven men had an elevated PSA and were referred as above. Seventeen men had prostatic biopsies, resulting in the diagnosis of six carcinomas; five were localized to the prostate and one was metastatic. In the latter patient, the PSA had risen from 2 to 120 ng/ml over 3 years. CONCLUSION: Serum PSA alone can be used as an acceptable repeat screening test to detect prostate cancer in general practice, but 3-year repeat screening will not always protect the individual against the interval development of metastatic disease.

Aged↗
PubMed1998

Reading ability and processing in Duchenne muscular dystrophy and spinal muscular atrophy.

We analysed the reading abilities and processing of 21 children with Duchenne muscular dystrophy (DMD), 11 matched children suffering from spinal muscular atrophy (SMA) and 42 children receiving normal education. The principal result observed was that the DMD children exhibited a reading age which was significantly lower than the SMA children compared with their chronological age. These learning disabilities were not related to a deficit in non-verbal performance intelligence, but psycholinguistic evaluation showed a deficit in verbal intelligence, especially in the Similarities and Arithmetic WISC-R subtests, in phonological abilities, oral word repetition, and in digit span score. The results for the DMD children were heterogeneous, and ranged from normal to greater or lesser involvement. In an attempt to clarify the nature of this reading impairment in DMD children, the three groups (DMD, SMA, and normal control children) were tested by reading aloud a list of single words and non-words. The DMD children were significantly impaired in reading non-words, suggesting reading disability similar to dysphonetic dyslexia, the most frequent subtype of developmental dyslexia. These results are discussed in the light of psychometric data available for our DMD population and in the light of previous studies. The practical consequences of diagnosis on rehabilitation are very important. The precise description of the cognitive deficits seen in DMD is of value for future clinical and genetic studies.

Adolescent↗
PubMed2006

Patient satisfaction and reported long-term therapeutic efficacy associated with 1,320 nm Nd:YAG laser treatment of acne scarring and photoaging.

BACKGROUND AND OBJECTIVE: Nonablative laser treatments have become increasingly used for the treatment of acne scarring and photoaging. While nonablative laser treatments are more convenient and relatively safer than ablative laser resurfacing, efficacy and patient satisfaction with the level of improvement of textural abnormalities in acne scarring and rhytids associated with photoaging needs further study. DESIGN/MATERIALS AND METHODS: Structured interviews were performed with 34 patients from a referral-based academic practice who each previously received a series of 6 monthly treatments with a 1,320 nm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser for treatment of acne scarring or photoaging. Topical anesthesia was applied 1 hour before each treatment. Patients were interviewed at least 3 months after cessation of treatment (range 3-12 months). RESULTS: Patients tolerated the treatments well. Combined results for acne scarring and photoaging patients were as follows: (a) patient satisfaction with treatment was rated at 62%, and (b) textural improvement was reported at 31% at the end of the six treatments, and 30% at the date of interview. When results were stratified by diagnosis, patient satisfaction was slightly higher for treatment of acne scarring than for photoaging. Overall degree of improvement on a 1-10 scale was 5.4 for acne scarring and 3.8 for wrinkling. CONCLUSION: Nonablative treatment with the 1,320 nm Nd:YAG laser induced significant patient-reported improvement in both acne scarring and photoaging. The majority of patients reported satisfaction with the degree of improvement.

Acne Vulgaris↗
PubMedDate not supplied

Continuous quality improvement efforts decrease postoperative ileus rates.

This article describes a continuous quality improvement team's efforts to reduce the number of patients at risk for developing a postoperative ileus. This study was limited to patients who underwent a surgical procedure that did not involve the bowel. Patients who developed an ileus after the surgical procedure (study group) were compared with patients who did not develop an ileus after the same procedure (control group). Principal factors associated with a postoperative ileus included a low serum albumin level, excessive use of narcotics, and a history of a previous gastrointestinal condition. Practice changes were made as a result of these findings. A follow-up chart review revealed a decrease in the postoperative ileus rate.

Analgesics, Opioid↗
PubMed1977

Sanitation in self-service automatic washers.

The potential for microbial transfer in self-service laundry washing machines was investigated by obtaining swab samples from the interior surfaces of commercial machines and wash water samples before and after disinfectant treatment. Three disinfectants (chlorine, a quaternary ammonium product, and a phenolic disinfectant) were used. Four self-service laundry facilities were sampled, with 10 replications of the procedure for each treatment at each location. Although washers were set on a warmwater setting, the wash water temperatures ranged from 24 to 51 degrees C. The quaternary ammonium product seemed most effective, averaging a 97% microbial kill; chlorine was the second most effective, with a 58% kill, and the phenolic disinfectant was least effective, with only a 25% kill. The efficacies of the chlorine and phenolic disinfectants were reduced at low water temperatures commonly experienced in self-service laundries. Interfamily cross-contamination in self-service facilities is a potential public health problem, which is aggravated by environmental conditions, such as water temperature and the practices of the previous users of the equipment. Procedural changes in laundering are recommended, including the use of a disinfectant to maintain adequate levels of sanitation.

Chlorine↗
PubMed2000

Use of length heterogeneity PCR and fatty acid methyl ester profiles to characterize microbial communities in soil.

In length heterogeneity PCR (LH-PCR) a fluorescently labeled primer is used to determine the relative amounts of amplified sequences originating from different microorganisms. Labeled fragments are separated by gel electrophoresis and detected by laser-induced fluorescence with an automated gene sequencer. We used LH-PCR to evaluate the composition of the soil microbial community. Four soils, which differed in terms of soil type and/or crop management practice, were studied. Previous data for microbial biomass, nitrogen and carbon contents, and nitrogen mineralization rates suggested that the microbial characteristics of these soils were different. One site received two different treatments: no-till and conventional till perennial ryegrass. The other sites were no-till continuous grass plots at separate locations with different soil types. Community composition was characterized by assessing the natural length heterogeneity in eubacterial sequences amplified from the 5' domain of the 16S rRNA gene and by determining fatty acid methyl ester (FAME) profiles. We found that LH-PCR results were reproducible. Both methods distinguished the three sites. The most abundant bacterial community members, based on cloned LH-PCR products, were members of the beta subclass of the class Proteobacteria, the Cytophaga-Flexibacter-Bacteriodes group, and the high-G+C-content gram-positive bacterial group. Strong correlations were found between LH-PCR results and FAME results. We found that the LH-PCR method is an efficient, reliable, and highly reproducible method that should be a useful tool in future assessments of microbial community composition.

Bacteria↗
PubMed1984

Is routine episiotomy necessary?

One hundred and eighty one primigravid women delivering vaginally in July and August 1982 in the Rotunda Hospital, Dublin, were randomly allocated to one of two groups. Patients in one group were to undergo episiotomy. Those in the other group were not to undergo episiotomy unless it was considered to be essential. The outcome was compared with that of the clinical practice over the previous six months at the hospital. Of the 92 patients allocated not to undergo episiotomy, seven (8%) had one done for medical reasons compared with 507 (89%) in the previous six months. First degree tears occurred in 23 (25%) and second degree tears in 43 (47%). Nineteen (21%), however, retained an intact perineum compared with only 35 (6%) of the women who had delivered in the preceding six months. Assessments of perineal pain, bruising, swelling, and healing and records of ingestion of analgesics were made for the first four days after delivery, and again at a check up six weeks after delivery, in patients who had had spontaneous vertex deliveries. Forty patients who underwent episiotomy and 37 who sustained a second degree tear formed two comparable groups. There was no difference in outcome between them. Data were also evaluated for 19 women who retained an intact perineum, 22 who sustained a first degree tear, and 11 who underwent episiotomy and epidural anaesthesia; all 52 of these women had spontaneous vertex deliveries. Despite severe soft tissue injury in two patients those who fared best were those who retained an intact perineum. First degree tears were associated with symptoms similar to those associated with second degree tears. Those who fared worst were women who underwent episiotomy after epidural anaesthesia. The value of routine episiotomy in primigravid patients is questioned, but the final decision can be made only by the accoucheur at the time of imminent delivery.

Adolescent↗
PubMed1999

Eosinophilic myelodysplasia transforming to acute lymphoblastic leukaemia.

A 43 year old male presented with a marked eosinophilia and associated systemic symptoms. A diagnosis of myelodysplasia was made on the basis of bone marrow morphology and karyotype. Over a 12 month period the disease transformed into acute lymphoblastic leukaemia, confirmed by flow cytometry, cytochemistry, and immunohistochemistry. Karyotyping was abnormal with 5q- and -7 which persisted from diagnosis through to blastic transformation. He died following initial induction chemotherapy. Eosinophilic myelodysplasia is an uncommon condition in haematological practice and no previous report of lymphoblastic transformation has been found.

Adult↗
PubMed1990

Inflammatory bowel disease in the rural Indian subcontinent: a survey of patients attending mission hospitals.

39 missionaries working at 38 separate mission hospitals or clinics in Bangladesh. India, Nepal and Pakistan completed questionnaires about their clinical practice during the previous year, 1980. Data were collected about gastrointestinal disorders, including coeliac disease, tropical sprue, bloody diarrhoea, amoebiasis, typhoid, cholera, inflammatory bowel disease and diverticular disease. More than 386,000 out-patients and over 56,000 in-patients were treated with an estimated 12,272 cases of bloody diarrhoea, 7,310 of amoebiasis, 2,113 of typhoid and 872 cases of intestinal tuberculosis, 74 cases of inflammatory bowel disease were diagnosed, of which 56 were ulcerative colitis and the remainder were said to have Crohn's disease. Surgery was performed in 28 hospitals, but only 10 (26%) had a histology service. Inflammatory bowel disease appears to be a relatively more common cause of diarrhoea in the Indian subcontinent than in sub-Saharan Africa (z = 5.47, p less than 0.001). The proportion of patients with bloody diarrhoea who have ulcerative colitis Crohn's disease was similar throughout the region. The rate of cases having ulcerative colitis rather than Crohn's disease was greater in India (z = 3.1, p less than 0.005), and in Bangladesh (z = 3.2, p less than 0.005), than in Pakistan (z = 1.28, NS) or Nepal and Bhutan (z = 0, NS). The relative risk of Indians developing ulcerative colitis rather than Crohn's disease is 2.6 (95% confidence limits 1.4-4.8, NS). This may reflect diagnostic difficulties in distinguishing Crohn's disease from intestinal tuberculosis, but it may also shed light on similar differences now being reported in migrant groups in Western Europe.

Bangladesh↗
PubMed1977

The emotionally disturbed psychiatric resident.

The authors compared data on 2,860 residents gathered by means of questionnaire responses by residency directors with data on 288 residents found in an earlier similar survey to have emotional difficulties. They found that age, marital status, previous psychiatric treatment, substance abuse, and previous nonpsychiatric medical practice differentiated the "problem" residents from the total residency population surveyed. However, sex, ethnicity, foreigh medical graduation, and transfer from other residency programs did not differentiate the two groups.

Adult↗
PubMed2003

A practical guideline for calculating parenteral nutrition cycles.

BACKGROUND: Both physiologic and psychological reasons for cycling total parenteral nutrition (TPN) have been well established. Despite widespread acceptance of this practice, the only previously published method for calculating TPN cycle rates is inherently flawed. METHODS: A mathematical formula was derived to facilitate reliable calculation of cyclic TPN flow rates as a function of total volume and cycle time. A publicly accessible website was subsequently developed to expedite rapid determination of TPN cycles. RESULTS: A fail-safe method of calculating TPN cycle flow rates can be expressed as F = V/(4T-10), where F is equal to the basal flow rate (mL/h), T is equal to the desired cycle time (hours), and V is equal to the total volume of TPN (mL) to be delivered in 24 hours. The basal flow rate and twice the basal flow rate are used for the first and last 2 hours of the TPN cycle, and the remainder of the cycle runs at 4 times the basal flow rate. TPN cycles may be easily calculated online using this formula at http://peds.stanford.edu/tpn.html. CONCLUSIONS: We have developed a fail-safe method of calculating TPN cycle flow rates that will consistently deliver the desired volume and have made an online implementation of this formula publicly available.

Journal Article↗
PubMed1989

Self-monitoring and self-managed reinforcement procedures for improving work productivity of developmentally disabled workers. A review.

This article reviews research that examined self-monitoring and/or self-managed reinforcement procedures for improving and maintaining work productivity of developmentally disabled workers. Seventeen articles were encountered that examined self-monitoring and/or self-administration of reinforcers for productivity. In total, 107 developmentally disabled persons experienced self-management procedures, with diagnoses varying from profoundly to mildly retarded. In most of the studies, work productivity improved during intervention conditions. However, in almost all cases, procedural limitations prevent us from confidently attributing improvements in productivity to the self-management components of the interventions. Moreover, because of practical limitations, we cannot yet offer self-management procedures as a viable strategy to maintain work rates of developmentally disabled workers at acceptable levels throughout typical working days. Additional research is needed that goes beyond the procedural and practical limitations of previous studies.

Adult↗
PubMed1982

Peer review of psychodynamic psychotherapy: generous versus restrictive reviewers.

American Psychological Association/CHAMPUS peer reviewers (N=168) evaluated clinical treatment reports that described psychodynamic treatment of middle-aged, depressed outpatients. Descriptive data are reported on the reviewer' recommendations concerning the reimbursement for previous and total (previous plus future) care. In addition, generous and restrictive reviewers are compared on their theorectical orientation, the self-reported factors affecting their review decisions, and their previously reported clinical practice patterns and attitudes toward psychological peer review. The implications of these findings for mental health quality assurance programs are discussed.

Health Benefit Plans, Employee↗