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PubMed1990

Injury and illness surveillance at local Special Olympic Games.

The purposes of this study were to: determine the incidence of injury and illness among Special Olympic athletes at local competitions; assess the relative risk of medical problems among Down's syndrome athletes; and compare the relative risk of sports injury incurred by athletes participating in various Special Olympic events. Health stations were set up at all sports venues and injury/illness surveillance records were kept for all injury/illness encounters during a 3-day competition for 777 Special Olympic athletes. A total of 3.5% of the athletes required injury/illness care during the games. Down's syndrome athletes were 3.2 times as likely to encounter a medical problem. Track and field events provided the least activity time and the most injuries. These data suggest that Special Olympic games at the local level are safe and that planners should prepare to treat more illnesses than injuries at such competitions.

Adolescent↗
PubMed1994

Hospital care for adults with cystic fibrosis: an overview and comparison between special cystic fibrosis clinics and general clinics using a patient questionnaire.

BACKGROUND: Provision of medical care for adult patients with cystic fibrosis is an increasing problem as the number of patients surviving into adulthood increases. Recent reports have suggested that care is best provided in specialist centres because of longer survival. Recent changes in the National Health Service funding and delivery of service may adversely affect the provision of such a specialist service. The aim of this study was to assess the current pattern of medical service received by adults with cystic fibrosis and to compare the type of care between special cystic fibrosis and general clinics. METHODS: Confidential postal questionnaires were sent to all 1052 members of the Association of Cystic Fibrosis Adults (ACFA) comprising 59% of the UK population of cystic fibrosis patients over 15 years and 80% over 25 years of age. The response rate was 82%. RESULTS: Two thirds of patients were attending special cystic fibrosis clinics for either adults or adults and children. There were significant differences in the proportion of patients using special cystic fibrosis clinics between regions but not between social class groups. Significant differences between cystic fibrosis and general clinics were noted. Patients attending cystic fibrosis clinics were more likely to have had simple clinical investigations (blood tests, sputum culture, oxygen saturation, chest radiography, weight and lung function measurement) in the previous year. They were also more likely to have received intravenous antibiotics at home, and to have access to paramedical personnel. Patients attending cystic fibrosis clinics were taking higher doses of pancreatic enzyme supplements with respect to quantity and potency of preparation. Such patients also had less severe symptoms irrespective of social class, and were more likely to be satisfied with professional aspects of their care. Regardless of type of clinic, potential deficiencies were identified in overall medical care with omission of clinical investigations in severely affected patients and evidence of undertreated respiratory and digestive symptoms in patients with moderate and severe disease. CONCLUSIONS: This survey provides evidence that adults with cystic fibrosis attending special cystic fibrosis clinics receive more intensive care, have better symptom control, and are more satisfied with the service provided than those attending general clinics.

Adolescent↗
PubMed2005

Regional specialization in pyramidal cell structure in the visual cortex of the galago: an intracellular injection study of striate and extrastriate areas with comparative notes on new world and old world monkeys.

Recent studies have revealed marked differences in the basal dendritic structure of layer III pyramidal cells in the cerebral cortex of adult simian primates. In particular, there is a consistent trend for pyramidal cells of increasing complexity with anterior progression through occipitotemporal cortical visual areas. These differences in pyramidal cell structure, and their systematic nature, are believed to be important for specialized aspects of visual processing within, and between, cortical areas. However, it remains unknown whether this regional specialization in the pyramidal cell phenotype is unique to simians, is unique to primates in general or is widespread amongst mammalian species. In the present study we investigated pyramidal cell structure in the prosimian galago (Otolemur garnetti). We found, as in simians, that the basal dendritic arbors of pyramidal cells differed between cortical areas. More specifically, pyramidal cells became progressively more spinous through the primary (V1), second (V2), dorsolateral (DL) and inferotemporal (IT) visual areas. Moreover, pyramidal neurons in V1 of the galago are remarkably similar to those in other primate species, in spite of large differences in the sizes of this area. In contrast, pyramidal cells in inferotemporal cortex are quite variable among primate species. These data suggest that regional specialization in pyramidal cell phenotype was a likely feature of cortex in a common ancestor of simian and prosimian primates, but the degree of specialization varies between species.

Animals↗
PubMed1994

Neurochemical specializations associated with vocal learning and production in songbirds and budgerigars.

Specialized neural circuitry has evolved in groups of birds where vocal learning is known to occur, such as in the oscine suborder of the Passeriformes (songbirds) and in the order Psittaciformes (parrots). These specializations are most prominent in the telencephalon, while the midbrain and medullary portions of the vocal control circuit are generally similar in all orders of birds. Specializations in songbirds have at least four components: 1) a set of distinct and interconnected vocal control nuclei in the forebrain; 2) unique connections between the auditory system and these vocal control nuclei; 3) the occurrence of receptors for sex steroid hormones in a subset of the vocal control nuclei; and 4) unique patterns in the distribution of various markers of the major classes of neurotransmitters within the vocal control nuclei. In the order Psittaciformes, as exemplified by budgerigars (Melopsittacus undulatus), it appears that neural specializations generally similar to those described in songbirds have evolved independently. Although anatomical studies have found a system of interconnected forebrain regions in budgerigars that are roughly similar to those described in oscines, detailed connectivity studies of this forebrain system suggest that it is only superficially similar to that of songbirds, and budgerigars also have unique connections between the auditory and motor systems. Also, analyses of the distribution of markers of neurotransmitter function in the budgerigar brain reveal patterns different from those described in songbird vocal control systems. This work suggests that songbirds and parrots have evolved separate neural 'solutions' to solve the problem of vocal plasticity. There are differences between these 'solutions' but also similarities that may be the result of convergent evolution. Although vocal behavior is learned in both songbirds and parrots, it differs in many respects. By taking advantage of this 'natural' experiment one can gain insight into the hormonal and neural events that mediate these different forms of vocal plasticity.

Animals↗
PubMed2002

Differential distribution of cardiac ion channel expression as a basis for regional specialization in electrical function.

The cardiac electrical system is designed to ensure the appropriate rate and timing of contraction in all regions of the heart, which are essential for effective cardiac function. Well-controlled cardiac electrical activity depends on specialized properties of various components of the system, including the sinoatrial node, atria, atrioventricular node, His-Purkinje system, and ventricles. Cardiac electrical specialization was first recognized in the mid 1800s, but over the past 15 years, an enormous amount has been learned about how specialization is achieved by differential expression of cardiac ion channels. More recently, many aspects of the molecular basis have been revealed. Although the field is potentially vast, an appreciation of key elements is essential for any clinician or researcher wishing to understand modern cardiac electrophysiology. This article reviews the major regionally determined features of cardiac electrical function, discusses underlying ionic bases, and summarizes present knowledge of ion channel subunit distribution in relation to functional specialization.

Action Potentials↗
PubMed2000

Duplication of modules facilitates the evolution of functional specialization.

The evolution of simulated robots with three different architectures is studied in this article. We compare a nonmodular feed-forward network, a hardwired modular, and a duplication-based modular motor control network. We conclude that both modular architectures outperform the non-modular architecture, both in terms of rate of adaptation as well as the level of adaptation achieved. The main difference between the hardwired and duplication-based modular architectures is that in the latter the modules reached a much higher degree of functional specialization of their motor control units with regard to high-level behavioral functions. The hardwired architectures reach the same level of performance, but have a more distributed assignment of functional tasks to the motor control units. We conclude that the mechanism through which functional specialization is achieved is similar to the mechanism proposed for the evolution of duplicated genes. It is found that the duplication of multifunctional modules first leads to a change in the regulation of the module, leading to a differentiation of the functional context in which the module is used. Then the module adapts to the new functional context. After this second step the system is locked into a functionally specialized state. We suggest that functional specialization may be an evolutionary absorption state.

Adaptation, Physiological↗
PubMed2005

Race, urban community stressors, and behavioral and emotional problems of children with special health care needs.

OBJECTIVES: This study examined the relationship of community-level stressors to behavioral and emotional problems among African-American and white children with special health care needs. METHODS: The authors interviewed 257 low-income caregivers of children with special health care needs in an urban Midwestern city who brought their child for a primary health care visit to a community health center between September 2001 and May 2002. Sociodemographic characteristics as well as information about the children's behavioral and emotional problems, the health status of the children, perceptions of urban community stress, access to health care, and satisfaction with health care were collected to determine racial differences in the impact of urban stress on behavioral and emotional problems. RESULTS: Urban community stressors, race, and child's health status were significantly associated with behavioral and emotional problems among children with special health care needs. The association between urban stress and total behavioral problems did not differ by race. CONCLUSIONS: When caring for children with special health care needs, especially those with emotional or behavioral problems, primary care providers may be better able to identify important aggravating factors if they also assess urban stress. Systems of care are needed that can assist in addressing urban community-level stressors.

Analysis of Variance↗
PubMed1977

Special living arrangements: a model for decision-making.

Many chronically disabled patients need special support systems to help them meet material needs, personal-care needs, and psychosocial needs. The authors propose two guidelines that must be considered simultaneously when deciding what special support system is most appropriate for a particular client. The first is that the system be adequate to meet the client's unmet needs, and the second is that the system not meet needs the client can meet hiself. The authors feel that one should look first to support systems other than special living arrangements, which can easily overprovide services to clients. If a special living arrangement is considered appropriate, the one selected should provide only for those needs the client cannot meet himself.

Community Mental Health Services↗
PubMed1999

Health status of children with special health care needs: measurement issues and instruments.

The methods for measuring health care outcomes and monitoring the health status of the child with a chronic health condition must be available, accessible, and meaningful. This review was evoked by this need to identify reliable and valid instruments for measuring the health status of children with special health care needs. The objectives are as follows: (1) to review the methodologic and substantive issues related to the selection of instruments and (2) to identify those instruments available currently for collecting data regarding health status of children with special health care needs. A Medline search of the literature published since 1966 through 1998 and restricted to human subjects and the English language was conducted. Indexing terms included health status, quality of life, outcome assessment, functional status, and patient satisfaction. Multiple reviewers selected instruments based on their usefulness in clinical settings as generic, disease nonspecific, child health status instruments. Few instruments were identified that can be used by pediatricians for tracking and monitoring the health status of children with special health care needs. In conclusion, to progress in the field of outcomes measurement of children with special health care needs, it will be necessary to develop new measurement tools. These instruments must (1) provide valid and reliable information on health status; (2) be useful in guiding the management of patients; and (3) not be a burden for physicians, patients, or patient's families.

Adolescent↗
PubMed2003

No excess risk of adverse birth outcomes in populations living near special waste landfill sites in Scotland.

A recent study showed small excess risks of low birth weight, very low birth weight and certain congenital anomalies in populations living near landfill sites in Great Britain. The objective of the current study was to investigate the risk of adverse birth outcomes associated with residence near special waste landfill sites in Scotland. We studied risks of adverse birth outcomes in populations living within 2 km of 61 Scottish special waste landfill sites operational at some time between 1982 and 1997 compared with those living further away. 324,167 live births, 1,849 stillbirths, and 11,138 congenital anomalies (including terminations) were included in the study. Relative risks were computed for all congenital anomalies combined, some specific anomalies and prevalence of stillbirth and low and very low birth weight (< 2500 g and < 1500 g). For all anomalies combined, relative risk of residence near special waste landfill sites was 0.96 (99% confidence interval 0.89 to 1.02) adjusted for confounders. Adjusted risks were 0.71 (0.36 to 1.42) for neural tube defects, 1.03 (0.85 to 1.26) for cardiovascular defects, 0.84 (0.58 to 1.22) for hypospadias and epispadias (with no excess of surgical corrections), 0.78 (0.27 to 2.23) for abdominal wall defects (1.32 (0.42-4.17) for hospital admissions), 1.22 (0.28 to 5.38) for surgical correction of gastroschisis and exomphalos and 1.01 (0.96 to 1.07) and 1.01 (0.90 to 1.15) for low and very low birth weight respectively. There was no excess risk of stillbirth. In conclusion, we found no statistically significant excess risks of congenital anomalies or low birth weight in populations living near special waste landfill sites in Scotland.

Adolescent↗
PubMed2005

The criminal activity of sexual offenders in adulthood: revisiting the specialization debate.

Two major hypotheses have been put forward to describe the criminal activity of sexual offenders in adulthood. The first hypothesis states that sexual offenders are specialists who tend to repeat sexual crimes. The second hypothesis describes sexual offenders as generalists who do not restrict themselves to one particular type of crime. The current state of knowledge provides empirical support for both the specialization and the generality hypothesis. The presence of both generality and specialization in the offending behavior of sexual offenders is not as contradictory as it may first appear. However, methodological problems limit the possibility of drawing firm conclusions. Indeed, the specialization hypothesis is based on just one parameter of criminal activity, that is, recidivism, which only takes into account two consecutive crimes. The generality hypothesis is focused mainly on two criminal activity parameters, participation and variety, which do not take into account the dynamic nature of criminal activity over time. Developmental criminology provides a new paradigm to explore the issue of generality and specialization in the offending behavior of sexual offenders.

Adult↗
PubMed2005

Occupational asthma due to manual metal-arc welding of special stainless steels.

Occupational asthma (OA) can be induced by fumes of manual metal-arc welding on stainless steel. In recent years, the use of special stainless steels (SSS) with high chromium content has increased. This study presents two cases of OA caused by manual metal-arc welding on SSS. In both cases, the diagnosis of OA was based on respiratory symptoms, occupational exposure and positive findings in the specific challenge tests. In the first case, a 46-yr-old welder had experienced severe dyspnoea while welding SSS (SMO steel), but not in other situations. Challenge tests with both mild steel and stainless steel using a common electrode were negative. Welding SSS with a special electrode caused a delayed 37% drop in forced expiratory volume in one second (FEV1). In the second case, a 34-yr-old male had started to experience dyspnoea during the past few years, while welding especially SSS (Duplex steel). The workplace peak expiratory flow monitoring was suggestive of OA. Challenge tests with both mild steel and stainless steel using a common electrode did not cause bronchial obstruction. Welding SSS with a special electrode caused a delayed 31% drop in FEV1. In conclusion, exposure to manual metal-arc welding fumes of special stainless steel should be considered as a new cause of occupational asthma.

Adult↗
PubMed1988

A preliminary study of violent incidents in a special hospital (Rampton).

A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.

England↗
PubMed2002

Psychosis in high-security and general psychiatric services: report from the UK700 and special hospitals' treatment resistant schizophrenia groups.

BACKGROUND: Serious violence is an unusual but significant correlate of psychosis, and leads to the need for specialist secure psychiatric services. Most such service users have previously used general psychiatric services. AIMS: To examine diagnostic and socio-demographic differences between high-security psychiatric service users from their peers in community services. METHOD: Two groups of patients with psychosis were compared: a national sample of high-security hospital residents, and a sample of patients in contact with general psychiatric services. RESULTS: Schizophrenia was the almost invariable diagnosis for all special hospital patients. White patients in the community sample were significantly more likely to have affective components to their illness compared with African-Caribbean patients; unlike those in special hospitals. There was a small excess in the proportion of African-Caribbean patients in the special hospital group, controlling for diagnosis, gender and locality. Men were overrepresented in this group. CONCLUSIONS: Among patients with psychosis, having a diagnosis of schizophrenia and being male increase the likelihood of special hospital admission. Suggestions that ethnic minority patients are much more likely to have engaged in serious violence and need high-security placement were not borne out.

Adolescent↗
PubMed1981

Ciliary specializations in mating cells of the ciliate Euplotes crassus.

In the ciliate Euplotes crassus, mixed cells of different compatible mating types pass through an induction period before agglutinating with each other by means of cilia in the mating reaction. We examined the ciliary membranes of cells involved in the mating reaction by the freeze-fracture technique and detected at least 5 distinct types of specialization, each indicated by a special congregation of intramembrane particles. Near to the necklace, at the ciliary base, we observed a set of several parallel transverse rows of 10-15 nm particles; a longitudinal row of 12 nm particles appeared more distally from the necklace, preferentially in replicas of intermediate regions of the ciliary shaft. These 3 specializations were common to both mating and vegetative cells. The other 2 appeared as more dynamic specializations found exclusively at least in their patterned organization, in the ciliary membranes of mating cells. Taking on the aspects of rosette-like arrays and patches, respectively, the former were positioned regularly on ciliary membrane bulges (containing an electron-opaque granule) and consisted of 8-9 nm particles; the latter had an elliptic shape and contained up to 50 closely packed 9-10 nm particles.

Animals↗
PubMed2006

The energetic consequences of dietary specialization in populations of the garter snake, Thamnophis elegans.

We investigated the intraspecific variation in digestive energetics between dietary specialist and generalist populations of the Western Terrestrial garter snake (Thamnophis elegans) in northern California. Coastal populations have a specialized diet of slugs and inland populations have a generalized diet of fish, anurans, mice and leeches. The difference in prey preference between the two populations is congenital, heritable and ontogenetically stable. To examine energetic specializations and trade-offs in these populations, we measured the net assimilation efficiency of each snake population on both slug (Ariolimax columbianus) and fish (Rhinichthys osculus) diets. The net assimilation efficiency was measured during digestion of a meal and continued until metabolic rate re-attained prefeeding levels. Coastal snakes were able to utilize 62% more of the ingested energy towards production from slug diets through both increased assimilation of nutrients and reduced digestive costs. For fish, assimilation and digestive costs were the same in both coastal and inland populations. These results support the hypothesis that snakes with specialized diets can evolve physiological traits to extract nutrients more efficiently. However, there was no apparent trade-off on the more generalized diet that was associated with this specialization.

Adaptation, Physiological↗
PubMed1997

Playmate preferences of children who are typically developing for their classmates with special needs.

The social preferences of children who are typically developing towards peers with special needs in inclusive preschool classrooms were examined. Children with special needs received few positive playmate preference nominations, but not a significant number of negative nominations. Children were disliked if they were aggressive, irrespective of disability status. Interventions need to be focused on improving the social skills of children with special needs and teaching preschool age children who are typically developing to understand the behaviors of classmates with special needs.

Child, Preschool↗
PubMedDate not supplied

Comparison of the children with special health care needs screener to the questionnaire for identifying children with chronic conditions--revised.

BACKGROUND: The Children with Special Health Care Needs (CSHCN) Screener is an instrument to identify CSHCN, one that is based on parent-reported consequences experienced by children with ongoing health conditions. Information about how this instrument compares to other methods for identifying CSHCN is important for current and future uses of the CSHCN Screener. RESEARCH OBJECTIVES: The goal of this study was to assess the level of agreement between the CSHCN Screener and the Questionnaire for Identifying Children With Chronic Conditions--Revised (QuICCC-R) and to describe the characteristics of children in whom these methods do not agree. METHODS: The CSHCN Screener and the QuICCC-R were administered to 2 samples: a random sample of parents of children under age 18 years through the first pretest of the National CSHCN Survey (n = 2420) and a random sample of children under age 14 years enrolled in a managed care health plan (n = 497). Information on specific conditions and needs for health services were collected for children identified by one or both instruments in the national sample. Data from the administrative data-based Clinical Risk Groups (CRGs) were collected for all children in the health plan sample. The proportions of children identified with the CSHCN Screener and the QuICCC-R were compared, the level of agreement between these 2 methods was assessed, and the health service needs of children identified by the QuICCC-R but not the CSHCN Screener were evaluated. RESULTS: In both study samples, the CSHCN Screener agreed with the QuICCC-R approximately 9 out of 10 times on whether or not a child was identified as having a special health care need. Compared to the CSHCN Screener, the QuICCC-R identified an additional 7.6% and 8.5% of children as having special health care needs in the national and health plan samples, respectively. Compared to children identified by the QuICCC-R only, the odds were 12 times greater that children identified by both the CSHCN Screener and the QuICCC-R needed health care services, 6 times greater that parents named a specific chronic health condition, and 9 times greater that children were identified with a chronic condition using the CRG algorithm. Study design and purposeful differences in question design or content account for most cases in which children are not identified by the CSHCN Screener but are identified using the QuICCC-R. CONCLUSIONS: The brief CSHCN Screener exhibits a high level of agreement with the longer QuICCC-R instrument. Whereas nearly all children identified by the CSHCN Screener are also identified by the QuICCC-R, the QuICCC-R classifies a higher proportion of children as having special health care needs.

Adolescent↗