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PubMed1996

Specialized service offerings and patients' choice of hospital: the case of cardiac catheterization.

Patients' choice of hospital is modeled as a function of their expectation of needing a specialized service (option demand). The estimation tests whether cardiac patients' choice of hospital responds to changes over time in the availability of a specialized cardiac service. Results suggest that availability of cardiac catheterization has a strong, significant effect on the choice of hospital, even after controlling for other quality characteristics. However, the effect appears confined to those patients whose diagnosis indicates some probability of needing the service. Patients with no 'option demand' do not appear to use specialized services as a signal of quality.

Aged↗
PubMed1996

Longitudinal in-shoe foot pressure relief achieved by specially designed footwear in high risk diabetic patients.

Specially designed Thor-Lo footwear has been shown to reduce the in-shoe foot pressures in diabetic patients at risk of foot ulceration when compared to their own footwear. Fifty at high risk patients 32 (64%) males, 17 (34%) type 1 diabetes) have been provided with this foot wear and have been followed up for 6 months. Mean age was 57.6 (range, 34-78) years, duration of diabetes 22.4 (range, 4-50) years, Neuropathy Symptom Score 3.36 +/- 2.96 (mean +/- S.D.), Neuropathy Disability Score 16.8 +/- 6.83, VPT 43.4 +/- 11.8 Volts while 43 (86%) could not feel a 5.07 or smaller Semmes-Weinstein monofilament. Forty-two (84%) patients were re-examined at an interim visit 3 months after baseline, while 37 (74%) completed the study. In-shoe peak forces and pressures were measured using the F-Scan system. No difference was found among the peak force among baseline (95.5 +/- 26 kg), interim (96.5 +/- 33) and final visit (97.7 +/- 25.2, P + NS). There was no difference in peak pressures at the baseline (3.98 +/- 1.42 kg.cm-2), second visit (4.13 +/- 2.30) and the final visit (4.25 +/- 1.51). Nine (18%) patients developed foot problems and one died during the study. We conclude that no changes in foot pressures were found over a period of 6 months of continuous usage of the specially designed footwear in a group of diabetic patients at risk of foot ulceration. Further prospective studies are required to evaluate the impact of specially designed footwear in reducing the rate of foot ulceration.

Adult↗
PubMed1991

Specializations for sharp tuning in the mustached bat: the tectorial membrane and spiral limbus.

The sense of hearing in the mustached bat, Pteronotus parnellii, is specialized for fine frequency analysis in three narrow bands that correspond to approx 30, 60 and 90 kHz constant frequency harmonics in the biosonar signals used for Doppler-shift compensation and acoustic imaging of the environment. Previous studies have identified anatomical specializations in and around the area of the cochlea that processes the dominant second harmonic component, but similar features have not been found in areas related to sharp tuning and high sensitivity for the first or third harmonics. In this report we call attention to the large size of the tectorial membrane and spiral limbus in all three areas that appear to process the harmonically related constant frequency components. These structures are especially pronounced in the regions of the cochlea that respond to the approx 61 kHz, second harmonic and 91.5 kHz, third harmonic bands; they correspond specifically to areas where the density of afferent nerve fibers is high and where very sharply tuned neurons occur. These data for cochleae with multiple specializations lend strong support to the idea that the mass of the tectorial membrane can be an important factor in establishing the response properties of the cochlea.

Animals↗
PubMed1988

The Special Treatment Team: an inpatient approach to the mentally ill alcoholic patient.

We review the problems unique to the diagnosis and treatment of patients who suffer both major mental illness and alcohol/drug abuse. We describe the experience and the approach evolved in the Special Treatment Team, a State Hospital unit that has specialized in this work. We discuss in detail the assessment and stabilization of such patients, including psychosocial and pharmacologic strategies, giving special attention to the problem of the unmotivated patient. Several case vignettes illustrate our approach.

Alcoholism↗
PubMed2005

Hemispheric specialization for language: Brain volume matters.

Increasing brain volume may impose constraints, through longer information transfer delays, on the distributed networks supporting language. Here, we assessed the relative effects of brain volume and other putative predictors of the functional variability of perisylvian language areas, as probed with PET, during both a language comprehension and a language production task. In the case of language comprehension (story listening), a linear combination of planum temporale surface, brain volume and handedness could explain almost 60% of the functional asymmetry observed in the perisylvian area. Without brain volume, the goodness of fit was significantly decreased (39%, P < 0.05), and furthermore, the effect of handedness was not detected anymore. This was due to the fact that in our sample, left-handers (n = 12) had a significantly larger brain volume as compared to right-handers (n = 8, P = 0.03). As for language production (verb generation), brain volume and the planum temporale also played a role. However, in this case, the main predictor of functional variability was handedness, where a greater degree of right-handedness was associated with larger activation of left inferior frontal regions. Depending on the language component of interest, these results support different (yet compatible) theories on hemispheric specialization. Left specialization for comprehension could be attributed to the constraints of processing speech stimuli, while a gestural origin of language is mostly supported by the relation we observed between left specialization for production and right-handedness.

Adult↗
PubMed2006

Specialization of pyramidal cell structure in the visual areas V1, V2 and V3 of the South American rodent, Dasyprocta primnolopha.

Marked phenotypic variation has been reported in pyramidal cells in the primate cerebral cortex. These extent and systematic nature of these specializations suggest that they are important for specialized aspects of cortical processing. However, it remains unknown as to whether regional variations in the pyramidal cell phenotype are unique to primates or if they are widespread amongst mammalian species. In the present study we determined the receptive fields of neurons in striate and extrastriate visual cortex, and quantified pyramidal cell structure in these cortical regions, in the diurnal, large-brained, South American rodent Dasyprocta primnolopha. We found evidence for a first, second and third visual area (V1, V2 and V3, respectively) forming a lateral progression from the occipital pole to the temporal pole. Pyramidal cell structure became increasingly more complex through these areas, suggesting that regional specialization in pyramidal cell phenotype is not restricted to primates. However, cells in V1, V2 and V3 of the agouti were considerably more spinous than their counterparts in primates, suggesting different evolutionary and developmental influences may act on cortical microcircuitry in rodents and primates.

Action Potentials↗
PubMed2004

Specially selected music in the cardiac laboratory-an important tool for improvement of the wellbeing of patients.

PURPOSE: To investigate the effect of a specially selected music sound environment on the feeling of wellbeing of adult, lightly sedated patients in a Cardiac Catheter Laboratory undergoing invasive procedures. METHOD: Patients (n=193) were randomly assigned to either a music group, who listened to music during the procedure (n=99) or to a non-music group (n=94). Immediately after the procedure all patients were interviewed by a questionnaire about their opinion of the sound environment in the room and about their feeling of wellbeing. RESULTS: In the music group 91% of the patients defined the sound environment as very pleasant/pleasant - compared to 56% in the non-music group. The number of patients with 'no opinion' on the sound environment was lower in the music group than in the non-music group (8% vs. 42%). In the non-music group only 34% of the patients would have liked to listen to music, if possible, whereas 82% of the patients in the music group were very pleased/pleased with the music. Both groups noticed basic sounds and noises with similar frequencies. In the music group 62% of the patients noticed the music spontaneously. Sixty-eight patients (68%) reported that music was of major positive importance to their feeling of wellbeing. These patients expressed that music made them feel less tense, more relaxed and safe. The results were not related to age, sex or procedure. CONCLUSION: Specially selected music had a positive effect on the wellbeing of patients and their opinion on the sound environment during invasive cardiac procedures. Based on the negative expectations and the positive experience of the patients with regard to music environment, we suggest that specially selected music should be a part of the sound environment in the Cardiac Catheter Laboratory.

Adult↗
PubMed2004

Iron(II) sulfate release from drop-formed lipophilic matrices developed by special hot-melt technology.

Iron(II) sulfate-containing lipophilic matrices were developed by a special hot-melt technology (melt solidification in drops), using stearin, white wax and their mixture as conventional bed materials. The special technology resulted in spherical particles which can be filled directly into capsules; these store iron as a depot and ensure a slow and uniform release, whereby the irritation of the gastric mucosa by the iron can be decreased. The rates of dissolution of the iron(II) sulfate from the various lipophilic matrices were different, but fundamentally low. Kinetic calculations demonstrated that the rate of dissolution of the iron(II) sulfate was of approximately zero kinetic order. The results of in vivo experiments on rabbits correlated well with the in vitro data. The plasma curves for the animals treated with the iron(II) sulfate preparations varied with the excipients in the depot products. The properties and ratio of the bed materials influenced the release of the iron(II) sulfate. In all probability, the release of the active agent can be regulated through the use of a melt of stearin and white wax in different ratios. The development products functioned as a sustained-release system and ensured elimination of the irritation of the gastric mucosa. At the same time, the results justified the applicability of the special hot-melt technology in the development of the solid dosage form.

Animals↗
PubMed2004

Survey of specialized tertiary care facilities for adults with congenital heart disease.

BACKGROUND: Specialized tertiary care facilities developed in response to the increasing numbers of adults with congenital heart disease (CHD). Because this patient population comprises a relatively new area of specialized cardiovascular interest, the first facilities necessarily evolved without preexisting guidelines or interaction. OBJECTIVES: To characterize the major features of the six original and largest tertiary adults CHD facilities. METHODS: Written questionnaire sent to six participating facilities in North America and Europe. Information was analyzed centrally. RESULTS: All but one facilities was established over 20 years ago, and each cares for over 1500 patients. Hospital admissions ranged from 100 to 660 patients/unit/year. Of the total number of registered patients, 52-81% had undergone one or more reparative surgeries. Reoperations constituted 25-80% of the 50-170 operations/unit/year. Overall mean surgical mortality was 1.9%/year. Inpatient and outpatient care was provided in adult (n = 4) or both adult and pediatric (n = 2) settings. All six facilities enjoyed close collaboration between adult and pediatric cardiologists, cardiac surgeons, nurse specialists and cardiac and non-cardiac consultants. Training and research were pivotal activities. CONCLUSIONS: Provision of comprehensive care by multidisciplinary teams including adult and pediatric cardiologists, cardiac surgeons, specialized nurses and other cardiac and non-cardiac consultants was the unifying feature for all six tertiary care facilities reported here. There were minor differences among them based on available resources, local expertise and national health care policies. There appears to be a significant shortfall in tertiary care provision for the adult with CHD that requires further planning and resource allocation. These data may be useful for new and evolving adult CHD services.

Adolescent↗
PubMed2006

Mechanisms of hemispheric specialization: insights from analyses of connectivity.

Traditionally, anatomical and physiological descriptions of hemispheric specialization have focused on hemispheric asymmetries of local brain structure or local functional properties, respectively. This article reviews the current state of an alternative approach that aims at unraveling the causes and functional principles of hemispheric specialization in terms of asymmetries in connectivity. Starting with an overview of the historical origins of the concept of lateralization, we briefly review recent evidence from anatomical and developmental studies that asymmetries in structural connectivity may be a critical factor shaping hemispheric specialization. These differences in anatomical connectivity, which are found both at the intra- and inter-regional level, are likely to form the structural substrate of different functional principles of information processing in the two hemispheres. The main goal of this article is to describe how these functional principles can be characterized using functional neuroimaging in combination with models of functional and effective connectivity. We discuss the methodology of established models of connectivity which are applicable to data from positron emission tomography and functional magnetic resonance imaging and review published studies that have applied these approaches to characterize asymmetries of connectivity during lateralized tasks. Adopting a model-based approach enables functional imaging to proceed from mere descriptions of asymmetric activation patterns to mechanistic accounts of how these asymmetries are caused.

Animals↗
PubMed2005

Predicting total urinary nitrogen excretion from urinary urea nitrogen excretion in multiple-trauma patients receiving specialized nutritional support.

OBJECTIVE: We investigated the accuracy of methods to estimate total urinary nitrogen (TUN) excretion from urinary urea nitrogen (UUN) excretion for patients who have multiple trauma and receive specialized nutritional support. METHODS: Fifty-five critically ill, adult patients who had multiple trauma and were receiving specialized nutritional support were evaluated. A 24-h urine collection for urea nitrogen and total nitrogen was performed 4.4 +/- 2.6 d after admission to the trauma intensive care unit. Patients with significant renal impairment, liver dysfunction, or obesity (>150% of ideal body weight) were excluded from study entry. Eight publications that examined the relation between TUN and UUN were evaluated for bias and precision in estimating TUN from UUN. RESULTS: TUN was 20.8 +/- 10.8 g/d with an average difference of 3.8 +/- 2.8 g/d between TUN and UUN. Linear regression analysis comparing TUN with UUN indicated a significant correlative relation (TUN = 1.1 x UUN + 2; r = 0.958, P < 0.001). The difference between TUN and UUN varied based on UUN: for UUN lower than 10 g/d, TUN minus UUN was 1.5 +/- 1.0 g/d; for UUN 10 to 20 g/d, TUN minus UUN was 4.1 +/- 3.2 g/d; and for UUN higher than 20 g/d, TUN minus UUN was 5.3 +/- 1.9 g/d (P < 0.001). Six methods were biased toward underpredicting TUN, one method was unbiased, and one was biased toward overpredicting TUN. A practical method for estimating TUN from UUN was developed: TUN = UUN + 2 for those with UUN lower than 10 g/d and TUN = 1.1 x UUN + 2 for those with UUN of at least 10 g/d. CONCLUSIONS: Our method, the modified Velasco method, UUN/0.84, and UUN/0.85 provided reasonable estimates of TUN from UUN in critically ill, adult patients who had multiple trauma and were receiving specialized nutritional support; however, our method requires further validation.

Adult↗
PubMed2005

Hypertension in special populations.

Hypertension is a multifaceted disease that may present somewhat differently in various populations. It is clear that hypertensive treatment reduces cardiovascular, renal, and cerebrovascular outcomes for all patients, yet recent clinical trial data suggest that some groups may benefit more than others from specific drug intervention. Furthermore, these data justify specific approaches for some special populations. This article reviews important features of the presentation, rationale for treatment, and treatment recommendations for the treatment of hypertension in special populations. The special populations addressed include diabetic patients, the elderly, and women.

Aging↗
PubMed2004

The XY body: a specialized meiotic chromatin domain.

The sex chromosomes of mammalian spermatocytes form a specialized nuclear territory known as the XY body, where both transcription and homologous recombination are restricted. The array of proteins assembled into the XY body is typical of heterochromatin. This special subnuclear domain is in distinct contrast to the autosomal domain of the spermatocyte nucleus, where both homologous recombination and transcription occur. The special features of the XY body might reflect absence of homology between the sex chromosomes, rather than any form of dosage compensation, and may also serve to mark parental origin of the paternal X chromosome.

Animals↗
PubMed1999

The development of M cells in Peyer's patches is restricted to specialized dome-associated crypts.

It is controversial whether the membranous (M) cells of the Peyer's patches represent a separate cell line or develop from enterocytes under the influence of lymphocytes on the domes. To answer this question, the crypts that produce the dome epithelial cells were studied and the distribution of M cells over the domes was determined in mice. The Ulex europaeus agglutinin was used to detect M cells in mouse Peyer's patches. Confocal microscopy with lectin-gold labeling on ultrathin sections, scanning electron microscopy, and laminin immuno-histochemistry were combined to characterize the cellular composition and the structure of the dome-associated crypts and the dome epithelium. In addition, the sites of lymphocyte invasion into the dome epithelium were studied after removal of the epithelium using scanning electron microscopy. The domes of Peyer's patches were supplied with epithelial cells that derived from two types of crypt: specialized dome-associated crypts and ordinary crypts differing not only in shape, size, and cellular composition but also in the presence of M cell precursors. When epithelial cells derived from ordinary crypts entered the domes, they formed converging radial strips devoid of M cells. In contrast to the M cells, the sites where lymphocytes invaded the dome epithelium were not arranged in radial strips, but randomly distributed over the domes. M cell development is restricted to specialized dome-associated crypts. Only dome epithelial cells that derive from these specialized crypts differentiate into M cells. It is concluded that M cells represent a separate cell line that is induced in the dome-associated crypts by still unknown, probably diffusible lymphoid factors.

Animals↗
PubMed1999

Special iliac artery considerations during aneurysm endografting.

BACKGROUND: The feasibility of endograft exclusion of abdominal aortic aneurysms (AAA) has been established. However, the technical challenges of graft delivery through tortuous or diseased iliac arteries and the treatment of associated iliac aneurysmal disease have received little attention. METHODS: Over 19 months, 74 patients underwent endoluminal repair of AAA and/or iliac artery aneurysms. Iliac anatomy that required special consideration during endografting was reviewed. RESULTS: Of the 74 patients, 35 (47%) had iliac anatomy that required special attention. Thirteen patients (18%) had aneurysmal involvement of a common iliac artery. Eleven of these patients required endograft extension into the external iliac artery (EIA) and hypogastric coil embolization due to the proximity of the aneurysm to the hypogastric origin. Eleven patients with ectatic, nonaneurysmal iliac arteries required aortic cuffs to achieve a distal seal in these oversized vessels. Iliac artery tortuosity or stenosis were complicating factors in 27 of the 74 patients (36%), requiring the use of brachial guidewire tension in 2 patients to facilitate tracking of the delivery device. Five patients with severely splayed aortic bifurcations required crossed placement of the iliac limbs to prevent kinking of the endograft. Occlusive atherosclerotic disease of the EIA mandated preprocedural dilatation and stenting in 3 patients and postprocedural surgical EIA reconstruction in another 5 patients. Three patients who underwent successful endograft placement required subsequent endovascular repair of traumatized EIAs. CONCLUSIONS: Iliac artery anatomy plays a significant role in the endoluminal treatment of infrarenal abdominal aortic aneurysms, complicating the procedure in up to 47% of patients with otherwise suitable anatomy. A variety of supplemental procedures, both surgical and endovascular, may be required to facilitate endograft placement. A special understanding of these constraints and proper planning is required for optimal therapy.

Aortic Aneurysm, Abdominal↗
PubMed1999

The lantibiotic nisin, a special case or not?

Nisin is a 34-residue-long peptide belonging to the group A lantibiotics with antimicrobial activity against Gram-positive bacteria. The presence of dehydrated residues and lanthionine rings (thioether bonds) in nisin, imposing structural restrains on the peptide, make it an interesting case for studying the mode of action. In addition, the relatively high activity (nM range) of nisin against Gram-positive bacteria indicates that nisin may be a special case in the large family of pore-forming peptides antibiotics. In this review, we attempted to dissect the mode of action of nisin concentrating on studies that used model membranes or biological membranes. The picture that emerges suggests that in model membrane systems, composed of only phospholipids, nisin behaves similar to the antimicrobial peptide magainin, albeit with an activity that is much lower as compared to its activity towards biological membranes. This difference can be contributed to a missing factor which nisin needs for its high activity. Novel results have identified the factor as Lipid II, a precursor in the bacterial cell wall synthesis. The special high affinity interaction of nisin with Lipid II resulting in high activity and the active role of Lipid II in the pore-formation process make nisin a special case.

Amino Acid Sequence↗
PubMed2003

Peptidoglycan recognition protein expression in mouse Peyer's Patch follicle associated epithelium suggests functional specialization.

Mammalian Peyer's Patches possess specialized epithelium, the follicle associated epithelium (FAE), and specialized cells called M cells which mediate transcytosis of antigens to underlying lymphoid tissue. To identify FAE specific genes, we used TOGA gene expression profiling of microdissected mouse Peyer's Patch tissue. We found expression of laminin beta3 across the FAE, and scattered expression of peptidoglycan recognition protein (PGRP)-S. Using the M cell specific lectin Ulex europaeus agglutinin 1 (UEA-1), PGRP-S expression was nearly exclusively co-localized with UEA-1+ M cells. By contrast, the related gene PGRP-L was expressed among a subset of UEA-1 negative FAE cells. Expression of these proteins in transfected cells demonstrated distinct subcellular localization. PGRP-S showed a vesicular pattern and extracellular secretion, while PGRP-L showed localization to both the cytoplasm and the cell surface. The potential function of these PGRP proteins as pattern recognition receptors and their distinctive cellular distribution suggests a complex coordination among specialized cells of the FAE in triggering mucosal immunity and innate immune responses.

Animals↗
PubMed1982

Hemispheric specialization for the processing of tactual stimuli in congenitally deaf and hearing children.

A group of congenitally deaf and a group of normal hearing children were given two dichhaptically presented tests of hemispheric specialization. Left hemisphere specialization for language was assessed by a letter sequences task and right hemisphere specialization for spatial stimuli was measured by the nonsense shapes test of Witelson (1974). The results showed a significant right tactual field superiority for the processing of tactually presented letter sequences. There were no significant differences between the tactual fields for the processing of tactually presented nonsense shapes. The pattern of lateralization demonstrated on the letter sequences task was consistent across both groups. However, groups differed significantly on the overall performance of the verbal task, with deaf subjects demonstrating lower accuracy scores compared to hearing subjects. Age and I.Q. factors produced significant differences between sub-groups on the nonsense shapes task.

Adolescent↗