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PubMed2001

Proportion of heritable paraganglioma cases and associated clinical characteristics.

OBJECTIVE/HYPOTHESIS: To determine the heritable proportion of paraganglioma (PGL) and identify clinical features associated with heritable PGL. STUDY DESIGN: Patients diagnosed with head and neck PGLs, identified retrospectively through clinical otolaryngology practices and/or participation in previous PGL research studies, were given a medical and family history questionnaire. METHODS: Questionnaire information was used to classify participants as having "heritable" or "non-heritable" cases of PGL. Classification of the participants identified through otolaryngology clinics was used to estimate the heritable proportion of PGL. Statistical analysis was performed to identify significant differences in the clinical characteristics of the heritable versus non-heritable groups. RESULTS: Among the otolaryngology clinic population, 35% were classified as having heritable PGL. Individuals with heritable PGL were younger on average than those with non-heritable PGL. The majority of non-heritable participants were female, but there was an equal gender ratio among the heritable participants. Individuals diagnosed with a carotid body tumor (CBT) were 5.8 times more likely to be classified as heritable than those diagnosed with PGL at other anatomic locations. CONCLUSIONS: Approximately 35% of individuals who present to an otolaryngologist with a head and neck PGL have inherited a predisposition for this growth. Among individuals diagnosed with head and neck PGL, those diagnosed with CBT are 5.8 times more likely to have an inherited predisposition than those diagnosed with PGL at other anatomic locations.

Adult↗
PubMed1996

Clinical findings before the onset of myopia in youth: 3. Heterophoria.

BACKGROUND: Some contemporary theories of the etiology of youth onset myopia suggest differences in accommodation and convergence function. Previous studies have related esophoria to various aspects of myopia development. This paper examines whether differences in phorias exist before the onset of myopia. METHODS: A cohort of initially emmetropic children had eye and vision examinations at 6-month intervals for a period of 3 years. Dissociated phorias were measured by the von Graefe method. These prospective data were analyzed by: (1) comparing phorias in children who became myopic to those in children who remained emmetropic; (2) determination of sensitivity and specificity of phorias to distinguish between children who became myopic and those who did not; and (3) determining the change in phorias with time. These same analyses were also performed as additional analyses of some previously published retrospective private practice data. RESULTS: Distance phorias were not significantly different in the became-myopic and remained-emmetropic group by the Mann Whitney U test in either the private practice data or the prospective data. The near phoria was more convergent in the became-myopic group than in the remained-emmetropic group in the private practice data (p < 0.02 by Mann Whitney U test). In the prospective data there were proportionately more children who became myopic outside the near phoria range of 3 delta exo to 1 delta eso (p < 0.05 by chi 2 test). In both data sets the near phoria showed an eso shift with time in the children who became myopic, beginning before and continuing after the onset of myopia. The children in the remained-emmetropic groups did not show eso shifts in near phoria. CONCLUSIONS: A near phoria which is not close to orthophoria appears to be a risk factor for youth onset myopia, but sensitivity and specificity were not as high as those for other variables such as corneal power, axial length to corneal radius ratio, positive relative accommodation (PRA), and midpoint of the near fusional vergence range. The onset of myopia is associated with an eso (convergent) shift in the near phoria.

Child↗
PubMed1990

Quantitative assessment of full range-of-motion isometric lumbar extension strength.

The purpose of this study was to evaluate the reliability and variability of repeated measurements of isometric (IM) lumbar extension (LB EXT) strength made at different joint angles. Fifty-six men (age, 29.4 +/- 10.7 years) and 80 women (age, 24.3 +/- 9.1 years) completed IM LB EXT strength tests on 3 separate days (D1, D2, and D3). On D1 and D2, subjects completed two tests (T1 and T2) separated by a 20- to 30-minute rest interval. For each test, IM LB EXT strength was measured at 72, 60, 48, 36, 24, 12, and 0 degrees of lumbar extension. Mean IM strength values, within-day reliability coefficients, and test variability over the seven angles improved from D1 to D2 (D1: mean, 160.0 to 304.1 N.m, r = 0.78 to 0.96, SEE = 37.6 to 46.9 N.m; D2: mean, 176.3 to 329.1 N.m, r = 0.94 to 0.98, SEE = 29.0 to 34.4 N.m). Mean strength values leveled off by D3 (174.5 to 317.0 N.m). The most reliable test results showed that the IM LB EXT strength curves were linear and descending from flexion to extension and ranged from 235.8 +/- 85.2 to 464.9 +/- 150.7 N.m for men (extension to flexion) and from 134.6 +/- 53.2 to 237.3 +/- 71.9 N.m for women. Lumbar extension strength was clearly greatest in full flexion, which is in contrast to previously reported results. One practice test was required to attain the most accurate and reliable results. These data indicate that repeated measures of IM LB EXT strength are highly reliable and can be used for the quantification of IM LB EXT strength through a range of motion.

Adult↗
PubMed2003

Surgical management of urogenital injuries at a war hospital in Bosnia-Hrzegovina, 1992 to 1995.

PURPOSE: Our experience with urogenital surgery during the Bosnia-Herzegovina conflict of 1992 to 1995 is compared with data from previous wars and peacetime practice. MATERIALS AND METHODS: A total of 5,370 wounded patients, including 136 (2.5%) with 1 or more urogenital injuries, were treated at a war hospital in northern Bosnia-Herzegovina during 37 months. The hospital was based at a village school and was poorly equipped but it was only 10 to 16 km. from the front line and average transportation time was 30 minutes. RESULTS: Of the 136 patients 72 (52.9%) were injured by explosive weapons, while the other 64 (47.1%) had bullet wounds. The 169 urogenital injuries were to the kidney in 65 cases (38.5%), scrotum in 44 (26%), bladder in 23 (13.6%), penis in 16 (9.5%), urethra in 9 (5.3%), ureter in 6 (3.6%) and other in 6. There was associated damage to organs other than the urogenital system in 116 patients (85.3%). Preference was given to organ sparing operations when possible, but 33.8% of renal injuries required nephrectomy and orchidectomy was performed for 58.3% of testicular injuries. CONCLUSION: In war settings when injuries are often severe and multiple, and the hospital may lack staff, instruments and other medical supplies, the surgeon frequently must improvise. Even so, the results achieved need not fall far below those of peacetime surgery provided that, as in this hospital in Bosnia-Herzegovina, wounded patients present to the surgeon rapidly, they are young and the surgeons are experienced with the management of war injury.

Adolescent↗
PubMed1993

Pay and nursing performance.

Discusses the merits and demerits of performance-related pay (PRP) with respect to nursing in the NHS but concludes that justification for it remains unproven through the absence of hard evidence in support of its efficiency. Sees previous experience of the practicalities of implementing PRP and the fear that it will be neither cheap nor effective in solving "productivity" problems as hostile to its introduction in the NHS.

Employee Incentive Plans↗
PubMed2005

Optical flow estimation using temporally oversampled video.

Recent advances in imaging sensor technology make high frame-rate video capture practical. As demonstrated in previous work, this capability can be used to enhance the performance of many image and video processing applications. The idea is to use the high frame-rate capability to temporally oversample the scene and, thus, to obtain more accurate information about scene motion and illumination. This information is then used to improve the performance of image and standard frame-rate video applications. This paper investigates the use of temporal oversampling to improve the accuracy of optical flow estimation (OFE). A method for obtaining high accuracy optical flow estimates at a conventional standard frame rate, e.g., 30 frames/s, by first capturing and processing a high frame-rate version of the video is presented. The method uses the Lucas-Kanade algorithm to obtain optical flow estimates at a high frame rate, which are then accumulated and refined to estimate the optical flow at the desired standard frame rate. The method demonstrates significant improvements in OFE accuracy both on synthetically generated video sequences and on a real video sequence captured using an experimental high-speed imaging system. It is then shown that a key benefit of using temporal oversampling to estimate optical flow is the reduction in motion aliasing. Using sinusoidal input sequences, the reduction in motion aliasing is identified and the desired minimum sampling rate as a function of the velocity and spatial bandwidth of the scene is determined. Using both synthetic and real video sequences, it is shown that temporal oversampling improves OFE accuracy by reducing motion aliasing not only for areas with large displacements but also for areas with small displacements and high spatial frequencies. The use of other OFE algorithms with temporally oversampled video is then discussed. In particular, the Haussecker algorithm is extended to work with high frame-rate sequences. This extension demonstrates yet another important benefit of temporal oversampling, which is improving OFE accuracy when brightness varies with time.

Algorithms↗
PubMed2003

Areca quid chewing by Taiwanese adolescents: application of the Attitudes Social Influence Self-efficacy (ASE) model.

AIMS: To investigate the factors associated with areca quid-chewing behaviour using the Attitudes-Social influence-Self-efficacy (ASE) model as a theoretical framework. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: A total of 400 students from a junior high school participated in the study in 2001 in Chia-Yi city (Taiwan). MEASUREMENTS: Expectancy scales (for the attitude component of the ASE), a self-efficacy scale (for the self-efficacy component of the ASE) and a social norm scale (for the social influence component of the ASE) were utilized. These measures displayed good reliability and validity. FINDINGS: Forty-seven students (11.75%) reported that they had tried chewing areca quid previously, eight of them practicing chewing it every day. Positive and negative expectancy (r = 0.43, r=- 0.20), self- efficacy (r = - 0.65), and subject social norm (r = 0.53) were significantly correlated with participants' intentions to chew areca quid. In a regression model, self-efficacy (beta = - 0.46, P < 0.001), social norm (beta = 0.22, P < 0.001), positive expectancy (beta = 0.18, P < 0.001) and negative expectancy (beta = - 0.08, P = 0.040) all made independent contributions to predicting intentions to chew and explained 46.8% of the variance in areca quid-chewing behaviour. CONCLUSIONS: Areca quid chewing appeared to be linked to positive expectancy and social norms pertaining to areca quid chewing associated with adolescents. However, high negative expectancy and high self-efficacy encouraged contrary behaviour. The application of the ASE model as the scenario could improve our understanding of the intention of the areca quid chewing among these adolescents.

Adolescent↗
PubMedDate not supplied

Nurse-led elective cardioversion: an evidence-based practice review.

By posing a clinical practice question, this article aims to document and explore the published evidence base supporting nurse-led cardioversion. A literature review was undertaken to determine the best evidence for practice. Five articles and two conference abstracts describing practice were found to be pertinent to the question. Description of the methodology used was a weakness of all the articles studied, with only one article purported to be framed as a research study. The remainder describe a planned change in nursing practice to encompass the delivery of a service previously, organizationally viewed as, physician led. Evaluations of practice were descriptive and supported by audit data in most articles, however, appropriate evidential comparisons were not offered. These articles were critically appraised in relation to safety and efficacy. Whilst the evidence may be seen to be limited and weak, it does add credence to the notion that a nurse with a suitable experiential background and knowledge base can make a significant contribution to the care of this group of patients. It is clearly evident that further developments in practice should be framed within a research context to support and strengthen the evidence base. Four prominent themes emerged from the review, 'change milieu', 'reshaping boundaries', 'nurse-led', 'efficacy of practice', which are modelled into a conceptual framework. Nursing roles are expanding within the cardiological setting, affording practitioners unprecedented practice opportunities within a supportive organizational framework, however, these roles must be subject to appropriate evaluation in order to continue informing a robust evidence base.

Benchmarking↗
PubMed1981

Prediction of phenytoin dosage in relation to the variability of phenytoin plasma concentration.

1 In a model study the influence of some variables on the accuracy of predictions of phenytoin doses which should produce desired plasma concentrations were studied. All predictions were extrapolations from low test doses with concurrent observations of plasma concentrations. 2 The variables in introduced were:--Variability in observed plasma concentration;--Variability in applied test doses;--Variability in patient characteristics as expressed in Km and Vmax values. 3 The model study generated the same sort of result as a previous one, executed in practice (Driessen. Van der Velde + Höppener, 1980), i.e. predictions are often inaccurate and of the method tested (Richens & Dunlop, 1975; Ludden, Hawkins, Allen & Hoffman, 1976; Martin, Tozer, Sheiner & Riegelman, 1977; Rambeck, Boenigk, Dunlop, Mullen, Wadsworth & Richens, 1980), Richens' first nomogram (Richens & Dunlop, 1975) is to be preferred.

Humans↗
PubMed2004

An update on predeposit autologous blood donation and transfusion in Europe.

BACKGROUND AND OBJECTIVES: The aim of this study was to update previous data on the practice of autologous blood transfusion in Europe. MATERIALS AND METHODS: A questionnaire, mainly about predeposit, was distributed to each National Representative on the Council of Europe's Committee of Experts on Blood Transfusion and Haematology. Detailed replies were received from 23. RESULTS: Predeposit autologous blood units collected in 2000 amounted to 3.3% of the allogeneic units, compared with 4.2% in 1997. Predeposit collection was commonest in Italy (7.8%) and Germany (6.4%). CONCLUSIONS: Although autologous transfusion showed no sign of increase in Europe from 1997 to 2000, the need for alternatives to allogeneic transfusion is growing. Policy and practices in this field should be followed on an ongoing basis.

Blood Donors↗
PubMed1976

A possible correlation between lipid hydration and lipid activation of the C55-isoprenoid alcohol phosphokinase apoprotein.

1. A direct method for determining the binding of triated water to lipids is described. The experimental conditions were practically identical to those previously employed (1974) in the determination of the cofactor activities of a series of oleyl-lipids in reactivation of the C55-isoprenoid alcohol phosphokinase apoprotein. 2. Active cofactor lipids (dioleyl lecithin, sodium oleate, 1-monoolein, 1-monomyristin)bound between 2.3 and 5.3 nmol 3H2O per nmol lipid, whereas less than 0.14 nmol 3H2O were bound per nmol of the inactive lipids (1,2- and 1,3-diolein, triolein, oleyl alcohol, methyl oleate, cholesteryl oleate). 3. When exposed to 3H2O vapour, the active lipids adsorbed between 1 and 2 nmol 3H2O per nmol lipid, whereas the inactive lipids adsorbed less than 0.1 nmol 3H2O per nmol lipid. 4. The active lipid cofactor, egg lecithin, bound more than twice as much 3H2O as egg phosphatidylethanolamine which was devoid of cofactor activity in the absence of detergent. 5. Appropriately hydrated lipid polar groups are concluded to be required for an alignment with polar amino acid side chains of the enzyme apoprotein in the formation of a mixed micellar lipoprotein complex. The enzyme reaction might occur at the resulting lipoprotein/water interface.

Apoenzymes↗
PubMed2006

Uncertain numbers and uncertainty in the selection of input distributions--consequences for a probabilistic risk assessment of contaminated land.

Risks from exposure to contaminated land are often assessed with the aid of mathematical models. The current probabilistic approach is a considerable improvement on previous deterministic risk assessment practices, in that it attempts to characterize uncertainty and variability. However, some inputs continue to be assigned as precise numbers, while others are characterized as precise probability distributions. Such precision is hard to justify, and we show in this article how rounding errors and distribution assumptions can affect an exposure assessment. The outcome of traditional deterministic point estimates and Monte Carlo simulations were compared to probability bounds analyses. Assigning all scalars as imprecise numbers (intervals prescribed by significant digits) added uncertainty to the deterministic point estimate of about one order of magnitude. Similarly, representing probability distributions as probability boxes added several orders of magnitude to the uncertainty of the probabilistic estimate. This indicates that the size of the uncertainty in such assessments is actually much greater than currently reported. The article suggests that full disclosure of the uncertainty may facilitate decision making in opening up a negotiation window. In the risk analysis process, it is also an ethical obligation to clarify the boundary between the scientific and social domains.

Body Weight↗
PubMed2003

Treatment of chronic constipation with colchicine: randomized, double-blind, placebo-controlled, crossover trial.

OBJECTIVE: Refractory constipation is a common GI complaint seen by physicians in all practice settings. We have previously shown that p.d. colchicine (0.6 mg t.i.d.) increases the number of spontaneous bowel movements, hastens GI transit, and improves GI symptoms in patients with chronic constipation during an 8-wk, open-label therapeutic trial. The aim of this study was to determine if p.d. colchicine will increase spontaneous bowel movements and accelerate colonic transit in patients with idiopathic chronic constipation in a randomized, placebo-controlled, crossover trial. METHODS: A total of 16 patients (15 women, one man) with a mean age of 47 yr (age range 25-89) with chronic idiopathic constipation who were refractory to standard medical therapy participated in the study. Patients randomly received either colchicine 0.6 mg p.o. t.i.d. or an identical placebo p.o. t.i.d. for a total of 4 wk in a double-blind, crossover fashion. Patients recorded their daily number of bowel movements and daily symptoms of daily nausea, abdominal pain, and bloating. Mean colonic transit was calculated at baseline, weeks 6 and 12. RESULTS: Colchicine increased the number of bowel movements and accelerated colonic transit compared with baseline and placebo conditions. There were no significant differences between conditions on ratings of nausea and bloating. During colchicine administration, mean abdominal pain was greater than the baseline or placebo conditions, however, the pain decreased significantly by the last week the patient was on colchicine. CONCLUSION: Colchicine increases the frequency of bowel movements and hastens colonic transit in patients with chronic constipation. Colchicine may be an effective agent available to practitioners to treat a subset of patients with chronic constipation who are refractory to standard medical therapy.

Adult↗
PubMed1979

Study of thioridazine cardiotoxic effects by means of His bundle activity recording.

The effect of thioridazine on sinusal automaticity, myocardial excitability and auriculoventricular conduction have been studied in dogs by measuring the spontaneous heart rate, the effective refractory period of the atrial contractile tissue, the time of auriculonodal and infrahisian conduction. Chloralose anaesthetized dogs were administered 10 mg/kg thioridazine hydrochloride via intravenous route. While sinusal automaticity was not altered, conduction times were prolonged in the suprahisian and mainly the infrahisian part and the atrial refractory period increased. These effects are related to quinidine-like properties and consistent with cardiotoxic effects previously reported in clinical practice.

Animals↗
PubMed1989

Population surveillance of congenital malformations. Possibilities and limitations.

The paper discusses the possibility of detecting newly introduced teratogenic agents by a population surveillance of congenital malformations. In practice, only outbreaks of previously rare malformations or combinations of malformations can be detected by such systems. The most important aspect of malformation surveillance is therefore a detailed reporting of malformations whereas statistical techniques play a minor role. For ongoing surveillance, a high ascertainment level is less important than speed and amount of detail. For studies of long-time changes in malformation rates, ascertainment must be as complete as possible. Such changes have been identified repeatedly, but are usually explained by changes in diagnosis, ascertainment or population characteristics.

Chromosome Aberrations↗
PubMed1989

Prognostic factors for recovery from coxo-femoral dislocation in cattle.

Details were recorded of 47 cases of coxo-femoral dislocation observed in cattle over 1 year. Treatment was successful in 20/47 (42.6%) cases using a method of closed reduction. Factors that most strongly influenced the prognosis were identified. The most useful single prognostic factor was whether the cow was able to stand before reduction. Other factors that also had a strong positive influence on the prognosis were: age less than 3y, bodyweight less than 400kg and duration of dislocation less than 12h. Nineteen unsuccessful cases were examined at the knackery. Four were found to have a fracture of the proximal femur. The coxo-femoral joint was carefully dissected in the other 15 cases and there was no evidence of hip dysplasia. A seasonal incidence of dislocations, which coincides with the calving and mating periods, was demonstrated during the survey and from practice records for the previous 3 years.

Age Factors↗
PubMed1966

Asphyxial potentials of spinal grey matter, and of ventral and dorsal roots.

1. Asphyxial potentials of short latency (from a few to about 10 sec) were recorded with mono- and bipolar electrodes from the cat's spinal cord. Monopolarly, a zone of maximum negativity was found somewhat dorsal of the central canal in the dorsal horn. With bipolar leads potentials of opposite polarity were observed in the dorsal and ventral horns. In the dorsal horn the more ventral electrode tip became negative with respect to the more dorsal one, in the ventral horn the more ventral tip became more positive. In the centre of the cord where the monopolar potential showed a maximum the bipolar potentials were small in either direction, or reversed during asphyxiation.2. These observations can be explained by the development of two independent dipoles of opposite polarity, located in the dorsal and ventral horn respectively, oriented with their negative poles towards the centre of the cord.3. In the ventral as well as in the dorsal root a negativity of a proximal electrode with respect to a more distal one developed during asphyxiation after the same latency as the asphyxial cord potentials. The asphyxial root potentials continued to grow during periods of asphyxiation as long as 30 min, and recovered promptly upon re-oxygenation.4. Ventral and dorsal root potentials were abolished by asphyxiation of the cord for a period of 60 min, 2 weeks previously. This procedure destroys practically all the neurones, but not the dorsal root fibres. The dorsal root potential, but not the ventral one, was abolished by extradural sectioning of the roots, 2 weeks previously.5. The asphyxial ventral and dorsal root potentials were interpreted as the result of depolarization of the intraspinal part of the motoneurones and primary afferent endings respectively, conducted electrotonically along the roots. The short latency of these potentials suggests that an early depolarization of motoneurone, and of the primary afferent end knobs occurs. The latter, which may have some relation to presynaptic inhibition, explains the early failure of synaptic conduction during acute asphyxiation.

Animals↗
PubMed1991

Audit of diabetes in general practice.

OBJECTIVES: To complete a first audit cycle of diabetes care in a general practice and to develop a simple method for continuing the audit cycle. DESIGN: Retrospective examination of the medical records of all diabetic patients in a general practice in 1990. SETTING: A group general practice in a Bristol health centre with roughly 13,200 patients, which since 1983 had had a protocol for care of its diabetic patients. PATIENTS: 223 known diabetic patients in the practice. MAIN AUDITED MEASURES: Comparison against previously agreed standards of process and outcome of diabetes care in the practice, including number of patients whose care had been reviewed in accordance with the practice protocol, serum fructosamine and blood glucose concentrations in patients aged under 70, and number of newly diagnosed patients given explicit education and referred for diatetic advice. RESULTS: Defined standards were not met for several criteria--for example, percentages of patients aged below 70 (n = 149) with serum fructosamine concentrations less than 3.5 mmol/l (62% v 90% defined value) and less than 2.8 mmol/l (35% v 70%) and last recorded blood glucose concentrations less than 10 mmol/l in insulin dependent patients (n = 48) (23% v 90%) and less than 8 mmol/l in non-insulin dependent patients (n = 101) (17% v 90%). Of newly identified diabetic patients (n = 32), 59% and 28% respectively were referred to dietitians and given educational material compared with the 100% standard. CONCLUSIONS: The practice has a high prevalence of diabetes (1.7%) but has the resources for their care. The format and implementation of the agreed systematic process of care for diabetic patients needs improvement. IMPLICATIONS: A simple audit suitable for most general practices might record two measures of the process of care--a disease register of all diabetic patients in a practice and an attendance register to determine whether they have regular check ups--and one measure of the outcome of care, such as serum fructosamine concentration (or local equivalent). A practice could establish its own standards for these measures and monitor its performance against them.

Adolescent↗