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PubMedDate not supplied

Training paramedics: emergency care for children with special health care needs.

OBJECTIVE: To enhance knowledge and comfort related to the emergency care of children with special health care needs (CSHCN) through an innovative continuing education program for paramedics. METHODS: A self-study program presenting in-depth information about common problems that affect the assessment and management of a child's airway, breathing, circulation, disability, and environment (ABCDEs), regardless of the child's diagnosis, was developed. This program used a manual, a video, practice mannequins, and skills evaluations to teach skills to paramedics employed at a municipal fire department. RESULTS: Pre- and posttraining surveys found that the paramedics were significantly more comfortable with the assessment and management of CSHCN after the completion of the self-study program, with a pretraining average of 2.83 and posttraining average of 4.20 on a five-point Likert-type scale, t(37) = 12.87, p < 0.001. A skills evaluation showed that skills performance varied widely across 21 skills, ranging from skills mastery to low skills knowledge. On the posttraining survey, between 74% and 94% of the paramedics rated each topic (tracheostomies, indwelling central venous catheters, cerebrospinal fluid shunts, gastrostomies, child abuse, and latex allergy) as applicable to their practices as paramedics. CONCLUSION: Given the growing population of CSHCN, it is important to provide specialized education to increase an EMS provider's preparedness to respond to emergency situations involving children with special health care needs.

Child↗
PubMed1999

Targeting treatments to special populations.

The average rate of long-term tobacco abstinence in a general population of treatment-seeking tobacco users is about 25%. Most of these treatments tend to use generic approaches, although the population of tobacco users is quite heterogeneous. It is entirely possible that special populations of smokers have specific treatment needs. If these needs are addressed, then treatment success may be augmented. This paper will review different issues that may surface when treating special populations. The special populations to be examined will be broken down by gender, age and route of tobacco administration. In addition, gaps in the scientific literature and directions for future research will be discussed. Once population-specific treatment needs are identified, then the effects of tailored treatments in augmenting treatment success can be determined.

Adolescent↗
PubMed1985

Membrane-related specializations associated with acetylcholine receptor aggregates induced by electric fields.

The localization of membrane-associated specializations (basal lamina and cytoplasmic density) at sites of acetylcholine receptor (AChR) aggregation is consistent with an involvement of these structures in receptor stabilization. We investigated the occurrence of these specializations in association with AChR aggregates that develop at the cathode-facing edge of Xenopus muscle cells during exposure to a DC electric field. The cultures were labeled with a fluorescent conjugate of alpha-bungarotoxin and the receptor distribution on selected cells was determined before and after exposure to the field. In thin sections taken from the same cells, the cathode-facing edge was characterized by plaques of basal lamina and cytoplasmic density co-extensive with sarcolemma of increased density. In sections cut in a plane similar to the fluorescence image, it was possible to demonstrate that the specializations were concentrated at areas of field-induced AChR aggregation, and at receptor clusters existing on control cells. This finding further indicates that these structures participate in AChR stabilization, and that the mechanisms involved in AChR aggregation that result from field exposure and nerve contact may be similar.

Animals↗
PubMed1962

Cell proliferation and specialization during endochondral osteogenesis in young rats.

Endochondral osteogenesis was studied autoradiographically in ribs and tibiae of 32 Long-Evans rats injected with 1 microc/gm H(3)-thymidine at 6 days of age and sacrificed at intervals between 1 hour and 2 weeks later. Proliferation and specialization of bone cells were studied by analyses of (a) the percentage of mitoses which were labeled, (b) the percentage of labeled nuclei in bone cells, and (c) grain counts. The following conclusions were derived: The various types of bone cells represent different functional states of the same cell. Cell division is usually restricted to cells in the morphologically unspecialized "osteoprogenitor" state. Specialized bone cells arise by modulation of osteoprogenitor cells. The average cell generation time is shortest in the metaphysis, longest in the periosteum, and intermediate in the endosteum. The average duration of DNA synthesis is relatively constant (about 8 hours). With increasing length of generation time there is a slight increase in G(2) + mitosis, but the major change is a lengthening of G(1). After dividing, cells in the osteoprogenitor state may remain within the progenitor pool or undergo modulation of cell type, specializing as osteoblasts or becoming incorporated in osteoclasts.

Animals↗
PubMed1976

Studies of excitable membranes. II. A comparison of specializations at neuromuscular junctions and nonjunctional sarcolemmas of mammalian fast and slow twitch muscle fibers.

Mammalian fast and slow twitch skeletal muscles are compared by freeze-fracture, thick and thin sectioning, and histochemical techniques using conventional and high voltage electron microscopy. Despite gross morphological differences in endplate structure visualized at relatively low magnifications in this sections, rat extensor digitorum longus (EDL) (fast twitch) and soleus (slow twitch) fibers cannot be distinguished on the basis of size, number, or distribution of molecular specializations of the pre- and postsynaptic junctional membranes exposed by freeze fracturing. Specializations in the cortex of the juxtaneuronal portions of the junctional folds are revealed by high voltage electron stereomicroscopy as a branching, ladder-like filamentous network associated with the putative acetylcholline receptor complexes. These filaments are considered to be involved in restricting the mobility of receptor proteins to the perineuronal aspects of the postynaptic membrane. Although the junctional membranes of both EDL and soleus appear similar, a differential specialization of the secondary synaptic cleft was noted. The extracellular matrix in the bottom of soleus clefts was observed as an ordered system of filamentous "combs," These filamentous arrays have not been detected in EDL junctions. Examination of the extrajunctional sarcolemmas of EDL and soleus reveal additional differences which may be correlated with variations in electrical and contractile properties. For example, particle aggregates termed "square arrays" previously described in the sarcolemmas of some fibers of the rat diaphragm were observed in large numbers in sarcolemmas of EDL fibers but were seldom encountered in soleus fibers. These gross compositional differences in the membranes are discussed in the light of functional differences between fiber types.

Animals↗
PubMed2004

Evolution of dietary specialization and chemical defense in poison frogs (Dendrobatidae): a comparative analysis.

Defensive mechanisms, including noxious or toxic substances, are favored by predation-driven natural selection. The acquisition of noxious/toxic substances can be either endogenous, in which the substances are produced by the organism, or exogenous, in which the substances are produced by another organism and are sequestered. Evidence indicates that the defensive skin alkaloids of Neotropical poison frogs (Dendrobatidae) have an exogenous source: a diet of ants and other small alkaloid-containing arthropods, which we term the diet-toxicity hypothesis. A critical prediction of the diet-toxicity hypothesis is that independent origins of dietary specialization will be found to be correlated with independent origins of skin alkaloids. We tested this prediction in an integrated framework using comparative methods with new and published data on feeding ecology and chemical defense for 15 species of dendrobatids in five genera. We found a significant correlation between alkaloid profiles and degree of dietary specialization. This reveals a recurring association of dietary specialization and alkaloid sequestration in dendrobatids, which suggests parallel evolutionary trends in the origins of defensive mechanisms.

Alkaloids↗
PubMed2005

Ecological specialization of mixotrophic plankton in a mixed water column.

In recent years, the population dynamics of plankton in light- or nutrient-limited environments have been studied extensively. Their evolutionary dynamics, however, have received much less attention. Here, we used a modeling approach to study the evolutionary behavior of a population of plankton living in a mixed water column. Initially, the organisms are mixotrophic and thus have both autotrophic and heterotrophic abilities. Through evolution of their trophic preferences, however, they can specialize into separate autotrophs and heterotrophs. It was found that the light intensity gradient enables evolutionary branching and thus may result in the ecological specialization of the mixotrophs. By affecting the gradient, other environmental properties also acquire influence on this evolutionary process. Intermediate mixing intensities, large mixing depths, and high nutrient densities were found to facilitate evolutionary branching and thus specialization. Later results may explain why mixotrophs are often more dominant in oligotrophic systems while specialist strategies are associated with eutrophic systems.

Adaptation, Physiological↗
PubMed2005

Communicating the risks of bioterrorism and other emergencies in a diverse society: a case study of special populations in North Dakota.

In the event that terrorists use air, water, or food to deliver destructive agents to civilian populations, some groups and populations may be disproportionately at risk and have unique communications needs. Bioterrorism represents an even greater national public health threat if the nation's preparedness and readiness plans do not address the needs and perspectives of, for example, low-income residents, racially and ethnically diverse communities, and other "special populations". The objective of this study was to develop communications strategies to reach special populations in North Dakota before, during, and after a bioterrorism attack or other crisis. To achieve the study objectives, the investigators used telephone interviews and telephone focus groups with organizations that represented special populations. Areas of inquiry included attitudes and concerns about crises, sources of information used and those identified as most credible, methods to reach people during a crisis event, and awareness of and attitudes about the agencies and organizations that affect risk communications.

Aged↗
PubMed1998

Histological changes induced by CO2 laser microprobe specially designed for root canal sterilization: in vivo study.

OBJECTIVE: Until now, no suitable delivery fiber has existed for CO2 laser endodontic radiation in the apical region, where it is most difficult to eliminate the pulp tissue using conventional methods. To overcome this problem, we have designed a microprobe that reaches closer to the apex, distributing the energy density to a smaller area of the root canal and thus favorably increasing the thermal effects. METHODS: A CO2 laser microprobe coupled onto a special hand piece was attached to the delivery fiber of a Sharplan 15-F CO2 laser. The study was conducted on 30 vital maxillary or mandibulary, central, lateral, or premolar teeth destined for extraction due to periodontal problems. Twenty were experimentally treated with pulsed CO2 laser delivered by this newly developed fiber after conventional root canal preparation. Temperature measured at three points on the root surface during laser treatment did not exceed 38 degrees C. Ten teeth represented the control group, in which only root canal preparation was performed in the conventional method. RESULTS: Histological examination of the laser-treated teeth showed coagulation necrosis and vacuolization of the remaining pulp tissue in the root canal periphery. Primary and secondary dentin appeared normal in all cases treated with 15-F CO2 laser. Gram stain and bacteriologic examination revealed complete sterilization. These results demonstrate the unique capabilities of this special microprobe in sterilization of the root canal, with no thermal damage to the surrounding tissue. CONCLUSIONS: The combination of classical root canal preparation with CO2 laser irradiation using this special microprobe before closing the canal can drastically change the quality of root canal fillings.

Bacteriological Techniques↗
PubMed1974

Specialized transducing phages derived from salmonella phage P22.

Salmonella phage P22 has been used in the construction of three sorts of specialized transducing phage: P22 proAB, P22 proABlac and P22 argF. The bacterial genes carried are derived from E. coli K12. Since E. coli and Salmonella chromosomes recombine very poorly, E. coli genes cannot be transduced into Salmonella recipients by P22's generalized transduction mechanism. Therefore, stable inheritance of E. coli material provides a means of detecting specialized transduction. Formation of these phages was possible because the P22 prophage recognizes an attachment site in the E. coli F' prolac episome. Salmonella strains carrying the F' prolac episome can be lysogenized by P22 so as to leave the prophage inserted into the E. coli material of the F' factor. Improper prophage excision can then lead to formation of P22 specialized phages carrying E. coli genetic material.

Alleles↗
PubMed1994

Nursing home special care units: distribution by type, state, and facility characteristics.

We used the 1991-92 Medicare and Medicaid Automated Certification Survey (MMACS) to document the distribution of nursing home special care units by type, state, and facility characteristics. Of the 16,105 facilities in our sample, 9.5% have at least one of eight types of specialty care units. Overall, special care beds as a percentage of total beds vary from 0.0% in South Carolina to 11.43% in Idaho. More non-profit facilities have special care units than for-profits (12.0% vs 8.5%), and more chain-affiliated facilities than independent facilities. Issues of access, efficacy, and cost are considered.

Certification↗
PubMed2003

Environmental correlates to behavioral health outcomes in Alzheimer's special care units.

PURPOSE: We systematically measured the associations between environmental design features of nursing home special care units and the incidence of aggression, agitation, social withdrawal, depression, and psychotic problems among persons living there who have Alzheimer's disease or a related disorder. DESIGN AND METHODS: We developed and tested a model of critical health-related environmental design features in settings for people with Alzheimer's disease. We used hierarchical linear modeling statistical techniques to assess associations between seven environmental design features and behavioral health measures for 427 residents in 15 special care units. Behavioral health measures included the Cohen-Mansfield physical agitation, verbal agitation, and aggressive behavior scales, the Multidimensional Observation Scale for Elderly Subjects depression and social withdrawal scales, and BEHAVE-AD (psychotic symptom list) misidentification and paranoid delusions scales. Statistical controls were included for the influence of, among others, cognitive status, need for assistance with activities of daily living, prescription drug use, amount of Alzheimer's staff training, and staff-to-resident ratio. Although hierarchical linear modeling minimizes the risk of Type II-false positive-error, this exploratory study also pays special attention to avoiding Type I error-the failure to recognize possible relationships between behavioral health characteristics and independent variables. RESULTS: We found associations between each behavioral health measure and particular environmental design features, as well as between behavioral health measures and both resident and nonenvironmental facility variables. IMPLICATIONS: This research demonstrates the potential that environment has for contributing to the improvement of Alzheimer's symptoms. A balanced combination of pharmacologic, behavioral, and environmental approaches is likely to be most effective in improving the health, behavior, and quality of life of people with Alzheimer's disease.

Aged↗
PubMed2001

Special nutritional needs of infants for prevention of and recovery from bronchopulmonary dysplasia.

Extremely low birth weight infants who develop severe respiratory disease may have special nutrient requirements imposed by a combination of enhanced utilization of nutrients or the need for epithelial cell repair resulting from the disease process, as well as to support catch-up growth. Inositol, free fatty acids, vitamin E and vitamin A are proposed as nutrients for which infants at risk of chronic pulmonary insufficiency may have special requirements. Of these nutrients, only for vitamin A does suggestive evidence exist that high doses when given intramuscularly may reduce the incidence of death or chronic lung disease. Exogenous steroid therapy (dexamethasone), which is often used to improve pulmonary compliance in ventilated premature infants, may compromise vitamin A status and induce restricted somatic and bone mineral growth. Supplemental nutrition by means of enriched infant formulas has provided benefits in growth and bone mass accretion to infants recovering from bronchopulmonary dysplasia up to 3-mo corrected age. This growth advantage was not sustained over the subsequent 9 mo, suggesting that prolonged nutritional support is required until catch-up growth is complete. Further studies are required to delineate the needs for specific nutrients such as antioxidant vitamins and minerals or vitamin A that may play a role in preventing severe chronic lung disease in premature infants. As well, the role of supplemental nutrition (beyond the requirements of term infants) to support catch-up growth and maintenance during the critical stages of early development requires further investigation before evidence-based nutrient recommendations can be developed for this special population of infants.

Bronchopulmonary Dysplasia↗
PubMed2003

Congruence between parents' and adolescents' reports of special health care needs in a Title XXI program.

OBJECTIVES: The purpose of this study was to examine agreement between adolescents and their parents about whether or not the adolescent had a special health care need, using the Children with Special Health Care Needs (CSHCN) Screener. METHODS: Telephone surveys that included the CSHCN Screener were conducted with 522 adolescents and their parents who were new enrollees in Florida's State Children's Health Insurance Program (SCHIP). RESULTS: Analyses revealed substantial agreement as to whether or not the adolescent had a chronic condition. However, a full 15% of pairs disagreed. Analyses of pair disagreement revealed that parents reported adolescents' chronic conditions more often than adolescents, most strikingly for mental health conditions. Additional analyses revealed that pairs with older adolescents, female adolescents, and Hispanic origin had higher odds of being congruent than their counterparts. CONCLUSIONS: The results showed higher congruence using the consequence-based CSHCN Screener than is typically reported for diagnosis-based approaches. Despite an impressive rate of agreement, the analyses also highlighted parents' tendency to overreport special health care needs relative to their adolescent, particularly for mental health issues, and illustrated some of the demographic factors that might predict congruence. These findings are relevant to work related to the use of tools such as the CSHCN Screener in profiling enrollees in health care programs that serve children and adolescents.

Adolescent↗
PubMed2002

THE DIET OF PLATYDORIS ARGO (GASTROPODA: NUDIBRANCHIA) AND THE DIETARY SPECIALIZATION OF SPONGE EATING DORIDS.

The diet of the dorid nudibranch Platydoris argo was studied in relation to prey availability, and under different environmental conditions to evaluate richness, evenness, and plasticity of its diet. In order to assess the availability of possible prey, the sponge assemblage at two different habitats was characterized. The results showed that P. argo is a relatively specialized benthic carnivore, feeding exclusively on spiculated demosponges. However, it has a relatively polyphagous diet (16 prey-species) and adapts well to contrasting patterns of prey availability at different sites. At the location with lower sponge diversity, the diet of P. argo included more prey categories, was more diverse, and less selective (lower dietary evenness), foraging preferentially on the most frequent resource, Stylopus dujardini. In contrast, at a station with a clearly more diverse and abundant sponge assemblage, the diet was more selective, and Phorbas tenacior was its principal component. Despite its trophic plasticity, P. argo displayed a specialized pattern of resource exploitation in terms of niche breadth within a given habitat. Foraging was focussed on one preferred prey (which changed from one habitat to another) as indicated by the significant positive selection indexes (S. dujardini = +0.29, P. tenacior = +0.74). The revision of quantitative data on the diet of so-called 'sponge eating dorids' indicates the existence of a more specialized guild of 'spiculated demosponge eating dorids'. Most species revised are 'non-stereotyped specialist', which indicates that they have a polyphagous and plastic diet but only exploit one or few main prey species in each habitat. However, obligate specialists, with a monophagous (or rather oligophagous) diet also seem to be present.

Journal Article↗
PubMed1995

Special considerations for conducting genotoxicity tests with protein materials.

Standard genotoxicity tests are often inappropriate for testing new biological entities, in particular for recombinant proteins which are nature-identical. Arguments that these may contain mutagenic impurities are not substantiated; however, we have produced evidence that such impurities would be detected amidst a vast excess of protein. Concerns that human patients receiving therapy may be at risk from higher-than-physiological levels of proteins are also somewhat theoretical. However, it is apparent that genotoxicity testing will be required for these products for the time being, even if pragmatic approaches reduce the battery of in vitro tests to Ames and chromosomal aberrations only, and reduce the top dose in vivo to 1000x the human therapeutic dose. There is a number of physical and chemical properties of proteins that demand special approaches to methodology if the tests are to produce accurate results. The potential for adsorption to certain forms of glass and plastic means special care must be taken in dissolving and diluting test solutions; adherence to filters means special low protein binding, non-pyrogenic filters should be used for sterilisation of test solutions, where this is necessary; freeze-dried powders aliquotted in multiple vials should be dissolved in minimal solvent and cascaded from vial to vial rather than trying to empty the solid contents for bulk weighing. As proteins are often supplied in solution, in order to achieve sufficiently high test concentrations, it may be necessary to resuspend test bacteria/cells in the test solutions for short periods of time before centrifuging and resuspending in selective or growth media.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2002

Special status consultation for frequent attenders. Who are the candidates?

BACKGROUND: The need to optimize frequent attender (FA) care and to economize on scarce resources in primary care has given rise to calls for intervention. However, precise knowledge of the specifics of this need is scarce, as is knowledge of how best to orchestrate intervention vis-à-vis particular FA groups. The aim of the study was to analyse the need for a special FA status consultation and to analyse if such need springs from physical, mental or social factors among FAs. METHOD: Half of the 270 general practices in the County of Aarhus, Denmark, were randomly allocated to the study group (in total 132 practices; 220 general practitioners (GPs)). From these practices age- and gender-stratified samples of FAs were drawn. FAs were defined as the top 10 per cent attenders in 12 months. Questionnaires were used to elicit FA and GP attitudes to the introduction of a status consultation and to obtain GPs' evaluation of their FAs' physical, mental and social status. The special FA consultation was introduced as a reimbursed half-hour consultation where the FA and the GP could discuss the patient's current and future care status. RESULTS: Over three-quarters of the FAs would accept the offer to have the status consultation, and the GPs would recommend it for one-fourth of their FAs. The expressed need was highly associated with an expected positive effect on health (prevalence ratio (PR) for GPs: 11.7 (8.9-15.5), PR for FAs: 1.6 (1.5-1.8)) and a decrease in attendance (PR for FAs: 1.4 (1.3-1.5)). The GPs quoted physical, mental and social indications for the consultation. The FAs who had high levels of functional symptoms were most likely to accept the consultation. CONCLUSIONS: There was an expressed need for an FA status consultation, which may lead to a positive effect on health and attendance. The GPs pointed to physical, mental and social indicators for a special FA consultation.

Adult↗
PubMed1993

Specialized brain cooling in humans?

Humans, compared to other species, have exceptional capability for dissipation of heat from the entire skin surface. We can secrete more than two liters per hour of sweat, indefinitely. The corresponding potential for evaporative cooling is near a thousand watts, sufficient to compensate for the extreme high levels of heat production during exercise. Also, the blood vessels of our skin have exceptional capability to dilate and deliver heat to the body surface. These are our special adaptations for thermal stress. They allow prolonged heavy exercise with modest elevations in the temperature of the fluid that cools all the internal organs, not just the brain-arterial blood. The vascular architecture of the human head is radically different from that of animals that exhibit SBC. These species have special adaptations that reflect their dependence on respiratory evaporation, particularly the limitation imposed on capability to dispose of heat produced during exercise. The increase in blood temperature in an intense sprint would heat the well-perfused brain rapidly. But the heat exchange over the large surface area of contact between a venous plexus cooled by respiratory evaporation and the meshwork of arterial vessels in the carotid rete precools blood bound for the brain. Specialized cooling of the brain (SBC) has not been demonstrated by direct measurements in humans. Changes in tympanic temperature (Tty) are taken as evidence for SBC. This continues an unfortunate tradition of exaggeration of the significance of Tty. In the only direct measurements available, brain temperature was unaffected by fanning the face although Tty did fall. What may appear to be a remnant of the carotid rete heat exchanger in humans is the intimate association between a short segment of the internal carotid artery and the plexus of veins in the cavernous sinus. Fortunately, the brain need not rely for its cooling on countercurrent heat exchange across this small surface area of contact. In humans, SBC stands for skin: the body cooler--we use our entire skin surface for heat dissipation.

Body Temperature Regulation↗