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PubMed2003

Effect of second-formant transitions on the perception of Hebrew voiced stop consonants.

Studies in English, Dutch, Danish and French show that of the possible acoustic cues that listeners use for the perception of place of articulation, the transition of the second formant (F2) appears to be a very important cue. Although the Hebrew language shares some similarities with the above languages, one cannot assume that it either has similar acoustic-articulatory patterns or uses the same cues for perception. The general goal of the present study was, therefore, to investigate the effect of the starting frequency of F2 transition on the perception of place of articulation of Hebrew voiced plosives in initial position. Sixteen Hebrew-speaking young normal-hearing adults served as subjects. Stimuli were generated by re-synthesizing a naturally spoken /ba/ syllable into 17 test syllables by varying only the starting frequency of F2. Listeners heard each stimulus six times (total of 102) at random and were required to label the stimuli as /ba/, /da/ or /ga/. Results showed that varying only F2 transitions caused a perceptual change of place of articulation for all listeners. There was, however, large inter-subject variability in the perceived category: 75% of the subjects identified /ba/ and /da/, half of them also identified /ga/, and 25% of the subjects were able to identify /ba/ and /ga/ only. These data suggest that while F2 transitions are important for perceiving place of articulation of Hebrew voiced stops, they cannot predict the perceived category. It also supports the notion that normal-hearing listeners differ in the relative importance they assign to the cues for the perception of place of articulation.

Acoustic Stimulation↗
PubMed2006

[Evaluation of diagnostic criteria for metabolic syndrome to identify insulin resistance].

UNLABELLED: The aim of study was to evaluate the possibilities of different diagnostic criteria for metabolic syndrome in identifying subjects with insulin resistance and to assess the prevalence of metabolic syndrome according to gender in one Lithuanian district. MATERIALS AND METHODS: A randomly selected sample of 1,115 subjects aged 45-96 years (562 men and 553 women) was formed from general population of Raseiniai district. Insulin resistance was estimated using the homeostasis model assessment. Metabolic syndrome was determined according to the definitions of the World Health Organization, National Cholesterol Education Program Adults Treatment Panel III, and International Diabetes Federation. RESULTS: Using the World Health Organization criteria, metabolic syndrome was observed in 384 (34.4%) subjects (no difference between genders); according to the National Cholesterol Education Program--in 336 (30.1%) patients (in 107 men (19.0%) and 229 women (41.4%), p < 0.001); using International Diabetes Federation criteria--in 474 (42.5%) (175 men (31.1%) and 299 women (54.1%), p < 0.001). Overall, 314 (28.5%) subjects were insulin resistant (no difference between genders). The highest prevalence of insulin resistance was determined in subjects with metabolic syndrome diagnosed according to the World Health Organization criteria--70.3% (n = 267), p < 0.05. Odds ratios to identify insulin-resistant subjects with metabolic syndrome according to the World Health Organization criteria and the International Diabetes Federation criteria were 22.4 and 2.3, respectively. CONCLUSIONS: The highest prevalence of metabolic syndrome was determined according to the International Diabetes Federation criteria. According to the National Cholesterol Education Program and International Diabetes Federation criteria metabolic syndrome was observed more frequently in women. The highest prevalence of insulin resistance was determined in metabolic syndrome group based on World Health Organization criteria. Using the World Health Organization and International Diabetes Federation criteria for metabolic syndrome provides more opportunities to identify subjects with insulin resistance.

Age Factors↗
PubMed2003

Telephone screening for amnestic mild cognitive impairment.

OBJECTIVES: To evaluate the utility of telephone screening for identifying subjects with amnestic mild cognitive impairment (aMCI) for enrollment in a clinical trial and to identify which elements of the modified Telephone Interview for Cognitive Status (TICS-m) best predicted the in-clinic determination of aMCI. METHODS: Subjects aged >/=65 years with memory complaints responded to an advertisement for a clinical trial by calling a central telephone recruiting agency. To determine eligibility, subjects went through a stepwise selection procedure involving a review of major protocol inclusion and exclusion criteria, followed by administration of the Category Fluency Test (CFT) and then the TICS-m. Subjects meeting entry criteria, who obtained a score of </=13 on the CFT for "animals" and </=24 on the CFT for "animals" and "fruits" and who scored between 19 and 38 on the TICS-m, were referred for a clinic appointment to determine whether they met clinical criteria for aMCI. Clinical criteria for aMCI required a score of >/=24 on the Mini-Mental State Examination and a score of </=37 on the Rey Auditory Verbal Learning Test. A post hoc analysis was performed using factor analysis and logistic regression models to investigate which elements of the TICS-m best predicted the in-clinic determination of aMCI. RESULTS: Of 16,988 subjects who called the telephone agency, 8,742 passed the review of inclusion/exclusion criteria; 6,090 met the CFT cut scores and received the TICS-m; 5,223 met cut scores on the TICS-m and were referred for an in-clinic appointment; 747 were seen in the clinic; and 324 met clinical criteria for aMCI. Factor analysis indicated three factors on the TICS-m: language/attention, orientation, and memory. The memory factor, comprising immediate and delayed recall of a word list, was the most important contributor for identifying subjects who met clinical criteria for aMCI. CONCLUSION: Only 2% of subjects who underwent telephone screening were recruited into the study, but 43% of those who passed telephone screening and were seen in the clinic met clinical criteria for aMCI. The word recall tests of the TICS-m were the most important items for identifying which subjects met clinical criteria for aMCI.

Age Distribution↗
PubMed2000

Low dose (1 microg) ACTH test in the evaluation of adrenal dysfunction in pre-clinical Addison's disease.

OBJECTIVE: The presence of 21-hydroxylase autoantibodies (21OHAb) is a marker of adrenal autoimmunity and can be used to identify subjects with pre-clinical Addison's disease. The low-dose (1 microg) ACTH test (LDT) is more sensitive than the high-dose (250 microg) test (HDT) for the diagnosis of pituitary adrenal insufficiency, but no information is available on the use of a LDT in subjects with autoimmune adrenalitis and primary adrenal insufficiency. The aim of our study was to evaluate the clinical use of the LDT in the diagnosis of early adrenocortical dysfunction in patients with adrenal autoantibodies. DESIGN AND METHODS: Firstly, we evaluated the cortisol responses to both a LDT and a HDT in a group of 12 healthy volunteers. We then performed a LDT in 11 subjects positive for 21OHAb, but without clinical signs of Addison's disease identified by screening 920 patients with one or more organ-specific autoimmune diseases. In all cases, the LDT was followed by a sequential HDT which was used as a control test of the sensitivity and specificity of the LDT. RESULTS: In healthy subjects, the peak cortisol levels after the LDT were similar to those after the classical HDT. In 21OHAb-positive subjects, the LDT showed a pathological response in five out of 11 (45%) cases and the diagnostic concordance between the results of the LDT and those of the HDT was 100%. All the five cases with pathological LDT were also positive for adrenal cortex autoantibodies (ACA) and 4/5 had high levels of basal ACTH. One subject with pathological LDT developed clinical Addison's disease 4 months after the test had been performed. CONCLUSIONS: Our study demonstrates that the low dose ACTH test has a high diagnostic sensitivity and specificity for primary adrenal insufficiency and suggests that it can accurately identify subjects with pre-clinical adrenal dysfunction.

Addison Disease↗
PubMed2002

Clinical assessment of retronasal olfactory function.

OBJECTIVES: To develop a test kit for the simple assessment of retronasal olfactory function and to compare orthonasal and retronasal olfactory function in healthy subjects and patients with olfactory disorders. DESIGN AND PATIENTS: We tested 230 individuals with normosmia, hyposmia, and anosmia using grocery-available powders. Initially, 30 different substances were investigated. Subjects identified each substance using a list with 4 verbal items (forced choice). After preliminary experiments, 20 items were selected according to the degree to which they were identified by normosmic and anosmic subjects. Orthonasal olfactory function was assessed psychophysically using "sniffin' sticks," which includes tests for odor identification, discrimination, and butanol odor thresholds. In addition, anosmia was confirmed electrophysiologically by means of olfactory-evoked potentials. RESULTS: In healthy subjects, there was a test-retest reliability correlation of r(27) = 0.76 for retronasal olfactory function, which is similar to other odor identification tests. Retronasal testing in normosmic subjects allowed for the discrimination of sex-related differences, with women scoring higher than men (P =.007), and the identification of a slight decrease with age (r(120) = -0.20; P =.03). Orthonasal and retronasal identification of odors was found to correlate (r(86) = 0.78; P<.001). Retronasal testing allowed for the discrimination between normosmia, hyposmia, and anosmia (P<.001). In addition, retronasal performance of anosmic patients appeared to improve with duration of anosmia (P =.03). No difference was found between patients with anosmia of different origin. CONCLUSION: Results of the present investigation indicate that the assessment of retronasal olfactory function is possible using oral stimulus presentation.

Adolescent↗
PubMed2005

Thyroid peroxidase autoantibodies in euthyroid subjects.

Thyroid peroxidase (TPO) is a key enzyme in the formation of thyroid hormones and a major autoantigen in autoimmune thyroid diseases. Titers of TPO antibodies also correlate with the degree of lymphocytic infiltration in euthyroid subjects, and they are frequently present in euthyroid subjects (prevalence 12-26%). Even within the normal range for thyrotropin (TSH), TPO antibody titers correlate with TSH levels, suggesting that their presence heralds impending thyroid failure. Assays for serum TPO antibodies have become much more sensitive, and very low titers can be found in virtually all subjects. However, titers above an assay-dependent cut-off are a clear risk factor for hypothyroidism; in the Whickham survey the annual risk of developing hypothyroidism in TPO-positive women with normal thyrotropin levels was 2.1%. Measuring TPO antibodies in euthyroid subjects can be used to identify subjects with increased risk for hypothyroidism: e.g. as triage to measure thyrotropin. This could be done in women who wish to become pregnant and those with an increased risk per se who are pregnant (to predict first trimester hypothyroidism, and postpartum thyroid dysfunction), patients with other autoimmune diseases, subjects on amiodarone, lithium, or interferon-alpha, and in relatives of patients with autoimmune thyroid diseases.

Autoantibodies↗
PubMedDate not supplied

Protocol for outpatient screening and initiation of continuous subcutaneous insulin infusion therapy: impact on cost and quality.

PURPOSE: The purpose of this study was to determine the effectiveness of a screening protocol in identifying subjects who would initiate continuous subcutaneous insulin infusion (CSII) and continue the therapy for at least 2 1/2 years. METHODS: One hundred four subjects were recruited to participate in a screening protocol involving a mock trial of insulin pump use. Participants who initiated CSII were followed for 2 1/2 years; those deemed ill suited for CSII used multiple insulin injections. Discontinuation rates, quality of life, and costs were evaluated for subjects using CSII. Baseline and quarterly hemoglobin A1C (A1C) were measured and compared. RESULTS: The screening protocol identified 37 subjects (35.6%) who were unsuited for CSII. Subjects who initiated CSII reported enhanced quality of life and exhibited a low discontinuation rate (3.3%). No safety issues were encountered. Screening, CSII initiation, and follow-up were accomplished at lower costs per subject ($2431.50) than those reported in the Diabetes Control and Complications Trial (DCCT) ($8265.00). A1C was significantly lower over time for subjects receiving CSII compared with those receiving multiple injections. CONCLUSIONS: A structured screening protocol with trial pump use was effective in identifying individuals who would initiate CSII and continue the therapy for at least 2 1/2 years.

Activities of Daily Living↗
PubMed1981

Castration fantasies and assertiveness in father-absent males.

In a previous report (Shill 1981), father-absence was linked to insecurity in core male gender identity in a nonclinical sample of college males. The present paper describes further aspects of the experimental use of projective techniques, based on psychoanalytic theory and clinical discussions, to assess the effect of father-absence on male personality development. Castration fantasies and sense of competence in the mastery of external reality as an index of masculine self-representation were coded from the projective test responses of 103 father-present and 28 father-absent college males. When given a choice of castrating figure at the human or animal level, all subjects identified the human mother rather than the father as the more frightening castrating figure. Father-absent subjects, however, identified the animal mother as the more frightening castrating figure, compared to the animal father, more frequently than the father-present subjects, suggesting a denial and displacement of castration fear toward the human mother onto the animal substitute. The father-absent subjects also evidence significantly less sense of mastery, suggesting less self-assertiveness and sense of competence than the father-present controls. The importance of identification with the father as the basis for a masculine ego style and of father absence as a developmental interference affecting the appropriate management of aggression in males is discussed.

Adult↗
PubMed2001

Improved prediction of proximal femoral fracture load using nonlinear finite element models.

Hip fracture, which is often due to osteoporosis or other conditions affecting bone strength, can lead to permanent disability, pneumonia, pulmonary embolism, and/or death. Great effort has been directed toward developing noninvasive methods for evaluating proximal femoral strength (fracture load), with the goal of assessing fracture risk. Previously, computed tomographic scan-based, linear finite element (FE) models were used to estimate proximal femoral fracture loads ex vivo in two load configurations, one approximating joint loading during single-limb stance and the other simulating impact from a fall. Measured and computed fracture loads were correlated (stance, r=0.867; fall, r=0.949). However, precision for the stance configuration was insufficient to identify subjects with below average fracture loads reliably. The present study examined whether, for this configuration, nonlinear FE models could be used to identify these subjects. These models were found to predict fracture load within +/-2.0 kN (r=0.962). This level of precision is sufficient to identify 97.5% of femora with fracture loads 1.3 standard deviations below the mean as having below average fracture loads. Accordingly, 20% of subjects with below average fracture loads, i.e. those with the lowest fracture loads and likely to be at greatest risk of fracture, would be correctly identified with at least 97.5% reliability. This FE modeling method will be a powerful tool for studies of hip fracture.

Aged↗
PubMedDate not supplied

[Allergy to latex].

In France 18% of all preoperative allergic shock syndromes result from allergic reactions to latex. IgE antibodies mediate the immediate hypersensitivity reaction to natural latex proteins extracted for the rubber tree (Hevea brasiliensis). Sensibilization occurs after repeated direct contact of the skin or mucosa with latex products including gloves, urinary catheters or after chronic inhalation of airborne particles of latex in the operating theatre. Clinical expressions include skin rash, asthma or anaphylactic shock. During the preoperative period, the shock may occur late after induction of anaesthesia and after the operative procedure has begun or after the arm cuff has been released. In obstetrics oxytocin injection can precipitate the phenomenon. Subjects at risk have been clearly identified: subjects who wear gloves regularly, those working in an environment contaminated with airborne latex, children who have undergone multiple operations on malformations of the urinary tract or who have had repeated catheterisms (40% of the spina bifida patients are sensitized), atopic subjects, those allergic to exotic fruits (banana, avocado, kiwi). These patients should be identified during the preoperative work-up in order to perform allergy tests. The diagnosis of over-sensitivity should be confirmed by prick-tests and perhaps complete antilatex antibody assay and challenge. All material composed of natural latex should be avoided for these patients. Proposed alternatives include synthetic rubber. Hypoallergenic gloves add no further safety. The operative procedure should be conducted using standard techniques.

Humans↗
PubMed2001

Utilizing multiple vital status tracing services optimizes mortality follow-up in large cohort studies.

PURPOSE: To compare the three national-scale death identification services used in our two-stage vital status tracing protocol, Pension Benefit Information Company (PBI), Social Security Administration (SSA), and the Health Care Financing Administration (HCFA), with respect to death identification and confirmation rate, and relevant demographic variables. METHODS: Information on 31,223 subjects with unconfirmed vital status in an ongoing occupational cohort mortality study was simultaneously submitted to PBI, SSA, and HCFA to identify subjects deceased as of December 31, 1992. Subjects whose dates of death were between 1979 and 1992 were then sent to the National Death Index (NDI) to obtain death certificate numbers and supplemental states of death. RESULTS: PBI identified and confirmed the highest number deaths in this cohort. PBI and SSA identified a higher proportion of deaths for persons who died in earlier years and/or who died at a younger age, for both confirmed and unconfirmed deaths. HCFA identified fewer deaths overall and had a smaller proportion of unconfirmed deaths. These deaths occurred in later years among older subjects and had the highest proportion of females. NDI provided exact matches for 92-96% of deaths identified by each of the three services. CONCLUSIONS: PBI was the most comprehensive service, especially for identifying younger subjects and those with an earlier date of death, while HCFA may help to identify deceased female subjects. SSA data can be purchased and used for periodic updates or interactively to identify deaths among subjects with poor identifiers (such as incorrect or missing social security numbers or misspelled names). Because each service makes a valuable contribution to the identification of deceased cohort subjects, all three should be considered for optimal mortality follow-up.

Adult↗
PubMed1993

Screening rules for determining blood pressure status in clinical trials. Application to the trials of hypertension prevention.

Multistage blood pressure screening rules are often used to select subjects for clinical trials. Multiple blood pressure readings are taken over successive visits, and the subject must meet eligibility criteria at each visit. In this paper, the authors present methods which depend on the distribution of the subject's underlying blood pressure values (the predictive value approach) or, alternatively, the subject's observed mean over all screening visits (the empirical predictive value approach) given the observed mean after one or more visits. The authors apply these methods to data from Phase I of the Trials of Hypertension Prevention, which attempts to identify subjects with mean diastolic blood pressures in the range 80-89 mmHg over three screening visits. The estimated efficiency of these rules is evaluated in terms of the number of clinic screening visits needed per eligible subject. Relative to reexamining all subjects at each visit (no screening), these approaches can reduce the number of visits required by 27%. This is in contrast to the standard rule in which a subject must have an observed mean diastolic blood pressure of 80-89 mmHg on each of three consecutive visits, which requires twice as many clinic visits per eligible subject as not screening. Thus, the approach presented is useful in identifying eligible subjects for clinical trials in an efficient manner.

Adult↗
PubMedDate not supplied

A study of diagnostic reasoning in pediatric nurses.

PURPOSE: To examine the data collecting and interpreting phases of the diagnostic reasoning process used by practicing pediatric nurses and to determine: (a) types of information deemed important for planning nursing care; (b) the functional health patterns addressed; and (c) frequency of validation of early hypotheses. METHOD: Thirty-four registered nurses who attended continuing education pediatric nursing workshops were asked to analyze a written simulated case study discussing maternal-infant interaction. Diagnostic cues in the case study were based on a framework that consisted of a clinical nursing model of maternal-infant interaction and selected nursing diagnoses. Open-ended questions were used to examine subjects' attention to and interpretation of these cues. FINDINGS: All subjects identified information related to the child's physical needs and the mother's responsibility to meet those needs as important for planning nursing care. There was less attention given to the interaction of mother and child. The most common response was identification of cues associated with five functional health patterns (29.4% of subjects). The functional health pattern, coping-stress tolerance, was addressed least often, although all nurses identified cues associated with role relationship. Only 38% of the subjects identified the need for validation of early hypotheses. CONCLUSION: The findings support the need for further research on the diagnostic reasoning of pediatric nurses. Recommendations include methods to enhance pediatric nurses' collection and interpretation of data specific to the pediatric clinical setting.

Clinical Nursing Research↗
PubMed1997

Tactile recognition in infantile nephropathic cystinosis.

Previous studies have demonstrated that individuals with cystinosis, an inherited metabolic disorder, have difficulty processing visual information, and may be selectively impaired in the ability to mentally rotate figures, despite having normal IQs and normal primary sensory function. In our novel task-the 'Black Box'-subjects identified objects solely by feeling the contours. Twenty-three subjects with cystinosis, aged 4 to 34 years, were individually matched with controls on age, sex, handedness, and test form. Subjects with cystinosis performed significantly worse in identifying objects than did controls. In addition, when only subjects over 7 years of age were included, those with cystinosis took significantly longer to correctly identify objects than did controls. Our findings suggest that individuals with cystinosis have difficulty with tactile recognition of common objects. These results support the hypothesis that a genetic disorder may have specific behavioral correlates.

Adolescent↗
PubMed1998

Plasma fibrinogen levels, other cardiovascular risk factors, and age-related maculopathy: the Blue Mountains Eye Study.

OBJECTIVE: To assess the relationship between stages of age-related maculopathy (ARM) and cardiovascular disease and cardiovascular disease risk factors, including serum lipid and plasma fibrinogen levels, smoking, cardiovascular events, systemic hypertension, diabetes mellitus, and obesity. DESIGN: A cross-sectional study of 3654 subjects from a defined geographic area identified subjects with late age-related macular degeneration (ARMD) and early ARM from the masked grading of retinal photographs. The history, physical examination findings, and fasting blood samples provided data on possible risk factors. Logistic regression, adjusting for age, sex, and possible confounders, and 2-way analysis of variance were used to assess associations. RESULTS: The only factors significantly associated with ARM included the 2 established risk factors, smoking and family history of ARMD (odds ratios, 4.1 and 4.2, for late ARMD, respectively), and the 2 variables, body mass index (odds ratio, 1.78 for obese compared with normal body mass index for early ARM) and plasma fibrinogen level (odds ratio, 6.7 for a fibrinogen level of >4.5 g/L [highest quartile] compared with a fibrinogen level of <3.4 g/L [lowest quartile] for late ARMD). CONCLUSIONS: These findings support the concepts that associations exist between plasma fibrinogen levels and late ARMD, a body mass index outside the normal range, and early ARM, and between the family history and smoking and any ARM. We found no other significant associations with any history of cardiovascular disease or other risk factors for cardiovascular disease.

Blood Pressure↗
PubMed2005

Congenital coronary anomalies in adults: comparison of anatomic course visualization by catheter angiography and electron beam CT.

The objective of this study was to compare the anatomic course of anomalous coronary arteries by axial and three-dimensional volume-rendered electron beam computed tomography (EBCT) angiography and X-ray catheter angiography (CAG). We performed a blinded study where patients who previously underwent CAG with (n = 14) and without (n = 14; age- and gender-matched controls) anomalous coronary anatomy were studied with EBCT coronary angiography. Forty to 50 EKG-triggered 3 mm overlapping axial slices were acquired with 2 mm table movement within one breath hold during the i.v. injection of 140 cc of nonionic iodinated contrast (4 ml/sec). The axial source images and volume-rendered three-dimensional reconstructions were evaluated for the presence, type, and course of coronary anomalies and the results were compared to those of CAG. All normal and anomalous coronary arteries were identified by both modalities in all subjects. Identified anomalies include single coronary artery (n = 3), left-sided right coronary artery (n = 3), right-sided left main coronary artery (n = 3), anterior descending coronary artery (n = 2), circumflex coronary artery (n = 2), and separate left-sided ostia for left anterior descending and circumflex coronary arteries (n = 1). In five cases, there was discrepancy in the course of the anomalous vessels between the two modalities. Consensus reading among cardiologist and radiologists favored the interpretation of EBCT over catheter angiography. Noninvasive EBCT coronary angiography compares well with CAG in identifying anomalous coronary arteries and may provide confirmatory evaluation of their precise anatomic relationships to the heart and great vessels.

Adult↗
PubMedDate not supplied

Dynamic scan-plane tracking using MR position monitoring.

An MR-based method for tracking subject motion is presented. The technique identifies subject motion from the three-dimensional positions of three small samples attached to the subject in a fixed, triangular configuration. The updated positions of these samples relative to their initial positions determine a rigid body transformation. Applied to the MRI scan prescription via adaptive feedback controls, this transformation yields an updated MRI scan plane that tracks the prescribed imaging section as the subject moves. The scan-plane tracking procedure is demonstrated experimentally for two-dimensional imaging of a standard imaging phantom and the head of a human subject. Sets of images were acquired sequentially, with motion (translations and/or rotations) introduced between image frames. The scan-plane tracking system provides well registered image slices of the same section, adaptively compensating for the subject motion.

Artifacts↗
PubMed2000

Differences in visual attention and task interference between males and females reflect differences in brain laterality.

Two cognitive tasks (a letter memory task and a spatial memory task) designed to selectively activate the left or right hemisphere were combined with attentional probe tasks to measure how hemispheric activation affects attention to left and right hemifields. The probe task in Experiment 1 required the identification of digits in the left and right hemifield. During the letter task, male subjects identified more probes from the left hemifield than from the right. Their accuracy varied little across the two hemifields during the dots task. Experiment 2 tested whether this pattern is due to either spatial attention or interference in character processing. Instead of identifying digits, the probe task required subjects to respond to a black square that appeared in the periphery of the screen. For male subjects, the pattern was opposite of that from Experiment 1. During the letter task they responded faster to the probe in the right hemifield than in the left. Their response times were equivalent across the two hemifields during the dots task.These results indicate two separate effects of laterality in male subjects. The activation of one hemisphere produced more attention to the contralateral hemifield in Experiment 2, and the letter memory task interfered with the processing of other characters in the right visual field more than those in the left visual field in Experiment 1. Neither of these effects appeared in female subjects, corroborating earlier claims that female brains are less lateralized than male brains.

Adult↗