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Slow event-related brain activity of aphasic patients and controls in word comprehension and rhyming tasks.

Slow event-related potentials (ERP) were examined in healthy and aphasic subjects in two-stimulus designs comprising a word comprehension and a rhyming task. Aphasics, though selected to perform above chance level, made significantly more errors and responded more slowly than controls, although canonical correlations did not indicate a statistical relationship between performance measures and ERP amplitudes. A discriminant analysis of ERP amplitudes distinguished the groups for the slow wave (SW; 0.5-1.0 s post-S1 onset) in the word comprehension, for the SW and the initial contingent negative variation (iCNV; 1.0-2.0 s post-S1 onset) in the rhyming task. Similarly for both tasks, ERP topography showed left-anterior predominance of the negative SW and iCNV in controls, whereas participants with aphasia showed smaller anterior and larger left-posterior amplitudes. The centroparietal terminal CNV (tCNV; 1 s pre-S2) was smaller in participants with aphasia than in controls, but similar in topography. Results suggest left-anterior activation for those language processes that were presumably provoked in the present tasks, like lexical access, or phonological encoding. The pattern of participants with aphasia may indicate effects of language impairment and recovery, but also consequences of the brain damage.

Adult↗

Pelvic floor dysfunction after Burch colposuspension--a comprehensive study. Part I.

OBJECTIVE: To evaluate the occurrence of voiding dysfunction and symptoms of genital prolapse at long-term follow-up after Burch colposuspension (Bc) in relation to the occurrence of the symptoms in an age-matched normal population. MATERIALS AND METHODS: A follow-up study of the 190 patients who underwent Bc in 1980-88 and 305 age-matched control women randomly selected from the general population. The participants answered a questionnaire in 1998 with detailed questions about the pelvic floor function. Univariate and multivariate analyses were performed. RESULTS: The prevalence and frequency of urinary incontinence were significantly higher in the patient group compared with those in the control group as were urge incontinence, difficulty to start voiding, time needed at the toilet for voiding, the need to return to the toilet for emptying the bladder, feeling of incomplete emptying of the bladder, and limitation of social life because of the leakage. The symptoms of genital prolapse were significantly more common in the patient group in spite of a significantly larger proportion of genital prolapse surgery in this group. Parity, high body mass index, heavy lifting work, chronic pulmonary diseases, hiatus hernias, and hysterectomy were significantly more common in the patient group than among the controls. CONCLUSIONS: At long-term follow-up, patients exhibit substantial symptoms of pelvic floor dysfunction (PFD) concerning voiding dysfunction and symptoms of genital prolapse compared with a normal population. This highlights the importance and need of treating pelvic floor disorders in a comprehensive way. Scientific works with comprehensive studies of PFD are needed.

Activities of Daily Living↗

Effects of a comprehensive rehabilitation program on quality of life in patients with chronic heart failure.

This evaluation was performed to assess the effects of a new, comprehensive outpatient rehabilitation program on generic and disease-specific quality of life related to exercise tolerance in stable chronic heart failure patients. Fifty-one patients (aged 59+/-11 years; 84% men) were treated for 12 weeks. Patients underwent optimized drug treatment, exercise training, and counseling and education. At baseline and at the end of the program, functional status, exercise capacity, and quality of life were assessed using the Medical Outcomes Study 36-item Short-Form Health Survey and the Minnesota Living with Heart Failure Questionnaire. Left ventricular ejection fraction and New York Heart Association functional class, as well as measures of physical fitness and walking distance covered in 6 minutes, improved significantly (by 11%-20% and by 58% on average, respectively). Physical functioning (effect size, 0.38; p<0.0001), role functioning (effect size, 0.17; p<0.05), and mental component score (effect size, 0.47; p<0.0001) on the questionnaire improved significantly. Disease-specific quality of life improved in sum score (effect size, 0.24; p<0.0001) and physical component score (effect size, 0.35; p<0.0001). The latter was inversely correlated to improvement in peak power output (r= -0.31; p<0.05). In patients with stable chronic heart failure, significant improvements in both generic and disease-specific quality of life related to improved exercise tolerance can be achieved within 12 weeks of comprehensive rehabilitation.

Aged↗

Global analysis of functional surfaces of core histones with comprehensive point mutants.

The core histones are essential components of the nucleosome that act as global negative regulators of DNA-mediated reactions including transcription, DNA replication and DNA repair. Modified residues in the N-terminal tails are well characterized in transcription, but not in DNA replication and DNA repair. In addition, roles of residues in the core globular domains are not yet well characterized in any DNA-mediated reactions. To comprehensively understand the functional surface(s) of a core histone, we constructed 320 yeast mutant strains, each of which has a point mutation in a core histone, and identified 42 residues responsible for the suppressor of Ty (Spt(-)) phenotypes, and 8, 30 and 61 residues for sensitivities to 6-azauracil (6AU), hydroxyurea (HU) and methyl-methanesulfonate (MMS), respectively. In addition to residues that affect one specific assay, residues involved in multiple reactions were found, and surprisingly, about half of them were clustered at either the nucleosome entry site, the surface required for nucleosome-nucleosome interactions in crystal packing or their surroundings. This comprehensive mutation approach was proved to be powerful for identification of the functional surfaces of a core histone in a variety of DNA-mediated reactions and could be an effective strategy for characterizing other evolutionarily conserved hub-like factors for which surface structural information is available.

Amino Acid Sequence↗

Comprehensive health seeking and coping paradigm.

While scholars in nursing are charged with the responsibility of advancing and structuring a body of knowledge for application in nursing practice, many of the currently utilized theories have been borrowed from other disciplines. Until such knowledge is redefined and synthesized according to the perspective of nursing, borrowed knowledge cannot be adequately understood. The purpose of this paper is to present a comprehensive client-orientated health seeking and coping paradigm. This paradigm is theorized to be a function of 12 factors which include: clients' situational and personal factors, resources, sociodemographic characteristics, cognitive appraisal, health goals, health seeking and coping behaviours, nursing goals and strategies, clients' perceived compliance, clients' perceived coping effectiveness, and immediate and long-term health outcome. The Lazarus Schema of Coping and Adaptation and the Schlotfeldt Health Seeking and Coping Paradigm were the parent conceptualizations from which the Comprehensive Health Seeking and Coping Paradigm (CHSCP) was derived. As a nursing-orientated multidimensional framework, the CHSCP will provide a useful framework for nurses interested in altering, enhancing or promoting the health seeking and coping of clients. By providing an intellectual focus for the initial and ongoing assessment of a multitude of variables which influence health seeking and coping, the specification of appropriate strategies can be developed and enhanced.

Adaptation, Psychological↗

Older women and dietary advice: occurrence, comprehension and compliance.

BACKGROUND: When a person becomes ill, traditional food habits may come into conflict with the disease-related recommended diet. AIM: The aim was to study perceptions of receiving dietary advice, the occurrence and comprehension of such advice and compliance among older women diagnosed with Parkinson's disease, stroke or rheumatoid arthritis. METHODS: The study took an ethnographic approach. Fifty-four community-dwelling women, 64-88 years of age, were interviewed using an open-ended interview technique during visits to their homes. FINDINGS: Two themes were found: 'dietary advice - occurrence and comprehension' describes whether the women had received dietary advice and, if so, how they understood the information. In the theme 'compliance with dietary advice', two principal reasons for complying or not complying with advice were found: First, women expressed a 'food interest', such that they were either 'interested in disease-related diet' or held a general view of the significance of foods and complied with the advice for their own 'health interest'. Secondly, the women were 'uninterested in food changes'. This could be because of 'poor appetite', 'food and disease ambivalence', 'habitual and preferred foods'. CONCLUSION: Dietary advice should be based on women's food preferences and habitual foods. It is important to inform about known relations between food and disease, but also to support eating favourite foods, thereby facilitating women's well-being.

Aged↗

Strategy and abilities training for prose recall and comprehension in mentally retarded children.

This study compared the effects of training conditions, abilities, strategies, and a combination of abilities and strategies on the recall and comprehension of prose passages. The subjects were 45 educable mentally retarded children divided equally into the three conditions. Although there was significant pre- to post-test improvement within each condition for factual recall, no differences were observed among the conditions for either factual recall or comprehension.

Child↗

A comprehensive clerkship in family medicine.

A 6-week family medicine clerkship that is comprehensive in its approach to the academic base of family medicine and in its integration of clinical and didactic experiences is discussed. The goals of the clerkship are to enable students to: acquire knowledge of common illnesses in ambulatory care; integrate compassion, concern and empathy in the delivery of comprehensive and personalized care; and to experience the medical and social issues of family medicine. The curriculum includes 50 hours of didactic preparation in the family life cycle, common illnesses, patient interviewing, problem-oriented medical records, genograms . compliance, and clinical problem-solving. Clinical experiences include placement in a family practice centre, an experience in a drug-abuse treatment centre and a brief rotation in geriatric medicine. Students are evaluated on their performance in clinical settings and in an objective test of primary care concepts. Test performance shows significant growth from student pre- to post-test scores. Student evaluations have been very favourable toward the clerkship, and self-reports reveal growth in knowledge of common illnesses, problems of the elderly, problems of drug abuse and the role of the family doctor.

Clinical Clerkship↗

Comprehensive undergraduate medical assessments improve prediction of clinical performance.

OBJECTIVES: This study aimed to compare an essay-style undergraduate medical assessment with modified essay, multiple-choice question (MCQ) and objective structured clinical examination (OSCE) undergraduate medical assessments in predicting students' clinical performance (predictive validity), and to determine the relative contributions of the written (modified essay and MCQ) assessment and OSCE to predictive validity. DESIGN: Before and after cohort study. SETTING: One medical school running a 6-year undergraduate course. PARTICIPANTS: Study participants included 137 Year 5 medical students followed into their trainee intern year. MAIN OUTCOME MEASURES: Aggregated global ratings by senior doctors, junior doctors and nurses as well as comprehensive structured assessments of performance in the trainee intern year. RESULTS: Students' scores in the new examinations predicted performance significantly better than scores in the old examinations, with correlation coefficients increasing from 0.05-0.44 to 0.41-0.81. The OSCE was a stronger predictor of subsequent performance than the written assessments but combining assessments had the strongest predictive validity. CONCLUSION: Using more comprehensive, more reliable and more authentic undergraduate assessment methods substantially increases predictive validity.

Clinical Competence↗

Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20-year survey.

Studies on the epidemiology of common adverse cutaneous drug reactions have rarely been reported, since they can only be successfully conducted in clinics of internal medicine employing consultant dermatologists and having a comprehensive or intensive system of monitoring. Between 1974 and 1993, the adverse skin reactions occurring in divisions of general internal medicine of three different hospitals were monitored by a computerized comprehensive system. The "drug-monitoring patient" was defined as the recipient of at least one drug during hospitalization. The relationship of the skin reactions to drug causality in these patients had to be either definite (proven by re-exposure) or probable (drug relation greater than that of nondrug causality). The skin reactions were classified into four diagnostic groups. Maculopapular exanthema, urticaria, and vasculitis were the three main groups. The fourth group comprised cases of nonhomogeneous but clinically well-defined special exanthema. For selected drugs and years of observation, special emphasis was placed on the study of time patterns (reaction time, exposure time). A total of 1317 definite or probable drug-induced skin reactions occurred during the hospitalization of 48,005 consecutively admitted "drug-monitoring patients": 1201 cases of maculopapular exanthema, 78 cases of urticaria, 18 cases of cutaneous vasculitis, and 20 cases of special exanthema (five of erythema multiforme minor, six of fixed eruption, one of photosensitivity reaction, and eight of acneiform eruption). The main drugs involved did not differ for the three main types of skin reactions, penicillins ranking in the first place, followed by sulfonamides--most often combined with trimethoprim--and in the third place nonsteroidal anti-inflammatory drugs. The reaction time (time from last drug exposure to first skin manifestation) for urticaria showed a relevant proportion of the acute type (within 1 h) and most of the subacute type (1-24 h). For maculopapular exanthema, the subacute or, rarely, the latent type (1-8 days, exceptionally more than 8 days) predominated. For aminopenicillins, the rate of occurrence of skin reactions increased with increasing exposure time up to 12 days, and then markedly diminished. Possibly due to the tendency to withdraw suspected drugs even in the case of minor (e.g., maculopapular) skin reactions, no severe events such as erythema multiforme major/Stevens-Johnson syndrome or toxic epidermal necrolysis occurred.

Adverse Drug Reaction Reporting Systems↗

Comprehensive typing of DQB1 alleles by PCR-RFLP.

The protocols represented in this report can resolve all 22 DQB1 alleles. The second exon of DQB1 was subjected to PCR using two group-specific primers to obtain DQB1 group 1 (DQ5 and DQ6) and group 2 (DQ2, DQ3, DQ4) specific amplified products, respectively. Three endonucleases, ApaI, BssHII and NciI, can provide typing of DQ5 and DQ6 based on easy-to-read uncleaved, cleaved and a combination of uncleaved/cleaved patterns. Similarly, two endonucleases, FokI and BgII can define the specificities DQ2, DQ3 and DQ4. Moreover, all 13 group 1 DQB1 alleles and all but one of their 78 possible heterozygotes can be unambiguously resolved using an extended panel of 10 endonucleases. The remaining pair of heterozygotes, DQB1*05031/0603 and 05032/0608, can however be resolved by double digestion with BsmFI and SfaNI. RsaI splits the previously unresolved alleles DQB1*0602 and 0603 in the amplified products of the modified primer SDQ-01. Fnu4HI can resolve DQB1*0606 from 0605. DQB1*0603, 0607 and 0608 can be resolved by SfaNI and the new endonuclease BsmFI. The comprehensive typing of group 2 DQB1 alleles can be achieved using five endonucleases. All 9 group 2 DQB1 alleles and all but one pair (DQB1*0301/0302 from DQB1*03032/0304) of 36 possible heterozygotes can be resolved. Thus, PCR-RFLP remains a simple, inexpensive and reliable method for DQB1 typing. The PCR-RFLP can be used for comprehensive DQB1 typing either independently or to complement the PCR-SSP and PCR-SSOP methods.

Alleles↗

Surgical treatment of epilepsy in the comprehensive care program: advantages and considerations.

To properly establish the surgical treatment of epilepsy in the comprehensive care program, we planned a surgical strategy mainly for a temporal lobe epilepsy and have performed 60 temporal lobectomies. The surgical candidates were selected from 142 patients who met the initial criteria, and passed the initial evaluation for surgical intervention. Forty-five patients had long-term intracranial EEG recording, and circumscribed organic lesions were disclosed in 27 patients by neuroimaging techniques. The outcome of 23 patients who were followed for 2 years postoperatively was complete freedom from complex partial seizures in 17 patients (74%) and an increase in full employment from 2 to 10 patients. Despite the possible surgical complications, including detrimental effects on the higher cerebral functions, it is essential that the surgical treatment of epilepsy should be established as a part of the comprehensive care program. Our experiences and analyses of the state of the art in surgical intervention also suggest that surgical indications for more intractable patients whose social adjustment is less hopeful should be established and the surgical care system for these patients should also be planned. Furthermore, some patients may be free from recurrent seizures postoperatively, but still have difficulties in social rehabilitation. The problems for such patients remain unsolved.

Adult↗

Results of open carpal tunnel release: a comprehensive, retrospective study of 188 hands.

BACKGROUND: Many recent reports of the results of decompression of the median nerve in the carpal tunnel have concentrated on only one aspect of recovery (numbness, grip etc.), and there are no reports of a comprehensive study of outcome. The aim of the present study was to review comprehensively the results of the direct visualization method of decompression of the carpal tunnel and to compare them with the published results of endoscopic release. METHODS: Patients' perceptions of the severity of pain, numbness and paraesthesiae due to carpal tunnel syndrome (CTS), before and after open carpal tunnel release (CTR) in 188 hands were reviewed retrospectively at a minimum time of follow-up of 18 months. Motor and sensory testing, provocation testing and measurement of scar tenderness in 135 hands were performed at a clinical review. RESULTS: Subjective results showed that 70% experienced a reduction in the severity of pain after CTR, 78% of hands experienced a reduction in the severity of paraesthesiae and 77% experienced a reduction in the severity of numbness. A total of 49% had improvements in all three symptoms after CTR. At the clinical review, sensory testing revealed that 59% of hands had normal or slightly diminished light touch, 35% had normal static two-point discrimination and 61% had normal dynamic two-point discrimination. Results for Tinel's test, Phalen's test and pressure provocation testing were positive in 10% of hands. There was no scar tenderness in 38%, no persisting thenar atrophy in 90%. Normal grip strength was found in 93% and 91% had normal pinch strength. CONCLUSIONS: It was concluded that open carpal tunnel release remains a safe and reliable treatment for carpal tunnel syndrome. The very low incidence of serious complications from the open technique of CTR, when compared with endoscopic CTR as published by different authors in the literature, and the comparable clinical results, appears to make the open technique a safer and preferable option. However, a properly controlled trial of both techniques is necessary to compare them.

Carpal Tunnel Syndrome↗

Why pragmatic impairment? A case study in the comprehension of inferential meaning.

This paper discusses a case study of Sarah (aged 9;8-10;3) who is reported to have pragmatic difficulties. The focus is on her comprehension of questions, which are asked on the basis of pictures and heard stories. Particular focus is on the pragmatic (or inferential) demands of the input questions and their relationship to the (in)appropriacy of the answer. Data from 16 normally functioning 6- and 8-year-old children are also presented for comparative purposes. The study shows that Sarah has difficulty with questions which require her to go beyond visually presented or verbally stated information. On one set of tasks she was to answer questions on the basis of composite pictures: for some of the questions, the answer was obvious from the picture (descriptive questions) and for others information needed to be inferred beyond the picture (for example, by imagining what had happened before and what is likely to happen next). Sarah's performance was poorer on the inferential questions than the descriptive questions and poorer than the performance of 6- and 8-year-old normally functioning control children. Although the control children also found the inferential questions more difficult than the descriptive questions, this difficulty was not as pronounced as Sarah's. This trend was also apparent in a set of tasks which required the children to answer questions on the basis of verbally told stories. This study suggests that pragmatically impaired children may have difficulty going beyond explicitly presented information and this would manifest as pragmatic production and comprehension problems. In cognitive terms, this may indicate difficulty with the process of inferencing.

Case-Control Studies↗

Improved serial analysis of V1 ribosomal sequence tags (SARST-V1) provides a rapid, comprehensive, sequence-based characterization of bacterial diversity and community composition.

Serial analysis of ribosomal sequence tags (SARST) is a recently developed technology that can generate large 16S rRNA gene (rrs) sequence data sets from microbiomes, but there are numerous enzymatic and purification steps required to construct the ribosomal sequence tag (RST) clone libraries. We report here an improved SARST method, which still targets the V1 hypervariable region of rrs genes, but reduces the number of enzymes, oligonucleotides, reagents, and technical steps needed to produce the RST clone libraries. The new method, hereafter referred to as SARST-V1, was used to examine the eubacterial diversity present in community DNA recovered from the microbiome resident in the ovine rumen. The 190 sequenced clones contained 1055 RSTs and no less than 236 unique phylotypes (based on > or = 95% sequence identity) that were assigned to eight different eubacterial phyla. Rarefaction and monomolecular curve analyses predicted that the complete RST clone library contains 99% of the 353 unique phylotypes predicted to exist in this microbiome. When compared with ribosomal intergenic spacer analysis (RISA) of the same community DNA sample, as well as a compilation of nine previously published conventional rrs clone libraries prepared from the same type of samples, the RST clone library provided a more comprehensive characterization of the eubacterial diversity present in rumen microbiomes. As such, SARST-V1 should be a useful tool applicable to comprehensive examination of diversity and composition in microbiomes and offers an affordable, sequence-based method for diversity analysis.

Bacteria↗

Sustainability and effectiveness of comprehensive diabetes care to a district population.

AIMS: To evaluate whether diabetes care in a district population can be sustained over time and intensive management of multiple risk factors can be achieved against a background of rising prevalence of known diabetes and shift of responsibility towards primary care. METHODS: Assessment of process and outcome measures achieved by a comprehensive diabetes service. Routine data were collected from patients registered with diabetes in a district population by repeated cross-sectional survey in 1991 (n = 2284 patients) and 2001 (n = 5809 patients). RESULTS: Between 1991 and 2001 the recording of body mass index (76.8 vs. 71.3%, P = 0.01) and HbA(1c) measurement (92.2 vs. 86.4%, P < 0.001) decreased, whereas recording of smoking status (72.4 vs. 82%, P < 0.001), cholesterol level (54.7 vs. 82.5%, P < 0.001) and eye screening result (86.1 vs. 91.3%, P < 0.001) improved. Surviving patients with Type 2 diabetes had significant improvements in systolic blood pressure, diastolic blood pressure and cholesterol, significant deterioration in HbA(1c) and creatinine, and no change in body mass index. Changes in blood pressure and HbA(1c) over time were similar to those reported in the UKPDS. CONCLUSIONS: The delivery of processes and outcomes of care to a district population can be sustained at a high level over a 10-year period within a comprehensive diabetes service. We would suggest that a multifaceted complex intervention is required to achieve these results.

Adult↗

A comparison of phonological skills in children with reading comprehension difficulties and children with decoding difficulties.

This paper examines phonological skills in children with two distinct forms of reading difficulty: comprehension problems and decoding problems. In the first study a group of children with normal decoding skills but poor reading comprehension skills was studied. These children were found to have age-appropriate phonological skills. It is argued that normal phonological skills have enabled them to develop proficient decoding skills. A second study assessed the phonological skills of a group of children with decoding difficulties. These children showed marked deficits on tests of phonological skills. It appears that weak phonological skills underlie these children's decoding difficulties.

Child↗

Contributions of phonological memory, language comprehension and hearing to the expressive language of adolescents and young adults with Down syndrome.

BACKGROUND: Expressive language constitutes a major challenge to the development of individuals with Down syndrome. This paper investigates the relationships between expressive language abilities, language comprehension and the deficits in verbal short-term memory and hearing which are also associated with the syndrome. METHODS: Tests of nonverbal ability, expressive language, verbal short-term memory, visuo-spatial memory, language comprehension and hearing were administered. RESULTS: Phonological memory, measured by nonword repetition, was significantly correlated with expressive language abilities measured by MLU and sentence recall. Adjusting for word repetition skills did not reduce this correlation, suggesting that the relationship did not depend on the fact that both tests required spoken output. Hearing did not contribute significantly to expressive language scores of participants who provided an intelligible narrative. However, level of hearing loss as well as other language and memory measures did differentiate these participants from those who were unable to produce an intelligible narrative. CONCLUSION: Phonological memory was closely associated with the expressive language abilities of individuals with Down syndrome. Hearing loss appeared to be less closely related except that individuals with uncorrected mild to moderate hearing loss had difficulty with the narrative task. Further research is necessary to establish the nature of these relationships.

Adolescent↗