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PubMed2003

Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children.

CONTEXT: Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures. OBJECTIVE: To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)-containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)-containing lipoprotein, high-density lipoprotein (HDL). DESIGN, SETTING, AND PATIENTS: A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months. INTERVENTION: A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n = 102], 3.5:1 [n = 7], or 3:1 [n = 32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control. MAIN OUTCOME MEASURES: Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I. RESULTS: At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) (P<.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P<.001); and total apoB (49 mg/dL) (P<.001). Mean HDL cholesterol decreased significantly (P<.001), although apoA-I increased (4 mg/dL) (P =.23). Significant but less marked changes persisted in children observed after 12 and 24 months. CONCLUSIONS: A high-fat ketogenic diet produced significant increases in the atherogenic apoB-containing lipoproteins and a decrease in the antiatherogenic HDL cholesterol. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions.

Adolescent↗
PubMed2004

Graduated driver licensing for reducing motor vehicle crashes among young drivers.

BACKGROUND: Graduated driver licensing (GDL) has been proposed as a means of reducing crash rates among novice drivers by gradually introducing them to higher risk driving situations. OBJECTIVES: To examine the effectiveness of GDL systems in reducing crash rates of young drivers. SEARCH STRATEGY: Studies were identified through searches of MEDLINE, EMBASE, CINAHL, Healthstar, Web of Science, NTIS Bibliographic Database, TRIS Online, SIGLE, the World Wide Web, relevant conference proceedings, consultation with experts and authors, and reference lists. The search was not restricted by language or publication status. SELECTION CRITERIA: Studies were included if: 1) they compared outcomes pre- and post-implementation of a GDL program within the same jurisdiction, 2) comparisons were made between jurisdictions with and without GDL, or 3) both. Studies had to report at least one objective, quantified outcome. Two reviewers independently screened searches and assessed the full text of potentially relevant studies for inclusion using a standard form. DATA COLLECTION AND ANALYSIS: Data were extracted by one reviewer and checked by a second. Additional data were requested from authors. Results were not pooled due to substantial heterogeneity between studies. Percentage change was calculated for each year after the intervention, using one year prior to the intervention as the baseline rate. Results were adjusted by internal controls. Analyses were stratified by different denominators (population, licensed drivers). Results were calculated for the different crash types (overall, injury, fatal, night-time, alcohol, and those resulting in hospitalization). Results were presented for 16 year-olds alone and all teenage drivers combined. MAIN RESULTS: We included 13 studies evaluating 12 GDL programs that were implemented between 1979 and 1998 in the US (n=7), Canada (3), New Zealand (1), and Australia (1). Programs varied in their restrictions during the intermediate stage: e.g. night curfews (8); limitations of extra passengers (2); roadway restrictions (1). Based on the Insurance Institute for Highway Safety classification scheme, no programs were good, six were acceptable, five were marginal, and one was poor. Reductions in crash rates were seen in all jurisdictions and for all crash types. Among 16 year-old drivers, the median decrease in per population overall crash rates during the first year was 31% (range 26-41%). Per population injury crash rates were similar (median 28%, range 4-43%). Results for all teenage drivers, rates per licensed driver, and rates adjusting for internal controls were generally reduced when comparing within jurisdictions. REVIEWERS' CONCLUSIONS: The existing evidence shows that GDL is effective in reducing the crash rates of young drivers, although the magnitude of the effect is unclear. The conclusions are supported by consistent direction of the findings, and the temporal relationship and plausibility of the association. The reviewers have made recommendations for primary research on GDL (e.g. study methods, standardized reporting of outcomes and results, long-term follow-up). The project has also shown what is needed to carry out systematic reviews of observational studies (e.g. quality assessment instruments).

Accidents, Traffic↗
PubMed1994

A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics.

Nonhomosexual male gender dysphorics often make their first requests for clinical assessment when they are in or approaching middle age. This study investigated how well patients' explanations for the timing of these requests fit the objective data. Subjects were 194 outpatients presenting for the first time at a gender identity clinic. Their common explanations for the timing of their requests were incorporated into a formal path model, which was tested using Bentler's structural equations program. The model provided an acceptable fit to the data. The more times a patient has been married and the more children he has fathered, the older he is likely to be when first presenting for clinical attention. This outcome is consistent with the claims of patients that they would have come to a gender clinic sooner if they had not been restrained by commitments to wives and children.

Adolescent↗
PubMed1993

Quality assurance for bone densitometry research studies: concept and impact.

A concept for quality assurance (QA) in bone densitometry has been developed for clinical multicenter studies. Major elements provided by a coordinating center comprise (1) consulting services and certification of participating centers in the start-up phase of the study, (2) review of scan data acquired on QA standards for cross-calibration and longitudinal assessment of scanner stability, (3) review of selected patient data as well as of problem cases during the study, and (4) comprehensive review and correction of patient results based on QA data after conclusion of the study. Limitations of phantom-based QA data should be acknowledged. Typical problems encountered during research studies and guidelines for solutions are presented. Successful implementation of QA measures may yield substantial enhancement of statistical power. Depending on the study design and the variability of response within patient groups, improvement in precision due to QA measures may reduce the smallest detectable difference between subject groups or, alternatively, sample size by a few to more than 50%, and thus may contribute to a substantial reduction in study cost. Formulae for calculation of the magnitude of these effects are presented. To maximize the net benefit, QA efforts have to be limited to levels that assure reliability of the data at acceptable QA cost. While QA programs at individual clinical sites or for local practitioners may not need to be as extensive as for multicenter clinical trials, awareness of the potential problems and implementation of basic QA measures will help in obtaining high-quality bone densitometry results.

Bone Density↗
PubMed2005

Exact tandem repeats analyzer (E-TRA): a new program for DNA sequence mining.

Exact Tandem Repeats Analyzer 1.0 (E-TRA) combines sequence motif searches with keywords such as 'organs', 'tissues', 'cell lines' and 'development stages' for finding simple exact tandem repeats as well as non-simple repeats. E-TRA has several advanced repeat search parameters/options compared to other repeat finder programs as it not only accepts GenBank, FASTA and expressed sequence tags (EST) sequence files, but also does analysis of multiple files with multiple sequences. The minimum and maximum tandem repeat motif lengths that E-TRA finds vary from one to one thousand. Advanced user defined parameters/options let the researchers use different minimum motif repeats search criteria for varying motif lengths simultaneously. One of the most interesting features of genomes is the presence of relatively short tandem repeats (TRs). These repeated DNA sequences are found in both prokaryotes and eukaryotes, distributed almost at random throughout the genome. Some of the tandem repeats play important roles in the regulation of gene expression whereas others do not have any known biological function as yet. Nevertheless, they have proven to be very beneficial in DNA profiling and genetic linkage analysis studies. To demonstrate the use of E-TRA, we used 5,465,605 human EST sequences derived from 18,814,550 GenBank EST sequences. Our results indicated that 12.44% (679,800) of the human EST sequences contained simple and non-simple repeat string patterns varying from one to 126 nucleotides in length. The results also revealed that human organs, tissues, cell lines and different developmental stages differed in number of repeats as well as repeat composition, indicating that the distribution of expressed tandem repeats among tissues or organs are not random, thus differing from the un-transcribed repeats found in genomes.

Cells, Cultured↗
PubMed2001

Dose reduction in evacuation proctography.

The goal of this study was to reduce the patient radiation dose from evacuation proctography. Ninety-eight consecutive adult patients referred for proctography to investigate difficult rectal evacuation were studied using a digital imaging system with either a standard digital program for barium examinations, a reduced dose digital program (both with and without additional copper filtration), or Video fluoroscopy. Dose-area products were recorded for each examination and the groups were compared. All four protocols produced technically acceptable examinations. The low-dose program with copper filtration (median dose 382 cGy cm2) and Video fluoroscopy (median dose 705 cGy cm2) were associated with significantly less dose than other groups (p < 0.0001). Patient dose during evacuation proctography can be reduced significantly without compromising the diagnostic quality of the examination. A digital program with added copper filtration conveyed the lowest dose.

Adult↗
PubMed1994

Predisposing factors differentiating adolescent dieters and nondieters.

OBJECTIVE: To examine whether certain biological, sociocultural, and psychological factors differentiate dieters from nondieters in male and female, black and white adolescents. DESIGN: In each race-sex group adolescents were divided into nondieters and dieters (those who had lost at least 5 lb through dieting) and compared using factors associated with overweight and dieting. SUBJECTS: Participants were 1,269 high school seniors, with a mean (+/- standard deviation) age of 17.5 +/- 0.6 years, from 10 schools in a large metropolitan area (72% of enrolled students). INTERVENTION: Each student completed a self-administered questionnaire designed for this research, the Culture-Free Self-Esteem Inventory, and the Eating Disorder Inventory. OUTCOME MEASURES: Comparisons were made of dieters and nondieters using their previous and current weights, parental weights, birth order, socioeconomic status, religious affiliation, self-esteem scores, and other psychological factors. STATISTICAL ANALYSES: Statistical analyses performed were chi 2 and t tests. RESULTS: Factors thought to be associated with overweight in adolescents, such as parental weights, birth order, and socioeconomic status, were not found to be significantly different in dieters and nondieters in any of the four race-sex groups. In fact, the majority of dieters in this study were not overweight (ie, above the 85th percentile of body mass index). Instead, what most clearly distinguished dieters from nondieters was their perception of being overweight before kindergarten, after kindergarten, and at the time of the study, and the feelings of body dissatisfaction and wanting to be thinner that being overweight engenders. APPLICATIONS: Because most adolescents diet because they perceive themselves to be overweight when they are not, adolescent dieters are not easy to identify. Instead, dietitians can offer educational programs that help all adolescents accept more realistic weights and adopt patterns of eating and exercise that remove or reduce the need to diet.

Adolescent↗
PubMed1976

Quality control in haemoglobinometry with special reference to the stability of haemiglobincyanide reference solutions.

In haemoglobinometry grave errors are still being made even though an internationally accepted standardized method is available for the determination of the haemoglobin content of blood. Up to the present only haemiglobincyanide reference solutions have been available on a wide scale to check the measuring stage of the standardized haemiglobincyanide method. These reference solutions are shown to remain stable, under proper storage conditions, for more than 10 years. Concentrated haemoglobin solutions have become available recently, offering the possibility to control the dilution and conversion steps of the haemiglobincyanide method. Such a solution is shown to remain stable, under proper storage conditions, for at least a year. Using both haemiglobincyanide reference solutions and concentrated haemoglobin solutions, as well as having the possibility of checking the cyanide content of the reagent used, an acceptable intra-laboratory control program may now be set up.

Cyanides↗
PubMed1995

A system for automated procedure documentation.

Quantitative information regarding competency in performing procedures is invaluable in attesting to a house officer's abilities when assessments need to be made. Thus, the means by which procedures, proficiency, and experience can be recorded and organized in an automated fashion need not be any further away than the nearest micro-computer. The procedure documenting system (PDS) automates the documenting of procedures and quantitative information pertaining to these procedures, and shortens the time demanded of the house officer to document procedures from a mean of 5.5 to 1.9 min. This paper is a description of the work done to automate the recording of procedures performed by housestaff at a teaching hospital and the acceptance by housestaff. This computer program takes the specific information and places it into a specialized database so that house officers can have detailed documentation attesting to their proficiency in various procedures. In addition, the program director can access the database to document the quantity of procedures to which an individual house officer has attained competence.

Automation↗
PubMed1990

Use of homology domains in sequence similarity detection.

We have found the detection of homology domains using a nonlinear similarity score and the DD algorithm to be a useful approach for identifying similarity between sequences and evaluating potential homology. There are several reasons for the success of the method. (i) Homology domains are identified by a rigorous method that guarantees they will be locally optimal. (ii) The relative significance of different homology domains can be directly compared using the nonlinear similarity score. (iii) Different cost matrices can be used in the calculation of the similarity score. (iv) Relatively long sequences can be compared in a single pass as storage requirements are proportional to the shorter of the two sequences being compared. (v) The method has proved to be very sensitive in practice. (vi) The boundaries of authentic regions of homology are accurately identified. (vii) The information required to define a homology domain (its location, size, similarity score, etc.) can be stored in a compact data structure, facilitating the sharing of homology domain data among different software tools. (viii) The method can be applied to similarity searches of the nucleotide and protein sequence data banks. These properties make the identification of homology domains for studying sequence similarity a useful companion to other accepted methods, such as dynamic programming based analyses.

Animals↗
PubMed1989

Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors.

A 10-h osteoarthritis education course was developed and evaluated for older low-income patients with osteoarthritis. Indigenous community leaders were trained to teach the course within inner-city neighborhoods of Hartford, Connecticut. Significant differences were obtained using a quasi-experimental group, pre/post-test design. There was a significant increase in knowledge (P less than 0.001) both on a verbal knowledge test and a picture story test (P less than 0.001). There was a significant increase in scores on an exercise scale (P less than 0.001). Attitude toward one's illness improved. There was a slight improvement in function which was not significant. Use of adaptive equipment increased as a direct result of the program. The course was well accepted and enjoyed by the participants.

Connecticut↗
PubMed1990

Effectiveness of a hospital-based cooperative care model on patients' functional status and utilization.

The primary objective of this study was to test the hypothesis that inpatient care which emphasized structured, patient education, self-care and social support from a care partner (the Cooperative Care Program) is a cost-effective alternative to the more expensive staff-intensive, traditional hospital care; and that such care can be substituted without resulting in poorer outcomes with regard to subsequent health status or use of services. The effects of this program on patient and physician acceptance, patient knowledge and treatment and health status, were evaluated by means of an experimental design with comparable groups of patients assigned to experimental (cooperative care) or control (usual hospitalization) group status. Follow-up analyses of both groups of patients for a 12-month time period concluded that there were comparable and equally positive post-hospitalization experiences, with greater than 90% of both groups of patients functioning well with respect to a series of measures of functional status. There was no evidence that Cooperative Care patients were re-hospitalized more often or needed more emergency, home care or other types of services. There was, on the other hand, evidence of the positive effect on patient understanding, adherence to treatment, satisfaction, and self-management.

Female↗
PubMed2005

Three-year outcome of family work in an early psychosis program.

At the initial presentation to a first-episode of psychosis program, family members were experiencing distress and difficulties. The purpose of the study was to assess the effectiveness of individualized family intervention integrated within a comprehensive treatment program for first episode psychosis. Participants were the family members of individuals who had presented with a first episode of psychosis. Family members were assessed with the Psychological General Well-Being Scale and the Experience of Caregiving Inventory (ECI). Patient data included assessment of positive and negative symptoms, depression, quality of life, and substance use. Assessments were conducted over a three-year period. Over time families demonstrated improved psychological well-being and ECI scores. The most significant predictor of poor psychological well-being was the family's appraisal of the impact of the illness on themselves and not the severity of symptoms or impaired functioning. This family intervention embedded within a treatment program proved to be highly acceptable and effective.

Adult↗
PubMed2006

The productivity effects of cattle tick (Boophilus microplus) infestation on cattle, with particular reference to Bos indicus cattle and their crosses.

In response to uncertainty among cattle producers in Australia regarding the need to treat Bos indicus and B. indicus crossbreeds, the scientific literature relating to the productivity effects of Boophilus microplus on cattle of all breeds was reviewed. Estimates of the mean effect of each engorging tick (damage coefficient, d) were made from a simple analysis of the reported data. On average, each engorging female tick is responsible for the loss of 1.37 +/- 0.25 g bodyweight in B. taurus cattle. The comparable value for B. taurusxB. indicus cattle is 1.18 +/- 0.21 g/engorging tick. These values were not statistically significantly different, indicating that if a threshold approach to tick control were taken, then the threshold number of standard ticks would be the same regardless of cattle genotype. No studies provided useable estimates of the effect of tick infestation on pure B. indicus cattle. An economic threshold for treatment, below which acaricide application is not beneficial, can be predicted, using known values for the cost of acaricide application and the price of beef. However, the application of a threshold approach to control has not been embraced by government advisers and runs contrary to the accepted principals of strategic control programs.

Animals↗
PubMed2005

[One thousand liver transplants. Hospital Clinic i Provincial de Barcelona (Spain)].

UNLABELLED: The aim of this study was to evaluate a consecutive series of 1000 liver transplants performed in our institution and to evaluate changes over time in donors and recipients, as well as results. MATERIAL AND METHOD: To clearly evaluate the differences between the initial transplantation period and the present period, the first 100 consecutive liver transplantations performed (June 1988-June 1990) and the last 200 consecutive liver transplantations performed (January 2001-June 2003) were compared. RESULTS: Donor age increased (23+/-10 vs. 45+/-19), the etiology of brain death changed (severe head injury: 78% vs. 23.5%; stroke: 17% vs. 52.5%) and the percentage of donors from alternative methods to cadaveric donors increased (living donors: 12.5%) in the second period. Regarding recipients, the piggy-back technique and biliary anastomosis without T-tube were introduced in the second period. Actuarial 1-year survival was higher in the second period than in the first (84% vs. 91.3%). The need for retrasplantation in the entire series was 9.5%, with actuarial survival at 1, 5 and 10 years of 67.7%, 51.3% and 39.4%, respectively. CONCLUSION: Because of the lack of donors and the greater number of patients on the waiting list, poorer quality donors and more critical recipients have been accepted and alternative and innovative programs have been started. Nevertheless, due to improvement in patient management before, during and after transplantation, the previous good results have been maintained.

Adult↗
PubMed1998

Transport in vitro fertilization and intracytoplasmic sperm injection: results of a collaborative trial.

OBJECTIVE: To determine whether the use of a central assisted reproduction laboratory, with gamete transport to the facility (transport assisted reproduction), would decrease oocyte quality or performance in IVF-ET and intracytoplasmic sperm injection (ICSI). DESIGN: Retrospective clinical study. SETTING: Public and private fertility clinics. PATIENT(S): A total of 467 couples underwent transport IVF, whereas 108 underwent transport ICSI. A group of 60 couples underwent conventional IVF during the same period. All methods and protocols used were similar among centers. Oocyte pick-up was performed by ultrasound-guided vaginal puncture. INTERVENTION(S): Oocytes were transported under controlled conditions, from the site of follicular aspiration to a central laboratory. MAIN OUTCOME MEASURE(S): The fertilization and cleavage rates and clinical pregnancies were compared among the study populations. RESULT(S): The differences between the fertilization and cleavage rates of ova and the rates of clinical pregnancies produced by transport and conventional methods were not statistically significant. CONCLUSION(S): Gamete transport to a central laboratory was not harmful for oocytes or for the outcome of assisted reproduction. Transport makes the use of IVF and ICSI available to physicians who are not affiliated with an assisted reproduction program, reduces costs, and increases acceptability of the procedures to patients.

Adult↗
PubMed2003

General principles of asthma management: symptom monitoring.

The first step in optimal asthma care is identifying and properly diagnosing patients who have asthma then classifying asthma severity carefully and accurately to ensure proper treatment. Objective monitoring of pulmonary function using spirometry and peak flow monitoring, subjective assessment using symptom identification, and physicians' acceptance of National Asthma Education Program's Expert Panel guidelines are needed to diminish the consequences of undertreatment of asthma. Persistent asthma requires continuous long-term controller therapy. Erratic and insufficient use of medication must be addressed. Clinicians should encourage patients to manage their asthma using routine peak flow monitoring and symptom assessment then intervene according to their asthma action plan. These efforts allow patients to take charge of their asthma instead of the asthma taking charge of them.

Asthma↗
PubMed2003

Attitudes of Israeli gynecologists regarding candidate screening and personal responsibility in assisted reproductive technologies versus adoption in Israel.

BACKGROUND: Although both assisted reproduction technologies (ART) and adoption services are designed to help childless couples, their legal status is overwhelmingly different. In particular, applicants for adoption services in Israel are required to undergo a meticulous background check, whereas ART has no such precondition. The present study evaluated the attitude of gynecologists in Israel towards this difference and their opinion of their own responsibility to children born by in vitro fertilization (IVF) treatment. METHODS: One hundred and eighty-one gynecologists were asked to complete a questionnaire covering their opinions on the acceptance of applicants for IVF programs compared to adopting couples and their professional responsibility to children born by IVF. RESULTS: Average age of the responders was 47.9+/-9.2 years; 75% were male; average number of own children was 2.6+/-1.3. Sixty-one percent believed that the use of IVF conferred a duty upon the physician to ensure the well-being of the future child, and 66% believed it important to somehow screen potential parents. Forty percent favored equalizing the preconditions for IVF candidates and adopting couples. Thirty-five percent supported changing the adoption laws to make the process easier, and 33% supported changing the IVF program to prevent unsuitable candidates from starting therapy. Among the latter, a strong marital bond was considered important by 17%, health status of the potential parents by 72%, and possession of a criminal record by 35%. Forty percent favored parental evaluation by a social worker, and 66%, by a psychological assessment. Only 24% thought that economic status was important. CONCLUSIONS: Most gynecologists in ART programs believe they have a duty to look out for the unborn child. Approximately one-third support the institution of changes in parental evaluation to facilitate the adoption process and to provide more restrictions in ART programs. Most believed that parental evaluation, preferably by a psychological assessment, is important prior to starting an IVF program.

Adoption↗