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PubMed1996

[Special features of orthopaedic pain treatment in diseases of the spine].

Besides the treatment of postoperative pain, working together with the anaesthesiologist, orthopaedic doctors are mostly involved in diseases of the locomotor system where pain is a leading feature. Painful orthopaedic diseases are very frequent. They afford a special diagnostic procedure. The pain treatment consists of special orthopaedic therapy and local injections with low doses of local anaesthetics and steroids at the site of pain. This treatment helps to avoid the use of high-dose systemic analgesics and perhaps avoids the need for operations.

English Abstract↗
PubMed2001

Three-dimensional image display without special eyeglasses: observation of magnetic resonance angiography using the stereoscopic liquid crystal display.

The authors have developed a new stereoscopic liquid crystal display that provides real-time 3-dimensional image viewing without special eyeglasses. The device consists of 3 major parts: (1) an image display composed of a 10.4-inch color liquid crystal plate with a resolution of 640 x 480, (2) an automatic head tracking system, and (3) a special backlight unit for the right and left eyes. Eight radiologists interpreted 60 cases of magnetic resonance angiography (29 cases of cerebrovascular disease and 31 normal cases) to compare film display and the liquid crystal display (ie, pseudo 3-dimensional display and true 3-dimensional display). Using a continuously distributed scale ranging from 0% to 100%, the observers ranked their confidence levels in determining the presence or absence of steno-occlusive disease, aneurysm, and arteriovenous malformation (AVM) and their locations. For statistical evaluation, receiver operating characteristic (ROC) analysis and Brier score were used. For detecting AVM, film reading showed a significantly higher value in the area under the binormal ROC curve (Az) than did pseudo-3-dimensional display (P < .05). Excluding this, however, no significant difference existed in Az values among the 3 viewing methods. Also, there was no significant difference in Brier score between not only the stereoscopic view and nonstereoscopic view groups, but also the senior and junior groups. Subjective estimation of true 3-dimensional display showed that vessels were more distinguishable with less eye fatigue compared with stereoscopic film reading. The stereoscopic liquid crystal display provided almost equal efficacy to film reading; however, the short optimum distance for observation and the low resolution should be improved.

Cerebrovascular Disorders↗
PubMed2003

Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization.

INTRODUCTION: Surgical management of left-sided large bowel emergencies has been evolving toward single-staged procedures. Selection for single or staged resection remains the most controversial issue. METHODS: The results from a series of 336 emergency colorectal procedures performed between January 1990 and December 2000 for cancer and diverticular disease by two different surgical units in one hospital are reported: one with a specific interest in colorectal surgery, and one specialized in upper gastrointestinal surgery. RESULTS: A primary anastomosis was performed in 142 (64.3 percent) patients by colorectal surgeons and in 42 (36.5 percent) by noncolorectal surgeons (P < 0.0001). The overall morbidity and mortality rates were lower for colon and rectal surgeons (14.5 vs. 24.3 percent and 10.4 vs. 17.4 percent, respectively). Trainees were more likely to perform anastomoses when assisted by colorectal consultants (72.1 percent of cases) than when a noncolorectal consultant was present (47.5 percent of cases; P < 0.05). The 30-day mortality for patients with primary anastomosis was 6 percent, and anastomotic dehiscence occurred in nine (4.9 percent) patients. The mortality for patients undergoing staged resections (21.1 percent) was significantly higher than those who had primary resections performed (P < 0.001). CONCLUSIONS: Primary anastomosis for left-sided colorectal diseases can be performed with low morbidity and mortality in selected patients. Specialization increased anastomotic rates and reduced morbidity. This study suggests that colon and rectal surgeons should manage colorectal emergencies, and trainees should not be left unsupervised.

Adult↗
PubMed2004

Attenuation of neuroleptic-induced extrapyramidal side effects by Kava special extract WS 1490.

We studied at 42 patients (17 female, 25 male) with different psychiatric diagnoses, who were pretreated by neuroleptics, the efficacy and tolerability of the Kava special extract WS 1490 on extrapyramidal side effects. In both patient and physician questionnaires as well as in the physician's global ratings, significant improvements were found for all extrapyramidal signs and symptoms recorded. The concomitant intake of WS 1490 was well tolerated by the patients. The findings of this observational study suggest that extrapyramidal side effects of neuroleptic drugs may be attenuated by Kava special extract WS 1490.

Adult↗
PubMed2005

Might we practice what we'ved preached? Thoughts on the special issue papers.

Commentary on the papers of the special issue identifies and discusses four themes: 1) strategies to bridge the gap between science and practice, 2) sources of community science questions of interest, 3) choice and quality of methods, and 4) epistemology and useful language for community science. The commentary identifies some limitations in the models proposed by the special issue authors, and proposes renewed attention to ecology, context and process in community change initiatives, calling for a common set of community level measures as one strategy to advance a community centered science agenda.

Community Mental Health Services↗
PubMed2006

A special vegetation index for the weed detection in sensor based precision agriculture.

Many technologies in precision agriculture (PA) require image analysis and image- processing with weed and background differentiations. The detection of weeds on mulched cropland is one important image-processing task for sensor based precision herbicide applications. The article introduces a special vegetation index, the Difference Index with Red Threshold (DIRT), for the weed detection on mulched croplands. Experimental investigations in weed detection on mulched areas point out that the DIRT performs better than the Normalized Difference Vegetation Index (NDVI). The result of the evaluation with four different decision criteria indicate, that the new DIRT gives the highest reliability in weed/background differentiation on mulched areas. While using the same spectral bands (infrared and red) as the NDVI, the new DIRT is more suitable for weed detection than the other vegetation indices and requires only a small amount of additional calculation power. The new vegetation index DIRT was tested on mulched areas during automatic ratings with a special weed camera system. The test results compare the new DIRT and three other decision criteria: the difference between infrared and red intensity (Diff), the soil-adjusted quotient between infrared and red intensity (Quotient) and the NDVI. The decision criteria were compared with the definition of a worse case decision quality parameter Q, suitable for mulched croplands. Although this new index DIRT needs further testing, the index seems to be a good decision criterion for the weed detection on mulched areas and should also be useful for other image processing applications in precision agriculture. The weed detection hardware and the PC program for the weed image processing were developed with funds from the German Federal Ministry of Education and Research (BMBF).

Agriculture↗
PubMed2005

The need for care coordination among children with special health care needs in Illinois.

OBJECTIVES: The objectives of this study were: 1) to estimate the need for care coordination among children with special health care needs (CSHCN) in Illinois, 2) to assess the need for care coordination among CSHCN in Illinois by sociodemographic, condition-related, and access to care factors, and 3) to discuss approaches for meeting the need for care coordination. METHODS: The study included 745 Illinois families interviewed as part of the State and Local Area Integrated Telephone Survey (SLAITS) of CSHCN. Classifying families of CSHCN as needing care coordination was based on three survey questions. The prevalence of the need for care coordination among CSHCN in Illinois was examined overall and by sociodemographic characteristics, descriptors of the child's health condition, and measures of access to services. Multivariable modeling was carried out to jointly assess these factors and the need for care coordination. RESULTS: In Illinois, 25.2% of CSHCN families reported a need for care coordination. Condition severity, need for supplementary/ancillary services, lack of insurance coverage and inadequate communication among providers were significantly associated with the need for care coordination (OR = 1.14, OR = 1.72, OR = 2.45, and OR = 3.08, respectively). Having a primary care provider/medical home was not associated with the need for care coordination in multivariable analysis. CONCLUSION: Coordination of health services is important for all children and all adults, but it is particularly important for children with special health care needs. The variation in the need for care coordination both within and across states underscores the need for flexibility in program and policy development for CSHCN.

Adolescent↗
PubMed2005

Delayed and forgone care for children with special health care needs in New York State.

OBJECTIVE: To identify characteristics associated with delayed/forgone care for children with special health care needs (CSHCN) in New York State (NYS) as reported by their parents. METHODS: Data come from NYS participants in the 2000-2002 National Survey of Children with Special Health Care Needs. Data were analyzed using weighted bivariate and multivariate regression models. The dependent variable was report of delayed/forgone routine health care. Independent variables included illness characteristics, potential and actual access to care, and provider care characteristics. RESULTS: In NYS, 8.4% reported delayed/forgone health care for their child. Parents of children with delayed/forgone care were more likely to report that their child was uninsured (adjusted odds ratio [aOR] 3.8, 95% confidence interval [CI] 1.3-11.8), had experienced interrupted health insurance (aOR 3.9, 95% CI 1.5-9.7), or their child's insurance was not adequate for CSHCN (aOR 3.6, 95% CI 1.4-9.1). Further, these parents were more likely to report that providers never spend adequate time (aOR 6.3, 95% CI 1.2-34.4), provide sufficient information (aOR 8.0, 95% CI 2.5-25.0), act as partners in care (aOR 6.7, 95% CI 2.3-19.7), or display cultural sensitivity (aOR 5.4, 95% CI 1.2-24.3). CONCLUSIONS: An estimated 40,771 NYS CSHCN experience delayed/forgone routine health care. Their families report two noteworthy barriers: inadequate or discontinuous insurance coverage and poor communication with health-care providers. Access to care for CSHCN can be improved by increasing consistent comprehensive insurance coverage and increasing sensitivity in relationships between health care providers and families of CSHCN.

Adolescent↗
PubMed2005

A data driven process in Washington State to improve systems of care for children with special health care needs: the National Survey of CSHCN.

OBJECTIVES: The purpose of this article is to present strategies used in one state to engage public health stakeholders in the use of National Survey of Children With Special Health Care Needs (NS-CSHCN) results to improve systems of care for children with special health care needs (CSHCN). This is not a research report. METHODS: Seven "CSHCN Road Shows" were conducted with 39 local health departments, five state agencies, five parent leaders, three managed health care plans, and 12 school nurses. These "CSHCN Road Shows" were used to present and validate Washington State findings from the NS-CSHCN, obtain input on additional topics for analysis and elicit ways of incorporating NS-CSHCN results into the state's MCH Five Year Needs Assessment. RESULTS: Overall, a majority of stakeholders reported a high level of interest in using state-level data from the NS-CSHCN for local community efforts. Uses included program planning, presenting data to local boards of health and other community agencies, and utilizing results as talking points with other partners on the needs and unmet needs of the population. The state Title V office used feedback from "CSHCN Road Show" participants to prioritize program-planning activities, initiate policy discussions, and incorporate feedback into the MCH Five Year Needs Assessment. CONCLUSIONS: State-level data from the NS-CSHCN are a rich source of information for driving improvements in systems of care, facilitating state and local program planning efforts, writing grants, and completing MCH Five Year Needs Assessment activities.

Child↗
PubMed2005

Economic impact on families caring for children with special health care needs in New Hampshire: the effect of socioeconomic and health-related factors.

OBJECTIVES: To describe the economic impact on families of caring for children with special health care needs (CSHCN), and to determine the relative contributions of socioeconomic and health-related factors to these impacts on families in the State of New Hampshire. METHODS: Seven hundred and fifty families with CSHCN in New Hampshire were interviewed in the National Survey of Children with Special Health Needs. Among respondents with CSHCN, univariate and bivariate analyses were conducted to examine economic impact and independent factors (income, insurance type, and impact of condition). Multiple logistic and linear regression models were used to examine relationships between impact and independent factors, controlling for race/ethnicity. RESULTS: Compared to typical children, CSHCN were more likely to have public insurance (12% and 21%, respectively) and less likely to live in higher income families (56% and 48%, respectively). Among CSHCN, nearly one-quarter were greatly affected by their condition, 31% had inadequate insurance, families of 21% had financial problems, parents of 27% had to cut work hours, and almost 15% needed professional care coordination. Adjusting for other factors in regression models, the impact of the condition was associated with all measures of impact, insurance type was associated with out-of-pocket costs, and income was associated with the total number of impacts. Parents of children who are usually or always affected by their conditions were 14 times more likely than those who are never affected to need care coordination. CONCLUSION: A family's need for support services, and particularly for care coordination, may depend less on the family's means than on the impact of their child's condition.

Caregivers↗
PubMed2005

Health care access for children with special health care needs in California.

OBJECTIVES: This study examines health care access for children with special health care needs (CSHCN) in California, one of the nation's most populous and diverse states. METHODS: Data are from the National Survey of Children with Special Health Care Needs (NS-CSHCN), a nationally representative survey of access for U.S. children fielded by the National Center for Health Statistics (NCHS). California CSHCN and those in California's Medicaid program are compared with CSHCN elsewhere on child health need, family enabling factors, health care enabling factors, system outcomes, and children's experiences with care. Multivariable analysis identifies family and health care factors associated with system outcomes and children's experiences with health care. RESULTS: California parents generally report poorer experiences with care, lower performance on systems outcomes, and fewer health care and family enabling factors. The magnitude of disparity is greatest for CSHCN in Medi-Cal, although lower-income privately insured CSHCN in California also have poorer access than their counterparts in other states. Among CSHCN in Medicaid, greater condition impact and adolescent age are associated with poorer experiences in California for most measures. Disparities between California and other states persist even adjusting for family and health care factors in multivariable analysis. CONCLUSIONS: Performance gaps in California stem from population differences and apparent administrative barriers. Several statewide initiatives are addressing system barriers through supports to providers and information to parents.

California↗
PubMed2005

Impact of caring for children with special health care needs on the family: Rhode Island's experience.

OBJECTIVES: The impact of caring for children with special health care needs (CSHCN) on their families' finances and employment was studied. METHODS: Data from the 2001 National Survey of Children with Special Health Care Needs were used to measure financial and employment problems. The level of impact was examined by child's age, gender, ethnicity, race, mother's education, poverty status, and severity of the child's condition. The association between core outcome measures and the level of family impact was determined after adjusting for potential confounding factors. RESULTS: Financial or employment problems were more likely to occur among families with young children, with incomes below 200% poverty and with children whose condition usually/always affected their activities. Compared to families without these problems, impacted families were less likely to partner in decision making, be satisfied with services, receive comprehensive care in a medical home, have adequate health insurance, and feel service systems are organized for easy use. CONCLUSIONS: Many families of CSHCN face financial and employment problems and are less likely to have a medical home, adequate insurance, and access to health care services.

Adolescent↗
PubMed2006

Dyslipidemia in special populations: Asian Indians, African Americans, and Hispanics.

Cardiovascular disease (CVD) is the leading cause of death in the United States, and certain population groups, such as South Asians, African Americans, and Hispanics, carry a disproportionately larger burden of CVD manifested as coronary artery disease, cerebrovascular disease, and hypertension. Persons of these special populations experience approximately two- to threefold greater morbidity and mortality. Prevalence of risk factors, including dyslipidemia, overweight, and diabetes, is not only higher in these groups, but is also rising. The reasons for such disparity appear to be multifactorial and influenced by such factors as lifestyle, diet, culture, genetics, and suboptimal healthcare. Furthermore, because these minority populations are not significantly represented in major clinical trials, evidence-based management strategies for treatment and prevention of CVD are seriously lacking. Lately, however, several randomized trials of therapy for dyslipidemia to reduce cardiovascular events among these ethnic groups have been undertaken. Preliminary data suggest the need for stricter goals and increasingly aggressive therapy for these special populations, including administrative and educational interventions.

Black or African American↗
PubMed1992

Increasing safety belt use in a secondary enforcement state: evaluation of a three-county special enforcement program.

Special enforcement programs to increase belt use present a unique challenge in states with secondary enforcement laws. This paper reports findings from an evaluation of a combined public information and education/enforcement program to increase restraint use along a highly traveled corridor in three Michigan counties. This program (US-31 SAVE) was successful in increasing belt use at least temporarily along the special enforcement corridor. Observed belt use increased from a baseline rate of 56.7% to 65.1% during the program before slipping slightly to 62.7% after the intensive enforcement and PI&E declined (all differences significant at p less than .05). This paper details program and evaluation activities and suggests future research needs to better understand the most effective mix of public information and enforcement efforts in states with secondary belt use laws.

Adolescent↗
PubMed1980

Occurrence and significance of coagulative myocytolysis in the specialized conduction system: clinicopathologic observations.

In 5 of 18 selected human hearts (15 from patients with early myocardial infarction and severe coronary arterial obstruction), coagulative myocytolysis (myofibrillar degeneration with contraction bands) was demonstrated in the specialized conduction tissue. Its morphologic peculiarities, apparently inherent in the number and arrangement of the affected myofibrils in each type of specific myocell, are described. In nine cases the ordinary cardiac muscle was also involved; in all hearts concomitant changes were present. The debated toxic catecholamine and anoxic aspects of coagulative myocytolysis are briefly reviewed in light of the finding that specialized tissue seems to withstand myocytolytic damage (or any ischemic-anoxic injury) better than ordinary myocardium. This may also explain why coagulative myocytolysis is observed less frequently and evidently in specific rather than in ordinary myocells. Clinicopathologic comparisons focused on arrhythmias, although hampered by inadequacies in routine electrocardiographic documentation, suggest that coagulative myocytolysis of the conduction system may be relevant to life-threatening disturbances in impulse formation and conduction. These data, with their bearing on important current problems in cardiologic emergencies, deserve better morphopathophysiologic assessment.

Adult↗
PubMed1984

Specialized delivery systems for intravenous nitroglycerin. Are they necessary?

Nitroglycerin is absorbed in vitro into polyvinyl chloride tubing, and it has been recommended that nitroglycerin be administered intravenously through specialized polyethylene infusion sets. To determine if tubing type is essential to achieve physiologic effectiveness, we studied dose responses to intravenous nitroglycerin in 15 patients with heart failure using standard polyvinyl chloride tubing in seven (group 2) and special polyethylene infusion sets in seven (group 1) (one patient was excluded from analysis because of technical difficulties). We monitored heart rate, blood pressure, right atrial pressure, pulmonary artery pressure, pulmonary capillary wedge pressure, and cardiac output. Cardiac index, systemic and pulmonary vascular resistance, triple index, rate pressure product, stroke volume, stroke volume index, and stroke work index were calculated. Baseline and treatment measurements were obtained from five to 15 minutes after the infusion of 10, 20, 40, and 80 micrograms of nitroglycerin per minute. Over-all, systolic blood pressure decreased (p less than 0.05) about 8 percent and mean blood pressure approximately 12 percent, mean pulmonary artery pressure and mean pulmonary capillary wedge pressure decreased 30 to 40 percent, and the decline in mean right atrial pressure was 35 percent of baseline (all p less than 0.05). Heart rate and cardiac index did not change (p greater than 0.05). Pulmonary vascular resistance decreased slightly (p = 0.07) and systemic vascular resistance significantly (p less than 0.05). When the two groups were compared physiologic changes were virtually identical (p less than 0.05). Two-way analysis of variance for baseline corrected data proved no differences between tubing sets (p less than 0.05), but the infusion concentration rate was highly related to response (p = 0.0001). A significant (p less than 0.05) decrease in mean blood pressure and mean right atrial pressure was noted at lower dose rates (20 micrograms per minute and 40 micrograms per minute, respectively) in group 1. Beneficial hemodynamic effects in heart failure patients can, then, be predicted to occur at 80 micrograms per minute infusion rates; these responses seem independent of the type of infusion tubing system employed. Additionally, when patients given intravenous nitroglycerin for various reasons were followed for 48 hours, the majority receiving infusions via polyvinyl chloride tubing (group 2) did not require dosage adjustments. Also, at lower flow rates, more solution than calculated may be delivered when polyethylene tubing infusion sets are employed with volumetric infusion pumps.

Blood Pressure↗
PubMed1993

Design for the elderly: user-based evaluation studies involving elderly users with special needs.

Although a considerable amount is known about the ageing process, very little is known about the consumer needs of elderly people with special needs. On the whole a large proportion make do with 'ordinary' products to the best of their ability. The Special Needs Research Unit's extensive experience of evaluating such products highlights the fact the access to domestic appliances can be enhanced if attention is paid to basic human factors issues at the drawing-board stage. For manufacturers it is potentially the most effective means of enlarging their markets. A user-based evaluation strategy is described centering on two well-known products. It is suggested that paying attention to specific features in the early stages of design would result in better products for all.

Journal Article↗
PubMed1980

Different regional specializations of neurons in the ganglion cell layer and inner plexiform layer of the California horned shark, Heterodontus francisci.

We have described a population of neurons in the retinal of a shark, Heterodontus francisci, which is precisely aligned within the inner plexiform layer (IPL) and which differs from neurons in the ganglion cell layer (GCL) in soma size and topographical distribution. GCL neurons are relatively small and form a horizontally oriented visual streak; IPL neurons are significantly larger and form a circular specialization in the far temporal retina. Thus, it appears that there are two distinct retinal specializations in Heterodontus: one subserving frontal vision and one which provides a panoramic view of the lateral visual field.

Animals↗