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PubMed2000

Adolescent sexual offender recidivism: success of specialized treatment and implications for risk prediction.

OBJECTIVE: To evaluate the success of specialized community-based treatment for reducing adolescent sexual reoffending and explore the predictive utility of variables assessed regarding sexual and nonsexual recidivism. METHOD: Recidivism data (criminal charges) were collected for 58 offenders participating in at least 12 months of specialized treatment at the SAFE-T Program. Data were also collected for a comparison group of 90 adolescents who received only an assessment (n = 46), refused treatment (n = 17), or dropped out before 12 months (n = 27). Follow-up interval ranged from 2 to 10 years (M = 6.23, SD = 2.02). Offenders completed a battery of psychological tests to provide standardized data regarding social, sexual, and family functioning. RESULTS: Recidivism rates for sexual, violent nonsexual, and nonviolent offenses for treated adolescents were 5.17%, 18.9%, and 20.7%, respectively. The Comparison group had significantly higher rates of sexual (17.8%), violent nonsexual (32.2%), and nonviolent (50%) recidivism. Sexual recidivism was predicted by sexual interest in children. Nonsexual recidivism was related to factors commonly predictive of general delinquency such as history of previous offenses, low self-esteem, and antisocial personality. CONCLUSIONS: Results support the efficacy of treatment for adolescent sexual offenders and are consistent with the notion that sexual recidivism is predicted by unique factors unrelated to general (nonsexual) reoffending.

Adolescent↗
PubMed1996

The floor plate of the hindbrain is a highly specialized gland. Immunocytochemical and ultrastructural characteristics.

Although the participation of the floor plate (FP) in the differentiation of neurons in the ventral spinal cord is well established, the function of the FP at the level of the hindbrain is not known. The present investigation was focused on the FP of the rat hindbrain. We used an antibody specifically labeling the rat FP (FP4) and an antiserum raised against the secretory glycoproteins of the subcommissural organ that also reacts with an intracellular material in the FP. Immunocytochemical and ultrastructural evidence was obtained indicating that the rostralmost end of the FP, at the metencephalon, is a highly specialized gland which differentiates early and undergoes regression before birth. The material(s) secreted by these FP cells appear to be transported downward into their basal processes, and upward into ventricular protrusions. It is proposed that the former would participate in the differentiation of the serotonergic neurons, and the latter could be released into the ventricle and reach distant targets. Furthermore, evidence is presented supporting the occurrence of regional and temporal specializations of the FP.

Animals↗
PubMed2005

[Urological attendance in the Integral Health Center "Alto Palancia": model of primary-specialized integration and unique consultation].

INTRODUCTION AND OBJECTIVE: The progressive increase in the demand of urological attendance demands to establish new welfare models that avoid the saturation of consultations and improve the quality in the attention to the user. The objective of this work is to analyze the improvement of the welfare activity developed in Integral the Sanitary Center Alto Palancia, after the restoration of new welfare models based on integration between Attention Primary and Specialized and the putting in practice of the denominated Unique Consultation. MATERIAL AND METHODS: We analyzed the characteristics of the Center, functions and activity of the specialty developed during year 2002. We described to the application of the model of Unique Consultation and the elements of integration with Primary Attention. We analyzed the improvement of the activity through indicators, that we compared with preceding years. In order to determine the degree of satisfaction of the users we made a survey of opinion of patients and/or taken care of relatives in the Center under the new welfare models. Finally we analyzed the advantages that the applied process presents for the patient and the own sanitary institution. RESULTS: 42% of patients have been taken care of by means of the model of Unique Consultation, being the predominant pathology the HBP in the man and the ITUs in the woman. The time of delay for first visit has been reduced from 49 days in single December 2001 to 3 in December 2002. Single 7.7% of patients discharged from the hospital for pursuit by Primary Attention have been sent again to the specialist. The time that the urólogo dedicates to consultations has reduced in a 29%, being this time dedicated to the accomplishment smaller surgery and final reconnaissances (echography, urodynamic studies and others). The opinion survey has shown a satisfaction of the user very elevated. CONCLUSION: The model of Integral Attention Primary-Specialized and the putting in practice of Unique Consultation applicable to the specialty of Urology, increasing the quality perceived by the user and with evident advantages for the Sanitary Organization.

Humans↗
PubMed2004

[Prevalence of the HIV infection in patients seen at specialized diagnosis centers in 9 cities in Spain from 1992 to 2001].

OBJECTIVE: To describe the prevalence of HIV infection in persons tested between 1992 and 2001. DESIGN: Descriptive, cross-sectional epidemiological study. SETTING: 10 ambulatory centers specialized in diagnosing HIV, located in 9 cities in Spain. PARTICIPANTS: 53,183 persons older than 12 years, tested for the first time for HIV. MAIN MEASURES: Number of persons tested per year, number of persons diagnosed as seropositive for HIV according to sex, age group and category of exposure. RESULTS: The number of persons tested increased from 4401 in 1992 to 6407 in 2001. Approximately half reported heterosexual risk exposure/exposure through high-risk heterosexual behaviors, excluding prostitution. Intravenous drug users (IVDU) increased from 15.3% in 1992-1993 to 1.4% in 2000-2001, and women prostitutes/female sex workers increased from 6.7% to 25.1%. A total of 2898 persons were diagnosed as having HIV infection; 78% of them were men. The number of diagnoses decreased from a high of 1058 in 1992-1993 to 304 in 2000-2001, and this trend was seen for all categories of exposure except female prostitutes and men with heterosexual risk factors. The prevalence decreased from 14% in 1992 to 2% in 2001. There were decreases in all categories of exposure, especially during the first years of the study, with a tendency to level off. In 2001 the prevalence figures were 23.8% for IVDU, 7.9% for homosexual men and women, 0.8% for female sex workers and 1% for other heterosexual men and women. CONCLUSIONS: The specialized diagnostic centers play an important role in diagnosing HIV, and this service complements primary care services. Greater efforts are needed in the prevention of HIV infection.

Adult↗
PubMed1999

From what and why did genetics emerge as a medical specialism in the 1970s in the UK? A case-history of research, policy and services in the Manchester region of the NHS. National Health Service.

The history of genetics has concentrated on eugenics in the first half of the 20th century and molecular genetics in the second. There is yet little historical analysis of the emergence of genetics as a medical specialism, even for the USA. This paper explores the creation of a regional genetic service in Manchester, UK. It surveys the ways in which hereditary diseases were managed and investigated in the first two decades of the NHS (1948-68), and the marginality of geneticists in this period. It suggests that the emergence of consultant geneticists as conspicuous service specialists depended heavily on their ability to create and control laboratory and counselling services for antenatal diagnosis, especially of Down's syndrome, from the late 1960s. These services, for syndromes that were not strongly hereditary, helped extend the meaning of 'genetic' in medicine from 'hereditary' to 'related to chromosomes and genes'. The services received government support because of popular demand for diagnoses (following the Abortion Act of 1967), because 'preventive services' were seen as cost effective, and because geneticists could argue that inadequate counselling might give rise to legal difficulties. By linking laboratory services and counselling, geneticists offered an integrated service, in line with other consultant-led services (e.g. for kidneys) which linked research, laboratory services, clinical work, and education/public health functions. We suggest such services fitted the hospital-dominated political economy of medicine which underlay the NHS re-organisation of 1974; and that the salience of the new genetics owed much to this combination of high-science and public concern. Geneticists were then able to integrate molecular genetics into key regional centres, so shaping the initial phases of the 'molecular' revolution. We maintain that this local study offers useful wider insights, not only into the development of a key specialism, but also into the changing dynamics of research and policy in the NHS.

Genetics, Medical↗
PubMed2003

Do separate processes identify objects as exemplars versus members of basic-level categories? Evidence from hemispheric specialization.

When an object is identified as a specific exemplar, is it analyzed differently than when it is identified at the basic level? On the basis of a previous theory, we predicted that the left hemisphere (LH) is specialized for classifying objects at the basic level and the right hemisphere (RH) is specialized for classifying objects as specific exemplars. To test this prediction, participants were asked to view lateralized pictures of animals, artifacts, and faces of famous people; immediately after each picture was presented, a label was read aloud by the computer, and the participants decided whether the label was correct for that picture. A label could name the object at either the basic level (e.g., bird) or as an exemplar (e.g., robin). As predicted, we found that basic-level labels were matched faster when pictures were presented in the right visual field (and hence encoded initially in the LH), whereas exemplar labels were matched faster when pictures were presented in the left visual field (and hence encoded initially in the RH).

Adult↗
PubMed2000

Haber's rule: a special case in a family of curves relating concentration and duration of exposure to a fixed level of response for a given endpoint.

The concept that the product of the concentration (C) of a substance and the length of time (t) it is administered produces a fixed level of effect for a given endpoint has been ascribed to Fritz Haber, who was a German scientist in the early 1900s. He contended that the acute lethality of war gases could be assessed by the amount of the gas in a cubic meter of air (i.e. the concentration) multiplied by the time in min that the animal had to breathe the air before death ensued (i.e. C x t=k). While Haber recognized that C x t=k was applicable only under certain conditions, many toxicologists have used his rule to analyze experimental data whether or not their chemicals, biological endpoints, and exposure scenarios were suitable candidates for the rule. The fact that the relationship between C and t is linear on a log-log scale and could easily be solved by hand, led to early acceptance among toxicologists, particularly in the field of entomology. In 1940, a statistician named Bliss provided an elegant treatment on the relationships among exposure time, concentration, and the toxicity of insecticides. He proposed solutions for when the log-log plot of C and t was composed of two or more rectilinear segments, for when the log-log plot was curvilinear, and for when the slope of the dosage-mortality curve was a function of C. Despite the fact that Haber's rule can underestimate or overestimate effects (and consequently risks), it has been used in various settings by regulatory bodies. Examples are presented from the literature of data sets that follow Haber's rule as well as those that do not. Haber's rule is put into perspective by showing that it is simply a special case in a family of power law curves relating concentration and duration of exposure to a fixed level of response for a given endpoint. Also shown is how this power law family can be used to examine the three-dimensional surface relating C, t, and varying levels of response. The time has come to move beyond the limited view of C and t relationships inferred by Haber's rule to the use of the broader family of curves of which this rule is a special case.

Animals↗
PubMed1994

Invasive micropapillary carcinoma of the breast. A new special type of invasive mammary carcinoma.

After reviewing 986 consecutive cases of breast carcinoma from our files, 27 ductal infiltrating cancers showing micropapillary differentiation in invasive areas (MP) were selected. Special immunohistological and ultrastructural techniques were used, and their characteristics compared to those of the Not Otherwise Specified type of carcinomas (NOS). Diagnostic areas of MP were easily identified in H&E sections and were composed of solid or tubular neoplastic cell groups inside a spongy background, where they appeared to swim in aqueous or mucinous material. Neoplastic cells displayed the reverse polarity typical of the papillary phenotype. This was revealed by the detection of acid mucinous rims, lineal deposits of EMA substances, and microvilli in a peripheral position, even in areas where the micropapillae resembled tubules. Histologically, most MP were mixed with N0S, Papillary, or Mucinous patterns, but regardless of the extension of their micropapillary diagnostic component, their tumour size, or their WHO histological grade, two thirds had extensive lymphatic vessel invasion and all the cases presented massive axillary lymph node metastasis. Six of the twelve patients followed died within a mean of 22 months. In conclusion, we propose the recognition of "Invasive Micropapillary Carcinoma of the Breast" as a new special entity with a potentially high degree of aggressiveness.

Breast Neoplasms↗
PubMed1985

Cystadenolymphoma: an immunohistochemical study with special reference to Ig E and mastcells.

Cystadenolymphomas (adenolymphomas) were analysed by immunohistochemical studies for the presence of immunoglobulin A, E, G and M. The distribution pattern was examined by a quantitative analysis. The relative ratio of immunoglobulins was 31.8% (Ig A), 26.6% (Ig E), 28.6% (Ig G) and 13% (Ig M). The different compartments of the lymphoid stroma were analysed separately (subepithelial area, parafollicular area, follicular area). The distribution of mast cells was studied in a parallel approach by the toluidine blue technique. These cells were found in the stroma, but also in the epithelial parts. Our results show that the subepithelial zone in cystadenolymphomas is a region of special cellular reaction (plasma cells, mast cells). The Ig E producing plasma cells and the mastcells seem to play a special role in these tumors.

Adenolymphoma↗
PubMed1976

Specialized blood filters and fresh whole blood.

Platelet counts and platelet functions were determined in fresh whole blood before and after it passed through two types of specialized transfusion filters. Both filters were capable of trapping 20% to 40% of the functional platelets, necessary for hemostasis, especially if heparin was used as the anticoagulant. When fresh whole blood is needed to treat the bleeding patient who has already received massive blood transfusions, these specialized filters should probably not be used.

Blood Platelets↗
PubMed2004

[Sensitivity and specificity of two methods used to identify incident breast cancer in specialized units using claims databases].

BACKGROUND: Hospital claims databases from acute care units are available nationwide and contain most patients at the beginning of their cancer. The goal is to define the ability of these databases to provide a number of incident breast cancer cases using identification methods. Two identification methods were assessed in three specialized sections of a teaching hospital. METHODS: The first method identified women who had at least one stay with a principal diagnosis of breast cancer. The second, which is more restrictive, identified women who had at least one stay with a principal diagnosis of breast cancer and a breast cancer-specific surgical treatment code. Both methods were applied to 4588 women 20 Years of age or older hospitalized in three specialized sections of the Hospices Civils de Lyon in 2000. To categorize these women in two groups, incident breast cancer cases or non-incident breast cancer cases, 150 women were randomized in each of two groups, one for incident breast cancer cases and one for non-incident breast cancer cases. Their medical records were used as references. RESULTS: Sensitivity, specificity and their credibility intervals were respectively 99.4% (84-99.9) and 91.7% (90.3-93.3) for the first method and 93.8% (76.2-98.7) and 97.3% (96.1-98) for the second. Among women wrongly identified with an incident breast cancer in 2000, 75.4% (43/57) had a breast cancer that was not incident that Year with the first method, compared to 96% (24/25) with the second. Among these women wrongly identified with an incident breast cancer, coding errors of the principal diagnosis were found for 24.6% (14/57) of patients with the first method and for 4% (1/25) with the second. Their correction led to 99.2% (86.5-99.9) sensitivity and 92.9% (91.4-94.6) specificity for the first method and to 94.2% (76.5-98.7) sensitivity and 97.3% (96.2-98.1) specificity for the second. CONCLUSIONS: The second method using cancer-specific surgical codes appeared more specific with a slight loss in sensitivity. The use of identification methods to assess the number of incident cancer cases still have to be defined.

Adult↗
PubMed2006

[Use of a directory of specialized services and guidance in the healthcare system: the example of the Orphanet database for rare diseases].

BACKGROUND: Orphanet is a database of rare diseases which includes a directory of services providing information on professional experts working either in laboratories offering diagnostic tests or in specialized outpatient clinics. The printed directory is sent to these experts, to all relevant hospital departments (public and private), healthcare authorities, and patient support groups. The directory is also available online (www.orpha.net). The aims of this study were (i) to determine how the directory is used to refer patients and send specimens, and (ii) to investigate its impact on patient referral. METHODS: Data were obtained from experts and patient support groups concerned with rare diseases, as well from non-expert health professionals and patients. Emphasis was placed on knowledge of the Orphanet database, use of the directory as a tool for referrals, opinion of users about the quality of the directory, and opinion of the referenced experts about its possible impact on their referrals. Four methods of data collection were used: (i) a postal questionnaire to all referenced experts; (ii) an on-line questionnaire posted for a few hours on the Orphanet Website that had to be completed to access the site; (iii) interviews with 25 of the referenced experts; (iv) interviews with 35 leaders of patient organizations. Data were analysed using the chi2 test and logistic regression. RESULTS: Response rates were good: 74% of laboratory experts (224/304) and 68% of clinicians (459/678) answered the questionnaire. The responders proved to be representative. Among those who responded, 85% of the laboratory experts and 80% of clinician experts used Orphanet. More than two-thirds of them used Orphanet to identify (other) laboratories to them send specimens, and (other) clinicians for patient referral. Some non-expert hospital-based clinicians had nearly the same use. Patient support groups also used the directory. Persons using the directory happened to know Orphanet in their professional environment. Conversely, patients, non-MDs healthcare professionals and professionals in private practice discovered Orphanet using search engines, often when searching information about a rare disease. Of those who had already accessed the directory, most (94%) consider that the quality of the lists was "good" or" rather good". Among the experts, 29% of laboratories and 9% of clinicians considered that Orphanet had an impact on their referrals. CONCLUSION: The Orphanet directory is used to refer patients and specimens, especially by experts and patient organizations. It appears to have more impact on referrals within the healthcare system for laboratories than for specialized outpatient clinics. The impact is strong when expertise in the field is very scarce.

Databases as Topic↗
PubMed2000

Knowledge and attitudes of high school pupils towards children with special health care needs: an Israeli exploration.

One hundred seventy-one pupils of a high school in Holon (Israel) were questioned regarding their attitudes towards chronically disabled individuals who have special health-care needs. The level of pupils' knowledge concerning the etiology, symptoms and complications of these chronic conditions was approximately 72%; it did not increase in four years of study. Previous personal knowledge of a child or adolescent with a chronic disease or handicap influenced the understanding of that particular ailment. The pupils' attitude towards handicapped individuals become more positive and tolerant with increasing age (and class level). A correlation was found between the level of knowledge about special medical-health needs and tolerant attitudes toward chronic patients. Most of the pupils think that the following occupational and recreational interests for the disabled will help to increase their self-image and improve their feelings of acceptance: computers, music (playing and listening), sports and domestic pets. The pupils believe the topics of chronic diseases and patients should be studied as a regular part of the school curriculum and these subjects should be taught with the participation of both physicians and teachers. The pupils stressed the role of the teacher in handling children with the chronic disease. Only half of the pupils think that their class peers should also know about the chronic disease of this individual pupil. The information sources of pupils concerning chronic disease are mainly TV, newspapers, adolescent periodicals, books, physicians and nurses, and lastly, the school. Conclusions are presented concerning health promotion activities in the school.

Adolescent↗
PubMed2003

Special operative considerations in musicians.

Musicians are a unique group, requiring digital control and skills at the highest levels. Each instrument has its own special needs and the musician must be seen in the context of the instrument played. Surgery also must be seen in this context. The special areas of modification of technique and some of the more commonsurgical situations encountered in musicians are considered in this article.

Finger Joint↗
PubMed2002

Dry powder inhalation of antibiotics in cystic fibrosis therapy, part 1: development of a powder formulation with colistin sulfate for a special test inhaler with an air classifier as de-agglomeration principle.

The aim of this study was to investigate the pulmonary administration of antibiotics as dry powder to patients with cystic fibrosis (CF), as an alternative for nebulization. This part of the study describes the development of a powder formulation with colistin sulfate as model substance. The aim of the new dosage form was to increase pulmonary deposition, therapeutic efficiency and, by that, compliance by the CF patients. A physical powder mixture of colistin and a size fraction of lactose (106-150 microm) was prepared and the mixture was optimized with respect to colistin content (83.3%) for use in a special test inhaler. A laser diffraction apparatus with special inhaler adapter was applied for analysis of the size distribution of the aerosol cloud from the inhaler. The size distributions of the aerosol clouds from the test inhaler at flow rates between 30 and 60 l/min for the optimized formulation showed nearly the same median diameter as that for the primary drug particles. But the X(100)-value was much lower, because of an effective large particle separation from the inspiratory air by an air classifier in the test inhaler. The results suggest that dry powder inhalation might be a suitable and highly efficient alternative for nebulization of antibiotic drugs in CF therapy.

Administration, Inhalation↗
PubMed1996

Special features of the intestinal lymphocytic system.

The gastrointestinal lymphocytic system can be divided in two functional compartments, the organized lymphoid tissue, for example, the Peyer's patches, and the lymphocytes located diffusely in the mucosa, the lamina propria lymphocytes (LPL), and the intra-epithelial lymphocytes (IEL). Antigens enter the Peyer's patches as the afferent part of the GALT via specialized epithelial cells called M cells. After the initiation of the immune response by antigen processing and presentation to B and T cells in Peyer's patches, primed lymphocytes leave the mucosa via the thoracic duct. Finally they migrate back to the mucosa where they exert effector functions. Adhesion molecules, including integrins, especially alpha 4 beta 7 and alpha E beta 7 (HML-1) are involved in these homing and adhesion processes. LPL and LEL differ from peripheral blood lymphocytes in their expression of adhesion molecules and other surface and activation markers. Additionally, they exhibit functional features different from those of other lymphocyte compartments. In the mucosal immune system, plasma cells mainly secrete IgA, which is part of the specialized humoral defence in the gut.

Animals↗
PubMed1999

Special-interest subgroups at the ASCB: Gap junctions.

The annual meeting of the American Society for Cell Biology (ASCB) is a large and diverse gathering. At last year's meeting**The American Society for Cell Biology 38th Annual Meeting, San Francisco, USA; 12-16 December, 1998. Program chair: Jennifer Lippincott-Schwartz., there were over 8000 attendees, and the topics discussed covered many areas of cell biology. It would be impossible to cover the entire meeting within a trends in CELL BIOLOGY report, so instead we are focusing on an aspect of it that provided some of the most interesting and fruitful discussions. On Saturday afternoon, before the main symposia began, there were 11 special-interest subgroup meetings. The atmosphere at these meetings was informal, and they encouraged open and frank discussion of data and issues. This report provides a brief summary of the discussions at seven of the special-interest subgroup meetings.

Journal Article↗
PubMed1999

Special-interest subgroups at the ASCB: Are there multiple roles for the Ran GTPase?

The annual meeting of the American Society for Cell Biology (ASCB) is a large and diverse gathering. At last year's meeting**The American Society for Cell Biology 38th Annual Meeting, San Francisco, USA; 12-16 December, 1998. Program chair: Jennifer Lippincott-Schwartz., there were over 8000 attendees, and the topics discussed covered many areas of cell biology. It would be impossible to cover the entire meeting within a trends in CELL BIOLOGY report, so instead we are focusing on an aspect of it that provided some of the most interesting and fruitful discussions. On Saturday afternoon, before the main symposia began, there were 11 special-interest subgroup meetings. The atmosphere at these meetings was informal, and they encouraged open and frank discussion of data and issues. This report provides a brief summary of the discussions at seven of the special-interest subgroup meetings.

Journal Article↗