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Biomedical subjects

H Lane

Publications and source records attributed to H Lane.

At least 19 recordsLinked to original sources
PubMed2005

July 2004: 40-year-old man with headaches and dyspnea.

A 40-year-old man had a 6-week history of severe frontal headaches and dry cough. Chest x-ray showed hilar adenopathy with bilateral parenchymal infiltrates. A diagnosis of atypical pneumonia was made. Four weeks later he was admitted with persistent headache. Infectious screen was negative. Brain MR post contrast, revealed cerebellar enhancement and swelling with moderate tonsillar herniation; findings which precluded the performance of a lumbar puncture. High resolution CT thorax confirmed hilar abnormalities; shown by microscopy to represent non caseating granulomata. A presumptive diagnosis of sarcoidosis was reached. Despite an initial symptomatic improvement his headache persisted. Repeat MRI, eleven days after admission, showed reduced cerebellar enhancement and swelling with no change in the degree of tonsillar herniation. He deteriorated acutely and died two weeks after admission. Autopsy revealed cerebral oedema with tonsillar herniation secondary to cryptococcal meningitis variety neoformans. There was no evidence of neurosarcoid. Active and inactive sarcoid was identified in the lungs and hilar nodes with no evidence of systemic sarcoid. Focal evidence of cryptococcal pneumonitis was present in the lung as a necrotic focus. A strong index of clinical suspicion is necessary to diagnose the rare association of cryptococcus complicating sarcoidosis.

Adult↗
PubMed2004

Link Family Support - an evaluation of an in-home support service.

A significant body of research has shown that parents who have a child or a dependent adult with a disability experience significant and persistent levels of stress. One of the recognized strategies for coping includes the provision of in-home practical support. Enable Ireland provides a range of services for children and adults with a physical disability. The present study explored home support services with a sample of 16 families of service users of Enable Ireland Cork. Practical support was deemed to be whatever support or intervention requested by the parent of the child/dependent adult which afforded the service user the opportunity to engage in social/recreational opportunities and that gave the parent free time. Sixteen members of the chosen families were interviewed (15 mothers and one father) using a semi-structured interview schedule and a standardized stress measure before and after the introduction of Link Family Support (LFS). LFS was put in place for a period of 12 months, tailored to the families and service users' individual needs. Although levels of stress continued to be high and scores on the Parenting Stress Index (PSI) did not show a statistically significant reduction after the programme, reported stress levels had improved. Parents reported LFS to be very helpful in reducing perceived stress and improving family's quality of life through providing free time and access to leisure and recreation facilities. This study provided limited but clear evidence of the need for regular, flexible, in-home support for families with children and dependent adults with a disability. LFS provided a personal, regular and effective means of meeting this need as the findings of this study demonstrated.

Adolescent↗
PubMed2003

The effects of depot long-acting somatostatin analog on central aortic pressure and arterial stiffness in acromegaly.

Acromegaly is associated with increased cardiovascular risk. Although conventional risk factors such as glucose intolerance, hypertension, and dyslipidemia probably contribute, there may also be direct effects of GH/IGF-I excess on the vasculature. To study the effects of GH excess on the vasculature, we have assessed arterial stiffness in acromegalic subjects with and without active disease and have investigated the effects of Sandostatin LAR (OCT-LAR) on vascular function. Sixteen normotensive subjects with acromegaly (10 males and 6 females) and 8 healthy controls were studied. Of the acromegalic subjects, eight had active disease (group A), and eight were cured (GH < 2.5 mU/liter; group B). The three groups were age, sex, and blood pressure matched. Group A subjects were restudied after 3 and 6 months of OCT-LAR therapy. Arterial stiffness was assessed by analyzing central arterial pressure waveforms derived from measured radial artery waveforms. This allowed determination of the augmentation of central pressure and the augmentation index. Lipids, glucose, and IGF-I were also measured. Comparing the three groups (ANOVA; mean +/- SD), the augmentation index was higher in group A (28 +/- 12 vs. 12 +/- 13%; P < 0.01) but not in group B (22 +/- 7 vs. 12 +/- 13%; P = 0.60), compared with controls. IGF-I was higher in group A (50.3 +/- 21.2 nmol/liter; P < 0.01), compared with group B (22.5 +/- 8.9 nmol/liter) and controls (19.5 +/- 5.3 nmol/liter). On regression analysis, IGF-I concentration was identified as a strong independent predictor of the augmentation index (beta = 0.50; P = 0.007). There were no significant differences in aortic systolic pressure, aortic diastolic pressure, lipids, or glucose. Compared with baseline, OCT-LAR treatment resulted in a lowering of augmentation index at 3 months (20 +/- 15 vs. 28 +/- 12%; P < 0.05), but at 6 months (24 +/- 16%; P = 0.21) there was no significant change. IGF-I was reduced from 50.3 +/- 21.2 nmol/liter at baseline to 31.4 +/- 13.2 nmol/liter at 3 months (P < 0.05) and 26.6 +/- 15.8 nmol/liter at 6 months (P < 0.05). In conclusion, acromegaly is associated with changes in the central arterial pressure waveform, suggesting large artery stiffening. This may have important implications for cardiac morphology and performance in acromegaly as well as increasing the susceptibility to atheromatous disease. Large artery stiffness is reduced in cured acromegaly and partially reversed after pharmacological treatment of active disease.

Acromegaly↗
PubMed2001

The effects of changes in hearing status in cochlear implant users on the acoustic vowel space and CV coarticulation.

In order to examine the role of hearing status in controlling coarticulation, eight English vowels in /bVt/ and /dVt/ syllables, embedded in a carrier phrase, were elicited from 7 postlingually deafened adults and 2 speakers with normal hearing. The deaf adults served in repeated recording sessions both before and up to a year after they received cochlear implants and their speech processors were turned on. Each of the two hearing control speakers served in two recording sessions, separated by about 3 months. Measures were made of second formant frequency at obstruent release and at 25 ms intervals until the final obstruent. An index of coarticulation, based on the ratio of F2 at vowel onset to F2 at midvowel target, was computed. Changes in the amount of coarticulation after the change in hearing status were small and nonsystematic for the /bVt/ syllables; those for the /dVt/ syllables averaged a 3% increase--within the range of reliability measures for the 2 hearing control speakers. Locus equations (F2 at vowel onset vs. F2 at vowel midpoint) and ratios of F2 onsets in point vowels were also calculated. Like the index of coarticulation, these measures tended to confirm that hearing status had little if any effect on coarticulation in the deaf speakers, consistent with the hypothesis that hearing does not play a direct role in regulating anticipatory coarticulation in adulthood. With the restoration of some hearing, 2 implant users significantly increased the average spacing between vowels in the formant plane, whereas the remaining 5 decreased that measure. All speakers but one also reduced vowel duration significantly. Four of the speakers reduced dispersion of vowel formant values around vowel midpoint means, but the other 3 did not show this effect.

Adult↗
PubMed2001

Covariation of cochlear implant users' perception and production of vowel contrasts and their identification by listeners with normal hearing.

This study investigates covariation of perception and production of vowel contrasts in speakers who use cochlear implants and identification of those contrasts by listeners with normal hearing. Formant measures were made of seven vowel pairs whose members are neighboring in acoustic space. The vowels were produced in carrier phrases by 8 postlingually deafened adults, before and after they received their cochlear implants (CI). Improvements in a speaker's production and perception of a given vowel contrast and normally hearing listeners' identification of that contrast in masking noise tended to occur together. Specifically, speakers who produced vowel pairs with reduced contrast in the pre-CI condition (measured by separation in the acoustic vowel space) and who showed improvement in their perception of these contrasts post-CI (measured with a phoneme identification test) were found to have enhanced production contrasts post-CI in many cases. These enhanced production contrasts were associated, in turn, with enhanced masked word recognition, as measured from responses of a group of 10 normally hearing listeners. The results support the view that restoring self-hearing allows a speaker to adjust articulatory routines to ensure sufficient perceptual contrast for listeners.

Adult↗
PubMed2001

Cancrum oris in a Caucasian male with Type 2 diabetes mellitus.

We describe a patient with Type 2 diabetes mellitus who developed cancrum oris requiring extensive oro-facial reconstructive surgery. There are no previous published reports of cancrum oris occurring in a Caucasian subject with no risk factors other than Type 2 diabetes.

Aged↗
PubMed2001

Multifocal fibrosclerosis: a case of thyroiditis and bilateral lacrimal gland involvement.

A patient with invasive fibrous thyroiditis (Riedel's thyroiditis), dysphagia, and bilateral lacrimal gland involvement is described. Resolution of the thyroid mass and orbital swellings followed corticosteroid therapy. The unusual ocular features of this case are briefly discussed and the use of corticosteroid and other immunosuppressant therapy in multifocal fibrosclerosis is reviewed.

Adrenal Cortex Hormones↗
PubMed2001

Changes in speech intelligibility of postlingually deaf adults after cochlear implantation.

OBJECTIVE: This study examines changes in the intelligibility of CVC words spoken by postlingually deafened adults after they have had 6 to 12 mo of experience with a cochlear implant. The hypothesis guiding the research is that the intelligibility of these speakers will improve after extended use of a cochlear implant. The paper also describes changes in CVC word intelligibility analyzed by phoneme class and by features. DESIGN: The speech of eight postlingually deaf adults was recorded before activation of the speech processors of their cochlear implants and at 6 mo and 1 yr after activation. Seventeen listeners with no known impairment of hearing completed a word identification task while listening to each implant user's speech in noise. The percent information transmitted by the speakers in their pre- and postactivation recordings was measured for 11 English consonants and eight vowels separately. RESULTS: An overall improvement in word intelligibility was observed: seven of the eight speakers showed improvement in vowel intelligibility and six speakers showed improvement in consonant intelligibility. However, the intelligibility of specific consonant and vowel features varied greatly across speakers. CONCLUSIONS: Extended use of a cochlear implant by postlingually deafened adults tends to enhance their intelligibility.

Aged↗
PubMed2001

Language-specific, hearing-related changes in vowel spaces: a preliminary study of English- and Spanish-speaking cochlear implant users.

OBJECTIVE: This study investigates the role of hearing in vowel productions of postlingually deafened cochlear implant users. Two hypotheses are tested that derive from the view that vowel production is influenced by competing demands of intelligibility for the listener and least effort in the speaker: 1) Hearing enables a cochlear implant user to produce vowels distinctly from one another; without hearing, the speaker may give more weight to economy of effort, leading to reduced vowel separation. 2) Speakers may need to produce vowels more distinctly from one another in a language with a relatively "crowded" vowel space, such as American English, than in a language with relatively few vowels, such as Spanish. Thus, when switching between hearing and non-hearing states, English speakers may show a tradeoff between vowel distinctiveness and least effort, whereas Spanish speakers may not. DESIGN: To test the prediction that there will be a reduction of average vowel spacing (AVS) (average intervowel distance in the F1-F2 plane) with interrupted hearing for English-speaking cochlear implant users, but no systematic change in AVS for Spanish cochlear implant users, vowel productions of seven English-speaking and seven Spanish-speaking cochlear implant users, who had been using their implants for at least 1 yr, were recorded when their implant speech processors were turned off and on several times in two sessions. RESULTS: AVS was consistently larger for the English speakers with hearing than without hearing. The magnitude and direction of AVS change was more variable for the Spanish speakers, both within and between subjects. CONCLUSION: Vowel distinctiveness was enhanced with the provision of some hearing in the language group with a more crowded vowel space but not in the language group with fewer vowels. The view that speakers seek to minimize effort while maintaining the distinctiveness of acoustic goals receives some support.

Adult↗
PubMed2000

Using a standardized family to teach clinical skills to medical students.

BACKGROUND: The use of standardized patients has been an accepted instructional methodology in medical education for many years. A logical evolution of this methodology is the creation of a standardized patient family. DESCRIPTION: This article describes one such standardized family, the Jones family, and how the family is used to teach interpersonal skills, interviewing, communication, counseling, and history-taking skills to medical students. EVALUATION: After several years of using the Jones family, we have found that more comprehensive scripts need to be developed, that recruitment and retention of standardized patients for a year long program does not seem to be a problem, and that the value added by a standardized family greatly enhances the educational experience for students. A standardized family seems a logical educational vehicle for teaching continuity of care, confidentiality, contextual placement of medical information within family dynamics, cultural beliefs, community orientation, and generalism. CONCLUSION: A standardized family is a viable instructional methodology that deserves greater use in medical education.

Adolescent↗
PubMed1999

Critical path plan for food and nutrition research required for planetary exploration missions.

In preparation for future planetary exploration, NASA-Johnson Space Center has developed a critical path plan for food and nutrition research needs. The plan highlights the risk factors pertaining to food and nutrition associated with exposure to the space flight environment as well as the possible consequences if no corrective measures are implemented. Included in the plan are the initiating events such as microgravity, remote environment and mission duration, which obviously impact the risk factors. The plan includes points of intervention where mitigating factors can be implemented to avoid outcomes such as malnutrition and unsafe foods. Physiological changes induced by lack of gravity, as well as increased exposure to radiation, may alter nutrient bio-availability, and/or nutrient requirements. An inadequate food system, whether due to technical limitations or nutritional shortcomings, can result in serious consequences. Additionally, microbial and chemical food contamination or psychological factors such as depression may lead to insufficient food intake. Critical questions define areas where further research is required to eliminate or ameliorate the risk from each of those factors. These questions delineate priorities for NASA food and nutrition research for planetary exploration missions.

Aerospace Medicine↗
PubMed1998

Ethics of cochlear implantation in young children: a review and reply from a Deaf-World perspective.

This article examines ethical dilemmas related to cochlear implant surgery in children. These dilemmas arise from the existence of a linguistic and cultural minority called the Deaf World. Organizations of culturally Deaf adults in the United States and abroad, as well as the World Federation of the Deaf, have, on ethical grounds, strongly criticized the practice of cochlear implant surgery in children. Three ethical dilemmas are examined. (1) The surgery is of unproven value for the main significant benefit sought, language acquisition, whereas the psychological, social, and linguistic risks have not been assessed. Thus the surgery appears to be innovative, but innovative surgery on children is ethically problematic. (2) It is now widely recognized that the signed languages of the world are full-fledged natural languages, and the communities that speak those languages have distinct social organizations and cultures. Deaf culture values lead to a different assessment of pediatric cochlear implant surgery than do mainstream (hearing) values, and both sets of values have standing. (3) The fields of otology and audiology want to provide cochlear implants to Deaf children but also, their leaders say, want to protect Deaf culture; those appear to be conflicting goals in principle because, if there were perfect implants, the ranks of the Deaf World would diminish.

Adult↗
PubMed1998

The effect of changes in hearing status on speech sound level and speech breathing: a study conducted with cochlear implant users and NF-2 patients.

According to a dual-process theory of the role of hearing in speech production, hearing helps maintain an internal model used by the speech control mechanism to achieve phonemic goals. It also monitors the acoustic environment and guides relatively rapid adjustments in postural parameters, such as those underlying average speech sound level and rate, in order to achieve suprasegmental goals that are a compromise between intelligibility and economy of effort. In order to obtain evidence bearing on this theory, acoustic and aerodynamic measures were collected from seven adventitiously deaf speakers who received cochlear implants, three speakers who had severe reduction in hearing following surgery for Neurofibromatosis-2, and one hard of hearing speaker. These speakers made recordings of the Rainbow Passage and an English vowel inventory before and after intervention. All but one of the postlingually deaf speakers who received prosthetic hearing reduced speech sound level, SPL. Three of these significantly increased a measure of inferred glottal aperture, H1-H2, and their session means for these two parameters were inversely correlated longitudinally. All but one of the speakers terminated respiratory limbs closer to functional residual capacity (FRC) once prosthetic hearing was supplied. Finally, the implant users' average values of air expenditure moved toward normative values with prosthetic hearing. These results are attributed to the mediation of changes in respiratory and glottal posture aimed at reducing speech sound level and economizing effort.

Adult↗
PubMed1997

Changes in sound pressure and fundamental frequency contours following changes in hearing status.

Sound-pressure level (SPL) and fundamental frequency (F0) contours were obtained from four postlingually deafened adults who received cochlear implants and from a subject with Neurofibromatosis-2 (NF2) who had her hearing severely reduced following surgery to remove an auditory-nerve tumor and to implant an auditory brainstem implant. SPL and F0 contours for each phrase in passages read before and after changes in hearing were averaged over repeated readings and then normalized with respect to the highest SPL or F0 value in the contour. The regularity of each average contour was measured by calculating differences between successive syllable means and averaging the absolute values of these differences. With auditory feedback made available, the cochlear implant user with the least contour variation preimplant showed no change but all of the remaining speakers produced less variable F0 contours and three also produced less variable SPL contours. In complementary fashion, when the NF2 speaker had her auditory feedback severely reduced, she produced more variable F0 and SPL contours. The results are interpreted as supporting a dual-process theory of the role of auditory feedback in speech production, according to which one role of self-hearing is to monitor transmission conditions, leading the speaker to make changes in speech postures aimed at maintaining intelligibility.

Age of Onset↗
PubMed1996

Acoustic and articulatory measures of sibilant production with and without auditory feedback from a cochlear implant.

The articulator positions of a subject with a cochlear implant were measured with an electromagnetic midsagittal articulometer (EMMA) system with and without auditory feedback available to the subject via his implant. Acoustic analysis of sibilant productions included specific measures of their spectral properties as well as the F3 formant amplitude. More general postural characteristics of the utterances, such as speech rate and sound level, were measured as well. Because of the mechanical and aerodynamic interdependence of the articulators, the postural variables must be considered before attributing speech improvement to the selective correction of a phonemic target with the use of auditory feedback. The tongue blade position was related to the shape and central tendency of the /integral of/ spectra; however, changes in the spectral contrast between /s/ and /integral of/ were not related to changes in the more general postural variables of rate and sound level. These findings suggest that the cochlear implant is providing this subject with important auditory cues that he can use to monitor his speech and maintain the phonemic contrast between /s/ and /integral of/.

Adult↗