Evaluation of a computer-assisted test engine in oral and maxillofacial radiography.
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Analysis of Variance↗
Biomedical subjects
M K Rayens
Publications and source records attributed to M K Rayens.
Impact of obesity on allogeneic stem cell transplant patients: a matched case-controlled study.
PURPOSE: To determine the impact of obesity on survival after high-dose therapy followed by allogeneic stem cell transplant in adults and children with various malignancies as well as metabolic disorders. PATIENTS AND METHODS: A matched case-controlled evaluation of 322 allogeneic patients from a single institution with a median follow-up of 296 and 120 days among nonobese and obese patients, respectively, was conducted between April 1983 and June 1995 at the University of Kentucky. The overall survival distributions among subsets defined as either obese or nonobese were measured. RESULTS: The overall survival among the nonobese and obese was 35% and 20%, respectively (P = 0.0045). When patients were separated by age, the adult patients maintained this difference, while the children did not. When patients were stratified according to donor status, both the histocompatible and the nonhistocompatible adults had an inferior outcome among obese patients. The difference, however, was significant only among the histocompatible group (P = 0.0007). Causes of deaths were insignificantly distributed among both relapse as well as nonrelapse mechanisms. CONCLUSION: Adult obese patients undergoing high-dose chemotherapy with stem cell rescue have a more adverse outcome. Both relapse and nonrelapse causes are responsible for the different outcome between obese and nonobese groups.
Adolescent↗
Treatment of leukemia with partially matched related bone marrow transplantation.
The results of partially matched related donor (PMRD) marrow transplantation for 82 patients with leukemia are reported, including 45 who received two antigen disparate grafts. Following intensive radiochemotherapy, patients received grafts which were partially depleted of T cells by the monoclonal antibody T10B9 and complement. Actuarial probability of engraftment was 86% (95% CI = 78-93%). The median day to engraftment was similar among recipients of grafts disparate at one, two or three antigen loci. The incidence of severe (grades III and IV) acute graft-versus-host disease and extensive chronic graft-versus-host disease was 13% and 6%, respectively. The probability of disease-free survival for the entire cohort of patients is 31% at 3 years. Age < or = 30 years, early or intermediate stage disease and a graft disparate at one or two loci predicted longer disease-free survival in multivariant analysis. Moreover, 47% of patients receiving PMRD grafts disparate at two loci who had both these favorable pretransplant characteristics were alive and free of disease 3 years after transplantation. We believe that the utilization of PMRDs, especially those with two antigen disparate grafts, can extend allogeneic transplantation to additional leukemic patients lacking a histocompatible donor, with acceptable results.
Acute Disease↗
Single focus of adenocarcinoma in the prostate biopsy specimen is not predictive of the pathologic stage of disease.
OBJECTIVES: To determine whether a very small focus of prostate cancer in a needle biopsy specimen correlates with organ-confined disease or with favorable disease parameters. METHODS: Of 598 needle biopsies of the prostate performed from January 1990 through June 1994, 49 specimens (8.2%) contained a microscopic focus (less than 2 mm in length of the entire biopsy core specimen) of adenocarcinoma. For these 49 patients, the clinical and pathologic features were correlated. RESULTS: Of these 49 patients, 27 (55.1%) underwent either radical prostatectomy, with or without pelvic lymph node dissection (26), or pelvic lymph node dissection alone (1). Seven of these 27 patients (25.9%) had extraprostatic disease: lymph node involvement (1), positive surgical margins (5), or seminal vesicle invasion (1). Ten of the 49 patients (20.4%) underwent radiotherapy, and 12 (24.5%) chose hormonal therapy. The pathologic stage for these 22 patients could not be ascertained. However, despite the limited amount of disease in the biopsy specimen, 2 patients treated with radiotherapy suffered a relapse (mean interval to recurrence, 11.5 months), and 3 patients treated with hormonal therapy (early or delayed) had bony metastasis at the time of diagnosis. Overall, 12 of the 49 patients (24.5%) had unfavorable disease (as defined by extraprostatic disease on pathologic specimen, relapse after radiotherapy, or bony metastasis at the time of diagnosis). CONCLUSIONS: These findings suggest that a microscopic focus of prostatic adenocarcinoma in a needle biopsy specimen, per se, does not predict the pathologic stage or the biologic behavior of a tumor.
Adenocarcinoma↗
Allogeneic bone marrow transplantation with T cell-depleted partially matched related donors for advanced acute lymphoblastic leukemia in children and adults: a comparative matched cohort study.
Allogeneic BMT provides the best treatment currently available for long-term disease-free survival in patients with recurrent ALL. Historically, partially matched related donors provided the opportunity for treatment to a greater number of patients than matched related donors at the expense of decreased overall survival. In this study we compare the results in recurrent ALL patients transplanted with either HLA identical sibling bone marrow or partially matched related bone marrow. Thirty-two patients with relapsed ALL received partially matched bone marrows from a relative with one to three HLA, A, B and Dr antigen mismatches. Bone marrow was partially T cell-depleted with murine T10B9.1A-31 moAb. Sixteen patients with relapsed ALL received HLA-matched sibling bone marrows. All partially matched patients received additional GVHD prophylaxis with methylprednisolone in addition to anti-CD5 immunotoxin and/or CYA. All matched patients in addition to methylprednisolone received MTX and/or CYA. We observed no difference in disease-free survival between patients transplanted with partially matched bone marrow (median follow-up 1252 days, range 778-2035 days) vs those transplanted with HLA-matched bone marrow (median follow-up 1472 days, range 1165-2800 days; P = 0.48). Median survival for all patients is 38% (95% CI 24-52%) at 6 years. Patients transplanted in remission had a significant increase in disease-free survival when compared to those in relapse (P = 0.007). Our data suggest that partially matched BMTs from related donors are a comparable alternative to fully matched transplants in patients with ALL.
Adolescent↗
The influence of deep (odontogenic) pain intensity, quality, and duration on the incidence and characteristics of referred orofacial pain.
This study examined the effects of the intensity, quality, and duration of odotogenic pain on the incidence, pattern, and clinical characteristics of pain referral in the orofacial region. Four hundred consecutive patients reporting with posterior toothache to the dental emergency clinic were included. Patients completed a standardized clinical questionnaire consisting of a numerical rating scale for pain intensity and chose verbal descriptors from a list of adjectives describing the quality of their pain. In addition, patients indicated sites to which pain referred by drawing on a mannequin* of the head and neck. Pain intensity was found to significantly affect the presence of referred pain (P < .005). However, neither duration nor quality of pain influenced the incidence of referred pain. Finally, pain referral occurred in vertical laminations as indicated on mannequin drawings, but these were not found to be diagnostic because of extensive horizontal overlap. The association of intensity and referral is attributed to central nervous system hyperexitability causing expansion of receptive fields and spread and referral of pain.
Adolescent↗
The influence of cutaneous tissue afferents on masticatory pain-pressure thresholds.
Pain-pressure thresholds are routinely used in orofacial pain research to record tenderness in masticatory muscles. This method is employed to stimulate deep tissue afferents, which are thought to be at least partially responsible for pain in temporomandibular disorders. Like other psychophysical measurements, however, this technique must stimulate cutaneous tissues before stimulating deeper tissues. This study examined 39 asymptomatic volunteers to quantify the effect of cutaneous sensory afferents on pain-pressure thresholds. In a randomized, double-blind fashion, pain-pressure thresholds were recorded at four facial sites before and after subjects received intradermal local anesthetic or a dry needle stick. Pain-pressure thresholds were significantly elevated after local anesthetic (P < .0001), suggesting that cutaneous tissues contribute significantly to the pain-pressure threshold. The authors discuss potentially important roles of cutaneous tissues in the assessment of deeper tissues and offer two theories of how the skin may be an important link in the assessment of temporomandibular disorders.
Administration, Cutaneous↗
Participation in transvaginal ovarian cancer screening: compliance, correlation factors, and costs.
The objective was to identify factors influencing participation in screening for ovarian cancer using transvaginal sonography in the free experimental program at the University of Kentucky over its 6+ year history. Database records for screenings, performed from 1987 to June 1994, were utilized. Computer sorts, 1990 census information as predictors, and stepwise multiple regression analysis were employed. Participation in the model ovarian screening program took 3-4 years to approach > 300 screens/month, with repeat screenings exceeding new subject participation in this time period. A number of participants traveled > 200 miles for screening on both initial and repeat encounters. Analysis of distance to the screening site, median family income, county physician population, and education levels indicated that distance and then education correlated best with participation. Unit screening cost shrank from $45 to under $25 when maximal participation was achieved. Distance and education correlated with participation. Expenses compare favorably with diagnostic procedures for other diseases.
Adult↗
Properties of Tango's index for detecting clustering in time.
Tango proposed an index for detecting disease clustering in time applicable to grouped data obtained from a population that remains fairly stable over the study period. In this paper, we show that Tango's index is a two-dimensional U-statistic having an asymptotic normal distribution. To apply this result in the finite sampling situation, an Edgeworth expansion is used and is shown to be at least as accurate as Tango's best result in approximating the tails of his test statistic under the null hypothesis. This is extended to show that the Edgeworth expansion can be used to approximate the power of Tango's test statistic under selected alternatives to randomness. A power study based on simulations is conducted to compare the power of Tango's index to that of three of its competitors.
Demography↗
Childhood physical and sexual abuse: their relationship with depressive symptoms in adulthood.
The purposes of this study were to determine the prevalence of childhood physical and sexual abuse among 206 low-income single mothers and to examine the relationship of childhood abuse to current maternal depressive symptoms. Severe physical abuse was reported by 36 percent of the women. The prevalence of sexual abuse was 22 percent; more than one-half of these women were violently abused. High depressive symptoms were reported by 51 percent of the mothers. Both severe physical abuse and sexual abuse in childhood were associated with high depressive symptoms. Women who experienced violent sexual abuse were almost four and one-half times more likely to report high depressive symptoms, compared to the women who were not sexually abused. These findings provide further evidence that childhood abuse may have long-term consequences for women's mental health.
Adolescent↗
Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale.
The Center for Epidemiologic Studies-Depression Scale (CES-D; L. S. Radloff, 1977) assesses the presence and severity of depressive symptoms occurring over the past week. Although it contains only 20 items, its length may preclude its use in a variety of clinical populations. This study evaluated psychometric properties of 2 shorter forms of the CES-D developed by F. J. Kohout, L. F. Berkman, D. A. Evans, and J. Cornoni-Huntley (1993): the Iowa form and the Boston form. Data were pooled from 832 women representing 6 populations. Internal consistency estimates, correlations with the original version of the CES-D, and omitted-included item correlations supported use of the Iowa form over the Boston form when a shortened version of the scale is desired. Regression statistics are provided for use in estimating scores on the original CES-D when either shortened form is used. Factor analytic results from two populations support a single-factor structure for the original CES-D as well as the short forms.
Adolescent↗
Self-esteem as a mediator of the effects of stressors and social resources on depressive symptoms in postpartum mothers.
The purpose of this study was to examine the role of self-esteem as a mediator of the effects of stressors and social resources on mothers' postpartum depressive symptoms. Data were collected during in-home interviews with 738 women 1 to 2 months postpartum. Forty-two percent of the women had high depressive symptoms. Self-esteem mediated the effects of everyday stressors and the quality of primary intimate relationships on depressive symptoms. However, everyday stressors also exhibited direct effects. Mothers with low self-esteem were 39 times more likely to have high depressive symptoms than those with high self-esteem. Interventions to decrease postpartum mothers' chronic stressors and to improve the quality of their primary intimate relationships may enhance their self-esteem, which in turn may decrease the likelihood of high depressive symptoms.
Adolescent↗
Mothers' potential for child abuse: the roles of childhood abuse and social resources.
BACKGROUND: The mechanism by which some victims of childhood abuse become abusive parents, whereas others do not, is not well understood. Previous empirical evidence indicates that social resources may modify the cycle of abuse or maladaptive parenting; however, the effects of different dimensions of social resources have not been compared. OBJECTIVES: To determine whether a measure of mothers' potential for physical child abuse was related to their retrospective reports of physical and sexual abuse before 18 years of age and to investigate the potential buffering effects of multiple dimensions of social resources on the relationship between childhood abuse and mothers' potential for physical child abuse. METHODS: The potential role of social resources as a moderator of the relationship between a history of childhood abuse and potential for physical child abuse was investigated in 206 low-income single mothers of young children. RESULTS: The levels of physical and sexual abuse in childhood were positively associated with the mothers' child abuse potential; sexual abuse displayed the strongest association. Compared with mothers who were not sexually abused in childhood, those reporting violent sexual abuse as children were almost six times more likely to have high potential for physically abusing their children. There was no evidence that any of the social resources modified the relationship of either type of childhood abuse with the mothers' potential for abuse. However, all four dimensions of social resources demonstrated significant main effects on child abuse potential. CONCLUSIONS: Low-income mothers face many stressors because of their lack of economic resources. This, coupled with a lack of social resources and a history of childhood abuse, makes low-income, single mothers particularly at risk for abusive parenting. The lives of these women and their children may be enhanced by assisting the women to improve their social resources which, ultimately, may reduce their potential for child abuse. Future research should focus on identifying factors that predict and/or modify the potential for abusive parenting as well as actual abuse.
Adult↗
Negative thinking mediates the effect of self-esteem on depressive symptoms in college women.
BACKGROUND: One of every three women between 18 and 24 years of age may be significantly depressed. Younger women have shown increasing rates of unipolar depression since the 1950s, and the average age of onset continues to decline. OBJECTIVES: To examine the prevalence and correlates of high depressive symptoms in single college women 18 to 24 years of age. Negative thinking was posited to mediate the relationship between self-esteem and depressive symptoms. METHODS: A sample of 246 women was recruited from a university student body. Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-esteem Scale, the Crandell Cognitions Inventory, and the Automatic Thoughts Questionnaire. RESULTS: Of the women, 35% had high depressive symptoms. Negative thinking mediated the relationship between self-esteem and depressive symptoms. However, self-esteem also showed a weak direct effect on depressive symptoms. CONCLUSION: The findings suggest that negative thinking may play an important role in the development of depressive symptoms in college women.
Adult↗