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Biomedical subjects

V Goel

Publications and source records attributed to V Goel.

At least 91 records · Page 5Linked to original sources
PubMed1996

Effect of dietary rhubarb stalk fiber on the bioavailability of calcium in rats.

Ground rhubarb stalk fiber containing, on a dry weight basis, 74% total dietary fiber (66% insoluble and 8% soluble) was prepared from rhubarb plants. This fiber source has been shown to have a pronounced lipid lowering effect in mice. Its high oxalic acid content may, however, be a limiting factor for its use. The present study was undertaken to determine the safe dose level of the fiber in terms of its effect on calcium bioavailability. Male weanling Sprague-Dawley rats were fed a semi-purified diet (AIN 76) for 4 weeks containing 0, 1, 3, or 5% rhubarb fiber, or pure oxalic acid equivalent to 5% rhubarb fiber. The fiber content of each diet was brought to 5% by adding cellulose, and the calcium level of all diets was the same. As the rhubarb stalk fiber content of the diet increased, a consistent trend of increasing total retention and apparent absorption of calcium was manifested. In contrast, however, cellulose, due to its increased effect on intestinal motility resulted in a decreased calcium bioavailability. Overall results suggest that an addition of rhubarb stalk powder up to the level of 5% in a diet does not have detrimental effect on calcium bioavailability.

Animals↗
PubMed1995

Necromancing the stones.

Since its introduction 15 years ago extracorporeal shockwave lithotripsy (ESWL) has become a standard treatment for urinary stones. The author comments on the results of Adrian R. Levy and Maurice McGregor's study of the use of ESWL for urinary stones in Quebec (see pages 1729 to 1736 of this issue). The rapid increase in the use of ESWL that occurred in the first 2 years of the study points to the fact that the application of a new technology is often quickly expanded before thorough assessments of effectiveness and safety have been carried out. New technologies also lead to shifts in cost distribution that must be considered in cost analyses. The author argues that continuing research is needed to document the dissemination of new technologies and points to methodologic concerns that should be addressed to make such research as fruitful as possible.

Hospital Costs↗
PubMed1995

Modeling other minds.

Nine normal volunteers performed a 'theory of mind' task while their regional brain blood flow pattern was recorded using the PET [15O]H2O technique. Control conditions induced subjects to attend to the visual and semantic attributes of known objects. In a third condition, subjects had to infer the function of an unfamiliar object from its form. In the 'theory of mind' condition, subjects had to infer function based on the form of both familiar and unfamiliar objects and in addition, model the knowledge and rationality of another mind about the function of these objects. Performance during the 'theory of mind' condition evoked the activation of a distributed set of neural networks with prominent activation of the left medial frontal lobe (Brodmann area 9) and left temporal lobe (Brodmann areas 21, 39/19, 38). This result suggests that when inferential reasoning depends on constructing a mental model about the beliefs and intentions of others, the participation of the prefrontal cortex is required. When access to such knowledge is affected by central nervous system dysfunction, such as that found in autism, modeling other minds may prove difficult.

Adolescent↗
PubMed1995

Are the frontal lobes implicated in "planning" functions? Interpreting data from the Tower of Hanoi.

Twenty adult patients with lesions in the prefrontal cortex were tested on the Tower of Hanoi puzzle. The performance of patients was significantly worse than that of controls. This difference could not be accounted for in terms of a general decline in intelligence or memory, or by the size of the lesion. The results further suggest that both patients and controls used the same general strategy to solve the problem and that patients' difficulties with the task have little to do with planning or "look ahead" deficits (as is generally assumed in the neuropsychology literature). Patient performance is best explained in terms of an inability to see or resolve a goal-subgoal conflict. This interpretation is compatible with several existing accounts of frontal lobe dysfunction that postulate a failure of inhibition of a prepotent response to explain poor performance on the Wisconsin Card Sorting task, the Stroop task, the Antisaccade task, the A-Not-B task, and the Delayed Alternation task.

Adult↗
PubMed1995

The impact of relocating vasectomies from hospital outpatient departments to non-hospital sites.

The objective of this study was to estimate the net dollar value of hospital resources that would be released if vasectomies currently performed in outpatient departments were performed in non-hospital sites. This article provides a descriptive analysis using administrative data for all non-hospital sites and all acute care institutions in Ontario performing vasectomies. It is based on 23,741 records of patients for whom a vasectomy was billed to the Ontario Health Insurance Plan (OHIP) in 1991-92. No substantial differences in the age distribution of patients were seen in non-hospital sites and those in hospital settings. About 75% of hospital outpatients received a local anesthetic that could have been administered in a non-hospital setting. Approximately $4.4 million in hospital resources would be released if 75% of all outpatient vasectomies were performed in non-hospital settings while OHIP billings would increase only by about $140,000. The demands on hospital funds available for patient activity could have been decreased by about $6.2 million, if this shift had occurred in 1991-92. Although opportunities exist in Ontario to release hospital resources by shifting vasectomies to non-hospital sites, current hospital and physician funding policies may represent a disincentive to shift activity away from institutional-based care.

Cost Savings↗
PubMed1994

Group education interventions for people with low back pain. An overview of the literature.

STUDY DESIGN: This study systematically reviewed the literature on group education for people with low back pain. Findings are considered in relation to parameters such as the characteristics of the study participants, the intervention, and the setting. OBJECTIVE: To make a recommendation regarding the effectiveness of group education as an intervention for people with low back pain. RESULTS: Based on a systematic search of the literature, 13 primary studies are cited; 6 of these were sufficiently well designed and executed for their findings to be considered. Of the four quality studies with chronic back pain subjects, only one found a positive short-term effect on one of the outcome measures considered (pain intensity). In the two studies with acute cases, group education was found by one of the studies to reduce pain duration and initial sick leave duration in the short term, but the intervention also included work-site visits. At 1 year of follow-up, there was no evidence in the six studies of clinically important benefits on any of the outcome measures. CONCLUSIONS: There is insufficient evidence to recommend group education for people with low back pain.

Adult↗
PubMed1994

Variation in breast cancer surgery in Ontario.

OBJECTIVES: To analyse the extent of variation by county and hospital in the use of breast-conserving surgery in the initial management of breast cancer and to assess some factors that might explain the observed variation. DESIGN: Population-based retrospective cohort study. SETTING: Ontario. PATIENTS: All women with breast cancer newly diagnosed from Jan. 1, 1989, to Dec. 31, 1991. MAIN OUTCOME MEASURE: Proportion of women undergoing unilateral breast cancer surgery who had breast-conserving surgery in each hospital and county. RESULTS: Of the 14,570 women with newly diagnosed breast cancer 12,815 (88.0%) underwent unilateral breast cancer surgery. The mean proportion of breast-conserving procedures by county was 52% and ranged from 11% to 84%. The proportion of breast-conserving procedures in individual hospitals with one or more cases of breast cancer per month ranged from 6% to 84%. The variations in the rates between hospitals was greater than that expected by chance alone (p < 0.0001). CONCLUSIONS: There was marked variation at the hospital and county level in the use of breast-conserving surgery in the initial management of breast cancer. This variation was strongly associated with the hospital where the surgery was performed.

Analysis of Variance↗
PubMed1994

Factors related to emergency department use: results from the Ontario Health Survey 1990.

STUDY OBJECTIVES: To assess factors related to emergency department use in the Ontario population. DESIGN: Population-based, cross-sectional study weighted to represent the entire noninstitutionalized population of the province. PARTICIPANTS: The 1990 Ontario Health Survey population sample of 60,972 individuals. INTERVENTIONS: Responses were given to survey questions on whether the ED had been visited in the past 12 months and, if so, how many times. RESULTS: Overall, 21.1% of all Ontario residents had had at least one visit to the ED in the preceding 12 months. Of these residents, 30.1% reported having two or more visits. Factors associated with increased ED use were described and tested with univariate and multivariate analysis, comparing the usage rates of ED users with those of nonusers and those of repeat users with those of one-time users. In all of the analyses, health needs (significant accidents, number of health problems, and self-reported health status) were the strongest determinants of ED use. However, even after adjusting for these health needs in the multivariate models, there still were significant variations in ED utilization among groups. CONCLUSION: Our study estimated that approximately one in five Ontario residents had reported one or more visits to the ED in the past 12 months. There were identifiable subgroups in the population with increased ED usage even after adjustment for health needs factors.

Accidents↗
PubMed1994

Predicting risk of back injuries, work absenteeism, and chronic disability. The shortcomings of preplacement screening.

Preplacement screening is put forth by some as an effective method for preventing low back disability at the workplace. Although there are still large gaps in knowledge regarding the natural history of and risk factors for back disability, it is clear that the majority of costs are derived from the small proportion of those that will suffer with back symptoms for 6 months or more. Thus, if preplacement screening is to have an impact on health care spending and compensation costs, the screening test will have to be predictive not so much of all back injuries, but rather of work absenteeism and especially chronic disability. This paper presents some criteria for evaluating a screening program and explores the effect of choosing different outcomes for evaluation. The literature on the effectiveness of a number of preplacement screening techniques is examined. Current legislation related to preplacement screening is also described. The natural history, etiologic factors, and prognostic markers for back injuries need to be elucidated further before effective screening strategies can be developed to reduce the incidence of back injuries and back disability in the population.

Absenteeism↗
PubMed1994

Sex differences in the use of invasive coronary procedures in Ontario.

OBJECTIVE: To determine whether sex differences exist in the use of coronary angiography, coronary artery bypass surgery (CABS) or percutaneous transluminal coronary angioplasty (PTCA) among persons recently diagnosed with an acute myocardial infarction (AMI) in Canada. BACKGROUND: A growing body of literature suggests that coronary artery disease in males is treated differently from females. Specifically, recent studies have indicated that sex may influence decisions about the use of invasive diagnostic and therapeutic coronary procedures in patients with suspected or proven coronary artery disease. PATIENTS AND METHODS: The study design is a population-based inception cohort study. The data source is hospital discharges from all acute care hospitals in Ontario. The study population consisted of 6949 men and women discharged with a principal diagnosis of AMI between April 1 and September 30, 1990, and followed through record linkage until March 31, 1991 to determine whether any invasive coronary procedures were performed after their AMI. Odds ratio estimates (OR) and 95% confidence intervals (95% CI) for use of coronary angiography, CABS and PTCA in men were compared with those in women. RESULTS: The adjusted OR for coronary angiography was 1.4 (95% CI 1.2 to 1.6), indicating that males were more likely to undergo angiography than females. A similar finding was seen for CABS (OR = 1.6, 95% CI 1.2 to 2.1), but for PTCA, the sex difference was less pronounced (OR = 1.3, 95% CI 1.0 to 1.7). Cox proportional hazards regression also was used to test the hypothesis and showed similar results. CONCLUSIONS: Women suffering AMI undergo coronary angiography and CABS at a significantly lower rate than men in Ontario, with similar trends evident in use of PTCA.

Adult↗
PubMed1994

Social inequity in risk of coronary artery disease in Ontario.

OBJECTIVES: To examine the distribution of risk factors for coronary artery disease (CAD) by socioeconomic status; to quantify the impact of this distribution on disease incidence; and to estimate by socioeconomic status the proportion of new CAD cases attributable to either smoking or elevated cholesterol. STUDY POPULATION: The overall study population consisted of participants from the Ontario Heart Health Survey (n = 2532) aged 18 to 74 years. A subset of these participants (n = 1293) aged 30 to 74 years, who provided a fasting blood sample for lipid analysis, were used for estimating impact of socioeconomic status on CAD incidence. METHODS: Frequency distributions of risk factors were calculated. The Framingham mathematical model was used to estimate the 10-year probability of developing CAD. Education was selected as the measure for socioeconomic status. OUTCOME MEASURES: Outcomes were prevalence of CAD risk factors, probability of developing CAD and proportion of new cases attributable to smoking and elevated blood cholesterol. MAIN RESULTS: Having an elevated cholesterol level, high blood pressure, diabetes, being overweight or smoking was more prevalent among those with low socioeconomic status. The 10-year probability of CAD was about twice as high among persons with lower education (socioeconomic status) (0.099 low versus 0.055 high). Among males aged 30 to 44 with low socioeconomic status, 26% of the CAD cases were due to smoking versus 13% for those with high socioeconomic status. The values for elevated cholesterol were 19 and 13%, respectively. CONCLUSIONS: Persons with low socioeconomic status are twice as likely to develop CAD because of their higher prevalence of smoking and elevated cholesterol.

Adolescent↗
PubMed1993

Articular facets of the human spine. Quantitative three-dimensional anatomy.

This study provides the quantitative three-dimensional surface anatomy of the articular facets for the entire human vertebral column based on a study of 276 vertebrae. Means and standard errors of the means for linear, angular, and area dimensions of the superior and inferior articular facets were measured for all vertebrae from C2 to L5. Facet orientations were described as angles with respect to the sagittal and transverse planes and also as card angles. The plane angles are similar to the angles seen on traditional radiographic views--radiographs and computed tomographic scans. The card angles, a new concept, are better at helping visualize the three-dimensional orientations of the facets. Excluding the superior C2 facet, the following minimum and maximum dimensions were found for the facets from C3 to L5: width = 9.6-16.3 mm; height = 10.2-18.4; surface area = 72.3-211.9 mm2; interfacet width = 20.8-40.6; interfacet height = 12.2-33.0 mm; transverse plane angle = 41.0-86.0; sagittal plane angle = 67.4-154.8; X-card angle = 41.0-86.0; and Y-card angle = 5.8-66.1. The quantitative anatomy of the facets may improve the understanding of the spinal anatomy, help improve the clinical diagnosis and treatment, and provide the necessary data for constructing more realistic mathematical models of the spine.

Adult↗
PubMed1992

Human lumbar vertebrae. Quantitative three-dimensional anatomy.

This study details the quantitative three-dimensional surface anatomy of human lumbar vertebrae based on a study of 60 vertebrae. The two lower vertebrae (L4 and L5) appeared to be transitional toward the sacral region, whereas the upper two vertebrae (L1 and L2) were transitional toward the thoracic region. Means and standard errors of the means for linear, angular, and area dimensions of vertebral bodies, spinal canal, pedicle, pars interarticularis, spinous and transverse processes were obtained for all lumbar vertebrae. This information provides a better understanding of the spine, and allows for a more precise clinical diagnosis and surgical management of spinal problems. The information is also necessary for constructing accurate mathematical models of the human spine.

Cadaver↗
PubMed1991

Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions.

In this study, the three-dimensional quantitative anatomy of middle and lower cervical vertebrae was determined. The three-dimensional coordinates of various marked points on the surface of the vertebra were measured with a specially designed morphometer instrument. From these coordinates, linear dimensions, angulations, and areas of surfaces and cross-sections of most vertebral components were calculated. The results showed two distinct transition regions: 1) toward the thoracic spine by the wider C7 vertebra but narrower spinal canal; and 2) toward the upper cervical region with the larger pedicle and spinous process of C2. Based on the study of 72 human cervical vertebrae, mean and standard error of the mean values of some clinically important dimensions of vertebral body, spinal canal, pedicles, transverse processes, spinous process, and uncovertebral joints are given for C2-C7 vertebrae. The areas of the end plates, spinal canal, and pedicles were modeled by elliptical and triangular shapes, and results were compared with the actual measurements.

Anthropometry↗
PubMed1991

Thoracic human vertebrae. Quantitative three-dimensional anatomy.

This study details the quantitative three-dimensional surface anatomy of thoracic vertebrae based on a study of 144 vertebrae. The thoracic spine was found to have three distinct regions: upper, middle, and lower segments. The two end segments appear to be transitional zones toward cervical and lumbar regions. The middle zone (T3 to T9) is of utmost importance due to the presence of the combination of narrow spinal canal and critical vascular supply. Means and standard errors of the means for linear, angular, and area dimensions of vertebral bodies, spinal canal, pedicle, pars articularis, spinous and transverse processes, and rib articulations are provided for all thoracic vertebrae. This information is necessary for constructing accurate mathematical models of the human spine. It will also provide a better understanding of the spine, and allow for a more precise clinical and surgical management of spinal problems.

Anthropometry↗