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PubMedDate not supplied

Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time?

OBJECTIVE: Preterm neonates undergo numerous painful procedures in the neonatal intensive care unit (NICU). Sucrose, with and without pacifiers, is effective and safe for relieving pain from single painful events. However, repeated use of sucrose for multiple painful procedures has not been adequately evaluated. The study objectives were to: 1) determine the efficacy and safety of consistent management of repeated procedural pain with sucrose; and 2) explore the impact of consistent pain management on clinical outcomes and neurobiological risk status. METHODS: Sixty-six preterm infants were randomized to receive standard care (positioning and swaddling; n = 21), sterile water plus pacifier (n = 23), or 24% sucrose plus pacifier (n = 22) prior to all painful procedures in the NICU during the first 28 days of life. Also, at a routine heel lance at 7, 14, 21, and 28 days of life, data were collected to determine efficacy and immediate and long-term adverse events. Data on clinical outcomes and neurobiological risk status were collected at 28 days or NICU discharge. RESULTS: There was no intervention by time interaction (P = 0.60). There was a significant main effect of intervention (P = 0.03) between the sucrose plus pacifier group, and the standard care group (P = 0.01), but there was no main effect of time (P = 0.72). No group differences existed for adverse events, clinical outcomes, or neurobiological risk status. DISCUSSION: Consistent management of painful procedures with sucrose plus pacifier was effective and safe for preterm neonates during their stay in the NICU. Further exploration of consistent pain management with sucrose on clinical, developmental, and neurobiological outcomes is required.

Analysis of Variance↗

PubMed2005

Towards a unification of the hierarchical reference theory and the self-consistent Ornstein-Zernike approximation.

The hierarchical reference theory and the self-consistent Ornstein-Zernike approximation are two liquid state theories that both furnish a largely satisfactory description of the critical region as well as phase coexistence and the equation of state in general. Furthermore, there are a number of similarities that suggest the possibility of a unification of both theories. As a first step towards this goal, we consider the problem of combining the lowest order gamma expansion result for the incorporation of a Fourier component of the interaction with the requirement of consistency between internal and free energies, leaving aside the compressibility relation. For simplicity, we restrict ourselves to a simplified lattice gas that is expected to display the same qualitative behavior as more elaborate models. It turns out that the analytically tractable mean spherical approximation is a solution to this problem, as are several of its generalizations. Analysis of the characteristic equations shows the potential for a practical scheme and yields necessary conditions that any closure to the Ornstein-Zernike relation must fulfill for the consistency problem to be well posed and to have a unique differentiable solution. These criteria are expected to remain valid for more general discrete and continuous systems, even if consistency with the compressibility route is also enforced where possible explicit solutions will require numerical evaluations.

Journal Article↗

PubMed2006

Consistent thermodynamic derivative estimates for tabular equations of state.

A valid fluid equation of state (EOS) must satisfy the thermodynamic conditions of consistency (derivation from a free energy) and stability (positive sound speed squared). Numerical simulations of compressible fluid flow for realistic materials require a tabular EOS, but typical software interfaces to such tables based on polynomial or rational interpolants may enforce the stability conditions, but do not enforce the consistency condition and its derivatives. The consistency condition is important for the computation of various dimensionless parameters of an EOS that may involve derivatives of up to second order which are important for the development of more sensitive artificial viscosities and Riemann solvers that accurately model shock structure in regions near phase transitions. We describe a table interface based on the tuned regression method, which is derived from a constrained local least-squares regression technique. It is applied to several SESAME EOS showing how the consistency and stability conditions can be satisfied to round-off while computing first and second derivatives with demonstrated second-order convergence. An improvement of 14 orders of magnitude over conventional derivatives is demonstrated, although the method is apparently two orders of magnitude slower, due to the fact that every evaluation requires solving an 11-dimensional nonlinear system. Application is made to the computation of the fundamental derivative.

Journal Article↗

PubMed2006

Quasiparticle self-consistent GW theory.

In past decades the scientific community has been looking for a reliable first-principles method to predict the electronic structure of solids with high accuracy. Here we present an approach which we call the quasiparticle self-consistent approximation. It is based on a kind of self-consistent perturbation theory, where the self-consistency is constructed to minimize the perturbation. We apply it to selections from different classes of materials, including alkali metals, semiconductors, wide band gap insulators, transition metals, transition metal oxides, magnetic insulators, and rare earth compounds. Apart from some mild exceptions, the properties are very well described, particularly in weakly correlated cases. Self-consistency dramatically improves agreement with experiment, and is sometimes essential. Discrepancies with experiment are systematic, and can be explained in terms of approximations made.

Journal Article↗

PubMed2004

Possible conflicts: a compilation technique for consistency-based diagnosis.

Consistency-based diagnosis is one of the most widely used approaches to model-based diagnosis within the artificial intelligence community. It is usually carried out through an iterative cycle of behavior prediction, conflict detection, candidate generation, and candidate refinement. In that process conflict detection has proven to be a nontrivial step from the theoretical point of view. For this reason, many approaches to consistency-based diagnosis have relied upon some kind of dependency-recording. These techniques have had different problems, specially when they were applied to diagnose dynamic systems. Recently, offline dependency compilation has established itself as a suitable alternative approach to online dependency-recording. In this paper we propose the possible conflict concept as a compilation technique for consistency-based diagnosis. Each possible conflict represents a subsystem within system description containing minimal analytical redundancy and being capable to become a conflict. Moreover, the whole set of possible conflicts can be computed offline with no model evaluation. Once we have formalized the possible conflict concept, we explain how possible conflicts can be used in the consistency-based diagnosis framework, and how this concept can be easily extended to diagnose dynamic systems. Finally, we analyze its relation to conflicts in the general diagnosis engine (GDE) framework and compare possible conflicts with other compilation techniques, especially with analytical redundancy relations (ARRs) obtained through structural analysis. Based on results from these comparisons we provide additional insights in the work carried out within the BRIDGE community to provide a common framework for model-based diagnosis for both artificial intelligence and control engineering approaches.

Algorithms↗

PubMed2003

Neuroendocrine and cardiovascular reactivity to stress in mid-aged and older women: long-term temporal consistency of individual differences.

We report long-term temporal consistency of stress-related neuroendocrine and cardiovascular variables in mid-aged and older women who performed mental math and speech stress tasks two times approximately 1 year apart. Epinephrine, norepinephrine, ACTH, cortisol, cardiac preejection period (PEP), respiratory sinus arrhythmia, heart rate (HR), blood pressure, and respiration rate were measured at baseline, after or during stressors, and 30 min posttask. Although there were exceptions, year-to-year Spearman coefficients showed mostly moderate to high consistency (rs approximately equal to .5-.8) for baseline, stressor, and posttask values. For reactivity, HR and PEP were most consistent (rs approximately equal to .65); consistency for other variables was moderate to low (rs approximately equal to .1-.4). Means of most variables changed from year to year. Results support the use of baseline, stressor, and posttask values in longitudinal studies.

Aged↗

PubMed2005

Consistent localization of interictal epileptiform activity on EEGs of patients with tuberous sclerosis complex.

PURPOSE: We addressed consistent localization of focal interictal epileptiform activity on EEGs of patients with tuberous sclerosis complex (TSC) and epilepsy. METHODS: Twenty-one patients with TSC with a 10-year history of epilepsy and interictal epileptiform activity in three or more EEG recordings were included. None of the patients had undergone epilepsy surgery. Local maxima of interictal epileptiform activity were measured from 76 EEG traces and 33 EEG reports. Information about the patients' clinical course was extracted from their medical records. Magnetic resonance imaging (MRI) and neuropsychological examinations were performed. Statistical analysis was performed with the Mann-Whitney U test. RESULTS: In eight patients, interictal epileptiform activity was consistently detected in one or two regions (group 1), and in 13 patients, epileptiform activity was detected in three or more regions (group 2). The number of foci increased throughout the disease course in both groups. Age at seizure onset and IQ were significantly higher in group 1. Complex partial seizures occurred more often in the patients of group 1. In 19 of the 21 patients, the most consistent epileptiform activity was localized in the frontotemporal region. CONCLUSIONS: Ninety percent of patients with TSC showed at least one region of consistent interictal epileptiform activity. Patients with one or two regions of epileptiform activity were older at seizure onset, often experienced complex partial seizures, and had mild or no mental deficits. These patients may be candidates for epilepsy surgery.

Adolescent↗

PubMed1994

The development of an instrument to measure self-consistency.

The maintenance of self-consistency is a task that engages elderly people, and it can be viewed as an indicator of how well a person can cope with stress in the ageing process. However, there is no reliable and valid instrument to date that measures this phenomenon. To help elderly people to accomplish the task warrants the necessity to develop an instrument to measure self-consistency. The purpose of this study was to develop an instrument to measure self-consistency in elderly people with chronic conditions. The Self-Consistency Scale (SCS) was designed and administered to hearing-impaired elderly people (n = 130) in the north-east part of the USA. Psychometric properties of the SCS were evaluated and the results indicated a promising psychometric integrity. The obtained alpha coefficient for the SCS total scale was 0.89, with a score range of 51-104 and a mean total score of 85.10 (SD = 11.04). Convergent validity of the SCS was established by correlating the SCS to a Visual Analogue Scale--A Sense of Self (VAS), r = 0.60 (P < 0.01). Divergent validity with the Geriatric Depression Scale (GDS) was established, r = -0.57 (P < 0.01). Maximum likelihood factor analysis with oblimin rotation resulted in a two-factor solution: Factor I, self-knowledge; and Factor II, stability of self-concept.

Adaptation, Psychological↗

PubMed2004

Consistent mapping and automatic visual search: comparing persons with and without intellectual disability.

BACKGROUND: Merrill et al. (1996) reported that persons with intellectual disability (ID) were slower at learning a visual search task to automaticity relative to persons of the same age without ID. For persons without ID, automaticity develops most rapidly under conditions in which a response is always the same for a particular stimulus. This study was designed to investigate whether persons with and without ID are differentially sensitive to the influence of consistently mapped versus inconsistently mapped stimulus responses. METHODS: The primary manipulation was the consistency between a particular stimulus and the response to that stimulus in a visual search task. Sixteen participants with ID and 16 without ID searched displays of two, three, or four pictured objects to determine if a target was present. For half of the participants, the targets were always targets. For the other half, the targets became nontargets on 25% of the trials. RESULTS: Analyses focused on changes in response times associated with set size. Because automaticity allows for parallel processing, the elimination of significant effects of set size was taken as an index of the development of automaticity. Results indicated that inconsistent mapping significantly slowed the development of automaticity for the participants without ID but not for the participants with ID. DISCUSSION: Results were discussed in terms of the role of inhibition processes in the development of automatic search and detection. The effectiveness of inhibition processes was compromised by the consistency manipulation. The effect of the consistency manipulation was greater for the participants without ID because they were presumed to be using inhibition processes more effectively during practice than did the participants with ID.

Adolescent↗

PubMed1983

The adjective generation technique: consistency of self-description in psychiatric patients.

There has been considerable controversy about whether human behavior is consistent across situations and time. Using the adjective generation technique (AGT), Allen and Potkay (1973, 1977a) found that subjects' self-favorability was quite variable and concluded that this did not support Bem and Allen's (1974) position that the consistency would be greater if idiographic assessment techniques were utilized. Bem (1977) criticized this conclusion, making the points that the AGT is not idiographic and that the favorability value of each day should be considered as a single item in a larger test rather than be considered independently. The present study was designed to address both the consistency of behavior across time and also the controversy regarding the AGT. Eleven psychiatric inpatients completed the AGT for 30 consecutive days. The results indicated that while AGT values are highly variable on a day-to-day basis, these values are quite consistent when averaged across even short periods of time. These results are very similar to those reported by Epstein (1979).

Adult↗

PubMed2006

Consistency of quality assessments in long-term care by the clients, family members and named nurses.

Combining assessments by the clients, their family members and named nurses of the quality of long-term care leads to a more comprehensive picture of the quality of the service. Clients should be the primary source of information, but particularly when they are not able to express their opinion, other sources of assessment are needed. This study describes and compares the consistency of quality assessments of long-term institutional care for the elderly made by the client (n = 312), his/her family member (n = 312) and the named nurse (n = 312). Data were gathered in 2002 from service houses, nursing homes and health centres. The consistency of the assessments made by the different groups of respondents was measured by frequency distributions, the weighted kappa coefficient and exact agreement. Frequency distributions differed significantly between the respondent groups in almost every item. Family members were more critical in their assessments than the other two groups. The consistency of assessments was highest with regard to the items 'contact with significant others' and 'medication'. In general the consistency of assessments, measured by weighted kappa, was rather low, but it was fair for 'clothing' (clients/family members) and 'privacy' (clients/named nurses and family members/named nurses). The occurrence of the option 'not applicable' to certain items was quite high, but varied somewhat between the three respondent groups. The results of this study support the viewpoint that comprehensive information gathering from family members and named nurses is useful, but they should not replace clients' assessments.

Adult↗

PubMed1998

Consistency between preference and use of long-term care among caregivers of stroke survivors.

Effective arguments have been made for the importance of expanded attention to understanding how family preferences influence decisions to choose long-term care. The effects of preference on the utilization of long-term care deserve further research, especially on a longitudinal basis. The family members of 582 first-time stroke patients from the neurology departments of four teaching hospitals in Taiwan were categorized into two groups based on their attitudes toward type of long-term care, i.e., a preference for nursing home care (n1 = 324) or a preference for home care (n2 = 258). The consistency rate between preference and utilization of the type of long-term care was estimated by the division of number of families preferring one type of long-term care by the number of families actually utilizing the services preferred. Results indicated that the consistency rate for those with nursing home preference was 8.3% while the consistency rate for those with home care preference was 94.2%. Accessibility of nursing home facilities near family residences was significantly associated with whether those preferring nursing home services actually utilized them, and the odds ratio was 20.8. The family manpower available for caregiving at home was tremendously associated with whether families utilized home care when home care was preferred; the odds ratio was 33.3. The preference for the type of long-term care was a strong predictor of the utilization when home care was preferred, yet not when a nursing home was preferred. The low consistency between preference and utilization for nursing homes preferred is due to the low accessibility of nursing home facilities in Taiwan. How to provide sufficient support to families for caregiving at home, and how to deal with the barrier of accessibility to nursing home services should be two major concerns for those who are planning and operating the long-term care system and for those trying to design institutional services and noninstitutional services as alternatives.

Caregivers↗

PubMed2005

Consistent efficacy, tolerability, and high levels of satisfaction with almotriptan 12.5 mg when used to treat multiple migraine attacks in routine clinical practice.

OBJECTIVE: To assess the efficacy, tolerability, and patient satisfaction with almotriptan 12.5 mg across multiple migraine attacks in routine clinical settings. BACKGROUND: The efficacy and tolerability of almotriptan have been well-documented in clinical trials. Less information is available about patient acceptance of therapy under normal prescribing conditions in routine practice. METHODS: This was a prospective, open-label surveillance study conducted on 899 adults with documented attacks fulfilling the IHS criteria for migraine in medical practices of 307 neurologists and primary care physicians across Germany from June 2001 to April 2002. Patients were eligible for inclusion in the study if they were being treated for the first time with almotriptan. Main outcome measures were pain relief, pain free, consistency, tolerability, and satisfaction with almotriptan 12.5 mg when used to treat multiple migraine attacks. RESULTS: A total of 899 patients with migraine treated 1 (18.4%), 2 (25.9%), or 3 (55.6%) migraine attacks with almotriptan for a total of 2131 attacks. Pain relief at 2 hours was achieved in 84.5% of attacks; pain free was achieved in 41.4%. Consistency of almotriptan 12.5 mg (at least 2 out of 3 attacks successfully treated) was 87.3%. Most patients (88.5%) indicated that they were "satisfied" or "very satisfied" with their treatment with almotriptan and 80.3% of patients expressed that almotriptan 12.5 mg therapy was better than their prior therapy. Physicians' global assessment of the efficacy of almotriptan 12.5 mg was judged to be "good" and "very good" in 87.6% of the patients, and tolerability was considered to be "good" and "very good" in 96.3% of patients. More than 92% of physicians indicated that they would continue to prescribe almotriptan for their patients. CONCLUSION: The high levels of efficacy, consistency, and tolerability of almotriptan 12.5 mg observed in this postmarketing surveillance study are not only consistent with the findings of controlled clinical trials but also resulted in high rates of patient and physician satisfaction with almotriptan and patient preference for almotriptan over prior acute treatments, including other triptans.

Adolescent↗

PubMed2000

The pathological substrate of limbic epilepsy: neuronal loss in the medial dorsal thalamic nucleus as the consistent change.

PURPOSE: The focus of research in limbic epilepsy has been the hippocampus because of its well-known pathology of hippocampal atrophy and sclerosis as well as the strong propensity for this structure to seize under a variety of circumstances. There is ample evidence, however, for pathological alterations in other regions of the limbic system in limbic/mesial temporal lobe epilepsy, including the amygdala, the entorhinal cortex, and, in some cases, the thalamus. In this preliminary evaluation of the pathological substrate for limbic epilepsy, we wished to determine if there was consistent anatomic change at extrahippocampal sites. METHODS: We compared paraffin sections of brains from rats with chronic spontaneous limbic epilepsy and age-matched controls to determine the consistency of the pathology at five sites: the hippocampus, amygdala, entorhinal cortex, piriform cortex, and medial dorsal thalamus. RESULTS: In a qualitative evaluation of these sections taken from standardized positions, we found that the medial dorsal thalamic nucleus in the epileptic animals was the site that was consistently involved with neuronal loss. With all other sites, at least several animals had qualitatively normal tissue. CONCLUSIONS: This finding suggests that neuronal loss in the medial dorsal thalamus may be the consistent pathology in limbic epilepsy, at least in an animal model of the disorder. The presence of a structurally abnormal subcortical region with broad connections to the limbic sites involved with chronic epilepsy may have implications for our understanding of the pathophysiology of this disorder.

Animals↗

PubMed2000

Consistency of physicians' legal standard and personal judgments of competency in patients with Alzheimer's disease.

OBJECTIVES: To investigate the consistency of physician judgments of treatment consent capacity (competency) for patients with Alzheimer's disease (AD) when specific legal standards (LS) for competency are used, and to identify the LS most clinically relevant to experienced physicians. DESIGN: Control and AD patient participants were videotaped being administered a measure of capacity to consent to medical treatment. Study physicians viewed videotapes of these assessments individually and made competency judgments for each participant under different LS followed by their own personal judgment of competency. SETTING: A university medical center. PARTICIPANTS: Participants were 10 older controls and 21 patients with AD (10 with mild and 11 with moderate AD). Five physicians with experience assessing the competency of AD patients were recruited from the geriatric psychiatry, geriatric medicine, and neurology services of a university medical center. MEASUREMENTS: The 31 participants were videotaped performing on a measure of treatment consent capacity (Capacity to Consent to Treatment Instrument) (CCTI). The CCTI consists of two clinical vignettes (A-neoplasm and B-cardiac) that test competency under five LS. Vignette A and B assessments were videotaped separately for each participant (total videotapes for sample = 62). Each study physician viewed each videotaped vignette individually, made judgments under each of the LS (competent or incompetent), and then made his/her own personal competency judgment. Physicians were blinded to participant diagnosis. Within participant group, consistency of physician judgments was evaluated across LS and personal judgments using percentage agreement and kappa. Agreement between personal and LS judgments for the AD group was evaluated for each physician using logistic regression. RESULTS: As expected, physicians as a group generally demonstrated very high percentage agreement in their LS and personal competency judgments for the control group. For the AD group, mean percentage judgment agreement among physicians ranged from a high of 84% (LS1) (evidencing a treatment choice) to a low of 67% (LS3) (appreciating consequences of treatment choice). Mean percentage agreement for personal competency judgments was 76%. For the AD sample, kappa analyses for physicians as a group demonstrated significant agreement not attributable to chance for LS5 (understanding treatment situation/choices) (k = 0.57, P = .001), LS4 (providing rational reasons for treatment choice) (k = 0.39, P = .04), and also for personal judgments (k = 0.48, P = .009). Analysis of LS judgment agreement within physician indicated that physicians applied the LS as discrete standards. Within-physician and for the AD sample, personal competency judgments were associated significantly with judgments on LS5 (P = .001), LS4 (P = .004), and LS3 (P < .04). CONCLUSIONS: Experienced physicians demonstrated significant agreement assessing competency in AD patients when judgments were based upon specific legal standards. Personal competency judgments of physicians showed a substantially higher level of agreement than found in a previous study, where specific LS were not used. These results suggest that consistency of physician competency judgments can be enhanced if they are guided by knowledge of specific LS. Physicians' personal competency judgments were most closely associated with comprehension and reasoning LS, the most conservative and clinically appropriate standards for deciding competency.

Alzheimer Disease↗

PubMed1999

Consistency of orthodontic treatment planning decisions.

OBJECTIVE: (i) To analyse the consistency of a group of orthodontists' treatment decisions and (ii) to identify factors that may influence this consistency. DESIGN: Cross-sectional observational study. SUBJECTS: Ten orthodontists. METHODS: The orthodontists examined 60 case vignettes and recorded their treatment decisions on two separate occasions. MAIN MEASURE: Inter- and intra-examiner agreement was evaluated with the Kappa statistic. RESULTS: The consistency within each orthodontist was moderate. However, between-orthodontist consistency was poor. CONCLUSION: It appears that there is marked variation between orthodontists in treatment planning decisions and this may reflect the lack of evidence for the effectiveness of competing treatments.

Adult↗

PubMed1982

Peristaltic transport of a power-law fluid with variable consistency.

Effects of the consistency variation on the peristaltic transport of a non-Newtonian power-law fluid through a tube have been investigated by taking into account the existence of a peripheral layer. It is shown that the flow rate flux, for zero pressure drop, increases as the amplitude of the peristaltic wave increases but it decreases due to the pseudoplastic nature of the fluid. It is also noted that, for zero pressure drop, the flux does not depend on the consistency of peripheral layer while the friction decreases as this consistency decreases. However, for nonzero pressure drop, the flux increases and the friction force decreases as the consistency of peripheral layer fluid decreases.

Biophysical Phenomena↗

PubMed1999

Dose model for a beta-emitting stent in a realistic artery consisting of soft tissue and plaque.

A model for the description of the near-field dose deposition from a 32p impregnated stent in an arterial system consisting of soft tissue and dense plaque is presented. The model is based on the scaling property of the dose-point-kernel (DPK) function which is extended to a heterogeneous medium consisting of a series of layers of different materials. It is shown that, for each point source originating from the stent surface, the DPK function for water can be scaled consistently along the path through the different layers of material to predict the dose at a given point in the heterogeneous medium. Radiochromic film dosimetry on actual 32p stents is used to test the new model. The experimental setup consists of a water-equivalent phantom in which a stent is deployed and on which a thin layer of polytetrafluoroethylene (PTFE) is deposited to simulate the presence of plaque. Layers of radiochromic films stacked over the phantom are used to measure the dose at distances varying from approximately 0.1 mm to approximately 3 mm from the stent surface with and without PTFE. It is shown that the proposed new DPK model for a heterogeneous medium agrees very well with the experimental data and that it compares favorably to the usual homogeneous DPK model. These results indicate that the new model can be used with confidence to predict the dose in a realistic artery in the presence of plaque.

Angioplasty, Balloon, Coronary↗