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A charcoal sampling method and a gas chromatographic analytical procedure for carbon disulfide.

Research is reported concerning an acceptable method for sampling and analyzing samples for carbon disulfide. Test atmospheres of carbon disulfide were generated dynamically using the syringe injection method, ant the theoretical concetnration verified by a liquid absorbent, colorimetric method. The CS2 was adsorbed on charcoal tubes, eluted with benzene, and quantitated with a gas chromatography equipped with a sulfer flame photometric detector. The results compared with the colorimetris analysis. The sensitivity of this method is 1 mug on a charcoal tube. The charcoal tubes were also tested for breakthrough volumes, holding power vs time, and the effect of air transport and temperature cycles.

Adsorption

Reproducibility of rotational panoramic radiography: mandibular linear dimensions and angles.

The reproducibility of nine mandibular variables (linear dimensions and angles) assessed from panoramic radiographs with the Orthopantomograph 5 (Siemens) was investigated. Attention was given to the possible influence of recording the reference number of the head positioner with one or two radiographers. Two separate exposures of three groups of patients were made under different radiographic conditions, each group representing one method. Acceptable reproducibility was observed for the vertical and angular variables, the method variance being mostly within 3% of the total variance. Horizontal variables were clearly more unreliable. No statistically significant differences were observed between the reproducibility of the right and left sides. A negative correlation was found between the angular variables within two groups. For most variables, only small differences among the methods were found. The highest reliability was obtained when the same radiographer recorded the reference number of the head positioner and made both exposures. An accuracy study on five dried skulls showed an image magnification of approximately 18% to 21% for the vertical variables, whereas the gonial angle assessed from a panoramic film was almost identical to that measured on the dried mandible.

Cephalometry

Environmental interventions for the prevention of travelers' diarrhea.

The diarrheal illnesses affecting travelers to areas with low standards of hygiene are due to exposure to microbial agents not in wide circulation in the travelers' home area. A major objective for the prevention of travelers' diarrhea should be to minimize exposure to these infectious agents. Studies of sporadic and epidemic travelers' diarrhea have shown that contaminated food and water are usually the most important vehicles for transmission of these agents. Travelers must know which foods and water sources to avoid and which they may reasonably be assured are safe. Also, methods for disinfecting potentially contaminated sources must be simple and practical. Acceptable methods for ensuring the safety of food and drink are amply documented in the literature. However, although the consumption of certain foods and beverages is clearly associated with an increased risk of developing travelers' diarrhea, in some retrospective studies adherence to strict dietary rules generally did not appear to diminish the incidence. Despite these findings, whose validity may have been weakened by study design flaws, careful attention to the preparation and choice of food and beverage is recommended for prevention of both diarrheal and nondiarrheal illnesses.

Diarrhea

The Periotest method for determining implant success.

The purpose of this paper is to show that the currently accepted methods for the determination of implant stability are unpredictable. It describes those techniques that are currently utilized for the assessment of implant success and discusses the problems they present. The paper will propose the Periotest method as a reliable and reproducible alternative to the methods currently available to the clinician for determining implant stability.

Dental Implants

Diagnostic communication in functional neurological disorder: A systematic review and meta-analysis of patient acceptance and clinical outcomes.

OBJECTIVES: Diagnostic disclosure is a key therapeutic moment in Functional Neurological Disorder (FND). This systematic review aimed to evaluate quantitative evidence on diagnostic acceptance, understanding, satisfaction, symptom outcomes, and healthcare utilisation following diagnostic disclosure in FND, and to conduct a meta-analysis of diagnostic acceptance. METHODS: Systematic searches of PubMed, Scopus, PsycINFO, and Web of Science identified quantitative studies in adults with FND. Screening followed predefined inclusion criteria. Data were extracted using a structured template and risk of bias was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis of proportions was conducted using the Freeman-Tukey transformation. RESULTS: Fifteen studies were included, four of which contributed to the meta-analysis (n = 481). Reported diagnostic acceptance rates ranged from 38.7% to 90%, although the timing and method of assessment varied across studies. Pooled acceptance was 0.68 (95% CI 0.44-0.88), with substantial heterogeneity. Structured or reinforced communication was frequently associated with improved understanding and satisfaction, although its superiority for diagnostic acceptance was not established. In some studies, diagnostic acceptance was associated with more favourable clinical outcomes, although findings were inconsistent. Some studies reported reductions in healthcare utilisation or costs following satisfactory diagnostic explanation, whereas others found no sustained overall reduction. CONCLUSIONS: Diagnostic communication in FND is associated with differences in acceptance, understanding, and downstream clinical and healthcare outcomes. Approximately two-thirds of patients were reported as accepting the diagnosis following disclosure, although the timing and method of assessment varied substantially across studies. Empathic and evidence-informed communication may enhance understanding and engagement, although its effects on healthcare use and recovery remain uncertain. PRACTICE IMPLICATIONS: Diagnostic disclosure should be delivered clearly, empathically, and with reinforcement over time. Written information, reputable educational resources, and opportunities for follow-up clarification may support patient understanding and engagement, although stronger comparative evidence is needed.

Humans

Making cancer prevention effective for African-Americans.

In order to reduce the racial disparities in cancer death rates, prevention programs designed for minorities must concentrate on the cancer sites and intervention methods which offer the greatest promise for closing the mortality gap. Generally accepted methods to achieve these results were recently published by the U.S. Preventive Services Task Force. Effective intervention recommendations will be increased when researchers understand the cultural differences of minorities, communicate clearly, collaborate with other programs, and treat the program participants with respect.

Adult

Nurses' attitudes toward conventional and automated vital signs measurement methods.

The acceptance and assimilation of new medical technologies into the health-care arena is a complex process involving financial, humanistic, and clinical considerations. This experimental research compared nurses' attitudes regarding the clinical acceptability of conventional methods of measuring vital signs with their attitudes toward a new, automated method, using the IVAC Model 4000 Vital-Check. Two studies were conducted, at different university-affiliated hospitals, involving different nursing-care-delivery models. The 102 nurses who participated in the studies generally favored the automated method with respect to provider convenience, patient acceptance, and the opportunity to simultaneously perform other nursing assessments. Conventional techniques were preferred for patients on isolation precautions and in some very specific clinical situations such as those requiring detection of abnormalities in the heart rhythm. Interviews of patients were also conducted at both sites and their comments supplemented and supported the quantitative findings for the nurses. Patients seemed to adapt very well to the new technology. They were particularly interested in being better able to monitor their own measurements with the automated process.

Attitude of Health Personnel

The calibration of automated instruments for accuracy in hemoglobinometry.

The surveys of the College of American Pathologists indicate a consistent bias between the manual "reference" method for hemoglobin determinations and the Coulter S measurements. The Coulter S hemoglobin values are invariably lower; the difference averages 0.3 g/dl. The commonly used calibration methods for the Coulter appear to be subobtimal. The hemoglobin calibration and quality assurance method proposed by Bull and colleagues is advocated as the presently most acceptable method. Commercial hemoglobin control materials should not be used for hemoglobin calibration.

Automation

A new method of measuring the cross-sectional area of connective tissue structures.

There appears to be no generally accepted method of measuring in-situ the cross-sectional area of connective tissues, particularly small ones, before mechanical testing. An instrument has therefore been devised to measure the cross-sectional area of one such tissue, the rabbit medial collateral ligament, directly and nondestructively. However, the methodology is general and could be applied to other tissues with appropriate changes in detail. The concept employed in the instrument is to measure the thickness of the tissue as a function of position along the width of the tissue. The plot obtained of thickness versus width position is integrated to provide the cross-sectional area. This area is accurate to within 5 percent, depending mainly on alignment of the instrument and pre-load of the ligament. Results on the mid-substance of the rabbit medial collateral ligaments are repeatable and reproducible. Values of maximum width and thickness are less variable than those obtained with a vernier caliper. The measured area is considerably less than that estimated assuming rectangular cross-section and slightly less than that estimated on the assumption of elliptical cross-section.

Animals

Acceptability of abortion methods.

This chapter has reported the findings of acceptability of prostaglandin pessaries compared with vacuum aspiration as methods for inducing abortion in a very early stage of pregnancy. Acceptability has been defined by the WHO as the degree with which a treatment method has attributes that make it perceived by a user or potential user to be consonant with his or her own sense of well-being and therefore will be used or preferred. The acceptability of the medical and surgical procedures for inducing abortion was studied in Swedish abortion patients using a pre- and post-abortion design for obtaining observations. Methods used included interview schedules, questionnaires, rating scales and attitude measuring techniques. Patients consenting to take part in the acceptability study had agreed to be randomly assigned to prostaglandin treatment, given at the clinic or self-administered by the patient at home, or to vacuum aspiration. A high degree of acceptability for the prostaglandin treatment was obtained in this group of patients who had applied for an abortion very soon after one missed menstrual period. This was indicated from the finding that the very high preference for this procedure remained unchanged in the group randomly assigned to it. Other measures of attitudes to prostaglandin treatment also indicated the unchanged positive attitude. There was a significant change in the attitude to vacuum aspiration among those assigned to this treatment, indicating that post-abortion it was more acceptable to these patients. However, 30% of them would still prefer the prostaglandin treatment, especially self-administered, in the event of another abortion. There were consistent and significant relationships found between the degree of negative emotional arousal before and after abortion and preference for the medical or surgical procedure and also the amount of complaints after abortion. Those patients who pre-abortion had preferred the self-administered procedure were, regardless of which treatment they had been assigned to, those who were least emotionally upset both before and after the treatment and also complained the least. This chapter also reported on findings of how acceptable the medical and surgical procedures can be inferred to be from comparisons of preferences and attitude measures obtained from abortion patients before treatment and from women in the same age group (who would not exclude an abortion if pregnant) in samples from outside the clinical setting. In the non-patient groups about half the subjects would prefer the medical alternative.(ABSTRACT TRUNCATED AT 400 WORDS)

Abortion, Induced

Laparoscopic varicocelectomy: preliminary report of a new technique.

The use of varicocelectomy for the treatment of subfertility seems to be incontrovertible. However, there is a difference of opinion as to the proper surgical method of varicocele ablation. The inguinal and high retroperitoneal approaches are the most commonly accepted methods to date. However, significant postoperative morbidity is common and return to normal activity often is prolonged. Also, bilateral operations are being performed more commonly. These considerations have prompted many to search for alternative techniques. We developed a laparoscopic procedure that is as simple and effective as more traditional methods. In addition, it offers lower morbidity, allows for microscopic dissection with preservation of the spermatic artery and is amenable to bilateral ligation without a second incision. Ten patients 16 to 54 years old underwent laparoscopic ligation of the spermatic veins at the internal inguinal ring. The diagnosis was based on physical examination. Indications for the operation were infertility with a stress sperm pattern in 5 patients, testicular atrophy in 4 and scrotal pain in 1. Four patients underwent bilateral ligation. Preliminary followup showed resolution of the varicocele in all patients and disappearance of pain in the patient treated for this symptom. No morbidity related to this procedure has been encountered and all patients resumed normal activity within 2 days. We believe that this new method is a viable alternative for varicocelectomy.

Adolescent

[Use of the pulsimetric method for estimating energy value of food rations for miners in deep coal mines].

Pulsimetry proved to be the most acceptable method for estimating energy requirements of miners working under extreme conditions with constantly changing ergometric parameters. It has been established that the mean daily energy requirements of miners working in deep coal mines under conditions of high temperature comprise 3500 kcal. Energy requirements for the main types of the physical activity of workers in deep mines have been calculated, basing on basal metabolism, metabolic constants for varying activities have been determined.

Coal Mining

The management of ocular herpesvirus infections.

The many treatment methods in current use for every known complaint only seem to aggravate the difficulty of treating ocular herpes simplex virus (HSV) infections, which are generally self-limited in the immunocompetent host. The cornea is already a somewhat immune-deficient tissue since its lack of blood vessels separates it partially from the host, and treatment with glucocorticoids, which are immunosuppressive, increases the risk of damaging complications such as scarring, prolonged morbidity, bacterial or fungal superinfection, and the occasional corenal perforation. Accepted methods of treatment of specific lesions, are discussed, as are some methods that are not yet accepted, but which seem promising. Herpes zoster may result in scarring and significant loss of vision even without the use of glucocorticoids, the disease often manifesting itself in the already compromised host. The major complication is postherpetic neuralgia. None of the available treatment methods has been fully satisfactory, and every effort should be made to prevent eye lesions in patients with early infection of the ophthalmic branch of the trigeminal nerve. Stimulation of cellular immunity by various means appears to offer some new promise for control of the disease. Management of varicella, cytomegalovirus, and infectious mononucleosis are also discussed.

Animals

Management of portal vein injuries.

Injuries to the portal vein are associated with a high mortality because of a high incidence of concomitant injury to surrounding structures and refractory shock. Repair of the portal vein injury is often difficult or impossible because of massive hemorrhage. The key to successful management of a portal vein injury is rapid blood volume resuscitation and obtaining rapid and adequate exposure. The optimal exposure for repair consists of reflection of the hepatic flexure of the colon with mobilization of the root of the mesentery, pancreas, and duodenum. Lateral venorrhaphy is the preferred method of management, but in hemodynamically unstable patients, ligation of the portal vein is an acceptable method of treatment.

Arteriovenous Shunt, Surgical

Detection of coliform bacteria and Escherichia coli by multiplex polymerase chain reaction: comparison with defined substrate and plating methods for water quality monitoring.

Multiplex polymerase chain reaction (PCR) and gene probe detection of target lacZ and uidA genes were used to detect total coliform bacteria and Escherichia coli, respectively, for determining water quality. In tests of environmental water samples, the lacZ PCR method gave results statistically equivalent to those of the plate count and defined substrate methods accepted by the U.S. Environmental Protection Agency for water quality monitoring and the uidA PCR method was more sensitive than 4-methylumbelliferyl-beta-D-glucuronide-based defined substrate tests for specific detection of E. coli.

Base Sequence

Controversy in organ preservation.

Renal preservation has contributed to improvements in human cadaver kidney transplantation in terms of viability testing and logistics. Unfortunately, the antigenicity of a kidney has not been reduced by our present preservation methods; consequently, immunologic problems in cadaver kidney transplantation still remain. Simple cold storage is an acceptable method for kidneys subjected to minimal warm ischemia. It can be used where anticipated storage time will not exceed 10 to 15 hours. Pulsatile or nonpulsatile machine perfusion will give better results especially when kidneys have sustained up to 60 minutes warm ischemia. Where there is also a need for storage time longer than 15 hours, perfusion should be used. Cryoprecipitated millipore-filtered plasma remains the most commonly used perfusate. Preservation really begins before the harvesting. Present preservation techniques cannot revive a dying kidney. No single test will determine the degree of viability of a kidney. A systematic multidisciplinary effort is needed to augment our understanding and knowlege about the effect of hypothermia on organs. Hopefully these efforts will result in the development of an organ bank whereby many more kidneys will be available for transplantation.

Animals

Patient acceptance of local anesthesia for breast biopsy.

Three out of every four patients undergoing breast biopsy found the outpatient local-anesthesia method acceptable in this study. Patient acceptance was greater among those who experienced less pain and anxiety. This suggests that acceptance could be increased by more complete preoperative explanation to the patient, adequate premedication, properly administered local anesthesia and gentle technique. Acceptance would also probably be far greater in a private practice setting than in the instititutional and sometimes impersonal setting of a large federal hospital. Breast biopsy under local anesthesia has not compromised survival rates or increased local recurrence. When it is done on an outpatient basis, hospital costs have been reduced at least threefold. It is apparent, then, that patient objection is not a deterrent to the use of breast biopsy under local anesthesia on an outpatient basis. For patients with dominant breast masses, this modality can be added to any plan of management which seeks to reduce patient risk and inconvencience, diminish hospital costs and alleviate bed demand all without impairing diagnostic accuracy or long-term survival.

Adolescent

Determination of bone mineral density by dual x-ray absorptiometry in patients with uncemented total hip arthroplasty.

Bone remodeling is an expected sequela with total hip arthroplasty (THA). Although there are several methods of estimating bone response in THA patients from radiographs, there are no accurate and generally accepted methods for quantitative determinations in vivo. In this study, we describe an application of dual x-ray absorptiometry (DXA) for measuring bone mineral content and bone mineral density in the proximal femur following THA. DXA is a noninvasive technique with minimal radiation exposure (< 5 mrem). Various aspects of measurement error (accuracy and reliability) of this application of DXA were determined in a series of studies reported here. Accuracy error (how similar are the measured and actual values) was < 1% determined in bone phantoms of four densities. Precision error (how reproducible are the measurements) was also < 1% at all four densities in the phantoms and was only slightly elevated (0.9-1.5%) in repeated measurements of implanted cadaver femora. Precision error in vivo, determined both from multiple replicates on five patients and from duplicate scans on 30 patients, was further elevated but remained < 5%. Contributions to precision error, rotation of the leg, and interoperator variability were assessed; none was found to elevate precision error appreciably. We suggest that DXA is a feasible method for quantifying bone response following THA, and will allow discrimination of small changes (> 5%) not previously measurable.

Absorptiometry, Photon