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PubMed1990

[Sports correlate with positive living habits. Results from the population survey the Swiss MONICA project].

Exercise is associated with positive health habits: Findings from the populations survey of the Swiss MONICA-project. Relatively little is known on population-wide relations of habitual exercise to relevant health factors such as diet, cigarette smoking and overweight. Data from a population-based sample of approximately 800 men and women each, aged 25-64, collected in western Switzerland as a part of an international WHO-project, were used to examine cross-sectionally the interrelationships between different lifestyle factors. Men and women training regularly (i.e. greater than or equal to 2 times/wk) exhibited consistently and highly significantly more favourable health habits, regarding diet (i.e. trimming visible fat, higher intake of fruits, salad and vegetables, yogurt and cottage cheese), nonsmoking, and weight control. Men and women with at least some regular physical activity during leisure-time had in turn more favourable health habits than their sedentary counterparts. In both sexes, educational level was directly related to exercise and a healthy diet, and inversely related to smoking and relative weight. Regularly training men and women also had a significantly improved lipid profile compared to inactive ones. It is concluded from this study that leisure-time physical activity and exercise are related to a positive health behaviour including diet, nonsmoking and efficient weight control. This may suggest that exercise should possibly be integrated into any population-wide attempts and efforts to promote health to enhance primary prevention.

Adult↗

PubMed1986

Geometry, growth rates, and duration of cancer and carcinoma in situ of the breast before detection by screening.

The purpose of this study is to report the time elapsing between the moment a breast cancer reaches threshold size that would permit detection and the size at actual detection defined as sojourn time (STt) using data from the Breast Cancer Detection and Demonstration Project (Louisville data and reported composite data from 27 centers) by dividing prevalence rates by incidence rates. The number of cellular generations (n) required to produce cancers of different volumes was calculated at threshold (nt), at detection (nd), and the difference between the two (nd - nt). By dividing the difference (nd - nt) into STt, the average actual or net tumor volume doubling time (DTact) in this interval have been estimated. The STt value for carcinoma in situ was 557 and for cancer it was 538. At ages 35-39, STt ranged from 365-456 days, by ages 70-74, 942-1383 days. The average DTact similarly varied with age, carcinoma in situ, cancer with negative axillary nodes, and cancer with positive axillary nodes over a range of 28-732 days (95% confidence). The estimated DTact in the predetectable period was manyfold less than the DTact measured for mammographically visible cancers, in keeping with the predictions of decelerating growth. Models of the cytokinetic and clinical behavior of breast cancer are discussed.

Adult↗

PubMed2005

A feasibility study for image guided radiotherapy using low dose, high speed, cone beam X-ray volumetric imaging.

BACKGROUND AND PURPOSE: Image Guidance of patient set-up for radiotherapy can be achieved by acquiring X-ray volumetric images (XVI) with Elekta Synergy and registering these to the planning CT scan. This enables full 3D registration of structures from similar 3D imaging modalities and offers superior image quality, rotational set-up information and a large field of view. This study uses the head section of the Rando phantom to demonstrate a new paradigm of faster, lower dose XVI that still allows registration to high precision. MATERIALS AND METHODS: One high exposure XVI scan and one low exposure XVI scan were performed with a Rando Head Phantom. The second scan was used to simulate ultra low dose, fast acquisition, full and half scans by discarding a large number of projections before reconstruction. Dose measurements were performed using Thermo Luminescent Dosimeters (TLD) and an ion chamber. The reconstructed XVI scans were automatically registered with a helical CT scan of the Rando Head using the volumetric, grey-level, cross-correlation algorithm implemented in the Syntegra software package (Philips Medical Systems). Reproducibility of the registration process was investigated. RESULTS: In both XVI scans the body surface, bone-tissue and tissue air interfaces were clearly visible. Although the subjective image quality of the low dose cone beam scan was reduced, registration of both cone beam scans with the planning CT scan agreed within 0.1 mm and 0.1 degrees . Dose to the patient was reduced from 28mGy to less than 1mGy and the equivalent scan speed reduced to one minute or less. CONCLUSIONS: Automatic 3D registration of high speed, ultra low dose XVI scans with the planning CT scan can be used for precision 3D patient set-up verification/image guidance on a daily basis with out loss of accuracy when compared to higher dose XVI scans.

Dose Fractionation, Radiation↗

PubMedDate not supplied

The lived experience of adolescent females with type 1 diabetes.

PURPOSE: The purpose of this study was to gain a better understanding of what it means for adolescent females to live with type 1 diabetes. METHODS: Van Manen's phenomenological framework was used to guide the project of inquiry. Adolescents were recruited from a diabetes camp. A purposive sample of 10 adolescent females, aged 16 and 17 years, volunteered to participate in the study. Unstructured, one-on-one interviews were conducted and participants' accounts were transcribed and analyzed for themes. RESULTS: Five themes were identified: (1) blending in with the adolescent culture, (2) standing out and being watched, (3) weighing the options and making choices, (4) being tethered to the system and to diabetes, and (5) struggling with conflicts. These adolescent females struggled with several conflicts and choices they were forced to make on a daily basis. They felt tethered to a disease that would never go away and to the healthcare system. Yet, they adopted ways to handle their disease so that it was manageable within the context of their lives. Fitting in with their peers was often more important than diabetes management. CONCLUSIONS: Making visible the experience of adolescent females living with type 1 diabetes has implications for practice, education, and research in diabetes education.

Adaptation, Psychological↗

PubMed2003

Why adoption is not an option in India: the visibility of infertility, the secrecy of donor insemination, and other cultural complexities.

Child adoption in the face of reproduction gone awry continues to remain an under researched aspect of contemporary Indian reality. This paper seeks to unpack some of the critical cultural issues underscoring the deep-seated reluctance towards adoption. Drawing on a larger multi-sited research project examining the experience of infertility and assisted conception in India, the paper sheds light on the state of current adoption practices in India. Thus, when faced with infertility, couples in this research emerged as favouring secret gamete donation as a means of bypassing infertility rather than the option of adoption. Invoking the concept of systematic misrecognition, the paper situates the modalities of salvaging infertility, either through medically assisted conception or adoption, as structuring infertile people's quest for children. The paper relates the perceived stigma associated with infertility treatment and adoption with the inclusion of a "third party" that fractures the culturally conceptualized boundaries of family as inextricably tied to the conjugal bond. It is therefore argued that secrecy is born out of a need to obfuscate a "public and visible" violation of a culturally priced ideal that views an intimate connection between the "married body" and the progeny. Adoption continues to remain an undesirable option because the links between an adopted child and the social parent become a public, vocal, and visible admission of infertility that cannot be subsumed, like donated gamete conception, under a conspiracy of silence.

Adoption↗

PubMed1985

A comparative study of laser beam characteristics in blood and saline media.

Little information is available concerning the influences on laser radiation exerted by the various media through which lasing is done. The effects of saline solution and blood on argon laser beam divergence and projection were studied. In addition, the resulting effects on arterial tissue were evaluated after lasing through these media. This was performed with the fiber tip held in various positions relative to the arterial wall. The presence of blood, even in a diluted form, increased beam divergence and reduced forward projection. Perpendicular lasing through saline solution resulted in crater diameters similar in size to the core diameter of the fiber used irrespective of energy levels (424 +/- 97 microns at energy = 2 W X 5 seconds and 490 +/- 80 microns at energy = 2 W X 10 seconds). In contrast, lasing through blood produced much wider craters that increased in size with the higher energy level (878 +/- 215 microns at 2 W X 5 seconds and 1,294 +/- 314 microns at 2 W X 10 seconds). Arterial wall damage could also be inflicted at a greater distance when lasing through blood than through saline solution. Lasing arterial tissue through blood with the fiber tip held parallel to and in contact with the arterial wall resulted in wide craters when lasing was performed in a "static" as well as a "dynamic" fashion. Lasing through saline solution in these positions produced no visible damage to the arterial wall. These results provide some guidelines that may be useful in the clinical application of Argon laser revascularization.

Arteries↗

PubMedDate not supplied

Visualization modes for CT colonography using cylindrical and planar map projections.

PURPOSE: The purpose of this study was to demonstrate the limitations to the effectiveness of CT colonography, colloquially called virtual colonoscopy (VC), for detecting polyps in the colon and to describe a new technique, map projection CT colonography using Mercator projection and stereographic projection, that overcomes these limitations. METHOD: In one experiment, data sets from nine patients undergoing CT colonography were analyzed to determine the percentage of the mucosal surface visible in various visualization modes as a function of field of view (FOV). In another experiment, 40 digitally synthesized polyps of various sizes (10, 7, 5, and 3.5 mm) were randomly inserted into four copies of one patient data set. Both Mercator and stereographic projections were used to visualize the surface of the colon of each data set. The sensitivity and positive predictive value (PPV) were calculated and compared with the results of an earlier study of visualization modes using the same CT colonography data. RESULTS: The percentage of mucosal surface visualized by VC increases with greater FOV but only approaches that of map projection VC (98.8%) at a distorting, very high FOV. For both readers and polyp sizes of > or =7 mm, sensitivity for Mercator projection (87.5%) and stereographic projection (82.5%) was significantly greater (p < 0.05) than for viewing axial slices (62.5%), and Mercator projection was significantly more sensitive than VC (67.5%). Mercator and stereographic projection had PPVs of 75.4 and 78.9%, respectively. CONCLUSION: The sensitivity of conventional CT colonography is limited by the percentage of the mucosal surface seen. Map projection CT colonography overcomes this problem and provides a more sensitive method with a high PPV for detecting polyps than other methods currently being investigated.

Adult↗

PubMed1996

The dimensions and vascular anatomy of the cricothyroid membrane: relevance to emergent surgical airway access.

Following traumatic injury, rapid surgical access to the airway may be required, with surgical cricothyroidostomy the procedure of choice. Immediate complications of cricothyroidostomy include unsuccessful or incorrect site of tube placement and hemorrhage. Subglottic stenosis is the most common late complication. This project was undertaken to better define the dimensions and vasculature of the cricothyroid region. In 15 cadaveric specimens, cervical dissection revealed the average width of the cricothyroid membrane visible between cricothyroid muscles to be 8.2 mm, and the average height 10.4 mm. Latex injection of the carotid artery demonstrated a transverse cricothyroid artery arising from the superior thyroid artery in 93% of cases. The cricothyroid artery crossed the upper one-half of the cricothyroid membrane in all but one specimen. Branches of the cricothyroid artery penetrated the membrane and ascended along the undersurface of the thyroid cartilage. Unilateral superior thyroid artery injection demonstrated anastomoses between right and left cricothyroid arteries. In 54% of specimens, the superior thyroid artery coursed anterior to the sternothyroid muscle and then the lateral edge of the cricothyroid membrane. The membrane was also crossed by venous tributaries to the superior and inferior thyroid veins. To lessen the possibility of complications following cricothyroidostomy, a knowledge of the dimensions, relations, and vasculature of the cricothyroid membrane is of inestimable value.

Aged↗

PubMed1993

School issues and the child with cancer.

American Cancer Society (ACS)-funded research projects in the 1980s were significant in the development of current school intervention programs for children and adolescents with cancer. These programs need to be part of the psychosocial service of every pediatric hematology/oncology center, not only for those student/patients with highly visible problems but for all children; first, to ensure a smooth re-entry into school after diagnosis; and second, to identify any cognitive and academic dysfunctions that may result from treatment. The restructuring of special education services in the public schools in the United States and decreasing budgets are a challenge to the ACS to join with other health organizations to lobby at the local, state, and national level for services for all children regardless of diagnosis. Classroom teachers need to be empowered by parents and hospital personnel to develop creative, situation-specific interventions on behalf of each child and to work with the school psychologist to assess and make appropriate recommendations for students with cognitive late effects. This population needs ongoing support as they progress through the educational system and make transitions from one level of education to the next.

Adolescent↗

PubMed2000

Production-orientated education and training of the mentally disabled in sheltered employment (PIONIER).

PURPOSE: The development and realization of a production-orientated education and training system for mentally disabled people in sheltered employment in the course of the project PIONIER. It focuses on the metal and electronic branches of a workshop with a mentally disabled workforce in Alsdorf, Germany. METHODS: For the development of the modules an assessment tool called MELBA was used to determine the abilities of the disabled people and the requirements of the tasks. Methods for the collection of this information was: observation, questionnaires and documents. RESULTS: Three months after the introduction of educational measures the improvements of the capacity for learning and education of disabled persons was visible. In the same way the development of their self-reliance and social abilities was recorded. The metal working branch was capable of fulfilling every task with respect to quality issues and within set delivery times. The electro working branch was accomplished enough to create new workplaces and to get orders from the computer industry. CONCLUSIONS: By the use of a qualification system like PIONIER the tasks of the disabled employees have been enlarged and enriched. In order to cope with the increase competition sheltered workshops have to realize new ways of vocational training for mentally disabled employees.

Education of Persons with Intellectual Disabilitie↗

PubMed2001

Corneal foreign bodies--first aid, treatment, and outcomes. Skills review for an occupational health setting.

Eye injuries from foreign body incidents remain prevalent in the workplace setting. Often the professional nurse provides the first line of treatment. The informal class presented at the authors' facility offered a comprehensive, organized presentation of a common injury encountered in the practice of occupational health nursing. Strenghts of the presentation included handouts demonstrating eye eversion technique and a flip chart summarizing the content to be placed in each medical station as quick reference. One challenge involved presenting the information to all nurses. The site encompasses four locations and some nurses function as the only staff in the plant for a given shift. With the support of administration and some creative scheduling, 10 of 17 nurses attended one of three classes offered in one morning, and the remaining 7 were able to view the class on videotape. Videotaping the presentation also provided material for future orientation, as well as an opportunity for review. Overall analysis found this a worthwhile offering relevant to practice. A brief formal written evaluation indicated the objectives for the class were achieved and elicited subjects for future topics. Informal chart reviews to check for documentation of visual acuity testing and eversion of the upper lid for foreign body injuries is another outcome measure currently in progress. In addition, a performance improvement project could be accomplished easily by retrospective chart review of assessment and treatment documentation, and tracking of revisits and referrals. Knowledge of current standards in the assessment, first aid, and treatment of eye injuries is every occupational health nurse's responsibility. However, prevention of foreign body injuries is far superior to any treatment modality available. As highly visible leaders within the occupational setting, nurses can be advocates and role models for safe work practices. Occupational health nurses may promote safe eye practices by actively seeking collaboration with safety departments to continuously monitor and improve eye injury and outcome statistics and use of protective eye-wear. By consistently wearing proper safety eyewear, such as approved goggles or prescription safety glasses with side sheilds, during each and every venture into the work area, occupational health nurses provide a strong role model and have the opportunity to educate employees and encourage safe work practices. It is important to encourage shared responsibility and awareness between workers and management for prevention of foreign body incidents and prompt, accurate treatment when necessary to promote optimal outcome.

Cornea↗

PubMed2004

Laser trabecular sclerosis for chronic hypotony after vitreoretinal surgery.

PURPOSE: To perform a pilot study of laser trabecular sclerosis (LTS) for chronic ocular hypotony after vitreoretinal surgery. DESIGN: Prospective noncomparative case series. PARTICIPANTS: Three patients with chronic hypotony after vitreoretinal procedures underwent LTS. All patients had undergone complex vitreoretinal surgery with attached retinas postoperatively but with persistent hypotony and poor vision. INTERVENTION: Laser trabecular sclerosis was performed in a fashion similar to laser trabeculoplasty, using a 100-microm spot, 800 to 1000 mW power at 0.1 seconds, and applying heavy confluent treatment in >/=1 sessions throughout the angle where trabecular meshwork was visible. MAIN OUTCOME MEASURES: Intraocular pressure (IOP), best spectacle-corrected visual acuity, and complications were studied. RESULTS: In 1 patient, a single session of LTS was followed by an increase in IOP of approximately 4 mm, with subjective and objective improvement in vision. A second patient exhibited improvement in IOP and visual acuity after 3 sessions of LTS. A third patient underwent 3 sessions of LTS without improvement in IOP or vision. CONCLUSION: Given the limitations of this small series, including the lack of a randomized prospective design, it is not possible to determine the safety or efficacy of LTS, but this study does suggest that this procedure could play a therapeutic role in some patients with chronic symptomatic hypotony after complex intraocular surgery. Further study is warranted.

Adult↗

PubMed1996

Habituation of the orienting response to stimuli of different functional values in 4-month old infants.

In experiments on infant attention, the sudden presentation of a stimulus elicits an orienting response (OR). Its persisting presence then reinforces its visual exploration. When subsequently projected, this stimulus comes to signal the availability of something to look at. The aim of the present study was to sort out the effect of these three functional values of stimuli on OR elicitation. Fifty 4-month-old infants (M = 120 days) were randomly assigned to one of three experimental conditions. In Condition 1, they received 12 presentations of a 2-s visual stimulus. In Condition 2, the same 12 short stimuli presentations were accompanied by the projection of another event, visible after having the infant's gaze oriented toward the first stimulus. Condition 3 was a infant-control procedure: the same stimulus was repeatedly presented and remained on for as long as the infant looked at it. In each condition, half of the infants were shown a 4 x 4 checkerboard pattern, the others a 8 x 8 pattern. After this phase of repetitive presentation of one checkerboard pattern, the other was presented for two test trials, followed by two dishabituation trials with the initial first pattern. When the eliciting function of the stimulus (Condition 1) was isolated, orienting responses decreased over trials, and were of different latencies, according to stimulus complexity. On the other hand, the isolated function of the stimulus (Condition 2) raised its capacity to elicit ORs. Stimulus complexity was a determining factor in OR habituation, in attention recovery and in dishabituation for Conditions 1 and 3, but it was overshadowed by its signaling function in Condition 2. These results suggest the importance of taking into account the functional value of stimuli when analyzing infant attention.

Arousal↗

PubMed1993

Carboxyl-terminal portions of the alpha chains of fibrinogen and fibrin. Localization by electron microscopy and the effects of isolated alpha C fragments on polymerization.

The locations of the carboxyl-terminal two thirds of the A alpha chains, or the alpha C domains, were determined for fibrinogen and some of its derivatives by electron microscopy of rotary-shadowed preparations. A monoclonal antibody, G8, to the carboxyl-terminal 150 amino acids of the A alpha chain, binds near the central region of fibrinogen, indicating that the alpha C domains of most molecules are not normally visible because they are on or near the amino-terminal disulfide knot. At pH 3.5, fibrinogen and fibrin monomers appear to be similar, with a projection terminating in a small globular domain from each end of most molecules. In contrast, fragment X monomers, produced by cleavage of the alpha C domains from fibrinogen with plasmin, show no such projections. When fibrin monomer is brought to neutral pH under conditions where polymerization is delayed, individual molecules are still visible showing the alpha C domains as a single additional nodule near the central region. Moreover, analysis of clusters of molecules reveals some intermolecular associations via the alpha C domains. A 40-kDa fragment comprising the alpha C domain has been isolated from a plasmin digest of fibrinogen and characterized by SDS-polyacrylamide gel electrophoresis and determination of amino-terminal amino acid sequences. Electron microscopy of alpha C fragments reveals individual globular structures, as well as oligomeric aggregates. The addition of alpha C fragments to fibrin monomer followed by dilution to neutral pH to initiate polymerization results in lower turbidity, longer lag period, and slower maximum rate of turbidity increase. Also, electron microscopy reveals complexes of alpha C fragments with fibrin monomer at neutral pH. It appears that the free alpha C fragments can bind to the alpha C domains of fibrin, competing with the normal alpha C domain interactions involved in polymerization.

Amino Acid Sequence↗

PubMed1998

MR sialography in patients with Sjögren syndrome.

PURPOSE: The purpose of this study was to evaluate the effectiveness of MR sialography of the parotid gland ducts in the diagnosis and staging of Sjögren syndrome. METHODS: MR imaging was performed on a 1.5-T unit with a neck phased-array coil. MR sialographic source images were obtained using a heavily T2-weighted fast spin-echo sequence with spectral fat suppression. All images were analyzed on the basis of maximum intensity projection reconstruction. Five healthy control subjects and 51 patients with definite Sjögren syndrome (43 with primary disease and eight with secondary disease) were examined with MR sialography. A labial gland biopsy was performed in all patients and histopathologic grading was done by means of focal scores. The findings of MR sialography were compared with the results of labial gland biopsy to determine the effectiveness of the technique in the diagnosis and staging of Sjögren syndrome. RESULTS: In all five control subjects, the main duct and the primary branching ducts of the parotid glands were clearly visible on MR sialographic images. In patients with Sjögren syndrome, a punctate, globular, cavitary, or destructive appearance was well seen within the parotid glands. Findings obtained at MR sialography correlated well with the results of labial gland biopsy. CONCLUSION: MR sialography has the potential to produce diagnostic findings in the parotid gland ducts of patients with Sjögren syndrome. Our results suggest that this method will augment and possibly replace X-ray sialography.

Adolescent↗

PubMed2005

A further study to investigate the detection and enhancement of latent fingerprints using visible absorption and luminescence chemical imaging.

This study investigated the application of chemical imaging to the detection of latent fingerprints using the Condor macroscopic chemical imaging system (ChemImage Corp., Pittsburgh, USA). Methods were developed and optimised for the visualisation of untreated latent fingerprints and fingerprints processed with DFO, ninhydrin, cyanoacrylate, and cyanoacrylate plus rhodamine 6G stain. The results obtained with chemical imaging were compared to the detection achieved using conventional imaging techniques. The Condor significantly improved the detection of many prints, especially those that might be considered poor quality or borderline prints. Prints on newspaper treated with ninhydrin and DFO, and prints on white and yellow paper treated with ninhydrin, benefited the most from chemical imaging detection. In many cases, fingerprints undetectable using conventional imaging techniques could be visualised with chemical imaging. Ridge detail from untreated prints on yellow paper was also detected using the Condor. When prints of high quality were examined, both detection techniques produced quality results. The results of this project demonstrate that chemical imaging offers advantages over conventional visualisation techniques when examining latent fingerprints, especially those that would be considered difficult, such as weak prints or prints on surfaces that produce highly luminescent backgrounds. Standard testing procedures for the detection and enhancement of fingerprints by chemical imaging are presented and discussed.

Dermatoglyphics↗

PubMed2005

Reduction of adverse drug events and medication errors in a community hospital setting.

Keys to success in reducing ADEs have included the support of administrative leaders through their visibility and emphasis on safety as an organizational priority, and financial support for safety projects. Administrative participation was also helpful in promoting safety efforts through the reinforcement of expectations when progress was sluggish. The use of rapid cycle change provided enough early success to serve in motivating staff to push ahead. It allowed staff the opportunity to analyze changes, make adjustments, and retest on a slightly larger scale. Other key success factors included the motivation of teams through continual sharing of progress and success stories; celebrations for achievements are held routinely. As an organization, SJMC has shared its success strategies with other organizations and promoted networking with other organizations to determine what strategies have worked elsewhere. This is helpful as it prevents time from being wasted on solutions that have been tried without success. Within the OSF Healthcare System, the following phrase has been adopted in regard to patient safety, "Safety is like peeling an onion; the more you look, the more you find, and each layer makes you cry."

Adverse Drug Reaction Reporting Systems↗

PubMed2002

Retinal thickness analysis(RTA): an objective method to assess and quantify the retinal thickness in healthy controls and in diabetics without diabetic retinopathy.

BACKGROUND: Since it has been shown that photocoagulation is indicated in patients with diabetic macular edema, quantitative and objective assessment of retinal thickness is of clinical importance. METHODS: A laser slit beam was projected on the retina and scanned across a 2 x 2 mm retinal area in 200 msec. Nine type 1 and 2 diabetic patients without funduscopically and photographically visible diabetic retinopathy and 10 healthy controls were scanned with the RTA. The intraindividual and interindividual variabilities of the RTA were determined. RESULTS: The intraindividual and interindividual variability was 5 microm and 15 microm, respectively. The mean value of the mean foveal thickness (MFT) and perifoveal retinal thickness (PFT) in the 10 healthy controls was 152 +/- 15 microm and 175 +/- 14 microm, respectively, and 181 +/- 26 microm and 191 +/- 27 microm, respectively, in the group of nine diabetics without signs of diabetic retinopathy. The MFT in the group of diabetic patients was significantly (P < 0.001) larger than in the control groups. CONCLUSION: Retinal thickness in diabetic patients without diabetic retinopathy was increased in all measurements in comparison with the findings in healthy subjects. Retinal thickness measurements with the RTA could possibly detect early signs of diabetic retinopathy before funduscopic and photographic signs are visible and may be helpful in guiding treatment.

Adult↗