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PubMed2004

Reporting of ethical standards: differences between complementary and orthodox medicine journals?

OBJECTIVES: This study aimed at assessing whether there are differences in the reporting of ethical aspects of complementary and alternative medicine (CAM) and mainstream medical research. DESIGN: Review of published literature. SETTING: Research department of medical school. MAIN OUTCOME MEASURES: Reports of ethical aspects including adherence to clinical guidelines, ethical approval from ethics committees, consent of the patient, declaration of conflict of interest, and declaration of funding for a study. RESULTS: We included 21 articles from CAM journals, as well as 16 from equal impact factor mainstream (EIF) journals and 27 from high impact factor (HIF) journals. A statistically significant difference was found in the reporting of ethical approval: 62% of all CAM articles, 75% of the EIF and 93% of the HIF journal articles reported approval from ethics committees [chi2 = (2, n = 64) 6.631, p<0.05]. Regarding the reporting of obtaining patients' consent there were no statistically significant differences: 48% of all CAM articles, 38% of the EIF mainstream and 67% of the HIF mainstream journal articles explicitly stated that patients signed a consent form [chi2 = (2, n = 64) 3.813, p>.05]. High impact factor journals were more likely to report on ethical standards than other journals on conflicts of interests and sponsorship. However, they were less likely to report a reference to ethical guidelines. Articles from CAM journals had more strict reporting requirements than mainstream medicine journals with comparable impact factors. CONCLUSIONS: Differences exist between complementary and orthodox medical journals in the reporting of ethical aspects of trial design.

Codes of Ethics↗

PubMed2005

Toxicological evaluation of glycerin as a cigarette ingredient.

Glycerin is applied to cigarette tobacco at levels in the range of about 1-5% to improve moisture holding characteristics of tobacco and act as a surface active agent for flavor application. Neat material pyrolysis studies, smoke chemistry and biological activity studies (bacterial mutagenicity, cytotoxicity, in vivo micronucleus, and sub-chronic rodent inhalation) with mainstream smoke, or mainstream smoke preparations from cigarettes containing various target levels (5%, 10%, and 15%) of the glycerin were performed to provide data for an assessment of the use of glycerin as a cigarette tobacco ingredient. The actual levels of glycerin in the respective test cigarettes were determined to be 3.2%, 6.2% and 8.4% after cigarette production. At simulated tobacco burning temperatures up to 900 degrees C, neat glycerin did not pyrolyze extensively suggesting that glycerin would transfer intact to mainstream smoke (smoke was not analyzed for glycerin in this study). On a tar basis, nicotine in smoke was significantly decreased at 10% and 15% glycerin while water was increased at all addition levels. Addition of 10% or 15% glycerin also resulted in a statistically significant increase in acrolein (9%) and a decrease in acetaldehyde, propionaldehyde, aromatic amines, nitrogen oxides, tobacco specific nitrosamines, and phenols. Addition of 5% glycerin produced the same decrease in smoke constituents as the 10% and 15% groups but there was no concomitant increase in acrolein. Biological tests indicated no relevant differences in the genotoxic or cytotoxic potential of either mainstream smoke (or smoke preparations) from cigarettes with added glycerin compared to control cigarettes. Cigarette smoke atmosphere dilution, coupled with the lower nicotine delivery in the test cigarettes containing glycerin resulted in a lower nicotine delivery to the glycerin cigarette smoke exposed rats of the 90-day inhalation study. Smoke atmosphere acrolein was also reduced in a concentration-related manner. Incorporation of glycerin at target levels up to 15% did not produce any adverse effects in rats exposed for 90-days. The major observation in the study was a reduced biological activity of the smoke as indicated by a reduction in the severity and/or incidence of focal macrophage accumulation in the lungs and goblet cell hyperplasia/hypertrophy in the nose (level 1), and goblet cell staining depletion in the nose (level 1). The results of these studies with glycerin applied to cigarette tobacco suggest that adding glycerin to cigarette tobacco at typical use levels does not adversely alter the smoke chemistry or biological effects normally associated with exposure to mainstream cigarette smoke.

Animals↗

PubMed1998

Childhood nocturnal enuresis in The Netherlands.

OBJECTIVES: To assess the prevalence of nocturnal enuresis in school children aged 5 to 15 years, and to investigate the association of bedwetting with ethnicity, the educational level of the parents, and the type of education (mainstream or special) received by the child. METHODS: Data were obtained for 5360 children in mainstream education and 2571 children in special education. The data were weighted to calculate estimates representative of the Dutch population. Nocturnal enuresis was examined in children 5 or 6 years of age who wet their bed at least twice in the 4 weeks previous to questioning, and in children 7 years of age and older who did so at least once in the previous 4 weeks. RESULTS: The prevalence of nocturnal enuresis was 6%; 15% in the 5 to 6-year-age group and 1% in the 13 to 15-year age group. Marked enuresis (at least twice a week) was reported in 4%. Nocturnal enuresis was more common in Turkish/Moroccan (14%) than in Dutch children (6%). The educational level of the parents was not significantly related to nocturnal enuresis. Children in special education more frequently reported nocturnal enuresis than children in mainstream education (14% and 6%, respectively). This was especially true for children in schools for the mentally retarded as compared to children in mainstream education ¿odds ratio [OR] in boys 3.21 (99% confidence interval [CI] 2.26 to 4.55) and OR in girls 4.25 [99% CI 2.61 to 6.92]¿. CONCLUSIONS: Nocturnal enuresis occurs most frequently among mentally retarded children. Children attending special education schools for reasons other than mental retardation are also at a higher risk of experiencing nocturnal enuresis than children attending mainstream education schools. Nocturnal enuresis is more prevalent in Turkish/Moroccan children than in Dutch children.

Adolescent↗

PubMed2004

Awakening consumer stewardship of health benefits: prevalence and differentiation of new health plan models.

CONTEXT: Despite widespread publicity of consumer-directed health plans, little is known about their prevalence and the extent to which their designs adequately reflect and support consumerism. OBJECTIVE: We examined three types of consumer-directed health plans: health reimbursement accounts (HRAs), premium-tiered, and point-of-care tiered benefit plans. We sought to measure the extent to which these plans had diffused, as well as to provide a critical look at the ways in which these plans support consumerism. Consumerism in this context refers to efforts to enable informed consumer choice and consumers' involvement in managing their health. We also wished to determine whether mainstream health plans-health maintenance organization (HMO), point of service (POS), and preferred provider organization (PPO) models-were being influenced by consumerism. DATA SOURCES/STUDY SETTING: Our study uses national survey data collected by Mercer Human Resource Consulting from 680 national and regional commercial health benefit plans on HMO, PPO, POS, and consumer-directed products. STUDY DESIGN: We defined consumer-directed products as health benefit plans that provided (1) consumer incentives to select more economical health care options, including self-care and no care, and (2) information and support to inform such selections. We asked health plans that offered consumer-directed products about 2003 enrollment, basic design features, and the availability of decision support. We also asked mainstream health plans about their activities that supported consumerism (e.g., proactive outreach to inform or influence enrollee behavior, such as self-management or preventive care, reminders sent to patients with identified medical conditions.) DATA COLLECTION/EXTRACTION METHODS: We analyzed survey responses for all four product lines in order to identify those plans that offer health reimbursement accounts (HRAs), premium-tiered, or point-of-care tiered models as well as efforts of mainstream health plans to engage informed consumer decision making. PRINCIPAL FINDINGS: The majority of enrollees in consumer-directed health plans are in tiered models (primarily point-of-care tiered networks) rather than HRAs. Tiers are predominantly determined based on both cost and quality criteria. Enrollment in HRAs has grown substantially, in part because of the entry of mainstream managed care plans into the consumer-directed market. Health reimbursement accounts, tiered networks, and traditional managed care plans vary in their capacity to support consumers in managing their health risks and selection of provider and treatment options, with HRAs providing the most and mainstream plans the least. CONCLUSIONS: While enrollment in consumer-directed health plans continues to grow steadily, it remains a tiny fraction of all employer-sponsored coverage. Decision support in these plans, a critical link to help consumers make more informed choices, is also still limited. This lack may be of concern in light of the fact that only a minority of such plans report that they monitor claims to protect against underuse. Tiered benefit models appear to be more readily accepted by the market than HRAs. If they are to succeed in optimizing consumers' utility from health benefit spending, careful attention needs to be paid to how well these models inform consumers about the consequences of their selections.

Consumer Behavior↗

PubMed2001

How can action research apply to health services?

The authors ask whether and how action research can apply to health services research, given action research's claim to be radically different from mainstream research. They analyze the key tenets of an idealized version of action research, comparing them with those of the approach characteristic of mainstream research. The authors conclude, firstly, that action research deserves all credit for pioneering flexible and imaginative ways of working. Yet, there is nothing in the fundamental logic of the mainstream approach to preclude it from adopting some of these. Action researchers therefore need to reconsider their critical stance toward mainstream research. Conversely, mainstream researchers need to reconsider their critical stance toward the ways of working pioneered by action research and to adopt them as appropriate.

Delivery of Health Care↗

PubMed2005

Impact of learning orientation on African American children's attitudes toward high-achieving peers.

This study examined Ogbu's widely accepted thesis that African American students reject high academic achievement because they perceive its limited utility in a world where their upward mobility is constrained by racial discrimination. Boykin's psychosocial integrity model contends that Black students value high achievement but that discrepancies between their formative cultural experiences and those imposed in school lead them to reject the modes of achievement available in classrooms. Ninety Black children completed a measure of attitudes toward students who achieve via mainstream or African American cultural values. Participants rejected the mainstream achievers and embraced the African American cultural achievers. Moreover, they expected their teachers to embrace the mainstream achievers and reject those who achieved through high-verve behavior. Results suggest that Boykin's thesis is a needed refinement to Ogbu's ideas. They indicate that Black children may reject not high achievement but some of the mainstream cultural values and behaviors on which success in mainstream classrooms is made contingent.

Black or African American↗

PubMed2006

Consultations in general practice and at an Aboriginal community controlled health service: do they differ?

INTRODUCTION: Despite the widely acknowledged health disparities between Indigenous and non-Indigenous Australians, little is known about consultations in primary care with Indigenous people. In particular, the nature of consultations in the Aboriginal Community Controlled Health Service (ACCHS) sector has been rarely studied. Data collection about consultations in primary care has been steadily improving, with good quality data now available on an ongoing basis about patient demographics, risk factors and consultation content in private general practice. This study aimed to characterise consultations at Townsville Aboriginal and Islander Health Service (TAIHS) in terms of patient demographics and consultation content. These could then be compared with existing datasets for local consultations in mainstream general practice and from a geographically distant ACCHS. METHODS: We conducted a prospective questionnaire audit of all consultations at Townsville Aboriginal and Islander Health Service (TAIHS) over two fortnights, 6 months apart in 2000 and 2001. The questionnaire was adapted from one used in previous general practice surveys, and was completed by the treating clinician at the end of each consultation. The questionnaire described consultations using the following variables: date of consultation; patient age; ethnicity and gender; postcode and whether or not they were new to the practice; where they were seen; the provider of the service (doctor, nurse, health worker etc); Medicare level of consultation; patient reasons for encounter; problems managed; treatment and medications given; investigations; admissions; follow up; and referral. Proportions with 95% confidence intervals were calculated to facilitate comparisons with other datasets. Comparison was made with previously reported data from mainstream Townsville general practice (via the local BEACH study report) and from Darwin ACCHS (Danila Dilba). RESULTS: Of 1211 consultations studied, 1994 problems managed were recorded. TAIHS patients had a significantly younger age distribution than patients in mainstream general practice (as did patients at Danila Dilba). TAIHS consultations involved the management of more problems (1.65 problems per consultation; 95%CI [1.60, 1.70]), when compared with mainstream general practice (Townsville BEACH study 1.45 problems per consultation [1.37, 1.52]; 1.48 for Indigenous patients). Danila Dilba recorded an average of 1.58 problems managed per consultation (95% CI [1.51, 1.65]). The most frequently managed problems differed between all three datasets, and at TAIHS the most common problems managed were type 2 diabetes mellitus (11.3 times per 100 consultations), upper respiratory tract infections (9.6) and hypertension (7.9). Aboriginal Health Workers (AHW) saw the patient at TAIHS in 224/1213 (18.5%) of consultations, nurses (two Indigenous) participated in 513 (42.3%) of consultations, and a (non-Indigenous) medical officer saw the patient in 1070 (88.2%) of consultations. The Danila Dilba study found that 42.6% of their consultations involved an Aboriginal health worker only, and a health worker and a doctor managed 53.5%; only 3.9% were managed by a doctor alone without input from a health worker. CONCLUSIONS: The greater number of problems managed per consultation in ACCHS, compared with Indigenous patients in mainstream general practice, supports the assertion that ACCHS fill an important role in the health system by providing care for their largely Indigenous patients with complex care needs. The Medicare system as it was structured at the time did not encourage involvement of Indigenous health workers in provision of primary medical care. It remains to be seen whether introduction of the new enhanced primary care Medicare numbers will assist in this process. These findings have implications for ACCHS in other areas of the country and for other providers of primary health care for Indigenous Australians.

Adolescent↗

PubMed1990

Tobacco-specific nitrosamines in European and USA cigarettes.

More than 170 types of commercial cigarettes from several European countries and the USA were analyzed for tobacco-specific nitrosamines (TSNA) in tobacco and mainstream smoke as well as for nitrate in tobacco. The cigarettes included filter and nonfilter cigarettes with different tar and nicotine yields. The observed range for N'-nitrosonornicotine (NNN) was from 4 to 1353 ng/cigarette in mainstream smoke and from 45 to 12454 ng/cigarette in tobacco. For 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) the values were between not detected (less than 4 ng/cigarette) and 1749 ng/cigarette in mainstream smoke and between not detected (less than 50 ng/cigarette) and 10745 ng/cigarette in tobacco. Nitrate levels ranged from 0.6 to 19.4 mg/cigarette. The TSNA levels for the cigarettes from the different countries investigated were in a similar range with the exception of few individual brands. The results demonstrated that there is no correlation between TSNA and tar deliveries in mainstream smoke. The TSNA deliveries in mainstream smoke depend on the amount or preformed TSNA in the actual tobacco composition, which is influenced by the nitrate level of the tobacco and the tobacco type. According to these results the tar delivery, although crucial, is not a sufficient index for the biological activity and the carcinogenic potential of cigarette smoke. Reduction of TSNA exposure can be achieved by selecting tobaccos with low levels of preformed TSNA in tobacco, which means a low nitrate content and reduction of the amount of Burley tobaccos and stems in blended cigarettes.

Chromatography, Gas↗

PubMed1999

Trends in educational placement and cost-benefit considerations in children with cochlear implants.

OBJECTIVES: To study the effect of cochlear implantation on the use of educational resources by profoundly hearing-impaired children and to determine trends in educational cost vs benefit. DESIGN: Retrospective study and cost-benefit analysis. SETTING: Outpatient pediatric cochlear implant program in an academic institution (The Listening Center at Johns Hopkins University School of Medicine, Baltimore, Md), in collaboration with public schools in Maryland and surrounding states. PATIENTS OR OTHER PARTICIPANTS: School-aged children with profound prelingual hearing impairment without other clearly defined disabilities. Thirty-five children with multiple-channel cochlear prostheses and a comparison group of 10 children without implants from 'total communication' programs in the Maryland public school system. INTERVENTIONS: Multiple-channel cochlear implantation and at least 1 year of a systematic auditory skill development program at the Listening Center, compared with standard educational management of children with conventional amplification. MAIN OUTCOME MEASURES: Classroom placement and number of hours of special educational support used. RESULTS: A correlation was observed between the length of cochlear implant experience and the rate of full-time placement in mainstream classrooms (r = 0.10; P= .04). There was also a negative correlation between the length of implant experience and the number of hours of special educational support used by fully mainstreamed children (Pearson product moment correlation = -0.10; P = .03). Children with greater than 2 years of implant experience were mainstreamed at twice the rate or more of age-matched children with profound hearing loss who did not have implants. They were also placed less frequently in self-contained classrooms and used fewer hours of special education support. A cost-benefit analysis based on conservative estimates of educational expenses from kindergarten to 12th grade shows a cost savings of cochlear implantation and appropriate auditory (re)habilitation that ranges from $30000 to $200000. CONCLUSIONS: Cochlear implantation accompanied by aural (re)habilitation increases access to acoustic information of spoken language, leading to higher rates of mainstream placement in schools and lower dependence on special education support services. The cost savings that results from a decrease in the use of support services indicates an educational cost benefit of cochlear implant (re)habilitation for many children.

Adolescent↗

PubMed2003

(Dis)abling children in primary school micro-spaces: geographies of inclusion and exclusion.

The geography of disabled children's schooling in the United Kingdom (UK) is changing, and this is underpinned by a growing international consensus that disabled children should be educated within mainstream school settings (UNESCO, The Salamanca statement and framework for action on special educational needs. World Conference on Special Needs Equality and Quality, Salamanca, Spain, 1994). As a result, new geographies of desegregation in disabled children's education are emerging, with disabled children being increasingly educated within mainstream rather than 'special' schools. This paper explores this issue, focusing on the (re)production of discourses of 'inclusion' and 'disability' in two mainstream primary schools in England. Empirical findings demonstrate that school actors reproduce meanings of inclusion and disability in different ways within and between school settings. It is shown that discourses of inclusion are frequently based on educational-medical models of disability, and can serve to exclude some children from mainstream schools. With this in mind, the paper highlights the value of a spatially sensitive evaluation of inclusion, that emphasises the importance of schools as unique moments in space and time to everyday practices of inclusion and disability.

Architectural Accessibility↗

PubMed1990

Making adult education accessible to the deaf. A model of direct instructor communication in ASL.

The purpose of this study was to develop a model of direct communication in American Sign Language for mainstreamed adult education courses. The model uses an individual instruction format with limited lecture time. Data were collected for 23 students (12 hearing and 11 deaf) newly enrolled in a mainstreamed word processing class. They were compared on average hours required to complete an exercise, average rates of attendance, and weekly drop rate. Attendance and drop rates were compared for new and returning students in the mainstreamed class (34 students) and 25 hearing students from a nonmainstreamed class. In addition, the average number of hours required to complete the exercises was compared for 10 new hearing students from the mainstreamed class and 11 new hearing students from the nonmainstreamed class. No significant differences were found in any of the comparisons. The study recommends further research to compare this Direct Instructor Communication Model with other more traditional deaf education models.

Adult↗

PubMed1986

Aerosols of smoke, respiratory physiology and deposition.

Tobacco smoke is discussed as a multi-component droplet aerosol system of finite airborne life time which changes rapidly right after formation near the combustion zone of the tobacco and continues to change gradually when aging and approaching a multiphase steady state between vaporized smoke constituents mixed into the air and the dispersed particulate phase which will eventually vanish because of physical mechanisms removing the smoke particles from the airborne state. Data on chemical composition and physical characteristics of mainstream and sidestream cigarette smoke are compared and the dynamic models of aerosol particle behavior and deposition in the respiratory tract under different physiological conditions are discussed. While differences in chemical composition between mainstream and sidestream smoke aerosol systems are reported in the literature at least for the gas phase, there seems to be no reliable body of evidence confirming that mainstream and sidestream cigarette smokes have sufficiently different physical characteristics which would cause substantially different deposition patterns and different relative deposition in the respiratory tract. However, there are scanty experimental data in the literature on cigarette smoke deposition in the lung which seem to indicate that mainstream smoke deposition may exceed theoretical expectations while sidestream smoke may not. Further experimental results are needed before firm conclusions can be drawn. An ongoing experimental effort is described where deposition of sidestream cigarette smoke will be measured on mouth breathing test panels.

Aerosols↗

PubMed2004

Parental decision-making in considering cochlear implant technology for a deaf child.

OBJECTIVES: Advances in cochlear implant (CI) technology have increased the complexity of treating childhood deafness. We compare parental decision-making, values, beliefs, and preferences between parents of eligible and ineligible children in considering cochlear implants. METHODS: Surveys were obtained from 83 hearing parents of deaf children. A subset of 50 parents also underwent semi-structured interviews. Nine hypothetical outcomes, ranging from mainstream success to poor mainstream outcome were created to measure parents' overall preferences and preference for specific outcomes for their child who is deaf. RESULTS: Among parents of eligible children (n = 50), approximately 2/3 considered implantation (n = 33). The other 1/3 did not consider implantation. Parents who were eligible but did not consider implantation placed significantly lower priority on mainstream success over bilingual success (P < 0.03), and on the child's ability to speak versus sign (P < 0.02). They also showed significantly higher concerns on the cost of services in general and on the availability of resources offered at the local school district (both P > 0.05). Parents of ineligible children (n = 30) rarely considered implantation, even if they showed similar aspirations in mainstream outcomes (P = 0.003). Semi-structured interview data supported these findings. CONCLUSIONS: The decision to consider cochlear implantation is strongly influenced by the eligibility and by professionals' recommendations. However, for some parents, the decision goes beyond eligibility and is determined by parental preferences, goals, values, and beliefs. This highlights the importance of careful audiologic evaluation and professionals' awareness of and sensitivity to parental goals, values, and beliefs in evaluating the child's candidacy.

Adolescent↗

PubMed1998

Chemical and biological studies of a new cigarette that primarily heats tobacco. Part 3. In vitro toxicity of whole smoke.

Mainstream smoke from Kentucky reference low "tar" (1R4F) and ultra-low "tar" (1R5F) cigarettes and a test cigarette (TOB-HT), that primarily heats tobacco, was compared for cytotoxic and genotoxic potential using cellular smoke exposure technology (CSET). CSET includes a computer controlled 30-port AMESA/Battelle-Geneva smoke generator which exposes cultured mammalian Chinese hamster ovary cells (CHO) to whole smoke. Cytotoxicity was assessed using the neutral red assay and genotoxicity was assessed using the sister chromatid exchange (SCE) assay. Compared on a per cigarette basis, mainstream smoke from 1R5F and the TOB-HT cigarette was significantly less cytotoxic and genotoxic than the smoke from the 1R4F cigarette. The cytotoxic and genotoxic activity of smoke from the TOB-HT cigarettes was slightly greater than the smoke from the ultra-low "tar" Kentucky 1R5F reference cigarettes. In conclusion, in these assays mainstream whole smoke of the TOB-HT cigarette had slightly greater cytotoxic and genotoxic potential compared with an ultra-low "tar" 1R5F Kentucky reference cigarette and significantly less activity compared with the whole mainstream smoke from a low "tar" 1R4F Kentucky reference cigarette, representative of the US market average cigarette for FTC yields of "tar", CO and nicotine.

Animals↗

PubMed2000

Myxoma is not a single entity: a review of the concept of myxoma.

Myxoid lesions can be subdivided into (1) mainstream myxomas of soft tissues, (2) mainstream myxomas located outside the soft tissue, (3) inadequately substantiated myxomas, (4) myxoid soft tissue tumors or lesions not regarded as myxomas, (5) myxoid fatty conditions, (6) other soft tissue lesions and tumors that are sometimes markedly myxoid, (7) other soft tissue tumors in which myxoid foci may be seen, and (8) nonneoplastic myxoid conditions of soft tissue. More than 60 such conditions are listed and the five entities regarded as mainstream soft tissue myxomas (namely, intramuscular myxoma, juxta-articular myxoma, superficial angiomyxoma, aggressive angiomyxoma, and myxoid neurothekeoma [myxoma of nerve sheath]) are reviewed in detail. Intramuscular myxoma is exclusively intramuscular, usually affects middle-aged women, is most commonly located in the thigh, and does not recur after simple excision. Multiple intramuscular myxomas are rare and are usually associated with monostotic or polyostotic fibrous dysplasia and Albright's syndrome. Juxta-articular myxoma histologically resembles an intramuscular myxoma, but involves periarticular tendons, ligaments, joint capsules, muscles, and even the subcutis of adults. It may be associated with osteoarthritis of the adjacent joint. Some 30% recur locally. Superficial angiomyxoma also has been called cutaneous myxoma. It affects all ages, with a peak incidence in the third and fourth decades; arises in the trunk, lower limb, head, and neck regions; and usually measures less than 5 cm in diameter. Epithelial components are present in approximately 25% of tumors. Approximately one third recur locally, but there have been no metastases. Patients with multiple lesions may have the Carney complex. Aggressive angiomyxoma usually arises in the pelvic and perineal regions and affects females seven times as often as males. Tumors usually measure 10 cm or more in diameter, invade surrounding tissues, and recur in approximately 50% of cases. None have metastasized. Myxoma of nerve sheath (the myxoid variant of neurothekeoma) preferentially affects the dermis and subcutis of the cervicofacial areas and shoulders of young women. Most patients are younger than 40 years; one third of them are in the second decade of life. The majority of tumors measure between 0.5 and 1.5 cm. Only three of 102 cases compiled from the two largest published series recurred; none metastasized. The different clinicopathologic features and behavior of these five mainstream myxomas indicate that myxoma is not a single entity.

Adult↗

PubMed2003

An improved in vitro model for testing the pulmonary toxicity of complex mixtures such as cigarette smoke.

Numerous approaches have been employed for testing the biological activity of cigarette smoke in vitro. None of them has managed to expose cultured lung cells in a realistic manner to the complex gaseous and particulate mixture that constitutes cigarette smoke. We have devised a system that makes this possible. The system presented here enables the direct exposure of human lung cells to native, unmodified cigarette mainstream smoke. It consists of a smoking machine, a dilution device for the smoke, analytical devices for online monitoring and a specially adapted exposure module based on the Cultex** cell cultivation system that is equipped with a gas-exposure top. Due to the special design of the exposure device and the optimised exposure conditions, this equipment allows cultured human lung cells to be exposed to freshly generated cigarette mainstream smoke. Exploratory experiments revealed that the smoke could be diluted over a wide concentration range in a reproducible way with respect to gas and particulate phases, and also demonstrated reproducible particle deposition depending on smoke concentration. Furthermore, it was shown that the exposed cells maintained their viability. Native cigarette mainstream smoke induced dose-dependent cellular effects in exposed cells with respect to cellular viability (viable cell number monitored by tetrazolium salt cleavage) and intracellular parameters (ATP and glutathione content). Therefore, fresh, physically and chemically unmodified cigarette mainstream smoke can be tested using this novel system.

Aerosols↗

PubMed1990

A model of cigarette smoke particle deposition.

A computer model of aerosol deposition has been extended to cover particle sizes representative of cigarette mainstream and sidestream smoke particles. The model is the first to theoretically predict total airway depositions of mainstream particles in a range which agrees with experimentally determined literature values by including effects of hygroscopicity and normal smoking breathing patterns. The hygroscopic characteristics of cigarette smoke particles are modeled as if they were saturated sodium chloride droplets. A discussion is included showing that this assumption is consistent with presently available data on the hygroscopic characteristics of cigarette smoke. Detailed regional depositions are provided. Though most of the particles are shown to deposit in the periphery, the surface concentrations of deposited particles are not necessarily much greater there than in centrally located airways. A peak in surface concentration at the third generation is exhibited, despite low total depositions there. Central airway surface concentrations are shown to be relatively independent of breathing pattern and airway geometry, implying that the effects of cigarette smoke particle deposition cannot be greatly reduced by changing the pattern of smoke inhalation. For sidestream smoke particles, total percent depositions agree with literature values of 7%-20% for both nonhygroscopic and hygroscopic particles. Deposition is seen to be favored in the periphery of the lung, though surface concentrations of the deposited material can be greater in Weibel Generations 3-6. Peak surface concentrations are again seen to occur in Generation 3. The increased toxicity of sidestream smoke particles may make them as unhealthy as mainstream smoke particles, despite the higher depositions observed for mainstream smoke.

Computer Simulation↗

PubMed2006

Cochlear implanted pupils in Scottish schools: 4-year school attainment data (2000-2004).

The Achievements of Deaf Pupils in Scotland (ADPS) project has been tracking the educational attainment of deaf pupils in Scotland's schools since 2000. At the time of writing, the database contains records for 1,752 deaf pupils (2000-2005). Here 4-year aggregate educational attainment data are reported for a subset of 152 school-aged deaf pupils with cochlear implants notified to the ADPS database between June 2000 and June 2004. The data describe primary and secondary school results in reading, writing, and math for this subgroup, as well as placement and communication characteristics. The educational attainment of the group of deaf pupils with cochlear implants is clearly marked when the deaf pupil population is disaggregated for hearing loss, achieving comparatively higher average attainment in both 5-14 Curriculum National Tests (Mathematics in particular) and Standard Grades. Therefore the gap in performance relative to the national population data is reduced for those deaf pupils, although it still widens at higher levels of achievement for the National Tests. Although most pupils with cochlear implants are placed in the mainstream, there is no pattern of migration toward mainstream schools. Some deaf pupils with cochlear implants moved out of mainstream to other types of placement, and this has implications for health-economic cost-utility assessments of cochlear implantation that favor mainstream education by drawing upon the relative cost of different placement types. These findings suggest that the ADPS program of research can contribute school outcome data as valuable real-life outcome measures in wider assessments of the benefit of cochlear implants to deaf children and deaf young people.

Adolescent↗