EFFECTS OF CONCURRENT DELAYS OF MATERIAL REWARDS AND PUNISHMENTS ON PROBLEM-SOLVING IN CHILDREN.
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The diagnosis of occupational illnesses may be considerably more difficult than is the case with occupational injuries because of a variety of factors: an intervening latency period, uncertainty in identifying the most significant chemical or physical exposures, determination of exposure levels retrospectively, and coordination of the physician with regulatory and workers' compensation bureaucracies. Such problem-solving techniques as retrospective industrial hygiene and attention to in-situ chemistry can act as means of reducing the uncertainty in making the diagnosis of occupational illness. Advance familiarity with workers' compensation and state or federal regulatory agencies can further facilitate diagnosis and patient advocacy.
We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.
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OBJECTIVE: We performed CT colonography in patients referred for conventional colonoscopy, interpreted the axial images, and used commercially available software to reconstruct endoluminal perspective views to differentiate polyps from folds. SUBJECTS AND METHODS: We prospectively examined 44 patients (27 men and 17 women; mean age, 58 years old) with CT colonography by interpreting the axial images and using three-dimensional rendering for problem solving only. The CT scans were interpreted by two radiologists who were unaware of patients' histories as revealed by colonoscopic findings. The findings on colonography were compared with those of conventional colonoscopy to determine sensitivity, specificity, time spent on interpretation, and confidence of interpretation. RESULTS: Colonoscopy showed normal findings in 28 patients and 22 polyps in the remaining 16 patients. Six polyps were 8 mm or larger, three were 5-7 mm, and 13 were 5 mm or smaller. The findings of the two observers revealed an overall sensitivity of 50% and 38%, respectively, and a specificity of 93% and 86%, respectively. Sensitivity for polyps larger than 8 mm was 83% and specificity was 100% for both observers. The average amount of time spent on interpretation was 28 min 30 sec (range, 14-65 min). Both observers used the endoluminal view for differentiating folds from polyps in 23 (52%) of 44 patients, which had only minimal impact on interpretation time. CONCLUSION: CT colonography can be performed and the images interpreted using currently available hardware and software by initially using the axial images to search for polyps of significant size. Endoluminal views should be used only when necessary to help distinguish normal folds from fixed raised lesions that are suggestive of polyps.
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An investigation was carried out into the problems experienced by 114 referred patients with complete dentures who were considered to be difficult or to have difficult prosthodontic problems. The commonest problems were those of pain and lack of retention, due mainly to occlusal discrepancies and excessive VDO. Treatment was carried out on an individual basis with a large proportion of dentures being remade. However, a small number was satisfied by counselling alone without procedural treatment. A diagnostic denture technique was used for particularly difficult cases. This technique showed that, in two cases, technical prosthodontic inadequacies could definitively be excluded as the problem. The overall success rate for treatment was 80 per cent. Further studies on a larger patient sample are needed so that specific problems can be linked to cause and outcome in a meaningful manner.
MR imaging is emerging as a valuable adjunct to mammography and ultrasound for the evaluation of the breast. Breast MR imaging has high sensitivity for the detection of breast cancer but suffers from a relatively low specificity. There is growing experience with this imaging modality as applied to breast diseases and more standardization in obtaining and interpreting these examinations is occurring, including the introduction ofa reporting lexicon similar to that for mammography. Breast MR imaging can be used for problem solving in determination of the local extent of disease in women with newly diagnosed breast cancer and for the evaluation of cases that remain inconclusive despite thorough mammographic and sonographic evaluation.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.