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Kinds of Charts Terms modified by Charts Selected AbstractsUsing the SWAP-200 in a personality-disordered forensic population: is it valid, reliable and useful?CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 1 2005Luisa E. Marin-Avellan Background Treatment and risk management of forensic patients relies heavily on diagnosing psychopathology, yet the reliability of clinical diagnoses of personality disorder has been found to be only fair to low. Structured instruments for the global assessment of personality disorder are infrequently used in clinical assessments possibly due to their limited validity and clinical utility. Aims/methods The Shedler-Westen Assessment Procedure-200 (SWAP-200) was developed in an effort to address these limitations. Although good reliability and validity in relation to clinicians' diagnosis of personality disorder has been reported, to date the validity of this instrument has not been assessed in relation to other standardized instruments or in a personality-disordered, forensic population. This study aims to establish the reliability and validity of the SWAP-200 against other diagnostic instruments and measures of interpersonal functioning in a personality disordered forensic population. Results This paper reports the results of 30 subjects from a high secure hospital in the UK who were assessed with the SWAP-200, the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), the Adult Attachment Interview (AAI) and the Chart of Interpersonal Reactions in Closed Living Environments (CIRCLE). Preliminary results suggest that the SWAP-200 is a reliable instrument for the diagnosis of personality disorder in forensic patients. Conclusions Although the small sample size allows only preliminary conclusions about the validity of this instrument, early results show a reduction of the diagnosis of comorbidity compared with the SCID-II, together with an increased number of expected associations between independent measures of interpersonal functioning and categories of personality disorder. Copyright © 2005 Whurr Publishers Ltd. [source] Perceptions about quality of life in a school-based population of adolescents with menorrhagia: implications for adolescents with bleeding disordersHAEMOPHILIA, Issue 3 2008A. PAWAR Summary., This study examined the effect of menorrhagia on the quality of life (QOL) of adolescents. We used data from a survey of 45 adolescents. Using the Pictorial Blood Assessment Chart (PBAC) and a PBAC score of ,100 we identified adolescents likely to have menorrhagia. Our statistical analysis indicated that menorrhagia adversely affects the QOL of adolescents. In this article we discuss the implications of our study and future research avenues. [source] Non-diagonal MIMO QFT controller design reformulationINTERNATIONAL JOURNAL OF ROBUST AND NONLINEAR CONTROL, Issue 9 2009Mario Garcia-Sanz Abstract This paper presents a reformulation of the full-matrix quantitative feedback theory (QFT) robust control methodology for multiple-input,multiple-output (MIMO) plants with uncertainty. The new methodology includes a generalization of previous non-diagonal MIMO QFT techniques; avoiding former hypotheses of diagonal dominance; simplifying the calculations for the off-diagonal elements, and then the method itself; reformulating the classical matrix definition of MIMO specifications by designing a new set of loop-by-loop QFT bounds on the Nichols Chart, which establish necessary and sufficient conditions; giving explicit expressions to share the load among the loops of the MIMO system to achieve the matrix specifications; and all for stability, reference tracking, disturbance rejection at plant input and output, and noise attenuation problems. The new methodology is applied to the design of a MIMO controller for a spacecraft flying in formation in a low Earth orbit. Copyright © 2008 John Wiley & Sons, Ltd. [source] Comparisons of Self-Reported and Chart-Identified Chronic Diseases in Inner-City SeniorsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2009John Leikauf BA OBJECTIVES: To examine agreement between self-report of chronic disease and medical record data for inner-city seniors, their sensitivity and specificity, and the association between patient characteristics and accuracy of self-reports. DESIGN: Cross-sectional analysis. SETTING: Two hospital-based primary care practices serving a low-income inner-city population. PARTICIPANTS: Adults aged 65 and older (n=323). MEASURES: Data on self-reported asthma, depression, diabetes mellitus, and hypertension were collected through interviewer-administered surveys (in English and Spanish) and chart abstraction. Chart-based disease was defined in two ways: physician documentation and physician documentation plus use of a medication to treat that condition. Sensitivity, specificity, and agreement were calculated. Univariate and multivariable regression analyses were used to determine the associations between patient characteristics and patient,chart agreement. RESULTS: Agreement between self-report and chart data was high for diabetes mellitus (kappa=0.94) intermediate for asthma (kappa=0.66), and hypertension (kappa=0.54) and low for depression (kappa=0.4). Sensitivity and specificity were high for diabetes mellitus (0.99 and 0.96, respectively) and low for depression (0.74 and 0.72, respectively). Specificity for hypertension was lowest (0.67). Age, education, health literacy, and other patient characteristics did not have clear associations across conditions. CONCLUSION: Self-reports may be most reliable for diabetes mellitus and least reliable for depression for surveys involving older, inner-city adults. Survey research with older adults should include confirmatory data when assessing presence of depression, hypertension, and asthma. [source] A Chart-Based Method for Identification of Delirium: Validation Compared with Interviewer Ratings Using the Confusion Assessment MethodJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2005Sharon K. Inouye MD Objectives: To validate a chart-based method for identification of delirium and compare it with direct interviewer assessment using the Confusion Assessment Method (CAM). Design: Prospective validation study. Setting: Teaching hospital. Participants: Nine hundred nineteen older hospitalized patients. Measurements: A chart-based instrument for identification of delirium was created and compared with the reference standard interviewer ratings, which used direct cognitive assessment to complete the CAM for delirium. Trained nurse chart abstractors were blinded to all interview data, including cognitive and CAM ratings. Factors influencing the correct identification of delirium in the chart were examined. Results: Delirium was present in 115 (12.5%) patients according to the CAM. Sensitivity of the chart-based instrument was 74%, specificity was 83%, and likelihood ratio for a positive result was 4.4. Overall agreement between chart and interviewer ratings was 82%, kappa=0.41. By contrast, using International Classification of Diseases, Ninth Revision, Clinical Modification, administrative codes, the sensitivity for delirium was 3%, and specificity was 99%. Independent factors associated with incorrect chart identification of delirium were dementia, severe illness, and high baseline delirium risk. With all three factors present, the chart instrument was three times more likely to identify patients incorrectly than with none of the factors present. Conclusion: A chart-based instrument for delirium, which should be useful for patient safety and quality-improvement programs in older persons, was validated. Because of potential misclassification, the chart-based instrument is not recommended for individual patient care or diagnostic purposes. [source] The practical near acuity chart (PNAC) and prediction of visual ability at near,OPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 2 2000James S. Wolffsohn Summary Objective: To improve on present reading chart designs, providing a quick and accurate method to measure the near acuity threshold, of particular importance with low vision patients. Design: The Practical Near Acuity Chart (PNAC) uses a single paragraph with 3 simple related words on each line (12 lower case letters). The line print size decreases in a logMAR progression (N80-N5). Methods: The time taken to measure near acuity of 53 subjects aged 9,91 years with the PNAC and Bailey,Lovie near chart was recorded and compared to their distance acuity (Bailey,Lovie chart), contrast sensitivity (Melbourne Edge Test) and ability to read extracts of newsprint. Results: There was no difference in near acuity threshold using related or un-related words. There was a high correlation (r=0.97) between near acuity measured with the PNAC and Bailey,Lovie charts. However, the time taken to measure near acuity was significantly faster with the PNAC (32±2 s vs 76±4 s, p<0.001). Near acuity measured with either chart was highly correlated (p<0.001) to distance acuity (r=0.74), contrast sensitivity (r=0.62) and ability to read newsprint (r=0.87). The PNAC was shown to have high test-reliable (r=0.99). Conclusions: The PNAC offers a quick but accurate way to measure near acuity and shows a high degree of correlation with distance acuity, contrast sensitivity and the ability to read newsprint. [source] A Bootstrap Control Chart for Weibull PercentilesQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 2 2006Michele D. Nichols Abstract The problem of detecting a shift of a percentile of a Weibull population in a process monitoring situation is considered. The parametric bootstrap method is used to establish lower and upper control limits for monitoring percentiles when process measurements have a Weibull distribution. Small percentiles are of importance when observing tensile strength and it is desirable to detect their downward shift. The performance of the proposed bootstrap percentile charts is considered based on computer simulations, and some comparisons are made with an existing Weibull percentile chart. The new bootstrap chart indicates a shift in the process percentile substantially quicker than the previously existing chart, while maintaining comparable average run lengths when the process is in control. An illustrative example concerning the tensile strength of carbon fibers is presented. Copyright © 2005 John Wiley & Sons, Ltd. [source] Design Strategies for the Multivariate Exponentially Weighted Moving Average Control ChartQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 6 2004Murat Caner Testik Abstract The multivariate exponentially weighted moving average (MEWMA) control chart has received significant attention from researchers and practitioners because of its desirable properties. There are several different approaches to the design of MEWMA control charts: statistical design; economic,statistical design; and robust design. In this paper a review and comparison of these design strategies is provided.Copyright © 2004 John Wiley & Sons, Ltd. [source] Therapeutic Effects of Vitamin E on Cyclic MastalgiaTHE BREAST JOURNAL, Issue 5 2009Sousan Parsay PhD Abstract:, Cyclic mastalgia is one of the most prevalent disorders among fertile women. To date, hormonal agents, despite their side effects, have been widely used for treatment of this ailment. This study was performed to clarify the therapeutic effects of Vitamin E (Vit E) as a safe treatment for cyclic mastalgia among fertile women. This study was conducted as a double blind clinical trial; 150 women with cyclic mastalgia, referred by three public health centers in Qazvin City in Iran, were enrolled in the trial and randomly divided into two distinct case and control groups; each containing 75 patients. The severity and duration of breast pain were measured according to both the Cardiff Breast Pain Chart and the Visual Analog Scale. Simple, chewable tablets of either Vit E or a placebo were prescribed twice a day for 4 months for case and control participants, respectively. Follow-up was performed at the end of both the second and the fourth months and, at that time, the severity, duration and side effects of intervention were evaluated. The administration of Vit E had significant curative results as tested at both the 2- and 4-month benchmarks. Chi-square testing indicated that after both 2 and 4 months of therapy, the efficacy demonstrated by the Vit E recipient case group was superior to that of the group that received a placebo. Applying the Mc Nemar Test, it also was shown that there was no significant difference in the benefits received between treatment courses of 2 versus 4 months. A 2-month prescription of Vit E has positive therapeutic effects on cyclic mastalgia. Given its lack of significant side effects, Vit E, therefore, can be considered a safe alternative to hormonal therapies currently being used in the treatment of cyclic mastalgia. [source] Thermal performance in three different low-cost dwellings for the tropical climate of BrazilBAUPHYSIK, Issue 1 2008Marlon Leão Msc. The aim of this project was to analyze the thermal performance of passive low-cost housing in half-humid tropical climate. The houses are located in Cuiabá-MT (15.5° southern latitude), one of the hottest cities in Brazil. The data about the typology of the houses were obtained from three representative construction systems; wood, masonry, and prefabricated. The measurements had been carried out through a year, during 20 consecutive days of each season and were evaluated by three distinct methodologies: (1) analyses of previous recommendations of the construction where the envelope materials were compared with the Brazilian standard NBR 15220-3/ 2005, (2) frequency, through dry bulb temperature with values of 18 °C and 29 °C, and (3) performance, by analysis of comfort levels and bioclimatic strategies processed by Analysis Bio 2.1.2 program in accordance to the adapted Bioclimatic Chart of Givoni for developing countries. Thermisches Verhalten dreier kostengünstiger Wohnhaustypen im tropischen Klima Brasiliens. Ziel des Projektes war, das thermische Verhalten kostengünstiger Passivwohnhäuser im halbfeuchten tropischen Klima zu untersuchen. Die Häuser befinden sich in Cuiabá-MT (15.5° südlicher Breite), eine der heißesten Städte Brasiliens. Die Daten über die Typologie der Häuser wurden von drei repräsentativen Bauweisen gewonnen: Holz, Mauerwerk und Massivbauweise. Die Messungen wurden innerhalb eines Jahres während jeweils 20 aufeinanderfolgenden Tagen in den vier Jahreszeiten durchgeführt und nach drei Kriterien ausgewertet: (1) Untersuchung der Konstruktionsempfehlungen und Vergleich der Außenwandkonstruktion mit der brasilianischen Norm NBR 15220-3/2005, (2) Häufigkeitsverteilung der Temperaturwerte 18 °C und 29 °C, sowie (3) thermisches Verhalten mit Untersuchung der Behaglichkeit und eines bioklimatischen Konzepts mit Hilfe der Software Analysis Bio 2.1.2 in Übereinstimmung mit dem darin verwendeten Bioklimatischen Diagramm für Entwicklungsländer nach Givoni. [source] Repeat Cesarean Delivery: What Indications Are Recorded in the Medical Chart?BIRTH, Issue 1 2006Mona T. Lydon-Rochelle PhD The study objective was to examine patterns of documented indications for repeat cesarean delivery in women with and without labor. Methods:We conducted a population-based validation study of 19 nonfederal short-stay hospitals in Washington state. Of the 4,541 women who had live births in 2000, 11 percent (n = 493) had repeat cesarean without labor and 3 percent (n = 138) had repeat cesarean with labor. Incidence of medical conditions and pregnancy complications, patterns of documented indications for repeat cesarean delivery, and perioperative complications in relation to repeat cesarean delivery with and without labor were calculated. Results:Of the 493 women who underwent a repeat cesarean delivery without labor, "elective"(36%) and "maternal request"(18%) were the most common indications. Indications for maternal medical conditions (3.0%) were uncommon. Among the 138 women with repeat cesarean delivery with labor, 60.1 percent had failure to progress, 24.6 percent a non-reassuring fetal heart rate, 8.0 percent cephalopelvic disproportion, and 7.2 percent maternal request during labor. Fetal indications were less common (5.8%). Breech, failed vacuum, abruptio placentae, maternal complications, and failed forceps were all indicated less than 5.0 percent. Women's perioperative complications did not vary significantly between women without and with labor. Regardless of a woman's labor status, nearly 10 percent of women with repeat cesarean delivery had no documented indication as to why a cesarean delivery was performed. Conclusions:"Elective" and "maternal request" were common indications among women undergoing repeat cesarean delivery without labor, and nearly 10 percent of women had undocumented indications for repeat cesarean delivery in their medical record. Improvements in standardization of indication nomenclature and documentation of indication are especially important for understanding falling VBAC rates. Future research should examine how clinicians and women anticipate, discuss, and make decisions about childbirth after a previous cesarean delivery within the context of actual antepartum care. (BIRTH 33:1 March 2006) [source] Liverpool Ultrasound Pictorial Chart: the development of a new method of documenting anal sphincter injury diagnosed by endoanal ultrasoundBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2008GE Fowler Objective, To develop and validate a pictorial chart that documents ultrasound examination of the anal sphincter. Design, A new pictorial chart (Liverpool Ultrasound Pictorial Chart [LUPIC]) depicting the normal anatomy of the anal sphincter was developed. Methods, To validate LUPIC, two observers documented the findings of 296 endoanal scans. Reliability was assessed between observers using kappa agreement for presence and position of sphincter defects. To validate the use of LUPIC by different observers, a video of ten endoanal ultrasound scans was reviewed by our local expert (gold standard). Seven clinicians underwent test-retest analysis. Kappa agreement was calculated to assess intra-observer and gold standard versus observer agreement for the overall presence of sphincter defects and compared with the gold standard. Complete agreement for the position and level of sphincter defects was assessed for the five abnormal scans. Main outcome measures, Excellent agreement between the two observers was found for the presence (kappa 0.99), position and level of external anal sphincter defects documented using LUPIC. The intra-observer and gold standard versus observer kappa values of experienced clinicians (A,E) showed good agreement for the overall presence of sphincter defects. Complete agreement for the position and level of sphincter defects was found in 23 of 35 (66%) observations. Conclusions, LUPIC is designed and validated method of documenting anal sphincter injury diagnosed by endoanal ultrasound. Standardisation of endoanal ultrasound findings by using LUPIC may help correlate the degree of damage with patient symptoms. [source] A randomised controlled trial of vitamin E in the treatment of primary dysmenorrhoeaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2005S. Ziaei Objective To study the effect of vitamin E in the treatment of primary dysmenorrhoea. Design A randomised, double-blind, placebo-controlled trial. Setting A secondary school in Tehran, Iran. Population Two hundred and seventy-eight girls aged 15,17 years who suffered from primary dysmenorrhoea. Methods Participants were given 200 units of vitamin E or placebo twice a day, beginning two days before the expected start of menstruation and continued through the first three days of bleeding. Treatment was continued over four consecutive menstrual periods. Main outcome measures The severity and duration of pain, and the amount of menstrual blood loss, at two and four months. A visual analogue scale (VAS) was used to record pain, and a validated Pictorial Blood Loss Assessment Chart (PBLAC) to measure menstrual loss. Results In the vitamin E group, pain severity was lower with vitamin E at two months (median VAS score 3 vs 5, P > 0.001) and four months (0.5 vs 6, P > 0.001), pain duration was shorter at two months (mean 4.2 [7.1] hours vs 15 [17], P > 0.001) and at four months (1.6 [4.0] hours vs 17 [18] hours, P > 0.0001), and blood loss assessed by PBLAC score was lower at two months (54 [31] vs 70 [40], P > 0.0001) and at four months (46 [28] vs 70 [37], P > 0.0001). Conclusion Vitamin E relieves the pain of primary dysmenorrhoea and reduces blood loss. [source] Mechanisms involved in the regulation of bovine pulmonary vascular tone by the 5-HT1B receptorBRITISH JOURNAL OF PHARMACOLOGY, Issue 1 2010C McKenzie Background and purpose:, 5-HT1B receptors may have a role in pulmonary hypertension. Their relationship with the activity of BKCa, a T-type voltage-operated calcium channel (VOCC) and cyclic nucleotide-mediated relaxation was examined. Experimental approach:, Ring segments of bovine pulmonary arteries were mounted in organ baths in modified Krebs,Henseleit buffer (37oC) under a tension of 20 mN and gassed with 95% O2/5% CO2. Isometric recordings were made using Chart 5 software. Key results:, Contractile responses to 5-HT (10 nM,300 µM) were inhibited similarly by the 5-HT1B receptor antagonist SB216641 (100 nM) and the T-type VOCC blockers mibefradil (10 µM) and NNC550396 (10 µM) with no additive effect between SB216641 and mibefradil. Inhibition by SB216641 was prevented by the potassium channel blocker, charybdotoxin (100 nM). 5-HT1B receptor activation and charybdotoxin produced a mibefradil-sensitive potentiation of responses to U46619. Bradykinin (0.1 nM,30 µM), sodium nitroprusside (0.01 nM,3 µM), zaprinast (1 nM,3 µM), isoprenaline (0.1 nM,10 µM) and rolipram (1 nM,3 µM) produced 50% relaxation of arteries constricted with 5-HT (1,3 µM) or U46619 (30,50 nM) in the presence of 5-HT1B receptor activation, but full relaxation of arteries constricted with U46619, the 5-HT2A receptor agonist 2,5 dimethoxy-4 iodoamphetamine (1 µM) or 5-HT in the presence of 5-HT1B receptor antagonism. Enhanced relaxation of 5-HT-constricted arteries by cGMP-dependent pathways, seen in the presence of the 5-HT1B receptor antagonist, was reversed by charybdotoxin whereas cAMP-dependent relaxation was only partly reversed by charybdotoxin. Conclusions and implications:, 5-HT1B receptors couple to inhibition of BKCa, thus increasing tissue sensitivity to contractile agonists by activating a T-type VOCC and impairing cGMP-mediated relaxation. Impaired cAMP-mediated relaxation was only partly mediated by inhibition of BKCa. [source] Are perceptions of parenting and interpersonal functioning related in those with personality disorder?CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 3 2001Evidence from patients detained in a high secure setting We explored the widely-held assumption that dysfunctional interpersonal behaviour, a key characteristic of personality disorder, is associated with adverse experiences in childhood in a sample of patients detained in high secure care. We obtained Parental Bonding Inventory (PBI) and Chart of Interpersonal Relations in Closed Living Environment (CIRCLE) data from 79 patients detained at a high secure hospital. This comprised 48 with the legal classification (1983 Mental Health Act) of Psychopathic Disorder (PD) and 31 with the legal classification of Mental Illness (MI). On the PBI, the PD group had significantly lower care scores and increased protection scores compared with the MI group; the latter reported care and protection scores similar to those from published norms. The CIRCLE scores also demonstrated significantly different interpersonal functioning between the PD and MI groups, with each group typically plotted in opposing halves of the interpersonal circle (IPC). Although the PDs showed abnormalities in both the PBI and CIRCLE in the expected direction, there were no clear associations between aspects of abnormal parenting and adult dysfunctional interpersonal behaviour within this group. This finding did not confirm our hypothesis and we discuss possible explanations. Copyright © 2001 John Wiley & Sons, Ltd. [source] Pain Assessments and the Provision of Analgesia: The Effects of a Templated ChartACADEMIC EMERGENCY MEDICINE, Issue 1 2007Brigitte M. Baumann MD Abstract Objectives Many emergency departments (EDs) have incorporated pain assessment scales in the medical record to improve compliance with the requirements of the Joint Commission on Accreditation of Healthcare Organizations. The authors conducted a pre-post trial investigating the effects of introducing a templated chart on the documentation of pain assessments and the provision of analgesia to ED patients. Methods A total of 2,379 charts were reviewed for inclusion based on the presence of a chief complaint related to trauma or nontraumatic pain, with 1,242 charts included in the analysis. Results Baseline demographic characteristics, mechanism of injury, location of injury, and initial pain severity were similar in the two groups. The proportion of patients with documentation of pain assessment increased from 41% to 57% (p < 0.001). In particular, traumatic mechanisms and chest, abdominal, and extremity pain yielded the largest improvements in documentation after introduction of the templated charts. Documentation of pain descriptors also improved for time of onset, duration, timing, and context (p < 0.01). Pain control in the templated chart group, however, remained unchanged and the provision of analgesia in the ED was not altered, with the exception of nonsteroidal medications, which decreased from 46% to 36% (p < 0.01). Conclusions Although documentation is improved with a templated chart, this improvement did not translate into improved patient care. [source] Use of Intraoperative Botulinum Toxin in Facial ReconstructionDERMATOLOGIC SURGERY, Issue 2 2009TIMOTHY CORCORAN FLYNN MD BACKGROUND Botulinum toxin is a potent neuromodulator that temporarily relaxes muscles and can improve wound healing. OBJECTIVE This retrospective analysis assessed the use of intraoperative botulinum toxin type A or B in patients undergoing surgical reconstruction after Mohs micrographic surgery for treatment of skin cancer. The primary effect of intradermal botulinum toxin on wound healing was also studied. METHODS & MATERIALS Charts of patients who received intraoperative botulinum toxin type A (n=9) or B (n=9) in conjunction with reconstructive surgery after Mohs micrographic surgery were reviewed. Three volunteers also underwent dermal injections of botulinum toxin type A followed by erbium laser resurfacing. RESULTS Outcomes did not differ in patients treated with botulinum toxin type A and type B. Patients had excellent apposition of wound edges and smooth skin overlying soft tissue; no significant complications were noted. Healing of erbium laser ablation did not differ between botulinum toxin type A,treated skin and control skin. CONCLUSIONS Administration of botulinum toxin type A or B after reconstruction after Mohs micrographic surgery aided wound healing; botulinum toxin type A and botulinum toxin type B were equally effective. Intradermal botulinum toxin type A demonstrated no primary effect on healing of erbium laser,resurfaced skin. [source] Extreme altitude mountaineering and Type 1 diabetes; the Diabetes Federation of Ireland Kilimanjaro ExpeditionDIABETIC MEDICINE, Issue 9 2001K. Moore Abstract Aims To examine the effects of extreme altitude mountaineering on glycaemic control in Type 1 diabetes, and to establish whether diabetes predisposes to acute mountain sickness (AMS). Methods Fifteen people with Type 1 diabetes and 22 nondiabetic controls were studied during the Diabetes Federation of Ireland Expedition to Kilimanjaro. Daily insulin requirements, blood glucose estimations and hypoglycaemic attacks were recorded in diaries by the people with diabetes. The performance of blood glucose meters at altitude was assessed using standard glucose solutions. Symptoms of acute mountain sickness were recorded daily by people with diabetes and by the nondiabetic controls using the Lake Louise Scoring Charts. The expedition medical team recorded the incidence of complications of altitude and of diabetes. The final height attained for each individual was recorded by the expedition medical team and verified by the expedition guides. Results The final altitude ascended was lower in the diabetic than the nondiabetic group (5187 ± 514 vs. 5654 ± 307 m, P= 0.001). The mean daily insulin dose was reduced from 67.1 ± 28.3,32.9 ± 11.8 units (P < 0.001), but only 50% of recorded blood glucose readings were within the target range of 6,14 mmol/L. There were few hypoglycaemic attacks after the first two days of climbing. Both blood glucose meters tested showed readings as low as 60% of standard glucose concentrations at high altitude and low temperatures. The Lake Louise questionnaires showed that symptoms of AMS occurred equally in the diabetic and nondiabetic groups. There were two episodes of mild diabetic ketoacidosis; two of the diabetic group and three of the nondiabetic group developed retinal haemorrhages. Conclusions People with Type 1 diabetes can participate in extreme altitude mountaineering. However, there are significant risks associated with this activity, including hypoglycaemia, ketoacidosis and retinal haemorrhage, with the additional difficulties in assessing glycaemic control due to meter inaccuracy at high altitude. People with Type 1 diabetes must be carefully counselled before attempting extreme altitude mountaineering. Diabet. Med. 18, 749,755 (2001) [source] Current Treatment of Myoclonic Astatic Epilepsy: Clinical Experience at the Children's Hospital of PhiladelphiaEPILEPSIA, Issue 9 2007Sudha Kilaru Summary:,Purpose: Myoclonic astatic epilepsy (MAE) is a generalized epilepsy of early childhood. Little is known about the use of newer antiepileptic treatments (AET) in MAE. The purpose of this study was to describe the characteristics, treatment, and outcome of a contemporary MAE cohort exposed to the new generation AET. Methods: Charts of subjects with MAE treated between 1998 and 2005 were reviewed. Results: Twenty-three subjects (19 boys), with a median (range) follow-up of 38 (2, 86) months were identified. Thirty-nine percent had a family history of epilepsy, and 39% had family history of febrile seizures. Age at seizure onset was a median of 36 (12,24) months. Initial EEG was normal in 30%. When seizures ceased, EEG background and epileptiform abnormalities persisted in 17 and 58%, respectively. On average, each subject was exposed to five AET. The most frequently used AET was valproate (83%). Seizure freedom occurred spontaneously in three subjects, with ethosuximide and levetiracetam in one each, valproate and lamotrigine in two each, topiramate in three and the ketogenic diet (KD) in five subjects. By 36 months after seizure onset, 67% achieved seizure freedom. At the last visit, 43% were developmentally normal, 52% had mild, and 5% had moderate cognitive disabilities. Time to seizure freedom did not correlate with cognitive outcome. Conclusions: The new generation of AET may offer significant benefit to children with MAE. The KD was the most effective AET in this series, and perhaps should be considered earlier in treatment. [source] Insularity, Sovereignty and Statehood: The Representation of Islands on Portolan Charts and The Construction of The Territorial StateGEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 4 2005Philip E. Steinberg Abstract This article investigates the cartographic origins of the idea that the territorial state is a unified, bounded, homogeneous and naturally occurring entity, in a world of equivalent but unique entities. It is noted that this image of the territorial state closely resembles the representation of islands on sixteenth-century portolan charts, and this suggests a historical link between the Renaissance-era imagination of islands and the modern imagination of states. The article posits that the concept of territorial unity and boundedness, which appeared on portolan charts to signify islands as obstacles amidst maritime routes of movement, migrated in the late sixteenth-century to form the basis for representing the emergent concept of the territorial state. It is suggested that the conceptual and aesthetic links between these representations of islands and states has led to an ongoing dilemma for those who seek to comprehend (or cartographically represent) islands that are divided between multiple states. [source] Primary cancer of the sphenoid sinus,A GETTEC study,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2009Pierre Olivier Vedrine MD Abstract Background. Primary involvement of the sphenoid sinus occurs in 2% of all paranasal sinus tumors and is associated with dismal prognosis. Optimal management remains debatable. Methods. A total of 23 patients were treated for a primary cancer of the sphenoid sinus from 1988 to 2004. Charts were reviewed for patient-, tumor-, and treatment-related parameters. Univariate and multivariate analyses were conducted to identify prognostic factors for locoregional control and survival. Results. Cranial neuropathies were present in 12 patients. Pathologic findings included adenoid cystic carcinoma, adenocarcinoma, lymphoma, squamous cell carcinoma, sarcoma, neuroendocrine carcinoma, melanoma, and malignant hemangiopericytoma. All but 2 patients had stages III to IV cancer. Radiotherapy was performed in 18 patients and chemotherapy in 12. Of 10 patients undergoing surgery, total excision with grossly negative margins was achieved in 4 patients and subtotal resection in 6. Median locoregional control and overall survival were 12 and 41 months, respectively. On multivariate analysis, cranial neuropathy was associated with worse locoregional control and survival. Surgery was rarely complete because of advanced stages at presentation, but it yielded better outcomes than other treatments without surgery in non lymphoma-cases. Conclusion. Early CT and MRI should be performed when facing aspecific, rhinological, or neuro-ophtalmological symptoms. Cranial neuropathies indicate a worse prognosis. Surgery, including debulking surgery, may be preferred to combined modality treatments without surgery. Its apparently favorable impact on prognosis would need to be tested in homogenous histological groups of patients, which is impossible because of the rarity of the disease. Highly conformal radiotherapy (adjuvant or definitive) should be encouraged and optimized with concurrent chemotherapy in advanced stages. Aggressive multidisciplinary management including surgery, chemotherapy, and radiotherapy should be encouraged and adapted on histology and tumor extensions. Progress is still warranted to improve outcomes. © 2008 Wiley Periodicals, Inc. Head Neck, 2009 [source] Neoadjuvant chemotherapy for squamous cell carcinoma of the oral tongue in young adults: A case seriesHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 9 2005Erich M. Sturgis MD Abstract Background. Squamous cell carcinoma of the oral tongue (SCCOT) in the young population has emerged as a growing worldwide health problem. Standard therapies, consisting primarily of surgery with possible adjuvant radiotherapy, have resulted in only modest improvements in survival in recent decades, whereas the treatments for SCCOT continue to impair oral function. With the increased use and improved functional results of neoadjuvant chemotherapy in the treatment of squamous cell carcinoma of other upper aerodigestive tract sites, we have reviewed our experience with neoadjuvant chemotherapy in young patients with SCCOT. Methods. A retrospective review was conducted of all patients younger than 45 years (N = 49) with previously untreated SCCOT evaluated at a comprehensive cancer center from July 1995 to August 2001. Charts were reviewed to obtain demographic data, comorbidities, nutritional status, tumor status, treatment and response information, and follow-up data. Results. Fifteen patients were identified who received neoadjuvant chemotherapy with taxane-based regimens before undergoing glossectomy and neck dissection. Thirteen of these patients (87%) exhibited stage III or IV disease at presentation, and all exhibited at least a partial response at the primary site. Pathologically positive nodes were identified in only six patients (40%), although 13 (87%) had clinically or radiographically suspicious nodes at presentation. Adjuvant radiation therapy was administered to seven patients (47%). With a median follow-up of 39 months, no patient has had local or regional recurrence, although three patients (20%) have had distant metastases develop; one patient with an isolated distant metastasis was successfully salvaged with radiation. By comparison during the same period, 34 young adult patients with SCCOT were treated with surgery with or without postoperative radiotherapy but without the use of chemotherapy. Although these patients had lower T classifications (18% vs 67% T3/T4; p = .0007), incidence of nodal metastases (15% vs 87% N+; p < .0001), and overall disease stage (24% vs 87% stage III/IV; p < .0001) than the neoadjuvant chemotherapy group, the overall survival (82%), disease-specific survival (88%), and recurrence-free survival (82%) of the surgery-first group was similar to that of the neoadjuvant chemotherapy group (87%, 87%, and 80%, respectively). Conclusions. This retrospective investigation demonstrates that neoadjuvant chemotherapy with taxane-based regimens may play a role in the successful treatment of SCCOT in young adult patients. Ultimately, this treatment plan may lead to improved functional outcomes in young patients with SCCOT by allowing function-sparing surgery and avoiding postoperative radiotherapy, without sacrificing disease control and survival, but a prospective trial is needed. We have initiated a prospective clinical trial to further investigate the impact of neoadjuvant chemotherapy in patients younger than 50 with SCCOT. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Azathioprine Maintains first remission in newly diagnosed pediatric Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 9 2006Gerald J. Jaspers Abstract 6-Mercaptopurine (6-MP) maintains remission in pediatric Crohn's disease (CD). Azathioprine, a prodrug of 6-MP, is used for maintenance of remission of CD in Europe. We evaluated to what extent azathioprine is used in newly diagnosed pediatric CD patients and whether maintenance of remission differed between patients using azathioprine or not. Charts of children (diagnosed 1998-2003, follow-up , 18 mo) were reviewed. Active disease was defined as Pediatric Crohn's Disease Activity Index (PCDAI) greater than 10 or systemic corticosteroid use. Remission was defined as PCDAI 10 or less without use of corticosteroids. Eighty-eight children (55M/33F, age 12 ± 3 yr) were included. Seventy-two (82%) patients received azathioprine during the follow-up period (38 ± 17 mo). Patients diagnosed after 2000 received azathioprine significantly earlier during the course of disease compared with those diagnosed earlier (median, at 233 vs. 686 days; P < 0.05). At initial presentation, moderate-severe disease activity and prescription of corticosteroids were more prevalent in patients using azathioprine compared with nonazathioprine patients (75% vs. 52%; P < 0.05; and 89% vs. 58%; P < 0.005, respectively). Duration of corticosteroid use was longer in patients receiving azathioprine (232 vs. 168 days; P < 0.005). Median maintenance of first remission in patients who initially used corticosteroids, however, was longer in patients receiving azathioprine compared with nonazathioprine patients (PCDAI, 544 vs. 254 days, P = 0.08; corticosteroid free, 575 vs. 259 days, P < 0.05, respectively). We conclude that, since 2000, azathioprine is being introduced earlier in the treatment of newly diagnosed pediatric CD patients. The use of azathioprine is associated with prolonged maintenance of the first remission. [source] Extended evidence on the use of technical analysis in foreign exchangeINTERNATIONAL JOURNAL OF FINANCE & ECONOMICS, Issue 4 2006Thomas Gehrig Abstract This work extends earlier survey studies on the use of technical analysis by considering flow analysis as a third form of information production. Moreover, the survey covers FX dealers and also the rising fund managers. Technical analysis has gained importance over time and is now the most equally spread kind of analysis. It has by far the greatest importance in FX dealing and is second in fund management. Charts are used for shorter-term forecasting horizons while flows dominate at the shortest-term and fundamentals at longer horizons. Preferred users of each kind of analysis exhibit different views about market frictions. Copyright © 2006 John Wiley & Sons, Ltd. [source] High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veteransJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2005I. O. Poon PharmD BCPS CGP Summary Background:, Orthostatic hypotension (OH) is defined as a reduction of systolic blood pressure of at least 20 mmHg, or diastolic blood pressure of at least 10 mmHg from a sitting to a standing position. It is a common physical finding among older adults and associated with significant morbidity and mortality. Use of medications that have the potential to induce OH, particularly concomitant use of several of such medications, is a major factor for the development of OH. Objectives:, To describe the prevalence of symptomatic and asymptomatic OH in veterans aged 75 years and older attending a geriatric clinic, and to assess the association between OH and the number of potentially causative medications used. Methods:, Charts of all patients who attended a VA geriatric clinic (Michael E. DeBakey VA Medical Center) during the period of 1 June 2002 to 1 June 2003 were reviewed retrospectively for (i) the use of potentially causative medications, i.e. medications that were reported to cause OH in at least 1% of the general population and that were available in the VA formulary, (ii) the presence or absence of OH, and (iii) the presence or absence of symptomatic OH. Patients with primary autonomic dysfunction, Parkinson's disease, and patients who were unable to stand, or who had no assessment for both sitting and standing blood pressure for other reasons were excluded. Results:, A total of 505 individual patients attended the clinic during the study period, and 342 patients fit the inclusion criteria. About 189 of these patients (55%) had OH. Among patients with OH, 61 patients (33%) were symptomatic, including 52 patients who had falls. The prevalence of OH in patients receiving zero, one, two, and three or more potentially causative medications was 35, 58, 60 and 65% respectively. Receiving hydrochlorothiazide was associated with the highest prevalence of OH (65%), followed by receiving lisinopril (60%), trazodone (58%), furosemide (56%) and terazosin (54%). Conclusion:, The prevalence of OH is very high in older veterans and significantly related to the number of concurrent causative medications used. Providers should be educated to reduce the amount of potentially causative medications in the elderly and better assess patients in which use of such medications is necessary to avoid symptomatic OH. [source] Statistical Process Control Charts for Measuring and Monitoring Temporal Consistency of RatingsJOURNAL OF EDUCATIONAL MEASUREMENT, Issue 1 2010M. Hafidz Omar Methods of statistical process control were briefly investigated in the field of educational measurement as early as 1999. However, only the use of a cumulative sum chart was explored. In this article other methods of statistical quality control are introduced and explored. In particular, methods in the form of Shewhart mean and standard deviation charts are introduced as techniques for ensuring quality in a measurement process for rating performance items in operational assessments. Several strengths and weaknesses of the procedures are explored with illustrative real and simulated rating data. Further research directions are also suggested. [source] Reconstructing the Sequence of Events Surrounding Body Disposition Based on Color Staining of Bone,JOURNAL OF FORENSIC SCIENCES, Issue 5 2009Meaghan A. Huculak H.B.Sc. Abstract:, Literature regarding bone color is limited to determining location of primary and secondary dispositions. This research is the first to use bone color to interpret the sequence of events surrounding body disposition. Two scenarios were compared,bones buried and then exposed on the ground surface and bones exposed then buried. Forty juvenile pig humeri with minimal tissue were used in each scenario with an additional 20 controls to determine if decomposing tissue affects bone color. Munsell Color Charts were used to record bone color of surface and 2.5 cm cross-sections. Results reveal five main surface colors attributed to soil, sun, hemolysis, decomposition, and fungi. Fungi on buried bones suggests prior surface exposure. Cross-sections of strictly buried bones are identical to buried then exposed bone, stressing the importance of bone surface analysis. Cross-sectioning may help verify remains have been exposed then buried. Decomposition of excess tissue creates minimal color staining. [source] Prospective Evaluation of Real-time Use of the Pulmonary Embolism Rule-out Criteria in an Academic Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 9 2010Jeffrey A. Kline MD Abstract Objectives:, The pulmonary embolism rule-out criteria (PERC rule) is a nine-component decision rule derived to exclude pulmonary embolism (PE) without the use of formal diagnostic testing (D-dimer, computed tomography pulmonary angiography, ventilation,perfusion lung scanning, or venous ultrasonography) when all nine components are negative ("PERC negative"). This study examined whether clinicians who document PERC negative also document results of all nine components of the PERC rule. Methods:, This was a pilot study at a single-center, urban teaching emergency department (ED) with a residency program in emergency medicine. Patients were over 17 years of age with at least one of nine predefined chief complaints. Clinicians were asked three questions regarding suspicion for PE, intent to use the PERC rule, and the result. Charts were independently reviewed by two authors for fidelity of the nine PERC components. Patients were followed for PE outcome at 14 days. Results:, The study examined 526 patients cared for by 82 clinicians, who indicated suspicion for PE in 183 of 526 (35%) and intent to use the PERC rule in 115 of 526 (22%) cases, of whom 65 of 115 were documented as PERC negative. No formal test for PE was ordered in 49 of 65 (75%), and 46 of 49 had incomplete documentation to support PERC negative. The most common deficiency was omission of two risk factors for PE in the rule (prior venous thromboembolism or recent surgery). Six patients had PE diagnosed within 14 days, but none of these had been deemed PERC negative. Conclusions:, Clinicians seldom document all nine data elements of the PERC rule in patients they deem PERC negative. These data suggest the need for paper or electronic aids to support use of the PERC rule. ACADEMIC EMERGENCY MEDICINE 2010; 17:1016,1019 © 2010 by the Society for Academic Emergency Medicine [source] Association of bullying with adolescent health-related quality of lifeJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2003A Wilkins-Shurmer Objective: To examine the relationship between being bullied and health-related quality of life (HR-QOL) in adolescence. Methodology: Subjects were a cohort of 805 adolescents with a mean age of 13.6 years (standard deviation 0.2 years). An adolescent questionnaire elicited the frequency of being bullied. HR-QOL was measured using the Child Health Questionnaire , Parent Report Form (CHQ-PF50) and Dartmouth COOP Functional Health Assessment Charts for Adolescents. Results: Thirty-six per cent of boys and 38 per cent of girls reported being bullied at least weekly. Adolescent psychosocial HR-QOL was inversely related to frequency of being bullied, while physical HR-QOL was not related. Conclusion: Peer bullying is an important determinant of adolescent HR-QOL with a negative impact on psychosocial well-being. [source] Rx Files: Drug Comparison Charts, 7th Edition, Academic Detailing Program, c/- Saskatoon City Hospital, 701 Queen Street, Saskatoon, SK, Canada S7K 0M7.JOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 7 2009www.RxFile.ca [source] | ||||||||||||||||||||||||||||