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Normative Values (normative + value)
Selected AbstractsAnterior coracoscapular ligament and suprascapular nerve entrapmentCLINICAL ANATOMY, Issue 6 2002B.W. Avery Abstract A reduction in the height of the suprascapular foramen may predispose to entrapment of the suprascapular nerve. In this study, 16 of 27 cadavers (60%) demonstrated a heretofore unreported ligament located on the anterior aspect of the suprascapular foramen. In 11 of the 27 cadavers (41%), the ligament was observed bilaterally. The ligament decreased the foraminal height from the normative value of 5.6 ± 0.4 to 2.3 ± 0.4 mm (mean ± SEM). Because this ligament, for which we propose the term anterior coracoscapular ligament (ACSL), substantially narrows the suprascapular foramen, it should be considered as a possible etiologic factor in suprascapular nerve entrapment. Clin. Anat. 15:383,386, 2002. © 2002 Wiley-Liss, Inc. [source] Gastric Stasis Occurs in Spontaneous, Visually Induced, and Interictal MigraineHEADACHE, Issue 10 2007Sheena Aurora MD Objective., To evaluate and compare gastric motility and emptying during spontaneous migraine to previous observations from induced migraine. Blackground., We have previously demonstrated a delay in gastric emptying both during the interictal period and during an induced migraine. A limitation noted in these studies was whether there are differences gastrointestinally during a visually induced migraine compared to spontaneous migraines. To address this, 9 additional studies have been performed to ascertain if there is a similar delay during spontaneous migraine Methods., Gastric scintigraphy using a standard meal was performed in 3 subjects during 3 periods: spontaneous migraine, induced migraine, and interictal period. Results., On average, the time to half emptying was delayed during spontaneous migraine (124 minutes), during induced migraine (182 minutes), and during the interictal period migraine (243 minutes) compared to normative values established at our center (112 minutes). On average, similar gastric slowing was seen in all 3 groups when the percentage of nuclear material remaining in the stomach at 2 hours was measured. Conclusions., This study provides additional evidence of gastric stasis in migraineurs interictally during induced and spontaneous migraine. [source] New labour and reform of the English NHS: user views and attitudesHEALTH EXPECTATIONS, Issue 2 2010Andrew Wallace PhD Abstract Background, The British National Health Service has undergone significant restructuring in recent years. In England this has taken a distinctive direction where the New Labour Government has embraced and intensified the influence of market principles towards its vision of a ,modernized' NHS. This has entailed the introduction of competition and incentives for providers of NHS care and the expansion of choice for patients. Objectives, To explore how users of the NHS perceive and respond to the market reforms being implemented within the NHS. In addition, to examine the normative values held by NHS users in relation to welfare provision in the UK. Design and setting, Qualitative interviews using a quota sample of 48 recent NHS users in South East England recruited from three local health economies. Results, Some NHS users are exhibiting an ambivalent or anxious response to aspects of market reform such as patient choice, the use of targets and markets and the increasing presence of the private sector within the state healthcare sector. This has resulted in a sense that current reforms, are distracting or preventing NHS staff from delivering quality of care and fail to embody the relationships of care that are felt to sustain the NHS as a progressive public institution. Conclusion, The best way of delivering such values for patients is perceived to involve empowering frontline staffs who are deemed to embody the same values as service users, thus problematizing the current assumptions of reform frameworks that market-style incentives will necessarily gain public consent and support. [source] Motor acquisition rate in Brazilian infantsINFANT AND CHILD DEVELOPMENT, Issue 2 2009Virlaine Bardella Lopes Abstract This study used the Alberta Infant Motor Scale (AIMS) with the aim of characterizing motor acquisition rate in 70 healthy 0,6-month-old Brazilian infants, as well as comparing both emergence (initial age) and establishment (final age) of each skill between the study sample and the AIMS normative data. New motor skills were continuously acquired from 0 to 6 months of age by the Brazilian infants, but their acquisition rate was non-linear. When compared to the AIMS sample, Brazilian infants achieved lower percentiles, and their initial age to acquire skills requiring greater antigravity demand was higher. In contrast, Brazilian infants stopped exhibiting primitive patterns earlier, and their final age to acquire antigravity skills was lower. These differences in motor development are suggested to be a consequence of different parental practices and not necessarily indicate motor delay. Thus, the AIMS normative values should be adapted to cultural particularities so as to avoid that infants are misclassified as at risk for motor delay. Furthermore, an adequate assessment of motor development should consider not only the age at which a skill is emerged, but also the age at which such a skill is established in the infant's motor repertoire. Copyright © 2009 John Wiley & Sons, Ltd. [source] Comparison of ventilator-dependent child reports of health-related quality of life with parent reports and normative populationsJOURNAL OF ADVANCED NURSING, Issue 1 2007Jane Noyes Abstract Title. Comparison of ventilator-dependent child reports of health-related quality of life with parent reports and normative populations Aims., This paper is a report of the first study of ventilator-dependent child and parent ratings of health-related quality of life using a validated instrument, which was undertaken as part of a case study of costs and consequences. Background., Advances in medical care and technologies such as the ventilator have extended childhood illness trajectories beyond our current range of knowledge and experience. These advances and their effects reinforce the need for further research to determine health-related quality of life as an outcome of ventilator-dependency in childhood. Methods., The KINDL was administered to ventilator-dependent children aged 4,18 years and parents as part of an in-depth case study. Twenty-seven parents and 17 children (including 17 child-parent pairs) completed questionnaires. Data were collected between 2001 and 2004. Findings were compared with normative values derived from a representative sample of children of a similar age in the general population. Results., Ventilator-dependent children reported significantly lower overall health-related quality of life, and significantly lower scores on all domains except about their friends, compared with school children, and chronically ill children in respect of their disease. Parents and children rated children's overall health-related quality of life the same but parents reported significantly lower scores for their child's disease and relationships with friends. There was a positive correlation between children and parents in all areas apart from self-esteem and school. Conclusions., Both child and parent perspectives are needed to understand the impact of ventilator-dependency and associated co-morbidity on the child. As new interventions and models of service delivery emerge it will be important for nurses to understand the impact on the child by evaluating physical, emotional and social consequences. [source] Normal Values of Balance Tests in Women Aged 20,80JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2004Rosemary C. Isles B Phty Objectives: To determine normal values for four commonly used clinical functional balance tests from community-dwelling women aged 20 to 80 and to identify any significant decline due to aging. Design: A cross-sectional study was undertaken to provide normative values for four clinical balance tests across 6 decade cohorts. Setting: The Betty Byrne-Henderson Center for Women and Aging, Royal Womens' Hospital, Brisbane, Australia. Participants: Four hundred fifty-six community-dwelling, independently ambulant women with no obvious neurological or musculoskeletal-related disability, aged 20 to 80, were randomly recruited from a large metropolitan region. Measurements: The clinical balance measures/tests were the Timed Up and Go test, step test, Functional Reach test, and lateral reach test. Multivariate analysis was used to test the effect for age, height, and activity level. Results: Normal data were produced for each test across each decade cohort. Gradual decline in balance performance was confirmed, with significant effect for age demonstrated. Conclusion: New normative data across the adult age decades are available for these clinical tests. Use of clinical balance tests could complement other balance tests and be used to screen women aged 40 to 60 whose performance is outside the normal values for age and to decrease later falls risk. [source] European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy.JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 2 2010Report of a joint task force of the European Federation of Neurological Societies, the Peripheral Nerve Society Revision of the guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy, published in 2005, has become appropriate due to publication of more relevant papers. Most of the new studies focused on small fiber neuropathy (SFN), a subtype of neuropathy for which the diagnosis was first developed through skin biopsy examination. This revision focuses on the use of this technique to diagnose SFN. Task force members searched the Medline database from 2005, the year of the publication of the first EFNS guideline, to June 30th, 2009. All pertinent papers were rated according to the EFNS and PNS guidance. After a consensus meeting, the task force members created a manuscript that was subsequently revised by two experts (JML and JVS) in the field of peripheral neuropathy and clinical neurophysiology, who were not previously involved in the use of skin biopsy. Distal leg skin biopsy with quantification of the linear density of intraepidermal nerve fibers (IENF), using generally agreed upon counting rules, is a reliable and efficient technique to assess the diagnosis of SFN (level A recommendation). Normative reference values are available for bright-field immunohistochemistry (level A recommendation) but not yet for confocal immunofluorescence or the blister technique. The morphometric analysis of IENF density, either performed with bright-field or immunofluorescence microscopy, should always refer to normative values matched for age (level A recommendation). Newly established laboratories should undergo adequate training in a well established skin biopsy laboratory and provide their own stratified age and gender-matched normative values, intra- and interobserver reliability, and interlaboratory agreement. Quality control of the procedure at all levels is mandatory (Good Practice Point). Procedures to quantify subepidermal nerve fibers and autonomic innervated structures, including erector pili muscles, and skin vessels are under development but need to be confirmed by further studies. Sweat gland innervation can be examined using an unbiased stereologic technique recently proposed (level B recommendation). A reduced IENF density is associated with the risk of developing neuropathic pain (level B recommendation), but it does not correlate with its intensity. Serial skin biopsies might be useful for detecting early changes of IENF density, which predict the progression of neuropathy, and to assess degeneration and regeneration of IENF (level C recommendation). However, further studies are warranted to confirm the potential usefulness of skin biopsy with measurement of IENF density as an outcome measure in clinical practice and research. Skin biopsy has not so far been useful for identifying the etiology of SFN. Finally, we emphasize that 3-mm skin biopsy at the ankle is a safe procedure based on the experience of 10 laboratories reporting absence of serious side effects in approximately 35,000 biopsies and a mere 0.19% incidence of non-serious side effects in about 15 years of practice (Good Practice Point). [source] Motor evoked potentials from the pelvic floorNEUROUROLOGY AND URODYNAMICS, Issue 7 2003Søren Brostrøm Proper function of the lower urinary tract depends on the integrity of the central and peripheral nervous pathways on multiple levels, and the complexity of this system leaves it susceptible to even minor lesions. While dysfunction of the lower urinary tract is prevalent amongst patients with nervous system disease, e.g., multiple sclerosis (MS), most women with lower urinary tract dysfunction (LUTD) have no overt neurological cause. Refined neuro-diagnostic approaches are needed to reveal neurogenicity in these patients. A potential method is transcranial magnetic stimulation (TMS), which is used routinely to test the motor innervation of limb muscles, but also can be applied to test pelvic floor efferents. To resolve the lack of methodological clarity and the need for normative values for the use of pelvic floor motor evoked potentials (MEPs), 30 healthy women and 16 women with MS were studied. Methods The healthy women underwent MEP studies with various stimulus and recording modalities, and, to test reproducibility, 18 of them were retested at a separate session. The women with MS underwent MEP testing as well as urodynamic studies. Results From the methodological studies of healthy women, the use of invasive concentric needle electrodes was found to be superior to surface electrodes. When applying magnetic stimuli over the sacral region, various methodological problems were encountered. In the healthy women, a large variability of responses was noted, the long-term reproducibility of pelvic floor MEP latencies was poor, and in some cases responses could not be obtained. In the study of women with MS, prolonged central conduction times were found, along with many cases of unevokable responses, and a poor correlation of MEPs to urodynamic findings. The problems of obtaining selective recordings from the inaccessible pelvic floor musculature are discussed, and possible sources of variability in MEPs from the pelvic floor are considered. By relating the findings in the present studies to those of others using different modalities, some reflections are presented on the nature of the neural pathways to the pelvic floor activated by magnetic stimulation. As unevokable responses from the pelvic floor were an occasional finding among the healthy women, it is argued that a pelvic floor non-response in a patient with suspected corticospinal lesion should be interpreted with care, and should not carry the same clinical significance as an absent limb response. Conclusions The inherent limitations of pelvic floor MEPs are discussed, and it is concluded that while there seems to be only limited clinical value of pelvic floor MEP testing, there might be some interesting scientific perspectives in studies that aim to control and explain the variability of responses. Neurourol. Urodynam. 22:620,637, 2003. © 2003 Wiley-Liss, Inc. [source] A survey of clinical productivity and current procedural terminology (CPT) coding patterns of pediatric hematologist/oncologistsPEDIATRIC BLOOD & CANCER, Issue 2 2004Timothy C. Griffin MD Abstract Background Subspecialty-specific normative values for clinical productivity of practicing pediatric hematologist/oncologists have not been well established. This information could be a useful adjunct in administrative decision-making in areas such as necessary levels of physician staffing and development of compensation plans. Methods Current procedural terminology (CPT) coding information was obtained from 27 pediatric hematology/oncology groups. Clinical productivity was assessed by overall number of patient encounters and the total number of physician work relative value units (RVU) as defined by the resource-based relative value scale. The average physician productivity within each individual program was calculated. To determine uniformity of CPT coding, an additional survey solicited mock patient encounter documentation and CPT coding for a simple clinical vignette. Results A broad range of clinical productivity was observed for both numbers of patient encounters and RVU. Evaluation of the CPT coding data of the surveyed groups revealed differences in usage of certain evaluation and management (E/M) codes and procedural and specimen interpretation codes. Within individual categories of E/M service codes, a wide variation in assigned CPT code levels was also observed. This observation was supported by differences in the E/M coding for the clinical vignette. Conclusions Assessment and tracking of physician productivity can provide useful information for the administrative management of pediatric hematology/oncology programs. Caution must be exercised, however, when making productivity comparisons with other subspecialties or even between pediatric hematology/oncology programs. Such comparisons should take into account the number of patient encounters, characteristics of E/M coding patterns, the use of physician extenders, as well as overall RVU production. © 2004 Wiley-Liss, Inc. [source] Validity and normative data for thirty-second chair stand test in elderly community-dwelling Hong Kong ChineseAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 3 2006D.J. Macfarlane It is important to establish valid field measures of lower body strength in the elderly, and to provide representative normative values that are culturally specific in order to help health professionals in the risk assessment of this group. A sample of 1,038 elderly Hong Kong Chinese undertook a 30-sec chair stand test (30CST), with a subsample of 143 completing isometric measures of maximal hip flexion and knee extension, plus a habitual physical activity questionnaire. The 30CST was significantly, yet only weakly, correlated with the isometric strength measures (r , 0.3,0.4), but accurately discriminated between levels of habitual physical activity and across ages in decades. The normative values generated provide useful data for health screening in this elderly Hong Kong population, but do not compare well with their healthier US counterparts. Am. J. Hum. Biol. 18:418,421, 2006. © 2006 Wiley-Liss, Inc. [source] Persuasion in International Politics: A Rationalist AccountPOLITICS & POLICY, Issue 4 2005James I. Walsh Governments offer us the promise of rewards or the threats of punishment to secure favorable international bargains, but they also draw on reasoned arguments to convince their bargaining partners to accept mutually beneficial agreements. Works that have studied such attempts at persuasion hold that it is most likely to succeed when the states involved share important normative values or are uncertain about what is the "right" action to take. Drawing on rational choice theory of strategic communication, this study seeks to expand understanding the conditions under which attempts at persuasion in international politics succeed or fail. Persuasion can occur for reasons other than shared values; under some conditions, one state can persuade another by altering the latter's beliefs about the rewards associated with available foreign policy options. [source] Maternal serum free-,-chorionic gonadotrophin, pregnancy-associated plasma protein-A and fetal nuchal translucency thickness at 10,13+6 weeks in relation to co-variables in pregnant Saudi womenPRENATAL DIAGNOSIS, Issue 4 2007Mohammed-Salleh M. Ardawi Abstract Objective To establish normative values and distribution parameters of first-trimester screening markers, namely, fetal nuchal translucency (NT), maternal serum free ,-human chorionic gonadotrophin (,-hCG) and pregnancy-associated plasma protein-A (PAPP-A), at 10 to 13+6 weeks of gestation in Saudi women and to evaluate the effect of co-variables including maternal body weight, gravidity, parity, fetal gender, twin pregnancy, smoking and ethnicity on these markers. Methods A cohort of Saudi women (first cohort n = 1616) with singleton pregnancies prospectively participated in the present study, and fetal NT together with maternal serum free ,-hCG and PAPP-A were determined at 10 to 13+6 weeks of gestation. The distribution of gestational age-independent multiples of the median (MoM) of the parameters was defined and normative values were established, and correction for maternal body weight was made accordingly. The influence of various co-variables was examined using the data collected from the first and the second (n = 1849) cohorts of women and 62 twin pregnancies, and compared with other studies. Results All markers exhibited log-normally distributed MoMs. Gestational age-independent normative values were established. Maternal body weight was corrected, particularly for maternal free ,-hCG and PAPP-A using standard methods. Fetal NT showed a negative relationship with increasing gravidity (r = ,0.296) or parity (r = ,0.311), whereas both free ,-hCG and PAPP-A exhibited a significant positive relationship. There was a significant increase in the MoM of free ,-hCG in female fetuses. Smoking decreased MoM values of free ,-hCG (by 14.6%; P < 0.01) and PAPP-A (by 18.8%; P < 0.001). Twin pregnancy showed significant increases in MoM values of free ,-hCG (by 1.87-fold) and PAPP-A (by 2.24-fold), with no significant changes in fetal NT MoM values. Fetal NT MoM values were lower in Africans and Asians but higher in Orientals, as compared to Saudi women (P < 0.05; in each case). MoM values (body weight-corrected) of free ,-hCG were 25.2% higher in Africans and 19.4% higher in Orientals but 6.8% lower in other Arabian and Asian (by 5.8%) women as compared to Saudi women (P < 0.05; in each case). Conclusions The normative values and distribution parameters for fetal NT, maternal serum free ,-hCG and PAPP-A were established in Saudi singleton pregnancies, the maternal body weight together with smoking, twin pregnancy and ethnicity being important first-trimester screening co-variables. Gravidity, parity and fetal gender are also considered to influence one or more of the first-trimester markers examined. Copyright © 2007 John Wiley & Sons, Ltd. [source] Public Management Reform: Competing Drivers of ChangePUBLIC ADMINISTRATION REVIEW, Issue 5 2002Lois Recascino Wise Public management reforms often are portrayed as part of a global wave of change, and all organizational change is interpreted within a single reform paradigm that is rooted in economics and market,based principles. Reforms outside this paradigm go unnoticed. This article examines the assertion that different drivers of change competing with the dominant focus of management discourse remain present and influence the direction of reform. It presents three alternative drivers of change rooted in normative values and provides evidence of their relevance from three national cases. Normative influences are reflected in a stream of activities occurring within the same time period in different civil service systems. The direction of public management practice cannot be seen as fully determined by any one approach to government reform or as traveling in only one direction. Understanding the balance among competing drivers of change is a key to interpreting both contemporary and future administrative reform. [source] Age-dependent normative values for differential luminance sensitivity in automated static perimetry using the Octopus 101ACTA OPHTHALMOLOGICA, Issue 4 2008Agnes Hermann Abstract. Purpose:, To determine age-dependent normative differential threshold values for the Octopus 101 instrument and to create a smooth mathematical model characterizing the age-dependency and asymmetry of the hill of vision. Methods:, Static automated perimetry within the central 30° visual field (VF) was conducted with the Octopus 101 (background luminance 10 cd/m2) in 81 eyes of 81 ophthalmologically healthy subjects (11,12 per decade of age) aged 10,79 years. A 4-2-2 staircase strategy with three reversals was run. The test point grid consisted of 68 concentrically arranged points with test point condensation towards the VF centre, representing the approximately rotation-symmetrical 30° hill of vision. Thresholds of differential luminance sensitivity (DLS) were estimated by the maximum likelihood method. A smooth mathematical model was fitted to the normative data. Results:, The model fit was satisfactory (r2 = 0.74). Covariables were: age, eccentricity, angle and subject. Total random standard deviation (SD) was 1.75 dB. The residual SD exceeded 1.75 dB in the border region, was 1.5 dB within the centre and fell below 1.25 dB in a ring around the centre. Average thresholds of DLS varied with age quadratically. It is close to constant for the 10,40,year-old age group and declines ever more steeply thereafter. The effect of age on DLS in the VF increased with eccentricity. The greatest drop was located in the peripheral superior hemifield: at 25° eccentricity the superior DLS was estimated to be 5.5 dB higher in 10-year-olds than in 75-year-olds. Conclusions:, This new smooth model allows for the prediction of age-related normal threshold values for any stimulus location within the 30° VF and thus for the calculation of global and local measures of defect such as mean defects or p-values for any type of stimulus. [source] Self-perceived health and burden of diabetes in teenagers with type 1 diabetes: psychometric properties of the Swedish measure ,Check your health'ACTA PAEDIATRICA, Issue 3 2010G Viklund Abstract The aim of this study was to test the psychometric properties of the instrument ,Check your health' in teenagers with type 1 diabetes. The instrument measures ,self-reported health' and ,burden of diabetes'. A convenience sample of 199 teenagers, 12,17 years of age, completed the questionnaires ,Check your health' and DisabKids when visiting the diabetes clinic. Forty-seven patients completed the questionnaires at home a second time. In the reliability test, the correlation between test and retest was found to be satisfactory, (0.94,0.62, except for social burden, 0.41). Convergent validity was moderate (0.62,0.38), while the instrument showed good discriminant validity. Self-reported health and burden of diabetes were different in boys and girls, in patients with good or poor metabolic control or who reported high and low disease severity. The domain burden of diabetes turned out to be very sensitive. Conclusion:, The instrument ,Check your health' showed clinical utility in teenagers with diabetes. Reliability and validity tests of the measure showed promising results in Swedish teenagers, and it can probably be used in clinical settings. To further strengthen the convergent validity, it should be compared with other QoL instruments, and to obtain normative values, it has to be used in a larger context. [source] Prevalence of adrenal androgen excess in patients with the polycystic ovary syndrome (PCOS)CLINICAL ENDOCRINOLOGY, Issue 6 2005Ashim Kumar Summary Objective, To determine the prevalence of adrenal androgen (AA) excess in the polycystic ovary syndrome (PCOS) using age- and race-specific normative values. Design, Cross-sectional observational study. Patients, One hundred and eight-two (88 Black and 94 White) age-matched healthy eumenorrhoeic nonhirsute women (controls) and 213 (27 Black and 186 White) women with PCOS were recruited. Measurements, Total testosterone (T), free T, androstenedione (A4), dehydroepiandrosterone sulfate (DHEAS) and SHBG, as well as fasting insulin and glucose, were measured in plasma. Results, The mean total T, free T, A4, DHEAS and body mass index (BMI) were higher in women with PCOS than in control women. DHEAS levels were significantly lower in Black controls than White controls, whereas fasting insulin and BMI were higher in Black controls. In control and Black PCOS women, DHEAS levels did not correlate with BMI, waist-to-hip ratio (WHR) or fasting insulin. Among White women with PCOS, DHEAS levels correlated negatively with BMI and fasting insulin. DHEAS levels decreased similarly with age in control and PCOS women of either race. For each race and age group the upper 95% normative values for log DHEAS was calculated, and the number of PCOS subjects with log DHEAS values above this level were assessed. The prevalence of supranormal DHEAS levels was 33·3% and 19·9%, respectively, among Black and White women with PCOS. Conclusions, The prevalence of DHEAS excess is approximately 20% among White and 30% among Black PCOS patients, when using age- and race-adjusted normative values. This study also indicates that the age-associated decline in DHEAS levels is observable and similar in both control and PCOS women, regardless of race. While BMI and fasting insulin had little impact on circulating DHEAS levels in healthy women, among White PCOS patients these parameters were negatively associated with circulating DHEAS levels. [source] | ||||||||||||||||