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Smith QW, Holcomb JD, Galvin J, Roberts JK. The effect of changes in the U.S. health care system on rehabilitation research: the results of a survey of rehabilitation health professionals. JOURNAL OF ALLIED HEALTH 2002; 30:207-14. [PMID: 11828581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
To obtain empirical data on the impact of changes in the health care system on rehabilitation research, physicians, psychologists, nurses, physical therapists, and occupational therapists involved in such research were surveyed to determine: 1) how the changes had affected their research productivity; 2) whether their scholarly activities (e.g., publications) had been affected; and 3) whether working in an academic vs non-academic institution made a difference. There were 438 usable responses (38% response rate) to the survey, which was sent to members of national organizations. Although the results somewhat supported suggestions that changes in the system had had a dampening effect on research, they were ambiguous, failing to clearly demonstrate a negative impact of managed care. More rigorous study is needed to enable firm conclusions and the formulation of actions to address factors that may influence rehabilitation research.
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Gillin MT, Galvin J, Brezovich IA, Chu J, Das I, Detorie NA, Fontenla D, Hanson W, Harms WB, Huq MS, Kline R, Orton C, Podgorsak EB, Purdy J, Rosen I, Schell M, Suntharalingam N, Winter KA, De Wyngaert JK. Radiation Therapy Oncology Group. Research Plan 2002-2006. Medical Physics Committee. Int J Radiat Oncol Biol Phys 2002; 51:96-102. [PMID: 11641023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Smith QW, Holcomb JD, Galvin J, DeJong G, DeLisa JA, Roberts JK. The effect of changes in the health care environment on rehabilitation research: a survey of rehabilitation physicians. Arch Phys Med Rehabil 2001; 82:1624-9. [PMID: 11689985 DOI: 10.1053/apmr.2001.26623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess what effect organizational, funding, and system changes in the health care environment may have on rehabilitation research. DESIGN National survey. SETTING Academic and clinical research programs. PARTICIPANTS A total of 138 physicians participated in the survey. INTERVENTION Mailed instrument requesting information on demographics, research activities, and indicators of change. MAIN OUTCOME MEASURES Percentage of respondents reporting specific perceptions on (1) how academic and research programs are affected by organizational changes, (2) availability of research funds, and (3) the overall impact that health care changes have on research; between-group comparisons on survey responses. RESULTS Usable responses were obtained from 138 physicians (response rate, 42.5%). Responding physicians reported workplace changes that included organizational restructuring (32.6%), affiliation with managed care plans (24%), and staff decreases (45.9%). Over half (54.8%) indicated that facility changes had detracted from their abilities to conduct research. A third (34.8%) reported declines in numbers of inpatient beds, and 89.6% reported decreased length of stay (LOS). Decreased LOS was cited as detracting from ongoing research by 36.6% and as discouraging new research by 33.3% of respondents. Although not reflected in measures of scholarly productivity, 53.6% reported having less time to devote to scholarship and 48.5% reported decreased professional activities. Over two thirds (67.4%) of responding physicians indicated that health care system changes had a negative impact on current research, and 54.5% indicated that such changes made it less likely that they would pursue new research. CONCLUSION Changes in the health care system have had a dampening effect on rehabilitation physicians' research pursuits.
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Hunninghake GW, Zimmerman MB, Schwartz DA, King TE, Lynch J, Hegele R, Waldron J, Colby T, Müller N, Lynch D, Galvin J, Gross B, Hogg J, Toews G, Helmers R, Cooper JA, Baughman R, Strange C, Millard M. Utility of a lung biopsy for the diagnosis of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2001; 164:193-6. [PMID: 11463586 DOI: 10.1164/ajrccm.164.2.2101090] [Citation(s) in RCA: 420] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
It is not known if a surgical lung biopsy is necessary in all patients for the diagnosis of idiopathic pulmonary fibrosis (IPF). We conducted a blinded, prospective study at eight referring centers. Initially, cases were evaluated by clinical history and examination, transbronchial biopsy, and high-resolution lung computed tomography scans. Pulmonologists at the referring centers then assessed their certainty of the diagnosis of IPF and provided an overall diagnosis, before surgical lung biopsy. The lung biopsies were reviewed by a pathology core and 54 of 91 patients received a pathologic diagnosis of IPF. The positive predictive value of a confident (certain) clinical diagnosis of IPF by the referring centers was 80%. The positive predictive value of a confident clinical diagnosis was higher, when the cases were reviewed by a core of pulmonologists (87%) or radiologists (96%). Lung biopsy was most important for diagnosis in those patients with an uncertain diagnosis and those thought unlikely to have IPF. These studies suggest that clinical and radiologic data that result in a confident diagnosis of IPF by an experienced pulmonologist or radiologist are sufficient to obviate the need for a lung biopsy. Lung biopsy is most helpful when clinical and radiologic data result in an uncertain diagnosis or when patients are thought not to have IPF.
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Suri R, Harthorne JW, Galvin J. Automatically optimizing pacing output: an excellent idea, but with potentially lethal pitfalls. Pacing Clin Electrophysiol 2001; 24:520-3. [PMID: 11341095 DOI: 10.1046/j.1460-9592.2001.t01-1-00520.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AutoCapture (AC) and Ventricular Capture Management (VCM) are pacing algorithms that attempt to automatically optimize pacing output, providing consistent capture and enhancing device longevity. This report describes potentially serious consequences from use of these algorithms. In one pacemaker dependent patient, AC malfunction led to failure of ventricular capture. This was fixed with a software correction. The potential seriousness of AC malfunction leads to the recommendation that this software be downloaded into all susceptible pacemakers. In a second patient, VCM malfunction resulted in unnecessary high output pacing. Our experience illustrates the need for postmarketing surveillance when embracing newer technology.
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Vallois MC, Galvin J. Gendering the revolution: language, politics, and the birth of a nation (1789-1795). THE SOUTH ATLANTIC QUARTERLY 2001; 100:423-445. [PMID: 18711845 DOI: 10.1215/00382876-100-2-423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Translated by John Galvin and Marie-Claire Vallois
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Abstract
In 1996, the cattle industries and government in the Australian state of Victoria established a Johne's disease (JD) test and control program under which participating farmers are provided with an annual ELISA test of their adult herd and advice on disease control that is tailored to their farm. The program is delivered through private veterinarians under contract with the government. There are over 600 herds enrolled in the program and about one third of these have had three or more whole herd tests. This paper provides a review of the program to date. It describes changes in ELISA reactor rates and numbers of clinical cases, and provides evidence for progress in the program.
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Xiao Y, Galvin J, Hossain M, Valicenti R. An optimized forward-planning technique for intensity modulated radiation therapy. Med Phys 2000; 27:2093-9. [PMID: 11011738 DOI: 10.1118/1.1289255] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Intensity modulated radiation therapy (IMRT) has stirred considerable excitement in the radiation oncology community. Its objective is to make the dose conform to the tumor and spare other organs. Instead of resorting to the rather complex inverse-planning, the technique described here is an extension of the conventional treatment planning technique. The beam orientation and wedge angles are chosen in the conventional rule-based manner. However, within each conformal beam's eye view (BEV) field including margin, a number of sub-field openings are added. The smaller field openings are designed to irradiate the tumor, while sparing the normal tissue of the organs at risk (OARs) that intrude into the target region in the BEV. As the number of intrusions into the target BEV increases, the number of sub-fields for each beam increases. The Cimmino simultaneous projection method was employed to obtain the optimized weighting for each field of each beam. In cases where the dose constraints for the tumor and for the OARs are reasonable, it is possible to obtain a plan with a fairly small number of beams that satisfies the specified dose objectives. This is illustrated for the treatment of prostate cancer, where the rectum creates a concavity in the planning target volume. An advantage of this technique is that the quality assurance for the delivery of these plans does not require extensive special efforts.
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Galvin J. Cardiac troponin I in patients with chest pain. Ir J Med Sci 2000; 169:165-7. [PMID: 11272868 DOI: 10.1007/bf03167687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hurtig HI, Trojanowski JQ, Galvin J, Ewbank D, Schmidt ML, Lee VM, Clark CM, Glosser G, Stern MB, Gollomp SM, Arnold SE. Alpha-synuclein cortical Lewy bodies correlate with dementia in Parkinson's disease. Neurology 2000; 54:1916-21. [PMID: 10822429 DOI: 10.1212/wnl.54.10.1916] [Citation(s) in RCA: 446] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dementia is a frequent complication of idiopathic parkinsonism or PD, usually occurring later in the protracted course of the illness. The primary site of neuropathologic change in PD is the substantia nigra, but the neuropathologic and molecular basis of dementia in PD is less clear. Although Alzheimer's pathology has been a frequent finding, recent advances in immunostaining of alpha-synuclein have suggested the possible importance of cortical Lewy bodies (CLBs) in the brains of demented patients with PD. METHODS The brains of 22 demented and 20 nondemented patients with a clinical and neuropathologic diagnosis of PD were evaluated with standard neuropathologic techniques. In addition, CLBs and dystrophic neurites were identified immunohistochemically with antibodies specific for alpha-synuclein and ubiquitin; plaques and tangles were identified by staining with thioflavine S. Associations between dementia status and pathologic markers were tested with logistic regression. RESULTS CLBs positive for alpha-synuclein are highly sensitive (91%) and specific (90%) neuropathologic markers of dementia in PD and slightly more sensitive than ubiquitin-positive CLBs. They are better indicators of dementia than neurofibrillary tangles, amyloid plaques, or dystrophic neurites. CONCLUSION CLBs detected by alpha-synuclein antibodies in patients with PD are a more sensitive and specific correlate of dementia than the presence of Alzheimer's pathology, which was present in a minority of the cases in this series.
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Xiao Y, Galvin J. A centralized dose calculation system for radiation therapy. J Digit Imaging 2000; 13:71-2. [PMID: 10847366 PMCID: PMC3453242 DOI: 10.1007/bf03167628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Centralization of treatment planning in a radiation therapy department is a realistic strategy to achieve an integrated and quality-controlled planning system, especially for institutions with numerous affiliations. The rapid evolution of computer hardware and software technology makes this a distinct possibility. However, the procedure of three-dimensional treatment planning involves a number of steps, such as: (1) input of patient computed tomography (CT) images and contour information; (2) interactions with local devices such as a film digitizer; and (3) output of beam information to be integrated with the record and verify the system. A full-fledged realization of the web-based centralized three-dimensional treatment planning system will require an extensive commercial development effort. We have developed and incorporated a web-based Timer/Monitor Unit (MU) program as a first step towards the full implementation of a centralized treatment planning system. The software application was developed in JAVA language. It uses the internet server and client technology. With one server that can handle multiple threads, it is a simple process to access the application anywhere on the network with an internet browser. Both the essential data needed for the calculation and the results are stored on the server, which centralizes the maintenance of the software and the storage of patient information.
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Chow T, Galvin J, McGovern B. Antiarrhythmic drug therapy in patients with renal failure, liver failure, and congestive heart failure. HEART DISEASE (HAGERSTOWN, MD.) 1999; 1:98-107. [PMID: 11720610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Commonly prescribed antiarrhythmic agents--and several recently developed agents--are reviewed with respect to their use in patients with renal failure, hepatic failure, and congestive heart failure. Because removal of electrophysiologically active agents from the systemic circulation in most cases depends on either renal elimination, hepatic metabolism, or both, patients with preexisting kidney or liver disease may be at increased risk of treatment-related drug toxicity, including proarrhythmia. These susceptibilities should be anticipated, with drug selection and/or dosage modified accordingly. Patients with left ventricular dysfunction and heart failure also are at increased risk of treatment-related complications, including proarrhythmia and hemodynamic intolerance. In addition, the metabolism of antiarrhythmic drugs may be impaired in these patients. Preference should be given to drugs with a proven safety profile, such as amiodarone, in patients with heart failure.
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Carpenter CM, Galvin J, Guy M, McGovern BA. Runaway pacemaker in an implantable cardioverter defibrillator. J Cardiovasc Electrophysiol 1998; 9:1008-11. [PMID: 9786083 DOI: 10.1111/j.1540-8167.1998.tb00143.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Runaway pacemaker is a potentially catastrophic complication of any permanent pacing system. METHODS AND RESULTS A 70-year-old man was found to have erratic behavior of his implantable cardioverter defibrillator (ICD) during a routine outpatient interrogation. His device was turned off, and he was hospitalized in preparation for a pulse generator replacement. During his hospitalization, his ICD unexpectedly began pacing rapidly. Despite prompt resuscitation attempts, the patient died. Postmortem examination of the device demonstrated a crystal oscillator failure. CONCLUSION A previously unrecognized component malfunction is a potentially lethal complication of ICDs.
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Abstract
Antiarrhythmic agents commonly used in clinical practice are reviewed with respect to their potential for teratogenic or other adverse fetal effects. Although most experience with antiarrhythmic drug therapy during pregnancy has accrued with digoxin, quinidine, and propranolol, other antiarrhythmic agents may also be used in the pregnant patient if indicated. The choice of antiarrhythmic drug depends on the specific arrhythmia being treated, the cardiac condition of the patient or fetus, and the known or anticipated actions of the antiarrhythmic drug being considered. The management of specific arrhythmias encountered in pregnant women are also discussed. For benign arrhythmias, a conservative approach starting first with preventive measures is appropriate. For more severe or symptomatic arrhythmias, pharmacologic therapy should be instituted using drugs with proven safety to the fetus, if possible. Electrical cardioversion of the patient may be performed with relative safety in more emergent situations.
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Seifer C, McNeill B, O’Donnell M, Daly K, Kellett J, McGee HM, Montogomery AJ, O’Callaghan D, Horgan JH, Mahon NG, Codd M, Brennan J, Egan B, McCann HA, Sugrue DD, Menown IBA, Patterson RSHW, McMechan SR, Hameed S, Adgey AAJ, Baird SH, McBride SJ, Trouton TG, Wilson C, McRedmond JP, Fitzgerald DJ, Crowley JJ, Tanguay JF, Santos RM, Stack RS, Mahon NG, Keelan P, McCann HA, Sugrue DD, McKenna CJ, AuBuchon R, Camrud AR, Holmes DR, Schwartz RS, McKenna CJ, Camrud AR, Wolff R, Edwards WD, Holmes DR, Schwartz RS, Hanratty C, McAuley D, Young I, Murtagh G, O’Keeffe B, Richardson G, Scott M, Chew EW, Bailie NA, Graham AMJ, O’Kane H, McKenna CJ, Kwon HM, Ellis L, Holmes DR, Virmani R, Schwartz RS, Noelke L, Wood AE, Javadpour H, Veerasingham D, Wood AE, O’Kane D, Allen JD, Adgey AAJ, Hennessy T, Johnson P, Hildick-Smith D, Winter E, Shapiro L, McKenna CJ, Edwards WD, Lerman A, Holmes DR, Schwartz RS, McGrath LT, Passmore P, Silke B, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, Lovell SL, McDowell G, McEneany D, Riley MS, Nicholls DP, Gilligan D, Sargent D, Dan D, Gilligan D, Elam G, Rhee B, Keane D, Zhou L, McGovern B, Garan H, Ruskin J, O’Shea JC, Tan HC, Zidar JP, Stack RS, Crowley JJ, O’Keeffe DB, Graffin S, Fitzsimmons D, Brown S, Duff D, Denham B, Woods F, Neligan M, Oslizlok P, Connolly CK, Danton MHD, O’Kane H, Danton M, Gladstone DJ, Craig B, Mulholland HC, Casey F, Chaudhuri S, Hinchion J, Wood AE, Hinchion J, Wood AE, Menown IBA, Patterson RHSW, MacKenzie G, Adgey AAJ, Harbinson MT, Burgess LM, Moohan V, McEneaney DJ, Adgey AAJ, Menown IBA, MacKenzie G, Patterson RSHW, Adgey AAJ, Finnegan OC, Doherty L, Silke B, Riddell JG, Meleady R, Daly L, Graham I, Quinn M, Foley B, Lee J, Mulvihill N, Crean P, Walsh M, O’Morain C, Quinn M, Crean P, Foley B, Walsh M, Hynes C, King SM, David S, Newton H, Maguire M, Rafferty F, Horgan JH, Sullivan PA, Murphy D, Gallagher S, Menown IBA, Allen J, Anderson JM, Adgey AAJ, Dan D, Hoag J, Eckberg D, Gilligan D, Galvin J, Garan H, McGovern B, Ruskin J, Mahon NG, Diamond P, Neilan T, Keelan E, H. A., McCarthy C, Sugrue DD, Harbinson MT, Moohan VP, McEneaney DJ, Burgess LM, Anderson JM, Ayers GM, Adgey AAJ, Roberts M, Burgess L, Anderson C, Wilson C, Khan M, Clements IP, Miller WL, Seifer C, O’Donnell M, McNeill B, Daly K, Turtle F, McDowell G, Long H, McNair W, Campbell NPS, Mathew TP, Turtle F, Smye M, Nesbitt GS, Young IS, Adgey AAJ, Meleady R, Mulcahy D, Graham IM, Moore D, Menown IBA, McMechan SR, MacKenzie G, Adgey AAJ, Diamond P, Sugrue D, Codd MB, Galvin J, Zimmerman P, Winget J, Capeless M, Galvin J, Garan H, McGovern B, Ruskin J, McKelvey TA, Danton MHD, Sarsam MIA, McEneaney D, Roberts M, Burgess L, Anderson C, Wilson C, Khan M. Irish cardiac society. Ir J Med Sci 1998. [DOI: 10.1007/bf02937898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Krishnan SC, Galvin J, McGovern B, Garan H, Ruskin JN. Reproducible induction of "atypical" torsades de pointes by programmed electrical stimulation: a novel form of sotalol-induced proarrhythmia? J Cardiovasc Electrophysiol 1997; 8:1055-61. [PMID: 9300303 DOI: 10.1111/j.1540-8167.1997.tb00629.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We present a patient with sotalol-induced polymorphic ventricular tachycardia that was seen only with programmed ventricular stimulation. Electrophysiologic studies performed prior to initiation of sotalol therapy revealed inducible monomorphic ventricular tachycardia. Possible underlying electrophysiologic mechanisms are discussed.
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McKenna CJ, Galvin J, McCann HA, Sugrue DD. Risks of long-term oral anticoagulation in a non-trial medical environment. IRISH MEDICAL JOURNAL 1996; 89:144-5. [PMID: 8824039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Randomised controlled trials have shown that anticoagulation with warfarin reduces the risk of stroke in patients with atrial fibrillation by two thirds. However there is concern as to whether the rate of anticoagulant-related haemorrhage seen in these trials would be reproduced in a non-trial setting. Four hundred and ten consecutive patients attending a special anticoagulation clinic over one year were asked to complete a questionnaire concerning their warfarin treatment. The total number of years on warfarin was 2870. Of the 410 patients, 59 (14%) admitted to 88 bleeding episodes while on warfarin. Of these bleeding problems, 36/88 (41%) required admission to hospital or to casualty for treatment and 52/88 (59%) required only a lowering or temporary cessation of warfarin therapy. The calculated annual non-fatal bleeding rate of 3% in this survey is identical to that reported from the Copenhagen AFASAK trial. Similarly the 1.3% annual rate of major bleeding requiring attendance at hospital is identical to that in the Stroke Prevention in Non-Rheumatic Atrial Fibrillation trial. The results of this study suggest that oral anticoagulation is as safe in an ordinary medical setting as in a closely supervised trial setting.
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Galvin J, Codd M, Leavy S, Sugrue D. Lipid profile, haemostatic variables and angiographically-defined coronary artery disease: a cross-sectional study in an Irish population. Ir J Med Sci 1996; 165:129-32. [PMID: 8698560 DOI: 10.1007/bf02943801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
More than 300 risk factors for coronary artery disease (CAD) have been described. There are important geographical and racial differences in both the prevalence of CAD and of potential risk factors. The purpose of this study was to determine the relationship between both the presence and extent of angiographically defined CAD in an Irish population and a spectrum of clinical risk factors, lipid profile and haemostatic variables. On univariate analysis, age, male gender, history of smoking, history of hypertension, total cholesterol, triglycerides, LDL, Cholesterol, the LDL:HDL ratio, apoprotein B-100 and the apoprotein B-100: A-II ratio were associated with the presence of CAD. However, in multivariate analysis only age, male gender, a history of smoking and the apoprotein B-100: A-II ratio remained significantly associated with the presence of CAD. These same risk factors and apoprotein B-100 were significantly associated with the extent of CAD on multivariate analysis. In addition, apoprotein B-100 levels appeared to be associated with disease extent. When all significant variables associated with the presence or extent of CAD were analysed together in a multivariate model, they only accounted for 28% of the variability in the distribution of CAD. Thus, advancing age, male gender, cigarette smoking and apoprotein B-100 appear to be important correlates of the presence and extent of CAD in this selected population. However, in individual patients most of the variability in the distribution of occlusive CAD remains unexplained.
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Hennessy T, Galvin J, McKenna C, McCann HA, Sugrue DD. Initial experience with percutaneous balloon mitral commissurotomy. IRISH MEDICAL JOURNAL 1995; 88:100-82. [PMID: 7635677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Percutaneous Transvenous Mitral Commissurotomy (PTMC) is an alternative to surgical mitral valvuloplasty for treatment of selected patients with rheumatic mitral stenosis. We report our initial experience with the technique in 10 patients. The procedure was successful in all patients. There were no major complications. Mitral valve area increased from a mean (+/- SD) of 0.95 +/- 0.2 to 2.18 +/- 0.8 cm2. Transmitral pressure gradient fell from 12 +/- 8 to 4 +/- 5 mmHg while New York Heart Association functional class improved by 1 grade or more in all patients. PTMC is a safe and cost effective alternative to surgical mitral valvotomy in appropriately selected cases.
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Oslizlok P, Duff D, Denham B, Penny WJ, Banning AP, Groves PH, Brewer L, Lewis MJ, Cheadle H, Crawford N, Kearney PP, Starkey IR, Fort S, McMurray JV, Shaw TR, Sutherland GR, Hennessy T, McCann H, Sugrue D, Foley DP, Melkert R, Keane D, Serruys PW, Vaughan CJ, O’Connell DP, McDonald D, Blake S, Garadah T, Mehana N, King G, Gearty G, Crean P, Walsh M, Galvin J, Codd MB, McCann HA, Sugrue DD, Gaylani NE, Weston C, Thomas A, Davies L, Tovey J, Musumeci F, Singh HP, Hargrove M, Fennell W, Aherne T, Crowley JJ, Hassanein H, Shapiro LM, McCrissican D, Morton P, O’Donnell AF, McBrinn S, McCarthy J, McCarthy D, Neligan MC, McGovern E, Herity NA, Allen JD, Silke B, Adgey AAJ, Johnston PW, Anderson J, McIlroy RL, Dunn HM, Nikookam K, McNeill AJ, Foley P, Foley D, de Jaegere P, Serruys P, O’Callaghan D, Vela J, Maguire M, Horgan J, Graham ANJ, Wilson CM, Hood JM, D’SA AABB, Khan MM, McClements B, Dalzell G, Campbell NPS, Webb SW, Shandall A, Buchalter MB, Northbridge DB, McMurray J, Dargie HJ, Sullivan PA, McLoughlin M, Varma MPS, Charleton P, Turkington E, Rusk RA, Richardson SG, Hale A, O’Shea JC, Murphy MB, Diamond P, McAleer B, Davies S, Kinnaird T, Duly E, McKenna CJ, Codd M, McGee HM, Browne C, Horgan JH. Irish cardiac society Proceedings of Annual General Meeting held 4th/5th November, 1994. Ir J Med Sci 1995. [DOI: 10.1007/bf02968121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kienzle M, Curry D, Franken EA, Galvin J, Hoffman E, Holtum E, Shope L, Torner J, Wakefield D. Iowa's National Laboratory for the study of Rural Telemedicine: a description of a work in progress. BULLETIN OF THE MEDICAL LIBRARY ASSOCIATION 1995; 83:37-41. [PMID: 7703937 PMCID: PMC225995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As the federal administration advances the idea of the "information superhighway," many disciplines are being challenged to find ways to use advanced telecommunications to improve access to information, enhance learning opportunities, and achieve higher levels of international competitiveness. Telemedicine, the use of communications technology in the practice of medicine, may change the way rural health care is provided by improving access to medical information, diagnostic tools, and consultations. The information and health care services required by health care professionals are rapidly changing, and dissemination of this information to isolated practitioners has proven to be difficult. By providing support electronically from a central site, the most current information is more readily available. Using test-bed hospitals in rural and urban settings, the National Library of Medicine-funded National Laboratory for the Study of Rural Telemedicine at the University of Iowa is currently developing the necessary infrastructure to support targeted projects studying how telemedicine applications can be made more effective and readily available.
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O’Callaghan D, Horgan JH, Kellett J, Graham J, Deb B, Caldwell MTP, O'Callaghan P, Byrne PJ, Hennessy TPJ, Crean P, Walsh M, Gearty G, Boyle DM, Higginson JDS, Salathia K, Chandler R, Shah P, Lavin F, Daly K, Steele IC, Nugent AM, Vallely SR, Campbell NPS, Nicholls DP, Coghlan JG, Flitter WD, Daly R, Wright GD, Ilsley CD, Slate T, Foley DP, Melkert R, Keane D, Serruys PW, Foley JB, Sridhar K, Brown RIG, Penn IM, Umans VA, de Jaegere P, Galvin J, Codd M, Hennessy A, Leavey S, Keelan E, McCarthy C, Sugrue D, Craig BG, Mulholland HC, Kearney P, Erbel R, Koch L, Ge J, Görge G, Meyer J, Anderson D, Marrinan M, Sulke N, Cooke R, Jackson G, Sowton E, McEneaney DJ, Anderson J, Adgey AAJ, Marks P, Walsh TN, Leavey, Crowley JJ, Kenny A, Dardas P, Shapiro LM, Delanty N, Moran N, Catella F, FitzGerald GA, Fitzgerald DJ, Umans V, Moore D, Weston A, Hughes M, Maurer B, Cleland J, McGee HM, Graham I, Cullen C, Dempsey G, Wright G, Martin L, MacKenzie G, Adgey J, Lawson JA, Herity NA, Allen JD, Silke B, Northridge DB, Jackson NC, Metcalfe MJ, Dargie HJ, Gates ARC, Huang CLH, Gresham A, Carpenter TA, Hall LD, Johnston PW, Jossinet J, Imam Z, Sheahan R, Newman D, Dorian P, Meleady R, Tan KS, O’Brien C, Graham IH, Maderna P, Fitzgerald D, O'Callaghan DM, Rafferty SM, Canton MC, Connolly BF, Buchalter MB, Shandall A, Rees A, Rajan L, Sheehan R, Ghaisas N, Geraty G. Irish Cardiac Society. Ir J Med Sci 1994. [DOI: 10.1007/bf02942835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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173
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Leavey S, Galvin J, McCann H, Sugrue D. Post-myocardial infarction ventricular septal defect: an angiographic study. Ir J Med Sci 1994; 163:182-3. [PMID: 8200783 DOI: 10.1007/bf02967226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Clinical and angiographic findings are reported in a consecutive series of nineteen patients with post infarction ventricular septal defect (PIVSD). In all patients PIVSD complicated a first myocardial infarct and none had a history of angina pectoris prior to presentation. In over 50% of the patients PIVSD occurred within three days of infarction. The mean patient age was 65 years. Single vessel disease was noted in 63% of the patients. The mean left ventricular ejection fraction was 27%. Contrast left ventriculography localised the defect in all patients. Although a comprehensive cardiac ultrasound examination will generally confirm the diagnosis of PIVSD, preoperative coronary angiography is essential for the selection of those patients most likely to benefit from concomitant coronary artery bypass grafting at the time of surgical repair of the interventricular septum.
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Hunninghake GW, Gilbert S, Pueringer R, Dayton C, Floerchinger C, Helmers R, Merchant R, Wilson J, Galvin J, Schwartz D. Outcome of the treatment for sarcoidosis. Am J Respir Crit Care Med 1994; 149:893-8. [PMID: 8143052 DOI: 10.1164/ajrccm.149.4.8143052] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The clinical characteristics and pathology of sarcoidosis are well defined; however, the optimal therapy for this disorder remains unclear. Although patients respond, acutely, to corticosteroid therapy, it is not clear that these agents ultimately alter the natural history of this disease. These observations and that corticosteroids have significant side effects suggest that only patients who will clearly benefit from corticosteroid therapy should be treated. In a prospective study of patients' with sarcoidosis (n = 98), we limited our use of corticosteroids to those patients who had objective evidence of recent deterioration in lung function or serious extrapulmonary disease. All patients with sarcoidosis fulfilling these criteria were treated with corticosteroids. Patients were tapered off corticosteroids after they were treated for 1 yr. Of the 98 study subjects, 91 had not received therapy for the disease and 7 were on therapy before entry into the study. Of the 91 previously untreated patients, 55 were observed without therapy and 36 were treated with corticosteroids. Of those who were observed off therapy, only eight deteriorated. Of these latter patients, six responded and stabilized with the administration of corticosteroids for treatment of the underlying disease, to antibiotics for an associated bronchiectasis, or to diuretics for treatment for congestive heart failure; two were lost to follow-up. None of these six patients deteriorated while receiving corticosteroids. Of the 36 patients who deteriorated and were treated with corticosteroids, 20 remained stable and 16 improved clinically. Of the 37 patients who were eventually tapered off corticosteroids, five deteriorated and required reinitiation of corticosteroid therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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175
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Galvin J, Needham M. Keeping possum. ELDERLY CARE 1994; 6:30-1. [PMID: 7920472 DOI: 10.7748/eldc.6.2.30.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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176
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Galvin J, Stephenson J, Wlodarczyk J, Loughran R, Waller G. Living near a lead smelter: an environmental health risk assessment in Boolaroo and Argenton, New South Wales. AUSTRALIAN JOURNAL OF PUBLIC HEALTH 1993; 17:373-8. [PMID: 8204720 DOI: 10.1111/j.1753-6405.1993.tb00171.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This paper outlines a risk assessment of a lead-contaminated residential site in Lake Macquarie, New South Wales, near the Pasminco Metals-Sulphide lead and zinc smelter. The assessment includes a hazard identification and a dose-response assessment based on recent research findings; an exposure assessment based on two interrelated indicators, soil/dust lead and blood lead; a risk characterisation; and finally, a discussion of environmental and behavioural options for the management of risk. The exposure assessment showed lead concentrations of 20 to 21,460 parts per million in soil survey samples, 23 to 35,870 parts per million in household dust, and a range of mean values for blood lead concentration of 11 micrograms/dl to 17 micrograms/dl, in four study groups. The proportions of children within these groups having blood lead concentrations of 10 micrograms/dl or greater, the current level of known health effect, ranged from 57 per cent to 85 per cent. The decision by the National Health and Medical Research Council in June 1993 to set a goal for blood lead of below 10 micrograms/dl has important implications for the definition and the management of the environmental health risk from 'living with lead' in the area assessed.
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177
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Cullen C, MacKenzie G, Adgey J, Lavin F, Keane M, Forde A, Shah P, Gannon F, Daly K, McClements BM, McNeil AJ, Wilson CM, Webb SW, Campbell NPS, Khan MM, O’Murchu B, Gersh BJ, Bailey KR, Holmes DR, Foley DP, Hermans WR, Rensing BJ, Vos J, Herman JP, Serruys PW, Mannion A, Finn J, Grimes H, Lonergan M, O’Donnell, Daly L, McGovern E, Graham I, Joseph PA, Robinson K, Kinsella T, Crean P, Gearty G, Walsh M, Ryan M, Clarke R, Refsum R, Ueland P, Coehrane DJ, Stewart AJ, McEneaney DJ, Allen JD, Anderson J, Dempsey G, Adgey AAJ, Casey FA, Mulholland HC, Craig BG, Power R, Rooney N, O’Keeffe DB, McComb J, Wilson C, Tan KS, Pye C, McCabe N, Hickey N, McEneaney D, Cochrane D, Oslizlok PC, Case CL, Gillette PC, Knick BJ, Henry LPN, Blair L, Gumbrielle T, Bourke JP, Hilton CJ, Campbell RWF, Kearney PP, Fennell F, McKiernan S, Fennell W, Escaned J, Hermans WR, Umans VA, de Jaegere PP, de Feyter PJ, Galvin J, Leavey S, Sugrue D, Vallely SR, Campbell NPS, Laird JD, Ferguson R, Duff S, Bridges AB, Pringle TH, McNeill GP, McLaren M, Belch JJF, O’Sullivan L, Bain H, Hunter S, Wren C, Hennesy A, Codd M, Daly C, McCarthy C, Carroll K, Coakley F, O’Mahony S, Sullivan PA, Kearney P, Higgins T, Crowey JJ, Donnelly SM, Tobin M, FitzGerald O, Bresnihan B, Maurer BJ, Quigley PJ, Shelley E, Collins C, Hickey N, ulcahy R, Johnston PW, Gibson J, Crowe P, King G, Freyne PJ, Geary G, McAdam B, Sheahan R, Gaylani NE, Simpson A, Temperley I, Mulcahy F, McGee HM, Graham T, Crowe B, Horgan JH, McGinley J, Hurley J, Neligan M, Austin C, Cleland J, Gladstone D, O’Kane H, O’Sullivan J, Hasan A, Hamilton JRL, Hunter S, Dark JH, McDaid CM, Phillips AS, Lewis SA, McMurray TJ, Walsh KP, Abrams SE, Diamond M, Clarkson MJ, Rutsch W, Emanuelsson H, Danchin N, Wijns W, Chappuis F. Irish cardiac society. Ir J Med Sci 1993. [DOI: 10.1007/bf02945184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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178
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Helmers R, Galvin J, Hunninghake GW. Pulmonary manifestations associated with rheumatoid arthritis. Chest 1991; 100:235-8. [PMID: 2060351 DOI: 10.1378/chest.100.1.235] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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179
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Brown AP, Urie MM, Barest G, Cheng E, Coia L, Emami BN, Galvin J, Kutcher J, Manolis J, Wong JW. Three-dimensional photon treatment planning for Hodgkin's disease. Int J Radiat Oncol Biol Phys 1991; 21:205-15. [PMID: 2032889 DOI: 10.1016/0360-3016(91)90179-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A multi-institutional study was undertaken using computerized planning systems to develop three-dimensional (3-D) radiotherapy plans for Hodgkin's disease (H.D.). Two patients, the first afflicted with bulky stage II disease and another one with early stage I H.D., were studied. Three main categories of plan were produced for each patient: a) a traditional plan which modelled a conventional mantle treatment on the 3-D system, b) a 3-D standard plan where anterior and posterior fields were designed to cover 3-D target volumes, and c) a 3-D unconstrained plan where innovational techniques were employed. Three-dimensional planning provides information about the dose distribution throughout the large volume irradiated in patients with H.D. that is not available with conventional mantle planning. The use of 3-D techniques resulted in improved tumor coverage, but by allowing for uncertainties such as motion, the doses to normal tissues tended to be higher. The use of unorthodox beam arrangements introduced added complexities, and further increased the lung doses. The most even dose distributions were obtained by incorporating compensating filters into anterior fields. Clinicians showed wide variations in their assessment of the plans, possible reasons for which are addressed in this paper. In addition, calculated probabilities from models of tumor control and normal tissue damage are also presented.
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Emami B, Purdy JA, Manolis J, Barest G, Cheng E, Coia L, Doppke K, Galvin J, LoSasso T, Matthews J. Three-dimensional treatment planning for lung cancer. Int J Radiat Oncol Biol Phys 1991; 21:217-27. [PMID: 2032890 DOI: 10.1016/0360-3016(91)90180-c] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The experience of four institutions involved in a three-dimensional treatment planning contract (NCI) for lung cancer is described. It was found that three-dimensional treatment planning has a significant potential for optimization of treatment plans for radiotherapy of lung cancer both for tumor coverage and sparing of critical normal tissues within the complex anatomy of the human thorax. Evaluation tools, such as dose-volume histograms, and three-dimensional isodose displays, such as multiple plane views, surface dose displays, etc., were found to be extremely valuable in evaluation and comparison of these complex plans. It is anticipated that with further developments in three-dimensional simulation and treatment delivery systems, major progress towards uncomplicated local regional control of lung cancer may be forthcoming.
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181
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Coia L, Galvin J, Sontag M, Blitzer P, Brenner H, Cheng E, Doppke K, Harms W, Hunt M, Mohan R. Three-dimensional photon treatment planning in carcinoma of the larynx. Int J Radiat Oncol Biol Phys 1991; 21:183-92. [PMID: 2032887 DOI: 10.1016/0360-3016(91)90177-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The role of three-dimensional (3-D) treatment planning in the definitive treatment of carcinoma of the larynx with radiation was evaluated at four institutions as part of an NCI contract. A total of 30 different treatment approaches were devised for two patients with larynx cancer. CT scans were obtained for both patients and various treatment planning tools were employed to optimize beam arrangements and to evaluate the resulting dose distribution. The effect on dose distribution of a number of factors was also examined: 1) the use of dose calculation algorithms which correct for tissue inhomogeneities, 2) the variation of the CT numbers used for inhomogeneity corrections to simulate inaccuracies in the knowledge of the CT numbers, and 3) the modification of beam energy. A multitude of data was used in plan evaluation and a numerical score was given to each plan to estimate the tumor control probability and the normal tissue complication probability. We found 3-D treatment planning to be of potential value in optimizing treatment plans in larynx cancer. Improved target coverage was achieved when complete information describing 3-D geometry of the anatomy was utilized. In some cases, the treatment planning tools employed, such as the beam's eye view, helped devise novel beam arrangements which were useful alternatives to standard techniques. We found little effect of change in CT number on dose distributions. A comparison between dose distributions calculated with tissue inhomogeneity corrections to those calculated without this correction showed little difference. We did find some improvement in the dose to the primary tumor volume at lower beam energies, but with an increased larynx volume potentially receiving doses above tolerance.
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Stanford W, Galvin J, Rooholamini M. Effects of awake tidal breathing, swallowing, nasal breathing, oral breathing and the Müller and Valsalva maneuvers on the dimensions of the upper airway. Evaluation by ultrafast computerized tomography. Chest 1988; 94:149-54. [PMID: 3383626 DOI: 10.1378/chest.94.1.149] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Determinations of the size and dynamics of the upper airway during respiration are important in individuals with sleep-related breathing disorders. Ultrafast computerized tomography can acquire eight 8-mm axial-slice thicknesses of the upper airway in 224 ms. If this sequence is acquired every 0.7 second over an entire respiratory cycle and played back in movie mode, the dynamic changes in the airway's size can be evaluated and measured. This report defines the size of the upper airway during normal tidal breathing and describes the changes that occur with swallowing, isolated nasal breathing, and isolated oral breathing and with the Müller and Valsalva maneuvers.
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Marcial V, Galvin J, Kumar P, D'Angiog G. Dosimetry of small electron and photon fields. Int J Radiat Oncol Biol Phys 1986. [DOI: 10.1016/0360-3016(86)90648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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185
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Fitzsimons RB, Keohane C, Galvin J. Prune belly syndrome with ultrasound demonstration of reduction of megacystis in utero. Br J Radiol 1985; 58:374-6. [PMID: 3904900 DOI: 10.1259/0007-1285-58-688-374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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186
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Reid M, Halliday HL, McClure BG, Egan D, O’Herlihy C, Dockeray CJ, Gleeson RP, Powell BFM, Hanratty TD, Keane A, Connolly J, MacCarthy P, O’Connell P, Bowman P, Gray PH, Derham R, Matthews TG, Clarke TA, Boylan P, O’Donovan P, Owens OJ, Fitsimons R, Keohane K, Galvin J, Clinch JAD, Gillen JE, Nicholson A, Bowell R, Gorman W, Erskine RLA, Ritchie JWK. Irish perinatal society Proceedings of the Annual General Meeting, March 31st, 1984. Ir J Med Sci 1984. [DOI: 10.1007/bf02939896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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187
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Galvin J, Bjarngard B. A method of reconstructing an object from a series of radiation shadows. Phys Med Biol 1974. [DOI: 10.1088/0031-9155/19/2/058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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188
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Shah J, Jones JG, Galvin J, Tomlin PJ. Pulmonary gas exchange during induction of anaesthesia with nitrous oxide in seated subjects. Br J Anaesth 1971; 43:1013-21. [PMID: 5131453 DOI: 10.1093/bja/43.11.1013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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189
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Tomlin PJ, Shah J, Jones JG, Galvin J. The effects of nitrous oxide uptake on alveolar oxygen concentrations. Br J Anaesth 1971; 43:202. [PMID: 5550853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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190
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Bahr GK, Kereiakes JG, Horwitz H, Finney R, Galvin J, Goode K. The method of linear programming applied to radiation treatment planning. Radiology 1968; 91:686-93. [PMID: 5677503 DOI: 10.1148/91.4.686] [Citation(s) in RCA: 100] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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191
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Chernushin M, Galvin J. Evaluation That Is Frankly Subjective. Am J Nurs 1962. [DOI: 10.2307/3418971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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