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The Indirect Effects of Recalled Trauma Severity on Pain Ratings among People with Fibromyalgia: a Moderated Mediation Model. Behav Med 2023:1-13. [PMID: 37066780 PMCID: PMC10601498 DOI: 10.1080/08964289.2023.2196389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/18/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023]
Abstract
Fibromyalgia syndrome (FM) is a chronic musculoskeletal condition that is accompanied by hypersensitivity to pain. Researchers have examined factors that affect pain ratings among people with FM, such as trauma, depressive symptoms, and coping; however, collectively, the interrelationships among this set of variables, and their relationships to pain, have not been examined. To better understand these relationships, a moderated-mediation model was used to examine how recalled trauma severity, depressive symptoms, relative emotion-focused coping relate to pain ratings. There were 501 participants who were primarily female, White, and ranged in age from 20 to 84 years. All participants had a physician's diagnosis of FM. The results indicated a significant moderated-mediation. Depressive symptoms significantly mediated the relationship between recalled trauma severity and pain ratings, such that greater trauma severity related to more depressive symptoms which in turn were associated with more pain. The mediation chain was moderated by relative emotion-focused coping (i.e., the proportion of emotion-focused coping compared to problem-focused coping), such that when relative emotion-focused coping was used at higher levels, the relationship between recalled trauma severity and depressive symptoms significantly weakened, reducing the indirect association between recalled trauma severity and pain ratings. The findings from the present study indicate that a treatment approach that includes a trauma-focused therapy such as exposure therapy or Emotional Awareness and Expression Therapy should be tested to determine whether these treatments can reduce the impact of past traumas, improve depressive symptoms, decrease pain ratings, and promote more adaptive coping among people with FM.
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Prognostic implication of neutrophil-lymphocyte ratio (NLR) in myocarditis: results from a multicentre, multinational study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Neutrophil–lymphocyte ratio (NLR) is an accessible inflammatory biomarker. Recently, baseline NLR has been shown to be independently associated with incident cardiovascular (CV) events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. The aim of the present study was to investigate the prognostic value of NLR in patients with AM.
Methods
All consecutive patients with a diagnosis of AM admitted to three tertiary referral cardiac centres in two countries between October 2006 and June 2020 were included in the study. Diagnosis was confirmed by either cardiac magnetic resonance or endomyocardial biopsy. The outcome measure was all-cause mortality. Patients were divided into two groups according to NLR value defined in previous studies (i.e., 2.5).
Results
A total of 287 patients with AM were included in the study. Baseline characteristics were comparable in both groups. Approximately two thirds of patients were males (n=194, 68%) with a mean age of 39±16 years. The main clinical presentation was predominantly infarct-like (n=215, 75%), followed by heart failure (HF) (n=46, 16%) and arrhythmic (n=26, 9%). Patients admitted with a HF presentation were more prevalent in the group with elevated NLR, while no difference was found in the other clinical presentations. For all patients, ECG features were comparable between groups. However, patients with elevated NLR presented with slightly higher LVEF (55±11% vs 50±13% respectively, p=0.003). Over a median follow-up of 54 months, higher NLR was associated with worse prognosis (Figure 1, p=0.02). Patients with high NLR have a 7-fold higher risk of adverse events during follow-up (Hazard Ratio 7.83, 95% confidence interval 1.02–59.89, p=0.047).
Conclusions
NLR is a promising and accessible inflammatory biomarker. In patients with AM, elevated NLR is associated with worse prognosis. Further research is advocated to confirm these data in larger populations.
Funding Acknowledgement
Type of funding sources: None.
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Would that it were so simple: Dimensions of context diversity differentially relate to four implicit interethnic associations. The Journal of Social Psychology 2020; 161:731-752. [PMID: 33357064 DOI: 10.1080/00224545.2020.1845594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Published studies point to heterogeneity in the relations between context diversity and implicit associations. To rule out methodological variations as an explanation, the relations between three dimensions of context diversity and four implicit associations were examined across 747 counties and 341 metropolitan areas, keeping constant as many factors as possible. Black people were evaluated more positively and were less associated with weapons in contexts with higher variety or higher integration combined with lower minority representation. Asian and Native Americans were more strongly associated with the American identity in contexts with higher minority representation and higher variety. These effects were largely consistent across context type, were seldom moderated by participant ethnicity, and held when controlling context-level education, median income, economic inequalities, proportion of U.S. citizens, and population density. The specificity of context diversity to implicit association relations is not attributable to methodological variations. Possible mechanisms underlying these effects are discussed.
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Temporal fluctuations in context ethnic diversity over three decades predict implicit national inclusion of Asian Americans. GROUP PROCESSES & INTERGROUP RELATIONS 2019. [DOI: 10.1177/1368430219887440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present research examined whether temporal fluctuations in context ethnic diversity account for current levels of implicit ethnic-American associations. Temporal fluctuations in ethnic diversity at the metropolitan level were assessed using data from four decennial U.S. censuses (1980–2010) and distinguishing three dimensions of context ethnic diversity (minority representation, variety, and integration). Project Implicit data (2011–2017) indexed the extent to which American identity was implicitly associated with European Americans over Asian Americans (i.e., American = White associations). Data were analyzed using multilevel modeling ( N = 152,011, nested within 226 metropolitan areas). Steeper increases in the proportion of Asian Americans were related to weaker implicit (but stronger explicit) American = White associations. Increases in ethnic integration accounted for stronger implicit American = White associations when integration fluctuations reflected accelerating rather than decelerating trends. These results suggest that current levels of implicit ethnic-national associations are linked to complex patterns of ethnic diversity fluctuations.
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Toxoplasma gondii tissue cyst formation and density of tissue cysts in shoulders of pigs 7 and 14 days after feeding infected mice tissues. Vet Parasitol 2019; 269:13-15. [DOI: 10.1016/j.vetpar.2019.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/05/2019] [Accepted: 04/08/2019] [Indexed: 11/25/2022]
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Collectivism Is Associated With Greater Neurocognitive Fluency in Older Adults. Front Hum Neurosci 2019; 13:122. [PMID: 31031611 PMCID: PMC6470262 DOI: 10.3389/fnhum.2019.00122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/22/2019] [Indexed: 11/13/2022] Open
Abstract
Neuropsychological research has been limited in the representation of cultural diversity due to various issues, raising questions regarding the applicability of findings to diverse populations. Nonetheless, culture-dependent differences in fundamental psychological processes have been demonstrated. One of the most basic of these, self-construal (individualism, collectivism), is central to how many other differences are interpreted. Self-construals may have possible consequences on social interactions, emotions, motivation, and cognition. This study aimed to evaluate the impact of self-construal on neurocognitive functions in older adults. A total of 86 community-dwelling older adults 60 years and older were assessed with three common self-report measures of self-construal along individualism and collectivism (IC). A cognitive battery was administered to assess verbal and non-verbal fluency abilities. Latent profile analysis (LPA) was used to categorize individuals according to IC, and one-way analyses of covariance (ANCOVA), including relevant covariates (e.g., ethnicity, gender, linguistic abilities), were used to compare neurocognitive functions between individualists and collectivists. Collectivists outperformed individualists on left frontally-mediated measures of verbal fluency (action, phonemic) after controlling for relevant covariates, F(1,77) = 6.942, p = 0.010, η2 = 0.061. Groups did not differ on semantic fluency, non-verbal fluency, or attention/working memory (all ps > 0.05). These findings suggest a cognitive advantage in collectivists for verbal processing speed with an additional contribution of left frontal processes involved in lexicosemantic retrieval. Self-construal may provide a meaningful descriptor for diverse samples in neuropsychological research and may help explain other cross-cultural differences.
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Ethnic diversity matters: Putting implicit associations between weapons and ethnicity in context. GROUP PROCESSES & INTERGROUP RELATIONS 2018. [DOI: 10.1177/1368430218796933] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Weapons are implicitly associated with Black Americans. We examined the extent to which this implicit stereotype fluctuates as a function of the ethnic diversity of contexts. Across 351 U.S. metropolitan areas, we tested whether three distinct indicators of ethnic diversity predicted implicit associations between the concept of “weapons” (vs. “harmless objects”) and Black Americans vs. White Americans. As predicted, implicit Black–weapon stereotypes were weaker in areas characterized by the presence of multiple ethnic groups (variety) and greater dispersion of ethnic groups at the neighborhood level (integration). Additionally, the negative association between integration and implicit stereotypes was strongest when minority representation was low compared to high. Considering multiple dimensions of ethnic diversity proved useful to document reliable relations between implicit associations and characteristics of local contexts.
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Abstract No. 681 Predictability of D-dimer levels in detecting pulmonary embolism in the sickle cell population. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Five-Year Outcomes of Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention at Auckland City Hospital. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Developments in nutrition: 20 years back, 20 years forward. NUTR BULL 2016. [DOI: 10.1111/nbu.12208] [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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A closed loop audit of pre-operative maintenance fluid prescriptions in patients made nil by mouth prior to surgery. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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New high precision data on the differential cross sections of the pion-proton elastic scattering. EPJ WEB OF CONFERENCES 2014. [DOI: 10.1051/epjconf/20148102001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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A case of ‘cryptogenic’ type D carotid cavernous fistula presenting initially with Cluster-like headache. Clin Neurol Neurosurg 2013; 115:1144-6. [DOI: 10.1016/j.clineuro.2012.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/13/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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007 Reading broadens the mind (but may short-circuit the brain). Journal of Neurology, Neurosurgery and Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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179 A delayed diagnosis of mistaken mitosis. J Neurol Psychiatry 2012. [DOI: 10.1136/jnnp-2011-301993.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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P.04 Syncope or Seizure? A case of ictal asystole. J Neurol Psychiatry 2011. [DOI: 10.1136/jnnp-2011-300645.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dyadic concordance among prostate cancer patients and their partners and health-related quality of life: does it matter? Psychol Health 2011; 26:651-66. [PMID: 20680885 DOI: 10.1080/08870441003721251] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Serious and chronic illnesses occur within a family context, affecting not only the patient but also the spouse/partner, children and extended family network. Spouses/partners are likely to experience the greatest personal impact, and may influence patient adjustment. Also, the intimate relationship may be affected by the illness experience. This study examined whether dyadic concordance on the characteristics of prostate cancer (PC) was related to health-related quality of life (HRQOL), psychological distress and marital adjustment in PC patients and their female partners. Couples (N=164) completed questionnaires on the appraisals of PC, and individual and dyadic adjustment. Patient and partner PC appraisal ratings were positively correlated. There was a general pattern of patients and partners in concordant dyads, versus those in dyads in which spouses maximised or minimised PC characteristics, reporting significantly better individual HRQOL outcomes, although there were several exceptions. Patient-partner appraisal (dis)agreement generally did not significantly predict dyadic adjustment. Overall, results suggest that dyadic disagreement is associated with worse HRQOL in couples facing PC.
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POC09 Effects of an attending physician system on acute neurology provision in Plymouth. Journal of Neurology, Neurosurgery and Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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POE07 Ambulatory care pathway for suspected first seizure patients attending the emergency department. Journal of Neurology, Neurosurgery and Psychiatry 2010. [DOI: 10.1136/jnnp.2010.226340.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
We report on the first determination of upper limits on the branching ratio (BR) of eta decay to pi0pi0gamma and to pi0pi0pi0gamma. Both decay modes are strictly forbidden by charge conjugation (C) invariance. Using the Crystal Ball multiphoton detector, we obtained BR(eta-->pi0pi0gamma)<5 x 10(-4) at the 90% confidence level, in support of C invariance of isoscalar electromagnetic interactions of the light quarks. We have also measured BR(eta-->pi0pi0pi0gamma)<6 x 10(-5) at the 90% confidence level, in support of C invariance of isovector electromagnetic interactions.
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Paroxysmal eyelid movements: A confusing feature of generalized photosensitive epilepsy. Am J Ophthalmol 2004. [DOI: 10.1016/j.ajo.2004.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Persistent, frequent, nonepileptic paroxysmal eyelid movements were observed in 19 children and adults with well-controlled generalized epilepsy. METHODS Patients were identified from five epilepsy centers. RESULTS Seventeen patients were female and two male. All had generalized photosensitive epilepsy requiring antiepileptic drugs (AEDs). In two children, paroxysmal eyelid movements began 2 to 4 years before their epilepsy was noted; in the remainder, it was noted when epilepsy was first diagnosed. Age at last follow-up was 8 to 38 years (average 21 years) with average follow-up of 9 years. All patients showed photosensitive generalized spike-wave discharges on EEG. Paroxysmal eyelid movements were a source of diagnostic confusion, but direct examination and video during EEG recording distinguished the attacks from absence seizures. In all cases, the epilepsy is completely or nearly completely controlled with AEDs, but the paroxysmal eyelid movements have not resolved with age. In 12 cases, there was a family history of the eyelid disorder without epilepsy. Videos of patients and an affected parent are available on the Neurology Web site. CONCLUSION There is an association between paroxysmal eyelid movements and photosensitive generalized epilepsy, creating diagnostic confusion.
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We move: www.wemove.org. Journal of Neurology, Neurosurgery and Psychiatry 2004. [DOI: 10.1136/jnnp.2003.012963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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The effect of severe hypoglycaemia on cognition in children and adolescents with type 1 diabetes mellitus. DIABETES, NUTRITION & METABOLISM 2002; 15:426-9. [PMID: 12678462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
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Abstract
The growing use of email and the world wide web (WWW), by the public, academics, and clinicians-as well as the increasing availability of high quality information on the WWW-make a working knowledge of the internet important. Although this article aims to enhance readers' existing use of the internet and medical resources on the WWW, it is also intelligible to someone unfamiliar with the internet. A web browser is one of the central pieces of software in modern computing: it is a window on the WWW, file transfer protocol sites, networked newsgroups, and your own computer's files. Effective use of the internet for professional purposes requires an understanding of the best strategies to search the WWW and the mechanisms for ensuring secure data transfer, as well as a compendium of online resources including journals, textbooks, medical portals, and sites providing high quality patient information. This article summarises these resources, available to incorporate into your web browser as downloadable "Favorites" or "Bookmarks" from www.jnnp.com, where there are also freely accessible hypertext links to the recommended sites.
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Properties of the Lambda(1670)(1-)/2 resonance. PHYSICAL REVIEW LETTERS 2002; 88:012002. [PMID: 11800936 DOI: 10.1103/physrevlett.88.012002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2001] [Indexed: 05/23/2023]
Abstract
Recently the Crystal Ball Collaboration measured precise new data for the near-threshold reaction K(-)p-->etaLambda, which is dominated by formation of the Lambda(1670)1 / 2(-). In this Letter, we present results of a unitary, multichannel analysis that incorporates the new Crystal Ball data. For our preferred fit, we obtain mass M = 1673+/-2 MeV, width Gamma = 23+/-6 MeV, and elasticity x = 0.37+/-0.07. This elasticity is significantly larger than previously recognized. Resonance parameters of our preferred fit are in striking agreement with the quark-model predictions of Koniuk and Isgur.
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Impact of NHS Direct on demand for immediate care. NHS Direct can help accident and emergency departments. BMJ (CLINICAL RESEARCH ED.) 2001; 322:612. [PMID: 11269253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Abstract
PURPOSE The concordance of lateralized EEG postictal polymorphic delta activity (PPDA) to the side of seizure origin in temporal lobe epilepsy (TLE) has received limited study. Our objective was to study the lateralizing value of PPDA in patients with documented TLE. METHODS A cohort of consecutive adults with TLE, detailed presurgical evaluation before temporal lobectomy, and minimal follow-up of 2 years were included. One author masked the ictal rhythm of presurgical EEGs and randomly presented 20 s of preictal and the postictal EEG to two electroencephalographers who were blind to all clinical data. They independently assigned PPDA to one of three categories: not present, bilateral, or lateralized (defined as newly appearing or an amplitude >50% of the preictal record). RESULTS Eighty seizures from 29 patients were studied. Fifteen patients had a left, and 14 had a right temporal lobectomy. Twenty-three patients were seizure free or substantially improved (defined as simple partial or nocturnal seizures only). Lateralized PPDA was present in 64% of all EEGs and at least one record from 22 (76%) patients. Lateralized PPDA, when present, was concordant with the side of surgery in 96% of the EEGs. CONCLUSIONS Lateralized PPDA is highly predictive of the side of ultimate temporal lobectomy, and by inference the side of seizure origin.
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NHS Direct. NHS Direct is a learning organisation. BMJ (CLINICAL RESEARCH ED.) 2001; 322:175. [PMID: 11159596 PMCID: PMC1119430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Measurement of pi(0)pi(0) production in the nuclear medium by pi(-) interactions at 0.408 GeV/c. PHYSICAL REVIEW LETTERS 2000; 85:5539-5542. [PMID: 11136041 DOI: 10.1103/physrevlett.85.5539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2000] [Indexed: 05/23/2023]
Abstract
We report on an investigation of the (pi(-),pi(0)pi(0)) reaction by means of measurements of the pi(0)pi(0) invariant mass distributions from pi(-) interactions on H, D, C, Al, and Cu targets at p(pi(-)) = 0.408 GeV/c. The sharp, strong peak in the pi(+)pi(-) invariant mass near 2m(pi) reported by the CHAOS Collaboration is not seen in our pi(0)pi(0) data. However, we do observe a change in the shape of the pi(0)pi(0) invariant mass spectrum for the different targets, indicating that the pi(0)pi(0) interaction diminishes in the nuclear medium as represented by nuclei D, C, Al, and Cu, compared to hydrogen.
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Abstract
OBJECTIVE The authors developed and validated a semi-structured interview; the Diabetes Self-Management Profile (DSMP), to measure self-management of type 1 diabetes. The DSMP includes the following regimen components: exercise, management of hypoglycemia, diet, blood glucose testing, and insulin administration and dose adjustment. RESEARCH DESIGN AND METHODS Families of youths with type 1 diabetes (n = 105) who were entering a controlled trial of intensive therapy (IT) versus usual care (UC) were administered the DSMP Analyses assessed the reliability and validity of the DSMP, including its associations with HbA1c and quality of life. RESULTS The DSMP total score has adequate internal consistency (Cronbach's alpha 0.76), 3-month test-retest reliability (Pearson correlation, r = 0.67), inter-interviewer agreement (r = 0.94), and parent-adolescent agreement (r = 0.61). DSMP total scores (r = -0.28) and 3 subscales correlated significantly with HbA1c (diet [r = -0.27], blood glucose testing [r = -0.37], and insulin administration and dose adjustment [r = -0.25 ]). Adolescents' reports of self-management did not differ from parental reports. Higher DSMP scores were associated with more favorable quality of life for mothers and youths. CONCLUSIONS The DSMP is a convenient measure that yields a reliable and valid assessment of diabetes self-management. Compared with extant similar measures, the DSMP is more strongly correlated with HbA1c.
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General practitioners have important roles in cancer. BMJ (CLINICAL RESEARCH ED.) 2000; 321:510-1. [PMID: 11012255 PMCID: PMC1118401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Negative predictive value of urine dipstick testing. Br J Gen Pract 2000; 50:579. [PMID: 10954945 PMCID: PMC1313759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Abstract
Electroencephalography (EEG) with standard scalp and additional noninvasive electrodes plays a major role in the selection of patients for temporal lobe epilepsy surgery. Recent studies have provided data supporting the value of interictal and postictal EEG in assessing the site of ictal onset. Scalp ictal rhythms are morphologically complex but at least one pattern (a five cycles/second rhythm maximum at the sphenoidal or anterior temporal electrode) occurs in >50% of patients and has a high predictive value and interobserver reliability for temporal lobe originating seizures. Thorough interictal and ictal scalp EEG evaluation, in conjunction with modern neuroimaging, is sufficient for proceeding to surgery without invasive recordings in some patients. Further studies are required to define the scalp ictal characteristics of mesial vs. lateral temporal lobe epilepsy.
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Abstract
OBJECTIVE Severe hypoglycemia may impair medial temporal-mediated cognitive skills, such as the ability to recall past events explicitly (delayed declarative memory). The objective of this study was to determine whether delayed declarative memory deficits are present in a group of diabetic children with an increased risk of severe hypoglycemia. RESEARCH DESIGN AND METHODS Nondiabetic children (n = 16) and children with type 1 diabetes who had been randomly assigned to either intensive (IT) (n = 13) or conventional (CT) (n = 12) diabetes therapy at the time of diagnosis participated in the study. All episodes of severe hypoglycemia were prospectively ascertained. All children were tested on memory tasks that have been closely linked to medial temporal functioning and on reaction time measures. RESULTS Our results demonstrated that the IT group had a threefold higher rate of severe hypoglycemia, performed less accurately on a spatial declarative memory task, and performed more slowly, but not less accurately, on a pattern recognition task than did the CT group or control subjects. In addition, both groups of type 1 diabetic children were significantly impaired on a motor speed task compared with their nondiabetic peers. CONCLUSIONS These results indicate a selective relative memory impairment associated with IT that is consistent with the effects of severe hypoglycemia and medial temporal damage or dysfunction. If larger prospective studies determine that severe hypoglycemia is the mediating factor for this memory impairment, extreme caution in imposing overly strict standards for glucose control in young patients with type 1 diabetes would be indicated because of the increased risk of hypoglycemia associated with IT regimens.
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Abstract
PURPOSE We tested whether the behavioral components of an Intracarotid Amobarbital Protocol (IAP) had criterion validity. It was hypothesized that a recognition-memory test designed for intracarotid injections and used to predict the risk of global amnesia before an elective temporal lobectomy should also identify persons who are severely amnesic due to other neurologic causes. Divergent validity predicts that speech tasks would be unaffected by amnesia. Test-retest reliability also was measured. METHODS Fifteen persons with severe amnesia were administered four alternate forms of a yes/no recognition-memory protocol and a speech protocol. No drug injection occurred. Standardized neuropsychological tests were used to divide the amnesic group into those with Global Amnesia (i.e., retain no ongoing memories), Severe Amnesia (i.e., memory impaired), and Amnesia Plus (severe amnesia plus other neuropsychologic deficits). RESULTS Two persons with Global Amnesia obtained scores at or below chance (i.e., failed) on the memory protocol. Unexpectedly, 12 of 13 severely amnesic persons obtained near-perfect memory scores. Amnesia had no impact on the speech protocol. Pass/Fail outcomes were highly correlated across all four sets. CONCLUSIONS A four-item IAP memory protocol showed good reliability and criterion validity in identifying the rare condition of Global Amnesia, but it was insensitive to other disabling, severe amnesic disorders. This IAP memory protocol might have validity in predicting a postsurgical Global Amnesic disorder, but it did not identify and therefore could not predict other more common severe amnesic disorders.
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Abstract
PURPOSE To review the incidence of lamotrigine (LTG)-associated insomnia in an adult tertiary care epilepsy outpatient clinic. METHODS The records of all patients who had received LTG were reviewed to identify patients who had experienced insomnia after introduction of this drug. Patients were included if they had experienced a sleep disturbance of sufficient severity to require a discontinuation of LTG or a dose reduction. RESULTS Among 109 patients exposed to LTG, seven (6.4%) had a sleep disturbance of a severity to required a change in therapy. The descriptions of the sleep disturbance were similar among the patients, and the LTG-induced insomnia appeared to be dose dependent. Unlike the few previous descriptions of LTG-induced insomnia in the literature, no factors predisposing to this adverse effect were identified. CONCLUSIONS The results of this retrospective review suggest an association between LTG and intolerable insomnia in a small proportion of patients. Physicians should inquire about sleep disturbances in patients treated with LTG.
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Plasma and cerebrospinal fluid saquinavir concentrations in patients receiving combination antiretroviral therapy. Clin Infect Dis 1999; 28:403-4. [PMID: 10064262 DOI: 10.1086/517200] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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45
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Clinical utility of PCR on cerebrospinal fluid for the diagnosis and management of HIV neurological complications. AIDS 1998; 12:2352-3. [PMID: 9863880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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46
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Abstract
Distal symmetrical peripheral neuropathy is a common adverse experience in persons with HIV infection. This condition, which presents as a pain, numbness. burning and/or dysaethesia initially in the feet, is often multi-factorial in its origin. Nucleoside analogue reverse transcriptase inhibitors represent an important contributor to peripheral neuropathy. Specifically, around 10% of patients receiving stavudine or zalcitabine and 1 to 2% of didanosine recipients may have to discontinue therapy with these agents due to neuropathy. Prompt withdrawal of these therapies enables gradual resolution of signs and symptoms in most patients, although a period of symptom intensification may occur shortly after withdrawal. Risk factors for developing peripheral neuropathy during nucleoside analogue therapy include low CD4+ cell count (<100 cells/mm3), a prior history of an AIDS defining illness or neoplasm, a history of peripheral neuropathy, use of other neurotoxic agents including high alcohol (ethanol) consumption and nutritional deficiencies such as low serum hydroxocobalamin levels. Thus, patients at increased risk of peripheral neuropathy should potentially avoid the use of the neurotoxic nucleoside analogues or be more carefully monitored during therapy. Management of this problem includes patient education. prompt withdrawal of the likely causative agent (giving consideration not to leave the patient on a sub-optimal therapy regimen) and simple analgesia. with augmentation with tricyclic antidepressants or anticonvulsant agents when pain is severe. New agents that may assist in managing this condition include levacecarnine (acetyl-L-carnitine) and nerve growth factors such as recombinant human nerve growth factor.
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Primary care. Red herring. THE HEALTH SERVICE JOURNAL 1998; 108:27. [PMID: 10185463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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48
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New treatments for progressive multifocal leukoencephalopathy in HIV-1-infected patients. AIDS 1998; 12:533-5. [PMID: 9543455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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49
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Abstract
A total of 95 patients who presented in 1994 and 1995 with focal brain lesions at a London HIV centre were studied retrospectively. Patients were allocated to "definite" or "presumed" diagnostic categories of toxoplasma encephalitis (TE), primary CNS lymphoma (PCNSL) or progressive multifocal leukoencephalopathy (PML), based on strict criteria. The number in each category was: TE, 20; PCNSL, 9; PML, 7; presumed TE, 12; presumed PCNSL, 8 and presumed PML, 17. There were 20 patients in whom a diagnosis could not be made, and there were three non-HIV diagnoses. Demographic data, features at presentation and routine CSF analysis were not discriminatory in making a diagnosis. Toxoplasma titres were a median of 1:256 in those with TE compared to 1:16 in all other groups (p < 0.001) and those with TE were less likely to be on toxoplasma prophylaxis compared to those with PCNSL (p < 0.002). Survival with TE (median of 446 days) was significantly longer than survival in all other groups. Survival with either confirmed or presumed PML was similar. The problems of diagnosis of focal brain lesions in HIV patients are discussed and a management flow chart for mass lesions is proposed.
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MESH Headings
- AIDS-Related Opportunistic Infections/complications
- AIDS-Related Opportunistic Infections/diagnosis
- AIDS-Related Opportunistic Infections/mortality
- Adult
- Central Nervous System Diseases/complications
- Central Nervous System Diseases/diagnosis
- Central Nervous System Diseases/mortality
- Diagnosis, Differential
- Female
- Humans
- Leukoencephalopathy, Progressive Multifocal/complications
- Leukoencephalopathy, Progressive Multifocal/diagnosis
- Leukoencephalopathy, Progressive Multifocal/mortality
- Lymphoma, AIDS-Related/complications
- Lymphoma, AIDS-Related/diagnosis
- Lymphoma, AIDS-Related/mortality
- Male
- Middle Aged
- Retrospective Studies
- Survival Rate
- Toxoplasmosis, Cerebral/complications
- Toxoplasmosis, Cerebral/diagnosis
- Toxoplasmosis, Cerebral/mortality
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50
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Mentholated cigarettes and non-lung smoking related cancers in California, USA. J Epidemiol Community Health 1998; 52:202. [PMID: 9616428 PMCID: PMC1756681 DOI: 10.1136/jech.52.3.202] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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