Incidence, characteristics, and predictive factors for dysphagia after pediatric traumatic brain injury

Objective: (1) To establish an incidence figure for dysphagia in a population of pediatric traumatic brain injury (TBI) cases; (2) to provide descriptive data on the admitting characteristics, patterns of resolution, and outcomes of children with and without dysphagia after TBI; and (3) to identify any factors present at admission that may predict dysphagia. Participants: A total of 1, 145 children consecutively admitted to an acute care setting for traumatic brain injury between July 1995 and July 2000. Main outcome measure: Medical parameters relating to dysphagia based on medical chart review. Results: (1) Dysphagia incidence figure of 5.3% across all pediatric head injury admissions. Incidence figures of 68% for severe TBI, 15% for moderate TBI, and only 1% for mild brain injury. (2) Statistically significant differences were found between the dysphagic and nondysphagic subgroups on the variables of length of stay, length of ventilation, Glasgow Coma Scale (GCS), computed tomography classification, duration of speech pathology intervention, supplemental feeding duration, duration until initiation of oral intake (DIOF), duration to total oral intake (DTOF), and period of time from the initiation of intake until achievement of total oral intake (DI-TOF). (3) Significant predictive factors for dysphagia included GCS < 8.5 and a ventilation period in excess of 1.5 days. Conclusion: The provision of incidence data and predictive factors for dysphagia will enable clinicians in acute care settings to allocate resources necessary to deal with the predicted number of dysphagia cases in a pediatric population, and assist in predicting patients who are at risk for dysphagia following TBI. Early detection of patients with swallowing dysfunction will be aided by these data, in turn helping to facilitate effective medical and speech pathology intervention via assisting the reduction of medical complications such as aspiration pneumonia.

Cognitive style factors affecting database query performance

As end-user computing becomes more pervasive, an organization's success increasingly depends on the ability of end-users, usually in managerial positions, to extract appropriate data from both internal and external sources. Many of these data sources include or are derived from the organization's accounting information systems. Managerial end-users with different personal characteristics and approaches are likely to compose queries of differing levels of accuracy when searching the data contained within these accounting information systems. This research investigates how cognitive style elements of personality influence managerial end-user performance in database querying tasks. A laboratory experiment was conducted in which participants generated queries to retrieve information from an accounting information system to satisfy typical information requirements. The experiment investigated the influence of personality on the accuracy of queries of varying degrees of complexity. Relying on the Myers–Briggs personality instrument, results show that perceiving individuals (as opposed to judging individuals) who rely on intuition (as opposed to sensing) composed queries more accurately. As expected, query complexity and academic performance also explain the success of data extraction tasks.

Factorizations of the complete graph into C-5-factors and 1-factors

In this paper, we show that K-10n can be factored into alpha C-5-factors and beta 1-factors for all non-negative integers alpha and beta satisfying 2alpha + beta = 10(n) - 1.

Estimates of global and regional potential health gains from reducing multiple major risk factors

Background Estimates of the disease burden due to multiple risk factors can show the potential gain from combined preventive measures. But few such investigations have been attempted, and none on a global scale. Our aim was to estimate the potential health benefits from removal of multiple major risk factors. Methods We assessed the burden of disease and injury attributable to the joint effects of 20 selected leading risk factors in 14 epidemiological subregions of the world. We estimated population attributable fractions, defined as the proportional reduction in disease or mortality that would occur if exposure to a risk factor were reduced to an alternative level, from data for risk factor prevalence and hazard size. For every disease, we estimated joint population attributable fractions, for multiple risk factors, by age and sex, from the direct contributions of individual risk factors. To obtain the direct hazards, we reviewed publications and re-analysed cohort data to account for that part of hazard that is mediated through other risks. Results Globally, an estimated 47% of premature deaths and 39% of total disease burden in 2000 resulted from the joint effects of the risk factors considered. These risks caused a substantial proportion of important diseases, including diarrhoea (92%-94%), lower respiratory infections (55-62%), lung cancer (72%), chronic obstructive pulmonary disease (60%), ischaemic heart disease (83-89%), and stroke (70-76%). Removal of these risks would have increased global healthy life expectancy by 9.3 years (17%) ranging from 4.4 years (6%) in the developed countries of the western Pacific to 16.1 years (43%) in parts of sub-Saharan Africa. Interpretation Removal of major risk factors would not only increase healthy life expectancy in every region, but also reduce some of the differences between regions, The potential for disease prevention and health gain from tackling major known risks simultaneously would be substantial.

Genetic and environmental risk factors and their interactions for Parkinson's disease in a Chinese population

The interaction between genetic and environmental factors for PD was examined in a Chinese population. It was found that although the intron 2 MAOB (GT)(n) repeat polymorphism was not associated with PID in the population, a relationship might have been masked by the protective effect of tea drinking. In individuals who did not drink tea (<1 cup/day), the possession of short length less than or equal to 178 bp (GT), alleles conferred a borderline significant increased risk for PD (adjusted OR = 1.47; C.l. = 1.03-2. 1). As the extent of tea consumption increased, the association between the less than or equal to178 bp allele and PD disappeared. This result suggests that the MAOB gene may be associated with PD in Chinese if the putative protective effect of tea drinking is taken into account. The significance of this finding is unclear as the study may be limited because of its marginal significance and limited numbers. However, it does demonstrate the importance of considering putative positive and negative environmental risk factors in any examination of genetic risk factors for PD. (C) 2003 Elsevier Science Ltd. All rights reserved.

High rate of detection of primary aldosteronism, including surgically treatable forms, after 'non-selective' screening of hypertensive patients

Background Wide testing of the aldosterone: renin ratio among hypertensive individuals has revealed primary aldosteronism to be common, with most patients normokalaemic. Some investigators, however, have reported aldosterone-producing adenoma to be rare among patients so detected. Objective To test the hypothesis that differences among reported studies in the rate of detection of aldosterone-producing adenoma (as opposed to bilateral adrenal hyperplasia) reflect differences in the procedures used for diagnosis of primary aldosteronism, and the methods used to identify aldosterone-producing adenomas. Methods In the newly established Princess Alexandra Hospital Hypertension Unit (PAHHU), we used procedures developed by Greenslopes Hospital Hypertension Unit (which reports that more than 30% of patients with primary aldosteronism have aldosterone-producing adenomas) to diagnose primary aldosteronism and determine the subtype. All patients with an increased aldosterone: renin ratio (measured after correction for hypokalaemia and while the patient was not receiving interfering medications) underwent fludrocortisone suppression testing to confirm or exclude primary aldosteronism; if they were positive, they underwent genetic testing to exclude glucocorticoid-remediable aldosteronism before adrenal venous sampling was used to differentiate lateralizing from bilateral primary aldosteronism. Results This approach allowed PAHHU to diagnose, within 2 years, 54 patients [only seven (13%) hypokalaemic] with primary aldosteronism. All tested negative for glucocorticoid-remediable aldosteronism. Aldosterone production was lateralized to one adrenal in 15 patients (31%; only six hypokalaemic) and was bilateral in 34 (69%; all normokalaemic) of 49 patients who underwent adrenal venous sampling. Among patients with lateralizing adrenal hyperplasia, computed tomography revealed an ipsilateral mass in only six and a contralateral lesion in one. Fourteen patients underwent unilateral adrenalectomy, which cured the hypertension in seven and improved it in the remainder. In patients with bilateral primary aldlosteronism, hypertension responded to spironolactone (112.5-50 mg/ day) or amiloride (2.5-10 mg/day). Conclusion When performed with careful regard to confounding factors, measurement of the aldosterone: renin ratio in all hypertensive individuals, followed by fludrocortisone suppression testing to confirm or exclude primary aldosteronism and adrenal venous sampling to determine the subtype, can result in the detection of significant numbers of patients with specifically treatable or potentially curable hypertension. (C) 2003 Lippincott Williams Wilkins.

Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction

Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients’ sides. It highlighted that the prosthesis bar should be modeled according to each patient’s rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.

Determining factors of environmental management practices in portuguese local entities

Purpose: The aim of this paper is to analyse the development of environmental management practices by Portuguese local entities and their determining factors. Design/methodology/approach: The data were collected by sending a postal questionnaire. In order to measure the degree of development of environmental management practices an index of environmental management practices (EMPI) was developed, which reflects the extent to which a set of 16 environmental management practices have been implemented by the entities included in the sample. Four variables are considered in this study as possible factors that drive the development of environmental management practices by local entities, namely type of entity, size, proactive environmental strategy and Local Agenda 21 Findings: Results indicate the degree of development of environmental management practices in Portuguese local entities is low. Additionally, entity size, the adoption of proactive environmental strategies and the implementation of Local Agenda 21 are explaining factors of the degree of development of such practices. Originality/value: This study adds to the international research on environmental management in public sector by providing empirical data from a country, Portugal, where empirical evidence is still relatively limited.

Determining factors of environmental management practices in portuguese local entities

Purpose – The purpose of this paper is to analyse the development of environmental management practices by Portuguese local entities and their determining factors. Design/methodology/approach – The data were collected by sending a postal questionnaire. In order to measure the degree of development of environmental management practices, an index of environmental management practices (EMPI) was developed, which reflects the extent to which a set of 16 environmental management practices have been implemented by the entities included in the sample. In total, four variables are considered in this study as possible factors that drive the development of environmental management practices by local entities: type of entity; size; proactive environmental strategy; and Local Agenda 21. Findings – Results indicate the degree of development of environmental management practices in Portuguese local entities is low. Additionally, entity size, the adoption of proactive environmental strategies and the implementation of Local Agenda 21 are explaining factors of the degree of development of such practices. Originality/value – The paper adds to the international research on environmental management in the public sector by providing empirical data from a country, Portugal, where empirical evidence is still relatively limited.

Factors Influencing the Implementation of the Balanced Scorecard in Portugal: Empirical Evidence From Privately Owned and Publicly Owned Organizations

In this paper we aim to identify and analyze a set of variables that can potentially influence the adoption and knowledge of the Balanced Scorecard (BSC) in Portugal. Hypotheses were tested using data obtained from a questionnaire sent to 591 publicly-owned organizations (local governments, municipal corporations and hospitals) and 549 privately-owned organizations (large companies and small and medium enterprises) in Portugal. The results allow us to conclude that although the majority of respondents claimed to know the BSC, its use in Portugal is still limited and very recent, particularly in the public sector organizations. However, it should be noted that its use has increased in Portugal in recent years. The study also reveals that in spite of the noticeable differences between public and private sector, the BSC is used in the public sector after a few adjustments to the traditional model. Using as theoretical framework the contingency and institutional theories, we found that decentralization, vertical differentiation and the degree of higher education are associated with the implementation of the BSC.

Thoracic wall reconstruction using ultrasound images to model/bend the thoracic prosthesis for correction of pectus excavatum

Pectus excavatum is the most common congenital deformity of the anterior thoracic wall. The surgical correction of such deformity, using Nuss procedure, consists in the placement of a personalized convex prosthesis into sub-sternal position to correct the deformity. The aim of this work is the CT-scan substitution by ultrasound imaging for the pre-operative diagnosis and pre-modeling of the prosthesis, in order to avoid patient radiation exposure. To accomplish this, ultrasound images are acquired along an axial plane, followed by a rigid registration method to obtain the spatial transformation between subsequent images. These images are overlapped to reconstruct an axial plane equivalent to a CT-slice. A phantom was used to conduct preliminary experiments and the achieved results were compared with the corresponding CT-data, showing that the proposed methodology can be capable to create a valid approximation of the anterior thoracic wall, which can be used to model/bend the prosthesis

Automatic modeling of an orthotic bracing for nonoperative correction of PectusCarinatum

Pectus Carinatum is a deformity of the chest wall, characterized by an anterior protrusion of the sternum, often corrected surgically due to cosmetic motivation. This work presents an alternative approach to the current open surgery option, proposing a novel technique based on a personalized orthosis. Two different processes for the orthosis’ personalization are presented. One based on a 3D laser scan of the patient chest, followed by the reconstruction of the thoracic wall mesh using a radial basis function, and a second one, based on a computer tomography scan followed by a neighbouring cells algorithm. The axial position where the orthosis is to be located is automatically calculated using a Ray-Triangle intersection method, whose outcome is input to a pseudo Kochenek interpolating spline method to define the orthosis curvature. Results show that no significant differences exist between the patient chest physiognomy and the curvature angle and size of the orthosis, allowing a better cosmetic outcome and less initial discomfort

Automatic prebent customized prosthesis for pectus excavatum minimally invasive surgery correction

Pectus excavatum is the most common deformity of the thorax. A minimally invasive surgical correction is commonly carried out to remodel the anterior chest wall by using an intrathoracic convex prosthesis in the substernal position. The process of prosthesis modeling and bending still remains an area of improvement. The authors developed a new system, i3DExcavatum, which can automatically model and bend the bar preoperatively based on a thoracic CT scan. This article presents a comparison between automatic and manual bending. The i3DExcavatum was used to personalize prostheses for 41 patients who underwent pectus excavatum surgical correction between 2007 and 2012. Regarding the anatomical variations, the soft-tissue thicknesses external to the ribs show that both symmetric and asymmetric patients always have asymmetric variations, by comparing the patients’ sides. It highlighted that the prosthesis bar should be modeled according to each patient’s rib positions and dimensions. The average differences between the skin and costal line curvature lengths were 84 ± 4 mm and 96 ± 11 mm, for male and female patients, respectively. On the other hand, the i3DExcavatum ensured a smooth curvature of the surgical prosthesis and was capable of predicting and simulating a virtual shape and size of the bar for asymmetric and symmetric patients. In conclusion, the i3DExcavatum allows preoperative personalization according to the thoracic morphology of each patient. It reduces surgery time and minimizes the margin error introduced by the manually bent bar, which only uses a template that copies the chest wall curvature.