bluuebunny/crossref_metadata_2025_split huggingface dataset:
Average Speech Levels and Spectra in Various Speaking/Listening Conditions
Authors: Olsen Wayne O. 
Published: April 2006

The large study undertaken by Pearsons et al. (1977) for the Environmental Protection Agency nicely demonstrates "usual" speech levels in a variety of settings in classrooms, homes, hospitals, department stores, and commercial transportation. In most settings, speech levels were between 55 and 66 dBA at conversation distances in the school, home, hospital, and department store environments. S/N ratios on the order of 5 to 15 dB were maintained.
Communication distance in the trains and airplanes was considerably less than the usual 1 m, and the speech levels were higher, 73 to 77 dBA, but still at a –1 or –2 dB S/N ratio in the train and airplanes, respectively. Their measurements in an anechoic chamber further reflected the levels of conversational speech in a quiet environment, as well as the levels and spectra for different vocal efforts by females, males, and children. Speech spectra were generally similar for the groups of talkers for casual conversation through raised vocal efforts. For loud speech, and particularly for shouted speech, male speech levels were greater than the speech levels of the females and children. The maximum one-third octave bands for loud and shouted speech shifted to higher frequencies for all three groups.
Benefit From, Satisfaction With, and Cost-Effectiveness of Three Different Hearing Aid Technologies
Authors: Newman Craig W. , Sandridge Sharon A. 
Published: April 2006

Clinical decision-making has become more complex as newer, more costly, hearing aid (HA) technologies become available. The expanding array of more expensive HAs demands that clinical researchers continue to justify the value of these instruments relative to the substantial increase in cost to both the provider and consumer.In the present report, 25 current conventional HA users with adult onset of sensorineural hearing loss were fitted with: (a) a one-channel linear HA; (b) a two-channel, nonlinear HA; and (c) a seven-band, two-channel digital signal processing (DSP) HA. All instruments were mini behind-the-ear units with identifying information removed from the cases. Subjects wore each HA for at least a 1-month period.A set of laboratory (Speech Perception in Noise [SPIN] test; audibility index calculated from real-ear measurements) and self-report (Abbreviated Profile of Hearing Aid Benefit; Hearing Handicap Inventory for the Elderly/Adults; Knowles Hearing Aid Satisfaction Survey; preference ratings) outcome measures were used to evaluate the benefit from, satisfaction with, and cost-effectiveness of each test HA. As expected, there were statistically significant differences between unaided and aided conditions across HAs.Although the DSP instrument yielded significantly higher word recognition scores on the SPIN test, no differences were observed among the test HAs for the standardized self-report measures. In contrast, however, more than 75% of the subjects preferred the “higher end” instruments. Yet, 33% of the subjects changed their preference for the “higher end” instruments after being informed of costs. A cost-effectiveness model for evaluating the relationship between HA retail purchase price and improvements in performance/benefit is presented.
Perspectives on Stuttering
Authors: Ambrose Nicoline Grinager , Yairi Ehud 
Published: April 2006

We did not, and do not, contest Onslow and Packman’s claim that it can be difficult to decide if a young child is stuttering. Our conclusion does indeed leave room for some cases that may not be clear. Nor does their claim, in any way, negate ours and others’ conclusion—based on several sets of data derived from different groups by different investigators using different measures—that there are clear differences in the disfluency patterns of stuttering and normally fluent children, even close to onset. Furthermore, at present, there are not good data that shed light on the extent of the difficulty of positive versus negative diagnoses of stuttering in working clinical settings.
As Dean Williams (1978) said, “The word ‘stuttering’ is an evaluative word, not a descriptive one” (p. 285). We examined children evaluated as stuttering and then described their disfluent behaviors. Onslow and Packman have raised some important issues that require clarification, and we appreciate this input. We respectfully disagree with their conclusions, however, and stand by the findings of our article, with the change in subject criteria as mentioned above. We look forward to future presentation of original data by Onslow and Packman to further explore the issues presented in this series of exchanges.
The Impact of Lexical Factors on Children's Word-Finding Errors
Authors: German Diane J. , Newman Rochelle S. 
Published: April 2006

This retrospective, exploratory investigation examined the types of target words that 30 children with word-finding difficulties (aged 8 to 12 years) had difficulty naming and the types of errors they made on these words. Words were studied with reference to lexical factors that might influence naming performance: word frequency, age of acquisition, familiarity, and lexical neighborhood. Findings indicated that neighborhood density predicted word-finding success, and target word substitutions and error patterns manifested were affected by the lexical factors under study. Students tended to produce substitutions that were higher in frequency, learned earlier, and that resided in neighborhoods of greater density and higher frequency than the target word. Lexical factors also influenced children’s error patterns. Neighborhood density predicted form-related errors: Children produced more blocked errors on words from sparse neighborhoods. Word frequency and neighborhood frequency predicted form-segment-related errors as phonologic errors occurred on rare words and words whose neighbors contained lower frequency, uncommon phonological patterns. This important first step in the examination of how lexical factors have an impact on word-finding errors in children suggests that different types of words are more likely to result in failures of lexical access at different stages of processing. Theoretical and practical implications of these preliminary findings are discussed.KEY WORDS: word-finding difficulties, lexical access, language and learning disabilities, word frequency, lexical neighborhood
Influenza Vaccine: Immunization Rates, Knowledge, and Attitudes of Resident Physicians in an Urban Teaching Hospital
Authors: Wodi A. Patricia , Samy Sawsan , Ezeanolue Echezona , Lamour Rytza , Patel Rakesh , Budnick Lawrence D. , Dashefsky Barry 
Published: April 2006

AbstractBackground:Because resident physicians (RPs) frequently have direct patient contact, those who are unimmunized against influenza potentially subject patients to unnecessary risk of infection.Objective:To determine the rates of, knowledge regarding, and attitudes toward influenza immunization among RPs. We hypothesized that rates of and knowledge about influenza immunization did not differ between primary care (PC) and non-PC RPs.Methods:A self-administered, anonymous questionnaire distributed to a convenience sample of 300 RPs (150 PC and 150 non-PC). The questionnaire requested influenza immunization status in the 2003-2004 and previous seasons and factors influencing respondents' decisions whether to be immunized. It included a 20-item test of knowledge about influenza immunization.Results:Two hundred five (68.3%) of 300 distributed questionnaires (196 that were evaluable) were returned. Response rates of PC and non-PC RPs did not differ (P = .79). The overall immunization rate of RPs in 2003-2004 was 38.3% and rates did not differ between PC (38.9%) and non-PC (37.6%) RPs. RPs most often cited “self-protection” as a reason for electing (93.3%) and “lack of time” for declining (47.1%) influenza immunization. Their ability to correctly answer questions about influenza immunization varied; their mean knowledge score was 13.7 (perfect = 20). PC and non-PC trainees did not differ by knowledge score (P = .48). However, RPs “ever vaccinated” had a higher knowledge score than those “never vaccinated” (P = .01).Conclusion:RPs have low immunization rates and significant gaps in knowledge regarding influenza immunization. These problems should be addressed during their training by education on the importance, effectiveness, and safety of influenza vaccine for them and their patients.
Influenza Vaccination of Healthcare Workers and Vaccine Allocation for Healthcare Workers During Vaccine Shortages
Authors: Talbot Thomas R. , Bradley Suzanne F. , Cosgrove Sara E. , Ruef Christian , Siegel Jane D. , Weber David J. 
Published: April 2006

AbstractInfluenza causes substantial morbidity and mortality annually, particularly in high-risk groups such as the elderly, young children, immunosuppressed individuals, and individuals with chronic illnesses. Healthcare-associated transmission of influenza contributes to this burden but is often under-recognized except in the setting of large outbreaks. The Centers for Disease Control and Prevention has recommended annual influenza vaccination for healthcare workers (HCWs) with direct patient contact since 1984 and for all HCWs since 1993. The rationale for these recommendations is to reduce the chance that HCWs serve as vectors for healthcare-associated influenza due to their close contact with high-risk patients and to enhance both HCW and patient safety. Despite these recommendations as well as the effectiveness of interventions designed to increase HCW vaccination rates, the percentage of HCWs vaccinated annually remains unacceptably low. Ironically, at the same time that campaigns have sought to increase HCW vaccination rates, vaccine shortages, such as the shortage during the 2004-2005 influenza season, present challenges regarding allocation of available vaccine supplies to both patients and HCWs. This two-part document outlines the position of the Society for Healthcare Epidemiology of America on influenza vaccination for HCWs and provides guidance for the allocation of influenza vaccine to HCWs during a vaccine shortage based on influenza transmission routes and the essential need for a practical and adaptive strategy for allocation. These recommendations apply to all types of healthcare facilities, including acute care hospitals, long-term-care facilities, and ambulatory care settings.
The pressure required to force liquid through breathing system filters*
Authors: Cann C. , Hampson M. A. , Wilkes A. R. , Hall J. E. 
Published: April 2006

SummaryLiquid in the form of sputum and condensation may be forced through a breathing system filter if sufficient pressure is applied to the filter layer, with the potential for cross‐infection. Twenty‐three different breathing system filters (12 adult, 11 paediatric) were assessed to determine the pressure causing liquid penetration. Five samples of each were tested by connecting the ventilator end of a breathing system filter to a water‐filled U‐tube and reservoir. The reservoir was positioned so that the water surface was level with the filter layer and raised until liquid appeared through the filter layer on the patient side and the water‐column height recorded. There were substantial differences in performance between models. Liquid penetration occurred at lower pressures for adult electrostatic than adult pleated filters: median [IQR] 1.18 [1.08– 1.32] and 8.04 [4.27–12.80] kPa, respectively, p < 0.0001. Liquid penetration occurred at similar pressures in paediatric electrostatic filters (0.98 [0.74–1.32] kPa) compared to adult electrostatic filters.
Caring for older people in prehospital emergency care: can nurses make a difference?
Authors: Melby Vidar , Ryan Assumpta 
Published: April 2006

Aims and objectives.  The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse‐led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people.Background.  There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role.Conclusions.  If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people.Relevance to clinical practice.  The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.
Cerebral blood flow velocity increases when propofol is changed to desflurane, but not when isoflurane is changed to desflurane in children
Authors: Smith J. H. , Karsli C. , Lagacé A. , Luginbuehl I. , Barlow R. , Bissonnette B. 
Published: April 2006

Background: Children may exhibit delayed emergence following maintenance of anesthesia with propofol or isoflurane. Desflurane is often used towards the end of procedures to facilitate emergence. This study evaluated the effect on middle cerebral artery blood flow velocity (Vmca) in anesthetized children when propofol or isoflurane was substituted with desflurane.Methods: Forty‐two healthy children aged 1–6 years were enrolled. A standardized anesthetic induction was used. Anesthesia was maintained with remifentanil (0.5 µg·kg−1bolus followed by an infusion of 0.2 µg·kg−1·min−1) and a randomly selected sequence of propofol/desflurane/propofol, desflurane/propofol/desflurane, isoflurane/desflurane/isoflurane or desflurane/isoflurane/desflurane. Propofol was administered to maintain a steady‐state serum concentration of 3 µg·ml−1. Desflurane and isoflurane were administered at age‐corrected 1 MAC. Hemodynamic stability was maintained. Transcranial Doppler sonography was used to measure Vmca. Hemodynamic variables as well as Vmca were measured 30 min after skin incision and repeated 30 min after each change in anesthetic maintenance agent.Results: The mean age and weight was 2.3 ± 1.3 years and 13.0 ± 3.7 kg, respectively. The Vmca (mean) increased by 35% from 37.7 ± 10.5 cm s−1to 57.8 ± 14.6 cm s−1(P < 0.0001) when propofol was changed to desflurane but was unaffected when desflurane replaced isoflurane.Conclusion: When propofol is changed to desflurane, cerebral blood flow velocity increases significantly in normal children. This cerebral vasodilatory effect may have important implications in the neurosurgical setting.
Continuous physostigmine combined with morphine‐based patient‐controlled analgesia in the postoperative period
Authors: Beilin B. , Bessler H. , Papismedov L. , Weinstock M. , Shavit Y. 
Published: April 2006

Background:  Recently, new drugs and techniques for the treatment of postoperative pain were introduced, with the goal of enhancing opiates' analgesia while minimizing their side‐effects. Cholinergic agents play an antinociceptive role, but their clinical use is quite limited, due to side‐effects. Physostigmine is a cholinesterase inhibitor, which crosses the blood–brain barrier and elevates brain acetylcholine level. Physostigmine can produce analgesia by itself, and enhance opiate analgesia; but these effects are of short duration following bolus administration.Methods:  We compared pain intensity and morphine consumption in two postoperative treatment groups: One group received continuous physostigmine infusion combined with morphine‐based patient‐controlled analgesia (PCA), and the other received PCA alone. Cholinergic anti‐inflammatory pathways have recently been described. We therefore also compared changes in proinflammatory cytokine production in the two pain management groups.Results:  Continuous infusion of physostigmine combined with morphine‐based PCA in the postoperative period significantly reduced opiate consumption, and enhanced the analgesic response. Patients in the physostigmine group also exhibited reduced ex‐vivo production of the proinflammatory cytokine, IL‐1β. At the same time, physostigmine increased nausea and vomiting, mostly in the first 2 h of the postoperative period.Conclusions:  Physostigmine combined with morphine in the postoperative period reduced morphine consumption, enhanced analgesia, and attenuated production of the proinflammatory cytokine, IL‐1β. This latter finding may account for the decreased pain observed in this group; this cytokine is known to mediate basal pain sensitivity and induce hyperalgesia in inflammatory conditions. Taking into account the other potential beneficial effects of physostigmine, we suggest that a continuous infusion of physostigmine should be considered as a useful component in multimodal postoperative analgesia.
Metachronous colorectal cancer
Authors: Park I. J. , Yu C. S. , Kim H. C. , Jung Y. H. , Han K. R. , Kim J. C. 
Published: April 2006

AbstractObjective  Although the diagnosis of metachronous colorectal cancer have increased, due primarily to improvements in diagnostic modalities, the potential risk factors for these tumours are not well known. We compared the characteristics of patients with metachronous and sporadic primary colorectal cancer to determine risk factors for its occurrence.Patients and methods  We reviewed the records of 5447 patients with colorectal cancer, who had been treated at Asan Medical Centre between July 1989 and January 2004. A metachronous cancer was defined as a secondary colorectal cancer occurring more than 6 months after the index cancer.Results  Metachronous colorectal cancer occurred in 39 (0.7%) patients. Their average age was 53 years, somewhat younger than the average age of sporadic colorectal cancer patients (58 years). In patients with metachronous cancer, the cancer was more likely to be located in the right colon (P < 0.03), and the incidence of synchronous polyps or cancer was significantly higher (P < 0.001). The relative distributions of histological grades and clinicopathological characteristics were similar in index and metachronous cancers. Metachronous cancers were diagnosed more frequently at an early stage. The time interval between index and metachronous cancer ranged from 6 to 215 months (mean 39 months), with 13 (33.3%) patients diagnosed with metachronous cancer after 5 years.Conclusion  We found that in patients aged < 50 years, existence of synchronous polyps or cancer influence on the development of metachronous colorectal cancer. Regular follow‐up is necessary for early detection, even after 5 years, for these patients.
What can studying musicians tell us about motor control of the hand?
Authors: Watson Alan H. D. 
Published: April 2006

AbstractMost standard accounts of human anatomy and physiology are designed to meet the requirements of medical education and therefore consider their subject matter from the standpoint of typical rather than outstanding levels of performance. To understand how high levels of skill are developed and maintained, it is necessary to study elite groups such as professional athletes or musicians. This can lead to the rediscovery of arcane knowledge that has fallen into neglect through a lack of appreciation of its significance. For example, although variability in the muscles and tendons of the hand was well known in the nineteenth and early twentieth centuries, it is through recent studies of musicians that its practical significance has become better appreciated. From even a cursory acquaintance with the training methods of sportsmen and women, dancers and musicians, it is clear that sophisticated motor skills are developed only at the cost of a great deal of time and effort. Over a lifetime of performance, musicians arguably spend more time in skill acquisition than almost any other group and offer a number of unique advantages for the study of motor control. Such intensive training not only modifies cortical maps but may even affect the gross morphology of the central nervous system. There is also evidence that in certain individuals this process can become maladaptive. Recent studies of musicians suggest that intensive training can lead to the appearance of ambiguities in the cortical somatosensory representation of the hand that may be associated with the development of focal dystonia; a condition to which musicians are particularly prone. The realization that changes in cortical maps may underlie dystonia has led to the development of new approaches to its treatment, which may ultimately benefit musicians and non‐musicians alike.
Early effects of embryonic movement: ‘a shot out of the dark’
Authors: Pitsillides Andrew A. 
Published: April 2006

AbstractIt has long been appreciated that studying the embryonic chick in ovo provides a variety of advantages, including the potential to control the embryo's environment and its movement independently of maternal influences. This allowed early workers to identify movement as a pivotal factor in the development of the locomotor apparatus. With an increasing focus on the earliest detectable movements, we have exploited this system by developing novel models and schemes to examine the influence of defined periods of movement during musculoskeletal development. Utilizing drugs with known neuromuscular actions to provoke hyperactivity (4‐aminopyridine, AP) and either rigid (decamethonium bromide, DMB) or flaccid (pancuronium bromide, PB) paralysis, we have examined the role of movement in joint, osteochondral and muscle development. Our initial studies focusing on the joint showed that AP‐induced hyperactivity had little, if any, effect on the timing or scope of joint cavity elaboration, suggesting that endogenous activity levels provide sufficient stimulus, and additional mobilization is without effect. By contrast, imposition of either rigid or flaccid paralysis prior to cavity formation completely blocked this process and, with time, produced fusion of cartilaginous elements and formation of continuous single cartilaginous rods across locations where joints would ordinarily form. The effect of these distinct forms of paralysis differed, however, when treatment was initiated after formation of an overt cavity; rigid, but not flaccid, paralysis partly conserved precavitated joints. This observation suggests that ‘static’ loading derived from ‘spastic’ rigidity can act to preserve joint cavities. Another facet of these studies was the observation that DMB‐induced rigid paralysis produces a uniform and specific pattern of limb deformity whereas PB generated a diverse range of fixed positional deformities. Both also reduced limb growth, with different developmental periods preferentially modifying specific osteochondral components. Changes in cartilage and bone growth induced by 3‐day periods of flaccid immobilization, imposed at distinct developmental phases, provides support for a diminution in cartilage elaboration at an early phase and for a relatively delayed influence of movement on osteogenesis, invoking critical periods during which the developing skeleton becomes receptive to the impact of movement. Immobilization also exerts differential impact along the proximo‐distal axis of the limb. Finally, our preliminary results support the possibility that embryonic hyperactivity influences the potential for postnatal muscle growth.