Objective Laryngoscopic Measures From Older Patients With Voice Complaints and Signs of Aging

2021 ◽  
pp. 1-13
Author(s):  
Sheila V. Stager ◽  
Simran Gupta ◽  
Richard Amdur ◽  
Steven A. Bielamowicz
Keyword(s):  
Large Degree ◽  
Small Degree ◽  
Treatment Recommendations ◽  
Treatment Modalities ◽  
Objective Measures ◽  
Recommended Treatment ◽  
Degrees Of Severity ◽  
Test Current ◽  
Degree Of Severity ◽  
Larger Sample

Purpose The purpose of this study was to use objective measures of glottal gap, bowing, and supraglottic compression from selected images of laryngoscopic examinations from adults over 60 years of age with voice complaints and signs of aging to test current hypotheses on whether degree of severity impacts treatment recommendations and potential follow-through with treatment. Method Records from 108 individuals 60 years or older with voice complaints and signs of aging were reviewed. Three objective measures (normalized glottal gap area [NGGA], total bowing index, and normalized true vocal fold width) were derived. Each measure was subsequently divided into three categories by severity: absence, small degree, or large degree. Nonparametric statistics tested associations between severity and treatment recommendations as well as potential follow-through. Results Noninvasive treatments (observation/voice therapy) were marginally associated with no glottal gap ( p = .09). More invasive treatments (injection/bilateral thyroplasty) were associated with glottal gaps being present ( p = .026), but bilateral thyroplasty recommendations were not significantly associated with the largest gaps. Treatment modalities were not characterized by specific severity categories for any of the objective measures. No significant differences were found for any of the three objective measures between those who followed through with recommended treatment and those who did not. Discussion Results demonstrated some support for current hypotheses on how degrees of severity of objective measures relate to treatment recommendations. Of the three measures, NGGA appears to be more informative regarding treatment recommendations and follow-through, but due to low power, larger sample sizes are needed to confirm clinical relevance.

scholarly journals Efektifitas Pemberlakuan Sistem Satu Arah pada Jalan Indraprasta Kota Semarang dalam Rangka Pemerataan Sebaran Beban Lalu Lintas

2016 ◽  
Vol 21 (1) ◽  
pp. 47
Author(s):  
Djoko Purwanto ◽  
EPF Eko Yulipriyono
Keyword(s):  
Large Degree ◽  
Small Degree ◽  
Degree Of Saturation ◽  
Short Term ◽  
Typical Situation ◽  
Short Term Study ◽  
Data Analysis Procedure ◽  
Big City ◽  
The One ◽  
Afternoon Peak

The traffic problems in a big city such as Semarang generally caused by the typical situation like overcrowding at peak hours. To overcome this problem, Semarang Government has implemented “One Way System” on the Indraprasta Street section without providing road partner. This study is intended to identify the effectiveness of this policy. The following streets were reviewed: Indraprasta, Imam Bonjol, Mgr. Soegiyopranoto, and Pierre Tendean. Further, the intersections which studied are Indraprasta-Imam Bonjol-Pierre Tendean and Tugu Muda. Traffic survey data were collected in the morning and afternoon peak hours. Manual Kapasitas Jalan Indonesia 1997 was used in the data analysis procedure. This short-term study was conducted by simulating the proposed scenario and compared with the existing situations.In conclusion, “One Way System” on Indraprasta Street section is assessed not effective due to its relatively small degree of saturation, while Mgr. Soegiyopranoto Street has a large degree of saturation. Therefore, the one-way system to Imam Bonjol Street and Mgr. Soegiyopranoto Street also needed to implement and form a “rotary link“. In addition, enacting contraflow for public transport on Soegiyopranoto Street and Imam Bonjol Street is necessary, also the arrangement of signals and geometric in the intersection that linked those three streets.

Treating a Patient with Body Dysmorphic Disorder Using Medication and Cognitive-Behavioral Therapy: An Illustrative Case Example

2017 ◽  
Author(s):  
Katharine A. Phillips ◽  
Rachel A. Simmons
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Mental Health Treatment ◽  
Body Dysmorphic Disorder ◽  
Behavioral Therapy ◽  
Treatment Strategies ◽  
Cognitive Behavioral ◽  
Treatment Modalities ◽  
Illustrative Case ◽  
Recommended Treatment ◽  
Decision Points

This chapter illustrates how the authors treated a representative patient with body dysmorphic disorder (BDD) using both medication and cognitive-behavioral therapy (CBT). The case example illustrates engagement strategies, treatment selection, implementation of recommended treatment strategies, approaches to some commonly encountered decision points, and possible solutions to frequently encountered treatment challenges. Following the case example, the authors comment on these issues. The chapter discusses approaches to patients who desire cosmetic treatment rather than mental health treatment. Factors involved in the decision to use CBT, pharmacotherapy, or both treatment modalities for BDD are also covered.

scholarly journals A Proposed Classification of ICD-11 Severity Degrees of Personality Pathology Using the Self and Interpersonal Functioning Scale

2021 ◽  
Vol 12 ◽  
Author(s):  
Dominick Gamache ◽  
Claudia Savard ◽  
Philippe Leclerc ◽  
Maude Payant ◽  
Nicolas Berthelot ◽  
...  
Keyword(s):  
The Self ◽  
Self Report ◽  
Screening Tools ◽  
Personality Pathology ◽  
Interpersonal Functioning ◽  
World Health ◽  
Anchor Points ◽  
Degrees Of Severity ◽  
Degree Of Severity

Background: The 11th version of the World Health Organization's International Classification of Diseases (ICD-11) has adopted a dimensional approach to personality disorder (PD) nosology. Notably, it includes an assessment of PD degree of severity, which can be classified according to five categories. To date, there is no gold standard measure for assessing degree of PD severity based on the ICD-11 model, and there are no empirically-based anchor points to delineate the proposed categories. With the operationalization of PD degrees of severity in the ICD-11 PD model now being closely aligned with Criterion A of the DSM-5 Alternative Model for Personality Disorders (AMPD), sharing a focus on self and interpersonal dysfunction, self-report instruments developed for the latter model might prove useful as screening tools to determine degrees of severity in the former.Methods: The Self and Interpersonal Functioning Scale, a brief validated self-report questionnaire originally designed to assess level of personality pathology according to the AMPD framework, was used to derive anchor points to delineate the five severity degrees from the ICD-11 PD model. Data from five clinical and non-clinical samples (total N = 2,240) allowed identifying anchor points for classification, based on Receiver Operating Characteristic curve analysis, Latent Class Analysis, and data distribution statistics. Categories were validated using multiple indices pertaining to externalizing and internalizing symptoms relevant to PD.Results: Analyses yielded the following anchor points for PD degrees of severity: No PD = 0–1.04; Personality Difficulty = 1.05–1.29; Mild PD = 1.30–1.89; Moderate PD = 1.90–2.49; and Severe PD = 2.50 and above. A clear gradient of severity across the five categories was observed in all samples. A high number of significant contrasts among PD categories were also observed on external variables, consistent with the ICD-11 PD degree of severity operationalization.Conclusions: The present study provides potentially useful guidelines to determine severity of personality pathology based on the ICD-11 model. The use of a brief self-report questionnaire as a screening tool for assessing PD degrees of severity should be seen as a time-efficient support for clinical decision and treatment planning.

Cryoglobulinemia as a Possible Primer for TRALI: Report of a Case

2019 ◽  
Vol 50 (3) ◽  
pp. 313-319 ◽  
Author(s):  
Cameron Beech ◽  
Deepika Kumar ◽  
Jeanne Hendrickson ◽  
Sudhir Perincheri ◽  
Christopher Tormey ◽  
...  
Keyword(s):  
Pulmonary Complications ◽  
Treatment Modalities ◽  
Lymphoplasmacytic Lymphoma ◽  
Monoclonal Antibody Production ◽  
Laboratory Findings ◽  
Systemic Complications ◽  
Hyperviscosity Syndrome ◽  
Waldenström Macroglobulinemia ◽  
Recommended Treatment ◽  
Waldenstrom Macroglobulinemia

AbstractWaldenström macroglobulinemia (WM) is a form of lymphoplasmacytic lymphoma that can cause hyperviscosity syndrome due to unchecked monoclonal antibody production. Some patients are also found to have associated cryoglobulinemia, which can cause systemic complications including vasculitis, renal disease, and pulmonary complications. Cryoglobulins can also serve as a source of interference with various laboratory assays. Therapeutic plasma exchange (TPE) is one of the recommended treatment modalities to manage hyperviscosity.Herein, we present the case of an 84-year-old female patient with Waldenström macroglobulinemia who presented with hyperviscosity syndrome and discrepant laboratory findings, and who then developed transfusion-related acute lung injury (TRALI) during TPE. This case is one of many in the emerging possible linkages observed between cryoglobulinemia and TRALI.

scholarly journals Impacted Lower Second Permanent Molars at the Ramus and Coronoid Process: A New Clinical Symptom of the WNT10A Mutation in Ectodermal Dysplasia

2017 ◽  
Vol 10 (4) ◽  
pp. 363-368 ◽  
Author(s):  
Samia Aboujaoude
Keyword(s):  
Clinical Symptom ◽  
Ectodermal Dysplasia ◽  
Coronoid Process ◽  
Treatment Modalities ◽  
Initial Time ◽  
Family Pedigree ◽  
Generation Family ◽  
Panoramic Images ◽  
Permanent Molars ◽  
Larger Sample

ABSTRACT Aim Hidrotic ectodermal dysplasia (ED) with the WNT10A mutation produces variable dentofacial symptoms. The aim of this study was to describe a new clinical symptom, i.e., specific to the WNT10A mutation in hidrotic ED. The study investigated the migratory trend of the lower second permanent molars to the ramus or coronoid process. To the best of authors' knowledge, no data in the literature describe this trend in cases of hidrotic ED. Materials and methods A three-generation family pedigree was established for seven families after the diagnosis of hidrotic ED in a 10-year-old boy. Thereafter, a genetic and clinical study was conducted on three families with at least one individual affected by hidrotic ED (20 individuals). We selected the children with molar germs 37 and 47. The eruption axes of these germs were then traced on the panoramic images at the initial time (T0) and 1 year later (T0 + 1 year), and the deviations between these axes were measured. Results A significant familial consanguinity was shown. Eight subjects presented with the hidrotic ED phenotype. Among them, three individuals carried germs 37 and 47. Over time, the measured deviations between the eruption axes of the latter displayed, in the majority of the cases, a distal inclination toward the ramus. Limitations A larger sample size is mandatory to assess the frequencies and treatment modalities. Conclusion The presence of germs in the lower second permanent molars in patients with hidrotic ED is an important clinical symptom that should be monitored to detect and prevent ectopic migration of these teeth. Clinical significance In hidrotic ED cases, the study of the presence of the second lower permanent germs must include clinical and radiological examinations. Establishing an interceptive treatment is necessary to prevent the migration of the molars in question. How to cite this article Sfeir E, Aboujaoude S. Impacted Lower Second Permanent Molars at the Ramus and Coronoid Process: A New Clinical Symptom of the WNT10A Mutation in Ectodermal Dysplasia. Int J Clin Pediatr Dent 2017;10(4):363-368.

scholarly journals Schizophrenia and violence: study in a general psychiatric hospital with HCR-20 and MOAS

2018 ◽  
Vol 40 (4) ◽  
pp. 310-317 ◽  
Author(s):  
Leonardo Fernandez Meyer ◽  
Lisieux E. de Borba Telles ◽  
Kátia Mecler ◽  
Ana Luiza Alfaya Galego Soares ◽  
Renata Santos Alves ◽  
...  
Keyword(s):  
Aggressive Behavior ◽  
Psychiatric Hospital ◽  
Patient Group ◽  
Item Analysis ◽  
Violent Behavior ◽  
Psychiatric Admission ◽  
Psychiatric Setting ◽  
Overt Aggression Scale ◽  
Degrees Of Severity ◽  
Degree Of Severity

Abstract Objective: This preliminary study aimed to identify and compare characteristics related to violent behavior in inpatients with schizophrenia at a general psychiatric hospital using the Historical, Clinical, and Risk Management 20 (HCR-20), the Modified Overt Aggression Scale (MOAS), and sociodemographic data. Method: Violent and nonviolent participants were selected based on psychiatric admission reports. Participants with reports of aggressive behavior and HCR-20 total score ≥ 21 upon admission were assigned to the violent patient group. Participants without aggressive behavior and with HCR-20 total score < 21 upon admission were assigned to the nonviolent patient group. The MOAS was applied to characterize the degree of severity of the violent behavior. Results: HCR-20 and its subscales were effective in differentiating between the violent and nonviolent participant groups. Twelve of the 20 HCR-20 items were useful for distinguishing between the groups, although total HCR-20 scores were more reliable when applied to the nonviolent patient group. The MOAS did not show high degrees of severity for the types of aggression observed in the participants. Conclusion: HCR-20 was useful and reliable for distinguishing between violent and nonviolent patients with schizophrenia in this clinical psychiatric setting. Item analysis identified the most relevant characteristics in each group. The use of the HCR-20 in clinical psychiatric settings should be encouraged.

scholarly journals Designing efficient hybrid strategies for information spreading in scale-free networks

2018 ◽  
Vol 5 (8) ◽  
pp. 180117 ◽  
Author(s):  
Shuangyan Wang ◽  
Wuyi Cheng ◽  
Yang Hao
Keyword(s):  
Large Degree ◽  
Small Degree ◽  
Network Structures ◽  
Scale Free Network ◽  
Scale Free ◽  
Monte Carlo Experiments ◽  
Scale Free Networks ◽  
Critical Issues ◽  
Free Network ◽  
Information Spreading

Designing a spreading strategy is one of the critical issues strongly affecting spreading efficiency in complex networks. In this paper, to improve the efficiency of information spreading in scale-free networks, we propose four hybrid strategies by combining two basic strategies, i.e. (i) the LS (in which information is preferentially spread from the large-degree vertices to the small-degree ones), and (ii) the SL (in which information is preferentially spread from the small-degree vertices to the large-degree ones). The objective in combining the two basic LS and SL strategies is to fully exploit the advantages of both strategies. To evaluate the spreading efficiency of the proposed four hybrid strategies, we first propose an information spreading model. Then, we introduce the details of the proposed hybrid strategies that are formulated by combining LS and SL. Third, we build a set of scale-free network structures by differently configuring the relevant parameters. In addition, finally, we conduct various Monte Carlo experiments to examine the spreading efficiency of the proposed hybrid strategies in different scale-free network structures. Experimental results indicate that the proposed hybrid strategies are effective and efficient for spreading information in scale-free networks.

scholarly journals ERADICATION OF PAPILLARY THYROID CARCINOMA IN A PATIENT RECEIVING PEMETREXED AND BEVACIZUMAB

2020 ◽  
Vol 6 (5) ◽  
pp. e247-e251
Author(s):  
John Dylan Pate ◽  
Christopher M. Gilbert ◽  
James T. Bonucchi
Keyword(s):  
Papillary Thyroid Carcinoma ◽  
Thyroid Carcinoma ◽  
Nodular Goiter ◽  
Needle Aspiration ◽  
Pet Scan ◽  
Treatment Modalities ◽  
Serous Carcinoma ◽  
Thyroid Function Tests ◽  
Papillary Thyroid ◽  
Recommended Treatment

Objective: To report a 66-year-old female patient whose medical management for advanced-stage, high-grade serous carcinoma of the ovary (HGSC-O) might have treated concomitant papillary thyroid carcinoma (PTC) diagnosed by fine-needle aspiration (FNA). Methods: Patient evaluation and management consisted of positron emission tomography (PET) scans, thyroid ultrasounds, FNA biopsies, and thyroid function tests. Results: The patient presented to the endocrinology clinic while undergoing treatment for HGSC-O with a PET scan revealing increased uptake in the thyroid gland. Due to the PET scan findings, she underwent a thyroid ultrasound examination which revealed co-existent multi-nodular goiter and a lesion with concerning features. FNA biopsy was read as PTC. Surgical intervention for PTC was delayed due to progression of the ovarian cancer. In the interim, she underwent chemotherapy with a regimen consisting of elesclomol, paclitaxel, pemetrexed (Alimta), carboplatin, gemcitabine (Gemazar), and bevacizumab (Avastin) at varying intervals. After the patient was able to complete near total thyroidectomy, surgical pathology revealed no viable malignancy. Conclusion: We postulate that the patient’s treatment for HGSC-O, namely pemetrexed (Alimta) and bevacizumab (Avastin), had antineoplastic effects against the PTC. These agents are not currently recommended treatment modalities for PTC. This hypothesis should be validated with further studies.

The Swirl in an S-Duct of Typical Air Intake Proportions

1983 ◽  
Vol 34 (2) ◽  
pp. 99-129 ◽  
Author(s):  
R.W. Guo ◽  
J. Seddon
Keyword(s):  
Separated Flow ◽  
Large Degree ◽  
Small Degree ◽  
General Nature ◽  
Through Flow ◽  
High Incidence ◽  
Classical Pattern ◽  
Throat Width ◽  
Air Intake ◽  
Low Incidence

SummaryThe paper presents the results of measurement of the static pressure, total pressure and swirl in the flow through an S-shaped duct of typical air intake proportions mounted in a wind tunnel and tested at different incidences and different through-flow ratios. In order to reduce the magnitude of swirl at high incidence, two methods have been studied - one, to change the distribution of pressures by means of a spoiler and two, to re-energize the separated flow with an inflow of free stream air through auxiliary inlets. Measurements were also made, at 0° incidence, with a perforated spoiler intended to simulate roughly the taking in of low energy flow from the fuselage boundary layer. The results show a small degree of swirl at low incidence which takes the classical pattern of two contra-rotating flows, and a large degree of swirl at high incidence, in the form of a single rotating flow. Of the anti-swirl devices, the spoiler is the more powerful and can be sized either to reverse the swirl direction or to eliminate the swirl completely. A parameter of swirl coefficient, SC60, has been suggested. Values of SC60 at 30° incidence are 0.188 for the duct as designed, 0.068 for the arrangement with auxiliary inflow and −0.039 with a solid spoiler of width 0.15 times throat width. The various arrangements tested, together with results of an earlier study, shed useful light on the general nature of swirl in an S-duct, its method of generation and its final form and magnitude. A further experiment will be made on a duct having both a horizontal and a vertical offset.

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