Speech recognition training for enhancing written language generation by a traumatic brain injury survivor.

Impairments in motor functioning, language processing, and cognitive status may impact the written language performance of traumatic brain injury (TBI) survivors. One strategy to minimize the impact of these impairments is to use a speech recognition system. The purpose of this study was to explore the effect of mild dysarthria and mild cognitive-communication deficits secondary to TBI on a 19-year-old survivor's mastery and use of such a system-specifically, Dragon Naturally Speaking. Data included the % of the participant's words accurately perceived by the system over time, the participant's accuracy over time in using commands for navigation and error correction, and quantitative and qualitative changes in the participant's written texts generated with and without the use of the speech recognition system. Results showed that Dragon NaturallySpeaking was approximately 80% accurate in perceiving words spoken by the participant, and the participant quickly and easily mastered all navigation and error correction commands presented. Quantitatively, the participant produced a greater amount of text using traditional word processing and a standard keyboard than using the speech recognition system. Minimal qualitative differences appeared between writing samples. Discussion of factors that may have contributed to the obtained results and that may affect the generalization of the findings to other TBI survivors is provided.

Issues in implementing prenatal screening for cystic fibrosis: results of a working conference.

PURPOSE: To summarize a conference convened to examine how cystic fibrosis screening might appropriately be introduced into routine prenatal practice. METHODS: Participants included experts from various relevant disciplines. Systematic reviews and data from individual trials were presented; issues were identified and discussed. RESULTS: Judged by published criteria, prenatal cystic fibrosis screening is suitable for introduction. Screening can be performed cost-effectively by identifying racial/ethnic groups at sufficient risk and then using either of two models for delivering laboratory services. Validated educational materials exist. Ethical issues are not unique. CONCLUSIONS: Once adequate facilities for patient and provider education, testing, counseling, quality control, and monitoring are in place, individual programs can begin prenatal screening for cystic fibrosis.

Couple-based prenatal screening for cystic fibrosis in primary care settings.

This study examines a couple-based screening protocol for cystic fibrosis (CF) during pregnancy. The screening test is positive only when both partners carry an identifiable mutation. The risk for the fetus to be homozygous is 1 in 4, and definitive prenatal diagnostic testing can be offered. Between six and seven of every ten CF cases can be identified by testing for seven CF mutations. Couple screening for CF has not been evaluated in a decentralized health-care system. Office guides, informational materials, and consent forms were provided to 69 physicians in Maine. Women sent buccal samples to the study centre and brought sampling materials to their partners. Samples from both individuals were required. When a mutation was identified in the woman's sample, the partner's sample was tested. Screening results were reported to the physician. Standardized follow-up surveys were carried out in selected women, key office staff, and physicians. 1770 women and 1682 partners submitted samples. Testing was successfully completed for 1645 couples. Screening results were positive in one couple; the fetus was homozygous for CF. Physicians, office staff, and nearly all women were satisfied with the screening process. Couple screening for CF is feasible and acceptable in decentralized primary care settings.

Physiologic changes during high field strength MR imaging.

High field strength MR imaging systems may require several kilowatts of RF power to obtain images. A fraction of this power is absorbed by the patient, and changes in body temperature have been measured in experimental animals. The purpose of this study was to quantify changes in body surface temperature and other physiologic parameters in humans during MR scanning at 1.5 T. Blood pressure, heart rate, respiration, and axillary temperature measurements were obtained on 27 normal volunteers. Measurements were made at RF power levels of 0, 0.2, and 0.8 W/kg, with the power sequence randomized. In 14 volunteers receiving lumbar scans, statistically significant increases in temperature were observed at RF power levels of 0.2 (+0.2 +/- 0.1 degree C) and 0.8 (+0.5 +/- 0.1 degree C) W/kg. No significant changes related to RF power were observed in blood pressure or respiratory rate. At the 0.8 W/kg level there was a slight increase in heart rate (3 +/- 1.3 beats per minute). In the 13 patients receiving head scans, physiologic changes were substantially smaller. The temperature increases and other physiologic changes observed during MR scanning with the 1.5 T imager at RF powers of 0.2 and 0.8 W/kg were small and of no clinical concern. Additional studies should be performed in patients with cardiac failure, vascular occulusion, and metallic implants or prostheses.

Factors affecting the loss of mitochondrial function in autolyzing cardiac muscle.

Rates of loss of mitochondrial respiratory function were monitored during autolyses of canine myocardial samples pretreated so as to affect tissue pH and/or tissue ATP content prevailing during tissue autolysis. When autolyses occurred under conditions of differing tissue pH, but at nearly identical tissue ATP levels, the rate of loss of mitochondrial function was virtually unchanged suggesting that tissue acidosis in the absence of a concomitant tissue ATP differential had little or no effect upon the rate of progression of mitochondrial damage. In a second comparison, autolyses were carried out at constant tissue pH, but where tissue ATP content differed dramatically. Here, the rate of loss of mitochondrial function was increased markedly suggesting that tissue ATP depletion in the absence of a concomitant tissue pH differential had a major effect upon the rate of loss of mitochondrial function. Thus, of the two parameters studied, tissue ATP content alone was far more important than tissue pH alone in determining the rate of cell membrane damage during ischemia. Finally, autolyses were carried out where both tissue pH and ATP content differed. Here, an even more dramatic increase in the rate of progression of mitochondrial damage occurred suggesting the operation of synergism between tissue ATP depletion and acidosis in promoting cell injury in ischemic cardiac muscle.

Effects of oligomycin and acidosis on rates of ATP depletion in ischemic heart muscle.

The perfusion of canine cardiac muscle with 10 microM oligomycin produced a nearly 90% slowing of the net rate of tissue ATP depletion from 0.200 to 0.025 mumol X min-1 X g wet wt-1 of tissue during a subsequent myocardial autolytic interval during which tissue pH was held constant. Moreover, lowering the tissue pH during the autolytic process by 0.6 unit from approximately 6.8 to approximately 6.2 produced a nearly 60% slowing of the net rate of tissue ATP depletion from 0.200 to 0.087 mumol X min-1 X g wet wt-1. The pH dependence of the net rate of tissue ATP depletion (by an oligomycin-sensitive process) was that predicted from the mitochondrial ATPase pH-inhibition profiles reported earlier (J. Biol. Chem. 258: 9657-9661, 1983). When taken together with our observation that the mitochondrial ATPase comprises approximately 90% of the total of all of the ATP hydrolyzing activities present in cardiac muscle cells, data reported here suggest that the protonic inhibition of the mitochondrial ATPase plays a major role in regulating the rate of tissue ATP depletion during myocardial ischemia.

Occupational risks for pleural mesothelioma in Sweden, 1961-79.

From national population-based registries linking cancer incidence from 1961 to 1979 with 1960 census data on industry and occupation for all employed individuals in Sweden, a systematic assessment was made of pleural mesothelioma occurrence according to occupational and industrial classifications. There were 318 cases of pleural mesothelioma recorded during the 19-year follow-up period among males employed in 1960, with significant variation by industrial and occupational categorizations. The observed number of pleural mesotheliomas for men employed in the sugar refining, cellulose, wood and pulp, shipbuilding, and railroad equipment manufacturing industries was more than three times the number expected. Occupations with at least twofold excess of mesotheliomas included the craftsman categories of plumbers, mechanics and repairmen, electricians, painters, tire makers, and stationary equipment operators. Our findings are consistent with available data relating mesothelioma to occupational asbestos exposure in other countries, although unexpected associations were found that deserve further epidemiologic study.

Comparison of iohexol and meglumine-Na diatrizoate in cerebral angiography.

A double blind investigation comparing meglumine-Na diatrizoate (290 mg I/ml) and iohexol (300 mg I/ml) showed that patients receiving iohexol experienced significantly less discomfort. Patients who received diatrizoate commonly showed transient episodes of hypertension while those who received iohexol either showed no changes or transient episodes of hypotension. No significant changes in heart rate were observed in either group.

Effects of hypothermia on propranolol kinetics.

Propranolol may be uniquely useful in cardiac surgical procedures, since beta adrenergic blockade can prevent the hypokalemia and associated arrhythmias which result from systemic hypothermia. To determine the effects of hypothermic cardiopulmonary bypass (HCPB) on the in vivo handling of propranolol, serial drug plasma concentrations (Cp) were measured during HCPB in 12 patients who had been treated chronically with propranolol prior to surgery. Although no further propranolol was given during the procedure, Cp values (corrected for plasma volume dilution) were higher during hypothermia than in the preoperative period, falling to or below control levels after rewarming. Due to the variables inherent in patient surgery, meaningful kinetic analysis could not be carried out. Therefore, intravenous propranolol (1 mg/kg) was given twice to each of 5 dogs, first after anesthesia only, then after anesthesia and systemic cooling to 26 degrees in a water bath Cp values measured serially over 2 hr after drug administration were consistently higher during hypothermia. Compared with the paired normothermic control studies, hypothermia markedly reduced the apparent volume of distribution (6.78 +/- 1.65 vs 2.08 +/- 0.58 L/kg; p less than 0.001) and the total body clearance of propranolol (64.4 +/- 11.0 vs 32.3 +/- 7.2 ml/kg/min; p less than 0.005). These data show that hypothermia substantially alters the pharmacokinetics of propranolol, resulting in plasma drug levels higher than those predicted from kinetic patterns derived under normothermic conditions.