Search

Objective: To develop and validate the Reflux Sign Assessment‐10 (RSA‐10) for documenting the physical findings of laryngopharyngeal reflux disease (LPRD). Methods: Patients with LPRD at the hypopharyngeal‐esophageal multichannel intraluminal impedance‐pH monitoring and asymptomatic individuals were consecutively recruited from two European hospitals. Three experienced otolaryngologists rated RSA‐10 in patients and controls for assessing internal validity. RSA‐10 was rated within a 7‐day period to assess test‐retest reliability. Internal consistency was measured using Cronbach's α in patients and controls. Convergent validity was evaluated through a correlation analysis between RSA‐10 and Reflux Finding Score (RFS). Interrater reliability was evaluated by comparing the RSA‐10 evaluations of the three otolaryngologists through Fleiss kappa. Pre‐ to posttreatment change of RSA‐10 was evaluated to assess responsiveness to change. The RSA‐10 thresholds were examined by receiver operating characteristic analysis. Results: Fifty‐five patients completed the pre‐ to posttreatment evaluations from January 2020 to December 2023. A total of 115 asymptomatic individuals completed the study. RSA‐10 reported high internal consistency reliability (α = 0.822) and test‐retest reliability (rs = 0.725). The RSA‐10 scores of patients were significantly higher than those of controls (p = 0.001), suggesting high internal validity. RSA‐10 was significantly correlated with the RFS (rs = 0.771). The interrater reliability was adequate for sub‐ and total RSA‐10 scores (k = 0.708). RSA‐10 significantly improved from baseline to 3‐month posttreatment (p = 0.001). An RSA‐10 > 13 may be suggestive of LPRD. Both RSA‐10 > 13 and Reflux Symptom Score‐12 > 11 were associated with a sensitivity of 92.7% and a specificity of 97.3%. Conclusion: The RSA‐10 is a reliable and valid clinical instrument for documenting the most prevalent laryngeal and extra‐laryngeal findings associated with LPRD. Level of Evidence: 3 Laryngoscope, 134:3981–3988, 2024 [ABSTRACT FROM AUTHOR]

This study provides an understanding of the needs for signs identifying rooms shown in group homes for the elderly with dementia (residents' room signs) and reveals the elements for planning. The purpose of staff displaying residents' room signs is to support residents with dementia returning to their own rooms by themselves. It is appropriate for the display contents shown on the residents' room signs to be displayed with the name of the resident approximately 30 to 50 mm. The appropriate display location is near the door handle at a height of approximately 1200 to 1400 mm. [ABSTRACT FROM AUTHOR]

Background: Previous studies have explored the size and word type composition (nouns, predicates, etc.) of expressive vocabularies of preschool children with Down syndrome, both spoken and signed. Separately, overall preferences for modality of expression have also been explored. Aims: To extend previous findings by describing the relationships between expressive vocabulary size and both word type and modality of expression in the preschool period including changes to modality preference over time. Methods & Procedures: Mothers of 35 children with Down syndrome, aged 36–66 months and attending the same early intervention programme, completed a version – with both spoken word and sign options – of the New Zealand MacArthur‐Bates Communicative Development Inventory (CDI): Words and Sentences. Most mothers completed the CDI on multiple occasions across the duration of the study. Completions (n = 114) were analysed cross‐sectionally and longitudinally in terms of (1) word type relative to vocabulary size, (2) modality of expression relative to word type and vocabulary size, and (3) individual trajectories in vocabulary size and modality of expression. Outcomes & Results: (1) Word type relative to vocabulary size was similar to previous studies with a greater proportion of the SOCIAL words being present in the children's vocabularies throughout, followed by NOUNS, PREDICATES and CLOSED class words, with proportions converging as vocabulary sizes increase. (2) An initial spoken word preference for SOCIAL and CLOSED class words and sign preference for NOUNS and PREDICATES was found, with more spoken words in larger vocabularies overall. (3) Individual trajectories were highly variable and also revealed temporary points of regression in overall expressive vocabulary size in some children. Children who shifted from reliance on sign to predominantly spoken word expression did so at different ages and at different vocabulary sizes. At school entry, while most of the children used both modalities, some children continued to rely on sign for most vocabulary items whereas others used only spoken words. Conclusions & Implications: An appreciation of both the general trends and potential for individual variation in vocabulary structure, modality of expression and change over time will better position clinicians and education specialists to provide individually tailored support to both preschool and school‐aged children with Down syndrome. What this study adds: What is already known on this subject: Preschool children with Down syndrome have been shown to demonstrate developmental patterns in overall conceptual vocabulary size and word type development broadly similar to typical development. The use of signed vocabulary has also been explored, but independently from word type development and with less attention to individual trajectories in either vocabulary size development or modality preferences throughout the preschool period than is necessary for clinical use. What this paper adds to existing knowledge: This study found interactions between word type and modality of expression in relation to vocabulary size as well as a few temporary vocabulary size regressions similar to those found in much younger typically developing children. An initial spoken word preference for social and closed class words, and sign preference for nouns and predicates, was followed by a general trend towards spoken words for all word types as vocabulary (with some fluctuations) increased over time. Children demonstrated considerable individual variation in size of vocabulary and age at which they pivoted from a signed to a spoken word preference. Moreover, while most children used both modalities at school entry, a few retained a sign‐only vocabulary and others had moved fully onto spoken word‐only expression. What are the potential or actual clinical implications of this work?: An understanding of both the general trends and individual variation in vocabulary structure and modality of expression development will better position clinicians and educational specialists to provide individually tailored support to children with Down syndrome. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To assess the evolution of laryngeal and extralaryngeal symptoms and findings of laryngopharyngeal reflux (LPR) throughout a 3-month to 9-month treatment.Study Design: Prospective Controlled Study.Methods: One hundred twenty-seven LPR patients and 123 healthy individuals were enrolled from four European hospitals. Patients were managed with a 3-month personalized treatment considering the LPR characteristics at the impedance-pH monitoring. Regarding the clinical therapeutic response, treatment was adapted for 3 to 6 additional months. Symptoms and findings were assessed throughout the therapeutic course with the Reflux Symptom Score (RSS) and the short version of the Reflux Sign Assessment (sRSA). The relationship between patient and reflux characteristics, symptoms, and findings was assessed.Results: One hundred twenty-one LPR patients completed the study. LPR patients exhibited more laryngeal and extralaryngeal symptoms and findings than healthy individuals. RSS significantly improved from baseline to 6 weeks posttreatment and continued to improve from 3 months to 6 months posttreatment. sRSA significantly improved from baseline to 3 months posttreatment. No further improvement was noted at 6 months posttreatment for pharyngeal and oral findings. Laryngeal findings continued to improve from 3 months to 6 months posttreatment. There was a significant association between patient stress level and RSS (P = .045). At 3 months posttreatment, 28.1% of patients had high or complete response, whereas 47.1% required 6 months or 9 months of treatment. Overall, 24.8% of patients had an LPR chronic course.Conclusions: Laryngeal and extralaryngeal symptoms and findings significantly improved throughout treatment in LPR patients. The improvement of laryngeal findings was slower. Regarding the low prevalence of some digestive or otolaryngological symptoms, a short version of the RSS could be developed.Level Of Evidence: 3 Laryngoscope, 131:1332-1342, 2021. [ABSTRACT FROM AUTHOR]

For the computation of a matrix sign function, a family of iterative methods is proposed. for some cases of the accelerator parameters, this method is proven to converge globally with higher rates of convergence. Its stability is discussed analytically as well. to illustrate the efficiency of the proposed methods from the family, several tests of various matrix sizes are considered to worked out. [ABSTRACT FROM AUTHOR]

The aim of this paper is to highlight some concerns about the partly inaccurate manner in which the currently available 2‐of‐2 and 2‐of‐3 simple and improved runs‐rules charts based on the sign and the signed‐rank statistics were designed using Markov chain matrix. Because of the memory‐less property of the Markov chains, the empirical average run‐length (ARL) values were not affected; but the design structure of the matrix makes it difficult to formulate the general expressions of the ARL explicitly. Also, the dimension (and consequently, the simplicity) of the transition probability matrices (TPMs) and the false alarm rates expressions were affected negatively. Thus, we present some zero‐ and steady‐state formulae that make it easier to construct some key elements of the run‐length distribution (including the TPMs) of the simple and improved 2‐of‐(H + 1) runs‐rules charts based on the sign and the signed‐rank statistics, for any positive integer value H > 0, not just H = 1 and 2, as currently available for these monitoring schemes, so that any interested reader may use these formulae to obtain the corresponding empirical study. [ABSTRACT FROM AUTHOR]

AUTHOR CONTRIBUTIONS Peng Jin, Lili Zhi, and Liang Dong conceptualized the study, administered the project, validated the study, and wrote, reviewed, and edited the manuscript. Dennie-Morgan folds in a child Upon physical examination, linear wrinkles beneath the lower eyelashes (Dennie-Morgan folds) were noticed (Figure 1). [Extracted from the article]

Aims Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way. Methods A dedicated working group (WG) was instituted by the ICS Standardisation Steering Committee according to published procedures. The WG extracted information from existing relevant guidelines, consensus documents, and scientific publications. Medline and other databases were searched in relation to each chronic pelvic pain domain from 1980 to 2014. Existing ICS Standards for terminology were utilized where appropriate to ensure transparency, accessibility, flexibility, and evolution. Consensus was based on majority agreement. Results The multidisciplinary CPPS Standard reports updated consensus terminology in nine domains; lower urinary tract, female genital, male genital, gastrointestinal, musculoskeletal, neurological aspects, psychological aspects, sexual aspects, and comorbidities. Each is described in terms of symptoms, signs and further evaluation. Conclusion The document presents preferred terms and definitions for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. 36:984-1008, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Walker Percy's use of the terms Umwelt (environment) and Welt (symbol world) as well as his separation of events into dyadic and triadic ones, where the latter involve human beings, is brought to bear on the relationship between science and religion with the upshot being that science (a dyadic enterprise) is not equipped to really understand or explain triadic entities (namely, human beings). [ABSTRACT FROM AUTHOR]

Cutaneous pigmentation due to the arthropod, Cydnidae (a.k.a. burrowing bug), is increasingly being reported in the literature. The transient nature of this pigmentation probably contributes to its underreporting. We report a case of an 8‐year‐old girl with a sudden onset of hyperpigmented lesions on her index finger, face, and neck due to burrowing bugs. We propose the term "transient pseudo‐lentigines sign" to better describe this fleeting arthropod‐induced pigmentation. [ABSTRACT FROM AUTHOR]

We evaluated a strategy for decreasing improperly stored dishes in a hospital unit. A humorous sign and a neutral sign were posted to remind staff to store dishes properly, and follow-up data were collected to determine maintenance effects. Relative to baseline, fewer dishes were stored improperly when a sign was posted, regardless of sign content. These effects were maintained during a 4-month follow-up. Results of social validity questionnaires showed low acceptability for the humorous sign and moderate acceptability for the neutral sign. [ABSTRACT FROM AUTHOR]

In this article we revisit, with the help of images, those classic signs in chest radiography described by Dr Benjamin Felson himself, or other illustrious radiologists of his time, cited and discussed in 'Chest Roentgenology'. We briefly describe the causes of the signs, their utility and the differential diagnosis to be considered when each sign is seen. Wherever possible, we use CT images to illustrate the basis of some of these classic radiographic signs. [ABSTRACT FROM AUTHOR]

This study examines online information value structure and its motivational communication competence using the motivational language theory (MLT). MLT explains how communication acts directed by managers to employees generate a greater motivation for work. Five information value dimensions - functional, hedonic, innovation, aesthetic and sign - were identified through literature on the subject of MLT and applied to online information. This study confirmed the multidimensionality of online information and proposed four online information dimensions: experiential (hedonic-innovation), sign, functional and aesthetic. The findings also suggested that experiential (hedonic-innovation) and functional information values have significant effects for travel motivation, including exploration, family togetherness, novelty, escape and socialisation. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A sign is something that refers to something else. Signs, whether of natural or cultural origin, act by provoking a receptive system, human or nonhuman, to form an interpretant (a movement or a brain activity) that somehow relates the system to this “something else.” Semiotics sees meaning as connected to the formation of interpretants. In a biosemiotic understanding living systems are basically engaged in semiotic interactions, that is, interpretative processes, and organic evolution exhibits an inherent tendency toward an increase in semiotic freedom. Mammals generally are equipped with more semiotic freedom than are their reptilian ancestor species, and fishes are more semiotically sophisticated than are invertebrates. The evolutionary trend toward the production of life forms with an increasing interpretative capacity or semiotic freedom implies that the production of meaning has become an essential survival parameter in later stages of evolution. [ABSTRACT FROM AUTHOR]

This paper compares two explanations of the process by which human communication systems evolve: iterated learning and social collaboration. It then reports an experiment testing the social collaboration account. Participants engaged in a graphical communication task either as a member of a community, where they interacted with seven different partners drawn from the same pool, or as a member of an isolated pair, where they interacted with the same partner across the same number of games. Participants’ horizontal, pair-wise interactions led “bottom up” to the creation of an effective and efficient shared sign system in the community condition. Furthermore, the community-evolved sign systems were as effective and efficient as the local sign systems developed by isolated pairs. Finally, and as predicted by a social collaboration account, and not by an iterated learning account, interaction was critical to the creation of shared sign systems, with different isolated pairs establishing different local sign systems and different communities establishing different global sign systems. [ABSTRACT FROM AUTHOR]

There has been a significant increase in the number of reported cases of Acanthamoeba keratitis reported internationally over the last 24 months. Diagnosing Acanthamoeba keratitis is often difficult and part of the difficulty is attributed to the variability of presentation. This article provides a comprehensive photographic reference of common and uncommon clinical signs of Acanthamoeba keratitis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the value of clinical features in differentiating between viral, pneumococcal and atypical bacterial pneumonia in children. Design: A retrospective analysis of clinical signs and symptoms, supplemented with chest radiograph and serum procalcitonin data, in 101 children with community-acquired pneumonia. Viral and bacterial aetiology was studied prospectively by antibody assays, and pneumococcal infection was found in 18, atypical bacterial infection in 28 and viral infection alone in 22 cases. Methods: Chest radiographs and serum procalcitonin were studied in all cases. Data on clinical signs and symptoms were retrospectively collected from the medical cards of the patients. Results: Among symptoms, cough was present in 89% and fever (>37.5°C) in 88% of the cases. Among physical signs, crackles were present in 49% and decreased breath sounds in 58%. No significant associations were found between any of the clinical signs or symptoms and the aetiology of pneumonia. In multivariate analyses, age over 5 years and serum procalcitonin over 1.0 ng/mL were the only independent predictors of bacterial aetiology, but no finding was able to screen between pneumococcal and atypical bacterial aetiology of infection. Conclusion: No clinical or radiological characteristic was helpful in the separation between viral, pneumococcal and atypical bacterial aetiology of community-acquired pneumonia (CAP) in children. [ABSTRACT FROM AUTHOR]

This guideline is the result of a consensus reached during a panel discussion at the second International Consensus Meeting on Urticara, Urticaria 2004, a joint initiative of the EAACI Dermatology Section and GA2LEN. Urticaria has a profound impact on the quality of life, and effective treatment is therefore required. The recommended first line treatment are nonsedating H1 antihistamines. They have proven to be effective in double-blind controlled studies, but dosages increased up to fourfold over the recommended doses may be necessary. However, for different urticaria subtypes and in view of individual variation in the course of the disease and response to treatment, additional or alternative therapies may be required. Immunosuppressive drugs like cyclosporin A and corticosteroids are not recommended for long-term treatment due to unavoidable severe adverse effects. This guideline was, in addition, accepted by the European Dermatology Forum (EDF) and formally approved by the European Union of Medical Specialists (UEMS). [ABSTRACT FROM AUTHOR]

The term active imagination is sometimes applied rather uncritically to describe all forms of creative activity that take place in depth psychology. Whilst there are many forms of expression that evoke or are evoked by active imagination, they cannot automatically be classed as active imagination. In this article investigation of visualized mental imagery, dreams and art reveals three distinct forms of image-based psychological activity. Integrated and mediated within the transference and countertransference dynamic, it is proposed that the engagement in active imagination reflects and is influenced by the transference. Distinctions between sign and symbol, simple and big dreams as well as diagrammatic and embodied imagery clarify the differences. Examples from clinical practice demonstrate each mode in action within the analytic frame. [ABSTRACT FROM AUTHOR]

We identified nest predators of northern bobwhites (Colinus virginianus) on private lands in northern Florida and southern Georgia, USA, using continuous infrared micro-video cameras, 1999-2001, and compared these results to predictions based on diagnostic sign at nests. Mammals (59%), snakes (29%), and ants (12%) accounted for known bobwhite nest depredations. Mammalian predators, in order of importance, were the raccoon (Procyon lotor), nine-banded armadillo (Dasypus novemcinctus), Virginia opossum (Didelphis virginiana), bobcat (Lynx rufus), hispid cotton rat (Sigmodon hispidus), and coyote (Canis latrans). Using diagnostic sign, technicians correctly classified 30% of mammalian depredations to species and overestimated nest depredations by snakes. A classification tree model correctly classified 75% of the test sample (n = 33) into "mammal" or "snake" categories, but still overestimated depredations by snakes. We documented a broader predator community upon bobwhite eggs than previously known for northern Florida and southern Georgia and confirmed that snakes were significant nest predators in some years. We conclude that diagnostic sign at depredated nests was unreliable for identifying nest predators of northern bobwhites. [ABSTRACT FROM AUTHOR]

Papuloerythroderma of Ofuji (PEO) is a disease of elderly men, characterized by intensely pruritic and widespread, red, flat-topped papules with sparing of the body folds and creases (the so-called ‘deck-chair’ sign). The etiopathogenesis of the disease remains unknown. Psoralen plus UVA (PUVA), topical and systemic corticosteroids, etretinate, cyclosporin and interferon are the main approaches in the treatment of this rare disease. A case of PEO in a 60-year-old man who responded to retinoid plus PUVA (Re-PUVA) treatment is reported here and a review of the therapy with other relevant cases is presented. [ABSTRACT FROM AUTHOR]

Most recent writing linking science and literature has concerned itself with challenges to the epistemological status of scientific knowledge in an attempt to demonstrate its contingency, arguing in the more radical efforts that the structures of science are no more than useful fictions. This essay also includes an epistemological comparison between science and literature, but instead of making grand or meta–statements about the nature of knowing generally in the two fields, mine is a much narrower aim. My exploration entails two tasks. First, I provide a close–up look at a particular type of experiment, called the delayed–choice experiment, which clearly reveals the strangeness of the quantum world. In connection with this experiment, I discuss wave functions—mathematical expressions used by physicists to describe quantum behavior and predict the outcome of experiments involving quanta. Second, I look at Walt Whitman’s “Song of Myself” focusing on the meaning of the “self” in the poem. My aim is to treat the object of study in each field as a “text” and to assert and demonstrate a parallel in the strategies of thought and response between physicists (“readers”) pondering the meaning and status of a wave function and poem readers pondering the meaning and status of the poem’s self. In Whitman’s “Song” we find an attempt to understand complex aspects of human experience that are said to transcend ordinary reality, an effort for which I believe there are parallels in the attempts of modern physicists to understand complex, nonintuitive aspects of the subatomic world. While not making the kind of broad claims eschewed above, I do suggest that this focused study has interesting implications since both the wave function and the poem’s self force their respective sets of “readers” to confront questions of ultimacy—to consider, that is, epistemological and ontological issues of more than passing interest to students of science as well as those of metaphysics and theology. [ABSTRACT FROM AUTHOR]

In this article the author holds that progress in philosophy is a vague concept. Its criteria are not universally acknowledged. All that is clear is that philosophy does not develop in a linear way. Philosophy is polydiscoursive. As for the past fifty years, the author believes three important things happened in philosophy. (1) It has been shown that consciousness exists not within one individual but spreads within a community of people; (2) philosophy has discovered autism, a result that helps us to understand a human being as neither a biological nor a social individual but a third thing-a dreaming being who is not only asocial but also tongueless, where speech and consciousness are separated; and (3) contemporary philosophy has learned to distinguish between sign and symbol. And it has been realized that the human mind is neither an instinct nor a computer but an objectified suffering, a transformed emotion. [ABSTRACT FROM AUTHOR]