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1.  Some clinical aspects of reconstruction for chronic anterior cruciate ligament deficiency. 
A total of 250 patients was reviewed 71.8 months (range 49-105 months) after anterior cruciate ligament (ACL) reconstruction for disabling instability that had not responded to conservative treatment or correction of internal derangements. Knees that had undergone previous operation or had damage to other ligaments were excluded. Four techniques were used; MacIntosh extra-articular lateral substitution alone (n = 18), extra-articular reconstruction plus intra-articular carbon fibre (n = 29), extra-articular reconstruction plus a free graft from the medial third of the patellar tendon (n = 74), or extra-articular reconstruction plus a Leeds-Keio prosthesis (n = 129). The knees were assessed 1, 3 and 6 years after reconstruction using the Lysholm score and clinical examination for the anterior drawer, Lachman and pivot shift signs. The mean Lysholm score after 6 years was 77.4 (range 31-100) in the extra-articular group; 74.4 (range 34-100) in the carbon fibre group; 95.4 (range 43-100) in the patellar tendon group; and 91.2 (range 45-100) in the Leeds-Keio group. The patellar tendon group had the highest scores (P < 0.003). The pivot shift sign returned in 39% of the extra-articular group; 48% of the carbon fibre group; 1% of the patellar tendon group, and 36% of the Leeds-Keio group. The pivot shift returned least often in the patellar tendon group (P < 0.001). There were 44% satisfactory results (pivot shift negative and Lysholm score 77 or more) in the extra-articular group; 55% in the carbon fibre group; 92% in the patellar tendon group; and 60% in the Leeds-Keio group.(ABSTRACT TRUNCATED AT 250 WORDS)
PMCID: PMC2502334  PMID: 7574323
2.  Implementation of a filmless mini picture archiving and communication system in ultrasonography: Experience after one year of use 
Journal of Digital Imaging  1997;10(Suppl 1):80-82.
This article details our experience in developing and operating an ultrasound mini-picture archiving and communication system (PACS). Using software developed in-house, low-end MacIntosh computers (Apple Computer Co, Cupertino, CA) equipped with framegrabbers coordinate the entry of patient demographic information, image acquisition, and viewing on each ultrasound scanner. After each exam, the data are transmitted to a central archive server where they can be accessed from anywhere on the network. The archive server also provides web-based access to the data and manages pre-fetch and other requests for data that may no longer be on-line. Archival is fully automatic and is performed on recordable compact disk (CD) without compression. The system has been filmless now for over 18 months. In the meantime, one film processor has been eliminated and the position of one film clerk has been reallocated. Previously, nine ultrasound machines produced approximately 150 sheets of laser film per day (at 14 images per sheet). The same quantity of data are now archived without compression onto a single CD. Start-up costs were recovered within six months, and the project has been extended to include computed tomography (CT) and magnetic resonance imaging (MRI).
PMCID: PMC3452806  PMID: 9268846
Ultrasound; PACS; filmless radiology; recordable CD
3.  An extra-articular procedure improves the clinical outcome in anterior cruciate ligament reconstruction with hamstrings in female athletes 
International Orthopaedics  2012;37(2):187-192.
A positive glide is a common finding after ACL reconstructions, especially in women. The aim of this study was to prospectively evaluate the role of Cocker-Arnold’s extra-articular procedure in reducing the incidence of a residual postoperative rotational knee laxity.
Sixty patients affected by an ACL injury with a +2 (clunk) or +3 (gross shift) pivot-shift test entered this prospective study; they were randomly assigned to group A (control group, hamstrings) or group B (study group, hamstrings plus Cocker-Arnold). Thirty-two patients entered group A and 28 group B. At follow-up, patients underwent clinical evaluation, KT-1000 arthrometer and Lysholm, Tegner, VAS and subjective and objective IKDC form.
At a mean follow-up of 44.6 months, the same expert surgeon reviewed 55 patients (28 group A and 27 group B). The comparison of the results of the evaluation scales used and of the KT-1000 arthrometer did not show statistically significant differences (p > 0.05). Lachman test was negative (S/S) in all the patients of both groups (100 %). A residual positive pivot-shift (glide) was found in 16 patients (57.1 %) of group A and in five patients (18.6 %) of group B (p < 0.05).
The extra-articular MacIntosh procedure modified by Cocker-Arnold in combination with ACL reconstruction significantly reduces the rotational instability of the knee.
PMCID: PMC3560890  PMID: 22623063
4.  MacIntosh arthroplasty for the rheumatoid knee: a 10-year follow up. 
Annals of the Rheumatic Diseases  1985;44(11):738-741.
The results of 75 MacIntosh arthroplasties performed for rheumatoid arthritis of the knee in 63 patients were reviewed at least 10 years after surgery. Forty-two knees in 35 patients were available for assessment. Eleven arthroplasties had been revised to total knee replacement without difficulty because of pain or poor function. The remaining 31 knees in 25 patients gave good or excellent results in 22 cases, fair in eight, and poor in one. Seven patients could not be traced, and 21 patients representing 26 knees had died. At least half these knees had given satisfactory results immediately before death judged by review of the case notes. The difficulty of comparing functional status with the preoperative state because of progressive multiarticular disease was highlighted. Although greater angular deformities preoperatively reduced the chance of success in the medium term, late failure of the arthroplasty after five years was very rare. Approximately two-thirds of all the arthroplasties performed gave satisfactory results at 10-year follow up or until the time of death.
PMCID: PMC1001760  PMID: 4062388
5.  Laryngoscope Modification to Avoid Perioral Trauma Due to Laryngoscopy† 
Anesthesia Progress  1982;29(2):47-49.
Trauma to hard and soft tissues of the oral and perioral regions occurs due to laryngoscopy. This paper identifies patients predisposed to dental complication preoperatively, explains the course to be taken intra- and post-operatively should such a complication occur and presents a modification of the MacIntosh laryngoscopy blade suitable for most patients.
PMCID: PMC2515600  PMID: 6130727
6.  A temporal comparison of BOLD, ASL, and NIRS hemodynamic responses to motor stimuli in adult humans 
NeuroImage  2005;29(2):368-382.
In this study, we have preformed simultaneous near-infrared spectroscopy (NIRS) along with BOLD (blood oxygen level dependent) and ASL (arterial spin labeling)-based fMRI during an event-related motor activity in human subjects in order to compare the temporal dynamics of the hemodynamic responses recorded in each method. These measurements have allowed us to examine the validity of the biophysical models underlying each modality and, as a result, gain greater insight into the hemodynamic responses to neuronal activation. Although prior studies have examined the relationships between these two methodologies through similar experiments, they have produced conflicting results in the literature for a variety of reasons. Here, by employing a short-duration, event-related motor task, we have been able to emphasize the subtle temporal differences between the hemodynamic parameters with a high contrast-to-noise ratio. As a result of this improved experimental design, we are able to report that the fMRI measured BOLD response is more correlated with the NIRS measure of deoxy-hemoglobin (R = 0.98; P < 10−20) than with oxy-hemoglobin (R = 0.71), or total hemoglobin (R = 0.53). This result was predicted from the theoretical grounds of the BOLD response and is in agreement with several previous works [Toronov, V.A.W., Choi, J.H., Wolf, M., Michalos, A., Gratton, E., Hueber, D., 2001. “Investigation of human brain hemodynamics by simultaneous near-infrared spectroscopy and functional magnetic resonance imaging.” Med. Phys. 28 (4) 521–527; MacIntosh, B.J., Klassen, L.M., Menon, R.S., 2003. “Transient hemodynamics during a breath hold challenge in a two part functional imaging study with simultaneous near-infrared spectroscopy in adult humans.” NeuroImage 20 1246– 1252; Toronov, V.A.W., Walker, S., Gupta, R., Choi, J.H., Gratton, E., Hueber, D., Webb, A., 2003. “The roles of changes in deoxyhemoglobin concentration and regional cerebral blood volume in the fMRI BOLD signal” Neuroimage 19 (4) 1521– 1531]. These data have also allowed us to examine more detailed measurement models of the fMRI signal and comment on the roles of the oxygen saturation and blood volume contributions to the BOLD response. In addition, we found high correlation between the NIRS measured total hemoglobin and ASL measured cerebral blood flow (R = 0.91; P < 10−10) and oxy-hemoglobin with flow (R = 0.83; P < 10−05) as predicted by the biophysical models. Finally, we note a significant amount of cross-modality, correlated, inter-subject variability in amplitude change and time-to-peak of the hemodynamic response. The observed co-variance in these parameters between subjects is in agreement with hemodynamic models and provides further support that fMRI and NIRS have similar vascular sensitivity.
PMCID: PMC2692693  PMID: 16303317
Near-infrared spectroscopy; BOLD; ASL; Multimodality comparison
7.  The acute abdomen in emergency with Hypercard. 
A non-sequential Bayesian program for diagnosing acute abdominal pain was developed using an Amdahl mainframe accessed by a Texas Instrument remote terminal. Transferring the program to a MacIntosh SE/30 using hypercard was attended by increased utilisation from 15 to 44%.
PMCID: PMC2247514  PMID: 1807577
8.  A Demonstration of Doctor-Patient Encounter Modules Written in SuperCard 
We illustrate three sample MacIntosh subsystems for a doctor to use: 1) grading of signs and symptoms; 2) writing prescriptions; and 3) recording procedures with simultaneous computation of medical charges using ICD-91 and CPT2 codes. The above examples are supported by small generic scripts written by the SuperCard programmer and larger medical databases (text, buttons, graphics) maintained by the physician user.
PMCID: PMC2245526
9.  Comparison of static and dynamic repairs for ligamentous instability of the knee. 
Twenty-three patients who have had a MacIntosh type of fasciodesis for anterolateral rotary instability of the knee have been studied. Overall 73% were improved by this procedure; of those whose only instability was when turning on the run, 90% improved. These results have been compared with a series of 51 patients who had a pes anserinus transfer for anteromedial instability (D'Arcy 1978). It is suggested that both static and dynamic reconstructions have a place in the management of knee instability resulting from anterior cruciate injury.
PMCID: PMC1439640  PMID: 6631873
10.  Use of Airtraq, C-Mac, and Glidescope laryngoscope is better than Macintosh in novice medical students’ hands: A manikin study 
Saudi Journal of Anaesthesia  2011;5(4):376-381.
Background and Aim:
Obtaining patent airway is a crucial task for many physicians. When opportunities to practice intubations on patients are really limited, skill gaining methods are needed. We conducted a study among novice 6th year medical students to assess their ability to intubate the trachea in normal airway in manikin using four airway tools.
Setting and Design:
Prospective, cohort study conducted at simulation center of university-based, tertiary care hospital.
Fifty medical students performed either oral or nasal tracheal intubation using the following four intubating tools: C-Mac videolaryngoscope, Glidescope, and Airtraq in comparison with regular Macintosh laryngoscope. Intubation time, visualization of glottic opening, ease of intubation, satisfaction of participants, incidence of dental trauma, and the need for optimization manoeuvres′ use among different airway tools were recorded.
In oral intubation, Airtraq was better than others in regard to intubation time, glottic opening, ease of intubation, and the need for external laryngeal pressure application, followed by Glidescope, C-Mac, and finally Macintosh laryngoscope (P<0.001). Airtraq and Glidescope associated with less dental trauma than C-Mac and Macintosh. In nasal route, fastest intubation time was reported with Airtraq followed by Glidescope, C-Mac, and lastly Macintosh. Airtraq, Glidescope, and C-Mac were similar to each other and better than the Macintosh in regard to ease of intubation, satisfaction, and number of attempts (P≤0.008).
New devices like Airtraq, Glidescope, and C-Mac are better than the regular Macintosh when used by novice medical students for oral and nasal intubation on manikin.
PMCID: PMC3227306  PMID: 22144924
Airtraq; airway tools; C-Mac video laryngoscope; Glidescope; Macintosh laryngoscope; medical students
11.  A multiple process solution to the logical problem of language acquisition* 
Journal of child language  2004;31(4):883-914.
Many researchers believe that there is a logical problem at the center of language acquisition theory. According to this analysis, the input to the learner is too inconsistent and incomplete to determine the acquisition of grammar. Moreover, when corrective feedback is provided, children tend to ignore it. As a result, language learning must rely on additional constraints from universal grammar. To solve this logical problem, theorists have proposed a series of constraints and parameterizations on the form of universal grammar. Plausible alternatives to these constraints include: conservatism, item-based learning, indirect negative evidence, competition, cue construction, and monitoring. Careful analysis of child language corpora has cast doubt on claims regarding the absence of positive exemplars. Using demonstrably available positive data, simple learning procedures can be formulated for each of the syntactic structures that have traditionally motivated invocation of the logical problem. Within the perspective of emergentist theory (MacWhinney, 2001), the operation of a set of mutually supportive processes is viewed as providing multiple buffering for developmental outcomes. However, the fact that some syntactic structures are more difficult to learn than others can be used to highlight areas of intense grammatical competition and processing load.
PMCID: PMC1876779  PMID: 15658750
12.  A randomised, controlled crossover comparison of the C-MAC videolaryngoscope with direct laryngoscopy in 150 patients during routine induction of anaesthesia 
BMC Anesthesiology  2011;11:6.
The C-MAC® (Karl Storz, Tuttlingen, Germany) has recently been introduced as a new device for videolaryngoscopy guided intubation. The purpose of the present study was to compare for the first time the C-MAC with conventional direct laryngoscopy in 150 patients during routine induction of anaesthesia.
After approval of the institutional review board and written informed consent, 150 patients (ASA I-III) with general anaesthesia were enrolled. Computer-based open crossover randomisation was used to determine the sequence of the three laryngoscopies: Conventional direct laryngoscopy (HEINE Macintosh classic, Herrsching, Germany; blade sizes 3 or 4; DL group), C-MAC size 3 (C-MAC3 group) and C-MAC size 4 (C-MAC4 group) videolaryngoscopy, respectively. After 50 patients, laryngoscopy technique in the C-MAC4 group was changed to the straight blade technique described by Miller (C-MAC4/SBT).
Including all 150 patients (70 male, aged (median [range]) 53 [20-82] years, 80 [48-179] kg), there was no difference of glottic view between DL, C-MAC3, C-MAC4, and C-MAC4/SBT groups; however, worst glottic view (C/L 4) was only seen with DL, but not with C-MAC videolaryngoscopy. In the subgroup of patients that had suboptimal glottic view with DL (C/L≥2a; n = 24), glottic view was improved in the C-MAC4/SBT group; C/L class improved by three classes in 5 patients, by two classes in 2 patients, by one class in 8 patients, remained unchanged in 8 patients, or decreased by two classes in 1 patient. The median (range) time taken for tracheal intubation in the DL, C-MAC3, C-MAC4 and C-MAC4/SBT groups was 8 sec (2-91 sec; n = 44), 10 sec (2-60 sec; n = 37), 8 sec (5-80 sec; n = 18) and 12 sec (2-70 sec; n = 51), respectively.
Combining the benefits of conventional direct laryngoscopy and videolaryngoscopy in one device, the C-MAC may serve as a standard intubation device for both routine airway management and educational purposes. However, in patients with suboptimal glottic view (C/L≥2a), the C-MAC size 4 with straight blade technique may reduce the number of C/L 3 or C/L 4 views, and therefore facilitate intubation. Further studies on patients with difficult airway should be performed to confirm these findings.
PMCID: PMC3060123  PMID: 21362173
13.  Comparison of the TruView infant EVO2 PCD™ and C-MAC video laryngoscopes with direct Macintosh laryngoscopy for routine tracheal intubation in infants with normal airways 
Clinics  2014;69(1):23-27.
Videolaryngoscopy has mainly been developed to facilitate difficult airway intubation. However, there is a lack of studies demonstrating this method's efficacy in pediatric patients. The aim of the present study was to compare the TruView infant EVO2 and the C-MAC videolaryngoscope with conventional direct Macintosh laryngoscopy in children with a bodyweight ≤10 kg in terms of intubation conditions and the time to intubation.
In total, 65 children with a bodyweight ≤10 kg (0-22 months) who had undergone elective surgery requiring endotracheal intubation were retrospectively analyzed. Our database was screened for intubations with the TruView infant EVO2, the C-MAC videolaryngoscope, and conventional direct Macintosh laryngoscopy. The intubation conditions, the time to intubation, and the oxygen saturation before and after intubation were monitored, and demographic data were recorded. Only children with a bodyweight ≤10 kg were included in the analysis.
A total of 23 children were intubated using the C-MAC videolaryngoscope, and 22 children were intubated using the TruView EVO2. Additionally, 20 children were intubated using a standard Macintosh blade. The time required for tracheal intubation was significantly longer using the TruView EVO2 (52 sec vs. 28 sec for C-MAC vs. 26 sec for direct LG). However, no significant difference in oxygen saturation was found after intubation.
All devices allowed excellent visualization of the vocal cords, but the time to intubation was prolonged when the TruView EVO2 was used. The absence of a decline in oxygen saturation may be due to apneic oxygenation via the TruView scope and may provide a margin of safety. In sum, the use of the TruView by a well-trained anesthetist may be an alternative for difficult airway management in pediatric patients.
PMCID: PMC3870305  PMID: 24473556
Videolaryngoscopy; Tracheal Intubation; Infants
14.  Dual-modality impairment of implicit learning of letter-strings versus color-patterns in patients with schizophrenia 
Implicit learning was reported to be intact in schizophrenia using artificial grammar learning. However, emerging evidence indicates that artificial grammar learning is not a unitary process. The authors used dual coding stimuli and schizophrenia clinical symptom dimensions to re-evaluate the effect of schizophrenia on various components of artificial grammar learning.
Letter string and color pattern artificial grammar learning performances were compared between 63 schizophrenic patients and 27 comparison subjects. Four symptom dimensions derived from a Chinese Positive and Negative Symptom Scale ratings were correlated with patients' artificial grammar implicit learning performances along the two stimulus dimensions. Patients' explicit memory performances were assessed by verbal paired associates and visual reproduction subtests of the Wechsler Memory Scales Revised Version to provide a contrast to their implicit memory function.
Schizophrenia severely hindered color pattern artificial grammar learning while the disease affected lexical string artificial grammar learning to a lesser degree after correcting the influences from age, education and the performance of explicit memory function of both verbal and visual modalities. Both learning performances correlated significantly with the severity of patients' schizophrenic clinical symptom dimensions that reflect poor abstract thinking, disorganized thinking, and stereotyped thinking.
The results of this study suggested that schizophrenia affects various mechanisms of artificial grammar learning differently. Implicit learning, knowledge acquisition in the absence of conscious awareness, is not entirely intact in patients with schizophrenia. Schizophrenia affects implicit learning through an impairment of the ability of making abstractions from rules and at least in part decreasing the capacity for perceptual learning.
PMCID: PMC1334227  PMID: 16343344
15.  A Demonstration of the MAClinical Workstation 
Medical Students at the Georgetown University School of Medicine on clinical rotations at the University Hospital now have access to Macintosh IIs and ImageWriter IIs on the wards. The MACs are connected to the medical center's local area network (LAN) with access to the Integrated Academic Information Management System (IAIMS) and Library Information System (LIS) databases. The Intent of the Macintosh project is to provide students with workstations of the sort they will use in future medical practice and to instill information query habits in the daily clinical activities of physicians- in-training. Currently, there are eight MACs located in conference rooms around the hospital where students and residents hold teaching rounds and write admission notes. Faculty participating in the project have been loaned MACs.
The student workstations at the hospital are designed to serve multiple educational purposes in the clinical setting. Primarily, students gain experience in medical informatics. Secondarily, but equally essential, students can use H&P Writer, a HyperCard stack developed at Georgetown with MacWrite and MacDraw to prepare the admission record on the patients they examine. Graphics, sketches and illustrations are part of the system. The work- stations have access to IAIMS/LIS databases, such as minIMEDLINE, Alerts/Current Contents, Physicians Data Query (PDQ), a Drug/Poison Information System and RECONSIDER, a diagnostic prompting system.
PMCID: PMC2245673
16.  A Genomic Background Based Method for Association Analysis in Related Individuals 
PLoS ONE  2007;2(12):e1274.
Feasibility of genotyping of hundreds and thousands of single nucleotide polymorphisms (SNPs) in thousands of study subjects have triggered the need for fast, powerful, and reliable methods for genome-wide association analysis. Here we consider a situation when study participants are genetically related (e.g. due to systematic sampling of families or because a study was performed in a genetically isolated population). Of the available methods that account for relatedness, the Measured Genotype (MG) approach is considered the ‘gold standard’. However, MG is not efficient with respect to time taken for the analysis of genome-wide data. In this context we proposed a fast two-step method called Genome-wide Association using Mixed Model and Regression (GRAMMAR) for the analysis of pedigree-based quantitative traits. This method certainly overcomes the drawback of time limitation of the measured genotype (MG) approach, but pays in power. One of the major drawbacks of both MG and GRAMMAR, is that they crucially depend on the availability of complete and correct pedigree data, which is rarely available.
In this study we first explore type 1 error and relative power of MG, GRAMMAR, and Genomic Control (GC) approaches for genetic association analysis. Secondly, we propose an extension to GRAMMAR i.e. GRAMMAR-GC. Finally, we propose application of GRAMMAR-GC using the kinship matrix estimated through genomic marker data, instead of (possibly missing and/or incorrect) genealogy.
Through simulations we show that MG approach maintains high power across a range of heritabilities and possible pedigree structures, and always outperforms other contemporary methods. We also show that the power of our proposed GRAMMAR-GC approaches to that of the ‘gold standard’ MG for all models and pedigrees studied. We show that this method is both feasible and powerful and has correct type 1 error in the context of genome-wide association analysis in related individuals.
PMCID: PMC2093991  PMID: 18060068
17.  MacPharmacy: A Relational Database Adjunt to a Hypermedia-Based Physician Workstation 
MacPharmacy is a relational database built as an adjunct to RadOnc, a hypermedia-based physician workstation in the domain of radiation oncology. Conceived originally as a RadOnc module for chemotherapeutic agents, the MacPharmacy database contains information on a large selection of drugs which can be accessed by a variety of users. Information on generic and trade names, pharmacodynamics, indications, and dosage is linked to RadOnc disease descriptions and patient records which contain a clinical summary of the presentation, treatment and results. MacPharmacy's features include data table addition and updating and a customizable user interface that can be linked to other applications. Due to the scarcity of Macintosh-based pharmacy databases, MacPharmacy fills an information gap for clinically-oriented Macintosh users.
PMCID: PMC2245471
18.  Endotracheal intubation using the C-MAC® video laryngoscope or the Macintosh laryngoscope: A prospective, comparative study in the ICU 
Critical Care  2012;16(3):R103.
Endotracheal intubation in the ICU is a challenging procedure and is frequently associated with life-threatening complications. The aim of this study was to investigate the effect of the C-MAC® video laryngoscope on laryngeal view and intubation success compared with direct laryngoscopy.
In a single-center, prospective, comparative before-after study in an anesthetist-lead surgical ICU of a tertiary university hospital, predictors of potentially difficult tracheal intubation, number of intubation attempts, success rate and glottic view were evaluated during a 2-year study period (first year, Macintosh laryngoscopy (ML); second year, C-MAC®).
A total of 274 critically ill patients requiring endotracheal intubation were included; 113 intubations using ML and 117 intubations using the C-MAC® were assessed. In patients with at least one predictor for difficult intubation, the C-MAC® resulted in more successful intubations on first attempt compared with ML (34/43, 79% vs. 21/38, 55%; P = 0.03). The visualization of the glottis with ML using Cormack and Lehane (C&L) grading was more frequently rated as difficult (20%, C&L grade 3 and 4) compared with the C-MAC® (7%, C&L grade 3 and 4) (P < 0.0001).
Use of the C-MAC® video laryngoscope improved laryngeal imaging and improved the intubating success rate on the first attempt in patients with predictors for difficult intubation in the ICU setting. Video laryngoscopy seems to be a useful tool in the ICU where potentially difficult endotracheal intubations regularly occur.
PMCID: PMC3580658  PMID: 22695007
19.  Growth of Escherichia coli O157:H7 in Bruised Apple (Malus domestica) Tissue as Influenced by Cultivar, Date of Harvest, and Source 
Four of five apple cultivars (Golden Delicious, Red Delicious, McIntosh, Macoun, and Melrose) inoculated with Escherichia coli O157:H7 promoted growth of the bacterium in bruised tissue independent of the date of harvest (i.e., degree of apple ripening) or the source of the apple (i.e., tree-picked or dropped fruit). Apple harvest for this study began 4 September 1998 and ended 9 October, with weekly sampling. Throughout this study, freshly picked (<2 days after harvest) McIntosh apples usually prevented the growth of E. coli O157:H7 for 2 days. Growth of E. coli O157:H7 did occur following 6 days of incubation in bruised McIntosh apple tissue. However, the maximum total cell number was approximately 80-fold less than the maximum total cell number recovered from Red Delicious apples. When fruit was stored for 1 month at 4°C prior to inoculation with E. coli O157:H7, all five cultivars supported growth of the bacterium. For each apple cultivar, the pH of bruised tissue was significantly higher and °Brix was significantly lower than the pH and °Brix of undamaged tissue regardless of the source. In freshly picked apples, changes in the pH did not occur over the harvest season. Bruised Golden Delicious, McIntosh, and Melrose apple tissue pHs were not significantly different (tree-picked or dropped), and the °Brix values of McIntosh, Macoun, and Melrose apple tissue were not significantly different. Single-cultivar preparations of cider did not support growth of E. coli, and the cell concentration of inoculated cider declined over an 11-day test period. The rate of decline in E. coli cell concentration in the McIntosh cider was greater than those in the other ciders tested. The findings of this study suggested that the presence of some factor besides, or in addition to, pH inhibited E. coli growth in McIntosh apples.
PMCID: PMC91945  PMID: 10698774
20.  Training understanding of reversible sentences: a study comparing language-impaired children with age-matched and grammar-matched controls 
PeerJ  2014;2:e656.
Introduction. Many children with specific language impairment (SLI) have problems with language comprehension, and little is known about how to remediate these. We focused here on errors in interpreting sentences such as “the ball is above the cup”, where the spatial configuration depends on word order. We asked whether comprehension of such short reversible sentences could be improved by computerized training, and whether learning by children with SLI resembled that of younger, typically-developing children.
Methods. We trained 28 children with SLI aged 6–11 years, 28 typically-developing children aged from 4 to 7 years who were matched to the SLI group for raw scores on a test of receptive grammar, and 20 typically-developing children who were matched to the SLI group on chronological age. A further 20 children with SLI were given pre- and post-test assessments, but did not undergo training. Those in the trained groups were given training on four days using a computer game adopting an errorless learning procedure, during which they had to select pictures to correspond to spoken sentences such as “the cup is above the drum” or “the bird is below the hat”. Half the trained children heard sentences using above/below and the other half heard sentences using before/after (with a spatial interpretation). A total of 96 sentences was presented over four sessions. Half the sentences were unique, whereas the remainder consisted of 12 repetitions of each of four sentences that became increasingly familiar as training proceeded.
Results. Age-matched control children performed near ceiling (≥ 90% correct) in the first session and were excluded from the analysis. Around half the trained SLI children also performed this well. Training effects were examined in 15 SLI and 16 grammar-matched children who scored less than 90% correct on the initial training session. Overall, children’s scores improved with training. Memory span was a significant predictor of improvement, even after taking into account performance on training session 1. Unlike the grammar-matched controls, children with SLI showed greater accuracy with repeated sentences compared with unique sentences. Training did not improve children’s performance on a standardized test of receptive grammar.
Discussion. Overall, these results indicate that a subset of children with SLI perform well below ceiling on reversible sentences with three key words and simple syntactic structure. For these children, weak verbal short-term memory appears to impair comprehension of spoken sentences. In contrast to the general finding that rule-learning benefits from variable input, these children seem to do best if given repeated exposure to the same nouns used with a given sentence frame. Generalisation to other sentences using the same syntactic frame may be more effective if preceded by such item-specific learning.
PMCID: PMC4226637  PMID: 25392757
Specific language impairment; Child; Language; Intervention; Grammar; Receptive language; Comprehension; Verbal memory; Procedural learning; Speech and language therapy
21.  Combined use of a McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome: a case report 
Korean Journal of Anesthesiology  2014;66(4):310-313.
Patients with Pierre Robin syndrome are characterized by micrognathia, retrognathia, glossoptosis, and respiratory obstruction and are prone to have a difficult-to-intubate airway. The McGrath® MAC video laryngoscope provides a better view of the glottis than a Macintosh laryngoscope, but it is not easy to insert an endotracheal tube through the vocal cords because a video laryngoscope has a much greater curvature than that of a conventional direct laryngoscope and an endotracheal tube has a different curvature. The Frova Intubating Introducer is used as a railroad for an endotracheal tube in cases of a difficult airway. We thought that a combination of these two devices would make it easy to insert an endotracheal tube through the vocal cords, as a McGrath® MAC video laryngoscope provides a better glottic view and the Frova Intubating Introducer is a useful device for placing an endotracheal tube through the glottis. We report a successful endotracheal intubation with use of the McGrath® MAC video laryngoscope and Frova Intubating Introducer in a patient with Pierre Robin syndrome.
PMCID: PMC4028560  PMID: 24851168
Airway management; Laryngoscope; Intubation; Pierre Robine syndrome
22.  Genome-Wide Association Analysis and Genomic Prediction of Mycobacterium avium Subspecies paratuberculosis Infection in US Jersey Cattle 
PLoS ONE  2014;9(2):e88380.
Paratuberculosis (Johne’s disease), an enteric disorder in ruminants caused by Mycobacterium avium subspecies paratuberculosis (MAP), causes economic losses in excess of $200 million annually to the US dairy industry. To identify genomic regions underlying susceptibility to MAP infection in Jersey cattle, a case-control genome-wide association study (GWAS) was performed. Blood and fecal samples were collected from ∼5,000 mature cows in 30 commercial Jersey herds from across the US. Discovery data consisted of 450 cases and 439 controls genotyped with the Illumina BovineSNP50 BeadChip. Cases were animals with positive ELISA and fecal culture (FC) results. Controls were animals negative to both ELISA and FC tests that matched cases on birth date and herd. Validation data consisted of 180 animals including 90 cases (positive to FC) and 90 controls (negative to ELISA and FC), selected from discovery herds and genotyped by Illumina BovineLD BeadChip (∼7K SNPs). Two analytical approaches were used: single-marker GWAS using the GRAMMAR-GC method and Bayesian variable selection (Bayes C) using GenSel software. GRAMMAR-GC identified one SNP on BTA7 at 68 megabases (Mb) surpassing a significance threshold of 5×10−5. ARS-BFGL-NGS-11887 on BTA23 (27.7 Mb) accounted for the highest percentage of genetic variance (3.3%) in the Bayes C analysis. SNPs identified in common by GRAMMAR-GC and Bayes C in both discovery and combined data were mapped to BTA23 (27, 29 and 44 Mb), 3 (100, 101, 106 and 107 Mb) and 17 (57 Mb). Correspondence between results of GRAMMAR-GC and Bayes C was high (70–80% of most significant SNPs in common). These SNPs could potentially be associated with causal variants underlying susceptibility to MAP infection in Jersey cattle. Predictive performance of the model developed by Bayes C for prediction of infection status of animals in validation set was low (55% probability of correct ranking of paired case and control samples).
PMCID: PMC3921184  PMID: 24523889
23.  OsiriX: An Open-Source Software for Navigating in Multidimensional DICOM Images 
Journal of Digital Imaging  2004;17(3):205-216.
A multidimensional image navigation and display software was designed for display and interpretation of large sets of multidimensional and multimodality images such as combined PET-CT studies. The software is developed in Objective-C on a Macintosh platform under the MacOS X operating system using the GNUstep development environment. It also benefits from the extremely fast and optimized 3D graphic capabilities of the OpenGL graphic standard widely used for computer games optimized for taking advantage of any hardware graphic accelerator boards available. In the design of the software special attention was given to adapt the user interface to the specific and complex tasks of navigating through large sets of image data. An interactive jog-wheel device widely used in the video and movie industry was implemented to allow users to navigate in the different dimensions of an image set much faster than with a traditional mouse or on-screen cursors and sliders. The program can easily be adapted for very specific tasks that require a limited number of functions, by adding and removing tools from the program’s toolbar and avoiding an overwhelming number of unnecessary tools and functions. The processing and image rendering tools of the software are based on the open-source libraries ITK and VTK. This ensures that all new developments in image processing that could emerge from other academic institutions using these libraries can be directly ported to the OsiriX program. OsiriX is provided free of charge under the GNU open-source licensing agreement at
PMCID: PMC3046608  PMID: 15534753
DICOM viewer; 3D; image fusion; dynamic series; open-source software
24.  Characteristics of early vocabulary and grammar development in Slovenian-speaking infants and toddlers: a CDI-adaptation study* 
Journal of Child Language  2012;40(4):779-798.
A large body of research shows that vocabulary does not develop independently of grammar, representing a better predictor of the grammatical complexity of toddlers' utterances than age. This study examines for the first time the characteristics of vocabulary and grammar development in Slovenian-speaking infants and toddlers using the Slovenian adaptation of the MacArthur-Bates Communicative Development Inventories (CDI). The sample included 512 Slovenian-speaking infants and toddlers aged 0 ; 8 to 2 ; 6. The findings suggest that between age 0 ; 8 and 2 ; 6 the development of vocabulary is best described using a quadratic function. The results also show that nouns predominate in the vocabularies of infants and toddlers of various ages; as they age and with the increasing size of their vocabularies, the share of interjections decreases and the share of verbs and adjectives increases. The size of vocabulary was also found to be related to the grammatical structure of toddlers' utterances.
PMCID: PMC3729236  PMID: 22863332
25.  Airtraq® versus Macintosh laryngoscope: A comparative study in tracheal intubation 
The curved laryngoscope blade described by Macintosh in 1943 remains the most widely used device to facilitate tracheal intubation. The Airtraq® (Prodol Meditec S.A, Vizcaya, Spain) is a new, single use, indirect laryngoscope introduced into clinical practice in 2005. It has wan exaggerated blade curvature with internal arrangement of optical lenses and a mechanism to prevent fogging of the distal lens. A high quality view of the glottis is provided without the need to align the oral, pharyngeal and tracheal axis. We evaluated Airtraq and Macintosh laryngoscopes for success rate of tracheal intubation, overall duration of successful intubation, optimization maneuvers, POGO (percentage of glottic opening) score, and ease of intubation.
Materials and Methods:
Patients were randomly allocated by computer-generated random table to one of the two groups, comprising 40 patients each, group I (Airtraq) and group II (Macintosh). After induction of general anesthesia, tracheal intubation was attempted with the Airtraq or the Macintosh laryngoscope as per group. Primary end points were overall success rate of tracheal intubation, overall duration of successful tracheal intubation, optimization maneuvers, POGO score and ease of intubation between the two groups.
We observed that Airtraq was better than the Macintosh laryngoscope as duration of successful intubation was shorter in Airtraq 18.15 seconds (±2.74) and in the Macintosh laryngoscope it was 32.72 seconds (±8.31) P < 0.001. POGO was also better in the Airtraq group 100% grade 1 versus 67.5% in the Macintosh group, P < 0.001. Ease of intubation was also better in the Airtraq group. It was easy in 97.5% versus 42.5% in the Macintosh group, P < 0.001.
Both Airtraq and Macintosh laryngoscopes are equally effective in tracheal intubation in normal airways. Duration of successful tracheal intubation was shorter in the Airtraq group which was statistically significant.
PMCID: PMC4173514
Airtraq; airway; laryngoscope; macintosh; tracheal intubation

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