Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation

Background: Although behavioural treatment (biofeedback) successfully treats the pelvic floor abnormalities in patients with idiopathic constipation, many patients also normalise their impaired bowel frequency. We postulated that a response may be associated with altered cerebral outflow via extrinsic autonomic nerves to the gut. We investigated whether treatment changes extrinsic innervation, using mucosal laser Doppler flowmetry, whether autonomic changes are gut specific, and whether it changes gut transit. Materials and methods: Forty nine patients (44 female, mean age 39 years) with idiopathic constipation were studied before and after biofeedback treatment (mean five sessions). Rectal mucosal blood flow was measured by laser Doppler flowmetry to assess direct extrinsic gut nerve autonomic activity. To assess general autonomic activity, RR (interval between successive R waves on the electrocardiogram) variability, Valsalva ratio, orthostatic adjustment ratio, and phase II:IV blood pressure ratio (II:IV) of the Valsalva manoeuvre were measured. All autonomic tests were compared with those of 26 healthy volunteers (19 female, mean age 37 years). Results: Twenty nine of 49 patients were symptomatically improved. Treatment reduced those with 3 bowel actions per week (27 v 9, pre v post), need to strain (26 v 9), and laxative or suppository use (34 v 9). Biofeedback reduced retained markers by 32% in those with slow transit and by 20% in those with normal transit. Twenty two had slow transit before treatment14 felt symptomatic improvement of whom 13 developed normal transit. There was a significantly greater increase in rectal mucosal blood flow in patients who subjectively improved compared with those who did not (29% v 7%; p<0.03) and in those with improved bowel frequency (33% v 9%, increased v unchanged bowel frequency; p<0.05). Thirty five patients had abnormal RR variability and 33 an abnormal Valsalva ratio; one had an abnormal orthostatic adjustment ratio and one an abnormal II:IV ratio. None of the general cardiorespiratory autonomic reflexes was changed by treatment. Conclusions: Biofeedback treatment affects more than the pelvic floor. Successful outcome after biofeedback treatment is associated with improved activity of the direct cerebral innervation to the gut and improved gut transit. This effect is gut specific; cardiovascular autonomic reflexes were not altered

Relationship between psychological state and level of activity of extrinsic gut innervation in patients with a functional gut disorder

Background: Anxiety and depression are known to be associated with alterations in central autonomic activity, and this may manifest as a functional gut disturbance. However, the final expression of motility disturbance is non-specific and non-quantifiable. This study examines the relationship between psychological state and psychosocial functioning with a new direct measure of the level of activity of extrinsic autonomic gut innervation, rectal mucosal Doppler blood flow. Materials and methods: Thirty four female patients (mean age 36 years, range 19-45) with constipation for greater than five years and 19 healthy women (mean age 38 years, range 21-60) were studied. They completed the general health questionnaire28 point scale (GHQ-28; psychosocial functioning) and the Bem sex role inventory (BSRI; an index of women's psychological feelings about their own femininity). On the same day they underwent measurement of rectal mucosal Doppler blood flow, a new validated measure of the activity of gut extrinsic nerve innervation. Measurements were made during the follicular phase and in the fasted state. Results: Women with constipation scored higher on the total GHQ-28 score and the somatisation (p=0.05) and anxiety (p=0.05) subscales of the GHQ-28. There was a negative correlation between mucosal blood flow and GHQ somatisation subscale (r=0.45, p<0.005), anxiety (r=0.38, p<0.05), and depression (r=0.40, p<0.01) scores in women with constipation. Although constipated women scored no higher than controls on the BSRI, there was a significant negative correlation between blood flow and BSRI score (r=0.49, p<0.005) for constipated women. Conclusions: General psychosocial function, somatisation, anxiety, depression, and feelings about female role are impaired in women with constipation and associated with altered rectal mucosal blood flow, a measure of extrinsic gut innervation. These findings suggest that psychological factors are likely to influence gut function via autonomic efferent neural pathways

Decoding coalescent hidden Markov models in linear time

In many areas of computational biology, hidden Markov models (HMMs) have been used to model local genomic features. In particular, coalescent HMMs have been used to infer ancient population sizes, migration rates, divergence times, and other parameters such as mutation and recombination rates. As more loci, sequences, and hidden states are added to the model, however, the runtime of coalescent HMMs can quickly become prohibitive. Here we present a new algorithm for reducing the runtime of coalescent HMMs from quadratic in the number of hidden time states to linear, without making any additional approximations. Our algorithm can be incorporated into various coalescent HMMs, including the popular method PSMC for inferring variable effective population sizes. Here we implement this algorithm to speed up our demographic inference method diCal, which is equivalent to PSMC when applied to a sample of two haplotypes. We demonstrate that the linear-time method can reconstruct a population size change history more accurately than the quadratic-time method, given similar computation resources. We also apply the method to data from the 1000 Genomes project, inferring a high-resolution history of size changes in the European population.Comment: 18 pages, 5 figures. To appear in the Proceedings of the 18th Annual International Conference on Research in Computational Molecular Biology (RECOMB 2014). The final publication is available at link.springer.co

The structure, function, and pathology of the thyroid gland

This item was digitized by the Internet Archive. Thesis (M.A.)--Boston Universityhttps://archive.org/details/thestructurefunc00kam

A Study of Patient Satisfaction at Big Horn Basin Orthopedic Clinic, P. C. Therapy Center in Powell, Wyoming

The purpose of this study was to design and distribute a patient satisfaction survey that identifies the needs of the patients of Big Horn Basin Orthopedic Clinic, P.C. Therapy Center in Powell, Wyoming (Clinic). The survey gathered information in 4 areas related to patient satisfaction: overall satisfaction, patient-therapist interactions, clinic operations, and billing procedures. During the summer of 2000, 150 surveys were sent out to discharged patients of the Clinic and 75 were returned. The mean scores for all of the questions on the survey scored near the high end of the scale. The questions related to clinic operations had the highest mean score while the billing questions had the lowest mean score. The data from this study was compared to the results of different patient satisfaction studies. It was found that the results from this study were consistent with other studies in physical therapy settings. However, patient satisfaction ratings from this study were much higher when compared to nonphysical therapy settings. Patient satisfaction remains an important indicator of quality in health care. As health care providers become more knowledgeable concerning patient expectations, corrections can be made in the health care delivery process to ensure satisfaction for everyone

Baselines and Compensation

The first problem that we shall examine is raised by the cases in which by our tortious wrong act someone is either (1) made no worse off than he would have been because the injury is one he would have suffered anyway by another means or (2) made better off because, though the act produces an injury, it benefits him by interfering with an upcoming greater injury. Should we assign liability based on the fact that an injury was caused relative to how the person was in his prior uninjured state (namely, the causal approach)? Or, should we take account of the fact that the person either was made no worse off or received a benefit relative to how he would have been in the future had there been no tortious act (namely, the counterfatual approach)

Turvalisel ühisarvutusel põhinev privaatsust säilitav statistiline analüüs

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Kaasaegses ühiskonnas luuakse inimese kohta digitaalne kirje kohe pärast tema sündi. Sellest hetkest alates jälgitakse tema käitumist ning kogutakse andmeid erinevate eluvaldkondade kohta. Kui kasutate poes kliendikaarti, käite arsti juures, täidate maksudeklaratsiooni või liigute lihtsalt ringi mobiiltelefoni taskus kandes, koguvad ning salvestavad firmad ja riigiasutused teie tundlikke andmeid. Vahel anname selliseks jälitustegevuseks vabatahtlikult loa, et saada mingit kasu. Näiteks võime saada soodustust, kui kasutame kliendikaarti. Teinekord on meil vaja teha keeruline otsus, kas loobuda võimalusest teha mobiiltelefonikõnesid või lubada enda jälgimine mobiilimastide kaudu edastatava info abil. Riigiasutused haldavad infot meie tervise, hariduse ja sissetulekute kohta, et meid paremini ravida, harida ja meilt makse koguda. Me loodame, et meie andmeid kasutatakse mõistlikult, aga samas eeldame, et meie privaatsus on tagatud. Käesolev töö uurib, kuidas teostada statistilist analüüsi nii, et tagada üksikisiku privaatsus. Selle eesmärgi saavutamiseks kasutame turvalist ühisarvutust. See krüptograafiline meetod lubab analüüsida andmeid nii, et üksikuid väärtuseid ei ole kunagi võimalik näha. Hoolimata sellest, et turvalise ühisarvutuse kasutamine on aeganõudev protsess, näitame, et see on piisavalt kiire ja seda on võimalik kasutada isegi väga suurte andmemahtude puhul. Me oleme teinud võimalikuks populaarseimate statistilise analüüsi meetodite kasutamise turvalise ühisarvutuse kontekstis. Me tutvustame privaatsust säilitavat statistilise analüüsi tööriista Rmind, mis sisaldab kõiki töö käigus loodud funktsioone. Rmind sarnaneb tööriistadele, millega statistikud on harjunud. See lubab neil viia läbi uuringuid ilma, et nad peaksid üksikasjalikult tundma allolevaid krüptograafilisi protokolle. Kasutame dissertatsioonis kirjeldatud meetodeid, et valmistada ette statistiline uuring, mis ühendab kaht Eesti riiklikku andmekogu. Uuringu eesmärk on teada saada, kas Eesti tudengid, kes töötavad ülikooliõpingute ajal, lõpetavad nominaalajaga väiksema tõenäosusega kui nende õpingutele keskenduvad kaaslased.In a modern society, from the moment a person is born, a digital record is created. From there on, the person’s behaviour is constantly tracked and data are collected about the different aspects of his or her life. Whether one is swiping a customer loyalty card in a store, going to the doctor, doing taxes or simply moving around with a mobile phone in one’s pocket, sensitive data are being gathered and stored by governments and companies. Sometimes, we give our permission for this kind of surveillance for some benefit. For instance, we could get a discount using a customer loyalty card. Other times we have a difficult choice – either we cannot make phone calls or our movements are tracked based on cellular data. The government tracks information about our health, education and income to cure us, educate us and collect taxes. We hope that the data are used in a meaningful way, however, we also have an expectation of privacy. This work focuses on how to perform statistical analyses in a way that preserves the privacy of the individual. To achieve this goal, we use secure multi-­‐party computation. This cryptographic technique allows data to be analysed without seeing the individual values. Even though using secure multi-­‐party computation is a time-­‐consuming process, we show that it is feasible even for large-­‐scale databases. We have developed ways for using the most popular statistical analysis methods with secure multi-­‐party computation. We introduce a privacy-­‐preserving statistical analysis tool called Rmind that contains all of our resulting implementations. Rmind is similar to tools that statistical analysts are used to. This allows them to carry out studies on the data without having to know the details of the underlying cryptographic protocols. The methods described in the thesis are used in practice to prepare for running a statistical study on large-­‐scale real-­‐life data to find out whether Estonian students who are working during university studies are less likely to graduate in nominal time