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11.
This article replicates for Kinsey's male sample the decade-of-birth analyses provided in the Kinsey female volume. Five generations of male respondents are compared in terms of total frequency of sexual activity, and frequency and incidence of nine specific categories of sexual behavior. In general, unmarried males born after 1900 experienced more frequent sexual outlet than did nineteenth-century males. Additionally, the proportion of total outlet devoted to various specific activities varied by birth decade. Solitary masturbation rose somewhat spectacularly in significance with the passing decades, while nocturnal emissions and animal contacts declined. Orgasms provided by heterosexual activities increased slightly for the early twentieth-century generations, but then declined to a point below their nineteenth-century levels. Although homosexual contacts accounted for a constant percentage of total outlet for unmarried males over the five generations, more males in each succeeding generation were actively engaging in homosexual activity, at least on a casual basis. Similarly, although heterosexual contacts accounted for a smaller percentage of all activity among the unmarried in later generations, more of the later-born males had engaged in such activity at least once. For married males, on the other hand, frequency of total outlet was unaffected by generation. A large and stable proportion of this outlet was provided by marital coitus. Although more males in later generations had experienced extramarital contacts, such activities accounted for a small and reasonably stable proportion of total outlet, when frequency of occurrence was considered. Masturbation gained in significance, while nocturnal emissions and homosexual contacts declined, and animal contacts among the married were almost nonexistent in all generations. 相似文献
12.
Whole body 18FDG-PET and the response of esophageal cancer to induction therapy: results of a prospective trial. 总被引:13,自引:0,他引:13
Robert J Downey Tim Akhurst David Ilson Robert Ginsberg Manjit S Bains Mithat Gonen Heng Koong Marc Gollub Bruce D Minsky Maureen Zakowski Alan Turnbull Steven M Larson Valerie Rusch 《Journal of clinical oncology》2003,21(3):428-432
PURPOSE: Whole-body 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) imaging before and after induction therapy was prospectively evaluated in patients with esophageal cancer to determine whether changes in PET images could measure response to therapy. PATIENTS AND METHODS: Between April 1997 and April 1999, 39 patients (34 men and five women; median age, 59 years; range, 36 to 76 years) with esophageal cancer were prospectively enrolled in a single-institution clinical trial of staging, including PET, induction therapy, restaging including PET, and esophagectomy. All patients undergoing esophagectomy after induction therapy (n = 17) were followed either to recurrence, to death, or through a disease-free interval of at least 24 months. RESULTS: PET after standard staging studies and before therapy imaged undetected sites of metastatic disease in six patients (15%). Restaging (including PET) after induction therapy did not identify any patients with disease progression or any patients with loco-regionally unresectable disease at exploration. The median decrease in the standardized uptake value (SUV) during induction therapy was 59%. After R0 esophagectomy, the 2-year disease-free and overall survival was 38% and 63%, respectively, among patients who had a less than 60% decrease in SUV, and 67% and 89%, respectively, among patients who had a greater than 60% decrease in SUV (P =.055 and P =.088, respectively). CONCLUSION: Compared with conventional imaging, PET detects additional sites of metastatic disease at initial evaluation. After induction therapy, PET did not add to the estimation of loco-regional resectability and did not detect new distant metastases. However, changes in [18F]FDG PET may predict disease-free and overall survival after induction therapy and resection in patients with esophageal cancer. Further evaluation in larger trials is warranted. 相似文献
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Michael H. McGillion Emmanuelle Duceppe Katherine Allan Maura Marcucci Stephen Yang Ana P. Johnson Sara Ross-Howe Elizabeth Peter Ted Scott Carley Ouellette Shaunattonie Henry Yannick Le Manach Guillaume Paré Bernice Downey Sandra L. Carroll Joseph Mills Andrew Turner Wendy Clyne P.J. Devereaux 《The Canadian journal of cardiology》2018,34(7):850-862
Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented. 相似文献
18.
Matthew E. Modes Ruth A. Engelberg Lois Downey Elizabeth L. Nielsen J. Randall Curtis Erin K. Kross 《Journal of pain and symptom management》2019,57(2):251-259
Context
Goals-of-care discussions are associated with improved end-of-life care for patients and therefore may be used as a process measure in quality improvement, research, and reimbursement programs.Objectives
To examine three methods to assess occurrence of a goals-of-care discussion—patient report, clinician report, and documentation in the electronic health record (EHR)—at a clinic visit for seriously ill patients and determine whether each method is associated with patient-reported receipt of goal-concordant care.Methods
We conducted a secondary analysis of a multicenter cluster-randomized trial, with 494 patients and 124 clinicians caring for them. Self-reported surveys collected from patients and clinicians two weeks after a clinic visit assessed occurrence of a goals-of-care discussion. Documentation of a goals-of-care discussion was abstracted from the EHR. Patient-reported receipt of goal-concordant care was assessed by survey two weeks after the visit.Results
Fifty-two percent of patients reported occurrence of a goals-of-care discussion at the clinic visit; clinicians reported occurrence of a discussion at 66% of visits. EHR documentation occurred in 42% of visits (P < 0.001 for each compared with other two). Patients who reported occurrence of a goals-of-care discussion at the visit were more likely to report receipt of goal-concordant care than patients who reported no discussion (β 0.441, 95% CI 0.190–0.692; P = 0.001). Neither occurrence of a discussion by clinician report nor by EHR documentation was associated with goal-concordant care.Conclusion
Different approaches to assess goals-of-care discussions give differing results, yet each may have advantages. Patient report is most likely to correlate with patient-reported receipt of goal-concordant care. 相似文献19.
20.
A ‘crazy-paving’ appearance of the lungs on computed tomography scanning of the chest was first described nearly 20 years ago in patients with pulmonary alveolar proteinosis, and was thought to be characteristic of this condition. However, this pattern has subsequently been reported in a variety of pulmonary diseases and is now considered to be nonspecific. The present report describes a case of a 74-year-old man in whom congestive heart failure presented with a crazy-paving appearance of the lungs on a chest computed tomography scan. This uncommon association illustrates the importance of the correlation of clinical and radiographic information. 相似文献