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PubMed2004

Moving toward a more patient-centered health care delivery system.

Quality-of-care measurement has not kept pace with the recent shift toward policy approaches that rely on patients to contain costs and improve quality. If patients are to play a critical role in care, then the degree to which providers support and improve patients' capabilities for participation must also be part of the quality measurement picture. Quality measures that focus on intermediate patient outcomes (such as self-management ability), that follow the patient over time, and that integrate measurement into the processes of care are necessary to move toward a delivery system that is centered on patients.

Chronic Disease↗
PubMed2000

Symbolic representation across domains in preschool children.

The study examines children's understanding of notational representation. Children 3 to 5 years old were shown a card containing a notation and told what it said. The children were asked to say what was printed on the card 3 times: when it was under a display named by the notation, when it was under a different display, and finally when it had been returned to the original position. In Study 1, the card contained a word or a picture indicating object identity or a numeral or an analogue indicating quantity. All the children could solve the problems containing pictures, numerals, or analogues, but the word condition was difficult and children believed that the word changed when the card moved to the new display. In Study 2, the comparison between object names and quantities was made more equitable by introducing easy and difficult versions of each condition. This time, there was little difference between cards indicating names and those indicating quantities but large differences in children's ability to solve the problem as a function of their familiarity with the notation that was written. The results point to weaknesses in children's understanding of how representations refer to meanings.

Child Development↗
PubMed1997

[Juvenile hyaline fibromatosis].

Juvenile hyaline fibromatosis is a rare autosomal recessive connective tissue disease first described in 1873 by Murray. Major diagnostic criteria are multiple cutaneous tumors and gingival hypertrophy; minor criteria include contractures, osteolytic lesions and a positive family history. After a normal perinatal period at the age of 6 months our 24 year old patient developed gingival hypertrophy. During the first months of life several skin coloured nodules had been noticed on the neck and in the perianal area. At the age of 15 months, these nodules began to appear more rapidly, both spontaneously and posttraumatically. The patient showed normal development, but the lesions progressed. By the age of 15 years, the patient had extensive deformities and was unable to walk and move by himself. Both his sisters and the unrelated parents had no lesions. Essential for the diagnosis are the clinical picture and the histology. Electron microscopy is helpful to support the diagnosis. Defective connective tissue proteins such as chondroitin, collagen and mucopolysaccharides are probably the pathological defect. A therapy is so far unknown.

Adult↗
PubMed1999

Motion of grains down a bumpy surface.

We summarize in this article an extensive experimental and theoretical effort carried out to understand the behavior of a single ball when rolling down a bumpy surface. This may appear to be a simple problem but in fact is one that displays a rich variety of different behaviors which allow us to understand better dissipative systems such as granular media. Studies performed previously have shown that the motion of the single ball on the rough surface can be characterized by three different dynamic regimes according to the different values of the two control parameters, the inclination angle theta and the ratio Phi=R/r, where R is the radius of the rolling ball and r the radius of the glass beads which make up the rough surface. The three regimes are a decelerated regime A, a stationary regime B, characterized by a constant average velocity and a jumping regime C. This result was found to be independent of the composition of the rolling ball and the rough surface. It has been demonstrated that regime B is characterized by a viscous-like friction force that appears for specific parameter values. This friction force can be explained by a model whose central ingredient is the geometry of the surface. The trajectory of the ball in regime B can be pictured as a driven random walk motion where the fluctuations of the local velocities are due to collisions of the moving sphere and the surface grains. A detailed analysis of diffusive properties of the motion is discussed. (c) 1999 American Institute of Physics.

Journal Article↗
PubMed1990

[Alveolitis caused by furnishing a medical office].

This article reports on the occurrence of an exogenous-allergic alveolitis that developed in a colleague who moved into new consulting rooms and an apartment. The diagnosis was established on the basis of typical X-ray picture, typical pulmonary function test findings, typical BAL and the histological findings established in transbronchial pulmonary biopsy material. The putative cause was moulds, the source of which could not be completely identified. In the history of an exogenous-allergic alveolitis, domestic allergens should be taken into account, even when such apparent sources of allergens as room humidifiers or pet birds are not present.

Adult↗
PubMed1991

Children's understanding of action lines and the static representation of speed of locomotion.

Children's understanding of the static representation of speed of locomotion was explored in 2 experiments. In Experiment 1, 20 7-year-olds and 20 9-year-olds drew pictures of 2 people walking and running at different speeds. Children then made judgments about pairs of unambiguous drawings of a person walking or running, as did a sample of 20 adults. The drawings varied according to whether action lines, background lines, or no lines were present. Children were asked to say which figure appeared to be moving faster. In Experiment 2, 20 7-year-olds, 20 9-year-olds, and 21 adults sorted ambiguous drawings of a person walking and running at different speeds. The pictures again contained action lines, background lines, or no lines. In the drawing task, children more frequently used page position and biomechanical information than action lines to represent fast and slow walking and running. In the judgment task, 7- and 9-year-olds offered equivalent judgments of action lines and background lines, whereas adults distinguished between these pictorial devices. In the sorting task, all subjects distinguished between action lines and background lines and judged that pictures containing action lines looked faster than pictures containing background lines and pictures without lines. Taken together, the results indicate that subjects' judgments were influenced by the form of locomotion and degree of ambiguity in the depicted events they saw. The findings are consistent with the view that different categories of pictorial devices exist, but the effectiveness of each device is contingent upon the perceiver's experience with it and the context in which it appears.

Acceleration↗
PubMed1992

[A new method for the quantitative and qualitative measurement of tooth movements].

A new method for the in vivo measurement of the movements of teeth is described. Measuring blocks are attached to brackets and tubes. Calibrated holes are drilled in each side of the blocks. Using an electronic sliding caliper, measurements are made in all three dimensions between moving teeth and blocks of anchored segments. With the aid of a computer programme, these measurements can be used to construct pictures of various teeth. By taking measurements at different stages of treatment, the movements of the teeth can be shown in three-dimensional images.

Adolescent↗
PubMedDate not supplied

Community residential care: comparison of cognitively impaired and noncognitively impaired residents.

Community residential care (CRC) is growing, with cognitive impairment the most common reason for CRC placement. We enrolled cognitively impaired and noncognitively impaired residents, informal caregivers, and providers in 219 CRC facilities for this study. Residents with cognitive impairment were older (p < .001), needed more activities of daily living (ADL) assistance (p < .001), and had a higher frequency of behavior problems (p < .001) than noncognitively impaired residents. Cognitively impaired and noncognitively impaired residents did not significantly differ in the facility-related factors they perceived as important or in the amount of control they felt they had over the decision to move. Including residents with cognitive impairment in future research and separately analyzing residents by cognitive status will give a more accurate picture of the needs of CRC residents.

Activities of Daily Living↗
PubMed1988

Relation of mobility-fixity to the interpretation of pictorial stimuli.

A group of 61 students who had previously (in 1986) been classified by Hansson, Rydén, and Johnsson in terms of perceptual fixity-mobility using a "free" Rod-and-Frame Test, were investigated regarding their interpretations of a nonfigurative stimulus shown repetitively at short exposure-times, and their characterization of two pictures each portraying two soldiers in intensive interaction--one man apparently attacking the other in the first picture and apparently rescuing or taking care of the other man in the second. Mobile subjects on the free Rod-and-Frame Test reported a larger number of different interpretations of the nonfigurative stimulus and construed it more frequently in terms of human themes than did the fixed subjects; in rating the pictures of soldiers, they used more extreme and complex characteristics. It appeared that, when confronted with ambiguous stimuli, the mobile individual moves both "horizontally", as it were, along the surface of objective reality, and "vertically", from present to past realities, thus conjoining subjective-emotional and objective-analytic aspects of perception. This interpretation agrees with Werner's model of mobility-fixity which implies that the mobile individual operates on different developmental levels of perceptual functioning.

Attention↗
PubMed2004

A contribution to sonograph image quality estimation using point spread function.

In medical sonography, sonograph image quality is an essential aspect for the safety of both patient and doctor. Its evaluation therefore requires an accurate and objective method for measurement. In this regard, a number of methods are in current use. Most of these are based on tissue mimicking phantom imaging. In contrast, we have used another principle based on Point Spread Function (PSF) analysis which is a product of the measuring system we have developed. In this case, the measured sonograph scans a small metallic ball target that moves in a water bath on a specified trajectory. The Region Of Interest (ROI) of the sonogram containing the ball target picture is digitised and the amplitude of the pixels analysed. The result is the PSF from which we calculate the lateral resolution (LR). For this purpose, we use our own original software. Using this method, we have to date been able to plot LR characteristics over the scanning plane. The method allows us to differentiate separate scanning lines and even multiple focal areas for dynamic focussing systems. It can detect malfunctions in dynamic focussing, size of aperture, time gain compensation function and/or transducer element failure. The procedure itself is not as easy or as fast to use as tissue mimicking phantoms or 3D signal to noise ratio evaluation, but it provides accurate and objective numeric parameters corresponding to the quality of image at any specified point over the whole scanning area. It is also a very powerful tool when used in combination with the other methods mentioned above.

Phantoms, Imaging↗
PubMed1989

[Inflammatory giant polyps of the colon].

Five cases of inflammatory giant polyps associated with idiopathic colitis are presented. The underlying disease was ulcerative colitis in 3 cases and Crohn's disease in 2 cases. The alteration caused in 3 cases passage disorders. Physical and X-ray examinations raised the possibility of malignancy, thus operation was performed. In 2 further cases endoscopic polypectomy brought improvement and the operation could be avoided. On the basis of electronmicroscopic examination the authors are of the opinion that giant polyps are specific forms of inflammatory granulation with fibroblasts, myofibroblasts, vessels, mast cells and extended autonomous nerves as dominant elements. It is held as feasible that due to the nerves and contractile myofibroblasts these forms are capable to move actively. This might explain the peduncle formation and - together with the passage disorders- the strong abdominal spasm characterizing the clinical picture.

Adult↗
PubMed1988

Effects of vincristine in combination with methotrexate and other antitumor agents in human acute lymphoblastic leukemia cells in culture.

The effects of vincristine (VCR) in combination with methotrexate (MTX) and other antitumor agents were evaluated by cell growth inhibition assay using a human acute lymphoblastic leukemia cell line (MOLT-3). The data were analyzed with the aid of an isobologram using the concept of an envelope of additivity (G. G. Steel and M. J. Peckman, Int. J. Radiat. Oncol., 5:85-91, 1979). Simultaneous exposure of VCR and MTX produced subadditive or mutually protective interactions. Sequential exposure to VCR first followed immediately by MTX produced similar interactions. When the interval of VCR exposure first and then MTX was increased from 0 to 3, 8, and 24 h, the inhibition of cell growth moved from protection and subadditivity to additivity only. The reversed order of exposure to the 2 drugs produced an entirely different picture. Thus, when the interval of MTX exposure first followed by VCR increased from 0 to 3, 8, and 24 h, the inhibitory effects of the combination changed progressively from the area of subadditivity to the area of supraadditivity. When these data were evaluated using median effect plot analyses (T-C. Chou and P. Talalay. In: New Avenues in Developmental Cancer Chemotherapy, pp. 36-64. Orlando, FL: Academic Press, 1987), strongly synergistic interaction of this sequence at space intervals was confirmed. These data show that the synergistic effects were produced only when MTX was followed 8 or 24 h later by VCR. Other schedules were only additive or even antagonistic. Simultaneous exposure of VCR with daunorubicin, 1-beta-D-arabinofuranosylcytosine, or bleomycin also had subadditive and protective effects. VCR, followed by daunorubicin with the interval of 24 h and vice versa, was again subadditive and protective. VCR, followed by 1-beta-D-arabinofuranosylcytosine with the interval of 24 h and vice versa, was again subadditive or additive only. Simultaneous and continuous exposures of VCR with vinblastine or L-asparaginase were only marginally supraadditive.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1994

[Practice patterns of dentists and maxillofacial surgeons in private practice, in 1993, in France].

Actually, oral medicine and maxillo-facial surgery are really moving. There is no detail's study of the different aspects of our specialty, so we had like to realise a "picture" of our activity in the private sector in 1993. In this evaluation, an answering has been sent to the whole professional. Per 37.2% of answers have been received. The aim of this article is describing you the oral medicine and maxillo-facial surgery population following, in 4 points: old and sex demography; university and post-university formation; surgical or no activity repartition; exercises and installations.

Adult↗
PubMed2004

Feasibility study of normal and septic tracheal imaging using optical coherence tomography.

BACKGROUND AND OBJECTIVES: Optical coherence tomography (OCT) is an imaging technology that may be adapted for use with flexible fiberoptic bronchoscopy, potentially allowing it to play an important role in pulmonary diagnostics. The goal of this study was to evaluate the feasibility of OCT to image tracheal pathology. STUDY DESIGN/MATERIALS AND METHODS: Tracheas were harvested from normal and septic New Zealand White rabbits and imaged using OCT. Two delivery devices were employed. One was a moving stage with an objective lens and collimator, the other a linear scanning flexible fiberoptic catheter using a GRIN lens and prism for endoscopic OCT. After OCT images were obtained from normal and septic tracheas, the excised tissues were prepared for standard histologic examination. Areas imaged by OCT were compared with corresponding histology slides. RESULTS: OCT images demonstrated in detail tracheal sub-surface structures such as the epithelium, lamina propria, submucosa, and cartilage. The appearance of structures imaged by OCT corresponded very well with histologic pictures obtained by light microscopy. The OCT images from septic tracheas showed marked swelling of the mucosal and submucosal layers. Such pathology was equally imaged by either the moving stage or fiberoptic catheter for endoscopic OCT. CONCLUSIONS: OCT images of the trachea can distinguish many sub-surface structural features usually requiring biopsy and light microscopy for visualization. Marked differences between normal and septic trachea were apparent in OCT images. In the future, OCT may be a valuable tool for evaluating tracheal pathology in situ with high image resolution.

Animals↗
PubMed1989

From non-random molecular structure to life and mind.

The evolutionary hierarchy molecular structure-->macromolecular structure-->protobiological structure-->biological structure-->biological functions has been traced by experiments. The sequence always moves through protein. Extension of the experiments traces the formation of nucleic acids instructed by proteins. The proteins themselves were, in this picture, instructed by the self-sequencing of precursor amino acids. While the sequence indicated explains the thread of the emergence of life, protein in cellular membrane also provides the only known material basis for the emergence of mind in the context of emergence of life.

Cell Membrane↗
PubMed2003

1H and 19F PGSE diffusion studies on iridium PHOX complexes: counterion and solvent dependences.

1H and (19)F pulsed gradient spin-echo (PGSE) diffusion studies on cationic mono- and trinuclear iridium complexes containing the PHOX chiral P,N-auxiliary (S)-4-tert-butyl-2-[2-(di-o-tolylphosphino)phenyl]-4,5-dihydrooxazole with the anions BF(4)(-), PF(6)(-), OTf(-), B(C(6)F(5))(4)(-), and BArF(-) in methanol, chloroform, methylene chloride, and 1,2-dichloroethane are reported. In chloroform, the anion and cation within each salt afford almost the same, relatively small, diffusion constant (D-value) suggesting strong ion-pairing. In methanol, the D-value for the cation is the same in the five mononuclear salts, suggesting that the cation is moving independently of the anion (no ion-pairing). In methylene chloride and 1,2-dichloroethane the diffusion data suggest a mixed picture for the five anions. While the smaller BF(4)(-), PF(6)(-), and OTf(-) anions do not affect the translation of the cations, the larger boron-based anions B(C(6)F(5))(4)(-) and BArF(-) clearly slow the motions of the cations. However, it would seem that for all five anions there is some--but not complete--ion pairing in these two solvents.

Journal Article↗
PubMed2000

Floating gallbladder: a questionable prelude to torsion: a case report.

A 55-year-old woman had recurrent bouts of low substernal and epigastric pain radiating into the interscapular region. A hepatobiliary scan initially showed what was believed to be a dilated common bile duct and nonvisualization of the gallbladder. A delayed image obtained after having the patient move about revealed the presence of a filled gallbladder and normal common bile duct. The combination of recurrent pain with this scintigraphic picture may be representative of a floating gallbladder or an incomplete torsion with spontaneous detorsion. This case is presented to describe the scintigraphic appearance of a mobile gallbladder that may be prone to volvulus and to emphasize the importance of obtaining decubitus or oblique views at the end of a hepatobiliary study in selected cases of unusual findings.

Common Bile Duct↗