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PubMed1996

Learning opportunities for internal medicine residents: comparison of a tertiary care setting and a regional setting.

PURPOSE: To compare the learning opportunities for internal medicine residents in tertiary care and community hospital settings. METHOD: Two sites were studied: Victoria General Hospital, a teaching hospital affiliated with the Dalhousie University Faculty of Medicine, staffed by five general internists and serving Halifax County (population of 420,000); and South Shore Regional Hospital, serving the community of Bridgewater (with a catchment area of 50,000) and staffed by three general internists. All in- and outpatients seen in the two settings over a one-year period (1993) were described in accordance with the Canadian Institute for Health Information's major clinical categories, as well as a case mixture recommended as providing appropriate learning experiences for internal medicine clerks. Over a one-month period (August 1993), consecutive patients were interviewed, completing a health status questionnaire, the Medical Outcome Study Short Form 36 (SF-36). RESULTS: Data were collected from the records of 2,763 patients, and the SF-36 questionnaire was administered to 406 patients. The data indicate that the settings were relatively similar except that there was more case variety in the tertiary care setting, and that more patients with cardiovascular disease and no patient with acquired immune deficiency syndrome were seen in the regional setting. Quality-of-life scores showed similarities to norms in the United States and United Kingdom, except that the ambulatory patients in the regional setting had rather lower scores. CONCLUSION: Overall, the patients' problems in the regional and tertiary care settings offered similar learning opportunities.

Aged↗
PubMed2002

Ranked set sampling: cost and optimal set size.

McIntyre (1952, Australian Journal of Agricultural Research 3, 385-390) introduced ranked set sampling (RSS) as a method for improving estimation of a population mean in settings where sampling and ranking of units from the population are inexpensive when compared with actual measurement of the units. Two of the major factors in the usefulness of RSS are the set size and the relative costs of the various operations of sampling, ranking, and measurement. In this article, we consider ranking error models and cost models that enable us to assess the effect of different cost structures on the optimal set size for RSS. For reasonable cost structures, we find that the optimal RSS set sizes are generally larger than had been anticipated previously. These results will provide a useful tool for determining whether RSS is likely to lead to an improvement over simple random sampling in a given setting and, if so, what RSS set size is best to use in this case.

Absorptiometry, Photon↗
PubMed1995

Effect of initial setting on convergence to optimal hearing aid setting using a simplex method.

We examined the final preferred frequency gain response (i.e. final setting) selected using different starting points (i.e. initial settings) with a modified simplex procedure. These starting points included a frequency response close to the one recommended by NAL-R (Byrne and Dillon, 1986), a frequency response with the high and low frequency gain set to the maximum (max), a frequency response with the high and low frequency gain set to the minimum (min), and one in-between these values (mid). The time taken to converge to the final setting was also recorded. Subjects judged the clarity of short discourse passages presented at 63 dB(A) in the presence of babble noise (S/N = 0). The results indicated that the majority of subjects selected the same preferred frequency response regardless of initial settings. Variations in initial settings mainly affected the convergence time to the final choice. The frequency response recommended by NAL-R required the least time to converge, while those of the extremes (min and max) required the longest convergence time. Clinical implications are discussed.

Adult↗
PubMed1990

National standard setting for quality of care in general practice: attitudes of general practitioners and response to a set of standards.

The Nederlands Huisartsen Genootschap (NHG), the college of general practitioners in the Netherlands, has begun a national programme of standard setting for the quality of care in general practice. When the standards have been drawn up and assessed they are disseminated via the journal Huisarts en Wetenschap. In a survey, carried out among a randomized sample of 10% of all general practitioners, attitudes towards national standard setting in general and to the first set of standards (diabetes care) were studied. The response was 70% (453 doctors). A majority of the respondents said they were well informed about the national standard setting initiatives instigated by the NHG (71%) and about the content of the first standards (77%). The general practitioners had a positive attitude towards the setting of national standards for quality of care, and this was particularly true for doctors who were members of the NHG. Although a large majority of doctors said they agreed with most of the guidelines in the diabetes standards fewer respondents were actually working to the guidelines and some of the standards are certain to meet with a lot of resistance. A better knowledge of the standards and a more positive attitude to the process of national standard setting correlated with a more positive attitude to the guidelines formulated in the diabetes standards. The results could serve as a starting point for an exchange of views about standard setting in general practice in other countries.

Attitude of Health Personnel↗
PubMed2005

Impairment in perceptual attentional set-shifting following PCP administration: a rodent model of set-shifting deficits in schizophrenia.

RATIONALE: Impaired ability to shift perceptual attentional set forms a core feature of schizophrenic illness and is associated with prefrontal cortical dysfunction. A pharmacological model producing equivalent deficits in rodents may enable the development of novel therapeutic strategies for effective treatment of cognitive impairments in schizophrenia. OBJECTIVE: This study was designed to investigate the effects of phencyclidine (PCP) administration on performance in a rodent attentional set-shifting task and the neural correlates of PCP-induced deficits in task performance. METHODS: Twenty-four hours following acute administration of 2.58 mg/kg PCP or vehicle, rats were tested on a perceptual attentional set shifting task (Birrell and Brown in J Neurosci 20:4320-4324, 2000). Following completion of the task, in situ hybridisation was employed to detect concurrent regional alterations in zif-268 and parvalbumin mRNA expression. RESULTS: PCP administration selectively decreased the ability of rats to shift attentional set between perceptual dimensions (extra-dimensional shift, EDS). This impairment was accompanied by, and correlated with, decreases in expression of zif-286 in the infralimbic cortex and of parvalbumin in the dorsal reticular nucleus of the thalamus. CONCLUSION: Acute administration of PCP produces deficits in perceptual set shifting comparable to an aspect of executive dysfunction in schizophrenia. Moreover, this impairment is associated with altered medial prefrontal cortical and reticular thalamic activity. Therefore, this rodent paradigm may model the set-shifting deficits that form a core feature of schizophrenic pathology.

Animals↗
PubMedDate not supplied

Negative experiences on Ecstasy: the role of drug, set and setting.

Similar to other sociological studies of Ecstasy use, the authors' research suggests that Ecstasy users tend to report positive effects of the drug. However, we also observed that most users experienced at least one adverse psychological outcome while using Ecstasy. The present study examines those negative experiences within the context of drug, set and setting. Data were collected through in-depth interviews with 98 current or former users of Ecstasy. The results indicate that, in general, negative experiences with Ecstasy did not deter people from using the drug again. The findings suggest that most negative experiences with Ecstasy can be attributed to the interaction between two or more factors, nearly always involving set or setting. Although various analyses have shown that the same "brand" of Ecstasy can contain varying degrees of MDMA, other drugs and adulterants, results from the present study suggest that users' expectations of the drug's effects appear to be related to the brand or label of Ecstasy that is consumed. The role of individual disposition in producing negative drug experiences is less clear; it is possible that this factor might interact with user set or friends' set in contributing to the overall drug experience.

Animals↗
PubMed2002

Syntheses, electronic absorption, emission, and ion-binding studies of platinum(III) C empty set N empty set C and terpyridyl complexes containing crown ether pendants.

A series of platinum (II) C empty set N empty set C complexes, [Pt(C empty set N empty set C) (L)] (HC empty set N empty set CH=2,6-diphenylpyridine (dppy); L=Ph(2)PB15C5 (1, B15C5=benzo[15]crown-5), Ph(2)PDMP (2, DMP=3,4-dimethoxyphenyl), pyCOA15C5 (3, A15C5=aza[15]crown-5), pyCON(CH(2)CH(2)OCH(3))(2) (4), pyC[triple bond]CB15C5 (5), pyC[triple bond]CDMP (6)) and terpyridyl complexes, [Pt(trpy)(L)](X)(2) (trpy=2,2':6',2''-terpyridine; L=Ph(2)PB15C5, X=OTf (7 a), PF(6) (7 b); X=PF(6), L=Ph(2)PDMP (8), pyC[triple bond]CB15C5 (9), and pyC[triple bond]CDMP (10)) have been successfully synthesized and characterized. The structures of 1, 3, and 7 a have been determined by X-ray crystallography. Excitation of complexes 1-6 in EtOH/MeOH (4:1 v/v) glass gave high-energy structured emission bands, assigned as derived from states of metal-perturbed intraligand (IL) origin. At higher concentrations, complexes 3-6 each displayed an additional, structureless emission band at 600-615 nm, with complexes 5 and 6 showing an obvious increase in the intensity of this emission band when the concentration was increased further. In dichloromethane at room temperature, complexes 3-6 showed, in addition to the high-energy emission at 490-505 nm, an extra, broad emission band at 620-625 nm when the concentration was increased. The emission origins of the low-energy band in glass and in fluid solutions are suggested to be derived from the ground-state oligomerization or aggregation process of the complexes. In the solid state at room temperature, complexes 1-6 each showed a broad, unstructured emission band at 560-600 nm, which was shifted to lower energy upon cooling to 77 K. On the other hand, the terpyridyl analogues 7-10 displayed intense vibronic-structured intraligand (IL) emissions at 460-472 nm in butyronitrile glass at 77 K. Solid-state samples of 9 and 10 displayed strong phosphorescence upon photoexcitation at 298 K and 77 K, tentatively assigned as derived from states of Pt(d pi)-->pi*(trpy) (3)MLCT origin(MLCT=metal-to-ligand charge transfer). The ion-binding properties of complexes 5 and 9 for Na(+), Ba(2+), and K(+) ions have been studied by UV/Vis spectrophotometric methods, and confirmed by ESI mass spectrometric studies. The ion-binding properties for Na(+) ions have also been probed by (1)H NMR experiments. For the same crown ether-containing ligand and the same metal ions, the neutral cyclometalated complexes gave larger binding constants than the positively charged terpyridyl analogues.

Crystallography, X-Ray↗
PubMed2006

Systematic Gaussian basis-set limit using completeness-optimized primitive sets. A case for magnetic properties.

We discuss the connection between the completeness of a basis set, measured by the completeness profiles introduced by Chong (Can J Chem 1995, 73, 79) at a certain exponent interval, and the possibility of reproducing molecular properties that arise either in the region close to the atomic nuclei or in the valence region. We present a scheme for generating completeness-optimized Gaussian basis sets, in which a preselected range of exponents is covered to an arbitrary accuracy. This is done by requiring Gaussian functions, the exponents of which are selected without reference to the atomic structure, to span the range with completeness profile as close to unity as wanted with as few functions as possible. The initial exponent range can be chosen suitable for calculations of molecular energetics or other valence-like properties. By extending the exponent range, properties requiring augmentation of the basis at a given angular momentum value and/or in a given distance range from the nucleus may be straightforwardly and systematically treated. In this scheme a universal, element-independent exponent set is generated in an automated way. The relation of basis-set completeness and performance in the calculation of magnetizability, nuclear magnetic shielding, and spin-spin coupling is tested with the completeness-optimized primitive sets and literature basis sets.

Algorithms↗
PubMed2000

Improved quantitative structure property relationships for the prediction of dielectric constants for a set of diverse compounds by subsetting of the data set

In a recent publication we explored the development of quantitative structure property relationships for the calculation of dielectric constants, which resulted in a general model for a wide range of compounds. Our current work explores the division of the set of compounds into eight more homogeneous subsets for which local models are developed. The full data set consists of 454 compounds with dielectric constants ranging from 1 to 40. A pool of up to 16 molecular descriptors is calculated for each of the eight data sets. The descriptors include dipole moment, polarizability, counts of elemental types or functional groups, charged partial surface area, and molecular connectivity. All possible 4-16 descriptor models are calculated for each of the eight data sets, and the best models are selected and compared to the results obtained from the best general model for all 454 compounds. Neural networks using the Broyden-Fletcher-Goldfarb-Shanno training algorithm are employed to build the models. The resulting combined mean test set error for the eight local models of 1.31 is significantly better than the mean test set error of 1.85 for the general model.

Journal Article↗
PubMed2004

Goals in their setting: a normative analysis of goal setting in physical rehabilitation.

Goal setting is an important professional method and one of the key concepts that structure a practical field such as physical rehabilitation. However, the actual use of goals in rehabilitation practice is much less straightforward than the general acceptance of the method suggests as goals are frequently unattained, modified or contested. In this paper, I will argue that the difficulties of goal setting in day-to-day medical practice can be understood by unravelling the normative assumptions of goal setting, in this case three different tensions that come along with it. First, goals are developed for a future state that may require activities that clash with necessities of the present situation. Second, professionals in clinical rehabilitation centres elaborate goals for an environment that differs in terms of spatial and social characteristics from the environment in the centre, where people train for the accomplishment of goals. Finally, goal setting requires active patient participation and individual control that sometimes appears impossible, unrealistic, and undesirable. I will describe how professionals deal with these tensions in a creative and dynamic way. With my articulation of the assumptions of goal setting, I hope to contribute to the self-reflection of rehabilitation practitioners as well as to theoretical discussions of goal setting in contexts other than rehabilitation.

Persons with Disabilities↗
PubMed2004

Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting.

BACKGROUND: Performance measurement and quality of care in community pharmacy settings is problematic because of the lack of formal patient registration and the resultant risk of selection bias. Although simulated patients have been used for teaching and education purposes, particularly in medical settings, their use as a research tool requires exploration in other health settings. The purpose of this paper is to describe how we used simulated patients to measure professional performance of community pharmacy staff. METHOD: Sixty pharmacies participated in a randomised controlled trial (RCT) to evaluate the effectiveness and efficiency of two guideline implementation strategies in the community pharmacy setting. The primary outcome measure for the study was derived from assessment forms completed by simulated patients following covert visits to participating pharmacies. RESULTS: Of the 420 simulated patient visits scheduled, 384 (91%) were completed. Nine visits were reported by pharmacy staff using reply-paid postcards, four of which concurred with known SP visits. Each detected visit was made by a different SP. In a post-intervention survey, 26 (52%) pharmacists stated they had been apprehensive about the use of simulated patients as part of the study, however, 41 (82%) pharmacists agreed that SP visits were an acceptable research method to use in a community pharmacy setting. DISCUSSION: Simulated patients are a feasible method of assessing professional performance in community pharmacy settings and overcome the methodological problems of other measurement methods. Further research is needed to assess the reliability and validity of simulated patients.

Adult↗
PubMed2005

Relativistic effects determined using the Douglas-Kroll contracted basis sets and correlation consistent basis sets with small-core relativistic pseudopotentials.

The coupled cluster approximation with single, double, and quasiperturbative triple excitations [CCSD(T)] was used in combination with the Douglas-Kroll contracted correlation consistent basis sets [cc-pVnZ-DK, where n = D(2), T(3), Q(4), and 5] and small-core relativistic pseudopotentials (PP) with correlation consistent polarized valence basis sets (cc-pVnZ-PP and aug-cc-pVnZ-PP) to investigate the impact of scalar relativistic corrections on energetic and structural properties of small molecules containing third-row (Ga-Kr) atoms. These molecules were taken from the Gaussian-2 extended test set for third-row atoms. Atomization energies, ionization energies, electron affinities, and proton affinities for molecules in the test set were determined and compared with nonrelativistic results which were obtained in a recent study in which the standard and augmented correlation consistent basis sets were used in combination with CCSD(T). Several schemes were used to extrapolate the energies to the complete basis set limit.

Journal Article↗
PubMed1998

Data sets, partitions, and characters: philosophies and procedures for analyzing multiple data sets.

We compared four approaches for analyzing three data sets derived from staphylinoid beetles, a superfamily whose known species diversity is roughly comparable to that of vertebrates. One data set is derived from adult morphology and the two molecular data sets are from 12S ribosomal RNA and cytochrome b mitochondrial DNA. We found that taxonomic congruence following conditional data combination, herein called compatible evidence (CE), resolved more nodes compatible with an initial conservative hypothesis than did total evidence (TE), conditional data combination (CDC), or taxonomic congruence (TC). CE sets a base of nodes obtained by CDC analysis and then investigates what further agreement may arise in a universe where these nodes are accepted as given. We suggest that CE75-75 may be appropriate for future studies that aim to both generate a well-corroborated tree and investigate conflicts between data sets, partitions, and characters. CE75-75 is a 75% bootstrap consensus CDC tree followed by combinable-component consensus of a 75% bootstrap consensus of each homogeneous set of partitions having hierarchical structure.

Animals↗
PubMed2006

Analysis of sample set enrichment scores: assaying the enrichment of sets of genes for individual samples in genome-wide expression profiles.

MOTIVATION: Gene expression profiling experiments in cell lines and animal models characterized by specific genetic or molecular perturbations have yielded sets of genes annotated by the perturbation. These gene sets can serve as a reference base for interrogating other expression datasets. For example, a new dataset in which a specific pathway gene set appears to be enriched, in terms of multiple genes in that set evidencing expression changes, can then be annotated by that reference pathway. We introduce in this paper a formal statistical method to measure the enrichment of each sample in an expression dataset. This allows us to assay the natural variation of pathway activity in observed gene expression data sets from clinical cancer and other studies. RESULTS: Validation of the method and illustrations of biological insights gleaned are demonstrated on cell line data, mouse models, and cancer-related datasets. Using oncogenic pathway signatures, we show that gene sets built from a model system are indeed enriched in the model system. We employ ASSESS for the use of molecular classification by pathways. This provides an accurate classifier that can be interpreted at the level of pathways instead of individual genes. Finally, ASSESS can be used for cross-platform expression models where data on the same type of cancer are integrated over different platforms into a space of enrichment scores. AVAILABILITY: Versions are available in Octave and Java (with a graphical user interface). Software can be downloaded at http://people.genome.duke.edu/assess.

Algorithms↗
PubMed2000

Priority setting for health research: lessons from developing countries. The Working Group on Priority Setting.

Research resources for addressing health problems of developing countries remain disproportionately low compared with the tremendous disease burdens borne by these countries. There is a need to focus these scarce resources on research that will optimize health benefits and lead to equity. This paper reviews processes and methods that have been used for setting research priorities. Past and current processes have focused on expert-driven research agenda, emphasizing scientific autonomy and global analyses. Methods for setting priorities have focused on the metrics of disease burdens, while less attention has been placed on who sets priorities and how choices are made. The paper proposes a strategy of priority setting, based on lessons learned from essential national health research (ENHR) approaches attempted in several developing countries. With equity in health and development as its goal, the proposed model is demand-driven, and involves multi-dimensional inputs and multiple stakeholders. Various steps of the process are discussed: getting participants involved; gathering evidence and information; determining criteria for priority setting; and implementation and evaluation. The paper concludes with a discussion of the gap between national research priorities and the research agenda set at regional and global levels, an issue that needs to be satisfactorily addressed in the future.

Developing Countries↗
PubMed2006

A comparison of quantum chemical models for calculating NMR shielding parameters in peptides: mixed basis set and ONIOM methods combined with a complete basis set extrapolation.

This article compares several quantum mechanical approaches to the computation of chemical shielding tensors in peptide fragments. First, we describe the effects of basis set quality up to the complete basis set (CBS) limit and level of theory (HF, MP2, and DFT) for four different atoms in trans N-methylacetamide. For both isotropic shielding and shielding anisotropy, the MP2 results in the CBS limit show the best agreement with experiment. The HF values show quite a different tendency to MP2, and even in the CBS limit they are far from experiment for not only the isotropic shielding of carbonyl carbon but also most shielding anisotropies. In most cases, the DFT values differ systematically from MP2, and small basis-set (double- or triple-zeta) results are often fortuitously in better agreement with the experiment than the CBS ones. Second, we compare the mixed basis set and ONIOM methods, combined with CBS extrapolation, for chemical shielding calculations at a DFT level using various model peptides. From the results, it is shown that the mixed basis set method provides better results than ONIOM, compared to CBS calculations using the nonpartitioned full systems. The information studied here will be useful in guiding the selection of proper quantum chemical models, which are in a tradeoff between accuracy and cost, for shielding studies of peptides and proteins.

Computer Simulation↗
PubMed1996

Non-decay type fast-setting calcium phosphate cement: setting behaviour in calf serum and its tissue response.

Non-decay type fast-setting calcium phosphate cement (nd-FSCPC) was evaluated in terms of its setting behaviour in calf serum and its tissue response to investigate the feasibility of its clinical use in surgical applications. Non-decay type cements were prepared by adding various amounts of sodium alginate to the liquid phase of base cements, fast-setting calcium phosphate cement (FSCPC) and conventional calcium phosphate cement (c-CPC). Cement pastes were immersed in serum at 37 degrees C immediately after mixing, and decay behaviour, setting time and mechanical strength were measured to evaluate the possibility of their use in surgical applications. Also, nd-FSCPC was implanted into rat subcutaneous tissue for the initial evaluation of biocompatibility of this potential bioactive cement. nd-FSCPC set in approximately 6-7 min in serum, even when the cement paste was immersed in the serum immediately after mixing, whereas c-CPC and FSCPC decayed completely upon immersion. nd-FSCPC transforms to hydroxyapatite (HA) within 24 h and shows a diametral tensile strength of approximately 4-5 MPa. As a result of transformation to HA, nd-FSCPC showed excellent tissue response when implanted subcutaneously in rats. We conclude that nd-FSCPC has good potential value for use in orthopaedics, plastic and reconstructive surgery, and oral and maxillofacial surgery, where the cement is exposed to blood.

Animals↗
PubMedDate not supplied

Determination of phenotypes of esterases (Set) in fresh saliva and saliva stains by disc electrophoresis and the distribution of Set phenotypes in the Japanese population.

A rapid and simple disc electrophoretic technique for the determination of saliva esterase (Set) types is described. The frequency of Set types was F 16.4%, FS 49.8% and S 33.8%. The estimated gene frequency of Set-1F was 0.413 and of Set-1S was 0.587. An accurate determination of Set types was possible in 5--7 week-old saliva stains. This system may be useful in medicolegal applications.

Electrophoresis, Disc↗