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PubMed1978

A transactional perspective on the interrelationship of the societal power structure, the mental health establishment, the individual, and the community: a commentary on Nassi.

While agreeing in part with Nassi's (1978) radical position on the failure of community control to be meaningfully implemented by the mental health establishment, a complementary analysis is proposed as being more complete by virtue of integrating a variety of societal and individual perspectives. This analysis builds on transactional epistemology and a multi-level model of service delivery, also bringing to bear developmental and social evolutionary theory. A new service delivery role, the human development liaison specialist, is advanced as consistent with these notions.

Community Mental Health Services↗
PubMed2006

Retrospective evaluation of a topology preserving non-rigid registration method.

This paper proposes a comprehensive evaluation of a monomodal B-spline-based non-rigid registration algorithm allowing topology preservation in 3-D. This article is to be considered as the companion of [Noblet, V., Heinrich, C., Heitz, F., Armspach, J.-P., 2005. 3-D deformable image registration: a topology preservation scheme based on hierarchical deformation models and interval analysis optimization. IEEE Transactions on Image Processing, 14 (5), 553-566] where this algorithm, based on the minimization of an objective function, was introduced and detailed. Overall assessment is based on the estimation of synthetic deformation fields, on average brain construction, on atlas-based segmentation and on landmark mapping. The influence of the model parameters is characterized. Comparison between several objective functions is carried out and impact of their symmetrization is pointed out. An original intensity normalization scheme is also introduced, leading to significant improvements of the registration quality. The comparison benchmark is the popular demons algorithm [Thirion, J.-P., 1998. Image matching as a diffusion process: an analogy with Maxwell's demons. Medical Image Analysis, 2 (3), 243-260], that exhibited best results in a recent comparison between several non-rigid 3-D registration methods [Hellier, P., Barillot, C., Corouge, I., Gibaud, B., Le Goualher, G., Collins, D.L., Evans, A., Malandain, G., Ayache, N., Christensen, G.E., Johnson, H.J., 2003. Retrospective evaluation of intersubject brain registration. IEEE Transactions on Medical Imaging, 22 (9), 1120-1130]. The topology preserving B-spline-based method proved to outperform the commonly available ITK implementation of the demons algorithms on many points. Some limits of intensity-based registration methods are also highlighted through this work.

Algorithms↗
PubMed2004

Managed care discounting: evidence from the MarketScan database.

The paper examines price discounting by health maintenance organizations (HMOs) and preferred provider organizations (PPOs) in markets for hospital services. Our empirical analysis focuses on transaction prices for angioplasty, which is a relatively common procedure with well-defined "product" characteristics. After controlling for patient and procedure heterogeneity and market power, we find that on average angioplasty prices are 8% lower for PPOs than for fee-for-service plans, followed by point-of-service HMOs, which capture a 24% discount. Our results are in general agreement with earlier work by Cutler, McClellan, and Newhouse (2000), who show that managed care discounts are "real," after accounting for case severity and process of care.

Angioplasty, Balloon, Coronary↗
PubMed1983

Hierarchy and food in Nepalese healing rituals.

An analysis of food transactions in a Nepalese village provides an interpretation of the cultural place of illness within high caste Hindu traditions. In several realms of village social life, rules of food transfer simultaneously mark hierarchical relationships between people and symbolize an interdependency among them. In these contexts, food transactions stress the importance of preserving hierarchy, reinforcing interdependence, and thereby maintaining a social framework within which exchanges of goods and services can harmoniously take place. But in the realm of illness, food use and references to food suggest conflicts or breakdowns in these kinds of interdependent relationships and ordered exchanges. I suggest that there is a fundamental conflict in village society since the local concern with human interdependency is set in a milieu of a sharply perceived scarcity of valued resources. This conception that human beings are interdependent for access to scarce goods introduces an element of danger into the system of exchange and opens a potential for disharmony in social relations. A cultural recognition of this danger is again reflected in the use of food, specifically in illness ideology and curing rituals. In this examination, illness emerges as the culturally apprehended outcome of some inevitable conflicts in the village social order.

Ceremonial Behavior↗
PubMed2005

Calculating the 2D motion of lumbar vertebrae using splines.

In this study we investigate the use of splines and the ICP method [Besl, P., McKay, N., 1992. A method for registration of 3d shapes. IEEE Transactions on Pattern Analysis and Machine Intelligence 14, 239-256.] for calculating the transformation parameters for a rigid body undergoing planar motion parallel to the image plane. We demonstrate the efficacy of the method by estimating the finite centre of rotation and angle of rotation from lateral flexion/extension radiographs of the lumbar spine. In an in vitro error study, the method displayed an average error of rotation of 0.44 +/- 0.45 degrees, and an average error in FCR calculation of 7.6 +/- 8.5 mm. The method was shown to be superior to that of Crisco et al. [Two-dimensional rigid-body kinematics using image contour registration. Journal of Biomechanics 28(1), 119-124.] and Brinckmann et al. [Quantification of overload injuries of the thoracolumbar spine in persons exposed to heavy physical exertions or vibration at the workplace: Part i - the shape of vertebrae and intervertebral discs - study of a yound, healthy population and a middle-aged control group. Clinical Biomechanics Supplement 1, S5-S83.] for the tests performed here. In general, we believe the use of splines to represent planar shapes to be superior to using digitised curves or landmarks for several reasons. First, with appropriate software, splines require less effort to define and are a compact representation, with most vertebra outlines using less than 30 control points. Second, splines are inherently sub-pixel representations of curves, even if the control points are limited to pixel resolutions. Third, there is a well-defined method (the ICP algorithm) for registering shapes represented as splines. Finally, like digitised curves, splines are able to represent a large class of shapes with little effort, but reduce potential segmentation errors from two dimensions (parallel and perpendicular to the image gradient) to just one (parallel to the image gradient). We have developed an application for performing all the necessary computations which can be downloaded from http://www.claritysmart.com.

Algorithms↗
PubMed2006

3D curve inference for diffusion MRI regularization and fibre tractography.

We develop a differential geometric framework for regularizing diffusion MRI data. The key idea is to model white matter fibres as 3D space curves and to then extend Parent and Zucker's 2D curve inference approach [Parent, P., Zucker, S., 1989. Trace inference, curvature consistency, and curve detection. IEEE Transactions on Pattern Analysis and Machine Intelligence 11, 823-839] by using a notion of co-helicity to indicate compatibility between fibre orientations at each voxel with those in a local neighborhood. We argue that this provides several advantages over earlier regularization methods. We validate the approach quantitatively on a biological phantom and on synthetic data, and qualitatively on data acquired in vivo from a human brain. We also demonstrate the use of the technique to improve the performance of a fibre tracking algorithm.

Algorithms↗
PubMed1999

The role of convexity in perceptual completion: beyond good continuation.

Since the seminal work of the Gestalt psychologists, there has been great interest in understanding what factors determine the perceptual organization of images. While the Gestaltists demonstrated the significance of grouping cues such as similarity, proximity and good continuation, it has not been well understood whether their catalog of grouping cues is complete--in part due to the paucity of effective methodologies for examining the significance of various grouping cues. We describe a novel, objective method to study perceptual grouping of planar regions separated by an occluder. We demonstrate that the stronger the grouping between two such regions, the harder it will be to resolve their relative stereoscopic depth. We use this new method to call into question many existing theories of perceptual completion (Ullman, S. (1976). Biological Cybernetics, 25, 1-6; Shashua, A., & Ullman, S. (1988). 2nd International Conference on Computer Vision (pp. 321-327); Parent, P., & Zucker, S. (1989). IEEE Transactions on Pattern Analysis and Machine Intelligence, 11, 823-839; Kellman, P. J., & Shipley, T. F. (1991). Cognitive psychology, Liveright, New York; Heitger, R., & von der Heydt, R. (1993). A computational model of neural contour processing, figure-ground segregation and illusory contours. In Internal Conference Computer Vision (pp. 32-40); Mumford, D. (1994). Algebraic geometry and its applications, Springer, New York; Williams, L. R., & Jacobs, D. W. (1997). Neural Computation, 9, 837-858) that are based on Gestalt grouping cues by demonstrating that convexity plays a strong role in perceptual completion. In some cases convexity dominates the effects of the well known Gestalt cue of good continuation. While convexity has been known to play a role in figure/ground segmentation (Rubin, 1927; Kanizsa & Gerbino, 1976), this is the first demonstration of its importance in perceptual completion.

Cues↗
PubMed2000

The patchwork engine: image segmentation from shape symmetries.

We propose blind segmentation of images into shape-related 'patches' based on pre-calculated local symmetries (Van Tonder, G.J. & Ejima, Y. (1999). (Forthcoming a) Flexible computation of shape symmetries. Submitted for publication) in shape boundary contours. First, lateral weights between all points in the boundary contour map are assigned analogous to Euclidean distance maps in watershed segmentation (Beucher, S. & Lantejoul, C. (1979). Use of watersheds in contour detection. Proceedings of the International Workshop on Image Processing, CCETT, Rennes, France.). Lateral weights are then used to: (1) extract local maxima in symmetries; (2) link maxima within locally enclosed boundary contours; and (3) reconstruct shape contours using symmetry maxima as 'seeds'. The new model overcomes weaknesses of watershed segmentation. The new model closes gaps in relatively more solid image contours, but it is fundamentally different from methods based on contour interpolation (Grossberg, S., Mingolla, E. & Todorovć, D. (1989). A neural network architecture for preattentive vision, IEEE Transactions on Biomedical Engineering 36, 65-84; Heitger, F. & von der Heydt, R. (1993). A computational model of neural contour processing: figure-ground segregation and illusory contours. Proceedings of the Fourth International Conference on Computer Vision, IEEE Computer Society Press, Washington D.C. (pp. 32-40)). Images are segmented into shape-relevant color-by-number-like patches which compare well to related methods (Gauch, J. & Pizer, M. (1993). The intensity axis of symmetry and its application to image segmentation, IEEE Transactions on Pattern Analysis and Machine Intelligence, 15 (8), 753-770; Ilg, W. & Ogniewicz, R. (1995). The application of Voronoi skeletons to perceptual grouping in line images, Proceedings of the 11th International Conference on Pattern Recognition, The Hague, The Netherlands, pp. 382-385; Zhu, S.C. & Yuille, A.L. (1996) FORMS: a flexible object recognition and modeling system, International Journal of Computer Vision, 20 (3), 187-212.). Two primitive operations, comparison and merging of patches, are proposed as drives for exposing more global shape contours from patches. We conclude that symmetry goes beyond abstract shape morphology: it can contribute to figure-ground segmentation in early vision and form part of primitive operations needed to create hypotheses of complex shape.

Animals↗
PubMed1996

Transcriptional regulation of the human cholecystokinin gene: composite action of upstream stimulatory factor, Sp1, and members of the CREB/ATF-AP-1 family of transcription factors.

We have examined cis-elements and trans-acting factors that regulate transcription of the human cholecystokinin (CCK) gene. Transient expression of CCK promoter deletion constructs in human SK-N-MC neuroblastoma cells depicted positive cis-elements between the positions -100 to -92, -84 to -74, and -58 to -37, 5' to the transcription initiation site. Correspondingly, DNase I protection analysis showed that transacting factors bound to elements within these regions. The sequences encompass a putative basic helix-loop-helix leucine zipper (bHLH-ZIP) element, an Sp1 element, and a combined cAMP- and TPA-responsive element (CRE/TRE) at positions -97 to -92, -39 to -34, and -80 to -73, respectively. Mobility and supershift assays demonstrated that upstream stimulatory factor (USF) and Sp1 bind to the former elements and competition experiments confirmed that CREB/ATF and AP-1 bind to the CRE/TRE element. Mutation of the bHLH-ZIP and CRE/TRE elements decreased the activity of the promoter by 65% and 42%, respectively. The activity of the promoter was increased six- and two-fold after stimulation with forskolin and TPA, respectively. Stimulation was eliminated after mutation of the CRE/TRE element. Co-transfection experiments with pRSV-c-jun, pSV-fos, and pRC-RSV-CREB constructs showed that jun, CREB, and AP-1 stimulate transcription. We conclude that USF, Sp1, and members of the CREB/ATF and AP-1 family of transcription factors are the major determinants of CCK gene transcription.

Base Sequence↗
PubMed1997

Post-dive blood lactate concentrations in emperor penguins, Aptenodytes forsteri.

In order to determine an aerobic diving limit (ADL) in emperor penguins (Aptenodytes forsteri), post-dive blood lactate concentrations were measured in penguins foraging at an isolated sea ice hole. Resting lactate concentrations were 1.2-2.7 mmol l-1. Serial samples revealed that lactate level usually peaked within 5 min after dives and that 7-12 min was required for lactate concentrations to decrease from 5-8 mmol l-1 to less than 2.5 mmol l-1. Post-dive lactate level was not elevated above 3 mmol l-1 for dives shorter than 5 min. Two-phase regression analysis revealed a transaction at 5.6 min in the post-dive lactate level versus diving duration relationship. All dives longer than 7 min were associated with lactate concentrations greater than 5 mmol l-1. We conclude that the ADL in emperor penguins ranges between 5 and 7 min. These are the first determinations of post-dive lactate concentrations in any free-diving bird and are currently the only physiological assessment of an ADL in an avian species.

Animals↗
PubMed1994

[Coping-oriented therapy in schizophrenia].

After a discussion of general problems concerning the development of new and innovative methods of psychotherapy, an approach based on the transactional perspective of coping and aiming at therapeutic interventions on schizophrenic persons' coping with their disease and related problems is presented. The development of this approach makes use of specific empirical data provided by coping research, a theoretical analysis of basic assumptions of the transactional approach including related theoretical elaborations and differentiations, and of empirical knowledge concerning specific impairments of schizophrenic persons, which may have an impact on their participation in this kind of therapy. Also, implications of the approach for the selection of specific methods of intervention and for the organization of the whole setting are discussed. After illustrating the approach by describing a program for groups of patients, which so far has clinically proved to be useful, some ideas concerning the strategy of evaluation are presented. These refer to the process of therapeutic intervention and to aspects of general and differential effectivity.

Adaptation, Psychological↗
PubMed1994

Contracts and supply assurance in the UK health care market.

We present a formal model of the relationship between a health care purchaser and a provider drawing on the recent experience of explicit contracting in the UK health sector. Specifically we model the contractual relationships emerging between District Health Authorities, who are presently the dominant health care purchasers, and the providers of hospital care. The comparative static analysis implies that the transaction cost of using non-local hospitals, the expected patient demand, the extent of excess capacity in local hospitals, and the proportion of that excess capacity expected to be lost to competitive purchasers, are all important determinants of the choice of contract.

Catchment Area, Health↗
PubMed2004

Transactional sex is the driving force in the dynamics of HIV in Accra, Ghana.

OBJECTIVE: To delineate the population attributable fraction (PAF) of transactional sex in prevalent cases of HIV infection in the male adult population of Accra, Ghana. DESIGN AND METHODS: Cross-sectional study of clients who visited a sex worker (SW), of boyfriends of SW and of male personnel in prostitution venues. A questionnaire was administered and urine obtained for detection of anti-HIV antibodies. The PAF of prevalent HIV acquired from SW was calculated using a combination of data from this survey of clients, from on-going SW surveys, the national HIV surveillance system and the national census. RESULTS: HIV prevalence was 4.9% (8/162) among clients of mobile SW, 15.8% (53/335) among clients of home-based SW, 17.5% (10/57) among personnel and 32.1% (9/28) among boyfriends. A condom was used in 90% of intercourses, according to clients. Non-use of a condom was clustered in selected locations and independently associated with older age of client, frequency of intercourse with SW in the last year and current urethritis. Among the male population of Accra aged 15-59 years, 84% of prevalent cases of HIV were attributable to transactional sex. A sensitivity analysis showed that under various assumptions PAF varied between 47% and 100%. CONCLUSIONS: In Accra, approximately four-fifths of prevalent cases of HIV in adult males were acquired from SW. Comprehensive interventions providing education, condoms and treatment for sexually transmitted diseases for SW and their clients should be approached as other public health priorities and provided in all cities, large and small, of West Africa.

Adolescent↗
PubMed2006

Parenteral transmission during excision and treatment of tuberculosis and trypanosomiasis may be responsible for the HIV-2 epidemic in Guinea-Bissau.

BACKGROUND AND OBJECTIVE: The factors that led to the simultaneous emergence, decades ago, of HIV-1 in central Africa and HIV-2 in West Africa remain unclear. The low HIV-2-associated mortality enables epidemiological assessment of risk factors potentially relevant in the early stages of the epidemic. In Guinea-Bissau, its epicentre, HIV-2 became highly prevalent (approximately 15%) in cohorts of individuals born before 1962, but is now disappearing whereas HIV-1 prevalence is increasing. We sought to verify the hypothesis that parenteral transmission was the key factor in the building-up of the HIV-2 epidemic. DESIGN: Cross-sectional community survey of 1608 individuals aged > or = 50 years in Bissau. METHODS: Capillary blood was obtained for HIV serology. Associations between HIV-2 (alone or in dual HIV-1/HIV-2 infections) and exposures were measured with crude and adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULTS: Prevalence of HIV-2 was higher in women (160/1063; 15.1%) than men (45/545; 8.3%, P < 0.001). Among women, excision (AOR, 1.54; 95% CI, 1.08-2.18) was independently associated with HIV-2, as were age and being widowed (AOR, 1.88; 95% CI, 1.29-2.74). Among men, HIV-2 was not associated with sexually transmitted infections or transactional sex. In an analysis comprising men and women that was adjusted for age, sex, ethnic group and marital status, HIV-2 was associated with having received injections for the treatment of tuberculosis (AOR, 2.12; 95% CI, 1.11-4.05) or trypanosomiasis (AOR, 1.75; 95% CI, 1.03-2.97). CONCLUSIONS: Parenteral transmission through ritual excision and multiple injections during treatment of tuberculosis and trypanosomiasis contributed to the emergence of HIV-2 in Guinea-Bissau.

Adolescent↗
PubMed2004

Fifty ways to leave your rubber: how men in Mombasa rationalise unsafe sex.

OBJECTIVE: To explore the reasons why men who have sex with sex workers in Kenya refuse to use condoms in order to develop potential interventions that might help to overcome these barriers. METHODS: We conducted participant observations over a period of 2 months in the bars, discos, shebeens, and guesthouses of Mombasa, Kenya, where many of the sexual transactions are initiated. RESULTS: Analysis of the participant observations revealed at least 50 reasons for not using a condom, which we grouped into six categories: condoms are not pleasurable, condoms are defective, condoms are harmful, condoms are unnecessary, condoms are too hard to use, and external forces prohibit using condoms. CONCLUSIONS: Some of the reasons men say they do not use condoms would be difficult to affect directly. Others are the result of gaps in knowledge and have not been impacted through better communication strategies. Finally, some of the reasons for not using condoms, such as men's weaknesses, and the loss of pleasure, could possibly be addressed through the introduction of female controlled devices. However, the most important conclusion of this paper is that men who pay for sex do so because it is pleasurable and many men do not find the male condom pleasurable. Therefore, messages targeted at men who have sex with sex workers may not be 100% successful if they only emphasise the benefits of condom use as disease control.

Attitude to Health↗
PubMed1979

The psychotherapy of the psychosomatic patient.

On the basis of a relatively restricted definition of psychotherapy, the authors describe some of the reasons why psychotherapy is rather seldom used for psychosomatic patients, on an individual or a group basis. Some details are then given about two other kinds of treatment which contain some elements of psychotherapy, and which have been developed in Lausanne as a consequence of the analysis of the early transactions between the psychosomatic patient and his attendants: (1) a bio-feedback method, whose technical aspect is used as a tool towards a more global approach, through encouraging insight and verbalization on the part of the patient; (2) an interdisciplinary approach by physiotherapists, psychiatrists and somaticians, working together in different modalities, adapted to the different cases.

Biofeedback, Psychology↗
PubMed1991

Special report on reimbursement. Final Medicare fraud and abuse safe harbors are published.

There has been great concern in the health care industry that business arrangements that do not comply with the Safe Harbors will automatically be deemed illegal. HHS has confirmed that this is not so; the commentary to the Regulations expressly states that "The failure of a particular business arrangement to comply with these provisions does not determine whether or not the arrangement violates the statute because...this regulation does not make conduct illegal. Any conduct that could be construed to be illegal after the promulgation of this rule would have been illegal at any time since the current law was enacted in 1977....This regulation is intended to provide a formula for avoiding risk in the future." 56 Fed. Reg. at 35955. In the final analysis, the majority of transactions will fall outside the Safe Harbors and thus will continue to be judged by the standards established by the Medicare antifraud statute enacted 14 years ago. Under these standards, as HHS states, "the degree of the risk [in any particular transaction] depends on an evaluation of the many factors which are part of the decision-making process regarding case selection for investigation and prosecution." Id. at 35954. Providers that are mindful of these criteria should therefore still be able to accomplish, with relative safety, transactions that do not qualify for Safe Harbor protection.

Commerce↗
PubMed1989

Enhancement of Aspergillus nidulans transformation by the ans1 sequence.

We have shown that the Aspergillus nidulans ans1 sequence enhances the efficiency of transformation when introduced into vectors containing argB or trpC genes. Increased efficiency of transformation is also observed when ans1 is present on a second cotransforming plasmid. In an attempt to explains the ans1 transactivity we have performed analysis of some cotransformants.

Aspergillus nidulans↗