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PubMed2006

Amnesia and the hippocampus.

PURPOSE OF REVIEW: Long-term memory impairments have great medical significance and a considerable health and economic burden. Understanding their cognitive and neuroanatomical underpinnings is of crucial importance. Severe amnesia is usually observed following bilateral hippocampal pathology. This review addresses the precise role of the hippocampus and related medial temporal lobe structures in amnesia. RECENT FINDINGS: Disagreements exist over whether, following selective hippocampal damage: retrograde amnesia for episodic memories is temporally limited or extensive and ungraded; anterograde amnesia involves both recollective and familiarity processes. It is accepted that material specific impairments follow unilateral medial temporal lobe damage, with verbal and nonverbal memory lateralized to left or right, respectively. Memory for unknown faces, however, may not depend on the hippocampus. Pharmacological studies in animals, with some extension to humans, highlight promising future therapeutic interventions targeting synaptic plasticity modulation. SUMMARY: Despite considerable progress, some issues remain unresolved. The available evidence favours the view, however, that the hippocampus, in conjunction with other cortical areas, is critical for the retrieval of remote episodic memories and for both recollection and familiarity anterograde memory processes. There are as yet no effective pharmacological treatments for medial temporal lobe amnesia, but various rehabilitative techniques may be useful.

Amnesia↗
PubMed2002

The application of computer touch-screen technology in screening for psychosocial distress in an ambulatory oncology setting.

The objective of the study was to evaluate the acceptability and feasibility of computer touch-screen technology as a method for patients to report psychosocial functioning in an ambulatory cancer clinic. Patients participating in a randomized trial evaluating the use of self-reported psychosocial information in the clinical encounter were surveyed. The patients completed the Cancer Needs Questionnaire (CNQ), European Organization for the Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30) and the Beck Depression Inventory - Short Form (BDI) using a touch-screen computer. The time taken to complete the questionnaires was recorded electronically. Patients completed a seven-item pen and paper survey to assess acceptability of the process. Of the 450 patients, 244 (54%) were 60 years or older. Although over half the patients had no prior computer experience, nearly all found the touch screen easy to use and the instructions easy to understand. Each question was answered by at least 447 (99.3%) patients. The average time to complete the CNQ was 9.1 min, EORTC QLQ-C30 4.0 min and BDI 3.1 min. Factors influencing time to completion were prior use of computers, physical condition, education and overall level of needs. The study found that the use of computer touch-screen technology is an acceptable and efficient method for obtaining self-reported information on quality of life, cancer needs and psychological distress.

Adaptation, Psychological↗
PubMed1981

Women's perceptions of their important dyadic relationships during pregnancy.

This study examined women's perceptions of important relationships during pregnancy. Fourteen women were interviewed at approximately monthly intervals from the third through the last month of their pregnancies. During these interviews, each woman (a) identified relationships which were important to her; (b) described each important relationship as either changing or stable; and (c) evaluated each important relationship as either satisfactory or unsatisfactory. Study results indicate that the women identified important relationships with their husbands, children, parental figures, and peers. Important relationships were described as more changing than stable throughout pregnancy. These relationships were experienced, over all, as more satisfactory than unsatisfactory. An analysis of the perceived satisfactory and unsatisfactory relationships reveals the woman's expectations for important relationships and indicates major considerations for the acceptance and accommodation process. The woman's expectations for her important relationships indicate the presence of two major systems of relationships within her social space. Each of these systems is characterized by a dominant function. One system of relationships has as its primary function, differentiation; the other, support. Within the differentiation system, the woman helps important others to reorganize for the addition of the expected baby to the family system. Within the supportive system, the pregnant woman is the recipient of the nurturing and caring actions of others. The interplay between these interdependent systems reflects the workings of the task of accommodation and acceptance.

Adult↗
PubMed2003

Holistic medicine III: the holistic process theory of healing.

It is possible to understand the process of healing from a holistic perspective. According to the life mission theory, we can stretch our existence and lower our quality of life when we are in crises, to survive and adapt, and we can relax to increase our quality of life when we later have resources for healing. The holistic process theory explains how this healing comes about: Healing happens in a state of consciousness exactly opposite to the state of crises. The patient enters the "holistic state of healing" when the (1) patient and (2) the physician have a perspective in accordance with life, (3) a safe environment, (4) personal resources, (5) the patient has the will to live, (6) the patient and (7) the physician have the intention of healing, (8) the trust of the patient in the physician, and (9) sufficient holding. The holding must be fivefold, giving the patient (1) acknowledgment, (2) awareness, (3) respect, (4) care, and (5) acceptance. The holistic process has three obligatory steps: (1) to feel, (2) to understand, and (3) to let go of negative decisions. This paper presents a theory for the holistic process of healing, and lists the necessities for holistic therapy restoring the quality of life, health, and ability to function of the patient.

Holistic Health↗
PubMed1992

Adaptation and age-related expectations of older gay and lesbian adults.

Results from a study of lesbian women and gay men in the Midwest over the age of 50, who indicate high levels of involvement in the gay community, provide a picture of the aging process of these adults that builds on previous research efforts. Respondents reported acceptance of the aging process, and high levels of life satisfaction, despite predictable problems associated with aging and sexual orientation. Being active in the gay community was an asset to accepting one's own aging.

Adaptation, Psychological↗
PubMed2000

[Graft safety and need satisfaction: searching for a crucial balance].

In 1998, 3,033 organs were transplanted and 3,186 stem cell and 4,053 cornea grafts were performed in France. Organ shortage varies for each organ but is particularly critical for kidneys. Given the physiological and therapeutic efficacy of grafting, an increase in organ procurement is likely to raise safety problems. This paper concerns donor-transmitted infections, mainly viral infections. Regulations on health risks express a social and cultural refusal to accept any hazard. This collective concern is however in opposition with the interests of individual patients who are likely to accept a greater risk for an obvious benefit. Although the assessment of the risk/benefit ratio is clearly different between organ and tissue transplantation, further thought needs to be given to the problem of acceptance of infectious risk in organ transplantation. In France, special exceptions are now legally authorized for specific situations. Infectious agents transmitted by grafting have not been largely reported, mainly because screening tests were not available. The number of transmitted infections is increasing with the expansion of transport facilities and with the various geographical origins of the population. In some cases, search for histocompatibility between relatives living in endemic areas introduces new risks, for example tropical diseases. Diagnosis is often made by serological or molecular biological tests which may be difficult to analyze depending on their specificity. Organ transplantation is often an emergency requiring rapid decision making, for the donor or the recipient. However, with a quality assurance process based on accepted guidelines, the appropriate answers to operational problems can be given rapidly. Patient satisfaction can be achieved only if the public health challenge is met. Increasing organ procurement can clearly be expected to be beneficial, but at the cost of higher risks. Nevertheless, benefit and risk are quite different, benefit is for the time being while risk is delayed and may be uncertain depending on individual survival. Because of the variability of human disease, especially in situations where an ultimate therapy is involved, automatic application of a standard procedure must be avoided as it would inevitable lead to a cut-back in organ procurement in an attempt to achieve a theoretically safe situation which would be contrary to individual patient's self-interest. Health care workers should have good knowledge of the epidemiology of these diseases in order to assess risk. The patient must be able to express informed consent.

France↗
PubMedDate not supplied

Quality assurance not equal to quality improvement.

The intent is not to be critical and the misconceptions are easy to understand. The verbiage related to QI and QA sound alike. Quality improvement is not an easy undertaking for any industry. Some industries have tried QI and failed, while others have tried with admirable successes (e.g., Ford, Florida Power and Light, Motorola). The undertaking of the successful programs has not been easy or painless. QI requires extensive education, change of management philosophy and re-evaluation of our organizational structure. For QA professionals this transition will not be easy or painless . We must first accept that the terminology sounds similar but that the definitions are different. We must accept that our prior processes are far from perfect and can improve. As QA professionals, we must accept that the time is here to learn and to improve. We must begin by improving those processes which we own. This effort must coincide with identification of our customers and implementing systematic mechanisms for identifying their needs and expectations. Through energy expenditure and analysis of data over time, we can improve our processes and ultimately improve the output of our efforts. Only after we have learned QI processes, practiced them through daily application, and improved them can we begin to think about applications of QI to clinical process. After we expend the energy to learn about QI and apply it daily, we will be among the informed. QA professionals must prepare for and learn to value this change. Quality improvement and its technology represents a concept which may truly improve America's healthcare.(ABSTRACT TRUNCATED AT 250 WORDS)

Hospital Administration↗
PubMed1993

Cardiac Doppler blood-flow signal analysis. Part 1. Evaluation of the normality and stationarity of the temporal signal.

The normality (Gaussian property) and stationarity of the cardiac Doppler blood-flow signal were evaluated on short-time segments distributed over the cardiac cycle. The basic approaches used to perform statistical tests on the nonstationary and quasiperiodic cardiac Doppler signal are presented. The results obtained from the data of ten patients having a normal aortic valve and ten patients having a stenotic valve indicate that a complex Gaussian random process is an acceptable approximation for the clinical cardiac Doppler signal. For segments of 10 ms or less, 82 per cent of them were accepted to be stationary with a significance level of 0.05, whereas for durations greater than 40 ms, the percentage of stationary segments was less than 75 per cent. It was concluded that the 10 ms window generally used in practice is a good choice for Doppler spectrogram estimation, but a shorter time interval would be preferable.

Aortic Valve↗
PubMed1991

Clinical evaluation of ColdSpor, a glutaraldehyde-phenolic disinfectant.

UNLABELLED: Disinfecting solutions may vary in concentration and bactericidal activity with use, may have subjectively unpleasant characteristics, and may affect the appearance and physical condition of the equipment processed. We evaluated the high-level disinfectant ColdSpor (0.5% glutaraldehyde, 0.025% ortho-phenylphenol, and 0.005% para-tertiary amylphenol) by using it as the disinfecting agent in the processing of equipment for a large respiratory care service. MATERIALS & METHOD: The type and quantity of equipment disinfected and the physical condition of the equipment were observed and recorded. Samples of the disinfectant solution were analyzed each week, and the antimicrobial activity of the solution was tested against clinical isolates and test cultures of Pseudomonas aeruginosa. The odor of the solution and ease of use were subjectively evaluated by two equipment-processing technicians. RESULTS: More than 2,400 pieces of respiratory equipment were passed through the disinfectant solution during the 30-day study period. No changes in the appearance of the equipment were noted. Analysis revealed that 71% or more of the antimicrobial chemicals remained in the solution. Clinical isolates and test cultures of P aeruginosa showed no growth when cultured with samples of the solution in use up to 30 days. The two technicians subjectively judged the solution to have no noticeable odor and to produce no burning of the eyes. CONCLUSION: The concentration of components of the glutaraldehyde-phenolic solution maintained bactericidal activity for as long as 30 days. The solution produced no apparent physical change in equipment and was subjectively acceptable to those processing equipment.

Data Collection↗
PubMed1992

Challenges in applying autofocus technology to low vision telescopes.

Autofocus (AF) low vision telescopes offer the potential to increase the acceptance and utilization of such low vision aids (LVA) by the visually impaired. Many patients resist conventional manual focus telescopes for a variety of reasons including appearance, field of view, weight, and utility. The elderly who comprise the significant part of the target population may also resist telescopes due to an avoidance of the technical challenge of its use. Although an AF telescope is technically advanced, it may allow for less manipulation by the wearer and hence enable its more effective application to visual tasks, especially in the near- to mid-range where depths of field narrow and the demands for focusing increase. There are many challenges involved in the application of AF technology to LVA including modification of the focusing range, signal processing for physiologically acceptable performance, and power and weight considerations. A preliminary infrared (IR) AF prototype based upon our recent work with the Ocutech Vision Enhancing System (VES) has been produced. Initial findings are presented which address the requirements of a subsequent version as well as the challenges that will be faced to optimize such a device.

Audiovisual Aids↗
PubMed2006

Effect of transporters on the secretion of phytochemicals by the roots of Arabidopsis thaliana.

Root exudation, the process by which plants secrete compounds into the soil, is becoming accepted as a communicative process that determines organismal interactions in the rhizosphere. However, the mechanistic processes involved in the root exudation of phytochemicals have not been elucidated; traditionally, exudation has been regarded as a passive process. There is evidence that transporters in plants (and other organisms) have been involved in the movement of chemicals across different membranes. Here, we describe the involvement of different transporters in root exudation of phytochemicals by employing a pharmacological approach. We used a range of concentrations of several compounds known to inhibit different transporters, including potassium cyanide, orthovanadate, quinidine, glibenclamide, nifedipine and verapamil, to examine the effects of transporter inhibition on root exudation profiles in Arabidopsis. Generally, the exudation profile of phenolic compounds in 18-day-old plants shows more than 15 major phytochemicals. In contrast, the inhibitors listed above caused differences in the secretion of specific compounds. For instance, nifedipine and verapamil completely inhibited the exudation of the phytochemicals with molecular masses of 142 and 294, respectively. These results highlight that root exudation of phytochemicals is an active process controlled at the biochemical level and that different transporters may be involved in this root-specific mechanism.

ATP-Binding Cassette Transporters↗
PubMed2002

Complexities in ETS-domain transcription factor function and regulation: lessons from the TCF (ternary complex factor) subfamily. The Colworth Medal Lecture.

The ETS-domain transcription factor family can be divided into a series of subfamilies. Elk-1 represents the founding member of the ternary complex factor (TCF) subfamily. By focusing on the TCF subfamily, we can demonstrate the complexities that exist in the function and regulation of ETS-domain transcription factors. This article focuses on Elk-1 in detail and summarizes the functions of other TCFs. The key themes covered include the domain structure of the TCFs, the mechanisms of complex formation with serum response factor, regulation of TCFs by mitogen-activated protein kinase cascades, and transcriptional regulatory properties of the TCFs. Finally, the emerging role of the TCFs in vivo is discussed. A picture is developing indicating that, while these proteins exhibit significant sequence and functional conservation, key differences in their structure and regulation are being identified which may relate to unique functions of these proteins in vivo.

Amino Acid Sequence↗
PubMed1988

Proposed guidelines for maximum acceptable air-borne microorganism levels in dairy processing and packaging plants.

From the total number of air-borne microorganisms present per m3 of air, 1.5% were found to contaminate a dairy product while being packed into a container with an opening of 100 cm2 if it was exposed for 60 s. This value was used to compile a proposed guideline of maximum acceptable number of air-borne microorganisms per m3 which, if complied with, could ensure that no significant air-borne contamination of the product being packaged would take place.

Air Microbiology↗
PubMed2005

Public appraisal of government efforts and participation intent in medico-ethical policymaking in Japan: a large scale national survey concerning brain death and organ transplant.

BACKGROUND: Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted. METHODS: Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future policy. RESULTS: A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex. CONCLUSIONS: Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable.

Bioethical Issues↗
PubMed1997

Phosphorus metabolite distribution in skeletal muscle: quantitative bioenergetics using creatine analogs.

The functional coupling of contractile activity to metabolic processes in skeletal, cardiac and smooth muscle has been extensively examined in the intact cell through the advent of 31P-NMR spectroscopy. The near-equilibrium formulation for creatine kinase (CK) has been used for the calculation of ADPfree and ATP chemical potential in many of these studies. However, control of the bulk cytoplasmic PCr/Cr ratio by the ATP/ADP ratio through CK implies that the ATP/ADP ratio is the same in all loci within the cell. Alternatively the cytoplasmic fraction of ATP and ADP must be so large that other 'compartments' do not influence the physicochemical properties of the bulk cytoplasm. By feeding creatine analogs to rodents, it is possible to test whether these synthetic analogs and the endogenous substrates obey simple rules of enzyme kinetics and equilibration. Two important concepts can be tested: (1) Are phosphorus metabolises fully visible to in vivo 31P-NMR measurements? (2) Does CK equilibrate with its substrates in the cytosol? It will be shown that in spite of localized enzymatic activity and microcompartments in the cell (such as mitochondria), creatine kinase equilibrates with its substrates in fast and slow skeletal muscles at rest. Therefore, the physicochemical properties of the cytosol are best described as freely mixing with respect to the bioenergetically important metabolites (PCr, ATP and phospho-analog) and fully quantifiable by 31P-NMR spectroscopy. It follows that only a narrow range of intercellular heterogeneity with respect to chemical potential is acceptable if bioenergetic processes (e.g. CK fluxes or regulation of oxidative phosphorylation) are to be meaningfully interpreted in a rigorous biochemical framework.

Animals↗
PubMed1999

The informed consent process and the use of the exception to informed consent in the clinical trial of diaspirin cross-linked hemoglobin (DCLHb) in severe traumatic hemorrhagic shock. DCLHb Traumatic Hemorrhagic Shock study group.

UNLABELLED: In the clinical trial of diaspirin cross-linked hemoglobin (DCLHb), optimal therapy required the immediate enrollment of patients with severe, uncompensated, traumatic hemorrhagic shock. When it was not feasible to obtain prospective consent, an exception to informed consent was used according to FDA regulation 21 CFR 50.24. OBJECTIVES: To examine the informed consent process and the use of the consent exception and consent to continue (CTC), and to describe the patients for whom this process was used. METHODS: This was a multicenter, randomized, controlled, single-blinded efficacy trial of DCLHb as an adjunct to standard therapy in the treatment of severe, traumatic hemorrhagic shock. Patients with unstable vital signs or a critical base deficit were treated, with a primary study endpoint of 28-day mortality. RESULTS: During the 11-month study period, 112 patients were randomized in 18 U.S. trauma centers, and data from 98 of the infused patients were analyzed. Prospective consent was obtained from two patients, three family members, and one legally authorized representative (LAR) (6%). Consent to continue was requested for 89 patients (89%), and full participation was granted for 87 of these patients (98%). Consent to continue was provided by 54 (98%) of the 55 patients approached. The mean number of days for family/LAR CTC was 1.1 +/-3.8 days, and 50% of the time it was obtained on the day of study enrollment. Patient CTC was obtained in an average of 13 +/- 23 days, with a median of four days. Patients treated in this protocol were more likely to have sustained penetrating trauma than the overall trauma patient population treated in these trauma centers (44% vs 21%, p = 0.002). CONCLUSIONS: Informed consent in this study of an emergent therapy most often involved the use of the consent exception and consent to continue, the latter of which occurred in a timely manner. Nearly all of those who were approached for CTC approved full participation in the study, suggesting acceptance of the process outlined in the new regulations. Patients treated in a hemorrhagic shock clinical trial may differ from the general trauma patient population.

Adult↗
PubMed2002

Broadband ultrasound attenuation imaging: algorithm development and clinical assessment of a region growing technique.

This paper presents a computerized method for the selection of an irregular region of interest (ROI) in broadband ultrasound attenuation (BUA) images. A region growing algorithm searches an initial region in the posterior part of the calcaneus until the pixel with the lowest attenuation value is found; this is the starting seed. Then, the algorithm evaluates the values of the eight pixels neighbouring the starting seed. Pixels that have the closest value to the starting seed are accepted. This procedure is the first processing level. The procedure is repeated for the group of pixels neighbouring those accepted from the previous processing level. The algorithm ceases when the number of accepted pixels reaches a user-specified number. The clinical part of this study compares measurements of BUA at an automatic ROI implemented on a quantitative ultrasound imaging device, defined as the circular region of lowest attenuation in the posterior part of the calcaneus, and at irregular ROIs of various sizes generated by the algorithm developed in this study. The algorithm was applied to BUA images obtained from 24 post-menopausal women with hip fractures and 26 age-matched healthy female subjects. The use of the irregular ROI with a size of 2400 pixels is proposed because that region yielded better clinical results compared to irregular ROIs with different size and the circular automatic ROI.

Algorithms↗
PubMed2000

Targeting of mRNAs within the glial cell cytoplasm: how to hide the message along the journey.

The subcellular targeting of mRNAs encoding myelin proteins to the oligodendrocyte processes is an accepted fact in myelin formation. How these messengers are kept silent during their movement to the subcellular domain where they are turned on remains a mystery. This review focuses on aspects of mRNA targeting and speculates on possible molecular mechanisms for the translational control of myelin-located mRNAs.

Animals↗