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Doing-being-becoming: occupational experiences of persons with life-threatening illnesses.

OBJECTIVE: Life-threatening illness profoundly affects people's occupational functioning, yet continuing occupational engagement seems vital to their well-being. This qualitative study used a doing-being-becoming framework to explore the place of occupation in human lives threatened by illness. METHOD: The experiences of 13 male and 10 female day hospice participants were investigated through a combination of focus groups, individual interviews, and participant observation. These data were interpreted by a process of constant comparison, coding, and theme building. RESULTS: Experiences of doing were evident in accounts of losing and maintaining valued occupations and striving to preserve physical and mental functioning. A sense of being through occupational engagement arose in social relationships and self-exploration that enhanced feelings of self-worth. Occupation promoted the experience of becoming by providing fresh learning opportunities and a sense of contributing to others' welfare. CONCLUSION: The data offer new insights into the potential benefits of occupational engagement for persons dealing with life-threatening illnesses. Use of the doing-being-becoming framework enriched analysis of these data, which, in turn, have contributed to the understanding of the framework's theoretical concepts.

Female↗

Obtaining access to coastal areas for large-scale mussel farming: obstacles and possibilities.

Eutrophication in the coastal waters of the northern part of the Swedish west coast is causing structural and functional changes to the coastal ecosystems. Large-scale mussel farming is proposed in the Program of Measures, required by the EU Water Framework Directive to reduce the nutrients in the coastal water and improve water quality over a transition period of 10-20 years. Ownership, land parcelling, conflicts of interest, and the protection of coastal water are obstructing accessibility to suitable water areas for the establishment of mussel farming plants. This paper studies the obstacles and possibilities in the relevant laws and legal regulations governing the accessibility to coastal waters for large-scale mussel farming. Alternative ways to solve the problem are shown and discussed, within the framework of the Planning and Building Act, the Environmental Code and the laws concerning land-parceling and property. It is shown that the Planning and Building Act, when used in a proper manner, can provide useful instruments for society to gain access to coastal water for mussel farming plants with the purpose of improving the ecological status of the water.

Animals↗

The human genome: information content and structure.

At a length of two meters and a width of two billionths of a meter, the genome amounts to a library whose code letters carry complete instructions for building and maintaining a human. Until recently, the code was modified only by mutation and natural selection. Today, however, we possess the technology to read and write DNA. The consequent knowledge is already changing medical practice.

Base Sequence↗

A visual coding system in histopathology and its consensual acquisition.

Divergent descriptions of histopathologic images induce inter- and intra-observer variability in diagnosis. Even though a controlled terminology exists to describe medical imaging, pathologists do not always agree on the visual representation of the descriptive terms. The main purpose of our work is to define a methodology to build a standardized visual coding system unambiguously characterizing the terms of a microglossary. The methodology follows two steps: 1) the acquisition of experts' descriptions of images using the microglossary and 2) a consensus derivation. The procedure was applied on a set of 85 histopathological images of breast tumors described by two experts. Among the 339 objects selected in images, 176 were detected by both experts, 77% localized at the same place and 25% also identically labeled. The microglossary was enriched and illustrated via the resulting consensual descriptions. The contribution of this work supports relevant indexing of biomedical images and image-related information.

Breast Neoplasms↗

Periodically-modulated inhibition of living pacemaker neurons--III. The heterogeneity of the postsynaptic spike trains, and how control parameters affect it.

Codings involving spike trains at synapses with inhibitory postsynaptic potentials on pacemakers were examined in crayfish stretch receptor organs by modulating presynaptic instantaneous rates periodically (triangles or sines; frequencies, slopes and depths under, respectively, 5.0 Hz, 40.0/s/s and 25.0/s). Timings were described by interspike and cross-intervals ("phases"); patterns (dispersions, sequences) and forms (timing classes) were identified using pooled graphs (instant along the cycle when a spike occurs vs preceding interval) and return maps (plots of successive intervals). A remarkable heterogeneity of postsynaptic intervals and phases characterizes each modulation. All cycles separate into the same portions: each contains a particular form and switches abruptly to the next. Forms differ in irregularity and predictability: they are (see text) "p:q alternations", "intermittent", "phase walk-throughs", "messy erratic" and "messy stammering". Postsynaptic cycles are asymmetric (hysteresis). This contrasts with the presynaptic homogeneity, smoothness and symmetry. All control parameters are, individually and jointly, strongly influential. Presynaptic slopes, say, act through a postsynaptic sensitivity to their magnitude and sign; when increasing, hysteresis augments and forms change or disappear. Appropriate noise attenuates between-train contrasts, providing modulations are under 0.5 Hz. Postsynaptic natural intervals impose critical time bases, separating presynaptic intervals (around, above or below them) with dissimilar consequences. Coding rules are numerous and have restricted domains; generalizations are misleading. Modulation-driven forms are trendy pacemaker-driven forms. However, dissimilarities, slight when patterns are almost pacemaker, increase as inhibition departs from pacemaker and incorporate unpredictable features. Physiological significance-(1) Pacemaker-driven forms, simple and ubiquitous, appear to be elementary building blocks of synaptic codings, present always but in each case distorted typically. (2) Synapses are prototype: similar behaviours should be widespread, and networks simulations benefit by nonlinear units generating all forms. (3) Relevant to periodic functions are that few variables need be involved in form selection, that distortions are susceptible to noise levels and, if periods are heterogeneous, that simple input cycles impose heterogeneous outputs. (4) Slow Na inactivations are necessary for obtaining complex forms and hysteresis. Formal significance--(1) Pacemaker-driven forms and presumably their modulation-driven counterparts, pertain to universal periodic, intermittent, quasiperiodic and chaotic categories whose formal properties carry physiological connotations. (2) Only relatively elaborate, nonlinear geometric models show all forms; simpler ones, show only alternations and walk-throughs. (3) Bifurcations resemble those of simple maps that can provide useful guidelines. (4) Heterogeneity poses the unanswered question of whether or not the entire cycle and all portions have the same behaviours: therefore, whether trajectories are continuous or have discontinuities and/or singular points.

Action Potentials↗

Culturally diverse management teams. Mercy International sponsors project on Guam.

In 1989 Mercy International Health Services (MIHS) sent a team of advisers to help upgrade the skills of the managers of Guam Memorial Hospital. Their experience offers lessons for U.S. healthcare organizations as they become culturally diverse. The hospital had a number of problems, including high management turnover, troubles with financial resources, political interference, and a building that did not meet codes. The advisers also planned to prepare the hospital for an accreditation survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). MIHS, which has a growing presence in the Pacific, does not take charge of healthcare organizations. Instead, it trains local persons to assume leadership roles. At Guam Memorial Hospital, the MIHS advisers spent their first year assessing the organization and the various cultures represented on its staff. Then the advisers devoted three years to coaching and mentoring their Guamanian counterparts. The advisers learned that the hospital had basically been run by one person. It had no management team, either formal or informal. The advisers began their coaching by forming a management team in the dietary department. When the rest of the hospital staff saw that team perform successfully, they became willing to join similar teams themselves. Guam Memorial Hospital had changed by the time the MIHS advisers left the island in 1993. It has not yet been accredited, but it does have management teams working to meet JCAHO standards. The hospital also has in place a continuous quality improvement system, with more than three years of documentation. And the hospital building now conforms to codes.

Accreditation↗

Computer handling of occupational exposure data.

A system has been developed for the computer handling of industrial hygiene data in the Michigan Division of Dow Chemical U.S.A. With the implementation of this system, future epidemiological studies might be completed in a few weeks as opposed to months when done menually. The system is capable of providing lists, either current or historical, of the chemicals used in a particular building; and all the available exposure data for specific employees can be obtained throughout their entire periods of employment. The system is also capable of summarizing all available exposure information for a given chemical. The heart of the chemical exposure data system lies in the record content. Each record contains: 1. Chemical identification number; 2. Employee number; 3. Job classification number; 4. Department index number; 5. Data type code; 6. Exposure data; 7. Units code; 8. Date; 9. Building number and 10. Reference. A detailed discussion of each of these parameters is contained in the text.

Chemical Industry↗

Do people know how they behave? Self-reported act frequencies compared with on-line codings by observers.

Behavioral acts constitute the building blocks of interpersonal perception and the basis for inferences about personality traits. How reliably can observers code the acts individuals perform in a specific situation? How valid are retrospective self-reports of these acts? Participants interacted in a group-discussion task and then reported their act frequencies, which were later coded by observers from videotapes. For each act, observer-observer agreement, self-observer agreement, and self-enhancement bias were examined. Findings show that (a) agreement varied greatly across acts; (b) much of this variation was predictable from properties of the acts (observability, base rate, desirability, Big Five domain); (c) on average, self-reports were positively distorted; and (d) this was particularly true for narcissistic individuals. Discussion focuses on implications for research on acts, traits, social perception, and the act frequency approach.

Adult↗

More about hospital generator sizing, testing and exercising.

The National Fire Protection Agency (NFPA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requirements for testing and exercising on-site standby generators are intended to prevent testing with insufficient load. However, engineers grapple with local and state enforcement agencies who require needlessly oversized standby generators, putting the engineer in the difficult position of using supplementary load banks because of insufficient building load for testing. This document examines the latest changes in NFPA codes and the JCAHO policy that aim to resolve testing issues.

Building Codes↗

Efficiency and complexity in neural coding.

Neural coding in the retina and lamina of fly compound eyes is amenable to detailed anatomical, physiological and theoretical analysis. This approach shows how identified cell signalling systems are optimized to maximize the transmission of information. Optimization reveals three familiar constraints, noise, saturation and bandwidth, and shows how coding can minimize their effects. Experiments reveal a fourth constraint, metabolic cost, whose properties favour the distribution of information among multiple pathways. The advantages of distributed codes will be offset by increasing complexity and the build up of noise. The optimization of coding in fly retina suggests that both noise and complexity will be reduced by matching each step in the system's operations to the input signal, and to the logical requirements of the network's ultimate function, pattern processing. This line of argument suggests tightly organized networks, laid out that information flows freely and independently, yet patterned so that the necessary contacts and transactions are made quickly and efficiently.

Animals↗

Functional proteomics for the discovery of carbohydrate-related enzyme activities.

Carbohydrate metabolism is central to the growth and development of organisms. Thousands of genes that are believed to code for proteins that build and remodel saccharides have been uncovered by genome sequencing projects, thereby necessitating higher-throughput methods to delineate the chemical and biological functions of all these proteins. Recent methods discussed in this review have begun to address this problem by the design of new activity-based probes and mass-differentiated carbohydrate libraries. In addition, a comparative view of carbohydrate-related enzymes from all three branches of life has led to the discovery of unusual enzymes to simplify the synthesis of carbohydrates such as the sugar nucleotides required by glycosyltransferases.

Carbohydrate Metabolism↗

Open Source software in medical informatics--why, how and what.

'Open Source' is a 20-40 year old approach to licensing and distributing software that has recently burst into public view. Against conventional wisdom this approach has been wildly successful in the general software market--probably because the openness lets programmers the world over obtain, critique, use, and build upon the source code without licensing fees. Linux, a UNIX-like operating system, is the best known success. But computer scientists at the University of California, Berkeley began the tradition of software sharing in the mid 1970s with BSD UNIX and distributed the major internet network protocols as source code without a fee. Medical informatics has its own history of Open Source distribution: Massachusetts General's COSTAR and the Veterans Administration's VISTA software have been distributed as source code at no cost for decades. Bioinformatics, our sister field, has embraced the Open Source movement and developed rich libraries of open-source software. Open Source has now gained a tiny foothold in health care (OSCAR GEHR, OpenEMed). Medical informatics researchers and funding agencies should support and nurture this movement. In a world where open-source modules were integrated into operational health care systems, informatics researchers would have real world niches into which they could engraft and test their software inventions. This could produce a burst of innovation that would help solve the many problems of the health care system. We at the Regenstrief Institute are doing our part by moving all of our development to the open-source model.

Database Management Systems↗

Building-associated pulmonary disease from exposure to Stachybotrys chartarum and Aspergillus versicolor.

The authors present an outbreak of disease associated with exposure to Stachybotrys chartarum and Aspergillus species. A courthouse and two associated office buildings had generated discomfort among employees for two years since initial occupancy. Multiple interventions had been unsuccessful An initial evaluation of 14 individuals identified three with potential asthma and three with symptoms consistent with interstitial lung disease. A clinical screening protocol to identify individuals who should be removed from work identified three likely and seven possible cases of building-related asthma. Detailed environmental and engineering assessments of the building identified major problems in mechanical system design, building construction, and operational strategies leading to excess moisture and elevated relative humidities. Moisture-damaged interior surfaces in both buildings were contaminated with S. chartarum, A. versicolor, and Penicillium species. Aspergillus species, especially A. versicolor, at concentrations of 10(1) to 10(4)/m3 dominated the indoor air under normal operating conditions. Bulk samples also revealed large quantities of Stachybotrys. A questionnaire survey of the three case and two control buildings documented between three- and 15-fold increases in symptoms. A nested case-control study suggested emphysematous-like disease in individuals meeting questionnaire definitions for cases. Replication of analysis strategies used in similar previous investigations suggested an association between worsening symptoms and decreased diffusing capacity of the lung. Performance on neuropsychological measures was similar for both cases and controls, although workers with symptoms reported increased levels of current but not past psychiatric symptomatology. Chemical analyses demonstrated the presence of satratoxins G and H. Cytotoxic laboratory analyses demonstrated the presence of agents with biological effectiveness in bulk materials. No association was seen between IgE or IgG antibodies and the presence of disease. This outbreak represents a likely human response to inhaled fungal toxins in indoor environments. Moisture indoors represents a public health issue currently inadequately addressed by building, health, or housing codes.

Adult↗

Large-scale molecular dynamics simulation of DNA: implementation and validation of the AMBER98 force field in LAMMPS.

Molecular modelling played a central role in the discovery of the structure of DNA by Watson and Crick. Today, such modelling is done on computers: the more powerful these computers are, the more detailed and extensive can be the study of the dynamics of such biological macromolecules. To fully harness the power of modern massively parallel computers, however, we need to develop and deploy algorithms which can exploit the structure of such hardware. The Large-scale Atomic/Molecular Massively Parallel Simulator (LAMMPS) is a scalable molecular dynamics code including long-range Coulomb interactions, which has been specifically designed to function efficiently on parallel platforms. Here we describe the implementation of the AMBER98 force field in LAMMPS and its validation for molecular dynamics investigations of DNA structure and flexibility against the benchmark of results obtained with the long-established code AMBER6 (Assisted Model Building with Energy Refinement, version 6). Extended molecular dynamics simulations on the hydrated DNA dodecamer d(CTTTTGCAAAAG)(2), which has previously been the subject of extensive dynamical analysis using AMBER6, show that it is possible to obtain excellent agreement in terms of static, dynamic and thermodynamic parameters between AMBER6 and LAMMPS. In comparison with AMBER6, LAMMPS shows greatly improved scalability in massively parallel environments, opening up the possibility of efficient simulations of order-of-magnitude larger systems and/or for order-of-magnitude greater simulation times.

Algorithms↗

The Howie Code: what are the real costs?

The costs of implementing the Code of Practice for the Prevention of Infection in Clinical Laboratories appear to have been inflated in various ways. These include: alterations and improvements not required by the Code; rehabilitation of neglected buildings to conform with the requirements of the Health and Safety at Work Act; correction of poor design in recently built laboratories; suboptimal management and courses of instruction; and numerous committees.

Costs and Cost Analysis↗

Social marketing and MARTIN: tools for organizing, analyzing, and interpreting qualitative data.

The purpose of this article is to discuss how the computer software program MARTIN and social marketing concepts (understanding the consumer perspective, exchange, marketing mix, and segmentation) were used as organizational, analytical, and interpretive tools for qualitative data. The qualitative data are from a case study on citizen participation in a health reform policy in British Columbia. The concept of broad-based public participation is a fundamental element of health promotion and citizenship. There is a gap, however, between the promise and reality of citizen participation in health promotion. Emerging from the analysis was an understanding of the societal circumstances that inhibited or fostered participation. This article describes how the code-based, theory-building attributes of the MARTIN software facilitated a new conceptualization of participatory citizenship and generated new insights into understanding why some people participate and others do not.

British Columbia↗

Cutaneous malignant melanoma: Tabuk experience.

Cutaneous melanoma (CM) has a rising morbidity and mortality in the western world but is rare in certain geographical areas including the Middle East. The aim of this study is to define the pattern of CM in this environment over a period of about two decades. A review of associated histological reports, dermatology, plastic general surgical admissions and outpatient census statistic of the North West Military Hospital (N.W.A.F.H.) were carried out from January 1978 to June 1996. The clinico-therapeutic information from both the review case and newly discovered CM was then studied. The result shows that CM is probably rare in the Tabuk military environment and possibly has a low mortality among the affected individuals. The presence of only 2 cases of CM among 73,955 patients over about 20 years suggests that this neoplasm is rare in N.W.A.F.H. Surgery, with localised expert reconstruction, probably offers the best cure for uncomplicated CM in this area. It is suggested that the geographical environment, genetic attributes, custom, attitude, presence of white, painted, sun-reflecting buildings, traditional dress-code and behaviour of the indigenes probably contribute to the suppression of and protection against CM in Tabuk. It is recommended that regular, antimlanoma education awareness programmes among the indigenes and avoidance of sunbathing attitude of the expatriate community should be encouraged in order to maintain this suggested natural selection protection.

Cheek↗

[REP and ERIC repetitive DNA sequences in bacteria--diagnostic significance].

Main part of eukaryotic genomes is build of unique sequences coding proteins and RNAs, but they contain as well numerous repeats interspersed with single-copy fragments. Existence of repetitive sequences were also demonstrated in prokaryotic genomes. They are found in different species of Gram-negative and Gram-positive bacteria. Interspersed repetitive sequence elements called REP and ERIC sequences are present in different species of Enterobacteriaceae family, including Escherichia coli and Salmonella typhimurium. Their functions are not completely clear, probably they play important role in regulation of gene expression. Nevertheless, REP and ERIC elements are widely use in identification and genetic analysis of bacteria. For example, using rep-PCR technique it is possible to discriminate between closely related serovars of the same species, which enables to analyze phylogenetic and epidemiological relations among them.

Animals↗