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PubMed1998

The integration of a novice user interface into a professional modeling tool.

This paper describes a software tool, the Oncology Thinking Cap (OncoTCAP) and reports on our efforts to develop a novice user interface to simplify the task of describing biological models of cancer and its treatment. Oncology Thinking Cap includes a modeling tool for making relationships explicit and provide dynamic feedback about the interaction between cancer cell kinetics, treatments, and patient outcomes. OncoTCAP supports student learning by making normally invisible processes visible and providing a representational tool that can be used to conduct thought experiments. We also describe our novice interface and report the results of initial usability testing.

Cell Cycle↗
PubMed2006

Vision and touch are automatically integrated for the perception of sequences of events.

The purpose of the present experiment was to investigate the integration of sequences of visual and tactile events. Subjects were presented with sequences of visual flashes and tactile taps simultaneously and instructed to count either the flashes (Session 1) or the taps (Session 2). The number of flashes could differ from the number of taps by +/-1. For both sessions, the perceived number of events was significantly influenced by the number of events presented in the task-irrelevant modality. Touch had a stronger influence on vision than vision on touch. Interestingly, touch was the more reliable of the two modalities-less variable estimates when presented alone. For both sessions, the perceptual estimates were less variable when stimuli were presented in both modalities than when the task-relevant modality was presented alone. These results indicate that even when one signal is explicitly task irrelevant, sensory information tends to be automatically integrated across modalities. They also suggest that the relative weight of each sensory channel in the integration process depends on its relative reliability. The results are described using a Bayesian probabilistic model for multimodal integration that accounts for the coupling between the sensory estimates.

Adult↗
PubMed2000

Origins of an epidemic: the methodological and political emergence of rapid assessment.

The recent emergence of rapid assessment as a public health tool in the drug and alcohol field has been a relatively ahistorical process. The lack of such an explicit historical biography is understandable - the findings and impact of rapid assessment have rarely made their way into mainstream journals. However, its continued absence presents the manifest danger of an inward-looking field. This paper describes the development of rapid assessment during the past two decades, with a detailed focus on the emergence of rapid assessment in the drug and alcohol field. This focuses on the central role played by international agencies during the 1980s and 1990s, and the development of rapid methodologies by the World Health Organization to prevent epidemics of HIV among injecting drug users, and the use of rapid methodologies by the United Nations International Drug Control Programme to instruct drug policy reform. The paper also describes key events in other fields including: the emergence of the first formal rapid methodologies in the late 1970s, and the production of the first formal guidelines on conducting rapid assessment during the mid-1980s. The paper concludes by highlighting common challenges that rapid methodologies have faced throughout their history.

Journal Article↗
PubMed2006

Charge delocalization in the special-pair radical cation of mutant reaction centers of Rhodobacter sphaeroides from Stark spectra and nonadiabatic spectral simulations.

Stark and absorption spectra for the hole-transfer band of the bacteriochlorophyll special pair in the wild-type and L131LH, M160LH, and L131LH/M160LH mutants of the bacterial reaction center of Rhodobacter sphaeroides are presented, along with extensive analyses based on nonadiabatic spectral simulations. Dramatic changes in the Stark spectra are induced by the mutations, changes that are readily interpreted in terms of the redox-energy asymmetry and degree of charge localization in the special-pair radical cation. The effect of mutagenesis on key properties such as the electronic coupling within the special pair and the reorganization energy associated with intervalence hole transfer are determined for the first time. Results for the L131LH and M160LH/L131LH mutants indicate that these species can be considered as influencing the special pair primarily through modulation of the redox asymmetry, as is usually conceptualized, but M160LH is shown to develop a wide range of effects that can be interpreted in terms of significant mutation-induced structural changes in and around the special pair. The nonadiabatic spectra simulations are performed using both a simple two-state 1-mode and an extensive four-state 70-mode model, which includes the descriptions of additional electronic states and explicitly treats the major vibrational modes involved. Excellent agreement between the two simulation approaches is obtained. The simple model is shown to reproduce key features of the Stark effect of the main intervalence transition, while the extensive model quantitatively reproduces most features of the observed spectra for both the electronic and the phase-phonon regions, thus giving a more comprehensive description of the effect of the mutations on the properties of the special-pair radical cation. These results for a series of closely related mixed-valence complexes show that the Stark spectra provide a sensitive indicator for the properties of the mixed-valence complexes and should serve as an instructive example on the application of nonadiabatic simulations to the study of mixed-valence complexes in general as well as other chemical systems akin to the photosynthetic special pair.

Absorption↗
PubMedDate not supplied

[Pharmacy Department standard procedures for clinical trial development].

INTRODUCTION: Regulations on good clinical practice in the execution of clinical trials require the establishment and compliance of normalised working procedures by the hospital Pharmacy Department. These procedures must indicate precisely each one of the processes involved in their development, e.g. the reception, custody, storage, preparation and dispensing of research samples. OBJECTIVE: The aim of the present study is to analyse the information included in clinical trial protocols involved in the circulation of drug samples during the research stage and, based on the results obtained, to develop normalised working procedures for our hospital Pharmacy Department in order to carry out these clinical trials. MATERIAL AND METHODS: Eleven items were defined in order to describe key processes involved in identification, storage, receipt, preparation, dispensation, administration, maintenance and return of research samples, as well as those related to the beginning and end or closing of a clinical trial. Information included in 39 clinical trial protocols that had been sent to the Hospital Ethics Committee for evaluation between January and August of 2002 and was analysed in terms of the items previously defined. RESULTS: 46% of the protocols included data from the monitor or person representing the sponsor. 64% adequately described conservation and storage conditions of the research samples; but in 39% of the studied cases external labelling descriptions did not comply with legislation. Only 15% of the cases included clear instructions on research sample reception and its acknowledgement. 25.6% reported correct handling and/or preparation instructions for research samples with parenteral administration. Sample dispensation procedures were correctly described in no more than 5.1% of the protocols analyzed. 41% included information for patients, relatives or nurses on administration and handling of research samples, but none of them included specific information pamphlets or three-page leaflets. Procedures for either returning research samples to the sponsor or for their maintenance and replacement were not specified in the 71.8 and 100% of the cases, respectively. Likewise, trial ending or closing dates as well as procedures that must be followed by the Hospital Pharmacy Department during these processes were not stated in 89.7% of the protocols. Finally, only 30.8% of the cases explicitly cite the hospital Pharmacy Department. CONCLUSION: These results support and justify the need to improve clinical trial protocols in order for them to be performed in a secure, effective and efficient way. Besides, they have been the starting point to devise the normalised working procedures of the hospital Pharmacy Department for the development of the clinical trials.

Clinical Protocols↗
PubMed2005

Official recommendations and actual practice in physiotherapy: managing troubles of physical performance.

This paper explores relations between official written recommendations for physiotherapists and actual practice. It does so by presenting and discussing findings from a conversation analytic study of 74 physiotherapy treatment sessions video-recorded in four English hospitals. Various practices are described by which therapists address troubles of ongoing or recent physical performance by patients during phases of sessions that are occupied with therapists' instructions in treatment activities and patients' physical responses. Divergence between practice and official guidance can be observed, particularly regarding recommendations that therapists always be unambiguous and clear in their communication with patients. Also, there seem to be conflicting demands between maintaining performance of physical treatment activities, whilst also spending time giving patients information and explanation about troubles of performance, and checking their understanding (as is recommended). There are also conflicting demands between individual recommendations. These observations inform a discussion of the wider challenges involved in formulating relevant, appropriate official guidance on communication practice. I argue that the difficulties of auditing actual conduct against official recommendations on interaction should be acknowledged, and that recommendations should be explicitly tentative and broad. Conversation analytic studies can provide resources and understandings to complement and augment such official guidance.

Aged↗
PubMed2002

Sample size slippages in randomised trials: exclusions and the lost and wayward.

Proper randomisation means little if investigators cannot include all randomised participants in the primary analysis. Participants might ignore follow-up, leave town, or take aspartame when instructed to take aspirin. Exclusions before randomisation do not bias the treatment comparison, but they can hurt generalisability. Eligibility criteria for a trial should be clear, specific, and applied before randomisation. Readers should assess whether any of the criteria make the trial sample atypical or unrepresentative of the people in which they are interested. In principle, assessment of exclusions after randomisation is simple: none are allowed. For the primary analysis, all participants enrolled should be included and analysed as part of the original group assigned (an intent-to-treat analysis). In reality, however, losses frequently occur. Investigators should, therefore, commit adequate resources to develop and implement procedures to maximise retention of participants. Moreover, researchers should provide clear, explicit information on the progress of all randomised participants through the trial by use of, for instance, a trial profile. Investigators can also do secondary analyses on, for instance, per-protocol or as-treated participants. Such analyses should be described as secondary and non-randomised comparisons. Mishandling of exclusions causes serious methodological difficulties. Unfortunately, some explanations for mishandling exclusions intuitively appeal to readers, disguising the seriousness of the issues. Creative mismanagement of exclusions can undermine trial validity.

Bias↗
PubMed1994

Treatment of self-injury and hand mouthing following inconclusive functional analyses.

Numerous studies have used functional analyses to prescribe interventions for severe behavior disorders. The majority of these studies have focused on behavior that is clearly maintained by socially mediated reinforcement, such as contingent access to attention, tangibles, or escape from instructional demands. However, a significant proportion of functional analyses do not yield conclusive results. We examined interventions for 3 children with severe disabilities following inconclusive functional analyses. First, preferred stimuli were identified for each child via a stimulus preference assessment. Second, a functional analysis was conducted for 2 of the 3 children. High rates of aberrant behavior were seen even (if not especially) in no-interaction sessions. The 3rd child was observed for several consecutive no-interaction sessions; behavior persisted in this condition. Third, interventions based on environmental enrichment were analyzed in an analogue setting. For all of the children, environmental enrichment decreased aberrant behavior if preferred stimuli were used in the procedure. To obtain further reductions in aberrant behavior, explicit reinforcement of toy play was required for 2 children, and a brief (5-s) time-out was necessary with 1 child. Finally, effects of treatment carried over to the school or home environment following teacher or family training. Results are discussed in the context of basic reinforcement principles and future directions for research.

Child, Preschool↗
PubMed1999

A patient diary as a tool to improve medicine compliance.

Compliance is a well recognised but still unresolved health problem; improvement of compliance to treatment would increase cost-effectiveness. One of the current methods used to measure treatment compliance in a clinical drug trial is through the use of a patient diary. In order to interpret data in these diaries it is important to also assess how compliant patients are in completing diaries. Patient compliance of standard diary completion was measured in 69 patients with perennial rhinitis, who were randomised into a double blind, placebo controlled trial with a new corticosteroid drug. During 3 months the patients were instructed to complete a diary twice a day for the following parameters: rhinitis signs and symptoms, dosage times, concomitant medication, use of rescue medication and comments. Diaries were reviewed by the physician at scheduled visits. Twenty patients (30%) completed their diaries for all items perfectly, while 62 patients (94%) completed more than 95% of all items. The compliance of diary completion in a well controlled trial is high. Overall completion of the diary was not influenced by age, gender, race, use of concomitant medication or treatment failure. Significant correlations were found for study duration and physician. This study suggests that completion of a daily diary is positively correlated with patient compliance in medication intake. Physicians could consider using diaries to try to improve compliance. More explicit investigations are needed.

Administration, Intranasal↗
PubMedDate not supplied

The tacit dimension of clinical judgment.

Two distinct views of the nature of clinical judgment are identified and contrasted. The dominant view that clinical judgment is a fully explicit process is compared to the relatively neglected view that tacit knowledge plays a substantial role in the clinician's mental operations. The tacit dimension of medical thinking is explored at length. The discussion suggests severe limits when applying decision analysis, expert systems, and computer-aided cost-benefit review to medicine. The goals and practices of postgraduate medical education are also examined from this perspective, as are various other implications for the clinician. The paper concludes that it is valuable to explore the nature of medical thinking in order to improve clinical practice and education. Such explorations should, however, take cognizance of the often overlooked tacit dimension of clinical judgment. Possible constraints on the medical applicability of both formal expert systems and heavily didactic instructional programs are considered.

Clinical Medicine↗
PubMed2006

Strategic influence on the time course of predictive inferences in reading.

In the present study, we investigated how reading strategies affect the time course of online predictive inferences. Participants read sentences under instructions either to anticipate the outcomes of described events or to understand the sentences. These were followed by a target word to be named, with stimulus onset asynchronies (SOAs) of 500 or 1,000 msec (50- or 550-msec interstimulus interval, respectively). Sentences either were predictive of events or were lexically matched control sentences. There was facilitation in naming latencies for predictable target words in the strategic-anticipation condition at both SOAs, but not in the read-to-understand condition, with a significant improvement in the former condition in comparison with the latter. This suggests that predictive inferences, which are typically considered to be resource demanding, can be speeded up by specific goals in reading. Moreover, this can occur at no cost to comprehension of explicit information, as was revealed by a comprehension test.

Adolescent↗
PubMed1988

Dental anxiety. Assessment, reduction and increasing patient satisfaction.

A conceptual schema relating a number of patient and dentist variables to patient anxiety reduction and satisfaction was presented. Evidence was examined that indicates that patient compliance with preventive and treatment regimens can be influenced in a major fashion through variables that reduce anxiety and increase satisfaction with the dentist. An accounting of several studies that investigated behavioral strategies for reducing patient stress during dental procedures indicated that recorded relaxation instructions and the active distraction provided by playing a video game can be effective anxiety-reducing treatments. Attempts to find other useful behavioral strategies were unsuccessful--only relaxation and distraction were consistently successful in reducing stress in moderately anxious patients. Observations of dentist-patient interaction in the context of the behavioral strategy studies indicated that the doctor-patient relationship was an important dimension associated with patient anxiety reduction and satisfaction. A series of investigations were conducted to elucidate the dentist behaviors that were associated with these variables. We found that the dentist behaviors most closely associated with patient satisfaction were those portraying empathy, friendliness, and a calm, competent image to the patient. The most important behavior associated with anxiety reduction was the dentist's explicit promise to prevent pain. Other dentist behaviors--friendliness, being calm, giving moral support--were seen as providing an appropriate behavioral context in support of the pledge to prevent pain. Finally, we considered the need for the dentist to be aware of patient anxiety in order to effectively deal with it. If nothing else, asking about anxiety gives the patient permission to express concerns that are present. If the patient is not anxious, asking about anxiety will not produce it. Two types of measuring instruments were considered in relation to assessing anxiety. The Dental Anxiety Scale, a brief four-item scale, was judged to be a reliable and valid method for assessing general dental anxiety. In addition, a new interval scale of anxiety response was discussed for those occasions on which it is important to assess the patient's response to treatment.

Anxiety↗
PubMed2002

Talking while performing a task: a better attentional performance in patients with closed head injury?

This study explored the potentially beneficial effect of explicit verbalization on the attentional performance in patients with closed head injury (CHI) in both distracting and nondistracting environments. Ten patients with CHI and 10 normal controls were recruited. The findings indicated that in the absence of distractors, the two groups did not differ significantly on the total actual time of off-task behaviour. When distractors were present, the patients performed worse than their controls; whereas verbalization tended to reduce total actual time of off-task behaviour in patients more than normal controls (z=1.965, p=.049), the controls were at ceiling under the verbalization condition. Although the findings must be considered tentative because of this ceiling effect and the small sample sizes, our results do suggest that patients with CHI benefit more from self-instructional cues in a complex and distracting environment.

Adult↗
PubMed2004

Divided attention and mental effort after severe traumatic brain injury.

The aim of this study was to assess dual-task performance in TBI patients, under different experimental conditions, with or without explicit emphasis on one of two tasks. Results were compared with measurement of the subjective mental effort required to perform each task. Forty-three severe TBI patients at the subacute or chronic phase performed two tasks under single- and dual-task conditions: (a) random generation; (b) visual go-no go reaction time task. Three dual-task conditions were given, requiring either to consider both tasks as equally important or to focus preferentially on one of them. Patients were compared to matched controls. Subjective mental effort was rated on a visual analogic scale. TBI patients showed a disproportionate increase in reaction time in the go-no go task under the dual-task condition. However, they were just as able as controls to adapt performance to the specific instructions about the task to be emphasised. Patients reported significantly higher subjective mental effort, but the variation of mental effort according to task condition was similar to that of controls. These results suggest that the divided attention deficit of TBI patients is related to a reduction in available processing resources rather than an impairment of strategic processes responsible for attentional allocation and switching. The higher level of subjective mental effort may explain why TBI patients frequently complain of mental fatigue, although this subjective complaint seems to be relatively independent of cognitive impairment.

Adult↗
PubMedDate not supplied

Auditory and visual cueing of the [+/- rounded] feature of vowels.

That lipreading plays a role in phoneme recognition, even when the acoustic signal alone is phonologically unambiguous, has been concluded from experiments in the perception of discrepant combinations of acoustic and visual speech signals. Little is known about the effect of visual information on explicitly phonetic judgments, the kind of judgments made by trained observers that are the basis for describing the phonological pattern of a language. In this study some isolated vowels, most of them similar to vowels in standard French, were produced in ten random orders by an experienced phonetician. The acoustic signals and frontal views of the lower half of the speaker's face were recorded on video tape. By computer editing, audiovisual stimuli were prepared in which pairs of vowels supposed to differ primarily in rounding were variously combined. Twenty French-speaking speech researchers carried out three tasks: to decide on the rounding of each vowel by sound alone, by sight alone, and by sound when accompanied by matching or discrepant images of the talker. Their summed responses indicate that, despite the instruction to base decisions on the auditory signal, visual evidence of speech activity significantly "perturbed" subjects' rounding judgments. However, the lipreading effect varied greatly across both subjects and vowels. Most subjects judged most vowels strictly on the basis of the auditory information, while for others lipreading exerted paramount influence. Only a small minority responded so as to indicate any integration of discrepant rounding information registered by ear and eye.

Auditory Perception↗
PubMed2000

Specificity of internal representations underlying grasping.

The present study examines anticipatory control of fingertip forces during grasping based on the center of mass (CM) of a manipulated object. Subjects lifted an object using a precision grip while the fingertip forces and the angle about the vertical axis (roll) were measured. The object's CM could be shifted to the left or right of the object's center parallel to the grip axis without changing it's visual appearance. Subjects performed 20 lifts with the CM in the center, left, and right side of the object, respectively. Subjects were instructed to lift the object while preventing it from tilting. Within three to five lifts, subjects were able to asymmetrically partition the load force development before lift-off such that it was higher in the digit opposing the CM. This anticipatory load force partitioning prevented the object from rolling sideways at lift-off. To determine whether the internal representation underlying the anticipatory control is specific to the effectors used to form it, subjects performed five lifts with the right hand with the CM on one side. Following these lifts, they rotated the object 180 degrees around the vertical axis and performed one lift with the same hand or they translated the object to the left side of the body (with or without rotating it) and performed one lift with the left hand. Despite subjects' explicit knowledge of the new weight distribution, they were unable to appropriately scale the load forces at each digit, resulting in a subsequent large roll of the object. The findings suggest that within a few lifts subjects achieve a stable internal representation which accounts for the object's CM and is used to scale the fingertip forces in advance. They also suggest that this representation, which is used for anticipatory control of fingertip forces, is specific to the effectors used to form it. We propose that multiple internal representations may be used during the anticipatory control of grasping.

Adult↗
PubMed2004

An intentional modeling process to teach professional behavior: students' clinical observations of preceptors.

BACKGROUND: Most formal instruction in professionalism and communication occurs in the preclinical years of medical school, with an acknowledged need to fortify and apply these competencies during the clinical years. Role modeling provides a powerful way to teach professionalism, particularly when mentors identify specific learning goals and focus the learners' observations. DESCRIPTION: The authors discuss an innovative process, called Students' Clinical Observations of Preceptors (SCOOP), which reverses the traditional direction of structured observations. With written cues to focus their observations, students observe their preceptors, who intentionally model professionalism and communication during clinical encounters. Students and preceptors discuss the observed patient-physician interaction during postencounter sessions. EVALUATION: Most medical students rated the SCOOP process highly and reported professional behaviors they gained. CONCLUSION: As educators seek methods for learners to attain greater competence in communication and interpersonal skills, the SCOOP provides an explicit framework to optimize modeling for the learning of professionalism.

Clinical Competence↗
PubMed2004

Staff training and computers in respiratory care.

The respiratory therapists' (RTs') knowledge base is among a hospital's greatest assets. RTs routinely use advanced medical technologies and must understand the patient's physiology, anatomy, and condition to deliver safe and effective treatment with those technologies, especially within critical care environments. Also RTs often must educate patients and patients' families, which requires thorough understanding of the operation of medical equipment. RT education must include both tacit and explicit knowledge, so RT education can be complex, which may present challenges to clinical educators. RTs must have continuing education, and computer-based education can help meet education challenges, promote safe and effective patient care, improve patient outcomes, and improve employee satisfaction, which may improve RT recruitment and retention, while decreasing the cost of staff training. However, since computer-based education is relatively new to health care, RT educators should learn from other industries that have extensive experience with computer-based staff education.

Computer-Assisted Instruction↗