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PubMed1990

[Computer stimulation of endoscopic resection of the prostate].

The number of urologists in need of training is increasing whereas the number of resections of the prostate is falling. Patients are less and less willing to have their procedure serve for young residents to learn the technique of endoscopic resection of the prostate. Despite teachings and videoendoscopy, this procedure remains difficult to learn. We decided to develop a simulator for endoscopic resection after having seen the remarkable model of endoscopic simulation developed by French gastroenterologists and presented at the computer science workshop of the AFU symposium. The hypercard program, the laservision disk, and the CD ROM project were elected as a good introduction to this challenging although not unsurmountable problem. We had to adequate our goals to the resources of French urologists: the Macintosh II is the most sophisticated affordable computer. Computerization of the televised images of the endoscopic procedure and formalization of the gestures of the operator are required. Conventional image synthesis programs for use with the Mac II are either very slow or very limited. Conventional simulation programs are highly mathematical. Computerized images take up considerable memory space and large capacity disks or optical disks are required. The urologic laservision to which we contributed in 1986 contains few endoscopic images of the prostate but served as a basis for devising a methodology. Object programming with hypercard and animated image programs for Macintosh computers will be the starting points for our project that will benefit from the significant advances announced by Apple concerning color image file maintenance.

Computer Simulation↗
PubMed2003

Reversible disorganization of the locomotor pattern after neonatal spinal cord transection in the rat.

The central pattern generators (CPGs) for locomotion, located in the lumbar spinal cord, are functional at birth in the rat. Their maturation occurs during the last few days preceding birth, a period during which the first projections from the brainstem start to reach the lumbar enlargement of the spinal cord. The goal of the present study was to investigate the effect of suppressing inputs from supraspinal structures on the CPGs, shortly after their formation. The spinal cord was transected at the thoracic level at birth [postnatal day 0 (P0)]. We examined during the first postnatal week the capacity of the CPGs to produce rhythmic motor activity in two complementary experimental conditions. Left and right ankle extensor muscles were recorded in vivo during airstepping, and lumbar ventral roots were recorded in vitro during pharmacologically evoked fictive locomotion. Mechanical stimulation of the tail elicited long-lasting sequences of airstepping in the spinal neonates and only a few steps in sham-operated rats. In vitro experiments made simultaneously on spinal and sham animals confirmed the increased excitability of the CPGs after spinalization. A left-right alternating locomotor pattern was observed at P1-P3. Both types of experiments showed that the pattern was disorganized at P6-P7, and that the left-right alternation was lost. Alternation was restored after the activation of serotonergic 5-HT(2) receptors in vivo. These results suggest that descending pathways, in particular serotonergic projections, control the strength of reciprocal inhibition and therefore shape the locomotor pattern in the neonatal rat.

Animals↗
PubMed2002

Evaluation of staff performance and material resources for integrated schistosomiasis control in northern Senegal.

BACKGROUND: A project to improve integrated control of schistosomiasis in the primary health care system of northern Senegal was implemented from February 1995 until September 1999, shortly after a Schistosoma mansoni outbreak. The activities included additional training of doctors and nurses in symptom-based treatment and making praziquantel (PZQ) available for an affordable price. OBJECTIVE: To investigate staff performance and the availability and costs of diagnostic materials and PZQ at the end of this intervention project. METHODS: We performed structured interviews with staff from 55 health care facilities in five districts. RESULTS: Respondents from 23 health care facilities reported both S. haematobium and S. mansoni in the coverage area, 32 reported only S. haematobium and three only S. mansoni. The average cost to patients for consultation, diagnosis, treatment and transportation to a referral health care facility was approximately 1.60 Euro. Fifty-seven per cent of the health care facilities with reported S. haematobium in the coverage area treated patients presenting with haematuria on symptoms; 56% of the health care facilities with reported S. mansoni in the coverage area treated patients presenting with blood in stool on symptoms. Thirteen per cent performed a diagnostic test for patients presenting with haematuria and 12% for patients presenting with blood in stool. The remainder, approximately one-third of the health care facilities, referred their patients to another facility for a diagnostic test. Implementation of symptom-based treatment in all health care facilities will reduce the total costs by 0.43 Euro (29%) for patients infected with S. haematobium and 0.78 Euro (46%) for patients infected with S. mansoni. Of the 53 health care facilities with schistosomiasis in their area, 37 had PZQ in stock of which 33 (88%) sold PZQ for the recommended retail price of 0.15 Euro per tablet (or 0.60 Euro per course of four tablets) or lower. CONCLUSION: Four years after the start of the intervention project, patients presenting with schistosomiasis related symptoms can generally expect proper diagnosis and treatment at all levels of the health care system in Northern Senegal, either at the initial visited health care facility or after referral. However, a further reduction of the total costs of treatment is still possible by a better implementation of symptom-based treatment and further reduction of the costs of PZQ.

Anthelmintics↗
PubMedDate not supplied

The PACS project in the radiology department of the LKH-Graz.

The PACS-project of Graz was started two years ago in cooperation with Siemens Erlangen. The system environment consists of three CT-devices (DR2, DR3, DRH) connected to an Ethernet-based LAN (CTnet), which is linked to a second Ethernet via a MicroVAX II. This computer works as a gateway, as an image-converter and as an archive. All CT-images of one device (DRH) are transmitted to the PACS system. The images are organized in patient-oriented folders. The physician is able to make reports about those examinations for which he is responsible. The availability of tools for secondary image processing during the reporting session (windowing, zooming, displaying statistic information, etc.) and further image-functions should make the PACS system more convenient for the physician than film-based images. After reporting, all scans which are relevant for the diagnosis (according to the physician's opinion) are selected, automatically reorganized in folders and transmitted to the archive. This needs about one to two minutes per examination. Some internal data-structures and further future aspects concerning the improvement of reliability and user acceptance are mentioned.

Database Management Systems↗
PubMed2001

Interval cancers in the Norwegian breast cancer screening program: frequency, characteristics and use of HRT.

Breast cancers diagnosed between screening examinations among women who attend a breast cancer screening program are defined as interval cancers. The Norwegian Breast Cancer Screening Program started as a pilot project in 1996, and data from the first 2-year interval are available. Our study quantifies interval cancers in the pilot project and explores characteristics and factors that may be associated with interval cancer. Interval cancers in the screening population were identified through the Cancer Registry of Norway. The frequency of invasive interval cancer was calculated as cases per 10,000 screened and as observed/expected ratio. Characteristics of the interval cancers were compared to screening-detected and clinical cancers. Breast density was assessed in a blinded review of 3 categories of screening mammograms. Information on hormone replacement therapy (HRT) use was collected from a questionnaire. The frequency of invasive interval cancers was 18.2 (15.9-20.7) per 10,000 screened and the observed/expected ratio was 0.49 (0.43-0.56). The frequency in the second year of the interval was higher than reported from other programs. The median tumor size of the interval cancers was 19.5 mm and 44.0% of the patients had affected axillary lymph nodes. The interval cancer cases had higher proportions of dense breasts and reported use of HRT compared to screen normal and screening-detected cases. The reported frequency of interval cancers is similar to comparable programs. The interval cancers differed significantly from the cancers detected in the first screening round and were more similar to clinical cancers. Interval cancer was associated with dense breasts and use of HRT. Screening programs must keep these associations in focus.

Aged↗
PubMed2005

Segmentation and size measurement of polyps in CT colonography.

Virtual colonoscopy is a relatively new method for the detection of colonic polyps. Their size, which is measured from reformatted CT images, mainly determines diagnosis. We present an automatic method for measuring the polyp size. The method is based on a robust segmentation method that grows a surface patch over the entire polyp surface starting from a seed. Projection of the patch points along the polyp axis yields a 2D point set to which we fit an ellipse. The long axis of the ellipse denotes the size of the polyp. We evaluate our method by comparing the automated size measurement with those of two radiologists using scans of a colon phantom. We give data for inter-observer and intra-observer variability of radiologists and our method as well as the accuracy and precision.

Algorithms↗
PubMed1996

Educational group support for patients with gynaecological cancer and their families.

Prior to the start of a psychosocial project for patients with gynaecological cancer and their families, a questionnaire was mailed to evaluate their potential interest in an educational and supportive group. Another aim was to rank the most important issues. Group I consisted of patients with a newly diagnosed cancer and group II comprised patients who had been in clinical remission for 2-5 years; 173 questionnaires were sent. The response rate was 80%. The rates of interest in the proposed group sessions were 63% and 65% from patients and relatives in group I, and 52% and 36% from those in group II (P < 0.05). Younger individuals, couples and people with a higher formal education were generally more interested in participating (P < 0.05). The highest-ranked issues (mean 3.9-3.7 on a four-point scale) were cancer and cancer treatment, living with a cancer diagnosis, side-effects of treatment, cancer pain and psychological reactions to cancer. Among patients in group I, the interest in questions related to sexual activity was moderate (mean 2.8); the corresponding figure was significantly higher in group II (P < 0.05). Interest in supportive and educational groups was significantly higher than in comparable studies. Since relaxation programmes and issues concerning problems with relationships have been generally regarded as the most crucial topics in supportive programmes, the preference for specifically cancer-related issues was surprising. The study underlines the importance of specifically ascertaining which issues an intended group considers to be important.

Adult↗
PubMed1996

CRMs for quality control of determinations of chemical forms of elements in support to EU legislation.

The concern for the control of toxic chemical forms of elements in the environment is reflected by an increasing number of analyses performed by research and routine laboratories. The European Commission has recognised the need to include some of these species in the list of dangerous substances to be monitored, e.g. in the marine environment or in groundwater. However, in most cases, the specifications are far from being sufficient in respect to the chemical forms of the element to be determined. Furthermore, these determinations are in most cases based on multi-step analytical techniques which are often prone to errors (e.g. at the extraction, derivatization or separation steps). Certified reference materials (CRMs) certified for their content in chemical forms of elements are, therefore, necessary to ensure the accuracy of these measurements and hence the respect of the regulations. However, the lack of CRMs for speciation analysis hampers the quality control of determinations which in turn leads to an incomparability of data produced; so far the number of CRMs produced by international organisations, e.g. NIST (USA), NIES (Japan), NRCC (Canada) and BCR (Belgium), is very limited and concerns mainly compounds such as e.g. methyl-mercury and butyltin compounds in biological matrices or sediments. The Standards, Measurements and Testing Programme (formerly BCR) of the European Commission has started a series of projects for the improvement of speciation analysis in environmental matrices, the final aim of which being the production of a variety of environmental CRMs. The existing EU legislation involving chemical forms of elements is presented, the requirements for the preparation of CRMs for speciation analysis are discussed and an update of the most recent CRMs produced within the Standards, Measurements and Testing Programme (SM&T) is given.

Journal Article↗
PubMed2007

RNAi-induced phenotypes suggest a novel role for a chemosensory protein CSP5 in the development of embryonic integument in the honeybee (Apis mellifera).

Small chemosensory proteins (CSPs) belong to a conserved, but poorly understood, protein family found in insects and other arthropods. They exhibit both broad and restricted expression patterns during development. In this paper, we used a combination of genome annotation, transcriptional profiling and RNA interference to unravel the functional significance of a honeybee gene (csp5) belonging to the CSP family. We show that csp5 expression resembles the maternal-zygotic pattern that is characterized by the initiation of transcription in the ovary and the replacement of maternal mRNA with embryonic mRNA. Blocking the embryonic expression of csp5 with double-stranded RNA causes abnormalities in all body parts where csp5 is highly expressed. The treated embryos show a "diffuse", often grotesque morphology, and the head skeleton appears to be severely affected. They are 'unable-to-hatch' and cannot progress to the larval stages. Our findings reveal a novel, essential role for this gene family and suggest that csp5 (unable-to-hatch) is an ectodermal gene involved in embryonic integument formation. Our study confirms the utility of an RNAi approach to functional characterization of novel developmental genes uncovered by the honeybee genome project and provides a starting point for further studies on embryonic integument formation in this insect.

Amino Acid Sequence↗
PubMed2002

Replacement of midgut epithelium in the greater wax moth, Galleria mellonela, during larval-pupal moult.

The epithelium of larval midgut of the greater wax moth, Galleria mellonela, was replaced during the larval-pupal moult. The development of this moth was tentatively divided into 11 stages, from the full-grown larva of last instar to the 4-day-old pupa. The midgut at each stage was observed for (1) overall structure, (2) the position of goblet cells, and (3) the appearance of the yellow body. Light microscopy revealed that cell death in the midgut began in a cocoon-spinning larva (stage II), when pigments in the stemmata started to migrate. Before drastic remodeling started to occur, cytoplasmic projections in the goblet cavities were transformed. The larval midgut changed markedly at stage III, when the pigments left the stemmata. The epithelium of the larval midgut dropped as a whole into the lumen, transforming into the yellow body. Simultaneously, a pupal midgut epithelium developed. Electron microscopy of the columnar cells of a stage III larva showed that microvilli and mitochondria looked normal even though the nucleus with condensed heterochromatin resembled an apoptotic nucleus of vertebrate and higher plant cells. Caspase-3-like protease activity was restricted to the larval midgut and increased in parallel with the formation of the yellow body. The results indicate that the replacement of the larval midgut is facilitated by a typical apoptotic process.

Animals↗
PubMed1978

Effects of intraventricular injections of norepinephrine on brain-pituitary-ovarian function in the rabbit.

In estrous estrogen-primed female rabbits with electrodes chronically implanted in various subcortical regions of the brain, the intraventricular injection of an ovulation-inducing dose of norepinephrine (NE) stimulated a prolonged episode of high amplitude 40-60 cps electroencephalographic (EEG) activity in the olfactory bulb (OB) and its projections. This activity, which started usually between 30 and 60 min after NE injection and was maintained continously for periods up to an hour thereafter, was regularly absent in the same rabbits when they were pseudopregnant and non-ovulatory to NE. Similar OB-EEG activity and ovulation had been observed earlier in response to intraventricular histamine under light pentobarbital anesthesia. The ovulatory response to histamine was eliminated by massive midbrain lesions or removal of the olfactory bulb, but intraventricular NE still induced ovulation after such losses. The ovulatory effectiveness of NE was blocked, however, by low doses of pentobarbital or high doses of atropine, neither of which inhibited the ovulatory response to intraventricular epinephrine. Atropine and alpha-adrenergic blocking agents also prevented the ovulatory response to intraventricular histamine. It is suggested that histamine activates pituitary-ovarian function by stimulating central noradrenergic elements and that NE has more of the physiological-pharmacological characteristics of a natural central nervous activator of luteinizing hormone-releasing hormone than has epinephrine.

Animals↗
PubMed1992

PACS experiences in Trieste.

The installation of a commercial PACS in the Hospitals of Trieste has been the start-point for a project of technology assessment, aimed at the evaluation of technical, clinical and economic aspects related to the introduction of this new and expensive technology in the health care system. During more than two years of use of this system in the clinical environment, several research activities have been carried out concerning the analysis of the organization of radiology departments in Italy, the analysis of work and data volumes, the evaluation of technical and clinical performances of PACS versus conventional film-based radiology, the integration between PACS and RIS, the experimentation of teleradiology applications. An overview of the most important activities and related results is given in this paper as well as some indications about future developments of the Trieste Project.

Computer Communication Networks↗
PubMed2006

The expression of a plant-type ferredoxin redox system provides molecular evidence for a plastid in the early dinoflagellate Perkinsus marinus.

Perkinsus marinus is a parasitic protozoan with a phylogenetic positioning between Apicomplexa and dinoflagellates. It is thus of interest for reconstructing the early evolution of eukaryotes, especially with regard to the acquisition of secondary plastids in these organisms. It is also an important pathogen of oysters, and the definition of parasite-specific metabolic pathways would be beneficial for the identification of efficient treatments for infected mollusks. Although these different scientific interests have resulted in the start of a genome project for this organism, it is still unknown whether P. marinus contains a plastid or plastid-like organelle like the related dinoflagellates and Apicomplexa. Here, we show that in vitro-cultivated parasites contain transcripts of the plant-type ferredoxin and its associated reductase. Both proteins are nuclear-encoded and possess N-terminal targeting sequences similar to those characterized in dinoflagellates. Since this redox pair is exclusively found in cyanobacteria and plastid-harboring organisms its presence also in P. marinus is highly indicative of a plastid. We also provide additional evidence for such an organelle by demonstrating pharmacological sensitivity to inhibitors of plastid-localized enzymes involved in fatty acid biosynthesis (e.g. acetyl-CoA carboxylase) and by detection of genes for three enzymes of plastid-localized isoprenoid biosynthesis (1-deoxy-D-xylulose 5-phosphate reductoisomerase, (E)-4-hydroxy-3-methyl-but-2-enyl diphosphate reductase, and (E)-4-hydroxy-3-methyl-but-2-enyl diphosphate synthase).

Amino Acid Sequence↗
PubMedDate not supplied

The genetic cohorts: facing the new challenges in infectious diseases. The HIV model.

All physicians are confronted with the diversity of susceptibility to infectious diseases or response to medication among patients. Much work has been done to characterize the virulence factors of pathogens, while less is known about the host (human) factor. Two unrelated people share about 99.9% of their DNA sequences, while the remaining 0.1% contains the genetic variants that influence how they differ in their risk of disease or response to drugs. The completion of the Human Genome Project gives a new start to developing the field of host genetic susceptibility. This review highlights ethical and practical issues on developing genetic cohorts by using the model of the Swiss HIV Cohort Study.

Anti-HIV Agents↗
PubMed2003

Smoking-related activities in prenatal care programs.

BACKGROUND: Convincing pregnant women who smoke to give up this behavior is one of the few universally agreed upon methods for improving pregnancy outcomes. An exploratory study was conducted to determine what public and quasi-public facilities serving pregnant women were doing to assist pregnant smokers in quitting, the reasons why more was not being done, and what could be done to increase smoking-cessation services. METHODS: Questionnaires eliciting information about pregnancy-related smoking prevention activities were mailed to home visitation projects, federally funded Healthy Start programs, CityMatCH members, and maternal and child health units in state health departments with a subsample of local health units. Responses were obtained from 354 programs. RESULTS: Only about a quarter of the respondents thought they were doing enough to help pregnant smokers stop or reduce smoking, and most thought that the inadequacy was due to insufficient funds. Only about a quarter offered smoking-cessation classes or clinics. Almost all programs had policies restricting smoking in their offices. The nationally sponsored activity that the respondents felt might be most helpful in increasing their efforts was the provision of materials. Among the 313 programs that included home visits, 86% required the home visitors to conduct a needs assessment, and 97% of those expected the woman's smoking status to be recorded. Smoking status prior to pregnancy or by other household members was required less often. Less than half of the programs provided training on smoking-cessation/reduction methods to home visitors. Only 28% said smoking-cessation/reduction had a very high priority in comparison to other home visit objectives. CONCLUSIONS; Programs for pregnant women, including those with a home visit component, do not pay sufficient attention to the problem of smoking among their clients. Programs should make greater use of the evidence-based interventions now available.

Community Health Nursing↗
PubMed2000

HIS purchase projects in public hospitals of Styria, Austria.

The Steiermärkische Krankenanstaltenges. m.b.H (KAGes) is a company, owned by the province of Styria in Austria, which operates 21 hospitals with about 8000 beds and 14000 employees, serving a population of ca. 1.2 million people. KAGes has purchased a new hospital information system (HIS) for its hospitals. Within the strategic IT plan and the 'system structure new' (SSN) project, a methodology was developed for making an effective HIS purchase. Several steps of this project are described in the paper, request for product information, evaluation of vendor proposals, product presentations, test site evaluation, reference site visits and selection of vendor finalists. The authors present the internal project management methodology, including the structure of the project team, project information management through intranet, criteria for different steps of the evaluation and evaluation site organization. Four major HIS vendors with leading HIS products qualified for this stage of the project (evaluation site). About 60 teams with 400 members (end users and IT-experts) have assessed all the products installed, during one or more, repeated test sessions. The decision on which new HIS to purchase were based on the recommendations derived from this evaluation. After completing SSN-project with the suggestion to KAGes-top-management for negotiations with two vendor finalists, the new project named MEDOCS was started mid-1999. Two pilot installations (one general hospital and one teaching hospital department) are nowadays in the pilot implementation and subsequent roll-out (including substitution of the legacy system) is scheduled until the year 2003.

Austria↗
PubMed2003

Doing the right thing and doing it right: toward a framework for assessing the policy relevance of health services research.

OBJECTIVES: Health services research is atypical instance of applied research, meaning that its research findings should contribute to a more evidence-based health policy. A basic assumption for the usefulness of policy research is that it is of good scientific quality, but evaluation of health services research would be incomplete without an assessment of its societal relevance. However, there is no generally accepted framework in which criteria to assess societal relevance are defined. METHODS: In this study, we made an effort to specify criteria and indicators for policy relevance. RESULTS AND CONCLUSIONS: In general, we concluded that it is important to define from the start of a research project, what kind of answers are being sought to the questions at hand, who the intended users of these answers will be, and how they can be reached. Furthermore, a productive dialogue between researchers and policy makers is indispensable for remaining in tune with policy thinking. In addition, we specified domains and a list of potential criteria for assessing policy relevance. For the purpose of quality assurance, these criteria have to be integrated into a quality improvement cycle. This means that the societal output of health services research should be related to the aims and missions at the level of projects, programs, and institutes. Furthermore, it is important that consensus is reached about (the weighting of) relevant indicators and that routines are developed for collecting information on these indicators.

Evidence-Based Medicine↗
PubMed2000

Feasibility study prior to the certification of trace elements in urban and industrial wastewater reference materials.

Reliable results for the determination of trace elements in urban and industrial wastewaters are of paramount importance for both checking the performance of sewage treatment and for detecting possible urban or industrial contamination sources. The quality control of measurements should in principle rely on external tools such as certified reference materials (CRM), which should represent, as closely as possible, the matrix of samples currently analysed, e.g., in the frame of environmental monitoring. To date, however, no CRM representatives of wastewater composition are available, which limits the possibility for control laboratories to check their QC externally. To fill this gap, the European Commission's Standards, Measurements and Testing Programme (formerly BCR) has started a European collaborative project of which the aim is to test the feasibility of preparation of wastewater reference materials and the analytical state-of-the-art to enable the certification of trace elements in such matrices. This paper presents the results of the first phase of this project, namely the feasibility study and the results of an interlaboratory trial.

Certification↗