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PubMed1996

Estimating mechanical parameters of leg segments in individuals with and without physical disabilities.

Methods are described for estimating the inertia, viscosity, and stiffness of the lower leg around the knee and of the whole leg around the hip that are applicable even to persons with considerable spasticity. These involve: 1) a "pull" test in which the limb is slowly moved throughout its range of motion while measuring angles (with an electrogoniometer) and torques (with a hand-held dynamometer) to determine passive stiffness and 2) a "pendulum" test in which the limb is moved against gravity and then dropped, while again measuring angles and torques. By limiting the extent of the movement and choosing a direction (flexion or extension) that minimizes reflex responses, the mechanical parameters can be determined accurately and efficiently using computer programs. In the sample of subjects studied (nine with disability related to spinal cord injury, head injury, or stroke, and nine with no neurological disability), the inertia of the lower leg was significantly reduced in the subjects with disability (p < 0.05) as a result of atrophy, but the stiffness and viscosity were within normal limits. The values of inertia were also compared with anthropometric data in the literature. The identification of these passive parameters is particularly important in designing systems for functional electrical stimulation of paralyzed muscles, but the methods may be widely applicable in rehabilitation medicine.

Adult↗
PubMed2006

An efficient dynamic system for real-time robot-path planning.

This paper presents a simple yet efficient dynamic-programming (DP) shortest path algorithm for real-time collision-free robot-path planning applicable to situations in which targets and barriers are permitted to move. The algorithm works in real time and requires no prior knowledge of target or barrier movements. In the case that the barriers are stationary, this paper proves that this algorithm always results in the robot catching the target, provided it moves at a greater speed than the target, and the dynamic-system update frequency is sufficiently large. Like most robot-path-planning approaches, the environment is represented by a topologically organized map. Each grid point on the map has only local connections to its neighboring grid points from which it receives information in real time. The information stored at each point is a current estimate of the distance to the nearest target and the neighbor from which this distance was determined. Updating the distance estimate at each grid point is done using only the information gathered from the point's neighbors, that is, each point can be considered an independent processor, and the order in which grid points are updated is not determined based on global knowledge of the current distances at each point or the previous history of each point. The robot path is determined in real time completely from the information at the robot's current grid-point location. The computational effort to update each point is minimal, allowing for rapid propagation of the distance information outward along the grid from the target locations. In the static situation, where both the targets and the barriers do not move, this algorithm is a DP solution to the shortest path problem, but is restricted by lack of global knowledge. In this case, this paper proves that the dynamic system converges in a small number of iterations to a state where the minimal distance to a target is recorded at each grid point and shows that this robot-path-planning algorithm can be made to always choose an optimal path. The effectiveness of this algorithm is demonstrated through a number of simulations.

Algorithms↗
PubMed2004

Screening for colorectal cancer.

Screening for a disease is an important concept in modern day preventive medicine. The aim is early disease detection and treatment of both asymptomatic individuals and those at risk of the disease, with the goal of better survival. The WHO published a set of essential criteria for screening in 1968 and colorectal cancer has been identified as a candidate disease. Three methods of screening are evaluated here: fecal occult blood test, flexible sigmoidoscopy and colonoscopy. Newer techniques are still being studied and preliminary results are encouraging. The incidence of colorectal cancer in Asia has been increasing in association with changes in lifestyle and therefore, designing efficient, acceptable screening programs for these populations is an important issue in the prevention of this common malignant disease.

Asia↗
PubMed1998

A prospective cohort study of blood donors: methodological issues in the investigation of injuries and chronic diseases.

Blood donors have made important contributions to research, most notably in cross-sectional seroprevalence studies. The proposed New Zealand Blood Donors Health Study is a prospective cohort study of 30,000 New Zealand donors designed to investigate the determinants of common injuries, cardiovascular disease and cancer. While robust from an analytic perspective, the execution of prospective cohort studies in many settings is impeded by methodological, economic and organisational barriers. We examined the operational considerations of implementing a large-scale cohort study at a transfusion centre and evaluated measures taken to optimise data collection procedures. A pilot study of 1,000 participants revealed donor motivation to participate in this research was high (91% response rate). Comprehensive exposure data on lifestyle, behavioural and psychosocial factors were obtained from 95% of participants. Substantial heterogeneity in levels of potential risk factors was noted among respondents. Detailed dietary habit information and a study blood sample were obtained from 67% and 100% of participants, respectively. Study recruitment and baseline data collection was feasible during routine donor visits with minimal interruption to donor centre staff and procedures. We conclude the study design and characteristics of the regional donor program enhance the efficiency and significance of the proposed research.

Adolescent↗
PubMed1999

Risk factors for hepatitis C transmission in the Victorian population: a telephone survey.

OBJECTIVE: To measure knowledge and prevalences of risk factors for hepatitis C infection in the Victorian community. METHOD: Telephone survey of 757 Victorian householders aged 15+ years, March 1996. RESULTS: An estimated 2.2% of Victorians have injected illicit drugs; 4.8% have tattoos and 49.6% have skin piercings; 11.4% received a blood transfusion before screening for HCV was introduced; 10.9% have had a test for HCV antibody. A majority of respondents perceived sexual contact and receipt of a transfusion to be risks for HCV transmission. CONCLUSIONS: Risk factors associated with the spread of HCV are widespread in the Victorian community; however, the most important risk factor--injecting drug use--has low prevalence. Considerable uncertainty exists about risk factors for hepatitis C. IMPLICATIONS: A very small percentage of Victorians are injecting drug users and therefore at highest risk of hepatitis C infection, therefore transmission control programs can be efficiently focused on this group. The Victorian community needs to be better educated about risk factors for hepatitis C, in particular that transfusions and blood donations are safe.

Adolescent↗
PubMed1991

Epidemiological study of oral leukoplakia based on mass screening for oral mucosal diseases in a selected Japanese population.

The purpose of this study was 1) to show the epidemiological status of oral leukoplakia in a selected population of 3131 Japanese (504 women, 2627 men, aged 18-63 yr, mean age 35.9 yr), and 2) to estimate of the validity of the diagnosis of oral leukoplakia by general practitioners. Seventy-seven individuals were detected as having leukoplakia, a prevalence of 2.5%; 2.7% and 1.0% for men and women, respectively, a difference that is statistically significant (P less than 0.001). The percentage of smokers was 75.3% for patients with leukoplakia and 47.8% for individuals detected as not having leukoplakia, a difference which is statistically significant (P less than 0.001). Of 77 leukoplakia patients, 37 cases (48.1%) received a clinically confirmed diagnosis and 27 patients were diagnosed in further examination as having leukoplakia. These results can also be expressed by a positive predictive value of 0.73 and a false positive ratio of 0.27 for the diagnosis of leukoplakia in the primary mass screening by general practitioners. The results of this study suggest that in order to carry out an efficient oral health program in Japan, the objects for mass screening for leukoplakia might be better limited to men over 30 and women over 40 yr of age.

Adolescent↗
PubMed1969

Nuclear magnetic resonance measurement of oil "unsaturation" in single viable corn kernels.

High-resolution nuclear magnetic resonance spectroscopy has been used to demonstrate the feasibility of determining iodine value and average molecular weight of oil in individual corn kernels. The procedure is rapid and nondestructive. Depending on heritability of individual fatty acids, this technique may greatly increase selection efficiency in breeding programs to alter the fatty acid composition of corn oil.

Breeding↗
PubMed1999

Genetic dissection of cell growth arrest functions mediated by the Epstein-Barr virus lytic gene product, Zta.

Expression of the Epstein-Barr virus (EBV) latency-associated genes activates cell cycle progression and drives immortalization of the infected cell. In contrast, progression of the EBV replication program occurs most efficiently in growth-arrested cells. Previous studies showed that the EBV-encoded immediate-early transcription factor, Zta, can induce expression of the cyclin-dependent kinase inhibitors, p21 and p27, the tumor suppressor, p53, and cell growth arrest. Moreover, Zta-mediated induction of growth arrest occurs independently of its transcriptional transactivation function. Here we show that substitution of Zta's basic DNA binding domain with the analogous region of the Zta homologue, c-Fos, abrogates Zta's ability to induce growth arrest and to induce p21, p27, or p53 expression, suggesting that protein-protein interactions between this region of Zta and key cell cycle control proteins are involved in signaling cell cycle arrest. We also show that despite the crucial role for Zta's basic domain in eliciting cell growth arrest, its amino terminus is required for efficient induction of p27 and it modulates the level of p53 induction. Last, we provide evidence that Zta-mediated inductions of p21, p27, and p53 occur, at least in part, through distinct pathways. Therefore, Zta interacts with multiple growth arrest pathways, a property which may have evolved partly as a means to ensure that lytic replication occurs in a growth-arrested setting in multiple different tissues in various states of differentiation.

Amino Acid Sequence↗
PubMed1995

Pulling the ribosome out of frame by +1 at a programmed frameshift site by cognate binding of aminoacyl-tRNA.

Programmed translational frameshifts efficiently alter a translational reading frame by shifting the reading frame during translation. A +1 frameshift has two simultaneous requirements: a translational pause which occurs when either an inefficiently recognized sense or termination codon occupies the A site, and the presence of a special peptidyl-tRNA occupying the P site during the pause. The special nature of the peptidyl-tRNA reflects its ability to slip +1 on the mRNA or to facilitate binding of an incoming aminoacyl-tRNA out of frame in the A site. This second mechanism suggested that in some cases the first +1 frame tRNA could have an active role in frameshifting. We found that overproducing this tRNA can drive frameshifting, surprisingly regardless of whether frameshifting occurs by peptidyl-tRNA slippage or out-of-frame binding of aminoacyl-tRNA. This finding suggests that in both cases, the shift in reading frame occurs coincident with formation of a cognate codon-anticodon interaction in the shifted frame.

Anticodon↗
PubMed1988

Use of microcomputer for histopathology: system using IBM PC and dBaseIII.

A microcomputer program for use in the storage and retrieval of histopathology records is described. The program was written using dBaseIII, a commercially available data management system. The program provides for efficient storage and rapid retrieval of pathology reports and facilitates clinical research. Downloading of data on to a mainframe computer is possible.

Computers↗
PubMed2006

Feasibility of a web-based continuing medical education program in dermatology: the DermoFAD experience in Italy.

BACKGROUND: Web-based systems are increasingly being considered for medical education. A draft legislation on distance-learning programs was licensed in Italy by the National Commission for Continuous Education in November 2003. A series of pilot studies were developed, among these the DermoFAD project, based on five simulated clinical cases of acne and a systematic appraisal of the evidence for their clinical management. From July 1 to August 27, 2004, a total of 500 medical doctors participated in a free of charge evaluation program of the project. OBSERVATIONS: Users were distributed all over Italy. Two hundred and eighty-one (56.2%) were primary care physicians, 83 (16.6%) dermatologists, and 136 (27.2%) other medical specialists. A wide range of connecting times was observed. The pass rate of each individual case, at first attempt, ranged from 44 to 77%. When asked to assess the overall distance-learning experience, 98% of the doctors considered it to be enjoyable. A total of 2,152 continuing medical education (CME) credits were awarded. Over 50% of the users stated they would still use the system if they had to pay for it. CONCLUSIONS: Our experience shows that distance learning is feasible and is well accepted by physicians. The DermoFAD program was an efficient means of delivering CME to the Italian medical community at large.

Dermatology↗
PubMed1996

Mortality and medical comorbidity among psychiatric patients: a review.

OBJECTIVES: To fuel advocacy for improved health care for mentally ill persons, the authors reviewed the literature that describes excess mortality and underrecognition and undertreatment of comorbid medical conditions in this population. Barriers to optimal primary medical care for psychiatric patients are discussed. METHODS: A MEDLINE search focusing on mortality and medical problems in psychiatric patients yielded 66 papers in English published between 1934 and 1996. These studies and a German paper from 1912 are included in the review. RESULTS AND CONCLUSIONS: Standardized mortality ratios for psychiatric patients, derived from comparisons with the general population and matched control groups, have repeatedly demonstrated excess mortality from both natural and unnatural causes among psychiatric patients. Several large studies that have attempted to clarify the issues underlying increased death rates are discussed. Although no single diagnostic group emerges as being at particularly high risk, substance abuse disorders alone or in combination with other psychiatric disorders have been repeatedly found to lead to increased mortality rates. Other studies have also repeatedly demonstrated that psychiatric patients suffer a high rate of comorbid medical illnesses, which are largely undiagnosed and untreated and which may cause or exacerbate psychiatric symptoms. Atypical presentations are common, and changes in vision are the symptoms most predictive of medical illness. Elderly patients and those with diagnoses of organic brain syndromes are at highest risk for comorbid medical illness. Parity in the medical and mental health treatment of psychiatric patients requires both political advocacy and development of primary care programs capable of efficiently meeting their needs.

Adult↗
PubMedDate not supplied

Are preferences for equality a matter of perspective?

BACKGROUND: Many subjects attach equal value to different health care programs in surveys eliciting preferences for resource allocation. It has been suggested that subjects may be prepared to attach different priority if they were asked to evaluate someone else's decision instead of adopting the role of a social decision maker. This study investigated whether the perspective individuals are asked to adopt affects their priority setting decisions and the likelihood of assigning equal value to health care programs. METHODS: 1253 members of an Internet panel were presented a set of clinical vignettes describing preventive health care initiatives and were asked to prioritize among these. They choose between "discrimination," that is, allocating all resources on the better program, and "equality," that is, dividing the resources equally between programs while reducing efficiency. Respondents were randomized to either of 4 survey versions that differed in terms of perspective (evaluator vs. decision maker) and expert status (expert vs. layperson) of the role to be adopted. RESULTS: Subjects in the evaluator perspectives were more likely to choose equality over discrimination between patients as compared to those in the social decision-maker perspectives, regardless of expert status (odds ratios 2.09 and 2.03, P<0.0001). Excess rates of equality choices in the evaluator frames resulted from passive acceptance of equality decisions and active revision of prioritization decisions. CONCLUSION: Preferences for an equal allocation of resources are strongly affected by decision-making perspective but stable across expert status of the adopted role.

Adult↗
PubMedDate not supplied

Low incidence of hereditary nonpolyposis colorectal cancer syndrome in a selected area of the Lombardy Cancer Registry.

AIMS AND BACKGROUND: Epidemiological investigations on the frequency of hereditary nonpolyposis colorectal cancer (HNPCC) syndrome are few and have shown a variable worldwide incidence ranging from 1% to 7% of all colorectal cancers (CRCs). In Italy, relevant differences have been observed: 2.8-3% of all CRCs in northern regions and less than 1% in southern regions. The aim of the present study was to investigate the HNPCC incidence in a selected area of northern Italy belonging to the Lombardy Cancer Registry. METHODS AND STUDY DESIGN: We analyzed 197 consecutive patients with newly diagnosed CRCs, histologically verified, and resident in two areas of the Lombardy Cancer Registry. For each case, genetic counseling with at least three generations pedigree reconstruction, HNPCC classification according to Amsterdam criteria, molecular analysis for microsatellite instability and immunohistochemistry for hMLH1 and hMSH2 were performed. RESULTS: A very low frequency (0.5%) of HNPCC fulfilling the Amsterdam criteria was found in comparison to the other Italian areas. Such an incidence seems to be due to actual population differences and reflects a genetic heterogeneity. CONCLUSIONS: The data underline the importance of a precise knowledge of actual HNPCC incidence in different populations in order to optimize effectiveness and efficiency of screening programs for the disease.

Adult↗
PubMed2005

Neuromuscular control of the knee during a resisted single-limb squat exercise.

BACKGROUND: Closed kinetic chain exercises such as single-limb squats are preferred for knee rehabilitation. A complete understanding of the neuromuscular control of the knee during the single-limb squat is essential to increase the efficiency of rehabilitation programs. HYPOTHESIS: Performing a controlled single-limb squat with resistance to knee flexion and extension will increase the coactivation of the hamstring muscle group, thus reducing the quadriceps/hamstrings ratio. STUDY DESIGN: Descriptive laboratory study. METHODS: A total of 15 healthy human subjects (7 women, 8 men) performed controlled single-limb squats in a custom mechanical device that provided resistance to both flexion and extension. Subjects performed the task at 3 levels of resistance, set as a percentage of body weight. Surface electromyographic recordings from 7 muscles (gluteus medius, rectus femoris, vastus medialis oblique, vastus lateralis, biceps femoris, semitendinosus, and medial gastrocnemius) were collected during the task. RESULTS: Biceps femoris activity during knee flexion increased from approximately 12% maximum voluntary isometric contractions during low resistance (0% body weight) to approximately 27% maximum voluntary isometric contractions during high resistance (8% body weight). Although the quadriceps had greater activity than the hamstrings at all levels of resistance, the quadriceps/hamstrings ratio declined significantly with resistance (F2,27 = 29.05; P = .012) from 3.0 at low resistance to 2.32 at the highest resistance. CONCLUSIONS: Performing controlled resisted single-limb squats may help to simultaneously strengthen the quadriceps and facilitate coactivation of the hamstrings, thus reducing anterior tibial shear forces. The coactivation may also increase the dynamic control of the knee joint. CLINICAL RELEVANCE: The typical single-limb squat exercise performed in the clinic does not usually control for bidirectional resistance and knee joint excursion. As seen in this study, controlled single-limb squats at increased levels of resistance help to increase the coactivation of the hamstring muscles, which is essential to optimize neuromuscular control of the knee.

Adult↗
PubMedDate not supplied

The impact of drug bulletins on physician prescribing habits in a health maintenance organization.

The concern over rising health care costs has created an environment that is favorable for the development of efficient health care programs. Pharmacists have been instrumental in developing and implementing programs to reduce drug costs, but many of these lack adequate documentation in the literature. One such area is the impact of disseminating drug bulletins to prescribers. This study was undertaken to assess quantitatively the impact of drug bulletins on physician prescribing habits and to measure the resultant changes in drug cost. This was a retrospective examination of Prime Health's acquisition of certain drugs described in five separate drug bulletins before and after issuance of the bulletins. We were able to demonstrate statistically significant changes in the proportions of drugs acquired after dissemination of each bulletin. In some cases, these changes persisted for the duration of the study (one year after issuance of the bulletin); in other cases, they reverted to pre-bulletin proportions. These changes resulted in mean drug cost reductions of 30 percent per calendar quarter for all of the post-bulletin period. Our findings suggest that the issuance of certain types of drug bulletins to prescribers is associated with a significant change in their prescribing habits, with resultant cost savings.

Cost-Benefit Analysis↗
PubMed2003

Introduction to the proceedings of the International Research on Infant Supplementation (IRIS) Initiative.

In 2001, students and professionals from 13 nations were hosted by UNICEF for the International Workshop on Multi-Micronutrient Deficiency Control in the Life Cycle in Lima, Peru, May 30-June 1, 2001. Workshop participants engaged in both narrow and broad discussions of ways to combat multiple micronutrient deficiencies in developing countries. Preliminary data from four common-protocol studies conducted in Peru, South Africa, Indonesia, and Vietnam were presented. Participants also discussed the immediate, preliminary, and interim issues that could guide both policy and planning of future studies of multiple micronutrient deficiency. Among the studies highlighted was the International Research on Infant Supplementation (IRIS) I trial. A review of IRIS I yielded some confirmation of the efficacy using a crushable "foodlet" (i.e., cross between food and tablet) as a supplementation vehicle, as well as concerns about potential adverse consequences of nutrient-nutrient and nutrient-nutriture interactions. Other plenary topics illustrated the practical matters of how the IRIS I logistics and operations were built, and several focused on how to best design follow-up research on infant supplementation. Finally, a series of working groups allowed for in-depth discussions on the topics of community and policy, monitoring and implementation, and research. Researchers continue to try to identify efficient and effective programs suited to the low-income settings in which infant multi-micronutrient malnutrition occurs. The papers in these proceedings elaborate on several aspects of the IRIS study, and they are published in the hope that their analysis by readers will produce wider dissemination of the details of this devastating problem.

Child Nutrition Disorders↗
PubMed2005

Coordination of intrinsic, extrinsic, and endoplasmic reticulum-mediated apoptosis by imatinib mesylate combined with arsenic trioxide in chronic myeloid leukemia.

A treatment strategy that combines arsenic trioxide (ATO) with the tyrosine kinase inhibitor imatinib mesylate (STI571, Gleevec) appears to induce markedly more cell apoptosis than imatinib mesylate alone in chronic myeloid leukemia (CML). To understand the mechanisms underlying the synergistic/additive action of these agents, we applied cDNA microarrays, component plane presentation integrated self-organizing map (CPP-SOM), and methods of protein biochemistry to study cell apoptosis induced by imatinib mesylate, ATO, and the combination of the 2 agents in the CML cell line K562. Numerous features with temporospatial relationships were revealed, indicating the coordinated regulation of molecular networks from various aspects of proapoptotic and apoptotic activities in CML. Imatinib mesylate appears to induce mainly the intrinsic pathway of cell apoptosis, whereas ATO induces the endoplasmic reticulum (ER) stress-mediated pathway of cell apoptosis, and the combination of the 2 agents seems to more effectively induce the intrinsic, extrinsic, and ER stress-mediated pathways of cell apoptosis, which results in a more effective and efficient induction of programmed cell death in K562 cells. This finding appears to be supported also by data derived from bone marrow cells of 2 patients with CML, one in chronic phase and the other in blast-crisis phase of the disease.

Antineoplastic Agents↗