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Installing PACS--lessons learned.

In 1997, Carson-Tahoe Hospital in Carson City, Nev., looked into the possibility of installing its own PACS system. Increased productivity was the main business goal the hospital hoped a PACS system would meet. Only two of three chosen vendors seriously considered the request to bid because of the small number of films produced by the hospital. After installation, the hospital identified the referring physicians who used the most film and then directed its marketing efforts to them. Lessons learned include the tremendous need for training of staff, referring physicians and radiologists. Expect everyone to be slow the first week the new system is running. Map out all processes to prepare for contingencies. Make plans for archiving and be flexible in assigning tasks--next week things may change. Consider bringing in an outside consultant to measure people's expectations and fears. After nearly a year, neither the technologists nor physicians express any regrets about the installation of PACS at Carson-Tahoe.

Capital Expenditures↗

Cochlear view: postoperative radiography for cochlear implantation.

OBJECTIVE: This study aimed to define a spatial position of the cochlea in the skull based on anatomical studies and to design an appropriate method of skull radiography for demonstration of the multichannel intracochlear electrode array and the structures of the inner ear, for use in evaluating the electrode position and its related pitch perception. BACKGROUND: The conventional skull radiograph (plain radiograph) can offer a complete and direct image of an intracochlear electrode array, if the x-ray is directed to the cochlea and parallel to the axis of the cochlea. METHODS: Measurement from computed tomography imaging and three-dimensional reconstruction were performed to define the spatial position of the cochlea in the skull. RESULTS: A radiographic projection, the cochlear view, was designed. A detailed radiographic method and radiologic interpretation of the cochlear view is described. An improved clinical method for measuring the longitudinal and angular position of the electrodes from the cochlear view is recommended. CONCLUSIONS: The application of the cochlear view has proved that it is beneficial postoperatively in documenting the results of cochlear implantation, and in evaluating the depth of insertion and position of individual electrodes. It serves as a valuable reference for managing frequency mapping, optimizing speech processing strategies, and further research purposes. The method can be widely used in cochlear implant clinics because of its simplicity, low radiation, speed, and minimal cost.

Adolescent↗

Developing a Respiratory Protection Program. Understanding the written elements.

1. Respirators can be the last defense for the estimated 5 million employees who use them for protection from dusts and fibers, fumes, mists, gases, vapors, and biological hazards. Because of these potentially lethal respiratory hazards, occupational and environmental health nurses need to be able to determine the need for, understand, develop, update, and implement an actionable respiratory protection program (RPP). 2. Regulated per 29 CFR 1910.134, a written RPP becomes the map or guideline process specific to the workplace that needs to be followed to ensure employee protection. 3. The nine required written elements of a RPP include respirator selection; fit testing; respirator use in routine and emergency situations; respirator maintenance and change schedules; ensuring adequate breathing air supply, quantity, and flow for atmosphere supplying respirators; regular evaluation of program effectiveness; medical evaluation; training employees in the respiratory hazards in routine and emergent situations; and training employees in proper use of the respirator. 4. Occupational and environmental health nurses are in a unique position to be a RPP program administrator, its designated licensed health care professional, or an active member of a team implementing the RPP process.

Equipment Design↗

Functional connectivity between the superficial and deeper layers of the superior colliculus: an anatomical substrate for sensorimotor integration.

The superior colliculus (SC) transforms both visual and nonvisual sensory signals into motor commands that control orienting behavior. Although the afferent and efferent connections of this midbrain nucleus have been well characterized, little is know about the intrinsic circuitry involved in sensorimotor integration. Transmission of visual signals from the superficial (sSC) to the deeper layers (dSC) of the SC has been implicated in both the triggering of orienting movements and the activity-dependent processes that align maps of different sensory modalities during development. However, evidence for the synaptic connectivity appropriate for these functions is lacking. In this study, we used a variety of anatomical and physiological methods to examine the functional organization of the sSC-dSC pathway in juvenile and adult ferrets. Axonal tracing in adult ferrets showed that, as in other species, sSC neurons project topographically to the dSC, providing a route for the transmission of visual signals to the multisensory output layers of the SC. We found that sSC axons terminate on dSC neurons that stain prominently for the NR1 subunit of the NMDA receptor, a subpopulation of which were identified as tectoreticulospinal projection neurons. We also show that the sSC-dSC pathway is topographically organized and mediated by monosynaptic excitatory synapses even before eye opening in young ferrets, suggesting that visual signals routed via the sSC may influence the activity of dSC neurons before the emergence of their multisensory response properties. These findings indicate that superficial- to deep-layer projections provide spatially ordered visual signals, both during development and into adulthood, directly to SC neurons that are involved in coordinating sensory inputs with motor outputs.

Age Factors↗

[A proposal for a protocol for use in the evaluation of the executive functions].

INTRODUCTION: Executive functions include a variety of components such as the capacity implicated in goal formulation, the faculties employed in processes planning, and the strategies used to achieve the pretended objectives. In a previous work, taking as starting basis those models which have attempted to clarify those processes implicated in executive functions, we posed an integrative model. DEVELOPMENT: Starting from this model, we now propose an assessment protocol. Thus, executive functions considered as problem solving, require in generic terms, objective selection, planning, and monitoring processes (tower of Hanoi and zoo map). Each of these sub-processes operate through the working memory both with the visospatial sketch and the phonological loop. The central executive system, or attentional supervisor system (ASS), acts when there is no known solution and we must create an alternative one. CONCLUSIONS: In this sense, the ASS could contain the following functions: amplification of the phonological loop and visospatial sketch capacity (Sternberg type tasks), information manipulation and actualization (n-back paradigm), information manipulation and maintenance (Wechsler Memory Scale letters and numbers), simultaneously work in two cognitive tasks (dual execution tasks), inhibition (Stroop and go-no go paradigms), and cognitive sets alternation (Wisconsin Card Sorting Test). Once this planning process has been done, we must take a decision (gambling task paradigm), being the somatic marker in charge of this process.

Algorithms↗

[Results of the evaluation of environmental technological risk of an Italian region (Puglia)].

In order to plan a correct planning and a realization of interventions to support Regional Environmental Authority, results of "Technological Risk" methodology applied in a Italian region (Puglia) are reported. In this paper two main risk factors has been evaluated (high risk activities, areas with environmental crisis high risk) and determined indicators able to describe, in case of accident or anomalous event, potential interactions in the normal industrial process. Than has been described operative phases to consent risk factors evaluation and their evolution, considering also pressures on the environment identified by other issues. Some themes were in detail studied through territorial analysis and set of rules. This work enables to carry out a specific database for factories subject to "substantial risk" and finally was completed data processing with thematic maps and statistic analysis.

Environmental Health↗

[The epidemic manifestation of natural foci of tick-borne encephalitis on the territory of the Maritime Territory. 2. The spatial differences in the seasonality of tick-borne encephalitis].

Using computer maps of the epidemic process season variations, tick-borne morbidity and lethality in the areas of the Maritime Territory [correction of Primorsky Region] have been analysed. According to season variations of the epidemic process the territory of Sikhote Alin has been divided into two separate parts--northern and southern, with morbidity peak in June and July, respectively.

Disease Outbreaks↗

A new class of lysosomal/vacuolar protein sorting signals.

A number of inherited lysosomal diseases are known to result from missorting of lysosomal proteins. Considerable attention has been directed toward an understanding of this sorting pathway, and it has become apparent that different mechanisms are used for the sorting of lysosomal membrane and soluble proteins. Protein sorting to the yeast vacuole/lysosome provides a simple model system to study this process. We have mapped the first sorting signal in a vacuolar membrane protein, repressible alkaline phosphatase, and have shown it to be both necessary and sufficient for vacuolar delivery of this enzyme. The sorting information is confined to the transmembrane and cytoplasmic tail region of this type II integral membrane protein. The location of this sorting signal provides an explanation for some of the differences observed between membrane and soluble vacuolar protein sorting.

Alkaline Phosphatase↗

[EEG-activity patterns in visual information processing: characteristics, variance-analytical deliminiation, discriminance-analytical determination of undispensable variables and scale level].

1. In order to determine the variable distributions of 5 activation dependent EEG activity patterns occurring during visual information processing, mean values and standard deviations of the percental quantities of the frequencies 4, 5, ..., 13 Hz, 14 to 20 Hz and 21 to 30 Hz, as well as the mean amplitudes in the frequency bands 3.5 ... 7.4 Hz, 7.5 ... 13.4 Hz and 13.5 to 30 Hz were determined on corresponding to 10 s samples. It could be demonstrated by regression analysis that an interval scale level can be assumed already on the basis of cethe percental quantities in the three last mentioned frequency bands. 2. On the basis of 18 relevant variables, all the adjacent activity patterns could be separated from each other by means of univariate variance analysis at pairwise mean value comparison by at least two variables. 3. After stepwise reduction of dispensable variables in the framework of a linear discriminance analysis an optimal set of variables was determined, comprising the percental quantities of the frequencies 4, 5, 6, 10, 12 Hz, and 14 to 20 Hz, as well as the mean value of the amplitudes in the frequency band 3.5 to 7.4 Hz. In 4 our of 5 elementary discriminance functions, the mean values calculated for each pattern were significantly distinguishable from each other (analysis of variance, Newman-Keuls test). 4. By linear regression analysis it could be shown that the classification system of the EEG activity patterns at visual information processing can be mapped on an interval scale after the reduction of variables, too. Finally, data about the reliability of the scoring procedure are presented.

Adult↗

Friedreich ataxia.

Friedreich ataxia is an autosomal recessive ataxia with onset usually before puberty whose characteristic clinical features include progressive ataxia of gait and limbs, dysarthria, loss of joint position and vibratory sense, absent knee and ankle jerks, and Babinski signs. Foot deformity, scoliosis, diabetes mellitus, and cardiac involvement are common and characteristic. Patients survive until about age 30 years although longer survivals occur. A later onset, more slowly progressive form seems to be an allelic variant. The basic process seems to be a dying-back of neuronal processes. Using linkage mapping techniques, the classical form of Friedreich ataxia has been localized to 9q13-q21, a region on the long arm of chromosome 9. Haplotype analysis, analysis of recombinants, and physical mapping techniques, including construction of a YAC contig, have narrowed the interval for the Friedreich ataxia gene, FRDA, to a few hundred thousand base pairs. Candidate genes in the region are being studied by techniques of mutation analysis. It is likely that the Freidreich ataxia gene will be cloned soon. A condition resembling Friedreich ataxia with decreased vitamin E levels has been localized to chromosome 8 and is discussed elsewhere.

Child↗

Protein kinase C-dependent desensitization of the atrial natriuretic peptide receptor is mediated by dephosphorylation.

Stimulation of guanylyl cyclase A (GC-A) by atrial natriuretic peptide (ANP) is antagonized by activators of protein kinase C (PKC). Thus, it has been suggested that PKC phosphorylates and desensitizes GC-A. Here, we have developed stable GC-A transfectants of NIH3T3 cells, which display marked reductions in hormone-dependent cGMP elevations and guanylyl cyclase activity after incubation with ANP or phorbol 12-myristate 13-acetate (PMA). ANP binding and immunoblot analysis indicated that the decreases were not due to receptor internalization or degradation. GC-A isolated from 32PO4-labeled cells contained phosphoserine and phosphothreonine. ANP and/or PMA addition caused substantial decreases in the 32P content of the receptor that coincided with reductions in hormone-dependent guanylyl cyclase activity. The specific PKC inhibitor, GF-109203X, completely blocked the PMA-dependent dephosphorylation and desensitization of GC-A but failed to inhibit either ANP-dependent process. Tryptic phosphopeptide maps of GC-A isolated from ANP- or PMA-treated cells were unique, suggesting that the sites that dephosphorylated in response to each agent were different. In contrast to previous reports, we conclude that PMA and ANP desensitization of GC-A are distinct events mediated by dephosphorylation of specific residues through PKC-dependent and -independent pathways, respectively.

3T3 Cells↗

A geographic information system approach to evaluating the effects of the endangered species protection program on mosquito control.

The purpose of this study was to assess what impacts on organized mosquito control the implementation of an Endangered Species Protection Program for the Houston toad might have in Chambers and Harris counties, Texas. The study was also intended to demonstrate the value of using geographic information system (GIS) techniques and methodologies in making such assessments to those in mosquito control who are unfamiliar with GIS and its applications. Using the GIS, Geographical Analysis Support System (GRASS), databases were developed on the habitats and patterns of mosquito control insecticide usage occurring in Chambers and Harris counties. These databases were then employed by means of various utilities associated with GRASS and computer-supported, rule-based reasoning processes to create maps depicting the amount and locations of toad habitat and the areas treated annually with insecticides by districts in Chambers and Harris counties. This map information was then used via other GRASS utilities to identify and depict zones of overlap or coincidence between toad habitat and areas treated with insecticides for mosquito control in the 2 counties. As compared to existing maps for toad habitat, our resulting GIS-generated maps gave more precise, easy-to-use information that could be used to make decisions as to how to protect the toad in the zones of coincidence in each county without causing undue disruption to mosquito control activities in these zones.

Animals↗

[Imaging of ORL diseases in acquired immunodeficiency syndrome].

More than 50% of patients with acquired immunodeficiency syndrome (AIDS) present a lesion affecting parotid gland, lymph nodes, paranasal sinuses, pharyngo-larynx or temporal bone. In about 20% out of cases affected patients present different head and neck lesions at the time of evaluation. Most often, clinical examination and endoscopy are sufficient to perform diagnosis and to manage the disease. Imaging studies (CT or MRI) are indicated when the nature of the disease is unknown or when a map of the process is mandatory for therapeutic approach. Some imaging features are strongly suggestive of HIV infection: parotid cysts associated with hyperplasia of the nasopharynx and cervical lymph nodes enlargement; labyrinthitis and multinevritis; and head and neck squamous cell carcinomas in non alcoolo-tobacco addicted patients. Such diseases suggest the need for knowledge of the patient's seropositivity status.

Acquired Immunodeficiency Syndrome↗

World Stress Map of the Earth: a key to tectonic processes and technological applications.

Modern civilisation explores and penetrates the interior of the Earth's crust, recovers from it and stores into it solids, fluids and gases to a hitherto unprecedented degree. Management of underground structures such as boreholes or reservoirs take into account the existing stress either to take advantage of it or at least to minimise the effects of man-made stress. This paper presents the World Map of Tectonic Stresses (in short: World Stress Map or WSM) as a fundamental geophysical data-base. The impact of the WSM is pointed out: in the context of global tectonics, in seismic hazard quantification and in a wide range of technological problems in industrial applications such as oil reservoir management and stability of underground openings (tunnels, boreholes and waste disposal sites).

Earth, Planet↗

Modeling the crystallization of magnesium ammonium phosphate for phosphorus recovery.

The crystallization of magnesium ammonium phosphate (MAP) is one of the main processes for recovering P and N from wastewater. Chemically defined solution systems were designed; the saturation indices (SIs) of the solution systems with respect to MAP were derived by using a geochemical aqueous model Program, PHREEQC 2.11; the effects of the solution conditions were evaluated using thermodynamic theories. The concentrations of P and Mg in the tested solutions were 10-600 mg l(-1) and 24-720 mg l(-1), respectively, the molar ratios of N/P and pH values of the solutions varied in the ranges of 1-40 and 6.0-12.0, respectively. The temperature of all the tests was set at 25 degrees C. The test results show that the SI value of MAP is the logarithmic functions of the concentrations of P, ammonium-N and Mg, and increases with the increase of the concentration of each element. The SI value of MAP is a polynomial function of pH value of the solution, and the optimum pH value for the crystallization of MAP is 9.0 but increases slightly with the increase of the N/P. Moreover, the SI value of MAP is a power law function of the ionic strength of solutions but decreases with its increase. The adjustment of the Mg concentration and the control of solution pH are two effective methods for the control of the crystallization of MAP. The results obtained from the research can be used to guide the design and control of MAP crystallization process for the removal and recovery of P.

Animal Husbandry↗

Event-related potentials correlate with task-dependent glucose metabolism.

Cognitive processing is associated with brain electrical activity that is reflected in event-related potentials (ERP). ERP during a target detection task, and regional cerebral glucose metabolism (CMRglc) measured simultaneously, may be influenced by the same neurophysiologic processes. We tested the hypothesis that ERP factors could be directly correlated with CMRglc to derive functional brain maps of brain activity at 120, 160, 200, 280, and 400 ms following stimulus presentation in a target detection task. We controlled for the potential confounding effects of age, sex, and task accuracy, and correlate target-related and nontarget-related ERP separately. Increases and decreases in CMRglc at each time point were identified with statistical parametric mapping (P < 0.001, uncorrected). The 120- and 160-ms maps were the same for target and nontarget processing, while maps for 280 and 400 ms clearly distinguished between targets and nontargets. Extrinsic (early) cognitive processes that depend mainly on stimulus characteristics show less variation based on stimulus meaning (i.e., letter vs shape; target vs nontarget) than later (intrinsic) cognitive processes. These early effects are lateralized to the left hemisphere, for negative ERP factors, and positive ERP-PET correlations are more likely than negative ERP-PET correlations. Thus, brain areas related to task processing impact both ERP and CMRglc measures, suggesting a shared neurophysiologic mechanism for negative ERP factors and increased CMRglc. Direct statistical analysis of these two measures using statistical parametric mapping provides high spatial and temporal resolution in multisubject experiments, while requiring only a single (18)FDG PET scan per subject.

Adult↗

Maps for distributions and their time evolution.

Many dynamical stochastic processes occur "on top" of a deterministic process. We present a method which uses the trajectory of the deterministic process as basis functions for quasiarbitrary distributions. A map for the stochastic process can then be computed. This may have applications in electron storage rings or other devices perturbed by a small stochasticity. In this paper we will look only at the most elementary applications of the method.

Journal Article↗

Criteria mapping: a method of quality assurance.

Criteria mapping is a flexible and responsive method of chart audit that allows the simultaneous assessment of both the process and the outcome of care by means of health record abstraction. This method of audit is particularly suited to occupational therapy because it includes branching to reflect the sequential judgments of therapists and does not penalize the clinician for omitting unnecessary procedures. The purpose of this study was to determine the utility and reliability of the criteria mapping process in evaluating the quality of care for a self-care disability in an acute care setting. Three occupational therapists and one independent abstractor evaluated 12 charts twice. Intraobserver reliability calculated with intraclass correlation coefficients was .77 for the therapists and .65 for all observers. Interobserver reliability was .73 for the therapists and .72 for all observers. The criteria map provided comprehensive and relevant information about each chart. This paper discusses the implications of these findings for the ongoing monitoring of the quality of care in occupational therapy.

Disability Evaluation↗