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Soteria Berne: an innovative milieu therapeutic approach to acute schizophrenia based on the concept of affect-logic.

The name "Soteria" stands for an alternative low-drug milieu-therapeutic approach to acute schizophrenia that was first implemented by Mosher and Menn in San Francisco, and since 1984 further developed by Ciompi and co-workers in Berne, on the basis of their concept of affect-logic, that emphasizes the often neglected influence of emotional factors in schizophrenia. In both settings, equal and even partly better therapeutic results, compared with traditional methods, were obtained with much lower doses of antipsychotics and comparable daily costs. Basic concepts, practical proceedings and empirical findings of Soteria Berne are reported, and their theoretical and practical implications for mainstream psychiatry are discussed. They support the hypothesis of a crucial pathogenetic and therapeutic-preventive role played by emotional factors not only in the so-called affective psychoses, but also in schizophrenia.

Journal Article↗

[Molecular logic of alcohol and taste].

Ethanol, a main constituent of every alcohol beverage, has long been calling our attention to its gustatory effect. Recent molecular dynamics studies have suggested that ethanol as well as other tastants in foods, when taken in the oral cavity, gives rise to a taste signal which is expressed via reception at taste cells in the taste bud, intracellular signal transduction in collaboration with G proteins and effecters, and signal transmission to synapsed taste neurons, and/or simultaneous reception at and signal transduction in somatosensory neurons. The taste of ethanol and its acceptability are then recognized and judged at the higher center, with generation of various physiological phenomena in the body. We have tried to make an all-inclusive DNA microarray analysis, demonstrating that when a rat tongue is stimulated with a drop of aqueous ethanol in vivo, several particular genes are specifically up- or down-regulated in trigeminal ganglions. These initial gene expression changes at peripheral neurocytes might in whole or in part trigger some of the ethanol-associated gustatory and bodily response. The importance of defining a related molecular logic is emphasized to understand academic and industrial significances of this unique food constituent, ethanol.

Alcoholic Beverages↗

The logical structure of the VIDEOFAR drug data base.

The quality of the analyses that can be carried out by a Drug Prescription Monitoring System depends on the completeness and accuracy of the information on drugs. Data quality depends also on the organization of the data base that must be designed to allow higher retrieval power with regard to the information level theoretically contained in stored data. Considering these requirements we developed inside the VIDEOFAR project, starting from the preceding experiences at the Istituto Superiore di Sanità, an activity of design and realization of a Drug Data Base whose structure, both logical and physical, is described.

Database Management Systems↗

Managing Medical Logic Modules.

A key element of IAIMS development at the Columbia Presbyterian Medical Center (CPMC) is the Medical Logic Module (MLM), designed to provide decision support to clinical users. A standard has been established for MLMs, and a number of institutions have agreed in principle to share them. At CPMC, MLMs are under development and MLMs from other institutions are being reviewed. The Columbia Health Sciences Library has developed a management system for MLMs which supports both internal development and sharing of MLMs among institutions. This paper describes the elements of the MLM management system.

Artificial Intelligence↗

PRELOG: precedence logic inference software for blood donor deferral.

Blood collection facilities have recently witnessed a substantial increase in the complexity of tests used to detect infectious disease in donor populations, and there is a stringent regulatory effort by the Food and Drug Administration (FDA) to validate the software for managing this information. PRELOG is precedence-based inference software used to determine a donor's suitability for continued donations and whether the donation can be released for transfusion. PRELOG accepts ternary input for test results (positive, negative, or undetermined), and solves the logic rules sequentially, so that the rulebase can be validated in a concise and consistent manner.

Blood Banks↗

[Use of logical decision rules during screening in order to identify groups at risk for diabetes mellitus].

The paper describes two-staged examination of population to detect diabetes mellitus using computerized methods and modern methods based on control theory. The authors present the results of screening population in one of the Moscow districts using a standard GTT with a logic decision rule to identify groups at high risk of developing diabetes mellitus. The efficacy of the rule and its use under actual conditions of limited resources were considered.

Decision Making, Computer-Assisted↗

[Experience and logic of breast conservation therapy].

One hundred patients with an operable breast cancer were treated with intent of breast conservation in six years. Five patients developed contralateral breast cancers synchronously or metachronously. Therefore, a total of 105 breasts were treated. T1 tumors were seen in 55 breasts, T2 tumors in 45, and T3 in 5. Breast conservation were possible for 95 breasts: 52 with T1 tumors,+ 41 with T2, and 2 with T3. No patients have relapsed yet. There is great concern or even fear for breast conservation among surgeons. We discuss about several issues concerning surgical margin, intraductal carcinoma, multicentricity, radiation injuries including carcinogenesis, racial difference of curability, etc., and try to establish the logic of doing or not-doing this treatment which has been proven by randomized clinical controlled trials. Reasons for conservative attitude expressed by the surgeons are irrelevant or illogical. We conclude that it now is the responsibility for the surgeons to prove survival benefit if they would continue to perform mutilating surgery such as Halsted operation.

Breast Neoplasms↗

Discriminating powers of partial agreements of names for linking personal records. Part I: The logical basis.

Machines have difficulty when using people's names to link medical and other records pertaining to the same individuals because of nicknames, ethnic synonyms, truncations, misspellings and typographical errors. Present algorithms used to compute the discriminating powers (or ODDS) associated with partial agreements of names are based, inappropriately, on the degrees of outward similarity alone. They are particularly ineffective in dealing with names that look alike but are unrelated, and with related names that have little apparent similarity. A fundamentally different rationale is, therefore, proposed which, like the human mind, assesses the relatedness of two alternative forms of a name in terms of how often they are used, interchangeably in practice. This must be taken into account if the associated discriminating powers (ODDS) are to be correctly computed. A way of implementing this more precise approach is described and illustrated, using the given names on linked records from an earlier epidemiological study. This first study of two describes the logical basis for record linkage, a second one the empirical test.

Humans↗

[The intragastric balloon: a logical and attractive idea, but probably ineffective].

Loss of post prandial satiety is often of limiting value in the success of a slimming training. Thus, the idea to introduce a balloon filled partially with air to occupy the stomach seems to be logic. A technic easy to handle had contributed to a large diffusion of this method before people asked about its real efficacy. Several short term (10 days) or medium term (6-10 months) studies show a significant weight loss, but there have been no controlled trials to determine the relative contribution to weight loss of the gastric balloon vs dietary and behaviour modifications. Furthermore, a great variability in the weight loss, some subjects even gaining weight, suggest that the compliance of the patients may be the most relevant factor. Adverse effects are effectively low and principally concern local gastric irritation (2-5%) and intestinal occlusion in some rare cases requiring surgical removal of the partially deflected balloon. Thus, if the implantation of a gastric balloon is relatively safe, it is difficult to recommend its use to the treatment of obesity in regard of the actual published results, even if most of the treated patients suffered of refractory obesity, difficult to modify with non surgical treatment.

Adult↗

Classifying cells from light microscopic bit features by binary logic. Application to grade neuronal injury in cerebral ischemia.

Degradative cellular processes within neurons were analyzed and graded by a conceptually new approach that decoupled the process of subcellular feature analysis and grading, the latter being based on the severity of observed deterioration in subcellular features. Rather than evaluate the cell's histologic image in a panoramic manner, investigators were required to give simple yes-no decisions about the presence or absence of a specific pathologic feature (bit feature as opposed to panoramic analysis). Multiple elementary decisions create a binary representation of the cell image that can be easily handled and analyzed using computer techniques to generate all possible unique phenotypes of the scanned neuronal population. In the first application of this method, however, the number of possible phenotypes were reduced by imposed a priori logic on the separation scheme focusing on a single cellular structure (the nucleus) that was followed through the stages of structural decay. We experimentally validated four neuronal types of five theoretical possibilities when three nuclear bit features were used in typing. Grading of neuronal injury for groups of normal, ischemic, and ischemic and reperfused rats into two, three, and four categories are reported. The consistency at which the method can be implemented was assessed by calculating the mean and standard deviation of the reconciled typing decisions given by the four investigators. The group of the four investigators showed less than 2, 3, and 5% error when grading cells from control, ischemic, and ischemic-reperfused animals, respectively.

Animals↗

The logical case for "wrongful life".

Suits that claim that a child would be better off never having been born often founder on conceptual and logical dilemmas. However, the correct interpretation of "wrongful life" does not require a comparison between existence and nonexistence. The New Jersey Supreme Court's decision in the Procanik case to limit damages to extraordinary medical expenses, barring recovery for pain and suffering, is a reasonable resolution.

Compensation and Redress↗

[Nosologic and inductive diagnosis of chronic polyarthritis: the logical criteria chain].

The terms of acuteness and chronicity in arthritis are being defined to their originally nosologic and fundamentally different dimension in contrast to their symptomatologic daily use. "Chronic arthritis" has on principle to be defined as being progressive and destructive causing permanent damages. The so-called ARA-criteria of rheumatoid arthritis are being pushed back to their didactic value and their originally epidemiologic purpose. In everyday life of a qualified rheumatologist they are at least superfluous, sometimes useless. The analytical-constructive train of thoughts leads from the symptom by means of methodologic steps of evidence and exclusion via nosologic categories to the respective diagnostic result. The diagnostic steps of decision are being introduced as "logic chain of criteria" and thus make the complex process of findings for our reflections at the bedside transparent.

Arthritis, Reactive↗

The logical structure of electrocardiographic diagnosis.

The description of a mathematical model of structure of electrocardiographic (ECG) diagnosis is given, starting from the automatically measurable characteristics of bioelectrical currents generated in the course of cardiac activity. The "dynamic diagnosis", established for rhythm and for atrioventricular conduction disturbances--by analysis in real time of the periodicity of electrical phenomena--is differentiated from the "static diagnosis", established for the other situations--by the logical intersection of amplitude conditions with duration of the waves belonging to a given ECG lead. Likewise, mathematical rationale separates atrial from infraatrial electrical activity.

Electrocardiography↗

[Hemodynamic investigation, a logical approach to the treatment of acute myocardial infarction].

The prognostic and therapeutic significance of different haemodynamic variables and subsets in acute myocardial infarction are analyzed. Eighty-eight patients underwent bedside catheterization by the Swan-Ganz technique. They were subdivided into 4 groups according to initial mean pulmonary wedge pressure (PWP) and cardiac index (CI). In group I (PWP less than 18 mm Hg; CI greater than 2.21/min/m2) in-hospital mortality was 2%, in group II (PWP less than 18 mm Hg; CI less than 2.21/min/m2), 8%; in group III (PWP greater than 18mm Hg; CI greater than 2.21/min/m2), 25% and in group IV (PWP greater than 18 mm Hg; CI less than 2.21/min/m2), 67%. Group I corresponds to minimal or mild ventricular dysfunction and group IV to severe ventricular failure or shock. In group III, despite a higher CI, mortality was three times that observed in group II, which suggests that in the absence of clinical signs of hypoperfusion and shock a subnormal cardiac index is not detrimental provided it is not accompanied by tachycardia and increased left ventricular end-diastolic pressure. The hemodynamic patterns of acute myocardial infarction are very variable. Bedside monitoring to evaluate short-term prognosis and form a logical approach to medical therapy represents a major advance in coronary care. The mechanical consequences of acute necrosis may be promptly and often effectively treated, the final goal being the preservation of ischemic myocardium.

Adult↗

Inductive logic programming used to discover topological constraints in protein structures.

This paper describes the application of the Inductive Logic Programming (ILP) program GOLEM to the discovery of constraints in the packing of beta-sheets in alpha/beta proteins. These constraints (rules) have a role in understanding the protein folding problem. Constraints were learnt for four features of beta-sheet packing: the winding direction of two sequential strands, whether two consecutive strands pack parallel or anti-parallel, whether two strands pack adjacently, and whether a beta-strand is at an edge. Investigation of the learnt constraints revealed interesting patterns, some of which were previously known, others that were novel. Novel features include the discovery: that the relationship between pairs of sequential strands is in general one of decreasing size, and that more sequential pairs of strands wind in the direction out than the direction in. We conclude that machine learning has a useful place in molecular biology as a pattern discovery tool.

Animals↗

MASH genes and the logic of neural crest cell lineage diversification.

Avian embryos have traditionally been the system of choice for studying neural crest development, but the combination of reverse genetics and clonal culture should allow new insights to be gained from mammalian systems as well. We describe one of the first examples where a targeted mutation in a developmental control gene, isolated on the basis of its homology to Drosophila neural determination genes, causes a highly selective phenotype affecting the early development of a subset of neural crest derivatives. Detailed analysis of the cellular phenotype and expression pattern of the gene, called MASH-1, have led to novel insights into the genetic logic that controls neural crest development. Most important, some features of the phenotype appear inconsistent with the predictions of current models of neural crest lineage diversification. These unexpected results have forced a reevaluation of our thinking about some aspects of neural crest development, and illustrate the power of the reverse genetic approach to reveal unanticipated features of complex biological systems as well as to suggest new directions for future study.

Animals↗

Postpneumonectomy chylothorax: a logical approach to successful management.

Chylothorax is unusual as a postoperative complication following pneumonectomy. Although rare today, it can still manifest life-threatening consequences if not recognized and treated in a timely and appropriate manner. Management options range from a conservative approach to immediate re-exploration, each of which has been reported as successful. However, treatment of this entity has been characterized as ill-defined or controversial despite the fact that most approaches to this clinical problem are similar. A successful outcome of this unusual complication is presented based on early recognition and institution of logical principles of conservative management. Treatment should be neither ill-defined nor controversial.

Chylothorax↗

[Metatarsus primus double osteotomy, a logical and non-disabling surgical technique for treatment of hallux valgus].

The procedure known as the Metatarsus Primus Double Osteotomy ("L'ostéotomie métatarsienne bipolaire" of Schnepp-Carret) for the treatment of the hallux valgus is a logical, efficient and non-mutilating procedure. The technique consists in reducing the hallux valgus deformity by a subcapital bone wedge resection of the metatarsus primus. The bone wedge is then pinched into a second proximal osteotomy of the metatarsus primus, correcting the varus deformity in a valgus direction. This procedure is little known and is not even mentioned in the classic orthopedic literature of German and English language.

Bone Wires↗