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PubMed2006

Creating a code of conduct to enable organizational change.

This article provides an overview of the elements that were involved in developing a comprehensive change management strategy at a large, multi-site laboratory as it readied for a major environmental change in the clinical laboratory. A multi-year strategic and tactical plan was created based on an organization-wide employee satisfaction survey, an environmental survey, business needs, and internal/external pressures. The goal was to build a collaborative, team-oriented, and respectful place to work, and to ensure that the workplace became a vibrant environment focused on both individual growth and business improvement and efficiency. This article presents the strategy and outcome of the change, including external and internal environmental influences, challenges, and successes. It also discusses the dissemination of information and engagement of staff, clarification of roles and responsibilities, code of conduct, career laddering and career self-management, and a review of deficiencies impacting efficiency and productivity.

Accreditation↗

PubMed2006

Density codes and shape spaces.

This paper presents an algorithm that allows for encoding probability density functions associated to samples of points of R(n). The resulting code is a sequence of points of R(n) whose density function approximates that of the set of data points. However, contrarily to sampled data points, code points associated to two different density functions can be matched, which allows to efficiently compare such functions. Moreover, the comparison of two codes can be made invariant to a wide variety of geometrical transformations of the support coordinates, provided that the Jacobian matrix of the transformation be everywhere triangular, with a strictly positive diagonal. Such invariances are commonly encountered in visual shape recognition, for example. Thus, using this tool, one can build spaces of shapes that are suitable input spaces for pattern recognition and pattern analysis neural networks. Moreover, a parallel neural implementation of the encoding algorithm is available for 2D image data.

Algorithms↗

PubMed2005

What do nurses do when they take to the streets? An analysis of psychiatric and mental health nursing interventions in the community.

Little research can be found on nursing practice for populations needing non-traditional mental health care. A descriptive study was done with the nurses on the Community Link Service (CLS), an intensive psychiatric community follow-up program, to identify nursing interventions and the types of situations encountered. These nurses use the guiding principles of two current treatment modalities, Assertive Community Treatment and Clinical Case Management. The Nursing Interventions Classification System (NIC, McCloskey & Bulecheck, 2000) was used to code nursing interventions reported through interviews and critical incidents. The nursing interventions represented 93 interventions and included 400 different activities. The analysis showed that Case Management (79%) and Complex Relationship Building (71%) were their most common interventions followed by Medication Management (64%) and Surveillance (60%). Systems such as the NIC are useful tools, but they may not give a complete description of nursing practice in this setting.

Case Management↗

PubMed2002

Photon specific absorbed fractions calculated in the trunk of an adult male voxel-based phantom.

A new approach for calculating internal dose estimates was developed through the use of a more realistic computational model of the human body. The study demonstrates the capability of building a patient-specific phantom with voxel-based data for the simulation of radiation transport and energy deposition using Monte Carlo methods such as the MCNP-4B code. MCNP-4B was used to calculate absorbed fractions for photons in a voxel-based phantom, and values were compared to reference values from traditional phantoms used for many years. Results obtained in general agreed well with previous values, but considerable differences were found in some cases due to two major causes; differences in the organ masses between the phantoms and the occurrence of organ overlap in the voxel-based phantom (which is not well modeled in the mathematical phantoms). These new techniques offer promise of developing a new generation of more realistic phantoms for internal, as well as external, dose assessment. The principal area of implementation in internal dose assessment should be the development of patient-specific dose estimates in nuclear medicine therapy, such as radioimmunotherapy (RIT). However, as new voxel-based phantoms for different individuals can be developed, they may also be used with the techniques developed here to derive new absorbed fractions and replace the traditional values usedfor other applications in internal and external dose assessment, which have been based on mathematical constructs that are not always very representative of real human organs.

Adult↗

PubMed2006

Self-assembly of DNA-coded nanoclusters.

We present a theoretical discussion of a self-assembly scheme which makes it possible to use DNA to uniquely encode the composition and structure of microparticle and nanoparticle clusters. These anisotropic DNA-decorated clusters can be further used as building blocks for hierarchical self-assembly of larger structures. We address several important aspects of possible experimental implementation of the proposed scheme: the competition between different types of clusters in a solution, possible jamming in an unwanted configuration, and the degeneracy due to symmetry with respect to particle permutations.

Colloids↗

PubMed2000

Apoptosis as a scaffold for building up the B cell repertoire.

Control of cell number is determined by a balance between cell proliferation and cell death, both of which are highly regulated processes, with numerous checks and balances. Cells control their own death through activation of an internally coded suicide program that, when activated, initiates a characteristic form of cell death called apoptosis. This type of regulation allows elimination of cells that have been produced in excess, that have developed improperly, or that have sustained genetic damage. Apoptosis is, therefore, the most common physiological form of cell death and occurs during embryonic development, tissue remodeling, immune regulation, cell activation and tumor regression.

Animals↗

PubMed2005

Building an ontology of adverse drug reactions for automated signal generation in pharmacovigilance.

Automated signal generation in pharmacovigilance implements unsupervised statistical machine learning techniques in order to discover unknown adverse drug reactions (ADR) in spontaneous reporting systems. The impact of the terminology used for coding ADRs has not been addressed previously. The Medical Dictionary for Regulatory Activities (MedDRA) used worldwide in pharmacovigilance cases does not provide formal definitions of terms. We have built an ontology of ADRs to describe semantics of MedDRA terms. Ontological subsumption and approximate matching inferences allow a better grouping of medically related conditions. Signal generation performances are significantly improved but time consumption related to modelization remains very important.

Adverse Drug Reaction Reporting Systems↗

PubMed2002

Models@Home: distributed computing in bioinformatics using a screensaver based approach.

MOTIVATION: Due to the steadily growing computational demands in bioinformatics and related scientific disciplines, one is forced to make optimal use of the available resources. A straightforward solution is to build a network of idle computers and let each of them work on a small piece of a scientific challenge, as done by Seti@Home (http://setiathome.berkeley.edu), the world's largest distributed computing project. RESULTS: We developed a generally applicable distributed computing solution that uses a screensaver system similar to Seti@Home. The software exploits the coarse-grained nature of typical bioinformatics projects. Three major considerations for the design were: (1) often, many different programs are needed, while the time is lacking to parallelize them. Models@Home can run any program in parallel without modifications to the source code; (2) in contrast to the Seti project, bioinformatics applications are normally more sensitive to lost jobs. Models@Home therefore includes stringent control over job scheduling; (3) to allow use in heterogeneous environments, Linux and Windows based workstations can be combined with dedicated PCs to build a homogeneous cluster. We present three practical applications of Models@Home, running the modeling programs WHAT IF and YASARA on 30 PCs: force field parameterization, molecular dynamics docking, and database maintenance.

Computational Biology↗

PubMed2002

The feasibility of paper-based Tracking Codes and electronic medical record systems to monitor tobacco-use assessment and intervention in an Individual Practice Association (IPA) Model health maintenance organization (HMO).

Despite evidence of its effectiveness, tobacco cessation is not systematically addressed in routine healthcare settings. Its measurement is part of the problem. A pilot study was designed to develop and implement two different tobacco tracking systems in two independent primary care offices that participated in an IPA Model health maintenance organization in Portland, Oregon. The first clinic, which utilized a paper-based charting system, implemented CPT-like tracking codes to measure and report tobacco-cessation activities, which were eventually included in the managed-care organization's (MCO) claims database. The second clinic implemented an electronic tracking system based on its computerized electronic medical record (EMR) charting system. This paper describes the pilot study, including the processes involved in building provider acceptance for the new tracking systems in these two clinics, the barriers and successes encountered during implementation, and the resources expended by the clinics and by the MCO during the pilot. The findings from the 3-month implementation period were that documentation of tobacco-use status remained stable at 42-45% in the paper-based clinic and increased from 79% to 88% in the EMR clinic. This pilot study demonstrated that Tracking Codes are a feasible preventive-care tracking system in paper-based medical offices. However, high levels of effort and support are needed, and a critical mass of insurers and health plans would need to adopt Tracking Codes before widespread use could be expected. Results of the EMR-based tracking system are also reviewed and discussed.

Costs and Cost Analysis↗

PubMed1996

Applying the object paradigm to a centralized database for a cardiology division.

In order to master the overwhelming quantity of data produced by the different laboratories of our Cardiology Division, we are presently developing a centralized database. Our aim is to improve the quality of diagnoses and therapies by constituting patient centered medical files integrating logically the results of the results of the different examinations and allowing for a rapid access to the patient data. The database has to be accessible from an heterogeneous set of PC, MacIntoshes and UNIX workstations. It must have an ergonomic graphic user interface and generate reports which can be sent to the patient physician. It is well known that the requirements for a medical database make its conceptual analysis very difficult. As medical knowledge continually evolves, the examination protocols change and, therefore, the data sets have to be updated. The maintenance of classical databases is usually expensive because it requires specialized staff to alter the database structure and to adapt the user interface. To allow for flexibility, modularity, code reusability and reliability, the object paradigm was applied to a classical relational database. Thanks to the combination of both data structure and behavior in single entities, it is possible to build generic user interfaces which can be easily tailored to the needs of every laboratory of our Cardiology Division.

Cardiology↗

PubMed1982

Identification of the 48-base-long primordial building block sequence of mouse immunoglobulin variable region genes.

Mouse immunoglobulin heavy-chain variable region (Ig VH) genes apparently arose from the approximately 600-base-pair-long (approximately 12 tandem repeats of the 48-base-pair-long primordial building block sequence TTC-AGC-AGC-CTG-ACT-GGA-TAT-GAC-CTG-GAG-TGG-ACT-TAC-TGC-GCA-AGA) that in the original reading frame specified the amino acid sequence Phe-Ser-Ser-Leu-Thr-Gly-Tyr-Asp-Leu-Glu-Trp-Thr-Tyr-Cys-Ala-Arg. The previously identified, shorter prototype building blocks merely represented particular portions of the above primordial sequence. Even today, the direct descendant in toto of this primordial sequence specifies the last one-sixth of each VH coding sequence: the 83rd to 98th amino acid residues. Furthermore, its four truncated derivatives specify the 4th to 14th, 17th to 23rd, 29th to 37th, and 38th to 48th amino acid residues. Accordingly, all three relatively invariant--therefore, conserved--framework regions (FW-1, FW-2, and FW-3) of VHs are specified by recognizable--therefore, conserved--descendants of the primordial sequence.

Amino Acid Sequence↗

PubMed2003

Parents' reactions to conflict with health care providers.

The purpose of this phenomenological study was to examine parents' reactions to conflict with health care providers and the outcomes of the conflicts. This study builds on previous research that confirmed the occurrence and sources of conflict among these informants. Seventeen parents whose children had a diagnosis of cancer were interviewed in this study. A priori coding was used to identify the specific strategies for dealing with conflict proposed by Rubin and associates. Ginsburg's approach to narrative analysis was used to examine parent's stories. Findings were that parents used the strategies of problem solving, yielding, withdrawing, inaction, and contending identified by Rubin and associates in reaction to conflict with health care providers. Following episodes of contending, many parents in the study reframed the conflict and experienced transformations or turning points, resolving to become more effective advocates for their children. A few of these advocates proceeded to become community activist.

Adolescent↗

PubMed2003

The NITE XML Toolkit: flexible annotation for multimodal language data.

Multimodal corpora that show humans interacting via language are now relatively easy to collect. Current tools allow one either to apply sets of time-stamped codes to the data and consider their timing and sequencing or to describe some specific linguistic structure that is present in the data, built over the top of some form of transcription. To further our understanding of human communication, the research community needs code sets with both timings and structure, designed flexibly to address the research questions at hand. The NITE XML Toolkit offers library support that software developers can call upon when writing tools for such code sets and, thus, enables richer analyses than have previously been possible. It includes data handling, a query language containing both structural and temporal constructs, components that can be used to build graphical interfaces, sample programs that demonstrate how to use the libraries, a tool for running queries, and an experimental engine that builds interfaces on the basis of declarative specifications.

Communication↗

PubMed1976

Effect of changed working techniques on asbestos dust levels in the working environment.

The methods are presented for correcting the working environment when asbestos dust concentrations are too high. Asbestos dust, being fibrous, remains suspended longer than most industrial dusts, and has a tendency to pack and cling together. Sophisticated monitoring techniques have made possible the attainment of standards that are effective in controlling risks of asbestos related diseases. The most difficult situation to control is the dust produced in stripping old asbestos lagging, but predamping has greatly reduced the contamination. Special attention has been paid to the special needs of people working with asbestos on building sites. Special hoods have been designed to protect workers drilling, cutting and sanding asbestos material. The Environmental Control Committee has prepared a series of Control and Safety Guides and a Code of Practice for the Disposal of Asbestos Waste Material as part of activities to promote new and improved methods of dust control.

Asbestos↗

PubMed2002

Terminology extraction from text to build an ontology in surgical intensive care.

In many medical fields, the maintenance of unabiguous terminologies, the comparison and aggregation of different terminologies go through the building of formal specialized clinical terminologies, the ontologies. In this paper, we describe the building of an ontology in the surgical intensive care medical domain. We considered textual reports as the main source of information and a natural language processing tool, the SYNTEX software, is used to build the ontology. We have tested the possibility for an expert to build a sizeable ontology in a reasonable time. The quality of the ontology has been evaluated according to its capacity to cover the ICD-10 terminology in the field. Examples of coding activity with the ontology are proposed and discussed.

Critical Care↗

PubMed2000

Biological information transfer beyond the genetic code: the sugar code.

In the era of genetic engineering, cloning, and genome sequencing the focus of research on the genetic code has received an even further accentuation in the public eye. In attempting, however, to understand intra- and intercellular recognition processes comprehensively, the two biochemical dimensions established by nucleic acids and proteins are not sufficient to satisfactorily explain all molecular events in, for example, cell adhesion or routing. The consideration of further code systems is essential to bridge this gap. A third biochemical alphabet forming code words with an information storage capacity second to no other substance class in rather small units (words, sentences) is established by monosaccharides (letters). As hardware oligosaccharides surpass peptides by more than seven orders of magnitude in the theoretical ability to build isomers, when the total of conceivable hexamers is calculated. In addition to the sequence complexity, the use of magnetic resonance spectroscopy and molecular modeling has been instrumental in discovering that even small glycans can often reside in not only one but several distinct low-energy conformations (keys). Intriguingly, conformers can display notably different capacities to fit snugly into the binding site of nonhomologous receptors (locks). This process, experimentally verified for two classes of lectins, is termed "differential conformer selection." It adds potential for shifts of the conformer equilibrium to modulate ligand properties dynamically and reversibly to the well-known changes in sequence (including anomeric positioning and linkage points) and in pattern of substitution, for example, by sulfation. In the intimate interplay with sugar receptors (lectins, enzymes, and antibodies) the message of coding units of the sugar code is deciphered. Their recognition will trigger postbinding signaling and the intended biological response. Knowledge about the driving forces for the molecular rendezvous, i.e., contributions of bidentate or cooperative hydrogen bonds, dispersion forces, stacking, and solvent rearrangement, will enable the design of high-affinity ligands or mimetics thereof. They embody clinical applications reaching from receptor localization in diagnostic pathology to cell type-selective targeting of drugs and inhibition of undesired cell adhesion in bacterial/viral infections, inflammation, or metastasis.

Animals↗

PubMed2005

Autonomy-related behaviors of patient companions and their effect on decision-making activity in geriatric primary care visits.

The objective of this study, undertaken in the USA, was to investigate the consequences of autonomy-related companion behaviors on patient decision-making activity during geriatric primary care visits. Videotapes were analyzed to characterize patient and companion decision-making activity and related companion behaviors. These behaviors were coded throughout the visit using an autonomy-based framework that included both autonomy enhancing (i.e. facilitating patient understanding, patient involvement, and doctor understanding) and detracting behaviors, (i.e. controlling the patient and building alliances with the physician). Patients (N = 93) in this cross-sectional sample range in age from 65 to 95 years and are mostly white (n = 73, 79%) and female (n = 67, 72%). Companions are spouses (n = 42, 46%), adult children (n = 33, 36%), or other relatives and friends (n = 15, 16%) of patients. Companions are active participants in medical visits and engage in more autonomy enhancing than detracting behaviors. Companions of sicker (compared with less sick) patients were more likely to facilitate patient understanding, p < .05; doctor understanding, p < .01; and patient involvement, p = .06, in care. Patients whose companions facilitated their involvement in the medical visit by asking the patient questions, prompting the patient to talk, and asking for the patient's opinion were more than four times as likely to be active in decision-making as patients whose companions did not assist in this manner (unadjusted OR 3.5, CI 1.4-8.7, p < .01; adjusted OR 4.5, CI 1.6-12.4, p < .01). Companions can play an important role in the visits of geriatric patients by facilitating communication throughout the visit as well as patient activity in decision-making.

Aged↗

PubMed2002

Policy and profession: elite perspectives on redefining general practice in Australia and England.

OBJECTIVES: To understand how general (family) practice is being redefined and is redefining itself, from the perspective of policy elites, and to build an analytical framework. METHODS: Politicians, senior bureaucrats and executives of professional organisations were interviewed (1998-2000) about the impact of general practice reforms on the profession. The information gathered was thematically coded and used to advance an understanding of profession from an elite perspective. RESULTS: Four main aspects of profession were discussed by interviewees. These were cultural authority, profession's authority, social authority and professional autonomy. The elites interviewed reported a potential challenge to the cultural authority of general practice in both countries through moves to redefine it as something broader. The profession's authority was seen as having shifted, especially in Australia where new forms of representation for the profession have been established. Medicine was viewed variously as having its social authority challenged, maintained, or extended in the granting of expertise in health, and professional autonomy was regarded as having been restructured through policy change. CONCLUSIONS: Policy elites perceive that the authority and autonomy of general practitioners has changed but reform has not resulted in generalised losses for the profession. The framework developed here, which employed aspects of profession that arose as major themes, proved useful for examining the redefinition of profession and for generating policy insights in regard to possibilities for change and likely impacts.

Attitude of Health Personnel↗