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PubMedDate not supplied

Representing nursing assessments in clinical information systems using the logical observation identifiers, names, and codes database.

In recent years, the Logical Observation Identifiers, Names, and Codes (LOINC) Database has been expanded to include assessment items of relevance to nursing and in 2002 met the criteria for "recognition" by the American Nurses Association. Assessment measures in LOINC include those related to vital signs, obstetric measurements, clinical assessment scales, assessments from standardized nursing terminologies, and research instruments. In order for LOINC to be of greater use in implementing information systems that support nursing practice, additional content is needed. Moreover, those implementing systems for nursing practice must be aware of the manner in which LOINC codes for assessments can be appropriately linked with other aspects of the nursing process such as diagnoses and interventions. Such linkages are necessary to document nursing contributions to healthcare outcomes within the context of a multidisciplinary care environment and to facilitate building of nursing knowledge from clinical practice. The purposes of this paper are to provide an overview of the LOINC database, to describe examples of assessments of relevance to nursing contained in LOINC, and to illustrate linkages of LOINC assessments with other nursing concepts.

Computational Biology↗
PubMed2000

Fast neutron absorbed dose distributions in the energy range 0.5-80 meV--a Monte Carlo study.

Neutron pencil-beam absorbed dose distributions in phantoms of bone, ICRU soft tissue, muscle, adipose and the tissue substitutes water, A-150 (plastic) and PMMA (acrylic) have been calculated using the Monte Carlo code FLUKA in the energy range 0.5 to 80 MeV. For neutrons of energies < or = 20 MeV, the results were compared to those obtained using the Monte Carlo code MCNP4B. Broad-beam depth doses and lateral dose distributions were derived. Broad-beam dose distributions in various materials were compared using two kinds of scaling factor: a depth-scaling factor and a dose-scaling factor. Build-up factors due to scattered neutrons and photons were derived and the appropriate choice of phantom material for determining dose distributions in soft tissue examined. Water was found to be a good substitute for soft tissue even at neutron energies as high as 80 MeV. The relative absorbed doses due to photons ranged from 2% to 15% for neutron energies 10-80 MeV depending on phantom material and depth. For neutron energies below 10 MeV the depth dose distributions derived with MCNP4B and FLUKA differed significantly, the difference being probably due to the use of multigroup transport of low energy (< 19.6 MeV) neutrons in FLUKA. Agreement improved with increasing neutron energies up to 20 MeV. At energies > 20 MeV, MCNP4B fails to describe dose build-up at the phantom interface and penumbra at the edge of the beam because it does not transport secondary charged particles. The penumbra width, defined as the distance between the 80% and 20% iso-dose levels at 5 cm depth and for a 10 x 10 cm2 field, was between 0.9 mm and 7.2 mm for neutron energies 10-80 MeV.

Acrylic Resins↗
PubMed2006

Gamma shielding factor for typical houses in Brazil.

The housing features in a country depend much on its climate. Dwellings in warm countries are much lighter constructions than in cold ones, which will reflect on the amount of shielding against radiation they provide. In addition to that, wealth is another factor that influences the building's finishing. Great effort has been taken to determine parameters to more accurately estimate dose to a population in case of a radioactive or nuclear accident. Nevertheless, most available data are concerned with typical housing in cold climate countries. This study aims to determine shielding factors for typical building materials used in the southeast of Brazil, a warm area, due to radioactive material deposited on the surrounding field, walls and ceiling of the external surfaces. The shielding factors determination was performed by simulation with the MCNP5 Monte Carlo computer code. The air kerma indoors for the 300, 662 and 3000 keV photon energies have been determined for three different housing patterns, ranging from the very simple to a very complex structure. The shielding factor, defined as the ratio of the air kerma indoor to the air kerma in open field, for the most simple house type and 300 keV photon energy was found to be twice of the best finished one for the same energy.

Air Pollution, Indoor↗
PubMed2005

Effects of inhibitory feedback in a network model of avian brain stem.

The avian auditory brain stem consists of a network of specialized nuclei, including nucleus laminaris (NL) and superior olivary nucleus (SON). NL cells show sensitivity to interaural time difference (ITD), a critical cue that underlies spatial hearing. SON cells provide inhibitory feedback to the rest of the network. Empirical data suggest that feedback inhibition from SON could increase the ITD sensitivity of NL across sound level. Using a bilateral network model, we assess the effects of SON feedback inhibition. Individual cells are specified as modified leaky-integrate-and-fire neurons with time constants and thresholds that vary with inhibitory input. Acoustic sound level is reflected in the discharge rates of the model auditory-nerve fibers, which innervate the network. Simulations show that with SON inhibitory feedback, ITD sensitivity is maintained in model NL cells over a threefold range in auditory-nerve discharge rate. In contrast, without SON feedback inhibition, ITD sensitivity is significantly reduced as input rates are increased. Feedback inhibition is most beneficial in maintaining ITD sensitivity at high-input rates (simulating high sound levels). With SON inhibition, ITD sensitivity is maintained for both interaurally balanced inputs (simulating an on-center sound source) and interaurally imbalanced inputs (simulating a lateralized source). Further, the empirically observed temporal build-up of SON inhibition and the presence of reciprocal inhibitory connections between the ipsi- and contralateral SON both improve ITD sensitivity. In sum, our network model shows that inhibitory feedback can substantially increase the sensitivity and dynamic range of ITD coding in the avian auditory brain stem.

Action Potentials↗
PubMed1999

The molecular characterization of the first autolytic lysozyme of Streptococcus pneumoniae reveals evolutionary mobile domains.

A biochemical approach to identify proteins with high affinity for choline-containing pneumococcal cell walls has allowed the localization, cloning and sequencing of a gene (lytC ) coding for a protein that degrades the cell walls of Streptococcus pneumoniae. The lytC gene is 1506 bp long and encodes a protein (LytC) of 501 amino acid residues with a predicted M r of 58 682. LytC has a cleavable signal peptide, as demonstrated when the mature protein (about 55 kDa) was purified from S. pneumoniae. Biochemical analyses of the pure, mature protein proved that LytC is a lysozyme. Combined cell fractionation and Western blot analysis showed that the unprocessed, primary product of the lytC gene is located in the pneumococcal cytoplasm whereas the processed, active form of LytC is tightly bound to the cell envelope. In vivo experiments demonstrated that this lysozyme behaves as a pneumococcal autolytic enzyme at 30 degrees C. The DNA region encoding the 253 C-terminal amino acid residues of LytC has been cloned and expressed in Escherichia coli. The truncated protein exhibits a low, but significant, choline-independent lysozyme activity, which suggests that this polypeptide adopts an active conformation. Self-alignment of the N-terminal part of the deduced amino acid sequence of LytC revealed the presence of 11 repeated motifs. These results strongly suggest that the lysozyme reported here has changed the general building plan characteristic of the choline-binding proteins of S. pneumoniae and its bacteriophages, i.e. the choline-binding domain and the catalytic domain are located, respectively, at the N-terminal and the C-terminal moieties of LytC. This work illustrates the natural versatility exhibited by the pneumococcal genes coding for choline-binding proteins to fuse separated catalytic and substrate-binding domains and create new and functional mature proteins.

Amino Acid Sequence↗
PubMed2002

Cognitive response repertoires to child noncompliance by mothers of aggressive boys.

Cognitive response repertoires to videotaped child noncompliance episodes were examined in mothers of aggressive (MAs) and nonaggressive 4-6-year-old boys. Mothers provided open-ended solutions to three subtypes of child noncompliance under conditions of time pressure, or after they waited for 15 s to consider alternatives. Solutions were coded as assistance/facilitation, coercion, deference, or explanation/clarification. Compared with controls, MAs offered fewer explanation/clarification responses, more coercive responses, and fewer unique solutions during pressured responding. Two to 6 weeks later, mothers were videotaped while participating with their sons in a challenging block building task. Maternal responses to the vignettes predicted conflict escalation during block building, even after rates of concurrent and past child noncompliance were partialled out. Implications for parent-training models are considered.

Adult↗
PubMed2000

Drosophila telomere transposons: genetically active elements in heterochromatin.

In Drosophila two non-LTR retrotransposons, HeT-A and TART, offer a novel experimental system for the study of heterochromatin. These elements, found only in heterochromatin, form Drosophila telomeres by repeated transposition onto chromosome ends. Their transposition yields arrays of repeats larger and more irregular than the repeats produced by telomerase; nevertheless, the transpositions are, in principle, equivalent to the telomere-building action of telomerase. The identification of the HeT-A promoter has given the first view of the molecular structure of a promoter active in heterochromatin. These telomere-specific elements are unusual in having a large amount of non-coding sequence. Like many other heterochromatic sequences, the HeT-A non-coding sequence has a repetitive organization strongly conserved within the species, although the sequence itself can undergo significant change between species (a typical example of concerted evolution). Such heterochromatic sequences could be important for the cell, perhaps as docking stations for essential proteins.

Animals↗
PubMed1992

Structural comparison of the chicken genes for alpha 1(VI) and alpha 2(VI) collagen.

The chicken alpha 1(VI) polypeptide is encoded by a single gene spanning 21 kbp of genomic DNA. This gene is composed of 34 exons and 33 introns. Its structure is closely related to that of the alpha 2(VI) collagen gene, suggesting that the two genes evolved by gene duplication. Both genes contain 19 exons coding for the triple-helical domain. These exons are multiples of 9 bp (27, 36, 45, 54, 63 and 90 bp) and encode an integral number of collagenous Gly-Xaa-Yaa triplets. Since there is no convincing correlation to a building block of 54 bp, it is unlikely that type VI collagen has evolved from a primordial 54-bp module as suggested for all fibrillar collagens.

Amino Acid Sequence↗
PubMed2006

A compression-based approach for coding sequences identification. I. Application to prokaryotic genomes.

Most of the gene prediction algorithms for prokaryotes are based on Hidden Markov Models or similar machine-learning approaches, which imply the optimization of a high number of parameters. The present paper presents a novel method for the classification of coding and non-coding regions in prokaryotic genomes, based on a suitably defined compression index of a DNA sequence. The main features of this new method are the non-parametric logic and the costruction of a dictionary of words extracted from the sequences. These dictionaries can be very useful to perform further analyses on the genomic sequences themselves. The proposed approach has been applied on some prokaryotic complete genomes, obtaining optimal scores of correctly recognized coding and non-coding regions. Several false-positive and false-negative cases have been investigated in detail, which have revealed that this approach can fail in the presence of highly structured coding regions (e.g., genes coding for modular proteins) or quasi-random non-coding regions (e.g., regions hosting non-functional fragments of copies of functional genes; regions hosting promoters or other protein-binding sequences). We perform an overall comparison with other gene-finder software, since at this step we are not interested in building another gene-finder system, but only in exploring the possibility of the suggested approach.

Algorithms↗
PubMed2005

The PANTHER database of protein families, subfamilies, functions and pathways.

PANTHER is a large collection of protein families that have been subdivided into functionally related subfamilies, using human expertise. These subfamilies model the divergence of specific functions within protein families, allowing more accurate association with function (ontology terms and pathways), as well as inference of amino acids important for functional specificity. Hidden Markov models (HMMs) are built for each family and subfamily for classifying additional protein sequences. The latest version, 5.0, contains 6683 protein families, divided into 31,705 subfamilies, covering approximately 90% of mammalian protein-coding genes. PANTHER 5.0 includes a number of significant improvements over previous versions, most notably (i) representation of pathways (primarily signaling pathways) and association with subfamilies and individual protein sequences; (ii) an improved methodology for defining the PANTHER families and subfamilies, and for building the HMMs; (iii) resources for scoring sequences against PANTHER HMMs both over the web and locally; and (iv) a number of new web resources to facilitate analysis of large gene lists, including data generated from high-throughput expression experiments. Efforts are underway to add PANTHER to the InterPro suite of databases, and to make PANTHER consistent with the PIRSF database. PANTHER is now publicly available without restriction at http://panther.appliedbiosystems.com.

Animals↗
PubMed2004

Evaluation of indoor gamma radiation dose in dwellings.

The use of materials containing naturally occurring radionuclides for house construction may enhance the natural radiation background to which some population groups are exposed. External exposure results from gamma emitter radionuclides existing in the walls, floor and ceiling. Mathematical models can be used to predict external dose rates inside a room, provided the compartment geometry and the radionuclide concentration activities are known. This paper presents a methodology and a computer code for theoretical evaluation of indoor external gamma doses in the air. The room was modelled as three pairs of rectangular slabs of finite thickness. Doses were evaluated by applying a photon transport model, taking into account self-absorption and radiation build-up. Calculations were performed for 40K, 226Ra and 232Th, considering concrete walls. The results obtained show good agreement with those reported in the literature. Dose conversion factors are presented in a practical manner, ready to use for radiological impact screening.

Air Pollution, Indoor↗
PubMed2005

[ICPC-2--international classification of primary health care and its application in Croatian health care].

A consensus reached by the medical profession, Croatian Institute of Health Insurance, Croatian Institute of Public Health, and Ministry of Health constitutes a solution to the problem of a data standard required in building an information system for primary health care. This consists of accepting ICPC-2 as a data standard for our Family Medicine, Pediatrics and Women's Health. The classification structure of the International Classification of Primary Care allows, recommends and urges that special codes be established by individual states or local authorities when registering patients' reasons for seeking medical aid or medical procedures. Namely, it urges the authorities to set the codes for such reasons about which a state or local agreement or determination has been made. This is the first public presentation of the proposal Croatia's Additions to the International Classification of Primary Care. They are essential to its implementation in our health insurance, health statistics and medical informatics.

Ambulatory Care Information Systems↗
PubMed1997

Patient-physician trust: an exploratory study.

BACKGROUND: Patients' trust in their physicians has recently become a focus of concern, largely owing to the rise of managed care, yet the subject remains largely unstudied. We undertook a qualitative research study of patients' self-reported experiences with trust in a physician to gain further understanding of the components of trust in the context of the patient-physician relationship. METHODS: Twenty-nine patients participants, aged 26 to 72, were recruited from three diverse practice sites. Four focus groups, each lasting 1.5 to 2 hours, were conducted to explore patients' experiences with trust. Focus groups were audio-recorded, transcribed, and coded by four readers, using principles of grounded theory. RESULTS: The resulting consensus codes were grouped into seven categories of physician behavior, two of which related primarily to technical competence (thoroughness in evaluation and providing appropriate and effective treatment) and five of which were interpersonal (understanding patient's individual experience, expressing caring, communicating clearly and completely, building partnership/sharing power and honesty/respect for patient). Two additional categories were predisposing factors and structural/staffing factors. Each major category had multiple subcategories. Specific examples from each major category are provided. CONCLUSIONS: These nine categories of physician behavior encompassed the trust experiences related by the 29 patients. These categories and the specific examples provided by patients provide insights into the process of trust formation and suggest ways in which physicians could be more effective in building and maintaining trust.

Adult↗
PubMed1994

The use of the Arden Syntax for MLMs in HIOS+, a decision support system for general practitioners in The Netherlands.

This paper covers query creation and evaluation in HIOS+, a General Practitioner Decision Support System. The International Classification of Primary Care (ICPC), free-text International Classification of Health Problems in Primary Care (ICHPPC)-II-Defined criteria, and the Arden Syntax for medical logic modules (MLMs) are building blocks in query creation with the free-text formalizer (FF) module. The backward-reasoning formal interpreter (FI) module evaluates queries by checking them against medical patient data. It can advise or warn users on the suitability of a registered diagnostic ICPC code in a patient's case. In all, 101 queries were created in MLM form on a wide range of diseases. The MLMs and FI were evaluated in a field and a laboratory test.

Artificial Intelligence↗
PubMed1990

Efficient expression of chicken alpha 1(VI) collagen chain in transiently transfected mammalian cells.

Type VI collagen is a component of the extracellular matrix made of three subunits, alpha 1(VI) and alpha 2(VI) (Mr = 140,000), and alpha 3(VI) (Mr = greater than 300,000). Triple helical monomers assemble intracellularly into disulfide-linked dimers and tetramers, with the tetramers being the "building blocks" that give rise to higher order extracellular structures by head-to-head association, the microfilaments. To study the pattern of assembly and the structure-function relationships of type VI collagen, we transfected mammalian cells with a full-length cDNA coding for chicken alpha 1(VI) under the control of SV40 early and late promoters and assayed the expression, secretion, and assembly of the protein by immunoperoxidase and immunoprecipitation of metabolically labeled cells. First, conditions were determined that allowed efficient transfection both in African monkey kidney COS-1 and CV-1 cells and in mouse fibroblasts. In our hands the late promoter was most efficient in CV-1 cells; whereas the early promoter was efficient in L cells at three days post-transfection. Chicken alpha 1(VI) could be isolated from cell extracts as well as from cell medium. Both the intracellular and the secreted forms of alpha 1(VI) are present as a monomer polypeptide and as disulfide-linked dimers and trimers that migrate in SDS gels with apparent Mr of about 130,000, 240,000 and 360,000, respectively. In L cells, endogenous mouse type VI collagen also was isolated by immunoprecipitation with specific antibodies. However, heterologous molecules made of the chicken alpha 1(VI) chain and the mouse alpha 2(VI) and alpha 3(VI) chains were not detected in the present experiments. Digestion with pepsin of the non-reduced chicken alpha 1(VI) polypeptides immunoprecipitated from the cell medium resulted in the disappearance of the bands, suggesting improper or non-stable assembly of alpha 1(VI) homotrimers. These data support predictions from sequence analysis that type VI collagen heterotrimeric molecules are more stable than other assembly alternatives.

Animals↗
PubMed1999

The Regenstrief Medical Record System: a quarter century experience.

Entrusted with the records for more than 1.5 million patients, the Regenstrief Medical Record System (RMRS) has evolved into a fast and comprehensive data repository used extensively at three hospitals on the Indiana University Medical Center campus and more than 30 Indianapolis clinics. The RMRS routinely captures laboratory results, narrative reports, orders, medications, radiology reports, registration information, nursing assessments, vital signs, EKGs and other clinical data. In this paper, we describe the RMRS data model, file structures and architecture, as well as recent necessary changes to these as we coordinate a collaborative effort among all major Indianapolis hospital systems, improving patient care by capturing city-wide laboratory and encounter data. We believe that our success represents persistent efforts to build interfaces directly to multiple independent instruments and other data collection systems, using medical standards such as HL7, LOINC, and DICOM. Inpatient and outpatient order entry systems, instruments for visit notes and on-line questionnaires that replace hardcopy forms, and intelligent use of coded data entry supplement the RMRS. Physicians happily enter orders, problems, allergies, visit notes, and discharge summaries into our locally developed Gopher order entry system, as we provide them with convenient output forms, choice lists, defaults, templates, reminders, drug interaction information, charge information, and on-line articles and textbooks. To prepare for the future, we have begun wrapping our system in Web browser technology, testing voice dictation and understanding, and employing wireless technology.

Computer Terminals↗
PubMed2004

Sequence variants in the transforming growth beta-induced factor (TGIF) gene are not associated with high myopia.

PURPOSE: High myopia is a common complex-trait eye disorder, with implications for blindness due to increased risk of retinal detachment, macular degeneration, premature cataracts, and glaucoma. Mapping studies have identified at least four loci for nonsyndromic autosomal dominant high myopia at 18p11.31, 12q22-q23, 17q21-q23, and 7q36. The smallest haplotyped interval for these loci is that of the MYP2 locus on 18p11.31. Recently, the transforming growth beta-induced factor (TGIF) gene was reported to be a candidate gene for MYP2-associated high myopia in single-nucleotide polymorphism studies. The purpose of this study was to determine whether DNA sequence variants in the human TGIF gene are causally related to MYP2-associated high myopia. METHODS: The protein coding regions and intron-exon boundaries of the human TGIF gene were sequenced using genomic DNA samples from MYP2 individuals (affected, unaffected) and external control subjects. The TGIF model used was the April 20, 2003, human genome National Center for Biotechnology Information (NCBI) build 33, which has 10 exons and encodes eight transcript variants. Polymorphic sequence changes were compared to those in the previous report. Reverse-transcription polymerase chain reaction (RT-PCR) was performed to validate TGIF gene expression in ocular tissues. RESULTS: A total of 21 polymorphisms of TGIF were found by direct sequencing: 3 were missense, 2 were silent, 10 were not translated, 4 were intronic, and 2 were homozygous deletions. The 3 missense allelic variants were localized to exon 10 at positions 236C-->T(Pro-->Leu), 244C-->T(Pro-->Ser), and 245C-->T(Pro-->Leu). Silent mutations were observed in exon 10 at positions 177A-->G, 333C-->T. Ten polymorphisms were novel. No sequence alterations were exclusively associated with the affected disease phenotype. RT-PCR results confirmed expression of TGIF in RNA samples derived from human sclera, cornea, optic nerve, and retina. CONCLUSIONS: TGIF is a known candidate gene for MYP2-associated high myopia, based on its mapped location within the MYP2 interval. Mutation analysis of the encoded TGIF gene for MYP2 autosomal dominant high myopia did not identify sequence alterations associated with the disease phenotype. Further studies of MYP2 candidate genes are needed to determine the gene that causes of this potentially blinding disorder.

DNA Mutational Analysis↗
PubMed1978

Time reporting within a health systems agency.

It is a truism that good management is a prerequisite to successful health planning and that essential to good management is reliable data on what is taking place. Health Systems Agencies (HSAs) have, in general, not taken advantage of management information systems (MIS) which might assist them in obtaining such data, perhaps because of cost or because of fear of burdening professionals with too much record keeping. Yet, performance categories mandated for HSAs provide an excellent base on which to build a simple, flexible MIS. The HSA of Western New York (HSAWNY) has installed an MIS, one component of which is a time reporting system for professional activity. This article discusses the purposes of the system, the analysis leading to its design, the input coding requirements, the output reports, uses for the output, the developmental and operational costs, the difficulties with system development and operation, and suggestions for further action.

Budgets↗