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PubMed2005

Prediction of segregation tendency occurrence in dry particulate pharmaceutical mixtures: development of a mathematical tool adapted for granular systems application.

Segregation phenomena are of importance in nearly all processes involving dry granular and powder mixtures. The extent of segregation directly influences the eventual rejection of a considerable percentage of the final product in the majority of pharmaceutical processes; among these are those mixtures destined for powder compression processing for the production of tablets. Although the parameters influencing segregation are relatively well-known qualitatively, there are, so far, no widely accepted quantitative prediction tools that permit process improvement and optimization of production as a function of the mixture's composition and the particulars of individual processes (e.g., geometry of the vessels). Thus, within present practice, only general design considerations and the technical expertise of engineers and operators are relied upon to optimize these processes on a case-by-case basis. It is in these circumstances that a study of the tendency towards segregation in free flowing granular materials was conducted, using a simple tool previously developed for the study of the behavior of continuous chemical reactors with classical fluid flows. The measurement of average residence times and their variance is used to calculate the deviation of chemical reactors from the ideal behavior of a perfectly mixed vessel or a plug flow pattern. In this work, these measurements are adapted to evaluate the tendency of a granular mixture to segregate. The method consists of introducing a pulse perturbation (of another material) to the established regular flow of a single granular material or a granular mixture and to then calculate the response of the system in terms of the concentration of the pulsed material at the process outlet. The average granular particle residence time and its standard deviation are then related to the segregation tendency.

Chemistry, Pharmaceutical↗
PubMed1985

Models for transmitter activation process in retinal rod outer segments to flash stimuli.

It has been generally accepted that transmitter molecules, which participated in the visual transduction process in retinal rod outer segments, are activated by bleached rhodopsin molecules serially one by one (serial activation model). This serial activation model accounts for some experimental observations, but not the quick and amplified activation of transmitter molecules. In this study, two models are proposed and solutions from the differential equations of the models are compared quantitatively with experimental observations. The two models proposed in this study are the serial-parallel activation model and the parallel-parallel activation model. In the serial-parallel activation model, rhodopsin molecules are activated by bleached rhodopsin molecules. Transmitter molecules are activated both by bleached and activated rhodopsin molecules. In the parallel-parallel activation model, both rhodopsin and transmitter molecules are activated by bleached and activated rhodopsin molecules. The time taken to activate 90% of transmitter molecules after flash stimuli, which bleaches 10(-4)% of rhodopsin, is 5.94 s, 3.91 ms and 23.7 microseconds for the serial, serial-parallel and parallel-parallel activation models, respectively. As contrasted to the serial activation model in which transmitter activation proceeds too slow, the present serial-parallel and parallel-parallel activation models can reproduce transmitter activation quick enough to account for the experimental observations.

Animals↗
PubMed1996

Mental and behavioural disorders due to use of psychoactive substances (F1). Results from the ICD-10 field trial of the Diagnostic Criteria for Research in German-speaking countries.

The results of the ICD-10 Diagnostic Criteria for Research (DCR) field trial in German-speaking countries concerning section F1 (mental and behavioural disorders due to use of psychoactive substances) show a comparatively sufficient level of acceptance. The subjective assessment of the diagnostic process and the chance-corrected interrater reliability (kappa = 0.70) are below average but quite acceptable, which is possibly due to the study design as well as the high comorbidity of disorders in this field. However, interrater reliability based on the strictly defined operationalized criteria of the DCR improved markedly compared to earlier ICD-10 field trials in German-speaking countries.

Germany↗
PubMed2002

EDMS implementation challenge.

The challenges faced by facilities wishing to implement an electronic medical record system are complex and overwhelming. Issues such as customer acceptance, basic computer skills, and a thorough understanding of how the new system will impact work processes must be considered and acted upon. Acceptance and active support are necessary from Senior Administration and key departments to enable this project to achieve measurable success. This article details one hospital's "journey" through design and successful implementation of an electronic medical record system.

California↗
PubMed2005

Feedback on video recorded consultations in medical teaching: why students loathe and love it - a focus-group based qualitative study.

BACKGROUND: Feedback on videotaped consultations is a useful way to enhance consultation skills among medical students. The method is becoming increasingly common, but is still not widely implemented in medical education. One obstacle might be that many students seem to consider this educational approach a stressful experience and are reluctant to participate. In order to improve the process and make it more acceptable to the participants, we wanted to identify possible problems experienced by students when making and receiving feedback on their video taped consultations. METHODS: Nineteen of 75 students at the University of Bergen, Norway, participating in a consultation course in their final term of medical school underwent focus group interviews immediately following a video-based feedback session. The material was audio-taped, transcribed, and analysed by phenomenological qualitative analysis. RESULTS: The study uncovered that some students experienced emotional distress before the start of the course. They were apprehensive and lacking in confidence, expressing fear about exposing lack of skills and competence in front of each other. The video evaluation session and feedback process were evaluated positively however, and they found that their worries had been exaggerated. The video evaluation process also seemed to help strengthen the students' self esteem and self-confidence, and they welcomed this. CONCLUSION: Our study provides insight regarding the vulnerability of students receiving feedback from videotaped consultations and their need for reassurance and support in the process, and demonstrates the importance of carefully considering the design and execution of such educational programs.

Adult↗
PubMedDate not supplied

Factors affecting and affected by user acceptance of computer-based nursing documentation: results of a two-year study.

OBJECTIVES: The documentation of the nursing process is an important but often neglected part of clinical documentation. Paper-based systems have been introduced to support nursing process documentation. Frequently, however, problems such as low quality of documentation are reported. It is unclear whether computer-based documentation systems can reduce these problems and which factors influence their acceptance by users. DESIGN: We introduced a computer-based nursing documentation system on four wards of the University Hospitals of Heidelberg and systematically evaluated its preconditions and its effects in a pretest-posttest intervention study. For the analysis of user acceptance, we concentrated on subjective data drawn from questionnaires and interviews. MEASUREMENTS: A questionnaire was developed using items from published questionnaires and items that had to be developed for the special purpose of this study. RESULTS: The quantitative results point to two factors influencing the acceptance of a new computer-based documentation system: the previous acceptance of the nursing process and the previous amount of self-confidence when using computers. On one ward, the diverse acceptance scores heavily declined after the introduction of the nursing documentation system. Explorative qualitative analysis on this ward points to further success factors of computer-based nursing documentation systems. CONCLUSION: Our results can be used to assist the planning and introduction of computer-based nursing documentation systems. They demonstrate the importance of computer experience and acceptance of the nursing process on a ward but also point to other factors such as the fit between nursing workflow and the functionality of a nursing documentation system.

Attitude of Health Personnel↗
PubMed1983

Evolution: questions for the modern theory.

The blind spot of the present generation of evolutionists is failure to see the consequences and limits of natural selection. Darwinian natural selection is a costly process of differential elimination of individuals. The widely accepted misdefinition of natural selection as differential reproduction mistakenly hides the Darwinian process and its cost. And current theories of selfish genes, inclusive fitness, and kin selection are incompatible with Darwinian selection. Implicitly, if not explicitly, they postulate genes that favor themselves but reduce the Darwinian fitness of the individuals carrying them. Such genes would not survive; they would eliminate themselves by causing the selective elimination of their carriers. Critical questions that evolutionists should be asked are suggested. My own "unhappy conclusion" is that, because most biologists have forgotten what natural selection is, much current evolutionary and sociobiological theory presented by the most influential evolutionists is mistaken and dangerous. Anthropologists and sociologists are wise to distrust it.

Animals↗
PubMed1975

Thermography.

As thermographic equipment is improved and as physicians gain experience in its use, thermography gradually is gaining importance as a diagnostic aid in a wide range of disease processes. The technic is finding increasing acceptance in diagnosis of breast disease particularly as an adjunct to mammography. The American Cancer Society and the National Cancer Institute are in the process of establishing 20 demonstration centers for breast cancer detection using thermography, mammography, and physical examinations. Although all of the centers are not at present fully staffed with personnel experienced in thermographic interpretation, the project promises to give a better basis for cost estimates for screening with the thermography as compared to present systems. The technologic knowledge exists for the development of improved scanning infrared cameras with magnetic tape storage and dynamic display. These systems will lend themselves to quantitative measurements and semiautomatic interpretation which can improve the accuracy and reduce the cost of mass screening for breast cancer. Although additional clinical research is necessary, thermography has numerous applications in a variety of disease states. In the future, total body thermography may well become an important part of medical screening examinations.

Arthritis, Rheumatoid↗
PubMed1993

Acceptance of direct physician access to a computer-based patient record in a managed care setting.

Kaiser Permanente Mid-Atlantic States has developed a fully integrated outpatient information system which currently runs on an IBM ES9000 on a VM platform written in MUMPS. The applications include Lab, Radiology, Transcription, Appointments. Pharmacy, Encounter tracking, Hospitalizations, Referrals, Phone Advice, Pap tracking, Problem list, Immunization tracking, and Patient demographics. They are department specific and require input and output from a dumb terminal. We have developed a physician's work station to access this information using PC compatible computers running Microsoft Windows and a custom Microsoft Visual Basic 2.0 environment which draws from these 14 applications giving the physician a comprehensive view of all electronic medical records. Through rapid prototyping, voluntary participation, formal training and gradual implementation we have created an enthusiastic response. 95% of our physician PC users access the system each month. The use ranges from 0.2 to 3.0 screens of data viewed per patient visit. This response continues to drive the process toward still greater user acceptance and further practice enhancement.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Structural changes of mitochondria related to apoptosis.

The original concept of apoptosis stressed the morphological changes of the nucleus, condensation with the aggregation of chromatin, and the intactness of intracellular organelles including mitochondria. However, the application of molecular biology and flow-cytometric techniques to the research field of apoptosis has led to the proposal of the apoptotic processes which emphasizes the 'swelling of mitochondria' due to the opening of the 'permeability transition pores' of the mitochondrial membranes followed by a series of events including the collapse of the transmembrane potential of mitochondria and release of cytochrome c from mitochondria into the cytosol. Enlargement of mitochondria induced by various pathological conditions are classified into two categories: the swelling and the formation of megamitochondria (MG). Recently, we have found that free radical-induced formation of MG is succeeded by apoptotic changes of the cell. If the MG formation is actually related to apoptosis, this will be a new aspect of the structural changes of mitochondria involved in apoptosis besides the simple swelling of mitochondria. First, we will discuss the 'swelling of mitochondria' which characterizes the currently accepted hypothesis on the apoptotic processes of the cell, as described above, in the light of the literature. Second, the mechanisms controlling the size and distribution of mitochondria in the cell are dealt with paying special attention to the genetic regulation and cytoskeletons. Third, we have tried to characterize the MG formation to correlate apoptotic changes of the cell. Finally, we will discuss several problems to be solved in the future which involve mitochondria in apoptotic processes of the cell.

Apoptosis↗
PubMed2002

Effect of spinal disease on successful arthrodesis in lumbar pedicle screw fixation.

OBJECT: Pedicle screw fixation with transverse process fusion has gained widespread acceptance since its inception. Improved rates of arthrodesis have been demonstrated when this technique is used. The authors present one of the largest series of patients to undergo this procedure at a single center; one of the goals was to correlate construct length and spinal disease with rates of successful arthrodesis by conducting a prospective analysis of lumbar fusion in which pedicle screws were placed. METHODS: During a 7-year period, the senior author performed pedicle screw fixation with posterolateral fusion in 457 patients; the mean follow-up period was 28.4 months. Indications for fusion included metastatic tumor, single-level degenerative disc disease (DDD), trauma, degenerative scoliosis, and translational vertebral instability. Successful fusion was based on the radiographic demonstration of a bilateral contiguous osseous bridge over the transverse processes and absence of movement on dynamic x-ray films. Fusion rates were lowest in cases of tumors (54%) and highest in cases of trauma (96%). In patients with single-level DDD the rate was 91%, and in those with translational instability it was 89%. Fusion rates, however, declined steeply in relation to each additional motion segment in the translational instability group. In this group a strong linear trend for proportion was demonstrated (p < 0.001). The overall fusion rate in patients with degenerative scoliosis was 70%. The overall fusion rate for the entire group was 86%. CONCLUSIONS: The data in this study can be used as a benchmark with which to compare newer technologies. Although overall pedicle screw-assisted fusion rate in cases of trauma or selected degenerative lesions approached 90%, the arthrodesis rates are not uniform for the different diagnoses. This appears to be related to the underlying spinal disease and the number of segments included in the fusion.

Adolescent↗
PubMed1994

Physician and staff acceptance of continuous quality improvement.

BACKGROUND: Increasing numbers of health care organizations are adopting Continuous Quality Improvement (CQI) principles. This study's objective was to evaluate the attitudes toward and acceptance of CQI by a family practice residency program's providers and staff after 3 years' experience with the process. METHODS: Our CQI project groups examine selected problems and develop system-based solutions. We surveyed staff, residents, and faculty to determine their awareness of the CQI projects, the perceived usefulness of the projects and results, how well they were informed of the results, and whether they believe CQI is a useful tool in our clinic. RESULTS: Of 19 clinical and/or administrative projects we implemented, 75% of the faculty, 55% of the residents, and 71% of the staff perceived the projects to be useful. Eighty-eight percent of the faculty, 64% of the residents, and 82% of the staff believe CQI to be useful tool in our clinic. However, only 50% of faculty, 36% of residents, and 24% of staff felt they were well informed of the project results. The time involved in CQI and the need to improve communication among personnel on CQI processes were identified as important concerns about CQI. CONCLUSION: Faculty, resident, and staff members accept the CQI process and perceive it to be a useful tool in clinical practice. CQI requires attention to the time involved and communication about CQI projects and results.

Attitude of Health Personnel↗
PubMedDate not supplied

Pet Rx: implications for good health.

According to Dr. Aaron Ketcher, Associate Professor of Psychiatry at the University of Pennsylvania, studies reveal that potential health values exist in use of pets in the rehabilitation process. Caution, however, must be taken. Animals are not a cure-all, but they can be urged as valuable complements to service offerings. As presented by AARP Board member Marion Waite, "Pets are good for your health." She goes on to state that pets help reduce stress and blood pressure and speed up recovery from traumatic incidents such as moves, illness, or the death of a loved one (AARP, 1987). Growing understanding of relationships between people and their pets suggests benefits that barely have been tapped. Some forecasters have predicted that one day patients may receive a prescription to obtain a pet as routinely as prescribed medication. Incorporating animals as a therapeutic approach for the development and rehabilitation of special population members can be unique and beneficial. Animal therapy can be a salutary form of rehabilitation if the program is organized, supervised, and implemented in a professional manner. Implementing this approach may result in promoting unconditional acceptance and enhancing the normalization process for special population members.

Animals↗
PubMed1979

Swine influenza vaccine program in the community: acceptability, reactions and responses.

The operation of the national swine influenza immunization program was observed in the community of Tecumseh, Michigan. The purpose was to determine acceptability of a parenteral vaccine intended for the general population. Participation of the residents was excellent. More than 64 per cent of eligibles were vaccinated; this figure resembled that of the rest of the local area, but not the national figures nor a suburban area of Michigan where a similar study was carried out. Sore arm after vaccination was reported most frequently in younger female participants; however, sore arm was accepted as part of the process of vaccination and not considered a reaction by most. Such perceived reactions were not as commonly reported as in the large suburban area. Antibody response to the vaccine was excellent, not only in terms of antibodies to the swine virus itself but also in terms of cross reactive antibodies to the emergent H1N1 (Russian) influenza strain. As a result of the program, many vaccine recipients in the 25 to 49 year age groups are protected against this new epidemic virus.

Adolescent↗
PubMed1979

Wound healing of endosteal vitreous carbon implants in dogs.

Endosteal vitreous carbon implants are biocompatible and were well-tolerated by the alveolar process of dogs but were not accepted by the gingival margin and the mucosa. A continuous gingival recession with 2 to 3 mm sulcus depth was not similar to that around adjacent natural teeth. There was no epithelial attachment around the neck of vitreous carbon implants, and there was very little or no resistance to probing. The feasibility of using vitreous carbon as it presently exists for the maintenance and preservation of alveolar bone is unfavorable and should be revised. Endosteal vitreous carbon implants require more intense laboratory and clinical studies. Therefore, the practical value of the vitreous carbon implant is questionable, and further investigations are needed before vitreous carbon can be declared acceptable in clinical dental practice.

Alveolar Process↗
PubMed1997

Acceptability, safety, and digestibility of spray-dried bovine serum added to diets of recovering malnourished children.

BACKGROUND: Specially collected, spray-dried bovine and porcine blood plasma have been incorporated previously in feeds of weanling farm animals, resulting in increased dietary intakes and greater rates of weight gain than observed in control animals. Before conducting similar trials in human populations, preliminary studies have been completed to assess the acceptability, safety, and digestibility of processed animal plasma in young children. METHODS: Masked study diets were provided sequentially to each of ten young, Peruvian children recovering from severe protein-energy malnutrition during three randomly ordered 7-day dietary periods. The control diet was prepared from rice, milk, vegetable oil, and sugar; the two study diets included spray-dried, bovine serum concentrate to replace either 25% or 50% of the milk protein of the control diet. Urine and feces were collected quantitatively during the last four days of each diet period to assess stool weight, apparent absorption of macronutrients, and retention of nitrogen. RESULTS: All children consumed the entire amounts offered of each of the diets. The mean number of daily bowel movements and mean apparent absorption and retention of nitrogen and mean apparent absorption of carbohydrate were similar for each diet. Fractional absorption of dietary lipid and of total energy increased significantly in relation to the amount of bovine serum concentrate in the diet, although this might be explained by the simultaneous replacement of milk fat with additional vegetable oil. CONCLUSIONS: Each of the diets was well accepted by the study children, and there was no evidence of any adverse effects of bovine serum concentrate.

Animals↗
PubMedDate not supplied

Psychiatric consultation for competency to refuse medical treatment. A retrospective study of patient characteristics and outcome.

Forty-one psychiatric consultations on medical-surgical inpatients for competency to refuse medical treatment were studied retrospectively. The competent (n = 16) and incompetent (n = 25) patients were compared in terms of demographic data, diagnoses, clinical variables, details about treatment refusal, and outcome following competency assessment. The incompetent patients tended to be men, the focus of more urgent requests, and to have refused operations. The incompetent patients tended to have organic brain syndromes; the competent patients had personality disorders, adjustment disorders, or no psychiatric diagnosis. Ultimate acceptance of treatment initially refused was common in both groups; differential psychiatric interventions were recommended. The process of psychiatric consultation appeared to facilitate acceptance of treatment initially refused.

Adult↗