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PubMed2006

The heuristic-analytic theory of reasoning: extension and evaluation.

An extensively revised heuristic-analytic theory of reasoning is presented incorporating three principles of hypothetical thinking. The theory assumes that reasoning and judgment are facilitated by the formation of epistemic mental models that are generated one at a time (singularity principle) by preconscious heuristic processes that contextualize problems in such a way as to maximize relevance to current goals (relevance principle). Analytic processes evaluate these models but tend to accept them unless there is good reason to reject them (satisficing principle). At a minimum, analytic processing of models is required so as to generate inferences or judgments relevant to the task instructions, but more active intervention may result in modification or replacement of default models generated by the heuristic system. Evidence for this theory is provided by a review of a wide range of literature on thinking and reasoning.

Decision Making↗
PubMed1990

Color Doppler artifact in anechoic regions.

For color Doppler imaging, several types of signal processing are employed in order to produce acceptable images of blood flow in blood vessels while suppressing color in moving solid tissue. The processing can produce an artifact in which color may arise from noise or from tissue motion and fill anechoic regions preferentially. This artifact may complicate the differentiation of areas with blood flow from anechoic regions without flow. By using four different color Doppler ultrasound units to image a tissue-equivalent phantom containing anechoic cylinders, artifactual color resulted when gain was raised sufficiently. This color was concentrated in anechoic regions of a gray-scale image that did not contain flow. In two instruments, this artifact was only observed when the transducer was vibrated, simulating tissue motion. In these instruments, the identification of low-frequency, high-amplitude Doppler signals is used to locate moving solid tissue and so suppress color in these regions. In the other two instruments, the presence of echoes within the image suppressed the assignment of color. With both types of processing, color may appear artifactually in echo-free regions without flow, such as fluid collections. Presence or absence of flow should be confirmed by Doppler spectral analysis. An understanding of the origin and appearance of artifactual color can prevent its occurrence from detracting from the usefulness of color Doppler imaging.

Aorta, Abdominal↗
PubMed2000

Different vulnerability among chromosomes to numerical instability in gastric carcinogenesis: stage-dependent analysis by FISH with the use of microwave irradiation.

Numerical chromosomal abnormalities are a well known characteristic of human cancer, but no "chromosome-wide investigation" encompassing almost all of the chromosomes has ever been reported. Furthermore, although the multistep process of carcinogenesis is widely accepted in human cancer, the stepwise numerical aberration of chromosomes has never been addressed. Touch preparations of 24 (male 20, female 4) surgically resected gastric cancer tissue samples in various stages in terms of depth of invasion were analyzed by fluorescence in situ hybridization using centromere-specific probes including 17 chromosomes, 1-4, 6-8, 10-12, 15-18, 20, X, and Y. Microwave irradiation was performed to increase the sensitivity and specificity of the signal. The depth of the tumor invasion in the gastric wall and histological subtypes were recorded by viewing the histology of the adjacent portion. Numerical chromosomal abnormalities of chromosomes 1 and 2 were found most frequently and from the early stage of gastric cancer. The abnormalities observed were limited to chromosomes 1, 2, 4, and 20 in tumors invading to the middle layer of the submucosa of the gastric wall, but these became more extensive, involving almost all of the chromosomes investigated when the tumor had invaded beyond the proper muscle of the gastric wall. Centromeric numbers of chromosomes 3 and 18 were exceptionally stable even after the tumor progressed to advanced stage. These profiles of the sequential process of numerical chromosomal abnormality were similar in both mucocellular and tubular-type gastric cancer, but the prevalence was significantly lower in the mucocellular type (39.0% versus 68.0%). On the basis of fluorescence in situ hybridization analysis of 17 different chromosome centromeres in gastric cancer in various stages, we conclude that the earliest events in gastric carcinogenesis in terms of chromosomal abnormality occur in chromosomes 1 and 2 and that chromosomal numerical aberrations expand in a stepwise manner with cancer progression.

Adult↗
PubMed1999

Feedback processing as parallel task in P300 conditioning.

Previous reports on conditioning P300 amplitude indicated that downtraining produced a stronger effect than uptraining. This asymmetry can be due to the effect of drain on processing resources of the brain produced by the attempts to use feedback information (parallel task effect). Such a drain should reduce P300 amplitude regardless of the direction of training. The aim of the experiment was to demonstrate this effect. Event-related potentials (ERPs) evoked by light stimuli in a standard odd-ball procedure were recorded from Fz, Cz and Pz scalp sites. Subjects were instructed to enlarge or to reduce the P300 amplitude. The first 30 presentations of the target stimulus were analyzed during which the effect of learning should be negligible and processing of feedback information should be intensive. ERPs recorded during uptraining and downtraining were compared with the no-feedback recordings. As predicted, downtraining significantly reduced the P300 amplitude even in the first session of learning. Unexpectedly, uptraining recordings did not differ from no-feedback ERPs but differed significantly from downtraining waves. Such results support the prediction that feedback procedures involve a number of processes that alter the P300 amplitude even before the effects of learning can be expected. But if the hypothesis of the parallel task is to be accepted there must be another instantaneous process that compensates for P300 amplitude reduction during uptraining.

Adult↗
PubMed1989

The health benefits of prevention: a simulation approach.

In 1986 the Health 2000 Report, a long term health policy document, was presented to the Dutch parliament. This document is part of shift in interest in public health towards health rather than health services planning. There are two interesting features in this shift. The one is the tendency to measure the effectiveness of a policy, and intervention or a technology in terms of health, the outcome rather than the input, output or process. The other is the acceptance that political choices need to be made, since however large the budget for health is, it will always be limited. One of the choices to make will be whether or not to invest in preventive interventions. Preventive interventions can be defined as deliberate changes in the prevalence of risk factors in a population. To be able to weigh the costs and the benefits of such preventive interventions, an estimate will have to be made of their effect on the health of the population. Furthermore changes in risk factor prevalence may also occur autonomously. An estimate of the changes in the health status of the population as a result of these shifts in risk factor prevalence, will be important for the planning of health services and for the setting of realistic targets, as proposed by WHO. Prevent is a tool that will estimate the health effects of changes in risk factor prevalence in a population, as a result of trends or interventions. Its results can either be used directly in health policy making to formulate targets or quantify different scenario's on changes in risk factor prevalence in the future, or its results can be used as input for formal decision making processes such as for instance cost effectiveness studies. In epidemiology an analysis of the distribution of disease incidence and risk factor prevalence in different populations is used to confirm the hypothesis of a causal relationship between risk factor and disease. The strength of the relationship is often expressed as the ratio of incidence between exposed and non exposed, the Incidence Density Ratio (IDR). The importance of a risk factor for the incidence of a certain disease in a population is usually expressed as the Etiologic Fraction (EF), the proportion of the total incidence of the disease that can be attributed to the prevalence of that risk factor in the population. The EF is sometimes used as an indication of the proportion of incidence that could be prevented by the total elimination of that risk factor in the population.(ABSTRACT TRUNCATED AT 400 WORDS)

Disease↗
PubMedDate not supplied

Proteomics: from basic research to diagnostic application. A review of requirements & needs.

For several years proteomics research has been expected to lead to the finding of new markers that will translate into clinical tests applicable to samples such as serum, plasma and urine: so-called in vitro diagnostics (IVDs). Attempts to implement technologies applied in proteomics, in particular protein arrays and surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF MS), as IVD instruments have initiated constructive discussions on opportunities and challenges inherent in such a translation process also with respect to the use of multi-marker profiling approaches and pattern signatures in IVD. Taking into account the role that IVD plays in health care, we describe IVD requirements and needs. Subject to stringent costs versus benefit analyses, IVD has to provide reliable information about a person's condition, prognosis or risk to suffer a disease, thus supporting decisions on treatment or prevention. It is mandatory to fulfill requirements in routine IVD, including disease prevention, diagnosis, prognosis, and treatment monitoring or follow up among others. To fulfill IVD requirements, it is essential to (1) provide diagnostic tests that allow for definite and reliable diagnosis tied to a decision on interventions (prevention, treatment, or nontreatment), (2) meet stringent performance characteristics for each analyte (in particular test accuracy, including both precision of the measurement and trueness of the measurement), and (3) provide adequate diagnostic accuracy, i.e., diagnostic sensitivity and diagnostic specificity, determined by the desired positive and negative predictive values which depend on disease frequency. The fulfillment of essential IVD requirements is mandatory in the regulated environment of modern diagnostics. Addressing IVD needs at an early stage can support a timely and effective transition of findings and developments into routine diagnosis. IVD needs reflect features that are useful in clinical practice. This helps to generate acceptance and assists the implementation process. On the basis of IVD requirements and needs, we outline potential implications for clinical proteomics focused on applied research activities.

Decision Making↗
PubMed1974

The intervals between miniature end-plate potentials in the frog are unlikely to be independently or exponentially distributed.

1. It has been suggested that spontaneous quantal release of transmitter at the neuromuscular junction is a Poisson process. One logical argument against accepting the Poisson hypothesis is that so far relatively few intervals between miniature end-plate potentials (min.e.p.p.s) have been studied in any single experiment. Release is known to occur from many sites on the nerve terminal, so many intervals must be studied before drawing any conclusions about the timing of release from the individual sites. Moreover, the statistical methods that have been used are relatively insensitive to deviations from Poisson predictions.2. The Poisson hypothesis is evaluated with respect to three major criteria:(a) The fit to the exponential distribution is analysed by five goodness of fit tests which were applied to eleven sets of data, showing that it is unlikely that the data sets were generated by an exponential distribution.(b) The independence of intervals is assessed in two ways. First, the autocorrelogram of intervals is constructed. This shows an excess of significant positive correlations beyond the 5% limits of the Poisson expectation. Secondly, the unsmoothed power spectrum is calculated, and compared to the Poisson prediction by means of the modified mean test. Again, most sets deviate significantly from the Poisson expectation. It is unlikely that the intervals are independent.(c) The possibility of simultaneous occurrences is evaluated by construction of the amplitude histogram of min.e.p.p.s. In all sets the Poisson prediction for the frequency of multiples of the unit height was exceeded by the empirical data sets. The over-all conclusion is that the process which generates spontaneous releases is unlikely to be Poisson.

Journal Article↗
PubMed2002

When rejection stings: how self-esteem constrains relationship-enhancement processes.

Three experiments examined how needs for acceptance might constrain low versus high self-esteem people's capacity to protect their relationships in the face of difficulties. The authors led participants to believe that their partner perceived a problem in their relationship. They then measured perceptions of the partner's acceptance, partner enhancement, and closeness. Low but not high self-esteem participants read too much into problems, seeing them as a sign that their partner's affections and commitment might be waning. They then derogated their partner and reduced closeness. Being less sensitive to rejection, however, high self-esteem participants affirmed their partner in the face of threat. Ironically, chronic needs for acceptance may result in low self-esteem people seeing signs of rejection where none exist, needlessly weakening attachments.

Courtship↗
PubMed1977

Nutrient quality and acceptability of mechanically deboned meat.

The meat processing industry has great incentive to push for the lifting of the ban on MDM. By using MDM equipment, much meat now being lost could be salvaged for human consumption with great economies and world food shortage implications. The properties of mechanically deboned meat vary with the percentage of bone and marrow in the original products, the equipment, and by other factors. The question of future use of MDM hinges on its readmission to the market, based on safety and health aspects. Dietiticians and others in health care service may be asked to give an opinion concerning the use of MDM. Consideration of the possible addition of nutrients over and above those usually supplied in meats may be a positive factor. Certainly, if its use is reinstated, health care professionals will need to be aware of the implications of including such products in the foods chosen for themselves and their patients.

Animals↗
PubMed1987

A comparison of Ektaspeed and Ultraspeed films using manual and automatic processing solutions.

Kodak's Ektaspeed (E) dental film is twice as fast as Ultraspeed (D) film and thereby significantly reduces radiation exposure to the patient. The film quality of the E film and D film was compared following processing with two manual and two automatic processing techniques. E-speed film processed manually or automatically produces diagnostically acceptable radiographs, with film densities within the recommended density limits commonly used in dentistry. High-contrast and low-contrast radiographs can be achieved by varying processing techniques.

Absorptiometry, Photon↗
PubMed2005

Hormesis: how it could affect the risk assessment process.

If the hormetic dose-response were accepted as the default dose-response model for risk assessment, it could have important implications for environmental exposure standards for noncarcinogens and especially for carcinogens. Most notably it would lead to the recognition that carcinogens act via a threshold process rejecting the concept of linearity at low doses. The hormetic concept also provides agencies with a broader range of toxicologically based exposure options, which permit a consideration for avoiding harm, as well as possibly enhancing benefits for both normal and high-risk segments of the population. By dismissing hormesis, regulatory agencies such as EPA deny the public the opportunity for optimal health and avoidance of disease.

Animals↗
PubMed2001

Accuracy and reliability of store-and-forward teledermatology: preliminary results from the St George Teledermatology Project.

Teledermatology is the practice of dermatology across distances (and time) and involves the transfer of electronic information. To be effective and safe, the teledermatology process needs to demonstrate an acceptable level of accuracy and reliability. Accuracy is reflected by the degree of concordance (agreement) between the teledermatology and face-to-face diagnoses. Reliability is dependent on how consistently a set of results can be reproduced across different operators. Mean concordance (primary diagnoses) achieved by four dermatologists studying 53 store-and-forward diagnostic cases, originating from 49 referred patients, was 79% (range 73-85%). When the differential diagnoses were taken into account, the variation across individual dermatologists narrowed further, with a mean of 86% (range 83-89%). In contrast, the mean general practitioner (GP; n=11) concordance (GP face-to-face vs reference dermatologist store-and-forward diagnoses) was 49%. An interim review of all 49 teledermatology patients showed no adverse outcome at the end of 3 months. The ability to request face-to-face visits by dermatologists, combined with GPs maintaining primary care of the referred patient, serve as additional safeguards for patients using a telemedicine system. Our results indicate that teledermatology management of referred skin complaints is both accurate and reliable.

Dermatology↗
PubMedDate not supplied

Validation of numerical ground water models used to guide decision making.

Many sites of ground water contamination rely heavily on complex numerical models of flow and transport to develop closure plans. This complexity has created a need for tools and approaches that can build confidence in model predictions and provide evidence that these predictions are sufficient for decision making. Confidence building is a long-term, iterative process and the author believes that this process should be termed model validation. Model validation is a process, not an end result. That is, the process of model validation cannot ensure acceptable prediction or quality of the model. Rather, it provides an important safeguard against faulty models or inadequately developed and tested models. If model results become the basis for decision making, then the validation process provides evidence that the model is valid for making decisions (not necessarily a true representation of reality). Validation, verification, and confirmation are concepts associated with ground water numerical models that not only do not represent established and generally accepted practices, but there is not even widespread agreement on the meaning of the terms as applied to models. This paper presents a review of model validation studies that pertain to ground water flow and transport modeling. Definitions, literature debates, previously proposed validation strategies, and conferences and symposia that focused on subsurface model validation are reviewed and discussed. The review is general and focuses on site-specific, predictive ground water models used for making decisions regarding remediation activities and site closure. The aim is to provide a reasonable starting point for hydrogeologists facing model validation for ground water systems, thus saving a significant amount of time, effort, and cost. This review is also aimed at reviving the issue of model validation in the hydrogeologic community and stimulating the thinking of researchers and practitioners to develop practical and efficient tools for evaluating and refining ground water predictive models.

Decision Making↗
PubMed1991

Improvement in transfusion safety using a new blood unit and patient identification system as part of safe transfusion practice.

A new patient and blood unit identification system designed to confirm the identity of crossmatched blood products and that of the intended recipient was evaluated. Six hundred seventy-two red cell concentrates were transfused to 312 patients. Participating hospital personnel and patients were interviewed regarding the use and benefit of this unique system, which incorporates a "lock-box" approach to the identification process. The product and procedure were accepted unanimously and enthusiastically, and three potential mistransfusions were avoided by use of the system during the limited period of observation. This type of approach to the identification process affords greater security than conventional practices and minimally burdens staff.

Blood Transfusion↗
PubMedDate not supplied

Hospital episode statistics: time for clinicians to get involved?

Hospital episode statistics contain clinical data. They are used for many purposes, including monitoring activity in the NHS and the allocation of funds. More recently they have been applied to monitoring performance, and it is intended that they will inform consultant appraisal and revalidation. The validity of hospital episode statistics was questioned by Körner in 1982. Recent publications have shown that problems persist in England and Wales, and that the quality of the data is inadequate for the task. The lack of involvement of clinicians in the process of data collection and validation is no longer acceptable. To rectify the situation there should be a change of process and culture, supported by education and investment. NHS data definitions of terms such as 'spells', 'episodes' and 'diagnoses' need to be reviewed. The development of separate data processes to monitor national service frameworks is regrettable.

Data Collection↗
PubMed1993

The electronic medical record: a definition and discussion.

The health care industry has had limited success in achieving some degree of an EMR in the past several years, and the industry has the potential to move even farther in the next decade. As standards begin to emerge and technologies conform to those standards, the industry will begin to see the evolution of a totally electronic patient record. Standard interfaces and hardware platforms, with software products designed to meet a standardized market need, will become more prevalent. Multifunction workstations, voice recognition, and other technological advancements will simplify the data-entry process for clinicians. Legal statutes that support automated records will be established and accepted by the courts, and optical disk image processing systems will take off as the storage medium of choice for the next generation. Because the EMR can provide the benefits outlined here, the health care industry must work together to ensure the success of this vision. As leaders in the health care information management arena, we need to participate in the realization of this ideal for the betterment of our patients, our health care organizations, and the entire health care delivery system.

Data Display↗
PubMed2000

Physicians' attitudes about involvement in lethal injection for capital punishment.

BACKGROUND: Physicians could play various roles in carrying out capital punishment via lethal injection. Medical societies like the American Medical Association (AMA) and American College of Physicians have established which roles are acceptable and which are disallowed. No one has explored physicians' attitudes toward their potential roles in this process. METHODS: We surveyed physicians about how acceptable it was for physicians to engage in 8 actions disallowed by the AMA and 4 allowed actions involving lethal injection. Questions assessing attitudes toward capital punishment and assisted suicide were included. The impact of attitudinal and demographic variables on the number of disallowed actions deemed acceptable was analyzed via analysis of variance and multiple logistic regression analysis. RESULTS: Four hundred eighty-two physicians (51%) returned questionnaires. Eighty percent indicated that at least 1 of the disallowed actions was acceptable, 53% indicated that 5 or more were acceptable, and 34% approved all 8 disallowed actions. The percentage of respondents approving of disallowed actions varied from 43% for injecting lethal drugs to 74% for determining when death occurred. All 4 allowed actions were deemed acceptable by the majority of respondents. Favoring the death penalty (P<.001) and the acceptance of assisted suicide (P<.001) were associated with an increased number of disallowed actions that were deemed acceptable. CONCLUSIONS: Despite medical society policies, the majority of physicians surveyed approved of most disallowed actions involving capital punishment, indicating that they believed it is acceptable in some circumstances for physicians to kill individuals against their wishes. It is possible that the lack of stigmatization by colleagues allows physicians to engage in such practices. Arch Intern Med. 2000;160:2912-2916

Aged↗
PubMed2003

Pharmacists on rounding teams reduce preventable adverse drug events in hospital general medicine units.

BACKGROUND: Previous studies found that medication errors result from lack of sufficient information during the prescribing step. Therefore, it is proposed that having a pharmacist available when patients are evaluated during the rounding process may reduce the likelihood of preventable adverse drug events (ADEs). The objectives of this study were to evaluate the impact of having a pharmacist participate with a physician rounding team on preventable ADEs in general medicine units and to document pharmacist interventions made during the rounding process. METHODS: A single-blind, standard care-controlled study design was used to compare patients receiving care from a rounding team including a pharmacist with patients receiving standard care (no pharmacist on rounding team). Patients admitted to and discharged from the same general medicine unit were included in the study. The main outcome measure of this study was preventable ADEs. Patient records were randomly selected and evaluated by a blinded process involving independent senior pharmacist specialists and a senior staff physician. Interventions made by the pharmacists in the treatment group were documented. RESULTS: The rate of preventable ADEs was reduced by 78%, from 26.5 per 1000 hospital days to 5.7 per 1000 hospital days. There were 150 documented interventions recommended during the rounding process, 147 of which were accepted by the team. The most common interventions were (1) dosing-related changes and (2) recommendations to add a drug to therapy. CONCLUSION: Pharmacist participation with the medical rounding team on a general medicine unit contributes to a significant reduction in preventable ADEs.

Drug Utilization Review↗