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PubMed1977

Computers and diagnostic radiology: the state of the art of meeting medical care objectives.

The term "state of the art" applied to medical technology should stimulate consideration of medical objectives as well as comparison of similar equipment. A communications model of the consult process is presented and examined using the diagnostic radiologist as the example. Examples of computer applications relating to the model are discussed, and some future possibilities for using computers to enhance the consultant's ability to meet medical objectives are suggested.

Communication↗
PubMed1994

Bernard Shaw and the doctors: the art and science of medicine in The Doctor's dilemma.

What did Bernard Shaw really think about doctors? Although any reader with a sketchy understanding of Shaw's work is inclined to think that he condemned the entire profession, a careful reading of his most well-known play featuring medical practitioners reveals a mixed attitude. In The Doctor's Dilemma, one finds a position that may be representative of Shaw's attitude. In this play, he places the entire Edwardian medical establishment--consultants and general practitioners--on stage, and he focuses the attention of this diverse group on the problem of a patient. In doing so, Shaw is able to separate the play's characters into representatives of (l) the new scientific medicine and (2) the venerable art of medicine. He satirizes the arrogance of the former, and he presents the humane attitude of the latter in a favorable light.

History, 20th Century↗
PubMedDate not supplied

Interdisciplinary research: a philosophy, art form, artifact or antidote?

Interdisciplinary research has many faces--a philosophy, an art form, an artifact, and an antidote. It is all of these things because interdisciplinary research attempts to ask questions in ways that cut across disciplinary boundaries. This is not politically correct and universities especially find it difficult to manage interdisciplinarians and their projects. The author argues that interdisciplinary research has persisted as an alternative when traditional research approaches have failed to come up with answers to common problems. Interdisciplinary research will continue to survive as long as there are creative, risk-taking scientists who are dissatisfied with the political and organizational boundaries we establish around disciplines which limit our ability to learn about their commonalities.

Philosophy↗
PubMed2004

[Genetically modified plants and food safety. State of the art and discussion in the European Union].

Placing genetically modified (GM) plants and derived products on the European Union's (EU) market has been regulated by a Community Directive since 1990. This directive was complemented by a regulation specific for genetically modified and other novel foods in 1997. Specific labelling requirements have been applicable for GM foods since 1998. The law requires a pre-market safety assessment for which criteria have been elaborated and continuously adapted in accordance with the state of the art by national and international bodies and organisations. Consequently, only genetically modified products that have been demonstrated to be as safe as their conventional counterparts can be commercialized. However, the poor acceptance of genetically modified foods has led to a de facto moratorium since 1998. It is based on the lack of a qualified majority of EU member states necessary for authorization to place genetically modified plants and derived foods on the market. New Community Regulations are intended to end this moratorium by providing a harmonized and transparent safety assessment, a centralised authorization procedure, extended labelling provisions and a traceability system for genetically modified organisms (GMO) and derived food and feed.

Consumer Product Safety↗
PubMed2006

["Bionic" arm prostheses. State of the art in research and development].

BACKGROUND: A new generation of arm prostheses is being developed worldwide. These so-called bionic prostheses are intended to offer additional functions, such as sensory feedback, extended range of possible movement, intuitive movement control as far as possible, and a more natural cosmetic appearance. STATE OF THE ART IN RESEARCH AND DEVELOPMENT: In recent years, prosthetic components with much enhanced performance have been developed for use at various levels of the upper limb. Artificial hands that allow for additional grips are are being tested in clinical settings. Innovative methods of signal acquisition and communication with the patient are being intensively researched. CONCLUSION: Several patients have been provided with prototypes of new arm prostheses. At the moment, the results are limited by the restricted communication between patient and prosthesis. However, we can expect the options for prosthesis control to be extended in the near future.

Arm↗
PubMed2000

Report from the meeting: Gastrointestinal Tonometry: State of the Art. 22nd-23rd May 1998, London, UK.

Gastrointestinal (GI) tonometry, the only clinically available method for the accurate diagnosis of compromised GI blood flow, has been shown to be a sensitive predictor of increased morbidity, mortality and prolonged hospitalization. The recent introduction of the Tonocap, as a means of performing automated air tonometry, has simplified the application of GI tonometry in the clinical setting. Despite this the utility of GI tonometry remains controversial. The GI Tonometry: State of the Art meeting brought together a group of clinicians with a proven track record of research, clinical interest and expertise in this field. The aim of the meeting was to come to a consensus regarding certain issues such as the past and future roles of GI tonometry and standards for its correct usage and interpretation. Finally suggestions as to further research and clinical evaluation were made within a broader discussion regarding the complexities of applying the principles of evidence-based medicine to the introduction of a new piece of medical technology.

Carbon Dioxide↗
PubMed2003

Compound-specific stable isotope analysis of organic contaminants in natural environments: a critical review of the state of the art, prospects, and future challenges.

Compound-specific stable isotope analysis (CSIA) using gas chromatography-isotope ratio mass spectrometry (GC/IRMS) has developed into a mature analytical method in many application areas over the last decade. This is in particular true for carbon isotope analysis, whereas measurements of the other elements amenable to CSIA (hydrogen, nitrogen, oxygen) are much less routine. In environmental sciences, successful applications to date include (i) the allocation of contaminant sources on a local, regional, and global scale, (ii) the identification and quantification of (bio)transformation reactions on scales ranging from batch experiments to contaminated field sites, and (iii) the characterization of elementary reaction mechanisms that govern product formation. These three application areas are discussed in detail. The investigated spectrum of compounds comprises mainly n-alkanes, monoaromatics such as benzene and toluene, methyl tert-butyl ether (MTBE), polycyclic aromatic hydrocarbons (PAHs), and chlorinated hydrocarbons such as tetrachloromethane, trichloroethylene, and polychlorinated biphenyls (PCBs). Future research directions are primarily set by the state of the art in analytical instrumentation and method development. Approaches to utilize HPLC separation in CSIA, the enhancement of sensitivity of CSIA to allow field investigations in the microg L(-1) range, and the development of methods for CSIA of other elements are reviewed. Furthermore, an alternative scheme to evaluate isotope data is outlined that would enable estimates of position-specific kinetic isotope effects and, thus, allow one to extract mechanistic chemical and biochemical information.

Chromatography, High Pressure Liquid↗
PubMed2004

A new instrument adapted to in situ Raman analysis of objects of art.

The analysis of precious artefacts and antiquities demands care in order to minimise the risk of accidental damage during measurement. Mobile fibre-optic-based Raman instruments offer a means to avoid destructive sampling and eliminate the need to transport artefacts for spectrochemical analysis. In this work we present a new mobile instrument developed and optimised for the in situ Raman investigation of objects of art and antiquities. The instrument is controlled by a portable computer. Selected mounts cover many types of artefacts. Newly written software routines organise spectra together with measurement parameters and facilitate calibration of the instrument. The present paper describes this new Raman instrument and discusses some challenges in the transition from a laboratory environment to in situ investigations in museums.

Journal Article↗
PubMed2000

Mass spectrometry with plasma sources at atmospheric pressure--state-of-the-art and some developmental trends.

The state-of-the art and trends of development in ICP-MS are presented. Special reference is made to progress in plasma sources, which can be used as ion sources and, especially, the inductively coupled plasma and new microwave plasma sources. Further, progress in sample introduction for plasma mass spectrometry is discussed with special reference to new pneumatic nebulizers, enabling, e.g., work with microflows of solutions at high efficiency, new developments in ultrasonic nebulization, in electrothermal evaporation, laser ablation and hydride generation. Innovation in the types of mass spectrometers used is discussed with special reference to the use of reaction and collision cells, sector field mass spectrometry, time-of-flight mass spectrometry and multicollector mass spectrometers. Challenging applications in the field of speciation, especially in environmental samples with the example of the chromium speciation, and in materials analysis, with special reference to the analysis of ceramic powders with and without on-line matrix removal, are also discussed.

Journal Article↗
PubMed2001

ArtTAX--a new mobile spectrometer for energy-dispersive micro X-ray fluorescence spectrometry on art and archaeological objects.

A newly developed spectrometer for energy-dispersive micro X-ray fluorescence spectrometry has been designed for the demands of archaeometry. ArtTAX combines the advantages of non-destructive and sensitive multi-elemental analysis at sub-mm resolution with the possibility of working outside the laboratory. The spectrometer consists of an air-cooled, low-power molybdenum tube, new generation polycapillary X-ray optics, a silicon drift detector without the need for liquid-nitrogen cooling, a CCD camera, and three light diodes for sample positioning. The motor-driven measurement head is fixed on a x,y,z-flexible tripod support which can be assembled and dismantled within minutes. The spot size of the primary X-ray beam was determined to be 94 microm for the Cu(Kalpha) energy, the detection limits are in a range of a few tens of microg g(-1) for the medium energy-range in glass. Additional open helium purging in the excitation and detection paths enables the determination of elements down to sodium, thus avoiding vacuum conditions or a size-limiting sample chamber. A selection of qualitative and quantitative results on pigment, metal, glass, and enamel analyses are presented to show the potential of ArtTAX in the field of art and archaeology.

Journal Article↗
PubMed2001

The state-of-the-art in the analysis of type-A and -B trichothecene mycotoxins in cereals.

The aim of this review is to describe the state-of-the-art in the analysis of A- and B-trichothecene mycotoxins in cereals and to support knowledge and experience exchange between laboratories in the field of Fusarium mycotoxin analysis. Current screening tests and quantitative methods for the most prevalent type-A and -B trichothecenes, HT-2 and T-2-toxin, and deoxynivalenol (DON) are reviewed. This includes the extraction and clean-up procedures and chromatographic methods (TLC, HPLC, GC) applied and the immunochemical methods, especially enzyme-linked immunosorbent assay (ELISA), employed for the determination of these mycotoxins. Results from recent intercomparison studies of the determination of DON are also discussed. Experience gained during these intercomparisons clearly shows the need for further improvement in the determination of trichothecenes, to obtain more accurate and comparable results. This also indicates there is a strong need for the development of further certified reference materials (CRM) which would enable comparison of measurement results between different European laboratories for several A- and B-trichothecenes. For both A- and B-trichothecenes there is still a lack of simple and reliable screening methods enabling the rapid detection of these mycotoxins at low cost.

Chemistry Techniques, Analytical↗
PubMedDate not supplied

Interventional pediatric cardiology: state of the art and future directions.

Although the interventional pediatric cardiology began in the early 1950s, it was not until the mid-1980s that a full spectrum of transcatheter interventions in children could be undertaken including balloon atrial septostomy which has been in usage since 1966. Enormous developments have occurred even from the mid-1980s to date. In this review, current state-of-the-art for each broad area of therapeutic catheterization is presented. A large variety of lesions could be opened-up or closed, as the case may be and the results of these interventions were either similar to or better than those reported for the alternative surgical therapy. Indeed, therapeutic catheterization techniques have replaced the conventional surgery for many lesions and are threatening to do so for others. However, long-term follow-up results are scanty and are needed. Further miniaturization of catheters/sheaths used in interventional pediatric cardiology and development of new technology for the lesions which are not amenable to currently available transcatheter methods are awaited. The future seems to be bright for interventional pediatric cardiology.

Arrhythmias, Cardiac↗
PubMed2005

Diagnosis of abdominal aortic hypoplasia by state-of-the-art MR angiography.

Abdominal aortic hypoplasia is a rare vascular variant with possible major clinical sequelae when the renal arteries are also involved. The condition is thought to result from embryonic overfusion of the two dorsal aortas. The diagnosis may be considered in patients presenting with hypertension in the neonatal period and severely reduced or absent arterial pulses in the groin. We present contrast-enhanced state-of-the-art magnetic resonance angiography imaging findings in an 8-year-old boy with abdominal aortic hypoplasia.

Aorta, Abdominal↗
PubMed2004

State of the art of current modalities for the diagnosis of breast lesions.

With the availability of numerous diagnostic techniques comes the possible risk of the unjustified use of such techniques and a lack of rational clinical application. Clearly, errors of this nature would affect the diagnostic accuracy and therefore reduce the possibilities for treatment. It is not uncommon for women and also for general practitioners to be misinformed about which is the most suitable technique or rather, which is the best combination of the various techniques. For this reason, inappropriate tests are often requested or, conversely, there is failure to request tests which would in fact make a useful contribution to safeguarding the patient's health. This work has the following aims: (a) to set out precisely the real diagnostic contribution of each method, both radiological and otherwise, and suggest methods of application and indications consistent with the state of the art, and (b) to suggest the most effective and rational combinations of the various techniques and organisation of diagnostic activities.

Biopsy, Needle↗
PubMed2003

Postlaryngectomy voice rehabilitation: state of the art at the millennium.

Total laryngectomy or laryngopharyngectomy remains the procedure of choice for advanced laryngeal/hypopharyngeal carcinoma, either as a primary procedure or as salvage following irradiation alone or concurrent chemoradiation therapy. Over the past 25 years there has been significant improvement in the rehabilitation of these patients, with speech restoration that has dramatically altered and improved their quality of life. This article reviews postlaryngectomy voice rehabilitation with a historical background as well as the present state-of-the-art tracheoesophageal shunt voice with an artificial valve. Finally, this article reviews and compares artificial valve prostheses as to their voice characteristics, patient satisfaction, complications associated with the procedure, and devices used at a center in Europe (The Netherlands Cancer Institute, Amsterdam) and a North American center (The Wharton Head and Neck Center, Princess Margaret Hospital, University of Toronto, Canada).

Female↗
PubMed2003

[German-speaking memory clinics: state of the art and practical recommendations].

The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

Aged↗
PubMed2004

Mortality and cancer incidence in a Swedish art glassworks--an updated cohort study.

AIM: To study mortality and cancer incidence, in a Swedish art glassworks producing both heavy and semi-crystal glassware, in an extended cohort of workers over a long time period during which some preventive actions had taken place. METHODS: In the updated study, 1,229 men and women were eligible as cohort members during the period 1964-1997. The observed number of cases was compared with expected numbers, as calculated from cause-, age-, gender- and calendar year-specific national rates for mortality and cancer incidence. RESULTS: Among men only, a significant risk was seen for cancer incidence in the colon and rectum [standardised incidence ratio (SIR) 1.92, 95% confidence interval (CI) 1.05-3.23; 14 cases] and increased, but statistically non-significant, risks were also seen for male cases of tumours in the liver/bile ducts and brain. Among women, statistically non-significant risks were seen for tumours in the liver/bile ducts and in the lymphatic and haematopoietic systems. No increased risk for cancer of the lung was found in this updated study. The risk for cancer in the colon/rectum was slightly increased in all work categories, and the increase was statistically significant among male and female unspecified glassworkers (SIR 3.13, 95% CI 1.35-6.16; five male and three female cases). A statistically significantly increased risk for cancer in the liver/bile ducts was seen among refinement workers (SIR 3.96, 95% CI 1.07-10.14; two male and two female cases). CONCLUSION: Most of the causes of death associated with an elevated standardised mortality ratio (SMR) in the 1985 cohort resulted in lower SMRs in this updated cohort, maybe as a consequence of preventive actions taken at the glassworks. On the other hand, the risk for cancers in the digestive system seems to remain, perhaps due to past asbestos exposure or inhalation/digestion of larger particles in the ambient air.

Bile Duct Neoplasms↗