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Computer control of mechanical ventilation.

Computer control of mechanical ventilators includes the operator-ventilator interface and the ventilator-patient interface. New ventilation modes represent the evolution of engineering control schemes. The various ventilation control strategies behind the modes have an underlying organization, and understanding that organization improves the clinician's appreciation of the capabilities of various ventilation modes and gives an idea of what we can and should expect for the future. The operator-ventilator interface has received little attention in the literature, despite the fact that there is a whole science of human-computer interaction. This report suggests a methodology for the study of ventilator interfaces.

Artificial Intelligence↗

Sensitivity index of antimicrobial agents as a simple solution for multidrug resistance in Salmonella Typhi.

BACKGROUND & OBJECTIVE: Multi drug-resistant (MDR) typhoid in India is an escalating problem. MDR isolates of Salmonella Typhi are on rise and are becoming a challenge for timely and appropriate treatment. Occurrence of per cent sensitive (%S), per cent resistant (%R) and per cent intermediate (%I) isolates may vary geographically and treatment decided on the basis of only one of these three subpopulations may lead to selection of inappropriate drug for treatment and thus treatment failure. Determination of sensitivity index (SI) of antimicrobial agents, instead of %S or %R subpopulations, may give clearer insight regarding selection of appropriate antimicrobial for treatment of typhoid. In present work, the data of sensitivity testing were analysed and interpreted both in terms of SI as well as %S, %I and %R. METHODS: A total of 205 isolates of Salmonella Typhi were collected during June 2000 and August 2002 from a network of five institutes- Lady Hardinge Medical College (LHMC, N=110), Ram Manohar Lohia Hospital (RML, N=14), Majeedia Hospital (MH, N=48), Lal's Pathology Lab (LAL, N=28) and All India Institute of Medical Sciences (AIIMS, N=5) on nutrient agar slopes. Of these, 142 isolates were subjected to phage typing and biotyping at National Salmonella Phage Typing Centre, New Delhi. Five isolates resistant to 3-7 and one isolate susceptible to all of total 12 antimicrobial tested were subjected to plasmid analysis. SI for various antimicrobials was determined as the ratio of %S and %R values derived form %RIS analysis using WHONET5. RESULTS: 18 (8.7%) isolates were susceptible to all tested antimicrobials and 124 (60%) were MDR. Of the 142 isolates, 103 were phage type E1 and biotype I. SI of antimicrobials rather than individual %S or %R or %I population presents a better criterion for interpretation of sensitivity testing data as well as selection of the most appropriate antimicrobial for timely treatment. Presence of 140, 48 and 23 Kb size plasmids in all 5 MDR isolates and none in susceptible isolate was observed. INTERPRETATION & CONCLUSION: Re-emergence of chloramphenicol sensitivity in Salmonella typhi was observed in the present study. Interpretation in terms of SI criteria warrants that reintroduction of chloramphenicol at present for treatment of typhoid may rebound resistance. Current empiric therapy used for treatment of typhoid may soon become ineffective. SI being a ratio will not only eliminate geographical variation of %RIS data but also its interpretation. SI can provide guidelines for clinicians in remote areas where facilities for sensitivity testing are not available.

Drug Resistance, Multiple, Bacterial↗

Testing the knowledge of postgraduate trainees in medicine: a multimedia software package.

1. TASK OF THE PROGRAM. The task of the program is to test the knowledge of applicants at the examination for specialists degrees. The applicants must answer a series of multiple choice test questions, 40% of them are connected to a medical diagnostic image of different modalities e.g., x-ray, 2D gray scale ultrasound, CT, MRI, and endoscopy images. The answer may need simple measurements and finding target areas on the image. The program manages to: test 20 applicants simultaneously in a network, handle a database of questions and images, and document and print out exam results. 2. ORGANIZATIONAL ENVIRONMENT OF THE PROGRAM. The program was developed at the Medical Informatics Department of "Haynal Imre" University of Health Sciences, Budapest (MID-HIETE) according to the needs and intentions of the National Board of Medical Postgraduate Training. The program was sponsored by the OMFB/National Committee of Technical Development, a government agency, and by one of the commercial banks. 3. TECHNICAL ENVIRONMENT OF THE PROGRAM. 4. SCIENTIFIC BASIS. The data bank was developed according to a previous study of medical images in clinical practice. The study describes the information content of different medical images and their role in medical practice. The image data bank originates from the developer's own medical image library and from internationally acknowledged medical textbooks (respecting copyright issues). Knowledge base of questions was drawn from basic international textbooks. 5. SUMMARY. Within a period of two years, the MID-HIETE staff succeeded in developing a modular multimedia software package that tests and screens the knowledge of postgraduate trainees. This screening method is offered as an entrance exam for the specialist degree. Currently, this exam is administered as an oral test; the knowledge of the applicants may therefore not be tested thoroughly.

Education, Medical↗

"Harnessing genomics to improve health in Africa" - an executive course to support genomics policy.

BACKGROUND: Africa in the twenty-first century is faced with a heavy burden of disease, combined with ill-equipped medical systems and underdeveloped technological capacity. A major challenge for the international community is to bring scientific and technological advances like genomics to bear on the health priorities of poorer countries. The New Partnership for Africa's Development has identified science and technology as a key platform for Africa's renewal. Recognizing the timeliness of this issue, the African Centre for Technology Studies and the University of Toronto Joint Centre for Bioethics co-organized a course on Genomics and Public Health Policy in Nairobi, Kenya, the first of a series of similar courses to take place in the developing world. This article presents the findings and recommendations that emerged from this process, recommendations which suggest that a regional approach to developing sound science and technology policies is the key to harnessing genome-related biotechnology to improve health and contribute to human development in Africa. METHODS: The objectives of the course were to familiarize participants with the current status and implications of genomics for health in Africa; to provide frameworks for analyzing and debating the policy and ethical questions; and to begin developing a network across different sectors by sharing perspectives and building relationships. To achieve these goals the course brought together a diverse group of stakeholders from academic research centres, the media, non-governmental, voluntary and legal organizations to stimulate multi-sectoral debate around issues of policy. Topics included scientific advances in genomics innovation systems and business models, international regulatory frameworks, as well as ethical and legal issues. RESULTS: Seven main recommendations emerged: establish a network for sustained dialogue among participants; identify champions among politicians; use the New Plan for African Development (NEPAD) as entry point onto political agenda; commission an African capacity survey in genomics-related R&D to determine areas of strength; undertake a detailed study of R&D models with demonstrated success in the developing world, i.e. China, India, Cuba, Brazil; establish seven regional research centres of excellence; and, create sustainable financing mechanisms. A concrete outcome of this intensive five-day course was the establishment of the African Genome Policy Forum, a multi-stakeholder forum to foster further discussion on policy. CONCLUSION: With African leaders engaged in the New Partnership for Africa's Development, science and technology is well poised to play a valuable role in Africa's renewal, by contributing to economic development and to improved health. Africa's first course on Genomics and Public Health Policy aspired to contribute to the effort to bring this issue to the forefront of the policy debate, focusing on genomics through the lens of public health. The process that has led to this course has served as a model for three subsequent courses (in India, Venezuela and Oman), and the establishment of similar regional networks on genomics and policy, which could form the basis for inter-regional dialogue in the future.

Editorial↗

The effects of migration on the establishment of networks: caste disintegration and reformation among the Indians of Fiji.

"This article focuses on how migration auspices affect the formation of migrant networks and ethnic communities. Using ethnographic data and migration histories to focus on caste ¿reformation' in the subcommunities of the Indians of Fiji, the ability to reestablish and maintain subcaste group ¿extensions' in Fiji is shown as directly related to the migration auspices that originally established the community. By determining the characteristics of migrants, the reason for migrating, and the magnitude and duration of migration streams, migration auspices define a migration type. This migration type affects the strength and density of social ties present in migration streams. It also affects the strength and density of network ties that members of a migrant community can establish in a receiving society."

Asia↗

Use of on-line bibliographic retrieval services in health sciences libraries in the United States and Canada.

This paper reports the major findings of a questionnaire sent to the 708 U. S. and Canadian institutions which were using the National Library of Medicine's search services as of November 1977. Development of the National Library of Medicine (NLM) on-line network is traced characterizes type of institution, use of NLM and non-NLM data bases, operational service patterns, staffing levels, fee-for-service policies, and perceived impact.

Bibliographies as Topic↗

Physiological roles of clathrin adaptor AP complexes: lessons from mutant animals.

Clathrin-associated adaptor protein (AP) complexes play a key role in the transport of proteins, by regulating the formation of transport vesicles as well as cargo selection, between organelles of the post-Golgi network, namely, the trans-Golgi network (TGN), endosomes, lysosomes and the plasma membrane. Evidence has been accumulating for the physiological importance of AP complexes. Deficiency in AP-1A or AP-2 results in embryonic lethality in mice, indicating that these AP complexes are essential for normal development of embryos in mammals. In contrast, mutations in the genes encoding subunits of AP-3A cause an autosomal recessive disorder, Hermansky-Pudlak syndrome in human and its disease models in mice. Knockout mice for the neuron-specific AP-3B suffer from epileptic seizure. Further studies on the physiological and pathological aspects of AP complexes will not only be beneficial for better understanding of developmental biology and medical sciences, but also deepen our insight into the molecular mechanisms of vesicular traffic.

Adaptor Proteins, Vesicular Transport↗

Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases.

BACKGROUND: The treatment of brain metastasis is generally palliative, with whole brain radiation therapy (WBRT), since the majority have uncontrollable systemic cancer. In certain circumstances, such as single brain metastases, death may be more likely from brain involvement than systemic disease. In this group, surgical resection has been proposed to relieve symptoms and prolong survival. OBJECTIVES: To assess the clinical effectiveness of surgical resection plus WBRT versus WBRT alone in the treatment of single brain metastasis. SEARCH STRATEGY: The Cochrane Cancer Network Specialised trials register (July 2003), Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 1 2003), MEDLINE (1966 to July 2003), EMBASE (1980 to July 2003), CANCERLIT (1980 to July 2003), BIOSIS (1985 to July 2003) and SCIENCE CITATION INDEX (1981 to July 2003) were searched. References of identified studies were hand searched, as was the Journal of Neuro-Oncology over the previous 10 years and Neuro-Oncology over the past 2 years, including all conference abstracts. Specialists in neuro-oncology were also contacted. SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing surgery and WBRT with WBRT alone, in patients with single brain metastasis. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Three RCTs were identified, with 195 patients in total. No significant difference in survival was noted hazard ratio (HR) 0.74 (95% confidence interval (CI) 0.39 to 1.40, p = 0.35), although there was a high degree of heterogeneity between trials. One trial has shown surgery and WBRT to increase the duration of functionally independent survival (FIS) HR 0.42 (95% CI 0.22 to 0.80, p < 0.008). There is a trend for surgery and WBRT to reduce the number of deaths due to neurological cause odds ratio (OR) 0.57 (95% CI 0.29 to 1.10, p = 0.09). Adverse effects were not found to be statistically more common in any group. AUTHORS' CONCLUSIONS: Surgery and WBRT may improve FIS but not overall survival. There is a trend that it may reduce the proportion of deaths due to neurological cause. All these results were in a highly selected group of patients. Operating on metastases does not confer significantly more adverse effects.

Brain Neoplasms↗

Asymptotic Stationarity of Discrete-time Stochastic Neural Networks.

This paper deals with a class of synchronous discrete-time stochastic neural network models. Dynamic stabilities (or asymptotic stationarities) are analysed for two sub-classes of the models, i.e., a class of stochasticized models from Little, and a class of Hopfield-type stochastic models. Copyright 1996 Elsevier Science Ltd.

Journal Article↗

European first aid guidelines.

AIM: Our objectives were to determine the most effective, safe, and feasible first aid (FA) techniques and procedures, and to formulate valid recommendations for training. We focussed on emergencies involving few casualties, where emergency medical services or healthcare professionals are not immediately present at the scene, but are available within a short space of time. Due to time and resource constraints, we limited ourselves to safety, emergency removal, psychosocial FA, traumatology, and poisoning. Cardiopulmonary resuscitation (CPR) was not included because guidelines are already available from the European Resuscitation Council (ERC). The FA guidelines are intended to provide guidance to authors of FA handbooks and those responsible for FA programmes. These guidelines, together with the ERC resuscitation guidelines, will be integrated into a European FA Reference Guide and a European FA Manual. METHODS: To create these guidelines we used an evidence-based guideline development process, based on the methodology of the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS: The recommendations cover FA for bleeding, wounds, burns, spinal and head trauma, musculoskeletal trauma, and poisoning, as well as safety and psychosocial FA. CONCLUSIONS: Where good evidence was available, we were able to turn science into practice. Where evidence was lacking, the recommendations were consensus-based. These guidelines provide systematically developed recommendations and justifications for the procedures and techniques that should be included in FA manuals and training programmes.

Europe↗

A case for the lemma/lexeme distinction in models of speaking: comment on Caramazza and Miozzo (1997)

In a recent series of papers, Caramazza and Miozzo [Caramazza, A., 1997. How many levels of processing are there in lexical access? Cognitive Neuropsychology 14, 177-208; Caramazza, A., Miozzo, M., 1997. The relation between syntactic and phonological knowledge in lexical access: evidence from the 'tip-of-the-tongue' phenomenon. Cognition 64, 309-343; Miozzo, M., Caramazza, A., 1997. On knowing the auxiliary of a verb that cannot be named: evidence for the independence of grammatical and phonological aspects of lexical knowledge. Journal of Cognitive Neuropsychology 9, 160-166] argued against the lemma/lexeme distinction made in many models of lexical access in speaking, including our network model [Roelofs, A., 1992. A spreading-activation theory of lemma retrieval in speaking. Cognition 42, 107-142; Levelt, W.J.M., Roelofs, A., Meyer, A.S., 1998. A theory of lexical access in speech production. Behavioral and Brain Sciences, (in press)]. Their case was based on the observations that grammatical class deficits of brain-damaged patients and semantic errors may be restricted to either spoken or written forms and that the grammatical gender of a word and information about its form can be independently available in tip-of-the-tongue states (TOTs). In this paper, we argue that though our model is about speaking, not taking position on writing, extensions to writing are possible that are compatible with the evidence from aphasia and speech errors. Furthermore, our model does not predict a dependency between gender and form retrieval in TOTs. Finally, we argue that Caramazza and Miozzo have not accounted for important parts of the evidence motivating the lemma/lexeme distinction, such as word frequency effects in homophone production, the strict ordering of gender and phoneme access in LRP data, and the chronometric and speech error evidence for the production of complex morphology.

Humans↗

Prevention and health promotion on the international scene: the need for a more effective and comprehensive approach.

The last decade has shown a boom in international networks and projects in health promotion and prevention. The growth of international collaboration is considered to be of crucial importance for the future development of the field. Several arguments are discussed in support of a further expansion of collaboration across countries and regions. The author criticizes the current lack of effectiveness in international collaboration in health promotion and prevention and identifies main barriers to effective collaboration. To make significant progress in research, evidence-based programs and policies, and their implementation worldwide, the creation of a comprehensive system of functional and effective linkages is needed across the core task areas, across disciplines, across system levels, and across countries and cultures. The quality of prevention and health promotion research as well as its impact on the health of communities depends on the degree to which research institutes and other stakeholders are embedded in an effective network of interorganizational and international relationships capable of performing a broad range of essential and functionally related tasks. It is critical that the dynamics of effective international collaboration become a legitimate subject of prevention and health promotion science.

Health Policy↗

Neural Networks for Predicting Conditional Probability Densities: Improved Training Scheme Combining EM and RVFL.

Predicting conditional probability densities with neural networks requires complex (at least two-hidden-layer) architectures, which normally leads to rather long training times. By adopting the RVFL concept and constraining a subset of the parameters to randomly chosen initial values (such that the EM-algorithm can be applied), the training process can be accelerated by about two orders of magnitude. This allows training of a whole ensemble of networks at the same computational costs as would be required otherwise for training a single model. The simulations performed suggest that in this way a significant improvement of the generalization performance can be achieved. Copyright 1997 Elsevier Science Ltd.

Journal Article↗

The relations between neuroscience and human behavioral science.

Neuroscience seeks to understand how the human brain, perhaps the most complex electrochemical machine in the universe, works, in terms of molecules, membranes, cells and cell assemblies, development, plasticity, learning, memory, cognition, and behavior. The human behavioral sciences, in particular psychiatry and clinical psychology, deal with disorders of human behavior and mentation. The gap between neuroscience and the human behavioral sciences is still large. However, some major advances in neuroscience over the last two decades have diminished the span. This article reviews the major advances of neuroscience in six areas with relevance to the behavioral sciences: (a) evolution of the nervous system; (b) visualizing activity in the human brain; (c) plasticity of the cerebral cortex; (d) receptors, ion channels, and second/third messengers; (e) molecular genetic approaches; and (f) understanding integrative systems with networks and circadian clocks as examples.

Animals↗

Visualization of multiple influences on ocellar flight control in giant honeybees with the data-mining tool Viscovery SOMine.

Viscovery SOMine is a software tool for advanced analysis and monitoring of numerical data sets. It was developed for professional use in business, industry, and science and to support dependency analysis, deviation detection, unsupervised clustering, nonlinear regression, data association, pattern recognition, and animated monitoring. Based on the concept of self-organizing maps (SOMs), it employs a robust variant of unsupervised neural networks--namely, Kohonen's Batch-SOM, which is further enhanced with a new scaling technique for speeding up the learning process. This tool provides a powerful means by which to analyze complex data sets without prior statistical knowledge. The data representation contained in the trained SOM is systematically converted to be used in a spectrum of visualization techniques, such as evaluating dependencies between components, investigating geometric properties of the data distribution, searching for clusters, or monitoring new data. We have used this software tool to analyze and visualize multiple influences of the ocellar system on free-flight behavior in giant honeybees. Occlusion of ocelli will affect orienting reactivities in relation to flight target, level of disturbance, and position of the bee in the flight chamber; it will induce phototaxis and make orienting imprecise and dependent on motivational settings. Ocelli permit the adjustment of orienting strategies to environmental demands by enforcing abilities such as centering or flight kinetics and by providing independent control of posture and flight course.

Animals↗

Nursing in tele-mental health.

This article discusses a cooperative project involving an academic health sciences center, a state university, a women's shelter, and a community mental health center in East Texas, a medically underserved, rural region of Texas. The U.S. Department of Commerce provided grant funding to develop a telehealth network to provide an evaluation, referral, and treatment program for victims of domestic violence. Nurses were involved in all phases of the project, from initial conception through development, implementation, and evaluation. The authors concluded that all of the women involved in the study had significant mental health issues and other health concerns that were not being addressed by the existing health care delivery system. Without the use of telehealth, these women would have had limited access to primary health care and virtually no access to mental health services. The East Texas Tele-Mental Health Network demonstrates the value of the clinical and organizational skills that nurses bring to innovative models of mental health service delivery.

Adult↗

Future trends in transplantation.

With over 15,000 solid organ transplants performed in the United States last year, it is exciting to follow trends in this field. The United Network for Organ Sharing is carefully studying the availability of organs and new methods to enhance organ donation. In the forefront at this time are new antirejection medications being tested throughout the United States. In the basic science and immunology arena are many studies on graft tolerance, whereby organs are accepted by the body with minimal or no immunosuppression. The real answers to many transplantation questions are still being answered through the efforts of ongoing research.

Forecasting↗

[Organization and development paths of the cardiology service in the Belorussian SSR].

Data providing evidence of a developed cardiological service in the Byelorussian SSR are presented. Besides the establishment of a network of in- and out-patient institutions, mass epidemiological study of the population has been started and rehabilitation centers for patients who had recovered from myocardial infarction were created. Ways for the further development of cardiological science in the republic and the prospects of widening the prevention of cardiovascular diseases are discussed.

Absenteeism↗