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PubMed2002

Nursing science as human science: the new world and human becoming.

The human science perspective of the theory of human becoming holds intrinsic characteristics conducive to permeating teaching-learning in the 21st century. This column focuses on the challenges involved in the teaching-learning of nursing science as a human science, particularly from a human becoming perspective. Moving from a medical model of studying disease processes as the foundation for nursing education, to a nursing model of understanding the meaning of unitary lived experiences, poses challenges for both faculty and students in today's nursing world. These challenges include: explicating the unitary nature of humankind, living the responsibility of expressing new thought, perceiving teaching-learning as engaging community; and visioning nursing leadership as a transformative presence in change.

Community Health Nursing↗
PubMed2002

The measurement of vision disability.

The American Medical Association's (AMA) visual efficiency scale, a vision disability metric based on visual impairment measurements, was adopted in 1925. That scale was based on a 30-year history of theoretical models in vision economics, a misinterpretation of Snellen notation for visual acuity, and an erroneous application of Weber's psychophysical law. The AMA visual efficiency scale survived uncontested for 75 years. In 2001, the AMA adopted a new vision disability scale based on logarithmic transformations of visual acuity and visual field diameter. Like the earlier visual efficiency scale, the new scale is theoretical-it is not supported by any data that speak to the relationship between vision disability and visual impairments. Attempts to measure vision disability date to the early 1980s with the development of self-assessment visual function rating scale questionnaires. Nearly all of the questionnaires developed over the last 20 years use Likert scales, but use them incorrectly. The development of a vision disability metric based on Likert scaling parallels the historical development of other forms of measurement. A tutorial review of psychometrics-classical test theory, item response theory, and Rasch analysis-shows how vision disability measurement scales can be estimated from Likert-type visual function rating scales. We conclude that preliminary data relating measures of vision disability to measures of visual acuity and visual fields support the new AMA vision disability scale.

Algorithms↗
PubMed1996

Transformational leadership.

Rapid changes in the health care system have caused competition among institutions, as organizations are restructured to increase client satisfaction, resulting in the need for a new style of leadership. The transformational leader communicates the mission and vision of the organization and empowers others to effectively resolve conflicts that may arise with change. The health care team that can cope with changes and conflicts views restructuring as a positive transaction and approaches client satisfaction with energy and motivation. Institutions with transformational leadership are the ones that will survive the transition.

Decision Making, Organizational↗
PubMedDate not supplied

Clifford Fourier transform on vector fields.

Image processing and computer vision have robust methods for feature extraction and the computation of derivatives of scalar fields. Furthermore, interpolation and the effects of applying a filter can be analyzed in detail and can be advantages when applying these methods to vector fields to obtain a solid theoretical basis for feature extraction. We recently introduced the Clifford convolution, which is an extension of the classical convolution on scalar fields and provides a unified notation for the convolution of scalar and vector fields. It has attractive geometric properties that allow pattern matching on vector fields. In image processing, the convolution and the Fourier transform operators are closely related by the convolution theorem and, in this paper, we extend the Fourier transform to include general elements of Clifford Algebra, called multivectors, including scalars and vectors. The resulting convolution and derivative theorems are extensions of those for convolution and the Fourier transform on scalar fields. The Clifford Fourier transform allows a frequency analysis of vector fields and the behavior of vector-valued filters. In frequency space, vectors are transformed into general multivectors of the Clifford Algebra. Many basic vector-valued patterns, such as source, sink, saddle points, and potential vortices, can be described by a few multivectors in frequency space.

Algorithms↗
PubMedDate not supplied

[Effect of sizes of the retinal receptive field on the precision of image perception].

A paradox of sharp vision regardless of relatively large receptive fields of the retina is discussed. Transformation of images by the receptive fields or intersecting fields of vision of omma-tidia of the complex eye is described as an approximation of Bool functions by the implicant forms. Such an approximation results in the information compression. The compression coefficient is determined by the ratio between the implicants number and the number of points in the field of determination of the Bool function. The approximation errors strongly depend on the size of the receptive fields. With their increase the error abruptly decreases and only after passing the deep minimum it begins to slowly increase. The mechanism of information compression is a universal one and is similarly realized on the retina, facet and t.v. sets.

Humans↗
PubMed2006

The clinical transformation of Ascension Health: eliminating all preventable injuries and deaths.

BACKGROUND: In 2002 Ascension Health, a 67-hospital not-for-profit health care system, articulated a call to action to provide excellent clinical care with no preventable injuries or deaths by July 2008. It embarked on a journey of clinical transformation. Transformational change implies a much greater pace of change than that reflected in traditional, incremental change processes. THE JOURNEY BEGINS: Progressing from vision to action plan required setting the clinical transformation agenda, identifying challenges to this agenda, and establishing measurements of progress. Environmental changes that must be addressed to successfully implement a transformational change process include culture, making the business case, infrastructure investments, standardization, and how we work together. TAKING ACTION: Improvement activities focused on eight priorities for action, including preventable mortality and areas such as adverse drug events, falls, and surgical complications. "Alpha" sites would develop the best clinical and implementation practices for eliminating the preventable adverse events related to these areas. EARLY RESULTS: The observed decrease in the mortality rate among non-end-of-life-care patients was 21% (p < .001), exceeding the 15% goal set for July 2008 and corresponding to 1,200 deaths prevented across the system. The alpha sites reported initial results in June 2004, with more than 50% reductions in adverse events for all the priorities for action areas.

Delivery of Health Care, Integrated↗
PubMed1994

Quantification of local symmetry: application to texture discrimination.

Symmetry is one of the most prominent cues in visual perception as well as in computer vision. We have recently presented a Generalized Symmetry Transform that receives as input an edge map, and outputs a symmetry map, where every point marks the intensity and orientation of the local generalized symmetry. In the context of computer vision, this map emphasizes points of high symmetry, which, in turn, are used to detect regions of interest for active vision systems. Many psychophysical experiments in texture discrimination use images that consist of various micro-patterns. Since the Generalized Symmetry Transform captures local spatial relations between image edges, it has been used here to predict human performance in discrimination tasks. Applying the transform to micro-patterns in some well-studied quantitative experiments of human texture discrimination, it is shown that symmetry, as characterized by the present computational scheme, can account for most of them.

Form Perception↗
PubMed2005

Computational analyses for illusory transformations in the optic flow field and heading perception in the presence of moving objects.

When we see a stimulus of a radial flow field (the target flow) overlapped with a lateral flow field or another radial flow field, the focus of expansion (FOE) of the target radial flow appears to be shifted in a direction. Royden and Conti [(2003). A model using MT-like motion-opponent operators explains an illusory transformation in the optic flow field. Vision Research, 43, 2811-2826] argued that local motion subtraction is crucial for explanation of this phenomenon. The flow field which causes the illusory displacement of FOE was computationally analyzed. It was shown that the flow field is approximately a rigid-motion flow; the flow can be generated by simulating a situation where an observer moves toward a stationary scene. The heading direction for the observer corresponds to the perceived position of the FOE of the radial flow pattern. It implies that any algorithms which assume rigidity of the scene and recover veridical heading explain the bias in perceived FOE. There is no need for local motion subtraction in order to explain the phenomena. Furthermore, the flow for an observer's translation in the presence of objects moving laterally or in depth was computationally analyzed. It was found that algorithms which minimizes standard error functions with less weights to the independently moving objects show similar biases in recovered heading to the bias of human observers. It implies that local motion subtraction is not necessary for explanation of the bias in perceived heading due to an object moving laterally or in depth, contrary to the argument of Royden [(2002). Computing heading in the presence of moving objects: a model that uses motion-opponent operators. Vision Research, 42, 3043-3058].

Algorithms↗
PubMed2005

Robust fusion of uncertain information.

A technique is presented to combine n data points, each available with point-dependent uncertainty, when only a subset of these points come from N < n sources, where N is unknown. We detect the significant modes of the underlying multivariate probability distribution using a generalization of the nonparametric mean shift procedure. The number of detected modes automatically defines N, while the belonging of a point to the basin of attraction of a mode provides the fusion rule. The robust data fusion algorithm was successfully applied to two computer vision problems: estimating the multiple affine transformations, and range image segmentation.

Algorithms↗
PubMed2004

Multiplicative neural noise can favor an independent components representation of sensory input.

Arguments have been advanced to support the role of principal components (e.g., Karhunen-Loéve, eigenvector) and independent components transformations in early sensory processing, particularly for color and spatial vision. Although the concept of redundancy reduction has been used to justify a principal components transformation, these transformations per se do not necessarily confer benefits with respect to information transmission in information channels with additive independent identically distributed Gaussian noise. Here, it is shown that when a more realistic source of multiplicative neural noise is present in the information channel, there are quantitative benefits to a principal components or independent components representation for Gaussian and non-Gaussian inputs, respectively. Such a representation can convey a larger quantity of information despite the use of fewer spikes. The nature and extent of this benefit depend primarily on the probability distribution of the inputs and the relative power of the inputs. In the case of Gaussian input, the greater the disparity in power between dimensions, the greater the advantage of a principal components representation. For non-Gaussian input distributions with a kurtosis that is super-Gaussian, an independent components representation is similarly advantageous. This advantage holds even for input distributions with equal power since the resulting density is still rotationally asymmetric. However, sub-Gaussian input distributions can lead to situations where maximally correlated inputs are the most advantageous with respect to transmitting the greatest quantity of information with the fewest number of spikes.

Models, Neurological↗
PubMed2005

Transformation of a leprosy hospital in Nepal into a rehabilitation centre: the Green Pastures Hospital experience.

Green Pastures Hospital for leprosy patients in Pokhara Nepal, was established in 1957 by the International Nepal Fellowship (INF) in a decade which saw the establishment of many similar hospitals in other leprosy endemic countries. In recent years, mainly due to significant improvements in leprosy control services and the wide implementation of multiple drug therapy (MDT) for all patients, many of these specialist hospitals have encountered 1) a decline in prevalence rate, 2) a large decline in the percentage of patients presenting with WHO grade 2 disability, 3) a decline in the previous indications for hospital admission, e.g. immunologically mediated reactions, and 4) a need to develop financial independence making them less dependent on donor agencies. In addition, the decision to change from specialist to general services opened up the possibility of using facilities and expertise for the rehabilitation of non-leprosy affected persons, whilst also moving towards the reduction of stigma and prejudice against patients with leprosy. This paper describes the process of 'transformation' of an established and well known leprosy hospital in Western Nepal from 1997 onwards into a general rehabilitation hospital. Careful preparation, with full involvement of existing staff and co-operation with other agencies in the hospital catchment area were key factors in what has now become a successful venture. Surgical procedures and orthopaedic appliance services for non-leprosy affected persons have increased in recent years and the introduction of a dermatology service has resulted in out-patient attendance rising from about 1000 in 1999 to 4500 in 2003. No evidence of reluctance to attend and use the facilities offered by this hospital because of stigma against leprosy has been encountered. Many of the changes described have been made in order to reduce financial dependence on donor sources of support, but the underlying reason for transformation is still based on the vision of the INF mission to work for and improve the condition of the marginalized in society.

Hospitals, Chronic Disease↗
PubMedDate not supplied

Embracing global solidarity.

For more than 60 years, Catholic Relief Services (CRS) has provided emergency relief overseas. But the guiding principles underlying the organization's work have evolved over time-particularly over the last decade-as staff members have adopted a new view of their role in supporting people in need worldwide. In CRS' early years, its focus was on corporal works of mercy: providing food, drink, clothing, and other material goods. Although the organization's breadth of services and geographic presence expanded throughout the latter part of the 20th century, it wasn't until the mid-1990s that the agency questioned its foundational principles and made an organization-wide move toward change. The impetus for change was the 1994 Rwandan genocide crisis. CRS staff members were deeply affected: not only were their aid programs destroyed; they also lost friends, colleagues, and family members. CRS staff realized that unless they addressed the justice issues underlying their beneficiaries' concerns, their aid would have minimal impact. Changing the way the organization approaches relief has been an extensive process. Staff members developed a strategic plan, held retreats and workshops to define the concept of justice, educated colleagues worldwide on the new approach, facilitated "Justice Reflections" to explore the basics of Catholic social teaching, and developed guiding principles and a vision. Despite challenges, CRS is successfully transforming itself into an agency that not only provides physical relief but also strives to help build a culture of justice, peace, and reconciliation.

Catholicism↗
PubMed2005

The future of patient-centered care: scenarios, visions, and audacious goals.

The U.S. health care system is transforming. It must. Patient-centered care (PCC) is a core quality that the system should include. This article presents the highlights of a project on the future of PCC created for the Picker Institute. As an example of futures work, this project developed four images or stories of what might happen, as well as a vision and audacious goals for what should happen to PCC. The first and most likely scenario is an increase in patient-centeredness as a function of current trends. However, in the second scenario, health care could become even more stressed and leave PCC behind as it seeks to lower cost without focusing on quality. The third scenario envisions more excellent systems that integrate PCC seamlessly into their work. The fourth scenario sees collaboration and shared responsibility, in association with advanced information tools, thereby enabling PCC to contribute to preventing illness and lowering health care costs. The scenarios indicate that the patient-centeredness of health care could improve slightly, stall, or advance significantly. The PCC Vision calls for each of us to be in charge of our health, and to get the care we need (not less and not more) in timely, effective, and personal ways consistent with our values. The audacious goals set an agenda with priorities from the PCC community. These include shared decision making by consumers, ensuring health care professionals are trained in supporting active patients, anticipating health and long-term care needs for individuals, adopting the Institute of Medicine's (IOM) simple rules for health care, and making the patient perspective a priority in policy and planning. Each of us and our organizations are confronted with the challenge of this vision and audacious goals. Health care professionals and provider systems, whether conventional or alternative in nature, face these issues. While complementary and alternative medicine (CAM) providers often get higher marks from consumers for their attention, many CAM modalities are largely provider-determined. Patient-centered care will require more empowerment and activation of patients and consumers.

Chronic Disease↗
PubMed2000

Ultraviolet pigments in birds evolved from violet pigments by a single amino acid change.

UV vision has profound effects on the evolution of organisms by affecting such behaviors as mating preference and foraging strategies. Despite its importance, the molecular basis of UV vision is not known. Here, we have transformed the zebra finch UV pigment into a violet pigment by incorporating one amino acid change, C84S. By incorporating the reverse mutations, we have also constructed UV pigments from the orthologous violet pigments of the pigeon and chicken. These results and comparative amino acid sequence analyses of the pigments in vertebrates demonstrate that many avian species have achieved their UV vision by S84C.

Amino Acid Sequence↗
PubMed1983

Trichromacy, opponent colours coding and optimum colour information transmission in the retina.

This paper presents a systematic analysis of the role of opponent type processing in colour vision and the relation between opponent type colour transformations and the initial three colour mechanisms. It is shown that efficient information transmission is achieved by a transformation of the initial three colour mechanisms into an achromatic and two opponent chromatic channels. The derivation of the transformation is dependent solely on criteria from information theory. Thus it provides a logical rationale reconciling opponent type processing as an optimal necessary step after the initial three colour mechanisms, unifying respectively the Hering and Young-Helmholtz approaches to colour vision. The effects of chromatic adaptation on the spectral response of the achromatic and two chromatic channels are discussed from the point of view of information theory. It is argued that adaptation serves as a dynamic readjustment of these responses, necessary to meet criteria of efficient colour information transmission. The results are confronted with empirical observations to test the principles of the theory and the relation to other theories is discussed. Within the same framework the issue of trichromacy is discussed. It is argued that a broad class of typical colour spectra can effectively be represented by three significant degrees of freedom that make up a trichromatic system.

Color Perception↗
PubMed2003

The cerebellum: organization, functions and its role in nociception.

Our vision of the cerebellum has been gradually transformed throughout the last century from a 'little brain' to a 'neuronal machine' capable of multitasks, all arguably based on a principle computational model. We review here the main functions of the cerebellum in light of its organization and connectivity. In addition to providing a clear and extensive review of the cerebellar literature, we emphasize the role of the cerebellum in nociception, which is novel to the neurophysiology of pain. However, it is premature to conclude that the cerebellum influences sensory experience in the absence of clinical data.

Animals↗
PubMed2006

A rare case of recurrent secretory meningioma with malignant transformation.

A 72-year-old woman previously operated for a sphenoid-ridge meningioma, now presented with double vision. Histology showed a secretory meningioma with an epithelial-appearing, malignant component. Malignant transformation in a secretory meningioma is not known. This is the first report of such an occurrence.

Aged↗