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PubMed2000

Development of speechreading supplements based on automatic speech recognition.

In manual-cued speech (MCS) a speaker produces hand gestures to resolve ambiguities among speech elements that are often confused by speechreaders. The shape of the hand distinguishes among consonants; the position of the hand relative to the face distinguishes among vowels. Experienced receivers of MCS achieve nearly perfect reception of everyday connected speech. MCS has been taught to very young deaf children and greatly facilitates language learning, communication, and general education. This manuscript describes a system that can produce a form of cued speech automatically in real time and reports on its evaluation by trained receivers of MCS. Cues are derived by a hidden markov models (HMM)-based speaker-dependent phonetic speech recognizer that uses context-dependent phone models and are presented visually by superimposing animated handshapes on the face of the talker. The benefit provided by these cues strongly depends on articulation of hand movements and on precise synchronization of the actions of the hands and the face. Using the system reported here, experienced cue receivers can recognize roughly two-thirds of the keywords in cued low-context sentences correctly, compared to roughly one-third by speechreading alone (SA). The practical significance of these improvements is to support fairly normal rates of reception of conversational speech, a task that is often difficult via SA.

Adult↗
PubMed2001

A new system for understanding modes of mechanical ventilation.

Numerous ventilation modes and ventilation options have become available as new mechanical ventilators have reached the market. Ventilator manufacturers have no standardized terminology for ventilator modes and ventilation options, and ventilator operator's manuals do not help the clinician compare the modes of ventilators from different manufacturers. This article proposes a standardized system for classifying ventilation modes, based on general engineering principles and a small set of explicit definitions. Though there may be resistance by ventilator manufacturers to a standardized system of ventilation terminology, clinicians and health care equipment purchasers should adopt such a system in the interest of clear communication--the lack of which prevents clinicians from fully understanding the therapies they administer and could compromise the quality of patient care.

Biomedical Engineering↗
PubMedDate not supplied

Through the looking glass: 21st century trauma registry innovations.

Trauma registries can be invaluable tools for improving quality of care and monitoring patient outcomes, but many function below their full potential. Reliance on low-tech, manual data management methods, such as the retyping of demographic information, can lead to inefficiency, increased personnel costs, and potential error. One low-cost solution is a digital interface between the medical records coding database and the trauma registry, allowing the registrar to pull demographic information and ICD-9 diagnostic and procedure codes directly from a reliable source without re-keying them. We created a batch interface for that purpose, reducing the burden of manual data entry and decreasing the time needed to complete patient records in the registry. The interface has eliminated our backlog and allowed the trauma registrar to focus on creating timely reports to track quality indicators.

Bias↗
PubMed1981

Factors predisposing to institutionalism.

UNLABELLED: All psychiatric patients staying in hospital-supervised boarding homes, and a random sample of 50 long-stay patients in the wards of the only mental hospital in Newfoundland were surveyed to determine if certain premorbid factors predispose to institutionalism ('institutional neurosis'). Three hundred and twenty-four patients were examined. Low intelligence, poor education and disabilities in hearing, speech, locomotion and manual dexterity, were significantly associated with institutionalism. Extremes of age on first admission, celibacy, low occupational status in the patient, or his father, and visual disability did not prove to be associated with institutionalism. IN CONCLUSION: institutionalism may be found among patients in boarding homes; some patients are more susceptible to institutionalism than others; and institutionalism tends to be associated with those biological or social handicaps which affect communication and activity of the patient.

Adult↗
PubMed1986

Dental appliance for intraoral voice prosthesis.

Hospitalized patients who are ventilator-dependent after a tracheostomy or who have inflated tracheal cuffs are unable to vocalize due to occlusion of the airway below the level of the larynx. The voice prostheses currently available are often inadequate, particularly for patients with limited manual dexterity. An adaptation of the Cooper-Rand Electronic Speech Aid with a dental retainer, designed by a speech-language pathologist and a hospital dental service, was a useful alternative for two patients who were unable to produce voice due to tracheal cuff inflation. Both patients had neuromotor impairment and one used the device while also on a respirator. The device allowed these patients to verbally communicate to hospital staff and family members.

Adult↗
PubMed2006

Factors that influence the performance of experienced speech recognition users.

Performance on automatic speech recognition (ASR) systems for users with physical disabilities varies widely between individuals. The goal of this study was to discover some key factors that account for that variation. Using data from 23 experienced ASR users with physical disabilities, the effect of 20 different independent variables on recognition accuracy and text entry rate with ASR was measured using bivariate and multivariate analyses. The results show that use of appropriate correction strategies had the strongest influence on user performance with ASR. The amount of time the user spent on his or her computer, the user's manual typing speed, and the speed with which the ASR system recognized speech were all positively associated with better performance. The amount or perceived adequacy of ASR training did not have a significant impact on performance for this user group.

Adolescent↗
PubMed1999

A hospital-wide clinical findings dictionary based on an extension of the International Classification of Diseases (ICD).

The use of a controlled vocabulary set in a hospital-wide clinical information system is of crucial importance for many departmental database systems to communicate and exchange information. In the absence of an internationally recognized clinical controlled vocabulary set, a new extension of the International statistical Classification of Diseases (ICD) is proposed. It expands the scope of the standard ICD beyond diagnosis and procedures to clinical terminology. In addition, the common Clinical Findings Dictionary (CFD) further records the definition of clinical entities. The construction of the vocabulary set and the CFD is incremental and manual. Tools have been implemented to facilitate the tasks of defining/maintaining/publishing dictionary versions. The design of database applications in the integrated clinical information system is driven by the CFD which is part of the Medical Questionnaire Designer tool. Several integrated clinical database applications in the field of diabetes and neuro-surgery have been developed at the HUG.

Databases as Topic↗
PubMed2005

Reification of psychiatric diagnoses as defamatory: implications for ethical clinical practice.

While the mental health professional generally has beneficent motives and an honest belief in the DSM diagnoses assigned to clients, such diagnoses may yet be defamatory when communicated to third parties. Mental health diagnoses invariably lower the individual's reputation in the eyes of the community. At the same time, DSM diagnoses are but one out of a myriad of possible interpretive frameworks. DSM descriptors for the client's distress thus cannot be said to capture the essence of the client's personhood. When a diagnosis is published as if it captured a definitive truth about an individual psychiatric client, it is, in that important regard, inaccurate. That is, such a communication meets the criterion for a reckless disregard for the truth or an honest belief but without reasonable basis insofar as it is considered to be anything more than a working hypothesis. Hence, in certain cases, DSM labeling may constitute defamation.

Confidentiality↗
PubMed2006

A sentence is to speech as what is to action?

This article offers a conceptual framework for integrated analysis of subprocesses in action and language, based on goal-directed action. Anatomical substrates are discussed in the companion paper (Arbib and Bota, 2003) which approaches "Integrative Models of Broca's Area and the Ventral Premotor Cortex" within the context of explaining why the evolution of the human brain yielded mechanisms which support language in a multi-modal vocal-manual-facial system rather than privileging the vocal mode. Arbib and Bota (2003) examine homologies between different cortical areas in macaque and human to revisit the Mirror System Hypothesis (MSH) of Rizzolatti and Arbib (1998)--the notion that the mirror system for grasping (which has its frontal outpost in premotor area F5 of the macaque) provides the substrate for the evolution of the language-ready brain which supports parity of communication. They also offer a critique and extension based on the work of Aboitiz and García (1997; Aboitiz et al., 2006). Arbib and Bota (2003) also discussed the utility of neuroinformatics in relating information across diverse cortical atlases and evaluating degrees of homology for brain regions of interest in different species (for discussion, see Deacon, 2004; Arbib and Bota, 2004).

Animals↗
PubMed1991

An intracrevicular washing method for collection of crevicular contents.

Gingival crevicular contents provide a potential source of markers of the destruction of periodontal structures and the disease activity. This communication introduces a new device designed for efficient collection of samples from the critical area of initial tissue break-up at the bottom of a sulcus or a periodontal pocket. The instrument is characterized by two injection needles fitted one within the other so that during sampling the thinner "ejection needle" is at the bottom of the pocket and the "collection needle" at the gingival margin. The washing solution is manually ejected into the crevice and immediately drained through the collection needle into a sample tube by continuous suction. The technique developed provides an easy and useful method for studies of qualitative differences in the crevicular cells and in the chemical components of the crevicular fluid in various clinical situations. Furthermore, the use of the technique can be extended for localized lavage of acute periodontal pockets with appropriate therapeutic solutions.

Adult↗
PubMed1992

Analytic study of the Tadoma method: improving performance through the use of supplementary tactual displays.

Although results obtained with the Tadoma method of speechreading have set a new standard for tactual speech communication, they are nevertheless inferior to those obtained in the normal auditory domain. Speech reception through Tadoma is comparable to that of normal-hearing subjects listening to speech under adverse conditions corresponding to a speech-to-noise ratio of roughly 0 dB. The goal of the current study was to demonstrate improvements to speech reception through Tadoma through the use of supplementary tactual information, thus leading to a new standard of performance in the tactual domain. Three supplementary tactual displays were investigated: (a) an articulatory-based display of tongue contact with the hard palate; (b) a multichannel display of the short-term speech spectrum; and (c) tactual reception of Cued Speech. The ability of laboratory-trained subjects to discriminate pairs of speech segments that are highly confused through Tadoma was studied for each of these augmental displays. Generally, discrimination tests were conducted for Tadoma alone, the supplementary display alone, and Tadoma combined with the supplementary tactual display. The results indicated that the tongue-palate contact display was an effective supplement to Tadoma for improving discrimination of consonants, but that neither the tongue-palate contact display nor the short-term spectral display was highly effective in improving vowel discriminability. For both vowel and consonant stimulus pairs, discriminability was nearly perfect for the tactual reception of the manual cues associated with Cued Speech. Further experiments on the identification of speech segments were conducted for Tadoma combined with Cued Speech. The observed data for both discrimination and identification experiments are compared with the predictions of models of integration of information from separate sources.

Blindness↗
PubMed1987

Prescription, precision, and decision in treatment planning.

The goal of radiotherapy is to eradicate a tumor without causing severe damage to healthy tissues. Various published experiences have lead to the conclusion that an overall precision of +/- 5% on the absorbed doses, at any point in the patient, is required to meet this goal. Clear definitions of the method for specifying the absorbed dose and dose homogeneity throughout the target volume are essential, to facilitate communication, to improve the knowledge of dose-effect relations and to establish the necessary criteria for the optimization of treatment plans. Determination of the optimal energy is one of the most controversial problems in treatment plan optimization. It is clearly related to the criteria selected. A brief review of some criteria is proposed according to the tumor site. Computers may provide three-dimensional dose calculations for treatment conditions for which manual calculations are not feasible. Because the random errors are very small, computer calculations are often considered as exact although large risks of error are associated with each step of the calculation. The reduction of the overall uncertainty to the stated level of +/- 5% requires a constant effort from both radiotherapists and physicists at each step of treatment planning from basic definitions to dose distribution calculations.

Humans↗
PubMed2004

Depression in patients with mild cognitive impairment increases the risk of developing dementia of Alzheimer type: a prospective cohort study.

BACKGROUND: Mild cognitive impairment has been regarded as a precursor to dementia of Alzheimer type, but not all patients with mild cognitive impairment develop dementia. OBJECTIVE: To determine whether depression may increase the risk of developing dementia. SETTING: The outpatient clinics of a community general hospital. DESIGN: Prospective cohort study. METHODS: A cohort of 114 patients with amnestic mild cognitive impairment was followed up for a mean period of 3 years. At baseline, the patients underwent memory tests, the Spanish version of the Mini-Mental State Examination, a verbal fluency test, the Geriatric Depression Scale, and the Clinical Dementia Rating Scale for staging purposes. Psychiatric examination for depression was based on structured interview and Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition criteria. We also carried out either computed tomography or magnetic resonance imaging of the brain. MAIN OUTCOME MEASURES: We carried out periodic evaluations based on the Mini-Mental State Examination, verbal fluency test, Geriatric Depression Scale, Blessed Dementia Rating Scale, and Clinical Dementia Rating Scale. The end point was the development of probable Alzheimer disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association. RESULTS: Depression was observed in 41 patients (36%) at baseline. After a mean period of 3 years, 59 patients (51.7%) developed dementia of Alzheimer type, and 6 died. Of the depressed patients, 35 (85%) developed dementia in comparison with 24 (32%) of the nondepressed patients (relative risk, 2.6; 95% confidence interval, 1.8-3.6). The survival analysis also showed that depressed patients developed dementia earlier than the nondepressed. Most patients with depression at baseline exhibited a poor response to antidepressants. CONCLUSIONS: We conclude that patients with mild cognitive impairment and depression are at more than twice the risk of developing dementia of Alzheimer type as those without depression. Patients with a poor response to antidepressants are at an especially increased risk of developing dementia.

Aged↗
PubMed1999

Salud para su Corazón: a community-based Latino cardiovascular disease prevention and outreach model.

Cardiovascular disease (CVD) is the leading cause of death for Latinos living in the United States. This population is generally unaware of important lifestyle or behavioral changes that can prevent CVD. The National Heart, Lung, and Blood Institute (NHLBI) designed and implemented Salud para su Corazón (Health for Your Heart), a culturally appropriate, community-based, theory-driven intervention model. NHLBI's goals were: (1) to design an intervention model appropriate to Latino populations; (2) to pilot test the model in a specific community with the objectives of increasing awareness about heart disease, raising knowledge about CVD prevention, and promoting heart-healthy lifestyles; and (3) to disseminate the model and the materials developed to other communities with similar needs. An agency-community partnership, under the leadership of the Community Alliance for Heart Health, guided all stages of the community intervention project. The multimedia bilingual community intervention included television telenovela format public service announcements (PSAs), radio programs, brochures, recipe booklets, charlas, a promotores training manual, and motivational videos. An evaluation survey assessed the impact of the intervention. A pre-post intervention survey was conducted with more than 300 participants, and results showed that the respondents were substantially more aware of risk factors for CVD, and had greatly increased their knowledge of ways to prevent heart disease. Dissemination efforts have resulted in numerous requests by health organizations, universities, and health maintenance organizations (HMOs) for educational materials and communication strategies produced by Salud para su Corazón. In addition, Univision, the largest Spanish-language broadcast television network, is airing the initiative's PSAs. Also, training seminars for promotores are being conducted in different regions of the United States, and several locations are planning to replicate this study.

Adolescent↗
PubMedDate not supplied

Effect of a self-management program on patients with chronic disease.

CONTEXT: For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. OBJECTIVE: To evaluate outcomes of a chronic disease self-management program in a real-world" setting. STUDY DESIGN: Before-after cohort study. PATIENTS AND SETTING: Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. INTERVENTION: The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building. MAIN OUTCOME MEASURES: Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires. RESULTS: At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant. CONCLUSIONS: We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.

California↗
PubMedDate not supplied

National surveillance of dialysis-associated diseases in the United States, 1988.

To determine trends in a variety of dialysis-associated diseases and practices, the Centers for Disease Control surveyed 1,734 chronic hemodialysis centers in the United States in 1988 in conjunction with the annual facility survey performed by the Health Care Financing Administration. The response rate to a mailed questionnaire was 91%. These 1,586 centers represented 107,804 patients and 28,501 staff members. Over the last 13 years, the incidence of hepatitis B virus (HBV) infection decreased from 3.0 to 0.2% among patients and from 2.6 to 0.1% among staff members. Over the same time, the prevalence of HBsAg-positivity declined from 7.8 to 1.5% among patients and from 0.9 to 0.3% among staff members. Hepatitis B vaccine was given by 90% of the centers. By the end of 1988, 17% of susceptible patients and 53% of susceptible staff members had received all three doses of hepatitis B vaccine. From 1982 to 1988, as a result of receiving vaccine, the prevalence of antibody to HBsAg increased from 12 to 20% among patients and from 18 to 54% among staff. The incidence of non-A, non-B hepatitis in 1988 was reported to be 1.0% among patients and 0.1% among staff members. Fifteen percent of the centers reported pyrogenic reactions in the absence of septicemia among their patients and 45% reported septicemia. The reported incidence of dialysis dementia among hemodialysis patients was 0.2%, with a case fatality rate of 25%. In 1988, 67% of centers reported that they reused disposable dialyzers; these centers treated 72% of the dialysis patient population. Among centers that reused disposable dialyzers, the average number of reuses ranged from 2 to 50 (mean, 11) and the maximum number of times a disposable dialyzer was reused ranged from 3 to 131 (mean, 28). Chemical germicides used for reprocessing dialyzers included formaldehyde; Renalin, a peracetic acid-hydrogen peroxide-based germicide; and glutaraldehyde-based germicides. Reuse of disposable dialyzers was not associated with any increased risk of acquiring HBV infection among either patients or staff. However, pyrogenic reactions occurring in clusters were more frequently reported in centers that reused conventional dialyzer membranes compared with centers that did not. This increased risk was only associated with centers that reused these dialyzers in a manual reprocessing system, a result consistent with those obtained in 1986 and 1987. Eighteen percent of centers reported treating at least some of their patients by high flux dialysis.(ABSTRACT TRUNCATED AT 400 WORDS)

Communicable Diseases↗
PubMedDate not supplied

The Minnesota Prenatal Care Coordination Project: successes and obstacles.

The Minnesota Prenatal Care Coordination Project was a statewide effort to present systematically education and technical support to providers as they implemented the Minnesota Prenatal Care Initiative for expanded services to high-risk women. Educational methods included holding 12 regional workshops throughout the State, one-to-one contacts by nurse consultants, and newsletters and a guidebook (manual) were distributed to reach community providers. Analysis of the implementation was conducted using site visits, interviews with providers, and reviews of medical records, claims data, and other project documents. Successes in the first year were a twofold increase in the numbers of Medicaid-enrolled women who received risk assessment and enhanced services, more than one-third increase in provider participation, greater collaboration among multidisciplinary providers at the community level, and improved communication between State and local health care agencies. Obstacles included provider resistance to changes in practice, dissatisfaction with the enhanced services package and level of reimbursement, and problems with implementation protocols. The project demonstrated that prenatal care providers will change; they will improve practices and collaboration as a result of personalized education and support.

Female↗