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PubMed1998

Interactive DICOM image transmission and telediagnosis over the European ATM network.

The European High-Performance Information Infrastructure in Medicine, n(o)B3014 (HIM3) project of the Trans-European Network--Integrated Broadband Communications (TEN-IBC) program, started on March 1996 and finished on February 1997, aimed to test the medical usability of the European asynchronous transfer mode (ATM) network in medical image transmission. The Department of Radiology, University of Pisa, Pisa, Italy, and St-Luc University Hospital, Brussels, Belgium, involved in the project as healthcare partners in the radiological domain, established several connection sessions finalized to test the usability of Digital Imaging and Communication (DICOM) image transmission and interactive telediagnosis tools in the daily radiological practice. The Pisa site was connected to the Italian ATM pilot (Sirius Network) through the Tuscany metropolitan area network (MAN), while St-Luc University Hospital was connected to Belgium ATM network through the Brussels MAN. By means of international connections provided by the European JAMES project, a link between the two sites was established, connecting both national ATM networks. Due to the large variety of hardware present in the medical centers, multiplatform software tools were used and tested: central test node (CTN) release 2.8 [3], VAT [6], NV-3.3 [7], and IDI (UCL homemade multiplatform teleradiology tool for interactive visualization and processing of DICOM images). During the telediagnosis session, lead by radiologists in both hospitals, each site submitted neuroradiological clinical cases to the other for remote consultation. The connection, available for a period of two weeks, at 2-Mbit/s bandwidth, allowed the transmission of MR images (256 x 256 x 12 bit) and simultaneous multimedia interactive discussion of the cases. Both off-line transmission and review of the images, using the CTN DICOM transfer routines, and on-line interactive image discussion, using the IDI telediagnosis software, were tested successfully from the technical and medical point of view.

Computer Communication Networks↗
PubMed1997

Measurement choices in multi-site studies of outcomes in dementia.

This paper summarizes the measurement choices made by selected current or recently completed multi-site projects with a common emphasis on measuring outcomes in dementia. Information on number of items and scoring, reason(s) for selecting the measure, and reliability and validity of the measure (either citations providing this information or a report of pertinent unpublished findings) is presented for eight domains: cognition, behavioral symptoms, physical health status, physical functioning and self-care abilities, quality of life, family/staff caregiver outcomes, service use, and cost. We found considerable reliance on the published literature as a guide to measurement choice, motivated largely by measures' superior psychometric properties, their ubiquity in the literature, and/or their brevity or ease of use. There is still evidence of "starting from scratch" in some domains, however. To the extent that these projects reflect the state of the art in dementia-relevant outcomes research, we conclude that comparison of outcomes across studies will continue to be problematic. However, as long as dissemination of methodological as well as substantive findings continues to characterize outcome studies in dementia, there is hope that a more congruent view of how to assess key outcomes in dementia will emerge.

Caregivers↗
PubMed1982

Interdisciplinary bioethics: but where do we start? A reflection of epochè as method.

It is generally accepted that bioethics is an interdisciplinary science. Why this is so and what it means is not always clear or agreed upon and, in this author's view, its implications are insufficiently researched. On the basis of involvement in projects which were labelled interdisciplinary, the author reflects upon the method of interdisciplinarity, especially to its starting point. It is suggested that interdisciplinarity cannot thrive unless it curbs, from the very start, the inevitable reductions of all monodisciplinary approaches. This effort is called methodical epoché, ideally the temporary suspension of all known methods. Its purpose is to achieve an interdisciplinary way of stating the question. Until then no breakdown of the global question by particular methods of single disciplines ought to be attempted. Realistic variations of this ideal are also discussed.

Bioethics↗
PubMed2002

In Ssarch of new anti-bacterial target genes: a comparative/structural genomics approach.

We outline a joint academic/industrial (CNRS/AVENTIS) functional genomics project aiming at the discovery of new anti-bacterial gene targets. Starting from all publicly available bacterial genomes, a subset of the most evolutionary conserved protein-coding genes has been identified. We retained genes with clear homolog in E. coli and at least one gram-positive bacterium among B.subtilis, M. tuberculosis, L. lactis or S. pyogenes. This subset was further reduced to genes encoding non-membrane proteins of unknown or hypothetical functions. The 221 E. coli Open Reading Frames (ORFs) identified through this comprehensive bioinformatic analysis are now submitted to a systematic 3-D structure determination protocol including cloning, protein expression and purification, crystallisation and X-ray diffraction. Our strategy was designed to focus on promising wide-spectrum targets as well as original biochemical pathways. Bioinformatics is used throughout all phases of project, including the initial large-scale comparative genomics analyses, the purification/expression and crystallisation stages for the detection of helpful sequence-specific features (e.g. cofactor binding motifs, non-structured N- or C- term extremities, etc ), and finally for the interpretation of the structures in conjunction with multiple sequence alignments for the identification of key residues, interaction areas on molecular surfaces, and overall function predictions.

Anti-Infective Agents↗
PubMed2005

[How to cope with the global tuberculosis burden--experiences and perspectives for Japan's international cooperation].

Tuberculosis is a global burden disease, most possibly ranking high among diseases over the coming several decades, with 2 million deaths and over 8 million new cases annually. How can TB be controlled and eradicated quickly in the world? A major answer will be the wider application of the most effective control programme, i.e. DOTS recommended by WHO. But it has been developed in the long try and error efforts, including the ones by Dr. K. Styblo of IUATLD in African countries. The key components of successful TB programme are summarised as follows, which Dr. Kochi of WHO adopted as a global policy package. They are; 1) political commitment, 2) case finding by sputum microscopy, 3) use of short course chemotherapy under supervision, 4) a secured supply of anti-TB drugs, and 5) a standardised recording, reporting and monitoring system. The targets by 2005 are set 85% cure rate and 70% detection rate. By 2002, however, only half the targets have been achieved, and global expansion of DOTS with other strategies need to be strengthened. Emerging threats are HIV epidemic, MDR-TB increase and health sector reform taking place in the world. Stop TB partnership with its office in WHO has been formed to strengthen a global capacity, mobilizing various technical and financial partners. Japan's contribution to the global TB problem started in early 1960s. In the last 40 years, technical cooperation in national TB programme (NTP) has been made through JICA in over 15 countries, including United Arab Emirates. Thailand, Nepal, Afghanistan, Tanzania, Indonesia, Solomon Islands, Yemen, Philippines, Cambodia, Myanmar, Pakistan, Zambia, and China (TB project is on-going in underlined countries). In these projects, capacity strengthening of NTP has been given priority, including construction of national TB center, a model area development, nationwide DOTS expansion in collaboration with WHO or others, supply of anti-TB drugs, TB laboratory network with QA, collaborative operational research. An operational research for community based DOTS and ART is newly started in Zambia under JICA project. Besides, over 1800 doctors and technologists from 90 countries have been trained at Research Institute of Tuberculosis (RIT) through its international training courses in the last 40 years. These courses are organised collaboratively with WHO or other agencies, inviting globally renowned lecturers and ex-participants, and have been reputed widely. We aim not only to teach skills and knowledge but also to motivate them to do something new. This becomes possible only through human relationship in the course. I may need to mention about my personal commitment: First, I have worked to develop a community based TB programme model utilising village health volunteers in Bangladesh in 1980s. This system has now covered over 70% of the total patients in the country through BRAC, local NGO. Secondly, the application of participatory action research (PAR) method in introducing or expanding DOTS in Bangladesh and other countries. Staff members of NTP and local/ peripheral workers participate in the trials and discuss actively in the workshops periodically. This PAR approach empowers both NTP managers and peripheral staff. Through the international cooperation, we aim ultimately at 1) support for self-reliance, 2) empowerment (capacity building for problem finding and solution) of the people concerned, and 3) promotion of global peace without arms.

Delivery of Health Care↗
PubMed2002

Knowledge of osteoporosis in a Swedish municipality--a prospective study.

BACKGROUND: As a part of the Vadstena Osteoporosis Prevention Project, the knowledge of osteoporosis was examined before the intervention program started, after 5 and 10 years. METHODS: At baseline (in 1989) 15% of the population in two Swedish municipalities was randomly invited to the study. The participants in the study group were invited for examination by forearm bone densitometry and a questionnaire concerning lifestyle and risk factors for osteoporosis and also knowledge of osteoporosis, while the subjects in the control group were examined only by questionnaire. Follow-ups were made in 1994 and in 1999. Meanwhile education about osteoporosis was given to the study group, to the public, and to various professionals in the study community. RESULTS: There was a difference in the level of knowledge between the groups prior to the intervention. The rate of increment did not differ significantly between the groups for the study period. Previous participants had 0.58 higher score than new participants in the study group in 1994 (P = 0.031) and 0.76 higher score in 1999 (P < 0.001) regarding the total number of correct answers. The women in the study group had 0.63 higher score than the men in 1994 (P = 0.016) and 1.03 higher score in 1999 (P < 0.001) regarding the total number of correct answers. CONCLUSION: There was no significant effect of a general intervention program concerning the knowledge of osteoporosis in participants in the intervention area compared to the control area.

Absorptiometry, Photon↗
PubMed1993

[Social class and cardiovascular risk factors in Italian-speaking Switzerland: results of the first Swiss population study MONIKA Project 1985-1986].

The relationship of social class and prevalence of risk factors for cardiovascular diseases was investigated within the Swiss MONICA-project, a cross sectional study of the Swiss-Italian population started in 1985/1986. A representative sample of 984 men and 1014 women ages 35 to 64 was selected, the response rate was 78%. Social class was measured by two indicators, occupational status and education. A significant trend was found in age standardized analysis with higher mean blood pressure and body mass index in lower social classes (p < 0.001). When other confounders for cardiovascular diseases were considered in a multiple regression model, the predictive power of social class was moderate. A significant inverse relationship of cardiovascular risk factors and social class was only found for body mass index (both sexes) and exercise in women which was directly related to higher social class and education. No relationship was found for lipids (cholesterol, HDL-cholesterol), blood pressure and smoking in both sexes. Risk factors for cardiovascular diseases beside obesity do not seem to cluster in lower social classes within the Swiss-Italian population.

Adult↗
PubMed2000

The genotypic landscape during in vitro evolution of a catalytic RNA: implications for phenotypic buffering.

The Tetrahymena group I ribozyme catalyzes the cleavage of a phosphodiester linkage in specific sequences of RNA. This phenotype can be used in an in vitro selection-amplification process to evolve variants that are capable of RNA catalysis in the presence of Ca(2+) as the sole available cation. With sufficient genotypic characterization of the population as it evolves, we have a rare opportunity of observing how the information stored in an evolving population responds to selective pressures, such as the requisite of catalyzing RNA cleavage in the absence of Mg(2+) or Mn(2+). In the present work, we examine the population dynamics of this system using sequence information from previous experimental work. We focus on two issues: How does the information content of the population evolve? and Is the system evolving as an adaptive walk on a rugged landscape? To investigate these questions, information theoretical parameters are examined. The evolution of the population is visualized by mapping the genotypic frequency distribution onto a two-dimensional projection of sequence space. The projection was generated using Hamming distances from the wild-type, starting sequence and a catalytically successful, evolved sequence. The evolution of the information content of the system was measured by calculating the grammar complexity of the observed sequences, which showed a very slight increase over 12 generations. This result is consistent with the system performing a search for a local optimum. The dynamics of the population in this sequence space is consistent with an adaptive walk on an uncorrelated, or "rugged," genotypic landscape, despite the observation that the phenotypic progress of the population appears smooth. The relative insensitivity of the phenotypic landscape to the variegation of the genotypic landscape suggests that the former is buffered against variation in the latter through various epigenetic-like mechanisms.

Evolution, Molecular↗
PubMed1990

A computational learning model for metrical phonology.

One of the major challenges to linguistic theory is the solution of what has been termed the "projection problem". Simply put, linguistics must account for the fact that starting from a data base that is both unsystematic and relatively small, a human child is capable of constructing a grammar that mirrors, for all intents and purposes, the adult system. In this article we shall address ourselves to the question of the learnability of a postulated subsystem of phonological structure: the stress system. We shall describe a computer program which is designed to acquire this subpart of linguistic structure. Our approach follows the "principles and parameters" model of Chomsky (1981a, b). This model is particularly interesting from both a computational point of view and with respect to the development of learning theories. We encode the relevant aspects of universal grammar (UG)--those aspects of linguistic structure that are presumed innate and thus present in every linguistic system. The learning process consists of fixing a number of parameters which have been shown to underlie stress systems and which should, in principle, lead the learner to the postulation of the system from which the primary linguistic data (i.e., the input to the learner) is drawn. We go on to explore certain formal and substantive properties of this learning system. Questions such as cross-parameter dependencies, determinism, subsets, and incremental versus all-at-once learning are raised and discussed in the article. The issues raised by this study provide another perspective on the formal structure of stress systems and the learnability of parameter systems in general.

Artificial Intelligence↗
PubMed1991

Impairments, disabilities, and handicaps of very preterm and very-low-birthweight infants at five years of age. The Collaborative Project on Preterm and Small for Gestational Age Infants (POPS) in The Netherlands.

The Project On Preterm and Small for gestational age infants (POPS) was started in the Netherlands in 1983 to investigate the relation between prenatal/perinatal factors and mortality/morbidity in very preterm and very-low-birthweight infants. Of the 1338 liveborn infants (less than 32 weeks and/or less than 1500 g) 966 were enrolled in the five-year (chronological age) follow-up programme; 96% of these children were assessed during a home visit. The overall outcome was expressed as impairments, disabilities, and handicaps according to World Health Organisation criteria. Of the assessed children, 13% had a disability and 14% were handicapped, which are much higher frequencies than those found in the general population. Handicaps were due mainly to abnormalities of neuromotor function, mental development, or language and speech development. Compared with the handicap frequency in the same cohort at two years of age, a more favourable outcome at five years of age was seen in 10%, and a less favourable outcome in 7% of the children. The findings show that most of those high-risk children survived without handicap or serious disability at preschool age.

Child, Preschool↗
PubMed1988

Initiating a surveillance system for childhood injuries.

Important considerations in establishing a surveillance system for pediatric injuries are described. At the start of surveillance, issues such as the purpose of the surveillance project, preferred methods for gathering information, optimum sites, appropriate populations, and requirements for data storage and analysis should be addressed. Since the epidemiology of childhood injuries is different from adult patterns, some specific challenges of pediatric injury surveillance are highlighted.

Child↗
PubMed2003

Dynamic tension spectroscopy and strength of biomembranes.

Rupturing fluid membrane vesicles with a steady ramp of micropipette suction produces a distribution of breakage tensions governed by the kinetic process of membrane failure. When plotted as a function of log(tension loading rate), the locations of distribution peaks define a dynamic tension spectrum with distinct regimes that reflect passage of prominent energy barriers along the kinetic pathway. Using tests on five types of giant phosphatidylcholine lipid vesicles over loading rates(tension/time) from 0.01-100 mN/m/s, we show that the kinetic process of membrane breakage can be modeled by a causal sequence of two thermally-activated transitions. At fast loading rates, a steep linear regime appears in each spectrum which implies that membrane failure starts with nucleation of a rare precursor defect. The slope and projected intercept of this regime are set by defect size and frequency of spontaneous formation, respectively. But at slow loading rates, each spectrum crosses over to a shallow-curved regime where rupture tension changes weakly with rate. This regime is predicted by the classical cavitation theory for opening an unstable hole in a two-dimensional film within the lifetime of the defect state. Under slow loading, membrane edge energy and the frequency scale for thermal fluctuations in hole size are the principal factors that govern the level of tension at failure. To critically test the model and obtain the parameters governing the rates of transition under stress, distributions of rupture tension were computed and matched to the measured histograms through solution of the kinetic master (Markov) equations for defect formation and annihilation or evolution to an unstable hole under a ramp of tension. As key predictors of membrane strength, the results for spontaneous frequencies of defect formation and hole edge energies were found to correlate with membrane thicknesses and elastic bending moduli, respectively.

Algorithms↗
PubMed1997

Incidence and severity of ketoacidosis in childhood-onset diabetes in Kuwait. Kuwait Diabetes Study Group.

In 1992, the diabetes registry was started in Kuwait, as part of DiaMond, a WHO multinational collaborative project on the incidence of childhood-onset diabetes. Children (243) aged below 15 years, were identified between 1 January 1992 and 31 December 1995. Children (203) were Kuwaiti and 40 were non-Kuwaiti children but resident of Kuwait. For the years 1992, 1993, the annual incidence of childhood onset diabetes for Kuwaiti children was 15.4 per 100,000 (95% confidence interval 12.9-19), and the degree of ascertainment was 92%. Polyuria, polydypsia, weight loss and nocturia were the most frequently reported symptoms; four children were in coma and one in shock at presentation. Nearly half of the children (49%) presented ketoacidosis (venous pH < 7.3 and/or plasma bicarbonate level < 18 mmol/l). and in 53 children (23.5%) it was severe (venous pH < 7.1 and/or plasma bicarbonate level < 10 mmol/l). In 62 children (25.5%) it was mild to moderate (venous pH 7.1-7.3 and/or plasma bicarbonate level 10.1-18 mmol/l). The incidence of severe ketoacidosis was similar in all age groups and sexes. All children recovered completely without major complications and no deaths were recorded. We conclude that diabetic ketoacidosis is a common presentation at the onset of diabetes in childhood in Kuwait and attests to the lack of awareness of general practitioners and parents to the symptoms and signs of diabetes in childhood.

Adolescent↗
PubMed1998

Case-based reasoning for medical decision support tasks: the Inreca approach.

We describe an approach for developing knowledge-based medical decision support systems based on the new technology of case-based reasoning. This work is based on the results of the Inreca European project and preliminary results from the Inreca + project which mainly deals with medical applications. One goal was to start from case-based reasoning technology for technical diagnosis and 'scale-up' to more general non-technical decision support tasks as typically given in medical domains. Inreca technology has been used to build an initial decision support system at the Russian Toxicology Information and Advisory Center in Moscow for diagnosing poison cases caused by psychotropes.

Artificial Intelligence↗
PubMed2003

Antibody response to purified chick embryo cell vaccine in equines for production of equine rabies immune globulin.

Rabies is endemic in India. The post exposure treatment of class three bite cases, as recommended by the World Health Organization, must involve the use of rabies immunoglobulin as soon as possible and up to the seventh day of start of anti rabies vaccination. The annual requirement in India as projected by the Ministry of Health, Government of India is about 1500 liters of purified anti rabies serum (ERIG). Central Research Institute (CRI), Kasauli, being the sole producer of ERIG in India, an effort was made to increase the production of ERIG by the use of tissue culture vaccine (Human) for primary immunization of equines. It also involved changing the vaccine from horse brain suspension to tissue culture vaccine by eliminating horse sacrifice for antigen preparation. A better immune response was obtained.

Animals↗
PubMed2004

Community control of hypertension- experiences from Finland.

The improvement in the hypertension control in Finland started in the 1970s by the activities of the North Karelia Project, a comprehensive programme for the control of cardiovascular diseases. The blood pressure level of the population has had a continuous downward trend according to the population surveys conducted every fifth year since 1972 and the rule of halves has changed to the rule of two-thirds. The serum cholesterol level has decreased among hypertensives, even though it is still higher than among normotensives; the patients with antihypertensive drug treatment smoke less than the rest of the population. However, the situation is far from optimal; BP levels are high and body mass index is continuously increasing among the patients. The need for intensifying both pharmacological and nonpharmacological treatment among the hypertensives on a large scale is obvious.

Antihypertensive Agents↗
PubMedDate not supplied

[Objective measurement of the height of lumbar intervertebral disks from lateral roentgen views of the spine].

OBJECTIVE: Published methods to quantify height of lumbar discs from lateral radiographic views of the lumbar spine yield inaccurate results due to distortion in central projection. Normal values of disc height have not been compiled. METHODS: Starting from an analysis of the imaging properties of vertebral bodies in a lateral view and following a logical evolution of Farfan's proposal, a new protocol for the measurement of disc height is given which is independent of distortion. A database of normal values of the height of lumbar discs from T12/L1 to L5/S1 was compiled from 892 lateral views of healthy male and female subjects in the age range between 16 and 57 years. RESULTS: Employing the new protocol, height of all discs on a lateral view can be measured. Variations in position (standing, side-lying) do not influence the result. Retrospective investigations are feasible. The precision of the disc height measurement amounts to 4.15%. Normal, age-appropriate values for the height of lumbar discs are given for the first time. In the individual case, disc height can be quantitatively evaluated by comparison with the normative database. CLINICAL RELEVANCE: The new protocol can be employed to quantitatively identify processes which effect a decrease of disc height. In the individual case, the new protocol and the comparison with the normal database can be employed to quantitatively assess overload injury to lumbar discs in compensation cases.

Adolescent↗