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PubMed2003

Genetics and health disparities: fears and realities.

The development and testing of explanatory hypotheses about the underlying mechanisms that create health disparities among ethnic minorities will be crucial in identifying solutions for reducing the current differentials. This paper addresses the potential for using genetic information as a useful and necessary addition to approaches to measures of the "environment" in the study of the origins of health disparities. Approaches and theoretical perspectives on the integration of social science and genetic findings are discussed.

Causality↗
PubMed2004

The hippocampal role in spatial memory and the familiarity--recollection distinction: a case study.

Memory for object locations and for events (comprising the receipt of an object) was tested in a case of developmental amnesia with focal hippocampal damage. Tests used virtual reality environments and forced-choice recognition with foils chosen to equalize the performance of control participants across conditions. Memory for the objects received was unimpaired, but the context of their receipt was forgotten. Memory for short lists of object locations was unimpaired when tested from the same viewpoint as presentation but impaired when tested from a shifted viewpoint. Same-view performance was disrupted by changing the background scene. These results are consistent with Jon having preserved matching to fixed sensory-bound representations but impaired reconstructed or manipulable representations underlying shifted-viewpoint recognition and episodic recollection.

Adult↗
PubMed1998

Alternative sequences of thyrotropin and free thyroxine assays for routine thyroid function testing. Quality and cost.

BACKGROUND: Current guidelines and practices for thyroid function testing are strongly affected by the usually higher patient billing charges and Medicare reimbursement for thyrotropin (TSH) vs free thyroxine (FT4) tests, despite their comparable direct costs. OBJECTIVE: Due to recently reduced laboratory costs, to reexamine the effectiveness and cost of alternative test sequences. METHODS: Alternative test sequences involve using the TSH test first, followed, if the TSH test result is abnormal, by the FT4 test; the FT4 test first, followed by the TSH test; and doing both tests together. We applied these strategies to consecutive patients referred for any thyroid function test to a health maintenance organization, a multispecialty fee-for-service group, a military hospital, and a commercial laboratory. Effectiveness was determined from a literature review. The cost was determined from direct costs and the distribution of diagnostic categories. RESULTS: The TSH and FT4 tests have similar sensitivities for detecting clinical hyperthyroidism and hypothyroidism. The TSH test detects subclinical function, and it monitors thyroxine treatment better; the FT4 test detects central hypothyroidism, and it monitors rapidly changing function better. Direct costs for both were equal, but charges for the TSH test were higher. The average direct cost per patient, starting with the FT4 test, was $4.61; starting with the TSH test, $5.90; and starting with both tests together, $6.50. Medicare reimbursements correlated poorly with costs. CONCLUSIONS: Starting with the TSH test and reflexing to the FT4 test provides a better first-line all-purpose sequence than the reverse. In managed care settings, the slightly higher direct cost of this approach is offset by greater clinical effectiveness. In fee-for-service settings, cost differences can be nearly eliminated by equalizing TSH and FT4 charges to reflect current direct-cost realities. Obtaining both tests together overcomes the disadvantages of each at a slightly higher direct cost.

Humans↗
PubMed2005

Method of testing very soft biological tissues in compression.

Mechanical properties of very soft tissues, such as brain, liver, kidney and prostate have recently joined the mainstream research topics in biomechanics. This has happened in spite of the fact that these tissues do not bear mechanical loads. The interest in the biomechanics of very soft tissues has been motivated by the developments in computer-integrated and robot-aided surgery--in particular, the emergence of automatic surgical tools and robots-as well as advances in virtual reality techniques. Mechanical testing of very soft tissues provides a formidable challenge for an experimenter. Very soft tissues are usually tested in compression using an unconfined compression set-up, which requires ascertaining that friction between sample faces and stress-strain machine platens is close to zero. In this paper a more reliable method of testing is proposed. In the proposed method top and bottom faces of a cylindrical specimen with low aspect ratio are rigidly attached to the platens of the stress-strain machine (e.g. using surgical glue). This arrangement allows using a no-slip boundary condition in the analysis of the results. Even though the state of deformation in the sample cannot be treated as orthogonal the relationships between total change of height (measured) and strain are obtained. Two important results are derived: (i) deformed shape of a cylindrical sample subjected to uniaxial compression is independent on the form of constitutive law, (ii) vertical extension in the plane of symmetry lambda(z) is proportional to the total change of height for strains as large as 30%. The importance and relevance of these results to testing procedures in biomechanics are highlighted.

Biomechanical Phenomena↗
PubMed2003

Secular gains in fluid intelligence: evidence from the Culture-Fair intelligence test.

There is no doubt about the reality of the secular increase in cognitive test scores. However, there is disagreement about a key issue: does the observed increase reflect a genuine upward trend in intelligence? Evidence from the Raven test is clear, although there are some doubts about its adequacy as a fine-grained measure of fluid intelligence. Evidence from the so-called 'method of correlated vectors' is much less clear. When a crystallized battery is considered, the results leave little doubt: the increase does not reflect gains in general intelligence. However, when a fluid battery is analysed, the increase does reflect gains in general intelligence. The present study uses one of the best available measures of fluid intelligence (the Culture-Fair intelligence test) to provide new evidence for the secular increase in fluid intelligence, beyond the findings from the Raven test and the method of correlated vectors. A total of 4498 Spanish high school students and high school graduates were tested within a time interval of 20 and 23 years, respectively. The results show that there is a clear upward trend in intelligence. Moreover, students show an average increase equivalent to 6 IQ points, while graduates show an average increase of 4 IQ points. Therefore, more selected people (graduates) show a smaller increase than less selected people (students). Some implications are discussed.

Adolescent↗
PubMed1989

Effect of latex agglutination test on prescribing for group A streptococcal throat disease in primary care.

Diagnosis and treatment of 849 sore throat patients in primary care was studied with regard to the utilization and accuracy of a latex test for group A beta-hemolytic streptococci. 78% were tested, but 11% of the rapid test results were uncertain, and 15% conflicted with traditional culture results. The negative predictive value of the test was 98%, and the positive predictive value only 59%. 52% of all patients received antibacterials, the rapid test result influencing the treatment decisions clearly but not solely. The nurses utilized the rapid test more often than the physicians. The study stresses the difficulties inherent in introducing new tests in primary care and illustrates the realities of overutilization of the test and overmedication despite test results.

Adolescent↗
PubMed1995

Virtual reality, telesurgery, and the new world order of medicine.

We are seeing the emergence of medical applications for virtual reality (VR). These include telepresence surgery, three-dimensional (3-D) visualization of anatomy for medical education, VR surgical simulators, and virtual prototyping of surgical equipment and operating rooms. Today, approximately 90% of the knowledge a physician requires can be obtained through electronic means, such as diagnostic sensors and imaging modalities, directly seeing the patient with a video camera for medical consultation, or using electronic medical records. In addition, with telepresence, a therapy can be effected electronically, regardless of the physical location of the patient. Therefore, it makes sense to send the electronic information or manipulation, rather than sending the patient or blood samples, to obtain tests or to produce a cure. In that these applications are mediated through the computer interface, they are the embodiment of VR as the major force for change in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and the remote worksite. At the remote site are a 3-D camera system and responsive manipulators with sensory input. At the workstation are a 3-D monitor and dexterous handles with force feedback. The next generation in medical education can learn anatomy from a new perspective by "flying" inside and around the organs, using sophisticated computer systems and 3-D visualization. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using this, students and surgeons can practice surgical procedures with virtual scalpels and clamps. To support these advanced technologies, the operating room and hospital of the future will first be designed and tested in virtual reality, allowing multiple iterations of equipment and surgical rooms before they are actually built. Insofar as all these technologies are based on digital information, they are the building blocks for the digital physician of the 21st century.

Computer Simulation↗
PubMed1995

Medical applications of virtual reality.

Medical applications for virtual reality (VR) are just beginning to emerge. These include VR surgical simulators, telepresence surgery, complex medical database visualization, and rehabilitation. These applications are mediated through the computer interface and as such are the embodiment of VR as an integral part of the paradigm shift in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and remote worksite. At the remote site there is a 3-D camera system and responsive manipulators with sensory input. At the workstation there is a 3-D monitor and dexterous handles with force feedback. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using a helmet mounted display and DataGlove, a person can learn anatomy from a new perspective by 'flying' inside and around the organs, or can practice surgical procedures with a scalpel and clamps. Database visualization creates 3-D images of complex medical data for new perspectives in analysis. Rehabilitation medicine permits impaired individuals to explore worlds not otherwise available to them, allows accurate assessment and therapy for their disabilities, and helps architects understand their critical needs in public or personal space. And to support these advanced technologies, the operating room and hospital of the future will be first designed and tested in virtual reality, bringing together the full power of the digital physician.

Computer Graphics↗
PubMed1994

Emerging medical applications of virtual reality: a surgeon's perspective.

Medical applications for virtual reality (VR) technologies are just beginning to emerge. These include VR surgical simulators, telepresence surgery, complex medical database visualization, and rehabilitation. These applications are mediated through the computer interface and embody VR as an integral part of a paradigm shift in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and the remote worksite. At the remote site there is a 3-D camera system and responsive manipulators with sensory input. At the workstation there is a 3-D monitor and dexterous handles with force feedback. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using a head-mounted display and DataGlove, a person can learn anatomy from a new perspective by 'flying' inside and around the organs, or can practice surgical procedures with a scalpel and clamps. Database visualization creates 3-D images of complex medical data for new perspectives in analysis. VR applications in rehabilitation medicine permit impaired individuals to perform tasks not otherwise available to them, allow accurate assessment and therapy for their disabilities, and help architects understand their critical needs in public or personal space. And to support these advanced technologies, the operating room and hospital of the future will be first designed and tested in virtual reality, bringing together the full power of the digital physician.

Computer Graphics↗
PubMed1996

Reality monitoring failure in schizophrenia: the role of selective attention.

Reality monitoring and selective attention have been repeatedly shown to be impaired in schizophrenia. Positive symptomatology has been found to be associated with deficits in both reality monitoring and selective attention. Therefore, a direct link between reality monitoring and selective attention was hypothesized. Thirty-two schizophrenic patients and 32 normal controls were administered the Stroop test as a measure of selective attention along with a test of three indices of reality monitoring, involving discrimination of: events vs. non-events, self- vs. externally-generated events, and oral vs. pictorial sources. A global memory test was administered for comparison. Results showed that schizophrenic patients were impaired in both reality monitoring and selective attention, and that these two were significantly correlated with each other in the schizophrenic sample. On the contrary, selective attention was not significantly correlated with memory efficiency in either group. Further, multiple regression analyses in schizophrenic patients showed that only selective attention contributed significantly to the variance in reality monitoring measures. Therefore, the results argue in favor of a specific role of a selective attention deficit in reality monitoring failure in schizophrenia.

Adult↗
PubMed2000

Barometers and bladders: a primer on pressures.

PURPOSE: We develop a "consilient" (unified) view of pressure as a physical phenomenon and "clinimetric" tool, making a connection between barometers and bladders. MATERIALS AND METHODS: The philosophy, physics and clinical applications of pressure during the last 2 millennia were examined from Lucretius to the modern medical subspecialties. RESULTS: A variety of units and systems of pressure quantification developed as the physics of pressure became understood. Applications of pressure in clinical medicine with distinct physiological relevance have been created for organ systems across the subspecialties. Some measurements have become useful for management of urinary tract and other diseases. CONCLUSIONS: Despite a broad range of units, systems and applications, a consilient view of pressure in medicine can be approached. This perspective is fundamental to understanding the significance of pressures in the expanding clinimetric arena and should mitigate against misplaced concreteness that is tempting in modern medical practice, whereby laboratory tests become virtual realities and are mistaken for patients.

Biophysics↗
PubMed2003

Medical education as a science: the quality of evidence for computer-assisted instruction.

OBJECTIVE: A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. STUDY DESIGN: Reports published between 1988 and 2000 on computer-assisted instruction in medical education were identified through a search of MEDLINE and Educational Resource Identification Center and a review of the bibliographies of the articles that were identified. Studies were selected if they included a description of computer-assisted instruction in medical education, regardless of the type of computer program. Data were extracted with a content analysis of 210 reports. The reports were categorized according to study design (comparative, prospective, descriptive, review, or editorial), type of computer-assisted instruction, medical specialty, and measures of effectiveness. RESULTS: Computer-assisted instruction programs included online technologies, CD-ROMs, video laser disks, multimedia work stations, virtual reality, and simulation testing. Studies were identified in all medical specialties, with a preponderance in internal medicine, general surgery, radiology, obstetrics and gynecology, pediatrics, and pathology. Ninety-six percent of the articles described a favorable impact of computer-assisted instruction in medical education, regardless of the quality of the evidence. Of the 210 reports that were identified, 60% were noncomparative, descriptive reports of new techniques in computer-assisted instruction, and 15% and 14% were reviews and editorials, respectively, of existing technology. Eleven percent of studies were comparative and included some form of assessment of the effectiveness of the computer program. These assessments included pre- and posttesting and questionnaires to score program quality, perceptions of the medical students and/or residents regarding the program, and impact on learning. In one half of these comparative studies, computer-assisted instruction was compared with traditional modes of teaching, such as text and lectures. Six studies compared performance before and after the computer-assisted instruction. Improvements were shown in 5 of the studies. In the remainder of the studies, computer-assisted instruction appeared to result in similar test performance. Despite study design or outcome, most articles described enthusiastic endorsement of the programs by the participants, including medical students, residents, and practicing physicians. Only 1 study included cost analysis. Thirteen of the articles were in obstetrics and gynecology. CONCLUSION: Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.

Computer-Assisted Instruction↗
PubMed1988

Cognitive deficits and thought disorder: a retest study.

Manic (n = 26), schizophrenic (n = 26), and normal (n = 25) subjects were examined with a digit span distraction task and with a reality monitoring task. All subjects were tested twice at a 4-day interval, and a clinical assessment of thought disorder was conducted both times on the patients. We found that reality monitoring, distraction task performance, and clinical thought disorder were all quite stable at the retest interval. We further found that different patterns of correlational relationships between cognitive deficits and positive and negative thought disorders were present in the manic and schizophrenic samples. When we conducted a cross-temporal analysis of our data, we found that no cognitive deficits in mania predicted the severity of positive thought disorder over time, although the severity of thought disorder predicted distraction performance over time. In the schizophrenic subjects, distraction performance, but not reality monitoring, exerted a significant cross-temporal influence on positive thought disorder.

Adult↗