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PubMed2005

What could be the reasons for giving up the implanted pump treatment?

The development of implanted insulin pump treatment has been particularly intense in France and French implanting centers joined to form an association called EVADIAC. The data collected by EVADIAC have clearly documented benefits as well possible problems with this treatment mode. In comparison with SC administration, intraperitoneal (IP) insulin infusion via an implanted pump achieves good metabolic control, improves long-term stability of diabetes and significantly reduces the risk of severe hypoglycemia. Problems can involve pump slowdown, catheter obstruction or local complication at the implantation site. With respect to the benefits, the rate of complications is highly acceptable. However, amongst the implanted diabetic patients, some elect to give up such a treatment mode. In a retrospective study we intended to examine their reasons for giving up this treatment. In our center, the patients who elected by themselves to give up the implanted pump account for 16% of all treated patients. This group of patients did not have, as compared to other implanted patients, less benefits nor more restrictions or incidents that could have impaired their well being. The reasons for giving up the implanted pump seem more often to be related to the refusal of a strict and institutional management linked to this treatment.

Blood Glucose↗
PubMed1997

Geometrical factor and physical reasons for its influence on the kinetic and thermodynamic properties of RNA-like heteropolymers.

BACKGROUND: It has been shown that not only the primary sequence but also the geometry of the native conformation influences the kinetic and thermodynamic properties of a protein-like model. The purpose of this paper is to elucidate the geometrical factor, which affects the kinetic and thermodynamic properties of RNA-like heteropolymers, and physical reasons for this phenomenon. RESULTS: It is shown that increasing the strength of long-range contacts can accelerate the finding of the native secondary structure for RNA-like heteropolymers. Decreasing the strength of long-range contacts results in deceleration of this process. The physical reason for this phenomenon is the increase in the average energy of non-native structures and, as a consequence, the increase (in absolute value) of the relative value of native energy from strengthening long-range contacts under constant energy of the native state. Statistical analysis of natural RNAs has shown that the mean stability of helices formed by the pairing of regions that are remote along the chain prevails over the mean stability of helices formed by regions that are close along the chain. CONCLUSIONS: The kinetics simulations suggest that the folding of the RNA secondary structure depends on the structural factors of the native state. One of these factors accelerating large RNA folding is the existence of strong long-range helices in the native secondary structure.

Animals↗
PubMed2001

Cased-Based Reasoning for medical knowledge-based systems.

In this paper we present the results of the MIE/GMDS-2000 Workshop 'Case-Based Reasoning for Medical Knowledge-based Systems'. While in many domains Cased-Based Reasoning (CBR) has become a successful technique for knowledge-based systems, in the medical field attempts to apply the complete CBR cycle are rather exceptional. Some systems have recently been developed, which on the one hand use only parts of the CBR method, mainly the retrieval, and on the other hand enrich the method by a generalisation step to fill the knowledge gap between the specificity of single cases and general rules. And some systems rely on integrating CBR and other problem solving methodologies. In this paper we discuss the appropriateness of CBR for medical knowledge-based systems, point out problems, limitations and possible ways to cope with them.

Artificial Intelligence↗
PubMedDate not supplied

Reasoning about diabetes and its relationship to the use of telecommunication technology by patients and physicians.

UNLABELLED: Health care is moving toward a team effort, with patients as partners. This requires effective communication between physicians and patients, who have different understandings of health and illness. These understandings in turn guide their decisions about management of health and illness. With the introduction of home-based technology, which provides an efficient way for doctors and patients to communicate, the question of the effectiveness of the decisions being made must be addressed. In this study, we assess the conceptualizations of health and illness related to diabetes and the relationship to the use of communication technology by patients and physicians. METHODS: The subjects were interviewed using a semi-structured questionnaire and were then asked to enter information into a telephone-based telecommunications system. Data were audiotaped, transcribed, and analyzed to characterize models of health and illness and for the factors that influence the decision making about diabetes management. Interactions with the system were then examined relative to these findings. RESULTS: Patients used lay concepts in providing explanations of their illness, whereas physicians used biomedical concepts. Use of these differing concepts influenced the use of telecommunication technology, with more errors in the communication of information being made by patients than by physicians. Examination of the organization of information required by the system showed it to be incongruent with the way patients normally reason, but in agreement with the way physicians reason. The paper discusses the implications of these findings for: (a) the nature of evidence used by patients and physicians; and (b) the design of technology to maximize effective doctor patient communication.

Attitude to Computers↗
PubMed1999

A process model of diagnostic reasoning in medicine.

The paper presents a model-based approach to diagnostic reasoning in medicine. A process model is defined on the levels of static elements, dynamic elements and reasoning control. Static elements, facts, hypotheses and different types of disease knowledge, are identified and variations relevant for hypotheses generation are described. Dynamic elements correspond to actions, which in turn modify static elements, but are also controlled and started by the expressions of the static elements. Hypothesis generation starts with the assessment of a given set of facts. According to their priorities, facts are used for the construction of a diagnostic differential: new hypotheses are considered, existing hypothesis refined or excluded. The purpose of hypotheses generation is to establish a complete diagnostic differential with disjunctive explanations which explain a given set of facts. The presented model could serve as a basis for an implementation in a model-based and process-oriented decision-support system.

Decision Making, Computer-Assisted↗
PubMed1999

The importance of pragmatic aspects in conditional reasoning.

The importance of pragmatic aspects in conditional reasoning was assessed in the performance of 54 subjects (26 female and 28 male; mean age 17.6 years) on 48 conditional inference problems, using a 3 x 2 x 4 design, with repeated measurements. The independent variables were probability of empirical frequency in the real world, type of conditional rule, and scenario availability. Number of correct responses and subjects' certainty about the correctness of their responses were the dependent variables. The results showed: a) the scenario availability is not sufficient in itself to explain differences in performance, but it does affect the subjects' degree of confidence in their conclusions; b) there is an interaction between probability of empirical frequency in the real world and type of conditional rule on correct performance. The results were contrasted with the predictions made by the mental models theory and its revised version proposed by Evans (1993). These findings support the semantic theories of conditional reasoning.

Adolescent↗
PubMed1998

Temporal trends in reasons for and result of HIV-testing among women in Rome, Italy.

To describe the trend in the reasons for and result of women's HIV testing, systematic data was gathered for 11,523 consecutive women during pre-and post-test visits at a major counseling and testing (CT) site of Rome, Italy, June 1985-July 1996. The number of tested women and the proportion of female clients attending the CT site significantly increased during the study period (p < 0.001), mostly because of reported sexual risk or when triggered by pregnancy. A significant increasing trend in the proportion of women who had one prior test (30% overall) was observed in all groups, apart from IDU. Newly diagnosed HIV infections were 319 (2.8%). The HIV prevalence was 27% in 1985-1987, when 66.7% of cases were IDUs, and decreased to 1.3% in 1994-1996, when 53.7% of cases were women reporting HIV infected partners. The findings suggest that information on the potential risk of HIV transmission has permeated the female population. The shift of newly diagnosed infections from IDUs towards women reporting sexual exposure, suggests the need for targeting preventive efforts to these population groups. Underlying reasons for multiple testing need further analysis.

AIDS Serodiagnosis↗
PubMed1997

The determinants of physician attitudes and subjective norms toward drug information sources: modification and test of the theory of reasoned action.

PURPOSE: To improve upon the theory of reasoned action and apply it to pharmaceutical research, we investigated the effects of relevant appraisals attributes, and past behavior of physicians on the use of drug information sources. We also examined the moderating effects of practice characteristics. METHODS: A mail questionnaire asked HMO physicians to evaluate seven common sources of drug information on general appraisals (degree of usefulness and ease of use), specific attributes (availability, quality of information on harmful effects and on drug efficacy), and past behavior when searching for information on a new, simulated H2 antagonist agent. Semantic differential scales were used to measure each appraisal, attribute and past behavior. Information was also collected on practice characteristics. RESULTS: Findings from 108/200 respondents indicated that appraisals and attributes were useful determinants of attitudes and subjective norms toward use. Degree of usefulness and quality of information on harmful effects were important predictors of attitudes toward use for several sources of information. Ease of use and degree of usefulness were important predictors of subjective norms toward use. In many cases, moderating effects of practice characteristics were in opposing directions. Past behavior had significant direct effects on attitudes toward the PDR. CONCLUSIONS: The findings suggest ways to improve the usefulness of the theory of reasoned action as a model of decision-making. We also propose practical guidelines that can be used to improve the types of drug information sources used by physicians.

Attitude of Health Personnel↗
PubMed2001

Genetic ignorance and reasonable paternalism.

The question concerning an individual's right to remain in ignorance regarding her own genetic makeup is central to debates about genetic information. Whatever is decided on this matter has a weighty bearing on all of the related third-party issues, such as whether family members or employers should be told about an individual's genetic makeup. Those arguing that no right to genetic ignorance exists tend to argue from a viewpoint I have called in this paper reasonable paternalism. It is an appealing position which rests on widely shared intuitions on reasonable choices, but which, in the end, smuggles paternalism back to medical practice.

Coercion↗
PubMed2002

An investigation of reasonable workplace accommodations for people with psychiatric disabilities: quantitative findings from a multi-site study.

Despite the requirement of many employers to provide accommodations in the workplace for individuals with disabilities under Section 504 of the Rehabilitation Act of 1973, the preponderance of accommodations that have been described in the literature concern physical rather than psychiatric disabilities. This study was an exploratory, descriptive, longitudinal, multi-site investigation of reasonable workplace accommodations for individuals with psychiatric disabilities involved in supported employment programs. We discuss the functional limitations and reasonable accommodations provided to 191 participants and the characteristics of 204 employers and 22 service provider organizations participating in the study. Implications for service providers and administrators in supported employment programs are discussed.

Adolescent↗
PubMed1999

Reasons for testing and exposure sources among women of childbearing age with moderate blood lead levels.

The purpose of this study was to examine the circumstances under which women receive blood lead tests in New York State and to characterize the sources of lead exposure among women of childbearing age with moderate blood lead levels. Telephone interviews were conducted with 135 women between the ages of 18 and 45, with blood lead levels from 10 through 25 micrograms/dl, were used to collect information on the reason for their blood lead test and possible sources of lead exposure. It was found that the two most common reasons to be tested for blood lead were workplace screening (47%) and pregnancy (27%). Occupational exposure was the primary source of lead exposure in this population (46%). Another common source of lead exposure was home renovation (24%). A significant proportion (31%) of women with blood lead levels from 10 through 25 micrograms/dl had no known current source of lead exposure. Based on New York's sample, there are a significant number of women of reproductive age with potentially fetotoxic blood lead levels.

Adult↗
PubMed1997

Gallstone dissolution with oral bile acid therapy. Importance of pretreatment CT scanning and reasons for nonresponse.

In patients with cholesterol-rich gallbladder stones and a patent cystic duct, complete stone clearance rates of 65-90% have been reported with oral bile acids (OBAs) alone or with adjuvant lithotripsy (extracorporeal shock-wave lithotripsy; ESWL). The aims of the present study were to analyze pretreatment gallstone characteristics that predict the speed and completeness of dissolution with OBAs +/- ESWL, and to assess, in patients with incomplete dissolution, the reasons for the poor response. We compared pretreatment gallstone characteristics in 43 patients who became stone-free after a median of 9 months OBAs +/- ESWL with those in 43 age- and sex-matched patients whose stones failed to dissolve after two years of treatment. In those with incomplete gallstone dissolution, we repeated the oral cholecystogram and computed tomogram (CT) and, in selected patients, obtained gallbladder bile by percutaneous fine-needle puncture. In patients who became stone-free, those with stones that were isodense with bile and/or had CT scores of < 75 Hounsfield units had the fastest dissolution rates. In the 43 nonresponders, the main causes for treatment failure were impaired gallbladder contractility and acquired stone calcification. CT-lucent, noncholesterol stones, or failure of desaturation of bile with the prescribed bile acids, occurred in a minority. We conclude that the pretreatment CT attenuation score predicts both the speed and completeness of gallstone dissolution. In patients with incomplete stone dissolution, the combination of oral cholecystography, CT, and analysis of gallbladder bile will determine the underlying reasons for treatment failure in most, but not all, cases.

Administration, Oral↗
PubMed1998

Factors associated with the conditional release of persons acquitted by reason of insanity: a decision tree approach.

Most NGRI (not guilty by reason of insanity) acquitties are hospitalized for some period of time following acquittal, which raises the question of when an individual can be safely released into the community. The conditional release (CR) of persons acquitted by reason of insanity, therefore, provokes the question of public safety. This study examines the CR systems in four states--Connecticut, Maryland, New York, and Ohio. A study sample of 529 persons acquitted as NGRI from 1985 to 1987 was followed up for at least five years to determine who is conditionally released. Following a description of the CR systems, findings suggestive of the role of dangerousness and diagnosis as predictors of CR are presented. Personal characteristics are also significant factors in predicting who will be released. The length of hospitalization for this population and other descriptive factors such as history of hospitalization, arrests, substance abuse, family violence, and living arrangements are also addressed.

Decision Trees↗
PubMed2004

Students' special needs and problems as reasons for the adaptation of substance abuse prevention curricula in the nation's middle schools.

In this study we estimate the proportion of the nation's middle school teachers who have adapted substance abuse curricula in response to their students' special problems or needs. We also explore a variety of characteristics associated with schools, teachers, and the curricula implemented that are associated with adaptations made in response to the most prevalent of these student problems or needs. Study data were collected in 1999 from a representative sample of lead substance abuse prevention teachers in the nation's public and private schools. We found that 79.8% of respondents report adapting their prevention curricula in response to at least one of the dozen student problems and needs specified. The problems cited most frequently, by slightly more than half of all respondents, relate to the needs of students who are sexually active or have discipline problems. Associated most strongly with adaptations for these two reasons were teachers who were recently trained in their curricula, and substance abuse prevention lessons that could readily be integrated into the school's overall curriculum. We discuss the need for curriculum developers to recognize the frequency with which, and reasons for which, teachers are adapting their curricula, and to include appropriate optional content that addresses students' needs.

Analysis of Variance↗
PubMed2004

[Venous and lymphatic reasons for edema--the swollen leg from the angiologist's point of view].

Peripheral edema develop as a consequence of imbalance in the processes of filtration, resorption and lymphatic transport in the capillary bed. Venous hypertension and impaired lymphatic function belong to the most important underlying pathomechanisms. Chronic venous insufficiency as a result of valve degeneration as well as venous obstruction in acute deep thrombosis lead to venous hypertension and to an increase of filtration pressure. As venous diseases are frequent, they are one of the most reasons for a swollen leg in clinical everyday life. Primary and secondary disturbances of the lymphatic system are another important reason for interstitial liquid retention. Although there are about 140 millions of people suffering from lymphedema worldwide, the disease is still underdiagnosed.

Capillary Permeability↗
PubMed2004

[Paroxetine versus clomipramine in female adolescents suffering from anorexia nervosa and depressive episode--a retrospective study on tolerability, reasons for discontinuing the antidepressive treatment and different outcome measurements].

OBJECTIVES: So far, there have only been few studies concerning the question of indication and efficacy of antidepressive medication in children and adolescents with anorexia nervosa and depressive episode in the course of an inpatient treatment. In addition, there is a lack of studies comparing the tolerability and efficacy of different antidepressants given to anorectic patients of this particular age group. This study compares paroxetine, a specific SRI, with clomipramine, a TCA with SRI activity, concerning the frequency and quality of adverse side effects, the frequency and the reasons for discontinuating the antidepressive treatment and different outcome measurements. METHODS: 83 female patients, aged 10.9 to 18.1 years, who underwent an inpatient treatment at the Departement of Child and Adolescent Psychiatry and Psychotherapy at the University of Wuerzburg, Germany, were enrolled in this retrospective study. All of them met the ICD-10 criteria for anorexia nervosa and depressive episode and received an antidepressant medication with clomipramine or paroxetine. We collected data from basic documentation, treatment reports, and the multiaxial classification (MAS). Outcome measurements were the duration of treatment (days) and the increase of body weight (kg/m2). RESULTS: The discontinuation of the antidepressive treatment due to adverse side effects or a lack of efficacy was significantly more frequent with clomipramine than paroxetine (33.3 vs. 15.4%). The increase of body weight (2.8 vs. 2.6 kg/m2) was similar in both groups, but the duration of treatment was significantly shorter under paroxetine (71.9 vs. 96.5 days). CONCLUSIONS: A shorter duration of treatment, faster increase of body weight, lower percentage of dicontinuating the antidepressive medication and last but not least economic reasons lead to the conclusion, that paroxetine should be preferred in female adolescents with anorexia nervosa and depressive episode. However, prospective studies are needed to confirm our findings.

Adolescent↗
PubMed1997

Educational implications of analogy. A view from case-based reasoning.

Case-based reasoning (CBR) focuses on analogy in the context of solving real-world problems. Its research methodology of computational modeling is aimed at deriving hypotheses about cognition. CBR's computational models show the roles of encoding, retrieval, and adaptation in analogical reasoning processes. In addition, its algorithms provide insight into what it might take to enhance human cognition. CBR as a plausible cognitive model can thus advise on educational philosophy, educational practice, and design of educational software.

Association Learning↗
PubMed1997

Early reasoning about desires: evidence from 14- and 18-month-olds.

Although there is substantial evidence that 30-month-old children can reason about other people's desires, little is known about the developmental antecedents of this ability. A food-request procedure was devised to explore this understanding in 14- and 18-month-olds. Children observed an experimenter expressing disgust as she tasted 1 type of food and happiness as she lasted another type of food. They were then required to predict which food the experimenter would subsequently desire. The 14-month-olds responded egocentrically, offering whichever food they themselves preferred. However, 18-month-olds correctly inferred that the experimenter wanted the food associated with her prior positive affect. They were able to make this inference even when the experimenter's desires differed from their own. These data constitute the first empirical evidence that 18-month-olds are able to engage in some form of desire reasoning. Children not only inferred that another person held a desire, but also recognized how desires are related to emotions and understood something about the subjectivity of these desires.

Choice Behavior↗