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Intentional and attentional dynamics of speech-hand coordination.

Interest is rapidly growing in the hypothesis that natural language emerged from a more primitive set of linguistic acts based primarily on manual activity and hand gestures. Increasingly, researchers are investigating how hemispheric asymmetries are related to attentional and manual asymmetries (i.e., handedness). Both speech perception and production have origins in the dynamical generative movements of the vocal tract known as articulatory gestures. Thus, the notion of a "gesture" can be extended to both hand movements and speech articulation. The generative actions of the hands and vocal tract can therefore provide a basis for the (direct) perception of linguistic acts. Such gestures are best described using the methods of dynamical systems analysis since both perception and production can be described using the same commensurate language. Experiments were conducted using a phase transition paradigm to examine the coordination of speech-hand gestures in both left- and right-handed individuals. Results address coordination (in-phase vs. anti-phase), hand (left vs. right), lateralization (left vs. right hemisphere), focus of attention (speech vs. tapping), and how dynamical constraints provide a foundation for human communicative acts. Predictions from the asymmetric HKB equation confirm the attentional basis of functional asymmetry. Of significance is a new understanding of the role of perceived synchrony (p-centres) during intentional cases of gestural coordination.

Adult↗

Interhemispheric relationships in 4- to 14-year-old children pointing to lateral targets.

Some developmental changes in movement control are not monotonic during childhood, which leads us to question how hemispheric relationships develop since they are closely involved with visuo-manual coordination. We tested right-handed children between 4 and 14 years of age performing pointing movements with the right and left hand towards visual targets located in the right and left hemifield. The analysis of movement parameters showed a left hand advantage in reaction time, but this is mainly due to the contralateral movements relative to the semifield of target presentation, suggesting that hemispheric asymmetry is not achieved even in older children. Interhemispheric transfer was evaluated through the difference between crossed (opposite hand and hemifield side) and uncrossed (same hand and hemifield side) movements. The difference was significant at all ages, and decreased with age between 4-6 and 7-9 years. It moved from early asymmetry in favor of the left-to-right interhemispheric transfer to adult-like symmetry at 10-14 years. The long development of hemispheric specificity and interhemispheric communication suggested by our results might be associated to asynchronous development of various processes involved in visuo-motor coordination, leading to qualitative changes in visually directed movement during childhood described in the literature.

Adolescent↗

Patient-related data management.

Patient-related data management (PDM) has become an increasingly important and time-consuming task in intensive care medicine. Currently, all data are usually collected in a poorly structured patient chart consisting of forms and pictures, with about 400 manual entries a day. To handle this amount of data, we have designed a three-level patient system: level 1, summarizing the whole patient; level 2, summarizing one organ system or one isolated problem; and level 3, variables describing morphology and function of organ systems. PDM must be adapted to different clinical situations. We observed three different scenarios: (1) Exploratory PDM, where the clinician learns about the patient and builds up an individual patient model in his or her mind. (2) Operational PDM, where in routine care clinicians are part of a feedback control system, in which they use the patient-related model. (3) Summary PDM, where a clinician summarizes all the information gathered during a period when he or she was responsible for the patient. Computing tools based on clinical thinking and adapted to different situations can ensure accurate, clear, and concise patient care communication among the members of the intensive care staff.

Computer Systems↗

The prevalence of eating disorders among university students and the relationship with some individual characteristics.

OBJECTIVE: The purpose of this study was to determine the prevalence of eating disorders (EDs) among university students in a rural area of Turkey and to compare groups based on the sociodemographic data, history of child abuse and neglect, family roles and self-esteem with a normal control group regarding EDs. METHOD: Subjects who were chosen by simple random sampling method were consisted of 980 Cumhuriyet University students who agreed to participate out of the 1003 total students and were given a sociodemographic information form and an Eating Attitudes Test (EAT). Students who scored above a cutoff level on the EAT were interviewed using the Structured Clinical Interview for DSM-IV axis I Disorders (SCID-I), Clinical Version. The Rosenberg Self-Esteem Scale, Family Assessment Device (FAD) and Childhood Abuse and Neglect Questionnaire Form were given to subjects in the control and study groups. RESULTS: Seventy-one of the 951 students (492 female, 459 male) who correctly filled out the EAT had a score above the cutoff level of 30 or higher. Of these 71 students, 21 (2.20%) were found to have an eating disorder based on the SCID-I. No subjects were found to have anorexia nervosa. Eighteen of the 21 subjects were female. Of these 18 female students, 15 (1.57%) were found to have bulimia nervosa and three (0.31%) were found to have binge eating disorder (BED). All of the three male subjects were diagnosed with BED (0.31%). The self-esteem of those in the study group was lower than those in the control group (p < 0.001). Subjects in the study group had more frequent histories of sexual and emotional abuse in childhood (p < 0.05). Also, in the study group scores showing communication in FAD families, unity and emotional attachment were statistically significantly lower than the control group (p < 0.001). CONCLUSIONS: It has been observed from the results of this research that the frequency of bulimia nervosa and BED in this sample is so similar to Western samples. Besides that, self-esteem, child abuse and neglect, and family functions must be examined in detail because they are risk factors for EDs and affect the course of treatment.

Adolescent↗

Towards an empirically based validation of intuitive diagnostic: Rümke's 'praecox feeling' across the schizophrenia spectrum: preliminary results.

BACKGROUND: The early identification of schizophrenia is important in establishing an adequate therapeutic intervention, especially in emergency situations. Intuitive reasoning is often necessary because a standardized classification according to ICD-10 or DSM-IV criteria is not suitable in these complex, and often changing, settings. The process of recognizing the specific schizophrenic structure in an intuitive way by an experienced psychiatrist was named 'praecox feeling' by the Dutch psychiatrist Rümke in 1941. SAMPLING AND METHODS: To evaluate the diagnostic quality of this kind of intuitive clinical approach we investigated 67 previously unknown patients. All patients displayed acute psychotic symptoms like paranoid delusions and hallucinations belonging to the schizophrenic spectrum. The first interview by an experienced psychiatrist included only the present state psychopathology. Data referring to the course of the illness or medication or family history of schizophrenia were explored later by other independent staff members who were blind to the aim of the investigation. The intensity of the 'praecox feeling' was rated in four degrees: not present--mild--moderate--high. At the end of the inpatient period a standardized diagnostic classification according to ICD-10 and DSM-IV classification was carried out by independent raters. RESULTS: Compared to the standardized diagnostic classification the precision of the intuitive reasoning was remarkably high with a sensitivity of about 0.85, a specificity of about 0.80, a positive predictive power of about 0.90, and a negative predictive power of about 0.65 depending on the standardized system used. Cognitive impairment, affective disturbances, disturbed self-perception, and reduced communication skills all correlated with intensity of 'praecox feeling'. The single variable 'affective disturbances' had the highest impact on the intensity of 'praecox feeling' in an ordinal regression analysis. Furthermore a high intensity of 'praecox feeling' strongly correlated with a hereditary predisposition to schizophrenia. Neither the severity of the mental illness nor extrapyramidal side effects of the medication correlated with the intensity of 'praecox feeling'. CONCLUSION: Our work can possibly help in contributing to reflection on our diagnostic practices and help to make the various factors involved in establishing diagnoses apparent.

Adolescent↗

The Internet as a research tool: worth the price of admission?

The Internet is a rich multimodal communication environment where researchers can often recruit large numbers of participants for survey studies at low cost; however, there are many unanswered questions about the use of this technology in medical research. An important question is whether the results obtained in such surveys are generalizable to other populations. In this article, we describe different approaches for recruitment of participants on the Internet and how specific approaches may limit generalizability. Another issue clouding use of the Web in research is the essential anonymity of participants. We discuss the risk and benefits of anonymous surveys and technical methods that minimize the risks while preserving anonymity and confidentiality. A related problem may be accidental or deliberate enrollment of unqualified individuals in studies. Researchers can use survey design and statistical methods described herein to partially address threats to validity arising from such individuals; however, in some situations, confirmation of eligibility, by manual review of medical records, may be necessary.

Bias↗

Comparison of childhood disintegrative disorder and disintegrative psychosis not diagnosed as childhood disintegrative disorder.

To clarify the difference of Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) childhood disintegrative disorder (CDD) from International Classification of Diseases (9th revision; ICD-9) disintegrative psychosis (DP), 10 CDD children (mean age, 7.7 years) and 18 DP children (mean, 6.5 years) not diagnosed as CDD divided into DSM-IV autistic disorder (DP-AD; n = 11) and pervasive developmental disorders not otherwise specified (DP-PDDNOS; n = 7) were compared on 31 variables not directly related to the normalcy before regression. The CDD, DP-AD, and DP-PDDNOS groups did not differ significantly in 28 variables. The DP-PDDNOS group met significantly a smaller number of items in criterion A of DSM-IV autistic disorder criteria than the CDD and DP-AD groups, both of which did not differ significantly in this respect. The CDD group tended to be more abnormal in auditory responsiveness and verbal communication than the DP-PDDNOS group. While CDD is distinct from DP-PDDNOS, its validity apart from AD with regression remains to be studied.

Age of Onset↗

[Personal emergency call system based on human vital and system technical parameters in a Smart Home environment].

Progress in microtechnology and radio transmission technology has enabled the development of highly reliable emergency-call systems. The present article describes systems that have been specially designed to improve the safety and independence of handicapped and elderly persons living at home. For such persons immediate help in an emergency situation is of crucial importance. The technical state of the art of emergency-call systems specially developed for use by the elderly, is briefly discussed, in particular the well-known radio emergency-call button, with the aid of which an alarm can be activated manually. This system, however, does not offer adequate safety in all emergency situations. Alternative or complementary systems designed to automatically trigger an alarm on the basis of the recording and evaluation of so-called vital parameters, are therefore proposed. In addition, in a smart-home environment with networked devices, further parameters--so-called environment parameters can be used. It is found that the identification of an emergency situation becomes more reliable as the number of parameters employed increases.

Aged↗

The introduction of a computerized system for notification and improved analysis of infectious diseases in Sheffield.

In 1989 the manual system of recording and analysing notifications of infectious disease in Sheffield was replaced by a computerized system based on the Epi Info software package. An analysis of the costs and benefits of this change shows that there has been a one-off cost of 780-930 h spent in developing the system. Offset against this is a continuing saving of time of around 400 h per annum. Other benefits which are harder to measure are enumerated and discussed. Costs of computer hardware and software are not substantial in comparison with the savings in staff time.

Communicable Diseases↗

The relationship between anxiety and stuttering: a multidimensional approach.

UNLABELLED: The relationship between anxiety and stuttering is equivocal from both clinical and empirical perspectives. This study examined the relationship within the framework of the multidimensional interaction model of anxiety that includes an approach to general anxiety in specific situations [J. Pers. Soc. Psychol. 60 (1991) 919]. Ninety-four males aged 18-43, half disfluent speakers and half fluent speakers completed two questionnaires: The Trait Anxiety Inventory [C.D. Spielberger, R.L. Gorsuch, R.E. Lushene, Manual for the State-Trait Anxiety Inventory (Self Evaluation Questionnaire), Consulting Psychologists Press, Palo Alto, CA, 1970] and the Speech Situation Checklist [G.J. Brutten, Neurolinguistic Approaches to Stuttering, Mouton, The Hague; G.J. Brutten, Stuttering: A Second Symposium, Harper and Row, New York, 1973; G.J. Brutten, P. Janssen, Proceedings 18th Congress of the International Association of Logopedics and Phoniatrists, Washington, DC, 1975; M. Vanryckeghem, Proceedings of the XXIVth Congress of the International Association of Logopedists and Phoniatrists, Nijmegen University Press, Nijmegen, 1981]. In addition, after performing speech and non-speech tasks, participants evaluated their level of anxiety on a subjective scale, labeled Task-Related Anxiety--TRA. The stuttering group also evaluated the level of severity of their stuttering. Findings indicate that trait anxiety is higher among people who stutter compared to fluent speakers, thus indicating that anxiety is a personality trait of people who stutter. State anxiety in social communication is higher among severe stutterers as compared to mild stutterers and fluent speakers. Thus, state anxiety is related to stuttering severity. The results are discussed in the frame of the multidimensional model of anxiety. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) describe the multidimensional anxiety model; (2) extend the model to the relations between stuttering and anxiety; (3) describe stuttering severity in relation to the levels of anxiety within the model.

Adolescent↗

A case study in iterative keyboard design using participatory design techniques.

Replacing a keyboard can be stressful for operators who take calls all day, particularly when special functions must be sacrificed. This study applied several participatory design techniques to involve over 3,000 operators in the redistribution of function keys on their replacement keyboard. Video analysis and manual data logging methods were surprisingly accurate when measured against software logs. User acceptance was excellent. In the initial cutover program, operator performance levels returned to normal very quickly, resulting in over-confidence and unrealistic expectations of post-implementation performance for the remaining call centres because the focus was on the technology rather than on the impact of technology on business benefits. As a consequence, business plan requirements for future projects have now been changed to accommodate predictions of post-implementation performance and taking into account other changes happening at the same time.

Australia↗

Analysis of a probabilistic record linkage technique without human review.

We previously developed a deterministic record linkage algorithm demonstrating sensitivities approaching 90% while maintaining 100% specificity. Substantially better performance has been reported using probabilistic linkage techniques; however, such methods often incorporate human review into the process. To avoid human review, we employed an estimator function using the Expectation Maximization (EM) algorithm to establish a single true-link threshold. We compared the unsupervised probabilistic results against the manually reviewed gold-standard for two hospital registries, as well against our previous deterministic results. At an estimated specificity of 99.95%, actual specificities were 99.43% and 99.42% for registries A and B, respectively. At an estimated sensitivity of 99.95%, actual sensitivities were 99.19% and 98.99% for registries A and B, respectively. The EM algorithm estimated linkage parameters with acceptable accuracy, and was an improvement over the deterministic algorithm. Such a methodology may be used where record linkage is required, but human intervention is not possible or practical.

Algorithms↗

Prominence of symptoms and level of stigma among depressed patients in Calcutta.

A pilot study of 29 patients for research on clinical depression employed the framework of cultural epidemiology to examine illness-related experience, meaning, behaviour with a Bengali version of the explanatory Model Interview Catalogue (EMIC). This report examined patterns of distress and stigma with reference to the most troubling patient-specified symptom. All subjects were psychiatric outpatients in the Institute of Psychiatry, Calcutta, and met Diagnostic and Statistical Manual (DSM)-IV criteria for a major depressive episode. Only 5 patients (17.2%) identified sadness as the most troubling problem, and 48.3% specified pains and other somatic symptoms instead. An internally consistent stigma scale with Cronbach's alpha of .67, comprised 13 items, was used to assess stigma. In addition to the scale score for each subject, the contribution of each item was reported and compared. A suggestive, though not significantly lower value of the stigma score for patients reporting somatic symptoms as most troubling, compared with sadness, was consistent with findings from prior studies showing a positive relationship between the magnitude of depression and stigma. These findings are discussed with reference to their impact on recognition and help seeking among patients, and recognition and management of depression by general practitioner. Culturally distinctive presentations and social contexts of depression and other mental illnesses should be addressed in professional training and public health communications.

Adult↗

A wireless mobile health-related quality of life assessment.

Self-administered waiting room questionnaires are popular tools for gathering health information from patients, but they require optical scanning or manual data entry to obtain survey results. The application described here eliminates those extra steps by inputting the results into a remote database directly through wireless connection, and the assessment can be finished easily anywhere in the clinic through a mobile platform. A measure of health-related quality of life, the SF-8 Health Survey, was used in developing this application for using in the clinical setting. It has only eight questions measuring each of the eight domains of health in the longer SF-36 Health Survey.

Computer Communication Networks↗

Efficacy of 3-year psychiatric daycare treatment in patients with schizophrenia.

The present study investigated the efficacy of a 3-year psychiatric daycare (DC) program with regard to psychiatric symptoms and difficulties with daily living experienced by patients with schizophrenia. The subjects were 28 patients who met the diagnostic criteria from the 4th edition of the Diagnostic and Statistical Manual for schizophrenia and continued DC treatment for 3 years. The present study assessed participants at two points: at the start of DC and after 3 years, by evaluating socioeconomic factors and Brief Psychiatric Rating Scale (BPRS) scores. In addition, in order to measure difficulties with daily living, the Life Assessment Scale for the Mentally Ill (LASMI) and the Etoh Daycare Assessment Scale (ETODAS) developed at the Etoh Hospital, were used. Results indicated that no significant changes in socioeconomic factors or BPRS scores occurred during the 3-year period of DC treatment. However, over this period, mean scores (+/- standard deviation [SD]) for LASMI subcategories decreased from 1.6 +/- 0.8 points to 0.9 +/- 0.7 for daily living and from 1.7 +/- 0.8 to 1.2 +/- 0.7 for interpersonal relations, indicating significant improvement (P < 0.05). In addition, mean scores (+/-SD) for the ETODAS subcategories increased from 3.4 +/- 0.8 to 4.1 +/- 0.8 for expressiveness, from 3.3 +/- 0.9 to 4.0 +/- 0.8 for communication, from 3.1 +/- 0.6 to 3.6 +/- 1.0 for initiative within a group, and from 3.4 +/- 0.5 to 3.8 +/- 0.7 for cooperation in work activities, indicating significant improvement (P < 0.05). The present study suggests that DC can enable patients with schizophrenia to maintain their condition without worsening the psychiatric symptoms, and to improve their daily living skills, social skills in human relations, and work skills.

Activities of Daily Living↗

Implementation of a Quality Plan (ISO 9002) In a Regional Tissue Bank.

Quality control and standardized preservation methods are essential in the field of transplantation. The International Organization for Standardization (ISO) has established a common set of manufacturing, trade and communications standards that are applicable worldwide and that provide the basis of a quality plan for Tissuebreak Banks.The Sectorial Tissue Banking (STB) of the Regional Blood Transfusion Center (RBTC) of Córdoba (Spain) is a non-profit-making tissue bank, established in 1992 to provide tissues for surgical procedures to the hospitals in a regional area. In 1998, the STB as a part of the RBTC embarked upon the path of becoming ISO-certified: after two years of the implementation of the project, STB attained ISO 9002 certification, thus becoming one of the first tissue banks in Europe to achieve this qualification. In this paper we describe the process of becoming ISO-certified, to demonstrate the positive impact that it has had on our entire organization.The assistance of an outside consultant who provided the necessary information for implementing an ISO quality management system was required. The initial improvement was: a well-defined quality manual to address all elements of the ISO 9002 standard, an improved document control system, detailed standard operating procedures (SOPs) and improved employees training processes. A quality committee team and developed quality indicators were created. The internal quality auditing program was established by the selection of employees from a cross-section of the organization, who were trained in internal auditing processes. A formal corrective action system was developed and implemented to facilitate process improvement. The consultant conducted a pre-certification audit, and one month later the certification audit was performed.In conclusion, the implementation of an ISO quality program in the STB has helped our center to establish a control process in the manufacturing of products and services to meet the expectations of our customers, by providing components and services that comply with the national regulatory standards and requirements.

Journal Article↗

[Hippocratic medicine and the treatise Airs, waters and places. A short history of the beginnings and influence of a scientific error].

The hippocratic treatise Airs, waters and places is a book for travelling practitioners, explaining them all they have to check when they arrive in a new unknown place. According to the author of this manual, one of the most frequent causes of diseases is the bad quality of environmental air. Admitting this theory, the medical man could not imagine that diseases might be transmitted by contagion. Yet vets had always known about contagion among herds and flocks. Christian literature which used so frequently the metaphor of the good sheperd and the sick sheep might have drawn doctors' attention and parallelized the situation among animals and that among human beings. The authority of the so-called father of medicine was so powerful that this did not happen and that contagionists and anticontagionists would quarrel for ages.

Communicable Disease Control↗

The Cerec 3--a quantum leap for computer-aided restorations: initial clinical results.

The Cerec 3 system simplifies and accelerates the fabrication of ceramic inlays, onlays, veneers, and quarter, half, and complete crowns for anterior and posterior teeth. Cerec 3 software simplifies occlusal and functional registration. Proper occlusion is established accurately and quickly; manual adjustment is reduced to a minimum. The separate grinding device, working true to morphologic detail and with fine surface quality, is connected to the optical unit by radio control. Equipped with a laser scanner, it can also be used for indirect application through a standard personal computer. The Cerec 3 system is network and multimedia ready and, in combination with an intraoral color videocamera or a digital radiography unit, can be used for patient education and for user training. The Cerec 3 system thus is a diagnostic, restorative, training, and documentation center for the dental practice.

Adult↗