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PubMed1996

The Interactive Video-Questionnaire: a new technology for interviewing deaf persons.

This paper traces the development of a new technology, the Interactive Video-Questionnaire, for interviewing Deaf persons by using manually signed questionnaires. After encountering numerous obstacles to conducting surveys with Deaf persons about substance abuse using the same methods typically used with hearing persons, the researchers, with a Small Business Innovative Research grant from the National Institute on Drug Abuse, piloted a survey method that uses videodisc and bar code readers to present survey questions signed on screen in American Sign Language and Signed English. Following consultations with Deaf participants, deficiencies of this method were identified and corrected. An interactive multimedia program was created in Phase II of this research effort that offered questions visually in American Sign Language, Signed English, or Speechreading. All questions were subtitled in written English, with Touchscreen entry and automatic data capture and storage. The potential exists for many important uses of the Interactive Video-Questionnaire.

Communication↗
PubMed2001

Bystander effects in cell death induced by photodynamic treatment UVA radiation and inhibitors of ATP synthesis.

Confluent layers of MDCK II cells were treated with four different photosensitizers (a purified version of hematoporphyrin derivative [Photofrin], tetra(3-hydroxyphenyl)porphine [3-THPP], meso-tetra(4-sulphonatophenyl)porphine [TPPS4] and ALA-induced Protoporphyrin IX) and irradiated with blue light, with UVA without exogenous photosensitizers, or incubated with the metabolic inhibitors carbonyl cyanide m-chlorophenylhydrazone and 2-deoxy-D-glucose. Necrotic and apoptotic cells were detected about 4 h later by fluorescence microscopy. Dead cells appeared in distinct clusters in the confluent layers. The number of dead cells in these clusters was determined by manual counting and image analysis. Forty-one of the 43 experimental distributions of dead cells in clusters were found to be significantly different from a Monte Carlo simulation of the distribution of independently inactivated cells. However, a Monte Carlo simulation model, assuming that each dead cell increased the probability of inactivation of adjacent cells, fitted 34 of the 43 observed distributions of dead cells in clusters, indicating a significant bystander effect for all the investigated treatments. The bystander-effect model parameter, defined as a cell's increase in probability of dying when it has dead neighbors, was significantly lower for 3-THPP-PDT and TPPS4-PDT than for Photofrin-PDT, ALA-PDT and treatment with metabolic inhibitors.

Adenosine Triphosphate↗
PubMed1999

[Automated anesthesia billing by electronic anesthesia record keeping system].

There has been loss of anesthesia fee by errors of filling out billing sheets manually. A large loss of anesthesia fee was pointed out by the audit during the past several years. In order to prevent these billing error, we have developed an automated anesthesia billing system combined with an electronic anesthesia record keeping (EARK) system. The system derives all the anesthesia cost-related parameters from the EARK database and calculates anesthesia fee according to the logic of the Japanese health care insurance system. After implementing the system, anesthesiologists and circulating nurses became free from filling out billing sheets. The accuracy of the automated billing was proved by the comparison with hand filled sheets. The survey showed that the system prevented 2.5 million yen of billing loss in a month. Such an economic impact of the system proves the rationale of an EARK as a cost containment tool.

Anesthesia↗
PubMed2003

Dimensional versus categorical classification of prototypic and nonprototypic cases of personality disorder.

This study examined interrater reliability and ratings of confidence and clinical utility (professional communication, case conceptualization, treatment planning) of categorical and dimensional approaches to diagnosing prototypic and nonprototypic personality disorder cases. Two national samples of psychologists (n = 93, n = 92) participated. Interrater reliability was higher for prototypic cases than nonprototypic cases for the categorical system, but similar for prototypic and nonprototypic cases using dimensional ratings. Across cases, interrater reliability and confidence were highest for the categorical model, hybrid models, and the five-factor model. However, ratings of clinical utility were highest for the categorical and the hybrid models, even when interrater reliability was inadequate, suggesting clinician preference for a classification based on the existing categories. Mean ratings for the prototypic cases supported the theorized relationships between the dimensional models and the personality disorders. Reasons for these findings and implications for moving towards a dimensional model of personality disorder are discussed.

Adult↗
PubMed2006

The Consortium on the Genetics of Endophenotypes in Schizophrenia: model recruitment, assessment, and endophenotyping methods for a multisite collaboration.

BACKGROUND: The Consortium on the Genetics of Schizophrenia (COGS) is an ongoing, National Institute of Mental Health-funded, 7-site collaboration investigating the occurrence and genetic architecture of quantitative endophenotypes related to schizophrenia. The purpose of this article is to provide a description of the COGS structure and methods, including participant recruitment and assessment. METHODS: The hypothesis-driven recruitment strategy ascertains families that include a proband with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of schizophrenia, and at least one unaffected full sibling available for genotyping and endophenotyping, along with parents available for genotyping and (optional depending on age) endophenotyping. The family structure is selected to provide contrast in quantitative endophenotypic traits and thus to maximize the power of the planned genetic analyses. Probands are recruited from many sources including clinician referrals, local National Alliance for the Mentally Ill chapters, and advertising via the media. All participants undergo a standardized protocol that includes clinical characterization, a blood draw for genotyping, and endophenotype assessments (P50 suppression, prepulse inhibition, antisaccade performance, continuous performance tasks, letter-number span, verbal memory, and a computerized neurocognitive battery). Investigators participate in weekly teleconferences to coordinate and evaluate recruitment, clinical assessment, endophenotyping, and continuous quality control of data gathering and analyses. Data integrity is maintained through use of a highly quality-assured, centralized web-based database. RESULTS: As of February 2006, 355 families have been enrolled and 688 participants have been endophenotyped, including schizophrenia probands (n = 154, M:F = 110:44), first-degree biological relatives (n = 343, M:F = 151:192), and community comparison subjects (n = 191, M:F = 81:110). DISCUSSION: Successful multisite genetics collaborations must institute standardized methodological criteria for assessment and recruitment that are clearly defined, well communicated, and uniformly applied. In parallel, studies utilizing endophenotypes require strict adherence to criteria for cross-site data acquisition, equipment calibration and testing and software equivalence, and continuous quality assurance for many measures obtained across sites. This report describes methods and presents the structure of the COGS as a model of multisite endophenotype genetic studies. It also provides demographic information after the first 2 years of data collection on a sample for whom the behavioral data and genetics of endophenotype performance will be fully characterized in future articles. Some issues discussed in the reviews that follow reflect the challenges of evaluating endophenotypes in studies of the genetic architecture of endophenotypes in schizophrenia.

Cooperative Behavior↗
PubMed2003

Teaching tuberculosis control to medical undergraduates: the Malawi experience.

SETTING: National Tuberculosis (TB) Control Programme (NTP) and College of Medicine (COM), Malawi. OBJECTIVES: To develop a TB/HIV module, incorporating TB control and the DOTS strategy, for 4th year medical undergraduates. To describe 1) the way in which the module was developed, 2) the contents and structure of the module, 3) the experience of teaching the module from 2000-2002, and d) the financial costs to the NTP. DESIGN: A descriptive study. RESULTS: The TB/HIV module, including the teaching manual, resource materials and undergraduate assessments, was developed between June and December 1999 by NTP, College of Medicine, interested stakeholders and an external consultant. The module was well received by medical undergraduates. Student knowledge, based on pre-module and post-module assessments, increased to satisfactory levels. Novel aspects of teaching, which included reading chapters in class followed by student-led knowledge reviews, modular assessments and using NTP staff as facilitators, were highly rated. The cost of developing the module was 14,070 US dollars, and the recurrent annual cost of teaching the module was 900 US dollars. CONCLUSION: The results show that a national tuberculosis control programme can work effectively with an academic medical institution in teaching medical undergraduates the important principles of country-wide TB control.

Adult↗
PubMed1994

A stimulus control procedure to increase requesting with individuals who are severely/profoundly intellectually disabled.

Various procedures have been used to establish and increase manual signed and spoken requesting with individuals who are intellectually disabled. A few studies have used the so-called blockable response conditioned establishing operation (BR-CEO) as a stimulus control procedure to increase requesting. A variation on the BR-CEO is the interrupted chain procedure, in which requesting for the activity that had been interrupted is reinforced by continuation of the activity. Rather than interrupting an ongoing activity, six individuals who are severely/profoundly intellectually disabled were studied with respect to the differential effectiveness of presenting them incomplete versus complete referents (i.e. activity and objects) as a consequence of their requesting on their rate of requesting. Data were collected within a reversal design. The results show that five out of six individuals more than doubled their rate of requesting. Incomplete presentation of referents may be a practical procedure to increase requesting.

Adolescent↗
PubMedDate not supplied

[Pollex flexus congenitus].

The authors report on the incidence, clinical picture, etiology, pathogenesis and treatment of congenital pollex flexus, and communicate the results of surgery on 52 thumbs. The permanent flexion anomaly in the interphalangeal joint and a hard, palpable knot in the long flexor tendon of the thumb over the metacarpophalangeal joint are typical for the deformity. Although these changes are sometimes observed immediately post partum, delayed diagnosis and treatment are more common. The hypothesis that it is a hereditary, endogenous condition is supported by observations in twins, relatively frequent bilateral occurrence and a high familial incidence. Constriction of the synovial sheath over the basal joint of the thumb is a key pathogenetic factor, although little is known about its causes; anatomical factors, influences affecting the growth of the sesamoid bones, and mechanical causes have been postulated. A more plausible hypothesis was first advanced by Jeannin. Like Hueston and Wilson 100 years later, he compared the tendon to a thick thread which had to be passed through a narrow eye of a needle: as a result, the "thread" would be frayed and compressed. The knot in the tendon is held to be a secondary phenomenon. The pathologicoanatomical picture varies. Lymphocyte and monocyte infiltration, and metaplasias to fiber cartilage have been detected in specimens excised from the tendon and the synovial sheath. However, pathologic changes have not been found in all cases. In the first year of life conservative therapy may be attempted, with temporary splinting of the thumb following manual correction of the flexion anomaly in the interphalangeal joint.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed2002

Autistic symptoms following herpes encephalitis.

Autism is a childhood onset neurodevelopmental disorder characterized by reciprocal social deficits, communication impairment, and rigid ritualistic interests, with the onset almost always before three years of age. Although the etiology of the disorder is strongly influenced by genes, environmental factors are also important. In this context, several reports have described its association with known medical conditions, including infections affecting the central nervous system. In this report, we describe an 11-year-old Asian youngster who developed the symptoms of autism following an episode of herpes encephalitis. In contrast to previous similar reports, imaging studies suggested a predominant involvement of the frontal lobes. At follow-up after three years, he continued to show the core deficits of autism. This case further supports the role of environmental factors, such as infections, in the etiology of autism, and suggests that in a minority of cases, autistic symptoms can develop in later childhood.

Autistic Disorder↗
PubMed2004

Classification of congenital melanocytic naevi and malignant transformation: a review of the literature.

INTRODUCTION: Congenital naevi (CN) vary greatly in size, macroscopic appearance and histology. There is a practical need to subdivide CN according to size, since size differences have a direct bearing on cosmetic and resultant psychological problems, and on therapeutic options, and probably on the chance of malignant transformation. In this review, we summarise the literature on size subgroupings of CN, with special focus on giant congenital naevi and their risk of malignant transformation. MATERIALS AND METHODS: A Medline literature search from 1966 to October 2002 was performed. Only English-language studies focusing on CN in association with melanoma were included. The final strategy consisted of textwords and medical subject heading (MeSH) terms on small, medium, large and giant congenital naevi combined with the textwords classification, histology and melanoma. Additional manual cross-referencing was performed. We excluded articles that dealt only with aspects of treatments. RESULTS: A wide variety of criteria for size subgrouping of CN has been put forward in the literature and precludes a direct comparison of reported data (Table 1). We identified 35 such articles in the world literature in which no less than seven different definitions of minimum size of a giant CN were employed. Histologically, it is difficult or even impossible to conclude that a naevus is congenital or acquired, especially in case of a small lesion, since the differences are not absolute (Table 2). Giant CN have an increased risk for malignant transformation, but the reported incidence rates have differed widely from one to 31% (Table 3). Reported melanoma incidence rates have derived from retro- and prospective studies, reviews and case reports, and compared with each other using different definitions. On top of this, patients in different age groups were reported, who were registered in different referral centers. CONCLUSION: To allow comparison of study results from different centers, it is essential that the size subclassification of CN is based on standard and generally accepted criteria. We recommend defining GCN as a CN covering one percent body surface area in face and neck and two percent elsewhere on the body. Based on a review of the world literature, we recommend prophylactic excision of all CN, in close communication with patient and family and individualising treatment accordingly.

Cell Transformation, Neoplastic↗
PubMed1992

Efficacy of double gloving as a protection against blood exposure in dermatologic surgery.

Double gloving has been widely suggested as a means of decreasing exposure to blood and other body fluids. However, most dermatologists do not routinely follow this practice when performing surgical procedures because it reduces manual dexterity and increases costs. To determine whether double gloving should be routinely practiced in dermatologic surgery, pairs of sterile surgical gloves worn during weekly UCLA dermatologic surgery clinics were collected over a period of 3 months and examined for perforations. The procedures gloves were used for ranged from excision of benign lesions, lasting 15 minutes, to hair transplants, lasting 3 hours. Upon completion of the procedures, 8 (5.5%) of 144 pairs of single gloves, 2 (3.7%) of 54 pairs of double inner gloves, and 3 (5.5%) of 54 pairs of double outer gloves were found to have perforations. There were no instances of both the double outer and the double inner gloves having perforations when worn on the same hand. This suggests that double gloving offers a protective advantage by providing extra protection for both the surgeon and the patient during dermatologic surgery.

Blood↗
PubMed2003

Biological constraints simplify the recognition of hand shapes.

This study sought to identify constraints that might lead to a concise system of recognizing fingerspelling hand shapes. Previous studies of grasping suggested that hand shape is controlled using combinations of a small number of neuromuscular synergies, but fingerspelling shapes appear to be more highly individuated and, therefore, might require a larger number of degrees of freedom. Static hand postures of the American Sign Language manual alphabet were recorded by measuring 17 joint angles. Principal components (PCs) analysis was compared to the use of subsets of individual variables (i.e., joint angles) for reduction in degrees of freedom. The first four PCs were similar across subjects. Classification using weightings from these four components was 86.6% accurate, while classification using four individual variables was 88.5% accurate (thumb abduction, as well as flexion at the index and middle finger proximal interphalangeal joints and the ring finger metacarpalphalangeal joint). When chosen for each subject, particular four-variable subsets yielded correct rates above 95%. This superior performance of variable subsets over PC weighting vectors suggests that the reduction in degrees of freedom is due to biomechanical and neuromuscular constraints rather than synergistic control. Thus, in future application to dynamic fingerspelling, reasonable recognition accuracy might be achieved with a significant reduction in both computational and measured degrees of freedom.

Cluster Analysis↗
PubMed1995

Self-measurement of blood pressure: recommendations of the Canadian Coalition for High Blood Pressure Prevention and Control.

OBJECTIVE: To provide health care professionals with guidelines on the use of blood pressure self-measurement. METHODS: Recommendations were devised after consideration of expert reviews and guidelines, personal files, international standards documents, personal communication with investigators and the results of a MEDLINE search (1966-94) using the term 'blood pressure determination'. BENEFITS, HARMS, COSTS: Self-measurement of blood pressure can be used to detect white coat hypertension, monitor changes in blood pressure closely, more rapidly achieve desired blood pressure goals, increase adherence to antihypertensive therapy and improve patient self-reliance. However, self-measured blood pressure readings may be misleading because there is insufficient normative, prognostic and outcome data and because some patients may not take accurate measurements. The use of self-measurement of blood pressure has a relatively small direct cost and may result in an overall reduction in treatment costs. RECOMMENDATIONS: Self-measured blood pressure readings can be a valuable supplement to clinic (or office) blood pressure readings. However, self-measurement is appropriate neither for patients who are physically or mentally incapable of accurate assessment and interpretation of readings nor for those who do not want to participate. Patients who self-monitor blood pressure require careful training in blood pressure measurement and instruction on the recording and interpretation of blood pressure readings. Advice to patients using monitoring equipment must take into account the needs and abilities of the patient. Although only a few electronic devices for the self-measurement of blood pressure have met recommended performance standards, their use may be more appropriate for some patients and the training requirements fewer than if manual devices are used. VALIDATION: The guidelines of several expert groups were examined in the preparation of these recommendations. The recommendations were presented at the World Conference on Hypertension Control in 1995 and were reviewed by the parent societies of the Canadian Coalition for High Blood Pressure Prevention and Control.

Blood Pressure Determination↗
PubMed2005

Three diagnostic approaches to Asperger syndrome: implications for research.

OBJECTIVE: To examine the implications for research of the use of three alternative definitions for Asperger syndrome (AS). Differences across the three nosologic systems were examined in terms of diagnostic assignment, IQ profiles, comorbid symptoms, and familial aggregation of social and other psychiatric symptoms. METHOD: Standard data on diagnosis, intellectual functioning, comorbidity patterns, and family history were obtained on 65 individuals screened for a very high probability of having autism without mental retardation (or higher functioning autism, HFA) or AS. Diagnoses of AS were established based on three different approaches: DSM-IV, presence/absence of communicative phrase speech by 3 years, and a system designed to highlight prototypical features of AS. RESULTS: Agreement between the three diagnostic systems was poor. AS could be differentiated from HFA (but not from PDD-NOS) on the basis of IQ profiles in two of the three systems. Differences in patterns of comorbid symptomatology were obtained in two of the three systems, although differences were primarily driven by the PDD-NOS category. Only one of the approaches yielded differences relative to aggregation of the "broader phenotype" in family members. CONCLUSIONS: Diagnostic assignments of AS based on three commonly used approaches have low agreement and lead to different results in comparisons of IQ profiles, patterns of comorbidity, and familial aggregation of psychiatric symptoms across the approach-specific resultant groups of HFA, AS, and PDD-NOS.

Adolescent↗
PubMed1997

Chimpanzee (Pan troglodytes) pointing: hand shapes, accuracy, and the role of eye gaze.

The manual pointing of 2 signing chimpanzees, Moja and Tatu, was examined in 2 experiments. Experiment 1 investigated eye-gaze direction, hand use, and hand shape while pointing. Both chimpanzees obtained the attention of a human before pointing toward an unreachable object. During 100 trials, the chimpanzees alternated their eye gaze between the object and the human while pointing. Moja's points were left-hand biased, and Tatu showed no lateral hand bias. Both indexical and whole hand points were recorded. Experiment 2 tested the chimpanzees' ability to point accurately toward objects in close proximity to each other. Humans were able to reliably determine the locations toward which the chimpanzees pointed. Both chimpanzees showed left-hand biases, and a higher proportion of indexical points were observed than in Experiment 1. These results are compared and contrasted with recent hypotheses pertaining to the topography of chimpanzee pointing and the role of eye gaze in deictic interactions.

Animal Communication↗
PubMed2006

Formal policies for flexible EHR security.

State of the Art methodologies for establishing requirements and solutions to securing applications are based on narrative descriptions about the use of available system, sometimes also dedicated to system components. Even nowadays new developments to ruling application security services by the use of predicate logic suffer from being administered manually. Therefore, security and privacy requirements cannot be properly met resulting in restrictions and fears for allowing the use of sensitive data and functions. Because of the sensitivity of personal health information and especially of genetic data with its wider implications beyond the original subject of care, weaknesses in guaranteeing fine-grained security and privacy rules lead to less acceptance or even the avoidance of essential information transfer and use. To overcome the problem, security and privacy have to become properties of the architectural components of the respective health information system. Embedding security into the systems architecture allows for negotiating and enforcing any security and privacy services related to principals, their roles, their relationships, further contextual information as well as other regulations summarized in formally modeled policies. The paper introduces the evolving paradigm of the model-driven architecture, first time also comprehensively deployed for security and privacy services in bio-genetic and health information systems.

Authorship↗
PubMed2006

Antimicrobe.org: an online reference for the practicing infectious diseases specialist.

Antimicrobe.org (http://www.antimicrobe.org) is a World Wide Web-based version of the textbook Antimicrobial Therapy and Vaccines, volumes I and II. The Web site currently consists of 3 texts (Microbes, Antimicrobial Agents, and HIV Clinical Manual) and will soon include a fourth, Empiric. The Web site focuses on therapy for infectious diseases, and it covers, in comprehensive detail, a great majority of infections encountered today. The dynamic nature of a Web-based reference allows for information to be frequently updated and enhances a physician's searching capabilities to find answers to very specific clinical questions and the latest available evidence. A Smart Search engine allows users to ask specific questions and to find focused answers, either within the textbook or through PubMed via a guided PubMed references option. The Web site also provides clinical vignettes and minireviews on hot topics in infectious diseases and hyperlinks to other important articles or Web sites. Chapters are written by experts in their field who provide evidence-based information, as well as anecdotal reports about rare infections. Antimicrobe.org would be of great benefit to physicians who treat infections on a routine basis.

Anti-Infective Agents↗
PubMed2005

The evolution of music in comparative perspective.

In this paper, I briefly review some comparative data that provide an empirical basis for research on the evolution of music making in humans. First, a brief comparison of music and language leads to discussion of design features of music, suggesting a deep connection between the biology of music and language. I then selectively review data on animal "music." Examining sound production in animals, we find examples of repeated convergent evolution or analogy (the evolution of vocal learning of complex songs in birds, whales, and seals). A fascinating but overlooked potential homology to instrumental music is provided by manual percussion in African apes. Such comparative behavioral data, combined with neuroscientific and developmental data, provide an important starting point for any hypothesis about how or why human music evolved. Regarding these functional and phylogenetic questions, I discuss some previously proposed functions of music, including Pinker's "cheesecake" hypothesis; Darwin's and others' sexual selection model; Dunbar's group "grooming" hypothesis; and Trehub's caregiving model. I conclude that only the last hypothesis receives strong support from currently available data. I end with a brief synopsis of Darwin's model of a songlike musical "protolanguage," concluding that Darwin's model is consistent with much of the available evidence concerning the evolution of both music and language. There is a rich future for empirical investigations of the evolution of music, both in investigations of individual differences among humans, and in interspecific investigations of musical abilities in other animals, especially those of our ape cousins, about which we know little.

Animals↗