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PubMed1995

The impact of mood on time perception, memorization, and acceptance of waiting.

The effects of mood on two cognitive processes, memorization and time perception, were examined. Participants (N = 155) first watched videos that successfully manipulated their mood (happy or sad); then they watched a video simulating a waiting line (Bateson & Hui, 1992; Bosselman & Craik, 1987). A questionnaire was administered to both groups to assess the number of items memorized from the "waiting" video, the estimated waiting time, and the degree of acceptance of waiting time. A series of analyses of variance showed that happy mood enhanced the number of items memorized and the acceptance of waiting but had no significant effect on time estimates. Memorization had no effect on time estimates or on acceptance of waiting; as expected, the longer the perceived waiting time, the less the acceptance of waiting time. A global model based on a system of linear equations (LINEQS) reproduced these results, which are interpreted in terms of both previous studies on mood and time estimate models.

Adaptation, Psychological↗
PubMed1990

Management of process technology.

A successful manufacturing scale cell culture process has as its basis a well-designed process. However, even the best designed large-scale process can become unreliable if not managed properly. The primary element to successful management of all large-scale processes is the careful attention to the details, especially the most important ones. The second element that requires serious consideration is the operation of that process within the confines of current regulatory environments. The major considerations are: 1. Adequate raw material specifications and testing. 2. Facility and equipment design that maximizes operational success and meets current regulatory requirements. 3. Thoroughly written procedures covering all aspects of operation and maintenance, and supported by a thorough documentation and review system. 4. A dedicated staff with a thorough understanding of systems and the importance of operational details. 5. Continual training and retraining programs. 6. Sound process and facility validation programs. 7. Comprehensive preventive maintenance programs. 8. Thorough understanding of process and facility trends, and the expected and acceptable ranges of results. 9. Development of sound procedures and practices that minimize batch losses and permit operation within current regulatory requirements. 10. Thorough and continual monitoring of all critical process parameters. 11. Process scheduling to minimize batch jeopardy or loss while maximizing throughout. 12. Maintenance of the appropriate environmental conditions of the plant and general cleanliness of plant and equipment. 13. Adequate batch loss prevention programs. 14. Adequate troubleshooting programs. 15. Adequate support organization and facilities both internally and externally to plant operations. With the appropriate application of sound process design and management principles, and with operational experience, large-scale cell culture process plants can be operated at success rates that exceed 95%.

Animals↗
PubMed2001

The classification of specialist student practice: results of an exploratory study.

An exploratory study investigating the feasibility and acceptability of an assessment tool designed to allow practice educators(1)to classify Specialist Practitioner student practice, identifies issues of interest to all educators involved with practice assessment. Within 3 months of commencing education leading to Specialist Practitioner Awards, the spread of marks awarded for practice achievements was already consistent with final degree classification and within 6 months slightly higher than normal. By the end of the course, continued improvements in practice achievements resulted in 73% of practice marks being 70% and over. The implications for total degree classification are less catastrophic than they appear; even if this trend continues there will only be a slight increase in first class Honours degrees. Although the strategy for practice assessment includes practice educators and students working together to discuss and agree marks for practice achievements, in the study practice educators and students provided marks intentionally without discussion or consultation with each other. Two comparisons of these marks showed that many students overestimate or underestimate their practice achievements as perceived by practice educators. Continuous monitoring of how marks are determined will be a priority for the Specialist Practice team. In most cases, practice educators considered the marked assessment of practice to be a reasonable working proposition, though there were concerns about the timing of assessments and the applied terminology. The main conclusions are that some practice educators may award marks for effort, despite contradictory written comments, and that the ability of specialist students to self-assess remains an unknown quantity but a potential moderating influence. The role of the HEI will be to ensure essential preparation and ongoing support for practice educators to enable a tri-partite assessment process and to provide a robust strategy for internal and external moderation. The marked assessment of practice was implemented in September 2000; to date progress has been remarkably unproblematic with practice educators and students accepting the process with relative ease and much enthusiasm.

Educational Measurement↗
PubMedDate not supplied

[Acceptance of cholesterol by high density lipoproteins in people with dys-alpha-lipoproteinemia and the possible role of apoprotein E in this process].

Both subfraction "2" of high density lipoproteins (HDL2) from patients with hypo-alpha-lipoproteinemia and subfraction HDL3 from persons with normal content of cholesterol were shown to accept the erythrocyte membranes cholesterol in vitro. Under these conditions HDL3 subfraction was transformed into HDL2-like particles, where content of unesterified cholesterol and its esters was increased simultaneously with enlargement of the particles size. The HDL subfraction, isolated from persons with high content of cholesterol, did not accept cholesterol under the experimental conditions. Apoprotein E, containing in the HDL subfractions, was not responsible for the particles cholesterol-accepting properties. Apoprotein E itself was capable of cholesterol elimination from erythrocytes as well as of cholesterol esters from HDL3 and HDL2-like particles with formation of a specific complex.

Apolipoproteins E↗
PubMed2006

Advanced breast cancer patients' perceptions of decision making for palliative chemotherapy.

PURPOSE: To examine advanced breast cancer patients' perceptions of the key decision-making consultation for palliative chemotherapy. PATIENTS AND METHODS: One hundred two women with advanced breast cancer, who were offered palliative chemotherapy, participated in a study-specific semistructured interview examining perceptions of the information they had received and their involvement in the decision-making process. One hundred seventeen interviews included 70 in relation to first-line chemotherapy and 47 in relation to second-line chemotherapy (15 patients were interviewed in relation to both first- and second-line chemotherapy). RESULTS: Eighty-six percent of patient interviews (n = 101) reported patient satisfaction with the information they received, and 91% (n = 106) reported satisfaction with the decision-making process. Factors most influential in decisions to accept chemotherapy were the possibility of controlling the tumor (45%, n = 53 of patient interviews) and providing hope (33%, n = 28 of patient interviews; 19%, n = 13 being offered first-line chemotherapy v 43%, n = 20 being offered second-line chemotherapy; P = .006). Thirty-eight percent of patient interviews (n = 44) reported the patient as taking an active role in the decision-making process (33%, n = 23 at first-line chemotherapy v 43%, n = 20 at second-line chemotherapy; P = .06). CONCLUSION: Women offered second-line chemotherapy were more likely to undergo chemotherapy because of the hope it offers and were more likely to take an active role in that decision compared with women who were offered first-line chemotherapy. Compassionate and honest communication about prognosis and likelihood of benefit from treatment may help to close the gap between hope and expectation and enable patients to make fully informed decisions about palliative chemotherapy.

Adult↗
PubMed1995

Improved electrotactile speech processor: Tickle Talker.

The Tickle Talker, an eight-channel electrotactile speech processor, has been developed from continuing research at the University of Melbourne. The development of the device has focused on production of reliable speech-processing hardware, design of cosmetically and ergonometrically acceptable electrode transducers, implementation of acute and chronic biomedical studies demonstrating device safety, design and testing of alternative speech-encoding strategies to provide benefit to speech perception and production, and design and testing of appropriate training methods for optimizing benefits. The Tickle Talker has been shown to provide benefits in supplementing lipreading or aided residual hearing for hearing-impaired adults and children. Improvements in speech processing have resulted in an increase in benefits to speech perception, and open the way for more flexible approaches to encoding speech input. Continuing development of the electrode circuitry has now produced a device that is robust and has an extended battery life. Safety studies have clearly demonstrated that there are no long-term contraindications to device use. The results suggest that the device has a role to play in rehabilitation programs for severely and profoundly hearing-impaired adults and children.

Deafness↗
PubMed1998

Patenting medical and surgical techniques: an ethical-legal analysis.

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations offered by proponents and opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques.

American Medical Association↗
PubMedDate not supplied

Conceptualizing functional neuroplasticity.

There are at least four major forms of functional neuroplasticity that can be studied in humans: homologous area adaptation, cross-modal reassignment, map expansion, and compensatory masquerade. Homologous area adaptation is the assumption of a particular cognitive process by a homologous region in the opposite hemisphere. Cross-modal reassignment occurs when structures previously devoted to processing a particular kind of sensory input now accepts input from a new sensory method. Map expansion is the enlargement of a functional brain region on the basis of performance. Compensatory masquerade is a novel allocation of a particular cognitive process to perform a task. By focusing on these four forms of functional neuroplasticity, several fundamental questions about how functional cooperation between brain regions is achieved can be addressed.

Brain↗
PubMed1997

Clinical process cost analysis.

BACKGROUND: New systems of reimbursement are exerting enormous pressure on clinicians and hospitals to reduce costs. Using cheaper supplies or reducing the length of stay may be a satisfactory short-term solution, but the best strategy for long-term success is radical reduction of costs by reengineering the processes of care. However, few clinicians or institutions know the actual costs of medical care; nor do they understand, in detail, the activities involved in the delivery of care. Finally, there is no accepted method for linking the two. METHODS: Clinical process cost analysis begins with the construction of a detailed flow diagram incorporating each activity in the process of care. The cost of each activity is then calculated, and the two are linked. This technique was applied to Diagnosis Related Group 75 to analyze the real costs of the operative treatment of lung cancer at one institution. RESULTS: Total costs varied between $6,400 and $7,700. The major driver of costs was personnel time, which accounted for 55% of the total. Forty percent of the total cost was incurred in the operating room. The cost of care decreased progressively during hospitalization. CONCLUSIONS: Clinical process cost analysis provides detailed information about the costs and processes of care. The insights thus obtained may be used to reduce costs by reengineering the process.

Cost Control↗
PubMed2000

Development of CPR security using impact analysis.

The HIPAA regulations will require that institutions ensure the prevention of unauthorized access to electronically stored or transmitted patient records. This paper discusses a process for analyzing the impact of security mechanisms on users of computerized patient records through "behind the scenes" electronic access audits. In this way, those impacts can be assessed and refined to an acceptable standard prior to implementation. Through an iterative process of design and evaluation, we develop security algorithms that will protect electronic health information from improper access, alteration or loss, while minimally affecting the flow of work of the user population as a whole.

Algorithms↗
PubMed1994

The use of radiolabeled nonspecific immunoglobulin in the detection of focal inflammation.

The serendipitous discovery that radiolabeled nonspecific immunoglobulin G (IgG) accumulates at a site of focal inflammation has led to the development of a new radiopharmaceutical for inflammation scanning, 111In-IgG. This reagent has been extensively studied in humans with focal infection and has been shown to be both safe and effective. It has been especially useful in the evaluation of patients with possible abdominal and skeletal infection, with the ability to perform serial scans being an important attribute in terms of determining "proof of cure." Preliminary data suggest that this approach may be particularly useful in immuno-compromised patients and may find a role in the quantitative assessment of patients with such noninfectious inflammatory processes as rheumatoid arthritis and inflammatory bowel disease. A new method of labeling IgG with technetium, via the hydrazino nicotinamide derivative, holds promise in terms of substituting this more practical radionuclide for indium. However, caution must be directed against total substitution, because such processes as suspected vascular or skeletal prosthesis infection may require the longer half-life of 111In for satisfactory diagnosis. When one compares the results obtained with radiolabeled IgG against the ideal specifications for a radiopharmaceutical to be used for inflammation imaging, most of the requirements are met. The major weakness of this approach is that even with the technetium-labeled reagent, a minimum of 6 to 12 hours is necessary for a scan to become positive, which is not acceptable in the evaluation of acutely evolving processes. Development of other radiopharmaceuticals for this purpose remains to be accomplished.

Abdomen↗
PubMed1999

A neural network model of lateralization during letter identification.

The causes of cerebral lateralization of cognitive and other functions are currently not well understood. To investigate one aspect of function lateralization, a bihemispheric neural network model for a simple visual identification task was developed that has two parallel interacting paths of information processing. The model is based on commonly accepted concepts concerning neural connectivity, activity dynamics, and synaptic plasticity. A combination of both unsupervised (Hebbian) and supervised (Widrow-Hoff) learning rules is used to train the model to identify a small set of letters presented as input stimuli in the left visual hemifield, in the central position, and in the right visual hemifield. Each visual hemifield projects onto the contralateral hemisphere, and the two hemispheres interact via a simulated corpus callosum. The contribution of each individual hemisphere to the process of input stimuli identification was studied for a variety of underlying asymmetries. The results indicate that multiple asymmetries may cause lateralization. Lateralization occurred toward the side having larger size, higher excitability, or higher learning rate parameters. It appeared more intensively with strong inhibitory callosal connections, supporting the hypothesis that the corpus callosum plays a functionally inhibitory role. The model demonstrates clearly the dependence of lateralization on different hemisphere parameters and suggests that computational models can be useful in better understanding the mechanisms underlying emergence of lateralization.

Adult↗
PubMed1992

The technology assessment and practice guidelines forum. A modified group judgment method.

This article describes a new group-judgment process, modified from the consensus development approach of the U.S. National Institutes of Health. It is called the "forum" method, a shorthand term for "technology assessment and practice guidelines forum." This approach is aimed at (a) describing the current state of knowledge of the technology under study; (b) developing practice guidelines for the use of the technology; and (c) providing information for insurers, consumers, policymakers, and others. A pilot study was conducted focusing on total parenteral nutrition. The validity of the process and of the recommendations and their acceptability were evaluated in a survey of participants and a selected group of nonparticipants. Based on the survey results, the forum method appears to be a valuable method for assessing technologies, defining their clinical role, and developing practice guidelines.

Consensus Development Conferences, NIH as Topic↗
PubMed2000

Larval development of the tropical deep-sea echinoid Aspidodiadema jacobyi: phylogenetic implications.

The complete larval development of an echinoid in the family Aspidodiadematidae is described for the first time from in vitro cultures of Aspidodiadema jacobyi, a bathyal species from the Bahamian Slope. Over a period of 5 months, embryos grew from small (98-micron) eggs to very large (3071-micron) and complex planktotrophic echinopluteus larvae. The fully developed larva has five pairs of red-pigmented arms (preoral, anterolateral, postoral, posterodorsal, and posterolateral); fenestrated triangular plates at the bases of fenestrated postoral and posterodorsal arms; a complex dorsal arch; posterodorsal vibratile lobes; a ring of cilia around the region of the preoral and anterolateral arms; and a long, unpaired posterior process containing a fenestrated rod. The presence of a posterior process and posterodorsal arms makes the larva of Aspidodiadema jacobyi much more similar to larvae of irregular urchins in the order Spatangoidea than to other families of the order Diadematoida, to which the family is normally assigned. This unexpected larval form lends support to a recommendation that the Aspidodiadematidae should be either elevated to ordinal status as a sister group of the order Diadematoida, or split off as a sister group of the other families within the order. In either case, if we accept the parsimonious hypothesis that the aboral process and posterodorsal arms were derived only once in the evolutionary history of euechinoids, then the larval data suggest that the Aspidodiadematidae may be very near the node where the irregular and regular euechinoids first diverged.

Animals↗
PubMed1996

The proactive medical record.

In this paper the results are presented from recent developments to increase the role of the HISCOM integrated hospital information system to support direct patient care. This process has resulted in an operational Electronic Obstetric Record System (EVS) and the introduction of a generic system (MDS) to document the medical care process starting in the outpatient clinics. These systems are based on a model of the clinical care process, agreed upon by clinicians. The EVS replaces the conventional paper record and was accepted mainly by the way the EVS follows and supports the care process. The main contribution is the completeness, the availability, and the support of the care related processes like scheduling next appointments and examinations, the reporting and the automatic creation of letters. The MDS approach addresses the issue of providing kernel information by episode about the care process to clinicians and managers. The MDS is based on the episode concept, which is not restricted to the outpatient departments, but can also be applied hospital wide, and even across the boundaries of the hospital. In this paper the categorisation of 'a proactive medical record' will be introduced, and the potential benefits of an integrated approach to the electronic medical record (EMR) will be addressed.

Hospital Information Systems↗
PubMed2006

Assessing the quality of radiographic processing in general dental practice.

OBJECTIVES: To determine if a commercial device (Vischeck) for monitoring film processing quality was a practical option in general dental practice, and to assess processing quality among a group of GDPs in the West Midlands with this device. DESIGN: Clinical evaluation. SETTING: General dental practice, UK, 2004. METHOD: Ten GDP volunteers from a practice based research group processed Vischeck strips (a) when chemicals were changed, (b) one week later, and (c) immediately before the next change of chemicals. These were compared with strips processed under ideal conditions. Additionally, a series of duplicate radiographs were produced and processed together with Vischeck strips in progressively more dilute developer solutions to compare the change in radiograph quality assessed clinically with that derived from the Vischeck. RESULTS: The Vischeck strips suggested that at the time chosen for change of processing chemicals, eight dentists had been processing films well beyond the point indicated for replacement. Solutions were changed after a wide range of time periods and number of films processed. The calibration of the Vischeck strip correlated closely to a clinical assessment of acceptable film quality. CONCLUSIONS: Vischeck strips are a useful aid to monitoring processing quality in automatic developers in general dental practice. Most of this group of GDPs were using chemicals beyond the point at which diagnostic yield would be affected.

General Practice, Dental↗
PubMedDate not supplied

Developing efficiency standards to improve service in hospital admitting.

The efficiency of admitting services at York Central Hospital in Richmond Hill, ON, Canada, was studied in terms of the timing of admissions. Over a 10-month period, information was collected relating to 1,630 patients' admissions. This information resulted in recommendations allowing the standard of waiting time to be changed and the standard of an admission time to be set. The patient wait time now is to be no longer than 15 minutes with an acceptable level of 80%. The information gathered in a 6-month period during the original 10 months of study showed that the admission process takes no longer than 18 minutes with an acceptable level of 90%.

Admitting Department, Hospital↗
PubMed2001

Maternal serum screening, political decision-making and social learning.

OBJECTIVE: Analysis and evaluation of the process by which serum screening has been introduced in Dutch maternity care. In our analysis of Dutch medical journals, reports of the government and the political and cultural debate, we use a theoretical framework in which the process of introduction of new technologies is described in terms of different social learning processes. RESULTS: The analysis shows a dual-track pattern: promotion by the medical community, and control and regulation of serum screening by the political decision-makers. This process left little room for social learning processes. This applied in particular to learning processes about the social and cultural meaning and acceptability of serum screening. Acceptability of the new serum screening was framed nearly exclusively in terms of freedom of choice. CONCLUSIONS: A too limited framework of assessment was used. Health technology assessment (HTA) should incorporate in the evaluation process the ethical, social, cultural and political dimensions of health technology, and stimulate the interplay between different perspectives and preferences among parties involved. As a new promising approach, we suggest the use of pilot experiments that are designed as social experiments involving different parties in a common learning process.

Congenital Abnormalities↗