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PubMed1997

[Quality management in a Swiss hospital].

Although there are quite good examples of quality management in Swiss hospitals available (the guidelines of quality management in the Swiss hospital etc.), the distribution of measures of quality assurance in Swiss hospitals is insufficient and focuses more on Hotel services and technical equipment rather than on the care by physicians and nurses. Beginning with Jan. 1, 1998, contracts of quality assurance between health care providers and sponsors have to be presented according to the new health insurance act. These contracts are proofed periodically by a national office. This necessitates a country-wide introduction of statistics (ICD-codes) and computerization. This is currently only in the process of realization. Additionally, hospitals and medical practices already undertake a comprehensive quality control due to local and regional initiatives. The society of Swiss physicians FMH supports mainly three areas: compulsory continuing medical education (80 hours annually, including 50 hours in recognized meetings), the development of guidelines by medical societies, and data collection including the development of a network for measures of quality assurance. The ISO-standard 9000 was changed for health care as ordered by the NAQ (National workshop for quality assurance) and the FMH. It is supposed to be used mainly for the certification of facilities for continuing medical education, perhaps also for the certification of hospitals.

Education, Medical, Continuing↗
PubMedDate not supplied

Crossmodal integration for perception and action.

The integration of information from different sensory modalities has many advantages for human observers, including increase of salience, resolution of perceptual ambiguities, and unified perception of objects and surroundings. Several behavioral, electrophysiological and neuroimaging data collected in various tasks, including localization and detection of spatial events, crossmodal perception of object properties and scene analysis are reviewed here. All the results highlight the multiple faces of crossmodal interactions and provide converging evidence that the brain takes advantages of spatial and temporal coincidence between spatial events in the crossmodal binding of spatial features gathered through different modalities. Furthermore, the elaboration of a multimodal percept appears to be based on an adaptive combination of the contribution of each modality, according to the intrinsic reliability of sensory cue, which itself depends on the task at hand and the kind of perceptual cues involved in sensory processing. Computational models based on bayesian sensory estimation provide valuable explanations of the way perceptual system could perform such crossmodal integration. Recent anatomical evidence suggest that crossmodal interactions affect early stages of sensory processing, and could be mediated through a dynamic recurrent network involving backprojections from multimodal areas as well as lateral connections that can modulate the activity of primary sensory cortices, though future behavioral and neurophysiological studies should allow a better understanding of the underlying mechanisms.

Animals↗
PubMed1975

Experimental immunohistochemical studies on the localization and distribution of substance P in cat primary sensory neurons.

With the indirect immunofluorescence technique of Coons and collaborators the occurrence of substance P (SP)-like immunoreactivity was studied in spinal ganglia (L6-S1), the spinal cord (L6-S1) and the pad skin of the hind paw of the cat. In untreated cats a very dense network of SP-positive fibers was found in the spinal cord in Lissauer's fasciculus, in laminae I-III and a rather dense plexus was seen in the ventral horns, in the area around the central canal (laminae X) and in the medial parts of laminae VI and VII. SP-positive fibers were also observed in the connective tissue under the epithelium of the skin. However, in untreated cats no specific immunogluorescnece was observed in the spinal ganglia, dorsal roots or certain large peripheral nerve trunks. After certain experimental procedures such as local application of colchicine or compression of the dorsal root close to the spinal ganglion, SP-positive fluorescence was observed in a rather small number of neuronal cell bodies and in fibers. The fluorescent material was observed in the peripheral parts of the cytoplasm and the cell bodies were exclusively of the small type. Ten days after transection of the dorsal roots a marked decrease in the number of SP-positive fibers was observed in the substantia gelatinosa but not in the ventral horns. The present results give strong evidence for the occurrence of SP in a certain population of primary sensory neurons and support earlier findings that SP may act as a transmitter or modulator in these neurons.

Animals↗
PubMed2000

Intussusceptive arborization contributes to vascular tree formation in the chick chorio-allantoic membrane.

Various reports indicate that the process of intussusceptive microvascular growth (IMG) plays a crucial role in capillary network formation of the chorio-allantoic membrane (CAM). In the present study we demonstrate by methylmethacrylate (Mercox) casting and in vivo time-lapse observations that intussusception, i.e. insertion of transcapillary tissue pillars, is also strongly involved in vascular tree formation, a process we refer to as intussusceptive arborization (IAR). From day 7 to day 14 of incubation, several arterial and venous branching generations arise from the capillary plexus. The process is initiated by pillar formation in rows, which are demarcating future large vessels in the capillary meshwork. In a subsequent step the pillars undergo reshaping to form narrow tissue septa that successively merge, which results in the production of new generations of blood vessels. This is followed by growth and maturation of all vascular components. The process of IAR in the CAM is very active at days 10 and 11 of incubation and takes place in preferentially perfused capillary regions determining "dynamic areas". The process of intussusception may be preceded by endothelial division, but the transcapillary pillar formation itself occurs primarily by rearrangement and attenuation of the endothelial cells without local endothelial cell proliferation. We conclude that after the early sprouting phase, the process of intussusception is the basic mechanism of CAM vascularization. It leads to capillary network growth and expansion (IMG) and, at the same time to feed vessel formation with several branching generations (IAR).

Allantois↗
PubMed1995

Visualization of the subsarcolemmal cytoskeleton network of mouse skeletal muscle cells by en face views and application to immunoelectron localization of dystrophin.

The ultrastructural organization of the highly interconnected filamentous network underneath the sarcolemma as well as the role played by the muscle protein dystrophin within this cytoskeleton remain yet unclear. More accurate information has been obtained by using a method which provides three-dimensional en face views of large membrane areas applied to mouse cultured myotubes and isolated adult skeletal muscle fibres. Two levels have been distinguished in the cytoskeleton underlying the sarcolemma: the submembranous level, partly integrated into the membrane, and the cortical level, invading the proximal cytoplasmic space. Few differences have been found between the membrane cytoskeletons of myotubes issued from 14-day-old cultures and those of adult fibres. The comparison was done with cells where dystrophin is missing (mdx mouse muscle): surprisingly, the lack of dystrophin does not induce obvious or dramatic ultrastructural disorganization, either in the cortical cytoskeletal network or in the submembranous one. Immunogold labelling of either the central-rod or the C-terminal domain of dystrophin is not located among the cortical network. This study provides additional data on the spatial ordering of subsarcolemmal cytoskeletal elements: dystrophin does not appear as a filamentous structure entirely located among subsarcolemmal cytoskeleton but seems partly embedded in membranous material.

Animals↗
PubMed1993

Localization of tenascin in human skin wounds--an immunohistochemical study.

A total of 56 surgically treated human skin wounds with a wound age between 8h and 7 months were investigated. Tenascin was visualized by immunohistochemistry and appeared first in the wound area pericellularly around fibroblastic cells approximately 2 days after wounding. A network-like interstitial positive staining pattern was first detectable in 3-day-old skin wounds. In all wounds with an age of 5 days or more, intensive reactivity for tenascin could be observed in the lesional area (dermal-epidermal junction, wound edge, areas of bleeding). In wounds with an age of more than approximately 1.5 months no positive staining occurred in the scar tissue. In conclusion, for forensic purposes, positive staining for tenascin restricted to the pericellular area of fibroblastic cells indicates a wound age of at least 2 days. Network-like structures appear after approximately 3 days or more. Since tenascin seems to be regularly detectable in skin wounds older than 5 days, the lack of a positive reaction in a sufficient number of specimens indicates a wound age of less than 5 days. The lack of a positive reaction in the granulation tissue of wounds with advanced wound age indicates a survival time of more than about 1.5 months, but a positive staining in older wounds cannot be excluded.

Adolescent↗
PubMed1994

Neural network simulations of the primate oculomotor system. I. The vertical saccadic burst generator.

The performance of a neural network that simulates the vertical saccade-generating portion of the primate brain is evaluated. Consistent with presently available anatomical evidence, the model makes use of an eye displacement signal for its feedback. Its major features include a simple mechanism for resetting its integrator at the end of each saccade, the ability to generate staircases of saccades in response to stimulation of the superior colliculus, and the ability to account for the monotonic relation between motor error and the instantaneous discharge of presaccadic neurons of the superior colliculus without placing the latter within the local feedback loop. Several experimentally testable predictions about the effects of stimulation or lesion of saccade-related areas of the primate brain are made on the basis of model output in response to "stimulation" or "lesion" of model elements.

Animals↗
PubMed1989

Endothelial cell junctional integrity modulation by serotonin: an ultrastructural analysis.

We have reported previously that exogenous serotonin (5-hydroxytryptamine, 5-HT) alters cultured bovine aortic endothelial cell (BAEC) structural integrity by modulating the assembly of stress fibers. In the present study a 5-HT stimulus-coupled change in BAEC junctional integrity was quantitated by determining the width and percentage of intercellular openings in a monolayer. BAEC treated with 5-HT at concentrations of 10(-9) M to 10(-3) M caused a significant dose-dependent decrease in interendothelial cell junctional openings compared to controls, with the greatest reduction induced at 10(-6) M (92% from control). Treatment of BAEC with histamine (10(-4) M) increased the junctional openings by 82% when compared to controls. This change could be prevented by either pretreatment of the monolayers with 5-HT or by adding 5-HT in conjunction with the histamine. To assess a direct interaction of 5-HT with actin filaments, cultured BAEC monolayers were extracted, treated with 5-HT, and processed for immunocytochemical localization of 5-HT using the Avidin-Biotin method. Electron microscopy revealed 5-HT antibody bound to actin filaments and dense in areas of filament intersection, which implies a role for internalized 5-HT in stimulating the assembly of an actin filament network. Collectively, these results suggest that 5-HT helps to regulate the endothelial junctional barrier by promoting actin filament formation and stability, which may in turn increase the junctional apposition between endothelial cells.

Actins↗
PubMedDate not supplied

Reliable disparity estimation through selective integration.

A network model of disparity estimation was developed based on disparity-selective neurons, such as those found in the early stages of processing in the visual cortex. The model accurately estimated multiple disparities in regions, which may be caused by transparency or occlusion. The selective integration of reliable local estimates enabled the network to generate accurate disparity estimates on normal and transparent random-dot stereograms. The model was consistent with human psychophysical results on the effects of spatial-frequency filtering on disparity sensitivity. The responses of neurons in macaque area V2 to random-dot stereograms are consistent with the prediction of the model that a subset of neurons responsible for disparity selection should be sensitive to disparity gradients.

Animals↗
PubMed1990

[Some recent, or claiming to be recent, data on the superficial lymphatic circulation of the limbs].

Superficial collecting lymphatics of the limbs are present in much greater number than deep collecting vessels. There is practically no connexion between both networks. Although lymphatics are abundant distally, they tend to fuse toward the root of the limb. At certain "critical" points along their course, local aggression of the vessels may cause lymphedema. In the lower extremity, at the knee and thigh levels, the "critical" area takes the form of a narrow strip of adipose tissue along the path of the great saphenous vein. In the groin, danger is localized at the inferior superficial inguinal nodes, where the superficial collecting lymph vessels merge. In the upper limb, superficial lymphatics converge towards the base of the axilla, where they form three or four trunks that perforate the clavipectoral fascia, each penetrating through its own orifice. Draining lymphatics may approach the axillary space independently. Unfortunately, the inferior axillary nodes wherein they converge also drain the breast, as can be demonstrated by injecting different coloring materials concurrently in both areas. Excision of nodes draining the mammary gland unavoidably jeopardize superficial lymphatic drainage of the upper extremity.

Arm↗
PubMed1997

The noninvasive identification of language function. Neuroimaging and rapid transcranial magnetic stimulation.

Neuroimaging techniques that rely on detecting alterations in blood flow may be used to map the cortical localization of cognitive function during task performance. O-15 water positron emission tomography studies have mapped neural networks that subserve language function. These techniques have been adapted to lateralize and localize language function in patients with intractable epilepsy prior to epilepsy surgery. Functional magnetic resonance (fMR) imaging, relying upon fast MR imaging techniques performed during cognitive tasks, allows localization of language areas in individual adults and children and, because there is no radiation exposure, allows for additional or repeat studies in patients. These noninvasive means of language localization may supplant the invasive means of language lateralization (intracarotid amytal procedure) and localization (corticography), and will allow for the continued study of language organization in health and disease.

Brain↗
PubMed1997

[Current status of dengue virus infections. Epidemiologic and pathogenetic aspects].

The epidemiology of dengue fever is changing dramatically. The worldwide incidence is rising and clinical symptoms are worsening. Reports describing forms associated with hemorrhage or shock syndrome involving both children and adults are increasingly frequent in regions beyond Southeast Asia where the first cases were observed. Many mechanisms could be implicated in these changes including modifications of the virus, host, vector, or socioeconomic factors. Since no current model allows laboratory analysis of these mechanisms, observation of epidemics is still a major source of data. The findings of well conducted epidemiological studies allow not only assessment of morbidity and mortality in endemic areas and early detection of epidemic outbreaks but also evaluation of socioeconomic impact and effectiveness of control measures. Surveillance techniques must be chosen in function of prevailing local conditions. To ensure reliable results studies should be carried out in collaboration with an international network and a simple and accurate method of disease identification should be used.

Adult↗
PubMed1999

Southern Health Board--advanced telematic/telemedicine in healthcare services in the south west of Ireland.

The Southern Health Board has been involved in Telematic Healthcare services for the past number of years. Our involvement in a number of EU funded projects has given us extensive experience and expertise in this area. The primary focus of our telematic applications is optimising health services delivery with a particular emphasis towards people who are isolated due to social and physical boundaries and limitations. Our main projects are: NIVEMES (Network of Integrated Vertical Medical Services) includes the exchange of medical information between urban centres and isolated communities including those at sea, rural, elderly and disabled persons. RISE (Remote Information Services for the Elderly) focuses on the enhanced healthcare services of the elderly and disabled through the use of telemedical applications. HEALTHLINE To strengthen the successful outcome of Telehealth implementation by specific projects in the EU by providing the expert Training and Information dissemination services to providers, beneficiaries and the general public, using the Telehealth systems and infrastructure applied by those projects. KATE (Killarney & Telecom Eireann) the SHB in conjunction with the Information Age Town Project in Killarney are working towards benefiting the local community through the innovative use of Information and Communication Technologies. TASTE (Technology Assessment in Telemedicine) An EU funded trans-national initiative aimed at developing a methodology for assessing medical technology, particularly in the area of Neurosurgery. FECV (Forward Emergency Control Vehicle) An European Space Agency project through which we are developing an advance communications vehicle for major emergence/event management through Satellite linkage to SHB systems.

Computer Communication Networks↗
PubMed2004

Participatory approaches to improving safety and health under trade union initiative--experiences of POSITIVE training program in Asia.

The participatory, action-oriented training program in occupational safety and health named POSITIVE (Participation-Oriented Safety Improvements by Trade Union InitiatiVE) was established in Pakistan and extended to other countries in Asia. The steps taken in the development of the POSITIVE program included collecting local good examples in safety and health, developing an action-checklist, testing a participatory training program, and conducting follow-up activities to examine local achievements. Training manuals were compiled to provide workers with the practical, easy-to-understand information on safety and health improvements and on the positive roles of trade unions. Trade union trainers trained in the methodology conducted serial POSITIVE training workshops in Pakistan and then in Bangladesh, Mongolia, Nepal, the Philippines and Thailand and recently in China. These workshops resulted in many low-cost improvements at the workplace level. These improvements were carried out in the technical areas of materials handling, workstations, machine safety, physical environment, and welfare facilities. The trade union networks have been vital in reaching an increasing number of grass-root workplaces and in expanding the program to other countries. This included the visits to Mongolia and Thailand of Pakistani trade union trainers to demonstrate the POSITIVE training. The participatory training tools used in the POSITIVE program such as the action checklist and group discussion methods were commonly applied in different local situations. Participatory approaches adopted in the POSITIVE program have proven useful for providing practical problem-solving measures based on the local trade union initiative.

Asia↗
PubMed2001

[Preliminary investigation on the pathogeny, diagnosis and treatment of chondromalacia patella].

This paper presents the preliminary investigation on chondromalacia patella at our department in recent years. A random cluster sampling survey covering 2743 normal persons was carried out. The prevalence rate is 36.2%. It was found that, applying transmission electron microscope and immunohistochemical methods on to cartilage tissues of the abnormal region, articular cartilage necrosis was in direct proportion with the abnormal pressure, while the restoration capability of local chondrocytes was in inverse proportion with pathological changes and the pressure. The chondromalacia patella was produced by repeated abnormal stress acting on the cartilage. The stress derived from the uncongruency and the decreasing in the contact area of patellofemoral joint when the subluxation or tilt of patellae was caused by the abnormal anatomical and biomechanical relationship. The initial lesion was at the matrix of cartilage, the collagen network was disrupted, then proteoglycan was lost. The microenvironment of chondrocytes was changed with degradation of matrix. So the chondrocytes became degenerative and necrosis from superficial to deep layer, then feed back the matrix again. Finally, the total cartilage layer might disappear, and the bone under cartilage might proliferate. At late stage, the cartilage was completely destroyed and had no self-restorative ability. Therefore, early diagnosis and treatment are necessary. It is highly suggested axis radiograph of the knee with the tibiae tuberositas localization are helpful to early diagnosis. Furthermore, JKY-Muscle Rehabilitation Instrument is invented for non-operative therapy. It enhances muscle power by selective training of the vastus medialis muscle using electrical stimulator to relieve pain and correct subluxation of patella with 90% efficiency (63% of excellent-effective rate). In late stage, patellofemoral replacement is recommended. The excellent-effective rate is 86.3%.

Arthroplasty, Replacement, Knee↗
PubMed2001

"They're doing people a service"-qualitative study of smoking, smuggling, and social deprivation.

OBJECTIVES: To examine the behaviour and attitudes related to smoking and contraband tobacco products among smokers in two socially deprived areas. DESIGN: Cross sectional study with qualitative semistructured interviews, augmented by smokers' day grid. SETTING: Two areas of socioeconomic deprivation in Edinburgh. PARTICIPANTS: 50 male and 50 female smokers aged 25-40 years randomly selected from general practitioners' lists from two health centres, each located in an area of deprivation. RESULTS: Most smokers wanted to quit but felt unable to because of the importance of smoking in their daily routine and their addiction to nicotine. Strategies for maintaining consumption levels in the face of increasing cigarette prices and low income included purchasing contraband cigarettes and tobacco. Vendors were contacted through social networks, family, and friends as well as common knowledge of people and places, particularly pubs where contraband was available. Most users of contraband considered that smugglers were providing a valuable service. Purchasing contraband tobacco was viewed as rational in the face of material hardship. Many smokers criticised the government for its high tobacco taxation and the lack of local services to help them to stop smoking. CONCLUSIONS: Smokers in deprived areas perceive a lack of support to help them to stop smoking. Cigarette and tobacco smuggling is therefore viewed positively by low income smokers as a way of dealing with the increasing cost of cigarettes. Smokers in areas of deprivation may thus show little support for tackling smuggling until more action is taken to deal with the material and personal factors that make it difficult for them to quit.

Adult↗
PubMed2000

Right-hemisphere dominance for the processing of sound-source lateralization.

Cortical processing of change in direction of a perceived sound source was investigated in 12 human subjects using whole-head magnetoencephalography. The German word "da" was presented either with or without 0.7 msec interaural time delays to create the impression of right- or left-lateralized or midline sources, respectively. Midline stimuli served as standards, and lateralized stimuli served as deviants in a mismatch paradigm. Two symmetrically linked dipoles fitted to the mismatch fields showed stronger moments in the hemisphere contralateral to the side of the deviant. The right dipole displayed equal latencies to both left and right deviants, whereas left dipole latencies were longer for ipsilateral than contralateral deviants. Frequency analysis between 20-70 Hz and statistical probability mapping revealed increased induced gamma-band activity at 53+/-2.5 Hz to both types of deviants. Right deviants elicited spectral amplitude enhancements in this frequency range, peaking at latencies of 160 and 240 msec. These effects were localized bilaterally over the angular gyri and posterior temporal regions. Coherence analysis suggested the existence of two separate interhemispheric networks. For left-lateralized deviants, both spectral amplitude enhancements at 110 and 220 msec and coherence increases were restricted to the right hemisphere. In conclusion, both mismatch dipole latencies at the supratemporal plane and gamma-band activity in posterior parietotemporal areas suggested a right hemisphere engagement in the processing of bidirectional sound-source shifts. In contrast, left-hemisphere regions responded predominantly to contralateral events. These findings may help to elucidate phenomena such as unilateral auditory neglect.

Acoustic Stimulation↗
PubMed1993

Expression of type XIV collagen during the differentiation of fetal bovine skin: immunolabeling with monoclonal antibody is prominent in morphogenetic areas.

Type XIV collagen belongs to the subclass of fibril-associated collagens with interrupted triple helices, which are composed of alternative triple helical and non-collagenous domains. Structural data show that these molecules interact with collagen fibrils and suggest that they might interact with cells. We have investigated the expression of type XIV collagen in bovine skin during development. Fetuses from 9 to 37 weeks were examined. Anti-type XIV collagen monoclonal antibody was produced, characterized, and used for immunofluorescence detection of the molecule. The localization of immunolabeling was analyzed by comparison with light and electron microscopic observations. In 9-week-old fetus, no type XIV collagen was found in the skin. From 19 weeks to birth, extensive immunofluorescence was observed on bundles of collagen fibrils in deep dermis. As shown by electron microscopy, this area exhibited bundles of collagen fibrils and cells with an abundant rough endoplasmic reticulum. In the upper dermis, a delicate fibrillar network of type XIV collagen was revealed by immunofluorescence around growing hair follicles at 19 and 24 weeks. Double labeling for type XIV collagen and fibronectin shows a more restricted pattern of expression of type XIV collagen in this area. The electron microscopic examination of skin of fetuses at these stages shows that the whole upper dermis is composed by a loose connective tissue containing scattered small bundles of collagen fibrils. Type XIV collagen was synthesized in the upper dermis between 24 weeks and birth. From this study, it appears that type XIV collagen expression is distinct from that of fibrillar collagens, at least during some developmental events. The prominent localization of type XIV collagen around growing hair follicles suggests a role for this molecule in epithelial-mesenchymal interactions.

Animals↗