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Recent results in cophylogeny mapping.

Virtually every problem in biology benefits from consideration within an evolutionary frame work. Parasitism has been part of life ever since one organism was able to provide an environment for another: questions of parasitology naturally lend themselves to consideration of the shared ancient history of parasites and hosts. The derivation of that shared history is therefore an area of great interest to theoreticians and practitioners alike. The most intuitive approach to this is by cophylogeny mapping. Mathematically the problem is that of optimally mapping the dependent tree into the independent one, e.g., parasite into host or gene tree into organismal phylogeny. This article describes some of the recent advances in cophylogenetic simulation, significance testing, and theoretical properties of maps. In simulation the author shows that the number of ways of mapping the parasite phylogeny into that of the hosts does indeed grow exponentially quickly in most cases and shows no close correlation with the similarity between the phylogenies, and that under a simple coevolutionary model, the range of behaviours of simulated parasite phylogenies is extremely broad and would appear to confound efforts to infer model parameters from observed cases. In the area of significance testing the author demonstrates that the maximal number of inferred codivergence events is not necessarily the best statistic for measuring cophylogenetic agreement, and that significance testing by randomisation which does not alter the parasite tree substantially biases results, and provides a new test to determine whether phylogenetic similarity is consistent with preferential host switching.

Animals↗

Effect of tectotomy and decerebration on spontaneous and elicited behavior of tadpoles and juvenile frogs.

The performance of tadpoles and juvenile frogs on a battery of behavioral tests was compared before and after tectotomy, removal of the telencephalon (decerebration), tectotomy in conjunction with decerebration, or before and after a sham operation. Posture, righting, and vestibular responses were not altered by any of the lesions at either stage of development, and gross motor abilities were not impaired. Cutaneous reflex thresholds of tadpoles were lower than those of juveniles prior to surgery, but removal of the tectum or the telencephalon, or of both, reduced the thresholds of juveniles to near-larval levels. All of the lesions abolished characteristic defensive responses of juveniles (freezing) and resulted in hyperreactivity to a wide variety of stimuli. Tectotomy and decerebration of larvae each resulted in a 50% reduction in spontaneous locomotion and, in combination, virtually eliminated spontaneous locomotion. None of the lesions had any effect on the level of spontaneous locomotion of juveniles, but activity elicited by the novelty of the testing environment was eliminated in decerebrate subjects. Visual and vestibular nystagmus consisted of eye movements in tadpoles and of head movements in juveniles. Neither nystagmus nor optokinetic locomotion was affected by any of the lesions at either stage.

Animals↗

Polycythemia and hyperviscosity in the newborn.

Research from the past 15 to 20 years has led to a comprehensive understanding of the etiology and effects of polycythemia and hyperviscosity in the newborn. Polycythemia and hyperviscosity are generally a result of a poor intrauterine environment or hypoxic complications during labor and delivery. Changes in blood viscosity are a direct result of changes in hematocrit because the plasma viscosity in the newborn is virtually always normal. Polycythemia and hyperviscosity are associated with decreases in blood flow to the brain, heart, lung, intestines, and carcass. Renal blood flow is not affected, but renal plasma flow is diminished, resulting in a lower glomerular filtration rate (GFR). The elevated hemoglobin and hematocrit are associated with an increase in the arterial oxygen content. It is the increase in arterial oxygen content, not the hyperviscosity, that is directly responsible for the decreased blood flow in the brain and heart as well as cardiac output. As a result, brain and cardiac oxygenation is normal. Decreased pulmonary blood flow appears to be the result of hyperviscosity and can result in system hypoxia. This can be corrected by a partial exchange transfusion to lower the hematocrit and viscosity. This will also improve renal function by increasing plasma flow. Because the abnormalities in brain function are due to a primary hypoxia event and not reduced cerebral blood flow, a partial exchange transfusion will not improve short-term or long-term abnormalities in neurological functioning.

Blood Viscosity↗

Surgical simulators.

The use of emerging virtual reality technology for surgical skill training has recently attracted a lot of attention. Computerized surgical simulators offer a significant potential for providing a realistic and configurable training environment that bridges the gap between basic training and performing the actual interventions on patients. This paper summarizes the current state of this rapidly developing field and analyses the major problems to be addressed in order to make this technology an indispensable tool for routine clinical training and education.

Journal Article↗

A simulated reality scenario compared with the computerized Wisconsin card sorting test: an analysis of preliminary results.

Neuropsychologists and other clinicians often comment on the minimal relationship that frequently exists between formal assessments of executive functions, analysis of findings, recommendations, and the person's real-life functioning. The authors' believe that current assessments of executive functions do not transfer easily to real-world behavior. There are limitations in the current examinations and in the settings in which they are given. The tests are artificial and the test settings lack the usual stresses, distractions, and multiple demands common to real life. The interactions are unlike what they experience in everyday life. The examiner often, but unintentionally orients the participant to relevant information that in turn can help the person compensate for the difficulties with executive control processes and bias the findings. We believe that virtual reality (VR) more closely approximates real life settings, the distractions, and the common interchanges (VR) provides a "life-like," three-dimensional (3-D) highly interactive environment, and safety from potential dangers that could arise in actual situations. VR can increase motivation because of its gaming, interactive, and immersive qualities and features are easily modified and allow for multiple applications. Our goal is to develop VR assessments that can be administered under controlled and safe conditions, but which are more sensitive to difficulties with executive control processes critical to safe, independent living. This initial study compares several functions assessed by the Wisconsin Card Sorting Test (WCST) with our three-dimensional, stereographic scenario, Look for a Match (LFAM) Study participants completed questionnaires, alternately began with either the WCST or LFAM, and then took the second test. All participants completed motion sickness and follow-up questionnaires. The results demonstrated that the study participants found LFAM to be more enjoyable and interesting, but found the WCST to be easier. While there is an effect of order with participants doing relatively better on the assessment tool administered second, overall the LFAM performance was inferior to that on the WCST. However, even considering the order effect, LFAM seemed to be more difficult than the WCST.

Adolescent↗

WebOnCOLL: medical collaboration in regional healthcare networks.

This paper presents WebOnCOLL, a web-based medical collaboration environment, which has been designed in the context of the regional healthcare network of Crete. WebOnCOLL employs the infrastructure of regional healthcare networks to provide integrated services for virtual workspaces, annotations, e-mail, and on-line collaboration. Virtual workspaces support collaborative concepts like personal web pages, bulletin boards, discussion lists, shared workspaces, and medical case folders. Annotations provide a natural way for people to interact with multimedia content, while e-mail is one of the most popular forms of communication today. On-line collaboration satisfies the need for a more direct form of communication.

Biomedical Technology↗

E-learning for healthcare students: developing the communities of practice framework.

AIM: This paper presents research considering whether healthcare students were able to develop characteristics of communities of practice when engaged in an online module. BACKGROUND: Little is known about whether the communities of practice framework can be applied to online learning, with no previous consideration of its potential use within healthcare education. METHODS: Using a case study approach the research, completed in 2004, had two phases. A questionnaire was administered to a group of 109 healthcare students to gain information on which to base sampling for the subsequent phase. Phase 2 employed three strands of data collection: five students completed an online diary, the online interactions of seven students were captured on a discussion board and three students were interviewed. Data were analysed using a form of pattern matching. FINDINGS: Students were able to develop essential elements of communities of practice: mutual engagement, joint enterprise and shared repertoire, though this was not uniformly seen. Particular issues emerged for the online community, including enabling access to the online environment to support mutual engagement. The development of trust was also threatened by difficulties of presenting identities online. Joint enterprise was hampered by the online situation, although the virtual classroom proved essential for supporting endeavour. Not all students were committed to their groups. There was some evidence of group members developing shared repertoire, as routines of group working emerged. Professional understanding and computer skills were also enhanced. CONCLUSION: The framework can be applied to supporting online learning internationally amongst students and has applicability to professional groups. Those intending to employ the framework should ensure that students can gain access to the community and have the computer skills to engage. Course design should be considered to ensure support for developing the essential components of communities of practice.

Adult↗

Age-related changes in the bone marrow and spleen of SAS/4 mice.

The total number of nucleated cells in the bone marrow of SAS/4 mice increase some twofold between 1 and 24 months of age but when related to body weight remains essentially constant over a wide range of ages. The concentration of CFU-S in femoral marrow is also constant with age and since other bones containing marrow appear, at least in young mice, to have the same CFU-S concentration as the femur it is concluded that the CFU-S compartment size of the whole bone marrow is independent of age when expressed on a body weight basis, In contrast, both the absolute number and the concentration of exogenous CFU-S in the spleen decline markedly in old mice. Smilary there is a decline in the number of endogenous colony-forming cells and the spleens of 24-month-old mice seem virtually devoid of such colonies. Not only were older mice less capable of supporting the growth of endogenous colonies, but their spleens also appear to provide a poorer environment for exogenous colony growth when compared with growth in younger recipient spleens.

Aging↗

The role of the androgen receptor in the development and progression of prostate cancer.

Androgens are essential for the development, growth, and maintenance of the prostate. They exert their effects via the intracellular androgen receptor (AR), which is a ligand-dependent transcription activator. As is the case with normal prostate development, primary prostatic cancers are largely dependent on androgens for growth and survival. Most patients respond favorably to androgen ablation and antiandrogen therapy, which has become a standard treatment of metastatic disease. However, virtually all patients will relapse with clinically defined androgen-independent cancer. This phenomenon raises the question of how cancer cells survive and grow in the low androgen environment? Two of the routes cells can take to adapt are (1) bypassing and (2) sensitizing the AR pathway. The vast numbers of AR abnormalities observed in prostate tumors from patients treated with hormonal therapy suggest that many cells sensitize or change the AR pathway. To continue to activate this pathway in a low androgen environment, cells can (1) mutate the AR to become promiscuously activated by different steroids, (2) amplify the AR, (3) activate the AR in a ligand-independent manner by growth factors and cytokines, or (4) amplify coactivators. Alternatively, prostate cancer cells that have lost AR expression must have bypassed the AR pathway. Activation of oncogenes and autocrine growth factor stimulation are two mechanisms that likely contribute to becoming completely androgen-independent. From all the studies on AR function in prostate cancer, it is clear that the AR plays an important role in cancer development and progression. Moreover, the AR pathway remains important in most cells from patients with clinically defined androgen-independent prostate cancer.

Androgens↗

A haptic model of a bone-cutting burr.

We describe a strategy for collecting experimental data and validating a bone-burr haptic contact model developed in a virtual surgical training system for middle ear surgery. The validation strategy is based on the analysis of data acquired during virtual and real burring sessions. Our approach involves intensive testing of the surgical simulator by expert surgeons and trainees as well as experimental data acquisition in a controlled environment.

Computer Simulation↗

Smart tutor: a pilot study of a novel adaptive simulation environment.

Computer-based learning environments create the possibility of dynamic adaptation to address learner capabilities and user performance. Software algorithms, code-named Smart Tutor, for motor skill learning were developed and applied to an abstract environment for laparoscopic surgery (RapidFire). Smart Tutor dynamically adjusts the environment to minimize frustration and optimize learning conditions for all learners. This study compared the first generation RapidFire / Smart Tutor (RF / ST) to the Minimal Invasive Surgery Trainer Virtual Reality (MIST VR) system for laparoscopic performance improvement and level of frustration. Two groups of novice laparoscopic learners were assessed by pre- and post- training paper cutting exercise and subjective surveys. Users of both systems showed improvement of laparoscopic skills as measured by the paper cutting exercises. No differences were shown between groups for level of improvement. However, a significant difference was seen in the subjective ratings on the post-training survey with less frustration for the RF / ST training group. Important information was acquired for refinements of the Smart Tutor algorithms.

Clinical Competence↗

[Environmental-medical diagnosis and therapy. Hasty diagnosis of unspecified environmental syndromes should be avoided].

In the past ten years environmental medicine has virtually exploded. Major instruments for the interdisciplinary environmental-medical diagnosis are history, on-site inspection, biomonitoring and ambient monitoring. Since the definitive diagnosis of an environment-related disease usually requires a joint evaluation of toxicological, somatic and psychosomatic findings, it is recommended that cooperation with an experienced center for environment medicine should be established early on. By doing so, an inappropriate diagnosis of unspecific environment-medical symptom complexes such as, e.g., multiple chemical sensitivity may be avoided. Such "diagnoses" may result in drastic, and for the patient and his family, often stressful, consequences.

Decision Making↗

The post-translational chemistry and molecular packing of mineralizing tendon collagens.

Using cross-linking stereochemistry as indicators, the molecular environment of two collagens in the turkey leg Achilles tendon were compared. The tendon from one year old turkeys was dissected into nonmineralized, fully mineralized and transitionally mineralized portions. Amino acid composition and cyanogen bromide peptide mapping of these portions indicated that the collagens were essentially type I throughout. The fully mineralized compartment had a lysine hydroxylation level similar to turkey or mammalian bone collagen. The non- and transitionally mineralized collagens had a significantly higher lysine hydroxylation, typical of tendon or ligament. However, unlike mammalian tendon, the collagen cross-links were essentially derived from the carboxy-terminal ends of the molecules. The predominant cross-link in this portion was pyridinoline having a high content of 0.95 +/- 0.09 res/mole of collagen. The cross-links in the fully mineralized collagen were also essentially derived from carboxy-terminal aldehyde. However, here significant amounts of the lysyl analog of pyridinoline and lysine-involved bifunctional cross-links were present. The molecular loci of pyridinoline in nonmineralized collagen and the lysyl analog of pyridinoline in mineralized collagen were found to be identical. The total trifunctional cross-link level in the mineralized collagen, 0.55 +/- 0.05 res/mole of collagen, was virtually identical to that observed in old mammalian bone and dentin, and in long term in vitro incubation studies of predentin. We have tentatively concluded that the post-translational chemistry and molecular environments are different in these two turkey tendon fibrils. However, a relative paucity of amino-terminal based cross-links is a feature they have in common. The possible involvement of the amino-terminal telopeptides in collagen mineralization is discussed.

Amino Acids↗

Eye-tracking in immersive environments: a general methodology to analyze affordance-based interactions from oculomotor dynamics.

This paper aims at presenting a new methodology to study how perceptual and motor processes organized themselves in order to achieve invariant visual information picking-up in virtual immersions. From a head-mounted display, head and eye movements were recorded using tracking devices (magnetic and infrared) that render the six degrees-of-freedom associated with the position and orientation of head movements, and two degrees-of-freedom from one eye. We measured the continuous line of sight's deviation from a pre-selected area on a virtual stimulus. Some preliminary analyses of the dynamical properties of the emergent perceptual and motor patterns are presented as they are considered to be representative of the process of affordance extraction.

Adaptation, Physiological↗

Virtual reality in paraplegia: a VR-enhanced orthopaedic appliance for walking and rehabilitation.

Spinal cord injuries (SCIs) have a profound physical, social and emotional cost to patients and their families. Obviously SCIs severely disrupt normal patterns of interaction with the environment. Firstly, the opportunities for active interaction are inevitably diminished due to motor or sensory impairment. Moreover, such problems may increase as the time since injury lengthens and the patient becomes more withdrawn and isolated in all spheres of activity. However, advances in Information Technology are providing new opportunities for rehabilitation technology. These advances are helping people to overcome the physical limitations affecting their mobility or their ability to hear, see or speak. In this chapter an overview is given of the design issues of a VR-enhanced orthopaedic appliance to be used in SCI rehabilitation. The basis for this approach is that physical therapy and motivation are crucial for maintaining flexibility and muscle strength and for reorganizing the nervous system after SCIs. First some design considerations are described and an outline of aims which the tool should pursue given. Finally, the design issues are described focusing both on the development of a test-bed rehabilitation device and on the description of a preliminary study detailing the use of the device with a long-term SCI patient.

Adult↗

Factors affecting how patients sleep in the hospital environment.

Promoting an environment conductive to sleep in hospital is a challenge. Although patients may appear to sleep in hospital, it may not be refreshing or restorative. The reasons for this can be categorized into three groups: environmental, physiological and psychological. These factors can work concomitantly, making sleep virtually impossible for some patients. Nurses can help their patients by understanding what influences sleep patterns and acting on this knowledge. This may include a variety of interventions, from allowing patients to carry out their own bedtime routine, to explaining to elderly people how their sleeping patterns changes with age.

Health Facility Environment↗

Clinical Decision Support Systems (CDSS) in GRID Environments.

This paper presents an architecture defined for searching and executing Clinical Decision Support Systems (CDSS) in a LCG2/GT2 Grid environment, using web-based protocols. A CDSS is a system that provides a classification of the patient illness according to the knowledge extracted from clinical practice and using the patient's information in a structured format. The CDSS classification engines can be installed in any site and can be used by different medical users from a Virtual Organization (VO). All users in a VO can consult and execute different classification engines that have been installed in the Grid independently of the platform, architecture or site where the engines are installed or the users are located. The present paper present a solution to requirements such as short-job execution, reducing the response delay on LCG2 environments and providing grid-enabled authenticated access through web portals. Resource discovering and job submission is performed through web services, which are also described in the article.

Classification↗

Blurring the boundaries: scenario-based simulation in a clinical setting.

CONTEXT: The ability to perform clinical procedures safely is a key skill for health care professionals. Performing such procedures on conscious patients is challenging and requires a combination of technical and communication skills. We have developed quasi-clinical scenarios, where inanimate models attached to simulated patients provide a convincing learning environment. Procedures are rated by expert observers and by the 'patient' and recorded for subsequent review. This study explores the potential of locating such scenarios within a real clinical setting, allowing participants to experience the challenges of the workplace while ensuring patient safety. An innovative portable digital recording device (the 'Virtual Chaperone') is evaluated for use in clinical settings. METHODS: A qualitative design (observation and interview studies) investigated volunteer medical students undertaking 2 procedure scenarios (insertion of urinary catheter and wound closure with sutures) within the accident unit of a large London hospital. All procedures were observed in real time and recorded digitally (using the Virtual Chaperone). A protocol was used for structured feedback. Observational and interview data was analysed using standard qualitative techniques. RESULTS: Seven sessions with 22 undergraduate medical students took place over 9 months within 1 centre. Data confirmed the feasibility of using a moveable, self-contained training scenario within an authentic clinical setting. Overall, the response from participants was positive. CONCLUSION: Scenario-based teaching within an authentic clinical environment is feasible and perceived by participants to be educationally useful. This approach blurs traditional boundaries between skills laboratory teaching and clinical practice and may offer considerable advantages in training for clinical procedures.

Clinical Competence↗