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Proportional and nonproportional transfer of movement sequences.

Two experiments were designed to determine participants' ability to transfer a learned movement sequence to new spatial locations. A 16-element dynamic arm movement sequence was used in both experiments. The task required participants to move a horizontal lever to sequentially projected targets. Experiment 1 included 2 groups. One group practised a pattern in which targets were located at 20, 40, 60, and 80 degrees from the start position (long sequence). The other group practised a pattern with targets at 20, 26.67, 60, and 80 degrees (mixed sequence). Both groups were tested 24 hours later on the long, mixed, and short sequence. The short sequence was considered a proportional transfer for the long acquisition group because all the amplitudes between targets were reduced by the same proportion. Nonproportional transfer occurred when the amplitudes between targets did not have the same proportions as those for their practice sequence (e.g., long sequence to mixed sequence or vice versa). The results indicated that participants could effectively transfer to new target configurations regardless of whether the transfer required proportional or nonproportional spatial changes to the movement pattern. Experiment 2 assessed the effects of extended practice on proportional and nonproportional spatial transfer. The data indicated that while participants can effectively transfer to both proportional and nonproportional spatial transfer conditions after 1 day of practice, they are only effective at transferring to proportional transfer conditions after 4 days of practice. The results are discussed in terms of the mechanism by which response sequences become increasingly specific over extended practice in an attempt to optimize movement production.

Analysis of Variance↗

How to manage the implementation of shared care: a discussion of the role of power, culture and structure in the development of shared care arrangements.

The Dutch health care sector has become familiar with innovation of care delivery in order to meet the changing demand of the steadily ageing population, in need of complex care. Innovations often concern the implementation of shared care models, implying collaboration and substitution of care. Whereas ageing is a European-wide phenomenon, the development of such new care arrangements can be observed not only in The Netherlands, but also in the UK, Scandinavia, Italy and other countries. In this article we discuss the implementation of shared care, with the help of three concepts: power, culture and structure. We discuss the role of these factors from the view that shared care can be considered as inter-professional working within a network context. The central question is how structure, culture and power can offer change managers a starting-point for improving their innovative capacity. To illuminate our discussion we make use of a number of event-descriptions from five Dutch shared care projects. Also, we give some practical recommendations for change managers.

Aged↗

An approach to setting priorities in health planning.

This paper describes work undertaken in Pakistan within a project to strengthen the health planning system, aimed at improving the capacity of the planning cells to identify priorities and develop broad strategic guidelines. The work starts from the premise that identification of priorities requires two stages. In the first stage, problems must be structured and defined in a way that is accepted by all major stakeholders in the planning process. In the second stage, a transparent process of decision making must exist which will provide the means for the planning group to establish priorities and time-scales. The tools chosen in this instance were selected in relation to the characteristics of the local environment, and the paper describes these.

Decision Making, Organizational↗

Efficacy of long-term growth hormone treatment in Turner's syndrome. European Study Group.

The efficacy of long-term growth hormone treatment and the optimal treatment modalities in Turner's syndrome are still controversial. Studies have shown widely divergent results. While there is still need for results of randomized controlled trials, large uncontrolled trials remain a valuable source of preliminary information. This study of 136 girls with Turner's syndrome (TS) from the European Lilly Turner Study shows that the treatment regimens followed by girls with TS who start GH treatment at a relatively late age (12.9 +/- 2.2 yr) lead at best to a small average gain in final height. Mean gain over initial projected final height was 3.7-4.7 cm, depending on the chosen Turner-specific height-for-age reference data. There was a considerable variation in gains over initial projected final height (range -10.6 to +17.2 cm), which may be partly explained by the existence of good and bad responders. Whether there is a genetic/molecular basis for this and how responsiveness can best be predicted remains an important challenge.

Adolescent↗

[Methodological education and care strategies in basic health care].

This paper discusses methodological and care strategies or tools used in basic health care practice. It is based on the dialogue established between what we think and what we carry out at the Life Quality Promotion Outpatient Centers (APQVs). These centers are located at two basic health care centers in Porto Alegre/RS, Brazil. Its users are mostly adult and elderly patients with long-term illnesses. The proposal of this discussion arose from a research project financed by the Brazilian Council for Scientific and Technological Development--CNPq, and integrates a thematic network called Education and Care Methodologies to Promote Life Quality. Starting from this empirical and conceptual base, methodological tools were built to develop nursing consulting services in outpatient health care to individuals and groups. This article aims to present relational and operational concepts used in care at these services.

Brazil↗

Historical and methodological aspects of computer-assisted medical history-taking.

The purpose is to draw, in a historical perspective, the main outlines of a theoretical and methodological approach of computer-assisted anamnesis (CAA). At the University of Liège (Belgium), studies on CAA were started in 1966, as an extension of previous works in the field of computer-assisted instruction (CAI). A short retrospect of the SIAM-DOCEO Project is given. Various factors contribute to reducing the place physicians effectively assign to history-taking, in spite of its essential role. Non-interactive self-administered questionnaires cope only very partially with that situation. For about 20 years, a number of CAA projects have been set up in many countries. Four basic questions dealing with the diffusion of CAA techniques are examined. (a) It is crucial not to put man-machine interaction and human dialogue on the same footing. A computer is quite unable to understand anything, but it can help health professionals in gathering medical history data. (b) As a rule, a CAA program should intervene in a limited and well defined pathological field, i.e. not too far from the diagnostic stage. (c) Acceptance by patients is very encouraging. (d) In contrast, reactions are mixed among physicians, essentially because of subjective factors. Accuracy and reliability, completeness and relevancy are, as a whole, undeniable qualities of CAA data, but the computer is--hopefully only for a short time--still often perceived more as a competitor than as a tool. The bibliography comprises 84 references.

Diagnosis, Computer-Assisted↗

Ultrastructural justification for the transfer of Pleistophora anguillarum Hoshina, 1959 to the genus Heterosporis Schubert, 1969.

This study presents the ultrastructure of the microsporidian infecting the trunk musculature of Anguilla japonica and originally described as Pleistophora anguillarum Hoshina, 1959. All stages develop within a special structure, the sporophorocyst (SPC), which is equipped with a thick dense wall. This wall grows along with the growth of the parasites within it. Meronts are uni- to binucleate, which divide and steadily give rise to sporonts. During transition to sporonts the cell coat of the meronts increases its thickness, temporarily featuring thick irregular projections. Eventually a uniformly thick sporont wall is formed, then the sporont cells detach themselves from the wall (= future wall of the sporophorous vesicle, SPV) and start a series of divisions to produce sporoblasts. The SPV wall is compact, has no pores and consists of 2 layers. The presence of the SPC justifies the transfer of the species into the genus Heterosporis. Spores from disrupted SPCs are ingested by macrophages and within them are spread into various body tissues including the outermost layers of the epidermis. From here, they can easily be released to the outside and can contaminate the environment while the host is still alive.

Anguilla↗

Functional genomics and gene microarrays--the use in research and clinical medicine.

In the year 2000, the Human Genome Project Consortium presented the first complete draft of the human genome together with Celera Genetics. Since then, the so-called "post-genome era" has started. Microarrays are capable of profiling gene expression patterns of tens of thousands of genes in a single experiment and thus allow a systematic analysis of DNA and RNA variation. They seem likely to become a standard tool of both molecular biology research and clinical diagnostics. These prospects have attracted great interest and investment from both the public and private sectors. This review introduces the principle of microarray technology and gives an overview of its current and future potential in clinical medicine.

Animals↗

[Executive function in Parkinson's disease].

Executive function declines in Parkinson's disease (PD). However, it has not been clearly shown at what stage in PD, this decline starts to occur. We here report a study aiming to answer this question. We conducted Wisconsin Card Sorting Test (WCST) and Trail Making Test A and B (TMT A, B) in three normal control groups (young, adult, and aged) and three PD patients groups (Hoehn & Yahr stage I, II, and III). We intend to analyze at what age or stage the decline in executive function would take place. The score of all the normal subjects and PD patients were 25 points or above by Mini-Mental State Examination. WCST in stage I PD patients (mean age 60.8, n = 9) was essentially same as those of young normal (mean age 23.1, n = 9) and adult normal (mean age 61.5, n = 10) subjects. Elderly normal subjects (mean age 75.8, n = 4) showed a significantly lower mean category achievement score (3.0 as the mean score) and higher numbers of errors and perseverations compared with those of young and adult normal subjects. Stage II (mean age 62.6, n = 8) and III PD (mean age 62.9, n = 8) patients showed significantly lower mean category achievement scores (2.4 and 2.1, respectively as the mean scores) and higher numbers of errors and perseverations compared with those of adult control subjects (5.4 as a mean score). TMT (B-A) in elderly normal subjects revealed significantly longer score (209 seconds as the mean score) compared with those of young and adult normal subjects (20 and 45 seconds, respectively as the mean scores). TMT (B-A) in stage III PD patients was significantly longer (219 seconds) compared with that of adult normal subjects (45 seconds as the mean), however TMT (B-A) in stage II PD patients (102 seconds as the mean) did not show prolongation. TMT (B/A) showed essentially similar results as TMT (B-A), however, stage II PD patients showed significant prolongation compared with that of normal adult subjects. Therefore, TMT (B/A) appears to be a more sensitive indicator of decline in executive function in PD. Between WCST and TMT, the former appeared to be a more sensitive indicator. Our results indicate that the decline in executive function takes place in normal ageing. In PD, this decline starts much earlier than the normal subjects. The onset in this decline coincides with the stage of PD, in which bilateral symptoms start to present. Anatomo-chemical subsrate of cognitive decline in PD is still to be debated, however, we believe that involvement of nigro-caudatal projection is at least in part responsible, as nigroputaminal pathway is mainly involved in motor functions. We also point out the importance of age factor in the evaluation of cognitive-executive function in PD, as this function is age-dependent in normal subjects.

Adult↗

New benchmarks and design criteria for laboratory consolidations.

Benchmarks and design criteria previously used for planning consolidated laboratories such as bed size, staffing, and test volumes no longer apply. To achieve greater operational efficiencies, consolidated laboratories should be designed with open, flexible, and adaptable space using work flow/workstations, instrumentation requirements, and the degree of automation as the key design criteria. The primary objective of most consolidations is the reduction of staff with a substantial increase in workload. A critical factor when planning a consolidated laboratory is the ability of the space to accommodate the increase in testing and procedures to serve multiple facilities and growing outreach programs with fewer FTEs. Designing the laboratory starts with a thorough evaluation of work flow, testing procedures, desired adjacencies, and relationships within the laboratory. An area analysis should be developed describing in detail projected space requirements. Consideration should be given for the incorporation of automation/robotics and new, more efficient, and comprehensive instrumentation. Safety, noise, vibration control, lighting, and engineering support systems are all critical issues that also must be effectively addressed and incorporated into the design. Specific issues that will be discussed at this program include projected space requirements; review and development of existing and projected workstations; equipment requirements; lighting options; workload and procedures review; staffing procedures; flexibility/adaptability; relationships and adjacencies; flow diagrams; plan development; cost implications, on-site versus off-site facilities; and new construction versus renovation construction cost comparisons. Using specific examples from consolidated laboratory projects, we have designed a case study presentation by the laboratory director from a recently completed laboratory consolidation project serving a multihospital system. We will discuss the new design criteria and benchmarks that must be established to create a functional, operationally efficient, and profitable laboratory consolidation.

Automation↗

[High speed cinematographic analysis of subglottal mucosal vibration during experimentally induced phonation in excised larynges].

Twenty-seven excised canine larynges and two excised human larynges fixed on a wall of a specially constructed glass box, were blown on and the subglottal mucosal vibrations were photographed using high speed cinematography from the tracheal side. Each film was repeatedly projected at normal speed and analyzed frame by frame. Mucosal upheaval appeared between the anterior commissure and the vocal process. The mucosal wave or "traveling wave" started from the mucosal upheaval and propagated medially and upward. The mucosal upheaval vibrated with a small amplitude and with an earlier phase than any other portion of the vocal fold. Increase of air flow resulted in increased amplitude of the free edge excursion. The mucosal upheaval seemed to shift more laterally after the increase of air flow. But judging from the positional relations between the mucosal upheaval and markers, the origin of the mucosal upheaval was the same despite the increase of air flow. After the increase of vocal fold tension by cricothyroid approximation, the mucosal wave occurred within the limited area near the vocal edge. The mucosal upheaval was located more medially as compared to the original position. The mucosal upheaval appeared on what was actually the superior portion of the vocal fold. Direct electrical stimulation of the thyroarytenoid muscle (TA) bulged the lower surface of the vocal fold medially, and narrowed the subglottic area surrounded by bilateral mucosal upheavals during vibration. The mucosal upheaval seemed to shift more medially after stimulation of TA, but combined with the movements of the marker, the mucosal upheaval appeared on a more inferior portion of the vocal fold compared to its position before the stimulation. Thus, a more dynamic mucosal wave appeared in the vertical direction. Histological examination revealed that the mucosal upheaval arose on the lower surface of the vocal fold, slightly above the area where the muscular layer came close to the epithelial layer. After the cricothyroid approximation, the mucosal upheaval occurred in a more upward area where the lamina propria was thicker. In addition, after stimulation of the TA, the mucosal upheaval was located in the area where the muscular layer was thick under the epithelial layer.

Animals↗

Regional water quality management for the Dong Nai River Basin, Vietnam.

A three-year study that started solely as an industrial pollution reduction effort in Dong Nai Province of Vietnam expanded into an ongoing regional river basin water quality management effort. The project was a cooperative effort between the United Nations (UNDP and UNIDO) and the Federal and Provincial governments in Vietnam. A comprehensive approach was used to assess the impacts and strategies for reducing industrial, municipal and agricultural pollution to the water, air and land. The strategy was based upon use of knowledge in four subject areas, economics, ecology, technology and institutions, integrated within a framework for regional environmental quality management, sometimes called Areawide Environmental Quality Management (AEQM). Dong Nal Province encompasses a major developing area immediately north of Ho Chi Minh City. The land area chosen for the AEQM study is the 1,400 square kilometre region in and around Bien Hoa that drains into the Dong Nai River. The Dong Nai River serves many purposes including navigation, fisheries and a water supply for both the Province and Ho Chi Minh City. Extensive industrial and residential development was underway and was projected to increase in the coming decade. A strategy for the control of pollution from liquid, gaseous and solid wastes for the period 1998 to 2010 in Dong Nai Province was developed.

Agriculture↗

Developing a health informatics policy for South Africa.

In a developing country, is it possible to produce a comprehensive national policy for health informatics in a rational and democratic way? This report argues that it is--if close attention is paid to the process of policy development. Although we have recently started our journey down this road, it is possible to draw useful conclusions. With sufficient funding to cover meeting costs and a supportive environment, such a project has a good chance of succeeding. The process should involve key stakeholders; agreement on definitions, purpose and scope should be obtained early. The policy should contain a strategy for implementation, measurable goals, plans for training and long term maintenance, and specifications for regular review. Health information systems should not be promoted as panaceas. Debates arising from the policy development process should promote realistic expectations shared by policy makers, system implementers, and managers. The process itself has significant benefits for the participants who both learn and establish networks with other people. Although developing countries depend on aid from international agencies, unexpected management problems may arise.

Health Policy↗

Telemedicine and developing countries. A report of study group 2 of the ITU Development Sector.

While there are significant potential advantages and benefits from telemedicine, the evidence of its cost-effectiveness and sustainability is meagre. This is because much of the telemedicine activity so far has been in the form of pilot projects of demonstrations in universities and hospitals with subsidized funding from government or other sources. The number of self-sustaining, commercial applications of telemedicine is still very small. Telemedicine undoubtedly yields cost savings in certain circumstances, but often the savings and benefits accrue to those who do not have to pay for the service. Thus, few service providers have found a way to recover their costs (and make a profit) from those to whom they provide their service. Even fewer countries have actually budgeted for the provision of telemedicine as a service widely available to their citizens. Nevertheless, with the rapidly declining cost in hardware and telecommunications, the level of interest and the corresponding activity in telemedicine is rising rapidly. Most of the telemedicine experience to date has been in the industrialized world. It is apparent that the first requirement of developing countries is for more information about telemedicine, what it is, and how it might be able to help solve some of the shortages in medical and health care. Given the potential of telemedicine to facilitate the provision of medical information and health care in rural areas, it seems useful for developing countries to undertake pilot projects in order to evaluate its potential and cost-benefits. The results of such pilot projects could be part of the development of a national health for all policy which takes telemedicine into account. In view of the other priorities of developing countries, especially those of the least developed countries, financing telemedicine activity is likely to remain a challenge for some time to come. Funding from external donor agencies may well be necessary, but local commitment and participation in pilot projects is essential if the project is to have a chance of success. As telemedicine requires a multidisciplinary approach, the active participation of telecommunication operators must be assured. Despite some false starts in the deployment of telemedicine as a continuing service to the general population--as opposed to a few well-to-do clients--telemedicine has great potential to improve access to health care and to contain costs in developing countries.

Computer Communication Networks↗

Epidemiology and prevention of arterial hypertension in Poland.

The authors review the present situation in epidemiology and prevention of arterial hypertension in Poland. In 2002, the NATPOL PLUS survey on representative sample of adults (n=3051, age range 18-93) was conducted. Prevalence of hypertension, diagnosed on basis of three separate visits, was 29%, awareness 67% and efficacy of treatment 12.5%. Thus, in Poland, one-third of 8.6 million hypertensives are unaware of their disease. A comparison with data from other countries should be careful due to the different methods (age range, number of readings and visits) used in the studies. The data, in concert with a decrease in awareness of one's own blood pressure (from 71% in 1994 to 59% in 2002), called for urgent preventive measures. Two large interventions were implemented under the National Programme POLKARD in 2003: the Polish 400 Cities Project aimed to increase detection and knowledge of hypertension and other risk factors among small-town and village communities, and the educational project, A Chance for the Young Heart targeted at children aged 11-14 years and using traditional teaching methods and an interactive Internet website. Also, an educational and marketing programme targeted at public opinion leaders and decision makers (trade unions, local governments, healthcare financing authorities, print media and radio, the Polish Parliament) started in 1999 and is still in process.

Adult↗

Distribution of hypothalamic neurons projecting to the thoracic and sacral spinal segments in the cat.

The distribution of hypothalamic neurons participating in hypothalamo-spinal projections (hypothalamo-spinal HSP neurons) to the thoracic and sacral segments was studied using the technique of retrograde axonal transport. Horseradish peroxidase (HRP) and nuclear yellow (NY) were injected into various thoracic and/or sacral spinal cord segments. The retrogradely labeled cells were distributed in a continuous crescent-shaped field in the posterior, dorsolateral and lateral regions of the hypothalamus: starting from the ventral tegmental area (VTA), through the posterior hypothalamic nucleus (PH), the supramammillary nucleus (SM), the dorsal- and lateral hypothalamic area (AH1) and LH), the dorsomedial nucleus (DM) as well as in the paraventricular nucleus (PV). Neurons in all of the above hypothalamic nuclei project as caudally as to the sacral segments. The projection is bilateral and the contralaterally projecting fibres cross the midline at or near their termination site. Projection to thoracic segments is mainly ipsilateral. HSP neurons projecting to upper thoracic and sacral segments showed different patterns of distribution. A sacral injection resulted in most labeled neurons in the SM and LH and less labeled neurons in the PV, than a thoracic injection of comparable size and locations. Experiments with two tracer substances suggested that some of HSP neurons had divergent axon collaterals terminating both in thoracic and sacral spinal segments.

Animals↗

Mass screening for control of breast cancer.

The serious import of breast cancer lies in its potential for metastatic spread, which probably starts early in the course of the disease. Detection of the lesion when immunocompetence can control the metastases leads to long-term survival. This usually involves detection of unsuspected, preclinical disease. This is the important lesson learned from the large screening program of the Health Insurance Plan of New York, where they used palpation and mammography. The substantial reduction in mortality over a matched control group has continued in a 15-year follow-up. Improved mammography techniques at the Guttman Institute, a mass screening project in New York, New York, conducted in cooperation with the American Cancer Society and in the Breast Cancer Detection Demonstration Project, which used the Guttman Institute program as a prototype, have led to substantially improved yield from mammography in screening. Three important factors in mass screening are discussed: (1) benefits versus hazards in mammography, (2) correct age to start screening, and (3) costs of screening.

Adult↗

Towards linking patients and clinical information: detecting UMLS concepts in e-mail.

The purpose of this project is to explore the feasibility of detecting terms within the electronic messages of patients that could be used to effectively search electronic knowledge resources and bring health information resources into the hands of patients. Our team is exploring the application of the natural language processing (NLP) tools built within the Lister Hill Center at the National Library of Medicine (NLM) to the challenge of detecting relevant concepts from the Unified Medical Language System (UMLS) within the free text of lay people's electronic messages (e-mail). We obtained a sample of electronic messages sent by patients participating in a randomized field evaluation of an internet-based home care support service to the project nurse, and we subjected elements of these messages to a series of analyses using several vocabularies from the UMLS Metathesaurus and the selected NLP tools. The nursing vocabularies provide an excellent starting point for this exercise because their domain encompasses patient's responses to health challenges. In successive runs we augmented six nursing vocabularies (NANDA Nursing Diagnosis, Nursing Interventions Classification, Nursing Outcomes Classification, Home Health Classification, Omaha System, and the Patient Care Data Set) with selected sets of clinical terminologies (International Classification of Primary Care; International Classification of Primary Care- American English; Micromedex DRUGDEX; National Drug Data File; Thesaurus of Psychological Terms; WHO Adverse Drug Reaction Terminology) and then additionally with either Medical Subject Heading (MeSH) or SNOMED International terms. The best performance was obtained when the nursing vocabularies were complemented with selected clinical terminologies. These findings have implications not only for facilitating lay people's access to electronic knowledge resources but may also be of assistance in developing new tools to aid in linking free text (e.g., clinical notes) to lexically complex knowledge resources such as those emerging from the Human Genome Project.

Artificial Intelligence↗