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T Becker

Publications and source records attributed to T Becker.

At least 91 records · Page 5Linked to original sources
PubMed2000

Sleep position, bedding and heating practices in high- and low-risk ethnic groups for unexpected death in infancy (UDI).

UNLABELLED: In a previous study, a significant increased risk for unexpected death in infancy (UDI) among Arab infants as compared to Jews (RR: 5.2) was found. The incidence has significantly decreased in both groups during the 'back to sleep' campaign. The objective of this study was to compare the prevalence of three risk factors, i.e. positioning, night dressing/covering and heating practices in these ethnic groups. A community sampling procedure was employed, resulting in the participation of 264 Jewish and 146 Arab mothers of infants between 1 and 4 months, born at term and with no chronic illness at the time of the study. A questionnaire in Arabic and Hebrew was designed, pertaining to sleep positioning at the time of the study and of the previous infant, prior to the SIDS prevention campaign, as well as clothing and heating practices. Significantly, more Arab infants were put to sleep in a supine or side position as compared to Jewish infants both during the study (p = 0.002) as well as prior to the SIDS campaign (p = 0.001). No ethnic difference was related to clothing practices. Open heating, however, was significantly more common in the Arab sector (p = 0.001). A logistic procedure for each of the practices indicated that ethnicity is related significantly to both sleep position (p = 0.002) and beating practices (p = 0.001). Prone sleep positioning was still prevalent (32.2%) more so among Jews (35.2%) than Arabs (27%). CONCLUSION: Sleep positioning and overdressing do not appear to be the major attributable risk factors for UDI among Arab infants as compared to Jews. The compliance with positioning recommendations is lower than expected in both ethnic groups.

Arabs↗
PubMed2000

American College of Cardiology/ European Society of Cardiology international study of angiographic data compression phase II. The effects of varying JPEG data compression levels on the quantitative assessment of the degree of stenosis in digital coronary angiography.

OBJECTIVES: This report describes whether lossy Joint Photographic Experts Group (JPEG) image compression/decompression has an effect on the quantitative assessment of vessel sizes by state-of-the-art quantitative coronary arteriography (QCA). BACKGROUND: The Digital Imaging and Communications in Medicine (DICOM) digital exchange standard for angiocardiography prescribes that images must be stored loss free, thereby limiting JPEG compression to a maximum ratio of 2:1. For practical purposes it would be desirable to increase the compression ratio (CR), which would lead to lossy image compression. METHODS: A series of 48 obstructed coronary segments were compressed/decompressed at CR 1:1 (uncompressed), 6:1, 10:1 and 16:1 and analyzed blindly and in random order using the QCA-CMS analytical software. Similar catheter and vessel start- and end-points were used within each image quartet, respectively. All measurements were repeated after several weeks using newly selected start- and end-points. Three different sub-analyses were carried out: the intra-observer, fixed inter-compression and variable inter-compression analyses, with increasing potential error sources, respectively. RESULTS: The intra-observer analysis showed significant systematic and random errors in the calibration factor at JPEG CR 10:1. The fixed inter-compression analysis demonstrated systematic errors in the calibration factor and recalculated vessel parameter results at CR 16:1 and for the random errors at CR 10:1 and 16:1. The variable inter-compression analysis presented systematic and random errors in the calibration factor and recalculated parameter results at CR 10:1 and 16:1. Any negative effect at CR 6:1 was found only for the calibration factor of the variable inter-compression analysis, which did not show up in the final vessel measurements. CONCLUSIONS: Compression ratios of 10:1 and 16:1 affected the QCA results negatively and therefore should not be used in clinical research studies.

Cardiology↗
PubMed2000

American College of Cardiology/ European Society of Cardiology international study of angiographic data compression phase III. Measurement Of image quality differences at varying levels of data compression.

OBJECTIVES: We sought to investigate up to which level of Joint Photographic Experts Group (JPEG) data compression the perceived image quality and the detection of diagnostic features remain equivalent to the quality and detectability found in uncompressed coronary angiograms. BACKGROUND: Digital coronary angiograms represent an enormous amount of data and therefore require costly computerized communication and archiving systems. Earlier studies on the viability of medical image compression were not fully conclusive. METHODS: Twenty-one raters evaluated sets of 91 cine runs. Uncompressed and compressed versions of the images were presented side by side on one monitor, and image quality differences were assessed on a scale featuring six scores. In addition, the raters had to detect pre-defined clinical features. Compression ratios (CR) were 6:1, 10:1 and 16:1. Statistical evaluation was based on descriptive statistics and on the equivalence t -test. Results At the lowest CR (CR 6:1), there was already a small (15%) increase in assigning the aesthetic quality score indicating "quality difference is barely discernible-the images are equivalent.' At CR 10:1 and CR 16:1, close to 10% and 55%, respectively, of the compressed images were rated to be "clearly degraded, but still adequate for clinical use' or worse. Concerning diagnostic features, at CR 10:1 and CR 16:1 the error rate was 9.6% and 13.1%, respectively, compared with 9% for the baseline error rate in uncompressed images. CONCLUSIONS: Compression at CR 6:1 provides equivalence with the original cine runs. If CR 16:1 were used, one would have to tolerate a significant increase in the diagnostic error rate over the baseline error rate. At CR 10:1, intermediate results were obtained.

Adult↗
PubMed2000

Common and epithelioid variants of hepatic angiomyolipoma exhibit clonal growth and share a distinctive immunophenotype.

Angiomyolipoma represents a rare liver tumor of uncertain histogenesis that is commonly considered a hamartoma. A series of 12 hepatic angiomyolipomas, including 3 samples of the epithelioid subtype, was analyzed for clonality using the human androgen receptor gene locus (HUMARA). Four of 6 informative cases revealed monoclonality. The polyclonal pattern in the 2 remaining cases was most probably caused by excessive infiltration of inflammatory cells. Monoclonality with an identical X-chromosomal inactivation pattern in all nodules was found in a multifocal recurrent tumor indicating a metastatic process. Despite the morphologic heterogeneity, all tumors displayed an identical immunohistochemical labeling pattern. It is concluded that different subtypes of hepatic angiomyolipoma exhibit a monoclonal and hence probably neoplastic growth and share an identical immunophenotype suitable for their identification even in small biopsy specimens. The epithelioid subtype may give rise to intrahepatic metastasis.

Adult↗
PubMed2000

[The role of diffuse axonal injury in psychiatric assessment of brain-head trauma].

The concept of diffuse axonal injury is presented and the relevance in medicolegal assessment of brain injured patients is discussed. The lesion pattern of diffuse axonal injury not only plays a significant role in the acute management and rehabilitation of brain injured patients but also in issues of litigation. Brain imaging techniques are most important in the evaluation of structural damage to the brain and play a pivotal role in the detection of diffuse axonal injury. While computer-tomography follow-up studies may be valuable for the detection of diffuse axonal injury, magnetic resonance imaging is superior due to better sensitivity and contrast-resolution. The article presents selected case studies and illustrates the different lesion patterns.

Axons↗
PubMed2000

Introducing residents to a career in management: the Physician Management Pathway.

To prepare their students and residents for the practice of medicine in a rapidly changing environment, medical educators must teach the business of medicine as well as the science and art of medicine. Recognizing the value of and demand for physician leaders, the authors sought to introduce residents to diverse aspects of medical administration within the context of an academically rigorous internal medicine residency program. The Physician Management Pathway (PMP) was developed in 1997 to expose interested residents to the management concepts employed by physician managers; to help physician trainees begin to develop the leadership and technical skills they will use as physician managers; to provide career mentoring; to provide experiences that enrich the resident's training in clinical medicine; to enhance resident-directed educational activities; and to produce physicians who can successfully work in any health care environment. The PMP curriculum consists of a monthly seminar series, a preceptorship experience in the second year of residency, and a supervised project in the third year. The program was not designed to provide competency in management, but rather is intended to provide an opportunity for new physicians to explore options in this exciting and changing profession.

Curriculum↗
PubMed2000

Return visits to the emergency room after minor trauma from motor vehicle accidents.

Most patients with minor trauma following motor vehicle accidents (MVAs) are discharged from the emergency room (ER) of a trauma centre after evaluation and observation. Some return with similar or additional symptoms. This study aimed to determine which patients returned, if any injuries had been missed, and what should be the policy of medical management. We reviewed the records of 8836 patients with minor trauma following MVAs who were examined in an inner city trauma centre during 1997. When the group of patients who returned to the emergency room (n = 160) was compared with the whole post-MVA minor trauma group, the former was found to have more males (75.6% vs. 55.9%), younger age (36.31 years vs. 39.72 years), more motorcyclists than drivers, passengers and pedestrians ( p < 0.002, for the three variables), and had more multi-site injures. During the return visits the patients stayed longer in the emergency room, were examined by more consultants and had repeated radiological evaluations and tests, compared with the initial visit. However, in none of the patients was the initial diagnosis revised nor were additional injuries found and consequently the initial management was not changed in any of them. It is concluded that the initial thorough evaluation by the primary traumatologist is adequate for MVA patients with minor trauma. These patients do not require any follow up in specialized clinics, and are best managed in the community by their general practitioners.

Accidents, Traffic↗
PubMed2000

Rudolf Karl Freudenberg - from pioneer of insulin treatment to pioneering social psychiatrist.

Rudolf Karl Freudenberg was Physician Superintendent at Netherne Hospital, Couldsdon, Surrey from 1951 to 1973. In his work as superintendent and government adviser he made important contributions to mental hospital reform and to the establishment of community psychiatric services in Britain. Earlier, in Vienna and following emigration to Britain, he was one of the pioneers of insulin coma treatment with a series of publications on this topic. The paper gives an account of published papers of both phases, and it highlights the background to Freudenberg's shift in professional interest from physical to social intervention. It argues that the change of emphasis reflects important general trends, i.e. profound change due to new forms of physical treatment on the one hand and similarly convincing evidence of the impact of social factors on clinical course and outcome on the other hand.

Austria↗
PubMed2000

Aims, outcome measures, study sites and patient sample. EPSILON Study 1. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

BACKGROUND: Cross-national research into the care of people with severe mental illnesses is hampered by a lack of standardised measures. The European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study is a European Union funded project within the BIOMED-2 programme. The project aims to develop standardised instruments to facilitate future cross-national research. AIMS: To describe the aims, outcome measures, study sites and patient samples of the EPSILON Study. METHOD, RESULTS, CONCLUSIONS: See companion papers in this supplement.

Adolescent↗
PubMed2000

Translation and cross-cultural adaptation of outcome measurements for schizophrenia. EPSILON Study 2. European Psychiatric Services: Inputs Linked to Outcome Domains and Needs.

BACKGROUND: Research on the comparison of mental health services has identified the need for internationally standardised and reliable measurements. AIMS: To describe the strategies adopted in the European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) Study for the translation and cross-cultural adaptation of five European versions of the instruments. METHOD: A protocol was developed for translation of the outcome scales, describing each step in the translation procedure. Disputed items were discussed in focus groups, which faced seven tasks: a list of topics to be discussed; choosing where the group should meet; composition of participants; conducting the group; data collection; data completion afterwards; reporting results. RESULTS: Modifications made to instruments were: changes in the instrument structure, contents and concepts; adjustments to the instrument structure; and modifications to the instrument manual. CONCLUSION: Use of focus groups is an adequate method to apply if concepts, constructs and translation issues are to be addressed; otherwise, less time-consuming methods should be considered.

Cross-Cultural Comparison↗
PubMed2000

Characterization of a receptor for heat shock protein 70 on macrophages and monocytes.

Heat shock proteins (Hsps) and molecular chaperones isolated from tumors or virally infected cells elicit an efficient CD8+ T cell response against bound antigenic peptides. This immune response is mediated by presentation of the peptides on MHC class I complexes of antigen-presenting cells (APCs), but the cellular mechanism of this presentation process is not yet understood. Here we provide evidence for the existence of a proteinaceous receptor on the surface of APCs that is specific for mammalian Hsp70. Using a flow cytometry-based assay, saturable binding of Hsp70 to the cell surface of macrophages and peripheral blood monocytes, but not of lymphocytes, can be demonstrated. The affinity of the receptor is in the sub-micromolar range (Kd < 100 nM). Only mammalian Hsc70/Hsp70, but not bacterial Hsp70, is bound with high affinity. Subsequent to binding, Hsp70 is taken up by endocytosis, resulting in an intracellular localization. Our results suggest that receptor-mediated endocytosis forms the basis for the demonstrated efficacy of Hsp70-peptide complexes as anti-tumor vaccines.

Animals↗
PubMed2000

[Standardized documentation system for the complementary sector of psychiatric care. Development and trial in Saxony].

The necessity for a standardized documentation system for the complementary sector of psychiatric care is pointed out, and the goals and requirements to be met are debated. The test-version of such a documentation system (abbrev. BADO-K) is shown. It consists of modules for the assessment of client-centered data, and for the documentation of the treatment process in various facilities. Furthermore, a module of questionnaires and instruments for assessing outcome variables (e.g. quality of life) is integrated. The principles for using the paper-pencil-version and the EDP-version are outlined and discussed with regard to the legal regulations concerning the protection of personal data. Finally, possibilities and limitations of the presented documentation system are discussed. It is argued that the BADO-K is an useful instrument for evaluating the process and outcome of community psychiatric care.

Community Mental Health Services↗
PubMed2000

[Limits of deinstitutionalization: experience in England].

Psychiatric reform and the current system of mental health care in England are outlined, the system context of the National Health Service (NHS) is described. Recent institutional change in the NHS has introduced internal market elements. More than 90 mental hospitals have been closed. The TAPS study, a longitudinal study evaluating mental hospital closure is described. Results show a range of advantages of the post-discharge care arrangements. Studies evaluating services with a home treatment and community focus (DLP, PRiSM) suggest that community mental health care is feasible. Shortages and problems of the current system of care (acute beds, intensive residential and rehabilitation services) are outlined.

Community Mental Health Services↗
PubMed2000

[Work profile of social work in inpatient psychotherapy. Clinical fields and social rights implications].

OBJECTIVES: The task profile of social work in (acute) inpatient psychotherapy--unlike psychiatric inpatient treatment--is only fragmentarily described by the so-called Psychiatrie-Personalverordnung (Psych-PV). The aim of the present investigation was, therefore, to provide valid and representative data to define its respective scope of duties. METHODS: During a prospective one-year assessment at the Department of Psychotherapy and Behavioral Medicine at the Philipps-University of Marburg/Germany, we recorded corresponding data of social work referring to three areas of interest, i.e., "education and occupation", "housing and family", and "psychotherapy support". RESULTS: Our data suggest a broad overlap with the corresponding task profile of social work at psychiatric hospitals, which clearly differs, however, from the more therapeutical approach in social work as practiced in Anglo-American countries. CONCLUSIONS: Our findings stress the need for a re-evaluation of social work in inpatient psychotherapy concerning its specific task profile and the respective time values.

Adolescent↗
PubMed1999

Tenascin-R inhibits the growth of optic fibers in vitro but is rapidly eliminated during nerve regeneration in the salamander Pleurodeles waltl.

Tenascin-R is a multidomain molecule of the extracellular matrix in the CNS with neurite outgrowth inhibitory functions. Despite the fact that in amphibians spontaneous axonal regeneration of the optic nerve occurs, we show here that the molecule appears concomitantly with myelination during metamorphosis and is present in the adult optic nerve of the salamander Pleurodeles waltl by immunoblots and immunohistochemistry. In vitro, adult retinal ganglion cell axons were not able to grow from retinal explants on a tenascin-R substrate or to cross a sharp substrate border of tenascin-R in the presence of laminin, indicating that tenascin-R inhibits regrowth of retinal ganglion cell axons. After an optic nerve crush, immunoreactivity for tenascin-R was reduced to undetectable levels within 8 d. Immunoreactivity for the myelin-associated glycoprotein (MAG) was also diminished by that time. Myelin was removed by phagocytosing cells at 8-14 d after the lesion, as demonstrated by electron microscopy. Tenascin-R immunoreactivity was again detectable at 6 months after the lesion, correlated with remyelination as indicated by MAG immunohistochemistry. Regenerating axons began to repopulate the distal lesioned nerve at 9 d after a crush and grew in close contact with putative astrocytic processes in the periphery of the nerve, close to the pia, as demonstrated by anterograde tracing. Thus, the onset of axonal regrowth over the lesion site was correlated with the removal of inhibitory molecules in the optic nerve, which may be necessary for successful axonal regeneration in the CNS of amphibians.

Animals↗
PubMed1999

Depression in Parkinson's disease: brainstem midline alteration on transcranial sonography and magnetic resonance imaging.

Recent studies using transcranial sonography (TCS) have provided evidence of alterations in the mesencephalic midline structures in patients with unipolar depression and depression in Parkinson's disease (PD), suggesting an involvement of the basal limbic system in primary and secondary mood disorders. This study tested the hypothesis of brainstem midline abnormality in depression and investigated 31 PD patients by magnetic resonance imaging (MRI) and TCS. Signal intensity of the pontine and mesencephalic brainstem midline was rated on T2-weighted images and measured by relaxometry. In addition, two blinded investigators assessed the echogenicity of the brainstem midline by TCS. The severity of motor symptoms and depression were graded independently using standard research scales. Rating of signal intensity and T2 relaxometry of the pontomesencephalic midline structures revealed significant difference between depressed and nondepressed PD patients (P < 0.05). This corresponded to a significant reduction in mesencephalic midline echogenicity of depressed PD patients on TCS images. No correlation was found between raphe signal intensity, T2 relaxation times, or TCS echogenicity and the severity of motor symptoms or depression. This study is the first to show changes in signal intensity and T2 relaxation time of the pontomesencephalic midline structures on MRI in depressed PD patients confirming previous TCS findings. As these midline structures comprise fiber tracts and nuclei of the basal limbic system, the findings may support the hypothesis of an alteration in the basal limbic system in mood disorders.

Aged↗
PubMed1999

Postoperative neuroimaging of high-grade gliomas: comparison of transcranial sonography, magnetic resonance imaging, and computed tomography.

BACKGROUND: A precise and comprehensive knowledge of tumor burden and its extent and growth pattern in the pre- and postsurgical states is required to optimize tumor therapy and to determine treatment success and failure. This prospective study compares the diagnostic potential of computed tomography (CT), magnetic resonance imaging (MRI), and transcranial sonography (TCS) in the postoperative follow-up of brain tumors. METHOD: Twenty-six patients with high-grade gliomas were included in the study. After tumor debulking, a total of 31 biopsy specimens were obtained from the resection margin in 21 patients and histological findings were compared with the findings of early postoperative TCS, CT, and MRI. Findings indicating residual tumor tissue were nonlinear contrast enhancement at the resection site revealed by CT or MRI or hyperechogenic lesions revealed by TCS. Follow-up examinations using all three imaging techniques were performed every 3 months. The end points of the follow-up were tumor recurrence as defined by CT and MRI, death, or severe clinical deterioration. RESULTS: On the basis of the above criteria, TCS identified residual tumor more often than did CT or MRI. In the group of 19 patients with histologically proven tumor remnants, residual tumor tissue was identified by TCS in all patients, whereas MRI and CT failed to show contrast enhancement in three and eight patients, respectively. However, the results of the TCS were false positive for one patient because of hemorrhage into the resection site. The average time to identification of tumor regrowth was 27 weeks using TCS, 29 weeks using CT, and 33 weeks using MRI. Only the differences between TCS and MRI reached statistical significance. For one patient, multicentric tumor recurrence was not detected using TCS. CONCLUSION: TCS may complement CT and MRI in the postoperative follow-up of patients with high-grade gliomas. Because none of these modalities alone is both sensitive and specific, an integrated analysis of imaging findings is recommended.

Adult↗