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PubMedDate not supplied

The HL7 Clinical Document Architecture.

Many people know of Health Level 7 (HL7) as an organization that creates health care messaging standards. Health Level 7 is also developing standards for the representation of clinical documents (such as discharge summaries and progress notes). These document standards make up the HL7 Clinical Document Architecture (CDA). The HL7 CDA Framework, release 1.0, became an ANSI-approved HL7 standard in November 2000. This article presents the approach and objectives of the CDA, along with a technical overview of the standard. The CDA is a document markup standard that specifies the structure and semantics of clinical documents. A CDA document is a defined and complete information object that can include text, images, sounds, and other multimedia content. The document can be sent inside an HL7 message and can exist independently, outside a transferring message. The first release of the standard has attempted to fill an important gap by addressing common and largely narrative clinical notes. It deliberately leaves out certain advanced and complex semantics, both to foster broad implementation and to give time for these complex semantics to be fleshed out within HL7. Being a part of the emerging HL7 version 3 family of standards, the CDA derives its semantic content from the shared HL7 Reference Information Model and is implemented in Extensible Markup Language. The HL7 mission is to develop standards that enable semantic interoperability across all platforms. The HL7 version 3 family of standards, including the CDA, are moving us closer to the realization of this vision.

Computer Communication Networks↗

PubMed2006

Treating skin disease: self-management behaviors of Latino farmworkers.

Latino migrant and seasonal farmworkers experience high rates of skin disease that result from their working and living conditions. Knowledge of the ways farmworkers treat skin disease symptoms will provide a foundation for developing culturally appropriate health education, improving the delivery of health services, and improving occupational health policy for agricultural workers. The purpose of this paper is to describe skin disease self-management practices among Latino migrant and seasonal farmworkers in North Carolina. This analysis uses a qualitative design based on in-depth interviews with 30 Latino farmworkers (six females, 24 males). Computer assisted, systematic procedures are used to analyze the verbatim transcripts of these interviews. Participants shared a consistent set of health self-management actions in treating skin disease. These actions were within the domains of self-care and medical care. A model of skin disease self-management among Latino farmworkers includes the self-care actions of hygiene, use of home remedies and use of over-the-counter remedies, with farmworkers often combining different domains of self-care. While farmworkers acknowledge the benefits of medical care, they are also mindful of barriers to its use, including cost, transportation and language. The large percentage of farmworkers who experience skin problems indicates that health outreach workers who serve this population need to provide education on preventing and treating skin problems, and they need to recommend to farmworkers appropriate over-the-counter medicines for the treatment of these skin problems. Appropriate medical care for treating skin problems that are dangerous and reduce farmworkers' quality-of-life needs to be made available to this population.

Adolescent↗

PubMed2005

Identifying lesions on structural brain images--validation of the method and application to neuropsychological patients.

The study of neuropsychological disorders has been greatly facilitated by the localization of brain lesions on MRI scans. Current popular approaches for the assessment of MRI brain scans mostly depend on the successful segmentation of the brain into grey and white matter. These methods cannot be used effectively with large lesions because lesions usually impair segmentation. We propose a novel, fully automated approach for the delineation of brain lesions on MR scans. This method involves comparing a skull stripped, smoothed, unsegmented T1 images to a control group using the general linear model. We tested this method by using images with simulated lesions of different sizes and images containing real lesions from patients with language deficits. We also tested how varying the size of the Gaussian smoothing kernel affects detection. The simulation was informed by findings of a lesion morphological study also presented here. The proposed method detected simulated lesions effectively in the range of 30--90%<normal signal. Smoothing kernels in the range of 8--12 mm resulted in the most accurate lesion detection. Both artificial and real lesions were optimally detected when the results were uncorrected for multiple comparisons at p<.001. This proposed method produced highly satisfactory results and can be used to generate reproducible detection of lesions.

Adult↗

PubMed2002

Topographical layout of hand, eye, calculation, and language-related areas in the human parietal lobe.

To identify subdivisions of the human parietal cortex, we collected fMRI data while ten subjects performed six tasks: grasping, pointing, saccades, attention, calculation, and phoneme detection. Examination of task intersections revealed a systematic anterior-to-posterior organization of activations associated with grasping only, grasping and pointing, all visuomotor tasks, attention and saccades, and saccades only. Calculation yielded two distinct activations: one unique to calculation in the bilateral anterior IPS mesial to the supramarginal gyrus and the other shared with phoneme detection in the left IPS mesial to the angular gyrus. These results suggest human homologs of the monkey areas AIP, MIP, V6A, and LIP and imply a large cortical expansion of the inferior parietal lobule correlated with the development of human language and calculation abilities.

Adult↗

PubMedDate not supplied

Experimental and clinical applications of molecular cell biology in nutrition and metabolism.

Rapid advances in molecular biology have yielded important new techniques for understanding the cellular mechanisms of normal homeostasis and disease. In particular, molecular laboratory methodologies have become important investigative tools for nutritional studies. Detection techniques for specific DNAs, RNAs, and proteins allow direct examination of cellular regulation of protein expression in health and illness. Construction of transgeneic models by recent techniques of inserting foreign genes into experimental animals has provided novel models for studies of cellular metabolism. In addition, molecular biology has had impact on clinical nutrition and therapy. Molecular techniques not only allow for early diagnosis of many inborn genetic errors of metabolism, recombinant technology has also provided for large-scale production of proteins and hormones of potential therapeutic value. The possibility for direct gene therapies is also nearing reality. Hence, understanding the language of molecular biology and the recent developments in this field is not only of research interest, but is also of clinical relevance.

Animals↗

PubMed1998

Formalising and acquiring model-based hypertext in medicine: an integrative approach.

Combining a knowledge acquisition methodology with a powerful data model we present an approach to the acquisition, maintenance and browsing of scientific medical hypertext. The hypergraph-based data model supports the consistent treatment of cyclic data structures, the nesting of complex object and provides an elegant way of path declaration to represent time-dependent medical processes or large hypertext tours. It encourages a stepwise schema design and therefore supports a spiral-shaped acquisition process. We formally define view mechanisms on the basis of a rule-based query and modification language. The views enable a context-sensitive presentation of medical knowledge according to the informational needs of the physician. Our approach has been applied to the implementation of an authoring and tutoring environment for a computer-based hypermedia reference book for cerebrovascular diseases (NeuroN). During the acquisition process the expressive power and flexibility of the representational formats have been evaluated.

Artificial Intelligence↗

PubMedDate not supplied

[Has the translation process impact on the psychometric structure of a questionnaire?].

Little is known about the impact of item translation on the psychometric structure of questionnaires. The analysis of different translation versions within the same language provides an opportunity to address this question. Therefore, in the present study, two of the six available German translations of Eating Disorder Inventory (EDI) were compared with respect to their psychometric structure. A total of 449 female students completed the short forms of the EDI (consisting of the subscales drive for thinness, bulimia and body dissatisfaction). Structural equation modeling revealed that the item contents in both translations had been interpreted equivalently by the participants. In addition, the structural relations among the factors were equivalent across both versions. Whereas invariance of item-pair reliability was not tenable, the distribution of raw scores of the scales was similar. All in all, the findings suggest a very large degree of similarity in the psychometric structure of the alternative translations of the EDI versions. The results are discussed with respect to the lack of standards for the translation of questionnaires.

Adolescent↗

PubMed1996

Identification of areas with high levels of untreated dental caries.

In order to examine the geographical variation of dental health within 10 county districts in North Wales, 3538 children were examined. The associations between three demographic indicators, based on the 1981 OPCS census, and dental health outcomes were assessed for electoral wards within the county districts. The Townsend and Jarman indices were the first two indicators employed and the third was based on a mathematical model representing the variation in the mean number of untreated decayed surfaces per person for the wards. This model was developed using the children examined in the five most westerly county districts. Using the data derived from the five most easterly county districts, the three indicators were assessed. All three showed strong correlations (r > or = 0.88) with dental health. These results indicate that measures of dental health based on large administrative units may obscure variation within them. It is concluded that geographical methods of this type may be useful for targeting dental resources at small areas with high levels of need.

Catchment Area, Health↗

PubMed2004

Modeling intra-sexual competition in a sex pheromone system: how much can female movement affect female mating success?

Mating disruption theory predicts that high concentrations of female pheromone, and/or large numbers of release sites, should confuse males orienting to "calling" females, reduce the number of successful matings, and decrease the reproductive potential of the population. In this scenario, females are regarded as stationary point sources of pheromone. Past behavioral observations, however, have shown virgin female grape root borers, Vitacea polistiformis Harris, significantly alter their behavior in mating disruption treatments. Treated females call at different heights, move less before call initiation, and move more after call initiation than control females. Pheromone gland dragging and wing fanning also increase significantly during pheromone treatments. These behavioral differences are significant only if they alter the mating success of females. Because long-term field studies are impractical, we used known behavior of male and female GRB to build a Fortran language time step model, adding the effects of female movement to past models of male pheromone plume following. Females were distributed randomly, and then assigned a conditional movement strategy. If females were within the competitive portion of another female's plume, the downwind female moved. Except in the lowest population density tested, females moving upwind and crosswind when in a competing female's pheromone plume mated significantly more often than females remaining stationary. In all population simulations, mating success was significantly reduced when females moved downwind. These field and simulation studies provide strong evidence for female movement as a previously overlooked potential mechanism for resistance to mating disruption treatments, as well as a shaping behavior in the evolution of pheromone communication systems.

Animals↗

PubMedDate not supplied

A FORTRAN program for multivariate survival analysis on the personal computer.

In this paper a FORTRAN program is presented for multivariate survival or life table regression analysis in a competing risks' situation. The relevant failure rate (for example, a particular disease or mortality rate) is modelled as a log-linear function of a vector of (possibly time-dependent) explanatory variables. The explanatory variables may also include the variable time itself, which is useful for parameterizing piecewise exponential time-to-failure distributions in a Gompertz-like or Weibull-like way as a more efficient alternative to Cox's proportional hazards model. Maximum likelihood estimates of the coefficients of the log-linear relationship are obtained from the iterative Newton-Raphson method. The program runs on a personal computer under DOS; running time is quite acceptable, even for large samples.

Actuarial Analysis↗

PubMed1997

Applications of abduction: hypothesis testing of neuroendocrinological qualitative compartmental models.

It is difficult to assess hypothetical models in poorly measured domains such as neuroendocrinology. Without a large library of observations to constrain inference, the execution of such incomplete models implies making assumptions. Mutually exclusive assumptions must be kept in separate worlds. We define a general abductive multiple-worlds engine that assesses such models by (i) generating the worlds and (ii) tests if these worlds contain known behaviour. World generation is constrained via the use of relevant envisionment. We describe QCM, a modeling language for compartmental models that can be processed by this inference engine. This tool has been used to find faults in theories published in international refereed journals; i.e. QCM can detect faults which are invisible to other methods. The generality and computational limits of this approach are discussed. In short, this approach is applicable to any representation that can be compiled into an and-or graph, provided the graphs are not too big or too intricate (fanout < 7).

Computer Simulation↗

PubMed2007

[Pain acceptance - concept and validation of a German version of the chronic pain acceptance questionnaire].

BACKGROUND: Up to now, only an English version of the Chronic Pain Acceptance Questionnaire (CPAQ) has been available for measuring the acceptance of chronic pain. This paper presents and analyzes a German adaptation of this instrument. METHODS: The German scale was tested on 150 patients at the DRK Pain Center in Mainz. Validity was assessed by means of various indicators of pain and psychosocial impairment. In a subgroup (n=50) the association with the heat pain threshold was determined. RESULTS: The factor structure of the German CPAQ scale is largely concordant with the theoretical model. The internal consistency of the total and subscales is 0.84-0.87 (Cronbach's alpha). The factors are closely related to indicators of psychosocial functioning. Associations with the affective dimension of pain are moderate and with the sensory dimension low. No association is found with heat pain thresholds (thermal sensory analyzer). CONCLUSIONS: The German CPAQ scale is a useful German-language instrument for the measurement of acceptance and shows good psychometric properties. The study confirms that acceptance is not an expression of a physiologically based indolence.

Adaptation, Psychological↗

PubMed2005

Factors associated with perceived health among 12-year-old school children. Relevance of physical exercise and sense of coherence.

BACKGROUND: Poor perceived health during childhood may affect an individual's well-being throughout life. In adult studies, sense of coherence (SOC) has been shown to be associated with perceived health. AIMS: The aim of this study was to determine which factors with an emphasis on SOC and physical exercise were associated with perceived health among 12-year-old children. METHODS: A total of 1,231 12-year-old school children (83%) completed a questionnaire. Most of the 37 questions had multiple-choice types of response. The questions were largely based on those used in the Health Behaviour in School-aged Children (HBSC) study coordinated by the WHO. SOC was determined using the 13-item scale developed by Antonovsky. Factors used in calculating performance at school were marks (given by the teachers, range 4-10, 10 being the best) in mathematics, native language, and first foreign language. Statistical analysis involved the use of logistic regression models and the so-called generalized estimation technique because of the multi-level study design. RESULTS: In a multivariate model adjusted for reported psychosomatic symptoms, insufficient physical exercise was clearly (OR 4.6) associated with poor perceived health. Other variables with significant associations (OR 1.4-1.7) were a mark below 9 in mathematics, belonging to the weakest SOC tertile, reporting of problems of perceived support from teachers, and reporting of various problems involving the class climate. CONCLUSIONS: Among the studied variables physical exercise was the most strongly associated with perceived health, even when several social and psychological risk factors were included in the analysis. SOC and variables of social support were also of importance.

Adaptation, Psychological↗

PubMed2004

Mining pinyin-to-character conversion rules from large-scale corpus: a rough set approach.

This paper introduces a rough set technique for solving the problem of mining Pinyin-to-character (PTC) conversion rules. It first presents a text-structuring method by constructing a language information table from a corpus for each pinyin, which it will then apply to a free-form textual corpus. Data generalization and rule extraction algorithms can then be used to eliminate redundant information and extract consistent PTC conversion rules. The design of our model also addresses a number of important issues such as the long-distance dependency problem, the storage requirements of the rule base, and the consistency of the extracted rules, while the performance of the extracted rules as well as the effects of different model parameters are evaluated experimentally. These results show that by the smoothing method, high precision conversion (0.947) and recall rates (0.84) can be achieved even for rules represented directly by pinyin rather than words. A comparison with the baseline tri-gram model also shows good complement between our method and the tri-gram language model.

Journal Article↗

PubMed2006

Tools for kinetic modeling of biochemical networks.

The number of software packages for kinetic modeling of biochemical networks continues to grow. Although most packages share a common core of functionality, the specific capabilities and user interfaces of different packages mean that choosing the best package for a given task is not trivial. We compare 12 software packages with respect to their functionality, reliability, efficiency, user-friendliness and compatibility. Although most programs performed reliably in all numerical tasks tested, SBML compatibility and the set-up of multicompartmentalization are problematic in many packages. For simple models, GEPASI seems the best choice for non-expert users. For large-scale models, environments such as Jarnac/JDesigner are preferable, because they allow modular implementation of models. Virtual Cell is the most versatile program and provides the simplest and clearest functionality for setting up multicompartmentalization.

Biochemistry↗

PubMed1983

Digit repetition in learning-disabled children.

Investigated digit repetition performance in learning-disabled children in an effort to assess its clinical and theoretical significance. Clinically, learning-disabled children were found to demonstrate a higher than expected incidence of large verbal-performance discrepancies, although mean overall digit repetition performance did not differ appreciably from that expected on the basis of intelligence (N = 100). Children with large discrepancies did not differ from those with no such discrepancies when compared on a variety of psychometric and neurobehavioral factors. Theoretically, a hemispheric specialization model and a neuropsychological function model have been proposed to underlie performance on the two somewhat different digit repetition tasks (forward and backward repetition). Some support was found for the neuropsychological function model, with significant correlations obtained between digits forward and a measure of language function and between digits backward and a test of visual constructional ability. Stronger evidence that could have been provided by a double dissociation of correlational findings was limited by a smaller, but significant, correlation between digits forward and Bender Gestalt errors. However, the results are consistent with previous research in suggesting that digit repetition can be an avenue to the study of brain-behavior relationships.

Child↗

PubMed1998

The LabBase system for data management in large scale biology research laboratories.

MOTIVATION: The development of laboratory information management systems (LIMSs) for large scale biology research projects can be a challenging problem. Many such projects generate complex datasets via complex procedures that undergo continuous refinement. A key software challenge is to simplify the database-development task so that databases can be built and modified quickly enough to keep pace with changing project-requirements. RESULTS: LabBase extends the facilities offered by relational database systems to simplify the task of creating databases for large scale biology research projects. LabBase provides a structural object data model, similar to ACEDB, and adds to this the concepts of Materials, Steps, and States: Materials are objects representing the identifiable things that participate in a laboratory protocol; Steps are objects reporting the results of a laboratory or analytical procedure; and States are objects denoting places in a laboratory protocol. The system provides a data definition language for succinctly defining laboratory databases, and operations for conveniently storing and retrieving data in such databases. The system also provides support for workflow management. LabBase is implemented in Perl5 and provides a natural interface for laboratory application programs written in Perl. AVAILABILITY: The software is freely available. Contact the authors. CONTACT: nat@jax.org

Computational Biology↗

PubMed2005

Adaptive dispersion theory and phonological vowel reduction in Russian.

Russian exhibits a rich pattern of phonological vowel reduction, by which some vowel contrasts are neutralized in unstressed syllables. Recent work in phonology suggests a mechanism by which phonetic vowel reduction--compression of the overall vowel space due to target undershoot--might lead to patterns like Russian. Presenting acoustic data from 9 speakers of Russian, we use Euclidean distance measures, measures of F1-F0 and F2-F1, and Bayesian classification to provide a basic picture of how the overall vowel space, as well as the distribution of vowels, change as stress is reduced. We are particularly interested in whether contraction of the vowel space in unstressed positions is primarily due to raising, and in whether contrasting pairs of vowels are evenly spaced within and across contexts. Our results provide qualified support for the first hypothesis, but largely do not support the hypothesis of equal spacing, in particular across contexts. Of additional interest, we find that some impressionistically described neutralizations are incomplete.

Acoustic Stimulation↗