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PubMed2002

Functional characterization of podia formation in normal and malignant hematopoietic cells.

Hematopoietic cells extend multiple podia of yet unknown function. Our morphological studies using scanning electron microscopy and functional studies using time-lapse video microscopy suggest that podia formed by CD34+ hematopoietic stem cells (HSC) on the bone marrow stroma component fibronectin are characteristic of lamellipodia at the leading edge and uropodia at the trailing edge, cytoskeletal structures that have previously been shown to be responsible for cell locomotion of lymphocytes. In the leukemic cells studied here, stroma-derived factor-1alpha (SDF-1alpha) led to a significant eightfold increase in transmigration (BCR-ABL-positive BV173 leukemia cell line; P<0.05) and podia formation in all BCR-ABL-positive leukemic cell lines studied (BV173, K562, 32Dp210) and in two of three BCR-ABL-negative lines (HL60, 32D, not KG1a). We could show that SDF-1alpha exposure led to a down-regulation of the gene expression of the chemokine receptors CCR4, CXCR4, and CXCR5, which are associated with cell motility and podia formation, indicating a negative feedback control. In BCR-ABL-positive leukemic cells, the effects of SDF-1alpha on podia formation and cell migration were independent of BCR-ABL-tyrosine kinase activity. Our data are compatible with the hypothesis that formation of specific podia by hematopoietic cells is associated with egression of these cells from the bone marrow.

Cell Movement↗
PubMed2004

Development of an online, team-based programme in telecare.

Few health-care providers have experience of delivering telecare and access to formal training is limited. We therefore developed an online training programme in telecare. A participatory design approach was used and telecare providers were invited to participate in each stage of the course design cycle. The course content, learning activities and learning materials such as video were based on the results of interviews with providers from various health disciplines and observations in the telecare workplace. The approach led to the development of a six-week, multimedia, online course for members of the health-care team. Participants were asked to review the prototype course for completeness and accuracy of content, quality of course design and the utility of learning activities. Overall feedback was favourable. Learners found the course content and learning activities helpful, and it met their needs. The learning material was then reviewed by a panel of experts and further revisions were made. Including providers in the development process led to the creation of a course that appears likely to improve the implementation and practice of telecare.

Attitude of Health Personnel↗
PubMed2002

The Video Suggestibility Scale for Children: how generalizable is children's performance to other measures of suggestibility?

This study explored the generalizability of the Video Suggestibility Scale for Children (VSSC), which was developed by Scullin and colleagues (Scullin & Ceci, 2001; Scullin & Hembrooke, 1998) as a tool for discriminating among children (aged three to five years) who have different levels of suggestibility. The VSSC consists of two subscales; Yield (a measure of children's willingness to acquiesce to misleading questions) and Shift (a measure of children's tendency to change their responses after feedback from the interviewer). Children's (N = 77) performance on each of the subscales was compared with their performance using several other measures of suggestibility. These measures included children's willingness to assent to a false event as well as the number of false interviewer suggestions and false new details that the children provided when responding to cued-recall questions about an independent true-biased and an independent false (non-experienced) event. An independent samples t-test revealed that those children who assented to the false event generated higher scores on the Yield measure. Hierarchical regression analyses revealed that Yield was a significant predictor of the number of false details reported about the false activity, but not the true-biased activity. There was no significant relationship between the Shift subscale and any of the dependent variables. The potential contribution of the VSSC for forensic researchers and practitioners is discussed.

Child↗
PubMed2002

Measurement of individual differences in children's suggestibility across situations.

The authors attempted to use scores on the Video Suggestibility Scale for Children (VSSC, M. H. Scullin & S. J. Ceci, 2001) to predict 50 preschool children's performance during a field study in which they were interviewed suggestively 4 times about both a true event and a suggested event. Among the 25 children over age 4 years 6 months, tendencies on the VSSC to respond affirmatively to suggestive questions ("yield"), change answers in response to negative feedback ("shift"), and the sum of these ("total suggestibility") were all related to lack of accuracy about the true event in the field study and to both accuracy and lack of accuracy about the suggested event. Results support a 2-factor model of suggestibility.

Child, Preschool↗
PubMed2006

Towards automatic skill evaluation: detection and segmentation of robot-assisted surgical motions.

This paper reports our progress in developing techniques for "parsing" raw motion data from a simple surgical task into a labeled sequence of surgical gestures. The ability to automatically detect and segment surgical motion can be useful in evaluating surgical skill, providing surgical training feedback, or documenting essential aspects of a procedure. If processed online, the information can be used to provide context-specific information or motion enhancements to the surgeon. However, in every case, the key step is to relate recorded motion data to a model of the procedure being performed. Robotic surgical systems such as the da Vinci system from Intuitive Surgical provide a rich source of motion and video data from surgical procedures. The application programming interface (API) of the da Vinci outputs 192 kinematics values at 10 Hz. Through a series of feature-processing steps, tailored to this task, the highly redundant features are projected to a compact and discriminative space. The resulting classifier is simple and effective.Cross-validation experiments show that the proposed approach can achieve accuracies higher than 90% when segmenting gestures in a 4-throw suturing task, for both expert and intermediate surgeons. These preliminary results suggest that gesture-specific features can be extracted to provide highly accurate surgical skill evaluation.

Algorithms↗
PubMed1995

Frameless stereotactic guidance. An intraoperative adjunct in the transoral approach for ventral cervicomedullary junction decompression.

METHODS: The application of a video-interactive frameless stereotactic guidance system for the treatment of ventral cervicomedullary junction compression is described in a patient with basilar invagination, odontoid dysgenesis, and a Chiari malformation who had irreducible impingement on the ventral brainstem by a partially fused mass of bone made up of the malformed odontoid peg, the inferior clivus, and dorsally protruding osteophytes at the odontoid-clival junction. RESULTS: This technology permitted instantaneous feedback of the surgeon's orientation in all planes, facilitating extensive removal of the dens and clival tip to achieve adequate ventral brainstem decompression. In view of the distortion of the craniovertebral anatomy produced by the patient's anomalies, the ability to visualize three dimensionally the location of the vertebral arteries also added an element of safety to the lateral bone removal. Similarly, the ability to localize the rostral limit of the clivus that needed to be resected and the caudal extent of C2 that needed to be removed to achieve an adequate decompression helped ensure that the extent of bone removal was appropriately tailored to the patient's anatomy. CONCLUSION: The authors believe this technique represents a significant advance over standard radiographic intraoperative localization techniques during transoral approaches to the ventral cervicomedullary junction for patients in whom the odontoid is fixed in position in relation to the clivus. This is based on the speed with which localization can be obtained, the accuracy of the information provided, the ability to obtain localization in multiple planes simultaneously, and the lack of radiation exposure during the procedure.

Brain Stem↗
PubMed1985

Analysis of visual scanning patterns of pistol shooters.

Visual behaviour of pistol shooters of various levels of experience was studied using a video-oculometric technique to record the direction of gaze. A spatio-temporal analysis of the fixation patterns of subjects (five international pistol shooters and five international pentathletes) found that patterns were related to the level of skill. The pentathletes, whose level was lower, positioned their gaze on the weapon sight and visually followed the movement of the weapon towards the target. The pistol shooters appeared to use negative feedback in bringing up their weapons, so reducing the angle formed by the weapon, target and gaze. They fixed their gaze directly on the target or between the target and the weapon. Observations showed a prolonged time of attack (means = 1.107 s vs 0.558 s; P less than 0.001) and a shorter stabilization time (means = 0.714 s vs 1.216 s; P less than 0.001) for the most expert shooters. The psycho-physiological mechanisms which were the basis of these patterns and the reasons why shooters chose them are discussed.

Humans↗
PubMed2004

Linear interpolation revitalized.

We present a simple, original method to improve piecewise-linear interpolation with uniform knots: we shift the sampling knots by a fixed amount, while enforcing the interpolation property. We determine the theoretical optimal shift that maximizes the quality of our shifted linear interpolation. Surprisingly enough, this optimal value is nonzero and close to 1/5. We confirm our theoretical findings by performing several experiments: a cumulative rotation experiment and a zoom experiment. Both show a significant increase of the quality of the shifted method with respect to the standard one. We also observe that, in these results, we get a quality that is similar to that of the computationally more costly "high-quality" cubic convolution.

Algorithms↗
PubMed2006

The efficacy of videotape feedback for enhancing the effects of exposure-based treatment for social anxiety disorder: a controlled investigation.

Correcting patients' faulty beliefs concerning social evaluative threats is the hallmark of cognitive-behavioral treatment of social anxiety disorder. The current study examined the efficacy of two videotape feedback procedures as adjuncts to exposure-based treatment. Participants suffering from social phobia (N=77) were randomly assigned to one of four conditions: (a) credible placebo treatment (PLA); (b) exposure + no feedback (EXP); (c) exposure + videotape feedback of performance (PER); or (d) exposure + videotape feedback of audience responses (AUD). Contrary to prediction, the videotape feedback procedures did not enhance the effects of exposure-based treatment. Clinical and theoretical implications are discussed.

Adult↗
PubMed2003

Factors contributing to guidance performance when using a camera-based guidance aid.

A guidance aid is a device that provides guidance information to the driver rather than replacing the driver. With a camera-based guidance aid, the view seen by a forward-looking video camera is displayed on a monitor situated within the operator station of the vehicle. As the vehicle moves forward, images of the ground scroll vertically across the monitor. The rate at which the image scrolls, the image velocity, is related to the forward velocity of the vehicle, the placement of the camera (height and tilt angle), and the optical characteristics of the guidance camera. When tested with a tractor at forward velocities between 1.6 and 12.8 km/h, lateral error increased linearly as image velocity increased. Driver self-confidence decreased linearly as image velocity increased. Based on subjective feedback, drivers preferred a camera tilt angle of 20 degrees (over either 30 degrees or 40 degrees) because it yielded the greatest look-ahead distance. Statistically, a tilt angle of 30 degrees was best for a camera with a narrow field of view (narrow FOV, 20 degrees in the lateral direction). For a camera with a wide field of view (wide FOV, 39 degrees in the lateral direction), there was no statistical difference. For the narrow FOV camera, a camera height of 1.1 m yielded statistically smaller lateral errors than a camera height of 1.5 m. There was no statistical difference for the wide FOV camera. Overall, the lateral error was statistically smaller for the narrow FOV camera than for the wide FOV camera due to the difference in the lateral ratio for each camera, where the lateral ratio is the ratio of the lateral field of view of the camera to the fixed monitor width.

Accidents, Occupational↗
PubMed2003

Evaluating the efficacy of tele-cognitive rehabilitation for functional performance in three case studies.

Traumatic brain injury (TBI) is one of the main causes of long-term disability, and its rehabilitation is a challenge to the healthcare team. Tele-rehabilitation, through using advancements in networking and tailor-made software, has been developed and applied to the cognitive rehabilitation of persons with brain injury in the present study. Tele-cognitive rehabilitation uses customized online computer software as a treatment mode. The online treatment software is operated on an interactive tele-communication platform--for example, video conferencing with screen sharing. Through implementing the tele-cognitive rehabilitation activities, therapists can help clients to practise and thus improve their cognitive skills through using the treatment software successfully. Moreover, hypermedia programming techniques allow the therapist to adjust the software to meet the client's treatment needs, so that the treatment is appropriate to his/her functional levels and living environment. Also the software can customize immediate visual, auditory and personalized feedback to motivate the client and training can be set at the right pace for the client's needs. The present study aimed to evaluate the effectiveness and perceived efficacy of the newly developed customized tele-cognitive rehabilitation programme for three subjects with traumatic brain injury through using single-case and qualitative research design. The cognitive factors investigated in this pilot study were, respectively, Chinese word recognition, prospective memory and semantic memory. The subjects had undergone a recruitment process with stipulated screening criteria. A single case experimental design (ABA reversal/withdrawal design) consisted of a no-intervention baseline phase (A), an intervention phase (B) and a no-intervention withdrawal phase (A). There were six sessions in each phase, making a total of 18 sessions. Tele-cognitive rehabilitation software was tailor-made according to each subject's cognitive functional needs. To monitor the change in cognitive functions, variables were tapped by tailor-made assessment and qualitative questionnaires through interviews, and they were then used to explore subjects' opinions of the programme and to test the treatment efficacy of the tele-cognitive rehabilitation programme. Finally, the relationships among the three phases were analysed through visual analysis and trend line analysis by means of the split-middle method. The three persons with brain injury showed improving trends and levels of specific cognitive performance during the treatment phase. Qualitative findings were analysed and confirmed the efficacy of the treatment module. The tele-cognitive rehabilitation approach was well received by subjects. The authors suggest that further replication studies of this kind should be conducted in the future and that more subjects should be recruited to improve the generalizability of the results.

Adult↗
PubMed2006

Transfer of heart rate feedback training to reduce heart rate response to laboratory tasks.

To examine whether transfer of heart rate (HR) feedback training to tasks not used during training could be improved by using multiple tasks during training, a modified multiple baseline across tasks, single subject design study was conducted using six high HR-reactive young adults. Participants received HR feedback training during the presentation of a videogame, and transfer of training was assessed to a mental arithmetic challenge and handgrip task. Transfer of training was next assessed following training with the mental arithmetic challenge and handgrip task. HR responses to each training task with no HR feedback were assessed during a pre-treatment session, an immediate post-training period following training on each task, a short delay (1-2 days) post-training session, and a long delay (1-2 weeks) post-training session. HR response to a novel speech task was assessed at pre-treatment and during short delay and long delay post-training sessions. Results revealed that participants reduced HR during training and generally maintained this reduction in HR during the immediate post-training assessment when HR feedback was not present. Participants were not able to reduce HR responses to tasks during short delay and long delay post-training sessions, and they were unable to transfer HR reduction skills to the speech task. Transfer of HR feedback training to new tasks was limited in nature and efforts to train across multiple stressors did not appear to improve transfer of training.

Adolescent↗
PubMed1988

Study of relation of continuing medical education to quality of family physicians' care.

A random sample of 120 physicians in Ontario was studied to assess quality of care in primary care and test an hypothesis that quality of care was related to continuing medical education (CME) activities. The quality-of-care scores were obtained by an in-office audit of a random selection of charts. The scores were global scores for charting, prevention, the use of 13 classes of drugs, and care of a two-year period for 182 different diagnoses. There were no relationships between global quality-of-care scores based on these randomly chosen charts and either the type or quantity of the physicians' CME activities. These activities were reading journals, attending rounds, attending scientific conferences, having informal consultations, using audio and video cassettes, and engaging in self-assessment. The implications of these findings are significant for future research in CME and for planners of present CME programs.

Certification↗
PubMed2006

Assessing procedural skills in context: Exploring the feasibility of an Integrated Procedural Performance Instrument (IPPI).

BACKGROUND: The assessment of clinical procedural skills has traditionally focused on technical elements alone. However, in real practice, clinicians are expected to be able to integrate technical with communication and other professional skills. We describe an integrated procedural performance instrument (IPPI), where clinicians are assessed on 12 clinical procedures in a simulated clinical setting which combines simulated patients (SPs) with inanimate models or items of medical equipment. Candidates are observed remotely by assessors whose data are fed back to the clinician within 24 hours of the assessment. This paper describes the feasibility of IPPI. RESULTS: A full-scale IPPI and 2 pilot studies with trainee and qualified health care professionals has yielded an extensive data set including 585 scenario evaluations from candidates, 60 from clinical assessors and 31 from simulated patients (SPs). Interview and questionnaire data showed that for the majority of candidates IPPI provided a powerful and valuable learning experience. Realism was rated highly. Remote and real-time assessment worked effectively, although for some procedures limited camera resolution affected observation of fine details. DISCUSSION: IPPI offers an innovative approach to assessing clinical procedural skills. Although resource-intensive, it has the potential to provide insight into individual's performance over a spectrum of clinical scenarios and at no risk to the safety of patients. Additional benefits of IPPI include assessment in real time from experts (allowing remote rating by external examiners) as well as provision of feedback from simulated patients.

Clinical Competence↗
PubMed2000

Telepathology: a diagnostic tool for the millennium?

Many developments in science have their origins in science fiction and telepathology is no exception. The concept was first illustrated in 1924 in the magazine 'Radio News'. It was not until 1980, however, that the first working telepathology system was demonstrated. Although the system was shown to work, it required special hardware, dedicated software and special microwave transmission links to be installed. Little interest was shown worldwide because of the very high cost and the inability of many people to replicate such a system. Ten years later, the personal computer (PC) was able to provide more than adequate performance at low cost for both image display quality and speed, and the development of video technology had resulted in high quality images being produced by television cameras that were now easily affordable. Microscopes were also relatively cheaper. Thus, by 1993 or 1994, all the hardware necessary to produce a telepathology system was available at reasonable cost. Telepathology can now be used for remote primary diagnosis, remote referral to a specialist pathologist, remote teaching, remote presentation of post-mortem or microscopic findings, quality assurance image circulation and feedback, and consensus diagnosis for pathological review in clinical trials. There are two residual problems. The first concerns the speed of data transmission, commonly referred to as the bandwidth. The second is that the software provided by most of the manufacturers and suppliers of these systems is not entirely suitable to the task and the systems are not interoperable. It is clear that the approach of the manufacturers is at present unlikely to produce telepathology systems which pathologists feel comfortable in using. A somewhat different approach is illustrated by the accompanying article in this issue from the Berlin group, where a relatively simple Java-based applet and the Internet are used to allow single or multiple users to view slides on a robotic microscope. This could form the basis for a truly useful system, but still needs modification for some applications.

Clinical Trials as Topic↗
PubMed2001

Changes in hemodynamic response to mental stress with heart rate feedback training.

This study was designed to examine underlying hemodynamic changes that accompany observed reductions in heart rate (HR) response to mental stress following HR feedback training. Twenty-five college males, assigned to either a HR feedback training group (FB+) or a control group (FB-), were presented with a videogame and mental arithmetic challenge, as HR, blood pressure, and impedance cardiography-derived measures of hemodynamic functioning were recorded. During training, the FB+ group received HR feedback and the FB- group was not provided with HR feedback while playing a videogame. At posttraining, results revealed that the FB+ group exhibited significantly lower HR, systolic blood pressure, stroke volume, and total peripheral resistance responses to the videogame compared to that at pretraining. There was no evidence that the acquired skills generalized to a mental arithmetic task. These results suggest that HR feedback training is an effective method for reducing cardiovascular and hemodynamic responses to a mental stressor; however, the generalizability of this effect remains questionable.

Adolescent↗
PubMed2004

Assessing the head-to-toe physical examination skills of medical students.

Second-year medical students performed a head-to-toe screening physical examination on trained patient instructors (PIs) as a high-stakes examination before beginning clinical clerkships. PIs completed a 138-item checklist and instructed the students in the proper performance of any incorrectly executed or omitted items. To assess the accuracy of the PI ratings, 'monitor' PIs watching the encounter by video completed checklists for 11 retests of failed students in 2001 and for 28 randomly selected encounters in 2002. Checklist-level discrepancies measured by mean absolute checklist difference were 8% in 2001 and 9% in 2002. Case-level mean difference between raters in 2002 was -2.9%. The inter-rater reliability for a single rater, estimated by the intra-class correlation coefficient for total encounter scores, was 0.95. The assessment and feedback were well received by the students. The Head-to-Toe examination provides a reliable assessment of a student's ability to carry out a complete screening physical examination. Patient instructors can be trained to acceptable accuracy and reliability despite the length and complexity of the exercise, and can provide effective feedback and teaching targeted to individual student deficiencies.

Clinical Competence↗