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PubMed1995

Radiology on the information superhighway.

PURPOSE: To explore the potential for the information superhighway to provide radiologists with new opportunities. MATERIALS AND METHODS: The Internet was used as the communication and distribution medium. MOSAIC, a graphical interface, provided access for clients, and a computer was used to serve text, images, sound, and cine onto the Internet. RESULTS: The system can be used to send reports and images to referring physicians or consulting radiologists; to provide a large database that is constantly available; to provide an increasing collection of teaching files; and to distribute interactive, multimedia teaching tools that can be used on any computer system. The use of the MOSAIC interface facilitates interaction, which allows users with limited computer experience to access the system. CONCLUSION: The Internet can dramatically expand the ways radiologists interact with their colleagues. These preliminary results indicate that there will be great challenges and opportunities for improving care and teaching in the future.

Computer Communication Networks↗

PubMed2001

Recreational ecstasy/MDMA and other drug users from the UK and Italy: psychiatric symptoms and psychobiological problems.

RATIONALE: Recreational drug use is increasingly widespread amongst young people, but there are concerns that psychoactive drugs may be associated with psychiatric symptoms or psychobiological problems. OBJECTIVES: To assess the psychiatric health status of a large, non-clinical sample of young adults from Italy and the UK, and relate it to their use of ecstasy/MDMA and other recreational drugs. METHODS: The UEL Recreational Drug Use Questionnaire was completed by 768 young people (mean age 21.7 years) from four European cities. The subjects comprised 150 non-drug users, 185 alcohol/tobacco users, 97 cannabis and alcohol/tobacco users, 102 illicit polydrug but not ecstasy users, 115 light (<20 times) ecstasy polydrug users, and 119 heavy (>20 times) ecstasy polydrug users. The unpaid volunteers completed the SCL-90 self-rating inventory for psychiatric symptoms when off drug, with 30 additional questions covering positive moods and life experiences. RESULTS: Heavy ecstasy polydrug users reported significantly higher scores than non-drug users on several SCL-90 factors, including phobic anxiety, obsessive-compulsive behaviour, anxiety, psychoticism, somatisation, and significantly higher rates of 'loss of sex interest or pleasure'. Self-rated symptom scores increased in line with greater drug use, so that polydrug users who had never taken ecstasy also reported a variety of psychobiological impairments. In contrast, positive moods and life experiences were broadly similar across subgroups. CONCLUSIONS: The recreational use of ecstasy/MDMA is associated with a range of psychiatric symptoms and psychobiological problems. However, these problems are not specific to ecstasy users but are also evident in other recreational polydrug users.

Adolescent↗

PubMed1999

Protein threading by PROSPECT: a prediction experiment in CASP3.

We present an analysis of the protein fold recognition experiment using PROSPECT in The Third Community Wide Experiment on the Critical Assessment of Techniques for Protein Structure Prediction (CASP3). PROSPECT is a computer program we have recently developed for finding an optimal alignment between a protein sequence and a protein structural fold. Two unique features of PROSPECT are (a) that it guarantees to find the globally optimal sequence-structure alignment and does so in an efficient manner, when the alignment-scoring function consists of three additive terms: (i) a singleton fitness term, (ii) a pairwise contact preference term between residues that are spatially close (</=15 A between their beta-carbons) and (iii) an alignment gap penalty; and (b) that it guarantees to find the globally-optimal alignment under various constraints on the unknown protein specified by the user. In the CASP3 experiment, PROSPECT correctly identified the most similar folds for 11 targets and predicted closely-similar folds for five other targets among the 23 targets which can be classified into the category of fold-recognition problems and also had their experimentally-determined structures available. Among the 11 correctly identified folds, PROSPECT obtained good sequence-structure alignments for nine of them. On three of the five ab initio prediction problems, PROSPECT successfully located partial structures from our template library, which align accurately with the corresponding targets.

Amino Acid Sequence↗

PubMed2000

The integrity of Web-delivered experiments: can you trust the data?

Data from Web-delivered experiments conducted in browsers by remote users of PsychExperiments, a public on-line psychology laboratory, reveal experiment effects that mirror lab-based findings, even for experiments that require nearly millisecond accuracy of displays and responses. Textbook results are obtained not just for within-subjects effects, but for between-subjects effects as well. These results suggest that existing technology is adequate to permit Web delivery of many cognitive and social psychological experiments and that the added noise created by having participants in different settings using different computers is easily compensated for by the sample sizes achievable with Web delivery.

Bias↗

PubMed2000

User-fees for family-planning methods: an analysis of payment behaviour among urban contraceptors in Bangladesh.

The study was carried out to review the experience with the existing user-fee (pricing) strategies and examine the socioeconomic and demographic factors associated with payment behaviour among contraceptors in urban Bangladesh for selected contraceptive methods, such as injectables, pill, and condom. Data for the study were drawn from a survey of more than 5,000 married women of reproductive age in Zone 3 of Dhaka city, Bangladesh, within the sample frame of the Urban Panel Survey of the ICDDR,B's former Urban MCH-FP Extension Project. The findings of the study showed that most (80%) urban contraceptors have been paying for selected family-planning services. This indicates the existence of a notable demand for contraceptives which suggests that there is scope for improved financial sustainability of the family-planning programme through charging appropriate user-fees for contraceptives with proper analyses of willingness-to-pay among the contraceptors and price elasticities of demand. Higher socioeconomic status of households, marked by higher levels of education and house rent, and location of residence in non-slum areas, is predictive of paying for contraception. Households having 1-3 living child(ren) are also more likely to make payment for the selected contraceptive services.

Adult↗

PubMedDate not supplied

Is talking to an automated teller machine natural and fun?

Usability and affective issues of using automatic speech recognition technology to interact with an automated teller machine (ATM) are investigated in two experiments. The first uncovered dialogue patterns of ATM users for the purpose of designing the user interface for a simulated speech ATM system. Applying the Wizard-of-Oz methodology, multiple mapping and word spotting techniques, the speech driven ATM accommodates bilingual users of Bahasa Melayu and English. The second experiment evaluates the usability of a hybrid speech ATM, comparing it with a simulated manual ATM. The aim is to investigate how natural and fun can talking to a speech ATM be for these first-time users. Subjects performed the withdrawal and balance enquiry tasks. The ANOVA was performed on the usability and affective data. The results showed significant differences between systems in the ability to complete the tasks as well as in transaction errors. Performance was measured on the time taken by subjects to complete the task and the number of speech recognition errors that occurred. On the basis of user emotions, it can be said that the hybrid speech system enabled pleasurable interaction. Despite the limitations of speech recognition technology, users are set to talk to the ATM when it becomes available for public use.

Analysis of Variance↗

PubMed2001

Cross-cultural approaches to harm reduction research: some considerations on the Brazil experience.

Harm reduction initiatives for drug users comprise a range of approaches, including drug-user treatment, advocacy for changes in drug policy, needle exchange programs, bleach distribution, and broad-based interventions that focus on both safer drug use and less risky sexual behaviors. In many developing nations, harm reduction is a relatively new strategy, which focuses almost exclusively on the connections between drug use and the spread of HIV infection. In Brazil, harm reduction programs are few, and little has been documented about their scope, experience, and effectiveness. This paper reviews the status of Brazilian harm reduction initiatives in general, with a specific focus on lessons learned from the conduct of cross-national research in Rio de Janeiro. The study demonstrated the feasibility of implementing a community-based prevention program among an at-risk population of cocaine users in Brazil, and in other countries where there is little tradition of research with out-of-treatment drug users. Finally, the paper addresses aspects of the harm reduction movement that tend to hamper its progress in both developed and developing nations.

Adolescent↗

PubMed2006

Determinants of colorectal cancer screening use, attempts, and non-use.

BACKGROUND: Relatively little is known about the experiences and preferences of users and those who attempt colorectal cancer (CRC) screening. This study describes factors influencing CRC screening decisions among users, attempters, attempter users (individuals who both attempted and completed at least one screening procedure), and non-users; identifies factors interfering with test completion; and describes correlates of screening preferences. METHODS: A primarily stratified random sample of patients from the University of Michigan Health System clinics, Ann Arbor, Michigan, with oversampling of FOBT attempters, completed a mailed questionnaire in fall, 2003. Descriptive and multivariate approaches evaluated factors influencing screening use and preferences. RESULTS: "Accuracy of results" was reported most often as important when deciding about CRC screening regardless of screening status. The importance of psychological decisional factors differed significantly by screening status (P<0.05). Among factors interfering with test completion, 38.5% attempting FOBT reported they "forgot" whereas 29.8% attempting colonoscopy were "afraid of pain." Approximately 56.3% indicated a preference for a CRC test: respondents who considered "discomfort" important preferred FOBT (OR: 0.39, 95% CI: 0.17, 0.87); those with a prior colonoscopy preferred an invasive test (OR: 6.50, 95% CI: 2.90, 14.50). CONCLUSIONS: To improve adherence to CRC screening recommendations, physicians should tailor discussions to patients' prior experiences and test-specific concerns and elicit preferences for screening.

Aged↗

PubMed2005

Semantic priming after ketamine acutely in healthy volunteers and following chronic self-administration in substance users.

BACKGROUND: Ketamine is used acutely as a model of schizophrenia. It has been suggested that chronic ketamine may also mimic aspects of this disorder, in particular impaired cognitive function. As semantic processing deficits are considered central to cognitive impairments in schizophrenia, this study aimed to characterize semantic impairments following both acute and chronic ketamine. METHODS: We examined the acute effects of two doses of ketamine (Experiment 1) using a double-blind, placebo-controlled, independent group design with 48 volunteers. Ketamine's chronic effects (Experiment 2) were explored in 16 ketamine users and 16 poly-drug controls. A semantic priming task with a frequency (high and low) and stimulus onset asynchrony (SOA: short-200 msec, long-750 msec) manipulation was used. RESULTS: In Experiment 1, acute ketamine produced inverse priming at the long SOA. In Experiment 2, ketamine users showed inverse priming for low-frequency words at the long SOA compared to poly-drug controls. CONCLUSIONS: The inverse priming effect at the long SOA induced by acute ketamine was indicative of controlled processing impairments. In ketamine users, there was also an indication of controlled processing impairments. Decreased priming for low-frequency words suggested that long-term ketamine abuse results in damage to the semantic store.

Adult↗

PubMed2003

Reflecting together: developing a new strategy for continuous user involvement in mental health nurse education.

This paper explores the first issues encountered when establishing a method of service user involvement in the preparation of a cohort of mental health nursing students during their branch programme. The method involved the creation of a group of service users and students whose purpose was to jointly reflect upon mental health issues. To do this students are expected to use their experience from practice placements and the service users to use their experiences as recipients of mental health services. This approach is being investigated through research utilizing an evaluative case study with features of action research incorporated into the design. The findings to date, which concern the process of negotiation, pre-study attitudinal survey and the first group process, will be presented. This will offer mental health professionals the opportunity to gain insight into one approach of actively involving service users in programmes of higher education over a sustained period of time. Reflection on practice themes will include: collaborative strategy, evaluative case study, education, mental health nursing, reflection on practice, and service-user involvement.

Education, Nursing↗

PubMed1979

Primary skeletal infections in heroin users: a clinical characterization, diagnosis and therapy.

Experience with 24 patients and 101 cases reported in the English literature demonstrate that primary skeletal infections occur in heroin users. In young individuals with no significant underlying disease, predominant involvement in the lumbar vertebrae and sternoclavicular joint, Pseudomonas aeruginosa was the dominant pathogen. Clinical manifestations, except for pain or local tenderness, and laboratory findings were of limited value. Diagnosis ultimately depended on isolation of the pathogens from either bone or joint fluid. The treatment, as indicated, was prolonged parenteral antibiotics, generally with an aminoglycoside, incision and drainage, and immobilization.

Adult↗

PubMed2001

Treatment for amphetamine psychosis.

BACKGROUND: During the phase of chronic, high-dose consumption of amphetamines, many amphetamine users may have the experience of paranoia and hallucination. It has long been believed that dopamine antagonists, such as chlorpromazine, haloperidol, and thioridazine, are effective for the treatment of amphetamine psychosis. OBJECTIVES: To search and determine risks, benefits, and costs of a variety treatments for amphetamine psychosis. SEARCH STRATEGY: Electronic searches of MEDLINE (1966-2000), EMBASE (1980-2000), CINAHL (1982- January 2001) and Cochrane Controlled Trials Register (Cochrane Library 2000 issue 4) were undertaken. References to the articles obtained by any means were searched. SELECTION CRITERIA: All relevant randomised controlled trials (RCTs) and clinical trials (CCTs) were included. Participants were people with amphetamine psychosis, diagnosed by any set of criteria. Any kinds of biological and psychological treatments both alone and combined were examined. A variety of outcomes, for example, number of treatment responders, score changes, were considered. DATA COLLECTION AND ANALYSIS: Two reviewers evaluated and extracted the data independently. The dichotomous data were extracted on an intention-to-treat basis in which the dropouts were assigned as participants with the worst outcomes. The Relative Risk (RR) with the 95% confidence interval (95% CI) was used to assess the dichotomous data. The Weighted Mean Difference (WMD) with 95% CI was used to assess the continuous data. MAIN RESULTS: The comprehensive searches found no controlled trials of treatment for amphetamine psychosis meeting the criteria for considering studies. REVIEWER'S CONCLUSIONS: The evidence about the treatment for amphetamine psychosis is very limited. To our knowledge, no controlled trials of treatment for amphetamine psychosis have been carried out. The results of two studies in amphetamine users show that agitation and some psychotic symptoms may be abated within an hour after antipsychotic injection. Whether this limited evidence can be applied for amphetamine psychotic patients is not yet known. The risks and benefits of giving an antipsychotic injection should be further investigated in amphetamine psychotic patients. Medications that have been used for the treatment of acute exacerbation of schizophrenia should be studied in amphetamine psychotic patients. The medications that may be of interest are conventional antipsychotics, newer antipsychotics and benzodiazepines. However, naturalistic studies of amphetamine psychotic symptoms and course are also crucial for the development of study designs appropriate for further treatment studies of amphetamine psychosis.

Amphetamine-Related Disorders↗

PubMedDate not supplied

Electrostatic tactile display with thin film slider and its application to tactile telepresentation systems.

A new electrostatic tactile display is proposed to realize compact tactile display devices that can be incorporated with virtual reality systems. The tactile display of this study consists of a thin conductive film slider with stator electrodes that excite electrostatic forces. Users of the device experience tactile texture sensations by moving the slider with their fingers. The display operates by applying two-phase cyclic voltage patterns to the electrodes. The display is incorporated into a tactile telepresentation system to realize explorations of remote surface textures with real-time tactile feedback. In the system, a PVDF tactile sensor and a DSP controller automatically generate voltage patterns to present surface texture sensations through the tactile display. A sensor, in synchronization with finger motion on the tactile display, scans a texture sample and outputs information about the sample surface. The information is processed by a DSP and fed back to the tactile display in real time. The tactile telepresentation system was evaluated in texture discrimination tests and demonstrated a 79 percent correct answer ratio. A transparent electrostatic tactile display is also reported in which the tactile display is combined with an LCD to realize a visual-tactile integrated display system.

Computer Peripherals↗

PubMed1995

Help: first aid issues.

First aid is the initial and immediate care given to a victim outside the hospital environment, with the purpose of assuring life and avoiding worsening conditions until he/she receives qualified assistance. Providing immediate aid to someone requires tranquility and, above all, knowledge on what has to be done or not in each situation. In addition to being treated by health professionals, the chances that a victim will receive early treatment by others are large. However, in Brazil, access to information, and the possibility of reviewing it whenever necessary, may contribute greatly to the process of assimilation of this knowledge, in addition to exercises on simulated cases. Informatics has been shown as an extremely useful tool in the development of educational software, considering its multiplicity of resources and providing for the users: motivation for an interactive experience, an individualized teaching that takes into account his/her own rhythm and desired complexity level, besides making possible the user's capacity for solving problems through simulated situations. Considering that, the number of individuals of the population prepared to act as First Aid helpers in situations of life threatening accidents or sudden illness is still very scarce. The ever increasing use of the computer as a mean of spreading information in schools, enterprises, and even households and considering the advantages of an educational software for the users regarding storage and retrieval of information when needed, we proposed the creation of an interactive teaching software. This software is being developed using Storyboard live. The methodology is the following: literature review, selection of images, development of the program, application tests. The initial selected issues are: assessment of the victim, cardiorespiratory arrest and resuscitation, airway obstruction, wounds, and hemorrhages. After utilizing the program, the user should be able to solve hypothetical situations with minimal initial care and maximal physical comfort for an accident or sudden illness victim.

Computer-Assisted Instruction↗

PubMed1994

[Propofol in emergency care--areas of application and initial experiences].

So far propofol has only been used in clinical settings for sedation and induction of anaesthesia. This study describes several indications in preclinical and emergency events. All users were anaesthetists, so that experience of administration and dosage was extremely helpful. Since the drug met the expected criteria it is now regularly used for the sedation of ventilated patients during transport. The most important indications for preclinical induction of anesthesia with propofol are patients with isolated head injury and patients with respiratory insufficiency due to status asthmaticus resistant to therapy. After repeated unsuccessful attempts at therapeutic intervention with benzodiazepines and other antiepileptics we were able to interrupt status epilepticus in 11 patients by means of propofol, thereby preventing the patient from being intubated as a consequence of iatrogenic respiratory failure. However, emergency doctors must always be aware of the severe cardiocirculatory side effects of the drug, and must, hence, ensure that hypovolaemia or cardiac failure is excluded or corrected prior to propofol administration.

Adult↗

PubMed1993

User fees plus quality equals improved access to health care: results of a field experiment in Cameroon.

Since the Bamako Initiative was launched in 1988, many African countries have embarked on comprehensive primary health care programs relying, at least partially, on revenues generated through user fees to revitalize health care delivery systems. Although these programs contain two critical components, user fees and improved quality, policy debates have tended to focus on the former and disregarded the latter. The purpose of this study is to provide a net assessment of these two components by testing how user fees and improved quality affect health facility utilization among the overall population and specifically among the poorest people. A "pretest-posttest controlled" experiment was conducted in five public health facilities in the Adamaoua province of Cameroon. Three health centers which were to introduce a user fee and quality improvement (i.e. reliable drug supply) policy were selected as "treatment" centers and two comparable facilities not yet phased into this policy were selected as "controls". Two rounds of household surveys were conducted (each to 800 households in 25 villages surrounding the five study sites) to measure the percentage of ill people seeking care at the health center before and after the implementation of the policy. The experiment was tightly controlled by conducting monthly observations at each study site. Results indicate that the probability of using the health center increased significantly for people in the "treatment" areas compared to those in the "control" areas. Travel and time costs involved in seeking alternative sources of care are high; when good quality drugs became available at the local health center, the fee charged for care and treatment represented an effective reduction in the price of care and thus utilization rose. Moreover, contrary to previous studies which have found that the poorest quintile is most hurt by user fees, this study found that probability of the poorest quintile seeking care increases at a rate proportionately greater than the rest of the population. Since the poor are most responsive to price changes, they appear to be benefitting from local availability of drugs more than others.

Age Factors↗

PubMed2005

Cochlear implant complications: utility of federal database in systematic analysis.

OBJECTIVES: To explore the suitability of the Manufacturer User Facility and Distributor Experience (MAUDE) database (which is maintained by the Food and Drug Administration and has a mandatory reporting requirement) for systemic analysis of cochlear implant complications and treatments and, in so doing, analyze trends in cochlear implant complications for 2 periods, 2002 and pre-1998. DATA SOURCES: All events from 2002 and from before 1998 were considered. Events and action taken were categorized and tabulated. DATA SYNTHESIS: Because there was no null hypothesis, statistical analysis (chi2) was only used in comparing the 2 time frames. CONCLUSIONS: Structural limitations of the database, in addition to disparate reporting quality, made systematic analysis difficult. It was noted that spontaneous device failure accounted for the greatest single number of adverse events for both 2002 and the pre-1998 period (267/654 [41%] and 74/129 [57%], respectively), confirming earlier studies. A statistically significant decrease in spontaneous device failure and a significant increase in infections from the pre-1998 period to 2002 was observed. Flap problems ranging from extrusion to infection that required explantation were less frequently reimplanted than other problems requiring explantation, such as device failure or trauma. We considered new directions, including close collaboration with the new MedSun reporting system and conclude that while a valuable resource for narrative data, the current structure of the MAUDE database is only modestly useful for analyzing trends in complications and cannot answer several crucial questions, including device type comparisons. We suggest changing the current report format to include patient age, duration of implant, presence of anatomical abnormalities, and details on spontaneous device failures.

Cochlear Implantation↗

PubMed2006

Methods and mechanisms for contact feedback in a robot-assisted minimally invasive environment.

Providing a surgeon with information regarding contacts made between instruments and tissue during robot-assisted interventions can improve task efficiency and reliability. In this report, different methods for feedback of such information to the surgeon are discussed. It is hypothesized that various methods of contact feedback have the potential to enhance performance in a robot-assisted minimally invasive environment. To verify the hypothesis, novel mechanisms needed for incorporating contact feedback were designed, including a surgeon-robot interface with full force feedback capabilities and a surgical end-effector with full force sensing capabilities, that are suitable for minimally invasive applications. These two mechanisms were used to form a robotic "master-slave" test bed for studying the effect of contact feedback on the system and user performance. Using the master-slave system, experiments for surgical tasks involving soft tissue palpation were conducted. The performance of the master-slave system was validated in terms of criteria that assess the accurate transmission of task-related information to the surgeon, which is critical in the context of soft tissue surgical applications. Moreover, using a set of experiments involving human subjects, the performance of several users in carrying out the task was compared among different methods of contact feedback.

Adult↗