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Unity and variety in visual form.

Some stimuli are perceived as unitary patterns, and others as dual or plural patterns. Such 'unity-and-variety' phenomena are explained by various process approaches of perception, such as the global precedence hypothesis, the preattentive orientation detection assumption, and the recognition-by-components model. However, these three approaches, which will be discussed in this paper, each explain a different subset of these phenomena. It will be argued that not only these three subsets but also other unity-and-variety phenomena can be explained from just one point of view by adopting the descriptive minimum principle. This principle states that the preferred interpretation of a pattern is reflected by the simplest of all possible representations of that pattern. The highest hierarchical level in the simplest pattern-representation will be called the 'superstructure' of the pattern. The superstructure of a pattern neither refers necessarily to the largest or global pattern component, nor is assessed necessarily in a primary stage in the perception process. Yet, it will be argued that the superstructure is decisive in determining whether a shape is perceived either as unitary or as dual.

Attention↗

2-Aminopurine fluorescence quenching and lifetimes: role of base stacking.

2-Aminopurine (2AP) is a fluorescent analog of guanosine and adenosine and has been used to probe nucleic acid structure and dynamics. Its spectral features in nucleic acids have been interpreted phenomenologically, in the absence of a rigorous electronic description of the context-dependence of 2AP fluorescence. Now, by using time-dependent density functional theory, we describe the excited-state properties of 2AP in a B-form dinucleotide stacked with guanosine, adenosine, cytosine, or thymine. Calculations predict that 2AP fluorescence is quenched statically when stacked with purines, because of mixing of the molecular orbitals in the ground state. In contrast, quenching is predicted to be dynamic when 2AP is stacked with pyrimidines, because of formation of a low-lying dark excited state. The different quenching mechanisms will result in different experimentally measured fluorescence lifetimes and quantum yields.

2-Aminopurine↗

Macro-organizational factors, the incidence of work disability, and work ability among the total workforce of home care workers in Sweden.

AIMS: To investigate the importance of macro-organizational factors, i.e. organizational sociodemographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, disability pension, and prevalence of workers with long-term work ability among home care workers. METHODS: In an ecological study design, data from national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-organizational factors (economic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers). RESULTS: The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disability pension was about four times as high for the women. A great variation in municipal incidence of long-term sick leave, disability pension, and long-term work ability (101-264, 0.6-19.6, and 913-1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work ability was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability (47-62% explained variance) better than long-term sick leave (33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days. CONCLUSIONS: The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.

Adult↗

Innovative interactive videodisc units for teaching of pathology laboratory cases. Five years' experience.

Seven computer-assisted interactive videodisc instruction units, based on laboratory cases in the General Pathology course for first-year medical students, were developed. Images from the laser videodisc Slice of Life, contributed previously by one of the authors, and the program "Hypercard stack 2.1" were used to develop these units to provide students with interactive software for independent supplemental review of the laboratory cases studied in the course. With the dual-screen system developed, specific picture frames from the videodisc are retrieved on one screen while the other screen displays the corresponding text. The seven units include two units each on cell injury, inflammation, and neoplasia, and one on opportunistic infections. Each unit contains several case studies, each of which consists of the following: a clinical profile, gross pictures and description of the tissue removed, sequential photomicrographs at successively higher magnifications from various fields of tissue slides and their descriptions, comparison with normal histology of the organ involved, interpretation of the observations and comments, final diagnosis, and a quiz. The histopathologic features are specifically emphasized with programmed, computer-generated pointers to indicate specific cells or structures on the images. Each case also contains a glossary to define terms not familiar to first-year students. Although no comparative performance data are available, evaluation of the units obtained from nine terms of use in the last 5 years indicates that these units are extremely valuable supplemental tools for students for independent review of the laboratory cases.

Computer-Assisted Instruction↗

Misuse of standard error of the mean (SEM) when reporting variability of a sample. A critical evaluation of four anaesthesia journals.

BACKGROUND: In biomedical research papers, authors often use descriptive statistics to describe the study sample. The standard deviation (SD) describes the variability between individuals in a sample; the standard error of the mean (SEM) describes the uncertainty of how the sample mean represents the population mean. Authors often, inappropriately, report the SEM when describing the sample. As the SEM is always less than the SD, it misleads the reader into underestimating the variability between individuals within the study sample. METHODS: The aim of this study was to evaluate the frequency of inappropriate use of the SEM in four leading anaesthesia journals in 2001. The journals were searched manually for descriptive statistics reporting either the mean (SD) or the mean (SEM), and inappropriate use of the SEM was noted. RESULTS: In 2001, all four anaesthesia journals published articles that used the SEM incorrectly: Anesthesia & Analgesia 27.7%, British Journal of Anaesthesia 22.6%, Anesthesiology 18.7% and European Journal of Anaesthesiology 11.5%. Laboratory reports and clinical studies were equally affected, except for Anesthesiology where 90% were basic science reports. CONCLUSIONS: One in four articles (n=198/860, 23%) published in four anaesthesia journals in 2001 inappropriately used the SEM in descriptive statistics to describe the variability of the study sample. Anaesthesia journals are encouraged to provide clearer statistical guidelines on how to report data variability in descriptive statistics.

Anesthesiology↗

A performance assessment framework for hospitals: the WHO regional office for Europe PATH project.

OBJECTIVE: The World Health Organization (WHO) Regional Office for Europe launched in 2003 a project aiming to develop and disseminate a flexible and comprehensive tool for the assessment of hospital performance and referred to as the performance assessment tool for quality improvement in hospitals (PATH). This project aims at supporting hospitals in assessing their performance, questioning their own results, and translating them into actions for improvement, by providing hospitals with tools for performance assessment and by enabling collegial support and networking among participating hospitals. METHODS: PATH was developed through a series of four workshops gathering experts representing most valuable experiences on hospital performance assessment worldwide. An extensive review of the literature on hospital performance projects was carried out, more than 100 performance indicators were scrutinized, and a survey was carried out in 20 European countries. RESULTS: Six dimensions were identified for assessing hospital performance: clinical effectiveness, safety, patient centredness, production efficiency, staff orientation and responsive governance. The following outcomes were achieved: (i) definition of the concepts and identification of key dimensions of hospital performance; (ii) design of the architecture of PATH to enhance evidence-based management and quality improvement through performance assessment; (iii) selection of a core and a tailored set of performance indicators with detailed operational definitions; (iv) identification of trade-offs between indicators; (v) elaboration of descriptive sheets for each indicator to support hospitals in interpreting their results; (vi) design of a balanced dashboard; and (vii) strategies for implementation of the PATH framework. CONCLUSION: PATH is currently being pilot implemented in eight countries to refine its framework before further expansion.

Benchmarking↗

Changes in water content, collagen degradation, collagen content, and concentration in repeated biopsies of the cervix of pregnant cows.

The objective of the present study was to assess if cervical ripeness could be quantified by measuring the percentage of denaturation of the collagen network of the stromal layer. Biopsy specimens from the caudal part of the cervix were obtained from nine pluriparous cows between Days 149 and 157 of gestation (second-trimester biopsy), at exactly Day 275 of gestation (term biopsy), and shortly after calving (calving biopsy). The samples were divided into a superficial stromal part and a deep stromal part. The water content was derived from the weight of the samples before and after lyophilization. A colorimetric assay was used to assess the percentage of collagen denaturation by determining the extinction at 570 nm of hydroxyproline released from alpha-chymotrypsine-treated samples. By incorporating a hydroxyproline standard series in the measurements, the insoluble collagen content (mug/mg dry wt) as well as the insoluble collagen concentration (mug/mg wet wt) could be derived. The water content of both layers of the cervix significantly increased between midpregnancy and parturition (P < 0.01). The insoluble collagen content and the insoluble collagen concentration were significantly increased at term (P < 0.01 and P < 0.05, respectively) but were significantly decreased at calving (P < 0.05 and P < 0.01, respectively). Both parameters showed no significant differences between the superficial and deep stromal layer, and they were significantly correlated with each other. A significant increase in the percentage denaturation of the deep stromal layer occurred between the second trimester and term pregnancy (P < 0.01), whereas at calving, the percentage denaturation had not significantly increased compared to term. The percentage of collagen denaturation of the superficial stromal layer did not significantly change with stage of gestation or at parturition. Our findings indicate that cervical ripening is a combination of increased collagen synthesis and increased percentage of collagen denaturation, whereas at calving, an increased digestion of the denatured collagen leads to increased collagen loss from the cervical connective tissue. The finding that cervical ripening mainly takes place in the deep stromal layer of the cervix emphasizes the importance of a detailed description of the tissue sampling sites for a proper interpretation of the results obtained from biochemical studies of the cervix.

Animals↗

Twist localizes three-dimensional patterns

A mechanism for the localization of spatially periodic, self-organized patterns in anisotropic media which requires systems extended in all three spatial dimensions is presented: When the anisotropy axis is twisted, the pattern becomes localized in planes parallel to the anisotropy axis. An analytical description of the effect is developed, and used to interpret recent experiments in the high-frequency regime of electroconvection by Bohatsch and Stannarius [Phys. Rev. E 60, 5591 (1999)]. The localization width is found to be of the order of magnitude of the geometrical average of the pattern wavelength and the inverse twist.

Journal Article↗

Light transport through the band-edge states of Fibonacci quasicrystals.

The propagation of light in nonperiodic quasicrystals is studied by ultrashort pulse interferometry. Samples consist of multilayer dielectric structures of the Fibonacci type and are realized from porous silicon. We observe mode beating and strong pulse stretching in the light transport through these systems, and a strongly suppressed group velocity for frequencies close to a Fibonacci band gap. A theoretical description based on transfer matrix theory allows us to interpret the results in terms of Fibonacci band-edge resonances.

Journal Article↗

The moral development of medical students: a pilot study of the possible influence of medical education.

Medicine endorses a code of ethics and encourages a high moral character among doctors. This study examines the influence of medical education on the moral reasoning and development of medical students. Kohlberg's Moral Judgment Interview was given to a sample of 20 medical students (41.7% of students in that class). The students were tested at the beginning and at the end of their medical course to determine whether their moral reasoning scores had increased to the same extent as other people who extend their formal education. It was found that normally expected increases in moral reasoning scores did not occur over the 4 years of medical education for these students, suggesting that their educational experience somehow inhibited their moral reasoning ability rather than facilitating it. With a range of moral reasoning scores between 315 and 482, the finding of a mean increase from first year to fourth year of 18.5 points was not statistically significant at the P < or = 0.05 level. Statistical analysis revealed no significant correlations at the P < or = 0.05 level between the moral reasoning scores and age, gender, Medical College Admission Test scores, or grade point average scores. Along with a brief description of Kohlberg's cognitive moral development theory, some interpretations and explanations are given for the findings of the study.

Adult↗

Migration efficiency ratios and the optimal distribution of population.

The authors present a theoretical description of the migration process and criticize the conventional interpretation of the migration efficiency ratio, which is defined as the ratio of the net number of moves of individuals between areas to the gross number of moves that take place. "The conventional interpretation of the migration efficiency ratio is that the closer it lies to zero the less efficient the migration process....However, [the authors] feel that this is a somewhat misleading conception of the notion of efficiency in migration in that it emphasizes the physical efficiency of the migration process rather than focusing on the contribution of migration to a socially efficient allocation of population. Thus, to redirect attention, [they] have chosen to judge migration efficiency on the basis of its contribution to producing an equilibrium population distribution." The focus is on internal migration.

Demography↗

Implications of the functional anatomy of the hand and forearm of Ailurus fulgens (Carnivora, Ailuridae) for the evolution of the 'false-thumb' in pandas.

Both the giant panda (Ailuropoda melanoleuca) and the red panda (Ailurus fulgens) possess a 'false-thumb', actually an enlarged radial sesamoid bone, which contributes to the gripping action of the hand. These species are not closely related, however, as one is an ursid and the other an ailurid, so the fact that they share this adaptation implies a remarkable convergence. We studied the functional anatomy of this structure in the red panda, comparing it with existing descriptions of the grasping mechanism in both pandas. Previous interpretations of the radial sesamoid in Ailurus as a rod-like structure without direct articulation to the wrist bones are inaccurate. There are various important differences between the red panda and the giant panda. In the former, the lesser development of the radial sesamoid, its connection with the flexor retinaculum, the presence of an insertion of the muscle abductor pollicis longus in the first metacarpal, which enhances its supinatory action, and the presence of a muscle flexor brevis digitorum manus point to thin-branch climbing features serving as an exaptation to the more recent role of the red panda hand in the manipulation of bamboo.

Animals↗

Swedish child health care in a changing society.

BACKGROUND: Staff in Swedish child health care today feel a gap between policy and practice. By revealing the main lines in the development of child health care, we hoped to achieve a better understanding of the current trends and problems in today's Swedish child health care. METHODS: A selection of official documents about the development of child health care during the period 1930-2000 was studied with the aid of discourse analysis. RESULTS: Four discourses were identified, which serve as a foundation for a periodization of the development of child health care. In the first period the main task of child health care, alongside checking on the development of the child, was to inform and educate the mothers. During the second period health supervision became the crucial task, to identify risks and discover abnormalities and disabilities. The third period focused on the discussion concerning the identification of health-related and social 'risk groups', and the work of child health care was increasingly geared to supervision of the parents' care of their children. Parents were to be given support so that they could cope with their difficulties by themselves. During the current period child health care is increasingly expected to direct its work towards the child's surroundings and the family as a whole and is now explicitly defined as an institution that should strengthen parents' self-esteem and competence. The level of responsibility for the child's health changed gradually during the different periods, from public responsibility to parental responsibility. The focus of efforts in child health care was changed from being general in the first and second periods to general and selective in period three, and then gradually becoming selective again in period four. While control of the child's physical health was central during the first two periods, psychosocial health came into focus in the last two, along with the importance of supporting the parents to enable them to handle their difficulties by themselves. CONCLUDING REMARKS: We noted that it was difficult to translate policy recommendations into practice. One reason was the shifting focus in child health care from the child's physical health to psychosocial problems which in itself meant a shift from descriptions of concrete and well-defined duties to more abstract and general descriptions of tasks which are by definition open to interpretation. Another reason for the noted difficulty was the transition from unambiguously described measures in terms of paternalistic regulation to more participatory and at the same time more expansive definitions of roles and responsibilities.

Adaptation, Psychological↗

The international labour office classification: use and misuse.

The main characteristics of the International Labour Office (ILO) International Classification of Radiographs of the Pneumoconioses (1980) are reviewed. Applications to epidemiological, research, and clinical problems are outlined. The need for multiple readings, reading protocols and appropriate administrative arrangements is emphasized. Possible improvements to the Classification are discussed. The basic descriptive features of the scheme are distinguished from supplementary interpretative facilities; it is suggested that misuse of the Classification occurs primarily when these two functions are confused.

Humans↗

Criteria for evaluating evidence on public health interventions.

Public health interventions tend to be complex, programmatic, and context dependent. The evidence for their effectiveness must be sufficiently comprehensive to encompass that complexity. This paper asks whether and to what extent evaluative research on public health interventions can be adequately appraised by applying well established criteria for judging the quality of evidence in clinical practice. It is adduced that these criteria are useful in evaluating some aspects of evidence. However, there are other important aspects of evidence on public health interventions that are not covered by the established criteria. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of an intervention, and the success or failure of the intervention itself. Moreover, if an intervention is unsuccessful, the evidence should help to determine whether the intervention was inherently faulty (that is, failure of intervention concept or theory), or just badly delivered (failure of implementation). Furthermore, proper interpretation of the evidence depends upon the availability of descriptive information on the intervention and its context, so that the transferability of the evidence can be determined. Study design alone is an inadequate marker of evidence quality in public health intervention evaluation.

Evidence-Based Medicine↗

From the RSNA Refresher Courses. Radiological Society of North America. Chronic adult hip pain: MR arthrography of the hip.

This article describes the technique for performance and interpretation of magnetic resonance arthrography of the hip. A description of normal anatomy of the hip is presented, and the appearance of the abnormal labrum is discussed. Labral detachments and tears are the most common clinically significant abnormalities to be identified. These abnormalities are recognized on the basis of the presence of contrast material at the acetabular-labral interface or within the substance of the labrum. Many varied appearances of the labrum have been identified within the asymptomatic population, and the correlation of these appearances is contrasted with those of the abnormal labrum in symptomatic patients. To date, it is difficult to draw conclusions regarding the significance of an absent labrum or of a sulcus at the acetabular-labral junction. Experience suggests that an absent labrum in a symptomatic individual is pathologic and that a sulcus at the anterosuperior acetabular-labral junction may be a normal variant.

Acetabulum↗

The famous case of rheumatic hematuria described by Giammatteo Ferrari da Grado, professor at the University of Pavia (1432-1472).

Giammatteo Ferrari da Grado was an influential professor and teacher of medicine at the University of Pavia in middle of the 15th century. He authored three important texts, among which is the Consilia, a collection of cases he visited and/or consulted. Among these, Ferrari describes a case of rheumatic hematuria in an eminent patient, Gaston de Foix, prince of Navarre. Following a precise description of the symptoms, he makes a complex pathogenic interpretation based on the theory of humors current at the time, and goes on to offer his patient a generous spectrum of herbal, hygienic and dietetic remedies.

Education, Medical↗

Taciturn patients in health counseling at a hospital: passive recipients or active participators?

This study explored patients' taciturnity as observed on videotape during hospital health counseling situations with a nurse. Health counseling sessions, 38 in number, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversation analysis. The data analysis included information on 18 selected patients who spoke little and did not introduce new topics, but rather supported the discussion on the theme chosen by the nurse. When we examined nurses' and patients' speech word by word, we discovered four participation frames that produced taciturnity: in the hands of professionals, compliant, guilty, and polite. These could fluctuate during interaction. The findings indicate that there is a need for a more extensive description of taciturn, or silent, patients. What has been interpreted as passivity in the literature can be interpreted more constructively. This insight can be useful for developing health counseling practice in hospitals.

Adolescent↗