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Telephone communications between diabetes clients and nurse educators.

The purpose of this study was to describe the use of telephone communications between diabetes nurse educators (DNEs) and their clients with diabetes. A questionnaire was designed to examine the use of the telephone with diabetes clients from the perspective of DNEs. A total of 465 DNEs across the US were selected using a systematic sample from the membership directory of the American Association of Diabetes Educators. A total of 247 were questionnaires completed and returned (55%). Ninety-one percent of DNEs reported using the phone with clients and averaged 15 phone calls per week. Over 90% frequently reported discussing the following topics with clients: home blood glucose monitoring, hyperglycemia, hypoglycemia, insulin use, and diet. Analysis of telephone users showed that DNE experience and diabetes educator certification were significant factors in the differences observed in the reported topics discussed over the telephone. These findings suggest the need for guidelines for telephone contact with diabetes clients.

Adult↗

Use and abuse of volatile substances in industry.

1. Although there are trends towards the use of 'safer' or non-solvent materials, the overall consumption of solvents will probably not change very much over the next few years. Substitution of solvents by 'safer' materials is a complex and difficult process and the rate of change is correspondingly slow. 2. HSE exposure data show that generally industry controls most solvent use quite well. High personal exposures are not widespread and tend to occur in a fairly small number of premises involving 'end user' processes (mixing, spraying, etc). 3. Exposure in industry is generally to mixtures of solvents rather than single substances. The degree to which abuse is a contributory factor in exposure is uncertain, but there is probably greater opportunity for abuse to occur in 'end user' processes. 4. The experience of the author and colleagues in the HSE supports the evidence for the occurrence of volatile substance abuse (particularly of organic solvents) in industry but the extent of the practice is not known. 5. The proposed Control of Substances Hazardous to Health Regulations (COSHH) will bring greater emphasis on the assessment of risks to health in industry, which must include the potential for abuse, together with appropriate training and supervision.

Environmental Exposure↗

The limit fold change model: a practical approach for selecting differentially expressed genes from microarray data.

BACKGROUND: The biomedical community is developing new methods of data analysis to more efficiently process the massive data sets produced by microarray experiments. Systematic and global mathematical approaches that can be readily applied to a large number of experimental designs become fundamental to correctly handle the otherwise overwhelming data sets. RESULTS: The gene selection model presented herein is based on the observation that: (1) variance of gene expression is a function of absolute expression; (2) one can model this relationship in order to set an appropriate lower fold change limit of significance; and (3) this relationship defines a function that can be used to select differentially expressed genes. The model first evaluates fold change (FC) across the entire range of absolute expression levels for any number of experimental conditions. Genes are systematically binned, and those genes within the top X% of highest FCs for each bin are evaluated both with and without the use of replicates. A function is fitted through the top X% of each bin, thereby defining a limit fold change. All genes selected by the 5% FC model lie above measurement variability using a within standard deviation (SDwithin) confidence level of 99.9%. Real time-PCR (RT-PCR) analysis demonstrated 85.7% concordance with microarray data selected by the limit function. CONCLUSION: The FC model can confidently select differentially expressed genes as corroborated by variance data and RT-PCR. The simplicity of the overall process permits selecting model limits that best describe experimental data by extracting information on gene expression patterns across the range of expression levels. Genes selected by this process can be consistently compared between experiments and enables the user to globally extract information with a high degree of confidence.

Animals↗

Survey of Australians using cannabis for medical purposes.

BACKGROUND: The New South Wales State Government recently proposed a trial of the medical use of cannabis. Australians who currently use cannabis medicinally do so illegally and without assurances of quality control. Given the dearth of local information on this issue, this study explored the experiences of medical cannabis users. METHODS: Australian adults who had used cannabis for medical purposes were recruited using media stories. A total of 147 respondents were screened by phone and anonymous questionnaires were mailed, to be returned by postage paid envelope. RESULTS: Data were available for 128 participants. Long term and regular medical cannabis use was frequently reported for multiple medical conditions including chronic pain (57%), depression (56%), arthritis (35%), persistent nausea (27%) and weight loss (26%). Cannabis was perceived to provide "great relief" overall (86%), and substantial relief of specific symptoms such as pain, nausea and insomnia. It was also typically perceived as superior to other medications in terms of undesirable effects, and the extent of relief provided. However, nearly one half (41%) experienced conditions or symptoms that were not helped by its use. The most prevalent concerns related to its illegality. Participants reported strong support for their use from clinicians and family. There was almost universal interest (89%) in participating in a clinical trial of medical cannabis, and strong support (79%) for investigating alternative delivery methods. CONCLUSION: Australian medical cannabis users are risking legal ramifications, but consistent with users elsewhere, claim moderate to substantial benefits from its use in the management of their medical condition. In addition to strong public support, medical cannabis users show strong interest in clinical cannabis research, including the investigation of alternative delivery methods.

Journal Article↗

Incidence of depressive symptoms in users of the oral contraceptive.

Evidence is presented that the incidence of depression among users of oral contraceptives is no higher than that among matched controls not taking such medication. There is an association between high depression scores and high neuroticism scores, more marked in controls than takers. Intensity of depression is related more to age, personality and occupation than to the use of oral contraceptives. A higher proportion of users than of controls experience sexual satisfaction. Past takers include a large number of individuals with a high neuroticism score. The incidence of depression symptoms in women increases with age. A higher proportion of housewives than of women going out to full-time work show depressive symptoms.

Adolescent↗

Three-dimensional ultrasonographic telepresence.

We have developed a three-dimensional ultrasound telepresence system for remote consultation. Three-dimensional ultrasound data-sets can be acquired by relatively unskilled operators. The data are stored in the remote unit and then transmitted to a consultant equipped with a similar unit. A telepresence pointing device enables the consultant to re-slice that data-set in any plane. During the study period, 72 volumetric scans of male and female volunteers aged 18-45 years were performed in Bosnia. Field users of limited ultrasound experience (most with less than 30 min of training) were able to acquire volumetric scans, send volume data and interact with remote consultants over standard communications lines at distances of up to 20,000 km. Communications links from 9.6 to 1500 kbit/s were used. Technical limitations included lack of motion data, lack of colour data, scan artefacts and increased scan-to-diagnosis time. However, our preliminary experience indicates that this technique may eventually prove to be a useful adjunct to telesonography. Further studies of the technique are needed to determine its value in the broader clinical setting.

Adolescent↗

Processing of physiological signals in automotive research.

The development of innovative driver assistance systems requires the evaluation of the predisposed hypotheses such as acceptance and driving safety. For this purpose, the conduction of experiments with end-users as subjects is necessary. Analysis and evaluation are based on the recording of numerous sensor values and system variables. Video, gaze and physiological data are recorded for the analysis of gaze distraction and emotional reactions of subjects to system behaviour. In this paper, a modular data streaming and processing architecture is suggested and a concept for this architecture is defined for consistent data evaluation, which integrates off-the-shelf products for data analysis and evaluation.

Automobile Driving↗

What is it about intrauterine devices that women find unacceptable? Factors that make women non-users: a qualitative study.

INTRODUCTION: There is a lack of published research into the perceptions of 'non-users' of copper intrauterine contraceptive devices (IUDs). Despite this being one of the most commonly used methods of contraception in other countries, only 5% of contraceptive users in Great Britain aged 16-49 years currently use an IUD. This study explores how women's lay beliefs and perceptions about IUDs lead to rejection of this contraceptive choice. METHODS: One-to-one semi-structured interviews were conducted with 10 women of varying ages and parity recruited from an urban general practice. None of the women had ever used IUDs but all had used contraception in the previous 6 months. Data were subjected to qualitative analysis. RESULTS: Five analytical themes were identified: lack of objective information about IUDs, reported side effects of IUDs, anxieties about the process of fitting an IUD, IUDs as an infection risk and lack of personal control of an IUD, once fitted. CONCLUSIONS: Some of the themes identified mirrored those found in studies of user attitudes to and experiences of IUDs. Others, particularly the prominent worries about mess and embarrassment during fitting and the association between the hidden nature of the fitted device and unreliability, are new and need wider exploration.

Adolescent↗

Dental treatment provided to young adult Danes enrolled in alternative dental programs during a 3-year period.

From age 16 to 19 years three groups of young adults received alternative dental programs on termination of the Public Child Dental Health Service (PCDHS) in different municipalities: public group, n = 386; mixed group, n = 161; and private group, n = 261. During the entire study information on dental service use by the participants was taken from the records and National Health Insurance files. All dental services were calculated relative to a standardized Dental Service Unit defined by the value of a dental examination. During the entire study a mean of 30.53 Dental Service Units were provided, corresponding to 10.18 per year. More than half were of a diagnostic preventive character, and well over one-fourth were fillings. Irrespective of dental program, differences in dental services were noted with regard to utilization of dental services and to initial caries status. Users with high caries experience also received more fillings, but fewer preventive services. No association was found between gingival status and dental services provided.

Adolescent↗

A social-learning approach to student marijuana use.

Three hundred seventy-two college students were administered a battery of questionnaires designed to assess the predictive power of four social variables (social support, perceived sanctions, availability, family models), and six psychological ones (locus of control, mortality-conscience guilt, personal meanings, functions for continuing use, belief in consequences, societal and non-societal means of valued goal attainment) with respect to marijuana use. Results support a social learning theory interpretation of marijuana use. Users have had pleasant experiences, believe that sanctions are minimal, and that marijuana is not harmful. Six predictor variables correlated +.76 with use.

Adolescent↗

Effect of signal-to-noise ratio on directional microphone benefit and preference.

This study examined speech intelligibility and preferences for omnidirectional and directional microphone hearing aid processing across a range of signal-to-noise ratios (SNRs). A primary motivation for the study was to determine whether SNR might be used to represent distance between talker and listener in automatic directionality algorithms based on scene analysis. Participants were current hearing aid users who either had experience with omnidirectional microphone hearing aids only or with manually switchable omnidirectional/directional hearing aids. Using IEEE/Harvard sentences from a front loudspeaker and speech-shaped noise from three loudspeakers located behind and to the sides of the listener, the directional advantage (DA) was obtained at 11 SNRs ranging from -15 dB to +15 dB in 3 dB steps. Preferences for the two microphone modes at each of the 11 SNRs were also obtained using concatenated IEEE sentences presented in the speech-shaped noise. Results revealed that a DA was observed across a broad range of SNRs, although directional processing provided the greatest benefit within a narrower range of SNRs. Mean data suggested that microphone preferences were determined largely by the DA, such that the greater the benefit to speech intelligibility provided by the directional microphones, the more likely the listeners were to prefer that processing mode. However, inspection of the individual data revealed that highly predictive relationships did not exist for most individual participants. Few preferences for omnidirectional processing were observed. Overall, the results did not support the use of SNR to estimate the effects of distance between talker and listener in automatic directionality algorithms.

Aged↗

Virtual reality: a new clinical setting lab.

Virtual Reality (VR) is a new technology halfway between television and computer. It constitutes another step in the evolution of our use of a tool that allows us to see, to hear and to feel in a world created graphically in three dimensions, and to interact with it. VR is, mainly, a mental experience which makes the user believe that "he is there", that he is present in the virtual world. With this new tool, the user is no longer a mere observer of that which is happening on a screen, but he "feels" that he is immersed in that world and participates in it, in spite of the fact that they are spaces and objects that only exist in the memory of the computer and in the user's mind. This chapter seeks to carry out different reflections at different levels. First, we will analyze the relationships between VR and Psychology, one of the disciplines that has made more efforts in order to understand how we obtain knowledge from the world and from ourselves. We will also analyze the impact VR can have in one of the applied disciplines of Psychology, which is Clinical Psychology. With regard to this application environment, VR becomes a tool which can generate useful models for Psychology (both normal and abnormal), and it is offered as a research context for Clinical Psychology; as a "realistic" laboratory where we can study behaviours, emotions, thoughts, etc.; and a new means to develop psychological treatments.

Computer Simulation↗

IT support for clinical pathways--lessons learned.

Clinical pathways are an effective instrument to decrease undesired practice variability and improve clinician performance. IT applications embedded into clinical routine work can help to increase pathway compliance. Successfully implementing such applications requires both a responsive IT infrastructure and a participatory and iterative design process aimed at achieving user acceptance and usability. Experiences from the implementation and iterative improvement of an online surgical pathway at Marburg University Medical Centre have shown that pathway conformance actually could be improved by the use of IT. An analysis of the iterative design process has shown that future pathway projects can benefit from the lessons learned during this project. Based on these lessons a method for developing well adapted interaction mechanisms is presented, which is aimed at improving process alignment. Our goal is to build up a library of tested reusable components to reduce the number of iterations for pathway implementation.

Academic Medical Centers↗

Computer assisted sperm motility analysis.

The CellSoft system was employed to study its reliability in the evaluation of seminal data in fertile and infertile subjects. In addition new motility data were introduced and added to the classic parameters. Various clinical and experimental applications are reported. The system is valid and extremely useful in seminal research. In order to obtain the above mentioned benefits it is necessary for the users to have extensive experience of seminology and computer technology.

Cryopreservation↗

SOFI: a bidimensional detector for fast direct on-line quantification of beta particles on blots.

We present a high-speed, high-resolution beta imager developed to replace autoradiographic films currently used in molecular biology experiments. It allows the user to locate and make quantitative analyses of 32P-labeled molecules on a 25.6 x 25.6-cm flat surface. Combining new techniques--scintillating optical fibers and multianode photomultipliers--this fast imager offers several advantages when compared with recent gas detectors and flexibility for further improvements. Several biological applications will be discussed.

Animals↗

Cinnamon oil abuse by adolescents.

Reports in the literature about cinnamon oil toxicity are limited to allergic reactions and local irritant effects from dermatologic exposure. Cinnamon oil is easily obtained from pharmacies in 5-10 ml amounts for use as a flavoring agent and in craft items. Within a 5-mo period the Pittsburgh Poison Center (PPC) documented 32 cases of cinnamon oil abuse; all cases involved males aged 11-16 y and were reported to the PPC by school nurses. Sucking on toothpicks or fingers which had been dipped in cinnamon oil was the primary method of abuse. A rush or sensation of warmth, facial flushing, and oral burning were the experiences reported by the users. Some children complained of nausea or abdominal pain but no systemic effects were reported. Eight patients with dermal exposure had irritation ranging from erythema to welts, which resolved after thorough soap and water decontamination. Two ocular exposures resulted in mild irritation and were successfully treated with irrigation or dilution. The recent popularity of cinnamon oil abuse appears to be related to the ease with which it can be carried, engendering little fear of discovery or chastisement. Despite the relatively low toxicity of cinnamon oil, medical professionals should be aware of its potential for misuse.

Adolescent↗

Human immunodeficiency virus infection in a Dublin general practice.

A group general practice in Dublin's inner city has had extensive experience of intravenous drug users since the late 1970s. Since 1985 a total of 54 human immunodeficiency virus (HIV) seropositive patients have attended the practice, of whom 48 are intravenous drug users, four are the children of drug users and two have been infected through sexual contacts. Three patients have developed the acquired immune deficiency syndrome and at least eight have symptomatic HIV disease. Sixty per cent of Ireland's seropositive population have been infected through intravenous drug abuse but nationally only 16% of all intravenous drug users tested are seropositive; in the study practice, however, at least 35% (48/137) of known intravenous drug users are seropositive.

Acquired Immunodeficiency Syndrome↗

HRRI: a high resolution radioimager for fast, direct quantification in in situ hybridization experiments.

We present a high-speed, high-resolution beta imager. It has been developed to be used in in situ hybridization experiments, either instead of or in complement with autoradiographic film and emulsions that are currently used for these experiments. It allows the user to locate and perform quantitative analyses of (3H-, 14C-, 35S-, 32P-, 125I-) labeled molecules with a 15-microns spatial resolution on a 1.2 cm2 area. We have combined recent techniques (specific scintillator thin sheets and intensified charge-coupled device [CCD]) so that this imager offers a wide dynamic range and real-time acquisition. Several biological applications will be discussed.

Animals↗