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PubMed2006

A framework for description and evaluation of the nurse specialist role in South Australia.

Professionalising forces in nursing, burgeoning costs and increasing crises in medical care in rural and remote areas have led to the development of specialty nursing. However, description and evaluation of the role of the Nurse Specialist in the Australian context has not been well documented. This interpretive study was designed to explore the major components of Nurse Specialist roles in South Australia and to develop a framework for description and evaluation of these roles. A total of 30 Nurse Specialists from two major metropolitan teaching hospitals participated in focus groups to explore their roles. Role components were used to develop tools and a framework for describing and evaluating these roles. Participants identified clinical, educational, professional development, management and research as key components of the Nurse Specialist role. The results highlighted the diversity within the role for each Nurse Specialist and the need for a comprehensive range of evaluation tools. Recommendations arising from the research suggest that evaluation strategies need to be accompanied by appropriate staff education and be sensitive to the social, political and economic context of practice.

Attitude of Health Personnel↗

PubMed1999

A new way of building a database of EEG findings.

Whereas computer-based electroencephalography (EEG) is widely applied, the EEG interpretations are usually not stored in a way that favours exploitation of modern computer technology. This paper reports an EEG description system facilitating categorization of EEG data in a computerized database. The system interactively communicates with the digital EEG system and also with the general patient administrative system. The main new quality of this system is the methods for data input and automatic data retrieval from several systems, rather than the establishment of a database of EEG data itself. The EEGs are visually analysed and categorized. Manually marked EEG events are automatically transferred to the database and such events as well as defined electrode positions within these epochs are directly linked to their corresponding descriptions. The database is updated without demand for filling in the events in the database in a second operation. Thereby, the EEG interpreter builds the database while analysing the EEG. This system provides an improved accessibility of EEG data for clinical, normative, educational and scientific use.

Brain↗

PubMedDate not supplied

Measurement of three-dimensional intra-articular kinematics: methodological and interpretation problems.

Intra-articular kinematics evaluates joint motion in terms of the configuration of the joint. Therefore data are needed concerning joint kinematics as well as joint configuration. We have developed accurate measurement methods for both in vivo and in vitro evaluation. Interpretation of the processed data is more complex than simply setting up a coordinate system based on the joint configuration. Although the description of intra-articular motion in terms of Euler-Cardan or helical angles may be complete, the therapeutic interpretation may be doubtful. Using the the ulno-humeral joint during flexion-extension as an example, we found the combination of helical angles in the directions of extension/external rotation/varus. In the case of the Cardan angles, inconsistent patterns of rotation resulted from a different choice of sequence order and were different from the helical angles. The finite helical axis (FHA) provides a functional representation of the joint movement, i.e. pathways of motion, whereas the sequence dependency of Euler-Cardan angles produces problems in the therapeutic interpretation of the movement. Therefore we believe that an FHA approach should be used in intra-articular kinematics research.

Biomechanical Phenomena↗

PubMed1995

Methods and problems in measuring quality of life.

The US health-care transition demands increased accountability for medical care. This has contributed to increased interest in documenting valued medical outcomes, including improvements in health-related quality of life and treatment satisfaction. These data can only be obtained validly by asking patients directly about their current health state, perception of well-being, and satisfaction with care. A core set of well-validated instruments have been developed to measure health-related quality of life in patients with cancer. As these are employed with increasing frequency, rigorous quality assurance of data collection is critical. Because of the necessity of quality control, patient-reported data collection can be labor-intensive and prohibitively costly. However, time and cost-saving methods, such as centralized telephone survey methods or on-site direct data entry via interactive computer, can guarantee high-quality data while minimizing costs. Justification of the need for these methods and a brief description are provided.

Data Interpretation, Statistical↗

PubMed1982

Quantitative description of the binding of GM1 oligosaccharide by cholera enterotoxin.

We present a quantitative molecular interpretation of binding between the five B subunits of cholera enterotoxin and the oligosaccharide of ganglioside GM1, based on the currently accepted quaternary structure of the toxin and principles of multiple equilibria. A sequential binding equation is derived and fitted to published binding data obtained by equilibrium dialysis. In one study of binding to reduced toxin (I), intact toxin (II), and isolated B subunits (III) at low concentrations, analysis by the Hill equation suggested that binding was positively cooperative and that there were only four binding sites per toxin molecule; individual affinity constants could not be estimated because of the empirical nature of the Hill equation. Our analysis suggests that the evidence for positive cooperativity is stronger for I and III than for II. Affinity constants for the first binding step are about 2.0-2.1 microM-1 for I and 2.5-2.7 microM-1 for II and III; those for the second binding step are about 3.5-5.0 microM-1 and for I and III, but only 2.5 microM-1 for II. Constants for later binding steps are apparently within the range of 2-7 microM-1. Predictions of the sequential model at higher ligand concentrations diverge substantially from those of the Hill equation, and are supported by data obtained at higher protein and ligand concentrations. Thus all available equilibrium dialysis data are consistent with a single set of affinity constants and with the hypothesis of five equivalent binding sites.

Binding Sites↗

PubMedDate not supplied

Enriching the portrait: methodological triangulation of life-closing theory.

Some researchers promote a triangulated or multiple-methods approach in studies that examine complex human phenomenon. Nonetheless, problems abound in combining 2 dissimilar data sets from 2 different methodologies. One way that numerical and textual data can be merged is through a research method called statistical triangulation. The purpose of this article was to describe the statistical triangulation of a simultaneous, between-methods causal model and grounded theory investigation that explained psychological adaptation in dying persons. The statistical triangulation involved the analysis of selected patterns of dying from the grounded theory study with the variables used in the causal model investigation. A 1-way analysis of variance confirmed that the variables of social support, physical function, and religious preference impacted end-of-life patterns. Post hoc comparisons validated the conceptualization of 3 patterns of dying (becoming, anguishing/agonizing, avoiding) that emerged from the qualitative data. Although there are limitations to this analysis, statistical triangulation shows promise as a research method for enriching qualitative description.

Adaptation, Psychological↗

PubMed2004

Complex unitary vectors for the direction of propagation and for the polarization of electromagnetic waves in absorbing isotropic media.

We introduce a formalism based on complex unitary vectors for the direction of propagation and for the polarization in order to describe in detail the propagation of inhomogeneous plane waves in absorbing isotropic media. We obtain analytic expressions for the displacement vector, the electric field, the magnetic field, and the Poynting vector, and we study their geometry in terms of the geometrical interpretation of the complex directions of propagation inside the material. We introduce a complex coordinate system based on complex unitary vectors, where the description of the polarization states of the field vectors and the Poynting vector becomes simpler. The physical meaning and the interpretation of the mathematical operations involving these complex unitary vectors is provided.

Journal Article↗

PubMed2005

[Epidemiology of cutaneous melanoma: descriptive data in France and Europe].

INTRODUCTION: The incidence of melanoma and the resulting mortality have been the subject of many studies. However, controversy remains as to the interpretation of the number of cases observed and the existence of an actual "epidemic" of melanomas in fair-skinned populations. OBJECTIVES: Analyze the descriptive epidemiological data available concerning cutaneous melanomas in France and in Europe. METHODS: Data regarding incidence and mortality published in the literature and on the Internet were reviewed and analyzed. RESULTS: In France, between 1980 and 2000, the standardized worldwide population incidence rate of melanoma increased from 2.4 to 7.6 per 100.000 inhabitants/years in men and from 3.9 to 9.5 in women. In the Haut-Rhin department in France, where Breslow indexes are registered, the increase in incidence was accompanied by an increase in the proportion of thin melanomas. In the year 2000, the estimated number of new cases of cutaneous melanomas was of 7231, with 58 p. 100 female and 42 p. 100 male cases. Great geographical disparity among the 9 departments in France equipped with registers was noted. This increase in incidence was accompanied by an increase in mortality. Between 1969 and 1997, mortality due to melanoma was multiplied by 2.7 in women and by 2.9 in men. In the year 2000, 1364 deaths were attributed to a melanoma. The standardized worldwide mortality rates were of 1.6/100000 inhabitants/years in men and 1.1/100000 inhabitants/years in women. In Europe, a great increase in the incidence and mortality has been registered in all countries since the nineteen fifties. It was earlier and greater in northern European countries, followed by western European countries, and finally by eastern and southern countries. There was great geographical disparity, with a double decreasing North-South East-West gradient. Analysis of the recent trends in development, in countries with high incidence such as those of northern Europe, showed a trend towards the stabilization in the incidence and decreased mortality in young adults. DISCUSSION: In France, as in Europe, the extensive increase in incidence of melanoma and resulting mortality is a reality, reaching a peak in the northern European countries. The decrease in mortality observed recently in young cohorts in these countries and in Eastern Europe may announce an ultimate decrease in the older populations and the rest of Europe. Massive primary and secondary prevention campaigns seem effective and warrant reinforcement.

Adolescent↗

PubMed2000

Gait disturbance interpreted as cerebellar ataxia after MMR vaccination at 15 months of age: a follow-up study.

Measles, mumps and rubella (MMR) vaccination was included in the Danish childhood vaccination programme in 1987. During the following 10-y period, 550 notification records of adverse events after MMR vaccination at 15 mo of age have been registered, and a total of 41 notifications have included "gait disturbance". This corresponds to a frequency of 8 per 100,000 doses of MMR vaccine used for 15-mo-old children. The symptoms and signs are characteristic of cerebellar ataxia. In 28 notifications, the descriptions by the doctors included only "gait disturbance", while in 13 an additional interpretation was included. Thirty-two parents (78%) filled in a questionnaire and 26 (63%) agreed to participate in a clinical follow-up study. The gait disturbance symptoms mainly occurred 7-14 d after the vaccination, and the duration was median 1-2 wk (range 1 d to more than 4 mo). One-third of the children had symptoms lasting more than 2 wk. Significantly more children with long duration of symptoms had some kind of complaint or clinical signs at the follow-up in 1997. Gait disturbance registered after MMR vaccination seems to be more frequent than hitherto reported. Most cases are mild and short-lasting and a longer duration of symptoms seems to be predictive of late sequelae. A clinical diagnosis of cerebellar ataxia after MMR and the exact frequency of this adverse event remains to be tested in prospective studies.

Age Factors↗

PubMed1992

Molecular dynamics study of the conformational behavior of a representative elastin building block: Boc-Gly-Val-Gly-Gly-Leu-OMe.

The conformational behavior of the synthetic peptide, Boc-Gly-Val-Gly-Gly-Leu-OMe, containing the X-Gly-Gly and Gly-Gly-X (X = Val or Leu) repeating sequences and constituting a fragment of elastin was investigated by molecular mechanics and molecular dynamics (MD) simulation. The results suggest that, irrespective of the approximations used, the molecule shows a manifold of low energy conformations characterized by gamma-turns and type II beta-turns. Furthermore, MD simulations point out a conformational floppiness due to very low barriers between different conformations. Experimental CD measurements in a virtually apolar medium (dioxane--epsilon = 2.209), which better mimics the vacuum conditions of the simulation, support the theoretical results. The general emerging picture, indicating the molecule as characterized by a combination of flexibility with conformational preferences, is in agreement with previous experimental findings and enriches of new aspects the description of the microscopic behavior of this molecule suggesting more detailed interpretation of previous data.

Amino Acid Sequence↗

PubMed2004

In vivo 3D analysis of the adipose tissue in the orbital apex and the compartments of the parasellar region.

As tissue dissections carried out on formaldehyde-fixed anatomical specimens demonstrate, the parasellar region (PSR), traditionally referred to as the cavernous sinus, is composed of three distinct compartments: orbital, pterygopalatine, and lateral sellar. The aim of our study was to identify and measure these compartments in the living and to describe the topography of their adipose body tissues. For this purpose data sets of 35 patients, who had undergone thin-section multislice computed tomography (CT), were examined using 3D-reconstruction software. The pterygopalatine and orbital compartments of the PSR could be identified in the images by their adipose bodies. We provide more exacting measurements of their size than have been presented in earlier studies. Furthermore, we include data about the uni- and bilateral presence of the single compartments and analyze the topography of the adipose tissue bodies in the orbital apex region. Our quantitative data and topographical descriptions confirm the compartmentalization concept of the PSR, allow for correct interpretation of CT scans of the orbital apex and anterior PSR, and provide baseline information for individual planning of surgical and radiological interventions.

Adipose Tissue↗

PubMed1990

Tomographic views of normal and abnormal hearts: the anatomic basis for various cardiac imaging techniques. Part I.

Recent developments have taken place in the diagnosis of cardiovascular disorders in the area of cardiac imaging techniques. From a previous era of imaging by silhouettes (chest roentgenography, fluoroscopy, angiocardiography), we have emerged into an era of imaging by tomographic scanning (echocardiography, radionuclide tomography, computed tomography, magnetic resonance). A basic understanding of tomographic cardiac anatomy is the foundation for proper use and interpretation of these new imaging modalities. The present report provides a description of the techniques of tomographic cutting of necropsy cardiac specimens and illustrates some of the pathologic cardiac abnormalities cut in these tomographic planes. Part I of this report describes position of the heart and tomographic axis planes, preparation of the heart and methods of cutting at necropsy, and the short-axis, two-chamber, and four-chamber views of the heart.

Heart↗

PubMed1990

Tomographic views of normal and abnormal hearts: the anatomic basis for various cardiac imaging techniques. Part II.

Recent developments have enhanced the diagnosis of cardiovascular disorders in the area of cardiac imaging techniques. From an era of imaging by silhouettes (chest roentgenography, fluoroscopy, angiocardiography), we have emerged into an era of imaging by tomographic scanning (echocardiography, radionuclide tomography, computed tomography, magnetic resonance). A basic understanding of tomographic cardiac anatomy is the foundation for proper use and interpretation of these new imaging modalities. The present report provides a description of the techniques of tomographic cutting of necropsy cardiac specimens and illustrates some of the pathologic cardiac abnormalities cut in these tomographic planes. Part II of this report describes the long-axis method, methods using the body rather than the heart as the reference axis, and includes transverse, frontal, and parasagittal methods of imaging the heart.

Autopsy↗

PubMed1994

Conservation and prediction of solvent accessibility in protein families.

Currently, the prediction of three-dimensional (3D) protein structure from sequence alone is an exceedingly difficult task. As an intermediate step, a much simpler task has been pursued extensively: predicting 1D strings of secondary structure. Here, we present an analysis of another 1D projection from 3D structure: the relative solvent accessibility of each residue. We show that solvent accessibility is less conserved in 3D homologues than is secondary structure, and hence is predicted less accurately from automatic homology modeling; the correlation coefficient of relative solvent accessibility between 3D homologues is only 0.77, and the average accuracy of predictions based on sequence alignments is only 0.68. The latter number provides an effective upper limit on the accuracy of predicting accessibility from sequence when homology modeling is not possible. We introduce a neural network system that predicts relative solvent accessibility (projected onto ten discrete states) using evolutionary profiles of amino acid substitutions derived from multiple sequence alignments. Evaluated in a cross-validation test on 238 unique proteins, the correlation between predicted and observed relative accessibility is 0.54. Interpreted in terms of a three-state (buried, intermediate, exposed) description of relative accessibility, the fraction of correctly predicted residue states is about 58%. In absolute terms this accuracy appears poor, but given the relatively low conservation of accessibility in 3D families, the network system is not far from its likely optimal performance. The most reliably predicted fraction of the residues (50%) is predicted as accurately as by automatic homology modeling. Prediction is best for buried residues, e.g., 86% of the completely buried sites are correctly predicted as having 0% relative accessibility.

Biological Evolution↗

PubMedDate not supplied

A classification of Scottish infants using latent class analysis.

This paper illustrates the use of latent class analysis to classify 50,000 infants into a small number of classes or case types, as a preliminary to a study of the allocation of neonatal hospital resources throughout Scotland. Information, extracted from a detailed neonatal discharge record, was summarized by 11 clinical and diagnostic catagorical variables. Statistical models incorporating 1 to 6 latent classes were then estimated using the EM algorithm. The 4 class model was chosen because it provided a good description of the data and the resulting classes had a medical interpretation. The factors influencing the choice of model are discussed and goodness of fit tests are presented. The stability of the classes was also investigated using random halves of the data and an earlier comparable data set.

Classification↗

PubMed2006

First experiences of radiation treatment planning with PET/CT.

BACKGROUND: Positron emission tomography/computed tomography (PET/CT) is composed of modern CT and PET technology in one machine enabling examinations of patients in one session in the same position. Its value for modern radiation treatment planning is under investigation. METHODS: In 53 patients with head-and-neck (n = 11), non-small cell lung (n = 16), prostate (n = 14) and other cancers (n = 12), a PET/CT investigation was performed. During the diagnostic examination process an integrated scan under radiation treatment-planning conditions was included. Interpretation and delineation of macroscopic tumor were done in an interdisciplinary approach. Treatment changes occurred after critical interpretation of the PET/CT findings by the responsible radiotherapist. Analysis is descriptive with regard to changes in treatment intention, mode, radiation volumes and doses. RESULTS: Examinations were well tolerated. CT datasets in treatment position could be used for planning. Delineation of macroscopic tumor led to changes of the planning target volume after PET/CT 15 times, total dose was modified twelve times. PET/CT examinations led to changes of the general treatment mode in 19 cases. Using the separate CT and PET datasets, fusion in the planning software was easily performed in all patients due to the use of the same positioning and immobilization devices in PET/CT. CONCLUSION: Despite the low number of patients and an expected bias of selection, the first results are encouraging to perform more extended and detailed trials of this technology in radiotherapy planning. Whether PET/CT is superior to PET alone is part of ongoing investigations.

Adult↗

PubMed2000

Analysis of lung tumour risk in radon-exposed rats: an intercomparison of multi-step modelling.

Three carcinogenesis modelling groups have both jointly and separately applied a multi-step carcinogenesis model with clonal expansion to one data set of lung tumours in rats exposed to radon (CEA, France). This study was designed to investigate the differences in modelling approach and fitting procedures used by the three groups in detail, and to explore possible discrepancies in the results. Using the same model assumptions and a (linear) radiation dependence on the first model step only, the three groups arrived at identical best fits, proving that the mathematical formalisms and fitting procedures do not lead to different results. However, when each group was allowed to find its own preferred fit for this data set, all three found a significantly better, but different fit to the data. All solutions indicated radiation to be an initiating agent and found additional radiation action necessary. The character of this additional radiation dependence, however, could not be unambiguously pinpointed. Tumour incidence data were described equally well when radiation dependence was taken into account in clonal expansion ("promotion") or in the second mutational step ("transformation"); extension to three model stages also resulted in an adequate description. The study showed that, although the three groups used one carcinogenesis model in principle, different model assumptions and/or different methods of finding the "best fit" could result in different descriptions of experimental data. This implies that on statistical grounds, different interpretations can be given for the action that radiation had in this data set. Different data, i.e. other data sets with age-dependent tumour data and/or information from cellular radiobiology experiments, are needed to specifically pin down the radiation dependence in the multi-step carcinogenesis process.

Age Factors↗

PubMed1994

Diagnostic accuracy in head-injured patients: an emergency department audit.

Records of 197 patients admitted to hospital with head injury were studied retrospectively to assess the influence of altered conscious state on injury misdiagnosis in the Emergency department (ED). Diagnostic errors were identified by discrepancies between an initial Injury Severity Score (ISS) calculated according to injuries diagnosed in the ED and a final ISS based on diagnoses confirmed on discharge from hospital, or death. The Glasgow Coma Scale (GCS) was used to assess neurological status. ISS discrepancies were present in 56 patients (29 per cent). These discrepancies arose because of: (i) failure of interpretation of radiographs; (ii) inadequate clinical examination; and (iii) inaccurate injury description in the ED notes. The risk of injury misdiagnosis was greatest for thoracic, abdominal and spinal injury, followed in descending order by extremity (limb), head, and external (skin and subcutaneous) injury. Although there was no linear correlation between GCS and ISS discrepancy rate, ISS discrepancies were significantly more frequent in comatose patients that in non-comatose patients (chi 2 = 3.69, 1 df; P < 0.05). Individual staff performance is at least as important as head injury severity in determining diagnostic accuracy on initial assessment in the ED.

Adolescent↗