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PubMed1997

Quasi-induced exposure: methodology and insight.

Even though the numerator in accident rates can be accurately determined nowadays, the denominator of these rates is an item of discussion and debate within the highway safety community. A critical examination of an induced exposure technique, based on the non-responsible driver/vehicle of a two-vehicle accident (quasi-induced exposure), is presented here. Differences in exposure for a series of accident location and time combinations are investigated, the assumption of similarities between drivers of single-vehicle accidents and the responsible driver of multiple-vehicle accidents is refuted, and the use of the non-responsible driver as a measure of exposure is tested using vehicle classification data. The results of the analyses reveal the following: (1) accident exposure is different for different location and time combinations: (2) induced exposure estimates provide an accurate reflection of exposure to multiple-vehicle accidents; (3) induced exposure estimates are acceptable surrogates for vehicle miles of travel when estimates are made for conditions during which the mix of road users is fairly constant; and (4) the propensity for involvement in single-vehicle accidents is generally different than that in multiple-vehicle accidents for a given class of road users. We concluded that the quasi-induced exposure is a powerful technique for measuring relative exposure of drivers or vehicles when real exposure data are missing.

Accidents, Traffic↗

PubMed1987

Mutagen levels in urine from snuff users, cigarette smokers and non tobacco users--a comparison.

The mutagenic activity of concentrates of urine from snuff users, cigarette smokers and non tobacco users has been investigated. A concentration procedure involving use of Sep-Pak C18 columns and elution with methylene chloride was used. The concentrates were assayed for mutagenicity towards strain TA98 of Salmonella typhimurium, both in the presence and absence of a metabolic activation system, the post-mitochondrial liver fraction (S9) from Aroclor 1254 induced rats. The mean mutagenic activity of smokers' urine concentrates was 8.6 X 10(3) revertants per 24 h and significantly higher than the corresponding values for snuff users, abstinent snuff users and non tobacco users, which were (1.3, 1.3 and 0.9) X 10(3), respectively. No significant difference in mutagenic activity was found between urine from snuff users, whether using or abstaining from snuff, and urine from non tobacco users. It could thus be concluded that the level of urinary mutagens, isolated by adsorption on Sep-Pak C18 columns, is not elevated by habitual usage of Swedish wet snuff.

Adult↗

PubMed1979

[Etiology and prevention of pelvic injuries in traffic accidents].

With hospitalized traffic accident victimes fractures of the pelvis are not very frequent (4-10%). Fatal cases show a higher fracture incidence (20-25%). Pedestrains are with regard to pelvic fractures twice as frequently affected as other road users. Pedestrians over 60 years of age are most often involved. Modifications of the car front structure are expected to lead to significant improvements for the unprotected road user. Seat belts are capable of reducing pelvic fracture with car occupants only in certain frontal collisions. However, the geometry of the lap belt portion is of importance for the overall effectiveness of the belt system.

Accidents, Traffic↗

PubMed2002

The application of PET-MR image registration in the brain.

The coregistration in three-dimensional space of positron emission tomography (PET) and magnetic resonance (MR) image volumes has, over the last decade, become a matter of routine in the analysis of brain PET studies. The ability to objectively localize small regions of interest in PET using images more closely correlated to tissue structure has itself improved the effective resolution of PET. There are a number of highly effective software packages for image coregistration available in the public domain. Voxel-by-voxel coregistration, involving little or no intervention from the user can, on today's computing hardware, provide fast and accurate registration with little or no pre-processing and algorithms based on mutual information measures now seem to be the mathematical method of choice. Registration may be applied in a number of ways. Rigid body registration is used to match a single subject's brain scanned using either different imaging modalities or as serial scans with the same modality. Increasingly, this technique is being extended to studies of disease involving regional atrophy, where location and extent of tissue loss can be identified. Non-linear registration can be used to warp a subject's brain onto a template, atlas or other standardized guide. While numerous examples are available of the added value produced by image registration in the brain, similar examples are not yet available from registration in the torso, where the problem is much more complex. It is here that newly emerging hardware such as combined PET/CT scanners may prove their worth.

Algorithms↗

PubMed1993

HIV infection.

Drug use will soon become the major risk for transmission of HIV infection in the United States, which will result in near equal incidence of the disease in men and women and more affected children. This has serious implications for the health care community and for the community at large. Thus, it is necessary to pursue aggressively risk reduction strategies targeted for difficult-to-reach populations such as illicit drug users and commercial sex workers. This will involve a vigorous public health campaign to bring education messages about safer sex practices, safer injection techniques, and enhanced drug treatment services to these groups. Prevention strategies include consideration of needle exchange as a public policy for IDUs. There are appropriate concerns in the larger community that needle exchange might send a mixed message or promote drug use, but there is no scientific evidence to support this view. To the contrary, there is a growing body of evidence that suggests drug users change behavior in response to education messages and that clean needles may reduce disease risk. Currently, stable seroprevalence rates in some IDU populations suggest that education messages about injection practices are heeded. Unfortunately, sexual practices have not shown similar changes. Most, if not all, HIV-infected persons will experience neurologic complications during their illness, especially as improved medical therapy ameliorates systemic complications. The approach to diagnosis and management requires a thorough understanding of the diverse clinical syndromes that may occur and a systematized approach to investigation of the cause.

AIDS Dementia Complex↗

PubMed2003

The current New York City heroin scene.

This article discusses the use and distribution of heroin in New York City, both historically and especially currently. Data on the current situation derive in large measure from the Heroin Project, a recently completed five-year ethnographic study of heroin in New York City funded by the National Institute on Drug Abuse. Findings about the new, young heroin user, particularly in regard to demographic characteristics, patterns of use, modes of ingestion, and involvement in crime, and some of the ways in which the new user is similar and different from the "old time" heroin user are presented. In addition changes in the New York City heroin markets over the years are discussed. We note the effectiveness of methadone maintenance treatment in terms of its impact on heroin-related crime, make suggestions as to how methadone treatment could be expanded, and review current heroin policy and the War on Drugs, with a focus on the New York State Rockefeller drug laws and the need for policy reform in this area.

Analgesics, Opioid↗

PubMed1998

Volatile solvent use among Western Australian adolescents.

Semistructured interviews were conducted with 40 adolescents who reported inhaling volatile solvents. Their average age was 14.2 years, and they used a range of substances. All were aware of the short-term health risks involved in volatile solvent use, and most reported experiencing ill effects, such as headaches and vomiting. Users were found to be organized into groups and peer networks, which often were involved in theft, prostitution, and other risk-taking behaviors. More chronic users had higher status within the group. Suggestions pertaining to intervention were obtained, and these are discussed in light of the findings.

Adolescent↗

PubMed2002

Drug users and HIV-combination therapy (HAART): factors which impede or facilitate adherence.

The current highly active antiretroviral therapy (HAART), i.e., triple combination treatment including a protease inhibitor, allows for long-term suppression of HIV-replication. The intake guidelines, however, are very strict and, like many other HIV positive patients, drug users have problems in achieving good therapy compliance. As a result, the effectiveness of the medication therapy is seriously jeopardized. This qualitative study, involving in-depth interviews with 27 "hard drug" users in Amsterdam, seeks to provide better insights into the extent of adherence to HAART. In addition, factors that impede or facilitate adherence have been listed in order to develop and improve strategies. The study shows that almost half of the "hard drug" users interviewed do not adhere to the therapy. A large number of determinants for adherence were identified at the level of medication, the individual, and the environment. Many of these determinants can be influenced, which means that they can provide clues for the effective implementation of measures that may enhance effectiveness of treatment.

Adult↗

PubMed2006

Human clock, PER1 and PER2 polymorphisms: lack of association with cocaine dependence susceptibility and cocaine-induced paranoia.

Considerable research points to the importance of genetic mechanisms in psychostimulant addiction. Behavioral sensitization, a well-documented response to repeated stimulant exposure, may be mechanistically important in clinical features of the disorder, including escalating patterns of drug use, craving and drug-induced paranoia. Basic studies in both Drosophila melanogaster and mice have suggested the importance of circadian rhythm genes in locomotor sensitization and reward. The primary objective of the current study was to assess the potential involvement of three human orthologs (CLOCK, PER1 and PER2) in clinical phenotypes of the disorder. Allelic associations of three single nucleotide polymorphisms (SNPs) were assessed for both cocaine dependence and cocaine-induced paranoia in 186 cases and 273 controls. Potential population stratification biases were controlled for by means of within-population comparisons, and by structured association methods (using all populations). No differences in allele frequencies were found for any of the three single nucleotide polymorphisms studied between cocaine dependent and control subjects or between paranoid and nonparanoid cocaine users. These results do not support the involvement of genetic variation in these three circadian gene SNPs for influencing risks for either of these cocaine phenotypes.

Animals↗

PubMed2002

A comparison of data obtained from service providers and service users to assess the quality of maternity care.

OBJECTIVE: to compare data obtained from two sources, service providers and service users, regarding the maternity services in Scotland. DESIGN: an audit of maternity services involving site visits, staff interviews and a cross-sectional survey of service users. PARTICIPANTS: lead professionals in every consultant-led maternity unit in Scotland and all 1639 women giving birth in Scotland during a ten-day period. DATA COLLECTION: structured group interviews with service providers and a questionnaire survey of recently delivered women. DATA ANALYSIS: professionals' and women's responses were cross-tabulated and differences in proportions were tested for statistical significance using the chi-square test. FINDINGS: a total of 1137 women completed the questionnaire (response rate 69%). Overall, there was good agreement between professionals' and women's perceptions of the aspects of care studied. However, there were disparities in some areas. For example, staff in eight units reported mechanisms to ensure early distribution of a free national pregnancy book; however, in six of these units less than 75% of women actually received this book prior to their first hospital visit. Eighteen units reported that they offer a postnatal 'reunion meeting'; in ten of these units, less than 50% of women were aware of the reunion meeting. Eighteen units reported a policy of each woman having a lead professional or care co-ordinator; in three of these units, less than 50% of women perceived that they had a care co-ordinator and for most women, the profession (midwife, general practitioner or obstetrician) of their perceived co-ordinator differed from that expected on the basis of staff reports. There was some evidence overall that unit policies had a direct influence on women's responses. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study demonstrates the importance of using a range of complementary methods of data collection and of ascertaining both service users' and providers' views when assessing the quality of care. Further research is required to explore differences in service provider's and women's perceptions and how this information can be used to improve the quality of maternity care. The finding that service provision may influence women's preferences has important implications for service planning, in particular the introduction of new models of care, and this needs further exploration.

Continuity of Patient Care↗

PubMed1994

Cerebral mucormycosis associated with intravenous drug use: three case reports and review.

We describe three cases of cerebral mucormycosis in intravenous drug users and review 22 previously reported cases. Involvement of the basal ganglia was demonstrated in all but two cases. Seven of the 10 patients tested for antibodies to the human immunodeficiency virus (HIV) were seronegative. Eight of the 25 patients survived and were discharged from the hospital; for 7 of 10 patients, cultures of brain lesions yielded Rhizopus arrhizus. The radiographic findings varied, and in most cases, no or minimal contrast enhancement was seen in the initial computed tomography scans. Although uncommon, the diagnosis of cerebral mucormycosis should be considered when basal ganglia lesions are present in an intravenous drug user, regardless of previous exposure to HIV.

AIDS-Related Opportunistic Infections↗

PubMed1992

Trends in Indian adolescent drug and alcohol use.

Trends in overall drug use among Indian and non-Indian youth have followed similar patterns, increasing from 1975 to the early 1980s and, for the most-used drugs, declining since then. At every point in time more reservation Indian youth are involved with drugs than are non-Indian youth. Rates for cocaine and hallucinogen use by Indian youth increase until 1990. The decline in overall drug use has occurred because a considerable number of moderate users have shifted to non-use. There has been no decrease in the proportion of high-risk users; since 1980, it has stayed between 17% and 20%. Societal changes and prevention programs are reaching casual drug users but not those susceptible to heavy drug involvement.

Adolescent↗

PubMed2002

Hair dye treatment use and clinical course in patients with systemic lupus erythematosus and cutaneous lupus.

The etiological role of hair dye treatment (HDT), some of them such as permanent hair dyes containing aromatic amines, in the development of SLE has been previously ruled out. However, the possible influence of HDT use on the course and prognosis of lupus patients has been assessed only in one short-term study. Since HDT is very extensive among the population, the knowledge of this possible negative effect may be very important. Thus, the aim of this study was to assess the long-term influence of several HDTs on the course and clinical severity of patients with both systemic lupus erythematosus (SLE) and cutaneous lupus (CL). In this longitudinal case series study, 91 SLE patients and 22 CL patients were prospectively studied from October 1988 to May 2000. They were divided into three groups: (a) non-HDT users--patients who have never used HDT (n = 65); (b) P-HDT users--HDT permanent type users, alone or in combination with other types of HDT (n = 28); (c) non P-HDT--users of other treatments different from permanent tinting (bleach, lowlights, etc; n = 20). In each patient we determined: (1) number of flares/year in SLE patients and worsening of cutaneous lesions for CL; (2) Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index; (3) predominant damaged organs/systems according to the HDT use and type of HDT; and (4) subjective impression about the disease evolution in relation to HDT use. No significant differences were found with respect to flares/year and SLICC/ACR damage index between the study groups. Non-HDT group presented more renal involvement and serositis than both HDT-user groups. No patient related the HDT use to the worsening of his disease. Therefore, in this study no evidence of an association between the long-term use of several types of HDT and the clinical activity and course of SLE and CL was found.

Adult↗

PubMed1977

Equipping a new hospital: bringing method to the madness.

Equipping a new hospital involves quickly shifting and sometimes overlapping phases. Consequently, considerable coordination is required among the hospital administration, user departments, purchasing department, suppliers, architect, builder, trade unions, and other involved parties. Detailed procedures such as those described in this article can help to efficiently organize this effort and protect the hospital's interests regarding the costs, specifications, acceptability, and safety of the equipment that is acquired and installed.

Equipment and Supplies, Hospital↗

PubMed2002

Human-computer interaction: psychological aspects of the human use of computing.

Human-computer interaction (HCI) is a multidisciplinary field in which psychology and other social sciences unite with computer science and related technical fields with the goal of making computing systems that are both useful and usable. It is a blend of applied and basic research, both drawing from psychological research and contributing new ideas to it. New technologies continuously challenge HCI researchers with new options, as do the demands of new audiences and uses. A variety of usability methods have been developed that draw upon psychological principles. HCI research has expanded beyond its roots in the cognitive processes of individual users to include social and organizational processes involved in computer usage in real environments as well as the use of computers in collaboration. HCI researchers need to be mindful of the longer-term changes brought about by the use of computing in a variety of venues.

Attitude to Computers↗

PubMed2002

Canadian illicit opiate users' views on methadone and other opiate prescription treatment: an exploratory qualitative study.

Although methadone treatment has been available in North America for decades, only a small proportion of opiate addicts (some 25% of estimated opiate users in Canada) are receiving methadone treatment. Many users have tried methadone treatment, often multiple times, but leave treatment prematurely. Others would not consider it as a worthwhile treatment option for themselves. This exploratory study examines regular opiate users' attitudes towards and experiences with methadone treatment in Canada, primarily setting out to determine what makes methadone an unsuccessful or even an undesirable treatment option for considerably large groups of opiate users. This empirical effort to explore the limitations of existing methadone treatment comes at an appropriate time, when alternative forms of opiate pharmacotherapy treatment are being proposed in Canada as complementary modes of intervention that hope to address the shortcomings of methadone treatment. The rationale for this study were feasibility questions and development efforts for a clinical trial in North America evaluating the effectiveness of using injectable opioids (heroin, dilaudid) in attracting and engaging treatment-resistant opiate users into treatment. Data for this exploratory qualitative study was collected in 1999 through a series of focus groups involving 47 treatment-experienced and treatment-naive opiate users in Vancouver, Montreal, and Toronto, with the objective of identifying key themes and issues on the described topic as a basis for further systematic research.

Adult↗

PubMed1996

Can the linguistic interdependence theory support a bilingual-bicultural model of literacy education for deaf students?

Drawing on Cummins' (1989) linguistic interdependence model, proponents of bilingual-bicultural models of literacy education for deaf students claim that, if ASL is well established as the L1, then literacy in English (L2) can be achieved by means of reading and writing without exposure to English through either speech or English-based sign. In our opinion, this claim is based on a false analogy: the situation of the deaf learner of English literacy does not match the conditions assumed by the linguistic interdependence model. We draw on the work of Vygotsky and Halliday to develop a conceptualization of the processes involved in becoming literate, examining the particular and unique challenges that deaf students face as they strive to become members of the linguistic community of users of written English. We argue that becoming literate involves mastering three modes of lanuage use: 'social speech,' 'inner speech,' and written text. In some respects the educational context for deaf students is analogous to that of other bilingual learners; in some crucial aspects, it is very different.

Journal Article↗

PubMed2006

Modeling end-users' acceptance of a knowledge authoring tool.

OBJECTIVES: Knowledge bases comprise a vital component in the classic medical expert system model, yet the knowledge acquisition process by which they are created has been characterized as highly iterative and labor-intensive. The difficulty of this process underscores the importance of knowledge authoring tools that satisfy the demands of end-users. The authors hypothesize that the acceptability of a knowledge authoring tool for the creation of medical knowledge base content can be predicted by an accepted model in the information technology (IT) field, specifically the Technology Acceptance Model (TAM). METHODS: An online survey was conducted amongst knowledge base authors who had previously established experience with the authoring tool software. The Likert-based questions in the survey were patterned directly after accepted TAM constructs with minor modifications to particularize them to the software being used. The results were analyzed using structural equation modeling. RESULTS: The TAM performed well in predicting endusers' behavioral intentions to use the knowledge authoring tool. Five out of seven goodness-of-fit statistics indicate that the model represents the behavioral intentions of the authors well. All but one of the hypothesized relationships specified by the TAM were significant with p values less than 0.05. CONCLUSIONS: The TAM provides an adequate means by which development teams can anticipate and better understand what aspects of a knowledge authoring tool are most important to their target audience. Further research involving other behavioral models and an expanded user base will be necessary to better understand the scope of issues that factor into acceptability.

Attitude↗