SEARCH · PubMed Health

Results for “virtual environment”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources

PubMed1998

Virtual electronic patient records for shared care.

Systems that primarily serve health-care organizations are changing into systems that support patient care. The core of this change is shaped by systems for computer-based patient records (CPRs), which are part of local or regional networks, giving access to data in different information systems. In principle, it should not matter where the patient data are located as long as data can be transferred to the physical location where patients and clinicians meet. Networking and electronic communication enable to realize an environment that makes all systems where patient data reside, acting as one integrated, virtual CPR-system from the user's perspective. The patient record itself needs not to be physically located at one place, but may be virtual. A development in this direction is the European 14C project, which aims at integrating patient record data, images, and biosignals from whatever system they are stored and on whatever computer they are processed in the network.

Computer Communication Networks↗

PubMed2002

On purpose in science, conservation and government. The functional integrity of the earth is at issue not biodiversity.

The objectives of conservation have been focused ever more intensively for two decades on the preservation of "biodiversity." Emphasis has been on the losses of species through extinction. The cure has been the establishment of parks and reserves to protect "hot spots," especially in the tropics, where the diversity of species is high. The efforts in preservation have often extended to the development of connecting links among reserves to allow movements among them. The approach has been codified in law in the form of the Endangered Species Act in the United States and the Biodiversity Treaty, both of which address the issue species by species and each of which has obvious weaknesses. Such efforts may be appropriate but they are totally inadequate as the sum of activities in conservation in a world of 6 billion people with exploding technologies for exploiting virtually all of the earth for immediate human benefit. The biosphere is decaying rapidly as a habitat for all life, including people, not because of the extinction of species, but because of the progressive impoverishment of natural communities through human-induced chronic disruption that is now global and ubiquitous. The improverishment leads to progressive environmental dysfunction that is cumulative, but only in its later stages leads to extinction of species. Long before extinction becomes important, genetically distinct, local ecotypes are lost and the natural communities in which they were developed become improverished and dysfunctional. The most conspicuous disruption is that of climate, a global change in the environment of every ecosystem. The most elaborate and carefully interlinked array of natural reserves will succumb as climate is moved out from under them... and biodiversity will suffer the very extinctions the parks were established to avoid. But long before that, the human environment will suffer conspicuous and progressive impoverishment. The objective of conservation is the preservation of the integrity of function of landscapes (and waterbodies). Emphasis falls on forests in the normally naturally forested parts of the earth because forests are so large in area globally and have such a large influence on virtually every aspect of environment. Functional integrity requires structural integrity over 85% or more of the naturally forested zone in most areas. It also requires objective measurement and definition by the scientific community. Suddenly, conservation has become, not the preservation of biodiversity, honorable as that may be, but the preservation of the functional integrity of the human environment. That purpose is the central purpose that we assign to the governments that we establish in democracies to define and defend the public interest. It is past time for the scientific and conservation communities to recognize the urgency of this transition, join in defining competent new objectives for conservation, and to convey to the public the urgency of the need for governmental responsibility in protecting the public interest in a habitable biosphere.

Animals↗

PubMed2006

Recognition of GPCRs by peptide ligands and membrane compartments theory: structural studies of endogenous peptide hormones in membrane environment.

One of the largest family of cell surface proteins, G-protein coupled receptors (GPCRs) regulate virtually all known physiological processes in mammals. With seven transmembrane segments, they respond to diverse range of extracellular stimuli and represent a major class of drug targets. Peptidergic GPCRs use endogenous peptides as ligands. To understand the mechanism of GPCR activation and rational drug design, knowledge of three-dimensional structure of receptor-ligand complex is important. The endogenous peptide hormones are often short, flexible and completely disordered in aqueous solution. According to "Membrane Compartments Theory", the flexible peptide binds to the membrane in the first step before it recognizes its receptor and the membrane-induced conformation is postulated to bind to the receptor in the second step. Structures of several peptide hormones have been determined in membrane-mimetic medium. In these studies, micelles, reverse micelles and bicelles have been used to mimic the cell membrane environment. Recently, conformations of two peptide hormones have also been studied in receptor-bound form. Membrane environment induces stable secondary structures in flexible peptide ligands and membrane-induced peptide structures have been correlated with their bioactivity. Results of site-directed mutagenesis, spectroscopy and other experimental studies along with the conformations determined in membrane medium have been used to interpret the role of individual residues in the peptide ligand. Structural differences of membrane-bound peptides that belong to the same family but differ in selectivity are likely to explain the mechanism of receptor selectivity and specificity of the ligands. Knowledge of peptide 3D structures in membrane environment has potential applications in rational drug design.

Ligands↗

PubMed2003

[New models in the model (Managerial challenges in the Hungarian managed care model)].

The Hungarian managed care model integrates the different levels of health care services. Its goal is a more efficient resource allocation within the health care system, quality improvement of services, developing incentives and financing methods. The basic concept of the model is to introduce the benefits of the American managed care and the British fundholding system. The managed care model brought a new approach in the Hungarian health care system and meets a lot of expectation in both professional and political context. The model has certain problems, but these are handled at macro level. Without an integrated approach of macro, meso and micro levels is hardly believable the efficient and effective functioning of the model. Such macro level problems are the cost-efficiency versus high quality health services, financing incentives, and risk taking. At meso and micro level we are facing with questionable efficiency and effectiveness of the MCOs other health care organisations, which are based on strong bureaucratic paradigms and are convicted to a long lasting crisis in their changing environment. The integrated use of Mintzberg's management models (machine model, network model, performance-control model, virtual government model and normative-control model) adapted by us for the Hungarian managed care model could resolve certain problems or make them at least more solvable. In the changing environment of the health cares organisations the top management has to frame the change-scenario, to initiate, realise and sustain organisational changes. Achieving this, the proposed management models are a useful support. Their practical application could contribute to the efficient and effective functioning of the Hungarian managed care model at macro, meso and micro levels, as well.

Health Care Reform↗

PubMed1979

Immediate postembolization excision of glomus jugulare tumors: advantages of new combined techniques.

Preoperative percutaneous transfemoral catheter embolization of feeding vessels in glomus jugulare tumors, followed by immediate application of standard surgical techniques, presents the treatment of choice, allowing meticulous microsurgery with virtually complete hemostasis. Therefore, the surgeon can operate in a bloodless environment throughout the compressed and intricate anatomic field, amidst such important yet vulnerable structures as cranial nerves, inner ear, carotid artery, jugular bulb, venous sinuses, and dura, while reducing surgical error and functional deficit for the patient. Review of the last 11 cases of glomus jugulare tumors at UCLA shows that even extensive Alford grade 2 tumors of the middle ear, jugular bulb, and mastoid had only minor blood losses with this combined technique of embolization-immediate surgery, as compared with earlier surgical methods. Pertinent literature on glomus jugulare and its treatment is reviewed. Combined embolization and immediate surgery offer the best approach for treatment of resectable glomus jugulare tumors.

Adult↗

PubMedDate not supplied

Differential expression of uterine progesterone receptor forms A and B during the menstrual cycle.

Recent studies suggest that the progesterone receptor isoforms (PR-A and PR-B) activate genes differentially and that PR-A may act as a repressor of PR-B function. Hence, the absolute and relative expression of the two isoforms will determine the response to progesterone. We have measured their relative expression in the uterus of cycling women who underwent endometrial biopsy. PR isoforms were identified on blots of SDS-PAGE gels by reaction with the AB-52 antibody after immunoprecipitation from endometrial extract. Both isoforms were highest in the peri-ovulatory phase, but levels of PR-A were always higher than those of PR-B. The ratio of PR-A to PR-B changed during the menstrual cycle. Between days 2 and 8, PR-B is almost undetectable and the A:B ratio is >10:1. From days 9 to 13, the ratio is about 5:1, and it is about 2:1 between days 14 and 16. Thereafter, PR-B dwindles rapidly and is virtually undetectable at the end of the cycle. In various hypoestrogenic environments, PR-B expression was reduced. However, exogenous estrogens in the follicular phase in the form of oral contraceptives, enhanced PR-B expression. These data support the possibility that progesterone acts through cycle-specific PR isoforms.

Contraceptives, Oral, Hormonal↗

PubMed1994

Coordination of iron by the ferric iron-binding protein of pathogenic Neisseria is homologous to the transferrins.

The ferric iron-binding protein (Fbp) functions as a periplasmic-binding protein in the high-affinity active transport of growth-essential iron by pathogenic Neisseria. Fbp reversibly binds a single ferric ion per molecule of protein with high affinity. Similarly, the transferrins are a highly conserved family of bilobed vertebrate proteins that reversibly bind a single molecule of iron on each of the N- and C-terminal lobes. While evolutionarily divergent, iron binding by all described transferrin lobes is accomplished by a remarkably similar repertoire of residues, including two Tyr, one His, and one Asp, as well as a synergestic bicarbonate anion. With a molecular mass of ca. 34 kDa, Fbp approximates the size of a transferrin lobe. Given the similarities in iron-binding properties, it was investigated whether Fbp bound iron by a similar molecular strategy as the transferrins. The studies reported here demonstrate that the spectral properties of purified Fbp and human transferrin are similar in the visible range. Chemical modification of purified Fbp in the presence and absence of iron using the Tyr-specific modifier tetranitromethane demonstrates that between two and three Tyr residues are implicated in iron binding. A similar experiment using the His-specific reagent diethyl pyrocarbonate indicates that one of the six Fbp-encoded His residues is protected by iron. In addition, like the transferrins, a bicarbonate anion is required for the efficient coordination of iron by Fbp. The range of metals bound by Fbp and human transferrin, including the luminescent lanthanide terbium, is identical. Finally, terbium derivatives of Fbp and human transferrin yield virtually identical luminescence excitation spectra, implying a highly similar binding site environment. These studies suggest that the prokaryotic Fbp is a mono-sited analog for iron binding by the eukaryotic transferrins.

Bicarbonates↗

PubMedDate not supplied

Zherlock: an open source data analysis software.

Zherlock is an open source software that provides state-of-the-art data analysis tools to the user in an intuitive and flexible way. It is a front-end to different numerical "engines" to produce a seamless integration of algorithms written in different computer languages. Of particular interest is creating an interface to high-level scientific languages such as Octave (a Matlab clone) and R (an S-PLUS clone) to enable efficient porting of new data analytical methods. Zherlock uses advanced scientific visualization tools in 2-D and 3-D and has been extended to work on virtual reality (VR) systems. Central to Zherlock is a visual programming environment (VPE) which enables diagram based programming. These diagrams consist of nodes and connection lines where each node is an operator or a method and lines describe the flow of data between nodes. A VPE is chosen for Zherlock because it forms an effective way to control the processing pipeline in complex data analyses. The VPE is similar in functionality to other programs such as IRIS Explorer, AVS or LabVIEW.

Algorithms↗

PubMed2003

Equilibrium and balanced growth of a vegetative crop.

MODEL: A previously developed dynamic model, NICOLET, designed to predict growth and nitrate content of a lettuce crop, is subjected to (virtual) constant environmental conditions. For every combination of shoot and root environment, the cell sap, here assumed to reside in the "vacuole" compartment, equilibrates at a certain nitrate concentration level. This, in turn, defines the composition of the crop in terms of carbon and nitrogen content in each of the three compartments of the model. Growth under constant environmental conditions is defined as "equilibrium" growth (EG). If, in addition, the source strengths of carbon and nitrogen balance each other, as well as the sink strength of the growing crop, the growth is said to be "balanced" (BG). RESULTS: It is shown that the range of BG approximately coincides with the range of "mild" nitrogen stress, where reduction in nitrogen availability results in a mild reduction of relative growth rate (RGR). Beyond a certain low nitrate concentration in the cell sap, the N-stress becomes "severe" and the loss of growth increases considerably. CONCLUSIONS: The model is able to mimic the five central observations of many constant-environment growth-chamber experiments, namely (1) the initial exponential growth and later decline of the RGR, (2) the constant chemical composition, (3) the equality of the RGR and the relative nutrient supply rate (RNR), (4) the proportionality between the N : C ratio and the RNR, and (5) the proportionality between the water content and the reduced N content. Guidelines for the optimal combination of the shoot and root environments are suggested.

Crops, Agricultural↗

PubMed1986

Intensive care unit: how stressful for physicians?

The ICU has been considered a psychologically stressful environment. Although numerous studies have investigated this stress in ICU nurses, virtually none have examined how stressful the ICU is for physicians. This prospective study compares housestaff physicians' ratings of stress in the ICU to other medical-surgical rotations. The 26 physicians in this study rated the ICU significantly less negatively than other rotations. There was also a trend to rate the ICU more positively. Prolonged care of patients with multisystem failure and a poor prognosis was the most frequently described source of stress. Humor, communication, and activities outside the ICU were the most frequently noted coping techniques.

Adult↗

PubMedDate not supplied

Long-term habituation to spatial novelty in blind cave fish (Astyanax hubbsi): role of the telencephalon and its subregions.

Blind cave fish, when released into a novel environment, show a typical exploratory behavior characterized by high swim speed along walls shortly after release. This behavior wanes during prolonged exposure and thus may reflect habituation to novelty. As the hippocampus of mammals, which plays a crucial role in spatial learning, is part of the telencephalon, the possible involvement of this brain structure of fish was investigated in exploratory behavior. Ablation of the whole telencephalon or bilateral removal of dorsal parts of the hemispheres reduced activity; in contrast, unilateral lesions of one hemisphere, bilateral lesions of dorsal and dorsoventral parts, and removal of olfactory bulbs increased activity. However, the time course of habituation in a novel environment remained unchanged, except for ablated animals in which there was virtually no habituation in swim speed. These data suggest that the telencephalon of fish may not participate in long-term habituation to spatial novelty but, rather, support the notion of the telencephalon being involved in generation of arousal.

Animals↗

PubMed1997

Effect of simulated microgravity and shear stress on microcin B17 production by Escherichia coli and on its excretion into the medium.

Production of the antibacterial polypeptide microcin B17 (MccB17) by Escherichia coli ZK650 was inhibited by simulated microgravity. The site of MccB17 accumulation was found to be different, depending on whether the organism was grown in shaking flasks or in rotating bioreactors designed to establish a simulated microgravity environment. In flasks, the accumulation was cellular, but in the reactors, virtually all the microcin was found in the medium. The change from a cellular site to an extracellular one was apparently not a function of gravity, since extracellular production occurred in these bioreactors, irrespective of whether they were operated in the simulated microgravity or normal gravity mode. More probably, excretion is due to the much lower degree of shear stress in the bioreactors. Addition of even a single glass bead to the 50-ml medium volume in the bioreactor created enough shear to change the site of MccB17 accumulation from the medium to the cells.

Anti-Bacterial Agents↗

PubMed2004

Diversity of microbial sialic acid metabolism.

Sialic acids are structurally unique nine-carbon keto sugars occupying the interface between the host and commensal or pathogenic microorganisms. An important function of host sialic acid is to regulate innate immunity, and microbes have evolved various strategies for subverting this process by decorating their surfaces with sialylated oligosaccharides that mimic those of the host. These subversive strategies include a de novo synthetic pathway and at least two truncated pathways that depend on scavenging host-derived intermediates. A fourth strategy involves modification of sialidases so that instead of transferring sialic acid to water (hydrolysis), a second active site is created for binding alternative acceptors. Sialic acids also are excellent sources of carbon, nitrogen, energy, and precursors of cell wall biosynthesis. The catabolic strategies for exploiting host sialic acids as nutritional sources are as diverse as the biosynthetic mechanisms, including examples of horizontal gene transfer and multiple transport systems. Finally, as compounds coating the surfaces of virtually every vertebrate cell, sialic acids provide information about the host environment that, at least in Escherichia coli, is interpreted by the global regulator encoded by nanR. In addition to regulating the catabolism of sialic acids through the nan operon, NanR controls at least two other operons of unknown function and appears to participate in the regulation of type 1 fimbrial phase variation. Sialic acid is, therefore, a host molecule to be copied (molecular mimicry), eaten (nutrition), and interpreted (cell signaling) by diverse metabolic machinery in all major groups of mammalian pathogens and commensals.

Amino Acid Sequence↗

PubMed1984

Physiological responses to prolonged bed rest and fluid immersion in humans.

Rest in bed and immersion in water have been used for centuries by physicians and healers in treating injury and disease. The qualitative similarity of acute and chronic responses to bed rest, immersion, and weightlessness has sparked renewed interest in and a resultant greater understanding of the mechanisms of disuse deconditioning. Some combination of changes in hydrostatic pressure, reduced total metabolism (exercise), compression force on weight-bearing bones, as well as psychological factors associated with prolonged confinement in a new environment probably comprise the major input stimuli for the adaptive responses. Virtually every physiological system is affected. Early responses involve the fluid, electrolyte, and blood pressure control systems with significant muscular atrophy and decreases in bone density occurring over weeks and months. Much effort has been expended to describe the various responses to bed rest and immersion with understandably less effort devoted to research during weightlessness. Future research should be directed mainly toward an understanding of the mechanisms of these adaptive responses. Additional work is especially needed to elucidate the effects of deconditioning on drug metabolism, functioning of the immune system, carbohydrate metabolism, protein and peptide metabolism in muscle, and calcium metabolism as it affects integrity of bone.

Adaptation, Physiological↗

PubMedDate not supplied

Radiology system evolution in the new millennium.

For many decades the practice of radiology grew slowly in America and was largely a secondary function under the control of hospitals. In more recent times it has vastly expanded its array of diagnostic, interventional, and therapeutic abilities. There is increasing consumer logic for direct access. Motivations have grown to create large independent entities with broadly diverse capabilities in order to succeed in the new millennium. Most regional markets are evolving rapidly in terms of managed care penetration, health system formation, physician practice consolidation and aggressive purchaser behavior by employers and consumers. To understand the enormity of healthcare evolution, it is useful to look at the industry's paradigm shifts in recent decades. Virtually every aspect of organizational infrastructure, delivery approaches, and the business environment has evolved markedly during the past fifty years. These changes will accelerate. To succeed financially, radiology groups must strengthen their market positions, technical capabilities, continuums of care and geographic dominance. Equally important is the wisdom of diversifying incomes into related services and businesses that provide additional related revenues. Key factors for successful development include facility market growth, full coverage of managed care contracts, high efficiency and aggressive diversification. A fully evolved system generates significant revenues and profitability by protecting and strengthening its financial position in this environment. That is accomplished through the development of strategically located radiology groups, aggressive alliances with medical practices in allied disciplines, and managed radiology departments and facilities for partner health systems. Organizational success ultimately depends on the ability to accept capitated payments under risk-bearing arrangements. The strategic business plan should be organized with the appropriate levels of detail needed to establish executive focus and priorities. These should be woven into operational and capital budgets to reflect expectations of the revenues, expenses and investments tied to the plan. While formidable, all of these objectives are realistic and can be accomplished if the right decisions are made. Initially, the entity's principle business objective is to formulate and begin implementation of methodical yet aggressive strategies for growth that are sensitive to sustaining high levels of quality patient care. The next phase features mergers with large, independent radiology practices in key geographic areas and successful acquisition of smaller practices. The objective of the final phase is to aggressively expand into select metropolitan areas with regional coverage and full teleradiology capabilities. High levels of market strength and financial performance are necessary to succeed. Passive limitations to small geographic areas and narrow practices will undermine their market position and dissolve financial strength with no hope of recovery. Only the dominant systems will survive and prosper.

Education, Continuing↗

PubMed2005

Maxillary sinus pathology in 119 patients--a histopathologic study.

INTRODUCTION: Information on histopathological changes within sinus mucosa is lacking, both in the general population, and in subjects with specific facial morphology and chronic respiratory obstruction. AIMS AND OBJECTIVES: To provide baseline data of the frequency and nature of pathological changes in the maxillary sinus in a specified group of patients. METHODS: 119 patients undergoing elective maxillary osteotomies were selected. These included patients with (70) and without (49) vertical maxillary excess (VME), and mouth and nasal breathers. The frequency and nature of the histopathological changes within the maxillary antral lining were recorded. RESULTS: Patients ranged from 13 to 47 years, with a M:F ratio of 1:2.4. The findings included congestion (95%), submucosal oedema (90%), retention cysts (26%), true polyps (4.6%) and inflammation. There was eosinophilia (68%), basement membrane thickening (28%), goblet cell hyperplasia (95%) and dystrophic calcification (59%). CONCLUSIONS: A significant degree of sinus pathology was found in this specified group of patients. This was probably due to their living in a polluted urban environment. In the presence of such widespread pathological changes and the virtual impossibility of obtaining "normal" control tissue, investigators may find it impossible to correlate maxillary sinus pathology with either facial form or breathing pattern.

Adolescent↗

PubMed2006

A meta-analysis of the training effectiveness of virtual reality surgical simulators.

The increasing use of virtual reality (VR) simulators in surgical training makes it imperative that definitive studies be performed to assess their training effectiveness. Indeed, in this paper we report the meta-analysis of the efficacy of virtual reality simulators in: 1) the transference of skills from the simulator training environment to the operating room, and 2) their ability to discriminate between the experience levels of their users. The task completion time and the error score were the two study outcomes collated and analyzed in this meta-analysis. Sixteen studies were identified from a computer-based literature search (1996-2004). The meta-analysis of the random effects model (because of the heterogeneity of the data) revealed that training on virtual reality simulators did lessen the time taken to complete a given surgical task as well as clearly differentiate between the experienced and the novice trainees. Meta-analytic studies such as the one reported here would be very helpful in the planning and setting up of surgical training programs and for the establishment of reference 'learning curves' for a specific simulator and surgical task. If any such programs already exist, they can then indicate the improvements to be made in the simulator used, such as providing for more variety in their case scenarios based on the state and/or rate of learning of the trainee.

Computer Simulation↗

PubMed2001

A virtual medical record for guideline-based decision support.

A major obstacle in deploying computer-based clinical guidelines at the point of care is the variability of electronic medical records and the consequent need to adapt guideline modeling languages, guideline knowledge bases, and execution engines to idiosyncratic data models in the deployment environment. This paper reports an approach, developed jointly by researchers at Newcastle and Stanford, where guideline models are encoded assuming a uniform virtual electronic medical record and guideline-specific concept ontologies. For implementing a guideline-based decision-support system in multiple deployment environments, we created mapping knowledge bases to link terms in the concept ontology with the terminology used in the deployment systems. Mediation components use these mapping knowledge bases to map data in locally deployed medical record architectures to the virtual medical record. We discuss the possibility of using the HL7 Reference Information Model (RIM) as the basis for a standardized virtual medical record, showing how this approach also complies with the European pre-standard ENV13606 for electronic healthcare record communication.

Decision Making, Computer-Assisted↗