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PubMed1999

High quality image oriented telemedicine with multimedia technology.

Researchers at Osaka and Kyoto University hospital performed three experiments, beginning in 1995, which looked at high quality-oriented telemedicine. This paper describes the system design for the three projects. Experiment 1 applied high-definition TV images and B-ISDN for distance learning and medical information exchange. Experiment 2 developed a super high-definition medical image filing system and the images were transmitted via B-ISDN for teleconferences and experiment 3 utilized digital, high-definition, TV images and communication satellites for teleconferences. Multimedia and communication technologies were considered to be fundamental components of telemedicine. The three projects were evaluated initially for quality of images, operability and utility. The experimental design and its implementation showed that it was possible to provide high quality image-oriented telemedicine in the health care environment. Obstacles to establishing practical telemedicine are also discussed.

Computer Communication Networks↗

PubMed2001

Subliminal visual oddball stimuli evoke a P300 component.

OBJECTIVE: To provide evidence that a P300 component can be elicited by subliminal stimuli in an oddball paradigm. METHODS: The words LEFT and RIGHT were presented in a frequent-rare ratio (80-20%), counterbalanced between subjects. Stimuli were presented at the objective detection threshold (d'=0, via unmasked 1 ms presentations), a stringent measure for detecting any conscious perception. RESULTS: A significantly larger amplitude component was found for rare vs. frequent stimulus presentations across electrodes Fz, Cz, and Pz using both a broad 200-900 ms window (F(1,27)=5.75, P<0.012, eta(2)=0.18; one-tailed), and a more narrow 400-760 ms window defined using principal component analysis (F(1,27)=10.10, P<0.002, eta(2)=0.27; one-tailed). No significant component latency effects were found. An analysis of the conscious perception index (d') and the oddball effect (rare-frequent amplitude difference) revealed a negative relationship, further supporting the contention that conscious perception does not account for the finding, and suggesting that any conscious stimulus detection may inhibit this subliminal effect. CONCLUSIONS: Results provide evidence that an endogenous component can be elicited by undetectable subliminal stimuli in an oddball paradigm. Implications are discussed for comparing conscious and unconscious information processing, unconscious learning, and the measurement of ERPs to subliminal stimuli.

Adult↗

PubMed1995

The HNRC 500--neuropsychology of HIV infection at different disease stages. HIV Neurobehavioral Research Center.

The present study examined neuropsychological (NP) functioning and associated medical, neurological, brain magnetic resonance imaging (MRI), and psychiatric findings in 389 nondemented males infected with Human Immunodeficiency Virus-Type 1 (HIV-1), and in 111 uninfected controls. Using a comprehensive NP test battery, we found increased rates of impairment at each successive stage of HIV infection. HIV-related NP impairment was generally mild, especially in the medically asymptomatic stage of infection, and most often affected attention, speed of information processing, and learning efficiency; this pattern is consistent with earliest involvement of subcortical or frontostriatal brain systems. NP impairment could not be explained on the bases of mood disturbance, recreational drug or alcohol use, or constitutional symptoms; by contrast, impairment in HIV-infected subjects was related to central brain atrophy on MRI, as well as to evidence of cellular immune activation and neurological abnormalities linked to the central nervous system.

AIDS Dementia Complex↗

PubMed1997

Dual-channel ambulatory esophageal pH monitoring. A useful diagnostic tool?

Ambulatory pH monitoring of the distal esophagus is the most accurate diagnostic study for patients with suspected gastroesophageal reflux disease (GERD). The measurement of proximal esophageal acid exposure time may be useful in patients with atypical reflux symptoms. The aim of this study is to evaluate if proximal esophageal pH monitoring provides useful information beyond that learned with distal esophageal pH monitoring. We routinely performed dual-channel pH monitoring with pH electrodes positioned at 20 and 5 cm above the manometric lower esophageal sphincter from January 1992 to August 1995. All patients scored their esophageal symptoms from zero (none) to four (severe). We compared proximal esophageal reflux (PR) in patients with typical symptoms (i.e., heartburn, regurgitation) and in patients with atypical symptoms (i.e., chest pain, cough, hoarseness, and asthma). We compared symptom profiles between patients with and without PR. We reviewed our experience in patients with abnormal PR, but with a normal amount of distal esophageal reflux (DR). We studied 441 consecutive patients. There were no significant differences in PR between patients with typical and atypical symptoms. There were no differences in symptom profiles between patients with normal and abnormal PR. There were no differences of PR between the different atypical symptoms. PR did not correlate with the severity of the patient's symptoms. PR correlated well only with DR. Twenty-four patients had isolated abnormal PR, but only six patients improved with antireflux therapy. We conclude that routine ambulatory esophageal pH monitoring of the proximal esophagus appears to be of little value. The decision to offer patients an empiric trial of antireflux therapy for suspected GERD should not be based on the presence or absence of PR.

Adult↗

PubMed1990

Human immunodeficiency virus-type 1 (HIV-1) and the brain.

Infection with human immunodeficiency virus Type-1 (HIV-1), the causative agent of AIDS, can be associated with central nervous system as well as immune system disease. Advanced AIDS can be complicated by a dementia. Short of frank dementia, many AIDS patients manifest neuropsychological (NP) impairment including disturbance in speeded information processing, abstraction, learning, and recall. Data conflict on whether medically asymptomatic HIV-1 carriers have subtle NP deficits. Variations in tests chosen, criterion specification, and sample selection may all be contributing to disparate results. Longitudinal research is needed, and this should examine representative samples of HIV-1 seropositive individuals for whom approximate date of seroconversion is known and in whom sources of comorbidity (e.g., drug abuse, concurrent infections, CNS injuries) can be specified.

AIDS Dementia Complex↗

PubMed2000

Updating geographical knowledge: principles of coherence and inertia.

In 2 experiments, the authors investigated how representations of global geography are updated when people learn new location information about individual cities. Participants estimated the latitude of cities in North America (Experiment 1) and in the Old and New Worlds (Experiment 2). After making their first estimates, participants were given information about the latitudes of 2 cities and asked to make a second set of estimates. Both the first and second estimates revealed evidence for psychologically distinct geographical subregions that were coordinated, in an ordinal sense, across the Atlantic Ocean. Further, the second estimates were affected by the nature of the physical adjacency between regions (e.g., the southern U.S. and Mexico) and by accurate location information about distant, but coordinated, subregions (e.g., the southern U.S. and Mediterranean Europe). The data provide support for a framework for making geographical estimates in which people strike a balance between 2 principles: the need to keep their knowledge base coherent, and the inertial tendency to resist changing the knowledge base unless it is necessary to maintain coherence.

Cognition↗

PubMed1991

Subcortical adaptive filtering in the auditory system: associative receptive field plasticity in the dorsal medial geniculate body.

Highly specific subcortical receptive field (RF) plasticity was found in the dorsal division of the guinea pig medial geniculate body during cardiac conditioning to a tonal frequency. There was increased response to the conditioned-stimulus (CS) frequency, and there were decreased responses to adjacent frequencies, especially at the pretraining best frequency (BF), which often resulted in a shift of tuning such that the CS became the new BF. Moreover, 1 hr later the effects were stronger, more sharply tuned, and centered on the CS frequency. A sensitization paradigm produced only broad, general increases of response across the RF. These findings reveal that the analysis of sensory RF dynamics is a valuable approach to understanding the neural mechanisms of information processing in learning and memory.

Animals↗

PubMed2006

Health information on the Internet and people living with HIV/AIDS: information evaluation and coping styles.

Individuals who seek information on the Internet to cope with chronic illness may be vulnerable to misinformation and unfounded claims. This study examined the association between health-related coping and the evaluation of health information. Men (n = 347) and women (n = 72) who were living with HIV/AIDS and reported currently using the Internet completed measures assessing their Internet use. Health Web sites downloaded from the Internet were also rated for quality of information. HIV-positive adults commonly used the Internet to find health information (66%) and to learn about clinical trials (25%); they also talked to their physicians about information found online (24%). In a multivariate analysis, assigning higher credibility to unfounded Internet information was predicted by lower incomes, less education, and avoidant coping styles. People who cope by avoiding health information may be vulnerable to misinformation and unfounded claims that are commonly encountered on the Internet.

Adaptation, Psychological↗

PubMed2000

Multiple reward signals in the brain.

The fundamental biological importance of rewards has created an increasing interest in the neuronal processing of reward information. The suggestion that the mechanisms underlying drug addiction might involve natural reward systems has also stimulated interest. This article focuses on recent neurophysiological studies in primates that have revealed that neurons in a limited number of brain structures carry specific signals about past and future rewards. This research provides the first step towards an understanding of how rewards influence behaviour before they are received and how the brain might use reward information to control learning and goal-directed behaviour.

Animals↗

PubMed1994

The function of home visits in maternal and child welfare as evaluated by service providers and users.

This study looks at how public health nurses and clients of maternal and child welfare clinics evaluate the function and meaning of home visits. Another concern is with the options available to the service user. The data were collected during November and December 1992 from a total of 203 health centres across Finland; responses were obtained from 263 public health nurses and 323 clients. The results are presented in the form of frequencies, percentages and cross tabulations. According to the results, the clients felt that the most important function of home visits was to have a competent professional examination of the newborn. They also attached much importance to the information function, i.e. learning about the growth and care of small children. The public health nurses, on the other hand, felt that the most important function of home visits was to support and encourage parents and to ensure the continuity of care. The advantages of meeting in the client's home environment were equally stressed by both sides. By contrast, clients and public health nurses had very different views on the options available to the client. Almost all nurses said that the client can freely choose between home visits and visiting the clinic; however, only about half the clients felt they could choose the service they best preferred.

Adolescent↗

PubMed1999

Mandatory practice self-appraisal: moving towards outcomes based continuing education.

Most organized physician continuing educational activities are undertaken without assessing their effects on long-term changes in physician practice patterns, patient outcomes or return on investment. Practice audit and practice self-appraisal are two activities that can be used to achieve these objectives. It is recommended that these be promoted from an educational perspective. A series of principles, including the mandatory application of practice audit and practice self-appraisal are proposed to guide the process. The identification of issues relating to learning, diffusion of information and behavioural change required to facilitate this change are briefly discussed.

Education, Medical, Continuing↗

PubMed2001

Students' perception of medical school stress and their evaluation of a wellness elective.

CONTEXT: Because medical education is known to be demanding and stressful, Case Western Reserve University developed a programme which included a wellness elective which focused on stress reduction and personal wellness. OBJECTIVES: The purpose of this study was to explore students' perceptions of medical school stress and to assess their perspective on the wellness elective. SUBJECTS: The essays of 60 medical students enrolled in the wellness elective were used. METHODS: The essays were analysed using qualitative methodology. Results were validated by questionnaires mailed to the students 2 years later. RESULTS: It was found that the students felt that: (1) wellness issues should be important for physicians; (2) their own wellbeing had been diminished by the burden of information to be learned in medical school; (3) talking to peers was a useful coping mechanism, and (4) the elective gave permission to engage in wellness activities without additional guilt. CONCLUSIONS: Based on the students' responses, a wellness elective could be a useful addition to the first- or second-year medical curriculum.

Adaptation, Psychological↗

PubMed2001

Idiopathic photodermatoses: clinical, diagnostic and therapeutic aspects.

UNLABELLED: Idiopathic photodermatoses are a group of photosensitivity dermatoses, which are not very frequent with the exception of polymorphous light eruption. Therefore, their recognition may not be easy for dermatologists who are not familiar with photosensitivity diseases. LEARNING OBJECTIVE: The information in this review is intended for giving clinical, diagnostic and therapeutic clues for the correct management of patients. Clinical features will be described together with diagnostic relevant procedures and usual therapeutic measures.

Chronic Disease↗

PubMed1999

Cigarette smoking and pregnancy I: ovarian, uterine and placental effects.

This review examines the major observations and principal controversies relating to the effects of smoking and the constituents of tobacco on ovarian, uterine and placental tissues. Maternal exposure is assessed relative to specific tobacco-related chemicals and the feto-placental impact of mutagenic products, in addition to nicotine replacement as a pharmacological intervention for smoking cessation. Important new information is being learned from clinical in vitro fertilization and assisted reproduction technologies regarding the effects of smoking on fertility. Present evidence supports an adverse effect of smoking on ovarian function which is prolonged and dose-dependent, whereas there appear to be more reversible effects on implantation and ongoing pregnancy. The anti-oestrogenic effect of smoking is reviewed in terms of direct effects of nicotine, cadmium and polyaromatic hydrocarbons on oestrogen synthesis and metabolism, oocytes and granulosa-luteal function. Innovative new models provide evidence that smoking may alter fertility through effects on uterine-fallopian tube functions which mediate gamete and conceptus transport. It is of interest that smoking is associated with a decreased incidence of uterine fibroids, endometriosis and uterine cancer, which may reflect inhibitory effects of smoke constituents on uterine cell proliferation and extracellular matrix interactions. The increased miscarriage rate among mothers who smoke may be related to direct adverse effects of nicotine, cadmium and polyaromatic hydrocarbons on trophoblast invasion and proliferation. In this respect, alterations in trophoblast differentiation along invasive or proliferative pathways may explain the changes in endocrine function and vascular morphology that are observed in smokers. In summary, significant advances are being made in the understanding of cellular and molecular mechanisms which underlie the differential effects of cigarette smoking on reproductive tissues.

Embryo Implantation↗

PubMed2001

Pathophysiology of neonatal resuscitation: application in a global context.

Despite the adoption of evidence-based guidelines for neonatal resuscitation, formulated with international consensus, the process of resuscitating a newly born infant remains a uniquely local activity. Variations in the physical environment, cultural and medical beliefs, and available resources mediate significant difference in practices worldwide. Yet, the universal nature of the physiology surrounding birth, and its disturbances, provides a common basis for reference. Recognition of the importance of assistance available at the moment of birth, management of the thermal environment, and establishment of adequate ventilation is nearly universal. Differences in specific practices arise from local differences in the risks and challenges to perinatal health, which, in turn, stem from the environment or the available resources. Valuable information can be learned through comparison and evaluation of different techniques. In such a way, the evidence base for neonatal resuscitation can be strengthened and infants around the world can share in the benefits realized.

Asphyxia Neonatorum↗

PubMed2002

Costs and consequences of comprehensive stillbirth assessment.

OBJECTIVE: The purpose of this study was to determine the consequences and costs of comprehensive stillbirth assessment. STUDY DESIGN: Through reconstruction, we determined what consequences arise from assessment in the first 1477 stillborn pregnancies that were referred to the Wisconsin Stillbirth Service Program. Economic costs of stillbirth assessment were derived from real-time studies of those who performed the analyses and the costs of materials that were consumed. RESULTS: When comprehensive, nonselective analysis is performed, new information that is relevant to recurrence risk estimation, prenatal diagnosis recommendation, or preconceptual, prenatal, perinatal, or neonatal treatment will arise in 51% of stillborn infants. The real cost of such assessment is approximately $1450 per assessment, or approximately $12 per cared-for pregnancy. CONCLUSION: Substantial relevant information can be learned from stillbirth assessment at a modest economic cost. Programs that can provide comprehensive stillbirth assessment services should become part of routine pregnancy care.

Cost-Benefit Analysis↗

PubMed2002

How context influences predominance during binocular rivalry.

Variations in the predominance of an object engaged in binocular rivalry may arise from variations in the durations of dominance phases, suppression phases, or both. Earlier work has shown that the predominance of a binocular rival target is enhanced if that target fits well-via common color, orientation, or motion-with its surrounding objects. In the present experiments, the global context outside of the region of rivalry was changed during rivalry, to learn whether contextual information alters the ability to detect changes in a suppressed target itself. Results indicate that context will maintain the dominance of a rival target, but will not encourage a suppressed target to escape from suppression. Evidently, the fate of the suppressed stimulus is determined by neural events distinct from those responsible for global organization during dominance. To reconcile diverse findings concerning rivalry, it may be important to distinguish between processes responsible for selection of one eye's input for dominance from processes responsible for the implementation and maintenance of suppression.

Adult↗

PubMed2002

Neuropsychological characteristics of adults with ADHD: a comprehensive review of initial studies.

The role of neuropsychological evaluation in the diagnosis of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) is a growing area of research and clinical interest. Our review of the literature indicates that adults with ADHD demonstrate subtle impairments on select measures of attention and executive functions, auditory-verbal list learning, and complex information processing speed relative to normal controls. The validity of these findings is nonetheless hampered by several limitations, including methodological and sample variability, a restricted range of interpretive techniques, and uncertain discriminant validity. Recommendations are offered to advance the cognitive and neurobehavioral understanding of this disorder and to enhance the utility of neuropsychological methods for diagnosis and management of adults with ADHD.

Adult↗