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PubMed2000

Specificity of projections from wide-field and local motion-processing regions within the middle temporal visual area of the owl monkey.

The middle temporal visual area (MT) of the owl monkey is anatomically organized with respect to both preferred direction of motion and different types of center-surround interaction. The latter organization consists of clusters of neurons whose receptive fields have antagonistic surrounds that render them unresponsive to wide-field motion (local motion columns) interdigitated with groups of neurons whose receptive fields have additive surrounds and thus respond best to wide-field motion (wide-field motion columns). To learn whether the information in these regions remained segregated further along the visual pathways, we made injections of retrograde tracers into two visual areas to which MT projects [the medial superior temporal area (MST) and fundus of the superior temporal sulcus (FST)] and then labeled the wide-field and local organization using 2-deoxyglucose. In complementary experiments, we injected anterograde tracers into regions of MT that we had mapped using microelectrode recordings. Injections into both dorsal FST and ventral MST labeled clusters of cell bodies in MT that were concentrated within wide-field motion columns, whereas injections into dorsal MST labeled neurons predominantly within local motion columns. Results from the anterograde tracer experiments corroborated these findings. The high degree of specificity in the connections reinforces a model of functional organization for wide-field versus local motion processing within MT. Our data support the previously reported division of FST into separate dorsal and ventral areas, and they also suggest that MST of the owl monkey is, like MST of the macaque, functionally organized with respect to local versus wide-field motion processing.

Animals↗
PubMed2000

[Good clinical practice:impediment of source of progress?].

On the bases of the Declaration of Helsinki (1964), the law called Huriet-Sérusclat (1988) and several subsequent decrees have clearly defined the appropriate organization and management of clinical trials in France. The law on the Commission de l'informatique et des libertés (1978) and several European regulations have also to be taken into account. This extensive legal and regulatory system has been the source of a major improvement in the scientific quality of clinical trials and in the security of participating persons. Indirectly, it has also improved daily clinical care, as physicians have learned how to inform their patients and have been trained to use protocols and standard operative procedures. However, the legal and regulatory pressure has increased the cost and complexity of trials to such an extent that no clinician with his own resources is now able to be the sponsor of a trial involving more than a few patients. In addition to trials organized by pharmaceutical companies for drug development, health authorities in France and Europe should consider to support major clinical trials on therapeutic strategies with public health implications. A few examples can be acknowledged thus far, but a real policy remains to be defined.

Clinical Trials as Topic↗
PubMed2000

Heritability and prevalence of specific fears and phobias in childhood.

Fears and phobias are relatively common in childhood. Both environmental and genetic theories have tried to explain the etiology behind these conditions. However, data supporting the different theories are sparse. To investigate the relative importance of genetic and environmental influences on specific phobias and fears, parental reports of animal, situational, and mutilation fears and phobias were completed for 1106 pairs of 8- to 9-year-old Swedish twins. The prevalence of specific phobias was 7.3% for boys and 10.0% for girls. Genetic. shared environmental, and nonshared environmental effects contributed to individual differences in fears and phobias in young children, but the magnitude of the effects differed between sexes. Shared environmental effects contributed to a general susceptibility for fearfulness. Genetic and nonshared environmental effects, on the other hand, contributed both to the general susceptibility and specific fearfulness, even though these effects primarily were fear specific. These results indicate that both heritable factors as well as environmental factors such as trauma, vicarious learning, and/or negative information are important for differences in fearfulness and phobias--at least in children.

Age Distribution↗
PubMed2001

Infants' long-term memory for a serial list: recognition and reactivation.

Serial lists contain information about item identity and item order. Using a task designed for nonverbal animals, we previously found that 3- and 6-month-olds exhibited a primacy effect after 24 hr, remembering both item identity and item order. Presently, we examined their memory of list information after longer delays. In Experiment 1, the serial-position curve reverted to a U-shape after 1 week at both ages, revealing that the common practice of attributing primacy and recency effects to long- and short-term memory, respectively, is flawed. In Experiment 2, a precuing procedure confirmed that 6-month-olds' memory still contained order information after 1 week, but 3-month-olds' reactivated memory contained none. Experiments 3A and 3B confirmed that increasing the complexity of information that was learned shortened the delay after which it could be retrieved. Testing infants after delays longer than have previously been used with animals or human adults sheds new light on an old phenomenon.

Analysis of Variance↗
PubMed1975

Motion effects on the human operator in a roll axis tracking task.

To better understand the effects of motion on tracking performance, a simulator, capable of being controlled in a static as well as motion mode, was developed. Using this simulator, 12 volunteers, separated into groups of four, attempted to track a wing angle target displayy. The target was driven with band-limited (0.5 rad/s) Gaussian noise so that a roll angle of 120 degrees was equivalent to 1 S.D. Different control dynamics (plants) were used for each group of volunteers. For manual control of plants of the form2, the experimental results indicate that large amplitude roll motion information reduces task learning time and cuases a significant improvement in tracking performance. For control of simpler plants, of the form K/S, no improvement due to the presence of the motion environment was observed.

Adult↗
PubMed1993

Howard: paternity and Pandora's box.

Howard, a young man named in a paternity suit, came to the Chief of the Genetics Clinic at a large teaching hospital to declare the charges against him false and ask for help in mounting evidence for his defense. Howard submitted to HLA testing, as did the mother and child; but in Howard's zeal to prove his innocence, he insisted that his siblings and parents also be tested to show conclusively there was no paternal link between himself and the child in question. The results of the tests solved one problem while creating another. Although the tests showed that Howard was not the father of the child as charged, the tests also indicated that the man Howard believed to be his own father could not, in fact, be his biological parent. The geneticist brought the case to the new ethics committee at a large teaching hospital to ask, "What, if anything, should be done with this information? Does a physician have the right to withhold information that, although acquired accidentally, would have great import for the patient?" In presenting his dilemma regarding Howard's situation, the geneticist also described a related and common problem of who owns the information. For example, a person comes in for genetic counseling about a particular family disorder. In the course of establishing a pedigree, it comes to light that there are relatives who are at high risk of developing a life-threatening disease that is preventable. What is the doctor's obligation to such a person who is not a patient and about whom crucial information has been learned through privileged communication?

Confidentiality↗
PubMed2001

From data to evidence: evaluative methods in evidence-based medicine.

The amount of published information is increasing exponentially, and recent technologic advances have created systems whereby mass distribution of this information can occur at an infinite rate. This is particularly true in the broad field of medicine, as the absolute volume of data available to the practicing clinician is creating new challenges in the management of relevant information flow. Evidence-based medicine (EBM) is an information management and learning strategy that seeks to integrate clinical expertise with the best evidence available in order to make effective clinical decisions that will ultimately improve patient care. The systematic approach underlying EBM encourages the clinician to formulate specific and relevant questions, which are answered in an iterative manner through accessing the best available published evidence. The arguments against EBM stem from the idea that there are inherent weaknesses in research methodologies and that emphasis placed on published research may ignore clinical skills and individual patient needs. Despite these arguments, EBM is gaining momentum and is consistently used as a method of learning and improving health care delivery. However, if EBM is to be effective, the clinician needs to have a critical understanding of research methodology in order to judge the value and level of a particular data source. Without critical analysis of research methodology, there is an inherent risk of drawing incorrect conclusions that may affect clinical decision-making. Currently, there is a trend toward using secondary pre-appraised data rather than primary sources as best evidence. We review the qualitative and quantitative methodology commonly used in EBM and argue that it is necessary for the clinician to preferentially use primary rather than secondary sources in making clinically relevant decisions.

Evidence-Based Medicine↗
PubMed1994

India. Rajasthan adopts new strategy in teacher training.

In the State of Rajasthan, there are about 100,000 teachers working in remote places. Training this large number of teachers in population education is always tedious, time consuming and expensive. To be able to reach and train these teachers working in primary schools without extra effort, time and money, the State Institute of Educational Research and Training (SIERT) adopted a new approach for this purpose. The approach makes use of the block level administrative approach in Rajasthan, where the monthly pay is distributed at various pay centers in the block. Every month, about 50-60 teachers gather at each pay center to collect their salaries. These teachers also take this opportunity to spend some time to learn new academic information and solve their problems. The SIERT took this opportunity of group meetings by presenting lectures or talks on population education to these teachers. Experts were invited from the District Institute of Education and Training to give lectures on various topics such as concepts and needs for population education; teaching, strategies and organization of co-curricular activities and discussion on the textual material in the Hindi language and environmental education for primary school students. So far, these talks had been arranged at 150 pay centers covering around 7500 teachers in the year 1993.

Asia↗
PubMedDate not supplied

[Dementia and cognitive impairment in Parkinson disease].

Changes in cognitive function and disturbances in behavior are commonly seen in parkinsonian patients and they are inherent features of the disease. Estimates on the prevalence of dementia in this disorder are quite variable, ranging from 15 to 25%. Advanced age, depression, severity of akinesia, and the presence of dopaminomimetic psychosis, are considered as risk factors in the development of cognitive deterioration within this patient population. Cognitive dysfunction may manifest as relatively circumscribed deficits or overt dementia. The finding of mild cognitive deficits is common in Parkinson's disease, such as reduced flexibility, psychomotor slowing, reduction in learning capacity and information retrieval, and disturbances in visuospatial tasks. The most prevalent cognitive disturbance is an impairment in visuospatial tasks, not necessarily related to the degree of motor disability. Dementia, when present early on in the course of the disease may suggest alternative diagnoses (Diffuse Lewy body dementia, Alzheimer's disease with extrapyramidal features, Fronto-temporal dementia, etc.), while in those cases in whom the dementing disorder develops at a later stage, it is assumed to be an integral part of the disease, albeit corresponding to variable pathogenetic mechanisms.

Cognition Disorders↗
PubMed1992

[Quality assurance of medical education--a prerequisite for good medical practice].

Assured quality of medical education is a prerequisite for high quality medicine. Quality assurance of medical education implies a well-planned assessment of the structure, process and outcome of education based on defined standards and objectives, and draws heavily on a thorough knowledge of how people learn. Learning in medicine shares common features at all levels, from undergraduate to continuing education. Three core elements are the context of learning, availability of information, and opportunities for elaboration (educational counselling, mentorship, interaction with peers) as a basis for linking practice and theory. A quality assurance programme must examine all these factors and suggest remedies when appropriate. The upgrading of educational research in medicine, and valuing and recognition of teaching within the profession, are important factors in promoting continuous improvement of the quality of medical education.

Education, Medical↗
PubMed2003

The Advanced Immunization Management (AIM) e-Learning Project.

New tools to educate immunization managers in developing countries are needed to keep these health policy makers current on the latest vaccines and procedures, and to provide support in decision making. The goal of the AIM e-Learning Project is to deliver up-to-date and engaging web-delivered media, with solid instructional design, to an audience relatively new to web-based learning. Accuracy of information and accessibility drive our design. Our ultimate objective is to aid immunization managers in developing timely, effective and sustainable policy.

Education, Distance↗
PubMed2005

Effective communication with patients.

This brief article aims at heightening awareness about communication with various patients, including strategies to assist in improving communicative effectiveness. It assists us as health care professionals to go back to basics and reflect on how we communicate. Several researchers have provided insight into ways that communication may be enhanced. Walter, Bundy, and Donan (2005) suggested personally greeting the patient, introducing oneself, engaging in talk about clinical concerns, and then discussing next steps toward healthcare solutions. Schillinger (2003) implored that health related jargon be avoided and that all messages be clear and simple. Illustrations in the form of black-white line drawn pictures also tend to assist in patient comprehension. Lawton and Carroll (2005) suggested that effective communication requires assessing what the patient knows about their illness. Seidel's model (2004) stated that healthcare providers listen to the patient's story and elicit information through questioning with sufficient time allotted to provide answers. He also discussed the importance of providing a short summary of what the patient conveyed and giving additional information so they learn more about what is happening to them and can become an active participant in making decisions. It is important that patients understand what we as healthcare professionals say to them. Wisner (1999) further conveyed that it is not words alone that communicate. Body language, facial expressions, and tone of voice often provide additional clues influencing communicative effectiveness. Without a doubt, communication, directly impacts service delivery and quality of care in healthcare today. Listen to your patients, they have much to say.

Clinical Competence↗
PubMed1990

Interferon as treatment for viral hepatitis: a progress report.

Treatment of chronic hepatitis with interferon is in its infancy and it is likely that information that we learn today will markedly improve the treatment that is offered tomorrow. The limitations of interferon treatment at the present time are the lack of complete predictable responses in approximately half the patients and the relatively high relapse rates observed thus far. It is predicted that higher doses will result in better response and lower relapse rates, but this remains to be seen. The cost and the frequency of side effects will likely be significantly increased by escalation of dose, but the chance of eradicating an otherwise untreatable and not benign condition is tempting and will continue to challenge our best efforts.

Hepatitis B↗
PubMed1990

AIDS. Natural history and prognosis.

Infection with HIV results in a chronic, persistent infection that usually progresses slowly from an asymptomatic state to full-blown AIDS. AIDS remains a lethal disease with no effective cure. A great deal of information has been learned in the past decade, yet many questions remain unresolved. Much more research is needed into the conditions surrounding the perinatal transmission of HIV. Many women who give birth to a child with AIDS are themselves asymptomatic for HIV infection during pregnancy and at delivery; thus, routine voluntary prenatal HIV screening programs must be instituted in areas of high seroprevalence. Such screening programs must provide pretest and post-test counseling with consent and confidentiality. Seroprevalence studies conducted during the perinatal period or at birth using newborn blood samples will provide important epidemiologic data for further research investigations as well as continued estimates of the prevalence of HIV infection. Currently, there is no formal reporting system for HIV infection, only for the clinical expression of AIDS. There may be a need to develop a centralized reporting unit for HIV infection. As the epidemic continues and the true prevalence rates are determined, additional resources for public health care, housing, insurance, and foster care for children will be needed. The number of women who are infected is increasing at an alarming rate. Every opportunity to increase public awareness about the AIDS epidemic and modes of transmission must be exploited if we are to impact on the spread of HIV infection. Prospective studies of pregnant HIV-positive women and pediatric follow-up can provide a wealth of data about AIDS and disease progression in both the mother and the infant. Even if some children do not develop AIDS, the possibility of permanent effects of in utero exposure to the virus still exists. At what exact point in gestation does infection occur? Can infection be prevented or delayed with current chemotherapeutic protocols? Even if a cure or vaccine is developed in the near future, the impact of this deadly virus will have repercussions for many years to come.

Acquired Immunodeficiency Syndrome↗
PubMed1989

A strategy for curriculum integration of information skills instruction.

The ever increasing need of health professionals for information and the inclusion of active learning experiences in the medical school curriculum require that students learn the effective use of health information tools. Curriculum integration is gaining acceptance as an effective approach to teaching information skills in this setting. At the University of Miami School of Medicine, information skills components taught by library faculty are integrated into the Freshman Orientation Program and two sophomore curriculum courses. Beginning with a core set of skills and basic information management tools, more complex and subject-specific skills are introduced sequentially throughout the basic sciences curriculum. During the first two years, a wide range of information skills are taught, and students receive many opportunities to seek and identify information using both printed sources and computerized bibliographic databases. This paper describes how curriculum integration of information skills instruction was achieved and the many benefits of this approach. Included are a description of the information skills components, evaluation data, and future plans.

Computer Systems↗
PubMed1988

Autopsy study of the elderly institutionalized patient. Review of 234 autopsies.

Autopsies are performed much less frequently in the elderly than in younger patients. Little information exists as to causes of death in the institutionalized elderly. The clinical diagnostic error rate documented by autopsy studies ranges from 6% to 68%. We analyzed the clinical and autopsy records of 234 patients who died during a 14 1/2-year period at our chronic care institution to determine the accuracy of clinical cause of death in addition to the pathologic cause of death. The most common causes of death included bronchopneumonia (33%), congestive heart failure (15%), metastatic carcinoma (14%), pulmonary embolism (8%), myocardial infarction (7%), cerebrovascular accident (6%), unknown cause of death (8%), and a miscellaneous group (9%). The highest diagnostic error rate was in the underdiagnosis of pulmonary embolism (39% antemortem accuracy rate). The most accurately diagnosed condition was cerebrovascular accident (92% antemortem accuracy rate). Pneumonia was correctly diagnosed antemortem in 73% of the patients studied. These data suggest that serious and potentially treatable illnesses are underdiagnosed in the elderly institutionalized patient and that there is valuable information to be learned by performing autopsies in the elderly population.

Aged↗
PubMed1978

[Psychotherapy: present state and developmental trends (author's transl)].

Psychotherapeutic theories and techniques are multiplying explosively. However, the newer developments are reducible to a few basic concepts, namely 1. training, learning, conditioning and information, 2. suggestion, 3. persuasion, 4. counselling, 5. insight (making conscious), 6. group-effects, 7. cartharsis, ecstasis and acting-out. In the present situation a therapeutic schedule based entirely on methods and theories is no longer acceptable and has been replaced by a patient-centred approach, i.e. the method is chosen on a pluralistic basis according to optimum fulfilment of the requirements of patient, therapist and institution. Apart from psychotherapy in the narrower sense, a psychotherapeutic attitude is recommended as an essential method of secondary prevention in all health and social services.

Austria↗