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PubMed1998

Surveillance of influenza in Wales: interpreting sentinel general practice rates using contemporaneous laboratory data. Opportunities and limitations.

OBJECTIVES: To evaluate the opportunities and limitations of using laboratory data to enhance sentinel general practice surveillance of influenza. DESIGN: Descriptive study of active sentinel surveillance of clinically diagnosed influenza in general practice and passive total population surveillance of laboratory reports of influenza A, influenza B, Mycoplasma pneumoniae, and respiratory syncitial virus infections. SETTING: Wales. SUBJECTS: Total sentinel practices population (currently 228,130); population of Wales (2,913,000, 1994 mid-year estimate). MAIN OUTCOME MEASURES: Simplicity, flexibility, acceptability, sensitivity, predictive value positive, representativeness, and timeliness of a surveillance system. Rate of influenza and other respiratory infections. RESULTS: Sentinel general practice surveillance of influenza in Wales is simple, flexible, acceptable, timely, representative, and relatively sensitive. Current laboratory surveillance is complex and less timely than sentinel practice surveillance but is complete and has a relatively high positive predictive value. For the period January 1993 to September 1996, peaks in rates of influenza reported by sentinel practices during winters 1993/94 and 1995/96 were temporally associated with increased rates of laboratory confirmed influenza A and respiratory syncitial virus, whereas the peak in 1994/95 was associated with increased rates of laboratory confirmed influenza B, M pneumoniae, and respiratory syncitial virus. CONCLUSIONS: Timely laboratory data can add value to influenza data already obtained from sentinel general practice surveillance. However continuous audit is essential to resolve the possible limitations of either surveillance system.

Evaluation Studies as Topic↗
PubMed1991

Radiographic grading of extrinsic allergic alveolitis. A comparison between a modified ILO classification and a descriptive method.

We analyzed the acute phase radiographs of 107 consecutive patients with clinically confirmed extrinsic allergic alveolitis. Three readers independently recorded the profusion and the type of opacities according to the standard ILO criteria extended with categories x, y, z, and ground glass for description as proposed by McLoud et al. The profusion of the changes was grade 0 in 13%, grade 1 in 37%, grade 2 in 35%, and grade 3 in 15% of the interpretations. The type of predominant small opacities was p in 33%, x in 22%, s in 13%, t in 10%, q in 9%, and 0, r, u, y, and z in 13% of the interpretations. Ground glass density was seen in 8% of the recordings. The changes were predominantly located in the middle and lower lung zones. For comparison, according to the classification of Hapke et al. miliary changes (68%) predominated over fibrotic (27%) and normal (11%) recordings. The intraobserver agreement was good by both methods, but there was less interobserver variation with the ILO method. The semiquantitative standardized modified ILO scheme was considered more informative than Hapke's descriptive classification for epidemiologic and research purposes.

Alveolitis, Extrinsic Allergic↗
PubMed2006

Score-moment combined linear discrimination analysis (SMC-LDA) as an improved discrimination method.

A new discrimination method called the score-moment combined linear discrimination analysis (SMC-LDA) has been developed and its performance has been evaluated using three practical spectroscopic datasets. The key concept of SMC-LDA was to use not only the score from principal component analysis (PCA), but also the moment of the spectrum, as inputs for LDA to improve discrimination. Along with conventional score, moment is used in spectroscopic fields as an effective alternative for spectral feature representation. Three different approaches were considered. Initially, the score generated from PCA was projected onto a two-dimensional feature space by maximizing Fisher's criterion function (conventional PCA-LDA). Next, the same procedure was performed using only moment. Finally, both score and moment were utilized simultaneously for LDA. To evaluate discrimination performances, three different spectroscopic datasets were employed: (1) infrared (IR) spectra of normal and malignant stomach tissue, (2) near-infrared (NIR) spectra of diesel and light gas oil (LGO) and (3) Raman spectra of Chinese and Korean ginseng. For each case, the best discrimination results were achieved when both score and moment were used for LDA (SMC-LDA). Since the spectral representation character of moment was different from that of score, inclusion of both score and moment for LDA provided more diversified and descriptive information.

Data Interpretation, Statistical↗
PubMed2005

The preconscious and psychic change in Fairbairn's model of mind.

Fairbairn's mature model of mind was developed over a period of time and was modified significantly as it developed. In contrast to some sympathetic commentators who have suggested changes, the author has been impressed by the untapped potential of the theory. There are two areas that he feels need clarification and explanation, which are the importance of the preconscious, so neglected in our literature, and its role in psychic growth. By looking closely at the topographic categories and the way that Fairbairn uses them, the author has developed a modified version of Fairbairn's original model, which has a crucial role for a structured preconscious. The preconscious now becomes both a crucial original aspect of the early self and a significant, descriptively unconscious, fulcrum for both psychic change and mature dependence.

Creativity↗
PubMed1991

["Anxiety glistens on our brows". Dream reports in literary works on the horrors of ghettos and concentration camps].

Dream reports occupy a special place in literature about confinement in concentration camps and ghettos (Robert Antelme, Charlotte Delbo, Anna Langfus, André Schwarz-Bart). They are central elements in the narrative that relate the anxiety of those threatened with destruction more faithfully than any realistic account could. They disrupt the chronological linearity and rationality and represent in images horror beyond memory or description.

Anxiety↗
PubMed1989

Expert systems in laboratory medicine: a practical consultative application.

Today, more than ever, clinical pathologists will be required to act as consultants, while at the same time coping with ever-increasing workloads. We present a knowledge-based expert system for providing interpretive reports on over 100 specimens per day in a large commercial laboratory. The program's developmental history is reviewed, followed by a description of the program's structure and operation and how it is used and edited.

Diagnosis, Computer-Assisted↗
PubMed1985

Capnography and the Bain circuit I: A computer model.

The Mapleson D anesthesia breathing system has no valves and allows rebreathing of carbon dioxide. Its coaxial version is known as the Bain system. The interpretation of capnograms obtained during its use requires an understanding of the interrelationships of patient and system variables. Toward that end, a systematic description of mechanical ventilation with the Bain circuit was undertaken based on the physical laws of gas transport. The mathematical formulation of the model contains the relations between pressure, flow, and volume in the tube, alveolar space, and ventilator. The flows, calculated from these relations, are used to determine the CO2 concentrations in the different parts of the model. Two sets of data are used--patient and system. The patient data, used to solve the equations numerically, are lung-thorax compliance, CO2 inflow into alveolar space (CO2 production), functional residual capacity, dead space volume, airway resistance, and respiratory quotient. The ventilation system data comprise the dimensions and volumes of the Bain circuit, ventilator, connectors, and tubes; spill valve pressure; resistances to flow in the individual tube parts; ventilator settings; and fresh-gas flow rates. After incorporation of a volunteer's respiratory variables into the model, capnograms obtained from the model compared well with those obtained from the volunteer. The structure of the model is such that it permits easy introduction or changes of patient and system variables to obtain individual results or model specific circumstances. This flexibility makes it a useful tool for understanding the properties of the Bain circuit under a variety of clinical circumstances. The results may be displayed in a number of different ways.

Anesthesia, General↗
PubMed2005

[Quality assurance in echocardiography. Three-level system in formation and qualifying and concept of an external quality review].

Measures of quality assurance in echocardiography can be categorized according to standard principles into measures of reviewing structure, processing, and results. This document contains 1) the description of a three level system for education and qualifying in echocardiographic examinations (quality of structure) and 2) the draft of an external quality assurance process for reviewing the results of one echocardiographic investigator or of one laboratory of echocardiography (quality of results). The document also contains a draft description of a nationwide independent institution for certification, which is needed for both projects.A level 1 investigator should be able to perform and interpret a basic investigation. A basic investigation allows to exclude most of all cardiac diseases that can be diagnosed by echocardiography, and pathological findings should be filtered out. A level 2 investigator is able to perform an extended examination, and a comprehensive echocardiographic diagnosis can be established after her or his examination. Additional specific training and experience is necessary to be certified for TEE and stress echo examinations. A level 3 echocardiographer has done research work in echocardiography and should have performed certified teaching courses in echocardiography. The external quality assurance process should provide the possibility to certify the results and reports of a single investigator or of an echo laboratory, according to standard principles of reviewing the records. The process of certification is exclusively performed on a voluntary basis. The nationwide institution of certification should be part of the academy of education in cardiology of the German Society of Cardiology.

Cardiology↗
PubMed2002

Monitoring the accuracy of a PACS image database.

"What you don't know won't hurt you" is a proverb that does not apply to a database on which patient lives depend. One of the core components of the picture Archiving and communications system (PACS) is an image database that contains the location and state of images and their corresponding demographic information. An image associated with the wrong patient name has potentially devastating implications, especially if the error is not caught early. This article describes how Texas Children's Hospital addresses the challenge of ensuring the accuracy of data of our PACS image database. It presents the routine checks that our PACS analysts perform every three hours and on a daily and monthly basis. These include steps involved in "fixing" exam data when an examination has missing or incorrect demographic information. In addition, this report compares how our institution assured accuracy of our film-based archive before PACS. Human error is the source of most inaccuracies in the image database, and automation such as bar code scanners and DICOM Modality Work List management have decreased their frequency, but without totally eliminating them. Some errors are routinely generated by the nature of radiology imaging operations and the limitations of devices for automating those operations. For example, computed tomography exams of the head, chest, and abdomen are routinely acquired during the same scan but must be separated into different exams for interpretation by different physicians. Factors contributing to inaccurate information include major system modifications, such as software or hardware upgrades, service interruptions, inaccurate problem descriptions provided by the user to the PACS analyst, and steps taken by the PACS analyst or technologist to correct errors.

Quality Control↗
PubMed2005

Office-based ambulatory anesthesia: Factors that influence patient satisfaction or dissatisfaction with deep sedation/general anesthesia.

PURPOSE: The purpose of this report was to analyze data collected in an outcomes study in an attempt to identify factors that may be significant predictors of either patient satisfaction or dissatisfaction with deep sedation/general anesthesia (DS/GA) administered in an office-based setting. MATERIALS AND METHODS: To address the research purpose, we used a prospective cohort study design and sample of patients undergoing procedures in the office-based ambulatory setting of oral and maxillofacial surgeons practicing in the United States who received local anesthesia (LA), conscious sedation (CS), or DS/GA. The predictor variables were categorized as demographic, anesthetic technique, adverse events, and patient-oriented outcomes (satisfaction/dissatisfaction). Appropriate descriptive and exact P values were completed as indicated. Statistical significance was set at P < .05. Multivariate analyses were performed to support the interpretation of univariate findings. RESULTS: The sample was composed of 34,191 patients, of whom 71.9% patients received DS/GA. There were 20,455 patient satisfaction forms completed, of which 14,912 forms were from patients undergoing DS/GA. Of patients who received DS/GA, 95.8% were extremely or moderately satisfied, 3.1% were neutral, and 1.1% moderately or extremely dissatisfied. Increased age and memory of postoperative instructions were identified as factors, which predicted satisfaction. The addition of nitrous oxide to some regimens also appeared to increase satisfaction. Young age, anxiety, pain, vomiting, and being awake during the procedure were predictors of dissatisfaction. CONCLUSIONS: The findings of this study indicate that patients are overwhelmingly satisfied with DS/GA provided in an office-based ambulatory setting. Items identified as significant predictors of dissatisfaction (anxiety, pain, vomiting, being awake) generally confirm preexistent suppositions. Surprisingly, patient age (<10 years old) and memory of postoperative instructions appear to have relevance to dissatisfaction as well. Lack of specific regimens and controls prevents confirmation that nitrous oxide improves patient satisfaction rates. Although statistically significant, the variations, which resulted in a higher or lower satisfaction rate, are of questionable clinical significance in many cases.

Adolescent↗
PubMed2002

A qualitative study of the theoretical models used by UK mental health nurses to guide their assessments with family caregivers of people with dementia.

Some researchers suggest that nurse training does not provide adequate theoretical knowledge to guide mental health nurses' work with carers of people with dementia. In recent years theoretical guidance for working with carers has emerged in the nursing literature. However, little attention has been given to theory practice links. This study used interpretative phenomenological analysis to investigate the theoretical model used by nurses to guide carer assessments. During the analysis the data evolved into a description of the model underlying the nurses' work. In the discussion this model was compared with the stress process model (SPM). This comparison highlighted striking similarities between the themes in the nurses' model of carer stress and the theoretical constructs of the SPM. However, the SPM describes influential links between different constructs which were absent in the nurses' model. The research illustrates developmental training needs for mental health nursing to improve the efficacy of assessments and therefore, interventions.

Adult↗
PubMed1997

Low-frequency oscillations of visual, auditory and somatosensory cortical neurons evoked by sensory stimulation.

Low-frequency oscillations-LFOs-below 20 Hz in the activity of cortical neurons are a commonly observed property across all sensory modalities. However, the functional significance and potential role of these intrinsic oscillations are not well understood. Here, we attempt to provide a general framework for the interpretation of this phenomenon by considering its properties across several sensory modalities. In the first part, we provide a survey and a general description of low-frequency oscillations (LFOs) at a cellular level observed following adequate [Basar, and Schürmann, 1994]. Sensory stimulation of neurons recorded in three sensory modalities of neocortices in higher mammals. The second part will address some functional aspects of low-frequency oscillations (LFOs) such as stimulus selectivity and so-called 'interference' phenomena, specifically with findings related to 'resetting' and 'gating' of sensory processing streams. Finally, a hypotheses is outlined in which the low-frequency oscillations are regarded as an organizational principle by which continuity of sensory and motor states over time could be accomplished.

Acoustic Stimulation↗
PubMed1996

Susceptibility contrast and transverse relaxation in porous media: simulations and experiments.

A numerical simulation of spin diffusion in inhomogeneous magnetic fields due to susceptibility contrast was developed to describe the transverse relaxation of fluids in porous media. The simulation results are in quantitative agreement with experimental measurements obtained on samples of simple geometry. They also confirm the interpretation of the 1H transverse relaxation observed in natural rocks either hydrophilic or hydrophobic for several deuterium oxide/oil saturations, based on the traditional description of water and oil arrangement.

Diffusion↗
PubMed1997

An oral history project in mental health nursing.

The main aim of this study was to produce material which would support, or alternatively challenge the content of a piece of historical writing, based largely on primary archival sources. The method chosen was to replicate and develop an earlier oral history project, which was carried out to discover and report on trained nurses who could offer their impressions of both the practical and theoretical frameworks of psychiatric care. The work described here took that project a stage further by focusing on a single organization, and developing the line of inquiry by adding topics of contemporary interest, such as gender issues, ethnicity, the management of violence and nurses' roles in treatment. Apart from comparisons and contrasts with the previous study, subsidiary interest was to reflect on the intrinsic value and continuing relevance of the material, or the lack of it. The process section considers the problems and dynamics of the interview situation, and how this may have affected the material produced and what this implied for the interpretation. The study confirms an assumption of the usefulness of oral history, as a record, additional to the written documents, which enriches the descriptions of historical processes.

Female↗
PubMed2001

Understanding mental health through reading selected literature sources: an evaluation.

The increasing use of the humanities in nurse education provides an alternative means of facilitating students' understanding of health issues. In part, this contributes to a critique of rationalist-technological approaches to education where knowledge is reduced to abstract, discernable and measured units. A more communal approach to education recognises the place of interpretation as part of learning and, within this, the significance of dialogue, identity, tradition, attachment and partnership. The reading of works of literature is one way in which the reader interprets texts in a multiplicity of ways in order to more fully understand the 'real' world. Mental health offers particular opportunities for literary descriptions. The evaluation of a learning unit within a mental health nursing branch programme where students read a number of works of literature is outlined. Results indicate a variety of student responses to use of such an approach. The authors assert the usefulness of these approaches in encouraging deeper understanding of complex issues faced in mental health nursing practice. At the same time, however, careful consideration is given to the place of such approaches within the overall philosophy of a curriculum programme.

Humans↗
PubMed1998

Aerobic and anaerobic energy expenditure during exhaustive ramp exercise.

Ramp tests are often manipulated so that oxygen uptake is able to interpret energy expenditure in its entirety. We hypothesized that oxygen deficits during ramp exercise to exhaustion would be significant, providing a more complete description of the types of energy expenditure available for this mode of testing. Oxygen deficits were obtained during a slow ramp (681 +/- 71 s) and a fast ramp (275 +/- 33 s) to exhaustion. Twelve healthy men (age 35 +/- 3 yrs; VO2max 51 +/- 10 ml x kg(-1) x min(-1)) performed several 10 min submaximal bike rides (at or below ventilatory threshold) to determine work rate -O2 uptake demands. Estimated O2 demands were compared to measured O2 uptake during each ramp test, the difference representing an oxygen deficit. Work levels were controlled and measurements collected with a commercially available electrically braked bike ergometer and metabolic testing system (MedGraphics, Minn., MN). Data were collected and averaged in 30 s time periods, power in watts (W), energy expenditure in cumulative O2 (L). Using a paired t-test, cumulative O2 uptakes were significantly lower (p = 0.0001) when measured O2 uptakes (26.0 L +/- 4.5 for slow ramp; 10.8 L +/- 2.8 for fast ramp) were compared to estimated O2 demands (29.0 L +/- 3.7 for slow ramp; 14.1 L +/- 3.5 for fast ramp). Anaerobic energy expenditures (oxygen deficits) represented 10.8% and 23.4% of total energy expenditure for slow ramps and fast ramps, respectively. Comparisons of the slopes for each test condition revealed significant differences (steady state > slow ramp > fast ramp; p = 0.0001,ANOVA). We conclude that the oxygen deficit during ramp testing represents a significant part of total energy expenditure.

Adult↗
PubMed1985

Comparison of nutrient calculation systems.

A set of 54 24-hour dietary recalls collected in 1975-1976 from males aged 35-57 years who were participating in a cardiovascular risk factor intervention program was submitted to three different nutrient calculation systems to investigate how much of a difference exists among systems in calculating nutrient intakes. The three computerized systems were of varying levels of sophistication. Among differences found, one system reported 1.4% more calories derived from polyunsaturated fat than the other two. For studies investigating the effects of dietary fat intake, this difference between systems may be important. Other significant group differences were seen for carbohydrate and alcohol. Although mean differences among the three systems were not great, dramatic differences were encountered when evaluating individual recalls. Nutrient intake data obtained from dietary recalls for individuals and for groups for whatever purpose are subject to the bias of the nutrient calculation system used. These biases should be considered when interpreting results, comparing results with other studies, and when developing treatment plans in the clinical setting. Recommendations for enhanced standardization include: 1) thorough descriptions in research reports of the particular system used; 2) exchange of standard menus between systems; 3) enhanced quality control of the coding process; 4) periodic updating of the nutrient data base to accommodate new food products and changes in composition of foods.

Adult↗