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PubMed2005

Logistics of companion animal rehabilitation.

Setting up rehabilitation services presents several challenges to the veterinary practitioner. Members of the rehabilitation team need to have a solid knowledge base of acute and chronic orthopedic and neurologic disorders and a knowledge of rehabilitation principles and applications. The working environment has to be adapted to patients with limited mobility, specific equipment and supplies are to be used, and a fee structure should be implemented. This article reviews these logistic aspects of companion animal rehabilitation.

Animals↗

PubMed1999

Developmental differences in sensitivity to semantic relations among good and poor comprehenders: evidence from semantic priming.

Semantic priming for category coordinates (e.g. CAT-DOG; AEROPLANE-TRAIN) and for pairs of words related through function (e.g. BROOM-FLOOR; SHAMPOO-HAIR) was assessed in children with good and poor reading comprehension, matched for decoding skill. Lexical association strength was also manipulated by comparing pairs of words that were highly associated with pairs that shared low association strength. Both groups of children showed priming for function-related words, but for the category co-ordinates, poor comprehenders only showed priming if the category pairs also shared high association strength. Good comprehenders showed priming for category-related targets, irrespective of the degree of prime-target association. These findings are related to models of language development in which category knowledge is gradually abstracted and refined from children's event-based knowledge and it is concluded that in the absence of explicit co-occurrence, poor comprehenders are less sensitive to abstract semantic relations than normal readers.

Child↗

PubMedDate not supplied

COLUMBUS Orbital Facility and Automated Transfer Vehicle: a challenge for agency & industry.

Long term continuous operation of the COLUMBUS Orbital Facility (COF) flight- and ground segment requires continuous mission control and operations support capability to ensure proper operation and configuration of the COF systems in support of ongoing science and technology payloads. The ISS logistics scenario will be supported by the Automated Transfer Vehicle (ATV). These operational needs require the built-up of a new ground infrastructure in Europe and USA, enabling an efficient operations for preparation, planning and mission execution. The challenge for the European space community consists in the development and operation of a user friendly operational environment but keeping costs within budgetary constraints. Results of detailed definition studies performed by both agency and industry for the ground infrastructure indicate solutions to those technical and programmatic requirements by using of existing centers and facilities, re-use of C/D phase products (Hardware, Software) and COTS equipment to avoid costly new developments, using engineering expertise of the industrial personnel from flight element phase C/D. The concept for operations execution defines the task sharing between Operations Control Facilities (OCF), Operations Support Facilities and User Operations Sites. Operations support consists of on-line engineering support, off-line engineering support, payload integration, logistics support and crew training support performed by industry. DASA RI has made internal investments in organizational concepts for mission operations as well as in mission technologies and tools based on the standard COLUMBUS Ground Software (CGS) toolset and on knowledge based systems to enable an efficient industrial operations support. These tools are available as prototypes being evaluated in a simulated operational environment.

Astronauts↗

PubMed1999

A date to remember: the nature of memory in savant calendrical calculators.

BACKGROUND: Savant calendar calculators can supply with speed the day of the week of a given date. Although memory is suggested to be an important component of this unusual ability, memory function has never been systematically investigated in these skilled yet learning impaired individuals. METHODS: Eight savant calendrical calculators, most of whom had autism, were compared with eight verbal IQ, age and diagnosis matched controls on digit and word span tests and measures of long-term memory for words and calendrical information (individual years). In an analogue to the 'generation effect', the savants' memory for dates was also compared following calculation and study/read tasks. RESULTS: The savants did not differ from controls on measures of general short- and long-term memory. They did, however, show a clear recall superiority for the long-term retention of calendrical material. They also remembered calculated dates better than those that were only studied. CONCLUSIONS: A general mnemonic advantage cannot explain savant date calculation skills. Rather, through exposure to date information, the savants are suggested to develop a structured calendar-related knowledge base with the process of calculation utilizing the interrelations within this knowledge store. The cognitive processing style characteristic of autism may also play a role in the acquisition of this savant ability.

Adult↗

PubMed2004

Implementing evidence-based psychosocial practices: lessons learned from statewide implementation of two practices.

OBJECTIVE: As part of this national project, we examined barriers and strategies to implementation of two evidence-based practices (EBPs) in Indiana. BACKGROUND: Despite many advances in the knowledge base regarding mental health treatment, the implementation of EBPs in real-world setting remains poorly understood. The National EBP Project is a multi-state study of factors influencing implementation of EBPs. METHODS: Over a 15-month period we observed eight assertive community treatment (ACT) programs and six integrated dual disorders treatment (IDDT) programs and noted pertinent actions taken by the state mental health agency influencing implementation. We created a database containing summaries of monthly visits to each program and interviews with key leaders. Using this database and clinical impressions, we rated barriers and strategies at each site on seven factors: Attitudes, Mastery, Leadership, Staffing, Policies, Workflow, and Program Monitoring. RESULTS: At the site level, the most frequently observed barriers were in the areas of leadership, staffing and policies for ACT, and mastery and leadership for IDDT. Overall, barriers were more evident for IDDT than for ACT. Strategies were less frequently noted but generally paralleled the areas noted for barriers. However, our central finding was that ACT was generally more successfully implemented than IDDT throughout the state, and that this difference could be traced in large part to state-level factors relating to historical preparation for the practice, establishment of standards, formation of a technical assistance center, and funding. CONCLUSION: In this case study, both state-level and site-specific factors influenced success of implementation of EBPs. To address these factors, the field needs systematic strategies to anticipate and overcome these barriers if full implementation is to be realized.

Community Mental Health Services↗

PubMed2000

[Whiplash injury of the cervical spine--initial evaluation and treatment of late sequelae].

Principal requirement for adequate management of whiplash patients is considerable familiarity with symptoms of whiplash injury and knowledge of risk factors contributing to delayed recovery. In addition, evidence based knowledge of treatment strategies may help promoting an integrative initial assessment leading to therapy which likely may prevent chronicity.

Cervical Vertebrae↗

PubMed1999

Coronary care nurses' clinical decision making.

Increasing acuity of hospitalized persons with cardiac disease places great demands on nurses' decision-making abilities. Yet nursing lags in knowledge-based system development because of limited understanding about how nurses use knowledge to make decisions. The two research questions for this study were: how do the lines of reasoning used by experienced coronary care nurses compare with those used by new coronary care nurses in a representative sample of hypothetical patient cases, and are the predominant lines of reasoning used by coronary care nurses in hypothetical situations similar to those used for comparable situations in clinical practice? Line of reasoning was defined as a set of arguments in which knowledge is embedded within decision-making processes that lead to a conclusion. Sixteen subjects (eight experienced and eight new nurses) from coronary care and coronary step-down units in a large, private, teaching hospital in Minnesota, USA, were asked to think aloud while making clinical decisions about six hypothetical cases and comparable actual case. One finding was that most subjects in both groups used multiple lines of reasoning per case; but they used only one predominantly. This finding highlighted the non-linear nature of clinical decision making. Subjects used 25 predominant lines of reasoning, with intergroup differences on six of them. Where there were differences, experienced nurses used lines of reasoning of lower quality than did new subjects. The type variability in lines of reasoning suggested that multiple pathways should be incorporated into knowledge-system design. One implication of the variability in subjects' line of reasoning quality is that nurses at all levels of expertise are fallible and could benefit from decision support. The finding that subjects tended to use similar lines of reasoning for comparable hypothetical and actual cases was modest validation of subjects' performance on hypothetical cases as representing their decision making in practice. Consequently, there was support for using simulations and case studies in teaching and studying clinical decision making.

Adult↗

PubMed2002

A critical assessment of published guidelines and other decision-support systems for the antibiotic treatment of community-acquired respiratory tract infections.

Guidelines are an important means by which professional associations and governments have sought to improve the quality and cost-effectiveness of disease management for infectious diseases. Prescribing of initial antibiotic therapy for community-acquired respiratory tract infections (RTIs) is primarily empiric and physicians may often have a limited appreciation of bacterial resistance. Recent guidelines for managing RTIs have adopted a more evidence-based approach. This process has highlighted important gaps in the existing knowledge base, e.g. concerning the impact of resistance on the effectiveness of oral antibiotics for outpatient community-acquired pneumonia and the level of resistance that should prompt a change in empiric prescribing. In upper RTIs, the challenge is to identify patients in whom antibiotic therapy is warranted. Concentrated, sustained efforts are needed to secure physicians' use of guidelines. The information should be distilled into a simple format available at the point of prescribing and supported by other behavioral change techniques (e.g. educational outreach visits). Advances in information technology offer the promise of more dynamic, computer-assisted forms of guidance. Thus, RTI prescribing guidelines and other prescribing support systems should help control bacterial resistance in the community. However, their effect on resistance patterns is largely unknown and there is an urgent need for collaborative research in this area. Rapid, cost-effective diagnostic techniques are also required and new antibiotics will continue to have a role in disease management.

Anti-Bacterial Agents↗

PubMed1994

The influence of the New Pathway curriculum on Harvard medical students.

BACKGROUND: This study evaluated the effect of a radically redesigned curriculum at Harvard Medical School on preclinical students' knowledge, skills, personal characteristics, approaches to learning, and educational experiences. METHOD: Multiple measures were used to collect data from 121 students from the entering classes of 1989 and 1990 who had been randomly assigned to the New Pathway or traditional curricula; all had applied to be in the new curriculum. RESULTS: The New Pathway students reported that they learned in a more reflective manner and memorized less than their control counterparts in the traditional curriculum during the preclinical years. The New Pathway group preferred active learning and demonstrated greater psychosocial knowledge, better relational skills, and more humanistic attitudes. They felt more challenged, had closer relationships with faculty, and were somewhat more anxious than those in the traditional program. There was no difference in problem-solving skills or biomedical knowledge base. CONCLUSION: Students in the new curriculum learned differently, acquired distinctive knowledge, skills, and attitudes, and underwent a more satisfying and challenging preclinical medical school experience without loss of biomedical competence. These findings should encourage other schools to consider such a curriculum.

Clinical Competence↗

PubMed2004

Accurate and efficient loop selections by the DFIRE-based all-atom statistical potential.

The conformations of loops are determined by the water-mediated interactions between amino acid residues. Energy functions that describe the interactions can be derived either from physical principles (physical-based energy function) or statistical analysis of known protein structures (knowledge-based statistical potentials). It is commonly believed that statistical potentials are appropriate for coarse-grained representation of proteins but are not as accurate as physical-based potentials when atomic resolution is required. Several recent applications of physical-based energy functions to loop selections appear to support this view. In this article, we apply a recently developed DFIRE-based statistical potential to three different loop decoy sets (RAPPER, Jacobson, and Forrest-Woolf sets). Together with a rotamer library for side-chain optimization, the performance of DFIRE-based potential in the RAPPER decoy set (385 loop targets) is comparable to that of AMBER/GBSA for short loops (two to eight residues). The DFIRE is more accurate for longer loops (9 to 12 residues). Similar trend is observed when comparing DFIRE with another physical-based OPLS/SGB-NP energy function in the large Jacobson decoy set (788 loop targets). In the Forrest-Woolf decoy set for the loops of membrane proteins, the DFIRE potential performs substantially better than the combination of the CHARMM force field with several solvation models. The results suggest that a single-term DFIRE-statistical energy function can provide an accurate loop prediction at a fraction of computing cost required for more complicate physical-based energy functions. A Web server for academic users is established for loop selection at the softwares/services section of the Web site http://theory.med.buffalo.edu/.

Membrane Proteins↗

PubMed1993

The contribution of nursing theory to nursing administration practice.

The requisite theoretical base of nursing administration has been defined as a synthesis of knowledge from nursing and other disciplines. The purpose of this paper is to explore the contribution made by nursing knowledge to the distinctive epistemology of nursing administration. The value of nursing theory to administration practice is articulated as well as levels of theory development and their relationship to the knowledge base of nursing administration practice.

Environment↗

PubMed1976

A framework for family assessment in chronic illness.

Family assessment can enable the nurse to expand the internal and external resource potential of the family unit. Specifically, the nurse may be able to determine what information the client and family need to cope effectively with the illness condition. Additionally, the nurse may supply the family with consumer information regarding qualifications, cost, and appropriate points of entry for additional health and welfare services, and intervene as client advocate by documenting more specific information relevant to the agency's criteria for acceptance. With an adequate knowledge base obtained through the use of such an assessment, and with knowledge of local health-care delivery systems and community agencies, the nurse will be able to assist the family more fully. Specific information about resources, points of entry, costs, and quality of services may be offered to the family members to enable them to evaluate alternative courses of action appropriate to the specific situation and select the most beneficial solution.

Adaptation, Psychological↗

PubMed2004

Perceptions toward HIV, HIV screening, and the use of antiretroviral medications: a survey of maternity-based health care providers in Zambia.

Mother-to-child transmission of HIV (MTCT) is a major contributor to Zambia's HIV burden. Based on our experience in Zambia, we felt that provider perceptions, knowledge base, and practice patterns toward HIV-positive mothers may pose as significant obstacles to preventing MTCT. Two hundred and twenty-five health care providers throughout Zambia were surveyed in 2002. Providers reported widespread stigma associated with HIV. Physicians (OR = 1.9), providers with research affiliations (OR = 2.3), and those located in Lusaka (OR = 9.0) were more likely to offer HIV testing. Only 30% routinely prescribed antiretroviral treatment (ART) to reduce MTCT. Practitioners from district facilities, those from Lusaka, and those employed at research facilities were more likely to prescribe ART routinely (OR = 2.8, 10.1 and 3.4 respectively). Among those never prescribing ART, most cited a lack of availability (83%). Our results highlight the need for further provider education, critical appraisal of the current system for HIV testing, and widespread distribution of ART.

Adult↗

PubMed2003

Progress in toxinformatics: the challenge of predicting acute toxicity.

Historically, acute toxicity based on LC(50) and LD(50) tests has been analyzed using various quantitative structure-activity relationships (QSARs). The obtained QSAR equations cannot be related to the multiple health effects reflected in the experimental data of analyzed compounds. Therefore little predictive power for novel compounds can be achieved. New methods based on classification SAR (C-SAR) analysis offer new mechanistic knowledge that can be related to new health effects, resulting in better predictive power. To this end, a very careful interpretation of the obtained results is required, implying the use of the existing mechanistic information to the maximum possible extent. The current mini-review aims at determining ways of automated extraction of new mechanistic knowledge from existing data, as well as ways of relating this knowledge to various health effects. A comparison of "statistical induction" and "knowledge-based" approaches is provided. The existing and future developments in predictive acute toxicity are discussed.

Algorithms↗

PubMedDate not supplied

An integrated approach for the computer-assisted treatment of diabetic patients on insulin.

A prototype computer system has been developed to provide advice on the day-to-day adjustment of carbohydrate intake and insulin regimen in the insulin-dependent diabetic patient. The system also produces a 24-h simulation of the patient's blood glucose profile based on these adjustments. Advice is generated by a qualitative knowledge-based system which suggests what the next step in improving glycaemic control might be for a given patient, e.g. 'decrease morning short-acting insulin by 2 units'. The quantitative simulator module contains two different mathematical models. The first is a non-linear model in differential equation form which consists of a one-compartment glucose model linked to a model with free and bound insulin compartments. This physiological model is solved by a general-purpose simulation engine. The second is a linear systems model which uses a transfer function to describe the insulin input/blood glucose response relationship for individual diabetic patients. Results of a preliminary medical validation are presented.

Blood Glucose↗

PubMedDate not supplied

Statement--sensory integration evaluation and intervention in school-based occupational therapy.

Based on the educational team recommendations, school-based occupational therapy practitioners provide interventions to students who are eligible for special education services under IDEA and who need occupational therapy to benefit from their education program. The occupational therapist develops an intervention plan based on the student's needs and the therapist's professional knowledge base. When students demonstrate deficits in sensorimotor performance components that contribute to a significant and documented discrepancy in their skills within their educational program, the use of sensory integrative approach may be one frame of reference for intervention chosen by the occupational therapist.

Adolescent↗

PubMedDate not supplied

Applying sensory integration framework in educationally related occupational therapy practice (2003 statement).

Based on the educational team recommendations, occupational therapists and occupational therapy assistants working in educationally related settings provide services to students who are eligible for Section 504 or special education under IDEA and need occupational therapy to benefit from their education program. It is the occupational therapist's responsibility to develop an intervention plan based on the student's needs and the therapist's professional knowledge base. The occupational therapist chooses and applies any frame of reference within the domain and process of occupational therapy. Regardless of the frame of reference utilized, the desired outcome of occupational therapy services is always engagement in occupations that allows participation in a student's daily life. When students demonstrate deficits in sensory integration that contribute to a significant and documented discrepancy in their skills within their educational program, the use of a sensory integrative approach may be one frame of reference for, intervention chosen by the occupational therapist.

Child↗

PubMed1998

A virtual university Web system for a medical school.

This paper describes a Virtual Medical University Web Server. This project started in 1994 by the development of the French Radiology Server. The main objective of our Medical Virtual University is to offer not only an initial training (for students) but also the Continuing Professional Education (for practitioners). Our system is based on electronic textbooks, clinical cases (around 4000) and a medical knowledge base called A.D.M. ("Aide au Diagnostic Medical"). We have indexed all electronic textbooks and clinical cases according to the ADM base in order to facilitate the navigation on the system. This system base is supported by a relational database management system. The Virtual Medical University, available on the Web Internet, is presently in the process of external evaluations.

Computer-Assisted Instruction↗