Evaluation of SNOMED3.5 in representing concepts in chest radiology reports: integration of a SNOMED mapper with a radiology reporting workstation

Standardized medical terminologies are gaining importance in the representation of medical data. In this paper, we present the evaluation of the SNOMED3.5 medical terminology to code concepts routinely used in chest radiology reports. Integration of this terminology mapper into a radiology reporting workstation that incorporates a speech recognition system and a natural language processor is also discussed. A total of 700 anatomical location terms (including synonyms) were tested and 72% of the terms had corresponding SNOMED terms. Of the 28% that did not result in a match, 16% were either morphological variants of SNOMED terms or could be found from a combination of terms from two or more SNOMED axes. Only 12% of the terms (primarily specialized radiology terms) were concepts not actually included in the SNOMED terminology.

Analogical encoding facilitates knowledge transfer in negotiation

Information learned in one situation often fails to transfer to a similarly structured situation. However, prior findings suggest that comparing two or more instances that embody the same principle can promote abstraction of a schema that can be transferred to new situations. In two lines of research, we examined the effects of analogical encoding on knowledge transfer in negotiation situations. In Experiment 1, undergraduates were more likely to propose optimal negotiation strategies and less likely to propose compromises (a suboptimal strategy) when they received analogy training. In Experiment 2, graduate management students who drew an analogy from two cases were nearly three times more likely to incorporate the strategy from the training cases into their negotiations than were students given the same cases separately. For both novices and experienced participants, the comparison process can be an efficient means of abstracting principles for later application.

Wiskott Aldrich syndrome presenting as congenital thrombocytopenia

The application of molecular biology to haematology has provided the opportunity to revisit previous diagnoses, many of which can now be redefined. This report is on a local family previously diagnosed and published as having X-linked thrombocytopenia in 1974, and shows how the application of molecular screening has confirmed the true diagnosis of Wiskott Aldrich syndrome.

Pallister-Hall syndrome: clinical and MR features

A 4-month-old boy with polydactyly and bifid epiglottis was found to have a large sellar and suprasellar mass. When the diagnosis of Pallister-Hall syndrome was made, conservative management was elected. When the patient was 2 years old, the tumor had grown proportionally with the patient, and he was developing appropriately. Although rare, this entity is important to recognize not only for clinical diagnosis but also for appropriate management and genetic counseling.

Persistent activity of doramectin and ivermectin against Ascaris suum in experimentally infected pigs

A study was conducted to investigate the persistent nematocidal activity of two avermectins against experimentally-induced infections of Ascaris suum in swine. Seventy-two nematode-free cross-bred pigs of similar bodyweight were randomly allotted to nine treatment groups of eight pigs each. Eight of the groups were treated with injectable solutions containing 300 microg of doramectin/kg (IM) or 300 microg of ivermectin/kg (SC) either 0 (same day), 7, 14, or 21 days prior to an oral challenge of 50000 embryonated A. suum eggs. The ninth group (control) was challenged in parallel without any avermectin treatment. At 41 or 42 days after challenge, pigs were euthanatized and adult and larval stages of A. suum were collected from the gastrointestinal tract of each pig and counted. Both avermectins significantly (P < 0.0002) reduced nematode counts when given on the day of challenge (0 days prior), and the efficacy was 100% and 97.5% for doramectin and ivermectin, respectively. Doramectin given 7 days prior to challenge significantly (P < 0.0001) reduced nematode counts, and the efficacy was 98.4%. For all other avermectin-treatment groups, nematode counts were not significantly reduced compared to those in control pigs. These data indicated that anthelmintic activity of ivermectin against A. suum persisted for less than 7 days and the activity of doramectin persisted for more than 7, but less than 14 days.

Influences of bilateral endoscopic transthoracic sympathicotomy on cardiac autonomic nervous activity

OBJECTIVES

Endoscopic transthoracic sympathicotomy (ETS) is a minimal invasive procedure of thoracic sympathetic blockage. The purpose of this study was to evaluate cardiac autonomic nervous activity after ETS in order to confirm the reliability and safety of ETS.

METHODS

A series of electrophysiological studies were performed before and 1 week after bilateral 2nd and 3rd thoracic sympathicotomy in 13 patients with primary palmar hyperhydrosis. Palmar perspiration was measured under sympathetic stress, and body surface mapping was recorded in a supine position. In the head-up tilt test of 0, 30, 60 and 90 degrees, corrected QT interval (QTc) and T wave amplitude (Twa) were assessed. The power spectral analysis of heart rate variability was processed to attain power values of the low-frequency (0.04-0.15 Hz), the high-frequency (0.15-0.40 Hz) and the low/high frequency ratio.

RESULTS

In all patients, the perspiration response on the palm to sympathetic stimulation was completely inhibited after ETS. Isointegral mapping revealed that ETS altered electroactivity on the heart. In the head-up tilt study, R-R intervals significantly increased after the surgery in the head-up tilt positions (P < 0.05), although there was no significant difference in the supine position. There is no significant difference in QTc and Twa before and after the surgery, both in the supine and the head-up tilt positions. There was no significant difference in the LF or HF before and after surgery, either in the supine position or the head-up tilt positions. In the LF/HF, there was no significant difference before and after surgery in the supine position. However, the LF/HF in the head-up tilt positions was significantly decreased after surgery (P < 0.05). Sympathetic suppression of ETS was recognized more obviously under the steeper head-up tilt positions.

CONCLUSIONS

The influences on the cardiac autonomic nerve system of the ETS of upper thoracic sympathetic nerve were seen to be of a lesser degree at rest. However, the response to sympathetic stimulation was suppressed after the surgery.

Endothelin receptor blockade prevents the rise in pulmonary vascular resistance after cardiopulmonary bypass in lambs with increased pulmonary blood flow

BACKGROUND

Children with increased pulmonary blood flow may experience morbidity as the result of increased pulmonary vascular resistance after operations in which cardiopulmonary bypass is used. Plasma levels of endothelin-1, a potent vasoactive substance implicated in pulmonary hypertension, are increased after cardiopulmonary bypass.

OBJECTIVES

In a lamb model of increased pulmonary blood flow after in utero placement of an aortopulmonary shunt, we characterized the changes in pulmonary vascular resistance induced by hypothermic cardiopulmonary bypass and investigated the role of endothelin-1 and endothelin-A receptor activation in postbypass pulmonary hypertension.

METHODS

In eleven 1-month-old lambs, the shunt was closed, and vascular pressures and blood flows were monitored. An infusion of a selective endothelin-A receptor blocker (PD 156707; 1.0 mg/kg/h) or drug vehicle (saline solution) was then begun 30 minutes before cardiopulmonary bypass and continued for 4 hours after bypass. The hemodynamic variables were monitored, and plasma endothelin-1 concentrations were determined before, during, and for 6 hours after cardiopulmonary bypass.

RESULTS

After 90 minutes of hypothermic cardiopulmonary bypass, both pulmonary arterial pressure and pulmonary vascular resistance increased significantly in saline-treated lambs during the 6-hour study period (P <.05). In lambs pretreated with PD 156707, pulmonary arterial pressure and pulmonary vascular resistance decreased (P <. 05). After bypass, plasma endothelin-1 concentrations increased in all lambs; there was a positive correlation between postbypass pulmonary vascular resistance and plasma endothelin-1 concentrations (P <.05).

CONCLUSIONS

This study suggests that endothelin-A receptor-induced pulmonary vasoconstriction mediates, in part, the rise in pulmonary vascular resistance after cardiopulmonary bypass. Endothelin-A receptor antagonists may decrease morbidity in children at risk for postbypass pulmonary hypertension. This potential therapy warrants further investigation.

The promotion of agricultural education for adults: the Lancashire federation of women's institutes, 1919-45

A recent article in Rural History illustrated how the Women's Institutes between the wars Were influenced by contemporary feminism. The argument of the article was that in seeking to change the material condition and status of countrywomen, and in effect, emulating craft trades union strategies, the WI movement sought to alter perceptions of women's labour in the home by enhancing their skills, encouraging co-operative endeavour and promoting an ‘active domesticity’. Furthermore, the domestic arena was extended to cover all aspects of rural life related to the home, garden, farm or allotment.

However, as time passed between the wars, less interest was shown in agricultural work outside the home, and, as Morgan states elsewhere, the agricultural ‘side’ of the movement became ‘severely diminished’. Whilst one might not seriously quarrel with this statement with reference to some periods of WI history, it is, nevertheless, a somewhat reductive approach to have taken when considering the interwar period. During that time, there is evidence to suggest that in some regions at least, WI members maintained more than a passing interest in agriculture per se. This was not simply in relation to the production and preservation of food, but rather as a means of maintaining the influence of women in rural policy making. This interest can be best detected in the educational sphere, from the promotion of classes in a wide range of agricultural activities and demonstrations at agricultural and horticultural shows, to WI membership of local agricultural education committees. Furthermore, the National Federation of Women's Institutes (NFWI) fought in many ways to maintain the agricultural ‘side’ of the movement because it was an integral part of its wider mission to educate countrywomen, particularly those who were destined to live and work in the Empire

Androgen synthesis in a songbird: a study of cyp17 (17alpha-hydroxylase/C17,20-lyase) activity in the zebra finch

Androgens and estrogens influence the maturation and function of numerous tissues in both male and female birds, especially the brains of the oscine songbirds. Although there exist a very large number of studies that have investigated circulating sex steroids in many species of wild and captive-held songbirds, there remain a significant number of questions about the sites of synthesis of the active steroids that act on the songbird brain. Estrogens are derived from androgen. Thus, the synthesis of androgen itself is critical for both androgen- and estrogen-dependent actions in both male and female songbirds. Therefore, we have undertaken studies of the enzyme 17alpha-hydroxylase/C17,20-lyase (Cyp17), the enzyme responsible for the synthesis of androgens from their progestin or pregnane precursors via their 17alpha-hydroxy intermediates. Here we have characterized optimal conditions for measuring Cyp17 in gonads of adult zebra finches via the conversion of tritiated [3H]progesterone into 17alpha-hydroxy P (17alpha-hydroxylase activity) and androstenedione and testosterone (C17,20-lyase) activity. Cyp17 activity is abundant in testis, with lesser amounts in ovary. Low levels of Cyp17 activity were also detected in male adrenals, but not in any other tissue, including brain. Testicular Cyp17 activity is readily inhibited in vitro by ketoconazole, a specific Cyp17 inhibitor. Ketoconazole works less well in vivo. In males castrated and/or treated with fadrozole, an inhibitor of aromatase, we detected no extragonadal sites of Cyp17 activity, although fadrozole appeared to increase circulating androgens in both castrated and intact males. Thus, we still do not know the site of androgen synthesis in these males. Further studies of Cyp17 will be useful in understanding more about the mechanisms of androgen delivery to neural circuits in adult and developing songbirds.

Pioneering the 12-hour shift in Australia--implementation and limitations

Twelve-hour shift rostering offers an alternative to the traditional 8- and 10-hour shifts usually worked in Australian nursing practice. This paper outlines the implementation process involved in introducing 12-hour shifts in a Melbourne hospital intensive care unit. The process was instigated by the nursing staff. After extensive consultation with the union and hospital management, a roster pattern of two 12-hour days, followed by 12-hour night shifts then days off, was introduced. Independent researchers were engaged to evaluate the impact of the 12-hour shifts on staff well-being and work performance. Effects on staff retention, sick leave and inservice education were examined. The researchers found that well-being and work performance were minimally affected by the 12-hour shift roster, while staff retention and sick leave were unaffected. Further, the pattern of 12-hour shifts, which was democratically implemented, was preferred by the nursing staff and did not diminish their well-being and work performance.

Neurofeedback combined with training in metacognitive strategies: effectiveness in students with ADD

A review of records was carried out to examine the results obtained when people with Attention Deficit Disorder (ADD) received 40 sessions of training that combined neurofeedback with the teaching of metacognitive strategies. While not a controlled scientific study, the results, including pre- and post-measures, are consistent with previously published research concerning the use of neurofeedback with children. A significant addition is that a description of procedures is included. The 111 subjects, 98 children (age 5 to 17) and 13 adults (ages 18 to 63), attended forty 50-min sessions, usually twice a week. Feedback was contingent on decreasing slow wave activity (usually 4-7 Hz, occasionally 9-11 Hz) and increasing fast wave activity (15-18 Hz for most subjects but initially 13-15 Hz for subjects with impulsivity and hyperactivity). Metacognitive strategies related to academic tasks were taught when the feedback indicated the client was focused. Some clients also received temperature and/or EDR biofeedback during some sessions. Initially, 30 percent of the children were taking stimulant medications (Ritalin), whereas 6 percent were on stimulant medications after 40 sessions. All charts were included where pre- and post-testing results were available for one or more of the following: the Test of Variables of Attention (TOVA, n = 76), Wechsler Intelligence Scales (WISC-R, WISC-III, or WAIS-R, n = 68), Wide Range Achievement Test (WRAT 3, n = 99), and the electroencephalogram assessment (QEEG) providing a ratio of theta (4-8 Hz) to beta (16-20 Hz) activity (n = 66). Significant improvements (p < .001) were found in ADD symptoms (inattention, impulsivity, and variability of response times on the TOVA), in both the ACID pattern and the full-scale scores of the Wechsler Intelligence Scales, and in academic performance on the WRAT 3. The average gain for the full scale IQ equivalent scores was 12 points. A decrease in the EEG ratio of theta/beta was also observed. These data are important because they provide an extension of results from earlier studies (Lubar, Swartwood, Swartwood, & O'Donnell, 1995; Linden, Habib, & Radojevic, 1996). They also demonstrate that systematic data collection in a private educational setting produces helpful information that can be used to monitor students' progress and improve programs. Because this clinical work is not a controlled scientific study, the efficacious treatment components cannot be determined. Nevertheless, the positive outcomes of decreased ADD symptoms plus improved academic and intellectual functioning suggest that the use of neurofeedback plus training in metacognitive strategies is a useful combined intervention for students with ADD. Further controlled research is warranted.

Absence of expression of the Wiskott-Aldrich syndrome protein in peripheral blood cells of Wiskott-Aldrich syndrome patients

Wiskott-Aldrich syndrome (WAS) is an X-linked primary immunodeficiency that is usually associated with thrombocytopenia and eczema. The very variable phenotype of WAS results from defects in the WAS protein (WASP), the function of which is not well understood. In many cases causative mutations have now been identified in the WAS gene. Attempts have been made to correlate the nature of the mutations with the severity of the disease. In this study we investigated mutations in 13 patients with WAS and analyzed the expression of WASP in patient blood samples by immunoblot analysis. We found that despite extensive variation in the nature of the mutations in patients with severe WAS symptoms, none express the protein. However, in 1 patient with a mild clinical phenotype WASP expression was detected. Such an analysis could be used as an initial screening procedure for the diagnosis of WAS prior to genotypic analysis.

The Social Construction of Injustice: Fairness Judgments in Response to Own and Others' Unfair Treatment by Authorities

The research literature in organizational justice has examined in some detail the dynamics and consequences of justice judgments based on direct experiences with fair and unfair authorities, but little is known about how people form justice judgments on the basis of reports of injustice by others or how group discussion changes justice judgments. The present study examined the consequences of distributed injustice, in which all members of a group experience some denial of voice, and concentrated injustice, in which one member experiences repeated denial of voice and others do not. It was predicted and found that mild personal experiences of injustice are a more potent source of group impressions of injustice than are reports of more severe injustice experienced by others. In both conditions, group ratings of unfairness were more extreme than were the mean of individual ratings either before or after discussion. Copyright 1998 Academic Press.

Medications used by children with asthma living in the inner city

OBJECTIVE

The purpose of the study was to examine medication use reported by families participating in an urban school-based community intervention program and to relate this use to other social and medical variables.

DESIGN

The design of the study was a cross-sectional questionnaire survey.

SETTING

Patients and their families recruited from elementary schools in a community setting were interviewed between December 1991 and January 1992.

PARTICIPANTS

A total of 508 children with asthma were identified by school health records and teacher surveys. Their families confirmed the diagnosis and agreed to enter the study. Questionnaires were completed by 392 families.

INTERVENTION

The 392 families participated in a controlled trial of asthma education after providing the data that are the basis of this report.

RESULTS

More than half of the children took two or more medications for asthma. Thirty-one percent took theophylline alone or in combination with an adrenergic agent; 11% took some form of daily antiinflammatory medication, either cromolyn (8%) or inhaled steroids (3%). The pattern of medication use related to measures of severity and to regular visits to physicians or nurses. In general, however, children were undermedicated. A total of 78 children (20%) reported no medication or over-the-counter medication use, although 37% reported asthma severe enough to be associated with >/=20 days of school missed per month, and 37% had had an emergency room visit for asthma in the past 6 months. More than half of children >/=9 years old supervised their own medication.

CONCLUSIONS

We concluded that undermedication is common in poor children with asthma living in urban areas. Antiinflammatory medications are used less commonly than in the general population, and theophylline is used more often. School children may be likely to supervise their own medication.

Chronic calcitonin administration and renal calcium transport in the rat

1. While calcitonin (CT) has now been clearly demonstrated to be a renal Ca2+-conserving hormone and may share similar transport mechanisms with parathyroid hormone (PTH), the effect of prolonged CT exposure on renal Ca2+ transport has not been evaluated. 2. Consequently, a submaximal and maximal Ca2+-conserving concentration of human CT was infused into groups of anaesthetized acutely thyroparathyroidectomized rats that had been treated with twice daily subcutaneous human (h) CT at a low or high dose or vehicle for 12 days. 3. The maximal hCT infusion (10 microg bolus and per hour) produced a marked inhibitory effect on renal Ca2+ excretion in vehicle-treated rats, with the fractional excretion rate of Ca2+ being reduced from 4.49+/-0.31 to 139+/-0.23% (P<0.001). However, in rats pretreated with high concentrations of hormone (0.25 microg hCT) twice daily for 12 days, marked Ca2+ conservation was measured (fractional excretion 1.09+/-0.18%), which was not altered by the additional intravenous administration of maximal hCT. 4. Renal Mg2+ transport was similarly altered by hCT administration, without any evidence that prolonged CT inhibited renal Mg2+ transport. The increase in glomerular filtration rate caused by hCT also appeared to persist with repeated hormone administration. The fractional excretion of Na+ and PO4 was significantly increased by high- but not low-dose hCT treatment and was not altered by the addition of a maximal hormone dose at day 12. 5. The present study failed to demonstrate any down-regulation of the response to prolonged hCT administration when renal Ca2+ and Mg2+ transport was measured. If renal escape does occur with CT, as has been suggested but not proven with PTH, other mechanisms, such as hormone production or release, may be responsible.

A Phase I trial of ifosfamide and paclitaxel with granulocyte-colony stimulating factor in the treatment of patients with refractory solid tumors

BACKGROUND

Ifosfamide and paclitaxel are antineoplastic agents with broad activity and with different mechanisms of action. A Phase I trial was conducted to determine the maximum tolerated dose and associated toxicities of these agents when used in combination.

METHODS

Patients with refractory, incurable solid tumors were entered on a 5-step Phase I trial of ifosfamide, given in doses of 2-3 g/m2 intravenous (i.v.) bolus for 3 days with mesna support, and paclitaxel, given in doses of 135-190 g/m2 i.v. by continuous infusion over 24 hours. Paclitaxel was given after the first dose of ifosfamide on Day 1.

RESULTS

Twenty-three patients were treated, and the maximum tolerated dose was the highest planned dose level of the trial: ifosfamide, 3 g/m2/day i.v. for 3 days, and paclitaxel, 190 mg/m2 i.v. over 24 hours. Hematologic toxicity was not dose-limiting, and although neutropenia occurred, it was brief (median, 2-4 days) and resulted in hospitalization for neutropenia and fever in only 7 of 111 courses of therapy. For patients treated at the highest dose level, only 1 of 50 courses of therapy resulted in hospitalization for neutropenia and fever. Nonhematologic toxicity also was not severe and no significant neuropathy occurred. Although patients entered into the study were heavily pretreated, responses were observed, particularly in patients with breast or ovarian carcinoma.

CONCLUSIONS

Ifosfamide and paclitaxel can be administered safely in the doses used in this study and there are indications of significant antitumor effect. Further studies are necessary to explore the antineoplastic activity of this regimen, particularly for patients with breast and ovarian carcinoma.

Negotiation Teamwork: The Impact of Information Distribution and Accountability on Performance Depends on the Relationship among Team Members

We examined how the distribution of information among team members and accountability pressures affected the quality of negotiated settlements reached among teams of friends negotiating against teams of strangers. The main conclusions of the experiment may be summarized by the following findings: (1) Teams of strangers reaped a greater share of the joint profit than did teams of friends when teammates were accountable to a supervisor as opposed to negotiating strictly on their own behalf. (2) Teams of strangers also reaped a marginally greater share of the joint profit than did teams of friends when teammates possessed unique, as opposed to common, information about their own team's preferences. (3) Not surprisingly, teams of friends were more cohesive than were teams of strangers; however, teams of friends were also more concerned about maintaining their relationship than were teams of strangers. (4) Teams of friends felt least cohesive when they were accountable to a supervisor, whereas teams of strangers felt most cohesive when they were accountable. Similarly, friends indicated greater relationship concerns when having to deal with distributed information, whereas information distribution had no effect on the relationship concerns of strangers. (5) For teams of strangers, greater team cohesiveness was positively correlated with better performance. (6) Moreover, when teams of strangers felt more cohesive than their opponents, they earned more than teams of strangers who felt less cohesive. Copyright 1997 Academic Press.

Factors determining the rate of referral, transplantation, and survival on dialysis in women with ESRD

The determinants of referral for transplantation in women have not been well-studied. Similarly, factors determining survival on dialysis and the rate of transplantation in women remain controversial. Women have been reported to have lower rates of transplantation than men, and black women have the lowest rates of all groups. We questioned whether black women were referred at lower rates than whites and if race and other socioeconomic factors predicted referral, rate of renal transplantation, and patient survival on dialysis. All women in Allegheny or Philadelphia counties in Pennsylvania initiating dialysis between January 1, 1990, and December 31, 1992, were eligible for this study. Information was requested by questionnaire from each dialysis unit in these areas. Of the 383 eligible patients, completed questionnaires were obtained for 276 (72%). Ninety-three (54.7%) of the black patients and 57 (53.8%) of the white patients were referred for transplantation (P = 0.8). Declining the transplant option was the most common reason for nonreferral in both races. Patients with high school or greater education were approximately twice as likely to be referred than those with grade school educations (odds ratio [OR], 2.2; P = 0.04). Patients with coexisting illness were 67% (OR, 0.33; P = 0.004) less likely to be referred compared with patients with no other illnesses. Each additional year of age reduced the chances of being referred by 6% (OR, 0.94; P = 0.0001). Homemakers were 83% (P = 0.0008) and others 55% (P = 0.07) less likely to be referred compared with employed patients. Patients in Philadelphia County were 56% less likely to be referred compared with those in Allegheny County (P = 0.024). Race was not significantly associated with referral. Predictors of transplantation included age (RR, 0.96; confidence interval [CI], 0.93 to 0.99; P = 0.13), white race (RR, 2.2; CI, 1.3 to 4.0; P = 0.0053), presence of other illnesses (RR, 0.37; CI, 0.21 to 0.65; P = 0.0006), and employment status. White homemakers were 86% (RR, 0.14; CI, 0.03 to 0.6; P = 0.0082) less likely than those with other employment situations to receive a transplant. Factors predicting patient survival on dialysis included race, educational status, and presence of comorbid illnesses. White patients were approximately four times (RR, 3.7; CI, 1.7 to 8.1; P = 0.002) more likely to die than black patients. Patients with high school or greater education were 56% (RR, 0.44; CI, 0.2 to 0.92; P = 0.008) less likely to die than those with grade school education alone. Patients with at least one coexisting illness were approximately 1.7 times (RR, 1.68; CI, 1.1 to 2.4; P = 0.001) more likely to die than those without other illnesses. In summary, race was not a factor in referral for transplantation, but was predictive of transplantation and patient survival on dialysis. Socioeconomic factors such as educational status, age, and employment status were highly predictive of transplantation and long-term survival on hemodialysis. White homemakers unexpectedly received transplants less than any other group of dialysis patients. Further study is needed to determine why these potential transplant patients have declined or deferred transplantation.