Telemedicine for diabetes care: the DIABTel approach towards diabetes telecare

Telemedicine is modifying classical health care by providing effective solutions to an increasing number of new situations. This article summarizes the potential benefits made available by this technology in diabetes care, and describes in detail how the new DIABTel Telemedicine Service complements the daily care of diabetic patients. The basic functions of the telemedicine system include telemonitoring of patient's blood glucose data and self-management actions, and remote care from doctors to diabetic patients. The system's architecture comprises two main components: the Medical Workstation, a PC-based system to be used by physicians and nurses in Diabetes Day Centre units in hospitals, and the Patient Unit, a palmtop-computer to be used by patients in their day to day activities. Both components, in an integrated approach, offer tools to doctors and patients for data collection and management, viewing and interpretation modules, data/message exchange services and an interactive glucose/insulin simulator for educational purposes. The DIABTel telemedicine diabetes care procedure aims: (1) to improve communication of the patient with the hospital-based diabetologist, in between the patient's visits to the clinic; (2) to allow doctors to assess the patient's condition on a frequent basis (every week); (3) to help patients with management in the daily care of diabetes, and (4) to provide patients with a service of 'supervised autonomy', to increase patient's independence without decreasing the necessary continual support and supervision from the doctor. Finally, we discuss the practical problems, limitations and vital issues regarding implementation of the telemedicine service.     

An Integrated Theory of the Mind.

Adaptive control of thought-rational (ACT-R; J. R. Anderson & C. Lebiere, 1998) has evolved into a theory that consists of multiple modules but also explains how these modules are integrated to produce coherent cognition. The perceptual-motor modules, the goal module, and the declarative memory module are presented as examples of specialized systems in ACT-R. These modules are associated with distinct cortical regions. These modules place chunks in buffers where they can be detected by a production system that responds to patterns of information in the buffers. At any point in time, a single production rule is selected to respond to the current pattern. Subsymbolic processes serve to guide the selection of rules to fire as well as the internal operations of some modules. Much of learning involves tuning of these subsymbolic processes. A number of simple and complex empirical examples are described to illustrate how these modules function singly and in concert. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An intelligent control system for ventilators

This study reports on a ventilator system that consists of several intelligent modules for controlling ventilator operation. These modules are software programs in two controllers. One controller is a personal computer used for diagnoses, determining settings and checking the effects of settings. The other controller is a single-chip microprocessor in a ventilator that controls the ventilator's settings in accordance with the computer settings. After setting up the system, an artificial lung model simulating a patient's lung is used to test the system. The result of test run indicated that it always responds to a patient's lung condition in a stable manner. Thus, the proposed system with its intelligent modules may assist clinicians in caring for patients and managing ventilator operation.     

Lung function of Zimbabwean farm workers exposed to flue curing and stacking of tobacco leaves

Our aim was to evaluate the efficacy of a revised tuberculosis (TB) contact tracing procedure in South Glamorgan whereby routine annual radiological surveillance was abandoned and contacts were either discharged or referred to chest clinic following their initial screening. We reviewed and evaluated data from the TB contact tracing clinic, the Public Health Service Mycobacterium Reference Unit, Cardiff and the Consultant in Communicable Diseases Control, South Glamorgan Health Authority and compared these results with those of our previous study. One hundred and three index cases and 732 contacts were identified. Seven hundred and seven contacts, 526 close and 181 casual, were screened, of whom 102 casuals should not have been. One hundred and sixty-one contacts were given BCG vaccination. Fifty-four contacts were referred to the chest clinic. Seven cases of TB were detected, all in young, unvaccinated, close contacts of pulmonary disease. Twenty-one contacts were given chemoprophylaxis, 20 of whom were close contacts of pulmonary TB and one of extrapulmonary disease. Five contacts who were screened and initially discharged developed TB later: in two the protocol had not been followed and three presented with extrapulmonary TB. Compared with the results of the previous protocol fewer contacts were unnecessarily screened and referrals to the chest clinic increased, as did the number given chemoprophylaxis. The case finding rate is similar to that found prior to the revision of the protocol. The yield from tracing casual contacts continues to be nil. It is very low in contacts of extrapulmonary disease. When the protocol was followed no case of pulmonary TB was missed. The revised protocol seems to be as effective as the previous, more complex protocol. In our area, one of low incidence of TB, screening of casual contacts and of contacts of extrapulmonary TB is not cost-effective. We will concentrate even more on screening close contacts of pulmonary TB.     

Complications of intravenous therapy. Influence of parenteral nutrition, central venous pressure and antibiotics

With regard to the controversy on whether the use of central venous catheters for the perfusion of other solutions as well as parenteral nutrition means an increase in the risk of sepsis caused by the catheter, a prospective study was made on 313 central intravenous catheters placed in patients admitted to the Intensive Medicine Unit of La Paz General Hospital over a one-year period. Collection of data on both catheters and patients was done following a protocol applied in all cases. From the results obtained, it can be concluded that in critical patients in whom a single central venous catheter has been placed, this can be used for the infusion of other liquids, apart from parenteral nutrition, without involving an increased risk of sepsis caused by the catheter. This pathology seems to bear more relation to the amount of time the catheter remains in place.     

Cerebrovascular pathology: inpatient study in a community hospital. A prospective study

We present the preliminary results of six months cerebrovascular pathology follow-up carried out at the Sant Boi Local Hospital as from when a Neurological Unit was set up within the Internal Medecine Service. For this purpose we drew up a prospective study based on questionnaires. A total of 69 neurological patients (2.45% of all those hospitalized) were studied, 62.3% of whom suffered acute stroke. Diagnostic and therapeutic activities were analyzed with regards to the afore mentioned pathology, as well as various data of an epidermiological nature. Lastly we present the experimental multidisciplinary approach to acute stroke as performed during hospitalization by the Internal Medecine Service, Convalescence Unit and an Interdepartmental Socio-Sanitary Functional Unit.     

Neuropsychology evolving.

Reviews the book, From neuropsychology to mental structure by Tim Shallice (see record 1989-97122-000). The basic question that the book addresses is "what can be learned about normal function from impaired behaviour?" The author approaches this question in two ways. First, he assumes that cognitive processing is organized into basic processing elements, much like Fodor's modules. The goal is to determine how the modules function together to underlie cognitive processes. Second, Shallice asks how neuropsychological data provide inferences about the nature of the modules. Overall, I liked this book, even if I cannot easily identify with the top-down approach to studying brain function. Nonetheless, this is a volume that will force psychologists of all stripes to think about questions surrounding the study of cognition and brain function. Indeed, one can seriously ask the question of whether cognitive neuropsychology is a natural evolution of Hebb's neuropsychology as opposed to a new and divergent species that will fill a different niche. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A computer-based reporting system in radiology of the chest

The aim of this study was to compare our computer-aided report writing system to standard techniques. A computer-aided reporting system for reporting on chest X-rays was developed and linked with a UNIX-based radiology information system. The reporting system consists of different text modules which can be composed to a complete radiological report. The quality of the report, the system's efficiency, flexibility and availability at the radiology information system (RIS), as well as its acceptance by the users, were criteria we took as a basis of evaluation. Acceptance and flexibility of the system were tested by assessing necessary changes and additions performed to text modules and by subjective evaluation. The time spent on working with the reporting system was evaluated by performing a time-analysis study comparing the new system to the two conventional methods, the tape system and handwriting. On average, the readers needed 22.6 text modules for each report. For the users the most important advantages of the new system are that primarily fewer changes to or additions to the text are necessary, and when they cannot be avoided they can be performed more easily. In comparison with the tape system and handwritten reports, it took on average two and a half to three times longer to report on a chest X-ray. The printed report had left the department within 6.4 h using the tape system within 0.4 h when handwritten and within 1.4 h when recorded by the reporting system. The completeness of the set of modules and the logical order were positively assessed by the users. The demand of time for reporting increases, but the final report is available sooner.     

Mouth care in intubated patients with nothing-by-mouth diet in an in tensive care unit

The objective of this study is to value the effectiveness of a care plan of mouth care and at the same time, compare the effects of the use of two different solutions: physiologic serum and non-diluted hexetidine (Oraldine). The sample studied was formed by 40 intubated patients or patients with an absolute oral diet who were in the Intensive Care Unit of the University Clinic. 50% of the patients underwent oral hygiene with physiological serum, following the established protocol and the other 50% were treated with non-diluted hexetidine with a frequency of five times a day. The mouth status was checked at the moment of admission and then daily: lips, tongue, gums, palate, presence of residua and saliva characteristics. Also, a series of factors which could alter the buccal integrity were registered: oxygenotherapy, orotraqueal intubation, anemia, plaquetopenia, medicines, etc. Bacteriological controls of traqueal secretion were performed periodically. From the analysis of the results we can conclude that the care plan established is efficient, although it is not enough for patients with coagulation alterations (plaquetopenia). From the solutions used for oral hygiene we can say that although there have not been significant differences, the physiologic serum is the chosen product, as it maintains the mouth status better and helps to keep the oral microbiota.     

Toward a code for the interactions of zinc fingers with DNA: selection of randomized fingers displayed on phage

We have used two selection techniques to study sequence-specific DNA recognition by the zinc finger, a small, modular DNA-binding minidomain. We have chosen zinc fingers because they bind as independent modules and so can be linked together in a peptide designed to bind a predetermined DNA site. In this paper, we describe how a library of zinc fingers displayed on the surface of bacteriophage enables selection of fingers capable of binding to given DNA triplets. The amino acid sequences of selected fingers which bind the same triplet are compared to examine how sequence-specific DNA recognition occurs. Our results can be rationalized in terms of coded interactions between zinc fingers and DNA, involving base contacts from a few alpha-helical positions. In the paper following this one, we describe a complementary technique which confirms the identity of amino acids capable of DNA sequence discrimination from these positions.     

Interaction of structural modules in substrate binding by the ribozyme from Bacillus subtilis RNase P

The ribozyme from bacterial ribonuclease P recognizes two structural modules in a tRNA substrate: the T stem-loop and the acceptor stem. These two modules are connected through a helical linker. The T stem-loop binds at a surface confined in a folding domain away from the active site. Substrates for the Bacillus subtilis RNase P RNA were previously selected in vitro that are shown to bind comparably well or better than a tRNA substrate. Chemical modification of P RNA-substrate complexes with dimethylsulfate and kethoxal was performed to determine how the P RNA recognizes three in vitro selected substrates. All three substrates bind at the surface known to interact with the T stem-loop of tRNA. Similar to a tRNA, the secondary structure of these substrates contains a helix around the cleavage site and a hairpin loop at the corresponding position of the T stem-loop. Unlike a tRNA, these two structural modules are connected through a non-helical linker. The two structural modules in the tRNA and in the selected substrates bind to two different domains in P RNA. The properties of substrate recognition exhibited by this ribozyme may be exploited to isolate new ribozyme-substrate pairs with interactive structural modules.     

Simple Expert System for Evaluation of Nutrient Pollution Potential in Groundwater from Manure Application

An expert system for the evaluation of groundwater pollution potential due to leaching of nutrients from land application of manure is developed in this study. The expert system consists of five modules: surface loading, sorption, vadose zone transport, saturated zone transport, and final module. The expert system evaluates the pollution potential in two steps. In the first step, rating values are evaluated for the selected modules. A set of expert system rules is assigned by the writers to evaluate the rating value of each selected module. In the second step, the pollution potential is evaluated from calculating the weighted average rating of the selected modules. Finally, the expert system is validated against a site assessment done by a group of experts for a concentrated animal feeding operation (CAFO) facility in Oklahoma. The advantages of the expert system are its user-friendliness, requirement of easily available input data, and faster evaluation time. The expert system is recommended to the farmers for improving their management practices and for selecting sites suitable for building new CAFOs. It is also recommended to the regulatory agencies as a screening level tool to identify the most vulnerable sites.     

Incidence of intermediate syndrome in organophosphorous poisoning

Seventy two patients admitted to the Intensive Care Unit following ingestion of organophosphorus compounds were studied prospectively with two different doses of pralidoxime (PAM). One group received 1 gm immediately after admission and no further PAM and the other group received infusion of PAM, 1 gm 8 hourly for four days (total 12 gms). The incidence of type II paralysis or intermediate syndrome was 47%. We observed a higher incidence in the 4 days of infusion of PAM group (61%) (20 patients) as compared to the single Bolus dose group (39%) (13 patients). Relative risk 1.48 (confidence interval = 0.9-2.4).     

Time delay to thrombolytic therapy--a Sri Lankan perspective

Reducing the time delay in initiating thrombolytic therapy in acute myocardial infarction is critical in maximising the functional and survival benefit. We analysed 120 consecutive admissions for thrombolytic therapy to the Coronary Care Unit. The total delay was divided into prehospital, in-hospital and Coronary Care Unit stages, and the median delays were found to be 130, 70, and 15 minutes, respectively. The delay was significantly longer in patients who sought prehospital medical advice, and when the diagnosis was not made at the emergency treatment unit. Educating at-risk groups and modifying the admission system may help to minimise these delays, while the establishment of an emergency ambulance service with well-trained crew would also improve the prognosis after acute myocardial infarction in Sri Lanka.     

A new protocol for training severely impaired patients in the usage of memory journals

Although memory disorders are frequently seen in survivors of brain injuries, remediation of patients with severe memory disorders is still relatively neglected in clinical practice due to pessimism by clinicians regarding the efficacy of such remediation. With respect to memory journal training, a further reason for this neglect is likely the lack of readily accessible protocols that therapists can use to work with these patients. The purpose of the present paper is to describe a new memory journal training protocol that was developed to teach brain injury survivors how to compensate for severe memory impairments by using three strengths of most brain injury survivors: immediate attention, procedural memory, and old learning. A training protocol is described that involves baseline testing and a needs assessment, five levels of training exercises, and discharge probe testing. It is concluded that patients with severely impaired memory abilities can learn the present system when care is taken to individualize journals, conduct proper needs assessments, and provide structured training exercises geared to the strengths of memory impaired persons.     

Percutaneous intentional extraluminal (subintimal) recanalization: how to do it yourself

INTRODUCTION AND OBJECTIVES: The high demand for health care has obliged Coronary Units to hasten the discharge of patients in less serious condition and this might be an influence on their prognosis. Our objective have been: a) to analyse the characteristics and the evolution (death or readmission) during the first month of patients with myocardial infarction and very early discharge from the Coronary Unit (stay of 2 days or less), and b) to assess the profile of very low risk group patients for complications who could be discharged early from the Coronary Unit. PATIENTS AND METHODS: A study of 978 consecutive patients who had been admitted for acute myocardial, in faration were divided into two groups according to their length of stay in the Coronary Unit (A < or = 2 and B > 2 days). Their baseline characteristics, course of stay and vital status at month, were compared. A subgroup of patients at low risk was studied and complications that might have arisen from their early discharge from the Coronary Unit were assessed. RESULTS: Seventy-three patients (7.5%) died within the first two days. Of the remaining 905, the stay was 2 days or less for 336 patients (group A); and longer than 2 days for 569 (group B). Group A had a higher frequency of dyslipemia, Killip class I on admission, uncomplicated myocardial infarction in the Coronary Unit and the use of beta-blockers and had less frequency of diabetes, Q wave myocardial infarction, anterior infarction or the use of fibrinolytics. In the first month after discharge from the Coronary Unit, 10 patients from group A and 18 patients from group B died, the rate of death or readmission into the Coronary Unit within 30 days was similar between both groups (group A = 13% and group B = 13%). A multiple regression showed that Killip class on admission (p < 0.001) and an uncomplicated course (p < 0.001) were independently related with the length of stay in the coronary unit. A subset of 378 low risk patients (Killip I on admission, uncomplicated course in the ICU and age < 71 years) had no mortality at 30 days and their readmission rate in the first month was 4%. In this subgroup, those patients whose stay was equal to or less than two days were more frequently readmitted in the first week. (group A = 9/197 [5%] and group B = 1/181 ([0.5%]; p = 0.034). CONCLUSION: Selected patients with myocardial infarction can be discharged very early from the Coronary Unit with a low risk of death. A readmission rate following discharge of some 5% must be allowed for these patients.     

备件实物全寿命跟踪管理系统开发

济钢以各生产单位的二级库管理为对象,开发备件实物全寿命跟踪管理系统,系统包括操作管理、数据查询、统计分析三大功能模块,将备件的计划提出、检修使用、报废处理的整个设备管理活动串成一体,实现了备件全方位实时监控。通过应用,2012年上半年消化库存及修复备件2100t,削减计划276项,创经济效益5200万元。     

D2-dopamine-receptor occupancy during treatment with haloperidol decanoate

The experience of development of a protocol for the nutritional management of postoperative surgical patients is described. The protocol was developed with the involvement of all the professionals working in the ward (nurses, anesthetists, dieticians and surgeons). It contained indications on how and when re-start feeding for non complicated surgical patients. Specific indications for diabetic, hypertensive and nephropatic patients were devised. The protocol was readily adopted and successfully implemented, indicating that the strategy of sharing and discussing problems involving all the professionals leads to a better chance of success.     

Object-Oriented Modeling of Structural Analysis and Design with Application to Damping Device Configuration

This paper presents an object-oriented (OO) software framework for computer-aided structural analysis and design research, where different structural analysis methods and design procedures need to be implemented and investigated. The framework is designed with four basic modules: structure, load, analysis, and design. Each module includes a set of cooperating interfaces and classes. Through the predefined interfaces, the framework provides architecture for many structural design applications. A variety of similar entities, such as different design applications, design procedures, and analysis methods, can be built on this architecture by implementing the necessary interfaces. The clearly defined interactions between the modules accommodate the future extensions within the modules. The final OO design of the framework can be communicated by many well-known design patterns, and it is described by unified modeling language. The framework is then customized to the application for optimizing the configuration of energy dissipation devices in a given structure. By implementing a few interfaces, this paper illustrates how this OO framework accommodates changes, and how reusability and extensibility can be achieved.     

Non-operative treatment of comminuted fractures of the proximal humerus in elderly patients

The aim of this paper is to review the incidence and characteristics found in traumatic spinal cord injury (SCI) occurring in patients with long-standing ankylosing spondylitis (AS). The incidence of patients with traumatic SCI admitted to our unit from January 1984 to February 1996 was 2% (15 out of 893). They were all men with a mean age of 56 years. Most frequently the etiology of the lesion was a motor vehicle accident and the injury was mainly due to a hyperextension mechanism. Acute spinal fracture occurred in 13 patients, all involving the cervical region. No fracture was observed in two patients with thoracic neurological level. Three patients presented with an interval free period of neurological symptoms in whom a spinal epidural hematoma was visualized with magnetic resonance imaging. On admission eight patients were diagnosed as having complete SCI and the other seven an incomplete SCI. In the acute phase, respiratory complications were most frequent, causing six patients to die. Treatment was conservative in 14 patients. Multidisciplinary management of these patients should be implemented in an institution equipped with both a Spinal Injury Unit and an Intensive Care Unit.