Concordance between ANSI occupational back injury codes and claim form diagnoses and a lower bound estimate of the fraction associated with disc displacement/herniation

The current BLS Annual Survey of Occupational Illnesses and Injuries and several recent analyses of factors affecting missed worktime in occupational back injuries rely on ANSI-based injury codes derived from injury narratives to classify occupational injuries and estimate incidence and outcome. No population-based studies of the concordance between back injury codes and clinical diagnoses have been reported. Back injury cases were identified in two large work-injured populations totaling almost 80,000 cases in the states of Michigan and Minnesota. In both populations, cases had been coded by the single nature-of-injury and part-of-body-injured codes assigned by an ANSI-based injury-coding system and by as many as four (Michigan) or three (Minnesota) clinical diagnoses according to the International Classification of Diseases-Clinical Modification, 9th Revision. Concordance was measured by the sensitivity and predictive value positive (PVP, aka PV+ or PPA) of the injury coding scheme for related diagnostic groups. We also used an algorithm based on the limited clinical information available to corroborate the diagnosis of displaced/herniated disc for cases that underwent spinal surgery. Cases identified by the algorithm were then used to obtain a lower bound estimate of the fraction with disc injury. The injury coding scheme had PVPs of 82.9-90.1% and overall sensitivities of 69.7-75.9%. Sensitivities for individual diagnostic groups show that their distribution in ANSI-coded injury groups is skewed slightly toward cases with sprain and disc displacement/herniation, but these shifts are modest. The lower bound estimate of the fraction of cases with disc displacement/herniation in a population of cases with back injuries producing at least 1 day of missed worktime is 5.8%. The demographic comparisons indicate that, as the time between injury and cohort ascertainment increases during the first 8 days of missed worktime following injury, the proportion of younger workers in an injury cohort decreases. The relationship between increasing age and increasing missed worktime disability, reported in various outcome studies, is also present during the first few days following injury. The use of ANSI injury codes underestimates the contribution of back injuries to missed worktime because 24-30% of cases are missed by the ANSI coding system. However, the distribution of diagnostic groups in the injury-coded groups approximates that observed with all diagnosed cases and supports the use of such data to study outcome. Our estimate, and one from Quebec, suggest that disc displacement/herniation occurs more frequently in the subset of occupational back injuries compared to the set of back injuries from all sources.     

Role of the Basal Ganglia in Category Learning: How Do Patients With Parkinson's Disease Learn?

The purpose of the present study was to gain a deeper understanding of the role of the basal ganglia in learning and memory by examining learning strategies among patients with basal ganglia dysfunction. Using a probabilistic category learning task (the "weather prediction" task) previously shown to be sensitive to basal ganglia function, the authors examined patterns of performance during learning and used mathematical models to capture different learning strategies. Results showed that patients with Parkinson's disease exhibit different patterns of strategy use. Specifically, most controls initially used a simple, but suboptimal, strategy that focused on single-cue-outcome associations; eventually, however, most controls adopted a more complex, optimal learning strategy, integrating single-cue associations to predict outcomes for multiple-cue stimuli. In contrast, the majority of individuals with Parkinson's disease continued to rely on simple single-cue learning strategies throughout the experiment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Passive care and active rehabilitation in a patient with failed back surgery syndrome

Blood-borne cytokines enter the brain by transport across the blood-brain barrier (BBB) or by leakage through extracellular pathways at sites, such as circumventricular organs (CVOs), without a BBB. We used radioactively labeled albumin (T-Alb) to differentiate the relative contribution of transport and extracellular pathways to the passage of interleukin-1 alpha ([125I]IL-1 alpha) across the BBB. The major mechanism of entry for [125I]IL-1 alpha after intravenous (i.v.) injection was a saturable transport system with extracellular pathways accounting for only a small fraction of entry into brain. CVOs concentrated blood-borne [125I]IL-1 alpha in a saturable manner to a much greater extent than did the cerebral cortex and cerebellum, but accounted for less that 5% of total brain uptake. After intracerebroventricular (i.c.v.) injection, [125I]IL-1 alpha and T-Alb were concentrated in the CVOs, especially the median eminence, although CVOs contained less that 1% of the substances injected. Distribution after i.c.v. injection was largely due to diffusion and leakage through extracellular pathways. We conclude that after i.c.v. injection, leakage across extracellular pathways accounts for the small but concentrated amount of [125I]IL-1 alpha found in CVOs. After i.v. injection, transport across the BBB accounts for the majority of [125I]IL-1 alpha in brain.     

Large-scale mapping of boreal forest in SIBERIA using ERS tandem coherence and JERS backscatter data

Siberia's boreal forests represent an economically and ecologically precious resource, a significant part of which is not monitored on a regular basis. Synthetic aperture radars (SARs), with their sensitivity to forest biomass, offer mapping capabilities that could provide valuable up-to-date information, for example about fire damage or logging activity. The European Commission SIBERIA project had the aim of mapping an area of approximately 1 million km² in Siberia using SAR data from two satellite sources: the tandem mission of the European Remote Sensing Satellites ERS-1/2 and the Japanese Earth Resource Satellite JERS-1. Mosaics of ERS tandem interferometric coherence and JERS backscattering coefficient show the wealth of information contained in these data but they also show large differences in radar response between neighbouring images. To create one homogeneous forest map, adaptive methods which are able to account for brightness changes due to environmental effects were required. In this paper an adaptive empirical model to determine growing stock volume classes using the ERS tandem coherence and the JERS backscatter data is described. For growing stock volume classes up to 80 m³/ha, accuracies of over 80% are achieved for over a hundred ERS frames at a spatial resolution of 50 m.     

A connectionist model of septohippocampal dynamics during conditioning: Closing the loop.

Septohippocampal interactions determine how stimuli are encoded during conditioning. This study extends a previous neurocomputational model of corticohippocampal processing to incorporate hippocamposeptal feedback and examines how the presence or absence of such feedback affects learning in the model. The effects of septal modulation in conditioning were simulated by dynamically adjusting the hippocampal learning rate on the basis of how well the hippocampal system encoded stimuli. The model successfully accounts for changes in behavior and septohippocampal activity observed in studies of the acquisition, retention, and generalization of conditioned responses and accounts for the effects of septal disruption on conditioning. The model provides a computational, neurally based synthesis of prior learning theories that predicts changes in medial septal activity based on the novelty of stimulus events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A connectionist approach to processing dimensional interaction

The difference between integral and separable interaction of dimensions is a classic problem in cognitive psychology (Garner 1970, American Psychologist, 25: 350-358, Shepard 1964, Journal of Mathematical Psychology, 1: 54-87) and remains an essential component of most current experimental and theoretical analyses of category learning (e.g. Ashby and Maddox 1994, Journal of Mathematical Psychology, 38: 423-466, Goldstone 1994, Journal of Experimental Psychology: General , 123: 178-200, Kruschke 1993, Connection Science, 5: 3-36, Melara et al. 1993, Journal of Experimental Psychology: Human Perception & Performance, 19: 1082-1104, Nosofsky 1992, Multidimensional Models of Perception and Cognition, Hillsdale NJ: Lawrence Erlbaum). So far the problem has been addressed through post hoc analysis in which empirical evidence of integral and separable processing is used to fit human data, showing how the impact of a pair of dimensions interacting in an integral or a separable manner enters into later learning processes. In this paper, we argue that a mechanistic connectionist explanation for variations in dimensional interactions can provide a new perspective through exploration of how similarities between stimuli are transformed from physical to psychological space when learning to identify, discriminate and categorize them. We substantiate this claim by demonstrating how even a standard backpropagation network combined with a simple image-processing Gabor filter component provides limited but clear potential to process monochromatic stimuli that are composed of integral pairs of dimensions differently from monochromatic stimuli that are composed of separable pairs of dimensions. Interestingly, the responses from Gabor filters are shown already to capture most ofthe dimensional interaction, which in turn can be operated upon by the neural network during a given learning task. In addition, we introduce a basic attention mechanism to back-propagation that gives it the ability to attend selectively to relevant dimensions and illustrate how this serves the model in solving a filtration versus condensation task (Kruschke 1993, Connection Science, 5: 3-36). The model may serve as a starting point in characterizing the general properties of the human perceptual system that causes some pairs of physical dimensions to be treated as integrally interacting and other pairs as separable. An improved understanding of these properties will aid studies in perceptual and category learning, selective attention effects and influences of higher cognitive processes on initial perceptual representations.     

Comparative analysis of breast cancer contamination in mobilized and nonmobilized hematopoietic grafts

We report a case of an 18-month-old female who presented with three supernumerary upper limbs of varying lengths on the right side. Each limb had a proximal, middle, and distal segment, and an intercalated elbow and wrist joint. A single digit was present in the superior limb, three digits in the middle limb, and two digits in the caudal-most limb. Right plagiocephaly, congenital torticollis, scoliosis involving the upper and mid thoracic region, and a hypoplastic right pectoralis major were the other abnormal features noted. Radiography showed two scapulae, humerus, a single forearm bone in each limb, and rudimentary metacarpals and phalanges. Limb duplication may rarely be encountered in parasitic conjoined twins. The role of mutagens, drugs, cellular contributions, and morphogens in the growth and differentiation of limbs has been studied in animals. It is rather difficult to deduce the time of action of the factors responsible for such a malformation.     

Factors predicting upper genital tract inflammation among women with lower genital tract infection

We sought to identify factors that discriminate between women with a lower genital tract infection and women with a lower genital tract infection and endometritis. This study enrolled women at risk for or having a lower genital tract infection with Chlamydia trachomatis or Neisseria gonorrhoeae and measured behavioral and clinical factors. Women were identified through contact tracing of male partners, presentation with cervicitis, or presentation with symptoms of pelvic inflammatory disease and classified as (1) having a lower genital tract infection without endometritis, (2) having a lower genital tract infection with endometritis, (3) having no lower genital tract infection with endometritis, and (4) having neither a lower genital tract infection nor endometritis. The primary comparison was between women having a lower genital tract infection without endometritis to women having a lower genital tract infection and endometritis. Women with a lower genital tract infection and endometritis were older and reported a history of more sexually transmitted diseases (70.0% vs. 56.7%), abdominal pain (82.2% vs. 60.0%), and use of barrier methods of contraception (28.9% vs. 8.6%) than women with a lower genital tract infection alone. The regression model found that women with a lower genital tract infection and endometritis were 7.1 times (95% CI = 2.2-23.0) more likely to report abdominal pain and 4.6 times (95% CI = 1.5-14.9) more likely to use barrier methods of contraception than women with a lower genital tract infection alone. These results suggest that behavioral factors, in addition to symptoms, can be used to identify women with and without upper genital tract involvement.