bluuebunny/crossref_metadata_2025 huggingface dataset:
Reproducibility of the cold-induced vasodilation response in the human finger
Authors: O'Brien Catherine
Published: December 2004

Cold-induced vasodilation (CIVD) is a cyclic oscillation in blood flow that occurs in the extremities on cold exposure and that is likely associated with reduced risk of cold injury (e.g., frostbite) as well as improved manual dexterity and less pain while working in the cold. The CIVD response varies between individuals, but the within-subject reproducibility has not been adequately described. The purpose of this study was to quantify the within-subject variability in the CIVD response under standardized conditions. Twenty-one volunteers resting in a controlled environment (27°C) immersed the middle finger in warm water (42°C) for 15 min to standardize initial finger temperature and then in cold water (4°C; CWI) for 30 min, on five separate occasions. Skin temperature (Tf) and blood flow (laser-Doppler; expressed as percent change from warm-water peak) responses that describe CIVD were identified, including initial nadir reached during CWI, onset time of CIVD, initial apex during CIVD, time of that apex, and overall mean during CWI. Within-subject coefficient of variation for Tfacross the five tests for the nail bed and pad, respectively, were as follows: nadir, 9 and 21%; onset, 18 and 19%; apex, 12 and 17%; apex time, 23 and 24%; mean 10 and 15%. For blood flow, these values were as follows: nadir 52 and 64%; onset, 6 and 5%; apex, 33 and 31%; apex time 9 and 8%; and mean 43 and 34%. Greater variability was found in the temperature response of the finger pad than the nail bed, but for blood flow the variability was similar between locations. Variability in onset and apex time between sites was similar for both temperature and blood flow responses. The reproducibility of the time course of CIVD suggests this methodology may be of value for further studies examining the mechanism of the response.
Effect of antioxidant vitamin treatment on the time course of hematological and hemorheological alterations after an exhausting exercise episode in human subjects
Authors: Senturk Umit K. , Yalcin Ozlem , Gunduz Filiz , Kuru Oktay , Meiselman Herbert J. , Baskurt Oguz K.
Published: December 2004

This study examined the effects of a 2-mo antioxidant vitamin treatment on acute hematological and hemorheological alterations induced by exhausting exercise; both sedentary and trained individuals were employed. Eighteen young male, human subjects (9 sedentary, 9 trained by regular exercise) participated in the study and performed an initial maximal aerobic cycle ergometer exercise with frequent blood sampling over a 24-h period and analysis of hematological and hemorheological parameters. All subjects were treated with an antioxidant vitamin A, C, and E regimen, supplemented orally for 2 mo, and then subjected to a second exercise test and blood sampling at the end of this period. In the sedentary group during the first testing period (before vitamin treatment), white blood cell counts and granulocyte percentages were increased at 2 h after the exercise test and remained elevated for 4–12 h. Red blood cell (RBC) deformability and aggregation were also altered by exercise in the sedentary group before vitamin treatment. However, none of these parameters in the sedentary group were altered by exercise after the 2-mo period of antioxidant vitamin treatment. With the exception of a transient rise in granulocyte percentage, these parameters were also not affected in the trained subjects before the vitamin treatment. Significant increases of RBC lipid peroxidation observed 12 h after the exercise test in both sedentary and trained subjects were also totally prevented by vitamin treatment. Our results indicate that antioxidant vitamin treatment is effective in preventing the inflammation-like response and coincident adverse hemorheological changes after an episode of exhausting exercise, and suggest that such changes may be related to exercise-induced death events.
Increased relaxation of immature airways to β2-adrenoceptor agonists is related to attenuated expression of postjunctional smooth muscle muscarinic M2 receptors
Authors: Fayon Michael , Dumas De La Roque Eric , Berger Patrick , Begueret Hugues , Ousova Olga , Molimard Mathieu , Marthan Roger
Published: December 2004

Spontaneous or agonist-induced contraction of airway smooth muscle can be observed very early in fetal life, thus explaining the possible occurrence of bronchospasm in very low birth weight infants within the first days of life. In an attempt to better manage such bronchospasms, the aim of the present study was to investigate the age-specific modifications in airway smooth muscle relaxation to β2-agonists and muscarinic antagonists using a combination of functional and molecular techniques. In the rat, isometric relaxation to the β2-agonist salbutamol was examined in tracheae; we also examined muscarinic receptor expression (M2R and M3R mRNA levels) in airway smooth muscle by immunochemistry, Western blotting, and real-time PCR. Compared with adults, salbutamol-induced relaxation was twofold greater in immature rat isolated tracheae preconstricted by carbachol. This effect was associated with a lower expression of M2R in the smooth muscle of immature animals (sixfold and almost twofold as assessed by immunochemistry and Western blotting, respectively). Real-time PCR data indicate that changes in M2R expression according to age occurred at a posttranscriptional level. In adult airways, there was a significantly greater functional efficacy of M2R blockade by methoctramine compared with that shown in immature rats. Because of the limited availability of human neonate lung tissue, only the molecular part of the study was performed, and we observed a qualitatively similar effect, i.e., a lower M2R expression in the neonatal airway smooth muscle, although this was quantitatively smaller. We conclude that β2-agonist-induced relaxation is enhanced in immature compared with adult airways as a result of greater postjunctional M2R expression in adult airway smooth muscle. This finding may be of importance in the clinical management of bronchoconstriction in neonates.
In vivo α-adrenergic responses and troponin I phosphorylation: anesthesia interactions
Authors: MacGowan Guy A. , Rager Jennifer , Shroff Sanjeev G. , Mathier Michael A.
Published: December 2004

The mechanisms by which α-adrenergic stimulation of the heart in vivo can cause contractile dysfunction are not well understood. We hypothesized that α-adrenergic-mediated contractile dysfunction is mediated through protein kinase C phosphorylation of troponin I, which in in vitro experiments has been shown to reduce actomyosin Mg-ATPase activity. We studied pressure-volume loops in transgenic mice expressing mutant troponin I lacking protein kinase C phosphorylation sites and hypothesized altered responses to phenylephrine. As anesthesia agents can produce markedly different effects on contractility, we studied two agents: avertin and α-chloralose-urethane. With α-chloralose-urethane, at baseline, there were no contractile abnormalities in the troponin I mutants. Phenylephrine produced a 50% reduction in end-systolic elastance in wild-type controls, although a 9% increase in troponin I mutants ( P < 0.05). Avertin was associated with reduced contractility compared with α-chloralose-urethane. Avertin anesthesia, at baseline, produced a reduction in end-systolic elastance by 31% in the troponin I mutants compared with wild-type ( P < 0.05), and this resulted in further marked systolic and diastolic dysfunction with phenylephrine in the troponin I mutants. Dobutamine produced no significant difference in the contractile phenotype of the transgenic mice with either anesthetic regimen. In conclusion, these data (α-chloralose-urethane) demonstrate that α-adrenergic-mediated force reduction is mediated through troponin I protein kinase C phosphorylation. β-Adrenergic responses are not mediated through this pathway. Altering the myofilament force-calcium relationship may result in in vivo increased sensitivity to negative inotropy. Thus choice of a negative inotropic anesthetic agent (avertin) with phenylephrine can lead to profound contractile dysfunction.
Role of nitric oxide in tolerance to lipopolysaccharide in mice
Authors: Dias Mirela B. , Almeida Maria C. , Carnio Evelin C. , Branco Luiz G. S.
Published: December 2004

The injection of repeated doses of lipopolysaccharide (LPS) results in attenuation of the febrile response, which is called endotoxin tolerance. We tested the hypothesis that nitric oxide (NO) arising from inducible NO synthase (iNOS) plays a role in endotoxin tolerance, using not only pharmacological trials but also genetically engineered mice. Body core temperature was measured by biotelemetry in mice treated with NG-monomethyl-l-arginine (l -NMMA, 40 mg/kg; a nonselective NO synthase inhibitor) or aminoguanidine (AG, 10 mg/kg; a selective iNOS inhibitor) and in mice deficient in the iNOS gene (iNOS KO) mice. Tolerance to LPS was induced by means of three consecutive LPS (100 μg/kg) intraperitoneal injections at 24-h intervals. In wild-type mice, we observed a significant reduction of the febrile response to repeated administration of LPS. Injection of l-NMMA and AG markedly enhanced the febrile response to LPS in tolerant animals. Conversely, iNOS-KO mice repeatedly injected with LPS did not become tolerant to the pyrogenic effect of LPS. These data are consistent with the notion that NO modulates LPS tolerance in mice and that iNOS isoform is involved in NO synthesis during LPS tolerance.
A simple telemedicine system to provide second-opinion advice to the patients of an Albanian diagnostic centre
Authors: Anogianakis George , Ilonidis George , Anogeianaki Antonia , Miliaras Spyros , Lianguris John , Katsaros Kyriakos , Pseftogianni Dimitra , Mustafa Ibro
Published: December 2004

Since August 2003, the IKEDA Klinika diagnostic centre in Tirana, Albania, has offered patients telemedical help from Greece. The teleconsultation service is based on Internet technologies adapted to telemedical use, including the use of forms (e.g. for the patient history), multimedia file exchanges (e.g. for radiographs and electroencephalograms) and videoconferencing. The teleconsultants assist in treatment planning and, when necessary, in organizing the transfer of patients to Greece. The four cornerstones of the service are: the provision of second opinions by telemedicine; assistance in treatment planning; assistance to patients during transfer; and the continuity of medical care on their repatriation. Based on the first six months of operation, we estimate that, if bureaucratic visa restrictions to patient movement between Albania and Greece are removed, more than 2000 patients per year will benefit from the service and more than 400 patients will be transferred to Greek hospitals for treatment.
Telehealth in New Zealand: Current practice and future prospects
Authors: Kerr Karolyn , Norris Tony
Published: December 2004

We have surveyed the current state of telehealth in New Zealand. The survey found 22 telehealth projects active in 2003, compared with 12 identified in a previous survey in 2000. Many projects were small, localized and led by enthusiasts. Sustainability was a problem and many projects had failed to enter routine operation. Teleradiology and telepsychiatry services focused on acute hospitals were the most frequent clinical applications. The majority of projects (9 of the 22) were on the North Island, concentrated around Auckland. Telehealth appears to have special potential for rural communities and for the remote treatment (telecare) of chronic disease. However, the provision of telehealth in New Zealand is patchy and meets the same barriers to success as have been identified elsewhere, which make it difficult to move telehealth into routine operation. The obstacles constitute not so much a failure of individual projects as a lack of a driving force to take advantage of the opportunities. It is to be hoped that a suggested strategic framework can help to harness the opportunities.
Development and evaluation of a point-of-care interactive patient education kiosk
Authors: Goldschmidt Leonard , Goodrich Gregory L
Published: December 2004

We have developed an interactive patient education kiosk. The kiosk provides access to stored health information and to selected Websites via a high-speed Internet connection. The output is bilingual (English or Spanish) and an enclosed printer allows information to be printed and taken home for later reading. Each kiosk records patient usage, as well as the results of a brief, voluntary, online evaluation questionnaire. Three kiosks were placed in the patient waiting area of busy multi-specialty clinics. Two kiosks were active for 2.5 years and one was active for 1.5 years. There were 38,868 user sessions recorded and 2878 users participated in the online survey questionnaire (7% of all user sessions). Patient satisfaction was high; for example, 68% of respondents found some or all of the information they were looking for on the kiosk. In the year following the introduction of the first kiosk (the 2001/02 flu season), there was a 24% increase in the number of patients receiving flu vaccinations within the Palo Alto health-care system, compared with the previous year. Experience to date suggests that the kiosks may increase patient compliance with selected clinical guidelines and instructions.
Automatic message handling for a national counselling service
Authors: Caffery Liam , Crew-Wegner Karly , Reid Wendy , Wootton Richard
Published: December 2004

An automatic email handling system (AutoRouter) was introduced at a national counselling service in Australia. In 2003, counsellors responded to a total of 7421 email messages. Over nine days in early May 2004 the administrator responsible for the management of the manual email counselling service recorded the time spent on managing email messages. The AutoRouter was then introduced. Since the implementation of the AutoRouter the administrator's management role has become redundant; an average of 12h 5 min per week of staff time has been saved. There have been further savings in supervisor time. Counsellors were taking an average of 6.2 days to respond to email messages (n=4307), with an average delay of 1.2 days from the time counsellors wrote the email to when the email was sent. Thus the response was sent on average 7.4 days after receipt of the original client email message. A significant decrease in response time has been noted since implementation of the AutoRouter, with client responses now taking an average of 5.4 days, a decrease of 2.0 days. Automatic message handling appears to be a promising method of managing the administration of a steadily increasing email counselling service.
Prospective case review of a global e-health system for doctors in developing countries
Authors: Wootton R , Youngberry K , Swinfen P , Swinfen R
Published: December 2004

The Swinfen Charitable Trust has managed email consultations for doctors in developing countries since 1999. The process was handled manually for the first three years and then subsequently using an automatic message-handling system. We conducted a prospective review of email consultations between referring doctors and consulting specialists during six months of automatic operation (December 2003 to May 2004). During the study period 125 consultations took place. These concerned a wide range of specialties (e.g. orthopaedics 17%, dermatology 16%, obstetrics and gynaecology 11%, radiology 10%). Of these referrals, 33% (41) were for paediatric cases. Consulting specialists, who were based in five countries, were volunteers. Referring doctors were from 24 hospitals in 12 developing countries. The median time from referral to definitive reply was 1.5 days (interquartile range 0.6–4.9). There was an 85% response rate (n=106) to a survey concerning the value of the consultation to the referring doctor. All the referring doctors who responded made positive comments about the service and half said that it improved their management of the case. The second-opinion consultation system operated by the Swinfen Charitable Trust represents an example of a global e-health system operated for altruistic, rather than commercial, reasons.
Evaluation of a pilot second-opinion child telepsychiatry service
Authors: Hockey A D , Yellowlees P M , Murphy S
Published: December 2004

A second-opinion child psychiatry service was piloted for six months in the northern-most two-thirds of Queensland. It provided specialist expertise by telehealth to local multidisciplinary teams of mental health staff. During the study period, 28 videoconferences were performed by the service: nine for administrative purposes, two for educational purposes, and 17 for direct and indirect clinical applications. The mean time between a referral being made and a consultation being performed was 4.7 days (range 1–13). A survey administered to referring and non-referring mental health workers showed that the major barriers to service implementation included the limited allied health applications that were offered, a perceived lack of communication during the implementation phase of the service, and the creation of a new referral network that did not conform to traditional referral patterns in the north of Queensland.
Published evidence on the success of telecardiology: A mixed record
Authors: Hailey David , Ohinmaa Arto , Roine Risto
Published: December 2004

We carried out a systematic review of the literature on telecardiology assessment from 1992 to September 2003. We selected articles reporting clinical, economic or administrative outcomes. Quality of evidence was assessed using an approach that considered both study design and study performance. Forty-four studies met the selection criteria. Studies of home care applications, particularly management of congestive heart failure, were of highest quality, giving a high degree of confidence in their findings. Studies on paediatric and non-emergency adult hospital applications were of poorer quality; they were mostly reports of case series and gave relatively little detail. Economic analysis was limited to cost studies and in most cases was judged to be of poor to fair quality. While telecardiology has been widely applied, there is still limited good-quality evidence of its benefits to health-care. Success in establishing the feasibility of telecardiology applications is offset by a failure to obtain convincing data on their influence on health outcomes and on their cost-effectiveness.
The use of telemedicine in the management of vascular surgical referrals
Authors: Hands L J , Jones R W , Clarke M , Mahaffey W , Bangs I
Published: December 2004

We have performed a feasibility study of telemedicine as an alternative to conventional outpatient appointments for the making of diagnostic and management decisions for patients referred for vascular surgery. Twenty-two sequential patients referred by a single general practice to a vascular centre were offered a telemedicine clinic appointment as an alternative to a conventional hospital outpatient appointment. A referral pro forma and digital photograph (where appropriate) were transmitted in advance of the videoconference. The videoconference involved patient, practice nurse and vascular consultant. All patients opted for the teleconsultation. The majority had leg ulceration or leg pain. Six patients required only the initial teleconsultation and were managed thereafter in the community. Thirteen were referred to the vascular laboratory for investigation. Three proceeded to angioplasty and four to surgery. Two patients had a conventional outpatient appointment for follow-up but all others were followed up via telemedicine. Overall 27 conventional outpatient appointments were replaced by a teleconsultation.
Trial of low-cost teledermatology in primary care
Authors: Hockey A D , Wootton R , Casey T
Published: December 2004

We examined the feasibility of a low-cost, store-and-forward teledermatology service for general practitioners (GPs) in regional Queensland. Digital pictures and a brief case history were transmitted by email. A service coordinator carried out quality control checks and then forwarded these email messages to a consultant dermatologist. On receiving a clinical response from the dermatologist, the service coordinator returned the message to the referring GP. The aim was to provide advice to rural GPs within one working day. Over six months, 63 referrals were processed by the teledermatology service, covering a wide range of dermatological conditions. In the majority of cases the referring doctors were able to treat the condition after receipt of email advice from the dermatologist; however, in 10 cases (16%) additional images or biopsy results were requested because image quality was inadequate. The average time between a referral being received and clinical advice being provided to the referring GPs was 46 hours. The number of referrals in the present study, 1.05 per month per site, was similar to that reported in other primary care studies. While the use of low-cost digital cameras and public email is feasible, there may be other issues, for example remuneration, which will militate against the widespread introduction of primary care teledermatology in Australia.
Implementation of a Web-based teleradiology management system
Authors: Caffery Liam , Manthey Ken
Published: December 2004

Five Queensland hospitals have been equipped with picture archiving and communication systems (PACS). Patient transfers from one facility to another involve transferring images from PACS to PACS. We have developed a Web-based teleradiology management system (TMS) that automates the transfer of images and radiologists’ reports, as well as the quality control and housekeeping associated with teleradiology. The TMS was installed at all five hospitals. During a two-month study period, 752 studies were transmitted. All studies and associated radiologists’ reports arrived correctly at the destination hospital, together with the notification email for the system administrators. PACS support personnel agreed that the TMS significantly reduced the amount of time they spent on image transfers. Staff at the busiest site estimated that the time they spent on image transfer had decreased from 10h per week to 1h per week.
Telepathology on the Solomon Islands—two years’ experience with a hybrid Web- and email-based telepathology system
Authors: Brauchli K , Jagilly R , Oberli H , Kunze K D , Phillips G , Hurwitz N , Oberholzer M
Published: December 2004

The National Referral Hospital in Honiara, Solomon Islands, has used an Internet-based system in Switzerland for telepathology consultations since September 2001. Due to the limited bandwidth of Internet connections on the Solomon Islands, an email interface was developed that allows users in Honiara to submit cases and receive reports by email. At the other end, consultants can use a more sophisticated Web-based interface that allows discussion of cases among an expert panel. The result is a hybrid email- and Web-based telepathology system. Over two years, 333 consultations were performed, in which 94% of cases could be diagnosed by a remote pathologist. A computer-assisted ‘virtual institute’ of pathologists was established. This form of organization helped to reduce the median time from submission of the request to a report from 28 h to 8.5 h for a preliminary diagnosis and 13h for a final report. A final report was possible in 77% of all submitted cases.
Paediatric telecardiology services in Queensland: A review of three years’ experience
Authors: Justo Robert , Smith Anthony C , Williams Michael , Van Der Westhuyzen Jasper , Murray John , Sciuto Gay , Wootton Richard
Published: December 2004

Videoconferencing at 384 kbit/s for the transmission of echocardiograms has proved useful for the assessment of children with suspected cardiac disease, in regional areas of Queensland. A retrospective review of patient and management outcomes was conducted on cardiac teleconsultations performed at two regional hospitals during the period November 2000 to February 2004, inclusive. There were 106 echo studies. A subset of 72 cardiac teleconsultations performed between May 2001 and February 2004 was reviewed in detail. The median age of patients at the time of consultation was 3 months (range 1 day–1 7 years). Sixteen per cent of teleconsultations were classified as urgent and were conducted on the same day as referral. Following the videoconference, 90% of patients could be managed locally and reviewed by the paediatrician or visiting paediatric cardiologist during an outreach clinic. Six children (8%) had significant cardiac lesions that were initially managed locally, with subsequent elective transfer at the appropriate time for treatment. Only one child (1%) required urgent transfer to the tertiary centre for specialist care and surgery. Telecardiology was effective in accurately identifying congenital heart disease. Paediatric telecardiology is an evolving modality of assessment and communication, and is likely to result in continued improvements in patient care, patient outcomes and parental satisfaction, in provincial centres removed from the tertiary cardiac centre.
A system for telephone and secure email consultations, with automatic billing
Authors: Rutland Jonathan , Marie Catherine , Rutland Benjamin
Published: December 2004

Doctors have traditionally provided medical advice during face-to-face consultations. A new remote consultation service has been developed based on an interactive voice response system and Internet-based technologies. If the doctor is unavailable, a return call can be requested at a mutually convenient time. The patient's credit card is billed automatically. All that is required of the doctor and patient is access to any telephone. A dial-in dictation and transcription facility allows documentation. The service was launched in late 2003. After six months, there were approximately 55 doctors registered in five Australian states and approximately 500 patients registered. Two hundred and fifty consultations were selected randomly for analysis. Of these, 84% were conducted by telephone and 16% by email. The mean fees charged were AUS$17.11 for telephone and AUS$12.93 for email consultations. The mean duration of telephone consultations was 4.3 min. Call duration ranged from a few seconds to 20.5 min.
The ups and downs of the International Society for Telemedicine
Authors: Nerlich M , Mohr M T J , Gürdal D
Published: December 2004

The International Society for Telemedicine (ISfT) was originally established in 1997 as an organization of individuals. It suffered from years of difficulty in finding any consensus and, despite the efforts of about a dozen individual members, the Society did not flourish. In 2002 it was decided that the ISfT in its then form was no longer effective and unable to achieve its original goals, and it therefore needed to be reformed. The refounding of the Society was carried out in 2003. One of the essential changes was the transformation of the ISfT from an organization of individuals into an umbrella association for national telemedicine and e-health organizations. The Society's Website now includes a regularly updated newsletter and a great deal of information about common efforts to prepare the ground for e-health and telemedicine. The new ISfT has more than 500 members from 18 countries and is receiving membership applications from all over the world. The ISfT appears to be moving in the right direction, to serve as an international association for national telemedicine and e-health organizations, with a politically neutral and democratic attitude.
A training network for introducing telemedicine, telecare and hospital informatics in the Adriatic–Danube–Black Sea region
Authors: Anogeianaki Antonia , Ilonidis George , Anogianakis George , Lianguris John , Katsaros Kyriakos , Pseftogianni Dimitra , Klisarova Anelia , Negrev Negrin
Published: December 2004

DIMNET is a training mechanism for a region of central Europe. The aim is to upgrade the information technology skills of local hospital personnel and preserve their employability following the introduction of medical informatics. DIMNET uses Internet-based virtual classrooms to provide a 200-hour training course in medical informatics. Training takes place in the cities of Drama, Kavala, Xanthi and Varna. So far, more than 600 people have benefited from the programme. Initial results are encouraging. DIMNET promotes a new vocational training culture in the Balkans and is supported by local governments that perceive health-care as a fulcrum for economic development.
Implementation of a radiology information system/picture archiving and communication system and an image transfer system at a large public teaching hospital — assessment of success of adoption by clinicians
Authors: Crowe Bernard , Sim Lawrence
Published: December 2004

In 2001 a radiology information system/picture archiving and communication system (RIS/PACS) was installed at the Princess Alexandra Hospital (PAH) in Brisbane, with electronic image transfer links to other major hospitals in Queensland. An assessment study is being performed of the effect of the ready availability of radiology results on clinicians, clinical decision making and the time taken to treat patients. A series of structured interviews with senior clinicians at the PAH began in July 2002. Administrative data are being collected from the PAH computer system. Preliminary results from the first six months of the study suggest that the introduction of the RIS/PACS at the PAH has been well received by senior clinicians and has been helpful in clinical decision making. Patient management has been improved and the time taken to arrive at clinical decisions has been reduced, particularly in neurosurgery. The RIS/PACS has significantly improved access to imaging resources for teaching, owing to the ability to retrieve reference images and to project high-quality images during teaching sessions. However, the introduction of the RIS/PACS has not reduced patient length of stay.
Successes and challenges in a field-based, multi-method study of home telehealth
Authors: Hebert M A , Jansen J J , Brant R , Hailey D , Van Der Pol M
Published: December 2004

We are conducting a three-year study of telehealth in 11 home care offices that serve rural clients in Alberta. Three hundred and twenty palliative home care clients are being recruited to participate in a randomized controlled trial (RCT) to answer three questions about the use of video-phones and their effect on symptom management, quality of life and cost, as well as readiness to use the technology. Both successes and challenges have been identified in three main areas: technology, people/organizational issues and study design. Maintaining study integrity has been the key factor in decision making, as adjustments from the original proposal are made. It is already clear that field-based RCTs are feasible, but require commitment and flexibility on the part of researchers and community partners to work through the study implementation.
The Varna–Thessaloniki telemedical collaboration in setting up a regional transborder transplantation network
Authors: Anogianakis George , Ilonidis George , Anogeianaki Antonia , Lianguris John , Katsaros Kyriakos , Pseftogianni Dimitra , Klisarova Anelia , Temelkov Temel , Tatsis Constantine
Published: December 2004

In most Balkan countries, with the exception of Greece, transplantation is very rare and equality of access does not exist. In 2003, a Balkan partnership was established called SETNET (South-Eastern European Transplantation Network) for the promotion of transplantation. The objectives are to bring about the diffusion of transplantation techniques and practices in the Balkans, to increase public support for and participation in transplantation, and to eliminate the disparities in access to good health-care. SETNET is already beginning to generate data for an analysis of transplantation-related needs in the Balkans and to accelerate cross-border data exchange in transplantation-related emergencies. In the next few years, a regional training programme will be introduced for all health-care staff involved in transplantation. A regional organ procurement and transplantation network will be set up to utilize the existing telemedicine infrastructure. If successful, it will also prove that telemedicine infrastructures, however modest, can be the backbone for other, far-reaching human networks.
The successes and challenges of developing a prison telepsychiatry service
Authors: Leonard Sarah
Published: December 2004

Prisoners are not typical of the general population with regard to their health needs, as they have a disproportionately high incidence of mental health problems and drug misuse. Health-care delivery in prison faces a significant number of challenges not experienced by other health-care organizations. Telepsychiatry is one strategy to improve the accessibility and quality of mental health-care in the prison setting. Despite some initial challenges, a telepsychiatry service was successfully established between a medium-secure unit in Fareham, Hampshire, and a category B training prison on the Isle of Wight. A low-cost, PC-based videoconferencing system was used, connected by ISDN lines at 128 kbit/s. A valuable lesson that was learnt was the importance of having the support of key individuals in a prison setting.
Rehabilitation after total knee replacement via low-bandwidth telemedicine: The patient and therapist experience
Authors: Russell Trevor G , Buttrum Peter , Wootton Richard , Jull Gwendolen A
Published: December 2004

After a total knee replacement, inadequate rehabilitation is associated with poor physical outcomes and a reduced longevity of the knee prosthesis. We have developed a low-bandwidth telemedicine system to enable rehabilitation services to be delivered directly to the home of patients in rural and remote areas. We have examined the experience of clinical physiotherapists and of 31 participants who received treatment via the system. High levels of satisfaction were reported by participants (mean responses >7 on a 10 cm visual analogue scale). The service was found to be effective, safe and easy to use, and it integrated well into current clinical practice. The study demonstrates the potential for delivering physiotherapy services via low-bandwidth Internet connections.
Development of a telerehabilitation system for training physiotherapists in rural areas
Authors: Iwatsuki Hiroyasu , Fujita Chikako , Maeno Ryutaro , Matsuya Ayako
Published: December 2004

The purpose of this study was to assess the effectiveness of transmitting moving pictures via the Internet for processing by a three-dimensional motion analyser. The movements of two patients were filmed by a videocamera and transmitted from a hospital to a university department of physiotherapy. After advanced analysis using a three-dimensional motion analyser, physiotherapists prepared a treatment plan. The transmitted moving pictures were clear enough for analysis. The physiotherapists in the hospital were satisfied with the results of the motion analysis and found the guidance from an expert physiotherapist valuable. In the future, a large number of video-sequences could be transmitted during the night, stored at the university and then analysed later by an expert physiotherapist.
A pilot study of physiotherapy education using videoconferencing
Authors: Maeno Ryutaro , Fujita Chikako , Iwatsuki Hiroyasu
Published: December 2004

We investigated the possibility of instructing people in how to assist patients with activities of daily living via videoconferencing. A videoconference system was installed in two rooms to simulate a connection between a home and an institution. The subjects were five first-year university students. First, they saw a video-tape on several general assistance procedures to help a patient with sitting up, standing up and walking with a cane. Then they assisted a simulated patient who reproduced the effects of right hemiplegia due to a stroke. They also received instructions from a physiotherapist in another room using the videoconference system. The students experienced most difficulty in assisting the patient to stand up from sitting with legs stretched in a tatami room. Their mean score in the first session for this was 34.5 points out of 45, and this increased to 38.5 in a second session, after a question and answer period. The present study shows that the delivery of rehabilitation services is feasible in remote places.
A cost analysis of a tele-oncology practice in the United States
Authors: Doolittle Gary C , Williams Arthur R , Spaulding Ashley , Spaulding Ryan J , Cook David J
Published: December 2004

Oncology services have been provided by telemedicine from the University of Kansas Medical Center (KUMC) for almost 10 years. We have analysed the costs associated with providing tele-oncology clinics to a rural Kansas town for two fiscal years, 1995 and 2000. The aim was to compare recent tele-oncology costs with those of the first year of tele-oncology practice. A study conducted in 1995 showed that the average cost was $812 per telemedicine consultation. Data from fiscal year 2000 showed that the average cost was $410 per telemedicine consultation, a decrease of almost 50%. As the tele-oncology practice in Kansas continues to grow, it can be expected that the costs associated with providing tele-oncology services will continue to decline.
Asthma educational videoconferencing for parents: A case-control study
Authors: Reznik Marina , Ozuah Philip O
Published: December 2004

We used a case-control, pre–post study to determine the effectiveness of educational videoconferencing in the delivery of an asthma education programme. The participants were immigrant parents attending scheduled classes on English as a second language. The cases participated in the educational videoconferences, while the controls attended a class on American civics. Knowledge in both groups was assessed with 10 true/false statements. Ninety subjects participated (47 cases and 43 controls). Controls showed no significant post-test improvement in knowledge scores (6.6 for pre-test, 6.4 for post-test). In contrast, cases demonstrated significant knowledge gain after the videoconference (7.3 vs 8.3). Educational videoconferencing was an effective tool for the delivery of health education in asthma.
Breastfeeding Rates in the United States by Characteristics of the Child, Mother, or Family: The 2002 National Immunization Survey
Authors: Li Ruowei , Darling Natalie , Maurice Emmanuel , Barker Lawrence , Grummer-Strawn Laurence M.
Published: December 2004

Objective. In the third quarter of 2001, the National Immunization Survey (NIS) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding. Using the data from the 2002 NIS, this study estimates breastfeeding rates in the United States by characteristics of the child, mother, or family.

Methods. The NIS uses random-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations and then validates the information through a mail survey of the health care providers who gave the vaccinations. In 2002, ∼3500 households from the NIS were randomized to 1 of the 3 rotating topical modules that covered breastfeeding.

Results. More than two thirds (71.4%) of the children had ever been breastfed. At 3 months, 42.5% of infants were exclusively breastfed, and 51.5% were breastfed to some extent. At 6 months, these rates dropped to 13.3% and 35.1%, respectively. At 1 year, 16.1% of infants were receiving some breast milk. Non-Hispanic black children had the lowest breastfeeding rates. Breastfeeding rates also varied by participation in day care or the Women, Infants, and Children program, socioeconomic status, and geographic area of residence.

Conclusions. Although the rate of breastfeeding initiation in the United States is near the national goal of 75%, at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50% and 25%, respectively. In addition, rates of exclusive breastfeeding are low. Strenuous public health efforts are needed to improve breastfeeding behaviors, particularly among non-Hispanic black women and socioeconomically disadvantaged groups.
Myelomeningocele, Temperament Patterns, and Parental Perceptions
Authors: Vachha Behroze , Adams Richard
Published: December 2004

Objective. Description of temperament profiles of children has largely been reported in typically developing populations. Children undergo individualized assessments of achievement (developmental/academic) and receive individualized interventions. In contrast, their individual behavioral styles are not evaluated as completely, if at all. For children with developmental disabilities, description of temperament characteristics can provide better understanding of the already complex child. This study describes temperament characteristics in a group of children with myelomeningocele and shunted hydrocephalus (MM/SH).

Methods. A consecutive cohort study with historical control group measuring temperament characteristics was conducted at a tertiary-level, university affiliated, interdisciplinary spina bifida program. Analysis includes group comparisons. Primary caregivers of 46 children (age range: 5–12 years) with MM/SH completed age-appropriate Carey Temperament Scales questionnaires as a component of a larger developmental study. The Carey Temperament Scales comprise a series of behavioral rating instruments that assess 9 temperament characteristics: activity, adaptability, approach-withdrawal, mood, intensity, attention/persistence, distractibility, sensory threshold, and rhythmicity/predictability. The Carey questionnaires used in this study were (1) the Behavioral Style Questionnaire for children aged 5 to 7 years and (2) the Middle Childhood Temperament Questionnaire for those aged 8 to 12 years. Both questionnaires assess the same temperament characteristics; the contexts within which items were rated were designed to better reflect developmental levels. Children were excluded when there were comorbid diagnoses of attention-deficit/hyperactivity disorder or mental retardation.

Results. One-sample normal tests (Bonferroni corrected) revealed that children within the MM/SH group differed significantly from the standardized population in 5 dimensions: (1) adaptability (less adaptable), (2) approach/withdrawal (poor first approach/greater withdrawal), (3) distractibility (more distractible), (4) attention/persistence (less attentive/persistent), and (5) predictability/rhythm (less predictable). Caregiver perceptions of having a difficult-to-manage child were significantly correlated with negative mood, more intensity of response, and less adaptability.

Conclusions. Temperament profiles previously described in typically developing populations (eg, “easy” or “difficult child”) were not prominent profiles in this group of children with MM/SH. A constellation of temperament characteristics not commonly recognized may place these children at risk for being contributors to and recipients of misunderstandings of social cues and have implications for successful learning within academic, home/community, and medical settings.
Mechanisms for microparticle dispersion in a jet in crossflow
Authors: Campolo Marina , Salvetti Maria Vittoria , Soldati Alfredo
Published: December 2004

The dispersion produced by a jet injecting microparticles in a cross stream is controlled by the interaction between dispersed species and large‐scale time‐dependent flow structures populating the transverse jet. These structures span over a wide range of spatial and temporal scales and are not equally effective in advecting and dispersing species. In many environmental and industrial applications, the species advected by the jet stream are expected to undergo rapid and homogeneous dilution away from the injection point. Preferential accumulation of particles into specific flow regions may have consequences on the overall industrial process. For instance, nonuniform particle distribution can severely downgrade the efficiency of postcombustion devices. In this work, we address the problem of identifying which of the flow structures in a jet in crossflow controls dispersion mechanisms of inertial particles, focusing specifically on the issue of their preferential distribution. The flow field produced by the transverse jet is calculated using a finite‐volume solver of Navier–Stokes equations and the dispersion of particles is computed using a Lagrangian approach. We investigate the behavior of particles of different sizes, examining 5 orders of magnitude of their inertial parameter—the particle timescale. The analysis of dispersion shows that particle distribution is not uniform and is dominated by specific flow structures. Examining the distribution of the different particles in connection with particle timescale and flow structure evolution, it is found that shear layer vortices initially control dispersion and segregation processes, whereas counterrotating vortices entrain and trap particles in the lee side of the jet. © 2004 American Institute of Chemical Engineers AIChE J, 51: 28–43, 2005
Association study between brain‐derived neurotrophic factor gene polymorphisms and methamphetamine abusers in Japan
Authors: Itoh Kanako , Hashimoto Kenji , Shimizu Eiji , Sekine Yoshimoto , Ozaki Norio , Inada Toshiya , Harano Mutsuo , Iwata Nakao , Komiyama Tokutaro , Yamada Mitsuhiko , Sora Ichiro , Nakata Kenji , Ujike Hiroshi , Iyo Masaomi
Published: December 2004

Several lines of evidence suggest that genetic factors might contribute to drug abuse vulnerability. Recent genomic scans for association demonstrated that the brain‐derived neurotrophic factor (BDNF) gene was associated with drug abuse vulnerability. In this study, we analyzed association of two BDNF gene single nucleotide polymorphisms (SNPs), 132C > T (C270T named formerly) in the noncoding region of exon V and 196G > A (val66met) in the coding region of exon XIIIA, with methamphetamine (MAP) abuse in Japan. No significant differences were found in the frequency of the genotype or allele in these two SNPs between MAP abusers and controls (132C > T in exon V: genotype, P = 0.586, allele, P = 0.594; 196G > A (val66met) in exon XIIIA: genotype, P = 0.889, allele, P = 0.713). Furthermore, there was no difference between clinical parameters (e.g., prognosis psychosis, spontaneous relapse, or poly‐substance abuse) and the two SNPs of BDNF gene. These results suggest that the two SNPs (132C > T in exon V and 196G>A (val66met) in exon XIIIA) of the BDNF gene may not be associated with Japanese MAP abusers. This article contains supplementary material, which may be viewed at the American Journal of Medical Genetics website at http://www.interscience.wiley.com/jpages/0148‐7299:1/suppmat/index.html. © 2004 Wiley‐Liss, Inc.