bluuebunny/crossref_metadata_2025 huggingface dataset:
A method for accurate detection of genomic microdeletions using real-time quantitative PCR
Authors: Weksberg Rosanna , Hughes Simon , Moldovan Laura , Bassett Anne S , Chow Eva WC , Squire Jeremy A
Published: December 2005

Background

Quantitative Polymerase Chain Reaction (qPCR) is a well-established method for quantifying levels of gene expression, but has not been routinely applied to the detection of constitutional copy number alterations of human genomic DNA. Microdeletions or microduplications of the human genome are associated with a variety of genetic disorders. Although, clinical laboratories routinely use fluorescence in situ hybridization (FISH) to identify such cryptic genomic alterations, there remains a significant number of individuals in which constitutional genomic imbalance is suspected, based on clinical parameters, but cannot be readily detected using current cytogenetic techniques.

Results

In this study, a novel application for real-time qPCR is presented that can be used to reproducibly detect chromosomal microdeletions and microduplications. This approach was applied to DNA from a series of patient samples and controls to validate genomic copy number alteration at cytoband 22q11. The study group comprised 12 patients with clinical symptoms of chromosome 22q11 deletion syndrome (22q11DS), 1 patient trisomic for 22q11 and 4 normal controls. 6 of the patients (group 1) had known hemizygous deletions, as detected by standard diagnostic FISH, whilst the remaining 6 patients (group 2) were classified as 22q11DS negative using the clinical FISH assay. Screening of the patients and controls with a set of 10 real time qPCR primers, spanning the 22q11.2-deleted region and flanking sequence, confirmed the FISH assay results for all patients with 100% concordance. Moreover, this qPCR enabled a refinement of the region of deletion at 22q11. Analysis of DNA from chromosome 22 trisomic sample demonstrated genomic duplication within 22q11.

Conclusion

In this paper we present a qPCR approach for the detection of chromosomal microdeletions and microduplications. The strategic use of in silico modelling for qPCR primer design to avoid regions of repetitive DNA, whilst providing a level of genomic resolution greater than standard cytogenetic assays. The implementation of qPCR detection in clinical laboratories will address the need to replace complex, expensive and time consuming FISH screening to detect genomic microdeletions or duplications of clinical importance.
Primary healthcare provision and Chronic Fatigue Syndrome: a survey of patients' and General Practitioners' beliefs
Authors: Thomas Marie A , Smith Andrew P
Published: December 2005

Background

The current study was conducted as part of a research project into the evaluation and assessment of healthcare provision and education in Chronic Fatigue Syndrome (CFS). One aim of the study was the development of informative and educational literature for both General Practitioners (GP) and sufferers. Issues such as diagnosis, management and treatment of the syndrome should be included in information booklets written by healthcare professionals. It was important to begin the process by assessing the level of specialist knowledge that existed in typical GP surgeries. This data would then be compared to data from CFS patients.

Method

197 survey booklets were sent to CFS sufferers from an existing research panel. The patients approached for the purpose of the study had been recruited onto the panel following diagnosis of their illness at a specialised CFS outpatient clinic in South Wales. A further 120 booklets were sent to GP surgeries in the Gwent Health Authority region in Wales.

Results

Results from the study indicate that the level of specialist knowledge of CFS in primary care remains low. Only half the GP respondents believed that the condition actually exists.

Conclusion

Steps are recommended to increase the knowledge base by compiling helpful and informative material for GPs and patient groups.
A rare case of disseminated cutaneous zoster in an immunocompetent patient
Authors: Gupta S , Jain A , Gardiner C , Tyring SK
Published: December 2005

Background

Disseminated cutaneous herpes zoster in healthy persons is uncommon, though it has been described in immunocompromised patients.

Case presentation

We describe a case of disseminated cutaneous herpes zoster in an elderly man with no apparent immunosuppressive condition. The patient was treated successfully with intravenous Acyclovir.

Conclusion

We suggest that disseminated zoster can occur in an immunocompetent host and should be promptly recognized and treated to prevent serious complications.
Vitamin status and cognitive function in a long-term care population
Authors: Paulionis Lina , Kane Sheri-Lynn , Meckling Kelly A
Published: December 2005

Background

Ageing can be associated with poor dietary intake, reduced nutrient absorption, and less efficient utilization of nutrients. Loss of memory and related cognitive function are also common among older persons. This study aimed to measure the prevalence of inadequate vitamin status among long-term care patients and determine if an association exists between vitamin status and each of three variables; cognitive function, vitamin supplementation, and medications which alter gastric acid levels.

Methods

Seventy-five patients in a long-term care hospital in Guelph, Ontario were recruited to a cross-sectional study. 47 were female and the mean age was 80.7 (+/-11.5) years, ranging from 48 to 100 years. Blood was used to measure levels of vitamins B12 (cobalamin), B6 (pyridoxal-5'-phosphate/PLP), erythrocyte folate, vitamin B3 (niacin) and homocysteine (Hcy). The Standardized Mini-Mental State Examination (SMMSE) was administered to measure cognitive function. A list of medications and vitamin supplementation for each patient was provided by the pharmacy.

Results

The prevalence of low vitamin (B12, B6, erythrocyte folate, niacin) or high metabolite (homocysteine) levels among 75 patients were as follows: B12 <148 pmol/L in 5/75 (6.7%); B12 between 148 and 221 pmol/L in 26/75 (34.7%); B6 ≤30 nmol/L in 4/75 (5.3%); erythrocyte folate <370 nmol/L in 1/75 (1.3%); niacin ratio ≤1 in 20/75 (26.7%); homocysteine >13.3 μmol/L in 31/75 (41.3%). There was no significant difference among residents grouped into marked (n = 44), mild (n = 14), or normal (n = 9) cognitive function when evaluating the effect of vitamin status. There were no significant differences in mean B12 and homocysteine levels between users and non-users of drug therapy (Losec, Zantac, or Axid). Compared to vitamin supplement non-users, supplemented residents had significantly higher mean B12 (p < 0.0001) and erythrocyte folate (p < 0.05) concentrations and significantly lower mean homocysteine (p < 0.01) levels; 229.1 versus 423.6 pmol/L for B12, 882.9 versus 1043.6 nmol/L for erythrocyte folate and 14.4 versus 12.0 μmol/L for homocysteine.

Conclusion

Given the prevalence data on vitamin status in this sample population, the possible benefits of vitamin supplementation should be considered in clinical intervention studies using these populations of elderly.
Unhappiness and dissatisfaction in doctors cannot be predicted by selectors from medical school application forms: A prospective, longitudinal study
Authors: McManus IC , Iqbal Sheeraz , Chandrarajan Amuthan , Ferguson E , Leaviss Joanna
Published: December 2005

Background

Personal statements and referees' reports are widely used on medical school application forms, particularly in the UK, to assess the suitability of candidates for a career in medicine. However there are few studies which assess the validity of such information for predicting unhappiness or dissatisfaction with a career in medicine. Here we combine data from a long-term prospective study of medical student selection and training, with an experimental approach in which a large number of assessors used a paired comparison technique to predict outcome.

Methods

Data from a large-scale prospective study of students applying to UK medical schools in 1990 were used to identify 40 pairs of doctors, matched by sex, for whom personal statements and referees' reports were available, and who in a 2002/3 follow-up study, one pair member was very satisfied and the other very dissatisfied with medicine as a career. In 2005, 96 assessors, who were experienced medical school selectors, doctors, medical students or psychology students, used information from the doctors' original applications to judge which member of each pair of doctors was the happier, more satisfied doctor.

Results

None of the groups of assessors were significantly different from chance expectations in using applicants' personal statements and the referees' reports to predict actual future satisfaction or dissatisfaction, the distribution being similar to binomial expectations. However judgements of pairs of application forms from pairs of doctors showed a non-binomial distribution, indicating consensus among assessors as to which doctor would be the happy doctor (although the consensus was wrong in half the cases). Assessors taking longer to do the task concurred more. Consensus judgements seem mainly to be based on referees' predictions of academic achievement (even though academic achievement is not actually a valid predictor of happiness or satisfaction).

Conclusion

Although widely used in medical student selection to assess motivation, interest and commitment to a medical career, the personal statement and the referee's report cannot validly be used by assessors, including experienced medical school selectors, to identify doctors who will subsequently be dissatisfied with a medical career.
Recognition of delirium in ICU patients: a diagnostic study of the NEECHAM confusion scale in ICU patients
Authors: Immers Henny EM , Schuurmans Marieke J , van de Bijl Jaap J
Published: December 2005

Background

A delirium, is a serious, high-frequency complication in intensive care unit (ICU) patients. The consequences of this complication range from high morbidity and mortality to greater need for nursing care. Despite these, delirium is often not recognized and there for not treated. In this study a nursing screening instrument, the NEECHAM confusion scale, was studied for early recognition of delirium ICU patients. This scale proved valid and reliable in several studies in the general hospital population.

Methods

In this study validity and reliability were tested in a prospective cohort of 105 patients. Gold standard for delirium was an independent DSM-IV diagnosis. User friendliness was tested by structured evaluation of nurses' experiences working with the scale.

Results

The NEECHAM confusion scale showed high internal consistency (Cronbach's alpha 0.88) and an interrater reliability of Cohen's Kappa 0.60. The concurrent validity with the DSM-IVcriteria showed a strong link (chi-square 67.52, p [less than or equal to] 0.001). Sensitivity was high, 97% and specificity was good 83%. ICU nurses completed the NEECHAM confusion rating in 3.69, ± 1.21 minutes average. In general the nurses were positive about the NEECHAM confusion scale. They were able to collect data during regular care, but experienced problems in rating the scale in intubated patients. The items in themselves were clear, the content validity, measured by the language used was rated good.

Conclusion

The psychometric characteristics of the NEECHAM confusion scale of this ICU study are generally consistent with validity research previously reported for the general hospital population. The psychometric characteristics and the ease of use of the NEECHAM confusion scale enables ICU nurses to early recognize delirium. Further study, especially in intubed patients is recommended.
Nutrient estimation from an FFQ developed for a black Zimbabwean population
Authors: Merchant Anwar T , Dehghan Mahshid , Chifamba Jephat , Terera Getrude , Yusuf Salim
Published: December 2005

Background

There is little information in the literature on methods of food composition database development to calculate nutrient intake from food frequency questionnaire (FFQ) data. The aim of this study is to describe the development of an FFQ and a food composition table to calculate nutrient intake in a Black Zimbabwean population.

Methods

Trained interviewers collected 24-hour dietary recalls (24 hr DR) from high and low income families in urban and rural Zimbabwe. Based on these data and input from local experts we developed an FFQ, containing a list of frequently consumed foods, standard portion sizes, and categories of consumption frequency. We created a food composition table of the foods found in the FFQ so that we could compute nutrient intake. We used the USDA nutrient database as the main resource because it is relatively complete, updated, and easily accessible. To choose the food item in the USDA nutrient database that most closely matched the nutrient content of the local food we referred to a local food composition table.

Results

Almost all the participants ate sadza (maize porridge) at least 5 times a week, and about half had matemba (fish) and caterpillar more than once a month. Nutrient estimates obtained from the FFQ data by using the USDA and Zimbabwean food composition tables were similar for total energy intake intra class correlation (ICC) = 0.99, and carbohydrate (ICC = 0.99), but different for vitamin A (ICC = 0.53), and total folate (ICC = 0.68).

Conclusion

We have described a standardized process of FFQ and food composition database development for a Black Zimbabwean population.
Catastrophic antiphospholipid syndrome and Kikuchi-Fujimoto disease: the first case reported
Authors: de Larrañaga G F , Remondino G I , Forastiero R R , Cunto E R , Narbaitz M , Olenchuk A B , Zala N S , Juan J A San
Published: December 2005

The case of a man with diagnosis of Kikuchi-Fujimoto disease (KFD) and catastrophic antiphospholipid syndrome (CAPS) is reported. He presented prolonged fever, lymphadenopathies, arthralgia, weight loss, hepatosplenomegaly and positive IgM for cytomegalovirus. While he was empirically treated with tuberculostatic drugs, he suddenly developed systemic inflammatory response syndrome, multiple organ failure and distal necrosis. On suspicion of severe sepsis, antibiotics, corticoids and recombinant human activated protein C (XIGRIS®) were administrated. Exhaustive laboratory searching was negative. Histopathologic examinations of lymph node first disclosed malignant lymphoma but later KFD was confirmed. One month later, laboratory tests showed the presence of antiphospholipid antibodies (aPL). The patient was discharged after two months of hospitalization. This case exhibits a KFD complicated by definite CAPS. Cytomegalovirus could be involved in the development of both CAPS and KFD. Because of the severity of the case, we believe that XIGRIS® noticeable improved the altered coagulation profile associated with CAPS.
The effect of TNFalpha blockade on the antinuclear antibody profile in patients with chronic arthritis: biological and clinical implications
Authors: De Rycke L , Baeten D , Kruithof E , Van den Bosch F , Veys E M , De Keyser F
Published: December 2005

Since the first proof of efficacy of TNFalpha blockade, both the number of patients treated worldwide and the number of indications for treatment with TNFalpha blockers have grown steadily. Surprisingly, the profound immunomodulation induced by anti-TNFalpha therapy is associated with a relatively low incidence of immune-related complications such as lupus-like syndromes and demyelinating disease. This contrasts sharply with the prominent induction of autoantibodies such as antinuclear antibodies (ANA) and anti-dsDNA antibodies during TNFalpha blockade. Although this phenomenon has been recognized for several years, the clinical and biological implications are not yet fully understood. In this review, recent studies analysing the effect of TNFalpha blockade (infliximab and etanercept) on the ANA profile in autoimmune arthritis will be discussed. Taken together, these reports indicate that the prominent ANA and anti-dsDNA autoantibody response is 1) not a pure class effect of TNFalpha blockers, 2) independent of the disease background, 3) largely restricted to the induction of short-term IgM anti-dsDNA antibodies, and 4) not associated with other serological or clinically relevant signs of lupus. Nevertheless, a careful follow-up of patients treated with TNFalpha blockers remains mandatory, including monitoring for lupus-like characteristics.
Suburban pastoral: Strawberry Fields forever and Sixties memory
Authors: Daniels Stephen
Published: December 2005

As a cultural period the 1960s is produced through overlapping forms of social memory in which private and public recollections overlap. In both sound and imagery, pop music, particularly that of the Beatles, is a principal medium of memory for the period. For the period from 1965, the progressive aspects of pop music, particularly in sonic and lyrical complexity, expressed a retrospective, pastoral strain that was itself a form of memory of other periods and places, of childhood and country life. The Beatles double-A-sided single Strawberry Fields forever/Penny Lane, released in February 1967, epitomizes these complexities in a suburban version of pastoral, recalling the Liverpool childhoods of songwriters John Lennon and Paul McCartney. An analysis of the production and reception of the record, including lyrical genesis and musical development, publicity imagery, reviews in both the popular music papers and national news press, and the impact of the record in Liverpool and London, identifies the importance of intense, immediate moments in cultural geography, and their connection to longer developments in a theatre of memory that plays comedy and history as well as tragedy.
Nuclear protein NP60 regulates p38 MAPK activity
Authors: Fu Jing , Yang Ziqiang , Wei Jinxue , Han Jiahuai , Gu Jun
Published: December 2005

The activation of p38α is mediated by its upstream kinase and associated proteins. Here we identify a new nuclear protein, NP60, which regulates the activation of p38α in response to sorbitol treatment. NP60 specifically binds to p38α, but not to JNK and ERK, in vitro and in vivo. Co-transfection of NP60 leads to the phosphorylation and activation of p38α, and subsequently results in the phosphorylation and activation of activating transcription factor 2. The phosphorylation of p38α induced by NP60 requires upstream activity of p38α MAP kinase, MAP kinase kinase 6 (MKK6) or MKK4. Our results indicate that NP60 mediates stress activation of p38α and regulates p38α signaling in a specific way.
Geldanamycin stimulates internalization of ErbB2 in a proteasome-dependent way
Authors: Lerdrup Mads , Hommelgaard Anette M. , Grandal Michael , van Deurs Bo
Published: December 2005

The potent oncoprotein and receptor tyrosine kinase ErbB2 is remarkable because it resists efficient downregulation. However, ErbB2 can be downregulated by the HSP-90 inhibitor geldanamycin, but the underlying cellular mechanisms are uncertain. Apparently, delivery of ErbB2 to lysosomes, cleavage of the ErbB2 kinase domain and proteasomal activity are all processes that are involved. Using a non-invasive confocal microscopical assay allowing quantitative analysis of ErbB2 internalization in cell populations, we show that whereas ErbB2 is resistant to internalization in untreated SK-BR-3 cells, geldanamycin stimulates internalization and subsequent degradation in lysosomes. This process depends on proteasomal activity, which is a regulatory upstream event in ErbB2 internalization rather than the actual mechanism of degradation. ErbB2 can be internalized as a full-length protein, thus cleavage of the ErbB2 kinase domain is not a requirement for geldanamycin-stimulated internalization. Moreover, as shown by FRAP (fluorescence recovery after photobleaching) and electron microscopy, geldanamycin induces an increase in the amount of mobile ErbB2 and a redistribution of ErbB2 in the plasma membrane making the receptor accessible to endocytosis. Cells with most ErbB2 endocytosis also have the highest fraction of mobile ErbB2. It is concluded that geldanamycin stimulates internalization of full-length ErbB2 in a proteasome-dependent manner leading to lysosomal degradation.
Centralspindlin regulates ECT2 and RhoA accumulation at the equatorial cortex during cytokinesis
Authors: Nishimura Yukako , Yonemura Shigenobu
Published: December 2005

During determination of the cell division plane, an actomyosin contractile ring is induced at the equatorial cell cortex by signals from the mitotic apparatus and contracts to cause cleavage furrow progression. Although the small GTPase RhoA is known to regulate the progression, probably by controlling actin filament assembly and enhancing actomyosin interaction, any involvement of RhoA in division plane determination is unknown. In this study, using a trichloroacetic acid (TCA) fixation protocol we recently developed, we show that RhoA accumulates at the equatorial cortex before furrow initiation and continues to concentrate at the cleavage furrow during cytokinesis. We also demonstrate that both Rho activity and microtubule organization are required for RhoA localization and proper furrowing. Selective disruption of microtubule organization revealed that both astral and central spindle microtubules can recruit RhoA at the equatorial cortex. We find that centralspindlin and ECT2 are required for RhoA localization and furrowing. Centralspindlin is localized both to central spindle microtubules and at the tips of astral microtubules near the equatorial cortex and recruits ECT2. Positional information for division plane determination from microtubules is transmitted to the cell cortex to organize actin cytoskeleton through a mechanism involving these proteins.
Induced airflow in flying insects I. A theoretical model of the induced flow
Authors: Sane Sanjay P.
Published: December 2005

A strong induced flow structure envelops the body of insects and birds during flight. This flow influences many physiological processes including delivery of odor and mechanical stimuli to the sensory organs, as well as mass flow processes including heat loss and gas exchange in flying animals. With recent advances in near-field aerodynamics of insect and bird flight, it is now possible to determine how wing kinematics affects induced flow over their body. In this paper, I develop a theoretical model based in rotor theory to estimate the mean induced flow over the body of flapping insects. This model is able to capture some key characteristics of mean induced flow over the body of a flying insect. Specifically, it predicts that induced flow is directly proportional to wing beat frequency and stroke amplitude and is also affected by a wing shape dependent parameter. The derivation of induced flow includes the determination of spanwise variation of circulation on flapping wings. These predictions are tested against the available data on the spanwise distribution of aerodynamic circulation along finite Drosophila melanogaster wings and mean flows over the body of Manduca sexta. To explicitly account for tip losses in finite wings, a formula previously proposed by Prandtl for a finite blade propeller system is tentatively included. Thus, the model described in this paper allows us to estimate how far-field flows are influenced by near-field events in flapping flight.
Induced airflow in flying insects II. Measurement of induced flow
Authors: Sane Sanjay P. , Jacobson Nathaniel P.
Published: December 2005

The flapping wings of insects and birds induce a strong flow over their body during flight. Although this flow influences the sensory biology and physiology of a flying animal, there are very little data on the characteristics of this self-generated flow field or its biological consequences. A model proposed in the companion paper estimated the induced flow over flying insects. In this study, we used a pair of hot wire anemometers to measure this flow at two locations near the body of a tethered flapping hawk moth, Manduca sexta. The axial inflow anemometer measured the airflow prior to its entry into the stroke plane, whereas the radial outflow anemometer measured the airflow after it crossed the stroke plane. The high temporal resolution of the hot wire anemometers allowed us to measure not only the mean induced flow but also subtle higher frequency disturbances occurring at 1-4 times the wing beat frequency. These data provide evidence for the predictions of a mathematical model proposed in the companion paper. Specifically, the absolute value of the measured induced flow matches the estimate of the model. Also, as predicted by the model, the induced flow varies linearly with wing beat frequency. Our experiments also show that wing flexion contributes significantly to the observed higher frequency disturbances. Thus, the hot wire anemometry technique provides a useful means to quantify the aerodynamic signature of wing flexion. The phasic and tonic components of induced flow influence several physiological processes such as convective heat loss and gas exchange in endothermic insects, as well as alter the nature of mechanosensory and olfactory stimuli to the sensory organs of a flying insect.
Fixed metabolic costs for highly variable rates of protein synthesis in sea urchin embryos and larvae
Authors: Pace Douglas A. , Manahan Donal T.
Published: December 2005

Defining the physiological mechanisms that set metabolic rates and the`cost of living' is important for understanding the energy costs of development. Embryos and larvae of the sea urchin Lytechinus pictus(Verrill) were used to test hypotheses regarding differential costs of protein synthesis in animals differing in size, rates of protein synthesis, and physiological feeding states. For embryos, the rate of protein synthesis was 0.22±0.014 ng protein embryo-1 h-1 (mean ±s.e.m.) and decreased in unfed larvae to an average rate of 0.05±0.001 ng protein larva-1 h-1. Fed larvae had rates of synthesis that were up to 194 times faster than unfed larvae (9.7±0.81 ng protein larva-1 h-1). There was no significant difference, however, in the cost of protein synthesis between these larvae with very different physiological states. Furthermore, the cost of synthesis in the larval stages was also similar to costs measured for blastula and gastrula embryos of 8.4±0.99 J mg-1 protein synthesized. The cost of protein synthesis was obtained using both direct (`inhibitor') and indirect (`correlative') measurements; both methods gave essentially identical results. Protein synthesis accounted for up to 54±8% of metabolic rate in embryos. Percent of metabolism accounted for by protein synthesis in larvae was dependent on their physiological feeding state, with protein synthesis accounting for 16±4% in unfed larvae and 75±11% in fed larvae. This regulation of metabolic rate was due to differential rates of synthesis for a fixed energy cost per unit mass of protein synthesized. The cost of synthesizing a unit of protein did not change with increasing rates of protein synthesis. We conclude that the cost of protein synthesis is independent of the rate of synthesis, developmental stage, size and physiological feeding state during sea urchin development.
Trabecular bone in the bird knee responds with high sensitivity to changes in load orientation
Authors: Pontzer H. , Lieberman D. E. , Momin E. , Devlin M. J. , Polk J. D. , Hallgrímsson B. , Cooper D. M. L.
Published: December 2005

Wolff's law of trajectorial orientation proposes that trabecular struts align with the orientation of dominant compressive loads within a joint. Although widely considered in skeletal biology, Wolff's law has never been experimentally tested while controlling for ontogenetic stage, activity level,and species differences, all factors that may affect trabecular bone growth. Here we report an experimental test of Wolff's law using a within-species design in age-matched subjects experiencing physiologically normal levels of bone strain. Two age-matched groups of juvenile guinea fowl Numida meleagris ran on a treadmill set at either 0° (Level group) or 20° (Incline group), for 10 min per day over a 45-day treatment period. Birds running on the 20° inclined treadmill used more-flexed knees than those in the Level group at midstance (the point of peak ground reaction force). This difference in joint posture enabled us to test the sensitivity of trabecular alignment to altered load orientation in the knee. Using a new radon transform-based method for measuring trabecular orientation, our analysis shows that the fine trabecular bone in the distal femur has a high degree of correspondence between changes in joint angle and trabecular orientation. The sensitivity of this response supports the prediction that trabecular bone adapts dynamically to the orientation of peak compressive forces.
The absence of spatial echo suppression in the echolocating bats Megaderma lyra and Phyllostomus discolor
Authors: Schuchmann Maike , Hübner Matthias , Wiegrebe Lutz
Published: December 2005

Acoustic orientation most often takes place in echoic environments. The mammalian auditory system shows a variety of specializations to suppress misleading spatial information mediated by echoes. Psychophysically these specializations are summarized as the precedence effect. This study investigates how echolocating bats deal with multiple reflections of their sonar emissions from different spatial positions.

In a two-alternative, forced choice paradigm, a study was made of the extent to which the echolocating bats Megaderma lyra and Phyllostomus discolor spontaneously suppress the spatial information of a second reflection of their sonar emission. The delay between the first and the second reflection ranged between 0 and 12.8 ms.

In general, M. lyra (five individuals) and P. discolor(two individuals) did not suppress the spatial information of the second reflection of their sonar emission, whatever the delay. Only one M. lyra showed significant suppression for delays between 0.8 and 3.2 ms. However, this suppression could not be confirmed in an exact repetition of the experiment.

The current data indicate that although bats may be able to suppress the spatial information of a second reflection, this is not their default mode of auditory processing. The reason for this exceptional absence of spatial echo suppression may lie in the shorter time constants of cochlear processing in the ultrasonic frequency range and the strong influence of cognitive components associated with the `precedence effect'.
The LifeShirt system for wireless patient monitoring in the operating room
Authors: Halín Nina , Junnila Mika , Loula Pekka , Aarnio Pertti
Published: December 2005

We examined the functionality and reliability of a wearable physiological monitoring system (LifeShirt) during normal daily activities and in a hospital operating room (OR) environment. The garment collects physiological data such as oxygen saturation, and stores them in a recorder from which it can be read afterwards. Ten normal subjects wore the shirt continuously for 8 h per day. Feedback from the testers was quite positive, although the collected data varied in quality. Ten hospital patients also wore the shirt during endoscopy. The data collected during the hospital stay were qualitatively adequate. Measuring respiratory function caused the biggest problems. The study showed that intelligent garment technology could be used in an OR environment for patient monitoring, albeit not in realtime. It may also be useful in home follow-up.
Wireless telemedicine for the delivery of specialist paediatric services to the bedside
Authors: Smith Anthony C , Coulthard Mark , Clark Ron , Armfield Nigel , Taylor Shauna , Goff Robyn , Mottarelly Ian , Youngberry Karen , Isles Alan , Mccrossin Robert , Wootton Richard
Published: December 2005

A mobile interactive online health system was used to conduct virtual ward rounds at a regional hospital which had no specialist paediatrician. The system was wireless, which allowed telepaediatric services to be delivered direct to the bedside. Between December 2004 and May 2005, 43 virtual ward rounds were coordinated between specialists based in Brisbane and local staff at the Gladstone Hospital. Eighty-six consultations were provided for 64 patients. The most common conditions included asthma (27%), chest infections (12%), gastroenteritis (10%) and urinary tract infections (10%). In the majority of cases, there were partial (67%) or complete changes (11%) in the clinical management of patients. Specialist services were offered by a team of 1 3 clinicians at the Royal Children's Hospital: 10 general paediatricians, two physiotherapists and one registered nurse. Feedback from all consultants involved in the service and local staff in Gladstone was extremely positive. In 43 videoconference calls there were three technical problems, probably due to an intermittent mains power supply at the regional hospital. There appears to be potential for other rural and regional hospitals to adopt this model of service delivery.
The Telemedicine Information Exchange: 10 years’ experience
Authors: Brown Nancy A
Published: December 2005

The Telemedicine Information Exchange (TIE) Website has provided information on telemedicine since 1995. The site could be considered successful from its longevity alone; however, it can also be considered a success using other measures. The usage of the site has grown steadily over the years, to more than 20,000 visitors per month by 2005. The Bibliographic database has over 16,000 telemedicine-related citations, more than found anywhere else, and is the most visited section of the Website. The second most visited database, Active Telemedicine Programs, is the result of 10 years of tracking activity and growth using a voluntary online survey. This continuous monitoring of telemedicine literature and activity has allowed TIE research staff to anticipate user needs and interests. For instance, a Home Telehealth section was initiated after it became apparent that interest in the subject was increasing. Longevity also provides a perspective about the best ways of maintaining a content-heavy online resource. Efforts to augment federal funding (the TIE's sole source of support) by selling packaged information products have taught us that online users will not pay for information. Our raison d'être for the past 10 years has been the provision of credible, up-to-date information, and our reward has been positive feedback from thousands of TIE users.
A survey of e-mentoring among New Zealand midwives
Authors: Stewart Sarah , Wootton Richard
Published: December 2005

Mentoring is a strategy that may assist the midwifery profession to support new graduates and midwives working in rural and remote areas. We conducted a survey of 1577 New Zealand midwives about their opinions and experiences of mentoring. The questionnaire comprised 33 questions, nine of which were open questions. There was a 44% response rate. While the telephone was commonly utilized by mentors (37%) and mentored midwives (37%), the Internet and email played only a small part. Participants acknowledged the potential of these avenues for communication, but midwives felt that mentoring could be provided only by immediate, face-to-face contact. Nevertheless, e-mentoring could be a viable option and requires further investigation. About one-third of midwives identified geographical isolation as a barrier to being a mentor (38%) and being mentored (36%). The use of e-mentoring could remove the barrier of location and allow the midwife to chose a mentor who meets her needs, rather than because she is the only mentor available.
Success and failure in Web-based medical collaboration
Authors: Burkow Tatjana M , Nilsen Line L
Published: December 2005

A Web-based collaboration tool was developed for ophthalmologists, called Øyenet. A feasibility study was performed in 2000. The system was ready to use in 2001, but the usage of the system was disappointing, compared to the enthusiasm expressed in the feasibility study. In order to identify facilitators and barriers for usage of the system, we performed a qualitative study. Nineteen ophthalmologists from different parts of Norway, who had been using the system but to a varying degree, were interviewed. The study revealed that a single common solution is not appropriate for the ophthalmology community as a whole. It also revealed that colleagues from abroad should be allowed to use the system, in order for it to act as a tool for collaboration and seeking advice in complex medical problem solving.
Difficulties in moving routine medical checks from the specialist level to the general practitioner level
Authors: Henriksen Eva , Johansen Monika , Deraas Trygve , Arild Eli
Published: December 2005

We began a project to move routine medical checks for appropriate patients from the specialist level to the patient's normal general practitioner (GP). The GP's analysis and conclusions would be checked by the specialist, using electronic messaging. The idea for the project came from the top level of the regional health authority. Despite that, the project was closed down before pilot testing began. We used stakeholder theory as a post-project evaluation to analyse what happened and where it went wrong. A common mistake in project planning is to focus the planning effort on system tasks and not to pay attention to a well-thought-out handling of the project's stakeholders. This was what happened in our project. Ideal objectives and good political intentions are not enough to implement a new e-health service.
The iPath telemedicine platform
Authors: Brauchli Kurt , Oberholzer Martin
Published: December 2005

An early, point-to-point telepathology system at the University of Basel developed into an open-source, Internet-based platform for telemedicine in 2001. The Internet Pathology Suite (iPath) is a Web-based telepathology platform that permits the online presentation and discussion of cases within user groups. It also allows realtime telemicroscopy across firewalls. After four years, the telepathology network has over 700 active users. More than 6300 cases with a total of about 39,000 images have been diagnosed. The diagnostic workload of all these cases is not exclusively handled by the Department of Pathology in Basel, but by a growing number of independent groups who also use the server simply as a case repository. What started as a small project for hospitals in Switzerland has become a global network.
Realtime telemedicine for paediatric otolaryngology pre-admission screening
Authors: Smith Anthony C , Williams Judy , Agnew Julie , Sinclair Stephen , Youngberry Karen , Wootton Richard
Published: December 2005

We conducted a feasibility study to examine whether a paediatric patient at a regional hospital could be assessed by an ear, nose and throat (ENT) specialist via videoconference, therefore saving at least one journey to the tertiary hospital for a preadmission appointment. A video-otoscope was used with standard videoconference equipment, and realtime images were transmitted at a bandwidth of 384 kbit/s. In all, 1 3 telepaediatric ENT clinics were conducted between November 2003 and April 2005, and 98 consultations were facilitated for 64 patients. The main reasons for referral were recurrent tonsillitis (25%) and obstructive sleep apnoea (23%). Of the 64 patients examined by telemedicine, 42 (66%) were recommended for surgery and placed on the surgical waiting list. About 12 patients (19%) required travel to the tertiary centre for further investigations and tests not available locally, while four patients (6%) were reviewed via videoconference during a scheduled clinic. Six patients (9%) required no further follow-up after their initial telepaediatric consultation. Videoconferencing is an effective method of assessing ENT conditions of paediatric patients and for pre-screening potential surgical admissions to a tertiary hospital. Careful consideration of a number of economic and logistical factors needs to be made before large investments are made to expand the service.
Work practice changes caused by the introduction of a picture archiving and communication system
Authors: Yu Ping , Hilton Paul
Published: December 2005

We studied the acceptance of work practice changes six months after the introduction of a picture archiving and communication system (PACS) in New South Wales. A one-page questionnaire was developed to assess doctors’ and nurses’ acceptance of work practice changes. Over 100 subjects were surveyed and 76 responded. In all, 92% of participants worked in the intensive-care unit (ICU) or the emergency department (ED). The results showed that the PACS had received a high level of acceptance. The respondents would not like to return to a film-based practice. They were happy with the accessibility of images, especially when patients returned from an X-ray examination. At the time of survey, the doctors still had difficulty in remembering their user name and password. The users rarely or only sometimes used their own user names and passwords to log on the system. They were sometimes annoyed by the automatic time-out function. Nurses were happy that the PACS relieved their burden of searching for X-ray images for doctors. However, they distanced themselves from accessing the PACS, which they regarded as a doctors’ tool.
Telemedicine for rural and remote child and youth mental health services
Authors: Ryan Ven-Nice , Stathis Stephen , Smith Anthony C , Best Denisse , Wootton Richard
Published: December 2005

The E-Child and Youth Mental Health Service was designed to provide children and adolescents in Queensland with access to specialist mental health consultations using telemedicine. A project officer provided a single point of contact for referral management and clinic coordination, thereby reducing barriers of access to the service. Over a six-month period from November 2004, 42 point-to-point videoconferences were conducted to nine sites in Queensland. Three multipoint conferences were also conducted. Eleven videoconferences (24%) were arranged for administrative purposes, and 34 (76%) were conducted for the delivery of clinical services (30 patients). The referral and consultation activity suggests an improvement in the capacity of rural and remote mental health service providers to deliver specialist services for children and adolescents.
Attitude to telemedicine, and willingness to use it, in audiology patients
Authors: Eikelboom Robert H , Atlas Marcus D
Published: December 2005

We studied the willingness of patients to use telemedicine for ear- and hearing-related appointments, and the factors that influenced their decision to participate in telemedicine. A survey was designed with questions about patient appointments, perceived advantages and barriers to telemedicine, and prior use of the Internet for health-related matters. A total of 116 patients in four audiology centres were surveyed from December 2004 to May 2005. There were 54 male and 62 female respondents; 46% of the participants were aged over 66 years. In all, 75% had not previously heard of telemedicine. The most common reasons for willingness to use telemedicine were to reduce the time waiting for an appointment and cost. The most common barrier to using telemedicine was a preference for face-to-face visits. Of those surveyed, 32% were willing to use telemedicine, 10% would sometimes be willing, 28% were unsure, and 30% were not willing. There was no relationship between willingness and age or gender, except that women over the age of 55 years were less willing. Patients who had previously heard of telemedicine and used the Internet for health-related matters, especially men, were more inclined to have a telemedicine appointment.
User acceptance of the Web-based distribution of radiology services in regional and remote centres of Western Australia
Authors: Tually Peter , Stavrianou Chris , Walker John
Published: December 2005

A large-scale, Web browser-based radiological information system integrated with a picture archiving and communication system (RIS/PACS) has been installed in regional and remote radiology centres of Western Australia. This provides patients in rural areas with local access to advanced medical imaging. User attitudes to the changes were surveyed in a six-week period starting in March 2005. A total of 53 people completed the survey (62% response rate). Respondents were eight radiologists, 21 medical imaging technologists, 10 administration officers and 14 reception staff. All groups gave average ratings of the system's quality. All staff rated the information quality of the system as good. On-site information technology support was judged to be reliable, professional and empathic towards user concerns. There was a broad range of opinion between groups, but on average they were satisfied. The lack of a modern network, comparable to what is available in the metropolitan areas, has impeded the full potential of RIS/PACS in the smaller rural centres.
Referral patterns in a global store-and-forward telemedicine system
Authors: Wootton R , Youngberry K , Swinfen R , Swinfen P
Published: December 2005

We examined the nature of the referral patterns in the email telemedicine network operated by the Swinfen Charitable Trust with a view to informing long-term resource planning. Over the first six years of operation, 62 hospitals from 19 countries registered with the Trust in order to be able to refer cases for specialist advice; 55 of these hospitals (89%) actually referred cases during this period. During the first six years of operation, nearly 1000 referrals were submitted and answered, from a wide range of specialty areas. Between July 2002 and March 2005 the referral rate rose from 127 to 318 cases per year. The median length of time required to provide a specialist's response was 2.3 days during the first 12 months and 1.8 days during the last 12 months. Five hospitals submitted cases for more than four years (together sending a total of 493 cases). Their activity data showed a trend to declining referral rates over the four-year period, which may represent successful knowledge transfer. There is some evidence that over the last three years the growth in demand has been exponential, while the growth in resources available (i.e. specialists) has been linear, a situation which cannot continue for very long before demand outstrips supply.
No More Than Necessary: Safety and Efficacy of Low-Dose Promethazine
Authors: Moser Joseph D , Caldwell James B , Rhule F Jane
Published: December 2005

Background:

Limitations in antiemetic options have resulted in increased use of intravenous promethazine. However, this drug has significant sedative effects with its standard dosage of 25 mg, especially when used in conjunction with narcotic analgesics. While studies have revealed the bioavailability of enteric promethazine to be 25%, current dosing references suggest identical dosing regardless of the route of administration.

Objective:

To compare the antiemetic efficacy and sedative effects of low-dose intravenous promethazine (6.25 or 12.5 mg) with intravenous ondansetron 4 mg.

Methods:

We assessed inpatients with noncritical conditions at Anne Arundel Medical Center who were treated for nausea or vomiting from any cause except chemotherapy or pregnancy. Forty-six patients received low-dose promethazine and 41 received ondansetron. Statistical analysis was carried out for significant differences in efficacy and sedation.

Results:

For patients who received intravenous promethazine 6.25 or 12.5 mg, nausea and vomiting were relieved at one hour in 74% and 68%, respectively, compared with 59% for intravenous ondansetron 4 mg. Results at 3 hours were 67% and 80% for promethazine and 71% for ondansetron. Median sedation scores at one hour were equal at 3 for promethazine and ondansetron (4 = fully awake); at 3 hours, the median scores were 4 and 3.5, respectively. There were no statistically significant differences among any of these results.

Conclusions:

Low-dose (6.25 mg) intravenous promethazine relieves nausea and vomiting as effectively as intravenous ondansetron 4 mg.