bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paradise – not without its plagues: Overwhelming Blastomycosis pneumonia after visit to lakeside cottages in Northeastern Ontario
Authors: Parmar Malvinder S 
Published: May 2005

Abstract

Background
Visiting lakes and cottages is a common leisure activity during summer among most Canadians and paradise for some. Various leisure activities are involved during these visits, including cleaning and 'airing' the cottage after long-winters, activities at the lakes and dock building etc, exposing the Canadians to moist soil and decaying woods – a source of white or tan mould – Blastomyces dermatitidis that may cause a flu-like illness to severe pneumonia that often remains a diagnostic challenge and results in delay in diagnosis and appropriate treatment thereby increasing associated morbidity and mortality.

Case Presentations
Five cases of overwhelming acute blastomycosis pneumonia are presented. Four of the five patients presented within few weeks of their visit to the cottages and surrounding lakes and all were initially treated as "community acquired pneumonia" that resulted in delay in diagnosis and poor outcome in the first patient. The first case, however, taught an important lesson that led to high-index of suspicion in the others with early diagnosis and improved outcomes. Interestingly, all patients were obese and had a shorter incubation period and severe clinical course. The possible mechanism for early and severe disease in association with obesity is speculated and literature is reviewed.

Conclusion
High-index of suspicion is important in the early diagnosis and appropriate management acute blastomycosis pneumonia to improve associated morbidity and mortality.
Hypervascular nodule in a fibrotic liver overloaded with iron: identification of a premalignant area with preserved liver architecture
Authors: Sá Cunha António , Blanc Jean-Frédéric , Trillaud Hervé , De Ledinghen Victor , Balabaud Charles , Bioulac-Sage Paulette 
Published: May 2005

Abstract
Background
The presence of a hypervascular nodule in a patient with cirrhosis is highly suggestive of a hepatocellular carcinoma.

Case presentation
A 55 year old man with idiopathic refractory anaemia was addressed for the cure of a recently appeared 3.3 cm hypervascular liver nodule. The nodule was not visible on the resected fresh specimen, but a paler zone was seen after formalin fixation. The surrounding liver was fibrotic (METAVIR score F3) and overloaded with iron. However, the paler zone, thought to be the nodule, had in fact a normal architecture, was less fibrotic, and contained some "portal tract-like structures" (but with arteries only); moreover, this paler area was devoid of iron, contained less glycogen and was characterized by foci of clear hepatocytes.

Conclusion
In spite of the absence of architectural distortion, and a normal proliferative index, the possibility of premalignancy or malignancy should be considered in this type of hypervascular and hyposiderotic nodule, occurring in the context of an iron overloaded liver.
Dopamine, uncertainty and TD learning
Authors: Niv Yael , Duff Michael O , Dayan Peter 
Published: May 2005

Abstract
Substantial evidence suggests that the phasic activities of dopaminergic neurons in the primate midbrain represent a temporal difference (TD) error in predictions of future reward, with increases above and decreases below baseline consequent on positive and negative prediction errors, respectively. However, dopamine cells have very low baseline activity, which implies that the representation of these two sorts of error is asymmetric. We explore the implications of this seemingly innocuous asymmetry for the interpretation of dopaminergic firing patterns in experiments with probabilistic rewards which bring about persistent prediction errors. In particular, we show that when averaging the non-stationary prediction errors across trials, a ramping in the activity of the dopamine neurons should be apparent, whose magnitude is dependent on the learning rate. This exact phenomenon was observed in a recent experiment, though being interpreted there in antipodal terms as a within-trial encoding of uncertainty.
Circadian pattern of activation of the medical emergency team in a teaching hospital
Authors: Jones Daryl , Bates Samantha , Warrillow Stephen , Opdam Helen , Goldsmith Donna , Gutteridge Geoff , Bellomo Rinaldo 
Published: May 2005

Abstract
Introduction
Hospital medical emergency teams (METs) have been implemented to reduce cardiac arrests and hospital mortality. The timing and system factors associated with their activation are poorly understood. We sought to determine the circadian pattern of MET activation and to relate it to nursing and medical activities.

Method
We conducted a retrospective observational study of the time of activation for 2568 incidents of MET attendance. Each attendance was allocated to one of 48 half-hour intervals over the 24-hour daily cycle. Activation was related nursing and medical activities.

Results
During the study period there were 120,000 consecutive overnight medical and surgical admissions. The hourly rate of MET calls was greater during the day (47% of calls in the 10 hours between 08:00 and 18:00), but 53% of the 2568 calls occurred between 18:00 and 08:00 hours. MET calls increased in the half-hour after routine nursing observation, and in the half-hour before each nursing handover. MET service utilization was 1.25 (95% confidence interval [CI] = 1.11–1.52) times more likely in the three 1-hour periods spanning routine nursing handover (P = 0.001). The greatest level of half-hourly utilization was seen between 20:00 and 20:30 (odds ratio [OR] = 1.76, 95% CI = 1.25–2.48; P = 0.001), before the evening nursing handover. Additional peaks were seen following routine nursing observations between 14:00 and 14:30 (OR = 1.53, 95% CI = 1.07–2.17; P = 0.022) and after the commencement of the daily medical shift (09:00–09:30; OR = 1.43, 95% CI = 1.00–2.04; P = 0.049).

Conclusion
Peak levels of MET service activation occur around the time of routine observations and nursing handover. Our findings raise questions about the appropriate frequency and methods of observation in at-risk hospital patients, reinforce the need for adequately trained medical staff to be available 24 hours per day, and provide useful information for allocation of resources and personnel for a MET service.
Double Dissociation of Exteroceptive and Interoceptive Feedback Systems in the Orbital and Ventromedial Prefrontal Cortex of Humans
Authors: Hurliman Elisabeth , Nagode Jennifer C. , Pardo José V. 
Published: May 2005

The primate ventral prefrontal cortex contains two densely interconnected subregions: a lateral/orbital cortex processing primarily sensory/exteroceptive information, and a ventromedial cortex processing primarily visceroappetitive/interoceptive information. These regions have major afferents from and efferents to other associative cortices. The organization of these structures leads to an hypothesized role in feedback processing. We use neuroimaging to test this model, defined so far mostly through anatomical studies.Healthy volunteers were trained operantly on a transitive inference task (A>B, B>C ⇒ A>C) requiring flexible manipulation of feedback to solve. Two groups of subjects learned an arbitrary face hierarchy, one adjacent face pair at a time; each group received either visual/exteroceptive (“XXXX”) or visceroappetitive/interoceptive (fruit juice) feedback for correct responses to adjacent face pairs. After task acquisition, the subjects were tested on novel stimulus pairs (i.e., nonadjacent, TEST) derived from the acquired hierarchy. The TEST condition required transitive inference. No feedback was provided during TEST.Brain activity during TEST in the group trained with visual/exteroceptive feedback increased in the orbital prefrontal cortex and decreased in the ventromedial prefrontal cortex. In contrast, brain activity during TEST in the group trained with visceroappetitive/interoceptive feedback decreased in the orbital prefrontal cortex and increased in the ventromedial prefrontal cortex.These results provide functional evidence, consistent with previous anatomical studies, for two major feedback systems in human ventral prefrontal cortex: a lateral system specialized for exteroceptive information and a medial system specialized for interoceptive information. Although highly interconnected, there is a double dissociation of function between these networks in healthy humans.
Creating Critical Consciousness in Health: Applications of Freire's Philosophy and Methods to the Health Care Setting
Authors: Minkler Meredith , Cox Kathleen 
Published: May 2005

Paulo Freire's philosophy of “education for critical consciousness” takes on special relevance within the context of the health care system. This dialogical approach to change, stressing action based on critical reflection by the people, is seen here as importantly supplementing current efforts to deal with the “health care crisis” in the United States and many developing countries. Applications of the Freire approach in a health context of necessity involve the perception of health and medical care within the total oppressive structure of society. Viewed thusly, health “reform” cannot justifiably be envisioned except within the context of broader structural transformations. Two case studies are presented to illustrate the application of the Freire approach within a health context. Successful utilization of the methodology among peasants in rural Honduras and a relatively unsuccessful application among impoverished elderly residents of an urban United States ghetto are described and analyzed. Modifications of the approach to increase its usefulness in a variety of situational contexts are suggested. The potentials and limitations of this approach to radical change in the health field finally are described, along with lessons learned from initial work in the applications of conscientización to the health field.
Psychologic Distress during Menopause: Associations across the Reproductive Life Cycle
Authors: Stewart Donna E. , Boydell Katherine M. 
Published: May 2005

Objective: To determine if women with high psychologic distress attending a menopause clinic report more previous psychiatric disorders (especially depression), or psychologic distress associated with oral contraceptive use and reproductive cycle events than women with low psychologic distress attending the clinic. Method: Consecutive women attending a university hospital menopause clinic were administered the Brief Symptom Inventory (BSI). Women with high psychologic distress (who met case severity on the BSI general severity index) were compared to a similar number of the lowest scoring clinic women on their reports of previous psychiatric diagnoses and treatment, and depression or distress related to oral contraceptive use, the premenstrual period, or associated with pregnancy. Results: The forty-four women with high psychologic distress were significantly more likely than the forty-two menopause clinic patients with low psychologic distress to report a past psychiatric diagnosis (usually depression) ( p = 0.001), requiring anti-depressant treatment ( p = 0.002), oral contraceptive dysphoria ( p = 0.004), dysphoric premenstrual syndrome ( p = 0.000), postnatal blues ( p = 0.02) and postpartum depression ( p = 0.004). Conclusions: Although the halo effect of current distress or retrospective reporting may have biased these results, the similarity of ratings in the two groups on physical symptoms in menopause and psychologic symptoms during pregnancy makes this less likely. These findings corroborate other recent studies showing that women who suffer from affective disorders following one reproductive event are more vulnerable to recurrences associated with others. Clinicians should inquire about possible relationships between previous depression or psychologic distress and reproductive cycle events as it may help predict women who are vulnerable to affective disorders and psychological distress at these critical times.
The Balint Group and Preventive Industrial Medicine
Authors: Chertok Leon G. , Bourguignon Odile 
Published: May 2005

The author presents the results of his innovative experience with a group of unique medical practitioners-industrial physicians-who appeared in some ways ideally suited to the Balint method of psychological instruction. Because the “work doctor” was, by definition, limited in his use of the traditional medical techniques available to his general practitioner colleagues, he would seem most potentially receptive to an opportunity to acquire new skills in the psychological “use of himself.” Some participants enthusiastically endorsed the experience, others felt dissatisfied with the “lack of structure and theoretical teaching” and still others, exhibiting some resistance to and denial of the relevance of psychological factors in their work, dropped out early. Detailed accounts and specific experiences of group members are described, and the author proffers his comments and conclusions.
Science and Technology as Integral Parts of Our Culture: Interdisciplinary Responsibilities of the Scientific Communicator
Authors: Richardson Jacques G. 
Published: May 2005

In this paper, part of a symposium on the popularization of science and technology, the author develops a number of themes: why should a specific topic be popularized; the topics currently be researched by UNESCO; the problems of man and his environment and man as the center of development; and the role of the communicator as interpreter. There are indications that the elimination of war as a legitimate means of settling a conflict and that the abolition of mass poverty and of disparities of economic development either already pertain to or will very soon pertain to the international imperatives for the survival of … society.
Approaches to Evaluation: Social Area Analysis
Authors: Struening Elmer L. 
Published: May 2005

Modern social area analysis, as presented by Tryon and Bailey, offers a methodology for understanding the selective use of health services and for evaluating the effects of change introduced into health service delivery systems. Definitions of evaluation research are given in this paper, followed by a brief history and definition of social area analysis. Three types of evaluation studies-descriptive, comparative or correlational, and experimental-are described and exemplified. The role of epidemiologic data in describing catchment areas and in the identification and location of high-risk populations is discussed. Applications of multivariate statistical procedures for identifying salient dimensions of defined areas and for developing equations linking area characteristics to rates of service use are described. It is concluded that applications of social area analysis methodology can make important contributions to the evaluation of health delivery systems serving catchment area populations.
The Issue of Communication within Medicine
Authors: Joyce C. R. B. 
Published: May 2005

Communicating is one of the physician's most important skills; yet there are serious impediments to acquiring such assets in medical curricula as customarily presented. Balint attempted to fill a void in this significant area through an innovative approach to group discussion of cases, which enabled the doctor to “use himself” more effectively in the doctor-patient relationship. Through self-development and insight, the physician could improve his “apostolic function” as a teacher-to the patient's benefit. Communication is viewed as a two-way exchange, acknowledging the impact of the doctor upon the patient as well as the patient upon the doctor. The “soft” data of experience, behavior, dress and speech are as relevant as more quantifiable information. The ambiguity of words-and even silence-can have a profound influence upon illness in the context of the interaction between patient and physician. In spite of the difficulties of evaluating studies in the area of human relations, medical students and physicians are urged to undertake such explorations to enhance their own growth and perceptiveness and thereby improve their capacity to communicate meaningfully. Representative examples of such studies–including the small-group experience as used by Balint-are reported.
Maladaptive Denial of Physical Illness: A Useful New “Diagnosis”
Authors: Muskin Philip R. , Feldhammer Tovah , Gelfand Janice L. , Strauss David H. 
Published: May 2005

Objective: Denial of physical illness and/or refusal of treatment are critical issues in the practice of medicine. A previous article proposed DSM-IV consider a new diagnosis for a subgroup of patients who refuse treatment, i.e., maladaptive denial of physical illness [1]. It is necessary to be able to use this form of denial as a diagnosis rather than invoke the term denial as merely a mental mechanism. This is a report of a prospective descriptive study of psychiatric consultations for medical inpatients who deny that they are ill or who refuse treatment. Method: In order to investigate the utility of this proposed diagnosis we conducted a one year study of all psychiatric consultations at a community hospital in Manhattan, New York. Results: The diagnosis of maladaptive denial of physical illness was made in 2.5 percent of 317 psychiatric consultations. The patients did not fit into other DSM-III-R or DSM-IV categories. Conclusions: We suggest a clarification of the concept of denial for use with medically ill patients. The findings in this study demonstrate that the current categories in DSM-IV do not provide physicians with a diagnosis that describes this particular type of pathological denial of illness.
Interactive Two-Way Television vs. In-Person Teaching
Authors: Johnson Glenn Ross , O'Connor Michael , Rossing Robert 
Published: May 2005

Are there differences in students' achievement scores and attitudes when the pupils are taught by two different modes: interactive two-way television and live expository teaching? Thirteen graduate students were enrolled in a university off-campus course: five were instructors at a community college, five worked in a hospital or Veterans Administration facility, and three were instructors at a university. A repeated measures design was used in collecting achievement and attitude data on six class sessions (three in-person expository and three interactive television). Analysis of variance was used with test scores as the dependent variable while the mode of instruction (in-person vs. two-way television), instructional strategy (expository, film, role play/simulation), and content of lesson (eight different sessions) were used as the independent variables. There were no negative student attitudes when the class was taught either in-person or by interactive two-way television. Analysis of variance revealed no significant differences when test scores were used as the dependent variable.
A Pilot Study of a Short Cognitive-Behavioral Group Treatment for Female Recurrent Suicide Attempters
Authors: Hengeveld Michiel W. , Jonker Daan J. L. , Rooijmans Harry G. M. 
Published: May 2005

Objective: To test the feasibility and effectiveness of a high-frequency short-term group cognitive-behavioral therapy (CBT) for recurrent suicide attempters. Method: CBT consisting of eight weekly and two “booster” sessions was given to nine female out-patients who had attempted suicide at least twice, seven of whom had a personality disorder. Results: Four patients dropped out during the treatment; either because they were “chronic repeaters” (i.e., had a history of more than 8 suicide attempts), or because the last suicide attempt was too long ago. Although the patients were generally positive about the content of the therapy, no effects on psychiatric symptomatology or repetition of suicidal behavior could be demonstrated. Conclusions: Based on this experience, and on the two controlled studies of CBT of recurrent suicide attempters published in the literature, it is tentatively concluded that it is difficult to organize a short-term high-frequency group treatment for recurrent suicide attempters with personality disorders, and that CBT may delay repetition of suicidal behavior, but that “major repeaters” (i.e., who made 4 or more suicide attempts) with a borderline personality disorder tend to stay major repeaters.
Technical and Creative Writing: Common Process, Common Goals
Authors: Rothmel Steven Zachary 
Published: May 2005

Creative and technical writing share definite, but seldom realized, affinities. Like the fiction writer, the engineer and the scientist must realize that writing is a creative process rather than a reflex action if they are to communicate successfully. Often, professional advancement depends on the ability to present and to interpret factual information coherently and effectively. Although technical writing presents factual information and creative writing fictional information, both crafts adhere to the same underlying rhetorical principles in order to create their desired effects. This article examines those shared principles that make technical writing more than a prosaic exercise and allow writers to express themselves meaningfully. The role of imagination in this craft is also explored.
The Pathophysiology of Chronic Fatigue Syndrome: Confirmations, Contradictions, and Conjectures
Authors: Manu Peter , Lane Thomas J. , Matthews Dale A. 
Published: May 2005

Objective: To examine published data regarding patient cohorts with the recently defined chronic fatigue syndrome. Method: Review of thirty-two peer-assessed research publications that included full disclosure of the methodology employed; classification of the findings as confirmed, contradictory, or non-duplicated. Results: Research studies have confirmed that the majority of patients with the chronic fatigue syndrome: 1) are white middle-aged women, 2) have a high prevalence of current major depression and somatization disorder, 3) have abnormal personality traits, 4) believe that their fatigue has a physical cause, and 5) show mild abnormalities of humoral immunity. Contradictory data have been presented with regard to: 1) the time of onset of depressive disorders, 2) the etiologic role of herpetic and enteroviral infections, 3) the presence of abnormal cellular immunity, and 4) the clinical utility of immunoglobulin therapy. Non-duplicated research has indicated 1) hypothalamic-pituitary-adrenal axis dysfunction, 2) abnormalities on magnetic resonance images of the brain, 3) altered cytokine production, and 4) the possibility of retroviral infection. Conclusions: As presently defined, the chronic fatigue syndrome has many of the clinical and biological features associated with depressive and somatoform disorders. A specific etiologic role for infections or immune dysfunction has not been confirmed.
Symposium on an Objective-Based Resource Retrieval System
Authors: Garmise Robert S. , Powers John R. 
Published: May 2005

The primary objective of any objective-based resource retrieval system is to provide users with a rapid, cost/effective means of retrieving resources suited to the needs of the learners. This is accomplished by Battelle's BETSY system through the use of a computerized retrieval system designed specifically for educators to facilitate learning. BETSY began as an idea during the summer of 1973. Its roots can be vaguely traced to the Computer Based Resource Units (CBRU) of Buffalo, New York. The original premise was to make CBRU available on-line to educators. Through an ESEA Title III grant to the Mentor, Ohio Board of Education, this original concept was stretched and expanded to the present system that not only provides on-line access to over 15,000,000 characters of data, but also provides a very low cost planning instrument. What was originally student oriented is now learner oriented. That learner can still be a student, but he can also be a teacher or curriculum designer.