An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge

PubMed Central

2014-01-01

Background There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. Results A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. Conclusions The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups. PMID:24667040

Interpretation of biomonitoring data in clinical medicine and the exposure sciences

DOE Office of Scientific and Technical Information (OSTI.GOV)

Williams, Bryan L.; Barr, Dana B.; Wright, J. Michael

2008-11-15

Biomonitoring has become a fundamental tool in both exposure science and clinical medicine. Despite significant analytical advances, the clinical use of environmental biomarkers remains in its infancy. Clinical use of environmental biomarkers poses some complex scientific and ethical challenges. The purpose of this paper is compare how the clinical and exposure sciences differ with respect to their interpretation and use of biological data. Additionally, the clinical use of environmental biomonitoring data is discussed. A case study is used to illustrate the complexities of conducting biomonitoring research on highly vulnerable populations in a clinical setting.

Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature

PubMed Central

Karliner, Leah S; Jacobs, Elizabeth A; Chen, Alice Hm; Mutha, Sunita

2007-01-01

Objective To determine if professional medical interpreters have a positive impact on clinical care for limited English proficiency (LEP) patients. Data Sources A systematic literature search, limited to the English language, in PubMed and PsycINFO for publications between 1966 and September 2005, and a search of the Cochrane Library. Study Design Any peer-reviewed article which compared at least two language groups, and contained data about professional medical interpreters and addressed communication (errors and comprehension), utilization, clinical outcomes, or satisfaction were included. Of 3,698 references, 28 were found by multiple reviewers to meet inclusion criteria and, of these, 21 assessed professional interpreters separately from ad hoc interpreters. Data were abstracted from each article by two reviewers. Data were collected on the study design, size, comparison groups, analytic technique, interpreter training, and method of determining the participants' need for an interpreter. Each study was evaluated for the effect of interpreter use on four clinical topics that were most likely to either impact or reflect disparities in health and health care. Principal Findings In all four areas examined, use of professional interpreters is associated with improved clinical care more than is use of ad hoc interpreters, and professional interpreters appear to raise the quality of clinical care for LEP patients to approach or equal that for patients without language barriers. Conclusions Published studies report positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes and satisfaction with care. PMID:17362215

Conceptualizing clinical nurse leader practice: an interpretive synthesis.

PubMed

Bender, Miriam

2016-01-01

The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. Interpretive synthesis design and grounded theory analysis were used to develop a theoretical understanding of clinical nurse leader practice that can facilitate systematic and replicable implementation across health-care settings. The core phenomenon of clinical nurse leader practice is continuous clinical leadership, which involves four fundamental activities: facilitating effective ongoing communication; strengthening intra and interprofessional relationships; building and sustaining teams; and supporting staff engagement. Clinical nurse leaders continuously communicate and develop relationships within and across professions to promote and sustain information exchange, engagement, teamwork and effective care processes at the microsystem level. Clinical nurse leader-integrated care delivery systems highlight the benefits of nurse-led models of care for transforming health-care quality. Managers can use this study's findings to frame an implementation strategy that addresses theoretical domains of clinical nurse leader practice to help ensure practice success. © 2015 John Wiley & Sons Ltd.

Interpreting “statistical hypothesis testing” results in clinical research

PubMed Central

Sarmukaddam, Sanjeev B.

2012-01-01

Difference between “Clinical Significance and Statistical Significance” should be kept in mind while interpreting “statistical hypothesis testing” results in clinical research. This fact is already known to many but again pointed out here as philosophy of “statistical hypothesis testing” is sometimes unnecessarily criticized mainly due to failure in considering such distinction. Randomized controlled trials are also wrongly criticized similarly. Some scientific method may not be applicable in some peculiar/particular situation does not mean that the method is useless. Also remember that “statistical hypothesis testing” is not for decision making and the field of “decision analysis” is very much an integral part of science of statistics. It is not correct to say that “confidence intervals have nothing to do with confidence” unless one understands meaning of the word “confidence” as used in context of confidence interval. Interpretation of the results of every study should always consider all possible alternative explanations like chance, bias, and confounding. Statistical tests in inferential statistics are, in general, designed to answer the question “How likely is the difference found in random sample(s) is due to chance” and therefore limitation of relying only on statistical significance in making clinical decisions should be avoided. PMID:22707861

Interpreting and Integrating Clinical and Anatomic Pathology Results.

PubMed

Ramaiah, Lila; Hinrichs, Mary Jane; Skuba, Elizabeth V; Iverson, William O; Ennulat, Daniela

2017-01-01

The continuing education course on integrating clinical and anatomical pathology data was designed to communicate the importance of using a weight of evidence approach to interpret safety findings in toxicology studies. This approach is necessary, as neither clinical nor anatomic pathology data can be relied upon in isolation to fully understand the relationship between study findings and the test article. Basic principles for correlating anatomic pathology and clinical pathology findings and for integrating these with other study end points were reviewed. To highlight these relationships, a series of case examples, presented jointly by a clinical pathologist and an anatomic pathologist, were used to illustrate the collaborative effort required between clinical and anatomical pathologists. In addition, the diagnostic utility of traditional liver biomarkers was discussed using results from a meta-analysis of rat hepatobiliary marker and histopathology data. This discussion also included examples of traditional and novel liver and renal biomarker data implementation in nonclinical toxicology studies to illustrate the relationship between discrete changes in biochemistry and tissue morphology.

Clinical Interpretation and Implications of Whole-Genome Sequencing

PubMed Central

Dewey, Frederick E.; Grove, Megan E.; Pan, Cuiping; Goldstein, Benjamin A.; Bernstein, Jonathan A.; Chaib, Hassan; Merker, Jason D.; Goldfeder, Rachel L.; Enns, Gregory M.; David, Sean P.; Pakdaman, Neda; Ormond, Kelly E.; Caleshu, Colleen; Kingham, Kerry; Klein, Teri E.; Whirl-Carrillo, Michelle; Sakamoto, Kenneth; Wheeler, Matthew T.; Butte, Atul J.; Ford, James M.; Boxer, Linda; Ioannidis, John P. A.; Yeung, Alan C.; Altman, Russ B.; Assimes, Themistocles L.; Snyder, Michael; Ashley, Euan A.; Quertermous, Thomas

2014-01-01

IMPORTANCE Whole-genome sequencing (WGS) is increasingly applied in clinical medicine and is expected to uncover clinically significant findings regardless of sequencing indication. OBJECTIVES To examine coverage and concordance of clinically relevant genetic variation provided by WGS technologies; to quantitate inherited disease risk and pharmacogenomic findings in WGS data and resources required for their discovery and interpretation; and to evaluate clinical action prompted by WGS findings. DESIGN, SETTING, AND PARTICIPANTS An exploratory study of 12 adult participants recruited at Stanford University Medical Center who underwent WGS between November 2011 and March 2012. A multidisciplinary team reviewed all potentially reportable genetic findings. Five physicians proposed initial clinical follow-up based on the genetic findings. MAIN OUTCOMES AND MEASURES Genome coverage and sequencing platform concordance in different categories of genetic disease risk, person-hours spent curating candidate disease-risk variants, interpretation agreement between trained curators and disease genetics databases, burden of inherited disease risk and pharmacogenomic findings, and burden and interrater agreement of proposed clinical follow-up. RESULTS Depending on sequencing platform, 10% to 19% of inherited disease genes were not covered to accepted standards for single nucleotide variant discovery. Genotype concordance was high for previously described single nucleotide genetic variants (99%-100%) but low for small insertion/deletion variants (53%-59%). Curation of 90 to 127 genetic variants in each participant required a median of 54 minutes (range, 5-223 minutes) per genetic variant, resulted in moderate classification agreement between professionals (Gross κ, 0.52; 95%CI, 0.40-0.64), and reclassified 69%of genetic variants cataloged as disease causing in mutation databases to variants of uncertain or lesser significance. Two to 6 personal disease-risk findings were discovered

Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism.

PubMed

Takach Lapner, Sarah; Julian, Jim A; Linkins, Lori-Ann; Bates, Shannon; Kearon, Clive

2017-10-05

Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7 %) and the age-adjusted strategy (99.6 %) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1 % vs, 50.9 %; difference 5.2 %; 95 % CI 3.5 % to 6.8 %). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

Sea-Based Infrared Scene Interpretation by Background Type Classification and Coastal Region Detection for Small Target Detection

PubMed Central

Kim, Sungho

2015-01-01

Sea-based infrared search and track (IRST) is important for homeland security by detecting missiles and asymmetric boats. This paper proposes a novel scheme to interpret various infrared scenes by classifying the infrared background types and detecting the coastal regions in omni-directional images. The background type or region-selective small infrared target detector should be deployed to maximize the detection rate and to minimize the number of false alarms. A spatial filter-based small target detector is suitable for identifying stationary incoming targets in remote sea areas with sky only. Many false detections can occur if there is an image sector containing a coastal region, due to ground clutter and the difficulty in finding true targets using the same spatial filter-based detector. A temporal filter-based detector was used to handle these problems. Therefore, the scene type and coastal region information is critical to the success of IRST in real-world applications. In this paper, the infrared scene type was determined using the relationships between the sensor line-of-sight (LOS) and a horizontal line in an image. The proposed coastal region detector can be activated if the background type of the probing sector is determined to be a coastal region. Coastal regions can be detected by fusing the region map and curve map. The experimental results on real infrared images highlight the feasibility of the proposed sea-based scene interpretation. In addition, the effects of the proposed scheme were analyzed further by applying region-adaptive small target detection. PMID:26404308

Cancer Genome Interpreter annotates the biological and clinical relevance of tumor alterations.

PubMed

Tamborero, David; Rubio-Perez, Carlota; Deu-Pons, Jordi; Schroeder, Michael P; Vivancos, Ana; Rovira, Ana; Tusquets, Ignasi; Albanell, Joan; Rodon, Jordi; Tabernero, Josep; de Torres, Carmen; Dienstmann, Rodrigo; Gonzalez-Perez, Abel; Lopez-Bigas, Nuria

2018-03-28

While tumor genome sequencing has become widely available in clinical and research settings, the interpretation of tumor somatic variants remains an important bottleneck. Here we present the Cancer Genome Interpreter, a versatile platform that automates the interpretation of newly sequenced cancer genomes, annotating the potential of alterations detected in tumors to act as drivers and their possible effect on treatment response. The results are organized in different levels of evidence according to current knowledge, which we envision can support a broad range of oncology use cases. The resource is publicly available at http://www.cancergenomeinterpreter.org .

Exploring Iconic Interpretation and Mathematics Teacher Development through Clinical Simulations

ERIC Educational Resources Information Center

Dotger, Benjamin; Masingila, Joanna; Bearkland, Mary; Dotger, Sharon

2015-01-01

Field placements serve as the traditional "clinical" experience for prospective mathematics teachers to immerse themselves in the mathematical challenges of students. This article reports data from a different type of learning experience, that of a clinical simulation with a standardized individual. We begin with a brief background on…

Anatomy and history of an external quality assessment program for interpretative comments in clinical biochemistry.

PubMed

Vasikaran, Samuel D

2015-05-01

The provision of clinical interpretation of results, either verbally or in the printed report, may be considered an integral part of clinical biochemistry diagnostic service. Proficiency testing or external quality assessment (EQA) of such activity may be useful in education, training, continuing professional development and ensuring the quality of such service. Details of the Patient Report Comments Program (RPCProgram) developed by the Royal College of Pathologists of Australasia (RCPA) Chemical Pathology Quality Assurance Programs Pty Ltd (QAP) is described in this review. The program is aimed at pathologists, clinical scientists and trainees. Registered participants are provided a report with case details and a set of clinical biochemistry results at monthly intervals and submit an interpretative comment for the report. Comments received are broken up into components that are translated into common key phrases. An expert panel evaluates the key phrases, classifies them according to appropriateness and drafts a suggested comment, a case summary and a rationale, which are included in a summary report returned to participants. There is considerable diversity in the quality of interpretative comments received from participants of the PRCProgram. The primary purpose of EQA of interpretative commenting is educational self-assessment, and they are recognized as a continuing professional development activity. Whilst there is some evidence for the utility of interpretative comments in improving patient outcomes, evidence for the utility of EQA in improving quality of comments is awaited. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Defining a clinically meaningful effect for the design and interpretation of randomized controlled trials.

PubMed

Keefe, Richard S E; Kraemer, Helena C; Epstein, Robert S; Frank, Ellen; Haynes, Ginger; Laughren, Thomas P; McNulty, James; Reed, Shelby D; Sanchez, Juan; Leon, Andrew C

2013-05-01

This article captures the proceedings of a meeting aimed at defining clinically meaningful effects for use in randomized controlled trials for psychopharmacological agents. Experts from a variety of disciplines defined clinically meaningful effects from their perspectives along with viewpoints about how to design and interpret randomized controlled trials. The article offers relevant, practical, and sometimes anecdotal information about clinically meaningful effects and how to interpret them. The concept for this session was the work of co-chairs Richard Keefe and the late Andy Leon. Faculty included Richard Keefe, PhD; James McNulty, AbScB; Robert S. Epstein, MD, MS; Shelby D. Reed, PhD; Juan Sanchez, MD; Ginger Haynes, PhD; Andrew C. Leon, PhD; Helena Chmura Kraemer, PhD; Ellen Frank, PhD, and Kenneth L. Davis, MD. The term clinically meaningful effect is an important aspect of designing and interpreting randomized controlled trials but can be particularly difficult in the setting of psychopharmacology where effect size may be modest, particularly over the short term, because of a strong response to placebo. Payers, regulators, patients, and clinicians have different concerns about clinically meaningful effects and may describe these terms differently. The use of moderators in success rate differences may help better delineate clinically meaningful effects. There is no clear consensus on a single definition for clinically meaningful differences in randomized controlled trials, and investigators must be sensitive to specific concerns of stakeholders in psychopharmacology in order to design and execute appropriate clinical trials.

Competency in ECG Interpretation Among Medical Students

PubMed Central

Kopeć, Grzegorz; Magoń, Wojciech; Hołda, Mateusz; Podolec, Piotr

2015-01-01

Background Electrocardiogram (ECG) is commonly used in diagnosis of heart diseases, including many life-threatening disorders. We aimed to assess skills in ECG interpretation among Polish medical students and to analyze the determinants of these skills. Material/Methods Undergraduates from all Polish medical schools were asked to complete a web-based survey containing 18 ECG strips. Questions concerned primary ECG parameters (rate, rhythm, and axis), emergencies, and common ECG abnormalities. Analysis was restricted to students in their clinical years (4th–6th), and students in their preclinical years (1st–3rd) were used as controls. Results We enrolled 536 medical students (females: n=299; 55.8%), aged 19 to 31 (23±1.6) years from all Polish medical schools. Most (72%) were in their clinical years. The overall rate of good response was better in students in years 4th–5th than those in years 1st–3rd (66% vs. 56%; p<0.0001). Competency in ECG interpretation was higher in students who reported ECG self-learning (69% vs. 62%; p<0.0001) but no difference was found between students who attended or did not attend regular ECG classes (66% vs. 66%; p=0.99). On multivariable analysis (p<0.0001), being in clinical years (OR: 2.45 [1.35–4.46] and self-learning (OR: 2.44 [1.46–4.08]) determined competency in ECG interpretation. Conclusions Polish medical students in their clinical years have a good level of competency in interpreting the primary ECG parameters, but their ability to recognize ECG signs of emergencies and common heart abnormalities is low. ECG interpretation skills are determined by self-education but not by attendance at regular ECG classes. Our results indicate qualitative and quantitative deficiencies in teaching ECG interpretation at medical schools. PMID:26541993

A Growing Consensus for Change in Interpretation of Clinical Research Evidence.

PubMed

Wilkerson, Gary B; Denegar, Craig R

2018-03-01

  The paradigm of evidence-based practice (EBP) is well established among the health care professions, but perspectives on the best methods for acquiring, analyzing, appraising, and using research evidence are evolving.   The EBP paradigm has shifted away from a hierarchy of research-evidence quality to recognize that multiple research methods can yield evidence to guide clinicians and patients through a decision-making process. Whereas the "frequentist" approach to data interpretation through hypothesis testing has been the dominant analytical method used by and taught to athletic training students and scholars, this approach is not optimal for integrating evidence into routine clinical practice. Moreover, the dichotomy of rejecting, or failing to reject, a null hypothesis is inconsistent with the Bayesian-like clinical decision-making process that skilled health care providers intuitively use. We propose that data derived from multiple research methods can be best interpreted by reporting a credible lower limit that represents the smallest treatment effect at a specified level of certainty, which should be judged in relation to the smallest effect considered to be clinically meaningful. Such an approach can provide a quantifiable estimate of certainty that an individual patient needs follow-up attention to prevent an adverse outcome or that a meaningful level of therapeutic benefit will be derived from a given intervention.   The practice of athletic training will be influenced by the evolution of the EBP paradigm. Contemporary practice will require clinicians to expand their critical-appraisal skills to effectively integrate the results derived from clinical research into the care of individual patients. Proper interpretation of a credible lower limit value for a magnitude ratio has the potential to increase the likelihood of favorable patient outcomes, thereby advancing the practice of evidence-based athletic training.

Interpretative commenting.

PubMed

Vasikaran, Samuel

2008-08-01

* Clinical laboratories should be able to offer interpretation of the results they produce. * At a minimum, contact details for interpretative advice should be available on laboratory reports.Interpretative comments may be verbal or written and printed. * Printed comments on reports should be offered judiciously, only where they would add value; no comment preferred to inappropriate or dangerous comment. * Interpretation should be based on locally agreed or nationally recognised clinical guidelines where available. * Standard tied comments ("canned" comments) can have some limited use.Individualised narrative comments may be particularly useful in the case of tests that are new, complex or unfamiliar to the requesting clinicians and where clinical details are available. * Interpretative commenting should only be provided by appropriately trained and credentialed personnel. * Audit of comments and continued professional development of personnel providing them are important for quality assurance.

Interpretative Commenting

PubMed Central

Vasikaran, Samuel

2008-01-01

Summary Clinical laboratories should be able to offer interpretation of the results they produce.At a minimum, contact details for interpretative advice should be available on laboratory reports.Interpretative comments may be verbal or written and printed.Printed comments on reports should be offered judiciously, only where they would add value; no comment preferred to inappropriate or dangerous comment.Interpretation should be based on locally agreed or nationally recognised clinical guidelines where available.Standard tied comments (“canned” comments) can have some limited use.Individualised narrative comments may be particularly useful in the case of tests that are new, complex or unfamiliar to the requesting clinicians and where clinical details are available.Interpretative commenting should only be provided by appropriately trained and credentialed personnel.Audit of comments and continued professional development of personnel providing them are important for quality assurance. PMID:18852867

Theory of mind in utterance interpretation: the case from clinical pragmatics.

PubMed

Cummings, Louise

2015-01-01

The cognitive basis of utterance interpretation is an area that continues to provoke intense theoretical debate among pragmatists. That utterance interpretation involves some type of mind-reading or theory of mind (ToM) is indisputable. However, theorists are divided on the exact nature of this ToM-based mechanism. In this paper, it is argued that the only type of ToM-based mechanism that can adequately represent the cognitive basis of utterance interpretation is one which reflects the rational, intentional, holistic character of interpretation. Such a ToM-based mechanism is supported on conceptual and empirical grounds. Empirical support for this view derives from the study of children and adults with pragmatic disorders. Specifically, three types of clinical case are considered. In the first case, evidence is advanced which indicates that individuals with pragmatic disorders exhibit deficits in reasoning and the use of inferences. These deficits compromise the ability of children and adults with pragmatic disorders to comply with the rational dimension of utterance interpretation. In the second case, evidence is presented which suggests that subjects with pragmatic disorders struggle with the intentional dimension of utterance interpretation. This dimension extends beyond the recognition of communicative intentions to include the attribution of a range of cognitive and affective mental states that play a role in utterance interpretation. In the third case, evidence is presented that children and adults with pragmatic disorders struggle with the holistic character of utterance interpretation. This serves to distort the contexts in which utterances are processed for their implicated meanings. The paper concludes with some thoughts about the role of theorizing in relation to utterance interpretation.

Theory of mind in utterance interpretation: the case from clinical pragmatics

PubMed Central

Cummings, Louise

2015-01-01

The cognitive basis of utterance interpretation is an area that continues to provoke intense theoretical debate among pragmatists. That utterance interpretation involves some type of mind-reading or theory of mind (ToM) is indisputable. However, theorists are divided on the exact nature of this ToM-based mechanism. In this paper, it is argued that the only type of ToM-based mechanism that can adequately represent the cognitive basis of utterance interpretation is one which reflects the rational, intentional, holistic character of interpretation. Such a ToM-based mechanism is supported on conceptual and empirical grounds. Empirical support for this view derives from the study of children and adults with pragmatic disorders. Specifically, three types of clinical case are considered. In the first case, evidence is advanced which indicates that individuals with pragmatic disorders exhibit deficits in reasoning and the use of inferences. These deficits compromise the ability of children and adults with pragmatic disorders to comply with the rational dimension of utterance interpretation. In the second case, evidence is presented which suggests that subjects with pragmatic disorders struggle with the intentional dimension of utterance interpretation. This dimension extends beyond the recognition of communicative intentions to include the attribution of a range of cognitive and affective mental states that play a role in utterance interpretation. In the third case, evidence is presented that children and adults with pragmatic disorders struggle with the holistic character of utterance interpretation. This serves to distort the contexts in which utterances are processed for their implicated meanings. The paper concludes with some thoughts about the role of theorizing in relation to utterance interpretation. PMID:26379602

Defining a Clinically Meaningful Effect for the Design and Interpretation of Randomized Controlled Trials

PubMed Central

Kraemer, Helena C.; Epstein, Robert S.; Frank, Ellen; Haynes, Ginger; Laughren, Thomas P.; Mcnulty, James; Reed, Shelby D.; Sanchez, Juan; Leon, Andrew C.

2013-01-01

Objective: This article captures the proceedings of a meeting aimed at defining clinically meaningful effects for use in randomized controlled trials for psychopharmacological agents. Design: Experts from a variety of disciplines defined clinically meaningful effects from their perspectives along with viewpoints about how to design and interpret randomized controlled trials. Setting: The article offers relevant, practical, and sometimes anecdotal information about clinically meaningful effects and how to interpret them. Participants: The concept for this session was the work of co-chairs Richard Keefe and the late Andy Leon. Faculty included Richard Keefe, PhD; James McNulty, AbScB; Robert S. Epstein, MD, MS; Shelby D. Reed, PhD; Juan Sanchez, MD; Ginger Haynes, PhD; Andrew C. Leon, PhD; Helena Chmura Kraemer, PhD; Ellen Frank, PhD, and Kenneth L. Davis, MD. Results: The term clinically meaningful effect is an important aspect of designing and interpreting randomized controlled trials but can be particularly difficult in the setting of psychopharmacology where effect size may be modest, particularly over the short term, because of a strong response to placebo. Payers, regulators, patients, and clinicians have different concerns about clinically meaningful effects and may describe these terms differently. The use of moderators in success rate differences may help better delineate clinically meaningful effects. Conclusion: There is no clear consensus on a single definition for clinically meaningful differences in randomized controlled trials, and investigators must be sensitive to specific concerns of stakeholders in psychopharmacology in order to design and execute appropriate clinical trials. PMID:23882433

An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications.

PubMed

Dweik, Raed A; Boggs, Peter B; Erzurum, Serpil C; Irvin, Charles G; Leigh, Margaret W; Lundberg, Jon O; Olin, Anna-Carin; Plummer, Alan L; Taylor, D Robin

2011-09-01

Measurement of fractional nitric oxide (NO) concentration in exhaled breath (Fe(NO)) is a quantitative, noninvasive, simple, and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. While Fe(NO) measurement has been standardized, there is currently no reference guideline for practicing health care providers to guide them in the appropriate use and interpretation of Fe(NO) in clinical practice. To develop evidence-based guidelines for the interpretation of Fe(NO) measurements that incorporate evidence that has accumulated over the past decade. We created a multidisciplinary committee with expertise in the clinical care, clinical science, or basic science of airway disease and/or NO. The committee identified important clinical questions, synthesized the evidence, and formulated recommendations. Recommendations were developed using pragmatic systematic reviews of the literature and the GRADE approach. The evidence related to the use of Fe(NO) measurements is reviewed and clinical practice recommendations are provided. In the setting of chronic inflammatory airway disease including asthma, conventional tests such as FEV(1) reversibility or provocation tests are only indirectly associated with airway inflammation. Fe(NO) offers added advantages for patient care including, but not limited to (1) detecting of eosinophilic airway inflammation, (2) determining the likelihood of corticosteroid responsiveness, (3) monitoring of airway inflammation to determine the potential need for corticosteroid, and (4) unmasking of otherwise unsuspected nonadherence to corticosteroid therapy.

Applying Chomsky's Linguistic Methodology to the Clinical Interpretation of Symbolic Play.

ERIC Educational Resources Information Center

Ariel, Shlomo

This paper summarizes how Chomsky's methodological principles of linguistics may be applied to the clinical interpretation of children's play. Based on Chomsky's derivation of a "universal grammar" (the set of essential, formal, and substantive traits of any human language), a number of hypothesized formal universals of…

Interpretation of Blood Microbiology Results - Function of the Clinical Microbiologist.

PubMed

Kristóf, Katalin; Pongrácz, Júlia

2016-04-01

The proper use and interpretation of blood microbiology results may be one of the most challenging and one of the most important functions of clinical microbiology laboratories. Effective implementation of this function requires careful consideration of specimen collection and processing, pathogen detection techniques, and prompt and precise reporting of identification and susceptibility results. The responsibility of the treating physician is proper formulation of the analytical request and to provide the laboratory with complete and precise patient information, which are inevitable prerequisites of a proper testing and interpretation. The clinical microbiologist can offer advice concerning the differential diagnosis, sampling techniques and detection methods to facilitate diagnosis. Rapid detection methods are essential, since the sooner a pathogen is detected, the better chance the patient has of getting cured. Besides the gold-standard blood culture technique, microbiologic methods that decrease the time in obtaining a relevant result are more and more utilized today. In the case of certain pathogens, the pathogen can be identified directly from the blood culture bottle after propagation with serological or automated/semi-automated systems or molecular methods or with MALDI-TOF MS (matrix-assisted laser desorption-ionization time of flight mass spectrometry). Molecular biology methods are also suitable for the rapid detection and identification of pathogens from aseptically collected blood samples. Another important duty of the microbiology laboratory is to notify the treating physician immediately about all relevant information if a positive sample is detected. The clinical microbiologist may provide important guidance regarding the clinical significance of blood isolates, since one-third to one-half of blood culture isolates are contaminants or isolates of unknown clinical significance. To fully exploit the benefits of blood culture and other (non- culture

Interpreting clinical trial results by deductive reasoning: In search of improved trial design.

PubMed

Kurbel, Sven; Mihaljević, Slobodan

2017-10-01

Clinical trial results are often interpreted by inductive reasoning, in a trial design-limited manner, directed toward modifications of the current clinical practice. Deductive reasoning is an alternative in which results of relevant trials are combined in indisputable premises that lead to a conclusion easily testable in future trials. © 2017 WILEY Periodicals, Inc.

Incorporation of a clinical history into the interpretation process in a PACS environment

NASA Astrophysics Data System (ADS)

Cooperstein, Lawrence A.; Good, Barbara C.; Miketic, Linda M.; Tabor, Ellen K.; Yousem, Samuel A.; King, Jill L.; Gennari, Rose C.; Felice, Marc A.; Sidorovich, Kathleen

1990-08-01

In a large-scale, multi-reader study to investigate questions surrounding the issue of the implementation of picture archiving and communications systems (PACS) into the modern radiology environment, we examined the effect that the incorporation of a clinical history into the reading process would have on levels of diagnostic accuracy. Because we wanted to test the inclusion of the clinical history in an environment as close to that of the clinical situation as possible, we defined "history" to be a concise, objective, and potentially computer-extractable version of what appears in the patient records, including a statement from the referring physician when this is available. In a series of studies, four radiologists interpreted 247 posteroanterior normal and abnormal chest images on conventional film both with and without accompanying patient histories; five radiologists read the same number of images presented on a high-resolution video workstation with and without clinical histories. There were no significant differences (p = .05) in diagnostic accuracy rates with or without clinical history for either the film or the workstation in cases of interstitial disease, nodules, or pneumothorax. Diagnostic accuracy for the radiologists as a group was not affected by the presence of the clinical history. We concluded that for the interpretation of these abnormalities, the incorporation of clinical history with images in the PACS environment should not be a major goal.

Automatic interpretation and writing report of the adult waking electroencephalogram.

PubMed

Shibasaki, Hiroshi; Nakamura, Masatoshi; Sugi, Takenao; Nishida, Shigeto; Nagamine, Takashi; Ikeda, Akio

2014-06-01

Automatic interpretation of the EEG has so far been faced with significant difficulties because of a large amount of spatial as well as temporal information contained in the EEG, continuous fluctuation of the background activity depending on changes in the subject's vigilance and attention level, the occurrence of paroxysmal activities such as spikes and spike-and-slow-waves, contamination of the EEG with a variety of artefacts and the use of different recording electrodes and montages. Therefore, previous attempts of automatic EEG interpretation have been focussed only on a specific EEG feature such as paroxysmal abnormalities, delta waves, sleep stages and artefact detection. As a result of a long-standing cooperation between clinical neurophysiologists and system engineers, we report for the first time on a comprehensive, computer-assisted, automatic interpretation of the adult waking EEG. This system analyses the background activity, intermittent abnormalities, artefacts and the level of vigilance and attention of the subject, and automatically presents its report in written form. Besides, it also detects paroxysmal abnormalities and evaluates the effects of intermittent photic stimulation and hyperventilation on the EEG. This system of automatic EEG interpretation was formed by adopting the strategy that the qualified EEGers employ for the systematic visual inspection. This system can be used as a supplementary tool for the EEGer's visual inspection, and for educating EEG trainees and EEG technicians. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Experience of Adjunct Novice Clinical Nursing Faculty: An Interpretive Case Study

ERIC Educational Resources Information Center

Mann, Carol

2013-01-01

The purpose of this qualitative interpretive case study was to describe the experience of adjunct novice clinical nursing faculty who has less than three years teaching experience or feels novice in this setting. The nursing shortage in the United States is well documented and is forecasted to have significant impacts on the health care delivery…

Clinical interpretation of opioid tolerance versus opioid-induced hyperalgesia.

PubMed

Chen, Lucy; Sein, Michael; Vo, Trang; Amhmed, Shihab; Zhang, Yi; Hilaire, Kristin St; Houghton, Mary; Mao, Jianren

2014-01-01

Opioid analgesics are commonly used to manage moderate to severe pain. However, the long-term use of opioids could lead to opioid tolerance (OT) and opioid-induced hyperalgesia (OIH). Distinguishing OIH from OT would impact the practice of opioid therapy because opioid dose adjustment may differentially influence OT and OIH. Currently, there are no standard criteria of OT versus OIH causing considerable ambiguity in clinical interpretation and management of these conditions. The authors designed a practitioner-based survey consisting of 20 targeted questions. Answering these questions would require responders' actual clinical experiences with opioid therapy. The survey was conducted between 2011 and 2012 through direct mails or e-mails to 1,408 physicians who are currently practicing in the United States. The authors find that certain clinical characteristics (eg, increased pain despite opioid dose escalation) are often used by practitioners to make differential diagnosis of OT and OIH despite some overlap in their clinical presentation. A key difference in clinical outcome is that OT and OIH could be improved and exacerbated by opioid dose escalation, respectively. Our survey results revealed a significant knowledge gap in some responders regarding differential diagnosis and management of OT and OIH. The results also identified several issues, such as opioid dose adjustment and clinical comorbidities related to OT and OIH, which require future patient-based studies.

Minimizing effects of methodological decisions on interpretation and prediction in species distribution studies: An example with background selection

USGS Publications Warehouse

Jarnevich, Catherine S.; Talbert, Marian; Morisette, Jeffrey T.; Aldridge, Cameron L.; Brown, Cynthia; Kumar, Sunil; Manier, Daniel; Talbert, Colin; Holcombe, Tracy R.

2017-01-01

Evaluating the conditions where a species can persist is an important question in ecology both to understand tolerances of organisms and to predict distributions across landscapes. Presence data combined with background or pseudo-absence locations are commonly used with species distribution modeling to develop these relationships. However, there is not a standard method to generate background or pseudo-absence locations, and method choice affects model outcomes. We evaluated combinations of both model algorithms (simple and complex generalized linear models, multivariate adaptive regression splines, Maxent, boosted regression trees, and random forest) and background methods (random, minimum convex polygon, and continuous and binary kernel density estimator (KDE)) to assess the sensitivity of model outcomes to choices made. We evaluated six questions related to model results, including five beyond the common comparison of model accuracy assessment metrics (biological interpretability of response curves, cross-validation robustness, independent data accuracy and robustness, and prediction consistency). For our case study with cheatgrass in the western US, random forest was least sensitive to background choice and the binary KDE method was least sensitive to model algorithm choice. While this outcome may not hold for other locations or species, the methods we used can be implemented to help determine appropriate methodologies for particular research questions.

The effect of client ethnicity on clinical interpretation of the MMPI-2.

PubMed

Knaster, Cara A; Micucci, Joseph A

2013-02-01

Client ethnicity has been shown to affect clinicians' diagnostic impressions. However, it is not known whether interpretation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical scales is affected by ethnic bias. In this study, clinicians (82 males, 60 females) provided severity ratings for six symptoms based on three MMPI-2 profiles (representing the 27/72, 49/94, and 68/86 code-types) with the ethnicity of the client randomly assigned as either African American or Caucasian. To determine whether symptom severity ratings based on MMPI-2 profiles were affected by ethnicity, a 3 (code-type) × 2 (ethnicity) MANOVA was performed. Neither the main effect for ethnicity nor the ethnicity × code-type interaction was significant. These results indicated that the symptom severity ratings based on the MMPI-2 clinical scales were not affected by the client's identification as African American or Caucasian. Future studies are needed to explore the interpretation of profiles from clients representing other ethnic groups and for female clients.

Patterns of Communication through Interpreters: A Detailed Sociolinguistic Analysis

PubMed Central

Aranguri, Cesar; Davidson, Brad; Ramirez, Robert

2006-01-01

BACKGROUND Numerous articles have detailed how the presence of an interpreter leads to less satisfactory communication with physicians; few have studied how actual communication takes place through an interpreter in a clinical setting. OBJECTIVE Record and analyze physician-interpreter-patient interactions. DESIGN Primary care physicians with high-volume Hispanic practices were recruited for a communication study. Dyslipidemic Hispanic patients, either monolingual Spanish or bilingual Spanish-English, were recruited on the day of a normally scheduled appointment and, once consented, recorded without a researcher present in the room. Separate postvisit interviews were conducted with the patient and the physician. All interactions were fully transcribed and analyzed. PARTICIPANTS Sixteen patients were recorded interacting with 9 physicians. Thirteen patients used an interpreter with 8 physicians, and 3 patients spoke Spanish with the 1 bilingual physician. APPROACH Transcript analysis based on sociolinguistic and discourse analytic techniques, including but not limited to time speaking, analysis of questions asked and answered, and the loss of semantic information. RESULTS Speech was significantly reduced and revised by the interpreter, resulting in an alteration of linguistic features such as content, meaning, reinforcement/validation, repetition, and affect. In addition, visits that included an interpreter had virtually no rapport-building “small talk,” which typically enables the physician to gain comprehensive patient history, learn clinically relevant information, and increase emotional engagement in treatment. CONCLUSIONS The presence of an interpreter increases the difficulty of achieving good physician-patient communication. Physicians and interpreters should be trained in the process of communication and interpretation, to minimize conversational loss and maximize the information and relational exchange with interpreted patients. PMID:16808747

Yield of the RYR2 Genetic Test in Suspected Catecholaminergic Polymorphic Ventricular Tachycardia and Implications for Test Interpretation.

PubMed

Kapplinger, Jamie D; Pundi, Krishna N; Larson, Nicholas B; Callis, Thomas E; Tester, David J; Bikker, Hennie; Wilde, Arthur A M; Ackerman, Michael J

2018-02-01

Pathogenic RYR2 variants account for ≈60% of clinically definite cases of catecholaminergic polymorphic ventricular tachycardia. However, the rate of rare benign RYR2 variants identified in the general population remains a challenge for genetic test interpretation. Therefore, we examined the results of the RYR2 genetic test among patients referred for commercial genetic testing and examined factors impacting variant interpretability. Frequency and location comparisons were made for RYR2 variants identified among 1355 total patients of varying clinical certainty and 60 706 Exome Aggregation Consortium controls. The impact of the clinical phenotype on the yield of RYR2 variants was examined. Six in silico tools were assessed using patient- and control-derived variants. A total of 18.2% (218/1200) of patients referred for commercial testing hosted rare RYR2 variants, statistically less than the 59% (46/78) yield among clinically definite cases, resulting in a much higher potential genetic false discovery rate among referrals considering the 3.2% background rate of rare, benign RYR2 variants. Exclusion of clearly putative pathogenic variants further complicates the interpretation of the next novel RYR2 variant. Exonic/topologic analyses revealed overrepresentation of patient variants in exons covering only one third of the protein. In silico tools largely failed to show evidence toward enhancement of variant interpretation. Current expert recommendations have resulted in increased use of RYR2 genetic testing in patients with questionable clinical phenotypes. Using the largest to date catecholaminergic polymorphic ventricular tachycardia patient versus control comparison, this study highlights important variables in the interpretation of variants to overcome the 3.2% background rate that confounds RYR2 variant interpretation. © 2018 American Heart Association, Inc.

Clinical laboratories collaborate to resolve differences in variant interpretations submitted to ClinVar.

PubMed

Harrison, Steven M; Dolinsky, Jill S; Knight Johnson, Amy E; Pesaran, Tina; Azzariti, Danielle R; Bale, Sherri; Chao, Elizabeth C; Das, Soma; Vincent, Lisa; Rehm, Heidi L

2017-10-01

Data sharing through ClinVar offers a unique opportunity to identify interpretation differences between laboratories. As part of a ClinGen initiative, four clinical laboratories (Ambry, GeneDx, Partners Healthcare Laboratory for Molecular Medicine, and University of Chicago Genetic Services Laboratory) collaborated to identify the basis of interpretation differences and to investigate if data sharing and reassessment resolve interpretation differences by analyzing a subset of variants. ClinVar variants with submissions from at least two of the four participating laboratories were compared. For a subset of identified differences, laboratories documented the basis for discordance, shared internal data, independently reassessed with the American College of Medical Genetics and Genomics-Association for Molecular Pathology (ACMG-AMP) guidelines, and then compared interpretations. At least two of the participating laboratories interpreted 6,169 variants in ClinVar, of which 88.3% were initially concordant. Laboratories reassessed 242/724 initially discordant variants, of which 87.2% (211) were resolved by reassessment with current criteria and/or internal data sharing; 12.8% (31) of reassessed variants remained discordant owing to differences in the application of the ACMG-AMP guidelines. Participating laboratories increased their overall concordance from 88.3 to 91.7%, indicating that sharing variant interpretations in ClinVar-thereby allowing identification of differences and motivation to resolve those differences-is critical to moving toward more consistent variant interpretations.Genet Med advance online publication 09 March 2017.

The Effect of Client Ethnicity on Clinical Interpretation of the MMPI-2

ERIC Educational Resources Information Center

Knaster, Cara A.; Micucci, Joseph A.

2013-01-01

Client ethnicity has been shown to affect clinicians' diagnostic impressions. However, it is not known whether interpretation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical scales is affected by ethnic bias. In this study, clinicians (82 males, 60 females) provided severity ratings for six symptoms based on three MMPI-2…

Clinical Interpretation of Variants in Cancer (CIViC) Knowledgebase | Informatics Technology for Cancer Research (ITCR)

Cancer.gov

CIViC is an open access, open source, community-driven web resource for Clinical Interpretation of Variants in Cancer. Our goal is to enable precision medicine by providing an educational forum for dissemination of knowledge and active discussion of the clinical significance of cancer genome alterations.

Cardiopulmonary Exercise Test: Background, Applicability and Interpretation.

PubMed

Herdy, Artur Haddad; Ritt, Luiz Eduardo Fonteles; Stein, Ricardo; Araújo, Claudio Gil Soares de; Milani, Mauricio; Meneghelo, Romeu Sérgio; Ferraz, Almir Sérgio; Hossri, Carlos; Almeida, Antonio Eduardo Monteiro de; Fernandes-Silva, Miguel Morita; Serra, Salvador Manoel

2016-11-01

Cardiopulmonary exercise test (CPET) has been gaining importance as a method of functional assessment in Brazil and worldwide. In its most frequent applications, CPET consists in applying a gradually increasing intensity exercise until exhaustion or until the appearance of limiting symptoms and/or signs. The following parameters are measured: ventilation; oxygen consumption (VO2); carbon dioxide production (VCO2); and the other variables of conventional exercise testing. In addition, in specific situations, pulse oximetry and flow-volume loops during and after exertion are measured. The CPET provides joint data analysis that allows complete assessment of the cardiovascular, respiratory, muscular and metabolic systems during exertion, being considered gold standard for cardiorespiratory functional assessment.1-6 The CPET allows defining mechanisms related to low functional capacity that can cause symptoms, such as dyspnea, and correlate them with changes in the cardiovascular, pulmonary and skeletal muscle systems. Furthermore, it can be used to provide the prognostic assessment of patients with heart or lung diseases, and in the preoperative period, in addition to aiding in a more careful exercise prescription to healthy subjects, athletes and patients with heart or lung diseases. Similarly to CPET clinical use, its research also increases, with the publication of several scientific contributions from Brazilian researchers in high-impact journals. Therefore, this study aimed at providing a comprehensive review on the applicability of CPET to different clinical situations, in addition to serving as a practical guide for the interpretation of that test. Resumo O teste cardiopulmonar de exercício (TCPE) vem ganhando importância crescente como método de avaliação funcional tanto no Brasil quanto no Mundo. Nas suas aplicações mais frequentes, o teste consiste em submeter o indivíduo a um exercício de intensidade gradativamente crescente até a exaustão ou o

Interpreter-mediated diabetes consultations: a qualitative analysis of physician communication practices

PubMed Central

2013-01-01

Background Patient-provider communication, in particular physicians’ ability to listen to their patients, and support them in making difficult lifestyle changes, is an essential component of effective diabetes care. Clinical communication around diabetes can be especially challenging when language barriers are present, and may contribute to poor diabetes management and outcomes. Clinicians need to be aware of and address potential communication difficulties associated with interpreter-mediated consultations. The purpose of our study was to explore how physicians communicate in interpreter-mediated consultations with diabetic patients, and how their communication behaviors may impact diabetes communication and care. Method We analyzed transcripts from 8 audio recorded, outpatient consultations at the Basel University Hospital general medicine outpatient clinic involving Turkish-speaking patients, German-speaking physicians, and Turkish-German interpreters (both community interpreters and family members). Results Clinicians used closed questions when asking about symptoms and glucose control. When providing information and explanation, they spoke in long and complex speech turns. They often directed their speech to interpreters or became sidetracked by family members’ questions or requests for information. Patients’ participation in the consultation was minimal, and limited to brief answers to clinicians’ questions. Conclusions Clinicians need to be aware of common pitfalls that diminish patient-centeredness during interpreter-mediated consultations, and learn strategies to avoid them. Attention to established guidelines on triadic communication is recommended, as is hands-on training with interpreters. PMID:24152539

Appendiceal goblet cell carcinoid: common errors in staging and clinical interpretation with a proposal for an improved terminology.

PubMed

Wen, Kwun Wah; Hale, Gillian; Shafizadeh, Nafis; Hosseini, Mojgan; Huang, Anne; Kakar, Sanjay

2017-07-01

Goblet cell carcinoid (GCC) is staged and treated as adenocarcinoma (AC) and not as neuroendocrine tumor (NET) or neuroendocrine carcinoma. The term carcinoid may lead to incorrect interpretation as NET. The aim of the study was to explore pitfalls in staging and clinical interpretation of GCC and mixed GCC-AC, and propose strategies to avoid common errors. Diagnostic terminology, staging, and clinical interpretation were evaluated in 58 cases (27 GCCs, 31 mixed GCC-ACs). Opinions were collected from 23 pathologists using a survey. Clinical notes were reviewed to assess the interpretation of pathology diagnoses by oncologists. NET staging was incorrectly used for 25% of GCCs and 5% of mixed GCC-ACs. In the survey, 43% of pathologists incorrectly indicated that NET staging is applicable to GCCs, and 43% incorrectly responded that Ki-67 proliferation index is necessary for GCC grading. Two cases each of GCC and mixed GCC-AC were incorrectly interpreted as neuroendocrine neoplasms by oncologists, and platinum-based therapy was considered for 2 GCC-AC cases because of the mistaken impression of neuroendocrine carcinoma created by use of the World Health Organization 2010 term mixed adenoneuroendocrine carcinoma. The term carcinoid in GCC and use of mixed adenoneuroendocrine carcinoma for mixed GCC-AC lead to errors in staging and treatment. We propose that goblet cell carcinoid should be changed to goblet cell carcinoma, whereas GCC with AC should be referred to as mixed GCC-AC with a comment about the proportion of each component and the histologic subtype of AC. This terminology will facilitate appropriate staging and clinical management, and avoid errors in interpretation. Copyright © 2017 Elsevier Inc. All rights reserved.

A Tale of Tails. Dark Matter Interpretations of the Fermi GeV Excess in Light of Background Model Systematics

DOE PAGES

Calore, Francesca; Cholis, Ilias; McCabe, Christopher; ...

2015-03-10

Several groups have identified an extended excess of gamma rays over the modeled foreground and background emissions towards the Galactic center (GC) based on observations with the Fermi Large Area Telescope. The excess emission is compatible in morphology and spectrum with a telltale sign from dark matter (DM) annihilation. Here, we present a critical reassessment of DM interpretations of the GC signal in light of the foreground and background uncertainties that some of us recently outlaid in Calore et al. (2014). We also find that a much larger number of DM models fits the gamma-ray data than previously noted. Inmore » particular: (1) In the case of DM annihilation into b¯b, we find that even large DM masses up to m χ≃74 GeV are allowed at p-value >0.05. (2) Surprisingly, annihilation into nonrelativistic hh gives a good fit to the data. (3) The inverse Compton emission from μ +μ - with m χ~60–70 GeV can also account for the excess at higher latitudes, |b|>2°, both in its spectrum and morphology. We also present novel constraints on a large number of mixed annihilation channels, including cascade annihilation involving hidden sector mediators. Finally, we show that the current limits from dwarf spheroidal observations are not in tension with a DM interpretation when uncertainties on the DM halo profile are accounted for.« less

Recommendations for Clinical Pathology Data Generation, Interpretation, and Reporting in Target Animal Safety Studies for Veterinary Drug Development.

PubMed

Siska, William; Gupta, Aradhana; Tomlinson, Lindsay; Tripathi, Niraj; von Beust, Barbara

Clinical pathology testing is routinely performed in target animal safety studies in order to identify potential toxicity associated with administration of an investigational veterinary pharmaceutical product. Regulatory and other testing guidelines that address such studies provide recommendations for clinical pathology testing but occasionally contain outdated analytes and do not take into account interspecies physiologic differences that affect the practical selection of appropriate clinical pathology tests. Additionally, strong emphasis is often placed on statistical analysis and use of reference intervals for interpretation of test article-related clinical pathology changes, with limited attention given to the critical scientific review of clinically, toxicologically, or biologically relevant changes. The purpose of this communication from the Regulatory Affairs Committee of the American Society for Veterinary Clinical Pathology is to provide current recommendations for clinical pathology testing and data interpretation in target animal safety studies and thereby enhance the value of clinical pathology testing in these studies.

Clinical, Biomechanical, and Physiological Translational Interpretations of Human Resting Myofascial Tone or Tension

PubMed Central

Masi, Alfonse T.; Nair, Kalyani; Evans, Tyler; Ghandour, Yousef

2010-01-01

Background Myofascial tissues generate integrated webs and networks of passive and active tensional forces that provide stabilizing support and that control movement in the body. Passive [central nervous system (CNS)–independent] resting myofascial tension is present in the body and provides a low-level stabilizing component to help maintain balanced postures. This property was recently called “human resting myofascial tone” (HRMT). The HRMT model evolved from electromyography (EMG) research in the 1950s that showed lumbar muscles usually to be EMG-silent in relaxed gravity-neutral upright postures. Methods Biomechanical, clinical, and physiological studies were reviewed to interpret the passive stiffness properties of HRMT that help to stabilize various relaxed functions such as quiet balanced standing. Biomechanical analyses and experimental studies of the lumbar multifidus were reviewed to interpret its passive stiffness properties. The lumbar multifidus was illustrated as the major core stabilizing muscle of the spine, serving an important passive biomechanical role in the body. Results Research into muscle physiology suggests that passive resting tension (CNS-independent) is generated in sarcomeres by the molecular elasticity of low-level cycling cross-bridges between the actomyosin filaments. In turn, tension is complexly transmitted to intimately enveloping fascial matrix fibrils and other molecular elements in connective tissue, which, collectively, constitute the myofascial unit. Postural myofascial tonus varies with age and sex. Also, individuals in the population are proposed to vary in a polymorphism of postural HRMT. A few people are expected to have outlier degrees of innate postural hypotonicity or hypertonicity. Such biomechanical variations likely predispose to greater risk of related musculoskeletal disorders, a situation that deserves greater attention in clinical practice and research. Axial myofascial hypertonicity was hypothesized to

Interpreting patient-reported outcomes from clinical trials in COPD: a discussion

PubMed Central

Jones, Paul W; Rennard, Stephen; Tabberer, Maggie; Riley, John H; Vahdati-Bolouri, Mitra; Barnes, Neil C

2016-01-01

One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs) in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique) the results derived from them. Therefore, in this paper, a series of questions is posed for the practising physician to consider when reviewing the treatment effectiveness as assessed by PROs. The focus is on the St George’s Respiratory Questionnaire for worked examples, but the principles apply equally to other symptom-based questionnaires. A number of different ways of presenting PRO data are discussed, including the concept of the minimum clinically important difference, whether there is a ceiling effect to PRO results, and the strengths and weaknesses of responder analyses. Using a worked example, the value of including a placebo arm in a study is illustrated, and the influence of the study on PRO results is considered, in terms of the design, patient withdrawal, and the selection of the study population. For the practising clinician, the most important consideration is the importance of individualization of treatment (and of treatment goals). To inform such treatment, clinicians need to critically review PRO data. The hope is that the questions posed here will help to build a framework for this critical review. PMID:27994447

Interpreting patient-reported outcomes from clinical trials in COPD: a discussion.

PubMed

Jones, Paul W; Rennard, Stephen; Tabberer, Maggie; Riley, John H; Vahdati-Bolouri, Mitra; Barnes, Neil C

2016-01-01

One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs) in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique) the results derived from them. Therefore, in this paper, a series of questions is posed for the practising physician to consider when reviewing the treatment effectiveness as assessed by PROs. The focus is on the St George's Respiratory Questionnaire for worked examples, but the principles apply equally to other symptom-based questionnaires. A number of different ways of presenting PRO data are discussed, including the concept of the minimum clinically important difference, whether there is a ceiling effect to PRO results, and the strengths and weaknesses of responder analyses. Using a worked example, the value of including a placebo arm in a study is illustrated, and the influence of the study on PRO results is considered, in terms of the design, patient withdrawal, and the selection of the study population. For the practising clinician, the most important consideration is the importance of individualization of treatment (and of treatment goals). To inform such treatment, clinicians need to critically review PRO data. The hope is that the questions posed here will help to build a framework for this critical review.

Getting By: Underuse of Interpreters by Resident Physicians

PubMed Central

Schenker, Yael; Curry, Leslie; Bradley, Elizabeth H.; Fernandez, Alicia

2008-01-01

Background Language barriers complicate physician–patient communication and adversely affect healthcare quality. Research suggests that physicians underuse interpreters despite evidence of benefits and even when services are readily available. The reasons underlying the underuse of interpreters are poorly understood. Objective To understand the decision-making process of resident physicians when communicating with patients with limited English proficiency (LEP). Design Qualitative study using in-depth interviews. Participants Internal medicine resident physicians ( = 20) from two urban teaching hospitals with excellent interpreter services. Approach An interview guide was used to explore decision making about interpreter use. Results Four recurrent themes emerged: 1) Resident physicians recognized that they underused professional interpreters, and described this phenomenon as “getting by;” 2) Resident physicians made decisions about interpreter use by weighing the perceived value of communication in clinical decision making against their own time constraints; 3) The decision to call an interpreter could be preempted by the convenience of using family members or the resident physician’s use of his/her own second language skills; 4) Resident physicians normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care. Conclusions Although previous research has identified time constraints and lack of availability of interpreters as reasons for their underuse, our data suggest that the reasons are far more complex. Residents at the study institutions with interpreters readily available found it easier to “get by” without an interpreter, despite misgivings about negative implications for quality of care. Findings suggest that increasing interpreter use will require interventions targeted at both individual physicians and the practice environment. PMID:19089503

Clinical importance of re-interpretation of PET/CT scanning in patients referred to a tertiary care medical centre.

PubMed

Löfgren, Johan; Loft, Annika; Barbosa de Lima, Vinicius Araújo; Østerlind, Kell; von Benzon, Eric; Højgaard, Liselotte

2017-03-01

To evaluate, in a controlled prospective manner with double-blind read, whether there are differences in interpretations of PET/CT scans at our tertiary medical centre, Rigshospitalet, compared to the external hospitals. Ninety consecutive patients referred to our department who had an external F-18-FDG PET/CT scan were included. Only information that had been available at the time of the initial reading at the external hospital was available at re-interpretation. Teams with one radiologist and one nuclear medicine physician working side by side performed the re-interpretation in consensus. Two oncologists subsequently and independently compared the original reports with the re-interpretation reports. In case of 'major discordance', the oncologists assessed the respective reports validities. The interpretations were graded as 'accordant' in 43 patients (48%), 'minor discordance' in 30 patients (33%) and 'major discordance' in 17 patients (19%). In 11 (65%) of the 17 cases graded as 'major discordance', it was possible to determine which report that was most correct. In 9 of these 11 cases (82%), the re-interpretation was most correct; in one case, the original report and in another case, both interpretations were incorrect. Major discordant interpretations were frequent [19% (17 of 90 cases)]. In those cases where follow-up could assess the validity, the re-interpretation at Rigshospitalet was most correct in 9 of 11 cases (82%), indicating that there is a difference in expertise in interpreting PET/CT at a tertiary referral hospital compared to primary local hospitals. © 2015 The Authors. Clinical Physiology and Functional Imaging published by John Wiley & Sons Ltd on behalf of Scandinavian Society of Clinical Physiology and Nuclear Medicine.

Performing and Interpreting Fractional Flow Reserve Measurements in Clinical Practice: An Expert Consensus Document

PubMed Central

Rudolph, Tanja; Rieber, Johannes; Eggebrecht, Holger; Richardt, Gert; Schmitz, Thomas; Werner, Nikos; Boenner, Florian; Möllmann, Helge

2017-01-01

Fractional flow reserve (FFR) measurements can determine the haemodynamic relevance of coronary artery stenoses. Current guidelines recommend their use in lesions in the absence of non-invasive proof of ischaemia. The prognostic impact of FFR has been evaluated in randomised trials, and it has been shown that revascularisation can be safely deferred if FFR is >0.80, while revascularisation of stenoses with FFR values ≤0.80 results in significantly lower event rates compared to medical treatment. Left main stenoses, aorto-ostial lesions, as well as patients with left ventricular hypertrophy and severely-impaired ejection fraction, have been excluded from large, randomised trials. While FFR measurements are relatively straightforward to perform, uncertainty about procedural logistics, as well as data acquisition and interpretation in specific situations, could explain why they are not widely used in clinical practice. We summarise the clinical data in support of FFR measurements, and provide recommendations for performing and interpreting the procedure. PMID:29588737

Clinical Utility of Blood Cell Histogram Interpretation.

PubMed

Thomas, E T Arun; Bhagya, S; Majeed, Abdul

2017-09-01

An automated haematology analyser provides blood cell histograms by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis. Histogram interpretation needs careful analysis of Red Blood Cell (RBC), White Blood Cell (WBC) and platelet distribution curves. Histogram analysis is often a neglected part of the automated haemogram which if interpreted well, has significant potential to provide diagnostically relevant information even before higher level investigations are ordered.

The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa.

PubMed

Vischer, N; Pfeiffer, C; Joller, A; Klingmann, I; Ka, A; Kpormegbe, S K; Burri, C

2016-08-01

To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers. © 2016 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Clinical Utility of Blood Cell Histogram Interpretation

PubMed Central

Bhagya, S.; Majeed, Abdul

2017-01-01

An automated haematology analyser provides blood cell histograms by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis. Histogram interpretation needs careful analysis of Red Blood Cell (RBC), White Blood Cell (WBC) and platelet distribution curves. Histogram analysis is often a neglected part of the automated haemogram which if interpreted well, has significant potential to provide diagnostically relevant information even before higher level investigations are ordered. PMID:29207767

The Interpretive Approach to Religious Education: Challenging Thompson's Interpretation

ERIC Educational Resources Information Center

Jackson, Robert

2012-01-01

In a recent book chapter, Matthew Thompson makes some criticisms of my work, including the interpretive approach to religious education and the research and activity of Warwick Religions and Education Research Unit. Against the background of a discussion of religious education in the public sphere, my response challenges Thompson's account,…

Expanding the basic science debate: the role of physics knowledge in interpreting clinical findings.

PubMed

Goldszmidt, Mark; Minda, John Paul; Devantier, Sarah L; Skye, Aimee L; Woods, Nicole N

2012-10-01

Current research suggests a role for biomedical knowledge in learning and retaining concepts related to medical diagnosis. However, learning may be influenced by other, non-biomedical knowledge. We explored this idea using an experimental design and examined the effects of causal knowledge on the learning, retention, and interpretation of medical information. Participants studied a handout about several respiratory disorders and how to interpret respiratory exam findings. The control group received the information in standard "textbook" format and the experimental group was presented with the same information as well as a causal explanation about how sound travels through lungs in both the normal and disease states. Comprehension and memory of the information was evaluated with a multiple-choice exam. Several questions that were not related to the causal knowledge served as control items. Questions related to the interpretation of physical exam findings served as the critical test items. The experimental group outperformed the control group on the critical test items, and our study shows that a causal explanation can improve a student's memory for interpreting clinical details. We suggest an expansion of which basic sciences are considered fundamental to medical education.

Modelling difficulties in abstract thinking in psychosis: the importance of socio-developmental background.

PubMed

Berg, A O; Melle, I; Zuber, V; Simonsen, C; Nerhus, M; Ueland, T; Andreassen, O A; Sundet, K; Vaskinn, A

2017-01-01

Abstract thinking is important in modern understanding of neurocognitive abilities, and a symptom of thought disorder in psychosis. In patients with psychosis, we assessed if socio-developmental background influences abstract thinking, and the association with executive functioning and clinical psychosis symptoms. Participants (n = 174) had a diagnosis of psychotic or bipolar disorder, were 17-65 years, intelligence quotient (IQ) > 70, fluent in a Scandinavian language, and their full primary education in Norway. Immigrants (N = 58) were matched (1:2) with participants without a history of migration (N = 116). All participants completed a neurocognitive and clinical assessment. Socio-developmental background was operationalised as human developmental index (HDI) of country of birth, at year of birth. Structural equation modelling was used to assess the model with best fit. The model with best fit, χ 2  = 96.591, df = 33, p < .001, confirmed a significant indirect effect of HDI scores on abstract thinking through executive functioning, but not through clinical psychosis symptoms. This study found that socio-developmental background influences abstract thinking in psychosis by indirect effect through executive functioning. We should take into account socio-developmental background in the interpretation of neurocognitive performance in patients with psychosis, and prioritise cognitive remediation in treatment of immigrant patients.

[CLINICAL BACKGROUND ANALYSIS ABOUT TRANSURETHRAL ELECTROCOAGULATION].

PubMed

Katsui, Masahiro; Kikuchi, Eiji; Yazawa, Satoshi; Hagiwara, Masayuki; Morita, Shinya; Shinoda, Kazunobu; Kosaka, Takeo; Mizuno, Ryuichi; Shinojima, Toshiaki; Asanuma, Hiroshi; Miyajima, Akira; Oya, Mototsugu

2015-10-01

Transurethral electrocoagulation (TUC) is a rare event but occurs in a constant manner with various causes or disorders and reduces patient quality of life. So far there have been no reports focusing on the details of TUC. We focused on the clinical background and related causes in cases of TUC in our institution. We identified 76 cases (65 patients) who underwent TUC at Keio University Hospital between April 2001 and March 2011. We focused on patient background, especially with respect to the primary disease, treatment modality, use of antiplatelet or anticoagulant agent, timing of TUC, type of electrosurgical device, and the incidence of transfusion. The primary disease for TUC included bladder tumor (BT) in 31 cases, benign prostate hyperplasia (BPH) in 13, prostate cancer (PCa) in 13, idiopathic bladder bleeding in 4, periarteritis nodosa in 3, uterine cervical cancer in 3, and others in 9. TUC after transurethral resection (TUR) was found in 38 cases, including transurethral resection of bladder tumor (TURBT) in 26 of 31 BT cases and transurethral resection of prostate (TURP) in 12 of 13 BPH cases. After TURBT, TUC was performed before removal of a urethral catheter in 7 cases, and after removal of a urethral catheter in 19 cases. With regard to TUC associated with TURP, the average estimated prostate volume in TUC cases before removal of the urethral catheter was 66.2 ml, which was significantly larger than that in TUC cases after removal of the urethral catheter (46.1 ml, p = 0.045). TUC after the radiation therapy was observed in 21 cases, and the average time from the radiation therapy to TUC was 3.4 years (7 months-10 years). TUC was caused by multiple causes or disorders, and 75% of our TUC was associated with BT, BPH or PCa. TUC associated with TURBT frequently occurred within 1 week after TURBT but was still observed after 1 month following the operation. All TUC associated with TURP occurred within 3 weeks after operation. The average period from

Application of computerized exercise ECG digitization. Interpretation in large clinical trials.

PubMed

Caralis, D G; Shaw, L; Bilgere, B; Younis, L; Stocke, K; Wiens, R D; Chaitman, B R

1992-04-01

The authors report on a semiautomated program that incorporates both visual identification of fiducial points and digital determination of the ST-segment at 60 ms and 80 ms from the J point, ST slope, changes in R wave, and baseline drift. The off-line program can enhance the accuracy of detecting electrocardiographic (ECG) changes, as well as reproducibility of the exercise and postexercise ECG, as a marker of myocardial ischemia. The analysis program is written in Microsoft QuickBASIC 2.0 for an IBM personal computer interfaced to a Summagraphics mm1201 microgrid II digitizer. The program consists of the following components: (1) alphanumeric data entry, (2) ECG wave form digitization, (2) calculation of test results, (4) physician overread, and (5) editor function for remeasurements. This computerized exercise ECG digitization-interpretation program is accurate and reproducible for the quantitative assessment of ST changes and requires minimal time allotment for physician overread. The program is suitable for analysis and interpretation of large volumes of exercise tests in multicenter clinical trials and is currently utilized in the TIMI II, TIMI III, and BARI studies sponsored by the National Institutes of Health.

Background Signal as an in Situ Predictor of Dopamine Oxidation Potential: Improving Interpretation of Fast-Scan Cyclic Voltammetry Data.

PubMed

Meunier, Carl J; Roberts, James G; McCarty, Gregory S; Sombers, Leslie A

2017-02-15

Background-subtracted fast-scan cyclic voltammetry (FSCV) has emerged as a powerful analytical technique for monitoring subsecond molecular fluctuations in live brain tissue. Despite increasing utilization of FSCV, efforts to improve the accuracy of quantification have been limited due to the complexity of the technique and the dynamic recording environment. It is clear that variable electrode performance renders calibration necessary for accurate quantification; however, the nature of in vivo measurements can make conventional postcalibration difficult, or even impossible. Analyte-specific voltammograms and scaling factors that are critical for quantification can shift or fluctuate in vivo. This is largely due to impedance changes, and the effects of impedance on these measurements have not been characterized. We have previously reported that the background current can be used to predict electrode-specific scaling factors in situ. In this work, we employ model circuits to investigate the impact of impedance on FSCV measurements. Additionally, we take another step toward in situ electrode calibration by using the oxidation potential of quinones on the electrode surface to accurately predict the oxidation potential for dopamine at any point in an electrochemical experiment, as both are dependent on impedance. The model, validated both in adrenal slice and live brain tissue, enables information encoded in the shape of the background voltammogram to determine electrochemical parameters that are critical for accurate quantification. This improves data interpretation and provides a significant next step toward more automated methods for in vivo data analysis.

Minimal Clinically Important Difference: A Review of Outcome Measure Score Interpretation.

PubMed

Engel, Lisa; Beaton, Dorcas E; Touma, Zahi

2018-05-01

Clinicians, researchers, and outcome stakeholders have the crucial, albeit difficult, task of quantifying when a person or group experiences important change or difference on any given outcome measure, often in response to a specific intervention. The minimal clinically important difference (MCID) provides this quantified value of change/difference for a measure. There are many methods for MCID derivation, which can result in multiple values for the same measure. Thus, it is important for potential users of MCID values to be aware of the nuances of MCID development and cautions for interpreting values. This review outlines MCID-related definitions, methods, and guidelines. Copyright © 2018 Elsevier Inc. All rights reserved.

Bayesian analysis of a mastitis control plan to investigate the influence of veterinary prior beliefs on clinical interpretation.

PubMed

Green, M J; Browne, W J; Green, L E; Bradley, A J; Leach, K A; Breen, J E; Medley, G F

2009-10-01

The fundamental objective for health research is to determine whether changes should be made to clinical decisions. Decisions made by veterinary surgeons in the light of new research evidence are known to be influenced by their prior beliefs, especially their initial opinions about the plausibility of possible results. In this paper, clinical trial results for a bovine mastitis control plan were evaluated within a Bayesian context, to incorporate a community of prior distributions that represented a spectrum of clinical prior beliefs. The aim was to quantify the effect of veterinary surgeons' initial viewpoints on the interpretation of the trial results. A Bayesian analysis was conducted using Markov chain Monte Carlo procedures. Stochastic models included a financial cost attributed to a change in clinical mastitis following implementation of the control plan. Prior distributions were incorporated that covered a realistic range of possible clinical viewpoints, including scepticism, enthusiasm and uncertainty. Posterior distributions revealed important differences in the financial gain that clinicians with different starting viewpoints would anticipate from the mastitis control plan, given the actual research results. For example, a severe skeptic would ascribe a probability of 0.50 for a return of < 5 UK pounds per cow in an average herd that implemented the plan, whereas an enthusiast would ascribe this probability for a return of > 20 UK pounds per cow. Simulations using increased trial sizes indicated that if the original study was four times as large, an initial skeptic would be more convinced about the efficacy of the control plan but would still anticipate less financial return than an initial enthusiast would anticipate after the original study. In conclusion, it is possible to estimate how clinicians' prior beliefs influence their interpretation of research evidence. Further research on the extent to which different interpretations of evidence result in

Accuracy and consistency of radiographic interpretation among clinical instructors using two viewing systems.

PubMed

Lanning, Sharon K; Best, Al M; Temple, Henry J; Richards, Philip S; Carey, Allison; McCauley, Laurie K

2006-02-01

Accurate and consistent radiographic interpretation among clinical instructors is needed for assessment of teaching, student performance, and patient care. The purpose of this investigation was to determine if the method of radiographic viewing affects accuracy and consistency of instructors' determinations of bone loss. Forty-one clinicians who provide instruction in a dental school clinical teaching program (including periodontists, general dentists, periodontal graduate students, and dental hygienists) quantified bone loss for up to twenty-five teeth into four descriptive categories using a view box for plain film viewing or a projection system for digitized image viewing. Ratings were compared to the correct category as determined by direct measurement using the Schei ruler. Agreement with the correct choice for the view box and projection system was 70.2 percent and 64.5 percent, respectively. The mean difference was better for a projection system due to small rater error by graduate students. Projection system ratings were slightly less consistent than view box ratings. Dental hygiene faculty ratings were the most consistent but least accurate. Although the projection system resulted in slightly reduced accuracy and consistency among instructors, training sessions utilizing a single method for projecting digitized radiographic images have their advantages and may positively influence dental education and patient care by enhancing accuracy and consistency of radiographic interpretation among instructors.

[The historical background and present development of evidence-based healthcare and clinical nursing].

PubMed

Tsai, Jung-Mei

2014-12-01

Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.

Bayesian methodology for the design and interpretation of clinical trials in critical care medicine: a primer for clinicians.

PubMed

Kalil, Andre C; Sun, Junfeng

2014-10-01

To review Bayesian methodology and its utility to clinical decision making and research in the critical care field. Clinical, epidemiological, and biostatistical studies on Bayesian methods in PubMed and Embase from their inception to December 2013. Bayesian methods have been extensively used by a wide range of scientific fields, including astronomy, engineering, chemistry, genetics, physics, geology, paleontology, climatology, cryptography, linguistics, ecology, and computational sciences. The application of medical knowledge in clinical research is analogous to the application of medical knowledge in clinical practice. Bedside physicians have to make most diagnostic and treatment decisions on critically ill patients every day without clear-cut evidence-based medicine (more subjective than objective evidence). Similarly, clinical researchers have to make most decisions about trial design with limited available data. Bayesian methodology allows both subjective and objective aspects of knowledge to be formally measured and transparently incorporated into the design, execution, and interpretation of clinical trials. In addition, various degrees of knowledge and several hypotheses can be tested at the same time in a single clinical trial without the risk of multiplicity. Notably, the Bayesian technology is naturally suited for the interpretation of clinical trial findings for the individualized care of critically ill patients and for the optimization of public health policies. We propose that the application of the versatile Bayesian methodology in conjunction with the conventional statistical methods is not only ripe for actual use in critical care clinical research but it is also a necessary step to maximize the performance of clinical trials and its translation to the practice of critical care medicine.

Clinically speaking: A communication skills program for students from non-English speaking backgrounds.

PubMed

Miguel, Caroline San; Rogan, Fran; Kilstoff, Kathleen; Brown, Di

2006-09-01

This paper reports on the design, delivery and evaluation of an innovative oral communication skills program for first year students in a Bachelor of Nursing degree at an Australian university. This program was introduced in 2004 to meet the needs of first year undergraduate students from non-English speaking backgrounds who had experienced difficulties with spoken English while on clinical placement. The program consisted of early identification of students in need of communication development, a series of classes incorporated into the degree program to address students' needs, followed by a clinical placement block. This paper describes the structure of the program, discusses some of the major problems encountered by students in the clinical setting and presents some of the teaching strategies used to address these problems. Evaluations of the program suggest that students' communication skills and confidence improved, resulting in a more positive clinical experience for the majority of students.

A new framework for the documentation and interpretation of oral food challenges in population-based and clinical research.

PubMed

Grabenhenrich, L B; Reich, A; Bellach, J; Trendelenburg, V; Sprikkelman, A B; Roberts, G; Grimshaw, K E C; Sigurdardottir, S; Kowalski, M L; Papadopoulos, N G; Quirce, S; Dubakiene, R; Niggemann, B; Fernández-Rivas, M; Ballmer-Weber, B; van Ree, R; Schnadt, S; Mills, E N C; Keil, T; Beyer, K

2017-03-01

The conduct of oral food challenges as the preferred diagnostic standard for food allergy (FA) was harmonized over the last years. However, documentation and interpretation of challenge results, particularly in research settings, are not sufficiently standardized to allow valid comparisons between studies. Our aim was to develop a diagnostic toolbox to capture and report clinical observations in double-blind placebo-controlled food challenges (DBPCFC). A group of experienced allergists, paediatricians, dieticians, epidemiologists and data managers developed generic case report forms and standard operating procedures for DBPCFCs and piloted them in three clinical centres. The follow-up of the EuroPrevall/iFAAM birth cohort and other iFAAM work packages applied these methods. A set of newly developed questionnaire or interview items capture the history of FA. Together with sensitization status, this forms the basis for the decision to perform a DBPCFC, following a standardized decision algorithm. A generic form including details about severity and timing captures signs and symptoms observed during or after the procedures. In contrast to the commonly used dichotomous outcome FA vs no FA, the allergy status is interpreted in multiple categories to reflect the complexity of clinical decision-making. The proposed toolbox sets a standard for improved documentation and harmonized interpretation of DBPCFCs. By a detailed documentation and common terminology for communicating outcomes, these tools hope to reduce the influence of subjective judgment of supervising physicians. All forms are publicly available for further evolution and free use in clinical and research settings. © 2016 The Authors. Allergy Published by John Wiley & Sons Ltd.

Genetic testing in heritable cardiac arrhythmia syndromes: differentiating pathogenic mutations from background genetic noise.

PubMed

Giudicessi, John R; Ackerman, Michael J

2013-01-01

In this review, we summarize the basic principles governing rare variant interpretation in the heritable cardiac arrhythmia syndromes, focusing on recent advances that have led to disease-specific approaches to the interpretation of positive genetic testing results. Elucidation of the genetic substrates underlying heritable cardiac arrhythmia syndromes has unearthed new arrhythmogenic mechanisms and given rise to a number of clinically meaningful genotype-phenotype correlations. As such, genetic testing for these disorders now carries important diagnostic, prognostic, and therapeutic implications. Recent large-scale systematic studies designed to explore the background genetic 'noise' rate associated with these genetic tests have provided important insights and enhanced how positive genetic testing results are interpreted for these potentially lethal, yet highly treatable, cardiovascular disorders. Clinically available genetic tests for heritable cardiac arrhythmia syndromes allow the identification of potentially at-risk family members and contribute to the risk-stratification and selection of therapeutic interventions in affected individuals. The systematic evaluation of the 'signal-to-noise' ratio associated with these genetic tests has proven critical and essential to assessing the probability that a given variant represents a rare pathogenic mutation or an equally rare, yet innocuous, genetic bystander.

Radiology image perception and observer performance: How does expertise and clinical information alter interpretation? Stroke detection explored through eye-tracking

NASA Astrophysics Data System (ADS)

Cooper, Lindsey; Gale, Alastair; Darker, Iain; Toms, Andoni; Saada, Janak

2009-02-01

Historically, radiology research has been dominated by chest and breast screening. Few studies have examined complex interpretative tasks such as the reading of multidimensional brain CT or MRI scans. Additionally, no studies at the time of writing have explored the interpretation of stroke images; from novices through to experienced practitioners using eye movement analysis. Finally, there appears a lack of evidence on the clinical effects of radiology reports and their influence on image appraisal and clinical diagnosis. A computer-based, eye-tracking study was designed to assess diagnostic accuracy and interpretation in stroke CT and MR imagery. Eight predetermined clinical cases, five images per case, were presented to participants (novices, trainee, and radiologists; n=8). The presence or absence of abnormalities was rated on a five-point Likert scale and their locations reported. Half cases of the cases were accompanied by clinical information; half were not, to assess the impact of information on observer performance. Results highlight differences in visual search patterns amongst novice, trainee and expert observers; the most marked differences occurred between novice readers and experts. Experts spent more time in challenging areas of interest (AOI) than novices and trainee, and were more confident unless a lesion was large and obvious. The time to first AOI fixation differed by size, shape and clarity of lesion. 'Time to lesion' dropped significantly when recognition appeared to occur between slices. The influence of clinical information was minimal.

Personal Background Knowledge Influences Cross-Cultural Understanding

ERIC Educational Resources Information Center

Lin, Xiaodong; Bransford, John D.

2010-01-01

Purpose of the Study: The purpose of the study was to investigate how two types of videos, personal background knowledge (PBK) and general background knowledge (GBK), affect people's interpretation of a classroom problem case that involved a disconnection between a foreign college professor and her students. The PBK video described the professor's…

Interpretive Medicine

PubMed Central

Reeve, Joanne

2010-01-01

Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the

Genetic, Clinical, and Pathologic Backgrounds of Patients with Autosomal Dominant Alport Syndrome

PubMed Central

Kamiyoshi, Naohiro; Fu, Xue Jun; Morisada, Naoya; Nozu, Yoshimi; Ye, Ming Juan; Imafuku, Aya; Miura, Kenichiro; Yamamura, Tomohiko; Minamikawa, Shogo; Shono, Akemi; Ninchoji, Takeshi; Morioka, Ichiro; Nakanishi, Koichi; Yoshikawa, Norishige; Kaito, Hiroshi; Iijima, Kazumoto

2016-01-01

Background and objectives Alport syndrome comprises a group of inherited heterogeneous disorders involving CKD, hearing loss, and ocular abnormalities. Autosomal dominant Alport syndrome caused by heterozygous mutations in collagen 4A3 and/or collagen 4A4 accounts for <5% of patients. However, the clinical, genetic, and pathologic backgrounds of patients with autosomal dominant Alport syndrome remain unclear. Design, setting, participants, & measurements We conducted a retrospective analysis of 25 patients with genetically proven autosomal dominant Alport syndrome and their family members (a total of 72 patients) from 16 unrelated families. Patients with suspected Alport syndrome after pathologic examination who were referred from anywhere in Japan for genetic analysis from 2006 to 2015 were included in this study. Clinical, laboratory, and pathologic data were collected from medical records at the point of registration for genetic diagnosis. Genetic analysis was performed by targeted resequencing of 27 podocyte-related genes, including Alport–related collagen genes, to make a diagnosis of autosomal dominant Alport syndrome and identify modifier genes or double mutations. Clinical data were obtained from medical records. Results The median renal survival time was 70 years, and the median age at first detection of proteinuria was 17 years old. There was one patient with hearing loss and one patient with ocular lesion. Among 16 patients who underwent kidney biopsy, three showed FSGS, and seven showed thinning without lamellation of the glomerular basement membrane. Five of 13 detected mutations were reported to be causative mutations for autosomal recessive Alport syndrome in previous studies. Two families possessed double mutations in both collagen 4A3 and collagen 4A4, but no modifier genes were detected among the other podocyte–related genes. Conclusions The renal phenotype of autosomal dominant Alport syndrome was much milder than that of autosomal recessive

An international effort towards developing standards for best practices in analysis, interpretation and reporting of clinical genome sequencing results in the CLARITY Challenge.

PubMed

Brownstein, Catherine A; Beggs, Alan H; Homer, Nils; Merriman, Barry; Yu, Timothy W; Flannery, Katherine C; DeChene, Elizabeth T; Towne, Meghan C; Savage, Sarah K; Price, Emily N; Holm, Ingrid A; Luquette, Lovelace J; Lyon, Elaine; Majzoub, Joseph; Neupert, Peter; McCallie, David; Szolovits, Peter; Willard, Huntington F; Mendelsohn, Nancy J; Temme, Renee; Finkel, Richard S; Yum, Sabrina W; Medne, Livija; Sunyaev, Shamil R; Adzhubey, Ivan; Cassa, Christopher A; de Bakker, Paul I W; Duzkale, Hatice; Dworzyński, Piotr; Fairbrother, William; Francioli, Laurent; Funke, Birgit H; Giovanni, Monica A; Handsaker, Robert E; Lage, Kasper; Lebo, Matthew S; Lek, Monkol; Leshchiner, Ignaty; MacArthur, Daniel G; McLaughlin, Heather M; Murray, Michael F; Pers, Tune H; Polak, Paz P; Raychaudhuri, Soumya; Rehm, Heidi L; Soemedi, Rachel; Stitziel, Nathan O; Vestecka, Sara; Supper, Jochen; Gugenmus, Claudia; Klocke, Bernward; Hahn, Alexander; Schubach, Max; Menzel, Mortiz; Biskup, Saskia; Freisinger, Peter; Deng, Mario; Braun, Martin; Perner, Sven; Smith, Richard J H; Andorf, Janeen L; Huang, Jian; Ryckman, Kelli; Sheffield, Val C; Stone, Edwin M; Bair, Thomas; Black-Ziegelbein, E Ann; Braun, Terry A; Darbro, Benjamin; DeLuca, Adam P; Kolbe, Diana L; Scheetz, Todd E; Shearer, Aiden E; Sompallae, Rama; Wang, Kai; Bassuk, Alexander G; Edens, Erik; Mathews, Katherine; Moore, Steven A; Shchelochkov, Oleg A; Trapane, Pamela; Bossler, Aaron; Campbell, Colleen A; Heusel, Jonathan W; Kwitek, Anne; Maga, Tara; Panzer, Karin; Wassink, Thomas; Van Daele, Douglas; Azaiez, Hela; Booth, Kevin; Meyer, Nic; Segal, Michael M; Williams, Marc S; Tromp, Gerard; White, Peter; Corsmeier, Donald; Fitzgerald-Butt, Sara; Herman, Gail; Lamb-Thrush, Devon; McBride, Kim L; Newsom, David; Pierson, Christopher R; Rakowsky, Alexander T; Maver, Aleš; Lovrečić, Luca; Palandačić, Anja; Peterlin, Borut; Torkamani, Ali; Wedell, Anna; Huss, Mikael; Alexeyenko, Andrey; Lindvall, Jessica M; Magnusson, Måns; Nilsson, Daniel; Stranneheim, Henrik; Taylan, Fulya; Gilissen, Christian; Hoischen, Alexander; van Bon, Bregje; Yntema, Helger; Nelen, Marcel; Zhang, Weidong; Sager, Jason; Zhang, Lu; Blair, Kathryn; Kural, Deniz; Cariaso, Michael; Lennon, Greg G; Javed, Asif; Agrawal, Saloni; Ng, Pauline C; Sandhu, Komal S; Krishna, Shuba; Veeramachaneni, Vamsi; Isakov, Ofer; Halperin, Eran; Friedman, Eitan; Shomron, Noam; Glusman, Gustavo; Roach, Jared C; Caballero, Juan; Cox, Hannah C; Mauldin, Denise; Ament, Seth A; Rowen, Lee; Richards, Daniel R; San Lucas, F Anthony; Gonzalez-Garay, Manuel L; Caskey, C Thomas; Bai, Yu; Huang, Ying; Fang, Fang; Zhang, Yan; Wang, Zhengyuan; Barrera, Jorge; Garcia-Lobo, Juan M; González-Lamuño, Domingo; Llorca, Javier; Rodriguez, Maria C; Varela, Ignacio; Reese, Martin G; De La Vega, Francisco M; Kiruluta, Edward; Cargill, Michele; Hart, Reece K; Sorenson, Jon M; Lyon, Gholson J; Stevenson, David A; Bray, Bruce E; Moore, Barry M; Eilbeck, Karen; Yandell, Mark; Zhao, Hongyu; Hou, Lin; Chen, Xiaowei; Yan, Xiting; Chen, Mengjie; Li, Cong; Yang, Can; Gunel, Murat; Li, Peining; Kong, Yong; Alexander, Austin C; Albertyn, Zayed I; Boycott, Kym M; Bulman, Dennis E; Gordon, Paul M K; Innes, A Micheil; Knoppers, Bartha M; Majewski, Jacek; Marshall, Christian R; Parboosingh, Jillian S; Sawyer, Sarah L; Samuels, Mark E; Schwartzentruber, Jeremy; Kohane, Isaac S; Margulies, David M

2014-03-25

There is tremendous potential for genome sequencing to improve clinical diagnosis and care once it becomes routinely accessible, but this will require formalizing research methods into clinical best practices in the areas of sequence data generation, analysis, interpretation and reporting. The CLARITY Challenge was designed to spur convergence in methods for diagnosing genetic disease starting from clinical case history and genome sequencing data. DNA samples were obtained from three families with heritable genetic disorders and genomic sequence data were donated by sequencing platform vendors. The challenge was to analyze and interpret these data with the goals of identifying disease-causing variants and reporting the findings in a clinically useful format. Participating contestant groups were solicited broadly, and an independent panel of judges evaluated their performance. A total of 30 international groups were engaged. The entries reveal a general convergence of practices on most elements of the analysis and interpretation process. However, even given this commonality of approach, only two groups identified the consensus candidate variants in all disease cases, demonstrating a need for consistent fine-tuning of the generally accepted methods. There was greater diversity of the final clinical report content and in the patient consenting process, demonstrating that these areas require additional exploration and standardization. The CLARITY Challenge provides a comprehensive assessment of current practices for using genome sequencing to diagnose and report genetic diseases. There is remarkable convergence in bioinformatic techniques, but medical interpretation and reporting are areas that require further development by many groups.

Interpretation of clinical relevance of X-chromosome copy number variations identified in a large cohort of individuals with cognitive disorders and/or congenital anomalies.

PubMed

Willemsen, Marjolein H; de Leeuw, Nicole; de Brouwer, Arjan P M; Pfundt, Rolph; Hehir-Kwa, Jayne Y; Yntema, Helger G; Nillesen, Willy M; de Vries, Bert B A; van Bokhoven, Hans; Kleefstra, Tjitske

2012-11-01

Genome-wide array studies are now routinely being used in the evaluation of patients with cognitive disorders (CD) and/or congenital anomalies (CA). Therefore, inevitably each clinician is confronted with the challenging task of the interpretation of copy number variations detected by genome-wide array platforms in a diagnostic setting. Clinical interpretation of autosomal copy number variations is already challenging, but assessment of the clinical relevance of copy number variations of the X-chromosome is even more complex. This study provides an overview of the X-Chromosome copy number variations that we have identified by genome-wide array analysis in a large cohort of 4407 male and female patients. We have made an interpretation of the clinical relevance of each of these copy number variations based on well-defined criteria and previous reports in literature and databases. The prevalence of X-chromosome copy number variations in this cohort was 57/4407 (∼1.3%), of which 15 (0.3%) were interpreted as (likely) pathogenic. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Interpretation of way-finding healthcare symbols by a multicultural population: navigation signage design for global health.

PubMed

Hashim, Muhammad Jawad; Alkaabi, Mariam Salem Khamis Matar; Bharwani, Sulaiman

2014-05-01

The interpretation of way-finding symbols for healthcare facilities in a multicultural community was assessed in a cross-sectional study. One hundred participants recruited from Al Ain city in the United Arab Emirates were asked to interpret 28 healthcare symbols developed at Hablamos Juntos (such as vaccinations and laboratory) as well as 18 general-purpose symbols (such as elevators and restrooms). The mean age was 27.6 years (16-55 years) of whom 84 (84%) were females. Healthcare symbols were more difficult to comprehend than general-purpose signs. Symbols referring to abstract concepts were the most misinterpreted including oncology, diabetes education, outpatient clinic, interpretive services, pharmacy, internal medicine, registration, social services, obstetrics and gynecology, pediatrics and infectious diseases. Interpretation rates varied across cultural backgrounds and increased with higher education and younger age. Signage within healthcare facilities should be tested among older persons, those with limited literacy and across a wide range of cultures. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Passive Fourier-transform infrared spectroscopy of chemical plumes: an algorithm for quantitative interpretation and real-time background removal

NASA Astrophysics Data System (ADS)

Polak, Mark L.; Hall, Jeffrey L.; Herr, Kenneth C.

1995-08-01

We present a ratioing algorithm for quantitative analysis of the passive Fourier-transform infrared spectrum of a chemical plume. We show that the transmission of a near-field plume is given by tau plume = (Lobsd - Lbb-plume)/(Lbkgd - Lbb-plume), where tau _{plume is the frequency-dependent transmission of the plume, L obsd is the spectral radiance of the scene that contains the plume, Lbkgd is the spectral radiance of the same scene without the plume, and Lbb-plume is the spectral radiance of a blackbody at the plume temperature. The algorithm simultaneously achieves background removal, elimination of the spectrometer internal signature, and quantification of the plume spectral transmission. It has applications to both real-time processing for plume visualization and quantitative measurements of plume column densities. The plume temperature (Lbb-plume ), which is not always precisely known, can have a profound effect on the quantitative interpretation of the algorithm and is discussed in detail. Finally, we provide an illustrative example of the use of the algorithm on a trichloroethylene and acetone plume.}

Combining natural background levels (NBLs) assessment with indicator kriging analysis to improve groundwater quality data interpretation and management.

PubMed

Ducci, Daniela; de Melo, M Teresa Condesso; Preziosi, Elisabetta; Sellerino, Mariangela; Parrone, Daniele; Ribeiro, Luis

2016-11-01

The natural background level (NBL) concept is revisited and combined with indicator kriging method to analyze the spatial distribution of groundwater quality within a groundwater body (GWB). The aim is to provide a methodology to easily identify areas with the same probability of exceeding a given threshold (which may be a groundwater quality criteria, standards, or recommended limits for selected properties and constituents). Three case studies with different hydrogeological settings and located in two countries (Portugal and Italy) are used to derive NBL using the preselection method and validate the proposed methodology illustrating its main advantages over conventional statistical water quality analysis. Indicator kriging analysis was used to create probability maps of the three potential groundwater contaminants. The results clearly indicate the areas within a groundwater body that are potentially contaminated because the concentrations exceed the drinking water standards or even the local NBL, and cannot be justified by geogenic origin. The combined methodology developed facilitates the management of groundwater quality because it allows for the spatial interpretation of NBL values. Copyright © 2016 Elsevier B.V. All rights reserved.

Classifying clinical decision making: interpreting nursing intuition, heuristics and medical diagnosis.

PubMed

Buckingham, C D; Adams, A

2000-10-01

This is the second of two linked papers exploring decision making in nursing. The first paper, 'Classifying clinical decision making: a unifying approach' investigated difficulties with applying a range of decision-making theories to nursing practice. This is due to the diversity of terminology and theoretical concepts used, which militate against nurses being able to compare the outcomes of decisions analysed within different frameworks. It is therefore problematic for nurses to assess how good their decisions are, and where improvements can be made. However, despite the range of nomenclature, it was argued that there are underlying similarities between all theories of decision processes and that these should be exposed through integration within a single explanatory framework. A proposed solution was to use a general model of psychological classification to clarify and compare terms, concepts and processes identified across the different theories. The unifying framework of classification was described and this paper operationalizes it to demonstrate how different approaches to clinical decision making can be re-interpreted as classification behaviour. Particular attention is focused on classification in nursing, and on re-evaluating heuristic reasoning, which has been particularly prone to theoretical and terminological confusion. Demonstrating similarities in how different disciplines make decisions should promote improved multidisciplinary collaboration and a weakening of clinical elitism, thereby enhancing organizational effectiveness in health care and nurses' professional status. This is particularly important as nurses' roles continue to expand to embrace elements of managerial, medical and therapeutic work. Analysing nurses' decisions as classification behaviour will also enhance clinical effectiveness, and assist in making nurses' expertise more visible. In addition, the classification framework explodes the myth that intuition, traditionally associated

Evaluating Topic Model Interpretability from a Primary Care Physician Perspective

PubMed Central

Arnold, Corey W.; Oh, Andrea; Chen, Shawn; Speier, William

2015-01-01

Background and Objective Probabilistic topic models provide an unsupervised method for analyzing unstructured text. These models discover semantically coherent combinations of words (topics) that could be integrated in a clinical automatic summarization system for primary care physicians performing chart review. However, the human interpretability of topics discovered from clinical reports is unknown. Our objective is to assess the coherence of topics and their ability to represent the contents of clinical reports from a primary care physician’s point of view. Methods Three latent Dirichlet allocation models (50 topics, 100 topics, and 150 topics) were fit to a large collection of clinical reports. Topics were manually evaluated by primary care physicians and graduate students. Wilcoxon Signed-Rank Tests for Paired Samples were used to evaluate differences between different topic models, while differences in performance between students and primary care physicians (PCPs) were tested using Mann-Whitney U tests for each of the tasks. Results While the 150-topic model produced the best log likelihood, participants were most accurate at identifying words that did not belong in topics learned by the 100-topic model, suggesting that 100 topics provides better relative granularity of discovered semantic themes for the data set used in this study. Models were comparable in their ability to represent the contents of documents. Primary care physicians significantly outperformed students in both tasks. Conclusion This work establishes a baseline of interpretability for topic models trained with clinical reports, and provides insights on the appropriateness of using topic models for informatics applications. Our results indicate that PCPs find discovered topics more coherent and representative of clinical reports relative to students, warranting further research into their use for automatic summarization. PMID:26614020

The quality of emergency room radiograph interpretations.

PubMed

McLain, P L; Kirkwood, C R

1985-05-01

Primary care physicians often make patient management decisions based in part on their own interpretations of radiographs. This important area of clinical decision making has not been previously analyzed in the literature. In this series of 294 consecutive radiographs from rural practice, interpretative disagreement between primary care providers and backup radiologists occurred 9.2 percent of the time, a discordance rate similar to that seen among radiologists in other studies. Although a majority of the films for which interpretative disagreement occurred had potential implications for influencing patient management, in only seven cases did actual case management vary from appropriate norms. Follow-up of cases where interpretative disagreement occurred revealed that in only two cases did unsatisfactory outcomes occur. Primary care physicians can provide high-quality radiographic interpretations that, when coupled with clinical information, yield extremely low rates of error or potential for poor patient outcomes.

iRENEX: a clinically informed decision support system for the interpretation of ⁹⁹mTc-MAG3 scans to detect renal obstruction.

PubMed

Garcia, Ernest V; Taylor, Andrew; Folks, Russell; Manatunga, Daya; Halkar, Raghuveer; Savir-Baruch, Bital; Dubovsky, Eva

2012-09-01

Decision support systems for imaging analysis and interpretation are rapidly being developed and will have an increasing impact on the practice of medicine. RENEX is a renal expert system to assist physicians evaluate suspected obstruction in patients undergoing mercaptoacetyltriglycine (MAG3) renography. RENEX uses quantitative parameters extracted from the dynamic renal scan data using QuantEM™II and heuristic rules in the form of a knowledge base gleaned from experts to determine if a kidney is obstructed; however, RENEX does not have access to and could not consider the clinical information available to diagnosticians interpreting these studies. We designed and implemented a methodology to incorporate clinical information into RENEX, implemented motion detection and evaluated this new comprehensive system (iRENEX) in a pilot group of 51 renal patients. To reach a conclusion as to whether a kidney is obstructed, 56 new clinical rules were added to the previously reported 60 rules used to interpret quantitative MAG3 parameters. All the clinical rules were implemented after iRENEX reached a conclusion on obstruction based on the quantitative MAG3 parameters, and the evidence of obstruction was then modified by the new clinical rules. iRENEX consisted of a library to translate parameter values to certainty factors, a knowledge base with 116 heuristic interpretation rules, a forward chaining inference engine to determine obstruction and a justification engine. A clinical database was developed containing patient histories and imaging report data obtained from the hospital information system associated with the pertinent MAG3 studies. The system was fine-tuned and tested using a pilot group of 51 patients (21 men, mean age 58.2 ± 17.1 years, 100 kidneys) deemed by an expert panel to have 61 unobstructed and 39 obstructed kidneys. iRENEX, using only quantitative MAG3 data agreed with the expert panel in 87 % (34/39) of obstructed and 90 % (55/61) of

The Use of Intuition in Homeopathic Clinical Decision Making: An Interpretative Phenomenological Study

PubMed Central

Brien, Sarah; Dibb, Bridget; Burch, Alex

2011-01-01

While intuition plays a role in clinical decision making within conventional medicine, little is understood about its use in complementary and alternative medicine (CAM). The aim of this qualitative study was to investigate intuition from the perspective of homeopathic practitioners; its' manifestation, how it was recognized, its origins and when it was used within daily clinical practice. Semi-structured interviews were carried out with clinically experienced non-National Health Service (NHS) UK homeopathic practitioners. Interpretative phenomenological analysis was used to analyze the data. Homeopaths reported many similarities with conventional medical practitioner regarding the nature, perceived origin and manifestation of their intuitions in clinical practice. Intuition was used in two key aspects of the consultation: (i) to enhance the practitioner-patient relationship, these were generally trusted; and (ii) intuitions relating to the prescribing decision. Homeopaths were cautious about these latter intuitions, testing any intuitive thoughts through deductive reasoning before accepting them. Their reluctance is not surprising given the consequences for patient care, but we propose this also reflects homeopaths' sensitivity to the academic and medical mistrust of both homeopathy and intuition. This study is the first to explore the use of intuition in decision making in any form of complementary medicine. The similarities with conventional practitioners may provide confidence in validating intuition as a legitimate part of the decision making process for these specific practitioners. Further work is needed to elucidate if these findings reflect intuitive use in clinical practice of other CAM practitioners in both private and NHS (i.e., time limited) settings. PMID:19773389

Interpretation of Renal Quality of Life Profile scores in routine clinical practice: an aid to treatment decision-making.

PubMed

Aawar, Nadine; Moore, Richard; Riley, Stephen; Salek, Sam

2016-07-01

High Renal Quality of Life Profile (RQLP) scores are associated with impaired health-related quality of life; however, the clinical meaning of the scores is difficult for clinicians and healthcare planners to interpret. The aim of this study was to determine clinical significance of RQLP scores which could be used to aid clinical decision-making. The anchor-based technique (a method for categorizing numeric scores to ease interpretation) was used to develop a categorization system for the RQLP scores using a global question (GQ). The GQ scores (i.e. no effect to extremely large effect) were mapped against the RQLP scores, and intraclass correlation coefficient (ICC) was used to test their agreement. The RQLP and the GQ were administered to 260 adult patients (males = 165 and females = 95) with chronic renal failure (CRF). The mean RQLP score was 67.2, median = 61, SD = 41.5, and range 0-172. The mean GQ score was 1.74, median = 2, SD = 1.27, and range 0-4. The mean, mode, and median of the GQ scores for each RQLP score were used to devise several sets of categories of RQLP score, and the ICC test of agreement was calculated. The proposed set of RQLP score banding for adoption includes: 0-20 = no effect on patient's life (GQ = 0, n = 35); 21-51 = small effect on patient's life (GQ = 1, n = 66); 52-93 = moderate effect on patient's life (GQ = 2, n = 87); 94-134 = very large effect on patient's life (GQ = 3, n = 54); and 135-172 = extremely large effect on patient's life (GQ = 4, n = 18). The ICC coefficient for the proposed banding system was 0.80. The proposed categorization of the RQLP will aid the clinical interpretation of change in RQLP score informing treatment decision-making in routine practice.

Cardiac imaging: working towards fully-automated machine analysis & interpretation.

PubMed

Slomka, Piotr J; Dey, Damini; Sitek, Arkadiusz; Motwani, Manish; Berman, Daniel S; Germano, Guido

2017-03-01

Non-invasive imaging plays a critical role in managing patients with cardiovascular disease. Although subjective visual interpretation remains the clinical mainstay, quantitative analysis facilitates objective, evidence-based management, and advances in clinical research. This has driven developments in computing and software tools aimed at achieving fully automated image processing and quantitative analysis. In parallel, machine learning techniques have been used to rapidly integrate large amounts of clinical and quantitative imaging data to provide highly personalized individual patient-based conclusions. Areas covered: This review summarizes recent advances in automated quantitative imaging in cardiology and describes the latest techniques which incorporate machine learning principles. The review focuses on the cardiac imaging techniques which are in wide clinical use. It also discusses key issues and obstacles for these tools to become utilized in mainstream clinical practice. Expert commentary: Fully-automated processing and high-level computer interpretation of cardiac imaging are becoming a reality. Application of machine learning to the vast amounts of quantitative data generated per scan and integration with clinical data also facilitates a move to more patient-specific interpretation. These developments are unlikely to replace interpreting physicians but will provide them with highly accurate tools to detect disease, risk-stratify, and optimize patient-specific treatment. However, with each technological advance, we move further from human dependence and closer to fully-automated machine interpretation.

Cardiac imaging: working towards fully-automated machine analysis & interpretation

PubMed Central

Slomka, Piotr J; Dey, Damini; Sitek, Arkadiusz; Motwani, Manish; Berman, Daniel S; Germano, Guido

2017-01-01

Introduction Non-invasive imaging plays a critical role in managing patients with cardiovascular disease. Although subjective visual interpretation remains the clinical mainstay, quantitative analysis facilitates objective, evidence-based management, and advances in clinical research. This has driven developments in computing and software tools aimed at achieving fully automated image processing and quantitative analysis. In parallel, machine learning techniques have been used to rapidly integrate large amounts of clinical and quantitative imaging data to provide highly personalized individual patient-based conclusions. Areas covered This review summarizes recent advances in automated quantitative imaging in cardiology and describes the latest techniques which incorporate machine learning principles. The review focuses on the cardiac imaging techniques which are in wide clinical use. It also discusses key issues and obstacles for these tools to become utilized in mainstream clinical practice. Expert commentary Fully-automated processing and high-level computer interpretation of cardiac imaging are becoming a reality. Application of machine learning to the vast amounts of quantitative data generated per scan and integration with clinical data also facilitates a move to more patient-specific interpretation. These developments are unlikely to replace interpreting physicians but will provide them with highly accurate tools to detect disease, risk-stratify, and optimize patient-specific treatment. However, with each technological advance, we move further from human dependence and closer to fully-automated machine interpretation. PMID:28277804

Defining thresholds of specific IgE levels to grass pollen and birch pollen allergens improves clinical interpretation.

PubMed

Van Hoeyveld, Erna; Nickmans, Silvie; Ceuppens, Jan L; Bossuyt, Xavier

2015-10-23

Cut-off values and predictive values are used for the clinical interpretation of specific IgE antibody results. However, cut-off levels are not well defined, and predictive values are dependent on the prevalence of disease. The objective of this study was to document clinically relevant diagnostic accuracy of specific IgE for inhalant allergens (grass pollen and birch pollen) based on test result interval-specific likelihood ratios. Likelihood ratios are independent of the prevalence and allow to provide diagnostic accuracy information for test result intervals. In a prospective study we included consecutive adult patients presenting at an allergy clinic with complaints of rhinitis or rhinoconjunctivitis. The standard for diagnosis was a suggestive clinical history of grass or birch pollen allergy and a positive skin test. Specific IgE was determined with the ImmunoCAP Fluorescence Enzyme Immuno-Assay. We established specific IgE test result interval related likelihood ratios for clinical allergy to inhalant allergens (grass pollen, rPhl p 1,5, birch pollen, rBet v 1). The likelihood ratios for allergy increased with increasing specific IgE antibody levels. The likelihood ratio was <0.03 for specific IgE <0.1 kU/L, between 0.1 and 1.4 for specific IgE between 0.1 kU/L and 0.35 kU/L, between 1.4 and 4.2 for specific IgE between 0.35 kU/L and 3.5 kU/L, >6.3 for specific IgE>0.7, and very high (∞) for specific IgE >3.5 kU/L. Test result interval specific likelihood ratios provide a useful tool for the interpretation of specific IgE test results for inhalant allergens. Copyright © 2015 Elsevier B.V. All rights reserved.

Biased Interpretation of Ambiguous Social Scenarios in Anorexia Nervosa.

PubMed

Cardi, Valentina; Turton, Robert; Schifano, Sylvia; Leppanen, Jenni; Hirsch, Colette R; Treasure, Janet

2017-01-01

Patients with anorexia nervosa experience increased sensitivity to the risk of social rejection. The aims of this study were to assess the interpretation of ambiguous social scenarios depicting the risk of rejection and to examine the relationship between interpretation biases and clinical symptoms. Thirty-five women with anorexia nervosa and 30 healthy eaters completed clinical questionnaires, alongside a sentence completion task. This task required participants to generate completions to ambiguous social scenarios and to endorse their best completion. Responses were rated as being negative, neutral or positive. Patients endorsed more negative interpretations and fewer neutral and positive interpretations compared with healthy eaters. The frequency of endorsed negative interpretations correlated with depression, anxiety and fear of weight gain and body disturbance. A negative interpretation bias towards social stimuli is present in women with anorexia nervosa and correlates with clinical symptoms. Interventions aimed at reducing this bias could improve illness prognosis. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence.

PubMed

Nguyen, Van N B; Forbes, Helen; Mohebbi, Mohammadreza; Duke, Maxine

2018-06-12

To describe how clinical nurse educators in Vietnam are prepared for their role; to identify which preparation strategies assist development of confidence in clinical teaching; and to measure the effect of educational qualifications and professional background on perceived confidence levels. The quality of clinical teaching can directly affect the quality of the student learning experience. The role of the clinical educator is complex and dynamic and requires a period of adjustment for successful role transition to occur. Planned orientation and specific preparation programs assist transition and reduce anxiety for new clinical nurse educators. There is, however, a lack of clear evidence to identify the form this preparation should take or which strategies are likely to facilitate the development of role confidence. Descriptive survey study. Cross-sectional surveys were used to collect data from 334 clinical nurse educators during January - March 2015. Eight preparation methods commonly used in Vietnam were identified. There was a small yet significant association between preparation and clinical nurse educators' perceived confidence. Formal preparation methods, as well as postgraduate qualifications and years of clinical teaching experience were linked to increased confidence in clinical teaching. Conversely, informal mentorship was found to hinder confidence development. This study identifies several preparation strategies that significantly enhance clinical educator confidence and readiness for their complex role. These preparation strategies drawn from the Vietnamese context, provide important examples for the wider nursing community to consider. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Cutting Corners: Provider Perceptions of Interpretation Services and Factors Related to Use of an Ad Hoc Interpreter.

PubMed

Mayo, Rachel; Parker, Veronica G; Sherrill, Windsor W; Coltman, Kinneil; Hudson, Matthew F; Nichols, Christina M; Yates, Adam M; Pribonic, Anne Paige

2016-06-01

This study assessed health providers' perceptions of factors related to professional interpretation services and the association between these factors and the potential use of ad hoc interpreters. Data were collected from a convenience sample of 150 health services providers at a large, regional health system in South Carolina. Providers rated "ability to communicate effectively during a clinical encounter" as paramount regarding the use of interpretation services. The most important factors related to the likely use of ad hoc interpreters (cutting corners) included locating a qualified interpreter, having to wait for a qualified interpreter, and technical difficulties regarding phone and video technology. Health care organizations may benefit from increasing staff awareness about patient safety and legal and regulatory risks involved with the use of ad hoc interpreters. © The Author(s) 2016.

Should Athletic Training Educators Utilize Grades When Evaluating Student Clinical Performance?

ERIC Educational Resources Information Center

Scriber, Kent; Gray, Courtney; Millspaugh, Rose

2010-01-01

Objective: To explore and address some of the challenges for assessing, interpreting, and grading athletic training students' clinical performance and to suggest athletic training educators consider using a more universal assessment method for professional consistency. Background: In years past students learned from teachers or mentors on an…

Studying extragalactic background fluctuations with the Cosmic Infrared Background ExpeRiment 2 (CIBER-2)

NASA Astrophysics Data System (ADS)

Lanz, Alicia; Arai, Toshiaki; Battle, John; Bock, James; Cooray, Asantha; Hristov, Viktor; Korngut, Phillip; Lee, Dae Hee; Mason, Peter; Matsumoto, Toshio; Matsuura, Shuji; Morford, Tracy; Onishi, Yosuke; Shirahata, Mai; Tsumura, Kohji; Wada, Takehiko; Zemcov, Michael

2014-08-01

Fluctuations in the extragalactic background light trace emission from the history of galaxy formation, including the emission from the earliest sources from the epoch of reionization. A number of recent near-infrared measure- ments show excess spatial power at large angular scales inconsistent with models of z < 5 emission from galaxies. These measurements have been interpreted as arising from either redshifted stellar and quasar emission from the epoch of reionization, or the combined intra-halo light from stars thrown out of galaxies during merging activity at lower redshifts. Though astrophysically distinct, both interpretations arise from faint, low surface brightness source populations that are difficult to detect except by statistical approaches using careful observations with suitable instruments. The key to determining the source of these background anisotropies will be wide-field imaging measurements spanning multiple bands from the optical to the near-infrared. The Cosmic Infrared Background ExpeRiment 2 (CIBER-2) will measure spatial anisotropies in the extra- galactic infrared background caused by cosmological structure using six broad spectral bands. The experiment uses three 2048 x 2048 Hawaii-2RG near-infrared arrays in three cameras coupled to a single 28.5 cm telescope housed in a reusable sounding rocket-borne payload. A small portion of each array will also be combined with a linear-variable filter to make absolute measurements of the spectrum of the extragalactic background with high spatial resolution for deep subtraction of Galactic starlight. The large field of view and multiple spectral bands make CIBER-2 unique in its sensitivity to fluctuations predicted by models of lower limits on the luminosity of the first stars and galaxies and in its ability to distinguish between primordial and foreground anisotropies. In this paper the scientific motivation for CIBER-2 and details of its first flight instrumentation will be discussed, including

Skill Assessment in the Interpretation of 3D Fracture Patterns from Radiographs

PubMed Central

Rojas-Murillo, Salvador; Hanley, Jessica M; Kreiter, Clarence D; Karam, Matthew D; Anderson, Donald D

2016-01-01

Abstract Background Interpreting two-dimensional radiographs to ascertain the three-dimensional (3D) position and orientation of fracture planes and bone fragments is an important component of orthopedic diagnosis and clinical management. This skill, however, has not been thoroughly explored and measured. Our primary research question is to determine if 3D radiographic image interpretation can be reliably assessed, and whether this assessment varies by level of training. A test designed to measure this skill among orthopedic surgeons would provide a quantitative benchmark for skill assessment and training research. Methods Two tests consisting of a series of online exercises were developed to measure this skill. Each exercise displayed a pair of musculoskeletal radiographs. Participants selected one of three CT slices of the same or similar fracture patterns that best matched the radiographs. In experiment 1, 10 orthopedic residents and staff responded to nine questions. In experiment 2, 52 residents from both orthopedics and radiology responded to 12 questions. Results Experiment 1 yielded a Cronbach alpha of 0.47. Performance correlated with experience; r(8) = 0.87, p<0.01, suggesting that the test could be both valid and reliable with a slight increase in test length. In experiment 2, after removing three non-discriminating items, the Cronbach coefficient alpha was 0.28 and performance correlated with experience; r(50) = 0.25, p<0.10. Conclusions Although evidence for reliability and validity was more compelling with the first experiment, the analyses suggest motivation and test duration are important determinants of test efficacy. The interpretation of radiographs to discern 3D information is a promising and a relatively unexplored area for surgical skill education and assessment. The online test was useful and reliable. Further test development is likely to increase test effectiveness. Clinical Relevance Accurately interpreting radiographic images is an

Developing evidence-based dentistry skills: how to interpret randomized clinical trials and systematic reviews.

PubMed

Kiriakou, Juliana; Pandis, Nikolaos; Madianos, Phoebus; Polychronopoulou, Argy

2014-10-30

Decision-making based on reliable evidence is more likely to lead to effective and efficient treatments. Evidence-based dentistry was developed, similarly to evidence-based medicine, to help clinicians apply current and valid research findings into their own clinical practice. Interpreting and appraising the literature is fundamental and involves the development of evidence-based dentistry (EBD) skills. Systematic reviews (SRs) of randomized controlled trials (RCTs) are considered to be evidence of the highest level in evaluating the effectiveness of interventions. Furthermore, the assessment of the report of a RCT, as well as a SR, can lead to an estimation of how the study was designed and conducted.

A pattern-based analysis of clinical computer-interpretable guideline modeling languages.

PubMed

Mulyar, Nataliya; van der Aalst, Wil M P; Peleg, Mor

2007-01-01

Languages used to specify computer-interpretable guidelines (CIGs) differ in their approaches to addressing particular modeling challenges. The main goals of this article are: (1) to examine the expressive power of CIG modeling languages, and (2) to define the differences, from the control-flow perspective, between process languages in workflow management systems and modeling languages used to design clinical guidelines. The pattern-based analysis was applied to guideline modeling languages Asbru, EON, GLIF, and PROforma. We focused on control-flow and left other perspectives out of consideration. We evaluated the selected CIG modeling languages and identified their degree of support of 43 control-flow patterns. We used a set of explicitly defined evaluation criteria to determine whether each pattern is supported directly, indirectly, or not at all. PROforma offers direct support for 22 of 43 patterns, Asbru 20, GLIF 17, and EON 11. All four directly support basic control-flow patterns, cancellation patterns, and some advance branching and synchronization patterns. None support multiple instances patterns. They offer varying levels of support for synchronizing merge patterns and state-based patterns. Some support a few scenarios not covered by the 43 control-flow patterns. CIG modeling languages are remarkably close to traditional workflow languages from the control-flow perspective, but cover many fewer workflow patterns. CIG languages offer some flexibility that supports modeling of complex decisions and provide ways for modeling some decisions not covered by workflow management systems. Workflow management systems may be suitable for clinical guideline applications.

Assessment of the level of agreement in the interpretation of plain radiographs of lumbar spondylosis among clinical physiotherapists in Ghana

PubMed Central

2014-01-01

Background Objective physical assessment of patients with lumbar spondylosis involves plain film radiographs (PFR) viewing and interpretation by the radiologists. Physiotherapists also routinely assess PFR within the scope of their practice. However, studies appraising the level of agreement of physiotherapists’ PFR interpretation with radiologists are not common in Ghana. Method Forty-one (41) physiotherapists took part in the cross-sectional survey. An assessment guide was developed from findings of the interpretation of three PFR of patients with lumbar spondylosis by a radiologist. The three PFR were selected from a pool of different radiographs based on clarity, common visible pathological features, coverage body segments and short post production period. Physiotherapists were required to view the same PFR after which they were assessed with the assessment guide according to the number of features identified correctly or incorrectly. The score range on the assessment form was 0–24, interpreted as follow: 0–8 points (low), 9–16 points (moderate) and 17–24 points (high) levels of agreement. Data were analyzed using one sample t-test and fisher’s exact test at α = 0.05. Results The mean score of interpretation for the physiotherapists was 12.7 ± 2.6 points compared to the radiologist’s interpretation of 24 points (assessment guide). The physiotherapists’ levels were found to be significantly associated with their academic qualification (p = 0.006) and sex (p = 0.001). However, their levels of agreement were not significantly associated with their age group (p = 0.098), work settings (p = 0.171), experience (p = 0.666), preferred PFR view (p = 0.088) and continuing education (p = 0.069). Conclusions The physiotherapists’ skills fall short of expectation for interpreting PFR of patients with lumbar spondylosis. The levels of agreement with radiologist’s interpretation have no link with year of clinial

A computer-human interaction model to improve the diagnostic accuracy and clinical decision-making during 12-lead electrocardiogram interpretation.

PubMed

Cairns, Andrew W; Bond, Raymond R; Finlay, Dewar D; Breen, Cathal; Guldenring, Daniel; Gaffney, Robert; Gallagher, Anthony G; Peace, Aaron J; Henn, Pat

2016-12-01

The 12-lead Electrocardiogram (ECG) presents a plethora of information and demands extensive knowledge and a high cognitive workload to interpret. Whilst the ECG is an important clinical tool, it is frequently incorrectly interpreted. Even expert clinicians are known to impulsively provide a diagnosis based on their first impression and often miss co-abnormalities. Given it is widely reported that there is a lack of competency in ECG interpretation, it is imperative to optimise the interpretation process. Predominantly the ECG interpretation process remains a paper based approach and whilst computer algorithms are used to assist interpreters by providing printed computerised diagnoses, there are a lack of interactive human-computer interfaces to guide and assist the interpreter. An interactive computing system was developed to guide the decision making process of a clinician when interpreting the ECG. The system decomposes the interpretation process into a series of interactive sub-tasks and encourages the clinician to systematically interpret the ECG. We have named this model 'Interactive Progressive based Interpretation' (IPI) as the user cannot 'progress' unless they complete each sub-task. Using this model, the ECG is segmented into five parts and presented over five user interfaces (1: Rhythm interpretation, 2: Interpretation of the P-wave morphology, 3: Limb lead interpretation, 4: QRS morphology interpretation with chest lead and rhythm strip presentation and 5: Final review of 12-lead ECG). The IPI model was implemented using emerging web technologies (i.e. HTML5, CSS3, AJAX, PHP and MySQL). It was hypothesised that this system would reduce the number of interpretation errors and increase diagnostic accuracy in ECG interpreters. To test this, we compared the diagnostic accuracy of clinicians when they used the standard approach (control cohort) with clinicians who interpreted the same ECGs using the IPI approach (IPI cohort). For the control cohort, the

Representation primitives, process models and patient data in computer-interpretable clinical practice guidelines: a literature review of guideline representation models.

PubMed

Wang, Dongwen; Peleg, Mor; Tu, Samson W; Boxwala, Aziz A; Greenes, Robert A; Patel, Vimla L; Shortliffe, Edward H

2002-12-18

Representation of clinical practice guidelines in a computer-interpretable format is a critical issue for guideline development, implementation, and evaluation. We studied 11 types of guideline representation models that can be used to encode guidelines in computer-interpretable formats. We have consistently found in all reviewed models that primitives for representation of actions and decisions are necessary components of a guideline representation model. Patient states and execution states are important concepts that closely relate to each other. Scheduling constraints on representation primitives can be modeled as sequences, concurrences, alternatives, and loops in a guideline's application process. Nesting of guidelines provides multiple views to a guideline with different granularities. Integration of guidelines with electronic medical records can be facilitated by the introduction of a formal model for patient data. Data collection, decision, patient state, and intervention constitute four basic types of primitives in a guideline's logic flow. Decisions clarify our understanding on a patient's clinical state, while interventions lead to the change from one patient state to another.

THE DELACATO INTERPRETATION OF NEUROLOGICAL ORGANIZATION.

ERIC Educational Resources Information Center

ROBBINS, MELVYN PAUL

THE RESULTS FROM AN EXPERIMENT TESTING A SERIES OF SIX HYPOTHESES DEDUCED FROM THE DELACATO INTERPRETATION OF NEUROLOGICAL ORGANIZATION ARE PRESENTED. SUBJECTS IN THE 3-MONTH STUDY WERE SECOND GRADERS FROM THE CHICAGO ARCHDIOCESAN SCHOOL SYSTEM WHO REPRESENTED SIMILAR BACKGROUNDS AND SOCIOECONOMIC LEVELS. COMPARISONS WERE MADE OF THE READING AND…

Religion, Spirituality, and Medicine: Psychiatrists’ and Other Physicians’ Differing Observations, Interpretations, and Clinical Approaches

PubMed Central

Curlin, Farr A.; Lawrence, Ryan E.; Odell, Shaun; Chin, Marshall H.; Lantos, John D.; Koenig, Harold G.; Meador, Keith G.

2010-01-01

Objective This study compared the ways in which psychiatrists and nonpsychiatrists interpret the relationship between religion/spirituality and health and address religion/spirituality issues in the clinical encounter. Method The authors mailed a survey to a stratified random sample of 2,000 practicing U.S. physicians, with an oversampling of psychiatrists. The authors asked the physicians about their beliefs and observations regarding the relationship between religion/spirituality and patient health and about the ways in which they address religion/spirituality in the clinical setting. Results A total of 1,144 physicians completed the survey. Psychiatrists generally endorse positive influences of religion/spirituality on health, but they are more likely than other physicians to note that religion/spirituality sometimes causes negative emotions that lead to increased patient suffering (82% versus 44%). Compared to other physicians, psychiatrists are more likely to encounter religion/spirituality issues in clinical settings (92% versus 74% report their patients sometimes or often mention religion/spirituality issues), and they are more open to addressing religion/spirituality issues with patients (93% versus 53% say that it is usually or always appropriate to inquire about religion/spirituality). Conclusions This study suggests that the vast majority of psychiatrists appreciate the importance of religion and/or spirituality at least at a functional level. Compared to other physicians, psychiatrists also appear to be more comfortable, and have more experience, addressing religion/spirituality concerns in the clinical setting. PMID:18056237

Experiences of Kurdish war-wounded refugees in communication with Swedish authorities through interpreter.

PubMed

Fatahi, Nabi; Nordholm, Lena; Mattsson, Bengt; Hellström, Mikael

2010-02-01

To study experiences of war-wounded Kurdish refugees with respect to cross-cultural communication through interpreters. Semi-structured interviews were conducted with ten men, aged 31-42. Content analysis was used for analysis and interpretation of data. War-wounded Kurdish refugees experienced a number of difficulties regarding communication through interpreters, mainly related to the insufficient language link to the Swedish authorities, particularly health care personnel. In many instances, interpreters were selected based on the immigrant's citizenship rather than mother tongue, leading to a more complex, tri-lingual interpretation situation. Differences in cultural background, fear, suspicion and lack of confidence in interpreters were addressed as other problems by the participants. Interpreter competence and patient confidence in the interpreter are essential for an adequate cross-cultural health communication. Assignment of interpreters should be based on knowledge of the patient's/client's mother tongue, rather than citizenship, and the outcome is improved by a common ethnic and cultural background of interpreter and patient/client. Our study should be considered as a pilot study, and the results should be validated in larger cohorts as well as in other ethnic and language groups. In order to minimize communication misunderstandings, complicated tri-lingual interpretation situations should be avoided. Interpreters should ideally be assigned according to patient's/client's mother tongue rather than citizenship. Interpreters' competence and patient's/client's confidence in interpreter may have significant impact on communication outcome. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

The value of Bayes' theorem for interpreting abnormal test scores in cognitively healthy and clinical samples.

PubMed

Gavett, Brandon E

2015-03-01

The base rates of abnormal test scores in cognitively normal samples have been a focus of recent research. The goal of the current study is to illustrate how Bayes' theorem uses these base rates--along with the same base rates in cognitively impaired samples and prevalence rates of cognitive impairment--to yield probability values that are more useful for making judgments about the absence or presence of cognitive impairment. Correlation matrices, means, and standard deviations were obtained from the Wechsler Memory Scale--4th Edition (WMS-IV) Technical and Interpretive Manual and used in Monte Carlo simulations to estimate the base rates of abnormal test scores in the standardization and special groups (mixed clinical) samples. Bayes' theorem was applied to these estimates to identify probabilities of normal cognition based on the number of abnormal test scores observed. Abnormal scores were common in the standardization sample (65.4% scoring below a scaled score of 7 on at least one subtest) and more common in the mixed clinical sample (85.6% scoring below a scaled score of 7 on at least one subtest). Probabilities varied according to the number of abnormal test scores, base rates of normal cognition, and cutoff scores. The results suggest that interpretation of base rates obtained from cognitively healthy samples must also account for data from cognitively impaired samples. Bayes' theorem can help neuropsychologists answer questions about the probability that an individual examinee is cognitively healthy based on the number of abnormal test scores observed.

Social Perception in Children with Intellectual Disabilities: The Interpretation of Benign and Hostile Intentions

ERIC Educational Resources Information Center

Leffert, J. S.; Siperstein, G. N.; Widaman, K. F.

2010-01-01

Background: A key aspect of social perception is the interpretation of others' intentions. Children with intellectual disabilities (IDs) have difficulty interpreting benign intentions when a negative event occurs. From a cognitive processing perspective, interpreting benign intentions can be challenging because it requires integration of…

Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Fei, E-mail: feisun@ccmijesususon.com; Crisóstomo, Verónica, E-mail: crisosto@ccmijesususon.com; Báez-Díaz, Claudia, E-mail: cbaez@ccmijesususon.com

Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance.more » BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.« less

Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications.

PubMed

Sun, Fei; Crisóstomo, Verónica; Báez-Díaz, Claudia; Sánchez, Francisco M

2016-01-01

Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.

Autoadaptivity and optimization in distributed ECG interpretation.

PubMed

Augustyniak, Piotr

2010-03-01

This paper addresses principal issues of the ECG interpretation adaptivity in a distributed surveillance network. In the age of pervasive access to wireless digital communication, distributed biosignal interpretation networks may not only optimally solve difficult medical cases, but also adapt the data acquisition, interpretation, and transmission to the variable patient's status and availability of technical resources. The background of such adaptivity is the innovative use of results from the automatic ECG analysis to the seamless remote modification of the interpreting software. Since the medical relevance of issued diagnostic data depends on the patient's status, the interpretation adaptivity implies the flexibility of report content and frequency. Proposed solutions are based on the research on human experts behavior, procedures reliability, and usage statistics. Despite the limited scale of our prototype client-server application, the tests yielded very promising results: the transmission channel occupation was reduced by 2.6 to 5.6 times comparing to the rigid reporting mode and the improvement of the remotely computed diagnostic outcome was achieved in case of over 80% of software adaptation attempts.

Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

PubMed Central

2013-01-01

Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community. PMID:23587282

On-Orbit Sky Background Measurements with the FOS

NASA Technical Reports Server (NTRS)

Lyons, R. W.; Baity, W. A.; Beaver, E. A.; Cohen, R. D.; Junkkarinen, V. T.; Linsky, J. B.; Bohlin, R. C.

1993-01-01

Observations of the sky background obtained with the Faint Object Spectrograph during 1991-1992 are discussed. Sky light can be an important contributor to the observed count rate in several of the instrument configurations especially when large apertures are used. In general, the sky background is consistent with the pre-launch expectations and showed the expected effects of zodiacal light and diffuse galactic light. In addition to these sources, there is, particularly during the daytime, a highly variable airglow component which includes a number of emission lines. The sky background will have an impact on the reduction and possibly the interpretation of some spectra.

Can patients interpret health information? An assessment of the medical data interpretation test.

PubMed

Schwartz, Lisa M; Woloshin, Steven; Welch, H Gilbert

2005-01-01

To establish the reliability/validity of an 18-item test of patients' medical data interpretation skills. Survey with retest after 2 weeks. Subjects. 178 people recruited from advertisements in local newspapers, an outpatient clinic, and a hospital open house. The percentage of correct answers to individual items ranged from 20% to 87%, and medical data interpretation test scores (on a 0- 100 scale) were normally distributed (median 61.1, mean 61.0, range 6-94). Reliability was good (test-retest correlation=0.67, Cronbach's alpha=0.71). Construct validity was supported in several ways. Higher scores were found among people with highest versus lowest numeracy (71 v. 36, P<0.001), highest quantitative literacy (65 v. 28, P<0.001), and highest education (69 v. 42, P=0.004). Scores for 15 physician experts also completing the survey were significantly higher than participants with other postgraduate degrees (mean score 89 v. 69, P<0.001). The medical data interpretation test is a reliable and valid measure of the ability to interpret medical statistics.

ICADx: interpretable computer aided diagnosis of breast masses

NASA Astrophysics Data System (ADS)

Kim, Seong Tae; Lee, Hakmin; Kim, Hak Gu; Ro, Yong Man

2018-02-01

In this study, a novel computer aided diagnosis (CADx) framework is devised to investigate interpretability for classifying breast masses. Recently, a deep learning technology has been successfully applied to medical image analysis including CADx. Existing deep learning based CADx approaches, however, have a limitation in explaining the diagnostic decision. In real clinical practice, clinical decisions could be made with reasonable explanation. So current deep learning approaches in CADx are limited in real world deployment. In this paper, we investigate interpretability in CADx with the proposed interpretable CADx (ICADx) framework. The proposed framework is devised with a generative adversarial network, which consists of interpretable diagnosis network and synthetic lesion generative network to learn the relationship between malignancy and a standardized description (BI-RADS). The lesion generative network and the interpretable diagnosis network compete in an adversarial learning so that the two networks are improved. The effectiveness of the proposed method was validated on public mammogram database. Experimental results showed that the proposed ICADx framework could provide the interpretability of mass as well as mass classification. It was mainly attributed to the fact that the proposed method was effectively trained to find the relationship between malignancy and interpretations via the adversarial learning. These results imply that the proposed ICADx framework could be a promising approach to develop the CADx system.

Patient Satisfaction with Different Interpreting Methods: A Randomized Controlled Trial

PubMed Central

Leng, Jennifer; Shapiro, Ephraim; Abramson, David; Motola, Ivette; Shield, David C.; Changrani, Jyotsna

2007-01-01

Background Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. Methods 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants. Results 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (β 0.10, 95% CI 0.02–0.18, scale 0–1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. Conclusions While not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged

A comparative review of clinical governance arrangements in the UK.

PubMed

Pridmore, Julia Ann; Gammon, John

This article provides a comparative review of the interpretation and implementation of clinical governance frameworks within the four home countries of the UK--England, Northern Ireland, Scotland and Wales. Clinical governance has become one of most significant and important concepts in modern health care. The article considers the policy background and the many definitions of clinical governance, but specifically compares the various strategic and operational approaches to delivery of clinical governance in different parts of the UK. It is suggested that these variations in approach, by each of the four UK countries, can lead to confusion for healthcare professionals in trying to understand, implement and monitor elements of clinical governance in practice.

Cognitive Bias Modification Training in Adolescents: Effects on Interpretation Biases and Mood

ERIC Educational Resources Information Center

Lothmann, Claudia; Holmes, Emily A.; Chan, Stella W. Y.; Lau, Jennifer Y. F.

2011-01-01

Background: Negative biases in the interpretation of ambiguous material have been linked to anxiety and mood problems. Accumulating data from adults show that positive and negative interpretation styles can be induced through cognitive bias modification (CBM) paradigms with accompanying changes in mood. Despite the therapeutic potential of…

Clinical associations of maternal thyroid function with foetal brain development: Epidemiological interpretation and overview of available evidence.

PubMed

Korevaar, Tim I M; Tiemeier, Henning; Peeters, Robin P

2018-04-24

Thyroid hormone is an important regulator of early brain development, particularly during early stages of gestation during which foetal thyroid hormone availability depends on the maternal transfer of thyroid hormones. There is a wide range of experimental studies showing that low maternal thyroid hormone availability is associated with suboptimal brain development parameters. While few clinical studies have shown that overt maternal hypothyroidism is associated with lower child IQ, the question whether more subclinical changes in maternal thyroid function could also lead to suboptimal foetal brain development. In this review, we put the latter studies in perspective and discuss their interpretation from an epidemiological and clinical perspective. Furthermore, we extend this discussion to also include future perspective and identify important knowledge gaps in the field. © 2018 John Wiley & Sons Ltd.

CardioClassifier: disease- and gene-specific computational decision support for clinical genome interpretation.

PubMed

Whiffin, Nicola; Walsh, Roddy; Govind, Risha; Edwards, Matthew; Ahmad, Mian; Zhang, Xiaolei; Tayal, Upasana; Buchan, Rachel; Midwinter, William; Wilk, Alicja E; Najgebauer, Hanna; Francis, Catherine; Wilkinson, Sam; Monk, Thomas; Brett, Laura; O'Regan, Declan P; Prasad, Sanjay K; Morris-Rosendahl, Deborah J; Barton, Paul J R; Edwards, Elizabeth; Ware, James S; Cook, Stuart A

2018-01-25

PurposeInternationally adopted variant interpretation guidelines from the American College of Medical Genetics and Genomics (ACMG) are generic and require disease-specific refinement. Here we developed CardioClassifier (http://www.cardioclassifier.org), a semiautomated decision-support tool for inherited cardiac conditions (ICCs).MethodsCardioClassifier integrates data retrieved from multiple sources with user-input case-specific information, through an interactive interface, to support variant interpretation. Combining disease- and gene-specific knowledge with variant observations in large cohorts of cases and controls, we refined 14 computational ACMG criteria and created three ICC-specific rules.ResultsWe benchmarked CardioClassifier on 57 expertly curated variants and show full retrieval of all computational data, concordantly activating 87.3% of rules. A generic annotation tool identified fewer than half as many clinically actionable variants (64/219 vs. 156/219, Fisher's P = 1.1  ×  10 -18 ), with important false positives, illustrating the critical importance of disease and gene-specific annotations. CardioClassifier identified putatively disease-causing variants in 33.7% of 327 cardiomyopathy cases, comparable with leading ICC laboratories. Through addition of manually curated data, variants found in over 40% of cardiomyopathy cases are fully annotated, without requiring additional user-input data.ConclusionCardioClassifier is an ICC-specific decision-support tool that integrates expertly curated computational annotations with case-specific data to generate fast, reproducible, and interactive variant pathogenicity reports, according to best practice guidelines.GENETICS in MEDICINE advance online publication, 25 January 2018; doi:10.1038/gim.2017.258.

Radiologist Uncertainty and the Interpretation of Screening

PubMed Central

Carney, Patricia A.; Elmore, Joann G.; Abraham, Linn A.; Gerrity, Martha S.; Hendrick, R. Edward; Taplin, Stephen H.; Barlow, William E.; Cutter, Gary R.; Poplack, Steven P.; D’Orsi, Carl J.

2011-01-01

Objective To determine radiologists’ reactions to uncertainty when interpreting mammography and the extent to which radiologist uncertainty explains variability in interpretive performance. Methods The authors used a mailed survey to assess demographic and clinical characteristics of radiologists and reactions to uncertainty associated with practice. Responses were linked to radiologists’ actual interpretive performance data obtained from 3 regionally located mammography registries. Results More than 180 radiologists were eligible to participate, and 139 consented for a response rate of 76.8%. Radiologist gender, more years interpreting, and higher volume were associated with lower uncertainty scores. Positive predictive value, recall rates, and specificity were more affected by reactions to uncertainty than sensitivity or negative predictive value; however, none of these relationships was statistically significant. Conclusion Certain practice factors, such as gender and years of interpretive experience, affect uncertainty scores. Radiologists’ reactions to uncertainty do not appear to affect interpretive performance. PMID:15155014

Randomized clinical trials as reflexive-interpretative process in patients with rheumatoid arthritis: a qualitative study.

PubMed

de Jorge, Mercedes; Parra, Sonia; de la Torre-Aboki, Jenny; Herrero-Beaumont, Gabriel

2015-08-01

Patients in randomized clinical trials have to adapt themselves to a restricted language to capture the necessary information to determine the safety and efficacy of a new treatment. The aim of this study was to explore the experience of patients with rheumatoid arthritis after completing their participation in a biologic therapy randomized clinical trial for a period of 3 years. A qualitative approach was used. The information was collected using 15 semi-structured interviews of patients with rheumatoid arthritis. Data collection was guided by the emergent analysis until no more relevant variations in the categories were found. The data were analysed using the grounded theory method. The objective of the patients when entering the study was to improve their quality of life by initiating the treatment. However, the experience changed the significance of the illness as they acquired skills and practical knowledge related to the management of their disease. The category "Interactional Empowerment" emerged as core category, as it represented the participative experience in a clinical trial. The process integrates the follow categories: "weight of systematisation", "working together", and the significance of the experience: "the duties". Simultaneously these categories evolved. The clinical trial monitoring activities enabled patients to engage in a reflexive-interpretative mechanism that transformed the emotional and symbolic significance of their disease and improved the empowerment of the patient. A better communicative strategy with the health professionals, the relatives of the patients, and the community was also achieved.

Computer-Interpreted Electrocardiograms: Benefits and Limitations.

PubMed

Schläpfer, Jürg; Wellens, Hein J

2017-08-29

Computerized interpretation of the electrocardiogram (CIE) was introduced to improve the correct interpretation of the electrocardiogram (ECG), facilitating health care decision making and reducing costs. Worldwide, millions of ECGs are recorded annually, with the majority automatically analyzed, followed by an immediate interpretation. Limitations in the diagnostic accuracy of CIE were soon recognized and still persist, despite ongoing improvement in ECG algorithms. Unfortunately, inexperienced physicians ordering the ECG may fail to recognize interpretation mistakes and accept the automated diagnosis without criticism. Clinical mismanagement may result, with the risk of exposing patients to useless investigations or potentially dangerous treatment. Consequently, CIE over-reading and confirmation by an experienced ECG reader are essential and are repeatedly recommended in published reports. Implementation of new ECG knowledge is also important. The current status of automated ECG interpretation is reviewed, with suggestions for improvement. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Interpretive focus groups: a participatory method for interpreting and extending secondary analysis of qualitative data

PubMed Central

Redman-MacLaren, Michelle; Mills, Jane; Tommbe, Rachael

2014-01-01

Background Participatory approaches to qualitative research practice constantly change in response to evolving research environments. Researchers are increasingly encouraged to undertake secondary analysis of qualitative data, despite epistemological and ethical challenges. Interpretive focus groups can be described as a more participative method for groups to analyse qualitative data. Objective To facilitate interpretive focus groups with women in Papua New Guinea to extend analysis of existing qualitative data and co-create new primary data. The purpose of this was to inform a transformational grounded theory and subsequent health promoting action. Design A two-step approach was used in a grounded theory study about how women experience male circumcision in Papua New Guinea. Participants analysed portions or ‘chunks’ of existing qualitative data in story circles and built upon this analysis by using the visual research method of storyboarding. Results New understandings of the data were evoked when women in interpretive focus groups analysed the data ‘chunks’. Interpretive focus groups encouraged women to share their personal experiences about male circumcision. The visual method of storyboarding enabled women to draw pictures to represent their experiences. This provided an additional focus for whole-of-group discussions about the research topic. Conclusions Interpretive focus groups offer opportunity to enhance trustworthiness of findings when researchers undertake secondary analysis of qualitative data. The co-analysis of existing data and co-generation of new data between research participants and researchers informed an emergent transformational grounded theory and subsequent health promoting action. PMID:25138532

The origin of the diffuse background gamma radiation

NASA Technical Reports Server (NTRS)

Stecker, F. W.; Puget, J. L.

1974-01-01

Recent observations provided evidence for diffuse background gamma radiation extending to energies beyond 100 MeV, and evidence of isotropy and implied cosmological origin. Significant features in the spectrum of this background radiation were observed which provide evidence for its origin in nuclear processes in the early stages of big-bang cosmology, and connect these processes with the galaxy formation theory. A test of the theory is in future observations of the background radiation in the 100 MeK to 100 GeV energy range which are made with large orbiting spark-chamber satellite detectors. The theoretical interpretations of present data, their connection with baryon-symmetric cosmology and galaxy formation theory, and the need for future observations are discussed.

Simulation of target interpretation based on infrared image features and psychology principle

NASA Astrophysics Data System (ADS)

Lin, Wei; Chen, Yu-hua; Gao, Hong-sheng; Wang, Zhan-feng; Wang, Ji-jun; Su, Rong-hua; Huang, Yan-ping

2009-07-01

It's an important and complicated process in target interpretation that target features extraction and identification, which effect psychosensorial quantity of interpretation person to target infrared image directly, and decide target viability finally. Using statistical decision theory and psychology principle, designing four psychophysical experiment, the interpretation model of the infrared target is established. The model can get target detection probability by calculating four features similarity degree between target region and background region, which were plotted out on the infrared image. With the verification of a great deal target interpretation in practice, the model can simulate target interpretation and detection process effectively, get the result of target interpretation impersonality, which can provide technique support for target extraction, identification and decision-making.

The effects of a novel hostile interpretation bias modification paradigm on hostile interpretations, mood, and aggressive behavior.

PubMed

AlMoghrabi, Nouran; Huijding, Jorg; Franken, Ingmar H A

2018-03-01

Cognitive theories of aggression propose that biased information processing is causally related to aggression. To test these ideas, the current study investigated the effects of a novel cognitive bias modification paradigm (CBM-I) designed to target interpretations associated with aggressive behavior. Participants aged 18-33 years old were randomly assigned to either a single session of positive training (n = 40) aimed at increasing prosocial interpretations or negative training (n = 40) aimed at increasing hostile interpretations. The results revealed that the positive training resulted in an increase in prosocial interpretations while the negative training seemed to have no effect on interpretations. Importantly, in the positive condition, a positive change in interpretations was related to lower anger and verbal aggression scores after the training. In this condition, participants also reported an increase in happiness. In the negative training no such effects were found. However, the better participants performed on the negative training, the more their interpretations were changed in a negative direction and the more aggression they showed on the behavioral aggression task. Participants were healthy university students. Therefore, results should be confirmed within a clinical population. These findings provide support for the idea that this novel CBM-I paradigm can be used to modify interpretations, and suggests that these interpretations are related to mood and aggressive behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Cosmic Microwave Background: Detection and Interpretation of the First Light

NASA Technical Reports Server (NTRS)

Wollack, Edward J.

2016-01-01

A host of astrophysical observations suggest the early Universe was incredibly hot, dense, and homogeneous. A powerful and useful probe of this epoch is provided by the relic radiation, which we refer to today as the Cosmic Microwave Background (CMB). Precision maps of this light contain the earliest glimpse of the Universe after the Big Bang and signatures of the evolution of its contents. By exploiting these clues, constraints on the age, mass density, detailed composition, and geometry of the Universe can be made. A brief survey of the evolution of the radiometric and polarimetric imaging systems used in advancing our understanding of the early Universe will be reviewed. A survey of detector technologies, instrumentation techniques, and experimental challenges encountered in these efforts will be presented.

Genetic, Clinical, and Pathologic Backgrounds of Patients with Autosomal Dominant Alport Syndrome.

PubMed

Kamiyoshi, Naohiro; Nozu, Kandai; Fu, Xue Jun; Morisada, Naoya; Nozu, Yoshimi; Ye, Ming Juan; Imafuku, Aya; Miura, Kenichiro; Yamamura, Tomohiko; Minamikawa, Shogo; Shono, Akemi; Ninchoji, Takeshi; Morioka, Ichiro; Nakanishi, Koichi; Yoshikawa, Norishige; Kaito, Hiroshi; Iijima, Kazumoto

2016-08-08

Alport syndrome comprises a group of inherited heterogeneous disorders involving CKD, hearing loss, and ocular abnormalities. Autosomal dominant Alport syndrome caused by heterozygous mutations in collagen 4A3 and/or collagen 4A4 accounts for <5% of patients. However, the clinical, genetic, and pathologic backgrounds of patients with autosomal dominant Alport syndrome remain unclear. We conducted a retrospective analysis of 25 patients with genetically proven autosomal dominant Alport syndrome and their family members (a total of 72 patients) from 16 unrelated families. Patients with suspected Alport syndrome after pathologic examination who were referred from anywhere in Japan for genetic analysis from 2006 to 2015 were included in this study. Clinical, laboratory, and pathologic data were collected from medical records at the point of registration for genetic diagnosis. Genetic analysis was performed by targeted resequencing of 27 podocyte-related genes, including Alport-related collagen genes, to make a diagnosis of autosomal dominant Alport syndrome and identify modifier genes or double mutations. Clinical data were obtained from medical records. The median renal survival time was 70 years, and the median age at first detection of proteinuria was 17 years old. There was one patient with hearing loss and one patient with ocular lesion. Among 16 patients who underwent kidney biopsy, three showed FSGS, and seven showed thinning without lamellation of the glomerular basement membrane. Five of 13 detected mutations were reported to be causative mutations for autosomal recessive Alport syndrome in previous studies. Two families possessed double mutations in both collagen 4A3 and collagen 4A4, but no modifier genes were detected among the other podocyte-related genes. The renal phenotype of autosomal dominant Alport syndrome was much milder than that of autosomal recessive Alport syndrome or X-linked Alport syndrome in men. It may, thus, be difficult to make an

Illness Perception and Clinical Treatment Experiences in Patients with M. Maroteaux-Lamy (Mucopolysaccharidosis Type VI) and a Turkish Migration Background in Germany

PubMed Central

Dilger, Hansjörg; Leissner, Linn; Bosanska, Lenka; Lampe, Christina; Plöckinger, Ursula

2013-01-01

Introduction Mucopolysaccharidosis VI (MPS VI) is an inherited lysosomal storage disease caused by a mutation of the gene for arylsulfatase B (ASB). Of the thirty-one patients registered in Germany, almost fifty percent have a Turkish migration background. MPS VI is treated by enzyme replacement therapy (ERT), which is time-consuming and expensive. Methods This interdisciplinary study explored the illness perceptions and clinical treatment experiences among ten MPS VI patients with a Turkish migration background in two centers for metabolic diseases (Berlin and Mainz, Germany). The clinical treatment situation was observed and semi-structured interviews were conducted with patients and health care personnel, in addition to participatory observation in four patients' everyday environments in Berlin. The data from the interviews, patient records, and personal field notes were encoded, cross-related, and analyzed. Results Patients' acknowledgement of the disease and coping strategies are influenced predominantly by the perception of their individual health status and the handling of the disease within their family. Patients' willingness to cooperate with treatment strategies is further modified by their knowledge of the disease and the relationships with their health care providers. In this analysis, cultural factors turned out to be marginally relevant. Conclusion As with other chronic and debilitating diseases, effective treatment strategies have to reach beyond delivering medication. Health care providers need to strengthen the support for patients with a migration background. In this regard, they should respect the patients' cultural and social background and their personal perception of the disease and the therapy. Yet structural and social aspects (clinical setting, family and educational background) may be more crucial here than “cultural barriers.” PMID:23826140

Joint Official Positions of the International Society for Clinical Densitometry and International Osteoporosis Foundation on FRAX(®). Executive Summary of the 2010 Position Development Conference on Interpretation and use of FRAX® in clinical practice.

PubMed

Hans, Didier B; Kanis, John A; Baim, Sanford; Bilezikian, John P; Binkley, Neil; Cauley, Jane A; Compston, Juliet E; Cooper, Cyrus; Dawson-Hughes, Bess; El-Hajj Fuleihan, Ghada; Leslie, William D; Lewiecki, E Michael; Luckey, Marjorie M; McCloskey, Eugene V; Papapoulos, Socrates E; Poiana, Catalina; Rizzoli, René

2011-01-01

The International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) convened the FRAX(®) Position Development Conference (PDC) in Bucharest, Romania, on November 14, 2010, following a two-day joint meeting of the ISCD and IOF on the "Interpretation and Use of FRAX(®) in Clinical Practice." These three days of critical discussion and debate, led by a panel of international experts from the ISCD, IOF and dedicated task forces, have clarified a number of important issues pertaining to the interpretation and implementation of FRAX(®) in clinical practice. The Official Positions resulting from the PDC are intended to enhance the quality and clinical utility of fracture risk assessment worldwide. Since the field of skeletal assessment is still evolving rapidly, some clinically important issues addressed at the PDCs are not associated with robust medical evidence. Accordingly, some Official Positions are based largely on expert opinion. Despite limitations inherent in such a process, the ISCD and IOF believe it is important to provide clinicians and technologists with the best distillation of current knowledge in the discipline of bone densitometry and provide an important focus for the scientific community to consider. This report describes the methodology and results of the ISCD-IOF PDC dedicated to FRAX(®). Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Could the clinical interpretability of subgroups detected using clustering methods be improved by using a novel two-stage approach?

PubMed

Kent, Peter; Stochkendahl, Mette Jensen; Christensen, Henrik Wulff; Kongsted, Alice

2015-01-01

Recognition of homogeneous subgroups of patients can usefully improve prediction of their outcomes and the targeting of treatment. There are a number of research approaches that have been used to recognise homogeneity in such subgroups and to test their implications. One approach is to use statistical clustering techniques, such as Cluster Analysis or Latent Class Analysis, to detect latent relationships between patient characteristics. Influential patient characteristics can come from diverse domains of health, such as pain, activity limitation, physical impairment, social role participation, psychological factors, biomarkers and imaging. However, such 'whole person' research may result in data-driven subgroups that are complex, difficult to interpret and challenging to recognise clinically. This paper describes a novel approach to applying statistical clustering techniques that may improve the clinical interpretability of derived subgroups and reduce sample size requirements. This approach involves clustering in two sequential stages. The first stage involves clustering within health domains and therefore requires creating as many clustering models as there are health domains in the available data. This first stage produces scoring patterns within each domain. The second stage involves clustering using the scoring patterns from each health domain (from the first stage) to identify subgroups across all domains. We illustrate this using chest pain data from the baseline presentation of 580 patients. The new two-stage clustering resulted in two subgroups that approximated the classic textbook descriptions of musculoskeletal chest pain and atypical angina chest pain. The traditional single-stage clustering resulted in five clusters that were also clinically recognisable but displayed less distinct differences. In this paper, a new approach to using clustering techniques to identify clinically useful subgroups of patients is suggested. Research designs, statistical

Body fluid analysis: clinical utility and applicability of published studies to guide interpretation of today's laboratory testing in serous fluids.

PubMed

Block, Darci R; Algeciras-Schimnich, Alicia

2013-01-01

Requests for testing various analytes in serous fluids (e.g., pleural, peritoneal, pericardial effusions) are submitted daily to clinical laboratories. Testing of these fluids deviates from assay manufacturers' specifications, as most laboratory assays are optimized for testing blood or urine specimens. These requests add a burden to clinical laboratories, which need to validate assay performance characteristics in these fluids to exclude matrix interferences (given the different composition of body fluids) while maintaining regulatory compliance. Body fluid testing for a number of analytes has been reported in the literature; however, understanding the clinical utility of these analytes is critical because laboratories must address the analytic and clinical validation requirements, while educating clinicians on proper test utilization. In this article, we review the published data to evaluate the clinical utility of testing for numerous analytes in body fluid specimens. We also highlight the pre-analytic and analytic variables that need to be considered when reviewing published studies in body fluid testing. Finally, we provide guidance on how published studies might (or might not) guide interpretation of test results in today's clinical laboratories.

A readers' guide to the interpretation of diagnostic test properties: clinical example of sepsis.

PubMed

Fischer, Joachim E; Bachmann, Lucas M; Jaeschke, Roman

2003-07-01

One of the most challenging practical and daily problems in intensive care medicine is the interpretation of the results from diagnostic tests. In neonatology and pediatric intensive care the early diagnosis of potentially life-threatening infections is a particularly important issue. A plethora of tests have been suggested to improve diagnostic decision making in the clinical setting of infection which is a clinical example used in this article. Several criteria that are critical to evidence-based appraisal of published data are often not adhered to during the study or in reporting. To enhance the critical appraisal on articles on diagnostic tests we discuss various measures of test accuracy: sensitivity, specificity, receiver operating characteristic curves, positive and negative predictive values, likelihood ratios, pretest probability, posttest probability, and diagnostic odds ratio. We suggest the following minimal requirements for reporting on the diagnostic accuracy of tests: a plot of the raw data, multilevel likelihood ratios, the area under the receiver operating characteristic curve, and the cutoff yielding the highest discriminative ability. For critical appraisal it is mandatory to report confidence intervals for each of these measures. Moreover, to allow comparison to the readers' patient population authors should provide data on study population characteristics, in particular on the spectrum of diseases and illness severity.

CNV-WebStore: online CNV analysis, storage and interpretation.

PubMed

Vandeweyer, Geert; Reyniers, Edwin; Wuyts, Wim; Rooms, Liesbeth; Kooy, R Frank

2011-01-05

Microarray technology allows the analysis of genomic aberrations at an ever increasing resolution, making functional interpretation of these vast amounts of data the main bottleneck in routine implementation of high resolution array platforms, and emphasising the need for a centralised and easy to use CNV data management and interpretation system. We present CNV-WebStore, an online platform to streamline the processing and downstream interpretation of microarray data in a clinical context, tailored towards but not limited to the Illumina BeadArray platform. Provided analysis tools include CNV analsyis, parent of origin and uniparental disomy detection. Interpretation tools include data visualisation, gene prioritisation, automated PubMed searching, linking data to several genome browsers and annotation of CNVs based on several public databases. Finally a module is provided for uniform reporting of results. CNV-WebStore is able to present copy number data in an intuitive way to both lab technicians and clinicians, making it a useful tool in daily clinical practice.

MO-B-BRB-01: 3D Dosimetry in the Clinic: Background and Motivation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schreiner, L.

Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by themore » development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data

A Study of the Competency of Third Year Medical Students to Interpret Biochemically Based Clinical Scenarios Using Knowledge and Skills Gained in Year 1 and 2

ERIC Educational Resources Information Center

Gowda, Veena Bhaskar S.; Nagaiah, Bhaskar Hebbani; Sengodan, Bharathi

2016-01-01

Medical students build clinical knowledge on the grounds of previously obtained basic knowledge. The study aimed to evaluate the competency of third year medical students to interpret biochemically based clinical scenarios using knowledge and skills gained during year 1 and 2 of undergraduate medical training. Study was conducted on year 3 MBBS…

Automated Interpretation of Blood Culture Gram Stains by Use of a Deep Convolutional Neural Network.

PubMed

Smith, Kenneth P; Kang, Anthony D; Kirby, James E

2018-03-01

Microscopic interpretation of stained smears is one of the most operator-dependent and time-intensive activities in the clinical microbiology laboratory. Here, we investigated application of an automated image acquisition and convolutional neural network (CNN)-based approach for automated Gram stain classification. Using an automated microscopy platform, uncoverslipped slides were scanned with a 40× dry objective, generating images of sufficient resolution for interpretation. We collected 25,488 images from positive blood culture Gram stains prepared during routine clinical workup. These images were used to generate 100,213 crops containing Gram-positive cocci in clusters, Gram-positive cocci in chains/pairs, Gram-negative rods, or background (no cells). These categories were targeted for proof-of-concept development as they are associated with the majority of bloodstream infections. Our CNN model achieved a classification accuracy of 94.9% on a test set of image crops. Receiver operating characteristic (ROC) curve analysis indicated a robust ability to differentiate between categories with an area under the curve of >0.98 for each. After training and validation, we applied the classification algorithm to new images collected from 189 whole slides without human intervention. Sensitivity and specificity were 98.4% and 75.0% for Gram-positive cocci in chains and pairs, 93.2% and 97.2% for Gram-positive cocci in clusters, and 96.3% and 98.1% for Gram-negative rods. Taken together, our data support a proof of concept for a fully automated classification methodology for blood-culture Gram stains. Importantly, the algorithm was highly adept at identifying image crops with organisms and could be used to present prescreened, classified crops to technologists to accelerate smear review. This concept could potentially be extended to all Gram stain interpretive activities in the clinical laboratory. Copyright © 2018 American Society for Microbiology.

Why prudence is needed when interpreting articles reporting clinical trial results in mental health.

PubMed

Dal-Ré, Rafael; Bobes, Julio; Cuijpers, Pim

2017-03-28

Clinical trial results' reliability is impacted by reporting bias. This is primarily manifested as publication bias and outcome reporting bias. Mental health trials are prone to two methodological deficiencies: (1) using small numbers of participants that facilitates false positive findings and exaggerated size effects, and (2) the obligatory use of psychometric scales that require subjective assessments. These two deficiencies contribute to the publication of unreliable results. Considerable reporting bias has been found in safety and efficacy findings in psychotherapy and pharmacotherapy trials. Reporting bias can be carried forward to meta-analyses, a key source for clinical practice guidelines. The final result is the frequent overestimation of treatment effects that could impact patients and clinician-informed decisions. Prospective registration of trials and publication of results are the two major methods to reduce reporting bias. Prospective trial registration will allow checking whether they are published (so it will help to prevent publication bias) and, if published, whether those outcomes and analyses that were deemed as appropriate before trial commencement are actually published (hence helping to find out selective reporting of outcomes). Unfortunately, the rate of registered trials in mental health interventions is low and, frequently, of poor quality. Clinicians should be prudent when interpreting the results of published trials and some meta-analyses - such as those conducted by scientists working for the sponsor company or those that only include published trials. Prescribers, however, should be confident when prescribing drugs following the summary of product characteristics, since regulatory agencies have access to all clinical trial results.

Drug-related disorders and the criminal and clinical background of the prison population of São Paulo State, Brazil.

PubMed

Mendes dos Santos, Maíra; Quintana, Maria Ines; Moreira, Fernanda Gonçalves; Taborda, José Geraldo Vernet; Mari, Jair de Jesus; Andreoli, Sérgio Baxter

2014-01-01

To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category. The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5). The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison populations.

Drug-Related Disorders and the Criminal and Clinical Background of the Prison Population of São Paulo State, Brazil

PubMed Central

dos Santos, Maíra Mendes; Quintana, Maria Ines; Moreira, Fernanda Gonçalves; Taborda, José Geraldo Vernet; Mari, Jair de Jesus; Andreoli, Sérgio Baxter

2014-01-01

Objective To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. Method Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category. Results The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5). Conclusion The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison

Exenatide Once-Weekly Clinical Development: Safety and Efficacy Across a Range of Background Therapies

PubMed Central

Stonehouse, Anthony; Walsh, Brandon

2011-01-01

Abstract In patients with type 2 diabetes mellitus (T2DM), the physiologic glucagon-like peptide-1 (GLP-1) response, which is involved in glucose regulation through several mechanisms, is dysfunctional. GLP-1 receptor agonists can fill an unmet therapeutic need in the treatment of T2DM: improving glycemic control without increasing the risk of hypoglycemia (except with concomitant sulfonylureas) and reducing weight in a substantial proportion of patients. GLP-1 receptor agonists have impacted established disease treatment algorithms for T2DM. For example, in 2009 the American Diabetes Association and European Association for the Study of Diabetes revised their consensus treatment algorithm to incorporate GLP-1 receptor agonists. GLP-1 receptor agonists were originally represented by exenatide BID (ExBID), a short-acting agent requiring twice-daily injections at mealtime. The longer-acting agent liraglutide, requiring once-daily injections, recently received regulatory approval. Several other long-acting agents are in clinical development, one of which is the once-weekly formulation of exenatide (exenatide once weekly [ExQW]). This article reviews the clinical development of ExQW in the DURATION program. Patients in theses clinical trials were receiving various background treatments, ranging from lifestyle therapy to combination oral therapy, although the majority (68%) received metformin monotherapy. Specifically, safety, glycemic control, and weight were compared in patients treated with ExQW versus ExBID, sitagliptin, pioglitazone, or insulin glargine. Moreover, measures of β-cell function, cardiovascular risk, inflammation, and hepatic health were investigated. During ExQW clinical development, consistent clinical efficacy (glycosylated hemoglobin, −1.5% to −1.9%; weight, −2 kg to −4 kg) and safety data were observed in patients with T2DM treated with ExQW. PMID:21732798

Choosing Accommodations: Signed Language Interpreting and the Absence of Choice.

PubMed

Burke, Teresa Blankmeyer

This paper carves out a topic space for discussion about the ethical question of whether input from signing Deaf consumers of interpreting services ought to be included in the provision of signed language interpreter accommodations. The first section provides background about disability accommodations and practices, including how signed language interpreting accommodations are similar and dissimilar to other kinds of disability accommodations. In the second section, I offer a personal narrative of my experience as a Deaf academic who has been excluded from the interpreter selection process, highlighting some of the harmful consequences of such exclusion. In the subsequent two sections, I describe and analyze the process of choosing interpreter accommodations, starting with the process of requesting signed language interpreters and the institutionalization of this process, followed by a brief overview of privacy and autonomy concerns from the standpoint of the signing Deaf consumer. The penultimate section considers some objections to the proposal of involving more consumer choice in signed language accommodations. I conclude the paper with some concrete suggestions for a more Deaf-centered, inclusive process for choosing interpreter accommodations.

Does a Rater's Professional Background Influence Communication Skills Assessment?

PubMed

Artemiou, Elpida; Hecker, Kent G; Adams, Cindy L; Coe, Jason B

2015-01-01

There is increasing pressure in veterinary education to teach and assess communication skills, with the Objective Structured Clinical Examination (OSCE) being the most common assessment method. Previous research reveals that raters are a large source of variance in OSCEs. This study focused on examining the effect of raters' professional background as a source of variance when assessing students' communication skills. Twenty-three raters were categorized according to their professional background: clinical sciences (n=11), basic sciences (n=4), clinical communication (n=5), or hospital administrator/clinical skills technicians (n=3). Raters from each professional background were assigned to the same station and assessed the same students during two four-station OSCEs. Students were in year 2 of their pre-clinical program. Repeated-measures ANOVA results showed that OSCE scores awarded by the rater groups differed significantly: (F(matched_station_1) [2,91]=6.97, p=.002), (F(matched_station_2) [3,90]=13.95, p=.001), (F(matched_station_3) [3,90]=8.76, p=.001), and ((Fmatched_station_4) [2,91]=30.60, p=.001). A significant time effect between the two OSCEs was calculated for matched stations 1, 2, and 4, indicating improved student performances. Raters with a clinical communication skills background assigned scores that were significantly lower compared to the other rater groups. Analysis of written feedback provided by the clinical sciences raters showed that they were influenced by the students' clinical knowledge of the case and that they did not rely solely on the communication checklist items. This study shows that it is important to consider rater background both in recruitment and training programs for communication skills' assessment.

Evidence-based Guidelines for Interpretation of the Panic Disorder Severity Scale

PubMed Central

Furukawa, Toshi A.; Shear, M. Katherine; Barlow, David H.; Gorman, Jack M.; Woods, Scott W.; Money, Roy; Etschel, Eva; Engel, Rolf R.; Leucht, Stefan

2008-01-01

Background The Panic Disorder Severity Scale (PDSS) is promising to be a standard global rating scale for panic disorder. In order for a clinical scale to be useful, we need a guideline for interpreting its scores and their changes, and for defining clinical change points such as response and remission. Methods We used individual patient data from two large randomized controlled trials of panic disorder (total n=568). Study participants were administered the PDSS and the Clinical Global Impression (CGI)-Severity and -Improvement. We applied equipercentile linking technique to draw correspondences between PDSS and CGI-Severity, numeric changes in PDSS and CGI-Improvement, and percent changes in PDSS and CGI-Improvement. Results The interpretation of the PDSS total score differed according to the presence or absence of agoraphobia. When the patients were not agoraphobic, score ranges 0–1 corresponded with “Normal,” 2–5 with “Borderline”, 6–9 with “Slightly ill”, 10–13 with “Moderately ill”, and 14 and above with “Markedly ill.” When the patients were agoraphobic, score ranges 3–7 meant “Borderline ill,” 8–10 “Slightly ill,” 11–15 “Moderately ill,” and 16 and above “Markedly ill.” The relationship between PDSS change and CGI-Improvement was more linear when measured as percentile change than as numeric changes, and was indistinguishable for those with or without agoraphobia. The decrease by 75–100% was considered “Very much improved,” that by 40–74% “Much improved,” and that by 10–39% “Minimally improved.” Conclusion We propose that “remission” of panic disorder be defined by PDSS scores of 5 or less and its “response” by 40% or greater reduction. PMID:19006198

Interpreting psychoanalytic interpretation: a fourfold perspective.

PubMed

Schermer, Victor L

2011-12-01

Following an overview of psychoanalytic interpretation in theory, practice, and historical context, as well as the question of whether interpretations have scientific validity, the author holds that hermeneutics, the philosophical and psychological study of interpretation, provides a rich understanding of recent developments in self psychology, inter-subjective and relational perspectives, attachment theory, and psycho-spiritual views on psychoanalytic process. He then offers four distinct hermeneutical vantage points regarding interpretation in the psychoanalytic context, including (1) Freud's adaptation of the Aristotelian view of interpretation as the uncovering of a set of predetermined meanings and structures; (2) the phenomenological view of interpretation as the laying bare of "the things themselves," that is, removing the coverings of objectification and concretization imposed by social norms and the conscious ego; (3) the dialogical existential view of interpretation as an ongoing relational process; and (4) the transformational understanding in which interpretation evokes a "presence" that transforms both patient and analyst. He concludes by contending that these perspectives are not mutually exclusive ways of conducting an analysis, but rather that all occur within the analyst's suspended attention, the caregiving and holding essential to good therapeutic outcomes, and the mutuality of the psychoanalytic dialogue.

The Growing Importance of CNVs: New Insights for Detection and Clinical Interpretation

PubMed Central

Valsesia, Armand; Macé, Aurélien; Jacquemont, Sébastien; Beckmann, Jacques S.; Kutalik, Zoltán

2013-01-01

Differences between genomes can be due to single nucleotide variants, translocations, inversions, and copy number variants (CNVs, gain or loss of DNA). The latter can range from sub-microscopic events to complete chromosomal aneuploidies. Small CNVs are often benign but those larger than 500 kb are strongly associated with morbid consequences such as developmental disorders and cancer. Detecting CNVs within and between populations is essential to better understand the plasticity of our genome and to elucidate its possible contribution to disease. Hence there is a need for better-tailored and more robust tools for the detection and genome-wide analyses of CNVs. While a link between a given CNV and a disease may have often been established, the relative CNV contribution to disease progression and impact on drug response is not necessarily understood. In this review we discuss the progress, challenges, and limitations that occur at different stages of CNV analysis from the detection (using DNA microarrays and next-generation sequencing) and identification of recurrent CNVs to the association with phenotypes. We emphasize the importance of germline CNVs and propose strategies to aid clinicians to better interpret structural variations and assess their clinical implications. PMID:23750167

Definition, reporting, and interpretation of composite outcomes in clinical trials: systematic review

PubMed Central

Cordoba, Gloria; Schwartz, Lisa; Woloshin, Steven; Bae, Harold

2010-01-01

Objective To study how composite outcomes, which have combined several components into a single measure, are defined, reported, and interpreted. Design Systematic review of parallel group randomised clinical trials published in 2008 reporting a binary composite outcome. Two independent observers extracted the data using a standardised data sheet, and two other observers, blinded to the results, selected the most important component. Results Of 40 included trials, 29 (73%) were about cardiovascular topics and 24 (60%) were entirely or partly industry funded. Composite outcomes had a median of three components (range 2–9). Death or cardiovascular death was the most important component in 33 trials (83%). Only one trial provided a good rationale for the choice of components. We judged that the components were not of similar importance in 28 trials (70%); in 20 of these, death was combined with hospital admission. Other major problems were change in the definition of the composite outcome between the abstract, methods, and results sections (13 trials); missing, ambiguous, or uninterpretable data (9 trials); and post hoc construction of composite outcomes (4 trials). Only 24 trials (60%) provided reliable estimates for both the composite and its components, and only six trials (15%) had components of similar, or possibly similar, clinical importance and provided reliable estimates. In 11 of 16 trials with a statistically significant composite, the abstract conclusion falsely implied that the effect applied also to the most important component. Conclusions The use of composite outcomes in trials is problematic. Components are often unreasonably combined, inconsistently defined, and inadequately reported. These problems will leave many readers confused, often with an exaggerated perception of how well interventions work. PMID:20719825

Definition, reporting, and interpretation of composite outcomes in clinical trials: systematic review.

PubMed

Cordoba, Gloria; Schwartz, Lisa; Woloshin, Steven; Bae, Harold; Gøtzsche, Peter C

2010-08-18

To study how composite outcomes, which have combined several components into a single measure, are defined, reported, and interpreted. Systematic review of parallel group randomised clinical trials published in 2008 reporting a binary composite outcome. Two independent observers extracted the data using a standardised data sheet, and two other observers, blinded to the results, selected the most important component. Of 40 included trials, 29 (73%) were about cardiovascular topics and 24 (60%) were entirely or partly industry funded. Composite outcomes had a median of three components (range 2-9). Death or cardiovascular death was the most important component in 33 trials (83%). Only one trial provided a good rationale for the choice of components. We judged that the components were not of similar importance in 28 trials (70%); in 20 of these, death was combined with hospital admission. Other major problems were change in the definition of the composite outcome between the abstract, methods, and results sections (13 trials); missing, ambiguous, or uninterpretable data (9 trials); and post hoc construction of composite outcomes (4 trials). Only 24 trials (60%) provided reliable estimates for both the composite and its components, and only six trials (15%) had components of similar, or possibly similar, clinical importance and provided reliable estimates. In 11 of 16 trials with a statistically significant composite, the abstract conclusion falsely implied that the effect applied also to the most important component. The use of composite outcomes in trials is problematic. Components are often unreasonably combined, inconsistently defined, and inadequately reported. These problems will leave many readers confused, often with an exaggerated perception of how well interventions work.

Associating Changes in the Immune System with Clinical Diseases for Interpretation in Risk Assessment

PubMed Central

Germolec, Dori R.; Luebke, Robert W.; Johnson, Victor J.

2016-01-01

This overview is an update of the unit originally published in 2004. While the basic tenants of immunotoxicity have not changed in the past 10 years, several publications have explored the application of immunotoxicological data to the risk assessment process. Therefore, the goal of this unit is still to highlight relationships between xenobiotic-induced immunosuppression and risk of clinical diseases progression. In immunotoxicology, this may require development of models to equate moderate changes in markers of immune functions to potential changes in incidence or severity of infectious diseases. For most xenobiotics, exposure levels and disease incidence data are rarely available and safe exposure levels must be estimated based on observations from experimental models or human biomarker studies. Thus, it is important to establish a scientifically sound framework that allows accurate and quantitative interpretation of experimental or biomarker data in the risk assessment process. PMID:26828330

Associating Changes in the Immune System with Clinical Diseases for Interpretation in Risk Assessment.

PubMed

DeWitt, Jamie C; Germolec, Dori R; Luebke, Robert W; Johnson, Victor J

2016-02-01

This overview is an update of the unit originally published in 2004. While the basic tenets of immunotoxicity have not changed in the past 10 years, several publications have explored the application of immunotoxicological data to the risk assessment process. Therefore, the goal of this unit is still to highlight relationships between xenobiotic-induced immunosuppression and risk of clinical diseases progression. In immunotoxicology, this may require development of models to equate moderate changes in markers of immune functions to potential changes in incidence or severity of infectious diseases. For most xenobiotics, exposure levels and disease incidence data are rarely available, and safe exposure levels must be estimated based on observations from experimental models or human biomarker studies. Thus, it is important to establish a scientifically sound framework that allows accurate and quantitative interpretation of experimental or biomarker data in the risk assessment process. Copyright © 2016 John Wiley & Sons, Inc.

Performance-based interpretation bias in clinically anxious youths: relationships with attention, anxiety, and negative cognition.

PubMed

Rozenman, Michelle; Amir, Nader; Weersing, V Robin

2014-09-01

This preliminary investigation sought to examine basic interpretive biases, as assessed via performance-based means, in the context of anxious symptomatology, attention, and negative cognition in children and adolescents. At a single assessment, 26 youths diagnosed with primary separation anxiety, social phobia, or generalized anxiety disorder completed performance-based assessments of interpretation and attention. Youths and parents also completed diagnostic interviews and youths completed a measure of negative self-statements. Components of interpretation (threat-valence judgments and speed of responding) were examined, and interpretation was explored as a correlate of youth anxiety, attention bias, and negative self-statements. Results found percentage of negative interpretations endorsed as the strongest predictor of anxiety symptoms; this index was also correlated with attention bias. Slower rejection of benign interpretations was also associated with youth-reported negative self-statements.This initial investigation provides support for a relationship between interpretation bias and anxiety and preliminary evidence for a relationship between attention and interpretation biases. Continued research dismantling the stages of basic cognition within the chain of information processing may provide a better understanding of the mechanisms underlying anxiety disorders in youths and lead to continued development and refinement of cognitive interventions. Copyright © 2014. Published by Elsevier Ltd.

The origin of the diffuse background gamma-radiation

NASA Technical Reports Server (NTRS)

Stecker, F. W.; Puget, J. L.

1974-01-01

Recent observations have now provided evidence for diffuse background gamma radiation extending to energies beyond 100 MeV. There is some evidence of isotropy and implied cosmological origin. Significant features in the spectrum of this background radiation have been observed which provide evidence for its origin in nuclear processes in the early stages of the big-band cosmology and tie in these processes with galaxy fromation theory. A crucial test of the theory may lie in future observations of the background radiation in the 100 MeV to 100 GeV energy range which may be made with large orbiting spark-chamber satellite detectors. A discussion of the theoretical interpretations of present data, their connection with baryon symmetric cosmology and galaxy formation theory, and the need for future observations are given.

How Childcare Providers Interpret "Reasonable Suspicion" of Child Abuse

ERIC Educational Resources Information Center

Levi, Benjamin H.; Crowell, Kathryn; Walsh, Kerryann; Dellasega, Cheryl

2015-01-01

Background: Childcare providers are often "first responders" for suspected child abuse, and how they understand the concept of "reasonable suspicion" will influence their decisions regarding which warning signs warrant reporting. Objective: The purpose of this study was to investigate how childcare providers interpret the…

Examining the Impact of Unscorable Item Responses on the Validity and Interpretability of MMPI-2/MMPI-2-RF Restructured Clinical (RC) Scale Scores

ERIC Educational Resources Information Center

Dragon, Wendy R.; Ben-Porath, Yossef S.; Handel, Richard W.

2012-01-01

This article examined the impact of unscorable item responses on the psychometric validity and practical interpretability of scores on the Restructured Clinical (RC) Scales of the Minnesota Multiphasic Personality Inventory-2/Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2/MMPI-2-RF). In analyses conducted with five…

The Development of Quality Measures for the Performance and Interpretation of Esophageal Manometry

PubMed Central

Yadlapati, Rena; Gawron, Andrew J.; Keswani, Rajesh N.; Bilimoria, Karl; Castell, Donald O.; Dunbar, Kerry B.; Gyawali, Chandra P.; Jobe, Blair A.; Katz, Philip O.; Katzka, David A.; Lacy, Brian E.; Massey, Benson T.; Richter, Joel E.; Schnoll-Sussman, Felice; Spechler, Stuart J.; Tatum, Roger; Vela, Marcelo F.; Pandolfino, John E.

2016-01-01

Background and Aims Esophageal manometry (EM) is the gold standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of EM result in discrepant diagnoses and unnecessary repeated procedures, and may negatively impact patient outcomes. A method to benchmark the procedural quality of EM is needed. The primary aim of this study was to develop quality measures for performing and interpreting EM. Methods The RAND/University of California, Los Angeles Appropriateness Methodology (RAM) was utilized. Fifteen experts in esophageal manometry were invited to be a part of the panel. Potential quality measures were identified through a literature search and interviews with experts. The expert panel ranked the proposed quality measures for appropriateness via a two-round process on the basis of RAM. Results Fourteen experts participated in all processes. A total of 29 measures were considered; 17 of these measures were ranked as appropriate and related to competency (2), pre-procedure (2), procedure (3) and interpretation (10). The latter 10 were integrated into a single composite measure. Thus, 8 final measures were determined to be appropriate quality measures for EM. Five strong recommendations were also endorsed by the experts, however they were not ranked as appropriate quality measures. Conclusions Eight formally validated quality measures for the performance and interpretation of EM were developed on the basis of RAM. These measures represent key aspects of a high-quality EM study and should be uniformly adopted. Evaluation of these measures in clinical practice is needed to assess their impact on outcomes. PMID:26499925

Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment

PubMed Central

Willemsen, Jochem; Della Rosa, Elena; Kegerreis, Sue

2017-01-01

This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases. PMID:28210235

The Radio Background below 100 MHz

NASA Astrophysics Data System (ADS)

Dowell, Jayce; Taylor, Greg B.

2018-05-01

The recent detection of the “cosmic dawn” redshifted 21 cm signal at 78 MHz by the Experiment to Detect the Global EoR Signatures (EDGES) differs significantly from theoretical predictions. In particular, the absorption trough is roughly a factor of two stronger than the most optimistic theoretical models. The early interpretations of the origin of this discrepancy fall into two categories. The first is that there is increased cooling of the gas due to interactions with dark matter, while the second is that the background radiation field includes a contribution from a component in addition to the cosmic microwave background (CMB). In this Letter we examine the feasibility of the second idea using new data from the first station of the Long Wavelength Array. The data span 40–80 MHz and provide important constraints on the present-day background in a frequency range where there are few surveys with absolute temperature calibration suitable for measuring the strength of the radio monopole. We find support for a strong, diffuse radio background that was suggested by the ARCARDE 2 results in the 3–10 GHz range. We find that this background is well modeled by a power law with a spectral index of ‑2.58 ± 0.05 and a temperature at the rest frame 21 cm frequency of {603}-92+102 mK.

Cultivating interpretive thinking through enacting narrative pedagogy.

PubMed

Scheckel, Martha M; Ironside, Pamela M

2006-01-01

Teachers and educational researchers in nursing have persisted in their attempts to teach students critical thinking and to evaluate the effectiveness of these efforts. Yet, despite the plethora of studies investigating critical thinking, there is a paucity of research providing evidence that teachers' efforts improve students' thinking. The purpose of this interpretive phenomenological study is to explicate how students' thinking can be extended when teachers use Narrative Pedagogy. Specifically, the theme Cultivating Interpretive Thinking refers to how teachers' use of Narrative Pedagogy moves beyond the critical thinking movement's emphasis on analytical thinking (i.e., problem solving). Cultivating Interpretive Thinking offers an innovative approach for teaching and learning thinking that attends to students' embodied, reflective, and pluralistic thinking experiences. Teachers who cultivate interpretive thinking add complexity to students' thinking to better prepare them for challenging, complex, and unpredictable clinical environments.

Relative arrival-time upper-mantle tomography and the elusive background mean

NASA Astrophysics Data System (ADS)

Bastow, Ian D.

2012-08-01

The interpretation of seismic tomographic images of upper-mantle seismic wave speed structure is often a matter of considerable debate because the observations can usually be explained by a range of hypotheses, including variable temperature, composition, anisotropy, and the presence of partial melt. An additional problem, often overlooked in tomographic studies using relative as opposed to absolute arrival-times, is the issue of the resulting velocity model's zero mean. In shield areas, for example, relative arrival-time analysis strips off a background mean velocity structure that is markedly fast compared to the global average. Conversely, in active areas, the background mean is often markedly slow compared to the global average. Appreciation of this issue is vital when interpreting seismic tomographic images: 'high' and 'low' velocity anomalies should not necessarily be interpreted, respectively, as 'fast' and 'slow' compared to 'normal mantle'. This issue has been discussed in the seismological literature in detail over the years, yet subsequent tomography studies have still fallen into the trap of mis-interpreting their velocity models. I highlight here some recent examples of this and provide a simple strategy to address the problem using constraints from a recent global tomographic model, and insights from catalogues of absolute traveltime anomalies. Consultation of such absolute measures of seismic wave speed should be routine during regional tomographic studies, if only for the benefit of the broader Earth Science community, who readily follow the red = hot and slow, blue = cold and fast rule of thumb when interpreting the images for themselves.

Using ClinVar as a Resource to Support Variant Interpretations

PubMed Central

Harrison, Steven M.; Riggs, Erin R.; Maglott, Donna R.; Lee, Jennifer M.; Azzariti, Danielle R.; Niehaus, Annie; Ramos, Erin M.; Martin, Christa L.; Landrum, Melissa J.; Rehm, Heidi L.

2016-01-01

ClinVar is a freely accessible, public archive of reports of the relationships among genomic variants and phenotypes. To facilitate evaluation of the clinical significance of each variant, ClinVar aggregates submissions of the same variant, displays supporting data from each submission, and determines if the submitted clinical interpretations are conflicting or concordant. The unit describes how to (1) identify sequence and structural variants of interest in ClinVar with by multiple searching approaches, including Variation Viewer and (2) understand the display of submissions to ClinVar and the evidence supporting each interpretation. By following this protocol, ClinVar users will be able to learn how to incorporate the wealth of resources and knowledge in ClinVar into variant curation and interpretation. PMID:27037489

Photo interpretation key to Michigan land cover/use

NASA Technical Reports Server (NTRS)

Enslin, W. R.; Hudson, W. D.; Lusch, D. P.

1983-01-01

A set of photo interpretation keys is presented to provide a structured approach to the identification of land cover/use categories as specified in the Michigan Resource Inventory Act. The designated categories are urban and; built up lands; agricultural lands; forest land; nonforested land; water bodies; wetlands; and barren land. The keys were developed for use with medium scale (1:20,000 to 1:24,000) color infrared aerial photography. Although each key is generalized in that it relies only upon the most distinguishing photo characteristics in separating the various land cover/use categories, additional interpretation characteristics, distinguishing features and background material are given.

Impact of patient questionnaires on completeness of clinical information and identification of causes of pain during outpatient abdominopelvic CT interpretation.

PubMed

Doshi, Ankur M; Huang, Chenchan; Ginocchio, Luke; Shanbhogue, Krishna; Rosenkrantz, Andrew B

2017-12-01

To evaluate the impact of questionnaires completed by patients at the time of abdominopelvic CT performed for abdominal pain on the completeness of clinical information and the identification of potential causes of pain, compared with order requisitions alone. 100 outpatient CT examinations performed for the evaluation of abdominal pain were retrospectively reviewed. The specificity of the location of pain was compared between the order requisition and patient questionnaire. An abdominal imaging fellow (Reader 1) and abdominal radiologist (Reader 2) reviewed the examinations independently in two sessions 6 weeks apart (one with only the order requisition and one also with the questionnaire). Readers recorded identified causes of pain and rated their confidence in interpretation (1-5 scale; least to greatest confidence). In 30% of patients, the questionnaire provided a more specific location for pain. Among these, the pain was localized to a specific quadrant in 40%. With having access to the questionnaire, both readers identified additional causes for pain not identified in session 1 (Reader 1, 8.6% [7/81]; Reader 2 5.3% [4/75]). Additional identified causes of pain included diverticulitis, cystitis, peritoneal implants, epiploic appendagitis, osseous metastatic disease, umbilical hernia, gastritis, and SMA syndrome. Confidence in interpretation was significantly greater using the questionnaire for both readers (Reader 1: 4.8 ± 0.6 vs. 4.0 ± 0.5; Reader 2: 4.9 ± 0.3 vs. 4.7 ± 0.5, p < 0.001). Patient questionnaires provide additional relevant clinical history, increased diagnostic yield, and improve radiologists' confidence. Radiology practices are encouraged to implement questionnaires and make these readily available to radiologists at the time of interpretation.

Assessing and Understanding Line Graph Interpretations Using a Scoring Rubric of Organized Cited Factors

ERIC Educational Resources Information Center

Boote, Stacy K.

2014-01-01

This study examined how 12- and 13-year-old students' mathematics and science background knowledge affected line graph interpretations and how interpretations were affected by graph question levels. A purposive sample of 14 students engaged in think aloud interviews while completing an excerpted Test of Graphing in Science. Data were…

Interpretation of geographic patterns in simulated orbital television imagery of earth resources

NASA Technical Reports Server (NTRS)

Latham, J. P.; Cross, C. I.; Kuyper, W. H.; Witmer, R. E.

1972-01-01

In order to better determine the effects of the television imagery characteristics upon the interpretation of geographic patterns obtainable from orbital television sensors, and in order to better evaluate the influences of alternative sensor system parameters such as changes in orbital altitudes or scan line rates, a team of three professional interpreters independently mapped thematically the selected geographic phenomena that they could detect in orbital television imagery produced on a fourteen inch monitor and recorded photographically for analysis. Three thematic maps were compiled by each interpreter. The maps were: (1) transportation patterns; (2) other land use; and (3) physical regions. The results from the three interpreters are compared, agreements noted, and differences analyzed for cause such as disagreement on identification of phenomenon, visual acuity, differences in interpretation techniques, and differing professional backgrounds.

Identification of the subthalamic nucleus in deep brain stimulation surgery with a novel wavelet-derived measure of neural background activity.

PubMed

Snellings, André; Sagher, Oren; Anderson, David J; Aldridge, J Wayne

2009-10-01

The authors developed a wavelet-based measure for quantitative assessment of neural background activity during intraoperative neurophysiological recordings so that the boundaries of the subthalamic nucleus (STN) can be more easily localized for electrode implantation. Neural electrophysiological data were recorded in 14 patients (20 tracks and 275 individual recording sites) with dopamine-sensitive idiopathic Parkinson disease during the target localization portion of deep brain stimulator implantation surgery. During intraoperative recording, the STN was identified based on audio and visual monitoring of neural firing patterns, kinesthetic tests, and comparisons between neural behavior and the known characteristics of the target nucleus. The quantitative wavelet-based measure was applied offline using commercially available software to measure the magnitude of the neural background activity, and the results of this analysis were compared with the intraoperative conclusions. Wavelet-derived estimates were also compared with power spectral density measurements. The wavelet-derived background levels were significantly higher in regions encompassed by the clinically estimated boundaries of the STN than in the surrounding regions (STN, 225 +/- 61 microV; ventral to the STN, 112 +/- 32 microV; and dorsal to the STN, 136 +/- 66 microV). In every track, the absolute maximum magnitude was found within the clinically identified STN. The wavelet-derived background levels provided a more consistent index with less variability than measurements with power spectral density. Wavelet-derived background activity can be calculated quickly, does not require spike sorting, and can be used to identify the STN reliably with very little subjective interpretation required. This method may facilitate the rapid intraoperative identification of STN borders.

The influence of interpreters' professional background and experience on the interpretation of multimodality imaging of pulmonary lesions using 18F-3'-deoxy-fluorothymidine and 18F-fluorodeoxyglucose PET/CT.

PubMed

Xu, Bai-xuan; Liu, Chang-bin; Wang, Rui-min; Shao, Ming-zhe; Fu, Li-ping; Li, Yun-gang; Tian, Jia-he

2013-01-01

Based on the results of a recently accomplished multicenter clinical trial for the incremental value of a dual-tracer (18F-FDG and 18F-FLT), dual-modality (PET and CT) imaging in the differential diagnosis of pulmonary lesions, we investigate some issues that might affect the image interpretation and result reporting. The images were read in two separate sessions. Firstly the images were read and reported by physician(s) of the imaging center on completion of each PET/CT scanning. By the end of MCCT, all images collected during the trial were re-read by a collective of readers in an isolated, blinded, and independent way. One hundred sixty two patients successfully passed the data verification and entered into the final analysis. The primary reporting result showed adding 18F-FDG image information did not change the clinical performance much in sensitivity, specifity and accuracy, but the ratio between SUVFLT and SUVFDG did help the differentiation efficacy among the three subgroups of patients. The collective reviewing result showed the diagnostic achievement varied with reading strategies. ANOVA indicated significant differences among (18)F-FDG, (18)F-FLT in SUV (F = 14.239, p = 0.004). CT had almost the same diagnostic performance as 18F-FLT. When the 18F-FDG, 18F-FLT and CT images read in pair, both diagnostic sensitivity and specificity improved. The best diagnostic figures were obtained in full-modality strategy, when dual-tracer PET worked in combination with CT. With certain experience and training both radiologists and nuclear physicians are qualified to read and to achieve the similar diagnostic accuracy in PET/CT study. Making full use of modality combination and selecting right criteria seems more practical than professional back ground and personal experience in the new hybrid imaging technology, at least when novel tracer or application is concerned.

Optimizing Clinical Interpretation of Distortion Product Otoacoustic Emissions in Infants.

PubMed

Blankenship, Chelsea M; Hunter, Lisa L; Keefe, Douglas H; Feeney, M Patrick; Brown, David K; McCune, Annie; Fitzpatrick, Denis F; Lin, Li

2018-03-06

in ambient absorbance were found between the NH and SNHL groups. Multifrequency analysis resulted in the best prediction of HL for the SNHL/MHL group with poorer sensitivity values when infants with CHL were included. Clinical interpretation of DPOAEs in infants can be improved by using age-appropriate normative ranges and optimized cutoff values. DPOAE interpretation is most predictive at higher F2 test frequencies in young infants (2-8 kHz) due to poor test performance at 1 to 1.5 kHz. Multifrequency rules can be used to improve sensitivity while balancing specificity. Last, a sensitive middle ear measure such as wideband absorbance should be included in the test battery to assess possibility of a conductive component to the HL.

Reading, Writing and Interpreting Literature: Pedagogy, Positions and Research.

ERIC Educational Resources Information Center

Blake, Robert W., Ed.

The purpose of this book is to provide teachers of literature with a sampling of a wide range of theoretical backgrounds and possible pedagogical applications for reading, writing, and interpreting literature in school classrooms, elementary through college. The book contains the following essays listed with their authors: (1) "Henny Penny to…

Ethnic background and genetic variation in the evaluation of cancer risk: a systematic review.

PubMed

Jing, Lijun; Su, Li; Ring, Brian Z

2014-01-01

The clinical use of genetic variation in the evaluation of cancer risk is expanding, and thus understanding how determinants of cancer susceptibility identified in one population can be applied to another is of growing importance. However there is considerable debate on the relevance of ethnic background in clinical genetics, reflecting both the significance and complexity of genetic heritage. We address this via a systematic review of reported associations with cancer risk for 82 markers in 68 studies across six different cancer types, comparing association results between ethnic groups and examining linkage disequilibrium between risk alleles and nearby genetic loci. We find that the relevance of ethnic background depends on the question. If asked whether the association of variants with disease risk is conserved across ethnic boundaries, we find that the answer is yes, the majority of markers show insignificant variability in association with cancer risk across ethnic groups. However if the question is whether a significant association between a variant and cancer risk is likely to reproduce, the answer is no, most markers do not validate in an ethnic group other than the discovery cohort's ancestry. This lack of reproducibility is not attributable to studies being inadequately populated due to low allele frequency in other ethnic groups. Instead, differences in local genomic structure between ethnic groups are associated with the strength of association with cancer risk and therefore confound interpretation of the implied physiologic association tracked by the disease allele. This suggest that a biological association for cancer risk alleles may be broadly consistent across ethnic boundaries, but reproduction of a clinical study in another ethnic group is uncommon, in part due to confounding genomic architecture. As clinical studies are increasingly performed globally this has important implications for how cancer risk stratifiers should be studied and employed.

Ethnic Background and Genetic Variation in the Evaluation of Cancer Risk: A Systematic Review

PubMed Central

Jing, Lijun; Su, Li; Ring, Brian Z.

2014-01-01

The clinical use of genetic variation in the evaluation of cancer risk is expanding, and thus understanding how determinants of cancer susceptibility identified in one population can be applied to another is of growing importance. However there is considerable debate on the relevance of ethnic background in clinical genetics, reflecting both the significance and complexity of genetic heritage. We address this via a systematic review of reported associations with cancer risk for 82 markers in 68 studies across six different cancer types, comparing association results between ethnic groups and examining linkage disequilibrium between risk alleles and nearby genetic loci. We find that the relevance of ethnic background depends on the question. If asked whether the association of variants with disease risk is conserved across ethnic boundaries, we find that the answer is yes, the majority of markers show insignificant variability in association with cancer risk across ethnic groups. However if the question is whether a significant association between a variant and cancer risk is likely to reproduce, the answer is no, most markers do not validate in an ethnic group other than the discovery cohort’s ancestry. This lack of reproducibility is not attributable to studies being inadequately populated due to low allele frequency in other ethnic groups. Instead, differences in local genomic structure between ethnic groups are associated with the strength of association with cancer risk and therefore confound interpretation of the implied physiologic association tracked by the disease allele. This suggest that a biological association for cancer risk alleles may be broadly consistent across ethnic boundaries, but reproduction of a clinical study in another ethnic group is uncommon, in part due to confounding genomic architecture. As clinical studies are increasingly performed globally this has important implications for how cancer risk stratifiers should be studied and

Development of criteria used to establish a background environmental monitoring station

DOE PAGES

Fritz, Brad G.; Barnett, J. Matthew; Snyder, Sandra F.; ...

2015-03-02

It is generally considered necessary to measure concentrations of contaminants-of-concern at a background location when conducting atmospheric environmental surveillance. This is because it is recognized that measurements of background concentrations can enhance interpretation of environmental monitoring data. Despite the recognized need for background measurements, there is little published guidance available that describes how to identify an appropriate atmospheric background monitoring location. This paper develops generic criteria that can guide the decision making process for identifying suitable locations for background atmospheric monitoring station. Detailed methods for evaluating some of these criteria are also provided and a case study for establishment ofmore » an atmospheric background surveillance station as part of an environmental surveillance program is described. While the case study focuses on monitoring for radionuclides, the approach is equally valid for any airborne constituent being monitored. The case study shows that implementation of the developed criteria can result in a good, defensible choice for a background atmospheric monitoring location.« less

The relationship between immediate relevant basic science knowledge and clinical knowledge: physiology knowledge and transthoracic echocardiography image interpretation.

PubMed

Nielsen, Dorte Guldbrand; Gotzsche, Ole; Sonne, Ole; Eika, Berit

2012-10-01

Two major views on the relationship between basic science knowledge and clinical knowledge stand out; the Two-world view seeing basic science and clinical science as two separate knowledge bases and the encapsulated knowledge view stating that basic science knowledge plays an overt role being encapsulated in the clinical knowledge. However, resent research has implied that a more complex relationship between the two knowledge bases exists. In this study, we explore the relationship between immediate relevant basic science (physiology) and clinical knowledge within a specific domain of medicine (echocardiography). Twenty eight medical students in their 3rd year and 45 physicians (15 interns, 15 cardiology residents and 15 cardiology consultants) took a multiple-choice test of physiology knowledge. The physicians also viewed images of a transthoracic echocardiography (TTE) examination and completed a checklist of possible pathologies found. A total score for each participant was calculated for the physiology test, and for all physicians also for the TTE checklist. Consultants scored significantly higher on the physiology test than did medical students and interns. A significant correlation between physiology test scores and TTE checklist scores was found for the cardiology residents only. Basic science knowledge of immediate relevance for daily clinical work expands with increased work experience within a specific domain. Consultants showed no relationship between physiology knowledge and TTE interpretation indicating that experts do not use basic science knowledge in routine daily practice, but knowledge of immediate relevance remains ready for use.

The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial.

PubMed

Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Haghani, Hamid

2016-01-01

This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P < .001), anxiety (P < .001), and relaxation (P < .001) levels before and after intervention in music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P < .001). No differences were detected in the mean scores of physiologic measures between groups before and after music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach.

Interpretable Deep Models for ICU Outcome Prediction

PubMed Central

Che, Zhengping; Purushotham, Sanjay; Khemani, Robinder; Liu, Yan

2016-01-01

Exponential surge in health care data, such as longitudinal data from electronic health records (EHR), sensor data from intensive care unit (ICU), etc., is providing new opportunities to discover meaningful data-driven characteristics and patterns ofdiseases. Recently, deep learning models have been employedfor many computational phenotyping and healthcare prediction tasks to achieve state-of-the-art performance. However, deep models lack interpretability which is crucial for wide adoption in medical research and clinical decision-making. In this paper, we introduce a simple yet powerful knowledge-distillation approach called interpretable mimic learning, which uses gradient boosting trees to learn interpretable models and at the same time achieves strong prediction performance as deep learning models. Experiment results on Pediatric ICU dataset for acute lung injury (ALI) show that our proposed method not only outperforms state-of-the-art approaches for morality and ventilator free days prediction tasks but can also provide interpretable models to clinicians. PMID:28269832

A short note on probability in clinical medicine.

PubMed

Upshur, Ross E G

2013-06-01

Probability claims are ubiquitous in clinical medicine, yet exactly how clinical events relate to interpretations of probability has been not been well explored. This brief essay examines the major interpretations of probability and how these interpretations may account for the probabilistic nature of clinical events. It is argued that there are significant problems with the unquestioned application of interpretation of probability to clinical events. The essay concludes by suggesting other avenues to understand uncertainty in clinical medicine. © 2013 John Wiley & Sons Ltd.

Parenting practices, interpretive biases, and anxiety in Latino children.

PubMed

Varela, R Enrique; Niditch, Laura A; Hensley-Maloney, Lauren; Moore, Kathryn W; Creveling, C Christiane

2013-03-01

A number of factors are believed to confer risk for anxiety development in children; however, cultural variation of purported risk factors remains unclear. We examined relations between controlling and rejecting parenting styles, parental modeling of anxious behaviors, child interpretive biases, and child anxiety in a mixed clinically anxious (n=27) and non-clinical (n=20) sample of Latino children and at least one of their parents. Families completed discussion-based tasks and questionnaires in a lab setting. Results indicated that child anxiety was: linked with parental control and child interpretative biases, associated with parental modeling of anxious behaviors at a trend level, and not associated with low parental acceptance. Findings that controlling parenting and child interpretive biases were associated with anxiety extend current theories of anxiety development to the Latino population. We speculate that strong family ties may buffer Latino children from detrimental effects of perceived low parental acceptance. Copyright © 2013 Elsevier Ltd. All rights reserved.

Lifting the veil: how to use clinical neuropsychology to assess dementia.

PubMed

Burrell, James R; Piguet, Olivier

2015-11-01

Neurologists often struggle to interpret the results of neuropsychological testing, even though cognitive assessments are an integral component of the diagnostic process in dementia syndromes. This article reviews the principles underlying clinical neuropsychology, background on common neuropsychological tests, and tips on how to interpret the results when assessing patients with dementia. General cognitive screening tools, appropriate for use by general neurologists and psychiatrists, as well as specific cognitive tests examining the main cognitive domains (attention and orientation, memory, visuospatial function, language and executive function) in patients with dementia are considered. Finally, the pattern of deficits, helpful in defining clinical dementia phenotypes and sometimes in predicting the underlying molecular pathology, are outlined. Such clinicopathological associations will become invaluable as disease-modifying treatments for dementia are developed and implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Social anxiety and the interpretation of positive social events.

PubMed

Alden, Lynn E; Taylor, Charles T; Mellings, Tanna M J B; Laposa, Judith M

2008-05-01

We report four independent studies that examined the relationship between social interaction anxiety and the tendency to interpret positive social events in a threat-maintaining manner. Study 1 described the development of a scale that measures negative interpretations of positive social events, the interpretation of positive events scale (IPES). Study 2 cross-validated the structure of the IPES and established that social interaction anxiety explained significant variance in negative interpretations of positive social events beyond negative affect in general. Study 3 demonstrated that negative interpretation of positive events was significantly greater in a clinical sample of patients with generalized social anxiety disorder (GSAD) than a matched group of non-anxious community controls. In addition, within the GSAD group, the IPES was associated with negative social predictions following a positive interaction. Finally, study 4 confirmed that negative interpretations of positive social events mediated the relationship between social interaction anxiety and low positive affect.

Advanced Practice Registered Nurses and Physician Assistants in Sleep Centers and Clinics: A Survey of Current Roles and Educational Background

PubMed Central

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.

2014-01-01

Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545

Massenmedien und Bildung: Eine padagogische Interpretation der Adorno-Benjamin-Kontroverse (Mass Media and Education: A Pedagogical Interpretation of the Controversy between Theodore Adorno and Walter Benjamin).

ERIC Educational Resources Information Center

Imai, Yasuo

1997-01-01

Gives a pedagogical interpretation of the controversy between Adorno (Theodore) and Benjamin (Walter). Sketches their different conceptions of what constitutes a pedagogical problem and discusses differences between their positions against the background of their shared concern, best described as "experiential poverty." (DSK)

Interpreters, Interpreting, and the Study of Bilingualism.

ERIC Educational Resources Information Center

Valdes, Guadalupe; Angelelli, Claudia

2003-01-01

Discusses research on interpreting focused specifically on issues raised by this literature about the nature of bilingualism. Suggests research carried out on interpreting--while primarily produced with a professional audience in mind and concerned with improving the practice of interpreting--provides valuable insights about complex aspects of…

'You find yourself.' Perceptions of nursing students from non-English speaking backgrounds of the effect of an intensive language support program on their oral clinical communication skills.

PubMed

Rogan, Fran; San Miguel, Caroline; Brown, Di; Kilstoff, Kathleen

2006-10-01

Nurses of ethnically diverse backgrounds are essential in providing multicultural populations in western societies with culturally and linguistically competent health care. However, many nurses from non-English speaking backgrounds (NESB) are at high risk of failure in university programs particularly during clinical placements. Few studies investigate the clinical experiences of students from NESB and strategies to support their learning. This study describes perceptions of fifteen undergraduate nursing students from NESB about their first clinical placement in an Australian university program and the effect of a language support program on their oral clinical communication skills. Three categories arose: *Wanting to belong but feeling excluded; *Wanting to learn how to...; and *You find yourself. While many students find clinical placement challenging, it appeared difficult for students in this study as language and cultural adjustments required some modification of their usual ways of thinking and communicating, often without coping strategies available to other students.

Working with interpreters: The challenges of introducing Option Grid patient decision aids.

PubMed

Wood, Fiona; Phillips, Katie; Edwards, Adrian; Elwyn, Glyn

2017-03-01

We aimed to observe how an Option Grid™ decision aid for clinical encounters might be used where an interpreter is present, and to assess the impact of its use on shared decision making. Data were available from three clinical consultations between patient, clinician (a physiotherapist), and interpreter about knee osteoarthritis. Clinicians were trained in the use of an Option Grid decision aid and the tool was used. Consultations were audio-recorded, transcribed, and translated by independent translators into English. Analysis revealed the difficulties with introducing a written decision aid into an interpreted consultation. The extra discussion needed between the clinician and interpreter around the principles and purpose of shared decision making and instructions regarding the Option Grid decision aid proved challenging and difficult to manage. Discussion of treatment options while using an Option Grid decision aid was predominantly done between clinician and interpreter. The patient appeared to have little involvement in discussion of treatment options. Patients were not active participants within the discussion. Further work needs to be done on how shared decision making can be achieved within interpreted consultations. Option Grid decision aids are not being used as intended in interpreted consultations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The Pedagogy of Hope at IMSTUS: Interpretation and Manifestation

ERIC Educational Resources Information Center

Ndlovu, M. C.

2011-01-01

The purpose of this chapter is to discuss how the idea of a Pedagogy of Hope is perceived, interpreted and realised at the Institute for Mathematics and Science Teaching of the University of Stellenbosch (IMSTUS). First some background information is given about the impact of the programmes which, it is argued, cannot be pinned to one Millennium…

Everybody Is…Drinking! Interpretation Bias in Problematic Drinkers with and without Mild to Borderline Intellectual Disability

ERIC Educational Resources Information Center

van Duijvenbode, Neomi; Didden, Robert; Korzilius, Hubert P. L. M.; Engels, Rutger C. M. E.

2016-01-01

Background: Problematic alcohol use is characterized by disrupted associative processing of environmental clues, where problematic drinkers interpret ambiguous, alcohol-relevant clues in an alcohol-related way. The present study examined the strength of this interpretation bias in a large sample (N = 230) of light and problematic drinkers with and…

Identification of the subthalamic nucleus in deep brain stimulation surgery with a novel wavelet-derived measure of neural background activity

PubMed Central

Snellings, André; Sagher, Oren; Anderson, David J.; Aldridge, J. Wayne

2016-01-01

Object A wavelet-based measure was developed to quantitatively assess neural background activity taken during surgical neurophysiological recordings to localize the boundaries of the subthalamic nucleus during target localization for deep brain stimulator implant surgery. Methods Neural electrophysiological data was recorded from 14 patients (20 tracks, n = 275 individual recording sites) with dopamine-sensitive idiopathic Parkinson’s disease during the target localization portion of deep brain stimulator implant surgery. During intraoperative recording the STN was identified based upon audio and visual monitoring of neural firing patterns, kinesthetic tests, and comparisons between neural behavior and known characteristics of the target nucleus. The quantitative wavelet-based measure was applied off-line using MATLAB software to measure the magnitude of the neural background activity, and the results of this analysis were compared to the intraoperative conclusions. Wavelet-derived estimates were compared to power spectral density measures. Results The wavelet-derived background levels were significantly higher in regions encompassed by the clinically estimated boundaries of the STN than in surrounding regions (STN: 225 ± 61 μV vs. ventral to STN: 112 ± 32 μV, and dorsal to STN: 136 ± 66 μV). In every track, the absolute maximum magnitude was found within the clinically identified STN. The wavelet-derived background levels provided a more consistent index with less variability than power spectral density. Conclusions The wavelet-derived background activity assessor can be calculated quickly, requires no spike sorting, and can be reliably used to identify the STN with very little subjective interpretation required. This method may facilitate rapid intraoperative identification of subthalamic nucleus borders. PMID:19344225

Houston Methodist Variant Viewer: An Application to Support Clinical Laboratory Interpretation of Next-generation Sequencing Data for Cancer

PubMed Central

Christensen, Paul A.; Ni, Yunyun; Bao, Feifei; Hendrickson, Heather L.; Greenwood, Michael; Thomas, Jessica S.; Long, S. Wesley; Olsen, Randall J.

2017-01-01

Introduction: Next-generation-sequencing (NGS) is increasingly used in clinical and research protocols for patients with cancer. NGS assays are routinely used in clinical laboratories to detect mutations bearing on cancer diagnosis, prognosis and personalized therapy. A typical assay may interrogate 50 or more gene targets that encompass many thousands of possible gene variants. Analysis of NGS data in cancer is a labor-intensive process that can become overwhelming to the molecular pathologist or research scientist. Although commercial tools for NGS data analysis and interpretation are available, they are often costly, lack key functionality or cannot be customized by the end user. Methods: To facilitate NGS data analysis in our clinical molecular diagnostics laboratory, we created a custom bioinformatics tool termed Houston Methodist Variant Viewer (HMVV). HMVV is a Java-based solution that integrates sequencing instrument output, bioinformatics analysis, storage resources and end user interface. Results: Compared to the predicate method used in our clinical laboratory, HMVV markedly simplifies the bioinformatics workflow for the molecular technologist and facilitates the variant review by the molecular pathologist. Importantly, HMVV reduces time spent researching the biological significance of the variants detected, standardizes the online resources used to perform the variant investigation and assists generation of the annotated report for the electronic medical record. HMVV also maintains a searchable variant database, including the variant annotations generated by the pathologist, which is useful for downstream quality improvement and research projects. Conclusions: HMVV is a clinical grade, low-cost, feature-rich, highly customizable platform that we have made available for continued development by the pathology informatics community. PMID:29226007

Working with interpreters: an interactive Web-based learning module.

PubMed

Kalet, Adina; Gany, Francesca; Senter, Lindsay

2002-09-01

Medical students are presented with unique challenges when they care for patients with limited English proficiency. Students must learn a complex set of skills needed to care for patients across cultural and language barriers and to understand the impact of their own attitudes and beliefs about caring for these patients. We developed and piloted a multimedia interactive Web-based module aimed at teaching students effective strategies for working with interpreters and diverse patient populations, and at raising their awareness of important legal, ethical, and cultural issues. First the learner completes a 37-multiple-choice-question (MCQ) pre-test that assesses attitudes, factual knowledge, and ability to analyze written clinical scenarios relevant to the module's content. Learners are then shown a series of professionally produced video vignettes, which reflect diverse patient populations, interpreters, and effectiveness of interpretation strategies (e.g., a Russian-speaking woman with chest pain whose daughter interprets, a medical student interpreting for a Chinese-speaking man using herbal medication, a Haitian woman told of an abnormal mammogram through a trained simultaneous interpreter). In each case, learners submit short answers to on-screen questions analyzing the effectiveness of the interpretation strategies demonstrated. Immediate feedback is given comparing student responses with those of experts. At any time during the module, the learners may view video commentary by legal, ethics, and cultural experts, or access a glossary and Web site links. Students conclude the module by again taking the MCQ test. A final screen compares their pre- and post-MCQ test responses and shows best answers, allowing them to assess their learning. The learners also complete a survey, providing personal cultural information and feedback on the module. All 160 first-year medical students completed the module and evaluated its effectiveness this year. On average, students

Diagnostic concordance among pathologists interpreting breast biopsy specimens.

PubMed

Elmore, Joann G; Longton, Gary M; Carney, Patricia A; Geller, Berta M; Onega, Tracy; Tosteson, Anna N A; Nelson, Heidi D; Pepe, Margaret S; Allison, Kimberly H; Schnitt, Stuart J; O'Malley, Frances P; Weaver, Donald L

2015-03-17

A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%-77.0%; 5194 of 6900 interpretations). Among invasive carcinoma cases (663 interpretations), 96% (95% CI, 94%-97%) were concordant, and 4% (95% CI, 3%-6%) were underinterpreted; among DCIS cases (2097 interpretations), 84% (95% CI, 82%-86%) were concordant, 3% (95% CI, 2%-4%) were overinterpreted, and 13% (95% CI, 12%-15%) were underinterpreted; among atypia cases (2070 interpretations), 48% (95% CI, 44%-52%) were concordant, 17% (95% CI, 15%-21%) were overinterpreted, and 35% (95

Comparative interpretations of renormalization inversion technique for reconstructing unknown emissions from measured atmospheric concentrations

NASA Astrophysics Data System (ADS)

Singh, Sarvesh Kumar; Kumar, Pramod; Rani, Raj; Turbelin, Grégory

2017-04-01

The study highlights a theoretical comparison and various interpretations of a recent inversion technique, called renormalization, developed for the reconstruction of unknown tracer emissions from their measured concentrations. The comparative interpretations are presented in relation to the other inversion techniques based on principle of regularization, Bayesian, minimum norm, maximum entropy on mean, and model resolution optimization. It is shown that the renormalization technique can be interpreted in a similar manner to other techniques, with a practical choice of a priori information and error statistics, while eliminating the need of additional constraints. The study shows that the proposed weight matrix and weighted Gram matrix offer a suitable deterministic choice to the background error and measurement covariance matrices, respectively, in the absence of statistical knowledge about background and measurement errors. The technique is advantageous since it (i) utilizes weights representing a priori information apparent to the monitoring network, (ii) avoids dependence on background source estimates, (iii) improves on alternative choices for the error statistics, (iv) overcomes the colocalization problem in a natural manner, and (v) provides an optimally resolved source reconstruction. A comparative illustration of source retrieval is made by using the real measurements from a continuous point release conducted in Fusion Field Trials, Dugway Proving Ground, Utah.

Estimating background and threshold nitrate concentrations using probability graphs

USGS Publications Warehouse

Panno, S.V.; Kelly, W.R.; Martinsek, A.T.; Hackley, Keith C.

2006-01-01

Because of the ubiquitous nature of anthropogenic nitrate (NO 3-) in many parts of the world, determining background concentrations of NO3- in shallow ground water from natural sources is probably impossible in most environments. Present-day background must now include diffuse sources of NO3- such as disruption of soils and oxidation of organic matter, and atmospheric inputs from products of combustion and evaporation of ammonia from fertilizer and livestock waste. Anomalies can be defined as NO3- derived from nitrogen (N) inputs to the environment from anthropogenic activities, including synthetic fertilizers, livestock waste, and septic effluent. Cumulative probability graphs were used to identify threshold concentrations separating background and anomalous NO3-N concentrations and to assist in the determination of sources of N contamination for 232 spring water samples and 200 well water samples from karst aquifers. Thresholds were 0.4, 2.5, and 6.7 mg/L for spring water samples, and 0.1, 2.1, and 17 mg/L for well water samples. The 0.4 and 0.1 mg/L values are assumed to represent thresholds for present-day precipitation. Thresholds at 2.5 and 2.1 mg/L are interpreted to represent present-day background concentrations of NO3-N. The population of spring water samples with concentrations between 2.5 and 6.7 mg/L represents an amalgam of all sources of NO3- in the ground water basins that feed each spring; concentrations >6.7 mg/L were typically samples collected soon after springtime application of synthetic fertilizer. The 17 mg/L threshold (adjusted to 15 mg/L) for well water samples is interpreted as the level above which livestock wastes dominate the N sources. Copyright ?? 2006 The Author(s).

Relating UMLS semantic types and task-based ontology to computer-interpretable clinical practice guidelines.

PubMed

Kumar, Anand; Ciccarese, Paolo; Quaglini, Silvana; Stefanelli, Mario; Caffi, Ezio; Boiocchi, Lorenzo

2003-01-01

Medical knowledge in clinical practice guideline (GL) texts is the source of task-based computer-interpretable clinical guideline models (CIGMs). We have used Unified Medical Language System (UMLS) semantic types (STs) to understand the percentage of GL text which belongs to a particular ST. We also use UMLS semantic network together with the CIGM-specific ontology to derive a semantic meaning behind the GL text. In order to achieve this objective, we took nine GL texts from the National Guideline Clearinghouse (NGC) and marked up the text dealing with a particular ST. The STs we took into consideration were restricted taking into account the requirements of a task-based CIGM. We used DARPA Agent Markup Language and Ontology Inference Layer (DAML + OIL) to create the UMLS and CIGM specific semantic network. For the latter, as a bench test, we used the 1999 WHO-International Society of Hypertension Guidelines for the Management of Hypertension. We took into consideration the UMLS STs closest to the clinical tasks. The percentage of the GL text dealing with the ST "Health Care Activity" and subtypes "Laboratory Procedure", "Diagnostic Procedure" and "Therapeutic or Preventive Procedure" were measured. The parts of text belonging to other STs or comments were separated. A mapping of terms belonging to other STs was done to the STs under "HCA" for representation in DAML + OIL. As a result, we found that the three STs under "HCA" were the predominant STs present in the GL text. In cases where the terms of related STs existed, they were mapped into one of the three STs. The DAML + OIL representation was able to describe the hierarchy in task-based CIGMs. To conclude, we understood that the three STs could be used to represent the semantic network of the task-bases CIGMs. We identified some mapping operators which could be used for the mapping of other STs into these.

Interpretive Reliability of Six Computer-Based Test Interpretation Programs for the Minnesota Multiphasic Personality Inventory-2.

PubMed

Deskovitz, Mark A; Weed, Nathan C; McLaughlan, Joseph K; Williams, John E

2016-04-01

The reliability of six Minnesota Multiphasic Personality Inventory-Second edition (MMPI-2) computer-based test interpretation (CBTI) programs was evaluated across a set of 20 commonly appearing MMPI-2 profile codetypes in clinical settings. Evaluation of CBTI reliability comprised examination of (a) interrater reliability, the degree to which raters arrive at similar inferences based on the same CBTI profile and (b) interprogram reliability, the level of agreement across different CBTI systems. Profile inferences drawn by four raters were operationalized using q-sort methodology. Results revealed no significant differences overall with regard to interrater and interprogram reliability. Some specific CBTI/profile combinations (e.g., the CBTI by Automated Assessment Associates on a within normal limits profile) and specific profiles (e.g., the 4/9 profile displayed greater interprogram reliability than the 2/4 profile) were interpreted with variable consensus (α range = .21-.95). In practice, users should consider that certain MMPI-2 profiles are interpreted more or less consensually and that some CBTIs show variable reliability depending on the profile. © The Author(s) 2015.

Problems in Communicating the Suspect's Rights in Interpreted Police Interviews

ERIC Educational Resources Information Center

Nakane, Ikuko

2007-01-01

At first glance, communicating a suspect's rights in police interviews appears to be a straightforward task. However, it is more complex than it appears. In particular, for suspects who come from different cultural backgrounds or legal systems and who rely on interpreters in police interviews, ensuring a thorough understanding of their rights and…

Evaluating Validity Evidence for USMLE Step 2 Clinical Skills Data Gathering and Data Interpretation Scores: Does Performance Predict History-Taking and Physical Examination Ratings for First-Year Internal Medicine Residents?

PubMed

Cuddy, Monica M; Winward, Marcia L; Johnston, Mary M; Lipner, Rebecca S; Clauser, Brian E

2016-01-01

To add to the small body of validity research addressing whether scores from performance assessments of clinical skills are related to performance in supervised patient settings, the authors examined relationships between United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills (CS) data gathering and data interpretation scores and subsequent performance in history taking and physical examination in internal medicine residency training. The sample included 6,306 examinees from 238 internal medicine residency programs who completed Step 2 CS for the first time in 2005 and whose performance ratings from their first year of residency training were available. Hierarchical linear modeling techniques were used to examine the relationships among Step 2 CS data gathering and data interpretation scores and history-taking and physical examination ratings. Step 2 CS data interpretation scores were positively related to both history-taking and physical examination ratings. Step 2 CS data gathering scores were not related to either history-taking or physical examination ratings after other USMLE scores were taken into account. Step 2 CS data interpretation scores provide useful information for predicting subsequent performance in history taking and physical examination in supervised practice and thus provide validity evidence for their intended use as an indication of readiness to enter supervised practice. The results show that there is less evidence to support the usefulness of Step 2 CS data gathering scores. This study provides important information for practitioners interested in Step 2 CS specifically or in performance assessments of medical students' clinical skills more generally.

Demographic and Practice Characteristics of Pathologists Who Enjoy Breast Tissue Interpretation

PubMed Central

Oster, Natalia V.; Geller, Berta; Carney, Patricia A.; Reisch, Lisa M.; Onega, Tracy; Weaver, Donald L.; Frederick, Paul; Elmore, Joann G.

2015-01-01

Summary Physician attributes, job satisfaction and confidence in clinical skills are associated with enhanced performance and better patient outcomes. We surveyed 252 pathologists to evaluate associations between enjoyment of breast pathology, demographic/clinical characteristics and diagnostic performance. Diagnostic performance was determined by agreement with patient cases previously reviewed by a panel of experienced pathologists. Eighty-three percent of study participants reported enjoying breast pathology. Pathologists who enjoy breast interpretation were more likely to review ≥10 cases/week (p=0.003), report breast interpretation expertise (p=0.013), and high levels of confidence interpreting breast pathology (p<0.001). These pathologists were less likely to report that the field was challenging (p<0.001) and that breast cases make them more nervous than other types of pathology (p<0.001). Enjoyment was not associated with diagnostic performance. Millions of women undergo breast biopsy annually, thus it is reassuring that although nearly a fifth of practicing pathologists who interpret breast tissue report not enjoying the field, precision is not impacted. PMID:25554017

Interpretation and the psychic future.

PubMed

Cooper, S H

1997-08-01

The author applies the analyst's multi-faceted awareness of his or her view of the patient's psychic future to analytic process. Loewald's (1960) interest in the way in which the analyst anticipates the future of the patient was linked to his epistemological assumptions about the analyst's superior objectivity and maturity relative to the patient. The elucidation of the authority of the analyst (e.g. Hoffman, 1991, 1994) allows us to begin to disentangle the analyst's view of the patient's psychic future from some of these epistemological assumptions. Clinical illustrations attempt to show how the analyst's awareness of this aspect of the interpretive process is often deconstructed over time and can help to understand aspects of resistance from both analyst and patient. This perspective may provide one more avenue for understanding our various modes of influence through interpretive process.

Interpreting Abstract Interpretations in Membership Equational Logic

NASA Technical Reports Server (NTRS)

Fischer, Bernd; Rosu, Grigore

2001-01-01

We present a logical framework in which abstract interpretations can be naturally specified and then verified. Our approach is based on membership equational logic which extends equational logics by membership axioms, asserting that a term has a certain sort. We represent an abstract interpretation as a membership equational logic specification, usually as an overloaded order-sorted signature with membership axioms. It turns out that, for any term, its least sort over this specification corresponds to its most concrete abstract value. Maude implements membership equational logic and provides mechanisms to calculate the least sort of a term efficiently. We first show how Maude can be used to get prototyping of abstract interpretations "for free." Building on the meta-logic facilities of Maude, we further develop a tool that automatically checks and abstract interpretation against a set of user-defined properties. This can be used to select an appropriate abstract interpretation, to characterize the specified loss of information during abstraction, and to compare different abstractions with each other.

Medical Students' Experiences and Perspectives on Interpreting for LEP Patients at Two US Medical Schools.

PubMed

Vela, Monica B; Fritz, Cassandra; Press, Valerie G; Girotti, Jorge

2016-06-01

Language concordance between patient and provider has been shown to improve health outcomes for Limited English Proficiency (LEP) patients. However, health care teams often use available ad hoc interpreters without knowing whether their language skills are adequate. Little is known about the role of medical students working as ad hoc interpreters. Bilingual medical students are engaged as interpreters in the care of LEP patients and may serve as a potential resource for health care teams caring for LEP patients. We conducted a multi-institutional online survey of graduating medical students at the University of Illinois and the University of Chicago in 2011 and 2012, containing both qualitative and quantitative questions regarding their experiences as interpreters for LEP patients. Half (216/430) of contacted students completed the survey; 40 % (87/216) of responding students reported being bilingual. Of these students, the vast majority, 84 % (73/87), had been asked to interpret for patients in the clinical setting. Only 12 % (10/87) of students reported having felt uncomfortable interpreting for patients "often" or "very often." Over half (53 %, 46/87) described incidents during which they felt uncomfortable interpreting. Seventeen (17/46, 37 %) students described those incidents as high-stakes clinical settings. Medical schools and health care institutions should establish guidelines for students who identify as fluent in another language and are interested in interpreting for LEP patients in clinical settings, to protect both students and patients when language poses a barrier to quality care.

Interpretive Reporting of Protein Electrophoresis Data by Microcomputer

PubMed Central

Talamo, Thomas S.; Losos, Frank J.; Kessler, G. Frederick

1982-01-01

A microcomputer based system for interpretive reporting of protein electrophoretic data has been developed. Data for serum, urine and cerebrospinal fluid protein electrophoreses as well as immunoelectrophoresis can be entered. Patient demographic information is entered through the keyboard followed by manual entry of total and fractionated protein levels obtained after densitometer scanning of the electrophoretic strip. The patterns are then coded, interpreted, and final reports generated. In most cases interpretation time is less than one second. Misinterpretation by computer is uncommon and can be corrected by edit functions within the system. These discrepancies between computer and pathologist interpretation are automatically stored in a data file for later review and possible program modification. Any or all previous tests on a patient may be reviewed with graphic display of the electrophoretic pattern. The system has been in use for several months and is presently well accepted by both laboratory and clinical staff. It also allows rapid storage, retrieval and analysis of protein electrophoretic datab.

Training interpretation biases among individuals with body dysmorphic disorder symptoms.

PubMed

Premo, Julie E; Sarfan, Laurel D; Clerkin, Elise M

2016-03-01

The current study provided an initial test of a Cognitive Bias Modification for Interpretations (CBM-I) training paradigm among a sample with elevated BDD symptoms (N=86). As expected, BDD-relevant interpretations were reduced among participants who completed a positive (vs. comparison) training program. Results also pointed to the intriguing possibility that modifying biased appearance-relevant interpretations is causally related to changes in biased, socially relevant interpretations. Further, providing support for cognitive behavioral models, residual change in interpretations was associated with some aspects of in vivo stressor responding. However, contrary to expectations there were no significant effects of condition on emotional vulnerability to a BDD stressor, potentially because participants in both training conditions experienced reductions in biased socially-threatening interpretations following training (suggesting that the "comparison" condition was not inert). These findings have meaningful theoretical and clinical implications, and fit with transdiagnostic conceptualizations of psychopathology. Copyright © 2015 Elsevier Ltd. All rights reserved.

The X-ray background contributed by QSOs ejected from galaxies

NASA Technical Reports Server (NTRS)

Burbidge, G.; Hoyle, F.

1996-01-01

The X-ray background can be explained as coming from the integrated effect of X-ray emitting quasi-stellar objects (QSOs) ejected from spiral galaxies. The model developed to interpret the observations is summarized. The redshift of the QSOs consisted of an intrinsic component and of a cosmological component. The QSOs have a spatial density proportional to that of normal galaxies.

European specialist porphyria laboratories: diagnostic strategies, analytical quality, clinical interpretation, and reporting as assessed by an external quality assurance program.

PubMed

Aarsand, Aasne K; Villanger, Jørild H; Støle, Egil; Deybach, Jean-Charles; Marsden, Joanne; To-Figueras, Jordi; Badminton, Mike; Elder, George H; Sandberg, Sverre

2011-11-01

The porphyrias are a group of rare metabolic disorders whose diagnosis depends on identification of specific patterns of porphyrin precursor and porphyrin accumulation in urine, blood, and feces. Diagnostic tests for porphyria are performed by specialized laboratories in many countries. Data regarding the analytical and diagnostic performance of these laboratories are scarce. We distributed 5 sets of multispecimen samples from different porphyria patients accompanied by clinical case histories to 18-21 European specialist porphyria laboratories/centers as part of a European Porphyria Network organized external analytical and postanalytical quality assessment (EQA) program. The laboratories stated which analyses they would normally have performed given the case histories and reported results of all porphyria-related analyses available, interpretative comments, and diagnoses. Reported diagnostic strategies initially showed considerable diversity, but the number of laboratories applying adequate diagnostic strategies increased during the study period. We found an average interlaboratory CV of 50% (range 12%-152%) for analytes in absolute concentrations. Result normalization by forming ratios to the upper reference limits did not reduce this variation. Sixty-five percent of reported results were within biological variation-based analytical quality specifications. Clinical interpretation of the obtained analytical results was accurate, and most laboratories established the correct diagnosis in all distributions. Based on a case-based EQA scheme, variations were apparent in analytical and diagnostic performance between European specialist porphyria laboratories. Our findings reinforce the use of EQA schemes as an essential tool to assess both analytical and diagnostic processes and thereby to improve patient care in rare diseases.

Lifetime prevalence of mental disorders among first and second generation individuals with Turkish migration backgrounds in Germany.

PubMed

Dingoyan, Demet; Schulz, Holger; Kluge, Ulrike; Penka, Simone; Vardar, Azra; von Wolff, Alessa; Strehle, Jens; Wittchen, Hans-Ulrich; Koch, Uwe; Heinz, Andreas; Mösko, Mike

2017-05-11

This paper focuses on the lifetime prevalence of mental disorders in individuals with Turkish migration backgrounds in Germany, as there is a lack of reliable epidemiological data on this subject. In total, 662 adults with Turkish migration backgrounds were interviewed in Hamburg and Berlin by trained, bilingual interviewers using the computerized Composite International Diagnostic Interview (CIDI DIA-X Version 2.8) to assess diagnoses according to the DSM-IVTR. The analyses showed a weighted lifetime prevalence of 78.8% for any mental disorder, 21.6% for more than one and 7.3% for five or more disorders. Any mood disorder (41.9%), any anxiety disorder (35.7%) and any somatoform disorder/syndrome (33.7%) had the highest prevalences. Despite the sociodemographic differences between the first and second generations, there were no significant differences in the lifetime prevalence between generations, with the exception of any bipolar disorder. Female gender, older age and no current partnership were significantly associated with the occurrence of any mood disorder. Overall, the results indicate a high lifetime prevalence in individuals with Turkish migration backgrounds in Germany. These initial data are highly relevant to the German clinical and psychosocial healthcare system; however, the methodological limitations and potential biases should be considered when interpreting the results.

Interpretation of Self-Talk and Post-Lecture Affective States of Higher Education Students: A Self-Determination Theory Perspective

ERIC Educational Resources Information Center

Oliver, Emily J.; Markland, David; Hardy, James

2010-01-01

Background: Self-determination theory posits that informational versus controlling interpretations of intra-personal events have positive and negative implications, respectively, for well-being. Self-talk represents an intra-personal event that could be interpreted as informational or controlling and may attenuate or exacerbate the negative…

Acquisition of background and technical information and class trip planning

NASA Technical Reports Server (NTRS)

Mackinnon, R. M.; Wake, W. H.

1981-01-01

Instructors who are very familiar with a study area, as well as those who are not, find the field trip information acquisition and planning process speeded and made more effective by organizing it in stages. The stage follow a deductive progression: from the associated context region, to the study area, to the specific sample window sites, and from generalized background information on the study region to specific technical data on the environmental and human use systems to be interpreted at each site. On the class trip and in the follow up laboratory, the learning/interpretive process are at first deductive in applying previously learned information and skills to analysis of the study site, then inductive in reading and interpreting the landscape, imagery, and maps of the site, correlating them with information of other samples sites and building valid generalizations about the larger study area, its context region, and other (similar and/or contrasting) regions.

X-Ray Background from Early Binaries

NASA Astrophysics Data System (ADS)

Kohler, Susanna

2016-11-01

What impact did X-rays from the first binary star systems have on the universe around them? A new study suggests this radiation may have played an important role during the reionization of our universe.Ionizing the UniverseDuring the period of reionization, the universe reverted from being neutral (as it was during recombination, the previous period)to once again being ionized plasma a state it has remained in since then. This transition, which occurred between 150 million and one billion years after the Big Bang (redshift of 6 z 20), was caused by the formation of the first objects energetic enough to reionize the universes neutral hydrogen.ROSAT image of the soft X-ray background throughout the universe. The different colors represent different energy bands: 0.25 keV (red), 0.75 keV (green), 1.5 keV (blue). [NASA/ROSAT Project]Understanding this time period in particular, determining what sources caused the reionization, and what the properties were of the gas strewn throughout the universe during this time is necessary for us to be able to correctly interpret cosmological observations.Conveniently, the universe has provided us with an interesting clue: the large-scale, diffuse X-ray background we observe all around us. What produced these X-rays, and what impact did this radiation have on the intergalactic medium long ago?The First BinariesA team of scientists led by Hao Xu (UC San Diego) has suggested that the very first generation of stars might be an important contributor to these X-rays.This hypothetical first generation, Population III stars, are thought to have formed before and during reionization from large clouds of gas containing virtually no metals. Studies suggest that a large fraction of Pop III stars formed in binaries and when those stars ended their lives as black holes, ensuing accretion from their companions could produceX-ray radiation.The evolution with redshift of the mean X-ray background intensities. Each curve represents a different

Immunogenicity of biologically-derived therapeutics: assessment and interpretation of nonclinical safety studies.

PubMed

Ponce, Rafael; Abad, Leslie; Amaravadi, Lakshmi; Gelzleichter, Thomas; Gore, Elizabeth; Green, James; Gupta, Shalini; Herzyk, Danuta; Hurst, Christopher; Ivens, Inge A; Kawabata, Thomas; Maier, Curtis; Mounho, Barbara; Rup, Bonita; Shankar, Gopi; Smith, Holly; Thomas, Peter; Wierda, Dan

2009-07-01

An evaluation of potential antibody formation to biologic therapeutics during the course of nonclinical safety studies and its impact on the toxicity profile is expected under current regulatory guidance and is accepted standard practice. However, approaches for incorporating this information in the interpretation of nonclinical safety studies are not clearly established. Described here are the immunological basis of anti-drug antibody formation to biopharmaceuticals (immunogenicity) in laboratory animals, and approaches for generating and interpreting immunogenicity data from nonclinical safety studies of biotechnology-derived therapeutics to support their progression to clinical evaluation. We subscribe that immunogenicity testing strategies should be adapted to the specific needs of each therapeutic development program, and data generated from such analyses should be integrated with available clinical and anatomic pathology, pharmacokinetic, and pharmacodynamic data to properly interpret nonclinical studies.

Exploring the Relationship Between Eye Movements and Electrocardiogram Interpretation Accuracy

NASA Astrophysics Data System (ADS)

Davies, Alan; Brown, Gavin; Vigo, Markel; Harper, Simon; Horseman, Laura; Splendiani, Bruno; Hill, Elspeth; Jay, Caroline

2016-12-01

Interpretation of electrocardiograms (ECGs) is a complex task involving visual inspection. This paper aims to improve understanding of how practitioners perceive ECGs, and determine whether visual behaviour can indicate differences in interpretation accuracy. A group of healthcare practitioners (n = 31) who interpret ECGs as part of their clinical role were shown 11 commonly encountered ECGs on a computer screen. The participants’ eye movement data were recorded as they viewed the ECGs and attempted interpretation. The Jensen-Shannon distance was computed for the distance between two Markov chains, constructed from the transition matrices (visual shifts from and to ECG leads) of the correct and incorrect interpretation groups for each ECG. A permutation test was then used to compare this distance against 10,000 randomly shuffled groups made up of the same participants. The results demonstrated a statistically significant (α  0.05) result in 5 of the 11 stimuli demonstrating that the gaze shift between the ECG leads is different between the groups making correct and incorrect interpretations and therefore a factor in interpretation accuracy. The results shed further light on the relationship between visual behaviour and ECG interpretation accuracy, providing information that can be used to improve both human and automated interpretation approaches.

A Clinical Case Presentation: Understanding and Interpreting Dreams while Working Through Developmental Trauma.

PubMed

Levy, Joshua; Finnegan, Paul

2016-02-01

The purpose of this paper is to demonstrate the unique place of understanding and interpreting dreams in the psychoanalytic process while working through developmental trauma. This psychoanalytic process extended over six years and is presented in four phases: establishing the therapeutic alliance, a crisis, working through, and termination. Dreams from each of these four phases of the analysis are presented, and the collaborative work of understanding and interpreting these dreams is highlighted. Evidence is presented that from this analytic work there ensued an amelioration of the impact of developmental trauma and a furtherance of the development of internal psychic structure. © 2016 by the American Psychoanalytic Association.

Are You "Tilting at Windmills" or Undertaking a Valid Clinical Trial?

PubMed Central

Zariffa, Jose; Kramer, John L.K.

2011-01-01

In this review, several aspects surrounding the choice of a therapeutic intervention and the conduct of clinical trials are discussed. Some of the background for why human studies have evolved to their current state is also included. Specifically, the following questions have been addressed: 1) What criteria should be used to determine whether a scientific discovery or invention is worthy of translation to human application? 2) What recent scientific advance warrants a deeper understanding of clinical trials by everyone? 3) What are the different types and phases of a clinical trial? 4) What characteristics of a human disorder should be noted, tracked, or stratified for a clinical trial and what inclusion /exclusion criteria are important to enrolling appropriate trial subjects? 5) What are the different study designs that can be used in a clinical trial program? 6) What confounding factors can alter the accurate interpretation of clinical trial outcomes? 7) What are the success rates of clinical trials and what can we learn from previous clinical trials? 8) What are the essential principles for the conduct of valid clinical trials? PMID:21786433

Background Pressure Effects on Krypton Hall Effect Thruster Internal Acceleration

DTIC Science & Technology

2013-08-01

This was also previously seen for xenon. Several interpretations of the continued velocity dis- tribution broadening of the high pressure case of...acceleration region into the thruster rel- ative to lower background pressures. We have at- tributed this behavior to increased electron mobility...density. While the data presented thus far does shown some changes in the breadth of the velocity Kr II dis- tributions with increasing

Interpretation bias for uncertain threat: A replication and extension.

PubMed

Oglesby, Mary E; Raines, Amanda M; Short, Nicole A; Capron, Daniel W; Schmidt, Norman B

2016-06-01

Intolerance of uncertainty (IU) has been proposed as an important transdiagnostic variable within various anxiety-related disorders. Research has suggested that individuals high in IU may interpret ambiguous information in a more threatening manner, suggesting a negative interpretation bias for uncertain information. However, interpretation biases within IU have not been adequately tested in the literature. The current study evaluated negative interpretation biases for uncertain information by directly measuring an individual's interpretations of ambiguous information across two samples. Participants consisted of 76 (Study 1; 72.4% female) and 31 (Study 2; 81% female) undergraduate students. Results indicated that individuals high in IU interpret ambiguous scenarios as more threatening compared to negative and/or positive scenarios (β = .45, p = .02). In addition, individuals high in IU showed a negative interpretation bias for ambiguous information, but not benign information (Study 1: β = -.40, p < .001; Study 2: β = -.57, p = .002). Future research should attempt to replicate these findings within clinical populations. In addition, future work would benefit from the inclusion of behavioral assessments of IU. These findings are the first to detect the presence of a negative interpretation bias for uncertain information among individuals high in IU utilizing a task designed to directly measure an individual's interpretation of information. Given the efficacy and low economic burden associated with interpretation bias modification protocols, and the transdiagnostic nature of IU, targeting IU within these protocols could have a tremendous public health impact. Copyright © 2015 Elsevier Ltd. All rights reserved.

International public health research involving interpreters: a case study from Bangladesh

PubMed Central

Pitchforth, Emma; van Teijlingen, Edwin

2005-01-01

Background Cross-cultural and international research are important components of public health research, but the challenges of language barriers and working with interpreters are often overlooked, particularly in the case of qualitative research. Methods A case-study approach was used to explore experiences of working with an interpreter in Bangladesh as part of a research project investigating women's experiences of emergency obstetric care. The case study Data from the researcher's field notes provided evidence of experiences in working with an interpreter and show how the model of interviewing was adapted over time to give a more active role to the interpreter. The advantages of a more active role were increased rapport and "flow" in interviews. The disadvantages included reduced control from the researcher's perspective. Some tensions between the researcher and interpreter remained hard to overcome, irrespective of the model used. Independent transcription and translation of the interviews also raised questions around accuracy in translation. Conclusion The issues examined in this case study have broader implications for public health research. Further work is needed in three areas: 1) developing effective relationships with interpreters; 2) the impact of the interpreter on the research process; and 3) the accuracy of the translation and level of analysis needed in any specific public health research. Finally, this paper highlights the importance to authors of reflecting on the potential impact of translation and interpretation on the research process when disseminating their research. PMID:15985161

Measurements of the cosmic background radiation

NASA Technical Reports Server (NTRS)

Lubin, P.; Villela, T.

1987-01-01

Maps of the large scale structure (theta is greater than 6 deg) of the cosmic background radiation covering 90 percent of the sky are now available. The data show a very strong 50-100 sigma (statistical error) dipole component, interpreted as being due to our motion, with a direction of alpha = 11.5 + or - 0.15 hours, sigma = -5.6 + or - 2.0 deg. The inferred direction of the velocity of our galaxy relative to the cosmic background radiation is alpha = 10.6 + or - 0.3 hours, sigma = -2.3 + or - 5 deg. This is 44 deg from the center of the Virgo cluster. After removing the dipole component, the data show a galactic signature but no apparent residual structure. An autocorrelation of the residual data, after substraction of the galactic component from a combined Berkeley (3 mm) and Princeton (12 mm) data sets, show no apparent structure from 10 to 180 deg with a rms of 0.01 mK(sup 2). At 90 percent confidence level limit of .00007 is placed on a quadrupole component.

Variability in Pathologists’ Interpretations of Individual Breast Biopsy Slides: A Population Perspective

PubMed Central

Elmore, Joann G.; Nelson, Heidi D.; Pepe, Margaret S.; Longton, Gary M.; Tosteson, Anna N.A.; Geller, Berta; Onega, Tracy; Carney, Patricia A.; Jackson, Sara L.; Allison, Kimberly H.; Weaver, Donald L.

2016-01-01

Background The effect of physician diagnostic variability on accuracy at a population level depends on the prevalence of diagnoses. Objective To estimate how diagnostic variability affects accuracy from the perspective of a U.S. woman aged 50 to 59 years having a breast biopsy. Design Applied probability using Bayes theorem. Setting B-Path (Breast Pathology) Study comparing pathologists’ interpretations of a single biopsy slide versus a reference consensus interpretation from 3 experts. Participants 115 practicing pathologists (6900 total interpretations from 240 distinct cases). Measurements A single representative slide from each of the 240 cases was used to estimate the proportion of biopsies with a diagnosis that would be verified if the same slide were interpreted by a reference group of 3 expert pathologists. Probabilities of confirmation (predictive values) were estimated using B-Path Study results and prevalence of biopsy diagnoses for women aged 50 to 59 years in the Breast Cancer Surveillance Consortium. Results Overall, if 1 representative slide were used per case, 92.3% (95% CI, 91.4% to 93.1%) of breast biopsy diagnoses would be verified by reference consensus diagnoses, with 4.6% (CI, 3.9% to 5.3%) overinterpreted and 3.2% (CI, 2.7% to 3.6%) underinterpreted. Verification of invasive breast cancer and benign without atypia diagnoses is highly probable; estimated predictive values were 97.7% (CI, 96.5% to 98.7%) and 97.1% (CI, 96.7% to 97.4%), respectively. Verification is less probable for atypia (53.6% overinterpreted and 8.6% underinterpreted) and ductal carcinoma in situ (DCIS) (18.5% overinterpreted and 11.8% underinterpreted). Limitations Estimates are based on a testing situation with 1 slide used per case and without access to second opinions. Population-adjusted estimates may differ for women from other age groups, unscreened women, or women in different practice settings. Conclusion This analysis, based on interpretation of a single breast

Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens

PubMed Central

Elmore, Joann G.; Longton, Gary M.; Carney, Patricia A.; Geller, Berta M.; Onega, Tracy; Tosteson, Anna N. A.; Nelson, Heidi D.; Pepe, Margaret S.; Allison, Kimberly H.; Schnitt, Stuart J.; O’Malley, Frances P.; Weaver, Donald L.

2015-01-01

IMPORTANCE A breast pathology diagnosis provides the basis for clinical treatment and management decisions; however, its accuracy is inadequately understood. OBJECTIVES To quantify the magnitude of diagnostic disagreement among pathologists compared with a consensus panel reference diagnosis and to evaluate associated patient and pathologist characteristics. DESIGN, SETTING, AND PARTICIPANTS Study of pathologists who interpret breast biopsies in clinical practices in 8 US states. EXPOSURES Participants independently interpreted slides between November 2011 and May 2014 from test sets of 60 breast biopsies (240 total cases, 1 slide per case), including 23 cases of invasive breast cancer, 73 ductal carcinoma in situ (DCIS), 72 with atypical hyperplasia (atypia), and 72 benign cases without atypia. Participants were blinded to the interpretations of other study pathologists and consensus panel members. Among the 3 consensus panel members, unanimous agreement of their independent diagnoses was 75%, and concordance with the consensus-derived reference diagnoses was 90.3%. MAIN OUTCOMES AND MEASURES The proportions of diagnoses overinterpreted and underinterpreted relative to the consensus-derived reference diagnoses were assessed. RESULTS Sixty-five percent of invited, responding pathologists were eligible and consented to participate. Of these, 91% (N = 115) completed the study, providing 6900 individual case diagnoses. Compared with the consensus-derived reference diagnosis, the overall concordance rate of diagnostic interpretations of participating pathologists was 75.3% (95% CI, 73.4%–77.0%; 5194 of 6900 interpretations). Consensus ReferenceDiagnosis Pathologist Interpretation vs Consensus-Derived Reference Diagnosis, % (95% CI) No. ofInterpretations Overall ConcordanceRate OverinterpretationRate UnderinterpretationRate Benign without atypia 2070 87 (85–89) 13 (11–15) Atypia 2070 48 (44–52) 17 (15–21) 35 (31–39) DCIS 2097 84 (82–86) 3 (2–4) 13 (12�

Breast MRI BI-RADS assessments and abnormal interpretation rates by clinical indication in US community practices.

PubMed

Lee, Christoph I; Ichikawa, Laura; Rochelle, Michele C; Kerlikowske, Karla; Miglioretti, Diana L; Sprague, Brian L; DeMartini, Wendy B; Wernli, Karen J; Joe, Bonnie N; Yankaskas, Bonnie C; Lehman, Constance D

2014-11-01

As breast magnetic resonance imaging (MRI) use grows, benchmark performance parameters are needed for auditing and quality assurance purposes. We describe the variation in breast MRI abnormal interpretation rates (AIRs) by clinical indication among a large sample of US community practices. We analyzed data from 41 facilities across five Breast Cancer Surveillance Consortium imaging registries. Each registry obtained institutional review board approval for this Health Insurance Portability and Accountability Act compliant analysis. We included 11,654 breast MRI examinations conducted in 2005-2010 among women aged 18-79 years. We categorized clinical indications as 1) screening, 2) extent of disease, 3) diagnostic (eg, breast symptoms), and 4) other (eg, short-interval follow-up). We characterized assessments as positive (ie, Breast Imaging Reporting and Data System [BI-RADS] 0, 4, and 5) or negative (ie, BI-RADS 1, 2, and 6) and provide results with BI-RADS 3 categorized as positive and negative. We tested for differences in AIRs across clinical indications both unadjusted and adjusted for patient characteristics and registry and assessed for changes in AIRs by year within each clinical indication. When categorizing BI-RADS 3 as positive, AIRs were 21.0% (95% confidence interval [CI], 19.8-22.3) for screening, 31.7% (95% CI, 29.6-33.8) for extent of disease, 29.7% (95% CI, 28.3-31.1) for diagnostic, and 27.4% (95% CI, 25.0-29.8) for other indications (P < .0001). When categorizing BI-RADS 3 as negative, AIRs were 10.5% (95% CI, 9.5-11.4) for screening, 21.8% (95% CI, 19.9-23.6) for extent of disease, 17.7% (95% CI, 16.5-18.8) for diagnostic, and 13.3% (95% CI, 11.6-15.2) for other indications (P < .0001). The significant differences in AIRs by indication persisted even after adjusting for patient characteristics and registry (P < .0001). In addition, for most indications, there were no significant changes in AIRs over time. Breast MRI AIRs differ significantly by

Embodied and exbodied mind in clinical psychology. A proposal for a psycho-social interpretation of mental disorders.

PubMed

Zatti, Alberto; Zarbo, Cristina

2015-01-01

A brief theoretical review of the current state of the art of embodiment research in clinical psychology has been expounded in order to highlight the key role that embodied conceptualization has on the understanding and explanation of several mental disorders, such as eating disorders, schizophrenia and depression. Evidence has suggested that mental disorders may be explained as disturbances of embodiment, from the disembodiment to the hyperembodiment. In order to understand how some clinical conditions are affected by cultural models, we propose and define a new framework called Exbodiment, complementary to the Embodiment approach to cognition. Mental disorder is strictly related to the subject-culture interaction that may be explained as a two way process in which embodiment and exbodiment are complementary points of view. In this perspective, embodiment may be seen as the "top-down" process, while exbodiment the "bottom-up" one. The introduction of exbodiment conceptualization highlights how subject is both receiver and interpreter of social influence. Subject is the target of a cultural pressure and, at the same time, enacts its own embodied culture in world. Exbodiment conceptualization may help clinicians to better understand and explain the role of culture in the onset and maintenance of mental disorders.

Embodied and exbodied mind in clinical psychology. A proposal for a psycho-social interpretation of mental disorders

PubMed Central

Zatti, Alberto; Zarbo, Cristina

2015-01-01

A brief theoretical review of the current state of the art of embodiment research in clinical psychology has been expounded in order to highlight the key role that embodied conceptualization has on the understanding and explanation of several mental disorders, such as eating disorders, schizophrenia and depression. Evidence has suggested that mental disorders may be explained as disturbances of embodiment, from the disembodiment to the hyperembodiment. In order to understand how some clinical conditions are affected by cultural models, we propose and define a new framework called Exbodiment, complementary to the Embodiment approach to cognition. Mental disorder is strictly related to the subject-culture interaction that may be explained as a two way process in which embodiment and exbodiment are complementary points of view. In this perspective, embodiment may be seen as the “top-down” process, while exbodiment the “bottom-up” one. The introduction of exbodiment conceptualization highlights how subject is both receiver and interpreter of social influence. Subject is the target of a cultural pressure and, at the same time, enacts its own embodied culture in world. Exbodiment conceptualization may help clinicians to better understand and explain the role of culture in the onset and maintenance of mental disorders. PMID:25784894

Proposed In-Training Electrocardiogram Interpretation Competencies for Undergraduate and Postgraduate Trainees.

PubMed

Antiperovitch, Pavel; Zareba, Wojciech; Steinberg, Jonathan S; Bacharova, Ljuba; Tereshchenko, Larisa G; Farre, Jeronimo; Nikus, Kjell; Ikeda, Takanori; Baranchuk, Adrian

2018-03-01

Despite its importance in everyday clinical practice, the ability of physicians to interpret electrocardiograms (ECGs) is highly variable. ECG patterns are often misdiagnosed, and electrocardiographic emergencies are frequently missed, leading to adverse patient outcomes. Currently, many medical education programs lack an organized curriculum and competency assessment to ensure trainees master this essential skill. ECG patterns that were previously mentioned in literature were organized into groups from A to D based on their clinical importance and distributed among levels of training. Incremental versions of this organization were circulated among members of the International Society of Electrocardiology and the International Society of Holter and Noninvasive Electrocardiology until complete consensus was reached. We present reasonably attainable ECG interpretation competencies for undergraduate and postgraduate trainees. Previous literature suggests that methods of teaching ECG interpretation are less important and can be selected based on the available resources of each education program and student preference. The evidence clearly favors summative trainee evaluation methods, which would facilitate learning and ensure that appropriate competencies are acquired. Resources should be allocated to ensure that every trainee reaches their training milestones and should ensure that no electrocardiographic emergency (class A condition) is ever missed. We hope that these guidelines will inform medical education programs and encourage them to allocate sufficient resources and develop organized curricula. Assessments must be in place to ensure trainees acquire the level-appropriate ECG interpretation skills that are required for safe clinical practice. © 2017 Society of Hospital Medicine.

Varying performance in mammographic interpretation across two countries: Do results indicate reader or population variances?

NASA Astrophysics Data System (ADS)

Soh, BaoLin P.; Lee, Warwick B.; Wong, Jill; Sim, Llewellyn; Hillis, Stephen L.; Tapia, Kriscia A.; Brennan, Patrick C.

2016-03-01

Aim: To compare the performance of Australian and Singapore breast readers interpreting a single test-set that consisted of mammographic examinations collected from the Australian population. Background: In the teleradiology era, breast readers are interpreting mammographic examinations from different populations. The question arises whether two groups of readers with similar training backgrounds, demonstrate the same level of performance when presented with a population familiar only to one of the groups. Methods: Fifty-three Australian and 15 Singaporean breast radiologists participated in this study. All radiologists were trained in mammogram interpretation and had a median of 9 and 15 years of experience in reading mammograms respectively. Each reader interpreted the same BREAST test-set consisting of sixty de-identified mammographic examinations arising from an Australian population. Performance parameters including JAFROC, ROC, case sensitivity as well as specificity were compared between Australian and Singaporean readers using a Mann Whitney U test. Results: A significant difference (P=0.036) was demonstrated between the JAFROC scores of the Australian and Singaporean breast radiologists. No other significant differences were observed. Conclusion: JAFROC scores for Australian radiologists were higher than those obtained by the Singaporean counterparts. Whilst it is tempting to suggest this is down to reader expertise, this may be a simplistic explanation considering the very similar training and audit backgrounds of the two populations of radiologists. The influence of reading images that are different from those that radiologists normally encounter cannot be ruled out and requires further investigation, particularly in the light of increasing international outsourcing of radiologic reporting.

Creating a Meeting Point of Understanding: Interpreters' Experiences in Swedish Childhood Cancer Care.

PubMed

Granhagen Jungner, Johanna; Tiselius, Elisabet; Lützén, Kim; Blomgren, Klas; Pergert, Pernilla

2016-01-01

Children and families with a foreign background and limited Swedish proficiency have to communicate through interpreters in childhood cancer care centers in Sweden. Interpreter-mediated events deal with many difficulties that potentially hinder the transfer of information. The purpose of our study was to explore interpreters' experiences of interpreting between health care staff and limited Swedish proficiency patients/families in childhood cancer care. Using purposive samples, we interviewed 11 interpreters individually. The interviews were analyzed using qualitative content analysis. Analyses of the data resulted in the main theme of creating a meeting point of understanding, constructed from 3 subthemes: balancing between cultures, bridging the gaps of knowledge, and balancing between compassion and professionalism. Our result shows that in order to create a sustainable meeting point of understanding, it is necessary to explain both the context and cultural differences. These results suggest that the responsibility for information transfer lies with both the health care profession and the interpreters. Tools have to be developed for both parties to contribute to creating the meeting point of understanding. © 2015 by Association of Pediatric Hematology/Oncology Nurses.

Algorithmic tools for interpreting vital signs.

PubMed

Rathbun, Melina C; Ruth-Sahd, Lisa A

2009-07-01

Today's complex world of nursing practice challenges nurse educators to develop teaching methods that promote critical thinking skills and foster quick problem solving in the novice nurse. Traditional pedagogies previously used in the classroom and clinical setting are no longer adequate to prepare nursing students for entry into practice. In addition, educators have expressed frustration when encouraging students to apply newly learned theoretical content to direct the care of assigned patients in the clinical setting. This article presents algorithms as an innovative teaching strategy to guide novice student nurses in the interpretation and decision making related to vital sign assessment in an acute care setting.

Medical Paraclinical Standards, Political Economy of Clinic, and Patients’ Clinical Dependency; A Critical Conversation Analysis of Clinical Counseling in South of Iran

PubMed Central

Kalateh Sadati, Ahmad; Iman, Mohammad Taghi; Bagheri Lankarani, Kamran

2014-01-01

Background: Despite its benefits and importance, clinical counseling affects the patient both psychosocially and socially. Illness labeling not only leads to many problems for patient and his/her family but also it imposes high costs to health care system. Among various factors, doctor-patient relationship has an important role in the clinical counseling and its medical approach. The goal of this study is to evaluate the nature of clinical counseling based on critical approach. Methods: The context of research is the second major medical training center in Shiraz, Iran. In this study, Critical Conversation Analysis was used based on the methodologies of critical theories. Among about 50 consultation meetings digitally recorded, 33 were selected for this study. Results: Results show that the nature of doctor-patient relationship in these cases is based on paternalistic model. On the other hand, in all consultations, the important values that were legitimated with physicians were medical paraclinical standards. Paternalism in one hand and standardization on the other leads to dependency of patients to the clinic. Conclusion: Although we can’t condone the paraclinical standards, clinical counseling and doctor-patient relationship need to reduce its dominance over counseling based on interpretation of human relations, paying attention to social and economical differences of peoples and biosocial and biocultural differences, and focusing on clinical examinations. Also, we need to accept that medicine is an art of interaction that can’t reduce it to instrumental and linear methods of body treatment. PMID:25349858

Accuracy of Screening Mammography Interpretation by Characteristics of Radiologists

PubMed Central

Barlow, William E.; Chi, Chen; Carney, Patricia A.; Taplin, Stephen H.; D’Orsi, Carl; Cutter, Gary; Hendrick, R. Edward; Elmore, Joann G.

2011-01-01

Background Radiologists differ in their ability to interpret screening mammograms accurately. We investigated the relationship of radiologist characteristics to actual performance from 1996 to 2001. Methods Screening mammograms (n = 469 512) interpreted by 124 radiologists were linked to cancer outcome data. The radiologists completed a survey that included questions on demographics, malpractice concerns, years of experience interpreting mammograms, and the number of mammograms read annually. We used receiver operating characteristics (ROC) analysis to analyze variables associated with sensitivity, specificity, and the combination of the two, adjusting for patient variables that affect performance. All P values are two-sided. Results Within 1 year of the mammogram, 2402 breast cancers were identified. Relative to low annual interpretive volume (≤1000 mammograms), greater interpretive volume was associated with higher sensitivity (P = .001; odds ratio [OR] for moderate volume [1001–2000] = 1.68, 95% CI = 1.18 to 2.39; OR for high volume [>2000] = 1.89, 95% CI = 1.36 to 2.63). Specificity decreased with volume (OR for 1001–2000 = 0.65, 95% CI = 0.52 to 0.83; OR for more than 2000 = 0.76, 95% CI = 0.60 to 0.96), compared with 1000 or less (P = .002). Greater number of years of experience interpreting mammograms was associated with lower sensitivity (P = .001), but higher specificity (P = .003). ROC analysis using the ordinal BI-RADS interpretation showed an association between accuracy and both previous mammographic history (P = .012) and breast density (P<.001). No association was observed between accuracy and years interpreting mammograms (P = .34) or mammography volume (P = .94), after adjusting for variables that affect the threshold for calling a mammogram positive. Conclusions We found no evidence that greater volume or experience at interpreting mammograms is associated with better performance. However, they may affect sensitivity and specificity

Interpretations

NASA Astrophysics Data System (ADS)

Bellac, Michel Le

2014-11-01

Although nobody can question the practical efficiency of quantum mechanics, there remains the serious question of its interpretation. As Valerio Scarani puts it, "We do not feel at ease with the indistinguishability principle (that is, the superposition principle) and some of its consequences." Indeed, this principle which pervades the quantum world is in stark contradiction with our everyday experience. From the very beginning of quantum mechanics, a number of physicists--but not the majority of them!--have asked the question of its "interpretation". One may simply deny that there is a problem: according to proponents of the minimalist interpretation, quantum mechanics is self-sufficient and needs no interpretation. The point of view held by a majority of physicists, that of the Copenhagen interpretation, will be examined in Section 10.1. The crux of the problem lies in the status of the state vector introduced in the preceding chapter to describe a quantum system, which is no more than a symbolic representation for the Copenhagen school of thought. Conversely, one may try to attribute some "external reality" to this state vector, that is, a correspondence between the mathematical description and the physical reality. In this latter case, it is the measurement problem which is brought to the fore. In 1932, von Neumann was first to propose a global approach, in an attempt to build a purely quantum theory of measurement examined in Section 10.2. This theory still underlies modern approaches, among them those grounded on decoherence theory, or on the macroscopic character of the measuring apparatus: see Section 10.3. Finally, there are non-standard interpretations such as Everett's many worlds theory or the hidden variables theory of de Broglie and Bohm (Section 10.4). Note, however, that this variety of interpretations has no bearing whatsoever on the practical use of quantum mechanics. There is no controversy on the way we should use quantum mechanics!

Interpretation miniatures

NASA Astrophysics Data System (ADS)

Nikolić, Hrvoje

Most physicists do not have patience for reading long and obscure interpretation arguments and disputes. Hence, to attract attention of a wider physics community, in this paper various old and new aspects of quantum interpretations are explained in a concise and simple (almost trivial) form. About the “Copenhagen” interpretation, we note that there are several different versions of it and explain how to make sense of “local nonreality” interpretation. About the many-world interpretation (MWI), we explain that it is neither local nor nonlocal, that it cannot explain the Born rule, that it suffers from the preferred basis problem, and that quantum suicide cannot be used to test it. About the Bohmian interpretation, we explain that it is analogous to dark matter, use it to explain that there is no big difference between nonlocal correlation and nonlocal causation, and use some condensed-matter ideas to outline how nonrelativistic Bohmian theory could be a theory of everything. We also explain how different interpretations can be used to demystify the delayed choice experiment, to resolve the problem of time in quantum gravity, and to provide alternatives to quantum nonlocality. Finally, we explain why is life compatible with the second law.

Interpreting suffering from illness: The role of culture and repressive suffering construal.

PubMed

Yang, Qian; Liu, Shi; Sullivan, Daniel; Pan, Shengdong

2016-07-01

Mental and physical illnesses are among the most prominent forms of suffering. Cultural worldviews provide tools for making sense of and coping with suffering. In this research, we examine how culture influences both experts' and laypeople's interpretation of suffering from illness. We focus on one type of interpretation of suffering- repressive suffering construal-an interpretation that frames suffering both as the result of immorality on the part of the sufferer and as having the function of maintaining social order by curtailing deviance. We sought to test whether this type of suffering interpretation is more common in cultural ecologies (e.g., urban vs. rural; higher vs. lower status) traditionally associated with collectivist values. Study 1 used data from the General Social Survey to examine variation in suffering interpretation in a representative sample of the U.S. Study 2 examined variation in suffering interpretation with a survey completed by a subsample of Chinese health-care professionals. Study 1 found that U.S. citizens living in a rural environment are more likely to interpret illnesses as being the fault of the sufferer. Study 2 found that those from a lower-SES background are more likely to interpret illnesses in a repressive fashion. In these studies, family size mediates the effect of ecological conditions on RSC. Our research highlights how ecological variables associated with collectivism may bias both laypeople and professionals to interpret suffering from illness in a more repressive way. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cancer clinical trials in persons with HIV infection.

PubMed

Little, Richard F

2017-01-01

The era of modern HIV therapeutics is well underway. The cancer and infectious disease epidemiology of HIV disease has markedly altered as populations are availed to the benefits of antiretroviral therapy (ARV). The types of cancers occurring among those with HIV infection has broadened but the case burden in absolute numbers is very low relative to the background population. There are fewer incident cases of the AIDS-defining cancers (aggressive B-cell lymphomas, Kaposi's sarcoma, and cervical cancer). There is an increased risk for certain non-AIDS-defining cancers, but these occur somewhat sporadically relative to clinical trial enrollment. The changing epidemiology of cancer in HIV poses challenges as well as opportunities for participation of persons with HIV in cancer therapy clinical trials. There are excellent examples of cancer trials that inform cancer therapy for patients with HIV infection. Examples include those from HIV-specific trials and from trials mainly focused on the background population that included patients with HIV infection. Interpretation of clinical trials to guide therapy for those with HIV infection and cancer largely depends on data that does not include HIV-infected patients. The ability to extend clinical trial findings to populations not included in clinical trials remains problematic for a variety of populations, including those with HIV or AIDS. Careful prioritization of studies designed to bridge this gap is needed. However, there are published studies that serve as excellent examples bridging these gaps and the portfolio of cancer therapy trials underway will inform HIV and cancer better than at any time in the past.

Use of Visual Cues by Adults With Traumatic Brain Injuries to Interpret Explicit and Inferential Information.

PubMed

Brown, Jessica A; Hux, Karen; Knollman-Porter, Kelly; Wallace, Sarah E

2016-01-01

Concomitant visual and cognitive impairments following traumatic brain injuries (TBIs) may be problematic when the visual modality serves as a primary source for receiving information. Further difficulties comprehending visual information may occur when interpretation requires processing inferential rather than explicit content. The purpose of this study was to compare the accuracy with which people with and without severe TBI interpreted information in contextually rich drawings. Fifteen adults with and 15 adults without severe TBI. Repeated-measures between-groups design. Participants were asked to match images to sentences that either conveyed explicit (ie, main action or background) or inferential (ie, physical or mental inference) information. The researchers compared accuracy between participant groups and among stimulus conditions. Participants with TBI demonstrated significantly poorer accuracy than participants without TBI extracting information from images. In addition, participants with TBI demonstrated significantly higher response accuracy when interpreting explicit rather than inferential information; however, no significant difference emerged between sentences referencing main action versus background information or sentences providing physical versus mental inference information for this participant group. Difficulties gaining information from visual environmental cues may arise for people with TBI given their difficulties interpreting inferential content presented through the visual modality.

Slowing of Femtosecond Laser-Generated Nanoparticles in a Background Gas

DOE PAGES

Rouleau, Christopher M.; Puretzky, Alexander A.; Geohegan, David B.

2014-11-25

The slowing of Pt nanoparticles in argon background gas was characterized by Rayleigh scattering imaging using a plume of nanoparticles generated by femtosecond laser through thin film ablation (fs-TTFA) of 20 nanometers-thick Pt films. The ablation was performed at threshold laser energy fluences for complete film removal to provide a well-defined plume consisting almost entirely of nanoparticles traveling with a narrow velocity distribution, providing a unique system to unambiguously characterize the slowing of nanoparticles during interaction with background gases. Nanoparticles of ~200 nm diameter were found to decelerate in background Ar gas with pressures less than 50 Torr in goodmore » agreement with a linear drag model in the Epstein regime. Based on this model, the stopping distance of small nanoparticles in the plume was predicted and tested by particle collection in an off-axis geometry, and size distribution analysis by transmission electron microscopy. These results permit a basis to interpret nanoparticle propagation through background gases in laser ablation plumes that contain mixed components.« less

Interpretation and classification of microvolt T wave alternans tests

NASA Technical Reports Server (NTRS)

Bloomfield, Daniel M.; Hohnloser, Stefan H.; Cohen, Richard J.

2002-01-01

Measurement of microvolt-level T wave alternans (TWA) during routine exercise stress testing now is possible as a result of sophisticated noise reduction techniques and analytic methods that have become commercially available. Even though this technology is new, the available data suggest that microvolt TWA is a potent predictor of arrhythmia risk in diverse disease states. As this technology becomes more widely available, physicians will be called upon to interpret microvolt TWA tracings. This review seeks to establish uniform standards for the clinical interpretation of microvolt TWA tracings.

Variant Interpretation: Functional Assays to the Rescue.

PubMed

Starita, Lea M; Ahituv, Nadav; Dunham, Maitreya J; Kitzman, Jacob O; Roth, Frederick P; Seelig, Georg; Shendure, Jay; Fowler, Douglas M

2017-09-07

Classical genetic approaches for interpreting variants, such as case-control or co-segregation studies, require finding many individuals with each variant. Because the overwhelming majority of variants are present in only a few living humans, this strategy has clear limits. Fully realizing the clinical potential of genetics requires that we accurately infer pathogenicity even for rare or private variation. Many computational approaches to predicting variant effects have been developed, but they can identify only a small fraction of pathogenic variants with the high confidence that is required in the clinic. Experimentally measuring a variant's functional consequences can provide clearer guidance, but individual assays performed only after the discovery of the variant are both time and resource intensive. Here, we discuss how multiplex assays of variant effect (MAVEs) can be used to measure the functional consequences of all possible variants in disease-relevant loci for a variety of molecular and cellular phenotypes. The resulting large-scale functional data can be combined with machine learning and clinical knowledge for the development of "lookup tables" of accurate pathogenicity predictions. A coordinated effort to produce, analyze, and disseminate large-scale functional data generated by multiplex assays could be essential to addressing the variant-interpretation crisis. Copyright © 2017 American Society of Human Genetics. Published by Elsevier Inc. All rights reserved.

Interpreting the cosmic far-infrared background anisotropies using a gas regulator model

NASA Astrophysics Data System (ADS)

Wu, Hao-Yi; Doré, Olivier; Teyssier, Romain; Serra, Paolo

2018-04-01

Cosmic far-infrared background (CFIRB) is a powerful probe of the history of star formation rate (SFR) and the connection between baryons and dark matter across cosmic time. In this work, we explore to which extent the CFIRB anisotropies can be reproduced by a simple physical framework for galaxy evolution, the gas regulator (bathtub) model. This model is based on continuity equations for gas, stars, and metals, taking into account cosmic gas accretion, star formation, and gas ejection. We model the large-scale galaxy bias and small-scale shot noise self-consistently, and we constrain our model using the CFIRB power spectra measured by Planck. Because of the simplicity of the physical model, the goodness of fit is limited. We compare our model predictions with the observed correlation between CFIRB and gravitational lensing, bolometric infrared luminosity functions, and submillimetre source counts. The strong clustering of CFIRB indicates a large galaxy bias, which corresponds to haloes of mass 1012.5 M⊙ at z = 2, higher than the mass associated with the peak of the star formation efficiency. We also find that the far-infrared luminosities of haloes above 1012 M⊙ are higher than the expectation from the SFR observed in ultraviolet and optical surveys.

Using professional interpreters in undergraduate medical consultation skills teaching

PubMed Central

Bansal, Aarti; Swann, Jennifer; Smithson, William Henry

2014-01-01

The ability to work with interpreters is a core skill for UK medical graduates. At the University of Sheffield Medical School, this teaching was identified as a gap in the curriculum. Teaching was developed to use professional interpreters in role-play, based on evidence that professional interpreters improve health outcomes for patients with limited English proficiency. Other principles guiding the development of the teaching were an experiential learning format, integration to the core consultation skills curriculum, and sustainable delivery. The session was aligned with existing consultation skills teaching to retain the small-group experiential format and general practitioner (GP) tutor. Core curricular time was found through conversion of an existing consultation skills session. Language pairs of professional interpreters worked with each small group, with one playing patient and the other playing interpreter. These professional interpreters attended training in the scenarios so that they could learn to act as patient and family interpreter. GP tutors attended training sessions to help them facilitate the session. This enhanced the sustainability of the session by providing a cohort of tutors able to pass on their expertise to new staff through the existing shadowing process. Tutors felt that the involvement of professional interpreters improved student engagement. Student evaluation of the teaching suggests that the learning objectives were achieved. Faculty evaluation by GP tutors suggests that they perceived the teaching to be worthwhile and that the training they received had helped improve their own clinical practice in consulting through interpreters. We offer the following recommendations to others who may be interested in developing teaching on interpreted consultations within their core curriculum: 1) consider recruiting professional interpreters as a teaching resource; 2) align the teaching to existing consultation skills sessions to aid integration

[Promoting directives of the Quality Law of the Spanish National Health System: Computer-interpretable clinical practice guidelines].

PubMed

González-Ferrer, Arturo; Valcárcel, María Ángel

2018-04-01

The Cohesion and Quality Act of the National Health System promotes the use of new technologies to make it possible for health professionals put the scientific evidence into practice. In order to do this, there are technological tools, known as of computer-interpretable guidelines, which can help achieve this goal from an innovation perspective. They can be adopted using an iterative process, having a great initial potential as an educational tool, of quality and safety of the patient, in the decision making and, optionally, can be integrated with the electronic medical history, once they are rigorously validated. This article presents updates on these tools, reviews international projects, and personal experiences in which they have demonstrated their value, and highlights the advantages, risks, and limitations they present from a clinical point of view. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

General practitioners’ views on consultations with interpreters: A triad situation with complex issues

PubMed Central

Fatahi, Nabi; Hellström, Mikael; Skott, Carola; Mattsson, Bengt

2008-01-01

Objective To study a group of general practitioners’ (GPs) views on cross-cultural consultations through interpreters in primary healthcare in Sweden. Design Two group interviews and three personal interviews with experienced GPs regarding clinical consultation through interpreters were carried out. The interviews were transcribed and analysed and the text was categorized according to content analysis. Setting Primary healthcare. Subjects Eight GPs were interviewed. Main outcome measures The response and opinions of the GPs. Results In the analysis it appeared that an optimal clinical encounter demands an active role by all participants involved in the consultation. The interpreter has to strive after being a stable neutral information bridge, and has a balancing role between the GP and the patient. The GP has to be open to cultural inequalities and recognize consultation through an interpreter as a part of her/his job. The patient needs to be an active and visible participant, not hiding behind the interpreter. Common obstacles and imperfections to reach the best possible triad were discussed. Additionally, practical assets in the encounter were delineated. Accurate physical placing of the persons in the room, adequate length of consultation time, and using the same interpreter from one visit to another were mentioned as factors influencing the outcome of the consultation. Conclusion Barriers in cross-cultural communications could originate from all persons involved, the interpreter, the GP, and the patient, as well as from tangible factors. Ways to reduce misunderstandings in GP–patient encounters through interpreters are suggested. PMID:18297562

Effect of Listeners' Linguistic Background on Perceptual Judgements of Hypernasality

ERIC Educational Resources Information Center

Lee, Alice; Brown, Susanna; Gibbon, Fiona E.

2008-01-01

Background: Many speech and language therapists work in a multilingual environment, making cross-linguistic studies of speech disorders clinically and theoretically important. Aims: To investigate the effect of listeners' linguistic background on their perceptual ratings of hypernasality and the reliability of the ratings. Methods &…

A Degree-Scale Measurement of the Anisotropy in the Cosmic Microwave Background

NASA Technical Reports Server (NTRS)

Wollack, Ed; Jarosik, Norm; Netterfield, Barth; Page, Lyman; Wilkinson, David

1995-01-01

We report the detection of anisotropy in the microwave sky at 3O GHz and at l deg angular scales. The most economical interpretation of the data is that the fluctuations are intrinsic to the cosmic microwave background. However, galactic free-free emission is ruled out with only 90% confidence. The most likely root-mean-squared amplitude of the fluctuations, assuming they are described by a Gaussian auto-correlation function with a coherence angle of 1.2 deg, is 41(+16/-13) (mu)K. We also present limits on the anisotropy of the polarization of the cosmic microwave background.

Repurposing historical control clinical trial data to provide safety context.

PubMed

Bhuyan, Prakash; Desai, Jigar; Louis, Matthew St; Carlsson, Martin; Bowen, Edward; Danielson, Mark; Cantor, Michael N

2016-02-01

Billions of dollars spent, millions of subject-hours of clinical trial experience and an abundance of archived study-level data, yet why are historical data underutilized? We propose that historical data can be aggregated to provide safety, background incidence rate and context to improve the evaluation of new medicinal products. Here, we describe the development and application of the eControls database, which is derived from the control arms of studies of licensed products, and discuss the challenges and potential solutions to the proper application of historical data to help interpret product safety. Copyright © 2015 Elsevier Ltd. All rights reserved.

How concept images affect students' interpretations of Newton's method

NASA Astrophysics Data System (ADS)

Engelke Infante, Nicole; Murphy, Kristen; Glenn, Celeste; Sealey, Vicki

2018-07-01

Knowing when students have the prerequisite knowledge to be able to read and understand a mathematical text is a perennial concern for instructors. Using text describing Newton's method and Vinner's notion of concept image, we exemplify how prerequisite knowledge influences understanding. Through clinical interviews with first-semester calculus students, we determined how evoked concept images of tangent lines and roots contributed to students' interpretation and application of Newton's method. Results show that some students' concept images of root and tangent line developed throughout the interview process, and most students were able to adequately interpret the text on Newton's method. However, students with insufficient concept images of tangent line and students who were unwilling or unable to modify their concept images of tangent line after reading the text were not successful in interpreting Newton's method.

ECG interpretation skills of South African Emergency Medicine residents

PubMed Central

Wallis, Lee; Maritz, David

2010-01-01

Background The use and interpretation of electrocardiograms (ECGs) are widely accepted as an essential core skill in Emergency Medicine. It is imperative that emergency physicians are expert in ECG interpretation when they exit their training programme. Aim It is unknown whether South African Emergency Medicine trainees are getting the necessary skills in ECG interpretation during the training programme. Currently there are no clear criteria to assess emergency physicians’ competency in ECG interpretation in South Africa. Methods A prospective cross-sectional study of Emergency Medicine residents and recently qualified emergency physicians was conducted between August 2008 and February 2009 using a focused questionnaire. Results At the time of the study, there were 55 eligible trainees in South Africa. A total of 55 assessments were distributed; 50 were returned (91%) and 49 were fully completed (89%). In this study, we found the overall average score of ECG interpretation was 46.4% [95% confidence interval (CI) 41.5–51.2%]. The junior group had an overall average of 42.2% (95% CI 36.9–47.5%), whereas the senior group managed 52.5% (95% CI 43.4–61.5%). Conclusion In this prospective cross-sectional study of Emergency Medicine residents and recently qualified emergency physicians, we found that there was improvement in the interpretation of ECGs with increased seniority. There exists, however, a low level of accuracy for many of the critical ECG diagnoses. The average score of 46.4% obtained in this study is lower than the scores obtained by other international studies from countries where Emergency Medicine is a well-established speciality. PMID:21373298

The Role of Shaping the Client's Interpretations in Functional Analytic Psychotherapy

ERIC Educational Resources Information Center

Abreu, Paulo Roberto; Hubner, Maria Martha Costa; Lucchese, Fernanda

2012-01-01

Clinical behavior analysis often targets the shaping of clients' functional interpretations of/or rules about his own behavior. These are referred to as clinically relevant behavior 3 (CRB3) in functional analytic psychotherapy (FAP). We suggest that CRB3s should be seen as contingency-specifying stimuli (CSS), due to the their ability to change…

[How to Interpret and Use Routine Laboratory Data--Our Methods to Interpret Routine Laboratory Data--Chairmen's Introductory Remarks].

PubMed

Honda, Takayuki; Tozuka, Minoru

2015-09-01

In the reversed clinicopathological conference (R-CPC), three specialists in laboratory medicine interpreted routine laboratory data independently in order to understand the detailed state of a patient. R-CPC is an educational method to use laboratory data appropriately, and it is also important to select differential diagnoses in a process of clinical reasoning in addition to the present illness and physical examination. Routine laboratory tests can be performed repeatedly at a relatively low cost, and their time-series analysis can be performed. Interpretation of routine laboratory data is almost the same as taking physical findings. General findings are initially checked and then the state of each organ is examined. Although routine laboratory tests cost little, we can gain much more information from them about the patient than physical examinations.

Presentation of Diagnostic Information to Doctors May Change Their Interpretation and Clinical Management: A Web-Based Randomised Controlled Trial

PubMed Central

Ben-Shlomo, Yoav; Collin, Simon M.; Quekett, James; Sterne, Jonathan A. C.; Whiting, Penny

2015-01-01

Background There is little evidence on how best to present diagnostic information to doctors and whether this makes any difference to clinical management. We undertook a randomised controlled trial to see if different data presentations altered clinicians’ decision to further investigate or treat a patient with a fictitious disorder (“Green syndrome”) and their ability to determine post-test probability. Methods We recruited doctors registered with the United Kingdom’s largest online network for medical doctors between 10 July and 6” November 2012. Participants were randomised to one of four arms: (a) text summary of sensitivity and specificity, (b) Fagan’s nomogram, (c) probability-modifying plot (PMP), (d) natural frequency tree (NFT). The main outcome measure was the decision whether to treat, not treat or undertake a brain biopsy on the hypothetical patient and the correct post-test probability. Secondary outcome measures included knowledge of diagnostic tests. Results 917 participants attempted the survey and complete data were available from 874 (95.3%). Doctors randomized to the PMP and NFT arms were more likely to treat the patient than those randomized to the text-only arm. (ORs 1.49, 95% CI 1.02, 2.16) and 1.43, 95% CI 0.98, 2.08 respectively). More patients randomized to the PMP (87/218–39.9%) and NFT (73/207–35.3%) arms than the nomogram (50/194–25.8%) or text only (30/255–11.8%) arms reported the correct post-test probability (p <0.001). Younger age, postgraduate training and higher self-rated confidence all predicted better knowledge performance. Doctors with better knowledge were more likely to view an optional learning tutorial (OR per correct answer 1.18, 95% CI 1.06, 1.31). Conclusions Presenting diagnostic data using a probability-modifying plot or natural frequency tree influences the threshold for treatment and improves interpretation of tests results compared to text summary of sensitivity and specificity or Fagan�

Clinical relevance is associated with allergen-specific wheal size in skin prick testing

PubMed Central

Haahtela, T; Burbach, G J; Bachert, C; Bindslev-Jensen, C; Bonini, S; Bousquet, J; Bousquet-Rouanet, L; Bousquet, P J; Bresciani, M; Bruno, A; Canonica, G W; Darsow, U; Demoly, P; Durham, S R; Fokkens, W J; Giavi, S; Gjomarkaj, M; Gramiccioni, C; Kowalski, M L; Losonczy, G; Orosz, M; Papadopoulos, N G; Stingl, G; Todo-Bom, A; von Mutius, E; Köhli, A; Wöhrl, S; Järvenpää, S; Kautiainen, H; Petman, L; Selroos, O; Zuberbier, T; Heinzerling, L M

2014-01-01

Background Within a large prospective study, the Global Asthma and Allergy European Network (GA2LEN) has collected skin prick test (SPT) data throughout Europe to make recommendations for SPT in clinical settings. Objective To improve clinical interpretation of SPT results for inhalant allergens by providing quantitative decision points. Methods The GA2LEN SPT study with 3068 valid data sets was used to investigate the relationship between SPT results and patient-reported clinical relevance for each of the 18 inhalant allergens as well as SPT wheal size and physician-diagnosed allergy (rhinitis, asthma, atopic dermatitis, food allergy). The effects of age, gender, and geographical area on SPT results were assessed. For each allergen, the wheal size in mm with an 80% positive predictive value (PPV) for being clinically relevant was calculated. Results Depending on the allergen, from 40% (blatella) to 87–89% (grass, mites) of the positive SPT reactions (wheal size ≥ 3 mm) were associated with patient-reported clinical symptoms when exposed to the respective allergen. The risk of allergic symptoms increased significantly with larger wheal sizes for 17 of the 18 allergens tested. Children with positive SPT reactions had a smaller risk of sensitizations being clinically relevant compared with adults. The 80% PPV varied from 3 to 10 mm depending on the allergen. Conclusion These ‘reading keys’ for 18 inhalant allergens can help interpret SPT results with respect to their clinical significance. A SPT form with the standard allergens including mm decision points for each allergen is offered for clinical use. PMID:24283409

Penultimate interpretation.

PubMed

Neuman, Yair

2010-10-01

Interpretation is at the center of psychoanalytic activity. However, interpretation is always challenged by that which is beyond our grasp, the 'dark matter' of our mind, what Bion describes as ' O'. O is one of the most central and difficult concepts in Bion's thought. In this paper, I explain the enigmatic nature of O as a high-dimensional mental space and point to the price one should pay for substituting the pre-symbolic lexicon of the emotion-laden and high-dimensional unconscious for a low-dimensional symbolic representation. This price is reification--objectifying lived experience and draining it of vitality and complexity. In order to address the difficulty of approaching O through symbolization, I introduce the term 'Penultimate Interpretation'--a form of interpretation that seeks 'loopholes' through which the analyst and the analysand may reciprocally save themselves from the curse of reification. Three guidelines for 'Penultimate Interpretation' are proposed and illustrated through an imaginary dialogue. Copyright © 2010 Institute of Psychoanalysis.

Presentation of laboratory test results in patient portals: influence of interface design on risk interpretation and visual search behaviour.

PubMed

Fraccaro, Paolo; Vigo, Markel; Balatsoukas, Panagiotis; van der Veer, Sabine N; Hassan, Lamiece; Williams, Richard; Wood, Grahame; Sinha, Smeeta; Buchan, Iain; Peek, Niels

2018-02-12

Patient portals are considered valuable instruments for self-management of long term conditions, however, there are concerns over how patients might interpret and act on the clinical information they access. We hypothesized that visual cues improve patients' abilities to correctly interpret laboratory test results presented through patient portals. We also assessed, by applying eye-tracking methods, the relationship between risk interpretation and visual search behaviour. We conducted a controlled study with 20 kidney transplant patients. Participants viewed three different graphical presentations in each of low, medium, and high risk clinical scenarios composed of results for 28 laboratory tests. After viewing each clinical scenario, patients were asked how they would have acted in real life if the results were their own, as a proxy of their risk interpretation. They could choose between: 1) Calling their doctor immediately (high interpreted risk); 2) Trying to arrange an appointment within the next 4 weeks (medium interpreted risk); 3) Waiting for the next appointment in 3 months (low interpreted risk). For each presentation, we assessed accuracy of patients' risk interpretation, and employed eye tracking to assess and compare visual search behaviour. Misinterpretation of risk was common, with 65% of participants underestimating the need for action across all presentations at least once. Participants found it particularly difficult to interpret medium risk clinical scenarios. Participants who consistently understood when action was needed showed a higher visual search efficiency, suggesting a better strategy to cope with information overload that helped them to focus on the laboratory tests most relevant to their condition. This study confirms patients' difficulties in interpreting laboratories test results, with many patients underestimating the need for action, even when abnormal values were highlighted or grouped together. Our findings raise patient safety

Standardization of Clinical Assessment and Sample Collection Across All PERCH Study Sites

PubMed Central

Prosperi, Christine; Baggett, Henry C.; Brooks, W. Abdullah; Deloria Knoll, Maria; Hammitt, Laura L.; Howie, Stephen R. C.; Kotloff, Karen L.; Levine, Orin S.; Madhi, Shabir A.; Murdoch, David R.; O’Brien, Katherine L.; Thea, Donald M.; Awori, Juliet O.; Bunthi, Charatdao; DeLuca, Andrea N.; Driscoll, Amanda J.; Ebruke, Bernard E.; Goswami, Doli; Hidgon, Melissa M.; Karron, Ruth A.; Kazungu, Sidi; Kourouma, Nana; Mackenzie, Grant; Moore, David P.; Mudau, Azwifari; Mwale, Magdalene; Nahar, Kamrun; Park, Daniel E.; Piralam, Barameht; Seidenberg, Phil; Sylla, Mamadou; Feikin, Daniel R.; Scott, J. Anthony G.; O’Brien, Katherine L.; Levine, Orin S.; Knoll, Maria Deloria; Feikin, Daniel R.; DeLuca, Andrea N.; Driscoll, Amanda J.; Fancourt, Nicholas; Fu, Wei; Hammitt, Laura L.; Higdon, Melissa M.; Kagucia, E. Wangeci; Karron, Ruth A.; Li, Mengying; Park, Daniel E.; Prosperi, Christine; Wu, Zhenke; Zeger, Scott L.; Watson, Nora L.; Crawley, Jane; Murdoch, David R.; Brooks, W. Abdullah; Endtz, Hubert P.; Zaman, Khalequ; Goswami, Doli; Hossain, Lokman; Jahan, Yasmin; Ashraf, Hasan; Howie, Stephen R. C.; Ebruke, Bernard E.; Antonio, Martin; McLellan, Jessica; Machuka, Eunice; Shamsul, Arifin; Zaman, Syed M.A.; Mackenzie, Grant; Scott, J. Anthony G.; Awori, Juliet O.; Morpeth, Susan C.; Kamau, Alice; Kazungu, Sidi; Kotloff, Karen L.; Tapia, Milagritos D.; Sow, Samba O.; Sylla, Mamadou; Tamboura, Boubou; Onwuchekwa, Uma; Kourouma, Nana; Toure, Aliou; Madhi, Shabir A.; Moore, David P.; Adrian, Peter V.; Baillie, Vicky L.; Kuwanda, Locadiah; Mudau, Azwifarwi; Groome, Michelle J.; Baggett, Henry C.; Thamthitiwat, Somsak; Maloney, Susan A.; Bunthi, Charatdao; Rhodes, Julia; Sawatwong, Pongpun; Akarasewi, Pasakorn; Thea, Donald M.; Mwananyanda, Lawrence; Chipeta, James; Seidenberg, Phil; Mwansa, James; wa Somwe, Somwe; Kwenda, Geoffrey

2017-01-01

Abstract Background. Variable adherence to standardized case definitions, clinical procedures, specimen collection techniques, and laboratory methods has complicated the interpretation of previous multicenter pneumonia etiology studies. To circumvent these problems, a program of clinical standardization was embedded in the Pneumonia Etiology Research for Child Health (PERCH) study. Methods. Between March 2011 and August 2013, standardized training on the PERCH case definition, clinical procedures, and collection of laboratory specimens was delivered to 331 clinical staff at 9 study sites in 7 countries (The Gambia, Kenya, Mali, South Africa, Zambia, Thailand, and Bangladesh), through 32 on-site courses and a training website. Staff competency was assessed throughout 24 months of enrollment with multiple-choice question (MCQ) examinations, a video quiz, and checklist evaluations of practical skills. Results. MCQ evaluation was confined to 158 clinical staff members who enrolled PERCH cases and controls, with scores obtained for >86% of eligible staff at each time-point. Median scores after baseline training were ≥80%, and improved by 10 percentage points with refresher training, with no significant intersite differences. Percentage agreement with the clinical trainer on the presence or absence of clinical signs on video clips was high (≥89%), with interobserver concordance being substantial to high (AC1 statistic, 0.62–0.82) for 5 of 6 signs assessed. Staff attained median scores of >90% in checklist evaluations of practical skills. Conclusions. Satisfactory clinical standardization was achieved within and across all PERCH sites, providing reassurance that any etiological or clinical differences observed across the study sites are true differences, and not attributable to differences in application of the clinical case definition, interpretation of clinical signs, or in techniques used for clinical measurements or specimen collection. PMID:28575355

A bridge between cultures: interpreters' perspectives of consultations with migrant oncology patients.

PubMed

Butow, Phyllis N; Lobb, Elizabeth; Jefford, Michael; Goldstein, David; Eisenbruch, Maurice; Girgis, Afaf; King, Madeleine; Sze, Ming; Aldridge, Lynley; Schofield, Penelope

2012-02-01

Migration is increasing worldwide. In previous research into people with cancer from culturally and linguistically diverse backgrounds, interpreter accuracy, professionalism and continuity have emerged as key concerns for patients. Little is known about interpreters' perceptions of their role and the challenges they face. This study aimed to obtain their perspective. Thirty interpreters (Greek n = 7, Chinese n = 11, and Arabic n = 12) participated in four focus groups which were audio-taped, transcribed and analysed for themes using N-Vivo software. Skills as an interpreter were broadly perceived as conveying information accurately, being confidential and impartial. Three broad dilemmas faced by interpreters emerged: accuracy versus understanding; translating only versus cultural advocacy and sensitivity; and professionalism versus providing support. Some saw themselves as merely an accurate conduit of information, while others saw their role in broader terms, encompassing patient advocacy, cultural brokerage and provision of emotional support. Perceived challenges in their role included lack of continuity, managing their own emotions especially after bad news consultations, and managing diverse patient and family expectations. Training and support needs included medical terminology, communication and counselling skills and debriefing. Interpreters suggested that oncologists check on interpreter/patient's language or dialect compatibility; use lay language and short sentences; and speak in the first person. Resolving potential conflicts between information provision and advocacy is an important area of cross-cultural communication research. Further training and support is required to enhance interpreters' competence in managing delicate situations from a professional, cultural and psychological perspective; and to assist doctors to collaborate with interpreters to ensure culturally competent communication. Ultimately, this will improve interpreters' well-being and

Consumer use and response to online third-party raw DNA interpretation services.

PubMed

Wang, Catharine; Cahill, Tiernan J; Parlato, Andrew; Wertz, Blake; Zhong, Qiankun; Cunningham, Tricia Norkunas; Cummings, James J

2018-01-01

With the availability of raw DNA generated from direct-to-consumer (DTC) testing companies, there has been a proliferation of third-party online services that are available to interpret the raw data for both genealogy and/or health purposes. This study examines the current landscape and downstream clinical implications of consumer use of third-party services. Study participants were recruited online from social media platforms. A total of 321 survey respondents reported using third-party services for raw DNA interpretation. Participants were highly motivated to explore raw DNA for ancestral information (67%), individual health implications (62%), or both (40%). Participants primarily used one of seven companies to interpret raw DNA; 73% used more than one. Company choice was driven by the type of results offered (51%), price (45%), and online reviews (31%). Approximately 30% of participants shared results with a medical provider and 21% shared with more than one. Outcomes of sharing ranged from disinterest/discounting of the information to diagnosis of genetic conditions. Participants were highly satisfied with their decision to analyze raw DNA (M = 4.54/5), yet challenges in understanding interpretation results were reported irrespective of satisfaction ratings. Consumers face challenges in understanding the results and may seek out clinical assistance in interpreting their raw DNA results. © 2017 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies.

PubMed

Rowe, Steven P; Deville, Curtiland; Paller, Channing; Cho, Steve Y; Fishman, Elliot K; Pomper, Martin G; Ross, Ashley E; Gorin, Michael A

2015-12-01

Prostate-specific membrane antigen (PSMA)-targeted PET imaging is an emerging technique for evaluating patients with prostate cancer (PCa) in a variety of clinical contexts. As with any new imaging modality, there are interpretive pitfalls that are beginning to be recognized. In this image report, we describe the findings in a 63-year-old male with biochemically recurrent PCa after radical prostatectomy who was imaged with 18 F-DCFPyL, a small molecule inhibitor of PSMA. Diffuse radiotracer uptake was noted throughout the sacrum, corresponding to imaging findings on contrast-enhanced CT, bone scan, and pelvic MRI consistent with Paget's disease of bone. The uptake of 18 F-DCFPyL in Paget's disease is most likely due to hyperemia and increased radiotracer delivery. In light of the overlap in patients affected by PCa and Paget's, it is important for nuclear medicine physicians and radiologists interpreting PSMA PET/CT scans to be aware of the potential for this diagnostic pitfall. Correlation to findings on conventional imaging such as diagnostic CT and bone scan can help confirm the diagnosis.

The role of the background: texture segregation and figure-ground segmentation.

PubMed

Caputo, G

1996-09-01

The effects of a texture surround composed of line elements on a stimulus within which a target line element segregates, were studied. Detection and discrimination of the target when it had the same orientation as the surround were impaired at short presentation time; on the other hand, no effect was present when they were reciprocally orthogonal. These results are interpreted as background completion in texture segregation; a texture made up of similar elements is represented as a continuous surface with contour and contrast of an embedded element inhibited. This interpretation is further confirmed with a simple line protruding from an annulus. Generally, the results are taken as evidence that local features are prevented from segmenting when they are parts of a global entity.

The Internet and Clinical Trials: Background, Online Resources, Examples and Issues

PubMed Central

Seib, Rachael; Prescott, Todd

2005-01-01

Both the Internet and clinical trials were significant developments in the latter half of the twentieth century: the Internet revolutionized global communications and the randomized controlled trial provided a means to conduct an unbiased comparison of two or more treatments. Large multicenter trials are often burdened with an extensive development time and considerable expense, as well as significant challenges in obtaining, backing up and analyzing large amounts of data. Alongside the increasing complexities of the modern clinical trial has grown the power of the Internet to improve communications, centralize and secure data as well as to distribute information. As more and more clinical trials are required to coordinate multiple trial processes in real time, centers are turning to the Internet for the tools to manage the components of a clinical trial, either in whole or in part, to produce lower costs and faster results. This paper reviews the historical development of the Internet and the randomized controlled trial, describes the Internet resources available that can be used in a clinical trial, reviews some examples of online trials and describes the advantages and disadvantages of using the Internet to conduct a clinical trial. We also extract the characteristics of the 5 largest clinical trials conducted using the Internet to date, which together enrolled over 26000 patients. PMID:15829477

Statistical significance versus clinical relevance.

PubMed

van Rijn, Marieke H C; Bech, Anneke; Bouyer, Jean; van den Brand, Jan A J G

2017-04-01

In March this year, the American Statistical Association (ASA) posted a statement on the correct use of P-values, in response to a growing concern that the P-value is commonly misused and misinterpreted. We aim to translate these warnings given by the ASA into a language more easily understood by clinicians and researchers without a deep background in statistics. Moreover, we intend to illustrate the limitations of P-values, even when used and interpreted correctly, and bring more attention to the clinical relevance of study findings using two recently reported studies as examples. We argue that P-values are often misinterpreted. A common mistake is saying that P < 0.05 means that the null hypothesis is false, and P ≥0.05 means that the null hypothesis is true. The correct interpretation of a P-value of 0.05 is that if the null hypothesis were indeed true, a similar or more extreme result would occur 5% of the times upon repeating the study in a similar sample. In other words, the P-value informs about the likelihood of the data given the null hypothesis and not the other way around. A possible alternative related to the P-value is the confidence interval (CI). It provides more information on the magnitude of an effect and the imprecision with which that effect was estimated. However, there is no magic bullet to replace P-values and stop erroneous interpretation of scientific results. Scientists and readers alike should make themselves familiar with the correct, nuanced interpretation of statistical tests, P-values and CIs. © The Author 2017. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management.

PubMed

Cervellin, Gianfranco; Comelli, Ivan; Benatti, Mario; Sanchis-Gomar, Fabian; Bassi, Antonella; Lippi, Giuseppe

2017-08-01

Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Text-interpreter language for flexible generation of patient notes and instructions.

PubMed

Forker, T S

1992-01-01

An interpreted computer language has been developed along with a windowed user interface and multi-printer-support formatter to allow preparation of documentation of patient visits, including progress notes, prescriptions, excuses for work/school, outpatient laboratory requisitions, and patient instructions. Input is by trackball or mouse with little or no keyboard skill required. For clinical problems with specific protocols, the clinician can be prompted with problem-specific items of history, exam, and lab data to be gathered and documented. The language implements a number of text-related commands as well as branching logic and arithmetic commands. In addition to generating text, it is simple to implement arithmetic calculations such as weight-specific drug dosages; multiple branching decision-support protocols for paramedical personnel (or physicians); and calculation of clinical scores (e.g., coma or trauma scores) while simultaneously documenting the status of each component of the score. ASCII text files produced by the interpreter are available for computerized quality audit. Interpreter instructions are contained in text files users can customize with any text editor.

Arabic-speaking migrants’ attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey

PubMed Central

2014-01-01

Background Good communication is an important prerequisite for equal treatment in a healthcare encounter. One way to overcome language barriers when patients and healthcare staff do not share the same language is to use a professional interpreter. Few previous studies have been found investigating the use of interpreters, and just one previous study from the perspective of European migrants, which showed that they perceived interpreters as a communication aid and a guide in the healthcare system as regards information and practical matters. No previous study has gathered quantitative information to focus on non-European migrants’ attitudes to the use of interpreters in healthcare encounters. Thus, the aim of this study was to investigate Arabic-speaking individuals’ attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare in order to: (i) understand how persons’ expectations and concerns regarding interpreters may vary, both within and across cultural/linguistic populations; (ii) understand the consequences of diverse opinions/expectations for planning responsive services; and (iii) confirm findings from previous qualitative studies. Method A postal cross-sectional study using a structured self-administered 51-item questionnaire was used to describe and document aspects of Arabic-speaking individuals’ attitudes to the use of interpreters in healthcare. The sample of 53 Arabic-speaking migrants was recruited from three different places. Participants were mostly born in Iraq and had a high level of education and were almost equally divided between genders. Data were analysed with descriptive statistics. Results The main findings were that most of the participants perceived the interpreter’s role as being a communication aid and a practical aid, interpreting literally and objectively. Trust in the professional interpreter was related to qualification as an interpreter and personal contact with face

Validity threats: overcoming interference with proposed interpretations of assessment data.

PubMed

Downing, Steven M; Haladyna, Thomas M

2004-03-01

Factors that interfere with the ability to interpret assessment scores or ratings in the proposed manner threaten validity. To be interpreted in a meaningful manner, all assessments in medical education require sound, scientific evidence of validity. The purpose of this essay is to discuss 2 major threats to validity: construct under-representation (CU) and construct-irrelevant variance (CIV). Examples of each type of threat for written, performance and clinical performance examinations are provided. The CU threat to validity refers to undersampling the content domain. Using too few items, cases or clinical performance observations to adequately generalise to the domain represents CU. Variables that systematically (rather than randomly) interfere with the ability to meaningfully interpret scores or ratings represent CIV. Issues such as flawed test items written at inappropriate reading levels or statistically biased questions represent CIV in written tests. For performance examinations, such as standardised patient examinations, flawed cases or cases that are too difficult for student ability contribute CIV to the assessment. For clinical performance data, systematic rater error, such as halo or central tendency error, represents CIV. The term face validity is rejected as representative of any type of legitimate validity evidence, although the fact that the appearance of the assessment may be an important characteristic other than validity is acknowledged. There are multiple threats to validity in all types of assessment in medical education. Methods to eliminate or control validity threats are suggested.

Background rates of adverse pregnancy outcomes for assessing the safety of maternal vaccine trials in sub-Saharan Africa.

PubMed

Orenstein, Lauren A V; Orenstein, Evan W; Teguete, Ibrahima; Kodio, Mamoudou; Tapia, Milagritos; Sow, Samba O; Levine, Myron M

2012-01-01

Maternal immunization has gained traction as a strategy to diminish maternal and young infant mortality attributable to infectious diseases. Background rates of adverse pregnancy outcomes are crucial to interpret results of clinical trials in Sub-Saharan Africa. We developed a mathematical model that calculates a clinical trial's expected number of neonatal and maternal deaths at an interim safety assessment based on the person-time observed during different risk windows. This model was compared to crude multiplication of the maternal mortality ratio and neonatal mortality rate by the number of live births. Systematic reviews of severe acute maternal morbidity (SAMM), low birth weight (LBW), prematurity, and major congenital malformations (MCM) in Sub-Saharan African countries were also performed. Accounting for the person-time observed during different risk periods yields lower, more conservative estimates of expected maternal and neonatal deaths, particularly at an interim safety evaluation soon after a large number of deliveries. Median incidence of SAMM in 16 reports was 40.7 (IQR: 10.6-73.3) per 1,000 total births, and the most common causes were hemorrhage (34%), dystocia (22%), and severe hypertensive disorders of pregnancy (22%). Proportions of liveborn infants who were LBW (median 13.3%, IQR: 9.9-16.4) or premature (median 15.4%, IQR: 10.6-19.1) were similar across geographic region, study design, and institutional setting. The median incidence of MCM per 1,000 live births was 14.4 (IQR: 5.5-17.6), with the musculoskeletal system comprising 30%. Some clinical trials assessing whether maternal immunization can improve pregnancy and young infant outcomes in the developing world have made ethics-based decisions not to use a pure placebo control. Consequently, reliable background rates of adverse pregnancy outcomes are necessary to distinguish between vaccine benefits and safety concerns. Local studies that quantify population-based background rates of adverse

Blinded interpretation of study results can feasibly and effectively diminish interpretation bias.

PubMed

Järvinen, Teppo L N; Sihvonen, Raine; Bhandari, Mohit; Sprague, Sheila; Malmivaara, Antti; Paavola, Mika; Schünemann, Holger J; Guyatt, Gordon H

2014-07-01

Controversial and misleading interpretation of data from randomized trials is common. How to avoid misleading interpretation has received little attention. Herein, we describe two applications of an approach that involves blinded interpretation of the results by study investigators. The approach involves developing two interpretations of the results on the basis of a blinded review of the primary outcome data (experimental treatment A compared with control treatment B). One interpretation assumes that A is the experimental intervention and another assumes that A is the control. After agreeing that there will be no further changes, the investigators record their decisions and sign the resulting document. The randomization code is then broken, the correct interpretation chosen, and the manuscript finalized. Review of the document by an external authority before finalization can provide another safeguard against interpretation bias. We found the blinded preparation of a summary of data interpretation described in this article practical, efficient, and useful. Blinded data interpretation may decrease the frequency of misleading data interpretation. Widespread adoption of blinded data interpretation would be greatly facilitated were it added to the minimum set of recommendations outlining proper conduct of randomized controlled trials (eg, the Consolidated Standards of Reporting Trials statement). Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Development of an Expert System as a Diagnostic Support of Cervical Cancer in Atypical Glandular Cells, Based on Fuzzy Logics and Image Interpretation

PubMed Central

Domínguez Hernández, Karem R.; Aguilar Lasserre, Alberto A.; Posada Gómez, Rubén; Palet Guzmán, José A.; González Sánchez, Blanca E.

2013-01-01

Cervical cancer is the second largest cause of death among women worldwide. Nowadays, this disease is preventable and curable at low cost and low risk when an accurate diagnosis is done in due time, since it is the neoplasm with the highest prevention potential. This work describes the development of an expert system able to provide a diagnosis to cervical neoplasia (CN) precursor injuries through the integration of fuzzy logics and image interpretation techniques. The key contribution of this research focuses on atypical cases, specifically on atypical glandular cells (AGC). The expert system consists of 3 phases: (1) risk diagnosis which consists of the interpretation of a patient's clinical background and the risks for contracting CN according to specialists; (2) cytology images detection which consists of image interpretation (IM) and the Bethesda system for cytology interpretation, and (3) determination of cancer precursor injuries which consists of in retrieving the information from the prior phases and integrating the expert system by means of a fuzzy logics (FL) model. During the validation stage of the system, 21 already diagnosed cases were tested with a positive correlation in which 100% effectiveness was obtained. The main contribution of this work relies on the reduction of false positives and false negatives by providing a more accurate diagnosis for CN. PMID:23690881

Can All Cosmological Observations Be Accurately Interpreted with a Unique Geometry?

NASA Astrophysics Data System (ADS)

Fleury, Pierre; Dupuy, Hélène; Uzan, Jean-Philippe

2013-08-01

The recent analysis of the Planck results reveals a tension between the best fits for (Ωm0, H0) derived from the cosmic microwave background or baryonic acoustic oscillations on the one hand, and the Hubble diagram on the other hand. These observations probe the Universe on very different scales since they involve light beams of very different angular sizes; hence, the tension between them may indicate that they should not be interpreted the same way. More precisely, this Letter questions the accuracy of using only the (perturbed) Friedmann-Lemaître geometry to interpret all the cosmological observations, regardless of their angular or spatial resolution. We show that using an inhomogeneous “Swiss-cheese” model to interpret the Hubble diagram allows us to reconcile the inferred value of Ωm0 with the Planck results. Such an approach does not require us to invoke new physics nor to violate the Copernican principle.

U-interpreter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arvind; Gostelow, K.P.

1982-02-01

The author argues that by giving a unique name to every activity generated during a computation, the u-interpreter can provide greater concurrency in the interpretation of data flow graphs. 19 references.

Treatment of attention deficit hyperactivity disorder with monoamine amino acid precursors and organic cation transporter assay interpretation

PubMed Central

Hinz, Marty; Stein, Alvin; Neff, Robert; Weinberg, Robert; Uncini, Thomas

2011-01-01

Background This paper documents a retrospective pilot study of a novel approach for treating attention deficit hyperactivity disorder (ADHD) with amino acid precursors of serotonin and dopamine in conjunction with urinary monoamine assays subjected to organic cation transporter (OCT) functional status determination. The goal of this research was to document the findings and related considerations of a retrospective chart review study designed to identify issues and areas of concern that will define parameters for a prospective controlled study. Methods This study included 85 patients, aged 4–18 years, who were treated with a novel amino acid precursor protocol. Their clinical course during the first 8–10 weeks of treatment was analyzed retrospectively. The study team consisted of PhD clinical psychologists, individuals compiling clinical data from records, and a statistician. The patients had been treated with a predefined protocol for administering amino acid precursors of serotonin and dopamine, along with OCT assay interpretation as indicated. Results In total, 67% of participants achieved significant improvement with only amino acid precursors of serotonin and dopamine. In patients who achieved no significant relief of symptoms with only amino acid precursors, OCT assay interpretation was utilized. In this subgroup, 30.3% achieved significant relief following two or three urine assays and dosage changes as recommended by the assay results. The total percentage of patients showing significant improvement was 77%. Conclusion The efficacy of this novel protocol appears superior to some ADHD prescription drugs, and therefore indicates a need for further studies to verify this observation. The findings of this study justify initiation of further prospective controlled studies in order to evaluate more formally the observed benefits of this novel approach in the treatment of ADHD. PMID:21326653

Lack of a benign interpretation bias in social anxiety disorder.

PubMed

Amir, Nader; Prouvost, Caroline; Kuckertz, Jennie M

2012-01-01

Cognitive models of social anxiety posit that recurrent interpretation of ambiguous information as threatening maintains symptoms (e.g. Clark & Wells, 1995, pp. 69-93, Social phobia: Diagnosis, assessment, and treatment. New York: Guilford Press; Rapee & Heimberg, 1997, pp. 741-756, Behavior Research and Therapy, 35). However, biased interpretation may also be represented as a failure to make a benign interpretation of the ambiguous event. Furthermore, interpretation bias can be characterized by both an online (automatic) component and an offline (effortful) component (Hirsch & Clark, 2004, pp. 799-825, Clinical Psychology Review, 24). To measure both benign and threat biases, as well as examine the effect of social anxiety on offline versus online interpretations, Beard and Amir (2009, pp. 1135-1141, Behaviour Research and Therapy, 46) developed the Word Sentence Association Paradigm (WSAP). In the current study, we administered the WSAP to a group of participants diagnosed with social anxiety disorder (SAD) as well as to a group of non-anxious control (NAC) participants. We found that participants with SAD demonstrated a lack of benign online bias, but not an online threat bias when compared to NACs. However, when examining offline biases, SAD patients endorsed social threat interpretations and rejected benign social interpretations to a greater degree than non-anxious individuals. Our results, when taken together, clearly implicate the role of reduced bias toward benign information in SAD.

Using narrative pedagogy: learning and practising interpretive thinking.

PubMed

Ironside, Pamela M

2006-08-01

This paper reports a hermeneutic study undertaken to explicate students' experiences in educational courses in which teachers enact Narrative Pedagogy. International interest in developing and implementing discipline-specific pedagogies is becoming commonplace as teachers respond to the challenges of preparing students for contemporary practice. Lifeworld Pedagogy, developed in Scandinavia, and Narrative Pedagogy, developed in the United States of America, Canada and New Zealand, are two approaches developed from nursing research for nursing education that provide teachers with research-based alternatives to conventional pedagogy. Further research is needed, however, that addresses how new pedagogies are experienced in schools of nursing. Teachers and students from 22 schools of nursing in the United States of America were interviewed over a 4-year period between 2002 and 2005. Using interpretive phenomenology as the philosophical background and Heideggerian hermeneutics as the method, accounts from 52 participants were analysed by a research team. The theme Learning and Practising Interpretive Thinking reveals how reform is occurring in schools of nursing that use Narrative Pedagogy. It documents how Narrative Pedagogy helps students challenge their assumptions and think through and interpret situations they encounter from multiple perspectives. Findings suggest that by focusing teachers' and students' attention on thinking and interpreting as communal experiences, interpretive pedagogies such as Narrative Pedagogy engage teachers and students in pooling their wisdom, challenging their preconceptions, envisioning new possibilities for providing care and engaging with others to ensure patient-centred care and safety. By documenting students' experiences in courses in which Narrative Pedagogy is used, this study provides teachers with research-based evidence to guide their pedagogical decisions. It extends international efforts to develop discipline

COSMIC INFRARED BACKGROUND FLUCTUATIONS AND ZODIACAL LIGHT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arendt, Richard G.; Kashlinsky, A.; Moseley, S. H.

We performed a specific observational test to measure the effect that the zodiacal light can have on measurements of the spatial fluctuations of the near-IR background. Previous estimates of possible fluctuations caused by zodiacal light have often been extrapolated from observations of the thermal emission at longer wavelengths and low angular resolution or from IRAC observations of high-latitude fields where zodiacal light is faint and not strongly varying with time. The new observations analyzed here target the COSMOS field at low ecliptic latitude where the zodiacal light intensity varies by factors of ∼2 over the range of solar elongations atmore » which the field can be observed. We find that the white-noise component of the spatial power spectrum of the background is correlated with the modeled zodiacal light intensity. Roughly half of the measured white noise is correlated with the zodiacal light, but a more detailed interpretation of the white noise is hampered by systematic uncertainties that are evident in the zodiacal light model. At large angular scales (≳100″) where excess power above the white noise is observed, we find no correlation of the power with the modeled intensity of the zodiacal light. This test clearly indicates that the large-scale power in the infrared background is not being caused by the zodiacal light.« less

Cosmic Infrared Background Fluctuations and Zodiacal Light

NASA Astrophysics Data System (ADS)

Arendt, Richard G.; Kashlinsky, A.; Moseley, S. H.; Mather, J.

2016-06-01

We performed a specific observational test to measure the effect that the zodiacal light can have on measurements of the spatial fluctuations of the near-IR background. Previous estimates of possible fluctuations caused by zodiacal light have often been extrapolated from observations of the thermal emission at longer wavelengths and low angular resolution or from IRAC observations of high-latitude fields where zodiacal light is faint and not strongly varying with time. The new observations analyzed here target the COSMOS field at low ecliptic latitude where the zodiacal light intensity varies by factors of ˜2 over the range of solar elongations at which the field can be observed. We find that the white-noise component of the spatial power spectrum of the background is correlated with the modeled zodiacal light intensity. Roughly half of the measured white noise is correlated with the zodiacal light, but a more detailed interpretation of the white noise is hampered by systematic uncertainties that are evident in the zodiacal light model. At large angular scales (≳100″) where excess power above the white noise is observed, we find no correlation of the power with the modeled intensity of the zodiacal light. This test clearly indicates that the large-scale power in the infrared background is not being caused by the zodiacal light.

Interpretive medicine: Supporting generalism in a changing primary care world.

PubMed

Reeve, Joanne

2010-01-01

Patient-centredness is a core value of general practice; it is defined as the interpersonal processes that support the holistic care of individuals. To date, efforts to demonstrate their relationship to patient outcomes have been disappointing, whilst some studies suggest values may be more rhetoric than reality. Contextual issues influence the quality of patient-centred consultations, impacting on outcomes. The legitimate use of knowledge, or evidence, is a defining aspect of modern practice, and has implications for patient-centredness. Based on a critical review of the literature, on my own empirical research, and on reflections from my clinical practice, I critique current models of the use of knowledge in supporting individualised care. Evidence-Based Medicine (EBM), and its implementation within health policy as Scientific Bureaucratic Medicine (SBM), define best evidence in terms of an epistemological emphasis on scientific knowledge over clinical experience. It provides objective knowledge of disease, including quantitative estimates of the certainty of that knowledge. Whilst arguably appropriate for secondary care, involving episodic care of selected populations referred in for specialist diagnosis and treatment of disease, application to general practice can be questioned given the complex, dynamic and uncertain nature of much of the illness that is treated. I propose that general practice is better described by a model of Interpretive Medicine (IM): the critical, thoughtful, professional use of an appropriate range of knowledges in the dynamic, shared exploration and interpretation of individual illness experience, in order to support the creative capacity of individuals in maintaining their daily lives. Whilst the generation of interpreted knowledge is an essential part of daily general practice, the profession does not have an adequate framework by which this activity can be externally judged to have been done well. Drawing on theory related to the

Responding to family requests for nondisclosure: the impact of oncologists' cultural background.

PubMed

Chittem, Mahati; Butow, Phyllis

2015-01-01

Nondisclosure of cancer diagnosis is common in many Eastern countries. Consequently, immigrant families often approach oncologists with requests for nondisclosure in Western countries. To explore differences in the attitudes and practices of Western-born and nonWestern born oncologists in Australia when faced with a nondisclosure request. Using a cross-sectional design, oncologists were interviewed over the telephone. Using the snowball method, 14 Australian (Western = 9, non-Western = 5) oncologists were recruited. Oncologists participated in a semi-structured interview exploring their experiences of, and response to, a request for nondisclosure, and their perceptions of how their cultural background influenced these attitudes and responses. The interviews were transcribed and analyzed using interpretative phenomenological analysis. Six main themes emerged from the study: (1) Barriers to truthful communication, (2) an ethical and moral dilemma, (3) high costs of nondisclosure, (4) cultural influences on interpretation and understanding of requests for nondisclosure, (5) emotional impact of bad news on patients, families and oncologists, and (6) truthful disclosure as a gentle balancing act. All oncologists felt that the family request for nondisclosure was difficult, with many cultural and emotional nuances to take into consideration. Some immigrant Australian oncologists who had a similar cultural background as the patient/family, felt they could better understand the desire for nondisclosure. Irrespective of their cultural background, all oncologists acknowledged that breaking bad news had to be done in a gentle, gradual manner. The study suggests a need to develop a culturally sensitive cancer communication model.

Interpreting the Clinical Significance of Capacity Scores for Informed Consent in Alzheimer Disease Clinical Trials

PubMed Central

Karlawish, Jason; Kim, Scott Y. H.; Knopman, David; van Dyck, Christopher H.; James, Bryan D.; Bioethics, M.; Marson, Daniel

2014-01-01

Objective Among Alzheimer disease (AD) patients enrolled in a clinical trial, the authors assessed the ability of a standardized capacity assessment procedure to identify persons who are capable of giving their own informed consent. Design Cross-sectional interview. Setting Thirteen sites participating in a randomized and placebo controlled study of simvastatin for the treatment of mild to moderate AD. Participants Persons with mild to moderate AD and their study partners enrolled in the simvastatin clinical trial. Measurements Interviews to assess decision-making capacity using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR). Results Judges blinded to the subject’s clinical status had a high rate of agreement on patients capable of giving their own informed consent (κ = 0.73). The understanding subscale had the best receiver operator characteristic and an analysis of positive and negative predictive values over a range of hypothetical prevalences of incapacity to consent demonstrated the value of a range of understanding cut-points. Conclusion Among mild to moderate AD patients, enrolled in an actual clinical trial, these results suggest evidence based guidelines for using the MacCAT-CR understanding subscale to help guide judgments about whether a patient has the capacity to consent. PMID:18556397

Elderly Japanese emigrants to Brazil before World War II: I. Clinical profiles based on specific historical background.

PubMed

Meguro, M; Meguro, K; Caramelli, P; Ishizaki, J; Ambo, H; Chubaci, R Y; Hamada, G S; Nitrini, R; Yamadori, A

2001-08-01

To research the demographic and clinical profiles of elderly Japanese emigrants, who arrived in Brazil before World War II, in order to give them appropriate psychogeriatric care. Elderly Japanese immigrants aged 65 years and over, belonging to the Miyagi Association in the São Paulo Metropolitan Area, were targeted. They emigrated from Miyagi Prefecture to Brazil and are now living in the area. We were able to interview 166 respondents. All data were gathered using standardized interview methods covering (a) free interview about the immigration history, (b) demographics, and (c) physical status. Through the free interview, we found their immigration histories, which affected their clinical profiles. The mean age and educational level were 77.5 years and 6.3 years, respectively. Sixty per cent of them immigrated when they were younger than 14. Ninety-four per cent of them still keep Japanese nationality. Fifty-seven per cent of them usually use Japanese, while 10% of them use Portuguese. Although their emigration histories were hard, 76% of them perceived their health as being excellent or relatively good. The percentages of subjects with histories of disease were hypertension, 52.5%; cardiac disease, 20.8%; diabetes mellitus, 24.2%; and hyperlipidemia, 25.0%, which were affected by the Brazilian environment. The elderly Japanese who emigrated to Brazil before World War II have a unique historical and demographic background. Their clinical profiles cannot be fully understood without knowing their histories. They definitely need high quality international psychogeriatric care. Copyright 2001 John Wiley & Sons, Ltd.

Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

PubMed

Werhagen, Lars; Borg, Kristian

2016-10-01

Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

Automatic wound infection interpretation for postoperative wound image

NASA Astrophysics Data System (ADS)

Hsu, Jui-Tse; Ho, Te-Wei; Shih, Hsueh-Fu; Chang, Chun-Che; Lai, Feipei; Wu, Jin-Ming

2017-02-01

With the growing demand for more efficient wound care after surgery, there is a necessity to develop a machine learning based image analysis approach to reduce the burden for health care professionals. The aim of this study was to propose a novel approach to recognize wound infection on the postsurgical site. Firstly, we proposed an optimal clustering method based on unimodal-rosin threshold algorithm to extract the feature points from a potential wound area into clusters for regions of interest (ROI). Each ROI was regarded as a suture site of the wound area. The automatic infection interpretation based on the support vector machine is available to assist physicians doing decision-making in clinical practice. According to clinical physicians' judgment criteria and the international guidelines for wound infection interpretation, we defined infection detector modules as the following: (1) Swelling Detector, (2) Blood Region Detector, (3) Infected Detector, and (4) Tissue Necrosis Detector. To validate the capability of the proposed system, a retrospective study using the confirmation wound pictures that were used for diagnosis by surgical physicians as the gold standard was conducted to verify the classification models. Currently, through cross validation of 42 wound images, our classifiers achieved 95.23% accuracy, 93.33% sensitivity, 100% specificity, and 100% positive predictive value. We believe this ability could help medical practitioners in decision making in clinical practice.

Linking the Tinnitus Questionnaire and the subjective Clinical Global Impression: Which differences are clinically important?

PubMed Central

2012-01-01

Background Development of new tinnitus treatments requires prospective placebo-controlled randomized trials to prove their efficacy. The Tinnitus Questionnaire (TQ) is a validated and commonly used instrument for assessment of tinnitus severity and has been used in many clinical studies. Defining the Minimal Clinically Important Difference (MCID) for TQ changes is an important step to a better interpretation of the clinical relevance of changes observed in clinical trials. In this study we aimed to estimate the minimum change of the TQ score that could be considered clinically relevant. Methods 757 patients with chronic tinnitus were pooled from the TRI database and the RESET study. An anchor-based approach using the Clinical Global Impression (CGI) scale and distributional approaches were used to estimate MCID. Receiver Operating Characteristic (ROC) curves were calculated to define optimal TQ change cutoffs discriminating between minimally changed and unchanged subjects. Results The relationship between TQ change scores and CGI ratings of change was good (r = 0.52, p < 0.05). Mean change scores associated with minimally better and minimally worse CGI categories were −6.65 and +2.72 respectively. According to the ROC method MCID for improvement was −5 points and for deterioration +1 points. Conclusion Distribution and anchor-based methods yielded comparable results in identifying MCIDs. ΔTQ scores of −5 and +1 points were identified as the minimal clinically relevant change for improvement and worsening respectively. The asymmetry of the MCIDs for improvement and worsening may be related to expectation effects. PMID:22781703

Learning accurate and interpretable models based on regularized random forests regression

PubMed Central

2014-01-01

Background Many biology related research works combine data from multiple sources in an effort to understand the underlying problems. It is important to find and interpret the most important information from these sources. Thus it will be beneficial to have an effective algorithm that can simultaneously extract decision rules and select critical features for good interpretation while preserving the prediction performance. Methods In this study, we focus on regression problems for biological data where target outcomes are continuous. In general, models constructed from linear regression approaches are relatively easy to interpret. However, many practical biological applications are nonlinear in essence where we can hardly find a direct linear relationship between input and output. Nonlinear regression techniques can reveal nonlinear relationship of data, but are generally hard for human to interpret. We propose a rule based regression algorithm that uses 1-norm regularized random forests. The proposed approach simultaneously extracts a small number of rules from generated random forests and eliminates unimportant features. Results We tested the approach on some biological data sets. The proposed approach is able to construct a significantly smaller set of regression rules using a subset of attributes while achieving prediction performance comparable to that of random forests regression. Conclusion It demonstrates high potential in aiding prediction and interpretation of nonlinear relationships of the subject being studied. PMID:25350120

Working with the Hmong Population in a Genetics Setting: an Interpreter Perspective.

PubMed

Krieger, Meghan; Agather, Aime; Douglass, Kathryn; Reiser, Catherine A; Petty, Elizabeth M

2018-06-01

The aim of this pilot qualitative study was to describe the experiences and beliefs of medical interpreters when working with genetic counselors and other genetic providers caring for Hmong patients who are not native English speakers. Specific goals were to identify interpreters' thoughts and perceptions on (a) their roles during sessions, (b) unique challenges in a genetics session, (c) knowledge genetics providers need when working with Hmong patients and interpreters, and (d) supports and training needed to effectively interpret in a genetics setting. Hmong medical interpreters from Wisconsin and Minnesota were invited by email to participate in the study. Six were interviewed by telephone. Participants had worked with a variety of providers including geneticists, genetic counselors, primary care physicians, and oncologists. Factors identified by Hmong interpreters that made interpretation of content difficult in clinical genetics sessions included: time constraints, technical terms, and unique cultural perspectives of Hmong patients. While all respondents felt their primary role was to interpret session content as close to verbatim as possible, there was notable variation in the description of their interpretation style and other perceived roles in the genetic counseling session. Cultural issues genetics providers could consider when working with Hmong patients and different style issues when working with Hmong interpreters are discussed. Ideas for future studies and suggestions to improve communication with Hmong patients are explored.

Cognitive bias modification of interpretation in children with social anxiety disorder.

PubMed

Orchard, Faith; Apetroaia, Adela; Clarke, Kiri; Creswell, Cathy

2017-01-01

Negative (or a lack of positive) interpretation of ambiguous social situations has been hypothesised to maintain social anxiety disorder in children, yet there is currently limited evidence to support this. Cognitive Bias Modification of Interpretation (CBM-I) provides a means to explore the causal influence of interpretation bias on social anxiety disorder, and has been associated with a reduction in social anxiety symptoms in adults. Seven to twelve year old children with a diagnosis of social anxiety disorder completed CBM-I training, adapted from materials designed for socially anxious children in the community, or no training. Effects on interpretation bias and social anxiety were assessed. The adapted CBM-I training was not associated with significant changes in benign or negative interpretation. Unsurprisingly given the lack of successful interpretation training, there were no significant changes in child or parent reported social anxiety symptoms, clinician-rated severity or diagnoses and change in interpretation was not significantly associated with change in social anxiety. These findings contrast with some studies with community populations although it is possible that more intensive CBM-I training is required to fully test this hypothesis among clinical groups. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Knowledge and Practices of Toxoplasmosis among Clinical Laboratory Professionals: A Cross-Sectional Study in Durango, Mexico.

PubMed

Alvarado-Esquivel, Cosme; Sánchez-Anguiano, Luis Francisco; Berumen-Segovia, Luis Omar; Hernández-Tinoco, Jesús; Rico-Almochantaf, Yazmin Del Rosario; Cisneros-Camacho, Alfredo; Cisneros-Martínez, Jorge Arturo

2017-11-18

Background : The aim of this study was to determine the level of knowledge and practices about toxoplasmosis in a sample of clinical laboratory professionals in Mexico. Methods : 192 clinical laboratory professionals were surveyed. They were asked about (1) Toxoplasma gondii ; (2) clinical manifestations, diagnosis, treatment, and epidemiology of toxoplasmosis; and (3) their practices with respect to toxoplasmosis. Results : The range of animals infected by T. gondii was known by 44.8% of participants. Clinical aspects of toxoplasmosis were known by up to 44.3% of subjects. Correct answers about the interpretation of serological markers of T. gondii infection were provided by up to 32.8% of participants. A minority (32.2%) of participants knew about a high number of false positive results of anti- T. gondii IgM antibody tests. Most participants (90.1%) did not know what the anti- T. gondii IgG avidity test was. Up to 55.7% of participants provided incorrect answers about the interpretation of serology tests for the treatment of pregnant women. Common routes of T. gondii infection were known by <15% of participants. Most (84.4%) participants had not performed tests for detection T. gondii infection. Conclusions : Results indicate incomplete knowledge of T. gondii infection and toxoplasmosis and a limited practice of laboratory tests among the professionals surveyed.

The value of core lab stress echocardiography interpretations: observations from the ISCHEMIA Trial.

PubMed

Kataoka, Akihisa; Scherrer-Crosbie, Marielle; Senior, Roxy; Gosselin, Gilbert; Phaneuf, Denis; Guzman, Gabriela; Perna, Gian; Lara, Alfonso; Kedev, Sasko; Mortara, Andrea; El-Hajjar, Mohammad; Shaw, Leslee J; Reynolds, Harmony R; Picard, Michael H

2015-12-18

Stress echocardiography (SE) is dependent on subjective interpretations. As a prelude to the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) Trial, potential sites were required to submit two SE, one with moderate or severe left ventricular (LV) myocardial ischemia and one with mild ischemia. We evaluated the concordance of site and core lab interpretations. Eighty-one SE were submitted from 41 international sites. Ischemia was classified by the number of new or worsening segmental LV wall motion abnormalities (WMA): none, mild (1 or 2) or moderate or severe (3 or more) by the sites and the core lab. Core lab classified 6 SE as no ischemia, 35 mild and 40 moderate or greater. There was agreement between the site and core in 66 of 81 total cases (81%, weighted kappa coefficient [K] =0.635). Agreement was similar for SE type - 24 of 30 exercise (80%, K = 0.571) vs. 41 of 49 pharmacologic (84%, K = 0.685). The agreement between poor or fair image quality (27 of 36 cases, 75%, K = 0.492) was not as good as for the good or excellent image quality cases (39 of 45 cases, 87%, K = 0.755). Differences in concordance were noted for degree of ischemia with the majority of discordant interpretations (87%) occurring in patients with no or mild LV myocardial ischemia. While site SE interpretations are largely concordant with core lab interpretations, this appears dependent on image quality and the extent of WMA. Thus core lab interpretations remain important in clinical trials where consistency of interpretation across a range of cases is critical. ClinicalTrials.gov NCT01471522.

Is Genetic Background Important in Lung Cancer Survival?

PubMed Central

Lindström, Linda S.; Hall, Per; Hartman, Mikael; Wiklund, Fredrik; Czene, Kamila

2009-01-01

Background In lung cancer, a patient's survival is poor with a wide variation in survival within the stage of disease. The aim of this study was to investigate the familial concordance in lung cancer survival by means of analyses of pairs with different degrees of familial relationships. Methods Our population-based Swedish family database included three million families and over 58 100 lung cancer patients. We modelled the proband (parent, sibling, spouse) survival utilizing a multivariate proportional hazard (Cox) model adjusting for possible confounders of survival. Subsequently, the survival in proband's relative (child, sibling, spouse) was analysed with a Cox model. Findings By use of Cox modelling with 5 years follow-up, we noted a decreased hazard ratio for death in children with good parental survival (Hazard Ratio [HR] = 0.71, 95% CI = 0.51 to 0.99), compared to those with poor parental survival. Also for siblings, a very strong protective effect was seen (HR = 0.14, 95% CI = 0.030 to 0.65). Finally, in spouses no correlation in survival was found. Interpretation Our findings suggest that genetic factors are important in lung cancer survival. In a clinical setting, information on prognosis in a relative may be vital in foreseeing the survival in an individual newly diagnosed with lung cancer. Future molecular studies enhancing the understanding of the underlying mechanisms and pathways are needed. PMID:19478952

Directionality effects in simultaneous language interpreting: the case of sign language interpreters in The Netherlands.

PubMed

Van Dijk, Rick; Boers, Eveline; Christoffels, Ingrid; Hermans, Daan

2011-01-01

The quality of interpretations produced by sign language interpreters was investigated. Twenty-five experienced interpreters were instructed to interpret narratives from (a) spoken Dutch to Sign Language of The Netherlands (SLN), (b) spoken Dutch to Sign Supported Dutch (SSD), and (c) SLN to spoken Dutch. The quality of the interpreted narratives was assessed by 5 certified sign language interpreters who did not participate in the study. Two measures were used to assess interpreting quality: the propositional accuracy of the interpreters' interpretations and a subjective quality measure. The results showed that the interpreted narratives in the SLN-to-Dutch interpreting direction were of lower quality (on both measures) than the interpreted narratives in the Dutch-to-SLN and Dutch-to-SSD directions. Furthermore, interpreters who had begun acquiring SLN when they entered the interpreter training program performed as well in all 3 interpreting directions as interpreters who had acquired SLN from birth.

Misleading reporting and interpretation of results in major infertility journals.

PubMed

Glujovsky, Demian; Sueldo, Carlos E; Borghi, Carolina; Nicotra, Pamela; Andreucci, Sara; Ciapponi, Agustín

2016-05-01

To evaluate the proportion of randomized controlled trials (RCTs) published in top infertility journals indexed on PubMed that reported their results with proper effect estimates and their precision estimation, while correctly interpreting both measures. Cross-sectional study evaluating all the RCTs published in top infertility journals during 2014. Not applicable. Not applicable. Not applicable. Proportion of RCTs that reported both relative and absolute effect size measures and its precision. Among the 32 RCTs published in 2014 in the top infertility journals reviewed, 37.5% (95% confidence interval [CI], 21.1-56.3) did not mention in their abstracts whether the difference among the study arms was statistically or clinically significant, and only 6.3% (95% CI, 0.8-20.8) used a CI of the absolute difference. Similarly, in the results section, these elements were observed in 28.2% (95% CI, 13.7-46.7) and 15.6% (95% CI, 5.3-32.8), respectively. Only one study clearly expressed the minimal clinically important difference in their methods section, but we found related proxies in 53% (95% CI, 34.7-70.9). None of the studies used CIs to draw conclusions about the clinical or statistical significance. We found 13 studies where the interpretation of the findings could be misleading. Recommended reporting items are underused in top infertility journals, which could lead to misleading interpretations. Authors, reviewers, and editorial boards should emphasize their use to improve reporting quality. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Assessing the Clinical Impact of Risk Prediction Models With Decision Curves: Guidance for Correct Interpretation and Appropriate Use

PubMed Central

Brown, Marshall D.; Zhu, Kehao; Janes, Holly

2016-01-01

The decision curve is a graphical summary recently proposed for assessing the potential clinical impact of risk prediction biomarkers or risk models for recommending treatment or intervention. It was applied recently in an article in Journal of Clinical Oncology to measure the impact of using a genomic risk model for deciding on adjuvant radiation therapy for prostate cancer treated with radical prostatectomy. We illustrate the use of decision curves for evaluating clinical- and biomarker-based models for predicting a man’s risk of prostate cancer, which could be used to guide the decision to biopsy. Decision curves are grounded in a decision-theoretical framework that accounts for both the benefits of intervention and the costs of intervention to a patient who cannot benefit. Decision curves are thus an improvement over purely mathematical measures of performance such as the area under the receiver operating characteristic curve. However, there are challenges in using and interpreting decision curves appropriately. We caution that decision curves cannot be used to identify the optimal risk threshold for recommending intervention. We discuss the use of decision curves for miscalibrated risk models. Finally, we emphasize that a decision curve shows the performance of a risk model in a population in which every patient has the same expected benefit and cost of intervention. If every patient has a personal benefit and cost, then the curves are not useful. If subpopulations have different benefits and costs, subpopulation-specific decision curves should be used. As a companion to this article, we released an R software package called DecisionCurve for making decision curves and related graphics. PMID:27247223

How to interpret Methylation Sensitive Amplified Polymorphism (MSAP) profiles?

PubMed Central

2014-01-01

Background DNA methylation plays a key role in development, contributes to genome stability, and may also respond to external factors supporting adaptation and evolution. To connect different types of stimuli with particular biological processes, identifying genome regions with altered 5-methylcytosine distribution at a genome-wide scale is important. Many researchers are using the simple, reliable, and relatively inexpensive Methylation Sensitive Amplified Polymorphism (MSAP) method that is particularly useful in studies of epigenetic variation. However, electrophoretic patterns produced by the method are rather difficult to interpret, particularly when MspI and HpaII isoschizomers are used because these enzymes are methylation-sensitive, and any C within the CCGG recognition motif can be methylated in plant DNA. Results Here, we evaluate MSAP patterns with respect to current knowledge of the enzyme activities and the level and distribution of 5-methylcytosine in plant and vertebrate genomes. We discuss potential caveats related to complex MSAP patterns and provide clues regarding how to interpret them. We further show that addition of combined HpaII + MspI digestion would assist in the interpretation of the most controversial MSAP pattern represented by the signal in the HpaII but not in the MspI profile. Conclusions We recommend modification of the MSAP protocol that definitely discerns between putative hemimethylated mCCGG and internal CmCGG sites. We believe that our view and the simple improvement will assist in correct MSAP data interpretation. PMID:24393618

Evaluation of total workstation CT interpretation quality: a single-screen pilot study

NASA Astrophysics Data System (ADS)

Beard, David V.; Perry, John R.; Muller, Keith E.; Misra, Ram B.; Brown, P.; Hemminger, Bradley M.; Johnston, Richard E.; Mauro, J. Matthew; Jaques, P. F.; Schiebler, M.

1991-07-01

An interpretation report, generated with an electronic viewbox, is affected by two factors: image quality, which encompasses what can be seen on the display, and computer human interaction (CHI), which accounts for the cognitive load effect of locating, moving, and manipulating images with the workstation controls. While a number of subject experiments have considered image quality, only recently has the affect of CHI on total interpretation quality been measured. This paper presents the results of a pilot study conducted to evaluate the total interpretation quality of the FilmPlane2.2 radiology workstation for patient folders containing single forty-slice CT studies. First, radiologists interpreted cases and dictated reports using FilmPlane2.2. Requisition forms were provided. Film interpretation was provided by the original clinical report and interpretation forms generated from a previous experiment. Second, an evaluator developed a list of findings for each case based on those listed in all the reports for each case and then evaluated each report for its response on each finding. Third, the reports were compared to determine how well they agreed with one another. Interpretation speed and observation data was also gathered.

Practice of Clinical Supervision.

ERIC Educational Resources Information Center

Holland, Patricia E.

1988-01-01

Clinical supervision remained grounded in empirical inquiry as late as Morris Cogan's writings on the subject in 1973. With the acknowledgment of Thomas Kuhn's (1962) paradigm shift, educational theory and practice developed interpretive methodologies. An interpretive reflection on Cogan's rationale offers insights into the current, matured…

Formal reporting of second-opinion CT interpretation: experience and reimbursement in the emergency department setting.

PubMed

Jeffers, Adam B; Saghir, Amina; Camacho, Marc

2012-06-01

The purpose of this study is to describe a system for formally reporting second-opinion interpretations of CT imaging exams accompanying patients transferred emergently to a tertiary care center. Second-opinion interpretations of cross-sectional imaging exams rendered in the emergency department setting over 6 months spanning 22 September 2009 to 22 March 2010 were reviewed and tallied by two radiologists and a research assistant, with a focus on professional fee reimbursement rates. A more in depth review was performed of those exams for which a clinical referral request form was available, detailing such information as the clinical history, content and source of available initial interpretation, and congruity of the initial interpretation with clinical data. Discrepancies between outside and second-opinion interpretations were also assessed. This quality assurance exercise was reviewed by our institutional review board, which waived formal informed consent. Formal second-opinion interpretation was rendered for 370 exams on 198 patients (mean age, 53.5 years; 45.1% female), received from 50 referring facilities. Head CT was the most common imaging exam referred for second opinion. Forty-one of 370 exams (11%) were submitted for self-pay, and 43 (12%) were written off as free care. The remaining 286 exams (77%) were submitted for reimbursement of the professional fee only. Ultimately, of the 286 exams submitted, 260 (91%) were reimbursed for professional fees, 199 (70%) on the initial submission. Of 29 health plans contracted with our facility, 22 ultimately approved all claims made. Three plans denied all claims submitted. The largest payer was Medicare, which reimbursed 88 of 90 submitted claims. Clinical intake forms were available for 184 exams on 107 patients (mean age, 52.7 years, 43.0% female). Trauma was the most common indication, or history, provided (55% of 184 exams, 40% of 107 patients). An outside report of some form was available for 112 of the 184

Interpretations of referral appropriateness by senior health managers in five PCT areas in England: a qualitative investigation.

PubMed

Blundell, N; Clarke, Aileen; Mays, N

2010-06-01

To explore interpretations of "appropriate" and "inappropriate" elective referral from primary to secondary surgical care among senior clinical and non-clinical managers in five purposively sampled primary care trusts (PCTs) and their main associated acute hospitals in the English National Health Service (NHS). Semi-structured face-to-face interviews were undertaken with senior managerial staff from clinical and non-clinical backgrounds. Interviews were tape-recorded, transcribed and analysed according to the Framework approach developed at the National Centre for Social Research using N6 (NUD*IST6) qualitative data analysis software. Twenty-two people of 23 approached were interviewed (between three and five respondents per PCT and associated acute hospital). Three attributes relating to appropriateness of referral were identified: necessity: whether a patient with given characteristics was believed suitable for referral; destination or level: where or to whom a patient should be referred; and quality (or process): how a referral was carried out, including (eg, investigations undertaken before referral, information contained in the referral and extent of patient involvement in the referral decision. Attributes were hierarchical. "Necessity" was viewed as the most fundamental attribute, followed by "destination" and, finally, "quality". In general, but not always, all three attributes were perceived as necessary for a referral to be defined as appropriate. For senior clinical and non-clinical managers at the local level in the English NHS, three hierarchical attributes (necessity, appropriateness of destination and quality of referral process) contributed to the overall concept of appropriateness of referral from primary to secondary surgical care.

Vertical or horizontal orientation of foot radiographs does not affect image interpretation

PubMed Central

Ferran, Nicholas Antonio; Ball, Luke; Maffulli, Nicola

2012-01-01

Summary This study determined whether the orientation of dorsoplantar and oblique foot radiographs has an effect on radiograph interpretation. A test set of 50 consecutive foot radiographs were selected (25 with fractures, and 25 normal), and duplicated in the horizontal orientation. The images were randomly arranged, numbered 1 through 100, and analysed by six image interpreters. Vertical and horizontal area under the ROC curve, accuracy, sensitivity and specificity were calculated for each image interpreter. There was no significant difference in the area under the ROC curve, accuracy, sensitivity or specificity of image interpretation between images viewed in the vertical or horizontal orientation. While conventions for display of radiographs may help to improve the development of an efficient visual search strategy in trainees, and allow for standardisation of publication of radiographic images, variation from the convention in clinical practice does not appear to affect the sensitivity or specificity of image interpretation. PMID:23738310

Atopy patch tests in young adult patients with atopic dermatitis and controls: dose-response relationship, objective reading, reproducibility and clinical interpretation.

PubMed

Bygum, Anette; Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

2003-01-01

The clinical interpretation and reproducibility of atopy patch tests was studied in 23 selected young adult patients with atopic dermatitis and 25 healthy controls using standard inhalant allergens. Non-invasive measurements were used for objective assessment of test reactions and the participants were retested after 6 weeks. Ten of 19 (53%) evaluable patients with atopic dermatitis had at least one positive atopy patch test. However, there was no clear clinical relevance of the atopy patch test results when related to patient history and distribution of dermatitis. Reproducible and dose-dependent results were obtained with Dermatophagoides pteronyssinus, grass and cat with a reproducibility rate of 0.69 to 0.81 in patients and 0.60-0.96 in controls. A unique finding was a significant positive correlation between a positive atopy patch test, allergen dose and increase in transepidermal water loss and erythema, while measurement of capacitance did not distinguish between positive and negative reactions. The results of the present study do not support the routine use of atopy patch tests in the evaluation of adult patients with atopic dermatitis.

Revolutionizing volunteer interpreter services: an evaluation of an innovative medical interpreter education program.

PubMed

Hasbún Avalos, Oswaldo; Pennington, Kaylin; Osterberg, Lars

2013-12-01

In our ever-increasingly multicultural, multilingual society, medical interpreters serve an important role in the provision of care. Though it is known that using untrained interpreters leads to decreased quality of care for limited English proficiency patients, because of a short supply of professionals and a lack of formalized, feasible education programs for volunteers, community health centers and internal medicine practices continue to rely on untrained interpreters. To develop and formally evaluate a novel medical interpreter education program that encompasses major tenets of interpretation, tailored to the needs of volunteer medical interpreters. One-armed, quasi-experimental retro-pre-post study using survey ratings and feedback correlated by assessment scores to determine educational intervention effects. Thirty-eight students; 24 Spanish, nine Mandarin, and five Vietnamese. The majority had prior interpreting experience but no formal medical interpreter training. Students completed retrospective pre-test and post-test surveys measuring confidence in and perceived knowledge of key skills of interpretation. Primary outcome measures were a 10-point Likert scale for survey questions of knowledge, skills, and confidence, written and oral assessments of interpreter skills, and qualitative evidence of newfound knowledge in written reflections. Analyses showed a statistically significant (P <0.001) change of about two points in mean self-ratings on knowledge, skills, and confidence, with large effect sizes (d > 0.8). The second half of the program was also quantitatively and qualitatively shown to be a vital learning experience, resulting in 18 % more students passing the oral assessments; a 19 % increase in mean scores for written assessments; and a newfound understanding of interpreter roles and ways to navigate them. This innovative program was successful in increasing volunteer interpreters' skills and knowledge of interpretation, as well as confidence

Bayesian methods for the design and interpretation of clinical trials in very rare diseases

PubMed Central

Hampson, Lisa V; Whitehead, John; Eleftheriou, Despina; Brogan, Paul

2014-01-01

This paper considers the design and interpretation of clinical trials comparing treatments for conditions so rare that worldwide recruitment efforts are likely to yield total sample sizes of 50 or fewer, even when patients are recruited over several years. For such studies, the sample size needed to meet a conventional frequentist power requirement is clearly infeasible. Rather, the expectation of any such trial has to be limited to the generation of an improved understanding of treatment options. We propose a Bayesian approach for the conduct of rare-disease trials comparing an experimental treatment with a control where patient responses are classified as a success or failure. A systematic elicitation from clinicians of their beliefs concerning treatment efficacy is used to establish Bayesian priors for unknown model parameters. The process of determining the prior is described, including the possibility of formally considering results from related trials. As sample sizes are small, it is possible to compute all possible posterior distributions of the two success rates. A number of allocation ratios between the two treatment groups can be considered with a view to maximising the prior probability that the trial concludes recommending the new treatment when in fact it is non-inferior to control. Consideration of the extent to which opinion can be changed, even by data from the best feasible design, can help to determine whether such a trial is worthwhile. © 2014 The Authors. Statistics in Medicine published by John Wiley & Sons, Ltd. PMID:24957522

Whole-body FDG PET-MR oncologic imaging: pitfalls in clinical interpretation related to inaccurate MR-based attenuation correction.

PubMed

Attenberger, Ulrike; Catana, Ciprian; Chandarana, Hersh; Catalano, Onofrio A; Friedman, Kent; Schonberg, Stefan A; Thrall, James; Salvatore, Marco; Rosen, Bruce R; Guimaraes, Alexander R

2015-08-01

Simultaneous data collection for positron emission tomography and magnetic resonance imaging (PET/MR) is now a reality. While the full benefits of concurrently acquiring PET and MR data and the potential added clinical value are still being evaluated, initial studies have identified several important potential pitfalls in the interpretation of fluorodeoxyglucose (FDG) PET/MRI in oncologic whole-body imaging, the majority of which being related to the errors in the attenuation maps created from the MR data. The purpose of this article was to present such pitfalls and artifacts using case examples, describe their etiology, and discuss strategies to overcome them. Using a case-based approach, we will illustrate artifacts related to (1) Inaccurate bone tissue segmentation; (2) Inaccurate air cavities segmentation; (3) Motion-induced misregistration; (4) RF coils in the PET field of view; (5) B0 field inhomogeneity; (6) B1 field inhomogeneity; (7) Metallic implants; (8) MR contrast agents.

Limited English proficient Hmong- and Spanish-speaking patients’ perceptions of the quality of interpreter services

PubMed Central

Lor, Maichou; Xiong, Phia; Schweia, Rebecca J.; Bowers, Barbara; Jacobs, Elizabeth A.

2015-01-01

Background Language barriers are a large and growing problem for patients in the U.S. and around the world. Interpreter services are a standard solution for addressing language barriers and most research has focused on utilization of interpreter services and their effect on health outcomes for patients who do not speak the same language as their healthcare providers including nurses. However, there is limited research on patients’ perceptions of these interpreter services. Objective To examine Hmong- and Spanish-speaking patients’ perceptions of interpreter service quality in the context of receiving cancer preventive services. Methods Twenty limited English proficient Hmong (n=10) and Spanish-speaking participants (N=10) ranging in age from 33 to 75 years were interviewed by two bilingual researchers in a Midwestern state. Interviews were audio taped, transcribed verbatim, and translated into English. Analysis was done using conventional content analysis. Results The two groups shared perceptions about the quality of interpreter services as variable along three dimensions. Specifically, both groups evaluated quality of interpreters based on the interpreters’ ability to provide: (a) literal interpretation, (b) cultural interpretation, and (c) emotional interpretation during the health care encounter. The groups differed, however, on how they described the consequences of poor interpretation quality. Hmong participants described how poor quality interpretation could lead to: (a) poor interpersonal relationships among patients, providers, and interpreters, (b) inability of patients to follow through with treatment plans, and (c) emotional distress for patients. Conclusions Our study highlights the fact that patients are discerning consumers of interpreter services; and could be effective partners in efforts to reform and enhance interpreter services. PMID:25865517

Hablamos Juntos (Together We Speak): Interpreters, Provider Communication, and Satisfaction with Care

PubMed Central

Morales, Leo S.

2010-01-01

BACKGROUND The Hablamos Juntos—Together We Speak (HJ)—national demonstration project targeted the improvement of language access for Spanish-speaking Latinos in areas with rapidly growing Latino populations. The objective of HJ was to improve doctor-patient communication by increasing access to and quality of interpreter services for Spanish-speaking patients. OBJECTIVE To investigate how access to interpreters for adult Spanish-speaking Latinos is associated with ratings of doctor/office staff communication and satisfaction with care. DESIGN Cross-sectional cohort study. PATIENTS A total of 1,590 Spanish-speaking Latino adults from eight sites across the United States who participated in the outpatient HJ evaluation. MEASUREMENTS We analyzed two multi-item measures of doctor communication (4 items) and office staff helpfulness (2 items), and one global item of satisfaction with care by interpreter use. We performed regression analyses to control for patient sociodemographic characteristics, survey year, and clustering at the site of care. RESULTS Ninety-five percent of participants were born outside the US, 81% were females, and survey response rates ranged from 45% to 85% across sites. In this cohort of Spanish-speaking patients, those who needed and always used interpreters reported better experiences with care than their counterparts who needed but had interpreters unavailable. Patients who always used an interpreter had better adjusted ratings of doctor communication [effect size (ES = 0.51)], office staff helpfulness (ES = 0.37), and satisfaction with care (ES = 0.37) than patients who needed but did not always use an interpreter. Patients who needed and always used interpreters also reported better experiences with care in all three domains measured [doctor communication (ES = 0.30), office staff helpfulness (ES = 0.21), and satisfaction with care (ES = 0.23)] than patients who did not need interpreters. CONCLUSIONS Among adult

Localized Smart-Interpretation

NASA Astrophysics Data System (ADS)

Lundh Gulbrandsen, Mats; Mejer Hansen, Thomas; Bach, Torben; Pallesen, Tom

2014-05-01

The complex task of setting up a geological model consists not only of combining available geological information into a conceptual plausible model, but also requires consistency with availably data, e.g. geophysical data. However, in many cases the direct geological information, e.g borehole samples, are very sparse, so in order to create a geological model, the geologist needs to rely on the geophysical data. The problem is however, that the amount of geophysical data in many cases are so vast that it is practically impossible to integrate all of them in the manual interpretation process. This means that a lot of the information available from the geophysical surveys are unexploited, which is a problem, due to the fact that the resulting geological model does not fulfill its full potential and hence are less trustworthy. We suggest an approach to geological modeling that 1. allow all geophysical data to be considered when building the geological model 2. is fast 3. allow quantification of geological modeling. The method is constructed to build a statistical model, f(d,m), describing the relation between what the geologists interpret, d, and what the geologist knows, m. The para- meter m reflects any available information that can be quantified, such as geophysical data, the result of a geophysical inversion, elevation maps, etc... The parameter d reflects an actual interpretation, such as for example the depth to the base of a ground water reservoir. First we infer a statistical model f(d,m), by examining sets of actual interpretations made by a geological expert, [d1, d2, ...], and the information used to perform the interpretation; [m1, m2, ...]. This makes it possible to quantify how the geological expert performs interpolation through f(d,m). As the geological expert proceeds interpreting, the number of interpreted datapoints from which the statistical model is inferred increases, and therefore the accuracy of the statistical model increases. When a model f

A formal approach to the analysis of clinical computer-interpretable guideline modeling languages.

PubMed

Grando, M Adela; Glasspool, David; Fox, John

2012-01-01

To develop proof strategies to formally study the expressiveness of workflow-based languages, and to investigate their applicability to clinical computer-interpretable guideline (CIG) modeling languages. We propose two strategies for studying the expressiveness of workflow-based languages based on a standard set of workflow patterns expressed as Petri nets (PNs) and notions of congruence and bisimilarity from process calculus. Proof that a PN-based pattern P can be expressed in a language L can be carried out semi-automatically. Proof that a language L cannot provide the behavior specified by a PNP requires proof by exhaustion based on analysis of cases and cannot be performed automatically. The proof strategies are generic but we exemplify their use with a particular CIG modeling language, PROforma. To illustrate the method we evaluate the expressiveness of PROforma against three standard workflow patterns and compare our results with a previous similar but informal comparison. We show that the two proof strategies are effective in evaluating a CIG modeling language against standard workflow patterns. We find that using the proposed formal techniques we obtain different results to a comparable previously published but less formal study. We discuss the utility of these analyses as the basis for principled extensions to CIG modeling languages. Additionally we explain how the same proof strategies can be reused to prove the satisfaction of patterns expressed in the declarative language CIGDec. The proof strategies we propose are useful tools for analysing the expressiveness of CIG modeling languages. This study provides good evidence of the benefits of applying formal methods of proof over semi-formal ones. Copyright © 2011 Elsevier B.V. All rights reserved.

Breast MRI BI-RADS Assessments and Abnormal Interpretation Rates by Clinical Indication in U.S. Community Practices

PubMed Central

Ichikawa, Laura; Rochelle, Michele C.; Kerlikowske, Karla; Miglioretti, Diana L.; Sprague, Brian L.; DeMartini, Wendy B.; Wernli, Karen J.; Joe, Bonnie N.; Yankaskas, Bonnie C.; Lehman, Constance D.

2014-01-01

Rationale and Objectives As breast MRI use grows, benchmark performance parameters are needed for auditing and quality assurance purposes. We describe the variation in breast MRI abnormal interpretation rates (AIRs) by clinical indication among a large sample of U.S. community practices. Materials and Methods We analyzed data from 41 facilities across five Breast Cancer Surveillance Consortium imaging registries. Each registry obtained IRB approval for this HIPAA compliant analysis. We included 11,654 breast MRI exams conducted in 2005–2010 among women aged 18–79 years. We categorized clinical indications as: 1) screening; 2) extent of disease; 3) diagnostic (e.g., breast symptoms); and 4) other (e.g., short-interval follow-up). We characterized assessments as positive (i.e., BI-RADS 0, 4, and 5) or negative (i.e., BI-RADS 1, 2, 6), and provide results with BI-RADS 3 categorized as positive and as negative. We tested for differences in AIRs across clinical indications both unadjusted and adjusted for patient characteristics and registry, and assessed for changes in AIRs by indication over time. Results When categorizing BI-RADS 3 as positive, AIRs were 21.0% (95% CI: 19.8, 22.3) for screening, 31.7% (95% CI: 29.6, 33.8) for extent of disease, 29.7% (95% CI: 28.3, 31.1) for diagnostic, and 27.4% (95% CI: 25.0, 29.8) for other indications (p<0.0001). When categorizing BI-RADS 3 as negative, AIRs were 10.5% (95% CI: 9.5, 11.4) for screening, 21.8% (95% CI: 19.9, 23.6) for extent of disease, 17.7% (95% CI: 16.5, 18.8) for diagnostic, and 13.3% (95% CI: 11.6, 15.2) for other indications (p<0.0001). The significant differences in AIRs by indication persisted even after adjusting for patient characteristics and registry (p<0.0001). In addition, for most indications, there were no significant changes in AIRs over time. Conclusion Breast MRI AIRs differ significantly by clinical indication. Practices should stratify breast MRI exams by indication for quality assurance

Cosmic Infrared Background Fluctuations and Zodiacal Light

NASA Technical Reports Server (NTRS)

Arendt, Richard G.; Kashlinsky, A.; Moseley, S. H.; Mather, J.

2017-01-01

We performed a specific observational test to measure the effect that the zodiacal light can have on measurements of the spatial fluctuations of the near-IR (near-infrared)background. Previous estimates of possible fluctuations caused by zodiacal light have often been extrapolated from observations of the thermal emission at longer wavelengths and low angular resolution or from IRAC (Infrared Array Camera) observations of high-latitude fields where zodiacal light is faint and not strongly varying with time. The new observations analyzed here target the COSMOS (Cosmic Evolution Survey) field at low ecliptic latitude where the zodiacal light intensity varies by factors of approximately 2 over the range of solar elongations at which the field can be observed. We find that the white-noise component of the spatial power spectrum of the background is correlated with the modeled zodiacal light intensity. Roughly half of the measured white noise is correlated with the zodiacal light, but a more detailed interpretation of the white noise is hampered by systematic uncertainties that are evident in the zodiacal light model. At large angular scales (greater than or approximately equal to 100 arcseconds) where excess power above the white noise is observed, we find no correlation of the power with the modeled intensity of the zodiacal light. This test clearly indicates that the large-scale power in the infrared background is not being caused by the zodiacal light.

The Treasures of Plato's "Phaedrus": A Creative Interpretation for Teaching and Learning in Modern Day.

ERIC Educational Resources Information Center

Brandenburg, Maryanne

This paper reflects upon Plato's "Phaedrus" from a background in education and experience teaching written business communications. The interpretation and development presented are guided by the Platonic method of collection and division, which is introduced in "Phaedrus." The paper begins with an evaluative overview, followed…

LIME: 3D visualisation and interpretation of virtual geoscience models

NASA Astrophysics Data System (ADS)

Buckley, Simon; Ringdal, Kari; Dolva, Benjamin; Naumann, Nicole; Kurz, Tobias

2017-04-01

Three-dimensional and photorealistic acquisition of surface topography, using methods such as laser scanning and photogrammetry, has become widespread across the geosciences over the last decade. With recent innovations in photogrammetric processing software, robust and automated data capture hardware, and novel sensor platforms, including unmanned aerial vehicles, obtaining 3D representations of exposed topography has never been easier. In addition to 3D datasets, fusion of surface geometry with imaging sensors, such as multi/hyperspectral, thermal and ground-based InSAR, and geophysical methods, create novel and highly visual datasets that provide a fundamental spatial framework to address open geoscience research questions. Although data capture and processing routines are becoming well-established and widely reported in the scientific literature, challenges remain related to the analysis, co-visualisation and presentation of 3D photorealistic models, especially for new users (e.g. students and scientists new to geomatics methods). Interpretation and measurement is essential for quantitative analysis of 3D datasets, and qualitative methods are valuable for presentation purposes, for planning and in education. Motivated by this background, the current contribution presents LIME, a lightweight and high performance 3D software for interpreting and co-visualising 3D models and related image data in geoscience applications. The software focuses on novel data integration and visualisation of 3D topography with image sources such as hyperspectral imagery, logs and interpretation panels, geophysical datasets and georeferenced maps and images. High quality visual output can be generated for dissemination purposes, to aid researchers with communication of their research results. The background of the software is described and case studies from outcrop geology, in hyperspectral mineral mapping and geophysical-geospatial data integration are used to showcase the novel

Interactive or static reports to guide clinical interpretation of cancer genomics.

PubMed

Gray, Stacy W; Gagan, Jeffrey; Cerami, Ethan; Cronin, Angel M; Uno, Hajime; Oliver, Nelly; Lowenstein, Carol; Lederman, Ruth; Revette, Anna; Suarez, Aaron; Lee, Charlotte; Bryan, Jordan; Sholl, Lynette; Van Allen, Eliezer M

2018-05-01

Misinterpretation of complex genomic data presents a major challenge in the implementation of precision oncology. We sought to determine whether interactive genomic reports with embedded clinician education and optimized data visualization improved genomic data interpretation. We conducted a randomized, vignette-based survey study to determine whether exposure to interactive reports for a somatic gene panel, as compared to static reports, improves physicians' genomic comprehension and report-related satisfaction (overall scores calculated across 3 vignettes, range 0-18 and 1-4, respectively, higher score corresponding with improved endpoints). One hundred and five physicians at a tertiary cancer center participated (29% participation rate): 67% medical, 20% pediatric, 7% radiation, and 7% surgical oncology; 37% female. Prior to viewing the case-based vignettes, 34% of the physicians reported difficulty making treatment recommendations based on the standard static report. After vignette/report exposure, physicians' overall comprehension scores did not differ by report type (mean score: interactive 11.6 vs static 10.5, difference = 1.1, 95% CI, -0.3, 2.5, P = .13). However, physicians exposed to the interactive report were more likely to correctly assess sequencing quality (P < .001) and understand when reports needed to be interpreted with caution (eg, low tumor purity; P = .02). Overall satisfaction scores were higher in the interactive group (mean score 2.5 vs 2.1, difference = 0.4, 95% CI, 0.2-0.7, P = .001). Interactive genomic reports may improve physicians' ability to accurately assess genomic data and increase report-related satisfaction. Additional research in users' genomic needs and efforts to integrate interactive reports into electronic health records may facilitate the implementation of precision oncology.

Interpretation biases in paranoia.

PubMed

Savulich, George; Freeman, Daniel; Shergill, Sukhi; Yiend, Jenny

2015-01-01

Information in the environment is frequently ambiguous in meaning. Emotional ambiguity, such as the stare of a stranger, or the scream of a child, encompasses possible good or bad emotional consequences. Those with elevated vulnerability to affective disorders tend to interpret such material more negatively than those without, a phenomenon known as "negative interpretation bias." In this study we examined the relationship between vulnerability to psychosis, measured by trait paranoia, and interpretation bias. One set of material permitted broadly positive/negative (valenced) interpretations, while another allowed more or less paranoid interpretations, allowing us to also investigate the content specificity of interpretation biases associated with paranoia. Regression analyses (n=70) revealed that trait paranoia, trait anxiety, and cognitive inflexibility predicted paranoid interpretation bias, whereas trait anxiety and cognitive inflexibility predicted negative interpretation bias. In a group comparison those with high levels of trait paranoia were negatively biased in their interpretations of ambiguous information relative to those with low trait paranoia, and this effect was most pronounced for material directly related to paranoid concerns. Together these data suggest that a negative interpretation bias occurs in those with elevated vulnerability to paranoia, and that this bias may be strongest for material matching paranoid beliefs. We conclude that content-specific biases may be important in the cause and maintenance of paranoid symptoms. Copyright © 2014. Published by Elsevier Ltd.

Canadian Open Genetics Repository (COGR): a unified clinical genomics database as a community resource for standardising and sharing genetic interpretations.

PubMed

Lerner-Ellis, Jordan; Wang, Marina; White, Shana; Lebo, Matthew S

2015-07-01

The Canadian Open Genetics Repository is a collaborative effort for the collection, storage, sharing and robust analysis of variants reported by medical diagnostics laboratories across Canada. As clinical laboratories adopt modern genomics technologies, the need for this type of collaborative framework is increasingly important. A survey to assess existing protocols for variant classification and reporting was delivered to clinical genetics laboratories across Canada. Based on feedback from this survey, a variant assessment tool was made available to all laboratories. Each participating laboratory was provided with an instance of GeneInsight, a software featuring versioning and approval processes for variant assessments and interpretations and allowing for variant data to be shared between instances. Guidelines were established for sharing data among clinical laboratories and in the final outreach phase, data will be made readily available to patient advocacy groups for general use. The survey demonstrated the need for improved standardisation and data sharing across the country. A variant assessment template was made available to the community to aid with standardisation. Instances of the GeneInsight tool were provided to clinical diagnostic laboratories across Canada for the purpose of uploading, transferring, accessing and sharing variant data. As an ongoing endeavour and a permanent resource, the Canadian Open Genetics Repository aims to serve as a focal point for the collaboration of Canadian laboratories with other countries in the development of tools that take full advantage of laboratory data in diagnosing, managing and treating genetic diseases. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Interpreting IgE sensitization tests in food allergy.

PubMed

Chokshi, Niti Y; Sicherer, Scott H

2016-01-01

Food allergies are increasing in prevalence, and with it, IgE testing to foods is becoming more commonplace. Food-specific IgE tests, including serum assays and prick skin tests, are sensitive for detecting the presence of food-specific IgE (sensitization), but specificity for predicting clinical allergy is limited. Therefore, positive tests are generally not, in isolation, diagnostic of clinical disease. However, rationale test selection and interpretation, based on clinical history and understanding of food allergy epidemiology and pathophysiology, makes these tests invaluable. Additionally, there exist highly predictive test cutoff values for common allergens in atopic children. Newer testing methodologies, such as component resolved diagnostics, are promising for increasing the utility of testing. This review highlights the use of IgE serum tests in the diagnosis of food allergy.

Why do some women choose to freebirth in the UK? An interpretative phenomenological study.

PubMed

Feeley, Claire; Thomson, Gill

2016-03-21

Freebirthing or unassisted birth is the active choice made by a woman to birth without a trained professional present, even where there is access to maternity provision. This is a radical childbirth choice, which has potential morbidity and mortality risks for mother and baby. While a number of studies have explored women's freebirth experiences, there has been no research undertaken in the UK. The aim of this study was to explore and identify what influenced women's decision to freebirth in a UK context. An interpretive phenomenological approach was adopted. Advertisements were posted on freebirth websites, and ten women participated in the study by completing a narrative (n = 9) and/or taking part in an in-depth interview (n = 10). Data analysis was carried out using interpretative methods informed by Heidegger and Gadamer's hermeneutic-phenomenological concepts. Three main themes emerged from the data. Contextualising herstory describes how the participants' backgrounds (personal and/or childbirth related) influenced their decision making. Diverging paths of decision making provides more detailed insights into how and why women's different backgrounds and experiences of childbirth and maternity care influenced their decision to freebirth. Converging path of decision making, outlines the commonalities in women's narratives in terms of how they sought to validate their decision to freebirth, such as through self-directed research, enlisting the support of others and conceptualising risk. The UK based midwifery philosophy of woman-centred care that tailors care to individual needs is not always carried out, leaving women to feel disillusioned, unsafe and opting out of any form of professionalised care for their births. Maternity services need to provide support for women who have experienced a previous traumatic birth. Midwives also need to help restore relationships with women, and co-create birth plans that enable women to be active agents in their birthing

GAVIN: Gene-Aware Variant INterpretation for medical sequencing.

PubMed

van der Velde, K Joeri; de Boer, Eddy N; van Diemen, Cleo C; Sikkema-Raddatz, Birgit; Abbott, Kristin M; Knopperts, Alain; Franke, Lude; Sijmons, Rolf H; de Koning, Tom J; Wijmenga, Cisca; Sinke, Richard J; Swertz, Morris A

2017-01-16

We present Gene-Aware Variant INterpretation (GAVIN), a new method that accurately classifies variants for clinical diagnostic purposes. Classifications are based on gene-specific calibrations of allele frequencies from the ExAC database, likely variant impact using SnpEff, and estimated deleteriousness based on CADD scores for >3000 genes. In a benchmark on 18 clinical gene sets, we achieve a sensitivity of 91.4% and a specificity of 76.9%. This accuracy is unmatched by 12 other tools. We provide GAVIN as an online MOLGENIS service to annotate VCF files and as an open source executable for use in bioinformatic pipelines. It can be found at http://molgenis.org/gavin .

The MMPI Assistant: A Microcomputer Based Expert System to Assist in Interpreting MMPI Profiles

PubMed Central

Tanner, Barry A.

1989-01-01

The Assistant is an MS DOS program to aid clinical psychologists in interpreting the results of the Minnesota Multiphasic Personality Inventory (MMPI). Interpretive hypotheses are based on the professional literature and the author's experience. After scores are entered manually, the Assistant produces a hard copy which is intended for use by a psychologist knowledgeable about the MMPI. The rules for each hypothesis appear first on the monitor, and then in the printed output, followed by the patient's scores on the relevant scales, and narrative hypotheses for the scores. The data base includes hypotheses for 23 validity configurations, 45 two-point clinical codes, 10 high scoring single-point clinical scales, and 10 low scoring single-point clinical scales. The program can accelerate the production of test reports, while insuring that actuarial rules are not overlooked. It has been especially useful as a teaching tool with graduate students. The Assistant requires an IBM PC compatible with 128k available memory, DOS 2.x or higher, and a printer.

Thinking like a nurse: a research-based model of clinical judgment in nursing.

PubMed

Tanner, Christine A

2006-06-01

This article reviews the growing body of research on clinical judgment in nursing and presents an alternative model of clinical judgment based on these studies. Based on a review of nearly 200 studies, five conclusions can be drawn: (1) Clinical judgments are more influenced by what nurses bring to the situation than the objective data about the situation at hand; (2) Sound clinical judgment rests to some degree on knowing the patient and his or her typical pattern of responses, as well as an engagement with the patient and his or her concerns; (3) Clinical judgments are influenced by the context in which the situation occurs and the culture of the nursing care unit; (4) Nurses use a variety of reasoning patterns alone or in combination; and (5) Reflection on practice is often triggered by a breakdown in clinical judgment and is critical for the development of clinical knowledge and improvement in clinical reasoning. A model based on these general conclusions emphasizes the role of nurses' background, the context of the situation, and nurses' relationship with their patients as central to what nurses notice and how they interpret findings, respond, and reflect on their response.

ORAL INTERPRETATION.

ERIC Educational Resources Information Center

CAMPBELL, PAUL N.

THE BASIC PREMISE OF THIS BOOK IS THAT LEARNING TO READ ORALLY IS OF FUNDAMENTAL IMPORTANCE TO THOSE WHO WOULD FULLY APPRECIATE OR RESPOND TO LITERATURE. BECAUSE READERS MUST INTERPRET LITERATURE ALWAYS FOR THEMSELVES AND OFTEN FOR AN AUDIENCE, THREE ASPECTS OF ORAL INTERPRETATION ARE EXPLORED--(1) THE CHOICE OF MATERIALS, WHICH REQUIRES AN…

Systematic interrogation of diverse Omic data reveals interpretable, robust, and generalizable transcriptomic features of clinically successful therapeutic targets.

PubMed

Rouillard, Andrew D; Hurle, Mark R; Agarwal, Pankaj

2018-05-01

Target selection is the first and pivotal step in drug discovery. An incorrect choice may not manifest itself for many years after hundreds of millions of research dollars have been spent. We collected a set of 332 targets that succeeded or failed in phase III clinical trials, and explored whether Omic features describing the target genes could predict clinical success. We obtained features from the recently published comprehensive resource: Harmonizome. Nineteen features appeared to be significantly correlated with phase III clinical trial outcomes, but only 4 passed validation schemes that used bootstrapping or modified permutation tests to assess feature robustness and generalizability while accounting for target class selection bias. We also used classifiers to perform multivariate feature selection and found that classifiers with a single feature performed as well in cross-validation as classifiers with more features (AUROC = 0.57 and AUPR = 0.81). The two predominantly selected features were mean mRNA expression across tissues and standard deviation of expression across tissues, where successful targets tended to have lower mean expression and higher expression variance than failed targets. This finding supports the conventional wisdom that it is favorable for a target to be present in the tissue(s) affected by a disease and absent from other tissues. Overall, our results suggest that it is feasible to construct a model integrating interpretable target features to inform target selection. We anticipate deeper insights and better models in the future, as researchers can reuse the data we have provided to improve methods for handling sample biases and learn more informative features. Code, documentation, and data for this study have been deposited on GitHub at https://github.com/arouillard/omic-features-successful-targets.

High resolution esophageal manometry--the switch from "intuitive" visual interpretation to Chicago classification.

PubMed

Srinivas, M; Balakumaran, T A; Palaniappan, S; Srinivasan, Vijaya; Batcha, M; Venkataraman, Jayanthi

2014-03-01

High resolution esophageal manometry (HREM) has been interpreted all along by visual interpretation of color plots until the recent introduction of Chicago classification which categorises HREM using objective measurements. It compares HREM diagnosis of esophageal motor disorders by visual interpretation and Chicago classification. Using software Trace 1.2v, 77 consecutive tracings diagnosed by visual interpretation were re-analyzed by Chicago classification and findings compared for concordance between the two systems of interpretation. Kappa agreement rate between the two observations was determined. There were 57 males (74 %) and cohort median age was 41 years (range: 14-83 years). Majority of the referrals were for gastroesophageal reflux disease, dysphagia and achalasia. By "intuitive" visual interpretation, the tracing were reported as normal in 45 (58.4 %), achalasia 14 (18.2 %), ineffective esophageal motility 3 (3.9 %), nutcracker esophagus 11 (14.3 %) and nonspecific motility changes 4 (5.2 %). By Chicago classification, there was 100 % agreement (Kappa 1) for achalasia (type 1: 9; type 2: 5) and ineffective esophageal motility ("failed peristalsis" on visual interpretation). Normal esophageal motility, nutcracker esophagus and nonspecific motility disorder on visual interpretation were reclassified as rapid contraction and esophagogastric junction (EGJ) outflow obstruction by Chicago classification. Chicago classification identified distinct clinical phenotypes including EGJ outflow obstruction not identified by visual interpretation. A significant number of unclassified HREM by visual interpretation were also classified by it.

The Effect of "Sad" and "Happy" Background Music on the Interpretation of a Story in 5 to 6-Year-Old Children

ERIC Educational Resources Information Center

Ziv, Naomi; Goshen, Maya

2006-01-01

Children hear music in the background of a large variety of situations and activities. Throughout development, they acquire knowledge both about the syntactical norms of tonal music, and about the relationship between musical form and emotion. Five to six-year-old children heard a story, with a background "happy", "sad" or no…

Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background.

PubMed

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E

2014-05-15

To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

Standards for Clinical Grade Genomic Databases.

PubMed

Yohe, Sophia L; Carter, Alexis B; Pfeifer, John D; Crawford, James M; Cushman-Vokoun, Allison; Caughron, Samuel; Leonard, Debra G B

2015-11-01

Next-generation sequencing performed in a clinical environment must meet clinical standards, which requires reproducibility of all aspects of the testing. Clinical-grade genomic databases (CGGDs) are required to classify a variant and to assist in the professional interpretation of clinical next-generation sequencing. Applying quality laboratory standards to the reference databases used for sequence-variant interpretation presents a new challenge for validation and curation. To define CGGD and the categories of information contained in CGGDs and to frame recommendations for the structure and use of these databases in clinical patient care. Members of the College of American Pathologists Personalized Health Care Committee reviewed the literature and existing state of genomic databases and developed a framework for guiding CGGD development in the future. Clinical-grade genomic databases may provide different types of information. This work group defined 3 layers of information in CGGDs: clinical genomic variant repositories, genomic medical data repositories, and genomic medicine evidence databases. The layers are differentiated by the types of genomic and medical information contained and the utility in assisting with clinical interpretation of genomic variants. Clinical-grade genomic databases must meet specific standards regarding submission, curation, and retrieval of data, as well as the maintenance of privacy and security. These organizing principles for CGGDs should serve as a foundation for future development of specific standards that support the use of such databases for patient care.

Blackboard architecture for medical image interpretation

NASA Astrophysics Data System (ADS)

Davis, Darryl N.; Taylor, Christopher J.

1991-06-01

There is a growing interest in using sophisticated knowledge-based systems for biomedical image interpretation. We present a principled attempt to use artificial intelligence methodologies in interpreting lateral skull x-ray images. Such radiographs are routinely used in cephalometric analysis to provide quantitative measurements useful to clinical orthodontists. Manual and interactive methods of analysis are known to be error prone and previous attempts to automate this analysis typically fail to capture the expertise and adaptability required to cope with the variability in biological structure and image quality. An integrated model-based system has been developed which makes use of a blackboard architecture and multiple knowledge sources. A model definition interface allows quantitative models, of feature appearance and location, to be built from examples as well as more qualitative modelling constructs. Visual task definition and blackboard control modules allow task-specific knowledge sources to act on information available to the blackboard in a hypothesise and test reasoning cycle. Further knowledge-based modules include object selection, location hypothesis, intelligent segmentation, and constraint propagation systems. Alternative solutions to given tasks are permitted.

A new framework to enhance the interpretation of external validation studies of clinical prediction models.

PubMed

Debray, Thomas P A; Vergouwe, Yvonne; Koffijberg, Hendrik; Nieboer, Daan; Steyerberg, Ewout W; Moons, Karel G M

2015-03-01

It is widely acknowledged that the performance of diagnostic and prognostic prediction models should be assessed in external validation studies with independent data from "different but related" samples as compared with that of the development sample. We developed a framework of methodological steps and statistical methods for analyzing and enhancing the interpretation of results from external validation studies of prediction models. We propose to quantify the degree of relatedness between development and validation samples on a scale ranging from reproducibility to transportability by evaluating their corresponding case-mix differences. We subsequently assess the models' performance in the validation sample and interpret the performance in view of the case-mix differences. Finally, we may adjust the model to the validation setting. We illustrate this three-step framework with a prediction model for diagnosing deep venous thrombosis using three validation samples with varying case mix. While one external validation sample merely assessed the model's reproducibility, two other samples rather assessed model transportability. The performance in all validation samples was adequate, and the model did not require extensive updating to correct for miscalibration or poor fit to the validation settings. The proposed framework enhances the interpretation of findings at external validation of prediction models. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Rates and Predictors of Professional Interpreting Provision for Patients With Limited English Proficiency in the Emergency Department and Inpatient Ward

PubMed Central

Ryan, Jennifer; Abbato, Samantha; Greer, Ristan; Vayne-Bossert, Petra; Good, Phillip

2017-01-01

The provision of professional interpreting services in the hospital setting decreases communication errors of clinical significance and improves clinical outcomes. A retrospective audit was conducted at a tertiary referral adult hospital in Brisbane, Australia. Of 20 563 admissions of patients presenting to the hospital emergency department (ED) and admitted to a ward during 2013-2014, 582 (2.8%) were identified as requiring interpreting services. In all, 19.8% of admissions were provided professional interpreting services in the ED, and 26.1% were provided on the ward. Patients were more likely to receive interpreting services in the ED if they were younger, spoke an Asian language, or used sign language. On the wards, using sign language was associated with 3 times odds of being provided an interpreter compared with other languages spoken. Characteristics of patients including their age and type of language spoken influence the clinician’s decision to engage a professional interpreter in both the ED and inpatient ward. PMID:29144184

Classroom Literacy Practices in Low- and Middle-Income Countries: An Interpretative Synthesis of Ethnographic Studies

ERIC Educational Resources Information Center

Nag, Sonali; Snowling, Margaret J.; Asfaha, Yonas Mesfun

2016-01-01

Surveys in low- and middle-income (LMI countries) reveal persistently low levels of learning among children in disadvantaged communities. Against this background, our synthesis of ethnographies aims at a fresh interpretation of classroom practices to clarify instruction-related barriers to literacy attainments. The review focuses on the period…

Managing Academic Tasks in Junior High School: Background, Design, and Methodology. (R & D Rep. No. 6185).

ERIC Educational Resources Information Center

Doyle, Walter; And Others

This report describes the conceptual background, design, and methodology for a study of management of academic tasks in junior high school. Previous research suggests that tasks students accomplish in classrooms determine what they actually learn, and acquisition of higher cognitive skills related to interpretation and planning is essential for…

Interpretation of the cosmic microwave background radiation anisotropy detected by the COBE Differential Microwave Radiometer

NASA Technical Reports Server (NTRS)

Wright, E. L.; Meyer, S. S.; Bennett, C. L.; Boggess, N. W.; Cheng, E. S.; Hauser, M. G.; Kogut, A.; Lineweaver, C.; Mather, J. C.; Smoot, G. F.

1992-01-01

The large-scale cosmic background anisotropy detected by the COBE Differential Microwave Radiometer (DMR) instrument is compared to the sensitive previous measurements on various angular scales, and to the predictions of a wide variety of models of structure formation driven by gravitational instability. The observed anisotropy is consistent with all previously measured upper limits and with a number of dynamical models of structure formation. For example, the data agree with an unbiased cold dark matter (CDM) model with H0 = 50 km/s Mpc and Delta-M/M = 1 in a 16 Mpc radius sphere. Other models, such as CDM plus massive neutrinos (hot dark matter (HDM)), or CDM with a nonzero cosmological constant are also consistent with the COBE detection and can provide the extra power seen on 5-10,000 km/s scales.

Considerations When Working with Interpreters.

ERIC Educational Resources Information Center

Hwa-Froelich, Deborah A.; Westby, Carol E.

2003-01-01

This article describes the current training and certification procedures in place for linguistic interpreters, the continuum of interpreter roles, and how interpreters' perspectives may influence the interpretive interaction. The specific skills needed for interpreting in either health care or educational settings are identified. A table compares…

The effects of proficiency and bias on residents' interpretation of the microscopic urinalysis.

PubMed

Flach, Stephen D; Canaris, Gay J; Tape, Thomas G; Huntley, Kathryn M; Wigton, Robert S

2002-01-01

This study aims to determine whether residents are influenced by clinical information when interpreting microscopic urinalysis (UA) and estimating the probability of a urinary tract infection (UTI), and to determine the accuracy and reliability of UA readings. Residents estimated the UA white blood cell count and the probability of a UTI in vignettes using a fractional factorial design, varying symptoms, gender, and the white blood cell count on preprepared urine slides. Individual-level results indicated a clinical information bias and poor accuracy. Seventeen of 38 residents increased the white blood cell count in response to female gender; 14 increased the white blood cell count in response to UTI symptoms. Forty-nine percent of the readings were inaccurate; agreement ranged from 50% to 67% for white and red blood cells and bacteria. Many residents gave inaccurate UA readings, and many readings varied with clinical information. A significant portion of residents needs assistance in objectively and accurately interpreting the UA.

Transference interpretations in dynamic psychotherapy: do they really yield sustained effects?

PubMed

Høglend, Per; Bøgwald, Kjell-Petter; Amlo, Svein; Marble, Alice; Ulberg, Randi; Sjaastad, Mary Cosgrove; Sørbye, Oystein; Heyerdahl, Oscar; Johansson, Paul

2008-06-01

Transference interpretation has remained a core ingredient in the psychodynamic tradition, despite limited empirical evidence for its effectiveness. In this study, the authors examined long-term effects of transference interpretations. This was a randomized controlled clinical trial, dismantling design, plus follow-up evaluations 1 year and 3 years after treatment termination. One hundred outpatients seeking psychotherapy for depression, anxiety, personality disorders, and interpersonal problems were referred to the study therapists. Patients were randomly assigned to receive weekly sessions of dynamic psychotherapy for 1 year with or without transference interpretations. Five full sessions from each therapy were rated in order to document treatment fidelity. Outcome variables were the Psychodynamic Functioning Scales (clinician rated) and the Inventory of Interpersonal Problems (self-report). Rating on the Quality of Object Relations Scale (lifelong pattern) and presence of a personality disorder were postulated moderators of treatment effects. Change over time was assessed using linear mixed models. Despite an absence of differential treatment efficacy, both treatments demonstrated significant improvement during treatment and also after treatment termination. However, patients with a lifelong pattern of poor object relations profited more from 1 year of therapy with transference interpretations than from therapy without transference interpretations. This effect was sustained throughout the 4-year study period. The goal of transference interpretation is sustained improvement of the patient's relationships outside of therapy. Transference interpretation seems to be especially important for patients with long-standing, more severe interpersonal problems.

Knowledge and Practices of Toxoplasmosis among Clinical Laboratory Professionals: A Cross-Sectional Study in Durango, Mexico

PubMed Central

Sánchez-Anguiano, Luis Francisco; Berumen-Segovia, Luis Omar; Hernández-Tinoco, Jesús; Rico-Almochantaf, Yazmin del Rosario; Cisneros-Camacho, Alfredo; Cisneros-Martínez, Jorge Arturo

2017-01-01

Background: The aim of this study was to determine the level of knowledge and practices about toxoplasmosis in a sample of clinical laboratory professionals in Mexico. Methods: 192 clinical laboratory professionals were surveyed. They were asked about (1) Toxoplasma gondii; (2) clinical manifestations, diagnosis, treatment, and epidemiology of toxoplasmosis; and (3) their practices with respect to toxoplasmosis. Results: The range of animals infected by T. gondii was known by 44.8% of participants. Clinical aspects of toxoplasmosis were known by up to 44.3% of subjects. Correct answers about the interpretation of serological markers of T. gondii infection were provided by up to 32.8% of participants. A minority (32.2%) of participants knew about a high number of false positive results of anti-T. gondii IgM antibody tests. Most participants (90.1%) did not know what the anti-T. gondii IgG avidity test was. Up to 55.7% of participants provided incorrect answers about the interpretation of serology tests for the treatment of pregnant women. Common routes of T. gondii infection were known by <15% of participants. Most (84.4%) participants had not performed tests for detection T. gondii infection. Conclusions: Results indicate incomplete knowledge of T. gondii infection and toxoplasmosis and a limited practice of laboratory tests among the professionals surveyed. PMID:29156547

Potential for unreliable interpretation of EEG recorded with microelectrodes.

PubMed

Stacey, William C; Kellis, Spencer; Greger, Bradley; Butson, Christopher R; Patel, Paras R; Assaf, Trevor; Mihaylova, Temenuzhka; Glynn, Simon

2013-08-01

Recent studies in epilepsy, cognition, and brain machine interfaces have shown the utility of recording intracranial electroencephalography (iEEG) with greater spatial resolution. Many of these studies utilize microelectrodes connected to specialized amplifiers that are optimized for such recordings. We recently measured the impedances of several commercial microelectrodes and demonstrated that they will distort iEEG signals if connected to clinical EEG amplifiers commonly used in most centers. In this study we demonstrate the clinical implications of this effect and identify some of the potential difficulties in using microelectrodes. Human iEEG data were digitally filtered to simulate the signal recorded by a hybrid grid (two macroelectrodes and eight microelectrodes) connected to a standard EEG amplifier. The filtered iEEG data were read by three trained epileptologists, and high frequency oscillations (HFOs) were detected with a well-known algorithm. The filtering method was verified experimentally by recording an injected EEG signal in a saline bath with the same physical acquisition system used to generate the model. Several electrodes underwent scanning electron microscopy (SEM). Macroelectrode recordings were unaltered compared to the source iEEG signal, but microelectrodes attenuated low frequencies. The attenuated signals were difficult to interpret: all three clinicians changed their clinical scoring of slowing and seizures when presented with the same data recorded on different sized electrodes. The HFO detection algorithm was oversensitive with microelectrodes, classifying many more HFOs than when the same data were recorded with macroelectrodes. In addition, during experimental recordings the microelectrodes produced much greater noise as well as large baseline fluctuations, creating sharply contoured transients, and superimposed "false" HFOs. SEM of these microelectrodes demonstrated marked variability in exposed electrode surface area, lead

Interpretation of statistical results.

PubMed

García Garmendia, J L; Maroto Monserrat, F

2018-02-21

The appropriate interpretation of the statistical results is crucial to understand the advances in medical science. The statistical tools allow us to transform the uncertainty and apparent chaos in nature to measurable parameters which are applicable to our clinical practice. The importance of understanding the meaning and actual extent of these instruments is essential for researchers, the funders of research and for professionals who require a permanent update based on good evidence and supports to decision making. Various aspects of the designs, results and statistical analysis are reviewed, trying to facilitate his comprehension from the basics to what is most common but no better understood, and bringing a constructive, non-exhaustive but realistic look. Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Non-existence of time-periodic solutions of the Dirac equation in a Reissner-Nordström black hole background

NASA Astrophysics Data System (ADS)

Finster, Felix; Smoller, Joel; Yau, Shing-Tung

2000-04-01

It is shown analytically that the Dirac equation has no normalizable, time-periodic solutions in a Reissner-Nordström black hole background; in particular, there are no static solutions of the Dirac equation in such a background metric. The physical interpretation is that Dirac particles can either disappear into the black hole or escape to infinity, but they cannot stay on a periodic orbit around the black hole.

Pretest expectations strongly influence interpretation of abnormal laboratory results and further management

PubMed Central

2010-01-01

Background Abnormal results of diagnostic laboratory tests can be difficult to interpret when disease probability is very low. Although most physicians generally do not use Bayesian calculations to interpret abnormal results, their estimates of pretest disease probability and reasons for ordering diagnostic tests may - in a more implicit manner - influence test interpretation and further management. A better understanding of this influence may help to improve test interpretation and management. Therefore, the objective of this study was to examine the influence of physicians' pretest disease probability estimates, and their reasons for ordering diagnostic tests, on test result interpretation, posttest probability estimates and further management. Methods Prospective study among 87 primary care physicians in the Netherlands who each ordered laboratory tests for 25 patients. They recorded their reasons for ordering the tests (to exclude or confirm disease or to reassure patients) and their pretest disease probability estimates. Upon receiving the results they recorded how they interpreted the tests, their posttest probability estimates and further management. Logistic regression was used to analyse whether the pretest probability and the reasons for ordering tests influenced the interpretation, the posttest probability estimates and the decisions on further management. Results The physicians ordered tests for diagnostic purposes for 1253 patients; 742 patients had an abnormal result (64%). Physicians' pretest probability estimates and their reasons for ordering diagnostic tests influenced test interpretation, posttest probability estimates and further management. Abnormal results of tests ordered for reasons of reassurance were significantly more likely to be interpreted as normal (65.8%) compared to tests ordered to confirm a diagnosis or exclude a disease (27.7% and 50.9%, respectively). The odds for abnormal results to be interpreted as normal were much lower when

Interpretive style and intolerance of uncertainty in individuals with anxiety disorders: a focus on generalized anxiety disorder.

PubMed

Anderson, Kristin G; Dugas, Michel J; Koerner, Naomi; Radomsky, Adam S; Savard, Pierre; Turcotte, Julie

2012-12-01

Interpretations of negative, positive, and ambiguous situations were examined in individuals with generalized anxiety disorder (GAD), other anxiety disorders (ANX), and no psychiatric condition (CTRL). Additionally, relationships between specific beliefs about uncertainty (Uncertainty Has Negative Behavioral and Self-Referent Implications [IUS-NI], and Uncertainty Is Unfair and Spoils Everything [IUS-US]) and interpretations were explored. The first hypothesis (that the clinical groups would report more concern for negative, positive, and ambiguous situations than would the CTRL group) was supported. The second hypothesis (that the GAD group would report more concern for ambiguous situations than would the ANX group) was not supported; both groups reported similar levels of concern for ambiguous situations. Exploratory analyses revealed no differences between the GAD and ANX groups in their interpretations of positive and negative situations. Finally, the IUS-US predicted interpretations of negative and ambiguous situations in the full sample, whereas the IUS-NI did not. Clinical implications are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Targeting Lexicon in Interpreting.

ERIC Educational Resources Information Center

Farghal, Mohammed; Shakir, Abdullah

1994-01-01

Studies student interpreters in the Master's Translation Program at Yarmouk University in Jordan. Analyzes the difficulties of these students, particularly regarding lexical competence, when interpreting from Arabic to English, emphasizing the need to teach lexicon all through interpreting programs. (HB)

Modifying interpretation biases: Effects on symptomatology, behavior, and physiological reactivity in social anxiety.

PubMed

Nowakowski, Matilda E; Antony, Martin M; Koerner, Naomi

2015-12-01

The present study investigated the effects of computerized interpretation training and cognitive restructuring on symptomatology, behavior, and physiological reactivity in an analogue social anxiety sample. Seventy-two participants with elevated social anxiety scores were randomized to one session of computerized interpretation training (n = 24), cognitive restructuring (n = 24), or an active placebo control condition (n = 24). Participants completed self-report questionnaires focused on interpretation biases and social anxiety symptomatology at pre and posttraining and a speech task at posttraining during which subjective, behavioral, and physiological measures of anxiety were assessed. Only participants in the interpretation training condition endorsed significantly more positive than negative interpretations of ambiguous social situations at posttraining. There was no evidence of generalizability of interpretation training effects to self-report measures of interpretation biases and symptomatology or the anxiety response during the posttraining speech task. Participants in the cognitive restructuring condition were rated as having higher quality speeches and showing fewer signs of anxiety during the posttraining speech task compared to participants in the interpretation training condition. The present study did not include baseline measures of speech performance or computer assessed interpretation biases. The results of the present study bring into question the generalizability of computerized interpretation training as well as the effectiveness of a single session of cognitive restructuring in modifying the full anxiety response. Clinical and theoretical implications are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Age index and an interpretation of survivorship curves (author's transl)].

PubMed

Lohmann, W

1977-01-01

Clinical investigations showed that the age dependences of physiological functions do not show -- as generally assumed -- a linear increase with age, but an exponential one. Considering this result one can easily interpret the survivorship curve of a population (Gompertz plot). The only thing that is required is that the probability of death (death rate) is proportional to a function of ageing given by mu(t) = mu0 exp (alpha t). Considering survivorship curves resulting from annual death statistics and fitting them by suitable parameters, then the resulting alpha-values are in agreement with clinical data.

Directionality Effects in Simultaneous Language Interpreting: The Case of Sign Language Interpreters in the Netherlands

ERIC Educational Resources Information Center

van Dijk, Rick; Boers, Eveline; Christoffels, Ingrid; Hermans, Daan

2011-01-01

The quality of interpretations produced by sign language interpreters was investigated. Twenty-five experienced interpreters were instructed to interpret narratives from (a) spoken Dutch to Sign Language of the Netherlands (SLN), (b) spoken Dutch to Sign Supported Dutch (SSD), and (c) SLN to spoken Dutch. The quality of the interpreted narratives…

Evaluating topic model interpretability from a primary care physician perspective.

PubMed

Arnold, Corey W; Oh, Andrea; Chen, Shawn; Speier, William

2016-02-01

Probabilistic topic models provide an unsupervised method for analyzing unstructured text. These models discover semantically coherent combinations of words (topics) that could be integrated in a clinical automatic summarization system for primary care physicians performing chart review. However, the human interpretability of topics discovered from clinical reports is unknown. Our objective is to assess the coherence of topics and their ability to represent the contents of clinical reports from a primary care physician's point of view. Three latent Dirichlet allocation models (50 topics, 100 topics, and 150 topics) were fit to a large collection of clinical reports. Topics were manually evaluated by primary care physicians and graduate students. Wilcoxon Signed-Rank Tests for Paired Samples were used to evaluate differences between different topic models, while differences in performance between students and primary care physicians (PCPs) were tested using Mann-Whitney U tests for each of the tasks. While the 150-topic model produced the best log likelihood, participants were most accurate at identifying words that did not belong in topics learned by the 100-topic model, suggesting that 100 topics provides better relative granularity of discovered semantic themes for the data set used in this study. Models were comparable in their ability to represent the contents of documents. Primary care physicians significantly outperformed students in both tasks. This work establishes a baseline of interpretability for topic models trained with clinical reports, and provides insights on the appropriateness of using topic models for informatics applications. Our results indicate that PCPs find discovered topics more coherent and representative of clinical reports relative to students, warranting further research into their use for automatic summarization. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Expanding the Basic Science Debate: The Role of Physics Knowledge in Interpreting Clinical Findings

ERIC Educational Resources Information Center

Goldszmidt, Mark; Minda, John Paul; Devantier, Sarah L.; Skye, Aimee L.; Woods, Nicole N.

2012-01-01

Current research suggests a role for biomedical knowledge in learning and retaining concepts related to medical diagnosis. However, learning may be influenced by other, non-biomedical knowledge. We explored this idea using an experimental design and examined the effects of causal knowledge on the learning, retention, and interpretation of medical…

Mental Health Problems in Adolescence and the Interpretation of Unambiguous Threat

PubMed Central

Henry, Julie D.; Moses, Ernestina; Castellini, Julieta; Scott, James

2015-01-01

Aberrant threat perception has been linked to paranoia, anxiety and other mental health problems, and is widely considered to be a core, transdiagnostic feature of psychopathology. However, to date there has been only limited investigation of whether mental health problems are associated with a biased interpretation of stimuli that have explicit (as opposed to ambiguous) connotations of threat. In the present study, 41 adolescents diagnosed with a mental illness and 45 demographically matched controls were asked to provide danger ratings of stimuli normatively rated as being either low or high in potential threat. All participants were also asked to complete background measures of cognitive function, mental health and wellbeing. The results indicated that the two groups did not differ in their capacity to discriminate between low and high threat stimuli, nor did they differ in the absolute level of threat that they attributed to these stimuli. However, for the control group, the overall level of threat perceived in facial stimuli was correlated with two important indices of mental health (depression and anxiety). No associations emerged in the clinical group. These data are discussed in relation to their potential implications for the role of aberrant threat perception in transdiagnostic models of mental health. PMID:26039081

Practical guidelines for interpreting copy number gains detected by high-resolution array in routine diagnostics

PubMed Central

Hanemaaijer, Nicolien M; Sikkema-Raddatz, Birgit; van der Vries, Gerben; Dijkhuizen, Trijnie; Hordijk, Roel; van Essen, Anthonie J; Veenstra-Knol, Hermine E; Kerstjens-Frederikse, Wilhelmina S; Herkert, Johanna C; Gerkes, Erica H; Leegte, Lamberta K; Kok, Klaas; Sinke, Richard J; van Ravenswaaij-Arts, Conny M A

2012-01-01

The correct interpretation of copy number gains in patients with developmental delay and multiple congenital anomalies is hampered by the large number of copy number variations (CNVs) encountered in healthy individuals. The variable phenotype associated with copy number gains makes interpretation even more difficult. Literature shows that inheritence, size and presence in healthy individuals are commonly used to decide whether a certain copy number gain is pathogenic, but no general consensus has been established. We aimed to develop guidelines for interpreting gains detected by array analysis using array CGH data of 300 patients analysed with the 105K Agilent oligo array in a diagnostic setting. We evaluated the guidelines in a second, independent, cohort of 300 patients. In the first 300 patients 797 gains of four or more adjacent oligonucleotides were observed. Of these, 45.4% were de novo and 54.6% were familial. In total, 94.8% of all de novo gains and 87.1% of all familial gains were concluded to be benign CNVs. Clinically relevant gains ranged from 288 to 7912 kb in size, and were significantly larger than benign gains and gains of unknown clinical relevance (P<0.001). Our study showed that a threshold of 200 kb is acceptable in a clinical setting, whereas heritability does not exclude a pathogenic nature of a gain. Evaluation of the guidelines in the second cohort of 300 patients revealed that the interpretation guidelines were clear, easy to follow and efficient. PMID:21934709

Ensemble Classifiers for Predicting HIV-1 Resistance from Three Rule-Based Genotypic Resistance Interpretation Systems.

PubMed

Raposo, Letícia M; Nobre, Flavio F

2017-08-30

Resistance to antiretrovirals (ARVs) is a major problem faced by HIV-infected individuals. Different rule-based algorithms were developed to infer HIV-1 susceptibility to antiretrovirals from genotypic data. However, there is discordance between them, resulting in difficulties for clinical decisions about which treatment to use. Here, we developed ensemble classifiers integrating three interpretation algorithms: Agence Nationale de Recherche sur le SIDA (ANRS), Rega, and the genotypic resistance interpretation system from Stanford HIV Drug Resistance Database (HIVdb). Three approaches were applied to develop a classifier with a single resistance profile: stacked generalization, a simple plurality vote scheme and the selection of the interpretation system with the best performance. The strategies were compared with the Friedman's test and the performance of the classifiers was evaluated using the F-measure, sensitivity and specificity values. We found that the three strategies had similar performances for the selected antiretrovirals. For some cases, the stacking technique with naïve Bayes as the learning algorithm showed a statistically superior F-measure. This study demonstrates that ensemble classifiers can be an alternative tool for clinical decision-making since they provide a single resistance profile from the most commonly used resistance interpretation systems.

Are biochemistry interpretative comments helpful? Results of a general practitioner and nurse practitioner survey.

PubMed

Barlow, Ian M

2008-01-01

Adding or incorporating clinical interpretative comments on biochemistry results is widespread in UK laboratories; although this consumes considerable human resource, there is still little evidence to suggest that it is either effective or appreciated by our clinical colleagues. I therefore decided to survey our local general practitioners (GPs) and nurse practitioners to analyse whether they found biochemistry comments on reports helpful. A simple questionnaire was designed and sent to 159 GPs and 81 nurse practitioners asking them whether they found this activity useful for the limited range of test groups that we routinely comment on and also whether they would like to see commenting on more groups of tests. Overall, 49.6% of questionnaires were returned. Of these, there was overwhelming support for commenting on reports and 77% would like to see comments on a greater range of tests. Although adding clinical interpretative comments is very time-consuming for senior laboratory staff, there is overwhelming support of this activity among our GPs and nurse practitioner users; therefore, our local policy of routinely adding clinical comments will remain for the foreseeable future.

On causal interpretation of race in regressions adjusting for confounding and mediating variables

PubMed Central

VanderWeele, Tyler J.; Robinson, Whitney R.

2014-01-01

We consider several possible interpretations of the “effect of race” when regressions are run with race as an exposure variable, controlling also for various confounding and mediating variables. When adjustment is made for socioeconomic status early in a person’s life, we discuss under what contexts the regression coefficients for race can be interpreted as corresponding to the extent to which a racial inequality would remain if various socioeconomic distributions early in life across racial groups could be equalized. When adjustment is also made for adult socioeconomic status, we note how the overall racial inequality can be decomposed into the portion that would be eliminated by equalizing adult socioeconomic status across racial groups and the portion of the inequality that would remain even if adult socioeconomic status across racial groups were equalized. We also discuss a stronger interpretation of the “effect of race” (stronger in terms of assumptions) involving the joint effects of race-associated physical phenotype (e.g. skin color), parental physical phenotype, genetic background and cultural context when such variables are thought to be hypothetically manipulable and if adequate control for confounding were possible. We discuss some of the challenges with such an interpretation. Further discussion is given as to how the use of selected populations in examining racial disparities can additionally complicate the interpretation of the effects. PMID:24887159

Diagnostic Reasoning for ST-Segment Elevation Myocardial Infarction (STEMI) Interpretation Is Preserved Despite Fatigue

PubMed Central

Kellogg, Adam R.; Coute, Ryan A.; Garra, Gregory

2015-01-01

Background Fatigue and sleepiness contribute to medical errors, although the effect of circadian disruption and fatigue on diagnostic reasoning skills is largely unknown. Objective To determine whether circadian disruption and fatigue negatively affect the emergency medicine (EM) resident's ability to make important clinical decisions based on electrocardiogram (ECG) interpretation. Methods Senior EM residents at 2 programs completed a questionnaire consisting of various measures of fatigue followed by an ECG test packet of ST-segment elevation myocardial infarction (STEMI) and STEMI mimics. Participants were asked to examine each ECG and determine whether cardiac catheterization laboratory activation (CLA) was indicated, and to report their confidence in their decision making on an 11-point, numeric rating scale. The primary outcome measured was a pairwise difference in accuracy of CLA between daytime and overnight testing. Results A total of 23 residents were enrolled in 2011 and 2012. Subjects demonstrated significant differences in multiple measures of sleepiness and fatigue during overnight periods. The median (interquartile range [IQR]) accuracy of CLA was not significantly different between daytime and overnight (70% [IQR, 50–80] versus 70% [IQR, 60–70], P  =  .82). There were no significant differences in the median number of overcalls (CLA when not a STEMI) and undercalls (no CLA when a STEMI was present; P  =  .57 and .37, respectively). Diagnostic confidence and confidence in CLA were not statistically different between daytime and overnight. Conclusions Despite a measurable degree of fatigue, senior EM residents experienced no decrease in their ability to accurately make CLA decisions based on ECG interpretation. PMID:26217418

Interrater agreement in the interpretation of neonatal electroencephalography in hypoxic-ischemic encephalopathy.

PubMed

Wusthoff, Courtney J; Sullivan, Joseph; Glass, Hannah C; Shellhaas, Renée A; Abend, Nicholas S; Chang, Taeun; Tsuchida, Tammy N

2017-03-01

Research using neonatal electroencephalography (EEG) has been limited by a lack of a standardized classification system and interpretation terminology. In 2013, the American Clinical Neurophysiology Society (ACNS) published a guideline for standardized terminology and categorization in the description of continuous EEG in neonates. We sought to assess interrater agreement for this neonatal EEG categorization system as applied by a group of pediatric neurophysiologists. A total of 60 neonatal EEG studies were collected from three institutions. All EEG segments were from term neonates with hypoxic-ischemic encephalopathy. Three pediatric neurophysiologists independently reviewed each record using the ACNS standardized scoring system. Unweighted kappa values were calculated for interrater agreement of categorical data across multiple observers. Interrater agreement was very good for identification of seizures (κ = 0.93, p < 0.001), with perfect agreement in 95% of records (57 of 60). Interrater agreement was moderate for classifying records as normal or having any abnormality (κ = 0.49, p < 0.001), with perfect agreement in 78% of records (47 of 60). Interrater agreement was good in classifying EEG backgrounds on a 5-category scale (normal, excessively discontinuous, burst suppression, status epilepticus, or electrocerebral inactivity) (κ = 0.70, p < 0.001), with perfect agreement in 72% of records (43 of 60). Other specific background features had lower agreement, including voltage (κ = 0.41, p < 0.001), variability (κ = 0.35, p < 0.001), symmetry (κ = 0.18, p = 0.01), presence of abnormal sharp waves (κ < 0.20, p < 0.05), and presence of brief rhythmic discharges (κ < 0.20, p < 0.05). We found good or very good interrater agreement applying the ACNS system for identification of seizures and classification of EEG background. Other specific EEG features showed limited interrater agreement. Of importance to both clinicians and

Modal Interpretation of Quantum Mechanics and Classical Physical Theories

NASA Astrophysics Data System (ADS)

Ingarden, R. S.

In 1990, Bas C. van Fraassen defined the modal interpretation of quantum mechanics as the consideration of it as ``a pure theory of the possible, with testable, empirical implications for what actually happens". This is a narrow, traditional understanding of modality, only in the sense of the concept of possibility (usually denoted in logic by the C. I. Lewis's symbol 3) and the concept of necessity 2 defined by means of 3. In modern logic, however, modality is understood in a much wider sense as any intensional functor (i.e. non-extensional or determined not only by the truth value of a sentence). In the recent (independent of van Fraassen) publications of the author (1997), an attempt was made to apply this wider understanding of modality to interpretation of classical and quantum physics. In the present lecture, these problems are discussed on the background of a brief review of the logical approch to quantum mechanics in the recent 7 decades. In this discussion, the new concepts of sub-modality and super-modality of many orders are used.

Social Interpretation Bias in Children and Adolescents with Anxiety Disorders: Psychometric Examination of the Self-Report of Ambiguous Social Situations for Youth (SASSY) Scale

ERIC Educational Resources Information Center

Gonzalez, Araceli; Rozenman, Michelle; Langley, Audra K.; Kendall, Philip C.; Ginsburg, Golda S.; Compton, Scott; Walkup, John T.; Birmaher, Boris; Albano, Anne Marie; Piacentini, John

2017-01-01

Background: Anxiety disorders are among the most common mental health problems in youth, and faulty interpretation bias has been positively linked to anxiety severity, even within anxiety-disordered youth. Quick, reliable assessment of interpretation bias may be useful in identifying youth with certain types of anxiety or assessing changes on…

Central Core Laboratory versus Site Interpretation of Coronary CT Angiography: Agreement and Association with Cardiovascular Events in the PROMISE Trial.

PubMed

Lu, Michael T; Meyersohn, Nandini M; Mayrhofer, Thomas; Bittner, Daniel O; Emami, Hamed; Puchner, Stefan B; Foldyna, Borek; Mueller, Martin E; Hearne, Steven; Yang, Clifford; Achenbach, Stephan; Truong, Quynh A; Ghoshhajra, Brian B; Patel, Manesh R; Ferencik, Maros; Douglas, Pamela S; Hoffmann, Udo

2018-04-01

Purpose To assess concordance and relative prognostic utility between central core laboratory and local site interpretation for significant coronary artery disease (CAD) and cardiovascular events. Materials and Methods In the Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE) trial, readers at 193 North American sites interpreted coronary computed tomographic (CT) angiography as part of the clinical evaluation of stable chest pain. Readers at a central core laboratory also interpreted CT angiography blinded to clinical data, site interpretation, and outcomes. Significant CAD was defined as stenosis greater than or equal to 50%; cardiovascular events were defined as a composite of cardiovascular death or myocardial infarction. Results In 4347 patients (51.8% women; mean age ± standard deviation, 60.4 years ± 8.2), core laboratory and site interpretations were discordant in 16% (683 of 4347), most commonly because of a finding of significant CAD by site but not by core laboratory interpretation (80%, 544 of 683). Overall, core laboratory interpretation resulted in 41% fewer patients being reported as having significant CAD (14%, 595 of 4347 vs 23%, 1000 of 4347; P < .001). Over a median follow-up period of 25 months, 1.3% (57 of 4347) sustained myocardial infarction or cardiovascular death. The C statistic for future myocardial infarction or cardiovascular death was 0.61 (95% confidence interval [CI]: 0.54, 0.68) for the core laboratory and 0.63 (95% CI: 0.56, 0.70) for the sites. Conclusion Compared with interpretation by readers at 193 North American sites, standardized core laboratory interpretation classified 41% fewer patients as having significant CAD. © RSNA, 2017 Online supplemental material is available for this article. Clinical trial registration no. NCT01174550.

The relationship between adult reactive and proactive aggression, hostile interpretation bias, and antisocial personality disorder.

PubMed

Lobbestael, Jill; Cima, Maaike; Arntz, Arnoud

2013-02-01

Reactive aggression (RA) refers to angry responses to provocation or frustration, while proactive aggression (PA) denotes nonemotional, instrumental, and unprovoked aggression. The current study examined personality-related and cognitive correlates of both aggressive types. Respectively, the predictive values of antisocial personality disorder (ASPD), and of hostile interpretation bias, which is the tendency to interpret ambiguous stimuli in a hostile manner, were studied. The sample consisted of n = 37 male adult patients with mixed diagnoses and n = 29 male nonpatients that responded to vignettes and pictures of ambiguous situations, using both open and closed answer formats. ASPD was assessed by means of the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), and the Reactive Proactive Questionnaire (RPQ) measured RA and PA. Results showed that although both RA and PA types were predicted by ASPD traits, RA was additionally predicted by a hostile interpretation bias. These findings suggest that reducing hostile bias is a promising avenue for clinical treatment of ASPD-patients high in RA.

Mechanistic background and clinical applications of indocyanine green fluorescence imaging of hepatocellular carcinoma.

PubMed

Ishizawa, Takeaki; Masuda, Koichi; Urano, Yasuteru; Kawaguchi, Yoshikuni; Satou, Shouichi; Kaneko, Junichi; Hasegawa, Kiyoshi; Shibahara, Junji; Fukayama, Masashi; Tsuji, Shingo; Midorikawa, Yutaka; Aburatani, Hiroyuki; Kokudo, Norihiro

2014-02-01

Although clinical applications of intraoperative fluorescence imaging of liver cancer using indocyanine green (ICG) have begun, the mechanistic background of ICG accumulation in the cancerous tissues remains unclear. In 170 patients with hepatocellular carcinoma cells (HCC), the liver surfaces and resected specimens were intraoperatively examined by using a near-infrared fluorescence imaging system after preoperative administration of ICG (0.5 mg/kg i.v.). Microscopic examinations, gene expression profile analysis, and immunohistochemical staining were performed for HCCs, which showed ICG fluorescence in the cancerous tissues (cancerous-type fluorescence), and HCCs showed fluorescence only in the surrounding non-cancerous liver parenchyma (rim-type fluorescence). ICG fluorescence imaging enabled identification of 273 of 276 (99%) HCCs in the resected specimens. HCCs showed that cancerous-type fluorescence was associated with higher cancer cell differentiation as compared with rim-type HCCs (P < 0.001). Fluorescence microscopy identified the presence of ICG in the canalicular side of the cancer cell cytoplasm, and pseudoglands of the HCCs showed a cancerous-type fluorescence pattern. The ratio of the gene and protein expression levels in the cancerous to non-cancerous tissues for Na(+)/taurocholate cotransporting polypeptide (NTCP) and organic anion-transporting polypeptide 8 (OATP8), which are associated with portal uptake of ICG by hepatocytes that tended to be higher in the HCCs that showed cancerous-type fluorescence than in those that showed rim-type fluorescence. Preserved portal uptake of ICG in differentiated HCC cells by NTCP and OATP8 with concomitant biliary excretion disorders causes accumulation of ICG in the cancerous tissues after preoperative intravenous administration. This enables highly sensitive identification of HCC by intraoperative ICG fluorescence imaging.

[Maintenance treatment in opioid-dependent patients with migration background].

PubMed

Bald, L K; Schouler-Ocak, M; Penka, S; Schoofs, N; Häbel, T; Bermpohl, F; Gutwinski, S

2016-05-01

No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries. This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT). From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis. Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT. The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.

Differences in spirometry interpretation algorithms: influence on decision making among primary-care physicians

PubMed Central

He, Xiao-Ou; D’Urzo, Anthony; Jugovic, Pieter; Jhirad, Reuven; Sehgal, Prateek; Lilly, Evan

2015-01-01

Background: Spirometry is recommended for the diagnosis of asthma and chronic obstructive pulmonary disease (COPD) in international guidelines and may be useful for distinguishing asthma from COPD. Numerous spirometry interpretation algorithms (SIAs) are described in the literature, but no studies highlight how different SIAs may influence the interpretation of the same spirometric data. Aims: We examined how two different SIAs may influence decision making among primary-care physicians. Methods: Data for this initiative were gathered from 113 primary-care physicians attending accredited workshops in Canada between 2011 and 2013. Physicians were asked to interpret nine spirograms presented twice in random sequence using two different SIAs and touch pad technology for anonymous data recording. Results: We observed differences in the interpretation of spirograms using two different SIAs. When the pre-bronchodilator FEV1/FVC (forced expiratory volume in one second/forced vital capacity) ratio was >0.70, algorithm 1 led to a ‘normal’ interpretation (78% of physicians), whereas algorithm 2 prompted a bronchodilator challenge revealing changes in FEV1 that were consistent with asthma, an interpretation selected by 94% of physicians. When the FEV1/FVC ratio was <0.70 after bronchodilator challenge but FEV1 increased >12% and 200 ml, 76% suspected asthma and 10% suspected COPD using algorithm 1, whereas 74% suspected asthma versus COPD using algorithm 2 across five separate cases. The absence of a post-bronchodilator FEV1/FVC decision node in algorithm 1 did not permit consideration of possible COPD. Conclusions: This study suggests that differences in SIAs may influence decision making and lead clinicians to interpret the same spirometry data differently. PMID:25763716

When neuroscience met clinical pathology: partitioning experimental variation to aid data interpretation in neuroscience.

PubMed

Jeffery, Nick D; Bate, Simon T; Safayi, Sina; Howard, Matthew A; Moon, Lawrence; Jeffery, Unity

2018-03-01

In animal experiments, neuroscientists typically assess the effectiveness of interventions by comparing the average response of groups of treated and untreated animals. While providing useful insights, focusing only on group effects risks overemphasis of small, statistically significant but physiologically unimportant, differences. Such differences can be created by analytical variability or physiological within-individual variation, especially if the number of animals in each group is small enough that one or two outlier values can have considerable impact on the summary measures for the group. Physicians face a similar dilemma when comparing two results from the same patient. To determine whether the change between two values reflects disease progression or known analytical and physiological variation, the magnitude of the difference between two results is compared to the reference change value. These values are generated by quantifying analytical and within-individual variation, and differences between two results from the same patient are considered clinically meaningful only if they exceed the combined effect of these two sources of 'noise'. In this article, we describe how the reference change interval can be applied within neuroscience. This form of analysis provides a measure of outcome at an individual level that complements traditional group-level comparisons, and therefore, introduction of this technique into neuroscience can enrich interpretation of experimental data. It can also safeguard against some of the possible misinterpretations that may occur during analysis of the small experimental groups that are common in neuroscience and, by illuminating analytical error, may aid in design of more efficient experimental methods. © 2018 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Theory Interpretations in PVS

NASA Technical Reports Server (NTRS)

Owre, Sam; Shankar, Natarajan; Butler, Ricky W. (Technical Monitor)

2001-01-01

The purpose of this task was to provide a mechanism for theory interpretations in a prototype verification system (PVS) so that it is possible to demonstrate the consistency of a theory by exhibiting an interpretation that validates the axioms. The mechanization makes it possible to show that one collection of theories is correctly interpreted by another collection of theories under a user-specified interpretation for the uninterpreted types and constants. A theory instance is generated and imported, while the axiom instances are generated as proof obligations to ensure that the interpretation is valid. Interpretations can be used to show that an implementation is a correct refinement of a specification, that an axiomatically defined specification is consistent, or that a axiomatically defined specification captures its intended models. In addition, the theory parameter mechanism has been extended with a notion of theory as parameter so that a theory instance can be given as an actual parameter to an imported theory. Theory interpretations can thus be used to refine an abstract specification or to demonstrate the consistency of an axiomatic theory. In this report we describe the mechanism in detail. This extension is a part of PVS version 3.0, which will be publicly released in mid-2001.

Refining diagnosis of Parkinson's disease with deep learning-based interpretation of dopamine transporter imaging.

PubMed

Choi, Hongyoon; Ha, Seunggyun; Im, Hyung Jun; Paek, Sun Ha; Lee, Dong Soo

2017-01-01

Dopaminergic degeneration is a pathologic hallmark of Parkinson's disease (PD), which can be assessed by dopamine transporter imaging such as FP-CIT SPECT. Until now, imaging has been routinely interpreted by human though it can show interobserver variability and result in inconsistent diagnosis. In this study, we developed a deep learning-based FP-CIT SPECT interpretation system to refine the imaging diagnosis of Parkinson's disease. This system trained by SPECT images of PD patients and normal controls shows high classification accuracy comparable with the experts' evaluation referring quantification results. Its high accuracy was validated in an independent cohort composed of patients with PD and nonparkinsonian tremor. In addition, we showed that some patients clinically diagnosed as PD who have scans without evidence of dopaminergic deficit (SWEDD), an atypical subgroup of PD, could be reclassified by our automated system. Our results suggested that the deep learning-based model could accurately interpret FP-CIT SPECT and overcome variability of human evaluation. It could help imaging diagnosis of patients with uncertain Parkinsonism and provide objective patient group classification, particularly for SWEDD, in further clinical studies.

How we implemented an analytical support clinic to strengthen student research capacity in Zambia.

PubMed

Andrews, Ben; Musonda, Patrick; Simuyemba, Moses; Wilson, Craig M; Nzala, Selestine; Vermund, Sten H; Michelo, Charles

2014-12-11

Abstract Background: Research outputs in sub-Saharan Africa may be limited by a scarcity of clinical research expertise. In Zambia, clinical and biomedical postgraduate students are often delayed in graduation due to challenges in completing their research dissertations. We sought to strengthen institutional research capacity by supporting student and faculty researchers through weekly epidemiology and biostatistics clinics. Methods: We instituted a weekly Analytical Support Clinic at the University of Zambia, School of Medicine. A combination of biostatisticians, clinical researchers and epidemiologists meet weekly with clients to address questions of proposal development, data management and analysis. Clinic sign-in sheets were reviewed. Results: 109 students and faculty members accounted for 197 visits to the Clinic. Nearly all clients (107/109, 98.2%) were undergraduate or postgraduate students. Reasons for attending the Clinic were primarily for proposal development (46.7%) and data management/analysis (42.1%). The most common specific reasons for seeking help were data analysis and interpretation (36.5%), development of study design and research questions (26.9%) and sample size calculation (21.8%). Conclusions: The Analytical Support Clinic is an important vehicle for strengthening postgraduate research through one-on-one and small group demand-driven interactions. The clinic approach supplements mentorship from departmental supervisors, providing specific expertise and contextual teaching.

The Diffuse Soft X-ray Background: Trials and Tribulations

NASA Astrophysics Data System (ADS)

Ulmer, Melville P.

2013-01-01

I joined the University of Wisconsin-Madison sounding rocket group at its inception. It was an exciting time, as nobody knew what the X-ray sky looked like. Our group focused on the soft X-ray background, and built proportional counters with super thin (2 micron thick) windows. As the inter gas pressure of the counters was about 1 atmosphere, it was no mean feat to get payload to launch without the window bursting. On top of that we built all our own software from space solutions to unfolding the spectral data. For we did it then as now: Our computer code modeled the detector response and then folded various spectral shapes through the response and compared the results with the raw data. As far as interpretation goes, here are examples of how one can get things wrong: The Berkeley group published a paper of the soft X-ray background that disagreed with ours. Why? It turned out they had **assumed** the galactic plane was completely opaque to soft X-ray and hence corrected for detector background that way. It turns out that the ISM emits in soft X-rays! Another example was the faux pas of the Calgary group. They didn’t properly shield their detector from the sounding rocket telemetry. Thus they got an enormous signal, which to our amusement some (ambulance chaser) theoreticians tried to explain! So back then as now, mistakes were made, but at least we all knew how our X-ray systems worked from soup (the detectors) to nuts (the data analysis code) where as toady “anybody” with a good idea but only a vague inkling of how detectors, mirrors and software work, can be an X-ray astronomer. On the one hand, this has made the field accessible to all, and on the other, errors in interpretation can be made as the X-ray telescope user can fall prey to running black box software. Furthermore with so much funding going into supporting observers, there is little left to make the necessary technology advances or keep the core expertise in place to even to stay even with

Do symptom interpretations mediate the relationship between panic attack symptoms and agoraphobic avoidance?

PubMed

Berle, David; Starcevic, Vladan; Milicevic, Denise; Hannan, Anthony; Moses, Karen

2010-05-01

There is little consensus as to whether agoraphobic avoidance in panic disorder is characterized by a prominence of particular symptoms and interpretations of those symptoms. We sought to clarify the relationship between symptoms and agoraphobic avoidance and to establish whether catastrophic interpretations of symptoms mediate any such relationships. The Symptom Checklist 90-Revised, Agoraphobic Cognitions Questionnaire and Mobility Inventory were administered to 117 patients with panic disorder who were attending an outpatient anxiety disorders clinic. Medium to large associations were found between most symptoms and agoraphobic avoidance and between particular symptoms and the corresponding symptom interpretation items. Some interpretations of symptoms were found to mediate relationships between symptoms and agoraphobic avoidance. These findings suggest that the catastrophic misinterpretation model of panic disorder can to some extent be invoked to explain the extent of agoraphobic avoidance, but that there may also be other pathways leading from symptoms to agoraphobia.

[Acceptance and Commitment Therapy: Theoretical background and practice].

PubMed

Eisenbeck, Nikolett; Schlosser, Károly Kornél; Szondy, Máté; Szabó-Bartha, Anett

The Acceptance and Commitment Therapy (ACT) is one of the modern, so-called third-wave behavioural therapies. Among them the most successful is ACT, both in the number of therapists and respective scientific research. ACT's theoretical and philosophical background is described explicitly and its therapeutic interventions were developed according to this philosophy. Its psychopathological model is based on the idea that mainly the person's regulatory efforts of their own thoughts and feelings lead to psychological problems. That is, the source of human suffering and various psychological problems is the so called psychological inflexibility: control attempts of private events instead of living a life based on personal values and long-term goals. Therefore, clinical work in ACT focuses on the acceptance and defusion of the unwanted inner experiences and on the development of a meaningful life. The present article aims to provide a comprehensive description of ACT in Hungarian: its theoretical background, clinical techniques, and efficacy. At the end of the article, the state of ACT in Hungary will also be briefly discussed.

Clinical interpretation of antinuclear antibody tests in systemic rheumatic diseases

PubMed Central

Mercado, Monica Vázquez-Del; Chan, Edward K. L.

2010-01-01

Autoantibody tests have been used extensively in diagnosis and follow-up of patients in rheumatology clinics. Immunofluorescent antinuclear antibody test using HEp-2 cells is still considered the gold standard for screening of autoantibodies, and most of specific autoantibodies are currently tested by ELISA as a next step. Among the many autoantibody specificities described, some have been established as clinically useful diagnostic markers and are included in the classification criteria of diseases. Despite a long history of routine tests and attempts to standardize such assays, there are still limitations and problems that clinicians need to be aware of. Clinicians should be able to use autoantibody tests more efficiently and effectively with a basic knowledge on the significance of and potential problems in autoantibody tests. PMID:19277826

Interpreting advance directives: ethical considerations of the interplay between personal and cultural identity.

PubMed

Schicktanz, Silke

2009-06-01

In many industrialized countries ethicists and lawyers favour advance directives as a tool to guarantee patient autonomy in end-of-life-decisions. However, most citizens seem reluctant to adopt the practice; the number of patients who have an advance directive is low across most countries. The article discusses the key argument for seeing such documents as an instrument of self-interpretation and life-planning, which ultimately have to be interpreted by third parties as well. Interpretation by third parties and the process of self-reflection are conceptually linked by a qualitative concept of identity. Identity is conceived here as constructed in a processual dialogue between a personal and a cultural perspective. How the cultural dimension comes into play in understanding the motivation, rejection or content of wished for end-of-life-decisions, is shown by a brief review of empirical and cultural studies. Understanding advance directives as a culturally embedded tool of self-interpretation should help to overcome urgent moral problems in clinical settings: how to interpret such documents, how to deliberate on the content and on the best form.

A taste of individualized medicine: physicians’ reactions to automated genetic interpretations

PubMed Central

Lærum, Hallvard; Bremer, Sara; Bergan, Stein; Grünfeld, Thomas

2014-01-01

The potential of pharmacogenomics is well documented, and functionality exploiting this knowledge is about to be introduced into electronic medical records. To explore physicians’ reactions to automatic interpretations of genetic tests, we built a prototype with a simple interpretive algorithm. The algorithm was adapted to the needs of physicians handling immunosuppressive treatment during organ transplantation. Nine physicians were observed expressing their thoughts while using the prototype for two patient scenarios. The computer screen and audio were recorded, and the qualitative results triangulated with responses to a survey instrument. The physicians’ reactions to the prototype were very positive; they clearly trusted the results and the theory behind them. The explanation of the algorithm was prominently placed in the user interface for transparency, although this design led to considerable confusion. Background information and references should be available, but considerably less prominent than the result and recommendation. PMID:24001515

Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial.

PubMed

Lion, K Casey; Brown, Julie C; Ebel, Beth E; Klein, Eileen J; Strelitz, Bonnie; Gutman, Colleen Kays; Hencz, Patty; Fernandez, Juan; Mangione-Smith, Rita

2015-12-01

Consistent professional interpretation improves communication with patients who have limited English proficiency. Remote modalities (telephone and video) have the potential for wide dissemination. To test the effect of telephone vs. video interpretation on communication during pediatric emergency care. Randomized trial of telephone vs. video interpretation at a free-standing, university-affiliated pediatric emergency department (ED). A convenience sample of 290 Spanish-speaking parents of pediatric ED patients with limited English proficiency were approached from February 24 through August 16, 2014, of whom 249 (85.9%) enrolled; of these, 208 (83.5%) completed the follow-up survey (91 parents in the telephone arm and 117 in the video arm). Groups did not differ significantly by consent or survey completion rate, ED factors (eg, ED crowding), child factors (eg, triage level, medical complexity), or parent factors (eg, birth country, income). Investigators were blinded to the interpretation modality during outcome ascertainment. Intention-to-treat data were analyzed August 25 to October 20, 2014. Telephone or video interpretation for the ED visit, randomized by day. Parents were surveyed 1 to 7 days after the ED visit to assess communication and interpretation quality, frequency of lapses in interpreter use, and ability to name the child's diagnosis. Two blinded reviewers compared parent-reported and medical record-abstracted diagnoses and classified parent-reported diagnoses as correct, incorrect, or vague. Among 208 parents who completed the survey, those in the video arm were more likely to name the child's diagnosis correctly than those in the telephone arm (85 of 114 [74.6%] vs. 52 of 87 [59.8%]; P = .03) and less likely to report frequent lapses in interpreter use (2 of 117 [1.7%] vs. 7 of 91 [7.7%]; P = .04). No differences were found between the video and telephone arms in parent-reported quality of communication (101 of 116 [87.1%] vs. 74 of 89 [83

Psychiatric emergencies of minors with and without migration background.

PubMed

Akkaya-Kalayci, Türkan; Popow, Christian; Waldhör, Thomas; Winkler, Dietmar; Özlü-Erkilic, Zeliha

2017-03-01

The conditions of children and adolescents with migration background receiving emergency psychiatric care in Europe are not well known. Migrants usually attend regular psychiatric care less frequently than the autochthonous population. We therefore speculated that, being undertreated, they would be overrepresented among psychiatric emergency care patients. We retrospectively analyzed the records of 1093 minors aged 4‑18 years treated during a period of three years at the psychiatric emergency outpatient clinic of the Department of Child and Adolescent Psychiatry at the Medical University of Vienna. More minors with migration background than natives consulted our emergency clinic. Most frequent reasons for referral were suicide attempts by Turkish patients, acute stress disorder in Serbian/Croatian/Bosnian and in Austrian patients. Psychiatric diagnoses like eating and personality disorders were mostly diagnosed in natives. We found gender specific differences between the groups. The reasons for these differences possibly relate to deficits of adequate mental health-care in Austria, to intercultural and intrafamiliar conflicts related to acculturation distress in the migrant population. Prospective longitudinal studies focusing on the utilization of mental health care by the migrant children and the impact of the migration background on their mental health are needed for improving adequate culture-sensitive mental-health care for this population.

The INTERPRET-DD study of diabetes and depression: a protocol.

PubMed

Lloyd, C E; Sartorius, N; Cimino, L C; Alvarez, A; Guinzbourg de Braude, M; Rabbani, G; Uddin Ahmed, H; Papelbaum, M; Regina de Freitas, S; Ji, L; Yu, X; Gaebel, W; Müssig, K; Chaturvedi, S K; Srikanta, S S; Burti, L; Bulgari, V; Musau, A; Ndetei, D; Heinze, G; Romo Nava, F; Taj, R; Khan, A; Kokoszka, A; Papasz-Siemieniuk, A; Starostina, E G; Bobrov, A E; Lecic-Tosevski, D; Lalic, N M; Udomratn, P; Tangwongchai, S; Bahendeka, S; Basangwa, D; Mankovsky, B

2015-07-01

People with diabetes are at an increased risk of developing depression and other psychological disorders. However, little is known about the prevalence, correlates or care pathways in countries other than the UK and the USA. A new study, the International Prevalence and Treatment of Diabetes and Depression Study (INTERPRET-DD) aims to address this dearth of knowledge and identify optimal pathways to care across the globe. INTERPRET-DD is a 2-year longitudinal study, taking place in 16 countries' diabetes outpatients' facilities, investigating the recognition and management of depressive disorders in people with Type 2 diabetes. Clinical interviews are used to diagnose depression, with clinical and other data obtained from medical records and through patient interviews. Pathways to care and the impact of treatment for previously unrecognized (undocumented) depression on clinical outcomes and emotional well-being are being investigated. Initial evidence indicates that a range of pathways to care exist, with few of them based on available recommendations for treatment. Pilot data indicates that the instruments we are using to measure both the symptoms and clinical diagnosis of depression are acceptable in our study population and easy to use. Our study will increase the understanding of the impact of comorbid diabetes and depression and identify the most appropriate (country-specific) pathways via which patients receive their care. It addresses an important public health problem and leads to recommendations for best practice relevant to the different participating centres with regard to the identification and treatment of people with comorbid diabetes and depression. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

General Mathematical Ability Predicts PASAT Performance in MS Patients: Implications for Clinical Interpretation and Cognitive Reserve.

PubMed

Sandry, Joshua; Paxton, Jessica; Sumowski, James F

2016-03-01

The Paced Auditory Serial Addition Test (PASAT) is used to assess cognitive status in multiple sclerosis (MS). Although the mathematical demands of the PASAT seem minor (single-digit arithmetic), cognitive psychology research links greater mathematical ability (e.g., algebra, calculus) to more rapid retrieval of single-digit math facts (e.g., 5+6=11). The present study evaluated the hypotheses that (a) mathematical ability is related to PASAT performance and (b) both the relationship between intelligence and PASAT performance as well as the relationship between education and PASAT performance are both mediated by mathematical ability. Forty-five MS patients were assessed using the Wechsler Test of Adult Reading, PASAT and Calculation Subtest of the Woodcock-Johnson-III. Regression based path analysis and bootstrapping were used to compute 95% confidence intervals and test for mediation. Mathematical ability (a) was related to PASAT (β=.61; p<.001) and (b) fully mediated the relationship between Intelligence and PASAT (β=.76; 95% confidence interval (CI95)=.28, 1.45; direct effect of Intelligence, β=.42; CI95=-.39, 1.23) as well as the relationship between Education and PASAT (β=2.43, CI95=.81, 5.16, direct effect of Education, β=.83, CI95=-1.95, 3.61). Mathematical ability represents a source of error in the clinical interpretation of cognitive decline using the PASAT. Domain-specific cognitive reserve is discussed.

Computer-aided interpretation approach for optical tomographic images

NASA Astrophysics Data System (ADS)

Klose, Christian D.; Klose, Alexander D.; Netz, Uwe J.; Scheel, Alexander K.; Beuthan, Jürgen; Hielscher, Andreas H.

2010-11-01

A computer-aided interpretation approach is proposed to detect rheumatic arthritis (RA) in human finger joints using optical tomographic images. The image interpretation method employs a classification algorithm that makes use of a so-called self-organizing mapping scheme to classify fingers as either affected or unaffected by RA. Unlike in previous studies, this allows for combining multiple image features, such as minimum and maximum values of the absorption coefficient for identifying affected and not affected joints. Classification performances obtained by the proposed method were evaluated in terms of sensitivity, specificity, Youden index, and mutual information. Different methods (i.e., clinical diagnostics, ultrasound imaging, magnet resonance imaging, and inspection of optical tomographic images), were used to produce ground truth benchmarks to determine the performance of image interpretations. Using data from 100 finger joints, findings suggest that some parameter combinations lead to higher sensitivities, while others to higher specificities when compared to single parameter classifications employed in previous studies. Maximum performances are reached when combining the minimum/maximum ratio of the absorption coefficient and image variance. In this case, sensitivities and specificities over 0.9 can be achieved. These values are much higher than values obtained when only single parameter classifications were used, where sensitivities and specificities remained well below 0.8.

Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey.

PubMed

Hadziabdic, Emina; Albin, Björn; Hjelm, Katarina

2014-02-03

professional interpreter were: a good knowledge of languages and medical terminology, translation ability, and sharing the same origin, dialect and gender as the patient. This study confirmed previous qualitative findings from European migrant groups with a different cultural and linguistic background. The study supports the importance of planning a good interpretation situation in accordance with individuals' desire, irrespective of the migrant's linguistic and cultural background, and using interpreters who interpret literally and objectively, who are highly trained with language skills in medical terminology, and with a professional attitude to promote communication, thus increasing cost-effective, high-quality individualized healthcare.

Using x-ray mammograms to assist in microwave breast image interpretation.

PubMed

Curtis, Charlotte; Frayne, Richard; Fear, Elise

2012-01-01

Current clinical breast imaging modalities include ultrasound, magnetic resonance (MR) imaging, and the ubiquitous X-ray mammography. Microwave imaging, which takes advantage of differing electromagnetic properties to obtain image contrast, shows potential as a complementary imaging technique. As an emerging modality, interpretation of 3D microwave images poses a significant challenge. MR images are often used to assist in this task, and X-ray mammograms are readily available. However, X-ray mammograms provide 2D images of a breast under compression, resulting in significant geometric distortion. This paper presents a method to estimate the 3D shape of the breast and locations of regions of interest from standard clinical mammograms. The technique was developed using MR images as the reference 3D shape with the future intention of using microwave images. Twelve breast shapes were estimated and compared to ground truth MR images, resulting in a skin surface estimation accurate to within an average Euclidean distance of 10 mm. The 3D locations of regions of interest were estimated to be within the same clinical area of the breast as corresponding regions seen on MR imaging. These results encourage investigation into the use of mammography as a source of information to assist with microwave image interpretation as well as validation of microwave imaging techniques.

The complexity of interpreting genomic data in patients with acute myeloid leukemia

PubMed Central

Nazha, A; Zarzour, A; Al-Issa, K; Radivoyevitch, T; Carraway, H E; Hirsch, C M; Przychodzen, B; Patel, B J; Clemente, M; Sanikommu, S R; Kalaycio, M; Maciejewski, J P; Sekeres, M A

2016-01-01

Acute myeloid leukemia (AML) is a heterogeneous neoplasm characterized by the accumulation of complex genetic alterations responsible for the initiation and progression of the disease. Translating genomic information into clinical practice remained challenging with conflicting results regarding the impact of certain mutations on disease phenotype and overall survival (OS) especially when clinical variables are controlled for when interpreting the result. We sequenced the coding region for 62 genes in 468 patients with secondary AML (sAML) and primary AML (pAML). Overall, mutations in FLT3, DNMT3A, NPM1 and IDH2 were more specific for pAML whereas UTAF1, STAG2, BCORL1, BCOR, EZH2, JAK2, CBL, PRPF8, SF3B1, ASXL1 and DHX29 were more specific for sAML. However, in multivariate analysis that included clinical variables, only FLT3 and DNMT3A remained specific for pAML and EZH2, BCOR, SF3B1 and ASXL1 for sAML. When the impact of mutations on OS was evaluated in the entire cohort, mutations in DNMT3A, PRPF8, ASXL1, CBL EZH2 and TP53 had a negative impact on OS; no mutation impacted OS favorably; however, in a cox multivariate analysis that included clinical data, mutations in DNMT3A, ASXL1, CBL, EZH2 and TP53 became significant. Thus, controlling for clinical variables is important when interpreting genomic data in AML. PMID:27983727

The complexity of interpreting genomic data in patients with acute myeloid leukemia.

PubMed

Nazha, A; Zarzour, A; Al-Issa, K; Radivoyevitch, T; Carraway, H E; Hirsch, C M; Przychodzen, B; Patel, B J; Clemente, M; Sanikommu, S R; Kalaycio, M; Maciejewski, J P; Sekeres, M A

2016-12-16

Acute myeloid leukemia (AML) is a heterogeneous neoplasm characterized by the accumulation of complex genetic alterations responsible for the initiation and progression of the disease. Translating genomic information into clinical practice remained challenging with conflicting results regarding the impact of certain mutations on disease phenotype and overall survival (OS) especially when clinical variables are controlled for when interpreting the result. We sequenced the coding region for 62 genes in 468 patients with secondary AML (sAML) and primary AML (pAML). Overall, mutations in FLT3, DNMT3A, NPM1 and IDH2 were more specific for pAML whereas UTAF1, STAG2, BCORL1, BCOR, EZH2, JAK2, CBL, PRPF8, SF3B1, ASXL1 and DHX29 were more specific for sAML. However, in multivariate analysis that included clinical variables, only FLT3 and DNMT3A remained specific for pAML and EZH2, BCOR, SF3B1 and ASXL1 for sAML. When the impact of mutations on OS was evaluated in the entire cohort, mutations in DNMT3A, PRPF8, ASXL1, CBL EZH2 and TP53 had a negative impact on OS; no mutation impacted OS favorably; however, in a cox multivariate analysis that included clinical data, mutations in DNMT3A, ASXL1, CBL, EZH2 and TP53 became significant. Thus, controlling for clinical variables is important when interpreting genomic data in AML.

The Role of Medical Interpretation on Breast and Cervical Cancer Screening Among Asian American and Pacific Islander Women

PubMed Central

Lee, Jessica; Tran, Jacqueline H.; Kagawa-Singer, Marjorie; Foo, Mary Anne; Nguyen, Tu-Uyen N.; Valdez-Dadia, Annalyn; Thomson, Jasmin; Tanjasiri, Sora Park

2010-01-01

We examined whether the impact of medical interpretation services was associated with the receipt of a mammogram, clinical breast exam, and Pap smear. We conducted a large cross-sectional study involving four Asian American and Pacific Islander (AAPI) communities with high proportions of individuals with limited English proficiency (LEP). Participants were recruited from community clinics, churches and temples, supermarkets, and other community gathering sites in Northern and Southern California. Among those that responded, 98% completed the survey rendering a total of 1,708 AAPI women. In a series of multivariate logistic regression models, it was found that women who typically used a medical interpreter had a greater odds of having received a mammogram (odds ratio [OR] = 1.85; 95% confidence interval [CI] = 1.21, 2.83), clinical breast exam (OR = 3.03; 95% CI = 1.82, 5.03), and a Pap smear (OR = 2.34; 95% CI = 1.38, 3.97) than those who did not usually use an interpreter. The study provides support for increasing language access in healthcare settings. In particular, medical interpreters may help increase the utilization of breast and cervical cancer screening among LEP AAPI women. PMID:20352398

Insights into the background of autonomic medicine.

PubMed

Laranjo, Sérgio; Geraldes, Vera; Oliveira, Mário; Rocha, Isabel

2017-10-01

Knowledge of the physiology underlying the autonomic nervous system is pivotal for understanding autonomic dysfunction in clinical practice. Autonomic dysfunction may result from primary modifications of the autonomic nervous system or be secondary to a wide range of diseases that cause severe morbidity and mortality. Together with a detailed history and physical examination, laboratory assessment of autonomic function is essential for the analysis of various clinical conditions and the establishment of effective, personalized and precise therapeutic schemes. This review summarizes the main aspects of autonomic medicine that constitute the background of cardiovascular autonomic dysfunction. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Urine Culture in Uncomplicated UTI: Interpretation and Significance.

PubMed

Stapleton, Ann E

2016-05-01

Acute uncomplicated urinary tract infection (UTI) is a common clinical problem, accounting for millions of outpatient visits in the USA annually. Although routinely obtaining urine cultures in UTI is not recommended, there are circumstances in which obtaining a pre-therapy culture may be warranted or chosen by clinicians, such as when indicated by the need for careful antimicrobial stewardship. This review focuses on understanding reasons for obtaining a pre-therapy culture, methods of collection, and appropriately interpreting urine culture data.

Native language governs interpretation of salient speech sound differences at 18 months

PubMed Central

Dietrich, Christiane; Swingley, Daniel; Werker, Janet F.

2007-01-01

One of the first steps infants take in learning their native language is to discover its set of speech-sound categories. This early development is shown when infants begin to lose the ability to differentiate some of the speech sounds their language does not use, while retaining or improving discrimination of language-relevant sounds. However, this aspect of early phonological tuning is not sufficient for language learning. Children must also discover which of the phonetic cues that are used in their language serve to signal lexical distinctions. Phonetic variation that is readily discriminable to all children may indicate two different words in one language but only one word in another. Here, we provide evidence that the language background of 1.5-year-olds affects their interpretation of phonetic variation in word learning, and we show that young children interpret salient phonetic variation in language-specific ways. Three experiments with a total of 104 children compared Dutch- and English-learning 18-month-olds' responses to novel words varying in vowel duration or vowel quality. Dutch learners interpreted vowel duration as lexically contrastive, but English learners did not, in keeping with properties of Dutch and English. Both groups performed equivalently when differentiating words varying in vowel quality. Thus, at one and a half years, children's phonological knowledge already guides their interpretation of salient phonetic variation. We argue that early phonological learning is not just a matter of maintaining the ability to distinguish language-relevant phonetic cues. Learning also requires phonological interpretation at appropriate levels of linguistic analysis. PMID:17911262

The Database for Aggregate Analysis of ClinicalTrials.gov (AACT) and Subsequent Regrouping by Clinical Specialty

PubMed Central

Tasneem, Asba; Aberle, Laura; Ananth, Hari; Chakraborty, Swati; Chiswell, Karen; McCourt, Brian J.; Pietrobon, Ricardo

2012-01-01

Background The ClinicalTrials.gov registry provides information regarding characteristics of past, current, and planned clinical studies to patients, clinicians, and researchers; in addition, registry data are available for bulk download. However, issues related to data structure, nomenclature, and changes in data collection over time present challenges to the aggregate analysis and interpretation of these data in general and to the analysis of trials according to clinical specialty in particular. Improving usability of these data could enhance the utility of ClinicalTrials.gov as a research resource. Methods/Principal Results The purpose of our project was twofold. First, we sought to extend the usability of ClinicalTrials.gov for research purposes by developing a database for aggregate analysis of ClinicalTrials.gov (AACT) that contains data from the 96,346 clinical trials registered as of September 27, 2010. Second, we developed and validated a methodology for annotating studies by clinical specialty, using a custom taxonomy employing Medical Subject Heading (MeSH) terms applied by an NLM algorithm, as well as MeSH terms and other disease condition terms provided by study sponsors. Clinical specialists reviewed and annotated MeSH and non-MeSH disease condition terms, and an algorithm was created to classify studies into clinical specialties based on both MeSH and non-MeSH annotations. False positives and false negatives were evaluated by comparing algorithmic classification with manual classification for three specialties. Conclusions/Significance The resulting AACT database features study design attributes parsed into discrete fields, integrated metadata, and an integrated MeSH thesaurus, and is available for download as Oracle extracts (.dmp file and text format). This publicly-accessible dataset will facilitate analysis of studies and permit detailed characterization and analysis of the U.S. clinical trials enterprise as a whole. In addition, the methodology

Deciphering Sources of Variability in Clinical Pathology.

PubMed

Tripathi, Niraj K; Everds, Nancy E; Schultze, A Eric; Irizarry, Armando R; Hall, Robert L; Provencher, Anne; Aulbach, Adam

2017-01-01

The objectives of this session were to explore causes of variability in clinical pathology data due to preanalytical and analytical variables as well as study design and other procedures that occur in toxicity testing studies. The presenters highlighted challenges associated with such variability in differentiating test article-related effects from the effects of experimental procedures and its impact on overall data interpretation. These presentations focused on preanalytical and analytical variables and study design-related factors and their influence on clinical pathology data, and the importance of various factors that influence data interpretation including statistical analysis and reference intervals. Overall, these presentations touched upon potential effect of many variables on clinical pathology parameters, including animal physiology, sample collection process, specimen handling and analysis, study design, and some discussion points on how to manage those variables to ensure accurate interpretation of clinical pathology data in toxicity studies. This article is a brief synopsis of presentations given in a session entitled "Deciphering Sources of Variability in Clinical Pathology-It's Not Just about the Numbers" that occurred at the 35th Annual Symposium of the Society of Toxicologic Pathology in San Diego, California.

Assessment of the level of agreement in the interpretation of plain radiographs of lumbar spondylosis among clinical physiotherapists in Ghana.

PubMed

Bello, Ajediran I; Ofori, Eric K; Alabi, Oluwasegun J; Adjei, David N

2014-03-29

Objective physical assessment of patients with lumbar spondylosis involves plain film radiographs (PFR) viewing and interpretation by the radiologists. Physiotherapists also routinely assess PFR within the scope of their practice. However, studies appraising the level of agreement of physiotherapists' PFR interpretation with radiologists are not common in Ghana. Forty-one (41) physiotherapists took part in the cross-sectional survey. An assessment guide was developed from findings of the interpretation of three PFR of patients with lumbar spondylosis by a radiologist. The three PFR were selected from a pool of different radiographs based on clarity, common visible pathological features, coverage body segments and short post production period. Physiotherapists were required to view the same PFR after which they were assessed with the assessment guide according to the number of features identified correctly or incorrectly. The score range on the assessment form was 0-24, interpreted as follow: 0-8 points (low), 9-16 points (moderate) and 17-24 points (high) levels of agreement. Data were analyzed using one sample t-test and fisher's exact test at α = 0.05. The mean score of interpretation for the physiotherapists was 12.7 ± 2.6 points compared to the radiologist's interpretation of 24 points (assessment guide). The physiotherapists' levels were found to be significantly associated with their academic qualification (p = 0.006) and sex (p = 0.001). However, their levels of agreement were not significantly associated with their age group (p = 0.098), work settings (p = 0.171), experience (p = 0.666), preferred PFR view (p = 0.088) and continuing education (p = 0.069). The physiotherapists' skills fall short of expectation for interpreting PFR of patients with lumbar spondylosis. The levels of agreement with radiologist's interpretation have no link with year of clinial practice, age, work settings and continuing education. Thus

International Union of Basic and Clinical Pharmacology. XCIX. Angiotensin Receptors: Interpreters of Pathophysiological Angiotensinergic Stimuli

PubMed Central

Unal, Hamiyet; Kemp, Jacqueline R.; Tirupula, Kalyan C.; Eguchi, Satoru; Vanderheyden, Patrick M. L.; Thomas, Walter G.

2015-01-01

The renin angiotensin system (RAS) produced hormone peptides regulate many vital body functions. Dysfunctional signaling by receptors for RAS peptides leads to pathologic states. Nearly half of humanity today would likely benefit from modern drugs targeting these receptors. The receptors for RAS peptides consist of three G-protein–coupled receptors—the angiotensin II type 1 receptor (AT1 receptor), the angiotensin II type 2 receptor (AT2 receptor), the MAS receptor—and a type II trans-membrane zinc protein—the candidate angiotensin IV receptor (AngIV binding site). The prorenin receptor is a relatively new contender for consideration, but is not included here because the role of prorenin receptor as an independent endocrine mediator is presently unclear. The full spectrum of biologic characteristics of these receptors is still evolving, but there is evidence establishing unique roles of each receptor in cardiovascular, hemodynamic, neurologic, renal, and endothelial functions, as well as in cell proliferation, survival, matrix-cell interaction, and inflammation. Therapeutic agents targeted to these receptors are either in active use in clinical intervention of major common diseases or under evaluation for repurposing in many other disorders. Broad-spectrum influence these receptors produce in complex pathophysiological context in our body highlights their role as precise interpreters of distinctive angiotensinergic peptide cues. This review article summarizes findings published in the last 15 years on the structure, pharmacology, signaling, physiology, and disease states related to angiotensin receptors. We also discuss the challenges the pharmacologist presently faces in formally accepting newer members as established angiotensin receptors and emphasize necessary future developments. PMID:26315714

A data-driven approach for quality assessment of radiologic interpretations.

PubMed

Hsu, William; Han, Simon X; Arnold, Corey W; Bui, Alex At; Enzmann, Dieter R

2016-04-01

Given the increasing emphasis on delivering high-quality, cost-efficient healthcare, improved methodologies are needed to measure the accuracy and utility of ordered diagnostic examinations in achieving the appropriate diagnosis. Here, we present a data-driven approach for performing automated quality assessment of radiologic interpretations using other clinical information (e.g., pathology) as a reference standard for individual radiologists, subspecialty sections, imaging modalities, and entire departments. Downstream diagnostic conclusions from the electronic medical record are utilized as "truth" to which upstream diagnoses generated by radiology are compared. The described system automatically extracts and compares patient medical data to characterize concordance between clinical sources. Initial results are presented in the context of breast imaging, matching 18 101 radiologic interpretations with 301 pathology diagnoses and achieving a precision and recall of 84% and 92%, respectively. The presented data-driven method highlights the challenges of integrating multiple data sources and the application of information extraction tools to facilitate healthcare quality improvement. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The language divide. The importance of training in the use of interpreters for outpatient practice.

PubMed

Karliner, Leah S; Pérez-Stable, Eliseo J; Gildengorin, Ginny

2004-02-01

Provision of interpreter services for non-English-speaking patients is a federal requirement. We surveyed clinicians to describe their experience using interpreters. In this cross-sectional study we surveyed clinicians in three academic outpatient settings in San Francisco (N = 194) regarding their most recent patient encounter which involved an interpreter. Questions about the visit included type of interpreter, satisfaction with content of clinical encounter, potential problems, and frequency of need. Previous training in interpreter use, languages spoken, and demographics were also asked. Questionnaires were self-administered in approximately 10 minutes. Of 194 questionnaires mailed, 158 were completed (81% response rate) and 67% were from resident physicians. Most respondents (78%) were very satisfied or satisfied with the medical care they provided, 85% felt satisfied with their ability to diagnose a disease and treat a disease, but only 45% were satisfied with their ability to empower the patient with knowledge about their disease, treatment, or medication. Even though 71% felt they were able to make a personal connection with their patient, only 33% felt they had learned about another culture as a result of the encounter. Clinicians reported difficulties eliciting exact symptoms (70%), explaining treatments (44%), and eliciting treatment preferences (51%). Clinicians perceived that lack of knowledge of a patient's culture hindered their ability to provide quality medical care and only 18% felt they were unable to establish trust or rapport. Previous training in interpreter use was associated with increased use of professional interpreters (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.5) and increased satisfaction with medical care provided (OR, 2.6; 95% CI, 1.1 to 6.6). Clinicians reported communication difficulties affecting their ability to understand symptoms and treat disease, as well as their ability to empower patients regarding their

Ethical and Clinical Considerations at the Intersection of Functional Neuroimaging and Disorders of Consciousness.

PubMed

Byram, Adrian C; Lee, Grace; Owen, Adrian M; Ribary, Urs; Stoessl, A Jon; Townson, Andrea; Illes, Judy

2016-10-01

Recent neuroimaging research on disorders of consciousness provides direct evidence of covert consciousness otherwise not detected clinically in a subset of severely brain-injured patients. These findings have motivated strategic development of binary communication paradigms, from which researchers interpret voluntary modulations in brain activity to glean information about patients' residual cognitive functions and emotions. The discovery of such responsiveness raises ethical and legal issues concerning the exercise of autonomy and capacity for decisionmaking on matters such as healthcare, involvement in research, and end of life. These advances have generated demands for access to the technology against a complex background of continued scientific advancement, questions about just allocation of healthcare resources, and unresolved legal issues. Interviews with professionals whose work is relevant to patients with disorders of consciousness reveal priorities concerning further basic research, legal and policy issues, and clinical considerations.

Electrocardiographic intricacies clarified by echocardiography--should the electrocardiogram be interpreted echocardiographically?

PubMed

Ker, James

2012-07-12

During the past century the electrocardiogram (ECG) has established itself as an integral part of the cardiovascular examination. Since the first direct recordings of cardiac potentials by Waller in 1887, to the invention of the string galvanometer by Willem Einthoven in 1901, to use in the clinic by 1910, the electrocardiogram has become the most widely used clinical tool in the diagnosis of virtually every type of heart disease. Currently up to 20 million ECGs are performed annually in the United States alone. However, in this era of readily available echocardiography, an important caveat in the interpretation of the electrocardiogram has emerged: variants of intracardiac structures which might mimic disease on the ECG. In this perspective various structural variants of intracardiac structures, specifically variants of papillary muscles and subaortic muscular bands, will be shown, together with their associated electrocardiographic changes, mimicking disease. It is concluded that in this era of readily available echocardiography, the electrocardiogram should be interpreted echocardiographically in instances where intricate variations are seen on the surface electrocardiogram. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Medical Interpreters in Outpatient Practice.

PubMed

Jacobs, Barb; Ryan, Anne M; Henrichs, Katherine S; Weiss, Barry D

2018-01-01

This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs. The only exception is providers whose only federal assistance is through Medicare Part B, an exception that applies to a very small percentage of practicing physicians. All required language assistance services must be free and provided by qualified translators and interpreters. Interpreters must meet specified qualifications and ideally be certified. Although the cost of interpreter services can be considerable, ranging from $45-$150/hour for in-person interpreters, to $1.25-$3.00/minute for telephone interpreters, and $1.95-$3.49/minute for video remote interpreting, it may be reimbursed or covered by a patient's Medicaid or other federally funded medical insurance. Failure to use qualified interpreters can have serious negative consequences for both practitioners and patients. In one study, 1 of every 40 malpractice claims were related, all or in part, to failure to provide appropriate interpreter services. Most importantly, however, the use of qualified interpreters results in better and more efficient patient care. © 2018 Annals of Family Medicine, Inc.

Assessment of Rapid-Blood-Culture-Identification Result Interpretation and Antibiotic Prescribing Practices

PubMed Central

Campbell, W. Scott; Lyden, Elizabeth; Van Schooneveld, Trevor C.

2017-01-01

ABSTRACT Rapid pathogen identification can alter antibiotic prescribing practices if interpreted correctly. Microbiology reporting can be difficult to understand, and new technology has made it more challenging. Nebraska Medicine recently implemented the BioFire FilmArray blood culture identification panel (BCID) coupled with stewardship-based education on interpretation. Physician BCID result interpretation and prescribing were assessed via an electronic survey, with a response rate of 40.8% (156/382 surveys). Seven questions required respondents to interpret BCID results, identify the most likely pathogen, and then choose therapy based on the results. The tallied correct responses resulted in a knowledge score. General linear models evaluated the effect of role, specialty, and utilization of the BCID interpretation guide on the mean knowledge score. The specialties of the respondents included 55.7% internal medicine, 19.7% family medicine, and 24.6% other. Roles included 41.1% residents, 5.0% fellows, and 53.9% faculty. Most reported that they reviewed antimicrobial susceptibility results (89.4%) and adjusted therapy accordingly (81.6%), while only 60% stated that they adjusted therapy based on BCID results. The correct response rates ranged from 52 to 86% for the interpretation questions. The most common errors included misinterpretation of Enterobacteriaceae and Staphylococcus genus results. Neither role nor specialty was associated with total knowledge score in multivariate analysis (P = 0.13 and 0.47, respectively). In conclusion, physician interpretation of BCID results is suboptimal and can result in ineffective treatment or missed opportunity to narrow therapy. With the implementation of new technology, improved reporting practices of BCID results with clinical decision support tools providing interpretation guidance available at the point of care is recommended. PMID:28250000

Interprofessional collaboration within Canadian integrative healthcare clinics: Key components.

PubMed

Gaboury, Isabelle; Bujold, Mathieu; Boon, Heather; Moher, David

2009-09-01

Research shows that interprofessional collaboration has become an important factor in the implementation of effective healthcare models. To date, the literature has not focused on the collaboration between medical doctors and complementary and alternative medicine (CAM) healthcare practitioners, an example of interdisciplinary collaboration called integrative healthcare (IHC). Drawing on in-depth, semi-standardized interviews conducted with 21 practitioners working in Canadian IHC clinics, this paper explored and interpreted how IHC is experienced by those working in Canadian IHC clinics. The interview questions and analysis were guided by the Input, Process, Output conceptual framework drawn from the organizational management theory (McGrath, J. E. (1964). Social psychology: A brief introduction. New York: Holt, Rinehart and Winston.) to study collaboration within teams. We found that constructs contributing to collaboration included practitioners' attitudes and educational background, as well as external factors such as the healthcare system and financial pressures. Major processes affecting collaboration included communication, patient referral and power relationships. These determinants of collaboration were found to result in learning opportunities for practitioners, modified burden of work and ultimately, higher affective commitment toward the clinic. These constructs serve as a guide for further investigation of interprofessional collaboration within an IHC clinic. This exploration of interprofessional collaboration in IHC identified a broad array of key factors associated with interprofessional collaboration. These factors are critical to better understand the functioning of IHC clinics, and provide guidance for creation or maintenance of successful clinics.

Impact of switching from Caucasian to Indian reference equations for spirometry interpretation.

PubMed

Chhabra, S K; Madan, M

2018-03-01

In the absence of ethnically appropriate prediction equations, spirometry data in Indian subjects are often interpreted using equations for other ethnic populations. To evaluate the impact of switching from Caucasian (National Health and Nutrition Examination Survey III [NHANES III] and Global Lung Function Initiative [GLI]) equations to the recently published North Indian equations on spirometric interpretation, and to examine the suitability of GLI-Mixed equations for this population. Spirometry data on 12 323 North Indian patients were analysed using the North Indian equations as well as NHANES III, GLI-Caucasian and GLI-Mixed equations. Abnormalities and ventilatory patterns were categorised and agreement in interpretation was evaluated. The NHANES III and GLI-Caucasian equations and, to a lesser extent, the GLI-Mixed equations, predicted higher values and labelled more measurements as abnormal. In up to one third of the patients, these differed from Indian equations in the categorisation of ventilatory patterns, with more patients classified as having restrictive and mixed disease. The NHANES III and GLI-Caucasian equations substantially overdiagnose abnormalities and misclassify ventilatory patterns on spirometry in Indian patients. Such errors of interpretation, although less common with the GLI-Mixed equations, remain substantial and are clinically unacceptable. A switch to Indian equations will have a major impact on interpretation.

What is left unsaid: an interpretive description of the information needs of parents of children with asthma.

PubMed

Archibald, Mandy M; Caine, Vera; Ali, Samina; Hartling, Lisa; Scott, Shannon D

2015-02-01

Parents of children with asthma provide the vast majority of day-to-day asthma care. Understanding their information needs is an essential step to provide meaningful and effective family-centered asthma education. To gain insight into the information needs and information deficits of parents of children with asthma, we conducted an interpretive descriptive study to capture the perspectives of 21 parents from diverse backgrounds whose 23 children with asthma had a range of illness trajectories and management scenarios. Parents were purposively sampled from two asthma clinics and one pediatric emergency department in a large urban center in North America. Semi-structured interviews were conducted in 2011-2012. In data analysis, parents' self-identified information needs were distinguished from analysts' interpretations of information deficits. Participants' knowledge did not always reflect time since diagnosis, and information needs and deficits persisted for years. Parents often reported receiving little or no little or no education about asthma and its management. An asthma management information hierarchy was identified, starting with the most foundational, recognizing severity; followed by acute management; prevention versus crisis orientation; and knowing "about" asthma. In the absence of adequate and accurate education, parents' beliefs about the nature of asthma as an acute rather than chronic condition shaped their asthma management decisions and information-seeking behaviors. Information deficits were affected by interactions with health care providers. These parents' pervasive unmet information needs and deficits highlight the need for comprehensive, problem-oriented asthma education. © 2015 Wiley Periodicals, Inc.

Self-Concept and Native Language Background: A Study of Measurement Invariance and Cross-Group Comparisons in Third Grade

ERIC Educational Resources Information Center

Niehaus, Kate; Adelson, Jill L.

2013-01-01

This study examined the measurement and interpretation of self-concept among the growing population of children who are English Language Learners (ELLs). More specifically, a 3-group analysis was conducted comparing native English-speaking children, Spanish-speaking ELLs, and ELLs from Asian language backgrounds. Data were drawn from the Early…

First-Light Galaxies or Intrahalo Stars: Multi-Wavelength Measurements of the Infrared Background Anisotropies

NASA Astrophysics Data System (ADS)

Cooray, Asantha

The research program described in this proposal can be broadly described as data analysis, measurement, and interpretation of the spatial fluctuations of the unresolved cosmic IR background. We will focus primarily on the background at optical and near-IR wavelengths as probed by Hubble and Spitzer. As absolute background intensity measurements are challenging, the focus is on the spatial fluctuations similar to the anisotropiesof the cosmic microwave background (CMB). Measurements of the unresolved Spitzer fluctuations by two independent teams on multiple fields agree within the measurement errors. However, there are now two interpretations on the origin of the unresolved IRAC fluctuations. One involves a population of faint sources at very high redshifts (z > 6) during the epoch of reionization. The second interpretation involves the integrated emission from intrahalo light associated with diffuse stars in the outskirts of z of 1 to 3 dark matter halos of galaxies. We now propose to further test these two interpretations with a new set of measurements at shorter IR and optical wavelengths with HST/ACS and WFC3 overlapping with deep IRAC surveys. A multi-wavelength study from 0.5 to 4.5 micron will allow us to independently determine the relative contribution of intrahalo light and z > 8 faint galaxies to the unresolved IR fluctuations. We will also place strong limits on the surface density of faint sources at z > 8. Such a limit will be useful for planning deep surveys with JWST. Moving to the recent wide IRAC fields with the warm mission, we propose to study fluctuations at tens of degree angular scales. At such large angular scales IRAC fluctuations should trace diffuse Galactic light (DGL), ISM dust-scattered starlight in our Galaxy. We will measure the amplitude and slope of the DGL power spectrum and compare them to measurements of the Galactic dust power spectrum from IRAS and Planck and study if the large degree-scale fluctuations seen in CIBER can be

User perception and interpretation of tornado probabilistic hazard information: Comparison of four graphical designs.

PubMed

Miran, Seyed M; Ling, Chen; James, Joseph J; Gerard, Alan; Rothfusz, Lans

2017-11-01

Effective design for presenting severe weather information is important to reduce devastating consequences of severe weather. The Probabilistic Hazard Information (PHI) system for severe weather is being developed by NOAA National Severe Storms Laboratory (NSSL) to communicate probabilistic hazardous weather information. This study investigates the effects of four PHI graphical designs for tornado threat, namely, "four-color"," red-scale", "grayscale" and "contour", on users' perception, interpretation, and reaction to threat information. PHI is presented on either a map background or a radar background. Analysis showed that the accuracy was significantly higher and response time faster when PHI was displayed on map background as compared to radar background due to better contrast. When displayed on a radar background, "grayscale" design resulted in a higher accuracy of responses. Possibly due to familiarity, participants reported four-color design as their favorite design, which also resulted in the fastest recognition of probability levels on both backgrounds. Our study shows the importance of using intuitive color-coding and sufficient contrast in conveying probabilistic threat information via graphical design. We also found that users follows a rational perceiving-judging-feeling-and acting approach in processing probabilistic hazard information for tornado. Copyright © 2017 Elsevier Ltd. All rights reserved.

Amplified fragment length polymorphism of Streptococcus suis strains correlates with their profile of virulence-associated genes and clinical background.

PubMed

Rehm, Thomas; Baums, Christoph G; Strommenger, Birgit; Beyerbach, Martin; Valentin-Weigand, Peter; Goethe, Ralph

2007-01-01

Amplified fragment length polymorphism (AFLP) typing was applied to 116 Streptococcus suis isolates with different clinical backgrounds (invasive/pneumonia/carrier/human) and with known profiles of virulence-associated genes (cps1, -2, -7 and -9, as well as mrp, epf and sly). A dendrogram was generated that allowed identification of two clusters (A and C) with different subclusters (A1, A2, C1 and C2) and two heterogeneous groups of strains (B and D). For comparison, three strains from each AFLP subcluster and group were subjected to multilocus sequence typing (MLST) analysis. The closest relationship and lowest diversity were found for patterns clustering within AFLP subcluster A1, which corresponded with sequence type (ST) complex 1. Strains within subcluster A1 were mainly invasive cps1 and mrp+ epf+ (or epf*) sly+ cps2+ strains of porcine or human origin. A new finding of this study was the clustering of invasive mrp* cps9 isolates within subcluster A2. MLST analysis suggested that A2 correlates with a single ST complex (ST87). In contrast to A1 and A2, subclusters C1 and C2 contained mainly pneumonia isolates of genotype cps7 or cps2 and epf- sly-. In conclusion, this study demonstrates that AFLP allows identification of clusters of S. suis strains with clinical relevance.

Patient satisfaction with different interpreting methods: a randomized controlled trial.

PubMed

Gany, Francesca; Leng, Jennifer; Shapiro, Ephraim; Abramson, David; Motola, Ivette; Shield, David C; Changrani, Jyotsna

2007-11-01

Growth of the foreign-born population in the U.S. has led to increasing numbers of limited-English-proficient (LEP) patients. Innovative medical interpreting strategies, including remote simultaneous medical interpreting (RSMI), have arisen to address the language barrier. This study evaluates the impact of interpreting method on patient satisfaction. 1,276 English-, Spanish-, Mandarin-, and Cantonese-speaking patients attending the primary care clinic and emergency department of a large New York City municipal hospital were screened for enrollment in a randomized controlled trial. Language-discordant patients were randomized to RSMI or usual and customary (U&C) interpreting. Patients with language-concordant providers received usual care. Demographic and patient satisfaction questionnaires were administered to all participants. 541 patients were language-concordant with their providers and not randomized; 371 were randomized to RSMI, 167 of whom were exposed to RSMI; and 364 were randomized to U&C, 198 of whom were exposed to U&C. Patients randomized to RSMI were more likely than those with U&C to think doctors treated them with respect (RSMI 71%, U&C 64%, p < 0.05), but they did not differ in other measures of physician communication/care. In a linear regression analysis, exposure to RSMI was significantly associated with an increase in overall satisfaction with physician communication/care (beta 0.10, 95% CI 0.02-0.18, scale 0-1.0). Patients randomized to RSMI were more likely to think the interpreting method protected their privacy (RSMI 51%, U&C 38%, p < 0.05). Patients randomized to either arm of interpretation reported less comprehension and satisfaction than patients in language-concordant encounters. While not a substitute for language-concordant providers, RSMI can improve patient satisfaction and privacy among LEP patients. Implementing RSMI should be considered an important component of a multipronged approach to addressing language barriers in health

Comments on the New International Criteria for Electrocardiographic Interpretation in Athletes.

PubMed

Serratosa-Fernández, Luis; Pascual-Figal, Domingo; Masiá-Mondéjar, María Dolores; Sanz-de la Garza, María; Madaria-Marijuan, Zigor; Gimeno-Blanes, Juan Ramón; Adamuz, Carmen

2017-11-01

Sudden cardiac death is the most common medical cause of death during the practice of sports. Several structural and electrical cardiac conditions are associated with sudden cardiac death in athletes, most of them showing abnormal findings on resting electrocardiogram (ECG). However, because of the similarity between some ECG findings associated with physiological adaptations to exercise training and those of certain cardiac conditions, ECG interpretation in athletes is often challenging. Other factors related to ECG findings are race, age, sex, sports discipline, training intensity, and athletic background. Specific training and experience in ECG interpretation in athletes are therefore necessary. Since 2005, when the first recommendations of the European Society of Cardiology were published, growing scientific evidence has increased the specificity of ECG standards, thus lowering the false-positive rate while maintaining sensitivity. New international consensus guidelines have recently been published on ECG interpretation in athletes, which are the result of consensus among a group of experts in cardiology and sports medicine who gathered for the first time in February 2015 in Seattle, in the United States. The document is an important milestone because, in addition to updating the standards for ECG interpretation, it includes recommendations on appropriate assessment of athletes with abnormal ECG findings. The present article reports and discusses the most novel and relevant aspects of the new standards. Nevertheless, a complete reading of the original consensus document is highly recommended. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

The Impacts of Language Background and Language-Related Disorders in Auditory Processing Assessment

ERIC Educational Resources Information Center

Loo, Jenny Hooi Yin; Bamiou, Doris-Eva; Rosen, Stuart

2013-01-01

Purpose: To examine the impact of language background and language-related disorders (LRDs--dyslexia and/or language impairment) on performance in English speech and nonspeech tests of auditory processing (AP) commonly used in the clinic. Method: A clinical database concerning 133 multilingual children (mostly with English as an additional…

Female Mecp2+/− mice display robust behavioral deficits on two different genetic backgrounds providing a framework for pre-clinical studies

PubMed Central

Samaco, Rodney C.; McGraw, Christopher M.; Ward, Christopher S.; Sun, Yaling; Neul, Jeffrey L.; Zoghbi, Huda Y.

2013-01-01

Rett syndrome (RTT) is an X-linked neurological disorder caused by mutations in the gene encoding the transcriptional modulator methyl-CpG-binding protein 2 (MeCP2). Typical RTT primarily affects girls and is characterized by a brief period of apparently normal development followed by the loss of purposeful hand skills and language, the onset of anxiety, hand stereotypies, autistic features, seizures and autonomic dysfunction. Mecp2 mouse models have extensively been studied to demonstrate the functional link between MeCP2 dysfunction and RTT pathogenesis. However, the majority of studies have focused primarily on the molecular and behavioral consequences of the complete absence of MeCP2 in male mice. Studies of female Mecp2+/− mice have been limited because of potential phenotypic variability due to X chromosome inactivation effects. To determine whether reproducible and reliable phenotypes can be detected Mecp2+/− mice, we analyzed Mecp2+/− mice of two different F1 hybrid isogenic backgrounds and at young and old ages using several neurobehavioral and physiological assays. Here, we report a multitude of phenotypes in female Mecp2+/− mice, some presenting as early as 5 weeks of life. We demonstrate that Mecp2+/− mice recapitulate several aspects of typical RTT and show that mosaic expression of MeCP2 does not preclude the use of female mice in behavioral and molecular studies. Importantly, we uncover several behavioral abnormalities that are present in two genetic backgrounds and report on phenotypes that are unique to one background. These findings provide a framework for pre-clinical studies aimed at improving the constellation of phenotypes in a mouse model of RTT. PMID:23026749

Mediation misgivings: ambiguous clinical and public health interpretations of natural direct and indirect effects.

PubMed

Naimi, Ashley I; Kaufman, Jay S; MacLehose, Richard F

2014-10-01

Recent methodological innovation is giving rise to an increasing number of applied papers in medical and epidemiological journals in which natural direct and indirect effects are estimated. However, there is a longstanding debate on whether such effects are relevant targets of inference in population health. In light of the repeated calls for a more pragmatic and consequential epidemiology, we review three issues often raised in this debate: (i) the use of composite cross-world counterfactuals and the need for cross-world independence assumptions; (ii) interventional vs non-interventional identifiability; and (iii) the interpretational ambiguity of natural direct and indirect effect estimates. We use potential outcomes notation and directed acyclic graphs to explain 'cross-world' assumptions, illustrate implications of this assumption via regression models and discuss ensuing issues of interpretation. We argue that the debate on the relevance of natural direct and indirect effects rests on whether one takes as a target of inference the mathematical object per se, or the change in the world that the mathematical object represents. We further note that public health questions may be better served by estimating controlled direct effects. © The Author 2014; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

77 FR 39654 - Proposed Legal Interpretation

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-05

...-0670] Proposed Legal Interpretation AGENCY: Federal Aviation Administration (FAA), DOT. ACTION... legal interpretation in which the agency considered clarifying prior legal interpretations regarding... inadvertently assigned an incorrect docket number to the proposed legal interpretation. This document corrects...

A comparison of image interpretation times in full field digital mammography and digital breast tomosynthesis

NASA Astrophysics Data System (ADS)

Astley, Susan; Connor, Sophie; Lim, Yit; Tate, Catriona; Entwistle, Helen; Morris, Julie; Whiteside, Sigrid; Sergeant, Jamie; Wilson, Mary; Beetles, Ursula; Boggis, Caroline; Gilbert, Fiona

2013-03-01

Digital Breast Tomosynthesis (DBT) provides three-dimensional images of the breast that enable radiologists to discern whether densities are due to overlapping structures or lesions. To aid assessment of the cost-effectiveness of DBT for screening, we have compared the time taken to interpret DBT images and the corresponding two-dimensional Full Field Digital Mammography (FFDM) images. Four Consultant Radiologists experienced in reading FFDM images (4 years 8 months to 8 years) with training in DBT interpretation but more limited experience (137-407 cases in the past 6 months) were timed reading between 24 and 32 two view FFDM and DBT cases. The images were of women recalled from screening for further assessment and women under surveillance because of a family history of breast cancer. FFDM images were read before DBT, according to local practice. The median time for readers to interpret FFDM images was 17.0 seconds, with an interquartile range of 12.3-23.6 seconds. For DBT, the median time was 66.0 seconds, and the interquartile range was 51.1-80.5 seconds. The difference was statistically significant (p<0.001). Reading times were significantly longer in family history clinics (p<0.01). Although it took approximately four times as long to interpret DBT than FFDM images, the cases were more complex than would be expected for routine screening, and with higher mammographic density. The readers were relatively inexperienced in DBT interpretation and may increase their speed over time. The difference in times between clinics may be due to increased throughput at assessment, or decreased density.

Interpretation of genetic testing for lynch syndrome in patients with putative familial colorectal cancer.

PubMed

Rybak, Christina; Hall, Michael J

2011-11-01

Colorectal cancer (CRC) risk assessment involves the evaluation of an individual's personal and family history for characteristics of an inherited susceptibility to develop CRC. Lynch syndrome (LS), or hereditary nonpolyposis colorectal cancer, is the most common cause of hereditary CRC, underlying 2% to 3% of patients with newly diagnosed (incident) CRC. Risk assessment for LS is complex, and the interpretation of the many available tests can be challenging even for the genetics specialist. A move toward universal (reflex) LS screening for mismatch repair in all patients with incident CRC supports the importance of improving the awareness and understanding of LS testing, teaching rational testing approaches, and honing interpretive skills among cancer care providers. This article reviews important clinical features of LS genetic evaluation using 3 pedigree-based case examples from the Fox Chase Cancer Center Gastrointestinal Risk Assessment Clinic.

Semantic Clinical Guideline Documents

PubMed Central

Eriksson, Henrik; Tu, Samson W.; Musen, Mark

2005-01-01

Decision-support systems based on clinical practice guidelines can support physicians and other health-care personnel in the process of following best practice consistently. A knowledge-based approach to represent guidelines makes it possible to encode computer-interpretable guidelines in a formal manner, perform consistency checks, and use the guidelines directly in decision-support systems. Decision-support authors and guideline users require guidelines in human-readable formats in addition to computer-interpretable ones (e.g., for guideline review and quality assurance). We propose a new document-oriented information architecture that combines knowledge-representation models with electronic and paper documents. The approach integrates decision-support modes with standard document formats to create a combined clinical-guideline model that supports on-line viewing, printing, and decision support. PMID:16779037

The Role of Self-reports and Behavioral Measures of Interpretation Biases in Children with Varying Levels of Anxiety.

PubMed

Klein, Anke M; Flokstra, Emmelie; van Niekerk, Rianne; Klein, Steven; Rapee, Ronald M; Hudson, Jennifer L; Bögels, Susan M; Becker, Eni S; Rinck, Mike

2018-04-21

We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders.

10 CFR 40.6 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Interpretations. 40.6 Section 40.6 Energy NUCLEAR REGULATORY COMMISSION DOMESTIC LICENSING OF SOURCE MATERIAL General Provisions § 40.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the...

10 CFR 76.6 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Interpretations. 76.6 Section 76.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS General Provisions § 76.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning...

10 CFR 76.6 - Interpretations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 2 2012-01-01 2012-01-01 false Interpretations. 76.6 Section 76.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS General Provisions § 76.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning...

10 CFR 76.6 - Interpretations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 2 2013-01-01 2013-01-01 false Interpretations. 76.6 Section 76.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS General Provisions § 76.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning...

10 CFR 76.6 - Interpretations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 2 2011-01-01 2011-01-01 false Interpretations. 76.6 Section 76.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS General Provisions § 76.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning...

10 CFR 76.6 - Interpretations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Interpretations. 76.6 Section 76.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) CERTIFICATION OF GASEOUS DIFFUSION PLANTS General Provisions § 76.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning...

10 CFR 55.6 - Interpretations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 2 2014-01-01 2014-01-01 false Interpretations. 55.6 Section 55.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) OPERATORS' LICENSES General Provisions § 55.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the regulations in...

10 CFR 1016.7 - Interpretations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Interpretations. 1016.7 Section 1016.7 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) SAFEGUARDING OF RESTRICTED DATA General Provisions § 1016.7 Interpretations. Except as specifically authorized by the Secretary of Energy in writing, no interpretation of the...

10 CFR 1016.7 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 4 2010-01-01 2010-01-01 false Interpretations. 1016.7 Section 1016.7 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) SAFEGUARDING OF RESTRICTED DATA General Provisions § 1016.7 Interpretations. Except as specifically authorized by the Secretary of Energy in writing, no interpretation of the...

10 CFR 20.1006 - Interpretations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 1 2013-01-01 2013-01-01 false Interpretations. 20.1006 Section 20.1006 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1006 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the...

10 CFR 20.1006 - Interpretations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Interpretations. 20.1006 Section 20.1006 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1006 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the...

10 CFR 20.1006 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Interpretations. 20.1006 Section 20.1006 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1006 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the...

10 CFR 20.1006 - Interpretations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 1 2012-01-01 2012-01-01 false Interpretations. 20.1006 Section 20.1006 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1006 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the...

10 CFR 20.1006 - Interpretations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 1 2014-01-01 2014-01-01 false Interpretations. 20.1006 Section 20.1006 Energy NUCLEAR REGULATORY COMMISSION STANDARDS FOR PROTECTION AGAINST RADIATION General Provisions § 20.1006 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the...

10 CFR 55.6 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Interpretations. 55.6 Section 55.6 Energy NUCLEAR REGULATORY COMMISSION (CONTINUED) OPERATORS' LICENSES General Provisions § 55.6 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the regulations in...

Background characterization of an ultra-low background liquid scintillation counter

DOE PAGES

Erchinger, J. L.; Orrell, John L.; Aalseth, C. E.; ...

2017-01-26

The Ultra-Low Background Liquid Scintillation Counter developed by Pacific Northwest National Laboratory will expand the application of liquid scintillation counting by enabling lower detection limits and smaller sample volumes. By reducing the overall count rate of the background environment approximately 2 orders of magnitude below that of commercially available systems, backgrounds on the order of tens of counts per day over an energy range of ~3–3600 keV can be realized. Finally, initial test results of the ULB LSC show promising results for ultra-low background detection with liquid scintillation counting.

Post-mortem clinical pharmacology

PubMed Central

Ferner, R E

2008-01-01

Clinical pharmacology assumes that deductions can be made about the concentrations of drugs from a knowledge of the pharmacokinetic parameters in an individual; and that the effects are related to the measured concentration. Post-mortem changes render the assumptions of clinical pharmacology largely invalid, and make the interpretation of concentrations measured in post-mortem samples difficult or impossible. Qualitative tests can show the presence of substances that were not present in life, and can fail to detect substances that led to death. Quantitative analysis is subject to error in itself, and because post-mortem concentrations vary in largely unpredictable ways with the site and time of sampling, as a result of the phenomenon of post-mortem redistribution. Consequently, compilations of ‘lethal concentrations’ are misleading. There is a lack of adequate studies of the true relationship between fatal events and the concentrations that can be measured subsequently, but without such studies, clinical pharmacologists and others should be wary of interpreting post-mortem measurements. PMID:18637886

Instruction-Based Clinical Eye-Tracking Study on the Visual Interpretation of Divergence: How Do Students Look at Vector Field Plots?

ERIC Educational Resources Information Center

Klein, P.; Viiri, J.; Mozaffari, S.; Dengel, A.; Kuhn, J.

2018-01-01

Relating mathematical concepts to graphical representations is a challenging task for students. In this paper, we introduce two visual strategies to qualitatively interpret the divergence of graphical vector field representations. One strategy is based on the graphical interpretation of partial derivatives, while the other is based on the flux…

10 CFR 26.7 - Interpretations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 1 2011-01-01 2011-01-01 false Interpretations. 26.7 Section 26.7 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Administrative Provisions § 26.7 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the regulations in...

10 CFR 26.7 - Interpretations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 1 2010-01-01 2010-01-01 false Interpretations. 26.7 Section 26.7 Energy NUCLEAR REGULATORY COMMISSION FITNESS FOR DUTY PROGRAMS Administrative Provisions § 26.7 Interpretations. Except as specifically authorized by the Commission in writing, no interpretation of the meaning of the regulations in...

10 CFR 26.7 - Interpretations.

Code of Federal Regulations, 2013 CFR

2013-01-01