Stray light analysis for the Thomson scattering diagnostic of the ETE Tokamak

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

Berni, L. A.; Albuquerque, B. F. C.

2010-12-15

Thomson scattering is a well-established diagnostic for measuring local electron temperature and density in fusion plasma, but this technique is particularly difficult to implement due to stray light that can easily mask the scattered signal from plasma. To mitigate this problem in the multipoint Thomson scattering system implemented at the ETE (Experimento Tokamak Esferico) a detailed stray light analysis was performed. The diagnostic system was simulated in ZEMAX software and scattering profiles of the mechanical parts were measured in the laboratory in order to have near realistic results. From simulation, it was possible to identify the main points that contributemore » to the stray signals and changes in the dump were implemented reducing the stray light signals up to 60 times.« less

Histological Image Feature Mining Reveals Emergent Diagnostic Properties for Renal Cancer

PubMed Central

Kothari, Sonal; Phan, John H.; Young, Andrew N.; Wang, May D.

2016-01-01

Computer-aided histological image classification systems are important for making objective and timely cancer diagnostic decisions. These systems use combinations of image features that quantify a variety of image properties. Because researchers tend to validate their diagnostic systems on specific cancer endpoints, it is difficult to predict which image features will perform well given a new cancer endpoint. In this paper, we define a comprehensive set of common image features (consisting of 12 distinct feature subsets) that quantify a variety of image properties. We use a data-mining approach to determine which feature subsets and image properties emerge as part of an “optimal” diagnostic model when applied to specific cancer endpoints. Our goal is to assess the performance of such comprehensive image feature sets for application to a wide variety of diagnostic problems. We perform this study on 12 endpoints including 6 renal tumor subtype endpoints and 6 renal cancer grade endpoints. Keywords-histology, image mining, computer-aided diagnosis PMID:28163980

Outcomes of an Innovative Evidence-Based Practice Project: Building a Difficult-Access Team in the Emergency Department.

PubMed

Whalen, Madeleine; Maliszewski, Barbara; Sheinfeld, Rebecca; Gardner, Heather; Baptiste, Diana

2018-04-25

Difficult venous access is a common problem in health care-especially in the emergency setting-that relies on quick diagnostics to differentiate patient acuities and administer critical medications. The creation of a dedicated team to address difficult venous access (DVA) is a possible solution to the problems of delayed venous access, yet no studies have been published on implementing such a team in the emergency department. This was a quasi-experimental study in an urban emergency department. Researchers performed chart audits of staff-identified patients with DVA to gather baseline data. A DVA team was subsequently implemented 16 hours a day, 7 days a week. Data were recorded on patients referred to the team and included time, number of IV attempts, and patient characteristics. Baseline data were collected on 53 patients, and postintervention data included 135 patients. The implementation of a DVA team decreased the mean lab order-to-lab completion time by 115 minutes (P < 0.0001). Decreases in the number of attempts were not statistically significant. Patients requiring increased numbers of IV attempts also had many common characteristics including history of multiple attempts, poor skin quality, and IV drug use. The use of a dedicated team for DVA reduces the lag time from physician orders to actionable diagnostics or administration of medication. A dedicated DVA technician is a concrete solution to threats of patient safety, as well as ED crowding, and has the potential to affect both patient- and department-level care. Copyright © 2018 Elsevier Inc. All rights reserved.

Large Osteoarthritic Cyst Presenting as Soft Tissue Tumour – A Case Report

PubMed Central

Kosuge, DD; Park, DH; Cannon, SR; Briggs, TW; Pollock, RC; Skinner, JA

2007-01-01

Large osteoarthritic cysts can sometimes be difficult to distinguish from primary osseous and soft tissue tumours. We present such a case involving a cyst arising from the hip joint and eroding the acetabulum which presented as a soft tissue malignancy referred to a tertiary bone and soft tissue tumour centre. We discuss the diagnostic problems it may pose, and present a literature review of the subject. PMID:17535605

Challenges in Fusarium, a Trans-Kingdom Pathogen.

PubMed

van Diepeningen, Anne D; de Hoog, G Sybren

2016-04-01

Fusarium species are emerging human pathogens, next to being plant pathogens. Problems with Fusarium are in their diagnostics and in their difficult treatment, but also in what are actual Fusarium species or rather Fusarium-like species. In this issue Guevara-Suarez et al. (Mycopathologia. doi: 10.1007/s11046-016-9983-9 , 2016) characterized 89 isolates of Fusarium from Colombia showing especially lineages within the Fusarium solani and oxysporum species complexes to be responsible for onychomycosis.

Using comparative genomics to develop a molecular diagnostic for the identification of an emerging pest Drosophila suzukii.

PubMed

Murphy, K A; Unruh, T R; Zhou, L M; Zalom, F G; Shearer, P W; Beers, E H; Walton, V M; Miller, B; Chiu, J C

2015-06-01

Drosophila suzukii (Spotted Wing Drosophila) has recently become a serious invasive pest of fruit crops in the USA, Canada, and Europe, leading to substantial economic losses. D. suzukii is a direct pest, ovipositing directly into ripe or ripening fruits; in contrast, other Drosophilids utilize decaying or blemished fruits and are nuisance pests at worst. Immature stages of D. suzukii are difficult to differentiate from other Drosophilids, posing problems for research and for meeting quarantine restrictions designed to prevent the spread of this pest in fruit exports. Here we used a combined phylogenetic and bioinformatic approach to discover genetic markers suitable for a species diagnostic protocol of this agricultural pest. We describe a molecular diagnostic for rapid identification of single D. suzukii larva using multiplex polymerase chain reaction. Our molecular diagnostic was validated using nine different species of Drosophila for specificity and 19 populations of D. suzukii from different geographical regions to ensure utility within species.

The Difficulty of Selecting the NANDA-I Nursing Diagnosis (2015-2017) of "Death Anxiety" in Japan.

PubMed

Shimomai, Kimiyo; Furukawa, Hidetoshi; Kuroda, Yuko; Fukuda, Kazuaki; Masuda, Mitsumi; Koizumi, Junko

2018-01-01

The purpose of our study was to clarify any difficulties or problems that exist in Japanese healthcare sites regarding the selection of death anxiety as a nursing diagnosis. This study was a qualitative, inductive research design. The semistructured interviews were conducted on the participants who were nurses and had 3 or more years of clinical experience in Japan. Results showed four categories: "The Japanese have a culture of avoiding death," "It is extremely difficult to match diagnostic indicators and related factors with specific patient cases," "Other diagnoses exist that are effective and enable proactive intervention," and "The definition of death anxiety and the meaning of its diagnostic indicators are unintelligible." It is thought that nursing diagnoses that reflect specific cultural backgrounds require definitions appropriate to each country and appropriate revisions to diagnostic indicators. © 2016 NANDA International, Inc.

A tri-fold hybrid classification approach for diagnostics with unexampled faulty states

NASA Astrophysics Data System (ADS)

Tamilselvan, Prasanna; Wang, Pingfeng

2015-01-01

System health diagnostics provides diversified benefits such as improved safety, improved reliability and reduced costs for the operation and maintenance of engineered systems. Successful health diagnostics requires the knowledge of system failures. However, with an increasing system complexity, it is extraordinarily difficult to have a well-tested system so that all potential faulty states can be realized and studied at product testing stage. Thus, real time health diagnostics requires automatic detection of unexampled system faulty states based upon sensory data to avoid sudden catastrophic system failures. This paper presents a trifold hybrid classification (THC) approach for structural health diagnosis with unexampled health states (UHS), which comprises of preliminary UHS identification using a new thresholded Mahalanobis distance (TMD) classifier, UHS diagnostics using a two-class support vector machine (SVM) classifier, and exampled health states diagnostics using a multi-class SVM classifier. The proposed THC approach, which takes the advantages of both TMD and SVM-based classification techniques, is able to identify and isolate the unexampled faulty states through interactively detecting the deviation of sensory data from the exampled health states and forming new ones autonomously. The proposed THC approach is further extended to a generic framework for health diagnostics problems with unexampled faulty states and demonstrated with health diagnostics case studies for power transformers and rolling bearings.

Rheumatoid pseudocyst (geode) of the femoral neck without apparent joint involvement.

PubMed

Morrey, B F

1987-05-01

Typically, rheumatoid cysts are associated with obvious joint involvement and are located in the subchondral portion of the adjacent joint. Giant pseudocysts (geodes) are uncommon and are characteristically associated with extensive joint destruction. The patient described in this report had a giant pseudocyst of the femoral neck but no joint involvement. To the best of my knowledge, this is the first report of such a manifestation of a giant pseudocyst. As such, it posed a somewhat difficult diagnostic problem.

ADHD and Challenging behaviour in People with Intellectual Disability: should we screen for ADHD?

PubMed

Perera, Bhathika; Courtenay, Ken

2017-09-01

People with Intellectual Disability (ID) have cognitive impairments that affect their level of functioning the causes of which are multiple and often unknown. Behavioural difficulties are common among people with ID. Attention Deficit Hyperactivity Disorder (ADHD) is recognised more among people with Intellectual Disability and could be a cause of problem behaviours. Screening and assessing for ADHD in people with ID is difficult because of the paucity of robust assessment tools and diagnostic criteria.

Do patients' disruptive behaviours influence the accuracy of a doctor's diagnosis? A randomised experiment.

PubMed

Schmidt, H G; Van Gog, Tamara; Schuit, Stephanie Ce; Van den Berge, Kees; Van Daele, Paul L; Bueving, Herman; Van der Zee, Tim; Van den Broek, Walter W; Van Saase, Jan L; Mamede, Sílvia

2017-01-01

Literature suggests that patients who display disruptive behaviours in the consulting room fuel negative emotions in doctors. These emotions, in turn, are said to cause diagnostic errors. Evidence substantiating this claim is however lacking. The purpose of the present experiment was to study the effect of such difficult patients' behaviours on doctors' diagnostic performance. We created six vignettes in which patients were depicted as difficult (displaying distressing behaviours) or neutral. Three clinical cases were deemed to be diagnostically simple and three deemed diagnostically complex. Sixty-three family practice residents were asked to evaluate the vignettes and make the patient's diagnosis quickly and then through deliberate reflection. In addition, amount of time needed to arrive at a diagnosis was measured. Finally, the participants rated the patient's likability. Mean diagnostic accuracy scores (range 0-1) were significantly lower for difficult than for neutral patients (0.54 vs 0.64; p=0.017). Overall diagnostic accuracy was higher for simple than for complex cases. Deliberate reflection upon the case improved initial diagnostic, regardless of case complexity and of patient behaviours (0.60 vs 0.68, p=0.002). Amount of time needed to diagnose the case was similar regardless of the patient's behaviour. Finally, average likability ratings were lower for difficult than for neutral-patient cases. Disruptive behaviours displayed by patients seem to induce doctors to make diagnostic errors. Interestingly, the confrontation with difficult patients does however not cause the doctor to spend less time on such case. Time can therefore not be considered an intermediary between the way the patient is perceived, his or her likability and diagnostic performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

[Difficulties with diagnosis of fibromyalgia: case report].

PubMed

Atarowska, Magdalena; Samborski, Włodzimierz

2006-01-01

We present a case of a 33-year-old woman with nonspecific systemic symptoms (fatigue, weakness), widespread pains, sleep disorders, morning stiffness, accompanied by symptoms from the autonomic nervous system (chest pain, digestive tract disorders, hyperesthesia of the skin, dizziness, paresthesia with a feeling of coldness in hands and feet, excessive sweating, breath problems, palpitations). The diagnostic process was difficult and it took a long time to establish the diagnosis partly because of problems in cooperating with this patient. During several years, the woman was hospitalized at several specialist departments, underwent many consultations, laboratory tests, and imaging studies. Finally, fibromyalgia was diagnosed. Treatment was implemented with good results improving the quality of life of this patient.

Computed tomography in the evaluation of Crohn disease

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

Goldberg, H.I.; Gore, R.M.; Margulis, A.R.

1983-02-01

The abdominal and pelvic computed tomographic examinations in 28 patients with Crohn disease were analyzed and correlated with conventional barium studies, sinograms, and surgical findings. Mucosal abnormalities such as aphthous lesions, pseudopolyps, and ulcerations were only imaged by conventional techniques. Computed tomography proved superior in demonstrating the mural, serosal, and mesenteric abnormalities such as bowel wall thickening (82%), fibrofatty proliferation of mesenteric fat (39%), mesenteric abscess (25%), inflammatory reaction of the mesentery (14%), and mesenteric lymphadenopathy (18%). Computed tomography was most useful clinically in defining the nature of mass effects, separation, or displacement of small bowel segments seen on smallmore » bowel series. Although conventional barium studies remain the initial diagnostic procedure in evaluating Crohn disease, computed tomography can be a useful adjunct in resolving difficult clinical and radiologic diagnostic problems.« less

[The diagnostic scores for deep venous thrombosis].

PubMed

Junod, A

2015-08-26

Seven diagnostic scores for the deep venous thrombosis (DVT) of lower limbs are analyzed and compared. Two features make this exer- cise difficult: the problem of distal DVT and of their proximal extension and the status of patients, whether out- or in-patients. The most popular score is the Wells score (1997), modi- fied in 2003. It includes one subjective ele- ment based on clinical judgment. The Primary Care score 12005), less known, has similar pro- perties, but uses only objective data. The pre- sent trend is to associate clinical scores with the dosage of D-Dimers to rule out with a good sensitivity the probability of TVP. For the upper limb DVT, the Constans score (2008) is available, which can also be coupled with D-Dimers testing (Kleinjan).

Proteomics, lipidomics, metabolomics: a mass spectrometry tutorial from a computer scientist's point of view.

PubMed

Smith, Rob; Mathis, Andrew D; Ventura, Dan; Prince, John T

2014-01-01

For decades, mass spectrometry data has been analyzed to investigate a wide array of research interests, including disease diagnostics, biological and chemical theory, genomics, and drug development. Progress towards solving any of these disparate problems depends upon overcoming the common challenge of interpreting the large data sets generated. Despite interim successes, many data interpretation problems in mass spectrometry are still challenging. Further, though these challenges are inherently interdisciplinary in nature, the significant domain-specific knowledge gap between disciplines makes interdisciplinary contributions difficult. This paper provides an introduction to the burgeoning field of computational mass spectrometry. We illustrate key concepts, vocabulary, and open problems in MS-omics, as well as provide invaluable resources such as open data sets and key search terms and references. This paper will facilitate contributions from mathematicians, computer scientists, and statisticians to MS-omics that will fundamentally improve results over existing approaches and inform novel algorithmic solutions to open problems.

Software Tools to Support the Assessment of System Health

NASA Technical Reports Server (NTRS)

Melcher, Kevin J.

2013-01-01

This presentation provides an overview of three software tools that were developed by the NASA Glenn Research Center to support the assessment of system health: the Propulsion Diagnostic Method Evaluation Strategy (ProDIMES), the Systematic Sensor Selection Strategy (S4), and the Extended Testability Analysis (ETA) tool. Originally developed to support specific NASA projects in aeronautics and space, these software tools are currently available to U.S. citizens through the NASA Glenn Software Catalog. The ProDiMES software tool was developed to support a uniform comparison of propulsion gas path diagnostic methods. Methods published in the open literature are typically applied to dissimilar platforms with different levels of complexity. They often address different diagnostic problems and use inconsistent metrics for evaluating performance. As a result, it is difficult to perform a one ]to ]one comparison of the various diagnostic methods. ProDIMES solves this problem by serving as a theme problem to aid in propulsion gas path diagnostic technology development and evaluation. The overall goal is to provide a tool that will serve as an industry standard, and will truly facilitate the development and evaluation of significant Engine Health Management (EHM) capabilities. ProDiMES has been developed under a collaborative project of The Technical Cooperation Program (TTCP) based on feedback provided by individuals within the aircraft engine health management community. The S4 software tool provides a framework that supports the optimal selection of sensors for health management assessments. S4 is structured to accommodate user ]defined applications, diagnostic systems, search techniques, and system requirements/constraints. One or more sensor suites that maximize this performance while meeting other user ]defined system requirements that are presumed to exist. S4 provides a systematic approach for evaluating combinations of sensors to determine the set or sets of sensors that optimally meet the performance goals and the constraints. It identifies optimal sensor suite solutions by utilizing a merit (i.e., cost) function with one of several available optimization approaches. As part of its analysis, S4 can expose fault conditions that are difficult to diagnose due to an incomplete diagnostic philosophy and/or a lack of sensors. S4 was originally developed and applied to liquid rocket engines. It was subsequently used to study the optimized selection of sensors for a simulation ]based aircraft engine diagnostic system. The ETA Tool is a software ]based analysis tool that augments the testability analysis and reporting capabilities of a commercial ]off ]the ]shelf (COTS) package. An initial diagnostic assessment is performed by the COTS software using a user ]developed, qualitative, directed ]graph model of the system being analyzed. The ETA Tool accesses system design information captured within the model and the associated testability analysis output to create a series of six reports for various system engineering needs. These reports are highlighted in the presentation. The ETA Tool was developed by NASA to support the verification of fault management requirements early in the Launch Vehicle process. Due to their early development during the design process, the TEAMS ]based diagnostic model and the ETA Tool were able to positively influence the system design by highlighting gaps in failure detection, fault isolation, and failure recovery.

Premenstrual syndrome, premenstrual dysphoric disorder, and beyond: a clinical primer for practitioners.

PubMed

Johnson, Susan R

2004-10-01

The management of adverse premenstrual symptoms has presented a difficult challenge for clinicians. However, based on numerous well-designed research studies over the last decade, we now have diagnostic criteria for the severe form of the syndrome, premenstrual dysphoric disorder, and a variety of evidence-based therapeutic strategies. This review presents a comprehensive, practical description of what the clinician needs to know to diagnose and treat adverse premenstrual symptoms at all levels of severity. Diagnostic criteria are described in detail, including a discussion of the distinction between premenstrual dysphoric disorder and premenstrual syndrome (PMS). The rationale for including prospective symptom calendars as a routine part of the diagnostic evaluation of severe symptoms is presented. The differential diagnosis of cyclic symptoms, including depression and anxiety disorders, menstrual migraine, and mastalgia, and an approach for the management of each of these problems are presented. A treatment approach is recommended that matches the treatment to the degree of problems the woman is experiencing. Serotonin reuptake inhibitors are the treatment of choice for severe symptoms, and most women with PMS/premenstrual dysphoric disorder will respond to intermittent, luteal phase-only therapy. Ovulation suppression should be reserved for women who do not respond to other forms of therapy. The role of oophorectomy is limited, and guidelines for its use are presented.

Chronic Lower Leg Pain in Athletes

PubMed Central

Brewer, Rachel Biber; Gregory, Andrew J. M.

2012-01-01

Context: Chronic lower leg pain in athletes can be a frustrating problem for patients and a difficult diagnosis for clinicians. Myriad approaches have been suggested to evaluate these conditions. With the continued evolution of diagnostic studies, evidence-based guidance for a standard approach is unfortunately sparse. Evidence Acquisition: PubMed was searched from January 1980 to May 2011 to identify publications regarding chronic lower leg pain in athletes (excluding conditions related to the foot), including differential diagnosis, clinical presentation, physical examination, history, diagnostic workup, and treatment. Results: Leg pain in athletes can be caused by many conditions, with the most frequent being medial tibial stress syndrome; chronic exertional compartment syndrome, stress fracture, nerve entrapment, and popliteal artery entrapment syndrome are also considerations. Conservative management is the mainstay of care for the majority of causes of chronic lower leg pain; however, surgical intervention may be necessary. Conclusion: Chronic lower extremity pain in athletes includes a wide differential and can pose diagnostic dilemmas for clinicians. PMID:23016078

[Nihilodermia in psychodermatology].

PubMed

Harth, W; Hermes, B; Seikowski, K; Gieler, U

2007-05-01

"Nihilodermia" refers to a group of difficult "problem" patients in dermatology without objective findings but with recurrent symptoms and stubborn demand for medical examination. These primary emotional disorders are somatoform disorders, but the patients usually strictly deny a psychosocial aspect and expect purely somatic treatment. Clinical patterns include pruritus, pain, paresthesias, feelings of disfiguration, eco-syndromes, erythrophobia and psychogenic pseudoeffluvium. The relevant somatoform disorders in dermatology can be differentiated as somatization disorders, hypochondriacal disorders, somatoform autonomous disorders, persistent somatoform pain disorders and "other somatoform disorders". A precise differential diagnostic division is necessary in order to initiate adequate therapy strategies.

Food-borne botulism: still actual topic.

PubMed

Brola, Waldemar; Fudala, Malgorzata; Gacek, Szymon; Gruenpeter, Pawel

2013-02-06

Even though since the mid-1990s the number of food-borne botulism cases has systematically decreased and it now occurs in Poland relatively rarely, it is still a real epidemiological problem. There are about 30 cases of botulism in Poland a year, which ranks Poland the first among the European Union. In most cases the symptomatology of botulism is typical, however it does not always fully coincide with the one described in medical manuals which emphasise the dramatic clinical course of botulism with its frequent fatal consequences. Diagnosis of botulism may be difficult because of its rare prevalence and a variable clinical course, especially in old patients. Authors of this paper describe two cases of botulism and diagnostic problems associated with it.

Food-borne botulism: still actual topic

PubMed Central

Brola, Waldemar; Fudala, Malgorzata; Gacek, Szymon; Gruenpeter, Pawel

2013-01-01

Even though since the mid-1990s the number of food-borne botulism cases has systematically decreased and it now occurs in Poland relatively rarely, it is still a real epidemiological problem. There are about 30 cases of botulism in Poland a year, which ranks Poland the first among the European Union. In most cases the symptomatology of botulism is typical, however it does not always fully coincide with the one described in medical manuals which emphasise the dramatic clinical course of botulism with its frequent fatal consequences. Diagnosis of botulism may be difficult because of its rare prevalence and a variable clinical course, especially in old patients. Authors of this paper describe two cases of botulism and diagnostic problems associated with it. PMID:23391950

The challenge of diagnosing focal hand dystonia in musicians

PubMed Central

Rosset-Llobet, J.; Candia, V.; Molas, S. Fàbregas i; Dolors Rosinés i Cubells, D.; Pascual-Leone, A.

2012-01-01

Background and purpose To most clinicians, medical problems in musicians, particularly those concerning focal hand dystonia, constitute an unfamiliar domain difficult to manage. The latter can importantly influence diagnostics and the course of treatment. The purpose of this study was to enlighten the issue and to identify possible problems in diagnosing musicians’ cramp within the Spanish medical community. Methods We used a brief questions’ catalog and clinical histories of 665 musicians seen at our clinic for performing artists. We analyzed patients’ diagnosis records in 87 cases of focal hand dystonia (13.1%). In so doing, we surveyed previous diagnoses and diverse treatments prescriptions prior to referral to our clinic. Results Referrals came primarily from orthopaedists and neurologists. The 52.9% arrived at our clinic without a diagnosis or a suspicion of suffering from focal dystonia. The most frequently attempted diagnoses other than musicians’ dystonia included nerve compression, tendonitis and trigger fingers. Commonly prescribed treatments included rest, various surgical procedures, physiotherapy and oral anti-inflammatory medication. Conclusions This data depicts the diagnostic challenges of medical professionals may encounter when confronted with musician’s focal dystonia. PMID:19473363

[Penicillin allergy as a diagnostic problem. Overview and personal studies].

PubMed

Walker, T; Jung, E G; Bayerl, C

2000-11-01

Penicillin allergy is a common clinical problem. The distinction between penicillin and para-infectious exanthems is difficult. We investigated the reliability of the history, as well as the sensitivity and specificity of skin tests and specific IgE levels. 160 patients with a history of penicillin allergy were retrospectively evaluated in the outpatient department of a dermatological clinic. Nearly 50% were diagnosed as allergic to penicillin by detection of specific IgE or skin test. About 60% of the patients with immediate type reactions, and 72% with maculo-papular erythema showed positive reactions in skin tests. Significantly more patients were diagnosed as allergic to penicillin by intradermal testing than by prick testing (p < 0.05). The sensitivity of the specific IgE RAST was 17.9%; the specifity, 89.5%. For the prick test the sensitivity was 8.2%; the specificity 90.8%. For the intradermal test the sensitivity was 26%; the specifity 69.7%. We suggest a step by step procedure to detect penicillin allergy making the diagnostic results as valid as possible.

The challenge of diagnosing focal hand dystonia in musicians.

PubMed

Rosset-Llobet, J; Candia, V; Fàbregas i Molas, S; Dolors Rosinés i Cubells, D; Pascual-Leone, A

2009-07-01

To most clinicians, medical problems in musicians, particularly those concerning focal hand dystonia, constitute an unfamiliar domain difficult to manage. The latter can importantly influence diagnostics and the course of treatment. The purpose of this study was to enlighten the issue and to identify possible problems in diagnosing musicians' cramp within the Spanish medical community. We used a brief questions' catalog and clinical histories of 665 musicians seen at our clinic for performing artists. We analyzed patients' diagnosis records in 87 cases of focal hand dystonia (13.1%). In so doing, we surveyed previous diagnoses and diverse treatments prescriptions prior to referral to our clinic. Referrals came primarily from orthopaedists and neurologists. The 52.9% arrived at our clinic without a diagnosis or a suspicion of suffering from focal dystonia. The most frequently attempted diagnoses other than musicians' dystonia included nerve compression, tendonitis and trigger fingers. Commonly prescribed treatments included rest, various surgical procedures, physiotherapy and oral anti-inflammatory medication. This data depicts the diagnostic challenges of medical professionals may encounter when confronted with musician's focal dystonia.

[Metastatic tumors in the ovary, difficulties of histologic diagnosis].

PubMed

Tamás, Judit; Vereczkey, Ildikó; Tóth, Erika

2015-09-01

The ovary is a common site of metastases. Secondary tumors account for 3-40% of all ovarian malignancies. Most ovarian metastases arise from the colon, although tumors of the breast, stomach and endometrium are also common places of origin. Clinical and histological features of metastatic tumors frequently mimic primary ovarian malignancies, causing serious diagnostic problems for the surgical pathologist. However, differentiation between primary ovarian cancer and ovarian metastasis is important in order to prevent inappropriate management and suboptimal treatment. The distinction between primary and secondary ovarian malignancies is especially difficult in cases when the metastasis is diagnosed before the primary tumor. Frozen section is widely used in the intra-operative assessment of patients with ovarian tumors but it can be very difficult to distinguish certain types of primary ovarian tumors and metastases from other sites. We examined 152 cases of secondary ovarian neoplasm diagnosed at the National Institute of Oncology, Hungary from 2000 to 2014. Colorectal cancer was the most common primary tumor (58 cases), followed by breast (33 cases), endometrium (30 cases) and stomach cancer (13 cases). The differential diagnosis proved the most difficult in cases when endometrioid and mucinous tumors were present in the ovaries. Metastases of colorectal and gastric adenocarcinomas may simulate benign or borderline cystadenomas too. In these cases the knowledge of the patient's history and immunohistochemical stains were helpful. In our study we discuss the diagnostic challenge of distinguishing these secondary ovarian tumors from primary ovarian neoplasms and the limits of the intraoperative frozen sections.

Antisocial personality disorder: diagnostic, ethical and treatment issues.

PubMed

Kaylor, L

1999-01-01

Antisocial personality disorder (ASPD) is a complex disorder that creates a diagnostic, ethical, and treatment dilemma for mental health professionals. Psychosocial, biological, and cultural influences play a role in the development of ASPD. People with ASPD often had harsh early childhoods that impaired their ability to trust in adulthood. Research supports intriguing biological links, but it remains unclear if biological differences are the cause or the effect of ASPD. Individualism, patriarchy, and widespread media violence create the cultural context for the development of ASPD. ASPD is difficult to clinically diagnose and treat, and there is controversy concerning whether ASPD is a psychiatric or a legal-ethical problem. However, the management of ASPD often falls to mental health services. This article addresses treatment and primary prevention of ASPD in a way that is relevant to mental health practice.

Assessment of a targeted resequencing assay as a support tool in the diagnosis of lysosomal storage disorders

PubMed Central

2014-01-01

Background With over 50 different disorders and a combined incidence of up to 1/3000 births, lysosomal storage diseases (LSDs) constitute a major public health problem and place an enormous burden on affected individuals and their families. Many factors make LSD diagnosis difficult, including phenotype and penetrance variability, shared signs and symptoms, and problems inherent to biochemical diagnosis. Developing a powerful diagnostic tool could mitigate the protracted diagnostic process for these families, lead to better outcomes for current and proposed therapies, and provide the basis for more appropriate genetic counseling. Methods We have designed a targeted resequencing assay for the simultaneous testing of 57 lysosomal genes, using in-solution capture as the enrichment method and two different sequencing platforms. A total of 84 patients with high to moderate-or low suspicion index for LSD were enrolled in different centers in Spain and Portugal, including 18 positive controls. Results We correctly diagnosed 18 positive blinded controls, provided genetic diagnosis to 25 potential LSD patients, and ended with 18 diagnostic odysseys. Conclusion We report the assessment of a next–generation-sequencing-based approach as an accessory tool in the diagnosis of LSDs, a group of disorders which have overlapping clinical profiles and genetic heterogeneity. We have also identified and quantified the strengths and limitations of next generation sequencing (NGS) technology applied to diagnosis. PMID:24767253

Association of renal xanthogranuloma and urological neoplasia.

PubMed

Ballesteros, J J; Munne, A; Rivalta, T; Palma, C; Manzano, I

1988-01-01

Seven of 66 cases of renal xanthogranuloma (RXG) were associated with urinary tumors (10.6%). The diagnostic and surgical problems can be difficult because of the similarities to a neoplasm and because of the inflammatory nature of RXG. Obstruction and infection seemed to be causative factors in 5 of the 7 cases. It was not possible to demonstrate an immunological deficit in these patients. A review of the literature shows the rarity of this association: 20 cases together with our 7 cases gives a total of 27 out of the 676 cases of RXG that have been published (an incidence of 4%).

The clinical management of diabetic foot in the elderly and medico-legal implications.

PubMed

Terranova, Claudio; Bruttocao, Andrea

2013-10-01

Diabetic foot is a complex and challenging pathological state, characterized by high complexity of management, morbidity and mortality. The elderly present peculiar problems which interfere on one hand with the patient's compliance and on the other with their diagnostic-therapeutic management. Difficult clinical management may result in medico-legal problems, with criminal and civil consequences. In this context, the authors present a review of the literature, analysing aspects concerning the diagnosis and treatment of diabetic foot in the elderly which may turn out to be a source of professional responsibility. Analysis of these aspects provides an opportunity to discuss elements important not only for clinicians and medical workers but also experts (judges, lawyers, medico-legal experts) who must evaluate hypotheses of professional responsibility concerning diabetic foot in the elderly.

Vertical root fractures and their management

PubMed Central

Khasnis, Sandhya Anand; Kidiyoor, Krishnamurthy Haridas; Patil, Anand Basavaraj; Kenganal, Smita Basavaraj

2014-01-01

Vertical root fractures associated with endodontically treated teeth and less commonly in vital teeth represent one of the most difficult clinical problems to diagnose and treat. In as much as there are no specific symptoms, diagnosis can be difficult. Clinical detection of this condition by endodontists is becoming more frequent, where as it is rather underestimated by the general practitioners. Since, vertical root fractures almost exclusively involve endodontically treated teeth; it often becomes difficult to differentiate a tooth with this condition from an endodontically failed one or one with concomitant periodontal involvement. Also, a tooth diagnosed for vertical root fracture is usually extracted, though attempts to reunite fractured root have been done in various studies with varying success rates. Early detection of a fractured root and extraction of the tooth maintain the integrity of alveolar bone for placement of an implant. Cone beam computed tomography has been shown to be very accurate in this regard. This article focuses on the diagnostic and treatment strategies, and discusses about predisposing factors which can be useful in the prevention of vertical root fractures. PMID:24778502

[Addison disease during pregnancy--a diagnostic dilemma. Symptoms are similar to normal pregnancy problems].

PubMed

Wålinder, Olov

The symptoms of primary adrenocortical insufficiency (Addison's disease) such as fatigue, anorexia, hypotension and hyperpigmentation are similar to those of normal pregnancy. Addison's disease is rare and the diagnosis can easily be overlooked during pregnancy. The concentration of corticosteroid-binding globulin (CBG) and cortisol in serum as well as urinary free cortisol increase 2-3 times during pregnancy. Therefore, the reference ranges for nonpregnant persons cannot be used during pregnancy. The diagnosis of Addison's disease in pregnancy should be based on analysis of p-ACTH which remains within the reference range in normal pregnancy until delivery. A case of Addison's disease diagnosed during pregnancy is presented and it illustrates the diagnostic difficulties. In patients taking oral estrogen containing contraceptives, serum levels of CBG and cortisol also increase 2-3 times, making s-cortisol values difficult to interpret. Also in these patients, analysis of p-ACTH is of value when suspecting Addison's disease.

WORK-UP OF STILLBIRTH: A REVIEW OF THE EVIDENCE

PubMed Central

SILVER, Robert M.; VARNER, Michael W.; REDDY, Uma; GOLDENBERG, Robert; PINAR, Halit; CONWAY, Deborah; BUKOWSKI, Radek; CARPENTER, Marshall; HOGUE, Carol; WILLINGER, Marian; DUDLEY, Donald; SAADE, George; STOLL, Barbara

2009-01-01

Despite improvements in antenatal and intrapartum care, stillbirth, defined as in utero fetal death at 20 weeks of gestation or greater, remains an important, largely unstudied, and poignant problem in obstetrics. Over 26,000 stillbirths were reported in the US in 2001. Although several conditions have been linked to stillbirth, it is difficult to define the precise etiology in many cases. This paper reviews known and suspected causes of stillbirth including genetic abnormalities, infection, fetal-maternal hemorrhage, and a variety of medical conditions in the mother. The proportion of stillbirths that have a diagnostic explanation is higher in centers that conduct a defined and systematic evaluation. Recommended diagnostic tests for stillbirth are discussed. The on-going work of the NICHD Stillbirth Collaborative Research Network, a consortium of 5 academic centers in the United States that are studying the scope and causes of stillbirth, is presented. PMID:17466694

Rocky Mountain spotted fever: a disease in need of microbiological concern.

PubMed Central

Walker, D H

1989-01-01

Rocky Mountain spotted fever, a life-threatening tick-transmitted infection, is the most prevalent rickettsiosis in the United States. This zoonosis is firmly entrenched in the tick host, which maintains the rickettsiae in nature by transovarian transmission. Although the incidence of disease fluctuates in various regions and nationwide, the problems of a deceptively difficult clinical diagnosis and little microbiologic diagnostic effort persist. Many empiric antibiotic regimens lack antirickettsial activity. There is neither an effective vaccine nor a generally available assay that is diagnostic during the early stages of illness, when treatment is most effective. Microbiology laboratories that offer only the archaic retrospective Weil-Felix serologic tests should review the needs of their patients. Research microbiologists who tackle these challenging organisms have an array of questions to address regarding rickettsial surface composition, structure-function analysis, and pathogenic and immune mechanisms, as well as laboratory diagnosis. PMID:2504480

[Prostate biopsy under magnetic resonance imaging guidance].

PubMed

Kuplevatskiy, V I; CherkashiN, M A; Roshchin, D A; Berezina, N A; Vorob'ev, N A

2016-01-01

Prostate cancer (PC) is one of the most important problems in modern oncology. According to statistical data, PC ranks second in the cancer morbidity structure in the Russian Federation and developed countries and its prevalence has been progressively increasing over the past decade. A need for early diagnosis and maximally accurate morphological verification of the diagnosis in difficult clinical cases (inconvenient tumor location for standard transrectal biopsy; gland scarring changes concurrent with prostatitis and hemorrhage; threshold values of prostate-specific antigen with unclear changes in its doubling per unit time; suspicion of biochemical recurrence or clinical tumor progression after special treatment) leads to revised diagnostic algorithms and clinically introduced new high-tech invasive diagnostic methods. This paper gives the first analysis of literature data on Russian practice using one of the new methods to verify prostate cancer (transrectal prostate cancer under magnetic resonance imaging (MRI) guidance). The have sought the 1995-2015 data in the MEDLINE and Pubmed.

[Transparency regime: semiotics of radiographical images in urological diagnostics].

PubMed

Martin, M; Fangerau, H

2012-10-01

Shortly after Röntgen discovered x-rays urology became one of the main test fields for the application of this new technology. Initial scepticism among physicians, who were inclined to cling to traditional manual methods of diagnosing, was replaced by enthusiasm for radiographic technologies and the new method soon became the standard in, for example the diagnosis of concrements. Patients favoring radiographic procedures over the use of probes and a convincing documentation of stones in radiograms were factors that impacted the relatively rapid integration of radiology into urology. The radiographic representation of soft tissues and body cavities was more difficult and the development of contrast agents in particular posed a serious problem. Several patients died during this research. A new diagnostic dimension was revealed when radiography and cystography were combined to form the method of retrograde pyelography. However, the problem of how urologists could learn how to read the new images remained. In order to allow trainee physicians to practice interpreting radiograms atlases were produced which offered explanatory texts and drawings for radiographic images of the kidneys, the bladder etc. Thus, urologists developed a self-contained semiotics which facilitated the appropriation of a unique urological radiographical gaze.

The Difference between Uncertainty and Information, and Why This Matters

NASA Astrophysics Data System (ADS)

Nearing, G. S.

2016-12-01

Earth science investigation and arbitration (for decision making) is very often organized around a concept of uncertainty. It seems relatively straightforward that the purpose of our science is to reduce uncertainty about how environmental systems will react and evolve under different conditions. I propose here that approaching a science of complex systems as a process of quantifying and reducing uncertainty is a mistake, and specifically a mistake that is rooted in certain rather hisoric logical errors. Instead I propose that we should be asking questions about information. I argue here that an information-based perspective facilitates almost trivial answers to environmental science questions that are either difficult or theoretically impossible to answer when posed as questions about uncertainty. In particular, I propose that an information-centric perspective leads to: Coherent and non-subjective hypothesis tests for complex system models. Process-level diagnostics for complex systems models. Methods for building complex systems models that allow for inductive inference without the need for a priori specification of likelihood functions or ad hoc error metrics. Asymptotically correct quantification of epistemic uncertainty. To put this in slightly more basic terms, I propose that an information-theoretic philosophy of science has the potential to resolve certain important aspects of the Demarcation Problem and the Duhem-Quine Problem, and that Hydrology and other Earth Systems Sciences can immediately capitalize on this to address some of our most difficult and persistent problems.

Students' understandings of electrochemistry

NASA Astrophysics Data System (ADS)

O'Grady-Morris, Kathryn

Electrochemistry is considered by students to be a difficult topic in chemistry. This research was a mixed methods study guided by the research question: At the end of a unit of study, what are students' understandings of electrochemistry? The framework of analysis used for the qualitative and quantitative data collected in this study was comprised of three categories: types of knowledge used in problem solving, levels of representation of knowledge in chemistry (macroscopic, symbolic, and particulate), and alternative conceptions. Although individually each of the three categories has been reported in previous studies, the contribution of this study is the inter-relationships among them. Semi-structured, task-based interviews were conducted while students were setting up and operating electrochemical cells in the laboratory, and a two-tiered, multiple-choice diagnostic instrument was designed to identify alternative conceptions that students held at the end of the unit. For familiar problems, those involving routine voltaic cells, students used a working-forwards problem-solving strategy, two or three levels of representation of knowledge during explanations, scored higher on both procedural and conceptual knowledge questions in the diagnostic instrument, and held fewer alternative conceptions related to the operation of these cells. For less familiar problems, those involving non-routine voltaic cells and electrolytic cells, students approached problem-solving with procedural knowledge, used only one level of representation of knowledge when explaining the operation of these cells, scored higher on procedural knowledge than conceptual knowledge questions in the diagnostic instrument, and held a greater number of alternative conceptions. Decision routines that involved memorized formulas and procedures were used to solve both quantitative and qualitative problems and the main source of alternative conceptions in this study was the overgeneralization of theory related to the particulate level of representation of knowledge. The findings from this study may contribute further to our understanding of students' conceptions in electrochemistry. Furthermore, understanding the influence of the three categories in the framework of analysis and their inter-relationships on how students make sense of this field may result in a better understanding of classroom practice that could promote the acquisition of conceptual knowledge --- knowledge that is "rich in relationships".

Image-guided fine-needle aspiration of retroperitoneal masses: The role of the cytopathologist.

PubMed

Mehdi, Ghazala; Maheshwari, Veena; Afzal, Sheerin; Ansari, Hena A; Ahmad, Ibne

2013-01-01

Retroperitoneal tumors constitute a difficult diagnostic category as they are not easily accessible. The advent of image-guided fine-needle aspiration (FNA) has resolved this problem significantly. We present a short study based on guided aspiration of retroperitoneal tumors, in which we have tried to assess the role of image-guided fine-needle aspiration cytology as a tool for pre-operative diagnosis. The study was conducted on patients diagnosed with retroperitoneal masses. FNA was performed under image guidance with the help of ultrasonography and/or computed tomography; smears were prepared and meticulously screened according to a fixed protocol. The results were analyzed to determine sensitivity, specificity, and diagnostic efficacy of cytopathological diagnosis using image-guided FNA techniques. We assessed 38 patients with retroperitoneal masses. In all cases, adequate cellular material was obtained. No major complications were encountered. Statistical analysis was carried out in 35 cases; sensitivity, specificity, and diagnostic accuracy were 100% in these cases. FNA under image guidance should be considered a first-line diagnostic approach for retroperitoneal and other abdominal tumors, although caution should be exercised in case selection. In areas where advanced tests are not available, the cytotechnologist and cytopathologist have a very important role to play in ensuring accurate diagnoses.

How to tell a patient's story? Influence of the case narrative design on the clinical reasoning process in virtual patients.

PubMed

Hege, Inga; Dietl, Anita; Kiesewetter, Jan; Schelling, Jörg; Kiesewetter, Isabel

2018-02-28

Virtual patients (VPs) are narrative-based educational activities to train clinical reasoning in a safe environment. Our aim was to explore the influence of the design of the narrative and level of difficulty on the clinical reasoning process, diagnostic accuracy and time-on-task. In a randomized controlled trial, we analyzed the clinical reasoning process of 46 medical students with six VPs in three different variations: (1) patients showing a friendly behavior, (2) patients showing a disruptive behavior and (3) a version without a patient story. For easy VPs, we did not see a significant difference in diagnostic accuracy. For difficult VPs, the diagnostic accuracy was significantly higher for participants who worked on the friendly VPs compared to the other two groups. Independent from VP difficulty, participants identified significantly more problems and tests for disruptive than for friendly VPs; time on task was comparable for these two groups. The extrinsic motivation of participants working on the VPs without a patient story was significantly lower than for the students working on the friendly VPs. Our results indicate that the measured VP difficulty has a higher influence on the clinical reasoning process and diagnostic accuracy than the variations in the narratives.

History, epidemiology and diagnostics of dengue in the American and Brazilian contexts: a review.

PubMed

Salles, Tiago Souza; da Encarnação Sá-Guimarães, Thayane; de Alvarenga, Evelyn Seam Lima; Guimarães-Ribeiro, Victor; de Meneses, Marcelo Damião Ferreira; de Castro-Salles, Patricia Faria; Dos Santos, Carlucio Rocha; do Amaral Melo, Ana Claudia; Soares, Marcia Regina; Ferreira, Davis Fernandes; Moreira, Monica Ferreira

2018-04-24

Dengue virus (DENV), an arbovirus transmitted by mosquitoes, has become a major threat to American human life, reaching approximately 23 million cases from 1980 to 2017. Brazil is among the countries most affected by this terrible viral disease, with 13.6 million cases. DENV has four different serotypes, DENV1-4, which show a broad clinical spectrum. Dengue creates a staggering epidemiological and economic burden for endemic countries. Without a specific therapy and with a commercial vaccine that presents some problems relative to its full effectiveness, initiatives to improve vector control strategies, early disease diagnostics and the development of vaccines and antiviral drugs are priorities. In this study, we present the probable origins of dengue in America and the trajectories of its spread. Overall, dengue diagnostics are costly, making the monitoring of dengue epidemiology more difficult and affecting physicians' therapeutic decisions regarding dengue patients, especially in developing countries. This review also highlights some recent and important findings regarding dengue in Brazil and the Americas. We also summarize the existing DENV polymerase chain reaction (PCR) diagnostic tests to provide an improved reference since these tests are useful and accurate at discriminating DENV from other flaviviruses that co-circulate in the Americas. Additionally, these DENV PCR assays ensure virus serotyping, enabling epidemiologic monitoring.

It shouldn't happen to a dog … or a veterinarian: clinical paradigms for canine vector-borne diseases.

PubMed

Irwin, Peter J

2014-02-01

Canine vector-borne diseases (CVBDs) comprise a diverse group of viral, bacterial, protozoal, and helminth pathogens, transmitted predominantly by ticks and fleas, and cause significant health problems for dogs worldwide. Growing numbers of reports indicate that CVBDs are emerging in regions where they previously did not exist and this, combined with pathogens that are inherently difficult to detect, is providing companion animal veterinarians with some significant diagnostic challenges. This review discusses six paradigms concerning the diagnosis, treatment, prevention, and zoonotic implications of CVBDs from a veterinary clinical perspective. Copyright © 2013 Elsevier Ltd. All rights reserved.

Theory of signs and statistical approach to big data in assessing the relevance of clinical biomarkers of inflammation and oxidative stress.

PubMed

Ghezzi, Pietro; Davies, Kevin; Delaney, Aidan; Floridi, Luciano

2018-03-06

Biomarkers are widely used not only as prognostic or diagnostic indicators, or as surrogate markers of disease in clinical trials, but also to formulate theories of pathogenesis. We identify two problems in the use of biomarkers in mechanistic studies. The first problem arises in the case of multifactorial diseases, where different combinations of multiple causes result in patient heterogeneity. The second problem arises when a pathogenic mediator is difficult to measure. This is the case of the oxidative stress (OS) theory of disease, where the causal components are reactive oxygen species (ROS) that have very short half-lives. In this case, it is usual to measure the traces left by the reaction of ROS with biological molecules, rather than the ROS themselves. Borrowing from the philosophical theories of signs, we look at the different facets of biomarkers and discuss their different value and meaning in multifactorial diseases and system medicine to inform their use in patient stratification in personalized medicine.

[Cytology in uropathological diagnostics].

PubMed

Gaisa, N T; Lindemann-Docter, K

2015-11-01

Cytology in uropathological diagnostics is mainly performed for oncological purposes. The assessment of malignancy by urothelial cell morphology is therefore decisive; however, cytology is only sensitive enough to detect high-grade tumor cells and the different low-grade tumors cannot be reliably diagnosed. Thus, the four-tier classification system of cytological findings (i.e. negative, atypical cells but significance uncertain, suspicious and positive) refers to high-grade tumor cells only. Furthermore, for valid cytological diagnostics not only the cytological specimen but also clinical information on cystoscopy findings and, if applicable, a biopsy should be evaluated together. In difficult differential diagnostic settings, e.g. differentiation between reactive versus neoplastic atypia or difficult to access lesions in the upper urinary tract, additional fluorescence in situ hybridization of cytological preparations might be helpful. At the moment there are no indications for further immunocytology or additional biomarker tests.

Groin injuries in sport: treatment strategies.

PubMed

Lynch, S A; Renström, P A

1999-08-01

Groin pain in athletes is a common problem that can result in significant amounts of missed playing time. Many of the problems are related to the musculoskeletal system, but care must be taken not to overlook other more serious and potentially life threatening medical cases of pelvis and groin pain. Stress fractures of the bones of the pelvis occur, particularly after a sudden increase in the intensity of training. Most of these stress fractures will heal with rest, but femoral neck stress fractures can potentially lead to more serious problems, and require closer evaluation and sometimes surgical treatment. Avulsion fractures of the apophyses occur through the relatively weaker growth plate in adolescents. Most of these will heal with a graduated physical therapy programme and do not need surgery. Osteitis pubis is characterised by sclerosis and bony changes about the pubic symphysis. This is a self-limiting disease that can take several months to resolve. Corticosteroid injection can sometimes hasten the rehabilitation process. Sports hernias can cause prolonged groin pain, and provide a difficult diagnostic dilemma. In athletes with prolonged groin pain, with increased pain during valsalva manoeuvres and tenderness along the posterior inguinal wall and external canal, an insidious sports hernia should be considered. In cases of true sports hernia, treatment is by surgical reinforcement of the inguinal wall. Nerve compression can occur to the nerves supplying the groin. In cases that do not respond to desensitisation measures, neurolysis can relieve the pain. Adductor strains are common problems in kicking sports such as soccer. The majority of these are incomplete muscle tendon tears that occur just adjacent to, the musculotendinous junction. Most of these will respond to a graduated stretching and strengthening programme, but these can sometimes take a long time to completely heal. Patience is the key to obtain complete healing, because a return to sports too early can lead to chronic pain, which becomes increasingly difficult to treat. Management of groin injuries can be challenging, and diagnosis can be difficult because of the degree of overlap of symptoms between the different problems. By careful history and clinical examination, with judicious use of special tests and good team work, a correct diagnosis can be obtained.

Diagnostic Problem-Solving Process in Professional Contexts: Theory and Empirical Investigation in the Context of Car Mechatronics Using Computer-Generated Log-Files

ERIC Educational Resources Information Center

Abele, Stephan

2018-01-01

This article deals with a theory-based investigation of the diagnostic problem-solving process in professional contexts. To begin with, a theory of the diagnostic problem-solving process was developed drawing on findings from different professional contexts. The theory distinguishes between four sub-processes of the diagnostic problem-solving…

Enhancing malaria diagnosis through microfluidic cell enrichment and magnetic resonance relaxometry detection

NASA Astrophysics Data System (ADS)

Fook Kong, Tian; Ye, Weijian; Peng, Weng Kung; Wei Hou, Han; Marcos; Preiser, Peter Rainer; Nguyen, Nam-Trung; Han, Jongyoon

2015-06-01

Despite significant advancements over the years, there remains an urgent need for low cost diagnostic approaches that allow for rapid, reliable and sensitive detection of malaria parasites in clinical samples. Our previous work has shown that magnetic resonance relaxometry (MRR) is a potentially highly sensitive tool for malaria diagnosis. A key challenge for making MRR based malaria diagnostics suitable for clinical testing is the fact that MRR baseline fluctuation exists between individuals, making it difficult to detect low level parasitemia. To overcome this problem, it is important to establish the MRR baseline of each individual while having the ability to reliably determine any changes that are caused by the infection of malaria parasite. Here we show that an approach that combines the use of microfluidic cell enrichment with a saponin lysis before MRR detection can overcome these challenges and provide the basis for a highly sensitive and reliable diagnostic approach of malaria parasites. Importantly, as little as 0.0005% of ring stage parasites can be detected reliably, making this ideally suited for the detection of malaria parasites in peripheral blood obtained from patients. The approaches used here are envisaged to provide a new malaria diagnosis solution in the near future.

A knowledge-based, concept-oriented view generation system for clinical data.

PubMed

Zeng, Q; Cimino, J J

2001-04-01

Information overload is a well-known problem for clinicians who must review large amounts of data in patient records. Concept-oriented views, which organize patient data around clinical concepts such as diagnostic strategies and therapeutic goals, may offer a solution to the problem of information overload. However, although concept-oriented views are desirable, they are difficult to create and maintain. We have developed a general-purpose, knowledge-based approach to the generation of concept-oriented views and have developed a system to test our approach. The system creates concept-oriented views through automated identification of relevant patient data. The knowledge in the system is represented by both a semantic network and rules. The key relevant data identification function is accomplished by a rule-based traversal of the semantic network. This paper focuses on the design and implementation of the system; an evaluation of the system is reported separately.

Diagnostic imaging and spending review: extreme problems call for extreme measures.

PubMed

Ciarrapico, Anna Micaela; Ugenti, Rossana; Di Minco, Lidia; Santori, Elisabetta; Altobelli, Simone; Coco, Irene; D'Onofrio, Silvia; Simonetti, Giovanni

2017-04-01

The number of diagnostic imaging tests has increased dramatically over the past decade and about 5 billion diagnostic examinations are performed worldwide each year. According to Health Ministry, Italy, is in second place for the number of CT and MR tests per thousand inhabitants in 2014 with a score of 83.3 (only Germany has a higher score, 95.2) that is a long way off from the European average of 46.5. It has also the highest ratio of magnetic resonances per person with 24,6 machines per million inhabitants, followed only by Greece and Finland. The development of the New Health Information System (NSIS) in 2010 made uniformly readable the non-homogeneous clinical data from all the different Italian regions and permitted a detailed analysis of all diagnostic imaging within the public outpatient care setting in Italy in 2012. Despite that MRI examinations represented only the 10% of the total number of imaging tests performed, their cost reached 30% of the health-care expenditure for outpatient diagnostic imaging with an overwhelming contribution coming from musculoskeletal MR which accounted for the 73% of the performed MR tests. It is reasonable to assume that these phenomena are likely due to a lack of appropriateness in MR requests that is difficult to analyze due to an absence or invalid query on the prescriptions which together accounted for the 98.7% of cases. Taking into account the above-mentioned situation, this is possibly why the Ministry of Health decided to perform "linear cuts" in expenditure for some diagnostic examinations.

[The treatment of pedophilia under juridical compulsion].

PubMed

Cosyns, P

1997-01-01

Public opinion is more and more concerned about the fate of victims of sexual violence and sexual abuse. Until now the focus of scientific research concerned the most appropriate approach of children and women as the main victims of male sexual offenders. We need more research on the psychopathology of sexuality and aggression in order to develop scientifically founded treatment modalities to prevent relapse of sexual abuse. The University Forensic Centre of the University of Antwerp started in 1993 with an outpatient consultation for the diagnosis and treatment of paraphilia disorders. During the first 3 years, 265 consecutive clients have been examined, including 157 persons referred for pedosexual activities. This paper reflects the experience of the diagnostic and treatment team with this specific population. The specialised outpatient treatment program is mainly based on cognitive and behaviour therapy. The program can be divided in six phases: 1. intake, 2. provision of the necessary safeguards, 3. diagnostic (bio-psycho-social and criminological), 4. enhancement of motivation for treatment, 5. relapse prevention I where the focus is on behavioural control and 6. relapse prevention II where the focus is on life style imbalances. Difficult ethical problems must be taken into account in the treatment of sexual abusers referred by judicial authorities (74% of our cases), 1) the lack of motivation for treatment, 2) the problem of confidentiality.

Intelligent classifier for dynamic fault patterns based on hidden Markov model

NASA Astrophysics Data System (ADS)

Xu, Bo; Feng, Yuguang; Yu, Jinsong

2006-11-01

It's difficult to build precise mathematical models for complex engineering systems because of the complexity of the structure and dynamics characteristics. Intelligent fault diagnosis introduces artificial intelligence and works in a different way without building the analytical mathematical model of a diagnostic object, so it's a practical approach to solve diagnostic problems of complex systems. This paper presents an intelligent fault diagnosis method, an integrated fault-pattern classifier based on Hidden Markov Model (HMM). This classifier consists of dynamic time warping (DTW) algorithm, self-organizing feature mapping (SOFM) network and Hidden Markov Model. First, after dynamic observation vector in measuring space is processed by DTW, the error vector including the fault feature of being tested system is obtained. Then a SOFM network is used as a feature extractor and vector quantization processor. Finally, fault diagnosis is realized by fault patterns classifying with the Hidden Markov Model classifier. The importing of dynamic time warping solves the problem of feature extracting from dynamic process vectors of complex system such as aeroengine, and makes it come true to diagnose complex system by utilizing dynamic process information. Simulating experiments show that the diagnosis model is easy to extend, and the fault pattern classifier is efficient and is convenient to the detecting and diagnosing of new faults.

[Rare bone tumour of the hand: capillary haemangioma of the second finger: case report].

PubMed

Chbani, L; Benmlih, A; Hammas, N; Znati, K; Marzouki, A; Chbani, B; Boutayeb, F; Amarti, A

2011-04-01

Primary vascular tumours of bone are rare. Haemangiomas occur as incidental findings in the skull or in the spine. A solitary haemangioma of the hand skeleton is rare and difficult in radiological and histological differential diagnosis. We report a case of a 23 year-old patient presenting with a capillary hemangioma of the left second finger of few months duration for which he underwent amputation. Postoperative evolution was good and showed no recurrence. We discuss this through observation and a review of the literature including the different clinical, radiological and pathological diagnostic problems associated with an unusual site for vascular proliferation. Copyright © 2011. Published by Elsevier SAS.

Diagnosis of Swimming Induced Pulmonary Edema—A Review

PubMed Central

Grünig, Hannes; Nikolaidis, Pantelis T.; Moon, Richard E.; Knechtle, Beat

2017-01-01

Swimming induced pulmonary edema (SIPE) is a complication that can occur during exercise with the possibility of misdiagnosis and can quickly become life threatening; however, medical literature infrequently describes SIPE. Therefore, the aim of this review was to analyse all individual cases diagnosed with SIPE as reported in scientific sources, with an emphasis on the diagnostic pathways and the key facts resulting in its diagnosis. Due to a multifactorial and complicated pathophysiology, the diagnosis could be difficult. Based on the actual literature, we try to point out important findings regarding history, conditions, clinical findings, and diagnostic testing helping to confirm the diagnosis of SIPE. Thirty-eight cases from seventeen articles reporting the diagnosis of SIPE were selected. We found remarkable differences in the individual described diagnostic pathways. A total of 100% of the cases suffered from an acute onset of breathing problems, occasionally accompanied by hemoptysis. A total of 73% showed initial hypoxemia. In most of the cases (89%), an initial chest X-Ray or chest CT was available, of which one-third (71%) showed radiological signs of pulmonary edema. The majority of the cases (82%) experienced a rapid resolution of symptoms within 48 h, the diagnostic hallmark of SIPE. Due to a foreseeable increase in participation in swimming competitions and endurance competitions with a swimming component, diagnosis of SIPE will be important, especially for medical teams caring for these athletes. PMID:28912730

Impact of production system on development of insecticide resistance in Frankliniella occidentalis (Thysanoptera: Thripidae).

PubMed

Bielza, P; Quinto, V; Grávalos, C; Fernández, E; Abellán, J

2008-10-01

The western flower thrips, Frankliniella occidentalis (Pergande) (Thysanoptera: Thripidae), has become one of the most difficult insects to control in the intensive agriculture of southeastern Spain. However, resistance problems are quite different in two neighboring areas, Murcia and Almeria, with distinct production systems. Thirty-six field populations of western flower thrips from sweet pepper crops were collected in two different dates in Murcia and Almeria in 2005 and 2006. Western flower thrips populations collected were exposed to a diagnostic concentration of spinosad, methiocarb, acrinathrin, and formetanate. The results allowed the recognition of higher levels of resistance in Almeria compared with Murcia throughout the growing season. The mortality at the diagnostic concentration for spinosad (120 ppm) in western flower thrips populations ranged from 34 to 81% in Almeria, and from 73 to 100% in Murcia. The mortalities at the diagnostic concentration to acrinathrin (800 ppm) and formetanate (8000 ppm) were 17-31% in Almeria and 77-100% in Murcia, and 14-41% in Almeria and 48-99% in Murcia, respectively, indicating large geographic variations. Toxicity of methiocarb was higher for western flower thrips populations from both areas. However, mortality at the diagnostic concentration of methiocarb (2000 ppm) varied from 56 to 90% in Almeria, and it was from 94 to 100% in Murcia. The impact of production systems and agricultural practices of each area on the development and stability of insecticide resistance is discussed.

Double obstruction of ureter: A diagnostic challenge.

PubMed

Halder, Pankaj; Shukla, Ram Mohan; Mandal, Kartik Chandra; Mukhopadhyay, Biswanath; Barman, Shibsankar

2014-07-01

Isolated obstruction of the ureteropelvic junction and the vesico-ureteric junction are the two most common causes of hydronephrosis in a pediatric population.[1] They do not pose diagnostic difficulties when are present alone but when together can be difficult to diagnose. Here, we discuss the problems we faced when we encountered these two anomalies in the same ureter and the way in which we managed them. To assess the difficulties in diagnosis of pediatric patients who present with both ureteropelvic junction obstruction (UPJO) and vesico-ureteric junction obstruction (VUJO) in the ipsilateral ureter and their management protocol. This is a retrospective study. The study period is from 1 January 2004 to 31 December 2011. Out of 254 children who were diagnosed to have hydronephrosis due to UPJO in our institute, 5 patients (in the age range of 5 to 10 years) had both UPJO and VUJO in the ipsilateral ureter. The problems we faced in diagnosing the two conditions are mentioned with a literature review. Operative intervention was used in four out of five patients; none of the patients had an accurate diagnosis before surgery. All patients were suspected of having double obstruction during pyeloplasty when appropriate size double J stent could not be negotiated through the vesicoureteric junction into the bladder. Postoperative nephrostogram confirmed the diagnosis in all patients. Children with double obstruction of the ipsilateral ureter present as a diagnostic dilemma. Because of the rarity of this condition it can escape the eye of even an astute clinician. Early diagnosis can be made if this condition is kept in mind while treating any hydronephrosis due to UPJO or UVJO.

Decision support in psychiatry – a comparison between the diagnostic outcomes using a computerized decision support system versus manual diagnosis

PubMed Central

Bergman, Lars G; Fors, Uno GH

2008-01-01

Background Correct diagnosis in psychiatry may be improved by novel diagnostic procedures. Computerized Decision Support Systems (CDSS) are suggested to be able to improve diagnostic procedures, but some studies indicate possible problems. Therefore, it could be important to investigate CDSS systems with regard to their feasibility to improve diagnostic procedures as well as to save time. Methods This study was undertaken to compare the traditional 'paper and pencil' diagnostic method SCID1 with the computer-aided diagnostic system CB-SCID1 to ascertain processing time and accuracy of diagnoses suggested. 63 clinicians volunteered to participate in the study and to solve two paper-based cases using either a CDSS or manually. Results No major difference between paper and pencil and computer-supported diagnosis was found. Where a difference was found it was in favour of paper and pencil. For example, a significantly shorter time was found for paper and pencil for the difficult case, as compared to computer support. A significantly higher number of correct diagnoses were found in the diffilt case for the diagnosis 'Depression' using the paper and pencil method. Although a majority of the clinicians found the computer method supportive and easy to use, it took a longer time and yielded fewer correct diagnoses than with paper and pencil. Conclusion This study could not detect any major difference in diagnostic outcome between traditional paper and pencil methods and computer support for psychiatric diagnosis. Where there were significant differences, traditional paper and pencil methods were better than the tested CDSS and thus we conclude that CDSS for diagnostic procedures may interfere with diagnosis accuracy. A limitation was that most clinicians had not previously used the CDSS system under study. The results of this study, however, confirm that CDSS development for diagnostic purposes in psychiatry has much to deal with before it can be used for routine clinical purposes. PMID:18261222

Concordance in diagnostic testing for respiratory pathogens of Bighorn Sheep

USDA-ARS?s Scientific Manuscript database

Reliable diagnostic tests are essential for disease investigation and management. This is particularly true for diseases of free-ranging wildlife where sampling is logistically difficult precluding retesting. Clinical assays for wildlife diseases frequently vary among laboratories because of lack ...

Pleural mesothelioma - case report.

PubMed

Klawiter, Anna; Damaszke, Tomasz

2010-10-01

Pleural mesothelioma is a very rare neoplasm; especially the local form. The diagnostics is difficult and the prognosis unfavourable. We presented a case of a man with dyspnoea and cough. His chest radiogram showed hydrothorax on the left side. Neither the examinations of the pleural liquid, nor the CT-guided fine needle biopsy established the diagnosis. CT showed features suggestive of pleural mesothelioma. The diagnosis was confirmed by thoracoscopy. Although no neoplastic cells were found in the thoracoscopic specimen from the supradiaphragmatic tumor, we assumed that to be a case of a diffuse, primarily local form of mesothelioma. Diagnostics of pleural mesothelioma is very difficult. CT and thoracoscopy seem to be very valuable diagnostic methods. It is worth remembering that pleural mesothelioma can have a local form which may transform into a diffuse one.

A STERILIZATION STANDARD FOR ENDOSCOPES AND OTHER DIFFICULT TO CLEAN MEDICAL DEVICES

EPA Science Inventory

An array of difficult to clean devices are used for diagnostic and surgical procedures involving various degrees of invasiveness. These range from prophylaxis angles used for cleaning and polishing teeth to flexible fiberoptic endoscopes for surgical procedures that penetrate the...

Perspective: Whither the problem list? Organ-based documentation and deficient synthesis by medical trainees.

PubMed

Kaplan, Daniel M

2010-10-01

The author argues that the well-formulated problem list is essential for both organizing and evaluating diagnostic thinking. He considers evidence of deficiencies in problem lists in the medical record. He observes a trend among medical trainees toward organizing notes in the medical record according to lists of organ systems or medical subspecialties and hypothesizes that system-based documentation may undermine the art of problem formulation and diagnostic synthesis. Citing research linking more sophisticated problem representation with diagnostic success, he suggests that documentation style and clinical reasoning are closely connected and that organ-based documentation may predispose trainees to several varieties of cognitive diagnostic error and deficient synthesis. These include framing error, premature or absent closure, failure to integrate related findings, and failure to recognize the level of diagnostic resolution attained for a given problem. He acknowledges the pitfalls of higher-order diagnostic resolution, including the application of labels unsupported by firm evidence, while maintaining that diagnostic resolution as far as evidence permits is essential to both rational care of patients and rigorous education of learners. He proposes further research, including comparison of diagnostic efficiency between organ- and problem-oriented thinkers. He hypothesizes that the subspecialty-based structure of academic medical services helps perpetuate organ-system-based thinking, and calls on clinical educators to renew their emphasis on the formulation and documentation of complete and precise problem lists and progressively refined diagnoses by trainees.

Wound Healing Finally Enters the Age of Molecular Diagnostic Medicine

PubMed Central

Tatum, Owatha L.; Dowd, Scot E.

2012-01-01

Background Many wounds are difficult to heal because of the large, complex community of microbes present within the wound. The Problem Classical laboratory culture methods do not provide an accurate picture of the microbial interactions or representation of microorganisms within a wound. There is an inherent bias in diagnosis based upon classical culture stemming from the ability of certain organisms to thrive in culture while others are underrepresented or fail to be identified in culture altogether. Chronic wounds also contain polymicrobial infections existing as a cooperative community that is resistant to antibiotic therapy. Basic/Clinical Science Advances New methods in molecular diagnostic medicine allow the identification of nearly all organisms present in a wound irrespective of the ability of these organisms to be grown in culture. Advances in DNA analyses allow absolute identification of microorganisms from very small clinical specimens. These new methods also provide a quantitative representation of all microorganisms contributing to these polymicrobial infections. Clinical Care Relevance Technological advances in laboratory diagnostics can significantly shorten the time required to heal chronic wounds. Identification of the genetic signatures of organisms present within a wound allows clinicians to identify and treat the primary organisms responsible for nonhealing wounds. Conclusion Advanced genetic technologies targeting the specific needs of wound care patients are now accessible to all wound care clinicians. PMID:24527290

Late-night salivary cortisol measurement in the diagnosis of Cushing's syndrome.

PubMed

Carroll, Ty; Raff, Hershel; Findling, James W

2008-06-01

Making a definite diagnosis of Cushing's syndrome is a challenging problem. Unsuspected Cushing's syndrome occurs in 2-3% of patients with poorly controlled diabetes, 0.5-1% with hypertension, 6-9% with incidental adrenal masses, and 11% with unexplained osteoporosis and vertebral fractures. The increasing recognition of this syndrome highlights the need for a simple, sensitive, and specific diagnostic test. Patients with Cushing's syndrome consistently do not reach a normal nadir of cortisol secretion at night. The measurement of late-night salivary cortisol levels might, therefore, provide a new diagnostic approach for this disorder. Salivary cortisol concentrations reflect those of active free cortisol in plasma and saliva samples can easily be obtained in a nonstressful environment (e.g. at home). Late-night salivary cortisol measurement yields excellent overall diagnostic accuracy for Cushing's syndrome, with a sensitivity of 92-100% and a specificity of 93-100%. Several factors can, however, make interpretation of results difficult; these factors include disturbed sleep-wake cycles, contamination of samples (particularly by topical corticosteroids), and illnesses known to cause physiologic activation of the pituitary-adrenal axis. In this Review, we discuss the methods and value of measuring salivary cortisol for the diagnosis of Cushing's syndrome, and put forward some recommendations to maximize accuracy of results.

Diagnostic approach of myocarditis: strike the golden mean.

PubMed

Hazebroek, M R; Everaerts, K; Heymans, S

2014-02-01

Myocarditis is a challenging diagnosis due to the extreme diversity of clinical manifestations. The actual incidence of myocarditis is also difficult to determine as endomyocardial biopsy (EMB), the diagnostic gold standard, is used infrequently. Nevertheless, in up to 30 % of patients with biopsy-proven myocarditis, progression to dilated cardiomyopathy (DCM) can occur and is associated with a poor prognosis. Recent position statements of the European Society of Cardiology (ESC) and the American Heart Association vary widely with regard to indications for performing an EMB in these patients. This makes decision-making, in particular for general practitioners (GPs) and regional hospitals, difficult and unclear. Therefore, we will present a short summary of the ESC Working Group on Myocardial and Pericardial Diseases statement and our suggestions for GPs and regional hospitals for the diagnostic approach in patients with suspected myocarditis.

Pleural mesothelioma – case report

PubMed Central

Klawiter, Anna; Damaszke, Tomasz

2010-01-01

Summary Background: Pleural mesothelioma is a very rare neoplasm; especially the local form. The diagnostics is difficult and the prognosis unfavourable. Case Report: We presented a case of a man with dyspnoea and cough. His chest radiogram showed hydrothorax on the left side. Neither the examinations of the pleural liquid, nor the CT-guided fine needle biopsy established the diagnosis. CT showed features suggestive of pleural mesothelioma. The diagnosis was confirmed by thoracoscopy. Although no neoplastic cells were found in the thoracoscopic specimen from the supradiaphragmatic tumor, we assumed that to be a case of a diffuse, primarily local form of mesothelioma. Conclusions: Diagnostics of pleural mesothelioma is very difficult. CT and thoracoscopy seem to be very valuable diagnostic methods. It is worth remembering that pleural mesothelioma can have a local form which may transform into a diffuse one. PMID:22802809

Technical errors in planar bone scanning.

PubMed

Naddaf, Sleiman Y; Collier, B David; Elgazzar, Abdelhamid H; Khalil, Magdy M

2004-09-01

Optimal technique for planar bone scanning improves image quality, which in turn improves diagnostic efficacy. Because planar bone scanning is one of the most frequently performed nuclear medicine examinations, maintaining high standards for this examination is a daily concern for most nuclear medicine departments. Although some problems such as patient motion are frequently encountered, the degraded images produced by many other deviations from optimal technique are rarely seen in clinical practice and therefore may be difficult to recognize. The objectives of this article are to list optimal techniques for 3-phase and whole-body bone scanning, to describe and illustrate a selection of deviations from these optimal techniques for planar bone scanning, and to explain how to minimize or avoid such technical errors.

Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences.

PubMed

Allali, Slimane; Brousse, Valentine; Sacri, Anne-Sylvia; Chalumeau, Martin; de Montalembert, Mariane

2017-11-01

Anemia in children is a major public health problem throughout the world. It is often multifactorial, iron deficiency being the most frequent etiology. Consequences are diverse and largely under evaluated. Areas covered: This paper briefly reviews the main causes and focus on the potential consequences of acute and chronic anemia in children. Expert commentary: Anemia in children should never be trivialized. Even if iron deficiency is frequently involved, other potentially life-threatening causes are possible and should be looked for. The exact contribution of anemia to child mortality and morbidity is difficult to assess because of overlapping comorbidities. Chronic anemia may impair growth, cardiac function and cognitive development in infants but other consequences are rather poorly described and should be explored more thoroughly.

Taking error into account when fitting models using Approximate Bayesian Computation.

PubMed

van der Vaart, Elske; Prangle, Dennis; Sibly, Richard M

2018-03-01

Stochastic computer simulations are often the only practical way of answering questions relating to ecological management. However, due to their complexity, such models are difficult to calibrate and evaluate. Approximate Bayesian Computation (ABC) offers an increasingly popular approach to this problem, widely applied across a variety of fields. However, ensuring the accuracy of ABC's estimates has been difficult. Here, we obtain more accurate estimates by incorporating estimation of error into the ABC protocol. We show how this can be done where the data consist of repeated measures of the same quantity and errors may be assumed to be normally distributed and independent. We then derive the correct acceptance probabilities for a probabilistic ABC algorithm, and update the coverage test with which accuracy is assessed. We apply this method, which we call error-calibrated ABC, to a toy example and a realistic 14-parameter simulation model of earthworms that is used in environmental risk assessment. A comparison with exact methods and the diagnostic coverage test show that our approach improves estimation of parameter values and their credible intervals for both models. © 2017 by the Ecological Society of America.

Characterizing Neutron Diagnostics on the nTOF Line at SUNY Geneseo

NASA Astrophysics Data System (ADS)

Harrison, Hannah; Seppala, Hannah; Visca, Hannah; Wakwella, Praveen; Fletcher, Kurt; Padalino, Stephen; Forrest, Chad; Regan, Sean; Sangster, Craig

2016-10-01

Charged particle beams from SUNY Geneseo's 1.7 MV Tandem Pelletron Accelerator induce nuclear reactions that emit neutrons ranging from 0.5 to 17.9 MeV via 2H(d,n)3He and 11B(d,n)12C. This adjustable neutron source can be used to calibrate ICF and HEDP neutron scintillators for ICF diagnostics. However, gamma rays and muons, which are often present during an accelerator-based calibration, are difficult to differentiate from neutron signals in scintillators. To mitigate this problem, a new neutron time-of-flight (nTOF) line has been constructed. The nTOF timing is measured using the associated particle technique. A charged particle produced by the nuclear reaction serves as a start signal, while its associated neutron is the stop signal. Each reaction is analyzed event-by-event to determine whether the scintillator signal was generated by a neutron, gamma or muon. Using this nTOF technique, the neutron response for different scintillation detectors can be determined. Funded in part by a LLE contract through the DOE.

Epidemiology of Malaria in Endemic Areas

PubMed Central

Autino, Beatrice; Noris, Alice; Russo, Rosario; Castelli, Francesco

2012-01-01

Malaria infection is still to be considered a major public health problem in those 106 countries where the risk of contracting the infection with one or more of the Plasmodium species exists. According to estimates from the World Health Organization, over 200 million cases and about 655.000 deaths have occurred in 2010. Estimating the real health and social burden of the disease is a difficult task, because many of the malaria endemic countries have limited diagnostic resources, especially in rural settings where conditions with similar clinical picture may coexist in the same geographical areas. Moreover, asymptomatic parasitaemia may occur in high transmission areas after childhood, when anti-malaria semi-immunity occurs. Malaria endemicity and control activities are very complex issues, that are influenced by factors related to the host, to the parasite, to the vector, to the environment and to the health system capacity to fully implement available anti-malaria weapons such as rapid diagnostic tests, artemisinin-based combination treatment, impregnated bed-nets and insecticide residual spraying while waiting for an effective vaccine to be made available. PMID:23170189

[Clinical examination of the hip joint in adults].

PubMed

Grifka, J; Keshmiri, A; Maderbacher, G; Craiovan, B

2014-12-01

Complaints in the region of the hips and pelvis are often difficult to classify. This is due to the fact that pain projection and overlapping can occur; therefore, the complete region of the lumbar spine, pelvis and hips must be considered as a single entity in which alterations can result in radiation throughout the whole region. There are many different anatomical structures within the pelvic region so that the function of various muscle components can be impaired and cause pathological alterations to positional relationships of bony structures or even alterations to other soft tissues, such as ligaments, tendons and labra. In terms of differential diagnostics the groin must be seen as the weak point of the peritoneum and vascular system and taken into consideration. Therefore, a detailed and targeted medical history, functional testing and specific examinations and tests are necessary to narrow down the pathology in question and reach a definitive diagnosis. Orthopedic surgeons must know which conspicuous features can lead to which problems and which anatomical structures are likely to be affected by irritation. The results of the clinical examination are the basis for targeted imaging diagnostics and subsequent therapy.

[Clinical examination of the hip joint in adults].

PubMed

Grifka, J; Keshmiri, A; Maderbacher, G; Craiovan, B

2015-07-01

Complaints in the region of the hips and pelvis are often difficult to classify. This is due to the fact that pain projection and overlapping can occur; therefore, the complete region of the lumbar spine, pelvis and hips must be considered as a single entity in which alterations can result in radiation throughout the whole region. There are many different anatomical structures within the pelvic region so that the function of various muscle components can be impaired and cause pathological alterations to positional relationships of bony structures or even alterations to other soft tissues, such as ligaments, tendons and labra. In terms of differential diagnostics the groin must be seen as the weak point of the peritoneum and vascular system and taken into consideration. Therefore, a detailed and targeted medical history, functional testing and specific examinations and tests are necessary to narrow down the pathology in question and reach a definitive diagnosis. Orthopedic surgeons must know which conspicuous features can lead to which problems and which anatomical structures are likely to be affected by irritation. The results of the clinical examination are the basis for targeted imaging diagnostics and subsequent therapy.

Caffeine Use Disorder: A Review of the Evidence and Future Implications.

PubMed

Addicott, Merideth A

2014-09-01

The latest edition of the Diagnostic and Statistical Manual (DSM-5) has introduced new provisions for caffeine-related disorders. Caffeine Withdrawal is now an officially recognized diagnosis, and criteria for caffeine use disorder have been proposed for additional study. caffeine use disorder is intended to be characterized by cognitive, behavioral, and physiological symptoms indicative of caffeine use despite significant caffeine-related problems, similar to other Substance Use Disorders. However, since nonproblematic caffeine use is so common and widespread, it may be difficult for some health professionals to accept that caffeine use can result in the same types of pathological behaviors caused by alcohol, cocaine, opiates, or other drugs of abuse. Yet there is evidence that some individuals are psychologically and physiologically dependent on caffeine, although the prevalence and severity of these problems is unknown. This article reviews the recent changes to the DSM, the concerns regarding these changes, and some potential impacts these changes could have on caffeine consumers.

Remote sensing for environmental protection of the eastern Mediterranean rugged mountainous areas, Lebanon

NASA Astrophysics Data System (ADS)

Khawlie, M.; Awad, M.; Shaban, A.; Bou Kheir, R.; Abdallah, C.

Lying along the eastern Mediterranean coast with elevated mountain chains higher than 2500 m straddling its terrain, Lebanon is a country of natural beauty and is thus attracting tourism. However, with a population density exceeding 800/km 2 and a rugged steep sloping land, problems abound in the country calling for holistic-approach studies. Only remote sensing, whose use is new in Lebanon can secure such needed studies within a scientific and pragmatic framework. The paper demonstrates for the concerned themes, the innovative use of remote sensing in such a difficult terrain, giving three examples of major environmental problems in the coastal mountains. Only few studies have so far focused on those mountains, notably application of remote sensing. The rugged mountainous terrain receives considerable rain, but the water is quickly lost running on the steep slopes, or infiltrating through fractures and the karstic conduits into the subsurface. Field investigations are difficult to achieve, therefore, remote sensing helps reveal various surface land features important in reflecting water feeding into the subsurface. Optical, radar and thermal infrared remotely sensed data cover a wide spectrum serving that purpose. A map of preferential groundwater accumulation potential is produced. It can serve for better water exploitation as well as protection. Because the terrain is karstic and rugged, the subsurface water flow is difficult to discern. Any pollution at a certain spot would certainly spread around. This constitutes the second example of environmental problems facing the mountainous areas in Lebanon. An integrated approach using remote sensing and geographic information systems (GIS) gives good results in finding out the likelihood of how pollution, or contaminants, can selectively move in the subsurface. A diagnostic analysis with a GIS-type software acts as a guide producing indicative maps for the above purpose. The third example given deals with the problem of losing soil, which is a very vital source in such mountainous land. With steep slopes, torrential rain and improper human interference, run-off is high and water-soil erosion is continuously deteriorating the land cover. Remote sensing can facilitate studying the factors enhancing the process, such as soil type, slope gradient, drainage, geology and land cover. Digital elevation models created from SAR imagery contribute significantly to assessing vulnerability of hydric-soil erosion over such a difficult terrain. GIS layers of the above factors are integrated with erosional criteria to produce a risk map of soil erosion. Results indicate that 36% of the Lebanese terrain is under threat of high-level erosion, and 52% of that is concentrated in the rugged mountainous regions.

Characteristics of a Cognitive Tool That Helps Students Learn Diagnostic Problem Solving

ERIC Educational Resources Information Center

Danielson, Jared A.; Mills, Eric M.; Vermeer, Pamela J.; Preast, Vanessa A.; Young, Karen M.; Christopher, Mary M.; George, Jeanne W.; Wood, R. Darren; Bender, Holly S.

2007-01-01

Three related studies replicated and extended previous work (J.A. Danielson et al. (2003), "Educational Technology Research and Development," 51(3), 63-81) involving the Diagnostic Pathfinder (dP) (previously Problem List Generator [PLG]), a cognitive tool for learning diagnostic problem solving. In studies 1 and 2, groups of 126 and 113…

Diagnosing ion-beam targets, data acquisition, reactor conditions

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

Mendel, Jr., C. W.

1982-01-01

The final lecture will discuss diagnostics of the target. These are very difficult because of the short times, small spatial extent, and extreme values of temperature and pressure. Diagnostics for temperature, density profile, and neutron production will be discussed. A few minutes will be devoted to data acquisition needs. The lecture will end with a discussion of current areas where improvements are needed and future diagnostics that will be required for reactor conditions.

Melioidosis Diagnostic Workshop, 20131

PubMed Central

AuCoin, David; Baccam, Prasith; Baggett, Henry C.; Baird, Rob; Bhengsri, Saithip; Blaney, David D.; Brett, Paul J.; Brooks, Timothy J.G.; Brown, Katherine A.; Chantratita, Narisara; Cheng, Allen C.; Dance, David A.B.; Decuypere, Saskia; Defenbaugh, Dawn; Gee, Jay E.; Houghton, Raymond; Jorakate, Possawat; Lertmemongkolchai, Ganjana; Limmathurotsakul, Direk; Merlin, Toby L.; Mukhopadhyay, Chiranjay; Norton, Robert; Peacock, Sharon J.; Rolim, Dionne B.; Simpson, Andrew J.; Steinmetz, Ivo; Stoddard, Robyn A.; Stokes, Martha M.; Sue, David; Tuanyok, Apichai; Whistler, Toni; Wuthiekanun, Vanaporn; Walke, Henry T.

2015-01-01

Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions. PMID:25626057

Image quality enhancement for skin cancer optical diagnostics

NASA Astrophysics Data System (ADS)

Bliznuks, Dmitrijs; Kuzmina, Ilona; Bolocko, Katrina; Lihachev, Alexey

2017-12-01

The research presents image quality analysis and enhancement proposals in biophotonic area. The sources of image problems are reviewed and analyzed. The problems with most impact in biophotonic area are analyzed in terms of specific biophotonic task - skin cancer diagnostics. The results point out that main problem for skin cancer analysis is the skin illumination problems. Since it is often not possible to prevent illumination problems, the paper proposes image post processing algorithm - low frequency filtering. Practical results show diagnostic results improvement after using proposed filter. Along that, filter do not reduces diagnostic results' quality for images without illumination defects. Current filtering algorithm requires empirical tuning of filter parameters. Further work needed to test the algorithm in other biophotonic applications and propose automatic filter parameter selection.

Revision of Canadian Eurytomidae (Hymenoptera, Chalcidoidea) associated with galls induced by cynipid wasps of the genus Diplolepis Geoffroy (Hymenoptera, Cynipidae)

USDA-ARS?s Scientific Manuscript database

Eurytomids are small parasitic wasps associated with many communities of phytophagous insects. In most cases, the accurate identification of eurytomids is impeded by inadequate species descriptions that do not include figures of diagnostic features, and keys that are difficult to use. Here, diagnost...

Identification of coniferous woods

Treesearch

B. Francis Kukachka

1960-01-01

The identification of coniferous woods is generally regarded as being more difficult than for the hardwood species. This is due to the fact that conifers are more elemental in their structure and, as a consequence, the number of diagnostic features that may he employed is proportionately smaller. Instructions are given here in the sequential use of primary diagnostic...

Utility of dengue NS1 antigen rapid diagnostic test for use in difficult to reach areas and its comparison with dengue NS1 ELISA and qRT-PCR.

PubMed

Shukla, Mohan K; Singh, Neeru; Sharma, Ravendra K; Barde, Pradip V

2017-07-01

The objective of this study was to demonstrate the utility of dengue virus (DENV) non structural protein 1 (NS1) based rapid diagnostic test (RDT) for use in tribal and difficult to reach areas for early dengue (DEN) diagnosis in acute phase patients and evaluate its sensitivity and specificity against DENV NS1 enzyme linked immune sorbent assay (ELISA) and real time reverse transcriptase polymerase chain reaction (qRT-PCR). The DENV NS1 RDT was used for preliminary diagnosis during outbreaks in difficult to reach rural and tribal areas. The diagnosis was confirmed by DENV NS1 ELISA in the laboratory. The samples were also tested and serotyped by qRT-PCR. The results were evaluated using statistical tests. The DENV NS1 RDT showed 99.2% sensitivity and 96.0% specificity when analyzed using DENV NS1 ELISA as standard. The specificity and sensitivity of the RDT when compared with qRT-PCR was 93.6% and 91.1%, respectively. The serotype specific evaluation showed more than 90% sensitivity and specificity for DENV-1, 2, and 3. The RDT proved a good diagnostic tool in difficult to reach rural and tribal areas. Further evaluation studies with different commercially available RDTs in different field conditions are essential, that will help clinicians and patients for treatment and programme managers for timely intervention. © 2017 Wiley Periodicals, Inc.

[Vestibulo-cochlear disturbances in the course of vaso-neural conflict of vestibule-cochlear nerve--diagnostic and therapeutic problems].

PubMed

Orendorz-Fraczkowska, Krystyna; Jaworska, Marzena; Gawron, Wojciech; Badowski, Roman; Nadolska, Beata

2007-01-01

Symptoms encompassing sensorineural hearing loss, tinnitus and vertigo occur in many diseases of various origin. The diagnostics in such cases is especially difficult and often requires interdisciplinary cooperation. Despite of that many cases remain unexplained. The two cases with above mentioned symptoms (52 year-old woman and 46 year-old man) with differentiated clinical course were presented. The woman for one year experienced left sided, extreme tinnitus with paroxysmal vertigo and dizziness. The man with sudden monolateral hearing loss and tinnitus that disappeared after corticosteroid therapy, complained about recurrence of fluctuating hearing loss and tinnitus accompanied by chronic instability. The diagnostics of hearing and balance organs was performed (pure tone audiometry, impedance audiometry, DPOAE, ABR, ENG) complemented with computed tomography and Nuclear Resonance. Female patient presented bilateral mild sensorineural hearing loss, more intensive on the left side, male patient right sided sensorineural hearing loss in the frequencies from 250 to 1500 Hz. The elongation of some peak values in ABR test (with bilaterally proper otoacoustic emissions) as well as partial canal paresis on the hearing loss side suggested primary diagnosis of neoplasmatic process. It was an indication to perform radiological diagnostics. The radiologic findings revealed the contact of vestibulo-cochlear nerve with the loop of cerebellar inferior anterior artery within the internal acoustic canal. The course of the disease and diagnostic tests do not provide characteristic data that let diagnose neuro-vascular conflict. One has to be aware of such possibility in patients with intensive vertigo and dizziness that do not improve after treatment when other causes do not justify the symptoms.

[An overview of neurometabolic diseases in Tunisia. a 3-year prospective study].

PubMed

Kraoua, I; Benrhouma, H; Rouissi, A; Youssef-Turki, I Ben; Zouari, B; Kaabachi, N; Gouider-Khouja, N

2009-01-01

Neurometabolic diseases are a large group of genetic diseases. In our country, the diagnostic and therapeutic approach to theses diseases is rather difficult. The aim of our study was to determine the frequency of neurometabolic diseases in the hospital population, to describe the problems in diagnosing these conditions and difficulties encountered during patient care. Our goal was to propose guidelines for a practical diagnostic and therapeutic approach to neurometabolic disorders in our country. We have conducted a prospective study over a 3-year period including all patients diagnosed with "metabolic disease" and followed at the Child and Adolescent Neurology Department of the National Institute of Neurology of Tunis. One hundred and thirty-six patients were included (2.4% of our patients). Mean age was 7.3 +/- 5.1 years. Mean age at onset was 4.3 years. There was a high consanguinity rate. Respiratory chain defects were the most frequently suspected diseases (16.9%), followed by lysosomal diseases (8.8%). Chromatography, initially systematically prescribed, became targeted with a higher diagnostic efficacy. Metabolic diseases diagnosed as certain, represented 22% of the studied cases. This can be explained by the insufficiency of available laboratory tests of confirmation. The prescription of specific treatment was insufficient, even for confirmed pathologies (14.7%) because of the high cost of these therapies. The diagnostic approach has to be rational, targeted, multidisciplinar and conducted within a care network. Diagnostic priority should focus on treatable neurometabolic diseases. The establishment of a systematized registry and neonatal screening for the main treatable neurometabolic diseases constitute the final objective of our work to prepare for biochemical and genetic studies.

Diagnostics barriers and innovations in rural areas: insights from junior medical doctors on the frontlines of rural care in Peru.

PubMed

Anticona Huaynate, Cynthia Fiorella; Pajuelo Travezaño, Monica Jehnny; Correa, Malena; Mayta Malpartida, Holger; Oberhelman, Richard; Murphy, Laura L; Paz-Soldan, Valerie A

2015-10-05

Worldwide, rural communities face barriers when accessing health services. In response, numerous initiatives have focused on fostering technological innovations, new management approaches and health policies. Research suggests that the most successful innovations are those involving stakeholders at all levels. However, there is little evidence exploring the opinions of local health providers that could contribute with further innovation development and research. The aims of this study were to explore the perspectives of medical doctors (MDs) working in rural areas of Peru, regarding the barriers impacting the diagnostic process, and ideas for diagnostic innovations that could assist them. Data gathered through three focus group discussions (FGG) and 18 individual semi-structured interviews (SSI) with MDs who had completed their medical service in rural areas of Peru in the last two years were analyzed using thematic analysis. Three types of barriers emerged. The first barrier was the limited access to point of care (POC) diagnostic tools. Tests were needed for: i) the differential diagnosis of malaria vs. pneumonia, ii) dengue vs. leptospirosis, iii) tuberculosis, iv) vaginal infections and cervical cancer, v) neurocysticercosis, and vi) heavy metal toxicity. Ultrasound was needed for the diagnosis of obstetric and intra-abdominal conditions. There were also health system-related barriers such as limited funding for diagnostic services, shortage of specialists, limited laboratory services and access to telecommunications, and lack of institutional support. Finally, the third type of barriers included patient related-barriers to follow through with diagnostic referrals. Ideas for innovations proposed included POC equipment and tests, and telemedicine. MDs at primary health facilities in rural Peru face diagnostic challenges that are difficult to overcome due to a limited access to diagnostic tools. Referrals to specialized facilities are constrained by deficiencies in the organization of health services and by barriers that impede the patients' travel to distant health facilities. Technological innovations suggested by the participants such as POC diagnostic tools and mobile-health (m-health) applications could help address part of the problem. However, other types of innovation to address social, adaptation and policy issues should not be dismissed.

Is there a place for quantitative risk assessment?

PubMed

Hall, Eric J

2009-06-01

The use of ionising radiations is so well established, especially in the practice of medicine, that it is impossible to imagine contemporary life without them. At the same time, ionising radiations are a known and proven human carcinogen. Exposure to radiation in some contexts elicits fear and alarm (nuclear power for example) while in other situations, until recently at least, it was accepted with alacrity (diagnostic x-rays for example). This non-uniform reaction to the potential hazards of radiation highlights the importance of quantitative risk estimates, which are necessary to help put things into perspective. Three areas will be discussed where quantitative risk estimates are needed and where uncertainties and limitations are a problem. First, the question of diagnostic x-rays. CT usage over the past quarter of a century has increased about 12 fold in the UK and more than 20 fold in the US. In both countries, more than 90% of the collective population dose from diagnostic x-rays comes from the few high dose procedures, such as interventional radiology, CT scans, lumbar spine x-rays and barium enemas. These all involve doses close to the lower limit at which there are credible epidemiological data for an excess cancer incidence. This is a critical question; what is the lowest dose at which there is good evidence of an elevated cancer incidence? Without low dose risk estimates the risk-benefit ratio of diagnostic procedures cannot be assessed. Second, the use of new techniques in radiation oncology. IMRT is widely used to obtain a more conformal dose distribution, particularly in children. It results in a larger total body dose, due to an increased number of monitor units and to the application of more radiation fields. The Linacs used today were not designed for IMRT and are based on leakage standards that were decided decades ago. It will be difficult and costly to reduce leakage from treatment machines, and a necessary first step is to refine the available radiation risks at the fractionated high doses characteristic of radiotherapy. The dose response for carcinogenesis is known for single doses up to about 2 Sv from the A-bomb data, but the shape at higher fractionated doses is uncertain. Third, the proliferation of proton facilities. The improved dose distribution made possible by charged particle beams has created great interest and led to the design and building of many expensive proton centres. However, due to technical problems, most facilities use passive scattering, rather than spot scanning, to spread the pencil beam to cover realistic target volumes. This process, together with the methods used of final collimation, results in substantial total body doses of neutrons. The relative biological effectiveness of these neutrons is not well known, and the risk estimates are therefore uncertain. Unless and until the risks are known with more certainty, it is difficult to know how much effort and cost should be directed towards reducing, or eliminating, the neutron doses. These three examples, where uncertainties in quantitative risk estimates result in important practical problems, will be discussed.

New Diagnostic Aides for Melanoma

PubMed Central

Ferris, Laura K.; Harris, Ryan J.

2012-01-01

Synopsis Detection of melanoma at an early stage is crucial to improving survival rates in melanoma. Accurate diagnosis by current techniques including dermatoscopy remains difficult, and new tools are needed to improve our diagnostic abilities. This article discusses recent advances in diagnostic techniques including confocal scanning laser microscopy, MelaFind, Siascopy, noninvasive genomic detection, as well as other future possibilities to aid in diagnosing melanoma. Advantages and barriers to implementation of the various technologies are discussed as well. PMID:22800557

Difficult relationships between parents and physicians of children with cancer: A qualitative study of parent and physician perspectives.

PubMed

Mack, Jennifer W; Ilowite, Maya; Taddei, Sarah

2017-02-15

Previous work on difficult relationships between patients and physicians has largely focused on the adult primary care setting and has typically held patients responsible for challenges. Little is known about experiences in pediatrics and more serious illness; therefore, we examined difficult relationships between parents and physicians of children with cancer. This was a cross-sectional, semistructured interview study of parents and physicians of children with cancer at the Dana-Farber Cancer Institute and Boston Children's Hospital (Boston, Mass) in longitudinal primary oncology relationships in which the parent, physician, or both considered the relationship difficult. Interviews were audiotaped, transcribed, and subjected to a content analysis. Dyadic parent and physician interviews were performed for 29 relationships. Twenty were experienced as difficult by both parents and physicians; 1 was experienced as difficult by the parent only; and 8 were experienced as difficult by the physician only. Parent experiences of difficult relationships were characterized by an impaired therapeutic alliance with physicians; physicians experienced difficult relationships as demanding. Core underlying issues included problems of connection and understanding (n = 8), confrontational parental advocacy (n = 16), mental health issues (n = 2), and structural challenges to care (n = 3). Although problems of connection and understanding often improved over time, problems of confrontational advocacy tended to solidify. Parents and physicians both experienced difficult relationships as highly distressing. Although prior conceptions of difficult relationships have held patients responsible for challenges, this study has found that difficult relationships follow several patterns. Some challenges, such as problems of connection and understanding, offer an opportunity for healing. However, confrontational advocacy appears especially refractory to repair; special consideration of these relationships and avenues for repairing them are needed. Cancer 2017;123:675-681. © 2016 American Cancer Society. © 2016 American Cancer Society.

[G-CSF (Neupogen Roche) in the treatment of patients with chronic aplastic anemia with severe neutropenia].

PubMed

Novotný, J; Zvarová, M; Prazáková, L; Jandlová, M; Konvicková, L

1995-10-01

Aplastic anaemia (AA) of the chronic type with severe cytopenia is very frequently a difficult therapeutic problem. Patients with granulocyte values below 0.5 G/l are threatened by infections, incl. sepsis possibly with a fatal outcome. If the pool of stem cells for granulocytes is not completely exhausted and can respond to growth factors, these patients can be treated either chronically and/or in risk situations (e.g. injury, surgery) with preparations of the type of a recombinant, granulocyte colony stimulating factor (rhG-CSF), or granulocyte and monocyte colony stimulating factor (rhGM-CSF). The authors present a review of diagnostic and therapeutic algorithms in patients with the AA syndrome and summarize their own experience with the preparation Neupogen Roche (rhG-CSF).

[Domestic violence: a current issue to take into account in diagnostic imaging].

PubMed

Santos Corraliza, E; Larrañaga Hernando, G; Neve Lete, I; Sánchez García, A

2014-01-01

Domestic violence is currently an issue of great political and social importance. The real incidence of domestic violence is difficult to determine due to the environment where it takes place and the reluctance of victims to report abuse. On the other hand, all types of violence represent an important public health problem. We report the case of a young woman who presented with thromboembolic phenomena at different sites due to domestic violence. We emphasize that it is necessary for radiologists and other healthcare professionals to consider the possibility of domestic violence when establishing the diagnosis. This can be important for determining the incidence of abuse, diminishing its sequela, and help increase its reporting. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

The classification of anxiety and hysterical states. Part I. Historical review and empirical delineation.

PubMed

Sheehan, D V; Sheehan, K H

1982-08-01

The history of the classification of anxiety, hysterical, and hypochondriacal disorders is reviewed. Problems in the ability of current classification schemes to predict, control, and describe the relationship between the symptoms and other phenomena are outlined. Existing classification schemes failed the first test of a good classification model--that of providing categories that are mutually exclusive. The independence of these diagnostic categories from each other does not appear to hold up on empirical testing. In the absence of inherently mutually exclusive categories, further empirical investigation of these classes is obstructed since statistically valid analysis of the nominal data and any useful multivariate analysis would be difficult if not impossible. It is concluded that the existing classifications are unsatisfactory and require some fundamental reconceptualization.

Model-based reasoning in SSF ECLSS

NASA Technical Reports Server (NTRS)

Miller, J. K.; Williams, George P. W., Jr.

1992-01-01

The interacting processes and reconfigurable subsystems of the Space Station Freedom Environmental Control and Life Support System (ECLSS) present a tremendous technical challenge to Freedom's crew and ground support. ECLSS operation and problem analysis is time-consuming for crew members and difficult for current computerized control, monitoring, and diagnostic software. These challenges can be at least partially mitigated by the use of advanced techniques such as Model-Based Reasoning (MBR). This paper will provide an overview of MBR as it is being applied to Space Station Freedom ECLSS. It will report on work being done to produce intelligent systems to help design, control, monitor, and diagnose Freedom's ECLSS. Specifically, work on predictive monitoring, diagnosability, and diagnosis, with emphasis on the automated diagnosis of the regenerative water recovery and air revitalization processes will be discussed.

Management of pediatric uveitis

PubMed Central

Wentworth, Bailey A.; Freitas-Neto, Clovis A.

2014-01-01

Pediatric uveitis is a topic of special interest not only because of the unique diagnostic and therapeutic challenges but also because of the lifetime burden of vision loss if the problem is not adequately treated, as well as the economic and psychological toll on the family. Often, uveitis in children is discovered as part of a routine eye exam; this silent, insidious inflammation can be difficult to treat and can lead to further complications if not handled skillfully. Corticosteroids have long been the mainstay of therapy; however, the significant associated side effects mandate a corticosteroid-sparing therapeutic regimen in pursuit of remission. In this review, we cover the therapeutic options for pediatric uveitis, specifically focusing on the most common non-infectious varieties, juvenile idiopathic arthritis-associated uveitis and pars planitis. PMID:24991418

Characteristics of Difficult-to-Place Youth in State Custody: A Profile of the Exceptional Care Pilot Project Population

ERIC Educational Resources Information Center

Armour, Marilyn P.; Schwab, James

2007-01-01

This study examines the characteristics of Texas youth designated as "most difficult to place" recipients of service under the "Exceptional Care Pilot Project" (N = 46). Findings include, among others, high levels of comorbid psychiatric disturbance (greater than 3 diagnostic groupings), physical (78.3%) and sexual (88%)…

Diagnosis and treatment of paediatric tuberculosis: An insight review.

PubMed

Mandal, Nityananda; Anand, Parveen Kumar; Gautam, Subhash; Das, Shritam; Hussain, Tahziba

2017-08-01

Tuberculosis (TB) is a major public health problem, invading all age groups world-wide. It is an opportunistic infection affecting the individuals alone or with co-infections. Childhood TB is a neglected aspect and a significant health problem in epidemic areas. It constitutes more than 20% of TB incidence. Pediatric TB exists in the shadow of adult TB. The clinicians concentrate on pulmonary manifestation of TB, whereas it is a major problem in both pulmonary and extra-pulmonary infections. The rate of infection with this disease is mostly associated with poverty, social disruption and human immunodeficiency virus (HIV) infection. The diagnosis of extra-pulmonary TB (EPTB) is more difficult than pulmonary TB (PTB). Delayed diagnosis and executive treatment contribute to increase in the mortality rate in endemic areas. This article provides the evidence-based simple and safe screening method, indicating rapid, highly sensitive and specific diagnostic tests for pulmonary and EPTB in children. The most important aspect of treatment is the correct course of anti-tubercular drugs. This review serves the purpose of quick reference for microbiologists, epidemiologists, academicians, students and researchers. It provides guidance regarding early diagnosis and treatment accuracy of pediatric TB.

The effect of process conditions on the performance of epitaxial InP solar cells

NASA Technical Reports Server (NTRS)

Borrego, J. M.; Ghandi, S. K.

1991-01-01

Indium phosphide solar cells have a higher resistance to electron irradiation than Si or GaAs cells of comparable junction depth. As a result, there is much interest in the use of this material for space applications. Cells of this material were made in bulk InP by a number of techniques, including ion implantation, direct diffusion in sealed ampoules, and by open tube diffusion. However, it is generally considered that the epitaxial approach will be superior to all of these techniques. The epitaxy of InP is considerably more difficult than that of gallium arsenide, for a number of reasons. Perhaps the most important is the fact that the native oxides of Indium are extremely difficult to remove, as compared to that of Gallium. In addition, thermal treatments for the desorption of these oxides often result in the formation of phosphorus vacancies and free indium on the surface. Thus, inadequate sample preparation before epitaxy, poor reactor cleaning procedures, or poor transition procedures between the growth of successive layers, all give rise to trap phenomena and to high interface recombination velocities. Moreover, the lifetime of the grown material is dominated by the occurrence of native defects, so that it is a strong function of growth parameters. These problems are of special interest to the fabrication of solar cells, where long life-time, combined with the absence of traps, is highly desirable. A study of this problem is described using a non-invasive diagnostic technique which was developed.

Philosophy of clinical psychopharmacology.

PubMed

Aragona, Massimiliano

2013-03-01

The renewal of the philosophical debate in psychiatry is one exciting news of recent years. However, its use in psychopharmacology may be problematic, ranging from self-confinement into the realm of values (which leaves the evidence-based domain unchallenged) to complete rejection of scientific evidence. In this paper philosophy is conceived as a conceptual audit of clinical psychopharmacology. Its function is to criticise the epistemological and methodological problems of current neopositivist, ingenuously realist and evidence-servant psychiatry from within the scientific stance and with the aim of aiding psychopharmacologists in practicing a more self-aware, critical and possibly useful clinical practice. Three examples are discussed to suggest that psychopharmacological practice needs conceptual clarification. At the diagnostic level it is shown that the crisis of the current diagnostic system and the problem of comorbidity strongly influence psychopharmacological results, new conceptualizations more respondent to the psychopharmacological requirements being needed. Heterogeneity of research samples, lack of specificity of psychotropic drugs, difficult generalizability of results, need of a phenomenological study of drug-induced psychopathological changes are discussed herein. At the methodological level the merits and limits of evidence-based practice are considered, arguing that clinicians should know the best available evidence but that guidelines should not be constrictive (due to several methodological biases and rhetorical tricks of which the clinician should be aware, sometimes respondent to extra-scientific, economical requests). At the epistemological level it is shown that the clinical stance is shaped by implicit philosophical beliefs about the mind/body problem (reductionism, dualism, interactionism, pragmatism), and that philosophy can aid physicians to be more aware of their beliefs in order to choose the most useful view and to practice coherently. In conclusion, psychopharmacologists already use methodological audit (e.g. statistical audit); similarly, conceptual clarification is needed in both research planning/evaluation and everyday psychopharmacological practice.

Molecular detection of Plasmodium knowlesi in a Dutch traveler by real-time PCR.

PubMed

Link, Lonneke; Bart, Aldert; Verhaar, Nienke; van Gool, Tom; Pronk, Marjolijn; Scharnhorst, Volkher

2012-07-01

Plasmodium knowlesi infection with low parasitemia presents a diagnostic challenge, as rapid diagnostic tests are often negative and identification to the species level by microscopy is difficult. P. knowlesi malaria in a traveler is described, and real-time PCR is demonstrated to support fast and reliable diagnosis and identification to the species level.

Diagnostics vehicle’s condition using obd-ii and raspberry pi technology: study literature

NASA Astrophysics Data System (ADS)

Moniaga, J. V.; Manalu, S. R.; Hadipurnawan, D. A.; Sahidi, F.

2018-03-01

Transportation accident rate are still being a major challenge in many countries. There are many factors that could be cause transportation accident, especially in vehicle’s internal system problem. To overcome this problem, OBD-II technology has been created to diagnostics vehicle’s condition. OBD-II scanner plugged to OBD-II port or usually called Data Link Connector (DLC), and after that it sends the diagnostics to Raspberry Pi. Compared from another microcontrollers, Arduino, Raspberry Pi are chosen because it sustains the application to receive real-time diagnostics, process the diagnostics and send command to automobiles at the same time, rather than Arduino that must wait for another process finished to run another process. Outcome from this application is to enable automobile’s user to diagnostics their own vehicles. If there is found something unusual or a problem, the application can told the problem to user, so they could know what to fix before they use their vehicle safely.

Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures.

PubMed

Jawad, Z; Odumala, A; Jones, M

2012-06-01

Hip injuries are becoming a more common problem as the elderly population increases and their management represents a significant proportion of health care costs. Diagnosis of a fracture based on clinical assessment and plain films is not always conclusive and further investigations for such occult fractures, such as magnetic resonance imaging (MRI), are sometimes required which are expensive and may be difficult to access. Disruption to the conduction of a sound wave travelling through a fractured bone is a concept that has been used to diagnose fractures. In our study we used a tuning fork with frequency of 128 Hz to objectively measure the reduction in sound amplitude in fractured and non-fractured hips. We looked at the feasibility of using this test as a diagnostic tool for neck of femur fractures. A total of 20 patients was included in the study, using MRI scan as the standard for comparison of diagnostic findings. Informed consent was obtained from the patients. There was a significant difference in the amplitude reduction of the sound waves when comparing normal to fractured hips. This was 0.9 in normal hips, compared to 0.31 and 0.18 in intra-capsular and extra-capsular fractures, respectively. Our test was 80% accurate at diagnosing neck of femur fractures. In conclusion this test may be used as a diagnostic test or screening tool in the assessment of occult hip fractures. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Diagnostic imaging and acute abdominal pain].

PubMed

Liljekvist, Mads Svane; Pommergaard, Hans-Christian; Burcharth, Jakob; Rosenberg, Jacob

2015-01-19

Acute abdominal pain is a common clinical condition. Clinical signs and symptoms can be difficult to interpret, and diagnostic imaging may help to identify intra-abdominal disease. Conventional X-ray, ultrasound (US) and computed tomography (CT) of the abdomen vary in usability between common surgical causes of acute abdominal pain. Overall, conventional X-ray cannot confidently diagnose or rule out disease. US and CT are equally trustworthy for most diseases. US with subsequent CT may enhance diagnostic precision. Magnetic resonance seems promising for future use in acute abdominal imaging.

Filter membrane-based automated therapeutic plasma exchange: a report of two cases from Nigeria.

PubMed

Arogundade, Fatiu A; Sanusi, Abubakr A; Akinbodewa, Akinwunmi A; Hassan, Muzamil O; Omotosho, Bolanle O; Balogun, Rasheed A; Akinsola, Adewale

2013-02-01

These case reports demonstrated the diagnostic dilemma encountered in patients with systemic lupus erythematosus and thrombotic thrombocytopenic purpura particularly in settings with limited diagnostic facilities and laboratory support. The similarities in the diagnostic criteria for both conditions make clear distinction as well as management decisions difficult. We present the difficulties encountered with both the diagnosis and the management of these two patients that were managed in our facility. Copyright © 2013 Wiley Periodicals, Inc.

The Difficult Patron in the Academic Library: Problem Issues or Problem Patrons?

ERIC Educational Resources Information Center

Simmonds Patience L.; Ingold, Jane L.

2002-01-01

Identifies difficult patron issues in academic libraries from the librarians' perspectives and offers solutions to try and prevent them from becoming problems. Topics include labeling academic library users; eliminating sources of conflict between faculty and library staff; and conflicts between students and library staff. (Author/LRW)

Laparoscopy In Unexplained Abdominal Pain: Surgeon's Perspective.

PubMed

Abdullah, Muhammad Tariq; Waqar, Shahzad Hussain; Zahid, Muhammad Abdul

2016-01-01

Unexplained abdominal pain is a common but difficult presenting feature faced by the clinicians. Such patients can undergo a number of investigations with failure to reach any diagnosis. The objective of this study was to evaluate the use of laparoscopy in the diagnosis and management of patients with unexplained abdominal pain. This cross-sectional study was conducted at Pakistan Institute of Medical Sciences Islamabad from January 2009 to December 2013. This study included 91 patients of unexplained abdominal pain not diagnosed by routine clinical examination and investigations. These patients were subjected to diagnostic laparoscopy for evaluation of their conditions and to confirm the diagnosis. These patients presented 43% of patients undergoing investigations for abdominal pain. Patients diagnosed with gynaecological problems were excluded to see surgeon's perspective. The findings and the outcomes of the laparoscopy were recorded and data was analyzed. Unexplained abdominal pain is common in females than in males. The most common laparoscopic findings were abdominal tuberculosis followed by appendicitis. Ninety percent patients achieved pain relief after laparoscopic intervention. Laparoscopy is both beneficial and safe in majority of patients with unexplained abdominal pain. General surgeons should acquire training and experience in laparoscopic surgery to provide maximum benefit to these difficult patients.

Development and Assessment of a Diagnostic Tool to Identify Organic Chemistry Students' Alternative Conceptions Related to Acid Strength

ERIC Educational Resources Information Center

McClary, LaKeisha M.; Bretz, Stacey Lowery

2012-01-01

The central goal of this study was to create a new diagnostic tool to identify organic chemistry students' alternative conceptions related to acid strength. Twenty years of research on secondary and college students' conceptions about acids and bases has shown that these important concepts are difficult for students to apply to qualitative problem…

Celiac Disease: Diagnostic Standards and Dilemmas

PubMed Central

Kaswala, Dharmesh H.; Veeraraghavan, Gopal; Kelly, Ciaran P.; Leffler, Daniel A.

2015-01-01

Celiac Disease (CD) affects at least 1% of the population and evidence suggests that prevalence is increasing. The diagnosis of CD depends on providers being alert to both typical and atypical presentations and those situations in which patients are at high risk for the disease. Because of variable presentation, physicians need to have a low threshold for celiac testing. Robust knowledge of the pathogenesis of this autoimmune disease has served as a catalyst for the development of novel diagnostic tools. Highly sensitive and specific serological assays including Endomysial Antibody (EMA), tissue transglutaminase (tTG), and Deamidated Gliadin Peptide (DGP) have greatly simplified testing for CD and serve as the foundation for celiac diagnosis. In addition, genetic testing for HLA DQ2 and DQ8 has become more widely available and there has been refinement of the gluten challenge for use in diagnostic algorithms. While diagnosis is usually straightforward, in special conditions including IgA deficiency, very young children, discrepant histology and serology, and adoption of a gluten free diet prior to testing, CD can be difficult to diagnose. In this review, we provide an overview of the history and current state of celiac disease diagnosis and provide guidance for evaluation of CD in difficult diagnostic circumstances. PMID:28943611

Why Do Disadvantaged Filipino Children Find Word Problems in English Difficult?

ERIC Educational Resources Information Center

Bautista, Debbie; Mulligan, Joanne

2010-01-01

Young Filipino students are expected to solve mathematical word problems in English, a language that many encounter only in schools. Using individual interviews of 17 Filipino children, we investigated why word problems in English are difficult and the extent to which the language interferes with performance. Results indicate that children could…

The Role of Anionic Polysaccharides in the Preparation of Nanomedicines with Anticancer Applications.

PubMed

Martínez, Ana M; Benito, Marta; Pérez, Elena; María Teijón, José; Dolores Blanco, María

2016-01-01

Cancer has become one of the main causes of death in developed countries, and it is expected to be declared as the disease with the highest worldwide morbidity and mortality indexes in the coming decades. Nanomedicine aims to overcome some problems related to this prevalent disease, particularly the lack of efficient diagnostic and therapeutic tools. The most recent scientific advances, which have conducted to a more personalized medicine, were focused on the production of nanocarriers involved into the transport and the delivery of drugs to targeted cells. A wide variety of nanocarriers composed by different materials have been designed for their use as drug delivery systems. Polysaccharides have emerged as very useful biopolymers among all raw materials used in the preparation of these nanoplatforms. They are highly stable, non-toxic and biodegradable molecules, and also present some chemical properties which are very difficult to reproduce using artificial polymers. Anionic polymers, such as hyaluronic acid, heparin or alginate, present some structural and chemical characteristics which make them ideal polymers to prepare nanosystems with anticancer applications. This review will focus on the description of some anionic polysaccharides and the possibilities they offer towards the preparation of nanosystems with applications in cancer treatment and diagnostics.

[Medical expert systems and clinical needs].

PubMed

Buscher, H P

1991-10-18

The rapid expansion of computer-based systems for problem solving or decision making in medicine, the so-called medical expert systems, emphasize the need for reappraisal of their indication and value. Where specialist knowledge is required, in particular where medical decisions are susceptible to error these systems will probably serve as a valuable support. In the near future computer-based systems should be able to aid the interpretation of findings of technical investigations and the control of treatment, especially where rapid reactions are necessary despite the need of complex analysis of investigated parameters. In the distant future complete support of diagnostic procedures from the history to final diagnosis is possible. It promises to be particularly attractive for the diagnosis of seldom diseases, for difficult differential diagnoses, and in the decision making in the case of expensive, risky or new diagnostic or therapeutic methods. The physician needs to be aware of certain dangers, ranging from misleading information up to abuse. Patient information depends often on subjective reports and error-prone observations. Although basing on problematic knowledge computer-born decisions may have an imperative effect on medical decision making. Also it must be born in mind that medical decisions should always combine the rational with a consideration of human motives.

Tuberculous meningitis: a uniform case definition for use in clinical research.

PubMed

Marais, Suzaan; Thwaites, Guy; Schoeman, Johan F; Török, M Estée; Misra, Usha K; Prasad, Kameshwar; Donald, Peter R; Wilkinson, Robert J; Marais, Ben J

2010-11-01

Tuberculous meningitis causes substantial mortality and morbidity in children and adults. More research is urgently needed to better understand the pathogenesis of disease and to improve its clinical management and outcome. A major stumbling block is the absence of standardised diagnostic criteria. The different case definitions used in various studies makes comparison of research findings difficult, prevents the best use of existing data, and limits the management of disease. To address this problem, a 3-day tuberculous meningitis workshop took place in Cape Town, South Africa, and was attended by 41 international participants experienced in the research or management of tuberculous meningitis. During the meeting, diagnostic criteria were assessed and discussed, after which a writing committee was appointed to finalise a consensus case definition for tuberculous meningitis for use in future clinical research. We present the consensus case definition together with the rationale behind the recommendations. This case definition is applicable irrespective of the patient's age, HIV infection status, or the resources available in the research setting. Consistent use of the proposed case definition will aid comparison of studies, improve scientific communication, and ultimately improve care. Copyright © 2010 Elsevier Ltd. All rights reserved.

Recording and submitting specimen history data

USGS Publications Warehouse

Bodenstein, Barbara L.; Franson, J. Christian; Friend, Milton; Gibbs, Samantha E.J.; Wild, Margaret A.

2016-06-14

SummaryIn wildlife disease investigations, determining the history or background of a problem is the first significant step toward establishing a diagnosis and aiding agencies with management considerations. The diagnostic process and overall investigation is often greatly expedited by a chronological record accompanying specimens submitted for laboratory evaluation. Knowing where and when the outbreak is taking place, what the environmental conditions and species involved are, and clinical signs in sick animals, along with necropsy findings and diagnostic test results are important for understanding the natural history or epizootiology of disease outbreaks. It becomes increasingly difficult to retrospectively obtain all of the pertinent history as time passes. The most helpful information is that which is obtained at the time of the die-off event by perceptive field biologists and other observers. Significant events preceding morbidity and/or mortality also provide valuable information on which to base corrective actions. In this chapter, readers will find information regarding what type of information should be recorded, how it should be recorded and why it is relevant to a disease investigation. A thoughtful approach in providing as much information as possible surrounding the situation including about host species and the biotic and abiotic environment, greatly aids in determining the most likely causative agent(s).

Evolving from academic to academic entrepreneur: overcoming barriers to scientific progress and finance.

PubMed

Miller, Andrew D

2016-07-01

The overall goal of my career as an academic chemist has always been the design and creation of advanced therapeutics and diagnostics that address unmet medical need in the management of chronic diseases. Realising this goal has been an immensely difficult process involving multidisciplinary problem-driven research at the chemistry-biology-medicine interfaces. With success in the laboratory, I started seriously to question the value of remaining an academic whose career is spent in the pursuit of knowledge and understanding alone without making any significant effort to translate knowledge and understanding gained into products of genuine utility for public benefit. Therefore, I elected by choice to become an academic entrepreneur, seeking opportunities wherever possible for the translation of the best of my personal and collaborative academic research work into potentially valuable and useful products. This choice has brought with it many unexpected difficulties and challenges. Nevertheless, progress bas been made and sufficient learnt to suggest that this would be an appropriate moment to take stock and provide some personal reflections on what it takes to design and create advanced therapeutics and diagnostics in the laboratory then seek to develop, innovate and translate the best towards market.

[Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma].

PubMed

Kruppa, C; Goericke, S L; Matheney, T; Ozokyay, L; Schildhauer, T A; Muhr, G; Dudda, M

2010-10-01

Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

Three-dimensional reconstruction of clustered microcalcifications from two digitized mammograms

NASA Astrophysics Data System (ADS)

Stotzka, Rainer; Mueller, Tim O.; Epper, Wolfgang; Gemmeke, Hartmut

1998-06-01

X-ray mammography is one of the most significant diagnosis methods in early detection of breast cancer. Usually two X- ray images from different angles are taken from each mamma to make even overlapping structures visible. X-ray mammography has a very high spatial resolution and can show microcalcifications of 50 - 200 micron in size. Clusters of microcalcifications are one of the most important and often the only indicator for malignant tumors. These calcifications are in some cases extremely difficult to detect. Computer assisted diagnosis of digitized mammograms may improve detection and interpretation of microcalcifications and cause more reliable diagnostic findings. We build a low-cost mammography workstation to detect and classify clusters of microcalcifications and tissue densities automatically. New in this approach is the estimation of the 3D formation of segmented microcalcifications and its visualization which will put additional diagnostic information at the radiologists disposal. The real problem using only two or three projections for reconstruction is the big loss of volume information. Therefore the arrangement of a cluster is estimated using only the positions of segmented microcalcifications. The arrangement of microcalcifications is visualized to the physician by rotating.

Temperament and major depression: How does difficult temperament affect frequency, severity, and duration of major depressive episodes among offspring of parents with or without depression?

PubMed Central

Sherman, Brian J.; Vousoura, Eleni; Wickramaratne, Priya; Warner, Virginia; Verdeli, Helen

2016-01-01

Introduction The current study examined the relationships between parental depression, offspring depression, and offspring temperament among 203 offspring of parents with or without depression. The specific aim was to investigate how offspring difficult temperament affects frequency, severity, and duration of offspring major depressive episodes (MDEs). Methods As part of an ongoing multigenerational study assessing familial transmission of depression, offspring were assessed over a 20-year study period. Offspring temperament was assessed at baseline using the Dimensions of Temperament Survey and diagnostic interviews were conducted at each of the four waves using best estimate procedures. Results Difficult temperament predicted greater frequency of lifetime MDEs. Parental depression moderated the relationship between offspring difficult temperament and severity of MDEs, such that difficult temperament was associated with increased severity ratings among high-risk, but not low-risk offspring. Dimensional analysis revealed that lower rhythmicity and adaptability were associated with greater number of lifetime MDEs, while higher inattention/distractibility was associated with shorter duration of MDEs. Discussion Certain limitations must be noted, namely the self-report nature of temperament data and the relatively small sample size drawn from a clinical and predominantly Caucasian and Christian sample. Notwithstanding these limitations, our results suggest that the clinical presentation of major depression may reflect temperamental profiles and should be considered in diagnostic and treatment settings. PMID:27130957

Aircraft Engine Gas Path Diagnostic Methods: Public Benchmarking Results

NASA Technical Reports Server (NTRS)

Simon, Donald L.; Borguet, Sebastien; Leonard, Olivier; Zhang, Xiaodong (Frank)

2013-01-01

Recent technology reviews have identified the need for objective assessments of aircraft engine health management (EHM) technologies. To help address this issue, a gas path diagnostic benchmark problem has been created and made publicly available. This software tool, referred to as the Propulsion Diagnostic Method Evaluation Strategy (ProDiMES), has been constructed based on feedback provided by the aircraft EHM community. It provides a standard benchmark problem enabling users to develop, evaluate and compare diagnostic methods. This paper will present an overview of ProDiMES along with a description of four gas path diagnostic methods developed and applied to the problem. These methods, which include analytical and empirical diagnostic techniques, will be described and associated blind-test-case metric results will be presented and compared. Lessons learned along with recommendations for improving the public benchmarking processes will also be presented and discussed.

Increasing role of arthropod bites in tularaemia transmission in Poland - case reports and diagnostic methods.

PubMed

Formińska, Kamila; Zasada, Aleksandra A; Rastawicki, Waldemar; Śmietańska, Karolina; Bander, Dorota; Wawrzynowicz-Syczewska, Marta; Yanushevych, Mariya; Niścigórska-Olsen, Jolanta; Wawszczak, Marek

2015-01-01

The study describes four cases of tularaemia - one developed after contact with rabbits and three developed after an arthropod bite. Due to non-specific clinical symptoms, accurate diagnosis of tularaemia may be difficult. The increasing contribution of the arthropod vectors in the transmission of the disease indicates that special effort should be made to apply sensitive and specific diagnostic methods for tularaemia, and to remind health-care workers about this route of Francisella tularensis infections. The advantages and disadvantages of various diagnostic methods - molecular, serological and microbiological culture - are discussed. The PCR as a rapid and proper diagnostic method for ulceroglandular tularaemia is presented.

Double-blind, placebo-controlled food challenge in adults in everyday clinical practice: a reappraisal of their limitations and real indications.

PubMed

Asero, Riccardo; Fernandez-Rivas, Montserrat; Knulst, André C; Bruijnzeel-Koomen, Carla Afm

2009-08-01

The double-blind, placebo-controlled food challenge (DBPCFC) is widely considered as the 'gold standard' for the diagnosis of food allergy. However, in adult patients, this procedure is rather rarely performed outside the academic context. This review article aims to reappraise the pros and cons of DBPCFC and to elicit some critical thoughts and discussions about the real indications of this diagnostic procedure in adult patients in everyday practice. There are many data showing that the DBPCFC poses a number of critical problems that are difficult to overcome in normal outpatient clinics and hospitals, and that are generally not addressed in most articles dealing with this issue. Performing DBPCFC poses a number of practical problems and has several pitfalls, which make its routine use in normal clinical settings generally impossible. This review article shows that the need for this procedure in adult patients seems in effect very little and specifies new, more limited indications to its use in everyday practice. Further, it suggests a role for the open challenge, which lacks several of the disadvantages of DBPCFC.

Core skills assessment to improve mathematical competency

NASA Astrophysics Data System (ADS)

Carr, Michael; Bowe, Brian; Fhloinn, Eabhnat Ní

2013-12-01

Many engineering undergraduates begin third-level education with significant deficiencies in their core mathematical skills. Every year, in the Dublin Institute of Technology, a diagnostic test is given to incoming first-year students, consistently revealing problems in basic mathematics. It is difficult to motivate students to address these problems; instead, they struggle through their degree, carrying a serious handicap of poor core mathematical skills, as confirmed by exploratory testing of final year students. In order to improve these skills, a pilot project was set up in which a 'module' in core mathematics was developed. The course material was basic, but 90% or higher was required to pass. Students were allowed to repeat this module throughout the year by completing an automated examination on WebCT populated by a question bank. Subsequent to the success of this pilot with third-year mechanical engineering students, the project was extended to five different engineering programmes, across three different year-groups. Full results and analysis of this project are presented, including responses to interviews carried out with a selection of the students involved.

Sentinel Node Detection in Head and Neck Malignancies: Innovations in Radioguided Surgery

PubMed Central

Vermeeren, L.; Klop, W. M. C.; van den Brekel, M. W. M.; Balm, A. J. M.; Nieweg, O. E.; Valdés Olmos, R. A.

2009-01-01

Sentinel node mapping is becoming a routine procedure for staging of various malignancies, because it can determine lymph node status more precisely. Due to anatomical problems, localizing sentinel nodes in the head and neck region on the basis of conventional images can be difficult. New diagnostic tools can provide better visualization of sentinel nodes. In an attempt to keep up with possible scientific progress, this article reviews new and innovative tools for sentinel node localization in this specific area. The overview comprises a short introduction of the sentinel node procedure as well as indications in the head and neck region. Then the results of SPECT/CT for sentinel node detection are described. Finally, a portable gamma camera to enable intraoperative real-time imaging with improved sentinel node detection is described. PMID:20016804

Study on ecological regulation of coastal plain sluice

NASA Astrophysics Data System (ADS)

Yu, Wengong; Geng, Bing; Yu, Huanfei; Yu, Hongbo

2018-02-01

Coastal plains are densely populated and economically developed, therefore their importance is self-evident. However, there are some problems related with water in coastal plains, such as low flood control capacity and severe water pollution. Due to complicated river network hydrodynamic force, changeable flow direction and uncertain flood concentration and propagation mechanism, it is rather difficult to use sluice scheduling to realize flood control and tackle water pollution. On the base of the measured hydrological data during once-in-a-century Fitow typhoon in 2013 in Yuyao city, by typical analysis, theoretical analysis and process simulation, some key technologies were researched systematically including plain river network sluice ecological scheduling, “one tide” flood control and drainage scheduling and ecological running water scheduling. In the end, single factor health diagnostic evaluation, unit hydrograph of plain water level and evening tide scheduling were put forward.

Difficult Temperament Moderates Links between Maternal Responsiveness and Children’s Compliance and Behavior Problems in Low-Income Families

PubMed Central

Kochanska, Grazyna; Kim, Sanghag

2012-01-01

Background Research has shown that interactions between young children’s temperament and the quality of care they receive predict the emergence of positive and negative socioemotional developmental outcomes. This multi-method study addresses such interactions, using observed and mother-rated measures of difficult temperament, children’s committed, self-regulated compliance and externalizing problems, and mothers’ responsiveness in a low-income sample. Methods In 186 30-month-old children, difficult temperament was observed in the laboratory (as poor effortful control and high anger proneness), and rated by mothers. Mothers’ responsiveness was observed in lengthy naturalistic interactions at 30 and 33 months. At 40 months, children’s committed compliance and externalizing behavior problems were assessed using observations and several well-established maternal report instruments. Results Parallel significant interactions between child difficult temperament and maternal responsiveness were found across both observed and mother-rated measures of temperament. For difficult children, responsiveness had a significant effect such that those children were more compliant and had fewer externalizing problems when they received responsive care, but were less compliant and had more behavior problems when they received unresponsive care. For children with easy temperaments, maternal responsiveness and developmental outcomes were unrelated. All significant interactions reflected the diathesis-stress model. There was no evidence of differential susceptibility, perhaps due to the pervasive stress present in the ecology of the studied families. Conclusions Those findings add to the growing body of evidence that for temperamentally difficult children, unresponsive parenting exacerbates risks for behavior problems, but responsive parenting can effectively buffer risks conferred by temperament. PMID:23057713

A Research Methodology for Studying What Makes Some Problems Difficult to Solve

ERIC Educational Resources Information Center

Gulacar, Ozcan; Fynewever, Herb

2010-01-01

We present a quantitative model for predicting the level of difficulty subjects will experience with specific problems. The model explicitly accounts for the number of subproblems a problem can be broken into and the difficultly of each subproblem. Although the model builds on previously published models, it is uniquely suited for blending with…

Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review

PubMed Central

Genzen, Jonathan R.; Kenney, Barton

2009-01-01

Aspergillus terreus was identified in an intra-dural spinal biopsy specimen from an African female with recurrent headache and hydrocephalus. Prior laboratory testing of cerebrospinal fluid (CSF) was non-diagnostic, despite extensive central nervous system (CNS) involvement. CNS Aspergillus infection presents a diagnostic and therapeutic challenge and is reviewed in the context of this particularly instructive and difficult case. PMID:19717262

Assessment of postural balance function.

PubMed

Kostiukow, Anna; Rostkowska, Elzbieta; Samborski, Włodzimierz

2009-01-01

Postural balance is defined as the ability to stand unassisted without falling. Examination of the patient's postural balance function is a difficult diagnostic task. Most of the balance tests used in medicine provide incomplete information on this coordination ability of the human body. The aim of this study was to review methods of assessment of the patient's postural balance function, including various tests used in medical diagnostics centers.

Using a Multi-Tier Diagnostic Test to Explore the Nature of Students' Alternative Conceptions on Reaction Kinetics

ERIC Educational Resources Information Center

Yan, Yaw Kai; Subramaniam, R.

2018-01-01

This study focused on grade 12 students' understanding of reaction kinetics. A 4-tier diagnostic instrument was developed for this purpose and administered to 137 students in the main study. Findings showed that reaction kinetics is a difficult topic for these students, with a total of 25 alternative conceptions (ACs) being uncovered. Except for…

Characterizing the impact of model error in hydrologic time series recovery inverse problems

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

Hansen, Scott K.; He, Jiachuan; Vesselinov, Velimir V.

Hydrologic models are commonly over-smoothed relative to reality, owing to computational limitations and to the difficulty of obtaining accurate high-resolution information. When used in an inversion context, such models may introduce systematic biases which cannot be encapsulated by an unbiased “observation noise” term of the type assumed by standard regularization theory and typical Bayesian formulations. Despite its importance, model error is difficult to encapsulate systematically and is often neglected. In this paper, model error is considered for an important class of inverse problems that includes interpretation of hydraulic transients and contaminant source history inference: reconstruction of a time series thatmore » has been convolved against a transfer function (i.e., impulse response) that is only approximately known. Using established harmonic theory along with two results established here regarding triangular Toeplitz matrices, upper and lower error bounds are derived for the effect of systematic model error on time series recovery for both well-determined and over-determined inverse problems. It is seen that use of additional measurement locations does not improve expected performance in the face of model error. A Monte Carlo study of a realistic hydraulic reconstruction problem is presented, and the lower error bound is seen informative about expected behavior. Finally, a possible diagnostic criterion for blind transfer function characterization is also uncovered.« less

Characterizing the impact of model error in hydrologic time series recovery inverse problems

DOE PAGES

Hansen, Scott K.; He, Jiachuan; Vesselinov, Velimir V.

2017-10-28

Hydrologic models are commonly over-smoothed relative to reality, owing to computational limitations and to the difficulty of obtaining accurate high-resolution information. When used in an inversion context, such models may introduce systematic biases which cannot be encapsulated by an unbiased “observation noise” term of the type assumed by standard regularization theory and typical Bayesian formulations. Despite its importance, model error is difficult to encapsulate systematically and is often neglected. In this paper, model error is considered for an important class of inverse problems that includes interpretation of hydraulic transients and contaminant source history inference: reconstruction of a time series thatmore » has been convolved against a transfer function (i.e., impulse response) that is only approximately known. Using established harmonic theory along with two results established here regarding triangular Toeplitz matrices, upper and lower error bounds are derived for the effect of systematic model error on time series recovery for both well-determined and over-determined inverse problems. It is seen that use of additional measurement locations does not improve expected performance in the face of model error. A Monte Carlo study of a realistic hydraulic reconstruction problem is presented, and the lower error bound is seen informative about expected behavior. Finally, a possible diagnostic criterion for blind transfer function characterization is also uncovered.« less

Granulomatous lobular mastitis: a complex diagnostic and therapeutic problem.

PubMed

Akcan, Alper; Akyildiz, Hizir; Deneme, Mehmet Ali; Akgun, Hulya; Aritas, Yucel

2006-08-01

Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. Clinical and radiological features may mimic breast carcinoma. Since this entity was first described, several clinical and pathologic features of the disease have been reported, but diagnostic features and treatment alternatives are still unclear. The purpose of this study is to evaluate diagnostic difficulties and discuss the outcome of surgical treatment in a series of 21 patients with granulomatous lobular mastitis. A retrospective review of 21 patients with histologically confirmed granulomatous lobular mastitis treated in our center between January 1995 and May 2005 was analyzed to identify issues in the diagnosis and treatment of this rare condition. The most common presenting symptoms were a mass in the breast and pain. Four patients had no significant mammographic findings (MMG), but on ultrasound (US), 2 had irregular hypoechoic mass, and 2 hypoechoic nodular structures had abnormalities-one parenchymal distortion and 1 mass formation in 2 of these 4 patients' magnetic resonance imaging (MRI). In recurrent cases, limited excision under local anesthesia was performed, as the clinical examination suggested carcinoma. Although some findings on MMG and US are suggestive of benign breast disease, these modalities do not rule out malignancy. MRI may be helpful in patients who do not have significant pathology at MMG or US. Fine-needle aspiration cytology may be useful in some cases but diagnosis is potentially difficult because of its cytologic characteristics. Wide excision, particularly under general anesthesia, can be therapeutic as well as useful in providing an exact diagnosis.

PROMISE AND PLAUSIBILITY: HEALTH TECHNOLOGY ADOPTION DECISIONS WITH LIMITED EVIDENCE.

PubMed

Campbell, Bruce; Knox, Paul

2016-01-01

The adoption of new medical devices and diagnostics is often hampered by lack of published evidence which makes conventional health technology assessment (HTA) difficult. We now have 5 years' experience of the Medical Technologies Advisory Committee of the National Institute for Health and Care Excellence (NICE) in the United Kingdom, addressing this problem. This committee assesses devices and diagnostics against claims of advantage, to produce guidance on adoption for the health service. We have reflected on the practical, technical, and intellectual processes we have used in developing guidance for the health service. When scientific and clinical evidence is sparse, promise and plausibility play an increased part in decision-making. Drivers of promise include a clear design and mechanism of action, the possibility of radical improvement in care and/or resource use, and improving health outcomes for large numbers of patients. Plausibility relates to judgements about the whether the promise is likely to be delivered in a "real world" setting. Promise and plausibility need to be balanced against the amount of evidence available. We examine the influence they may have on decision-making compared with other factors such as risk and cost. Decisions about adoption of new devices and diagnostics with little evidence are influenced by judgements of their promise and the plausibility of claims that they will provide benefits in a real-world setting. This kind of decision making needs to be transparent and this article explains how these influences can be balanced against the use of more familiar criteria.

Fusion alpha-particle diagnostics for DT experiments on the joint European torus

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

Kiptily, V. G.; Beaumont, P.; Syme, D. B.

2014-08-21

JET equipped with ITER-like wall (a beryllium wall and a tungsten divertor) can provide auxiliary heating with power up to 35MW, producing a significant population of α-particles in DT operation. The direct measurements of alphas are very difficult and α-particle studies require a significant development of dedicated diagnostics. JET now has an excellent set of confined and lost fast particle diagnostics for measuring the α-particle source and its evolution in space and time, α-particle energy distribution, and α-particle losses. This paper describes how the above mentioned JET diagnostic systems could be used for α-particle measurements, and what options exist formore » keeping the essential α-particle diagnostics functioning well in the presence of intense DT neutron flux. Also, α-particle diagnostics for ITER are discussed.« less

Concordance in diagnostic testing for respiratory pathogens of bighorn sheep

USGS Publications Warehouse

Walsh, Daniel P.; Cassirer, E. Frances; Bonds, Michael D.; Brown, Daniel R.; Edwards, William H.; Weiser, Glen C.; Drew, Mark L.; Briggs, Robert E.; Fox, Karen A.; Miller, Michael W.; Shanthalingam, Sudarvili; Srikumaran, Subramaniam; Besser, Thomas E.

2016-01-01

Reliable diagnostic tests are essential for disease investigation and management. This is particularly true for diseases of free-ranging wildlife where sampling is logistically difficult precluding retesting. Clinical assays for wildlife diseases frequently vary among laboratories because of lack of appropriate standardized commercial kits. Results of diagnostic testing may also be called into question when investigators report different etiologies for disease outbreaks, despite similar clinical and pathologic findings. To evaluate reliability of diagnostic testing for respiratory pathogens of bighorn sheep (Ovis canadensis), we conducted a series of ring tests across 6 laboratories routinely involved in detection of Mycoplasma ovipneumoniae, Pasteurellaceae, lktA (the Pasteurellaceae gene encoding leukotoxin), and 3 reference laboratories. Consistency of results for replicate samples within laboratories was high (median agreement = 1.0). Agreement between laboratories was high for polymerase chain reaction (PCR) detection of M. ovipneumoniae and culture isolation of Mannheimia spp. and Bibersteinia trehalosi(median agreement = 0.89–0.95, Kappa = 0.65–0.74), and lower for PCR detection of Mannheimiaspp. lktA (median agreement = 0.58, Kappa = 0.12). Most errors on defined status samples were false negatives, suggesting test sensitivity was a greater problem than specificity. However, tests for M. haemolytica and lktA yielded some false positive results. Despite differences in testing protocols, median agreement among laboratories and correct classification of controls for most agents was ≥0.80, meeting or exceeding the standard required by federal proficiency testing programs. This information is valuable for interpreting test results, laboratory quality assessments, and advancing diagnosis of respiratory disease in wild sheep. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Challenges in Routine Implementation and Quality Control of Rapid Diagnostic Tests for Malaria–Rufiji District, Tanzania

PubMed Central

McMorrow, Meredith L.; Masanja, M. Irene; Abdulla, Salim M. K.; Kahigwa, Elizeus; Kachur, S. Patrick

2018-01-01

Rapid diagnostic tests (RDTs) represent an alternative to microscopy for malaria diagnosis and have shown high sensitivity and specificity in a variety of study settings. Current World Health Organization (WHO) guidelines for quality control of RDTs provide detailed instructions on pre-field testing, but offer little guidance for quality assurance once RDTs are deployed in health facilities. From September 2006 to April 2007, we introduced a histidine-rich protein II (HRP2)-based RDT (Paracheck) for suspected malaria cases five years of age and older in nine health facilities in Rufiji District, Tanzania, to assess sensitivity and specificity of RDTs in routine use at rural health facilities. Thick blood smears were collected for all patients tested with RDTs and stained and read by laboratory personnel in each facility. Thick smears were subsequently reviewed by a reference microscopist to determine RDT sensitivity and specificity. In all nine health facilities, there were significant problems with the quality of staining and microscopy. Sensitivity and specificity of RDTs were difficult to assess given the poor quality of routine blood smear staining. Mean operational sensitivity of RDTs based on reference microscopy was 64.8%, but varied greatly by health facility, range 18.8–85.9%. Sensitivity of RDTs increased with increasing parasite density. Specificity remained high at 87.8% despite relatively poor slide quality. Institution of quality control of RDTs based on poor quality blood smear staining may impede reliable measurement of sensitivity and specificity and undermine confidence in the new diagnostic. There is an urgent need for the development of alternative quality control procedures for rapid diagnostic tests that can be performed at the facility level. PMID:18784230

Use of a Mathematics Word Problem Strategy to Improve Achievement for Students with Mild Disabilities

ERIC Educational Resources Information Center

Taber, Mary R.

2013-01-01

Mathematics can be a difficult topic both to teach and to learn. Word problems specifically can be difficult for students with disabilities because they have to conceptualize what the problem is asking for, and they must perform the correct operation accurately. Current trends in mathematics instruction stem from the National Council of Teachers…

Feeding and Eating Disorders: Ingestive Problems of Infancy, Childhood, and Adolescence.

ERIC Educational Resources Information Center

Kerwin, MaryLouise E.; Berkowitz, Robert I.

1996-01-01

The fourth edition of the "Diagnostic Statistical Manual of Mental Disorders" (DSM) recognizes that feeding problems of infants and children are not typically the same as eating problems of adolescents, thus the addition of a broad diagnostic category, "Feeding and Eating Disorders of Infancy or Early Childhood." Subtypes are…

Approximation algorithms for a genetic diagnostics problem.

PubMed

Kosaraju, S R; Schäffer, A A; Biesecker, L G

1998-01-01

We define and study a combinatorial problem called WEIGHTED DIAGNOSTIC COVER (WDC) that models the use of a laboratory technique called genotyping in the diagnosis of an important class of chromosomal aberrations. An optimal solution to WDC would enable us to define a genetic assay that maximizes the diagnostic power for a specified cost of laboratory work. We develop approximation algorithms for WDC by making use of the well-known problem SET COVER for which the greedy heuristic has been extensively studied. We prove worst-case performance bounds on the greedy heuristic for WDC and for another heuristic we call directional greedy. We implemented both heuristics. We also implemented a local search heuristic that takes the solutions obtained by greedy and dir-greedy and applies swaps until they are locally optimal. We report their performance on a real data set that is representative of the options that a clinical geneticist faces for the real diagnostic problem. Many open problems related to WDC remain, both of theoretical interest and practical importance.

Hybrid Nanostructured Textile Bioelectrode for Unobtrusive Health Monitoring

NASA Astrophysics Data System (ADS)

Rai, Pratyush

Coronary heart disease, cardiovascular diseases and strokes are the leading causes of mortality in United States of America. Timely point-of-care health diagnostics and therapeutics for person suffering from these diseases can save thousands of lives. However, lack of accessible minimally intrusive health monitoring systems makes timely diagnosis difficult and sometimes impossible. To remedy this problem, a textile based nano-bio-sensor was developed and evaluated in this research. The sensor was made of novel array of vertically standing nanostructures that are conductive nano-fibers projecting from a conductive fabric. These sensor electrodes were tested for the quality of electrical contact that they made with the skin based on the fundamental skin impedance model and electromagnetic theory. The hybrid nanostructured dry electrodes provided large surface area and better contact with skin that improved electrode sensitivity and reduced the effect of changing skin properties, which are the problems usually faced by conventional dry textile electrodes. The dry electrodes can only register strong physiological signals because of high background noise levels, thus limiting the use of existing dry electrodes to heart rate measurement and respiration. Therefore, dry electrode systems cannot be used for recording complete ECG waveform, EEG or measurement of bioimpedance. Because of their improved sensitivity these hybrid nanostructured dry electrodes can be applied to measurement of ECG and bioimpedance with very low baseline noise. These textile based electrodes can be seamlessly integrated into garments of daily use such as vests and bra. In combination with embedded wireless network device that can communicate with smart phone, laptop or GPRS, they can function as wearable wireless health diagnostic systems.

Effect Size as the Essential Statistic in Developing Methods for mTBI Diagnosis.

PubMed

Gibson, Douglas Brandt

2015-01-01

The descriptive statistic known as "effect size" measures the distinguishability of two sets of data. Distingishability is at the core of diagnosis. This article is intended to point out the importance of effect size in the development of effective diagnostics for mild traumatic brain injury and to point out the applicability of the effect size statistic in comparing diagnostic efficiency across the main proposed TBI diagnostic methods: psychological, physiological, biochemical, and radiologic. Comparing diagnostic approaches is difficult because different researcher in different fields have different approaches to measuring efficacy. Converting diverse measures to effect sizes, as is done in meta-analysis, is a relatively easy way to make studies comparable.

Persistent hypertransaminasemia in asymptomatic children: A stepwise approach

PubMed Central

Vajro, Pietro; Maddaluno, Sergio; Veropalumbo, Claudio

2013-01-01

We aimed to examine the major causes of isolated chronic hypertransaminasemia in asymptomatic children and develop a comprehensive diagnostic flow diagram. A MEDLINE search inclusive of publications throughout August 2012 was performed. We found only a small number of publications that had comprehensively investigated this topic. Consequently, it was difficult to construct a diagnostic flowchart similar to those already available for adults. In children, a “retesting panel” prescription, including gamma-glutamyl transpeptidase and creatine kinase in addition to aminotransferases, is considered a reasonable approach for proficiently confirming the persistence of the abnormality, ruling out cholestatic hepatopathies and myopathies, and guiding the subsequent diagnostic steps. If re-evaluation of physical and historical findings suggests specific etiologies, then these should be evaluated in the initial enzyme retesting panel. A simple multi-step diagnostic algorithm incorporating a large number of possible pediatric scenarios, in addition to the few common to adults, is available. Accurately classifying a child with asymptomatic persistent hypertransaminasemia may be a difficult task, but the results are critical for preventing the progression of an underlying, possibly occult, condition later in childhood or during transition. Given the high benefit/cost ratio of preventing hepatic deterioration, no effort should be spared in diagnosing and properly treating each case of persistent hypertransaminasemia in pediatric patients. PMID:23687411

Temperament and major depression: How does difficult temperament affect frequency, severity, and duration of major depressive episodes among offspring of parents with or without depression?

PubMed

Sherman, Brian J; Vousoura, Eleni; Wickramaratne, Priya; Warner, Virginia; Verdeli, Helen

2016-08-01

The current study examined the relationships between parental depression, offspring depression, and offspring temperament among 203 offspring of parents with or without depression. The specific aim was to investigate how parental depression and offspring difficult temperament affect frequency, severity, and duration of offspring major depressive episodes (MDEs). As part of an ongoing multigenerational study assessing familial transmission of depression, offspring were assessed over a 20-year study period. Offspring temperament was assessed at baseline using the Dimensions of Temperament Survey and diagnostic interviews were conducted at each of the four waves using best estimate procedures. Difficult temperament predicted greater frequency of lifetime MDEs. Parental depression moderated the relationship between offspring difficult temperament and severity of MDEs, such that difficult temperament was associated with increased severity ratings among high-risk, but not low-risk offspring. Dimensional analysis revealed that lower rhythmicity and adaptability were associated with greater number of lifetime MDEs, higher inattention/distractibility was associated with shorter duration of MDEs, and greater activity was associated with decreased severity of MDEs. Certain limitations must be noted, namely the self-report nature of temperament data and the relatively small sample size drawn from a clinical and predominantly Caucasian and Christian sample. Notwithstanding these limitations, our results suggest that the clinical presentation of major depression may reflect temperamental profiles and should be considered in diagnostic and treatment settings. Copyright © 2016 Elsevier B.V. All rights reserved.

Painful Shoulder in Swimmers: A Diagnostic Challenge.

ERIC Educational Resources Information Center

McMaster, William C.

1986-01-01

This article discusses the incidence, diagnosis, and treatment of painful shoulder in swimmers, including: regional problems that can cause shoulder pain; physical, clinical, and laboratory tests for diagnostic use; and approaches to management of the problem. (Author/CB)

Difficult incidents and tutor interventions in problem-based learning tutorials.

PubMed

Kindler, Pawel; Grant, Christopher; Kulla, Steven; Poole, Gary; Godolphin, William

2009-09-01

Tutors report difficult incidents and distressing conflicts that adversely affect learning in their problem-based learning (PBL) groups. Faculty development (training) and peer support should help them to manage this. Yet our understanding of these problems and how to deal with them often seems inadequate to help tutors. The aim of this study was to categorise difficult incidents and the interventions that skilled tutors used in response, and to determine the effectiveness of those responses. Thirty experienced and highly rated tutors in our Year 1 and 2 medical curriculum took part in semi-structured interviews to: identify and describe difficult incidents; describe how they responded, and assess the success of each response. Recorded and transcribed data were analysed thematically to develop typologies of difficult incidents and interventions and compare reported success or failure. The 94 reported difficult incidents belonged to the broad categories 'individual student' or 'group dynamics'. Tutors described 142 interventions in response to these difficult incidents, categorised as: (i) tutor intervenes during tutorial; (ii) tutor gives feedback outside tutorial, or (iii) student or group intervenes. Incidents in the 'individual student' category were addressed relatively unsuccessfully (effective < 50% of the time) by response (i), but with moderate success by response (ii) and successfully (> 75% of the time) by response (iii). None of the interventions worked well when used in response to problems related to 'group dynamics'. Overall, 59% of the difficult incidents were dealt with successfully. Dysfunctional PBL groups can be highly challenging, even for experienced and skilled tutors. Within-tutorial feedback, the treatment that tutors are most frequently advised to apply, was often not effective. Our study suggests that the collective responsibility of the group, rather than of the tutor, to deal with these difficulties should be emphasised.

Development of an intelligent diagnostic system for reusable rocket engine control

NASA Technical Reports Server (NTRS)

Anex, R. P.; Russell, J. R.; Guo, T.-H.

1991-01-01

A description of an intelligent diagnostic system for the Space Shuttle Main Engines (SSME) is presented. This system is suitable for incorporation in an intelligent controller which implements accommodating closed-loop control to extend engine life and maximize available performance. The diagnostic system architecture is a modular, hierarchical, blackboard system which is particularly well suited for real-time implementation of a system which must be repeatedly updated and extended. The diagnostic problem is formulated as a hierarchical classification problem in which the failure hypotheses are represented in terms of predefined data patterns. The diagnostic expert system incorporates techniques for priority-based diagnostics, the combination of analytical and heuristic knowledge for diagnosis, integration of different AI systems, and the implementation of hierarchical distributed systems. A prototype reusable rocket engine diagnostic system (ReREDS) has been implemented. The prototype user interface and diagnostic performance using SSME test data are described.

An overview of gambling disorder: from treatment approaches to risk factors

PubMed Central

Menchon, José M; Mestre-Bach, Gemma; Steward, Trevor; Fernández-Aranda, Fernando; Jiménez-Murcia, Susana

2018-01-01

Gambling disorder (GD) has been reclassified recently into the “Substance-Related and Addictive Disorders” category of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a landmark occurrence for a behavioral addiction. GD is characterized by recurrent, maladaptive gambling behavior that results in clinically significant distress. Although the number of randomized controlled trials assessing the effectiveness of pharmacological treatments is limited, some pharmacological treatments, notably opiate antagonists, have been employed in the treatment of GD. Patients with GD often present cognitive distortions and specific personality traits, making treatment more difficult. Cognitive behavioral therapy has become the most common psychological intervention for treating gambling problems, and it is effective in reducing gambling behavior. In this brief overview, we provide a report on the state of pharmacological and psychological treatments for gambling disorder. Risk factors and potential future lines of research are addressed.

Decision Making: from Neuroscience to Psychiatry

PubMed Central

Lee, Daeyeol

2013-01-01

Adaptive behaviors increase the likelihood of survival and reproduction and improve the quality of life. However, it is often difficult to identify optimal behaviors in real life due to the complexity of the decision maker’s environment and social dynamics. As a result, although many different brain areas and circuits are involved in decision making, evolutionary and learning solutions adopted by individual decision makers sometimes produce suboptimal outcomes. Although these problems are exacerbated in numerous neurological and psychiatric disorders, their underlying neurobiological causes remain incompletely understood. In this review, theoretical frameworks in economics and machine learning and their applications in recent behavioral and neurobiological studies are summarized. Examples of such applications in clinical domains are also discussed for substance abuse, Parkinson’s disease, attention-deficit/hyperactivity disorder, schizophrenia, mood disorders, and autism. Findings from these studies have begun to lay the foundations necessary to improve diagnostics and treatment for various neurological and psychiatric disorders. PMID:23622061

Primary obturator externus pyomyositis in a child presenting as hip pain: a case report.

PubMed

Kumar, Abhishek; Anderson, David

2008-02-01

Hip pain in children often poses a diagnostic dilemma. Septic arthritis, Perthes disease, and slipped capital femoral epiphysis are among the most important causes. Pyomyositis involving muscles around the hip can present with similar features as septic arthritis and are difficult to diagnose because of their rarity and indolent presentation. Obturator internus and iliopsoas muscle abscess have been most commonly reported, with only 1 such report on isolated obturator externus muscle abscess. Routine laboratory investigations are nonspecific, and the diagnosis rests on imaging modalities. Magnetic resonance scan is the most useful investigation in the diagnosis and can pick up early changes in the muscle. Treatment involves appropriate antibiotic therapy with or without drainage. Most cases resolve completely. We report here a case of isolated obturator externus muscle abscess in an 11-year-old child illustrating the similarities with septic arthritis of hip and problems encountered during diagnosis and management.

Importance of inlet boundary conditions for numerical simulation of combustor flows

NASA Technical Reports Server (NTRS)

Sturgess, G. J.; Syed, S. A.; Mcmanus, K. R.

1983-01-01

Fluid dynamic computer codes for the mathematical simulation of problems in gas turbine engine combustion systems are required as design and diagnostic tools. To eventually achieve a performance standard with these codes of more than qualitative accuracy it is desirable to use benchmark experiments for validation studies. Typical of the fluid dynamic computer codes being developed for combustor simulations is the TEACH (Teaching Elliptic Axisymmetric Characteristics Heuristically) solution procedure. It is difficult to find suitable experiments which satisfy the present definition of benchmark quality. For the majority of the available experiments there is a lack of information concerning the boundary conditions. A standard TEACH-type numerical technique is applied to a number of test-case experiments. It is found that numerical simulations of gas turbine combustor-relevant flows can be sensitive to the plane at which the calculations start and the spatial distributions of inlet quantities for swirling flows.

Management of Orbital Diseases.

PubMed

Betbeze, Caroline

2015-09-01

Orbital diseases are common in dogs and cats and can present on emergency due to the acute onset of many of these issues. The difficulty with diagnosis and therapy of orbital disease is that the location of the problem is not readily visible. The focus of this article is on recognizing classical clinical presentations of orbital disease, which are typically exophthalmos, strabismus, enophthalmos, proptosis, or intraconal swelling. After the orbital disease is confirmed, certain characteristics such as pain on opening the mouth, acute vs. chronic swelling, and involvement of nearby structures can be helpful in determining the underlying cause. Abscesses, cellulitis, sialoceles, neoplasia (primary or secondary), foreign bodies, and immune-mediated diseases can all lead to exophthalmos, but it can be difficult to determine the cause of disease without advanced diagnostic imaging, such as ultrasound, magnetic resonance imaging, or computed tomography scan. Fine-needle aspirates and biopsies of the retrobulbar space can also be performed. Published by Elsevier Inc.

[Differential diagnosis in potency disorders].

PubMed

Kockott, G; Dittmar, F

1976-12-02

Disorders of sexual libido are seldom organic, in general they are of psychological origin. It is, however, difficult to obtain a differential diagnosis. One of the first diagnostic considerations must be the establishment of primary or secondary libidinal dificit, or indeed, whether there is no libido at all. In cases of libido disorders with primary libido dificit, depression, organic disease, or side effects of pharmaca may be the cause. Libido disorders in the presence of functional libido, however, must be regarded as primarily psychologically caused. An exception are libido problems in the presence of diabetes mellitus and peripheral vasculatory defeciencies. In these cases libido is either totally absent or appears only secondarily. The symptomatology of libido disorders in the presence of depression, diabetes melitus, and peripheral vasculatory disturbancies, as well as psychologically caused erectile and ejaculatory difficulties are discussed in detail. These groups are compared with respect to libido and behavior involving erection, ejaculation, anxiety and avoidance.

[Intussusception in infant with diagnostic botulism: A case report].

PubMed

Spini, Roxana G; Ferraris, Verónica; Glasman, María P; Orofino, Guillermina; Casanovas, Alejandra; Debaisi, Gustavo

2015-10-01

Botulism is an important public health problem in Argentina. It is a potentially fatal disease, and its diagnosis may be difficult. There are rare presentation forms of the disease, such as acute abdomen. We present a 4-month baby with a 3-day constipation condition, associated with weakness and abnormal eating attitude in the last 12 hours. The baby presented preserved muscle tone, with no changes in sucking or deglutition according to the mother's observations. Altered sensorium and acute abdomen were found; the patient was entered into the operating room with presumptive diagnosis of intussusception, which was confirmed by pneumatic desinvagination. During hospitalization, the patient did not make good progress and presented weak cry, progressive hypotonia and respiratory failure requiring intensive care. Clostridium botulinum was isolated from the stool sample and botulinum toxin type A was isolated from serum. The patient was treated with equine botulinum toxin. Twenty five days after admission, he was totally recovered.

Olfaction: New Understandings, Diagnostic Applications.

PubMed

Ruggiero, Gabrielle F; Wick, Jeannette Y

2016-11-01

Estimates indicate that 14 million Americans have olfactory dysfunction. As with other senses, such as sight and hearing, olfaction frequently declines with age. Impaired olfaction can be a warning sign of Parkinson's disease, sometimes occurring before motor symptoms develop. It's also an initial symptom of Alzheimer's dementia (AD); the amyloid plaques and tangles characterizing AD invade the olfactory bulb and hippocampus early in its course, hampering odor identification. Olfactory dysfunction is associated with some serious problems, including inability to smell warning odors (fire, gas) and impaired ability to taste food. Standardized, validated methods are available to measure several different dimensions of olfactory function, including odor identification, discrimination, and threshold levels. Researchers are currently studying the unique olfactory deficits associated with different conditions in hopes of identifying new, noninvasive tools for early diagnosis and treatment. Drugs may cause or contribute to olfactory dysfunction, but it can be difficult to pinpoint offending medications.

[Guillain-Barré syndrome as differential diagnosis of intervertebral disk-induced nerve root compression].

PubMed

Perlick, L; Möller, G; Wallny, T; Schmitt, O

1999-01-01

Diagnosis of Guillian-Barré Syndrome usually is not difficult, but diagnostic failure occurs for the variable initial presentation. Diagnosis is based on physical examination showing loss of motor strength in more than one limb and loss of deep tendon reflexes. Ventilatory assistance, pharmacologic maintenance of cardiovascular homeostasis, corticosteroids, IgG and plasma exchange are the dominant therapeutic measures. This article reports on a case of a 59-year old surgeon suffering from degenerative disc disease in the lumbar spine. The patient developed a severe course of the Guillian-Barré Syndrome with persisting motor weakness of the legs. If the primary problem at presentation is limb and back pain the pathology appears to be in the musculoskeletal rather than in neurological system. The awareness of this presentation of Guillian-Barré-Syndrome will eliminate delay in diagnosis.

Postmortem dynamic cerebral angiography for detecting aneurysm and bleeding sites in cases of subarachnoid hemorrhage.

PubMed

Inokuchi, Go; Yajima, Daisuke; Hayakawa, Mutsumi; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Makino, Yohsuke; Iwase, Hirotaro

2014-12-01

One of the advantages of postmortem imaging is its ability to obtain diagnostic findings in a non-destructive manner when autopsy is either difficult or may destroy forensic evidence. In recent years, efforts have been made to incorporate computed tomography (CT) based postmortem angiography into forensic pathology; however, it is not currently clear how well the modality can determine sites of bleeding in cases of subarachnoid hemorrhage. Therefore, in this study, we investigated the utility of postmortem cerebral angiography using multi-detector row CT (MDCT) by injecting a contrast medium through a catheter inserted into the internal carotid and vertebral arteries of 10 subarachnoid hemorrhage cases. While postmortem MDCT angiography (PMCTA) was capable of detecting aneurysms in a non-destructive manner, it was sometimes difficult to identify the aneurysm and bleeding sites because of a large amount of contrast medium leaking into the extravascular space. To overcome this problem, we developed the novel contrast imaging method "dynamic cerebral angiography," which involves scanning the same area multiple times while injecting contrast medium to enable real-time observation of the contrasted vasculature. Using multiphase contrast images acquired by this method, we successfully captured the moment when contrast medium leaked from the hemorrhage site. This method will be useful for identifying exact bleeding sites on PMCTA.

Modeling visual problem solving as analogical reasoning.

PubMed

Lovett, Andrew; Forbus, Kenneth

2017-01-01

We present a computational model of visual problem solving, designed to solve problems from the Raven's Progressive Matrices intelligence test. The model builds on the claim that analogical reasoning lies at the heart of visual problem solving, and intelligence more broadly. Images are compared via structure mapping, aligning the common relational structure in 2 images to identify commonalities and differences. These commonalities or differences can themselves be reified and used as the input for future comparisons. When images fail to align, the model dynamically rerepresents them to facilitate the comparison. In our analysis, we find that the model matches adult human performance on the Standard Progressive Matrices test, and that problems which are difficult for the model are also difficult for people. Furthermore, we show that model operations involving abstraction and rerepresentation are particularly difficult for people, suggesting that these operations may be critical for performing visual problem solving, and reasoning more generally, at the highest level. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Integrated Diagnostic and Treatment Devices for Enroute Critical Care of Patients within Theater

DTIC Science & Technology

2010-04-01

are all indicated for both adult and pediatric patients, are lightweight systems designed to attach either directly to a NATO litter or attach to a...external defibrillator and blood chemistry analysis system. Figure 1: Patient Being Transported with the Life Support for Trauma and Transport...be difficult to replace or refill. The LSTAT was also designed to accept external oxygen sources. Integrated Diagnostic and Treatment Devices for

A dynamic model of Flo-Tron flowmeters

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

Cichy, M.; Bossio, R.B.

1984-08-01

The optimization of diagnostic equipment for reciprocating both internal and external combustion engines are deeply affected by suitability of simulation models. One of the most attractive and difficult diagnostic aspect deals with the fuel instantaneous mass flow rate measurement. A new model of the dynamic simulation of the Flo-Tron flowmeter, whose working principle is based on the hydraulic Wheatstone's bridge is then presented, dealing with the state space equations and bond-graph method.

Reliability and Validity of a Procedure to Measure Diagnostic Reasoning and Problem-Solving Skills Taught in Predoctoral Orthodontic Education.

ERIC Educational Resources Information Center

Albanese, Mark A.; Jacobs, Richard M.

1990-01-01

The reliability and validity of a procedure to measure diagnostic-reasoning and problem-solving skills taught in predoctoral orthodontic education were studied using 68 second year dental students. The procedure includes stimulus material and 33 multiple-choice items. It is a feasible way of assessing problem-solving skills in dentistry education…

Diagnostic reasoning strategies and diagnostic success.

PubMed

Coderre, S; Mandin, H; Harasym, P H; Fick, G H

2003-08-01

Cognitive psychology research supports the notion that experts use mental frameworks or "schemes", both to organize knowledge in memory and to solve clinical problems. The central purpose of this study was to determine the relationship between problem-solving strategies and the likelihood of diagnostic success. Think-aloud protocols were collected to determine the diagnostic reasoning used by experts and non-experts when attempting to diagnose clinical presentations in gastroenterology. Using logistic regression analysis, the study found that there is a relationship between diagnostic reasoning strategy and the likelihood of diagnostic success. Compared to hypothetico-deductive reasoning, the odds of diagnostic success were significantly greater when subjects used the diagnostic strategies of pattern recognition and scheme-inductive reasoning. Two other factors emerged as independent determinants of diagnostic success: expertise and clinical presentation. Not surprisingly, experts outperformed novices, while the content area of the clinical cases in each of the four clinical presentations demonstrated varying degrees of difficulty and thus diagnostic success. These findings have significant implications for medical educators. It supports the introduction of "schemes" as a means of enhancing memory organization and improving diagnostic success.

Diagnostic problems in case of twin pregnancies: US vs. MRI study.

PubMed

Bekiesinska-Figatowska, Monika; Herman-Sucharska, Izabela; Romaniuk-Doroszewska, Anna; Jaczynska, Renata; Furmanek, Mariusz; Bragoszewska, Hanna

2013-09-01

To present an experience with twin pregnancies underlining the impact of magnetic resonance imaging (MRI) on diagnosis and management. There were 17 cases of twin pregnancies: nine monochorionic [including four monochorionic diamniotic and five monochorionic monoamniotic (conjoined twins)] and eight dichorionic. The MRI examinations were performed between 19 and 39 weeks of gestational age in two centers using 1.5 T scanners (GE Signa Excite and GE Signa HDxt; GE Healthcare, Waukesha, WI, USA), always after ultrasound (US). In the first period of our activity, SSFSE sequence in T2-weighted images (SSFSE/T2WI) was the main diagnostic tool supported by TSE or GRE T1-weighted images (T1WI). After upgrading the scanners, diffusion-weighted imaging (DWI), steady-state free precession (FIESTA), and echoplanar GRE imaging (EPIGRE) became available. In 11 cases (64.7%), MRI was superior to US and supplied additional information, including two cases in which pathology of the second twin suspected on US was ruled out on the basis of MRI. In six cases (35.3%) MRI confirmed US diagnosis and brought no new data. MRI offers more detailed assessment of fetal pathology in cases of twin pregnancies, including conjoined twins, in which sonographic evaluation is more difficult than in single cases.

Classical swine fever in pigs: recent developments and future perspectives.

PubMed

Chander, Vishal; Nandi, S; Ravishankar, C; Upmanyu, V; Verma, Rishendra

2014-06-01

Classical swine fever (CSF) is one of the most devastating epizootic diseases of pigs, causing high morbidity and mortality worldwide. The diversity of clinical signs and similarity in disease manifestations to other diseases make CSF difficult to diagnose with certainty. The disease is further complicated by the presence of a number of different strains belonging to three phylogenetic groups. Advanced diagnostic techniques allow detection of antigens or antibodies in clinical samples, leading to implementation of proper and effective control programs. Polymerase chain reaction (PCR)-based methods, including portable real-time PCR, provide diagnosis in a few hours with precision and accuracy, even at the point of care. The disease is controlled by following a stamping out policy in countries where vaccination is not practiced, whereas immunization with live attenuated vaccines containing the 'C' strain is effectively used to control the disease in endemic countries. To overcome the problem of differentiation of infected from vaccinated animals, different types of marker vaccines, with variable degrees of efficacy, along with companion diagnostic assays have been developed and may be useful in controlling and even eradicating the disease in the foreseeable future. The present review aims to provide an overview and status of CSF as a whole with special reference to swine husbandry in India.

Multi-dimensional optical and laser-based diagnostics of low-temperature ionized plasma discharges

DOE PAGES

Barnat, Edward V.

2011-09-15

In this paper, a review of work centered on the utilization of multi-dimensional optical diagnostics to study phenomena arising in radiofrequency plasma discharges is given. The diagnostics range from passive techniques such as optical emission to more active techniques utilizing nanosecond lasers capable of both high temporal and spatial resolution. In this review, emphasis is placed on observations that would have been more difficult, if not impossible, to make without the use of such diagnostic techniques. Examples include the sheath structure around an electrode consisting of two different metals, double layers that arise in magnetized hydrogen discharges, or a largemore » region of depleted argon 1s 4 levels around a biased probe in an rf discharge.« less

Molecular Pathology and Personalized Medicine: The Dawn of a New Era in Companion Diagnostics-Practical Considerations about Companion Diagnostics for Non-Small-Cell-Lung-Cancer.

PubMed

Plönes, Till; Engel-Riedel, Walburga; Stoelben, Erich; Limmroth, Christina; Schildgen, Oliver; Schildgen, Verena

2016-01-15

Companion diagnostics (CDx) have become a major tool in molecular pathology and assist in therapy decisions in an increasing number of various cancers. Particularly, the developments in lung cancer have been most impressing in the last decade and consequently lung cancer mutation testing and molecular profiling has become a major business of diagnostic laboratories. However, it has become difficult to decide which biomarkers are currently relevant for therapy decisions, as many of the new biomarkers are not yet approved as therapy targets, remain in the status of clinical studies, or still have not left the experimental phase. The current review is focussed on those markers that do have current therapy implications, practical implications arising from the respective companion diagnostics, and thus is focused on daily practice.

Rosetta Structure Prediction as a Tool for Solving Difficult Molecular Replacement Problems.

PubMed

DiMaio, Frank

2017-01-01

Molecular replacement (MR), a method for solving the crystallographic phase problem using phases derived from a model of the target structure, has proven extremely valuable, accounting for the vast majority of structures solved by X-ray crystallography. However, when the resolution of data is low, or the starting model is very dissimilar to the target protein, solving structures via molecular replacement may be very challenging. In recent years, protein structure prediction methodology has emerged as a powerful tool in model building and model refinement for difficult molecular replacement problems. This chapter describes some of the tools available in Rosetta for model building and model refinement specifically geared toward difficult molecular replacement cases.

Diagnosis of Osteoporosis.

ERIC Educational Resources Information Center

Wahner, H. W.

1987-01-01

Early recognition of osteoporosis is difficult because symptoms are lacking and there are no distinct, readily accessible diagnostic features. This article reviews the standard approach, radiographic and laboratory diagnosis, bone mass measurement techniques, and interpretation of bone mineral data. (MT)

The optical diagnostics of parameters of biological tissues of human intact skin in near-infrared range

NASA Astrophysics Data System (ADS)

Petruk, Vasyl; Kvaternyuk, Sergii; Bolyuh, Boris; Bolyuh, Dmitry; Dronenko, Vladimir; Harasim, Damian; Annabayev, Azamat

2016-09-01

Melanoma skin is difficult to diagnose in the early stages of development despite its location outside. Melanoma is difficult to visually differentiate from benign melanocytic nevi. In the work we investigated parameters of human intact skin in near-infrared range for different racial and gender groups. This allows to analyze statistical differences in the coefficient of diffuse reflection and use them in the differential diagnosis of cancer by optical methods subject.

Urban Mathematics Teacher Retention

ERIC Educational Resources Information Center

Hamdan, Kamal

2010-01-01

Mathematics teachers are both more difficult to attract and more difficult to retain than social sciences teachers. This fact is not unique to the United States; it is reported as being a problem in Europe as well (Howson, 2002). In the United States, however, the problem is particularly preoccupying. Because of the chronic teacher shortages and…

Baccalaureate Student Perceptions of Challenging Family Problems: Building Bridges to Acceptance

ERIC Educational Resources Information Center

Floyd, Melissa; Gruber, Kenneth J.

2011-01-01

This study explored the attitudes of 147 undergraduate social work majors to working with difficult families. Students indicated which problems (from a list of 42, including hot topics such as homosexuality, transgender issues, abortion, and substance abuse) they believed they would find most difficult to work with and provided information…

Diagnostic tolerance for missing sensor data

NASA Technical Reports Server (NTRS)

Scarl, Ethan A.

1989-01-01

For practical automated diagnostic systems to continue functioning after failure, they must not only be able to diagnose sensor failures but also be able to tolerate the absence of data from the faulty sensors. It is shown that conventional (associational) diagnostic methods will have combinatoric problems when trying to isolate faulty sensors, even if they adequately diagnose other components. Moreover, attempts to extend the operation of diagnostic capability past sensor failure will necessarily compound those difficulties. Model-based reasoning offers a structured alternative that has no special problems diagnosing faulty sensors and can operate gracefully when sensor data is missing.

Rocket Engine Oscillation Diagnostics

NASA Technical Reports Server (NTRS)

Nesman, Tom; Turner, James E. (Technical Monitor)

2002-01-01

Rocket engine oscillating data can reveal many physical phenomena ranging from unsteady flow and acoustics to rotordynamics and structural dynamics. Because of this, engine diagnostics based on oscillation data should employ both signal analysis and physical modeling. This paper describes an approach to rocket engine oscillation diagnostics, types of problems encountered, and example problems solved. Determination of design guidelines and environments (or loads) from oscillating phenomena is required during initial stages of rocket engine design, while the additional tasks of health monitoring, incipient failure detection, and anomaly diagnostics occur during engine development and operation. Oscillations in rocket engines are typically related to flow driven acoustics, flow excited structures, or rotational forces. Additional sources of oscillatory energy are combustion and cavitation. Included in the example problems is a sampling of signal analysis tools employed in diagnostics. The rocket engine hardware includes combustion devices, valves, turbopumps, and ducts. Simple models of an oscillating fluid system or structure can be constructed to estimate pertinent dynamic parameters governing the unsteady behavior of engine systems or components. In the example problems it is shown that simple physical modeling when combined with signal analysis can be successfully employed to diagnose complex rocket engine oscillatory phenomena.

West nile virus and equine encephalitis viruses: new perspectives.

PubMed

Long, Maureen T

2014-12-01

Mosquito-borne diseases affect horses worldwide. Mosquito-borne diseases generally cause encephalomyelitis in the horse and can be difficult to diagnose antemortem. In addition to general disease, and diagnostic and treatment aspects, this review article summarizes the latest information on these diseases, covering approximately the past 5 years, with a focus on new equine disease encroachments, diagnostic and vaccination aspects, and possible therapeutics on the horizon. Copyright © 2014 Elsevier Inc. All rights reserved.

The revolution in psychiatric diagnosis: problems at the foundations.

PubMed

Galatzer-Levy, Isaac R; Galatzer-Levy, Robert M

2007-01-01

The third edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-III; 1974) not only revolutionized psychiatric diagnosis, it transformed and dominated American psychiatry. The nosology of psychiatry had been conceptually confusing, difficult to apply, and bound to widely questioned theories. Psychiatry and clinical psychology had been struggling with their scientific status. DSM attempted to solve psychiatry's problems by making psychiatry more like its authors' perception of general medicine. It tried to avoid theory, especially psychoanalytic theories, by discussing only observable manifestations of disorders. But DSM is actually highly theory-bound. It implicitly and powerfully includes an exclusively "medical" model of psychological disturbance, while excluding other psychiatric ideas. Its authors tried to meet what they saw as "scientific standards." To a surprising extent, DSM reflects its creators' personal distaste for psychoanalysis. The result is that DSM rests on a narrow philosophical perspective. The consequences of its adoption are widespread: it has profoundly affected drug development and other therapeutic studies, psychiatric education, attitudes toward patients, the public perception of psychiatry, and administrative and legal decisions. This article explores how DSM's most problematic features arise from its history in psychiatric controversies of the 1960s and its underlying positivistic philosophy.

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

Morin, R

The Medical Physics community lost one of its prominent leaders in April, 2013 with the passing of Donald D. Tolbert, PhD. He received his Doctorate at the University of Kansas followed by post Doctoral training at Florida State University and the University of Wisconsin. He was Chief of Radiation Therapy Medical Physics at the University of Wisconsin Hospital for 7 years before relocating to Honolulu Hawaii, where he founded the consulting group Mid-Pacific Medical Physics. Don was a leader in both the AAPM and the ACR, chairing the Professional Council and the Commission on Medical Physics. He was active onmore » the AAPM Board of Directors and a member of the ACR Board of Chancellors. Dr. Tolbert's approach to the difficult problems of the times was admired and respected by colleagues in Medical Physics, Radiation Oncology, and Diagnostic Radiology. He always rose above the heated political rhetoric and led the discussion to higher ground. His wisdom was continually sought to solve complicated problems. Following retirement, he returned to homes in Kansas and Colorado, devoting his time to writing about coping with diabetes and providing support for Seniors in Beloit Kansas. Don is survived by his wife, Mattie, his 3 children and 5 grandchildren. He will be greatly missed.« less

Are health care provider organizations ready to tackle diagnostic error? A survey of Leapfrog-participating hospitals.

PubMed

Newman-Toker, David E; Austin, J Matthew; Derk, Jordan; Danforth, Melissa; Graber, Mark L

2017-06-27

A 2015 National Academy of Medicine report on improving diagnosis in health care made recommendations for direct action by hospitals and health systems. Little is known about how health care provider organizations are addressing diagnostic safety/quality. This study is an anonymous online survey of safety professionals from US hospitals and health systems in July-August 2016. The survey was sent to those attending a Leapfrog Group webinar on misdiagnosis (n=188). The instrument was focused on knowledge, attitudes, and capability to address diagnostic errors at the institutional level. Overall, 61 (32%) responded, including community hospitals (42%), integrated health networks (25%), and academic centers (21%). Awareness was high, but commitment and capability were low (31% of leaders understand the problem; 28% have sufficient safety resources; and 25% have made diagnosis a top institutional safety priority). Ongoing efforts to improve diagnostic safety were sparse and mostly included root cause analysis and peer review feedback around diagnostic errors. The top three barriers to addressing diagnostic error were lack of awareness of the problem, lack of measures of diagnostic accuracy and error, and lack of feedback on diagnostic performance. The top two tools viewed as critically important for locally tackling the problem were routine feedback on diagnostic performance and culture change to emphasize diagnostic safety. Although hospitals and health systems appear to be aware of diagnostic errors as a major safety imperative, most organizations (even those that appear to be making a strong commitment to patient safety) are not yet doing much to improve diagnosis. Going forward, efforts to activate health care organizations will be essential to improving diagnostic safety.

Conversion disorder: a problematic diagnosis.

PubMed

Nicholson, Timothy R J; Stone, Jon; Kanaan, Richard A A

2011-11-01

The diagnosis of conversion disorder is problematic. Since doctors have conceptually and practically differentiated the symptoms from neurological ('organic') disease it has been presumed to be a psychological disorder, but the psychological mechanism, and how this differs from feigning (conscious simulation), has remained elusive. Although misdiagnosis of neurological disease as conversion disorder is uncommon, it remains a concern for clinicians, particularly for psychiatrists who may be unaware of the positive ways in which neurologists can exclude organic disease. The diagnosis is anomalous in psychiatry in that current diagnostic systems require that feigning is excluded and that the symptoms can be explained psychologically. In practice, feigning is very difficult to either disprove or prove, and a psychological explanation cannot always be found. Studies of childhood and adult psychological precipitants have tended to support the relevance of stressful life events prior to symptom onset at the group level but they are not found in a substantial proportion of cases. These problems highlight serious theoretical and practical issues not just for the current diagnostic systems but for the concept of the disorder itself. Psychology, physiology and functional imaging techniques have been used in attempts to elucidate the neurobiology of conversion disorder and to differentiate it from feigning, but while intriguing results are emerging they can only be considered preliminary. Such work looks to a future that could refine our understanding of the disorder. However, until that time, the formal diagnostic requirement for associated psychological stressors and the exclusion of feigning are of limited clinical value. Simplified criteria are suggested which will also encourage cooperation between neurology and psychiatry in the management of these patients.

[From the editor].

PubMed

Dudek, Dominika; Sobański, Jerzy A; Klasa, Katarzyna

2015-01-01

Dear Readers We are happy and proud to announce that we managed to achieve intention announced in the last issue: for the first time in PubMed there is a possibility of direct and free access to the full texts published in Polish Psychiatry (Polish and English language versions are available)!!! For the issue 6/2014 they have been downloaded by Medline users already 500 times. Owing to this, papers by Polish scientists-psychiatrists are more readily available to colleagues from around the world interested in them, and Polish Psychiatry actually becomes journal of international scope. We hope that it will result in a marked improvement in the bibliometric indicators (which, however, is unrealistic to expect in the current or next year) in the following years. Spring issue of Polish Psychiatry touches several important problems. We pay attention to the texts on addiction - behavioural (Internet addiction) and alcohol. Two papers by prof. M. Wojnar's team summarize the issues related to the coexistence of alcohol dependence with other psychiatric disorders. The issue of dual diagnosis has already appeared in our magazine (for example [1]). This is an extremely difficult problem, and patients are a real challenge, both therapeutic and diagnostic. They often require a comprehensive approach: pharmacotherapy of comorbid mental illness, psychoeducation, addiction treatment programmes. For these patients the maintenance of abstinence is particularly difficult, especially in a situation of exacerbation of psychopathological symptoms. An important direction is searching for additional pharmacotherapeutic methods which help to reduce the degree of alcohol abuse and the resulting damage. These include: acamprosate, drugs which are opioid receptor antagonists [2], and in the current issue the authors from the University of Cagliari focused on baclofen. (...).

A Primer on Receiver Operating Characteristic Analysis and Diagnostic Efficiency Statistics for Pediatric Psychology: We Are Ready to ROC

PubMed Central

2014-01-01

Objective To offer a practical demonstration of receiver operating characteristic (ROC) analyses, diagnostic efficiency statistics, and their application to clinical decision making using a popular parent checklist to assess for potential mood disorder. Method Secondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews. Results Internalizing Problems raw scores discriminated mood disorders significantly better than did age- and gender-normed T scores, or an Affective Problems score. Internalizing scores <8 had a diagnostic likelihood ratio <0.3, and scores >30 had a diagnostic likelihood ratio of 7.4. Conclusions This study illustrates a series of steps in defining a clinical problem, operationalizing it, selecting a valid study design, and using ROC analyses to generate statistics that support clinical decisions. The ROC framework offers important advantages for clinical interpretation. Appendices include sample scripts using SPSS and R to check assumptions and conduct ROC analyses. PMID:23965298

A primer on receiver operating characteristic analysis and diagnostic efficiency statistics for pediatric psychology: we are ready to ROC.

PubMed

Youngstrom, Eric A

2014-03-01

To offer a practical demonstration of receiver operating characteristic (ROC) analyses, diagnostic efficiency statistics, and their application to clinical decision making using a popular parent checklist to assess for potential mood disorder. Secondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews. Internalizing Problems raw scores discriminated mood disorders significantly better than did age- and gender-normed T scores, or an Affective Problems score. Internalizing scores <8 had a diagnostic likelihood ratio <0.3, and scores >30 had a diagnostic likelihood ratio of 7.4. This study illustrates a series of steps in defining a clinical problem, operationalizing it, selecting a valid study design, and using ROC analyses to generate statistics that support clinical decisions. The ROC framework offers important advantages for clinical interpretation. Appendices include sample scripts using SPSS and R to check assumptions and conduct ROC analyses.

Diagnostic Evaluation of Carbon Sources in CMAQ

EPA Science Inventory

Traditional monitoring networks measure only total elemental carbon (EC) and organic carbon (OC) routinely. Diagnosing model biases with such limited information is difficult. Measurements of organic tracer compounds have recently become available and allow for more detailed di...

An update on PCOS in adolescents.

PubMed

Fitzgerald, Shannon; DiVasta, Amy; Gooding, Holly

2018-05-17

Polycystic ovarian syndrome (PCOS) is a common endocrinopathy which can be difficult to treat in adolescents. Fortunately, early identification and treatment can help mitigate some of the metabolic complications. In this review, we reflect on recent literature regarding PCOS diagnosis, associated complications, and treatment options. Although there are three well known criteria to diagnose PCOS, they can be difficult to translate to adolescence. Newer diagnostic tools under study include anti-Mullerian hormone and revised ultrasound criteria. More is known about the many complications associated with PCOS, and new treatment options are on the horizon. PCOS frequently will present during adolescence. These young women may already have symptoms of metabolic comorbidities. Providers caring for these patients must be aware of the many related complications and common treatment options. Newer diagnostic techniques and treatment options are under active study in adults, and may soon be translated to adolescence. A comprehensive approach allows treatment of patients' concerns, and also prevention of metabolic complications.

[Mobile phone abuse or addiction. A review of the literature].

PubMed

Pedrero Pérez, Eduardo J; Rodríguez Monje, María Teresa; Ruiz Sánchez De León, José María

2012-01-01

The mobile phone is a relatively new technological tool, versatile and accessible, and very attractive, especially for young people, but whose use involves a risk of abuse and addictive behavior. In recent years there has been increasing interest in this problem, especially in view of the fact that it involves an increasingly younger population. The aim of this paper is to review the current state of scientific knowledge about cell phone addiction/abuse. To this end, a search was carried out in international databases, using the descriptors "mobile phone", "cellular telephones", "addiction" and "abuse", and focusing on prevalence studies, diagnostic tests, associations with psychological variables and gender differences. There is a conceptual vagueness about the concepts of abuse and addiction in relation to mobile phones, and wide disparity in the adoption of diagnostic criteria; moreover, there are numerous instruments for the assessment of these concepts. As a result, the estimated prevalence ranges from 0-38%, depending on the scale used and the characteristics of the population studied. Surprisingly, self-attribution of cell phone addiction exceeds the prevalence estimated in the studies themselves. The personality trait most consistently associated with addiction is low self-esteem, though extraversion is associated with more intense use. Women with low self-esteem are the most vulnerable group, and the most commonly associated psychopathological symptom was depression. In short, while the evidence suggests a problem in relation to mobile phone use, the vagueness of the cell phone addiction concept and the poor quality of the studies make it difficult to generalize the results. It is necessary to define and unify criteria with a view to carrying out quality studies that permit appropriate comparisons.

Reaction Workup Planning: A Structured Flowchart Approach, Exemplified in Difficult Aqueous Workup of Hydrophilic Products

ERIC Educational Resources Information Center

Hill, George B.; Sweeney, Joseph B.

2015-01-01

Reaction workup can be a complex problem for those facing novel synthesis of difficult compounds for the first time. Workup problem solving by systematic thinking should be inculcated as mid-graduate-level is reached. A structured approach is proposed, building decision tree flowcharts to analyze challenges, and an exemplar flowchart is presented…

Single-cell proteomics: potential implications for cancer diagnostics.

PubMed

Gavasso, Sonia; Gullaksen, Stein-Erik; Skavland, Jørn; Gjertsen, Bjørn T

2016-01-01

Single-cell proteomics in cancer is evolving and promises to provide more accurate diagnoses based on detailed molecular features of cells within tumors. This review focuses on technologies that allow for collection of complex data from single cells, but also highlights methods that are adaptable to routine cancer diagnostics. Current diagnostics rely on histopathological analysis, complemented by mutational detection and clinical imaging. Though crucial, the information gained is often not directly transferable to defined therapeutic strategies, and predicting therapy response in a patient is difficult. In cancer, cellular states revealed through perturbed intracellular signaling pathways can identify functional mutations recurrent in cancer subsets. Single-cell proteomics remains to be validated in clinical trials where serial samples before and during treatment can reveal excessive clonal evolution and therapy failure; its use in clinical trials is anticipated to ignite a diagnostic revolution that will better align diagnostics with the current biological understanding of cancer.

An evidence-based diagnostic classification system for low back pain

PubMed Central

Vining, Robert; Potocki, Eric; Seidman, Michael; Morgenthal, A. Paige

2013-01-01

Introduction: While clinicians generally accept that musculoskeletal low back pain (LBP) can arise from specific tissues, it remains difficult to confirm specific sources. Methods: Based on evidence supported by diagnostic utility studies, doctors of chiropractic functioning as members of a research clinic created a diagnostic classification system, corresponding exam and checklist based on strength of evidence, and in-office efficiency. Results: The diagnostic classification system contains one screening category, two pain categories: Nociceptive, Neuropathic, one functional evaluation category, and one category for unknown or poorly defined diagnoses. Nociceptive and neuropathic pain categories are each divided into 4 subcategories. Conclusion: This article describes and discusses the strength of evidence surrounding diagnostic categories for an in-office, clinical exam and checklist tool for LBP diagnosis. The use of a standardized tool for diagnosing low back pain in clinical and research settings is encouraged. PMID:23997245

Characteristics of difficult-to-place youth in state custody: a profile of the Exceptional Care Pilot Project population.

PubMed

Armour, Marilyn P; Schwab, James

2007-01-01

This study examines the characteristics of Texas youth designated as 'most difficult to place' recipients of service under the "Exceptional Care Pilot Project" (N = 46). Findings include, among others, high levels of comorbid psychiatric disturbance (> 3 diagnostic groupings), physical (78.3%) and sexual (88%) maltreatment, and placement breakdowns (m = 4.8 therapeutic placements). This initial profile of the population provides a base for helping other states identify and plan for the needs of their most troubled youth.

Torque and Learning and Behavior Problems in Children.

ERIC Educational Resources Information Center

Zendel, Ivan H.; Pihl, R. O.

1980-01-01

Findings indicate minimal differences, on diagnostic tests, between children who exhibited torque and those who did not. Torque is defined as the circling of any X in a clockwise direction. Torque is not associated with learning problems in school. Diagnostic utility of torque should be carefully considered. (Author)

Distraction during learning with hypermedia: difficult tasks help to keep task goals on track

PubMed Central

Scheiter, Katharina; Gerjets, Peter; Heise, Elke

2014-01-01

In educational hypermedia environments, students are often confronted with potential sources of distraction arising from additional information that, albeit interesting, is unrelated to their current task goal. The paper investigates the conditions under which distraction occurs and hampers performance. Based on theories of volitional action control it was hypothesized that interesting information, especially if related to a pending goal, would interfere with task performance only when working on easy, but not on difficult tasks. In Experiment 1, 66 students learned about probability theory using worked examples and solved corresponding test problems, whose task difficulty was manipulated. As a second factor, the presence of interesting information unrelated to the primary task was varied. Results showed that students solved more easy than difficult probability problems correctly. However, the presence of interesting, but task-irrelevant information did not interfere with performance. In Experiment 2, 68 students again engaged in example-based learning and problem solving in the presence of task-irrelevant information. Problem-solving difficulty was varied as a first factor. Additionally, the presence of a pending goal related to the task-irrelevant information was manipulated. As expected, problem-solving performance declined when a pending goal was present during working on easy problems, whereas no interference was observed for difficult problems. Moreover, the presence of a pending goal reduced the time on task-relevant information and increased the time on task-irrelevant information while working on easy tasks. However, as revealed by mediation analyses these changes in overt information processing behavior did not explain the decline in problem-solving performance. As an alternative explanation it is suggested that goal conflicts resulting from pending goals claim cognitive resources, which are then no longer available for learning and problem solving. PMID:24723907

A synthetic diagnostic for beam emission spectroscopy in the helically symmetric experiment stellarator

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

Dobbins, T. J., E-mail: tdobbins@wisc.edu; Kumar, S. T. A.; Anderson, D. T.

The Helically Symmetric Experiment (HSX) has a number of active spectroscopy diagnostics. Due to the relatively large beam width compared to the plasma minor radius, it is difficult to achieve good spatial resolution at the core of the HSX plasma. This is due to the fact that the optical sightline cuts through many flux surfaces with varying field vectors within the beam. In order to compare the experimental results with theoretical models it is important to accurately model the beam width effects. A synthetic diagnostic has been developed for this purpose. This synthetic diagnostic calculates the effect of spot sizemore » and beam width on the measurements of quantities of interest, including radial electric field, flow velocity, and Stark polarization.« less

A synthetic diagnostic for beam emission spectroscopy in the helically symmetric experiment stellarator

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

Dobbins, T. J.; Kumar, S. T. A.; Anderson, D. T.

The Helically Symmetric Experiment (HSX) has a number of active spectroscopy diagnostics. Due to the relatively large beam width compared to the plasma minor radius, it is difficult to achieve good spatial resolution at the core of the HSX plasma. This is due to the fact that the optical sightline cuts through many flux surfaces with varying field vectors within the beam. It is important to accurately model the beam width effects in order to compare the experimental results with theoretical models. We've developed a synthetic diagnostic for this purpose. This synthetic diagnostic calculates the effect of spot size andmore » beam width on the measurements of quantities of interest, including radial electric field, flow velocity, and Stark polarization.« less

A synthetic diagnostic for beam emission spectroscopy in the helically symmetric experiment stellarator

DOE PAGES

Dobbins, T. J.; Kumar, S. T. A.; Anderson, D. T.

2016-08-03

The Helically Symmetric Experiment (HSX) has a number of active spectroscopy diagnostics. Due to the relatively large beam width compared to the plasma minor radius, it is difficult to achieve good spatial resolution at the core of the HSX plasma. This is due to the fact that the optical sightline cuts through many flux surfaces with varying field vectors within the beam. It is important to accurately model the beam width effects in order to compare the experimental results with theoretical models. We've developed a synthetic diagnostic for this purpose. This synthetic diagnostic calculates the effect of spot size andmore » beam width on the measurements of quantities of interest, including radial electric field, flow velocity, and Stark polarization.« less

Abnormal cerebrospinal fluid biochemistry in biotinidase deficiency causing diagnostic conundrum.

PubMed

Krishnakumar, Deepa; Maw, Anna; Brown, Richard; Hogg, Sarah; Calvin, Jackie; Parker, Alasdair P J

2014-01-01

Biotinidase deficiency is a treatable cause of infantile epilepsy and the presentation can be nonspecific. The seizures are difficult to differentiate from other causes of epileptic encephalopathy, which generally have a poor prognosis. We report 2 infants who presented with seizures, and whose low cerebrospinal fluid glucose and high cerebrospinal lactate caused a diagnostic dilemma. Subsequent urine organic acids pointed to the correct diagnosis and avoided invasive investigation. The children had a good clinical outcome with resolution of their seizures on biotin treatment.

Science teacher's perception about science learning experiences as a foundation for teacher training program

NASA Astrophysics Data System (ADS)

Tapilouw, Marisa Christina; Firman, Harry; Redjeki, Sri; Chandra, Didi Teguh

2017-05-01

Teacher training is one form of continuous professional development. Before organizing teacher training (material, time frame), a survey about teacher's need has to be done. Science teacher's perception about science learning in the classroom, the most difficult learning model, difficulties of lesson plan would be a good input for teacher training program. This survey conducted in June 2016. About 23 science teacher filled in the questionnaire. The core of questions are training participation, the most difficult science subject matter, the most difficult learning model, the difficulties of making lesson plan, knowledge of integrated science and problem based learning. Mostly, experienced teacher participated training once a year. Science training is very important to enhance professional competency and to improve the way of teaching. The difficulties of subject matter depend on teacher's education background. The physics subject matter in class VIII and IX are difficult to teach for most respondent because of many formulas and abstract. Respondents found difficulties in making lesson plan, in term of choosing the right learning model for some subject matter. Based on the result, inquiry, cooperative, practice are frequently used in science class. Integrated science is understood as a mix between Biology, Physics and Chemistry concepts. On the other hand, respondents argue that problem based learning was difficult especially in finding contextual problem. All the questionnaire result can be used as an input for teacher training program in order to enhanced teacher's competency. Difficult concepts, integrated science, teaching plan, problem based learning can be shared in teacher training.

Educational Reform as a Dynamic System of Problems and Solutions: Towards an Analytic Instrument

ERIC Educational Resources Information Center

Luttenberg, Johan; Carpay, Thérèse; Veugelers, Wiel

2013-01-01

Large-scale educational reforms are difficult to realize and often fail. In the literature, the course of reform and problems associated with this are frequently discussed. The explanations and recommendations then provided are so diverse that it is difficult to gain a comprehensive overview of what factors are at play and how to take them into…

Using the Competent Small Group Communicator Instrument to Assess Group Performance in the Classroom.

ERIC Educational Resources Information Center

Albert, Lawrence S.

If being a competent small group problem solver is difficult, it is even more difficult to impart those competencies to others. Unlike athletic coaches who are near their players during the real game, teachers of small group communication are not typically present for on-the-spot coaching when their students are doing their problem solving. That…

Examining problem solving in physics-intensive Ph.D. research

NASA Astrophysics Data System (ADS)

Leak, Anne E.; Rothwell, Susan L.; Olivera, Javier; Zwickl, Benjamin; Vosburg, Jarrett; Martin, Kelly Norris

2017-12-01

Problem-solving strategies learned by physics undergraduates should prepare them for real-world contexts as they transition from students to professionals. Yet, graduate students in physics-intensive research face problems that go beyond problem sets they experienced as undergraduates and are solved by different strategies than are typically learned in undergraduate coursework. This paper expands the notion of problem solving by characterizing the breadth of problems and problem-solving processes carried out by graduate students in physics-intensive research. We conducted semi-structured interviews with ten graduate students to determine the routine, difficult, and important problems they engage in and problem-solving strategies they found useful in their research. A qualitative typological analysis resulted in the creation of a three-dimensional framework: context, activity, and feature (that made the problem challenging). Problem contexts extended beyond theory and mathematics to include interactions with lab equipment, data, software, and people. Important and difficult contexts blended social and technical skills. Routine problem activities were typically well defined (e.g., troubleshooting), while difficult and important ones were more open ended and had multiple solution paths (e.g., evaluating options). In addition to broadening our understanding of problems faced by graduate students, our findings explore problem-solving strategies (e.g., breaking down problems, evaluating options, using test cases or approximations) and characteristics of successful problem solvers (e.g., initiative, persistence, and motivation). Our research provides evidence of the influence that problems students are exposed to have on the strategies they use and learn. Using this evidence, we have developed a preliminary framework for exploring problems from the solver's perspective. This framework will be examined and refined in future work. Understanding problems graduate students face and the strategies they use has implications for improving how we approach problem solving in undergraduate physics and physics education research.

Model of critical diagnostic reasoning: achieving expert clinician performance.

PubMed

Harjai, Prashant Kumar; Tiwari, Ruby

2009-01-01

Diagnostic reasoning refers to the analytical processes used to determine patient health problems. While the education curriculum and health care system focus on training nurse clinicians to accurately recognize and rescue clinical situations, assessments of non-expert nurses have yielded less than satisfactory data on diagnostic competency. The contrast between the expert and non-expert nurse clinician raises the important question of how differences in thinking may contribute to a large divergence in accurate diagnostic reasoning. This article recognizes superior organization of one's knowledge base, using prototypes, and quick retrieval of pertinent information, using similarity recognition as two reasons for the expert's superior diagnostic performance. A model of critical diagnostic reasoning, using prototypes and similarity recognition, is proposed and elucidated using case studies. This model serves as a starting point toward bridging the gap between clinical data and accurate problem identification, verification, and management while providing a structure for a knowledge exchange between expert and non-expert clinicians.

Characterizing a Hidden Group of At-Risk Drinkers: Epidemiological Profiles of Alcohol-Use Disorder Diagnostic Orphans.

PubMed

Gilbert, Paul A; Marzell, Miesha

2017-11-29

Drinkers who report some symptoms of alcohol-use disorder (AUD) but fail to meet full criteria are "diagnostic orphans." To improve risk-reduction efforts, we sought to develop better epidemiologic profiles of this underrecognized subgroup. This study estimated the population prevalence and described AUD symptoms of diagnostic orphans using the 2012-2013 National Epidemiological Survey of Alcohol and Related Conditions-III. Multivariate logistic regression was used to model odds of being a diagnostic orphan or meeting mild, moderate, and severe AUD criteria versus no AUD symptoms. Models were adjusted for the complex survey design using sampling weights and survey procedures (e.g., proc surveylogistic). Among drinkers, 14% of men and 11% of women were classified as diagnostic orphans. The most common symptoms were drinking more or for longer periods than intended, wanting or trying unsuccessfully to quit or cut back, and drinking in ways that increased risk of injury. We noted broad similarities between diagnostic orphans and mild/moderate AUD groups. There were no differences in odds of diagnostic orphans status by race/ethnicity; however, female gender was associated with lower odds of diagnostic orphan status and all levels of AUD. Individual history of AUD, family history of problem drinking, concurrent smoking, and concurrent marijuana use were associated with greater odds of problem drinking, with stronger associations as AUD severity increased. Diagnostic orphans remain a sizeable and overlooked population of problem drinkers. Clarifying the array of symptoms and cooccurring disorders can improve screening and facilitate alcohol risk-reduction intervention efforts.

Pregnancy and mesenchimal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia).

PubMed

Radetskaya, L S; Makatsariya, A D; Bitsadze, V O; Khizroeva, J K

2018-07-01

The objective of this article is to attract the attention of clinical physicians to the rare but extremely relevant clinical pathology of mesenchymal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, hereditary hemorrhagic telangiectasia) and especially specific characteristics of such diseases during pregnancy. Connective tissue pathology can cover different organs and systems, symptoms of the same disease can vary in different patients thus making diagnostics significantly difficult. Here clinical diagnostic criteria and methods of molecular diagnostics of diseases are described. The pathogenesis of mesenchymal dysplasias is not currently well understood. For the patients with mesenchymal dysplasias pregnancy is fraught with high risk of life-threatening complications. The preferred delivery method for such patients is caesarean section.

Terminological debate over language impairment in children: forward movement and sticking points

PubMed Central

Reilly, Sheena; Bishop, Dorothy V M; Tomblin, Bruce

2014-01-01

Background There is no agreed terminology for describing childhood language problems. In this special issue Reilly et al. and Bishop review the history of the most widely used label, ‘specific language impairment’ (SLI), and discuss the pros and cons of various terms. Commentators from a range of backgrounds, in terms of both discipline and geographical background, were then invited to respond to each lead article. Aims To summarize the main points made by the commentators and identify (1) points of consensus and disagreement, (2) issues for debate including the drivers for change and diagnostic criteria, and (3) the way forward. Conclusions & Implications There was some common ground, namely that the current situation is not tenable because it impedes clinical and research progress and impacts on access to services. There were also wide-ranging disagreements about which term should be adopted. However, before debating the broad diagnostic label it is essential to consider the diagnostic criteria and the systems used to classify childhood language problems. This is critical in order to facilitate communication between and among clinicians and researchers, across sectors (in particular health and education), with the media and policy-makers and with families and individuals who have language problems. We suggest four criteria be taken into account when establishing diagnostic criteria, including: (1) the features of language, (2) the impact on functioning and participation, (3) the presence/absence of other impairments, and (4) the language trajectory or pathway and age of onset. In future, these criteria may expand to include the genetic and neural markers for language problems. Finally, there was overarching agreement about the need for an international and multidisciplinary forum to move this debate forward. The purpose would be to develop consensus regarding the diagnostic criteria and diagnostic label for children with language problems. This process should include canvassing the views of families and people with language problems as well as the views of policy-makers. PMID:25142092

An efficient and accurate solution methodology for bilevel multi-objective programming problems using a hybrid evolutionary-local-search algorithm.

PubMed

Deb, Kalyanmoy; Sinha, Ankur

2010-01-01

Bilevel optimization problems involve two optimization tasks (upper and lower level), in which every feasible upper level solution must correspond to an optimal solution to a lower level optimization problem. These problems commonly appear in many practical problem solving tasks including optimal control, process optimization, game-playing strategy developments, transportation problems, and others. However, they are commonly converted into a single level optimization problem by using an approximate solution procedure to replace the lower level optimization task. Although there exist a number of theoretical, numerical, and evolutionary optimization studies involving single-objective bilevel programming problems, not many studies look at the context of multiple conflicting objectives in each level of a bilevel programming problem. In this paper, we address certain intricate issues related to solving multi-objective bilevel programming problems, present challenging test problems, and propose a viable and hybrid evolutionary-cum-local-search based algorithm as a solution methodology. The hybrid approach performs better than a number of existing methodologies and scales well up to 40-variable difficult test problems used in this study. The population sizing and termination criteria are made self-adaptive, so that no additional parameters need to be supplied by the user. The study indicates a clear niche of evolutionary algorithms in solving such difficult problems of practical importance compared to their usual solution by a computationally expensive nested procedure. The study opens up many issues related to multi-objective bilevel programming and hopefully this study will motivate EMO and other researchers to pay more attention to this important and difficult problem solving activity.

Recognition of depression in people of different cultures: a qualitative study.

PubMed

Lehti, Arja; Hammarström, Anne; Mattsson, Bengt

2009-07-27

Many minority group patients who attend primary health care are depressed. To identify a depressive state when GPs see patients from other cultures than their own can be difficult because of cultural and gender differences in expressions and problems of communication. The aim of this study was to explore and analyse how GPs think and deliberate when seeing and treating patients from foreign countries who display potential depressive features. The data were collected in focus groups and through individual interviews with GPs in northern Sweden and analysed by qualitative content analysis. In the analysis three themes, based on various categories, emerged; "Realizing the background", "Struggling for clarity" and "Optimizing management". Patients' early life events of importance were often unknown which blurred the accuracy. Reactions to trauma, cultural frictions and conflicts between the new and old gender norms made the diagnostic process difficult. The patient-doctor encounter comprised misconceptions, and social roles in the meetings were sometimes confused. GPs based their judgement mainly on clinical intuition and the established classification of depressive disorders was discussed. Tools for management and adequate action were diffuse. Dialogue about patients' illness narratives and social context are crucial. There is a need for tools for multicultural, general practice care in the depressive spectrum. It is also essential to be aware of GPs' own conceptions in order to avoid stereotypes and not to under- or overestimate the occurrence of depressive symptoms.

A critical incident study of general practice trainees in their basic general practice term.

PubMed

Diamond, M R; Kamien, M; Sim, M G; Davis, J

1995-03-20

To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Management of complicated gallstones: results of an alternative approach to difficult cholecystectomies.

PubMed

Lirici, Marco Maria; Califano, Andrea

2010-10-01

Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstones. Nevertheless, the incidence of conversion and injuries to the biliary tract is still high in difficult cholecystectomies. In this study we sought to determine how using operative risk predictive scores (PSs) and the Nassar scale to grade the difficulty of LC would optimize the perioperative management of complicated gallstone patients. We also evaluated whether the "fundus-first" approach to LC combined with ultrasonic dissection minimizes the risk of conversion and biliary injury in difficult cholecystectomies, and avoids routine intraoperative cholangiography. A prospective non-randomized study was carried out from 2005 to 2007 including 237 patients referred for gallbladder diseases. All patients were evaluated using an operative risk PS. The LC grade of difficulty was assessed according to Nassar. Diagnostic accuracy, sensitivity, and specificity of PS were calculated. LC in difficult cases was accomplished with a fundus-first approach. Outcome measures included: Conversion rate, bile duct (BD) injury rate, and postoperative complications according to Clavien. In 178 out of 237 patients, a higher risk of conversion and complication was predicted. In 146 out of these 178 cases, intra-operative grading confirmed the difficulty of the procedure. The PS diagnostic accuracy was 0.865, sensitivity was 100%, and specificity 65%. Positive predictive value and negative predictive value were 0.82 and 1, respectively. Conversion rate was 2.7%. Mean operating time and postoperative length of hospital stay were 75 minutes and 3.5 days. Intra-operative cholangiography was necessary in five cases, and one intraoperative biliary complication occurred with an uneventful postoperative course. Overall, postoperative complications were 2.7% with a mortality rate of 0.68% (1 myocardial infarction). Fundus-first LC by ultrasonic dissection is safe and minimizes the risk of conversion and biliary injuries in difficult cases. Difficult cholecystectomies may be predicted preoperatively; in these cases the fundus-first approach and ultrasound dissection may be advised.

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study

PubMed Central

Chara, Liaskou; Eleftherios, Vouzounerakis; Maria, Moirasgenti; Anastasia, Trikoupi; Chryssoula, Staikou

2014-01-01

Background and Aims: Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. Methods: We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack–Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack–Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Results: Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). Conclusions: The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC. PMID:24963183

Anatomic features of the neck as predictive markers of difficult direct laryngoscopy in men and women: A prospective study.

PubMed

Liaskou, Chara; Chara, Liaskou; Vouzounerakis, Eleftherios; Eleftherios, Vouzounerakis; Moirasgenti, Maria; Maria, Moirasgenti; Trikoupi, Anastasia; Anastasia, Trikoupi; Staikou, Chryssoula; Chryssoula, Staikou

2014-03-01

Difficult airway assessment is based on various anatomic parameters of upper airway, much of it being concentrated on oral cavity and the pharyngeal structures. The diagnostic value of tests based on neck anatomy in predicting difficult laryngoscopy was assessed in this prospective, open cohort study. We studied 341 adult patients scheduled to receive general anaesthesia. Thyromental distance (TMD), sternomental distance (STMD), ratio of height to thyromental distance (RHTMD) and neck circumference (NC) were measured pre-operatively. The laryngoscopic view was classified according to the Cormack-Lehane Grade (1-4). Difficult laryngoscopy was defined as Cormack-Lehane Grade 3 or 4. The optimal cut-off points for each variable were identified by using receiver operating characteristic analysis. Sensitivity, specificity and positive predictive value and negative predictive value (NPV) were calculated for each test. Multivariate analysis with logistic regression, including all variables, was used to create a predictive model. Comparisons between genders were also performed. Laryngoscopy was difficult in 12.6% of the patients. The cut-off values were: TMD ≤7 cm, STMD ≤15 cm, RHTMD >18.4 and NC >37.5 cm. The RHTMD had the highest sensitivity (88.4%) and NPV (95.2%), while TMD had the highest specificity (83.9%). The area under curve (AUC) for the TMD, STMD, RHTMD and NC was 0.63, 0.64, 0.62 and 0.54, respectively. The predictive model exhibited a higher and statistically significant diagnostic accuracy (AUC: 0.68, P < 0.001). Gender-specific cut-off points improved the predictive accuracy of NC in women (AUC: 0.65). The TMD, STMD, RHTMD and NC were found to be poor single predictors of difficult laryngoscopy, while a model including all four variables had a significant predictive accuracy. Among the studied tests, gender-specific cut-off points should be used for NC.

District, state or regional veterinary diagnostic laboratories.

PubMed

Gosser, H S; Morehouse, L G

1998-08-01

The district, regional or state laboratory is the local laboratory to which veterinarian practitioners usually submit samples, and consequently these laboratories are usually the first to observe a suspected disease problem. In most countries, these laboratories are under the jurisdiction of the State or region in which they are located. In the United States of America (USA), most veterinary diagnostic laboratories are State-associated and operate under the aegis of either the State Department of Agriculture or a university. The national laboratory provides reference assistance to the State laboratories. In the USA, the national Laboratory (the National Veterinary Services Laboratories) acts as a consultant to confirm difficult diagnoses and administer performance tests for State-associated laboratories. District, state or regional laboratories need to share information regarding technological advances in diagnostic procedures. This need was met in the USA by the formation of the American Association of Veterinary Laboratory Diagnosticians (AAVLD) in the late 1950s. Another requirement of district, state or regional diagnostic laboratories is a method to confirm quality assurance, which was fulfilled in the USA by an accreditation programme established through the AAVLD. The Accreditation Committee evaluates laboratories (on request) in terms of organisation, personnel, physical facilities and equipment, records, finance and budget. Those laboratories which meet the standards as established in the 'Essential Requirements for Accreditation' are given accreditation status, which indicates that they have the expertise and facilities to perform tests on food-producing animals for shipment in national or international commerce and on companion, laboratory or zoo animals. While confidentiality of test records is most important, it is becoming necessary to release certain types of animal disease test information if a country is to participate in the exportation of animals and animal products. As district, state and regional laboratories operate under many different administrative entities (i.e., universities, State governments and the Federal government), various checks at different administrative levels provide safeguards and reduce the possibility of faulty disease reporting.

A Diagnostic Taxonomy of Adult Career Problems.

ERIC Educational Resources Information Center

Campbell, Robert E.; Cellini, James V.

1981-01-01

Developed a taxonomy for the differential diagnosis of adult career development problems. Problem categories identified were: (1) problems in career decision making; (2) problems in implementing career plans; (3) problems in organizational/institutional performance; and (4) problems in organizational/institutional adaption. (Author)

Modification of the Integrated Sasang Constitutional Diagnostic Model

PubMed Central

Nam, Jiho

2017-01-01

In 2012, the Korea Institute of Oriental Medicine proposed an objective and comprehensive physical diagnostic model to address quantification problems in the existing Sasang constitutional diagnostic method. However, certain issues have been raised regarding a revision of the proposed diagnostic model. In this paper, we propose various methodological approaches to address the problems of the previous diagnostic model. Firstly, more useful variables are selected in each component. Secondly, the least absolute shrinkage and selection operator is used to reduce multicollinearity without the modification of explanatory variables. Thirdly, proportions of SC types and age are considered to construct individual diagnostic models and classify the training set and the test set for reflecting the characteristics of the entire dataset. Finally, an integrated model is constructed with explanatory variables of individual diagnosis models. The proposed integrated diagnostic model significantly improves the sensitivities for both the male SY type (36.4% → 62.0%) and the female SE type (43.7% → 64.5%), which were areas of limitation of the previous integrated diagnostic model. The ideas of these new algorithms are expected to contribute not only to the scientific development of Sasang constitutional medicine in Korea but also to that of other diagnostic methods for traditional medicine. PMID:29317897

Improvement of Railroad Roller Bearing Test Procedures & Development of Roller Bearing Diagnostic Techniques. Volume 2.

DOT National Transportation Integrated Search

1982-04-01

A comprehensive review of existing basic diagnostic techniques applicable to the railcar roller bearing defect and failure problem was made. Of the potentially feasible diagnostic techniques identified, high frequency vibration was selected for exper...

Screening and Diagnostic Procedure for Identification of Adult Learning Problems. 309 Demonstration Project.

ERIC Educational Resources Information Center

International Labour Office, Islamabad (Pakistan). Asian and Pacific Skill Development Programme.

This screening and diagnostic procedure is intended to identify Level 1 adults with specific learning problems. The adults not meeting criteria on the assessments for visual and auditory functions should be referred to proper medical services for full evaluations. A prescriptive teaching program should be specifically designed to meet needs of…

Mathematical Frameworks for Diagnostics, Prognostics and Condition Based Maintenance Problems

DTIC Science & Technology

2008-08-15

REPORT Mathematical Frameworks for Diagnostics, Prognostics and Condition Based Maintenance Problems (W911NF-05-1-0426) 14. ABSTRACT 16. SECURITY ...other documentation. 12. DISTRIBUTION AVAILIBILITY STATEMENT Approved for Public Release; Distribution Unlimited 9. SPONSORING/MONITORING AGENCY NAME...parallel and distributed computing environment were researched. In support of the Condition Based Maintenance (CBM) philosophy, a theoretical framework

Self-Instructional Methods of Teaching Diagnostic Problem Solving to Automotive Students. Vocational-Industrial Education Research Report.

ERIC Educational Resources Information Center

Finch, Curtis R.

The objective of this study was to investigate the effects of three methods of teaching diagnostic problem-solving (troubleshooting) to automotive students. The sample consisted of 45 community college students enrolled in automotive courses. Initially, all students received a presentation on ignition principles, and the Otis Mental Ability Test…

Identification of selected CITES-protected Araucariaceae using DART TOFMS

Treesearch

Philip D. Evans; Ignacio A. Mundo; Michael C. Wiemann; Gabriela D. Chavarria; Pamela J. McClure; Doina Voin; Edgard O. Espinoza

2017-01-01

Determining the species source of logs and planks suspected of being Araucaria araucana (Molina) K.Koch (CITES Appendix I) using traditional wood anatomy has been difficult, because its anatomical features are not diagnostic. Additionally, anatomical studies of Araucaria angustifolia (Bertol.) Kuntze, Araucaria...

Efficiency of the confocal method of laser endomicroscopy in complex diagnoses of diseases of common bile duct

NASA Astrophysics Data System (ADS)

Anaskin, S. G.; Panchenkov, D. N.; Chertyuk, V. B.; Sazonov, D. V.; Zabozlayev, F. G.; Danilevskaya, O. V.; Mokshina, N. V.; Korniletsky, I. D.

2017-01-01

One of the more frequent manifestations of diseases of the bile ducts are its’ strictures or stenoses that could be of either malignant or benign nature. Current methods of diagnosing this pathology include computer tomography (CT) scan, magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). However, these methods are not always informative, which makes this a current and topical problem. A fundamentally new method that broadens the capabilities of ERCP when diagnosing diseases of the bile duct accompanied by the development of strictures or stenoses is probe-based confocal laser endomicroscopy (pCLE). The method is based on the principle of confocal fluorescence microscopy. The most elaborate complications arise with the presence of the pre-existing pancreatobiliary pathology: pseudotumoral chronic pancreatitis, acute cholangitis, etc. Early stage cholangiocarcinoma diagnosis can be difficult (and not always possible) even with the help of modern research methods. For the timely diagnostic it is advantageous to conduct pCLE and targeted biopsy of the zone with most manifested changes. In all instances, the first use of the pCLE method for diagnostic purposes allowed us to clarify and correctly verify the diagnosis. When concerning the diseases of the bile duct, the modern stage of pCLE development can be of critical importance when other methods are not effective.

Diagnostic, design and implementation of an integrated model of care in France: a bottom-up process with a continuous leadership

PubMed Central

de Stampa, Matthieu; Vedel, Isabelle; Mauriat, Claire; Bagaragaza, Emmanuel; Routelous, Christelle; Bergman, Howard; Lapointe, Liette; Cassou, Bernard; Ankri, Joel; Henrard, Jean-Claude

2010-01-01

Purpose To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs. Context Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs). Case description In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people. In the second step, an integrated care model called Coordination Personnes Agées (COPA) was designed by the same major stakeholders in order to define its detailed characteristics based on the local context. In the third step, the model was implemented in two phases: adoption and maintenance. This strategy was carried out by a continuous and flexible leadership throughout the process, initially with a mixed leadership (clinician and researcher) followed by a double one (clinician and managers of services) in the implementation phase. Conclusions The implementation of this bottom-up and pragmatic strategy relied on establishing a collaborative dynamic among health and social stakeholders. This enhanced their involvement throughout the implementation phase, particularly among the GPs, and allowed them to support the change practices and services arrangements.

Mission Evaluation Room Intelligent Diagnostic and Analysis System (MIDAS)

NASA Technical Reports Server (NTRS)

Pack, Ginger L.; Falgout, Jane; Barcio, Joseph; Shnurer, Steve; Wadsworth, David; Flores, Louis

1994-01-01

The role of Mission Evaluation Room (MER) engineers is to provide engineering support during Space Shuttle missions, for Space Shuttle systems. These engineers are concerned with ensuring that the systems for which they are responsible function reliably, and as intended. The MER is a central facility from which engineers may work, in fulfilling this obligation. Engineers participate in real-time monitoring of shuttle telemetry data and provide a variety of analyses associated with the operation of the shuttle. The Johnson Space Center's Automation and Robotics Division is working to transfer advances in intelligent systems technology to NASA's operational environment. Specifically, the MER Intelligent Diagnostic and Analysis System (MIDAS) project provides MER engineers with software to assist them with monitoring, filtering and analyzing Shuttle telemetry data, during and after Shuttle missions. MIDAS off-loads to computers and software, the tasks of data gathering, filtering, and analysis, and provides the engineers with information which is in a more concise and usable form needed to support decision making and engineering evaluation. Engineers are then able to concentrate on more difficult problems as they arise. This paper describes some, but not all of the applications that have been developed for MER engineers, under the MIDAS Project. The sampling described herewith was selected to show the range of tasks that engineers must perform for mission support, and to show the various levels of automation that have been applied to assist their efforts.

TEMPERAMENT, FAMILY ENVIRONMENT, AND BEHAVIOR PROBLEMS IN CHILDREN WITH NEW-ONSET SEIZURES

PubMed Central

Baum, Katherine T.; Byars, Anna W.; deGrauw, Ton J.; Johnson, Cynthia S.; Perkins, Susan M.; Dunn, David W.; Bates, John E.; Austin, Joan K.

2007-01-01

Children with epilepsy, even those with new-onset seizures, exhibit relatively high rates of behavior problems. The purpose of this study was to explore the relationships among early temperament, family adaptive resources, and behavior problems in children with new-onset seizures. Our major goal was to test whether family adaptive resources moderated the relationship between early temperament dimensions and current behavior problems in 287 children with new-onset seizures. Two of the three temperament dimensions (difficultness and resistance to control) were positively correlated with total, internalizing, and externalizing behavior problems (all p < 0.0001). The third temperament dimension, unadaptability, was positively correlated with total and internalizing problems (p < 0.01). Family adaptive resources moderated the relationships between temperament and internalizing and externalizing behavior problems at school. Children with a difficult early temperament who live in a family environment with low family mastery are at the greatest risk for behavior problems. PMID:17267291

The value of cyclooxygenase-2 expression in differentiating between early melanomas and histopathologically difficult types of benign human skin lesions.

PubMed

Kuźbicki, Łukasz; Lange, Dariusz; Strączyńska-Niemiec, Anita; Chwirot, Barbara W

2012-02-01

Early cutaneous melanomas may present a substantial diagnostic challenge. We have already reported that expression of cyclooxygenase-2 (COX-2) may be useful for differentiating between cutaneous melanomas and naevi. The purpose of this study was to examine the value of COX-2 in a challenging task of differential diagnosis of early melanomas and melanocytic naevi considered by histopathologists as morphologically difficult to unequivocally diagnose as benign lesions. The material for the study comprised formalin-fixed paraffin-embedded samples of 46 naevi (including 27 cases of dysplastic, Spitz and Reed naevi) and 30 early human cutaneous melanomas. The expression of COX-2 was detected immunohistochemically. Melanomas expressed COX-2 significantly more strongly compared with naevi. The test, on the basis of determination of the percentage fractions of COX-2-positive cells, allows for differentiation of early skin melanomas and naevi with high sensitivity and specificity. Receiver operating characteristic analysis of the test results yielded areas under receiver operating characteristics curves (AUC)=0.946±0.030 for central regions and AUC=0.941±0.031 for the peripheries of the lesions. The performance of the test in differentiating between melanomas and the naevi group comprising dysplastic, Spitz and Reed naevi was also good, with AUC=0.933±0.034 and 0.923±0.037 for the central and the border regions of the lesions, respectively. Using a more complex diagnostic algorithm also accounting for the staining intensity did not result in an improvement in the resolving power of the assay. A diagnostic algorithm using differences in the percentage fractions of cells expressing COX-2 may serve as a useful tool in aiding the differential diagnosis of 'histopathologically difficult' benign melanocytic skin lesions and early melanomas.

Rapid, scalable and highly automated HLA genotyping using next-generation sequencing: a transition from research to diagnostics

PubMed Central

2013-01-01

Background Human leukocyte antigen matching at allelic resolution is proven clinically significant in hematopoietic stem cell transplantation, lowering the risk of graft-versus-host disease and mortality. However, due to the ever growing HLA allele database, tissue typing laboratories face substantial challenges. In light of the complexity and the high degree of allelic diversity, it has become increasingly difficult to define the classical transplantation antigens at high-resolution by using well-tried methods. Thus, next-generation sequencing is entering into diagnostic laboratories at the perfect time and serving as a promising tool to overcome intrinsic HLA typing problems. Therefore, we have developed and validated a scalable automated HLA class I and class II typing approach suitable for diagnostic use. Results A validation panel of 173 clinical and proficiency testing samples was analysed, demonstrating 100% concordance to the reference method. From a total of 1,273 loci we were able to generate 1,241 (97.3%) initial successful typings. The mean ambiguity reduction for the analysed loci was 93.5%. Allele assignment including intronic sequences showed an improved resolution (99.2%) of non-expressed HLA alleles. Conclusion We provide a powerful HLA typing protocol offering a short turnaround time of only two days, a fully integrated workflow and most importantly a high degree of typing reliability. The presented automated assay is flexible and can be scaled by specific primer compilations and the use of different 454 sequencing systems. The workflow was successfully validated according to the policies of the European Federation for Immunogenetics. Next-generation sequencing seems to become one of the new methods in the field of Histocompatibility. PMID:23557197

DNA Barcoding of Recently Diverged Species: Relative Performance of Matching Methods

PubMed Central

van Velzen, Robin; Weitschek, Emanuel; Felici, Giovanni; Bakker, Freek T.

2012-01-01

Recently diverged species are challenging for identification, yet they are frequently of special interest scientifically as well as from a regulatory perspective. DNA barcoding has proven instrumental in species identification, especially in insects and vertebrates, but for the identification of recently diverged species it has been reported to be problematic in some cases. Problems are mostly due to incomplete lineage sorting or simply lack of a ‘barcode gap’ and probably related to large effective population size and/or low mutation rate. Our objective was to compare six methods in their ability to correctly identify recently diverged species with DNA barcodes: neighbor joining and parsimony (both tree-based), nearest neighbor and BLAST (similarity-based), and the diagnostic methods DNA-BAR, and BLOG. We analyzed simulated data assuming three different effective population sizes as well as three selected empirical data sets from published studies. Results show, as expected, that success rates are significantly lower for recently diverged species (∼75%) than for older species (∼97%) (P<0.00001). Similarity-based and diagnostic methods significantly outperform tree-based methods, when applied to simulated DNA barcode data (P<0.00001). The diagnostic method BLOG had highest correct query identification rate based on simulated (86.2%) as well as empirical data (93.1%), indicating that it is a consistently better method overall. Another advantage of BLOG is that it offers species-level information that can be used outside the realm of DNA barcoding, for instance in species description or molecular detection assays. Even though we can confirm that identification success based on DNA barcoding is generally high in our data, recently diverged species remain difficult to identify. Nevertheless, our results contribute to improved solutions for their accurate identification. PMID:22272356

DNA barcoding of recently diverged species: relative performance of matching methods.

PubMed

van Velzen, Robin; Weitschek, Emanuel; Felici, Giovanni; Bakker, Freek T

2012-01-01

Recently diverged species are challenging for identification, yet they are frequently of special interest scientifically as well as from a regulatory perspective. DNA barcoding has proven instrumental in species identification, especially in insects and vertebrates, but for the identification of recently diverged species it has been reported to be problematic in some cases. Problems are mostly due to incomplete lineage sorting or simply lack of a 'barcode gap' and probably related to large effective population size and/or low mutation rate. Our objective was to compare six methods in their ability to correctly identify recently diverged species with DNA barcodes: neighbor joining and parsimony (both tree-based), nearest neighbor and BLAST (similarity-based), and the diagnostic methods DNA-BAR, and BLOG. We analyzed simulated data assuming three different effective population sizes as well as three selected empirical data sets from published studies. Results show, as expected, that success rates are significantly lower for recently diverged species (∼75%) than for older species (∼97%) (P<0.00001). Similarity-based and diagnostic methods significantly outperform tree-based methods, when applied to simulated DNA barcode data (P<0.00001). The diagnostic method BLOG had highest correct query identification rate based on simulated (86.2%) as well as empirical data (93.1%), indicating that it is a consistently better method overall. Another advantage of BLOG is that it offers species-level information that can be used outside the realm of DNA barcoding, for instance in species description or molecular detection assays. Even though we can confirm that identification success based on DNA barcoding is generally high in our data, recently diverged species remain difficult to identify. Nevertheless, our results contribute to improved solutions for their accurate identification.

EVALUATION AND IMPORTANCE OF SELECTED MICROBIOLOGICAL METHODS IN THE DIAGNOSIS OF HUMAN BRUCELLOSIS

PubMed Central

Šiširak, Maida; Hukić, Mirsada

2009-01-01

Brucellosis is an important public health problem in Bosnia and Herzegovina. The diagnosis of bru-cellosis in the country without any experiences with this kind of infection may be very difficult. The aim of this study was to evaluate diagnostic methods: Rose Bengal test, blood cultures and ELISA IgM and IgG in the patients with brucellosis. The study included 91 brucellosis patients in the period 2004 to 2007. All the patients were treated at the Clinic for Infectious Diseases, University of Sarajevo Clinics Centre. Blood cultures were positive in 28/91 (30, 8%) patients. This method often needs a long period of incubation and specimens need to be obtained early. These limitations make serology the most useful tool for the laboratory diagnosis of Brucella infection. Rose Bengal is a rapid plate agglutination test, very sensitive irrespective of the stage of the disease. In our study, Rose Bengal test was positive in all patients 91/91 (100, 0%). Brucella IgM antibodies with ELISA were positive in 59/91 (64, 8%). Brucella IgG antibodies with ELISA were positive in 51/91 (56%). In order to determine the diagnostic value of the different tests, we compared the sensitivity among test-methods: Rose Bengal test-100.0%, blood culture-30.8%, ELISA IgM-64.8% and ELISA IgG-56.1%. Sensitivity of test methods was different in the different stages of illness. It is necessary to use combination of different tests such are blood culture, Rose Bengal test and ELISA in order to ensure the diagnosis. Rose Bengal test is excellent for the screening. Blood culture is a method of choice for the diagnosis acute infection. ELISA is a very good method for the diagnostic chronic disease and relapse. PMID:19754473

Concordance between a simpler definition of major depressive disorder and Diagnostic and statistical manual of mental disorders, fourth edition: an independent replication in an outpatient sample.

PubMed

Zimmerman, Mark; Emmert-Aronson, Benjamin O; Brown, Timothy A

2011-01-01

The diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV) symptom criteria for major depressive disorder (MDD) are somewhat lengthy with several studies showing that clinicians have difficulty recalling all 9 symptoms. Moreover, the criteria include somatic symptoms that are difficult to apply in patients with medical illnesses. To address these problems, a simpler definition of MDD was developed that did not include the somatic symptoms. Previous reports found high levels of agreement between the simplified and full DSM-IV definition of MDD. However, the same research group has conducted all previous studies of psychiatric patients. The goal of the present study was to determine if a high level of concordance between the 2 definitions would be replicated in an independent setting. We interviewed 2907 psychiatric outpatients presenting for treatment at the Boston University Center for Anxiety and Related Disorders. A trained diagnostic rater administered a semistructured interview and inquired about all symptoms of depression for all patients. A high level of agreement was found between the DSM-IV and the simpler definition of MDD. The absolute level of agreement between the 2 definitions was 95.5% and the κ coefficient was 0.88. Thus, consistent with previous studies, a high level of concordance was found between a simpler definition of MDD and the DSM-IV definition. This new definition offers 2 advantages over the current DSM-IV definition-it is briefer, and it is easier to apply with medically ill patients because it is free of somatic symptoms. Implications of these findings for DSM-5 are discussed. Copyright © 2011 Elsevier Inc. All rights reserved.

Development of a scale to measure problem use of short message service: the SMS Problem Use Diagnostic Questionnaire.

PubMed

Rutland, J Brian; Sheets, Tilman; Young, Tony

2007-12-01

This exploratory study examines a subset of mobile phone use, the compulsive use of short message service (SMS) text messaging. A measure of SMS use, the SMS Problem Use Diagnostic Questionnaire (SMS-PUDQ), was developed and found to possess acceptable reliability and validity when compared to other measures such as self-reports of time spent using SMS and scores on a survey of problem mobile phone use. Implications for the field of addiction research, technological and behavioral addictions in particular, are discussed, and directions for future research are suggested.

Psychiatrists' relationships with industry: the principal-agent problem.

PubMed

Appelbaum, Paul S; Gold, Azgad

2010-01-01

Psychiatrists' relationships with the pharmaceutical and device industries have been a growing focus of attention, with questions raised about the impact of those relationships on prescribing practices, diagnostic criteria, practice guidelines, continuing education, conduct and reporting of research, and patients' and public trust. Indeed, these concerns exist for the medical profession as a whole, with various remedial measures proposed. We suggest that such relationships can be understood as giving rise to a "principal-agent problem," which occurs when an agent (here, a physician) is engaged to advance the interests of another party, the principal (typically a patient), but also faces incentives to promote other interests. Studies suggest that at least some relationships--which include attending industry-sponsored presentations, meeting with marketing representatives, and accepting samples--can alter psychiatrists' and other physicians' behavior in ways that can compromise patients' interests, and that industry-funded research may create bias in the medical literature. These effects are difficult to detect in specific cases, however, because of asymmetries of information and may not be apparent even to physicians themselves. Principal-agent analysis suggests that the possible responses to such problems, including appeals to ethical principles, monitoring behavior, and managing risk-inducing situations, should include consideration of aligning agents' incentives with principals' interests. This type of analysis underscores the similarity of the issues raised by physicians' relationships with industry to problems that arise more generally in society, thus reducing physicians' potential affective responses to these issues and efforts to address them. Finally, such analysis directs attention to the benefits and costs of each alternative, thereby encouraging reliance on evidence as a basis for policy.

[Clinical interview in psychiatric difficult situations].

PubMed

Lorettu, Liliana; Nivoli, Gian Carlo; Milia, Paolo; Depalmas, Cristiano; Clerici, Massimo; Nivoli, Alessandra M A

2017-01-01

There are here described a number of basic principles underlying an effective clinical interview in psychiatric difficult situations (violent or suicidal patients, victims of serious physical and psychological damages, authors of inadequate or anti-social requests to the therapist). The aim of the present study is to provide the psychiatric operator with useful skills for the optimal management of the interview in difficult situations both at diagnostically and therapeutically level. The methodology was based on examination of the literature and personal experience of the authors. The authors highlighted 18 working hypothesis that may represent beneficial instruments in situations of difficult psychiatric interview. Further studies will deepen under the clinical, actuarial and statistical validity the principles covered in various clinical and crisis situations with difficulty to the interview, in relation also to specific types of patients for a more updated training of the operators in the field of mental health.

Dealing with Institutional Racism on Campus: Initiating Difficult Dialogues and Social Justice Advocacy Interventions

ERIC Educational Resources Information Center

D'Andrea, Michael; Daniels, Judy

2007-01-01

The authors describe social justice advocacy interventions to initiate difficult discussions at the university where they are employed. They emphasize the need to foster difficult dialogues about the problem of institutional racism among students, faculty members, and administrators where they work. The Privileged Identity Exploration (PIE) model…

[Hypopituitarism following traumatic brain injury: diagnostic and therapeutic issues].

PubMed

Lecoq, A-L; Chanson, P

2015-10-01

Traumatic Brain Injury (TBI) is a well-known public health problem worldwide and is a leading cause of death and disability, particularly in young adults. Besides neurological and psychiatric issues, pituitary dysfunction can also occur after TBI, in the acute or chronic phase. The exact prevalence of post-traumatic hypopituitarism is difficult to assess due to the wide heterogeneity of published studies and bias in interpretation of hormonal test results in this specific population. Predictive factors for hypopituitarism have been proposed and are helpful for the screening. The pathophysiology of pituitary dysfunction after TBI is not well understood but the vascular hypothesis is privileged. Activation of pituitary stem/progenitor cells is probably involved in the recovery of pituitary functions. Those cells also play a role in the induction of pituitary tumors, highlighting their crucial place in pituitary conditions. This review updates the current data related to anterior pituitary dysfunction after TBI and discusses the bias and difficulties encountered in its diagnosis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Sport and physical activity].

PubMed

Bria, S; Zeppilli, P

2010-01-01

A regular sport activity involves physical and psychological benefits helping to improve the quality of life at any age. This aspect is even more important in the developing age, when the sport takes on a role of training and education. In this context, instances directed to allow adolescent and young adults with heart disease to practice sports seem justified, and they're becoming more pressing since when the diagnostic and therapeutic advances, especially in cardiac surgery and in interventional hemodynamics, allow an increasing number of patients, previously allocated to physical inactivity, to lead an active lifestyle. However, we have to keep in mind that congenital heart disease population is varied, not only by the nature of the malformation, but also because in the same cardiopathy you can find subjects in "natural history" or after surgery and, between them, subjects treated with several techniques and different outcomes. This justifies the need for a close collaboration between sports doctors, cardiologists and heart surgeons, particularly in the management of the most difficult and delicate problems.

Novel High Integrity Bio-Inspired Systems with On-Line Self-Test and Self-Repair Properties

NASA Astrophysics Data System (ADS)

Samie, Mohammad; Dragffy, Gabriel; Pipe, Tony

2011-08-01

Since the beginning of life nature has been developing some remarkable solutions to the problem of creating reliable systems that can operate under difficult environmental and fault conditions. Yet, no matter how sophisticated our systems are, we are still unable to match the high degree of reliability that biological organisms posses. Since the early '90s attempts have been made to adapt biological properties and processes to the design of electronic systems but the results have always been unduly complex.This paper, proposes a novel model using a radically new approach to construct highly reliable electronic systems with online fault repair properties. It uses the characteristics and behaviour of unicellular bacteria and bacterial communities to achieve this. The result is a configurable bio-inspired cellular array architecture that, with built-in self-diagnostic and self-repair properties, can implement any application specific electronic system but is particularly suited for safety critical environments, such as space.

Recursive feature elimination for biomarker discovery in resting-state functional connectivity.

PubMed

Ravishankar, Hariharan; Madhavan, Radhika; Mullick, Rakesh; Shetty, Teena; Marinelli, Luca; Joel, Suresh E

2016-08-01

Biomarker discovery involves finding correlations between features and clinical symptoms to aid clinical decision. This task is especially difficult in resting state functional magnetic resonance imaging (rs-fMRI) data due to low SNR, high-dimensionality of images, inter-subject and intra-subject variability and small numbers of subjects compared to the number of derived features. Traditional univariate analysis suffers from the problem of multiple comparisons. Here, we adopt an alternative data-driven method for identifying population differences in functional connectivity. We propose a machine-learning approach to down-select functional connectivity features associated with symptom severity in mild traumatic brain injury (mTBI). Using this approach, we identified functional regions with altered connectivity in mTBI. including the executive control, visual and precuneus networks. We compared functional connections at multiple resolutions to determine which scale would be more sensitive to changes related to patient recovery. These modular network-level features can be used as diagnostic tools for predicting disease severity and recovery profiles.

Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy.

PubMed

Hsu, Wei-Fan; Tsang, Yuk-Ming; Teng, Chung-Jen; Chung, Chen-Shuan

2015-01-21

Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article.

Synthetic Microwave Imaging Reflectometry diagnostic using 3D FDTD Simulations

NASA Astrophysics Data System (ADS)

Kruger, Scott; Jenkins, Thomas; Smithe, David; King, Jacob; Nimrod Team Team

2017-10-01

Microwave Imaging Reflectometry (MIR) has become a standard diagnostic for understanding tokamak edge perturbations, including the edge harmonic oscillations in QH mode operation. These long-wavelength perturbations are larger than the normal turbulent fluctuation levels and thus normal analysis of synthetic signals become more difficult. To investigate, we construct a synthetic MIR diagnostic for exploring density fluctuation amplitudes in the tokamak plasma edge by using the three-dimensional, full-wave FDTD code Vorpal. The source microwave beam for the diagnostic is generated and refelected at the cutoff surface that is distorted by 2D density fluctuations in the edge plasma. Synthetic imaging optics at the detector can be used to understand the fluctuation and background density profiles. We apply the diagnostic to understand the fluctuations in edge plasma density during QH-mode activity in the DIII-D tokamak, as modeled by the NIMROD code. This work was funded under DOE Grant Number DE-FC02-08ER54972.

Research of the Heart Information Monitoring Robert Based on the 3G Wireless Communication Platform

NASA Astrophysics Data System (ADS)

Zhang, Fuli; Yang, Huazhe; Li, Gensong; Hong, Yang; Hu, Qingzhe

Electrocardiogram (ECG) of a person can be recorded and the diagnostic results can be displayed through touching the heart information monitoring Robert. In addition, the heart rate, phonocardiogram (PCG) and the dynamic three-dimensional echocardiography can also be displayed synchronously. Then the difficult ECG can be transmitted to the service center through 3G wireless communication center, followed by diagnosing the ECG by doctors and transmitting the feedback diagnostic results. I-lead ECG of the person can be recorded by the amplification circuit with high gain and low noise. Then, the heart rate and output phonocardiogram are displayed and the model of heart beat are started to trace through the recognition of R wave. Finally, the difficult ECG is transmitted to the service center via 3G communication chips. The displayed ECG is clear, and the stimulated heart beat is synchronous with that of the person. Furthermore, ECG received by the service center is in accordance with the one recorded by the Robert.

Fibrosarcoma of the nose and the paranasal sinuses.

PubMed

Olekszyk, J; Siliunas, V; Mauer, T; Biondi, R

1989-07-01

We report a case of fibrosarcoma of the nose and paranasal sinuses and give a brief review of the literature. Fibrosarcoma of the nose and paranasal sinuses is uncommon, and few cases have been reported to date. Previously these tumors may have been overdiagnosed secondary to inadequate diagnostic procedures. Because histologic diagnosis is difficult, these tumors have been confused with other lesions of the head and neck. Thus, the improvement in diagnostic procedures has significantly reduced the reported incidence of fibrosarcoma. Because histologic diagnosis is difficult, this tumor has often been confused with other lesions of the head and neck. To ensure proper handling of the tissue, the pathologist should be informed if fibrosarcoma is suspected. It may be necessary to use electron microscopy or staining techniques such as immunoperoxidase stains to distinguish fibrosarcoma from other lesions. Unfortunately, the early signs and symptoms of the tumor are vague and sometimes misleading. Thus, at the patient's initial visit, it is important that the physician consider the possibility of fibrosarcoma.

The next organizational challenge: finding and addressing diagnostic error.

PubMed

Graber, Mark L; Trowbridge, Robert; Myers, Jennifer S; Umscheid, Craig A; Strull, William; Kanter, Michael H

2014-03-01

Although health care organizations (HCOs) are intensely focused on improving the safety of health care, efforts to date have almost exclusively targeted treatment-related issues. The literature confirms that the approaches HCOs use to identify adverse medical events are not effective in finding diagnostic errors, so the initial challenge is to identify cases of diagnostic error. WHY HEALTH CARE ORGANIZATIONS NEED TO GET INVOLVED: HCOs are preoccupied with many quality- and safety-related operational and clinical issues, including performance measures. The case for paying attention to diagnostic errors, however, is based on the following four points: (1) diagnostic errors are common and harmful, (2) high-quality health care requires high-quality diagnosis, (3) diagnostic errors are costly, and (4) HCOs are well positioned to lead the way in reducing diagnostic error. FINDING DIAGNOSTIC ERRORS: Current approaches to identifying diagnostic errors, such as occurrence screens, incident reports, autopsy, and peer review, were not designed to detect diagnostic issues (or problems of omission in general) and/or rely on voluntary reporting. The realization that the existing tools are inadequate has spurred efforts to identify novel tools that could be used to discover diagnostic errors or breakdowns in the diagnostic process that are associated with errors. New approaches--Maine Medical Center's case-finding of diagnostic errors by facilitating direct reports from physicians and Kaiser Permanente's electronic health record--based reports that detect process breakdowns in the followup of abnormal findings--are described in case studies. By raising awareness and implementing targeted programs that address diagnostic error, HCOs may begin to play an important role in addressing the problem of diagnostic error.

Reliability and Validity of a Procedure To Measure Diagnostic Reasoning and Problem-Solving Skills Taught in Predoctoral Orthodontic Education.

ERIC Educational Resources Information Center

Albanese, Mark A.; Jacobs, Richard M.

Preliminary psychometric data assessing the reliability and validity of a method used to measure the diagnostic reasoning and problem-solving skills of predoctoral students in orthodontia are described. The measurement approach consisted of sets of patient demographic data and dental photos and x-rays, accompanied by a set of 33 multiple-choice…

Diagnostic Performance of the CBCL-Attention Problem Scale as a Screening Measure in a Sample of Brazilian Children with ADHD

ERIC Educational Resources Information Center

Lampert, T. L.; Polanczyk, G.; Tramontina, S.; Mardini, V.; Rohde, L. A.

2004-01-01

Objective: To evaluate the diagnostic performance of the Attention Problem Scale of the Child Behavior Checklist (CBCL-APS) for the screening of Attention-Deficit/Hyperactivity Disorder (ADHD) in a sample of Brazilian children and adolescents. Methods: The CBCL-APS was given to 763 children and adolescents. Child psychiatrists using DSM-IV…

Diagnostic reasoning by hospital pharmacists: assessment of attitudes, knowledge, and skills.

PubMed

Chernushkin, Kseniya; Loewen, Peter; de Lemos, Jane; Aulakh, Amneet; Jung, Joanne; Dahri, Karen

2012-07-01

Hospital pharmacists participate in activities that may be considered diagnostic. Two reasoning approaches to diagnosis have been described: non-analytic and analytic. Of the 6 analytic traditions, the probabilistic tradition has been shown to improve diagnostic accuracy and reduce unnecessary testing. To the authors' knowledge, pharmacists' attitudes toward having a diagnostic role and their diagnostic knowledge and skills have never been studied. To describe pharmacists' attitudes toward the role of diagnosis in pharmacotherapeutic problem-solving and to characterize the extent of pharmacists' knowledge and skills related to diagnostic literacy. Pharmacists working within Lower Mainland Pharmacy Services (British Columbia) who spent at least 33% of their time in direct patient care were invited to participate in a prospective observational survey. The survey sought information about demographic characteristics and attitudes toward diagnosis. Diagnostic knowledge and skills were tested by means of 3 case scenarios. The analysis included simple descriptive statistics and inferential statistics to evaluate relationships between responses and experience and training. Of 266 pharmacists invited to participate, 94 responded. The attitudes section of the survey was completed by 90 pharmacists; of these, 80 (89%) agreed with the definition of "diagnosis" proposed in the survey, and 83 (92%) agreed that it is important for pharmacists to have diagnosis-related skills. Respondents preferred an analytic to a non-analytic approach to diagnostic decision-making. The probabilistic tradition was not the preferred method in any of the 3 cases. In evaluating 5 clinical scenarios that might require diagnostic skills, on average 84% of respondents agreed that they should be involved in assessing such problems. Respondents' knowledge of and ability to apply probabilistic diagnostic tools were highest for test sensitivity (average of 61% of respondents with the correct answers) and lower for test specificity (average of 48% with correct answers) and likelihood ratios (average of 39% with correct answers). Respondents to this survey strongly believed that diagnostic skills were important for solving drug-related problems, but they demonstrated low levels of knowledge and ability to apply concepts of probabilistic diagnostic reasoning. Opportunities to expand pharmacists' knowledge of diagnostic reasoning exist, and the findings reported here indicate that pharmacists would consider such professional development valuable.

Reliability of criteria for borderline personality disorder: a comparison of DSM-III and the Diagnostic Interview for Borderline Patients.

PubMed

Frances, A; Clarkin, J F; Gilmore, M; Hurt, S W; Brown, R

1984-09-01

The authors compared the reliability of two methods of distinguishing borderline personality disorder--DSM-III and the Diagnostic Interview for Borderline Patients. The reference group, outpatients with other personality disorders and without major axis I pathology, was more difficult to distinguish from the patients with borderline personality disorder than such groups used in previous samples. The sensitivity and specificity of the Diagnostic Interview for Borderline Patients were calculated, with DSM-III used as a criterion. The findings confirm considerable overlap between borderline and schizotypal personality disorders, more impairment in functioning in borderline patients than in those with other personality disorders, and the high reliability with which borderline personality disorder can be diagnosed.

Defining Characteristics of Diagnostic Classification Models and the Problem of Retrofitting in Cognitive Diagnostic Assessment

ERIC Educational Resources Information Center

Gierl, Mark J.; Cui, Ying

2008-01-01

One promising application of diagnostic classification models (DCM) is in the area of cognitive diagnostic assessment in education. However, the successful application of DCM in educational testing will likely come with a price--and this price may be in the form of new test development procedures and practices required to yield data that satisfy…

[Gender identity disorders or andromimetic behaviour in a victim of incest--a case study].

PubMed

Piegza, Magdalena; Leksowska, Aleksandra; Pudlo, Robert; Badura-Brzoza, Karina; Matysiakiewicz, Jerzy; Gierlotka, Zbigniew; Gorczyca, Piotr W

2014-01-01

Nowadays, it is becoming increasingly difficult to clearly classify the issues associated with the phenomenon of gender dysphoria due to the fact that one identifies oneself in the context of increasingly fluid categories of gender identity-- an intrinsic sense of being a woman or a man. The authors present a woman whose internal problems connected with her sexuality and incomplete identification with the role attributed to her gender originate from her family history. Long-lasting, traumatic experiences of incestuous abuse and violence on the part of close relatives disturbed her development in many areas of personality and functioning. The aim of the study was to verify the hypothesis of the existence of gender identity disorder accompanied by depressive disorders. In addition to the medical history, the study of patient's problems included the following diagnostic tools: the Minnesota Multiphasic Personality Inventory (MMPI) and the Rorschach Inkblot Test in a CSR Exner system (TPA). The study revealed that as for sexual identification, the patient unambiguously identifies herself as a woman. Her behaviour to become like a man does not deny her sex, or even involve a temporary need of belonging to the opposite sex. It should be interpreted in the broader context of her traumatic experiences, not just sexual, but also concerning different aspects of a female gender role.

Multiple Chemical Sensitivity and the Workplace: Current Position and Need for an Occupational Health Surveillance Protocol

PubMed Central

Martini, A.; Iavicoli, S.; Corso, L.

2013-01-01

Multiple chemical sensitivity, commonly known as environmental illness, is a chronic disease in which exposure to low levels of chemicals causes correlated symptoms of varying intensity. With the continuous introduction of new substances, people with MCS suffer significant limitations to their living environment and frequently to their workplace. This paper describes the current situation as regards MCS and the critical points in its case definition, which is still not generally agreed upon; this makes it difficult to recognize with certainty, especially, its precise relationship with work. Other problems arise in relation to the occupational physician's role in diagnosing and managing the worker with the disorder, the question of low levels of exposure to chemicals, and the best measures possible to prevent it. A diagnostic “route” is proposed, useful as a reference for the occupational physician who is often called in first to identify cases suspected of having this disease and to manage MCS workers. Work-related problems for people with MCS depend not only on occupational exposure but also on the incompatibility between their illness and their work. More occupational physicians need to be “sensitive” to MCS, so that these workers are recognized promptly, the work is adapted as necessary, and preventive measures are promoted in the workplace. PMID:23844274

Radiographic findings in late-presenting congenital diaphragmatic hernia: helpful imaging findings.

PubMed

Muzzafar, Sofia; Swischuk, Leonard E; Jadhav, Siddharth P

2012-03-01

Imaging findings in delayed presentation of congenital diaphragmatic hernia can be confusing and misleading, resulting in a delay in diagnosis. To evaluate the often puzzling plain film findings of late-presenting CDH in an effort to determine whether any of the findings could be helpful in arriving at an early diagnosis. We reviewed and documented the plain film findings and clinical data in eight patients seen during the last 20 years with late-presenting CDH. IRB exempt status was obtained in this study. There were five boys and three girls. The age range was 4 months to 12 years with a mean of 2.4 years. Five children presented with acute respiratory problems while three presented with acute abdominal pain. Two children presented with both respiratory and abdominal findings and one also presented with hematemesis. Two children had radiographic findings that were not difficult to analyze while the remaining six had findings that posed initial diagnostic problems. Although not common, late-presenting CDH can result in confusing plain film radiographic findings and a delay in diagnosis. We found that the most important finding in analyzing these radiographs is in evaluating the location and position of the gastric bubble with the more common left-side hernias.

The reliability and validity of the Greenspan Social Emotional Growth Chart (GSEGC) in Israeli children with developmental delay and autism-A pilot study.

PubMed

Tede, Zoma; Ophir Cohen, Michal; Riskin, Arieh; Tirosh, Emanuel

2016-08-01

Healthy social-emotional development in early childhood is important as an indicator of general well-being and for positive outcome in later childhood. Therefore, screening for potential social emotional problems is valuable. Accurate, usable, and affordable screening tools have been especially difficult to develop. The cross cultural validity of a screening instrument should be assessed. The aim of the current study was to investigate the reliability and validity of the Greenspan social-emotional growth chart (GSEGC) in Israeli children of three diagnostic groups: (1) Autistic spectrum disorder (ASD) (2) Developmental language disorder (DLD) and (3) Developmental motor delay (DMD). An internal reliability of alpha of 0.95 for the GSEGC standardized for age score and of 0.78 for the sensory processing sub scores was found. A confirmatory factor analysis (CFA) using a 5-factor model confirmed an acceptable fit. Positive (62.86%) and negative (94.73%) predictive values also support the clinical usefulness of the GSEGC in identifying children at low risk for ASD. The GSEGC appears to be a promising tool for the screening of social emotional problems in early childhood. Further studies in different cultures are warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

[The complications of skin expansion in paediatrics: Diagnostic, taking over and prevention].

PubMed

Pascal, S; Philandrianos, C; Bertrand, B; Bardot, J; Degardin, N; Casanova, D

2016-10-01

Skin expansion is a difficult and long process in which can occur more or less serious complications. Overall complications rates describe in the literature vary between 13 and 37%. We can categorize them in major complications, which can lead to a failure maybe even an aggravation of the anterior status, and in minor complications that do not compromise the expansion process but can alter it. The main major complications are infection, skin suffering and necrosis which can lead to prosthesis exposition, leaks and technical problems with equipment dysfunctions that may cause difficulties or a failure of the inflations. The main minor complications are hematomas, seromas, valve or tube exposition, pains with paraesthesias caused by neighbouring organs compression, pathologic and unsightly scares and can lead to an important psychological impact. These complications can be due to a precarious skin's state, a material dysfunction or unpredictable technical problems but also by an inappropriate preoperative indication or planning. The emerging of a complication, however, is not synonymous to a failure of the procedure; a satisfactory reconstruction may still be obtained in 75% of all cases. The purpose of this article is to help to identify the situations at risk of complications in order to prevent, detect and treat them early. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Developments of scintillator-based soft x-ray diagnostic in LHD with CsI:Tl and P47 scintillators.

PubMed

Bando, T; Ohdachi, S; Suzuki, Y

2016-11-01

Multi-channel soft x-ray (SX) diagnostic has been used in the large helical device (LHD) to research magnetohydrodynamic equilibria and activities. However, in the coming deuterium plasma experiments of LHD, it will be difficult to use semiconductor systems near LHD. Therefore, a new type of SX diagnostic, a scintillator-based type diagnostic, has been investigated in order to avoid damage from the radiation. A fiber optic plate coated by P47 scintillator will be used to detect SX emission. Scintillation light will be transferred by pure silica core optical fibers and detected by photomultiplier tubes. A vertically elongated section of LHD will be covered by a 13 ch. array. Effects from the Deuterium Deuterium neutrons can be negligible when the scintillator is covered by a Pb plate 4 cm in thickness to avoid gamma-rays.

Developments of scintillator-based soft x-ray diagnostic in LHD with CsI:Tl and P47 scintillators

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

Bando, T., E-mail: bando.takahiro@nifs.ac.jp; Ohdachi, S.; Suzuki, Y.

2016-11-15

Multi-channel soft x-ray (SX) diagnostic has been used in the large helical device (LHD) to research magnetohydrodynamic equilibria and activities. However, in the coming deuterium plasma experiments of LHD, it will be difficult to use semiconductor systems near LHD. Therefore, a new type of SX diagnostic, a scintillator-based type diagnostic, has been investigated in order to avoid damage from the radiation. A fiber optic plate coated by P47 scintillator will be used to detect SX emission. Scintillation light will be transferred by pure silica core optical fibers and detected by photomultiplier tubes. A vertically elongated section of LHD will bemore » covered by a 13 ch. array. Effects from the Deuterium Deuterium neutrons can be negligible when the scintillator is covered by a Pb plate 4 cm in thickness to avoid gamma-rays.« less

Digital diffraction analysis enables low-cost molecular diagnostics on a smartphone

PubMed Central

Im, Hyungsoon; Castro, Cesar M.; Shao, Huilin; Liong, Monty; Song, Jun; Pathania, Divya; Fexon, Lioubov; Min, Changwook; Avila-Wallace, Maria; Zurkiya, Omar; Rho, Junsung; Magaoay, Brady; Tambouret, Rosemary H.; Pivovarov, Misha; Weissleder, Ralph; Lee, Hakho

2015-01-01

The widespread distribution of smartphones, with their integrated sensors and communication capabilities, makes them an ideal platform for point-of-care (POC) diagnosis, especially in resource-limited settings. Molecular diagnostics, however, have been difficult to implement in smartphones. We herein report a diffraction-based approach that enables molecular and cellular diagnostics. The D3 (digital diffraction diagnosis) system uses microbeads to generate unique diffraction patterns which can be acquired by smartphones and processed by a remote server. We applied the D3 platform to screen for precancerous or cancerous cells in cervical specimens and to detect human papillomavirus (HPV) DNA. The D3 assay generated readouts within 45 min and showed excellent agreement with gold-standard pathology or HPV testing, respectively. This approach could have favorable global health applications where medical access is limited or when pathology bottlenecks challenge prompt diagnostic readouts. PMID:25870273

Complementary approaches to diagnosing marine diseases: a union of the modern and the classic

PubMed Central

Burge, Colleen A.; Friedman, Carolyn S.; Getchell, Rodman; House, Marcia; Mydlarz, Laura D.; Prager, Katherine C.; Renault, Tristan; Kiryu, Ikunari; Vega-Thurber, Rebecca

2016-01-01

Linking marine epizootics to a specific aetiology is notoriously difficult. Recent diagnostic successes show that marine disease diagnosis requires both modern, cutting-edge technology (e.g. metagenomics, quantitative real-time PCR) and more classic methods (e.g. transect surveys, histopathology and cell culture). Here, we discuss how this combination of traditional and modern approaches is necessary for rapid and accurate identification of marine diseases, and emphasize how sole reliance on any one technology or technique may lead disease investigations astray. We present diagnostic approaches at different scales, from the macro (environment, community, population and organismal scales) to the micro (tissue, organ, cell and genomic scales). We use disease case studies from a broad range of taxa to illustrate diagnostic successes from combining traditional and modern diagnostic methods. Finally, we recognize the need for increased capacity of centralized databases, networks, data repositories and contingency plans for diagnosis and management of marine disease. PMID:26880839

Complementary approaches to diagnosing marine diseases: a union of the modern and the classic

USGS Publications Warehouse

Burge, Colleen A.; Friedman, Carolyn S.; Getchell, Rodman G.; House, Marcia; Lafferty, Kevin D.; Mydlarz, Laura D.; Prager, Katherine C.; Sutherland, Kathryn P.; Renault, Tristan; Kiryu, Ikunari; Vega-Thurber, Rebecca

2016-01-01

Linking marine epizootics to a specific aetiology is notoriously difficult. Recent diagnostic successes show that marine disease diagnosis requires both modern, cutting-edge technology (e.g. metagenomics, quantitative real-time PCR) and more classic methods (e.g. transect surveys, histopathology and cell culture). Here, we discuss how this combination of traditional and modern approaches is necessary for rapid and accurate identification of marine diseases, and emphasize how sole reliance on any one technology or technique may lead disease investigations astray. We present diagnostic approaches at different scales, from the macro (environment, community, population and organismal scales) to the micro (tissue, organ, cell and genomic scales). We use disease case studies from a broad range of taxa to illustrate diagnostic successes from combining traditional and modern diagnostic methods. Finally, we recognize the need for increased capacity of centralized databases, networks, data repositories and contingency plans for diagnosis and management of marine disease.

Digital diffraction analysis enables low-cost molecular diagnostics on a smartphone.

PubMed

Im, Hyungsoon; Castro, Cesar M; Shao, Huilin; Liong, Monty; Song, Jun; Pathania, Divya; Fexon, Lioubov; Min, Changwook; Avila-Wallace, Maria; Zurkiya, Omar; Rho, Junsung; Magaoay, Brady; Tambouret, Rosemary H; Pivovarov, Misha; Weissleder, Ralph; Lee, Hakho

2015-05-05

The widespread distribution of smartphones, with their integrated sensors and communication capabilities, makes them an ideal platform for point-of-care (POC) diagnosis, especially in resource-limited settings. Molecular diagnostics, however, have been difficult to implement in smartphones. We herein report a diffraction-based approach that enables molecular and cellular diagnostics. The D3 (digital diffraction diagnosis) system uses microbeads to generate unique diffraction patterns which can be acquired by smartphones and processed by a remote server. We applied the D3 platform to screen for precancerous or cancerous cells in cervical specimens and to detect human papillomavirus (HPV) DNA. The D3 assay generated readouts within 45 min and showed excellent agreement with gold-standard pathology or HPV testing, respectively. This approach could have favorable global health applications where medical access is limited or when pathology bottlenecks challenge prompt diagnostic readouts.

Diagnostics of breast cancer by analysis of spectra diffuse reflections

NASA Astrophysics Data System (ADS)

Kuzmina, Natalya V.; Plaksin, Fedor G.; Polovnikov, Eugeny S.

2001-05-01

The work is dedicated to problems of diagnostic oncologic diseases by a spectroscopic-optical method and is prolongation of long-term examinations held earlier by Vovk S.M, Naumov S.A. and Pushkarev S.V. The actual spectra of a diffuse reflection removed in vivo and in vitro are given, is angry- and good-quality neoplasms, healthy tissue and blood of breast and other organs. Problems of a clinical oncology are in a center of attention in medicine because the cases of disease malignant swellings increase, which is stipulated by an irregularity of present methods of diagnostic.

Some Cognitive Components of the Diagnostic Thinking Process.

ERIC Educational Resources Information Center

Gale, Janet

1982-01-01

Identifies 14 cognitive components of the diagnostic thinking process in clinical problem solving. Analyzes the differences between medical students, hospital house officers, and hospital registrars in London, England, on the relative use of such thinking processes. Suggests that diagnostic thinking processes cannot be incorporated into medical…

Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity--the behavior change ball.

PubMed

Hendriks, Anna-Marie; Jansen, Maria W J; Gubbels, Jessica S; De Vries, Nanne K; Paulussen, Theo; Kremers, Stef P J

2013-04-18

Childhood obesity is a 'wicked' public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers. We propose the 'Behavior Change Ball' as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the 'Behavior Change Wheel' by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system's resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity. Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by incorporating multiple theoretical perspectives, specifying a set of organizational behaviors and linking the analysis of these behaviors to interventions and policies. We would encourage examination by others of our framework as a tool to explain and guide the development of integrated policies for the prevention of wicked public health problems.

Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity - the behavior change ball

PubMed Central

2013-01-01

Background Childhood obesity is a ‘wicked’ public health problem that is best tackled by an integrated approach, which is enabled by integrated public health policies. The development and implementation of such policies have in practice proven to be difficult, however, and studying why this is the case requires a tool that may assist local policy-makers and those assisting them. A comprehensive framework that can help to identify options for improvement and to systematically develop solutions may be used to support local policy-makers. Discussion We propose the ‘Behavior Change Ball’ as a tool to study the development and implementation of integrated public health policies within local government. Based on the tenets of the ‘Behavior Change Wheel’ by Michie and colleagues (2011), the proposed conceptual framework distinguishes organizational behaviors of local policy-makers at the strategic, tactical and operational levels, as well as the determinants (motivation, capability, opportunity) required for these behaviors, and interventions and policy categories that can influence them. To illustrate the difficulty of achieving sustained integrated approaches, we use the metaphor of a ball in our framework: the mountainous landscapes surrounding the ball reflect the system’s resistance to change (by making it difficult for the ball to roll). We apply this framework to the problem of childhood obesity prevention. The added value provided by the framework lies in its comprehensiveness, theoretical basis, diagnostic and heuristic nature and face validity. Summary Since integrated public health policies have not been widely developed and implemented in practice, organizational behaviors relevant to the development of these policies remain to be investigated. A conceptual framework that can assist in systematically studying the policy process may facilitate this. Our Behavior Change Ball adds significant value to existing public health policy frameworks by incorporating multiple theoretical perspectives, specifying a set of organizational behaviors and linking the analysis of these behaviors to interventions and policies. We would encourage examination by others of our framework as a tool to explain and guide the development of integrated policies for the prevention of wicked public health problems. PMID:23597122

Putting the Aero Back into Aeroelasticity

NASA Technical Reports Server (NTRS)

Bousman, William G.

2000-01-01

The lack of progress in understanding the physics of rotorcraft loads and vibration over the last 30 years is addressed in this paper. As befits this extraordinarily difficult problem, the reasons for the lack of progress are complicated and difficult to ascertain. It is proposed here that the difficulty lies within at least three areas: 1) a loss of perspective as to what are the key factors in rotor loads and vibration, 2) the overlooking of serious unsolved problems in the field, and 3) cultural barriers that impede progress. Some criteria are suggested for future research to provide a more concentrated focus on the problem.

Putting the Aero Back Into Aeroelasticity

NASA Technical Reports Server (NTRS)

Bousman, William G.; Aiken, Edwin W. (Technical Monitor)

1999-01-01

The lack of progress in understanding the physics of rotorcraft loads and vibration over the last 30 years is addressed in this paper. As befits this extraordinarily difficult problem, the reasons for the lack of progress are complicated and difficult to ascertain. It is proposed here that the difficulty lies within at least three areas: 1) a loss of perspective as to what are the key factors in rotor loads and vibration, 2) the overlooking of serious unsolved problems in the field, and 3) cultural barriers that impede progress. Some criteria are suggested for future research to provide a more concentrated focus on the problem.

Towards a Better Understanding of Complex Disease: Identifying Endotypes of Childhood Asthma

EPA Science Inventory

Complex disease, where the diagnostic criteria cannot distinguish among differing etiologies, is often difficult to diagnose, treat and study due to the inability to classify individuals into suitable subtypes of the disease. Here, we aim to use and compare a combination of met...

ASSESSING UST CORRECTIVE ACTION TECHNOLOGIES: DIAGNOSTIC EVALUATION OF IN SITU SVE-BASED SYSTEM PERFORMANCE

EPA Science Inventory

In situ corrective action technologies are being proposed and installed at an increasing number of underground storage tank (LIST) sites contaminated with petroleum products in saturated and unsaturated zones. It is often difficult to accurately assess the performance of these sy...

Help-seeking Following Termination of Pregnancy after Diagnosis of Fetal Anomaly: Women's Intentions and Experiences 1 to 7 Years after the Event.

PubMed

Hanschmidt, Franz; Hoffmann, Rahel; Klingner, Johanna; Kersting, Anette; Stepan, Holger

2018-02-01

Diagnosis of fetal anomaly and the difficult circumstances involved in the decision to terminate an affected pregnancy can go along with severe psychological distress. However, little is known about women's help-seeking for emotional problems following an abortion after diagnosis of fetal anomaly. 148 women who had been treated for abortion after diagnosis of fetal anomaly at the University Hospital Leipzig responded to self-report questionnaires 1 to 7 years after the event. Main outcomes were help-seeking intentions and actual help-seeking behavior. Logistic regression was used to explore the associations between participants' sociodemographic characteristics and help-seeking intentions. Most women reported that they would seek help from their partner (91.7%), friends/family (82.8%) or the internet (62.2%). With regard to health services, 50.0% of women would seek help from gynecologists and between 43.8 and 47.9% from counseling services and mental health professionals. Intentions to seek help from support groups were lowest (21.7%). Age, income, region, and religion were associated with help-seeking intentions. Among participants with elevated levels of current psychological distress, 23.8% indicated that they had not discussed their emotional problems with a health service ever. Gynecologists are among the most preferred health professionals for women to discuss psychological problems in the aftermath of an abortion after diagnosis of fetal anomaly. They should be actively involved in screening, diagnostic assessment, and referral of affected women.

Tooth wear and erosion: methodological issues in epidemiological and public health research and the future research agenda.

PubMed

Ganss, C; Young, A; Lussi, A

2011-09-01

This paper addresses methodological issues in the field of tooth wear and erosion research including the epidemiological indices, and identifies future work that is needed to improve knowledge about tooth wear and erosion. The paper is result of the work done at the meetings of the Special Interest Group "Tooth Surface Loss and Erosion" at the 2008, 2009 and 2010 conferences of the European Association for Dental Public Health, and the Workshop "Current Erosion indices- flawed or valid" which took place in Basel in 2007. Although there is consensus about the definition and the diagnostic criteria of various forms of tooth wear, gaps in research strategies have been identified. A basic problem is that fundamental concepts of wear and erosion as an oral health problem, have not yet been sufficiently defined. To a certain extent, tooth wear is a physiological condition, and there is no consensus as to whether it can be regarded as a disease. Furthermore, the multitude of indices and flaws in existing indices, make published data difficult to interpret. Topics for the research agenda are: the initiation of a consensus process towards an internationally accepted index, and the initiation of data collection on the prevalence of various forms of wear on a population-based level. There should be an emphasis on promoting communication between basic and clinical sciences, and the area of Public Health Dentistry. Furthermore, the question of whether tooth wear is a public health problem remains open for debate.

Contrast-enhanced spectral mammography in patients with MRI contraindications.

PubMed

Richter, Vivien; Hatterman, Valerie; Preibsch, Heike; Bahrs, Sonja D; Hahn, Markus; Nikolaou, Konstantin; Wiesinger, Benjamin

2017-01-01

Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method's technical limitations.

Efficient Credit Assignment through Evaluation Function Decomposition

NASA Technical Reports Server (NTRS)

Agogino, Adrian; Turner, Kagan; Mikkulainen, Risto

2005-01-01

Evolutionary methods are powerful tools in discovering solutions for difficult continuous tasks. When such a solution is encoded over multiple genes, a genetic algorithm faces the difficult credit assignment problem of evaluating how a single gene in a chromosome contributes to the full solution. Typically a single evaluation function is used for the entire chromosome, implicitly giving each gene in the chromosome the same evaluation. This method is inefficient because a gene will get credit for the contribution of all the other genes as well. Accurately measuring the fitness of individual genes in such a large search space requires many trials. This paper instead proposes turning this single complex search problem into a multi-agent search problem, where each agent has the simpler task of discovering a suitable gene. Gene-specific evaluation functions can then be created that have better theoretical properties than a single evaluation function over all genes. This method is tested in the difficult double-pole balancing problem, showing that agents using gene-specific evaluation functions can create a successful control policy in 20 percent fewer trials than the best existing genetic algorithms. The method is extended to more distributed problems, achieving 95 percent performance gains over tradition methods in the multi-rover domain.

Likelihood-Based Clustering of Meta-Analytic SROC Curves

ERIC Educational Resources Information Center

Holling, Heinz; Bohning, Walailuck; Bohning, Dankmar

2012-01-01

Meta-analysis of diagnostic studies experience the common problem that different studies might not be comparable since they have been using a different cut-off value for the continuous or ordered categorical diagnostic test value defining different regions for which the diagnostic test is defined to be positive. Hence specificities and…

Problem Representation, Background Evidence, Analysis, Recommendation: An Oral Case Presentation Tool to Promote Diagnostic Reasoning.

PubMed

Carter, Cristina; Akar-Ghibril, Nicole; Sestokas, Jeff; Dixon, Gabrina; Bradford, Wilhelmina; Ottolini, Mary

2018-03-01

Oral case presentations provide an opportunity for trainees to communicate diagnostic reasoning at the bedside. However, few tools exist to enable faculty to provide effective feedback. We developed a tool to assess diagnostic reasoning and communication during oral case presentations. Published by Elsevier Inc.

A Three-Tier Diagnostic Test to Assess Pre-Service Teachers' Misconceptions about Global Warming, Greenhouse Effect, Ozone Layer Depletion, and Acid Rain

ERIC Educational Resources Information Center

Arslan, Harika Ozge; Cigdemoglu, Ceyhan; Moseley, Christine

2012-01-01

This study describes the development and validation of a three-tier multiple-choice diagnostic test, the atmosphere-related environmental problems diagnostic test (AREPDiT), to reveal common misconceptions of global warming (GW), greenhouse effect (GE), ozone layer depletion (OLD), and acid rain (AR). The development of a two-tier diagnostic test…

The Diagnostic/Therapeutic Preabortion Interview.

ERIC Educational Resources Information Center

Boekelheide, Priscilla Day

1978-01-01

The therapeutic and diagnostic aspect of the preabortion interview are discussed with attention to specifics that will identify students with the greatest likelihood for psychological problems and/or repeat abortions. (JD)

[Quality assurance in airway management: education and training for difficult airway management].

PubMed

Kaminoh, Yoshiroh

2006-01-01

Respiratory problem is one of the main causes of death or severe brain damage in perioperative period. Three major factors of respiratory problem are esophageal intubation, inadequate ventilation, and difficult airway. The wide spread of pulse oximeter and capnograph reduced the incidences of esophageal intubation and inadequate ventilation, but the difficult airway still occupies the large portion in the causes of adverse events during anesthesia. "Practice guideline for management of the difficult airway" was proposed by American Society of Anesthesiologists (ASA) in 1992 and 2002. Improvement of knowledge, technical skills, and cognitive skills are necessary for the education and training of the difficult airway management. "The practical seminar of difficult airway management (DAM practical seminar)" has been cosponsored by the Japanese Association of Medical Simulation (JAMS) in the 51 st and 52 nd annual meetings of Japanese Society of Anesthesiologists and the 24th annual meeting of Japanese Society for Clinical Anesthesia. The DAM practical seminar is composed of the lecture session for ASA difficult airway algorithm, the hands-on training session for technical skills, and the scenario-based training session for cognitive skills. Ninty six Japanese anesthesiologists have completed the DAM practical seminar in one year. "The DAM instructor course" should be immediately prepared to organize the seminar more frequently.

Validating DNA barcodes: A non-destructive extraction protocol enables simultaneous vouchering of DNA and morphological vouchers

USDA-ARS?s Scientific Manuscript database

Morphology-based keys support accurate identification of many taxa. However, identification can be difficult for taxa that are not well studied, very small, members of cryptic species complexes, or represented by immature stages. For such cases, DNA barcodes may provide diagnostic characters. Ecolog...

Communicating with Faculty Using a Diagnostic Performance Appraisal Process.

ERIC Educational Resources Information Center

Gibson, Ken

In spite of the many teacher evaluation models available and the extensive research on performance appraisal, few community colleges have effectively come to terms with this difficult task. Many administrators prefer to avoid the interpersonal conflict and the possible legal ramifications of performance appraisal. However, in times of limited…

Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research

ERIC Educational Resources Information Center

Lewin, Adam B.; Piacentini, John

2010-01-01

Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom…

Differential Diagnosis in Older Adults: Dementia, Depression, and Delirium.

ERIC Educational Resources Information Center

Gintner, Gary G.

1995-01-01

Examines three common disorders, dementia, depression, and delirium, which can be particularly difficult to diagnose in older adults. Presents three aspects that are helpful in making a decision: age-related differences, medical issues that need to be ruled out, and assessment methods particularly useful in the diagnostic process. (JPS)

Journal: Efficient Hydrologic Tracer-Test Design for Tracer-Mass Estimation and Sample Collection Frequency, 1 Method Development

EPA Science Inventory

Hydrological tracer testing is the most reliable diagnostic technique available for the determination of basic hydraulic and geometric parameters necessary for establishing operative solute-transport processes. Tracer-test design can be difficult because of a lack of prior knowl...

The Effect of Multimedia Replacing Text in Resident Clinical Decision-Making Assessment

ERIC Educational Resources Information Center

Chang, Todd P.; Schrager, Sheree M.; Rake, Alyssa J.; Chan, Michael W.; Pham, Phung K.; Christman, Grant

2017-01-01

Multimedia in assessing clinical decision-making skills (CDMS) has been poorly studied, particularly in comparison to traditional text-based assessments. The literature suggests multimedia is more difficult for trainees. We hypothesize that pediatric residents score lower in diagnostic skill when clinical vignettes use multimedia rather than text…

Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

ERIC Educational Resources Information Center

Danner, Stephanie; Fristad, Mary A.; Arnold, L. Eugene; Youngstrom, Eric A.; Birmaher, Boris; Horwitz, Sarah M.; Demeter, Christine; Findling, Robert L.; Kowatch, Robert A.

2009-01-01

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current…

Drilling Regolith: Why Is It So Difficult?

NASA Astrophysics Data System (ADS)

Schmitt, H. H.

2017-10-01

The Apollo rotary percussive drill system penetrated the lunar regolith with reasonable efficiency; however, extraction of the drill core stem proved to be very difficult on all three missions. Retractable drill stem flutes may solve this problem.

Everyday beliefs about sources of advice for the parents of difficult children.

PubMed

Sonuga-Barke, E J; Thompson, M; Balding, J

1993-01-01

Parents were asked which sources of advice families with difficult children should seek. The results suggested a similar hierarchy of agencies for both boys and girls with emotional and behavioural problems. Teachers, doctors, child psychiatrists and health visitors all received strong positive ratings, books about children with problems received moderate positive ratings, religious leaders received the strongest negative ratings and grandparents and friends received neutral ratings. Implications for service provision are discussed.

A child with a difficult airway: what do I do next?

PubMed

Engelhardt, Thomas; Weiss, Markus

2012-06-01

Difficulties in pediatric airway management are common and continue to result in significant morbidity and mortality. This review reports on current concepts in approaching a child with a difficult airway. Routine airway management in healthy children with normal airways is simple in experienced hands. Mask ventilation (oxygenation) is always possible and tracheal intubation normally simple. However, transient hypoxia is common in these children usually due to unexpected anatomical and functional airway problems or failure to ventilate during rapid sequence induction. Anatomical airway problems (upper airway collapse and adenoid hypertrophy) and functional airway problems (laryngospasm, bronchospasm, insufficient depth of anesthesia and muscle rigidity, gastric hyperinflation, and alveolar collapse) require urgent recognition and treatment algorithms due to insufficient oxygen reserves. Early muscle paralysis and epinephrine administration aids resolution of these functional airway obstructions. Children with an 'impaired' normal (foreign body, allergy, and inflammation) or an expected difficult (scars, tumors, and congenital) airway require careful planning and expertise. Training in the recognition and management of these different situations as well as a suitably equipped anesthesia workstation and trained personnel are essential. The healthy child with an unexpected airway problem requires clear strategies. The 'impaired' normal pediatric airway may be handled by anesthetists experienced with children, whereas the expected difficult pediatric airway requires dedicated pediatric anesthesia specialist care and should only be managed in specialized centers.

When Your Child Is Difficult: Solve Your Toughest Child-Raising Problems with a Four-Step Plan That Works.

ERIC Educational Resources Information Center

Silberman, Mel

Written for parents, this book discusses four steps for dealing with children's difficult behavior. The book is divided into two parts. Part 1, "The Building Blocks," discusses baseline perspectives parents need to establish in order to effectively deal with difficult behavior. Topics covered include: (1) parents' dual roles as caregivers and…

ROC curves in clinical chemistry: uses, misuses, and possible solutions.

PubMed

Obuchowski, Nancy A; Lieber, Michael L; Wians, Frank H

2004-07-01

ROC curves have become the standard for describing and comparing the accuracy of diagnostic tests. Not surprisingly, ROC curves are used often by clinical chemists. Our aims were to observe how the accuracy of clinical laboratory diagnostic tests is assessed, compared, and reported in the literature; to identify common problems with the use of ROC curves; and to offer some possible solutions. We reviewed every original work using ROC curves and published in Clinical Chemistry in 2001 or 2002. For each article we recorded phase of the research, prospective or retrospective design, sample size, presence/absence of confidence intervals (CIs), nature of the statistical analysis, and major analysis problems. Of 58 articles, 31% were phase I (exploratory), 50% were phase II (challenge), and 19% were phase III (advanced) studies. The studies increased in sample size from phase I to III and showed a progression in the use of prospective designs. Most phase I studies were powered to assess diagnostic tests with ROC areas >/=0.70. Thirty-eight percent of studies failed to include CIs for diagnostic test accuracy or the CIs were constructed inappropriately. Thirty-three percent of studies provided insufficient analysis for comparing diagnostic tests. Other problems included dichotomization of the gold standard scale and inappropriate analysis of the equivalence of two diagnostic tests. We identify available software and make some suggestions for sample size determination, testing for equivalence in diagnostic accuracy, and alternatives to a dichotomous classification of a continuous-scale gold standard. More methodologic research is needed in areas specific to clinical chemistry.

Mycotoxins

USGS Publications Warehouse

Creekmore, Lynn H.

1999-01-01

Mycotoxins are toxins produced by molds (fungi) that, when they are ingested, can cause diseases called mycotoxicosis. These diseases are are not infectious. The effects on the animal are caused by fungal toxins in foods ingested, usually grains, and are not caused by infection with the fungus. Many different molds produce mycotoxins and many corresponding disease syndromes have been described for domestic animals. However, only two types of mycotoxin poisoning, aflatoxicosis and fusariotoxicosis, have been documented in free-ranging migratory birds. Until recently, sickness or death caused by mycotoxins were rarely reported in migratory birds. Identification of mycotoxins as the cause of a mortality event can be difficult for a number of reasons. The effects may be subtle and difficult to detect or identify, or the effects may be delayed and the bird may have moved away from the contaminated food source before becoming sick or dying. Also, grain containing toxin-producing molds can be difficult or impossible to recognize because it may not appear overtly moldy.Techniques to detect and quantify a variety of mycotoxins important to domestic animal and human health are available through many diagnostic laboratories that serve health needs for those species. These same techniques are applicable for wildlife. Further study and improved diagnostic technology is likely to result in identification of additional types of mycotoxins as causes of disease and death in waterfowl and other wildlife.

The five-year diagnostic utility of "diagnostic orphans" for alcohol use disorders in a national sample of young adults.

PubMed

Harford, Thomas C; Yi, Hsiao-Ye; Grant, Bridget F

2010-05-01

This study was conducted to assess the association of "diagnostic orphans" at baseline and subsequent development of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorders (AUDs) 5 years later. A sample of 8,534 respondents was drawn from the National Longitudinal Survey of Youth for the years 1989 and 1994. Diagnostic orphans were defined as respondents who met one or two alcohol dependence symptom criteria but did not meet the criteria for a diagnosis of alcohol abuse or dependence. Using multinomial logistic regression analysis, 1994 assessments of DSM-IV AUD were regressed on 1989 baseline assessments of diagnostic orphan status and DSM-IV AUD. In addition to demographic characteristics, other background variables included heavy episodic drinking at baseline and early problem behaviors (antisocial behaviors, illicit substance use, and age at onset of alcohol use). Findings from this 5-year prospective study indicate that diagnostic orphan status at baseline was predictive of DSM-IV AUD at follow-up. These associations remained significant when other early behavioral problems were included in the models. The present findings have important diagnostic implications for the proposed DSM-V, particularly for a dimensional diagnosis incorporating less severe forms of alcohol dependence.

EPs welcome new focus on reducing diagnostic errors.

PubMed

2015-12-01

Emergency medicine leaders welcome a major new report from the Institute of Medicine (IOM) calling on providers, policy makers, and government agencies to institute changes to reduce the incidence of diagnostic errors. The 369-page report, "Improving Diagnosis in Health Care," states that the rate of diagnostic errors in this country is unacceptably high and offers a long list of recommendations aimed at addressing the problem. These include large, systemic changes that involve improvements in multiple areas, including health information technology (HIT), professional education, teamwork, and payment reform. Further, of particular interest to emergency physicians are recommended changes to the liability system. The authors of the IOM report state that while most people will likely experience a significant diagnostic error in their lifetime, the importance of this problem is under-appreciated. According to conservative estimates, the report says 5% of adults who seek outpatient care each year experience a diagnostic error. The report also notes that research over many decades shows diagnostic errors contribute to roughly 10% of all.deaths. The report says more steps need to be taken to facilitate inter-professional and intra-professional teamwork throughout the diagnostic process. Experts concur with the report's finding that mechanisms need to be developed so that providers receive ongoing feedback on their diagnostic performance.

Diagnostic features of polycystic ovary syndrome in adolescents (review).

PubMed

Beltadze, K; Barbakadze, L

2015-01-01

The problem of Polycystic Ovary Syndrome (PCOS) is of a special importance due to its connection with not only medical but with psychosocial factors. PCOS is the most common endocrine cause of anovulatory infertility. It is a major factor for the metabolic syndrome, cardiovascular disease, type 2 diabetes mellitus (T2DM). Clinical symptoms of PCOS such as acne, hirsutism, obesity, alopecia represent psychological problem, especially for the adolescents. Many women who have PCOS have the onset of symptoms during adolescence. Early diagnosis and treatment of PCOS are important for preventing of the above mentioned long-term consequences associated with this condition. Adolescent patients often have diagnostic problems because the features of normal puberty are similar with symptoms of PCOS. This article reviews the diagnostic and differential diagnostic characteristics of PCOS in adolescents. In conclusion, consensus statement in adolescent patients is still awaiting. Our data suggest that it may be prudent to define adolescent PCOS according to the Carmina modified Rotterdam criteria. The increase rate of metabolic syndrome in adolescents with PCOS emphasize the importance of regular screening due to the high cardiometabolic disorders risk.

[Infantile facial paralysis: diagnostic and therapeutic features].

PubMed

Montalt, J; Barona, R; Comeche, C; Basterra, J

2000-01-01

This paper deals with a series of 11 cases of peripheral unilateral facial paralyses affecting children under 15 years. Following parameters are reviewed: age, sex, side immobilized, origin, morbid antecedents, clinical and neurophysiological explorations (electroneurography through magnetic stimulation) and the evolutive course of the cases. These items are assembled in 3 sketches in the article. Clinical assessment of face movility is more difficult as the patient is younger, nevertheless electroneurography was possible in the whole group. Clinical restoration was complete, excepting one complicated cholesteatomatous patient. Some aspects concerning the etiology, diagnostic explorations and management of each pediatric case are discussed.

An Incidental Renal Oncocytoma: 18F-Choline PET/MRI

PubMed Central

Mallia, Andrew; Bashir, Usman; Stirling, James; Wolfe, Konrad; Goh, Vicky; Cook, Gary

2016-01-01

PET/MRI is a new hybrid imaging modality and has the potential to become a powerful imaging tool. It is currently one of the most active areas of research in diagnostic imaging. The characterisation of an incidental renal lesion can be difficult. In particular, the differentiation of an oncocytoma from other solid renal lesions such as renal cell carcinoma (RCC) represents a diagnostic challenge. We describe the detection of an incidental renal oncocytoma in a 79-year gentleman who underwent a re-staging 18F-Choline PET/MRI following a rise in PSA values (4.07, nadir 1.3).

Figure and ground in physician misdiagnosis: metacognition and diagnostic norms.

PubMed

Hamm, Robert M

2014-01-01

Meta-cognitive awareness, or self reflection informed by the "heuristics and biases" theory of how experts make cognitive errors, has been offered as a partial solution for diagnostic errors in medicine. I argue that this approach is not as easy nor as effective as one might hope. We should also promote mastery of the basic principles of diagnosis in medical school, continuing medical education, and routine reflection and review. While it may seem difficult to attend to both levels simultaneously, there is more to be gained from attending to both than from focusing only on one.

Signal evaluations using singular value decomposition for Thomson scattering diagnostics.

PubMed

Tojo, H; Yamada, I; Yasuhara, R; Yatsuka, E; Funaba, H; Hatae, T; Hayashi, H; Itami, K

2014-11-01

This paper provides a novel method for evaluating signal intensities in incoherent Thomson scattering diagnostics. A double-pass Thomson scattering system, where a laser passes through the plasma twice, generates two scattering pulses from the plasma. Evaluations of the signal intensities in the spectrometer are sometimes difficult due to noise and stray light. We apply the singular value decomposition method to Thomson scattering data with strong noise components. Results show that the average accuracy of the measured electron temperature (Te) is superior to that of temperature obtained using a low-pass filter (<20 MHz) or without any filters.

Signal evaluations using singular value decomposition for Thomson scattering diagnostics

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

Tojo, H., E-mail: tojo.hiroshi@jaea.go.jp; Yatsuka, E.; Hatae, T.

2014-11-15

This paper provides a novel method for evaluating signal intensities in incoherent Thomson scattering diagnostics. A double-pass Thomson scattering system, where a laser passes through the plasma twice, generates two scattering pulses from the plasma. Evaluations of the signal intensities in the spectrometer are sometimes difficult due to noise and stray light. We apply the singular value decomposition method to Thomson scattering data with strong noise components. Results show that the average accuracy of the measured electron temperature (T{sub e}) is superior to that of temperature obtained using a low-pass filter (<20 MHz) or without any filters.

SFEMG in ocular myasthenia gravis diagnosis.

PubMed

Padua, L; Stalberg, E; LoMonaco, M; Evoli, A; Batocchi, A; Tonali, P

2000-07-01

In typical cases, the patient's history and clinical examination make it possible to diagnose ocular myasthenia gravis (OMG). But, in many cases a clear clinical picture is not present and OMG diagnosis is very difficult because gold diagnostic standard tests are not available. The diagnostic tests for OMG are usually unable to display a good sensitivity and specificity simultaneously. In this paper, we studied 86 cases submitted for suspected OMG. The patients were studied clinically and with various other tests used in OMG diagnosis (SFEMG, repetitive nerve stimulation, Ab anti AChR titration, tensilon test). SFEMG showed the highest sensitivity (100%) while Ab anti AChR showed the highest specificity (100%). To our knowledge this is the largest population of suspected OMG studied using most of the diagnostic parameters, reported in the literature.

[Anatomo-functional aspects and diagnostic algorithm (of the upper limb pathologies secondary to repeated trauma)].

PubMed

Bazzini, G

2001-01-01

The epidemiology of work-related musculo-skeletal pathologies of the upper limbs has become significantly relevant in the last years, and a sharp increasing trend can be observed. This paper mainly focuses on the chronic inflammatory and degenerative conditions, which are more complex and difficult to accurately diagnose and treat. A synthesis of the diagnostic picture of the different types, involving the joints, muscles and tendons, and peripheral nerves is provided, with mention of the sensitivity and specificity of the main diagnostic tests. The possible entrapments of the radial, median and ulnar nerves are described in detail. Finally, a brief critical review on the principal movements of the upper limbs which are responsible of the onset of such conditions is presented.

Idiopathic granulomatous mastitis: a diagnostic dilemma for the breast radiologist.

PubMed

Sripathi, Smiti; Ayachit, Anurag; Bala, Archana; Kadavigere, Rajagopal; Kumar, Sandeep

2016-08-01

Idiopathic granulomatous mastitis is a chronic inflammatory disease of the breast, which is often difficult to differentiate both clinically and radiologically from infectious aetiologies such as tuberculosis, fungal infections, and also from malignancy, thus posing a diagnostic dilemma. We present a pictorial review of the commonly encountered imaging findings in idiopathic granulomatous mastitis on mammography and ultrasound. Mammographic and ultrasound findings of histopathologically proven cases of granulomatous mastitis are discussed. Idiopathic granulomatous mastitis has varied and non-specific appearances on ultrasound and mammography. Histopathology is essential to establish diagnosis. • Idiopathic granulomatous mastitis often poses a diagnostic dilemma for the radiologist by mimicking malignancy. • It has varied and non-specific appearances on mammography and ultrasound. • Histopathology is mandatory to establish the diagnosis and decide management.

Introducing First-Year Medical Students to Early Diagnostic Hypotheses

ERIC Educational Resources Information Center

Taylor, P. J.; And Others

1978-01-01

A method of instruction in gynecology is described that encouraged the formulation of early diagnostic hypotheses, an important part of clinical problem-solving. Students were given a set of clinical clues to help them make broad diagnostic hypotheses. Student ability, results, and student perceptions of the course are provided. (Author/LBH)

Problem of glider models

NASA Technical Reports Server (NTRS)

Lippisch, Espenlaub

1922-01-01

Any one endeavoring to solve the problem of soaring flight is confronted not only by structural difficulties, but also by the often far more difficult aerodynamic problem of flight properties and efficiency, which can only be determined by experimenting with the finished glider.

Gamma-Ray Imaging Probes.

NASA Astrophysics Data System (ADS)

Wild, Walter James

1988-12-01

External nuclear medicine diagnostic imaging of early primary and metastatic lung cancer tumors is difficult due to the poor sensitivity and resolution of existing gamma cameras. Nonimaging counting detectors used for internal tumor detection give ambiguous results because distant background variations are difficult to discriminate from neighboring tumor sites. This suggests that an internal imaging nuclear medicine probe, particularly an esophageal probe, may be advantageously used to detect small tumors because of the ability to discriminate against background variations and the capability to get close to sites neighboring the esophagus. The design, theory of operation, preliminary bench tests, characterization of noise behavior and optimization of such an imaging probe is the central theme of this work. The central concept lies in the representation of the aperture shell by a sequence of binary digits. This, coupled with the mode of operation which is data encoding within an axial slice of space, leads to the fundamental imaging equation in which the coding operation is conveniently described by a circulant matrix operator. The coding/decoding process is a classic coded-aperture problem, and various estimators to achieve decoding are discussed. Some estimators require a priori information about the object (or object class) being imaged; the only unbiased estimator that does not impose this requirement is the simple inverse-matrix operator. The effects of noise on the estimate (or reconstruction) is discussed for general noise models and various codes/decoding operators. The choice of an optimal aperture for detector count times of clinical relevance is examined using a statistical class-separability formalism.

Frequency of ICD-10 psychiatric diagnosis in children with intellectual disability in Lahore, Pakistan & Caregivers Perspective.

PubMed

Imran, Nazish; Azeem, Muhammad Waqar; Sattar, Ahsan; Bhatti, Mohammad Riaz

2015-01-01

Association between Intellectual disability (ID) and psychiatric disorders in children & adolescents is well established but there is a paucity of published studies from Pakistan on this topic. The main aim of the study was to assess the frequency of ICD-10 psychiatric diagnosis in the hospital outpatient sample of children with ID in Lahore, Pakistan as well as to find out which challenging behaviors, caregivers find difficult to manage in this setup. Socio-demographic information was collected, Wechsler Intelligence Scale for Children-Revised & ICD-10 diagnostic criteria was used to assess children (age range 6 - 16 years) with suspected ID along with identification of behaviors found to be difficult to manage by caregivers. 150 children were assessed with mean age of 10.7 years (males 70 %). Majority (72%) had mild ID while 18.7% and 9.3% had moderate and severe ID respectively. Thirty percent of children met the criteria for any psychiatric diagnosis, the most common being Oppositional Defiant Disorder (14%) and Hyperkinetic Disorders (10%). Verbal and physical aggression, school difficulties, socialization problems, inappropriate behaviors (e.g. disinhibition), sleep & feeding difficulties were the significant areas identified by the caregivers as a cause of major concern. Significantly high prevalence of ICD-10 psychiatric diagnosis in children with ID was found in Lahore, Pakistan. Support services for these children should be responsive not only to the needs of the child, but also to the needs of the family.

Frequency of ICD-10 psychiatric diagnosis in children with intellectual disability in Lahore, Pakistan & Caregivers Perspective

PubMed Central

Imran, Nazish; Azeem, Muhammad Waqar; Sattar, Ahsan; Bhatti, Mohammad Riaz

2015-01-01

Objective: Association between Intellectual disability (ID) and psychiatric disorders in children & adolescents is well established but there is a paucity of published studies from Pakistan on this topic. The main aim of the study was to assess the frequency of ICD-10 psychiatric diagnosis in the hospital outpatient sample of children with ID in Lahore, Pakistan as well as to find out which challenging behaviors, caregivers find difficult to manage in this setup. Methods: Socio-demographic information was collected, Wechsler Intelligence Scale for Children-Revised & ICD-10 diagnostic criteria was used to assess children (age range 6 – 16 years) with suspected ID along with identification of behaviors found to be difficult to manage by caregivers. Results: 150 children were assessed with mean age of 10.7 years (males 70 %). Majority (72%) had mild ID while 18.7% and 9.3% had moderate and severe ID respectively. Thirty percent of children met the criteria for any psychiatric diagnosis, the most common being Oppositional Defiant Disorder (14%) and Hyperkinetic Disorders (10%). Verbal and physical aggression, school difficulties, socialization problems, inappropriate behaviors (e.g. disinhibition), sleep & feeding difficulties were the significant areas identified by the caregivers as a cause of major concern. Conclusions: Significantly high prevalence of ICD-10 psychiatric diagnosis in children with ID was found in Lahore, Pakistan. Support services for these children should be responsive not only to the needs of the child, but also to the needs of the family. PMID:26101476

Comparison of Rating Scales in the Development of Patient-Reported Outcome Measures for Children with Eye Disorders.

PubMed

Hatt, Sarah R; Leske, David A; Wernimont, Suzanne M; Birch, Eileen E; Holmes, Jonathan M

2017-03-01

A rating scale is a critical component of patient-reported outcome instrument design, but the optimal rating scale format for pediatric use has not been investigated. We compared rating scale performance when administering potential questionnaire items to children with eye disorders and their parents. Three commonly used rating scales were evaluated: frequency (never, sometimes, often, always), severity (not at all, a little, some, a lot), and difficulty (not difficult, a little difficult, difficult, very difficult). Ten patient-derived items were formatted for each rating scale, and rating scale testing order was randomized. Both child and parent were asked to comment on any problems with, or a preference for, a particular scale. Any confusion about options or inability to answer was recorded. Twenty-one children, aged 5-17 years, with strabismus, amblyopia, or refractive error were recruited, each with one of their parents. Of the first 10 children, 4 (40%) had problems using the difficulty scale, compared with 1 (10%) using frequency, and none using severity. The difficulty scale was modified, replacing the word "difficult" with "hard." Eleven additional children (plus parents) then completed all 3 questionnaires. No children had problems using any scale. Four (36%) parents had problems using the difficulty ("hard") scale and 1 (9%) with frequency. Regarding preference, 6 (55%) of 11 children and 5 (50%) of 10 parents preferred using the frequency scale. Children and parents found the frequency scale and question format to be the most easily understood. Children and parents also expressed preference for the frequency scale, compared with the difficulty and severity scales. We recommend frequency rating scales for patient-reported outcome measures in pediatric populations.

Diagnostics in Japan's microgravity experiments

NASA Technical Reports Server (NTRS)

Kadota, Toshikazu

1995-01-01

The achievement of the combustion research under microgravity depends substantially on the availability of diagnostic systems. The non-intrusive diagnostic systems are potentially applicable for providing the accurate, realistic and detailed information on momentum, mass and energy transport, complex gas phase chemistry, and phase change in the combustion field under microgravity. The non-intrusive nature of optical instruments is essential to the measurement of combustion process under microgravity which is very nervous to any perturbation. However, the implementation of the non-intrusive combustion diagnostic systems under microgravity is accompanied by several constraints. Usually, a very limited space is only available for constructing a highly sophisticated system which is so sensitive that it is easily affected by the magnitude of the gravitational force, vibration and heterogeneous field of temperature and density of the environments. The system should be properly adjusted prior to the experiment. Generally, it is quite difficult to tune the instruments during measurements. The programmed sequence of operation should also be provided. Extensive effort has been toward the development of non-intrusive diagnostic systems available for the combustion experiments under microgravity. This paper aims to describe the current art and the future strategy on the non-intrusive diagnostic systems potentially applicable to the combustion experiments under microgravity in Japan.

Antibiotic and Diagnostic Discordance Between ED Physicians and Hospitalists for Pediatric Respiratory Illness.

PubMed

Coon, Eric R; Maloney, Christopher G; Shen, Mark W

2015-03-01

Imperfect diagnostic tools make it difficult to know the extent to which a bacterial process is contributing to respiratory illness, complicating the decision to prescribe antibiotics. We sought to quantify diagnostic and antibiotic prescribing disagreements between emergency department (ED) and pediatric hospitalist physicians for children admitted with respiratory illness. Manual chart review was used to identify testing, diagnostic, and antibiotic prescribing decisions for consecutive children admitted for respiratory illness in a winter (starting February 20, 2012) and a summer (starting August 20, 2012) season to a tertiary, freestanding children's hospital. Respiratory illness diagnoses were grouped into 3 categories: bacterial, viral, and asthma. A total of 181 children admitted for respiratory illness were studied. Diagnostic discordance was significant for all 3 types of respiratory illness but greatest for bacterial (P<.001). Antibiotic prescribing discordance was significant (P<.001), with pediatric hospitalists changing therapy for 93% of patients prescribed antibiotics in the ED, including stopping antibiotics altogether for 62% of patients. Significant diagnostic and antibiotic discordance between ED and pediatric hospitalist physicians exists for children admitted to the hospital for respiratory illness. Copyright © 2015 by the American Academy of Pediatrics.

Causes of homelessness prevalence: Relationship between homelessness and disability.

PubMed

Nishio, Akihiro; Horita, Ryo; Sado, Tadahiro; Mizutani, Seiko; Watanabe, Takahiro; Uehara, Ryosuke; Yamamoto, Mayumi

2017-03-01

Many studies have reported that the prevalence of mental illness and cognitive disability is higher among homeless individuals compared to the general population, and the rates of mental illness among the homeless population have recently increased. This study: (i) compares causes of homelessness or barriers to escaping homelessness for people with/without mental illness/cognitive disability; (ii) reveals problems with the Japanese homeless policy; and (iii) proposes an effective and necessary support system. The participants were 114 homeless individuals. A psychiatric diagnostic interview and the Wechsler Adult Intelligence Scale, version III were used to measure participants' mental health and cognitive abilities. A questionnaire was administered comprising 17 items related to the causes of their homelessness and barriers to escaping from it. Participants were divided into four groups - with/without mental illness or cognitive disability - and Fisher's exact test was used to compare the questionnaire results. Individuals with cognitive disabilities considered bad relationships with their family members to be the cause of their homelessness. Conversely, normal individuals considered their homelessness to be the result of debt more so than did individuals with mental problems. Individuals with mental illness had more difficulties escaping homelessness than did either normal individuals or individuals with cognitive disability. This tendency was observed most strongly among individuals with both mental illness and cognitive disability. Most homeless individuals considered economic problems to be the cause of their homelessness; however, difficulties with human relationships were also important factors and were more difficult for participants to acknowledge. Furthermore, these difficulties were exacerbated among those individuals with mental problems. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

Using Technology to Meet the Developmental Needs of Deaf Students To Improve Their Mathematical Word Problem Solving Skills.

ERIC Educational Resources Information Center

Kelly, Ronald R.

2003-01-01

Presents "Project Solve," a web-based problem-solving instruction and guided practice for mathematical word problems. Discusses implications for college students for whom reading and comprehension of mathematical word problem solving are difficult, especially learning disabled students. (Author/KHR)

Must "Hard Problems" Be Hard?

ERIC Educational Resources Information Center

Kolata, Gina

1985-01-01

To determine how hard it is for computers to solve problems, researchers have classified groups of problems (polynomial hierarchy) according to how much time they seem to require for their solutions. A difficult and complex proof is offered which shows that a combinatorial approach (using Boolean circuits) may resolve the problem. (JN)

The Interference of Stereotype Threat with Women's Generation of Mathematical Problem-Solving Strategies.

ERIC Educational Resources Information Center

Quinn, Diane M.; Spencer, Steven J.

2001-01-01

Investigated whether stereotype threat would depress college women's math performance. In one test, men outperformed women when solving word problems, though women performed equally when problems were converted into numerical equivalents. In another test, participants solved difficult problems in high or reduced stereotype threat conditions. Women…

The Role of Expository Writing in Mathematical Problem Solving

ERIC Educational Resources Information Center

Craig, Tracy S.

2016-01-01

Mathematical problem-solving is notoriously difficult to teach in a standard university mathematics classroom. The project on which this article reports aimed to investigate the effect of the writing of explanatory strategies in the context of mathematical problem solving on problem-solving behaviour. This article serves to describe the…

Using KIE To Help Students Develop Shared Criteria for House Designs.

ERIC Educational Resources Information Center

Cuthbert, Alex; Hoadley, Christopher M.

How can students develop shared criteria for problems that have no "right" answer? Ill-structured problems of this sort are called design problems. Like portfolio projects, these problems are difficult to evaluate for both teachers and students. This investigation contrasts two methods for developing shared criteria for project…

Expert Systems and Diagnostic Monitors in Psychiatry

PubMed Central

Gelernter, David; Gelernter, Joel

1984-01-01

We argue that existing expert systems for medical diagnosis have not satisfactorily addressed an important problem: how are such systems to be integrated into the clinical environment? This problem should be addressed before and not after a working system is developed, because its solution might well determine important aspects of the ultimate system structure. We propose as one solution the online diagnostic monitor, which is a diagnostic expert system designed for interactive use by a clinican during the course of a patient interview. The exchange between a diagnostic monitor and its clinican user is guided by the user, not the system, and the monitor functions as a passive advisor rather than an active decision-maker. We discuss why a system of this sort might be particularly well-suited to psychiatric diagnosis, and describe preliminary work on an experimental prototype.

Diagnostic orphans: comparing self-report lifetime course to groups with DSM-IV alcohol abuse and dependence.

PubMed

McBride, Orla; Adamson, Gary; Bunting, Brendan; McCann, Siobhan

2009-01-01

Research has highlighted the significant alcohol symptoms and mental health problems experienced by diagnostic orphans - individuals who experience 1-2 criteria of DSM-IV alcohol dependence but do not meet the criteria for a DSM-IV alcohol use disorder. This study used a sub-sample (n=34827) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), and formed mutually exclusive groups to compare the self-report retrospective course of diagnostic orphans to individuals with DSM-IV abuse and dependence. Multinomial logistic regressions were conducted to examine the associations between the groups and a range of demographic and clinical variables. Collectively, the findings demonstrate that diagnostic orphans shared similar characteristics to the abuse and dependence groups, but appeared to experience specific comorbid mental health problems. Orphan status has the potential to be a persistent condition and may result in significant dysfunction. In conclusion, diagnostic orphans represent a distinct group that may benefit from cost-effective treatment or intervention, designed to prevent the escalation of alcohol symptoms.

Talbot-Lau x-ray interferometry for high energy density plasma diagnostic.

PubMed

Stutman, D; Finkenthal, M

2011-11-01

High resolution density diagnostics are difficult in high energy density laboratory plasmas (HEDLP) experiments due to the scarcity of probes that can penetrate above solid density plasmas. Hard x-rays are one possible probe for such dense plasmas. We study the possibility of applying an x-ray method recently developed for medical imaging, differential phase-contrast with Talbot-Lau interferometers, for the diagnostic of electron density and small-scale hydrodynamic instabilities in HEDLP experiments. The Talbot method uses micro-periodic gratings to measure the refraction and ultra-small angle scatter of x-rays through an object and is attractive for HEDLP diagnostic due to its capability to work with incoherent and polychromatic x-ray sources such as the laser driven backlighters used for HEDLP radiography. Our paper studies the potential of the Talbot method for HEDLP diagnostic, its adaptation to the HEDLP environment, and its extension of high x-ray energy using micro-periodic mirrors. The analysis is illustrated with experimental results obtained using a laboratory Talbot interferometer. © 2011 American Institute of Physics

[Epidemiology of Minamata Disease--Focus on the Clinical Features Related to the 1977 Diagnostic Criteria].

PubMed

Futatsuka, Makoto

2015-01-01

Large-scale food poisoning caused by methylmercury was identified in Minamata, Japan, in the 1950s (Minamata Disease). Although the diagnostic criteria for the disease was controversial and difficult during that time, we, the Kumamoto University Study Group, carried out a large-scale study to assess the clinical features in 1972-1973. The author tried to reassess the results of that study to appraise the diagnostic criteria established in 1977 on the basis of those results. A substantial number of residents in the exposed area exhibited neurologic signs, especially paresthesia of only the extremities, namely, the male residents of Minamata City showed a positive predictive value of 0.73 and a negative predictive value of 0.23. The relative risks of paresthesia only were 2.6 (2.0-3.3) and 1.2 (0.9-1.5), in Minamata and Goshonoura related to Ariake (control), respectively. At least until 1977, the diagnostic criteria remained valid, although it was inadequate. Nevertheless, presently, a follow-up study of the certified patients may lead to the development of efficient new diagnostic criteria.

Artificially designed pathogens - a diagnostic option for future military deployments.

PubMed

Zautner, Andreas E; Masanta, Wycliffe O; Hinz, Rebecca; Hagen, Ralf Matthias; Frickmann, Hagen

2015-01-01

Diagnostic microbial isolates of bio-safety levels 3 and 4 are difficult to handle in medical field camps under military deployment settings. International transport of such isolates is challenging due to restrictions by the International Air Transport Association. An alternative option might be inactivation and sequencing of the pathogen at the deployment site with subsequent sequence-based revitalization in well-equipped laboratories in the home country for further scientific assessment. A literature review was written based on a PubMed search. First described for poliovirus in 2002, de novo synthesis of pathogens based on their sequence information has become a well-established procedure in science. Successful syntheses have been demonstrated for both viruses and prokaryotes. However, the technology is not yet available for routine diagnostic purposes. Due to the potential utility of diagnostic sequencing and sequence-based de novo synthesis of pathogens, it seems worthwhile to establish the technology for diagnostic purposes over the intermediate term. This is particularly true for resource-restricted deployment settings, where safe handling of harmful pathogens cannot always be guaranteed.

Spondylodiscite granulomateuse: surtout la tuberculose mais ne pas omettre le lymphome

PubMed Central

Zinebi, Ali; Rkiouak, Adil; Akhouad, Yousef; Reggad, Ahmed; Kasmy, Zohour; Boudlal, Mostafa; Lho, Abdelhamid Nait; Rabhi, Moncef; Sinaa, Mohamed; Ennibi, Khalid; Chaari, Jilali

2016-01-01

Les douleurs lombaires relèvent d'étiologies multiples dont le diagnostic peut être source de grandes difficultés. Le lymphome rachidien primitif est rare et son diagnostic nécessite une biopsie souvent scanoguidée. Un homme de 30 ans, était hospitalisé pour lombalgies inflammatoires évoluant dans un contexte d'altération de l'état général avec à l'examen des douleurs à la palpation des apophyses épineux L2L3, sans syndrome tumoral périphérique. Le bilan biologique montrait un syndrome inflammatoire. Le bilan morphologique était en faveur d'une spondylodiscite. La première biopsie montrait une ostéite granulomateuse. L'aggravation clinique et radiologique sous anti bacillaire a mené à reconsidérer le diagnostic et la deuxième biopsie confirme le diagnostic du lymphome. Le diagnostic de tuberculose osseuse en particulier vertébrale nécessite une confirmation bactériologique et ou histologique pour ne pas méconnaître un lymphome osseux primitif. PMID:28292061

[Nodular toxoplasmosis as a diagnostic and therapeutic problem].

PubMed

Zaorski, P; Kozłowski, J

1999-01-01

Enlargement of lymph nodes of the neck, slightly elevated body temperature and discomfort are symptoms characteristic of many illnesses. One of these can be toxoplasmosis. Because the rarity of its occurrence, sometimes toxoplasmosis may be last to be recognized. In many cases absence of specific additional examination guidelines can contribute to several problems with correct diagnosis. At the present time, the most reliable sample analysis methods are the examination of levels of antibodies IgG and IgM, and the histopathological verification. The authors also indicate that varying therapeutic effects using prophilactic treatment and insufficient additional examination could lead to diagnostic problems.

Haemophilia at various stages of life: design of new therapeutic strategies through an interactive course - the Kogeniale project

PubMed Central

Santagostino, Elena; Messina, Maria; Tagliaferri, Annarita; Iorio, Alfonso; Morfini, Massimo

2013-01-01

Background High-quality evidence is lacking in several areas of haemophilia treatment, in part because little time is allocated to the treatment and care of haemophilia in university education in Italy. Physicians caring for patients with haemophilia must, therefore, rely on their information on background pathophysiology and more experienced colleagues. This makes diagnostic and therapeutic choices difficult, especially when the patient has concomitant disorders or psychological issues. Material and methods This article describes a course to educate young physicians who were already engaged in the management of haemophilia on the emerging and unmet issues of haemophilia care and to implement existing guidelines. Physicians (n=53) already caring for patients with haemophilia in their haematology, internal medicine, or paediatric practices in Italy attended the course. Problem-solving group activity and open discussion were the methods chosen to formulate consensus statements. During the specifically designed interactive course, three clinical cases were simulated: a young child with congenital dislocation of the hip, an adolescent refusing prophylactic treatment, and an elderly man with cardiovascular disorders. The physicians were asked questions during the course and, through a Wi-Fi console, were able to answer and discuss each case interactively. Results Following discussion of each case, agreement was reached regarding general statements on the management of patients with severe haemophilia A in the three different age ranges considered. Discussion This project helped to outline useful decision-making tools for handling diagnostic and treatment issues in the field of haemophilia. PMID:23399360

Applying cybernetic technology to diagnose human pulmonary sounds.

PubMed

Chen, Mei-Yung; Chou, Cheng-Han

2014-06-01

Chest auscultation is a crucial and efficient method for diagnosing lung disease; however, it is a subjective process that relies on physician experience and the ability to differentiate between various sound patterns. Because the physiological signals composed of heart sounds and pulmonary sounds (PSs) are greater than 120 Hz and the human ear is not sensitive to low frequencies, successfully making diagnostic classifications is difficult. To solve this problem, we constructed various PS recognition systems for classifying six PS classes: vesicular breath sounds, bronchial breath sounds, tracheal breath sounds, crackles, wheezes, and stridor sounds. First, we used a piezoelectric microphone and data acquisition card to acquire PS signals and perform signal preprocessing. A wavelet transform was used for feature extraction, and the PS signals were decomposed into frequency subbands. Using a statistical method, we extracted 17 features that were used as the input vectors of a neural network. We proposed a 2-stage classifier combined with a back-propagation (BP) neural network and learning vector quantization (LVQ) neural network, which improves classification accuracy by using a haploid neural network. The receiver operating characteristic (ROC) curve verifies the high performance level of the neural network. To expand traditional auscultation methods, we constructed various PS diagnostic systems that can correctly classify the six common PSs. The proposed device overcomes the lack of human sensitivity to low-frequency sounds and various PS waves, characteristic values, and a spectral analysis charts are provided to elucidate the design of the human-machine interface.

[Operative treatment of painful neuromas].

PubMed

Stokvis, Annemieke; Coert, J Henk

2011-01-01

3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. The diagnosis is based on the medical history and physical examination, supplemented by Tinel's test and a diagnostic nerve blockade. Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time. 3-5% of patients with traumatic or iatrogenic peripheral nerve injury develop a painful neuroma, especially following trauma of small cutaneous sensory nerve branches. Neuroma pain is difficult to treat and often leads to loss of function and reduction of quality of life. Patients with a painful neuroma present with spontaneous electric, shooting or burning pain, allodynia, hyperalgesia and cold intolerance. The diagnosis is based on the medical history and physical examination, supplemented by Tinel's test and a diagnostic nerve blockade. Lasting pain relief is possible by means of surgical neuroma treatment performed by a plastic surgeon. Surgical treatment consists of repair or denervation of the nerve with relocation of the nerve stump in bone or muscle tissue or a vein. Referral of neuroma patients without delay to a plastic surgeon or multidisciplinary consultation is important, because the symptoms become increasingly difficult to treat over time.

Landing A Man Downtown

ERIC Educational Resources Information Center

Waters, W. G., II

1973-01-01

Analyzes the urban transport problems in comparison with those involved in a journey to the Moon. Indicates that the problem of enabling man to travel through the inner space of conurbations may prove to be more difficult than the transport problem of space travel. (CC)

"But You Look So Good!": Managing Specific Issues

MedlinePlus

... and resources about handling bladder or bowel problems. Self-esteem “I think the most difficult thing to cope ... feel. It’s understandable then that MS can impact self-esteem and confidence. “It’s difficult to feel powerful, competent, ...

Teleconsultation in paediatric orthopaedics in Djibouti: evaluation of response performance.

PubMed

Bertani, A; Launay, F; Candoni, P; Mathieu, L; Rongieras, F; Chauvin, F

2012-11-01

Djibouti has no paediatric orthopaedics department and three options are available for difficult cases: transfer of the patient to another country; overseas mission transfer to Djibouti by a specialised surgical team; and management by a local orthopaedic surgeon receiving guidance from an expert. The extreme poverty of part of the population of Djibouti often precludes the first two options. Telemedecine can allow the local orthopaedic surgeon to receive expert advice. HYPOTHESES AND STUDY DESIGN: We prospectively recorded all the paediatric orthopaedics teleconsultations that occurred between November 2009 and November 2011. Our objective was to assess the performance of the teleconsultations. We hypothetized that this option was influential in decision making. We assessed the influence of the teleconsultation on patient management (i.e., change in the surgical indication and/or procedure). We then used the electronic patient records to compare the actual management to that recommended retrospectively by two independent orthopaedic surgeon consultants who had experience working overseas. Finally, we assessed the clinical outcomes in the patients. Of 48 teleconsultations for 39 patients, 13 dealt with diagnostic problems and 35 with therapeutic problems. The teleconsultation resolved the diagnostic uncertainties in 90% of cases. Advice from the expert modified the management in 37 (77%) teleconsultations; the change was related to the surgical indication in 18 cases, the surgical technique in 13 cases, and both in six cases. Agreement between the advice from the independent consultants and the treatment delivered by the local surgeon was 2.2/3. Clinical outcomes were good or very good in 31 (81%) of the 38 treated patients. This study establishes the feasibility and usefulness of paediatric orthopaedics teleconsultations in Djibouti. The introduction of telemedicine has changed our approach to challenges raised by patients in remote locations or precarious situations. Input from experts considerably benefits patient management. III, prospective comparative study. Copyright © 2012. Published by Elsevier Masson SAS.

Performance of seven serological assays for diagnosing tularemia

PubMed Central

2014-01-01

Background Tularemia is a rare zoonotic disease caused by the Gram-negative bacterium Francisella tularensis. Serology is frequently the preferred diagnostic approach, because the pathogen is highly infectious and difficult to cultivate. The aim of this retrospective study was to determine the diagnostic accuracy of tularemia specific tests. Methods The Serazym®Anti-Francisella tularensis ELISA, Serion ELISA classic Francisella tularensis IgG/IgM, an in-house ELISA, the VIRapid® Tularemia immunochromatographic test, an in-house antigen microarray, and a Western Blot (WB) assay were evaluated. The diagnosis tularemia was established using a standard micro-agglutination assay. In total, 135 sera from a series of 110 consecutive tularemia patients were tested. Results The diagnostic sensitivity and diagnostic specificity of the tests were VIRapid (97.0% and 84.0%), Serion IgG (96.3% and 96.8%), Serion IgM (94.8% and 96.8%), Serazym (97.0% and 91.5%), in-house ELISA (95.6% and 76.6%), WB (93.3% and 83.0%), microarray (91.1% and 97.9%). Conclusions The diagnostic value of the commercial assays was proven, because the diagnostic accuracy was >90%. The diagnostic sensitivity of the in-house ELISA and the WB were acceptable, but the diagnostic accuracy was <90%. Interestingly, the antigen microarray test was very specific and had a very good positive predictive value. PMID:24885274

Photolithography diagnostic expert systems: a systematic approach to problem solving in a wafer fabrication facility

NASA Astrophysics Data System (ADS)

Weatherwax Scott, Caroline; Tsareff, Christopher R.

1990-06-01

One of the main goals of process engineering in the semiconductor industry is to improve wafer fabrication productivity and throughput. Engineers must work continuously toward this goal in addition to performing sustaining and development tasks. To accomplish these objectives, managers must make efficient use of engineering resources. One of the tools being used to improve efficiency is the diagnostic expert system. Expert systems are knowledge based computer programs designed to lead the user through the analysis and solution of a problem. Several photolithography diagnostic expert systems have been implemented at the Hughes Technology Center to provide a systematic approach to process problem solving. This systematic approach was achieved by documenting cause and effect analyses for a wide variety of processing problems. This knowledge was organized in the form of IF-THEN rules, a common structure for knowledge representation in expert system technology. These rules form the knowledge base of the expert system which is stored in the computer. The systems also include the problem solving methodology used by the expert when addressing a problem in his area of expertise. Operators now use the expert systems to solve many process problems without engineering assistance. The systems also facilitate the collection of appropriate data to assist engineering in solving unanticipated problems. Currently, several expert systems have been implemented to cover all aspects of the photolithography process. The systems, which have been in use for over a year, include wafer surface preparation (HMDS), photoresist coat and softbake, align and expose on a wafer stepper, and develop inspection. These systems are part of a plan to implement an expert system diagnostic environment throughout the wafer fabrication facility. In this paper, the systems' construction is described, including knowledge acquisition, rule construction, knowledge refinement, testing, and evaluation. The roles played by the process engineering expert and the knowledge engineer are discussed. The features of the systems are shown, particularly the interactive quality of the consultations and the ease of system use.

The Zero to Three Diagnostic System: A Framework for Considering Emotional and Behavioral Problems in Young Children

ERIC Educational Resources Information Center

Evangelista, Nancy; McLellan, Mary J.

2004-01-01

The expansion of early childhood services has brought increasing recognition of the need to address mental health disorders in young children. The transactional perspective of developmental psychopathology is the basis for review of diagnostic frameworks for young children. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is…

Using a Diagnosis-Based Approach to Individualize Instructional Explanations in Computer-Mediated Communication

ERIC Educational Resources Information Center

Wittwer, Jorg; Nuckles, Matthias; Renkl, Alexander

2010-01-01

To maximize the effectiveness of instructional explanations, they should be tailored to an individual learner. However, instructors are often not able to collect diagnostically relevant information about a learner to individualize their explanations. This is particularly true in computer-mediated settings where it is more difficult to thoroughly…

[Refeeding in a teenager with an eating disorder; when the patient refuses, but the doctor is obliged to intervene].

PubMed

Nusman, C M; van Bellegem, A C M

2016-01-01

Young patients with eating disorders frequently present with physical complications. These young patients, who may decline to eat or drink can be difficult to treat. Knowledge of possible complications, diagnostic tools and the legal situation is necessary to provide optimal care.

Illustrated Key to Species of Genus Dendroctonus (Coleoptera: Curculionidae) Occurring in Mexico and Central America

PubMed Central

Armendáriz-Toledano, Francisco

2017-01-01

Abstract We provide an illustrated key of species of Dendroctonus Erichson from Mexico and Central America based on characters of the male genitalia and external morphology. The key incorporates newly identified diagnostic characters for this genus that enhance discrimination of particularly difficult sibling species. PMID:28355476

Virtopsy: postmortem imaging of laryngeal foreign bodies.

PubMed

Oesterhelweg, Lars; Bolliger, Stephan A; Thali, Michael J; Ross, Steffen

2009-05-01

Death from corpora aliena in the larynx is a well-known entity in forensic pathology. The correct diagnosis of this cause of death is difficult without an autopsy, and misdiagnoses by external examination alone are common. To determine the postmortem usefulness of modern imaging techniques in the diagnosis of foreign bodies in the larynx, multislice computed tomography, magnetic resonance imaging, and postmortem full-body computed tomography-angiography were performed. Three decedents with a suspected foreign body in the larynx underwent the 3 different imaging techniques before medicolegal autopsy. Multislice computed tomography has a high diagnostic value in the noninvasive localization of a foreign body and abnormalities in the larynx. The differentiation between neoplasm or soft foreign bodies (eg, food) is possible, but difficult, by unenhanced multislice computed tomography. By magnetic resonance imaging, the discrimination of the soft tissue structures and soft foreign bodies is much easier. In addition to the postmortem multislice computed tomography, the combination with postmortem angiography will increase the diagnostic value. Postmortem, cross-sectional imaging methods are highly valuable procedures for the noninvasive detection of corpora aliena in the larynx.

Adaptive decision processes in perceptual comparisons: effects of changes in the global difficulty context.

PubMed

Baranski, Joseph V; Petrusic, William M

2003-06-01

Adaptive decision processes were investigated in experiments involving an unexpected change in the global ease or difficulty of the task. Under accuracy stress, a shift from an easy to a difficult context induced a marked increase in decision time, but a shift from a difficult to an easy context did not. Under speed stress, a shift to a more difficult context induced lower accuracy and rated confidence, depending on the difficulty of the decisions. A view of caution developed in D. Vickers's (1979) accumulator theory--whereby one seeks to base decisions on more information--is compared with a view based on slow and fast guessing theory (W. M. Petrusic, 1992; W. M. Petrusic & J. V. Baranski, 1989a)--whereby one seeks to base decisions on more diagnostic information. On balance, the findings support the latter view.

[Humoral response markers in GCK MODY].

PubMed

Skała-Zamorowska, Eliza; Deja, Grażyna; Borowiec, Maciej; Fendler, Wojciech; Małachowska, Beata; Kamińska, Halla; Wyka, Krystyna; Młynarski, Wojciech; Jarosz-Chobot, Przemysława

2016-01-01

The prevalence of antibodies to pancreatic islets in monogenic diabetes remains unknown and the incidence estimation is difficult as the occurrence of autoantibodies in patient is one of the well-known exclusion criteria for further genetic diagnostics. They has been found not only among patients with type 1 diabetes, but also in other types of diabetes: Type 2 diabetes, Latent Autoimmune Diabetes in Adults (LADA) (16) and monogenic diabetes (MD). Immunological characteristic of GCK MODY patients. The study group included families of 27 adolescent patients with GCK MODY (39 parents and 19 siblings) monitored in the Department of Pediatrics, Endocrinology and Diabetes and in the Diabetes Clinic of John Paul II Upper Silesian Child Health Centre in Katowice in the years 2007-2012. All patients and family members with GCK MODY underwent a blood sample drawing for immunological (classic humoral response markers: ICA, GAD, IA-2, IAA) and biochemical diagnostics. Pediatric, diabetes and family medical history was collected from the subjects and parents. Immunological diagnostics was performed in all patients except 1 (96.3%). Immunological diagnostics included 17 (89.5%) parents and 7 (87.5%) siblings with diagnosed GCK MODY. 8 (30.8%) adolescent patients with GCK MODY, 3 subjects (17.64%) among parents (with GCK MODY), as well as 2 subjects (28.57%) among siblings (with GCK MODY) showed a positive antibodies screen. The results of our study in children with GCK MODY and their family members suggest that the occurrence of classic antibodies directed against pancreatic islets antigens is fairly common in patients with GCK MODY. Despite various observations and many legitimate discussions, it is difficult to clarify the pathogenesis of the occurrence of autoantibodies in monogenic diabetes. © Polish Society for Pediatric Endocrinology and Diabetology.

An investigative framework to facilitate epidemiological thinking during herd problem-solving.

PubMed

More, Simon J; Doherty, Michael L; O'Grady, Luke

2017-01-01

Veterinary clinicians and students commonly use diagnostic approaches appropriate for individual cases when conducting herd problem-solving. However, these approaches can be problematic, in part because they make limited use of epidemiological principles and methods, which has clear application during the investigation of herd problems. In this paper, we provide an overview of diagnostic approaches that are used when investigating individual animal cases, and the challenges faced when these approaches are directly translated from the individual to the herd. Further, we propose an investigative framework to facilitate epidemiological thinking during herd problem-solving. A number of different approaches are used when making a diagnosis on an individual animal, including pattern recognition, hypothetico-deductive reasoning, and the key abnormality method. Methods commonly applied to individuals are often adapted for herd problem-solving: 'comparison with best practice' being a herd-level adaptation of pattern recognition, and 'differential diagnoses' a herd-level adaptation of hypothetico-deductive reasoning. These approaches can be effective, however, challenges can arise. Herds are complex; a collection of individual cows, but also additional layers relating to environment, management, feeding etc. It is unrealistic to expect seamless translation of diagnostic approaches from the individual to the herd. Comparison with best practice is time-consuming and prioritisation of actions can be problematic, whereas differential diagnoses can lead to 'pathogen hunting', particularly in complex cases. Epidemiology is the science of understanding disease in populations. The focus is on the population, underpinned by principles and utilising methods that seek to allow us to generate solid conclusions from apparently uncontrolled situations. In this paper, we argue for the inclusion of epidemiological principles and methods as an additional tool for herd problem-solving, and outline an investigative framework, with examples, to effectively incorporate these principles and methods with other diagnostic approaches during herd problem-solving. Relevant measures of performance are identified, and measures of case frequencies are calculated and compared across time, in space and among animal groupings, to identify patterns, clues and plausible hypotheses, consistent with potential biological processes. With this knowledge, the subsequent investigation (relevant on-farm activities, diagnostic testing and other examinations) can be focused, and actions prioritised (specifically, those actions that are likely to make the greatest difference in addressing the problem if enacted). In our experience, this investigative framework is an effective teaching tool, facilitating epidemiological thinking among students during herd problem-solving. It is a generic and robust process, suited to many herd-based problems.

Alcohol Use Disorders in Argentinian Girls and Women 12 Months Before Delivery: Comparison of DSM-IV, DSM-5, and ICD-10 Diagnostic Criteria.

PubMed

López, Mariana B; Conde, Karina; Cremonte, Mariana

The evidence of important problems related to prenatal alcohol exposure has faced researchers with the problem of understanding and screening alcohol use in this population. Although any alcohol use should be considered risky during pregnancy, identifying alcohol-drinking problems (ADPs) could be especially important because women with ADPs could not benefit from a simple advice of abstinence and because their offsprings are subjected to a higher risk of problems related with prenatal alcohol exposure. In this context, we aim to study the prevalence and characteristics of ADPs in pregnant women, evaluating the performance of different diagnostic systems in this population. The aims of the study were to describe the prevalence of ADPs obtained with the criteria of the Diagnostic and Statistical Manual of Mental Disorders in its fourth (DSM-IV) and fifth edition (DSM-5), and the International Classification of Diseases (ICD)-10, in Argentinean females aged 13 to 44 years, 12 months before delivery; to evaluate the level of agreement between these classification systems; and to analyze the performance of each diagnosis criterion in this population. Data were collected through personal interviews of a probability sample of puerperal women (N = 641) in the city of Santa Fe (Argentina), between October 2010 and February 2011. Diagnoses compatible with DSM-IV, DSM-5, and ICD-10 were obtained through the Composite International Diagnostic Interview. Agreement among diagnostic systems was measured through Cohen kappa. Diagnosis criteria performance were analyzed considering their prevalence and discriminating ability (D value). Total ADP prevalence was 6.4% for DSM-IV (4.2% abuse and 2.2% dependence), 8.1% for DSM-5 (6.4% mild, 0.8% moderate, and 0.9% severe alcohol use disorder), and 14.1% for the ICD-10 (11.9% harmful use and 2.2% dependence). DSM-5 modifications improved agreement between DSM and ICD. The least prevalent and worst discriminating ability diagnostic criterion was "legal problems." The most prevalent and 1 of the best discriminating ability diagnostic criterion was '"health issues." DSM-IV and ICD-10 dependence prevalence was similar to that of previous studies in pregnant women, whereas abuse prevalence was surprisingly higher. Our results indicate a better performance of the DSM-5 alcohol use disorder category relative to the DSM-IV dual categorization. Nevertheless, the poor diagnostic performance of some DSM-5 criteria in this population could evidence their intercultural variability.

When acute-stage psychosis and substance use co-occur: differentiating substance-induced and primary psychotic disorders.

PubMed

Caton, C L; Samet, S; Hasin, D S

2000-09-01

Substances such as alcohol, cocaine, amphetamine, and cannabis can produce psychotic reactions in individuals who are otherwise free of serious mental illness. However, persons with primary psychotic disorders, such as schizophrenia and bipolar disorder, who use these substances often present for treatment with signs and symptoms similar to those whose psychosis resulted from the use of drugs alone. While it is often difficult to distinguish substance-induced from primary psychoses, especially early in the course of treatment, this differential diagnosis has important implications for treatment planning. To help clinicians distinguish these two types of presentations, the authors first review the types of psychotic symptoms that can co-occur with substance use. They discuss the prevalence and patterns of substance use that have been found in patients with schizophrenia and other primary psychotic disorders and review the negative outcomes associated with substance use in this population. The prevalence of and types of symptoms and problems associated with psychotic symptoms that occur as a result of substance use alone are also reviewed. The authors describe assessment procedures for differentiating substance-induced and primary psychotic disorders. They stress the importance of accurately establishing the temporal relationship between the substance use and the onset and continuation of psychotic symptoms in making a differential diagnosis, as well as the importance of being familiar with the types of psychological symptoms that can occur with specific substances. The authors review the utility and limitations of a number of diagnostic instruments for assessing patients with co-occurring psychosis and substance use problems, including The Addiction Severity Index, The Michigan Alcohol Screening Test, and diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia and the Structured Clinical Interview for DSM. They then discuss the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), an instrument that has been developed to address the lack of a diagnostic interview that is suitable for assessing the comorbidity of substance use and psychiatric disorders. The article concludes with a discussion of the importance of an appropriate match between diagnosis and treatment and the current state of our knowledge concerning the most appropriate types of treatment interventions for patients with substance-induced psychosis and those with dual diagnoses.

Collis-Romberg Mathematical Problem Solving Profiles.

ERIC Educational Resources Information Center

Collis, K. F.; Romberg, T. A.

Problem solving has become a focus of mathematics programs in Australia in recent years, necessitating the assessment of students' problem-solving abilities. This manual provides a problem-solving assessment and teaching resource package containing four elements: (1) profiles assessment items; (2) profiles diagnostic forms for recording individual…

Investigation of learning environment for arithmetic word problems by problem posing as sentence integration in Indonesian language

NASA Astrophysics Data System (ADS)

Hasanah, N.; Hayashi, Y.; Hirashima, T.

2017-02-01

Arithmetic word problems remain one of the most difficult area of teaching mathematics. Learning by problem posing has been suggested as an effective way to improve students’ understanding. However, the practice in usual classroom is difficult due to extra time needed for assessment and giving feedback to students’ posed problems. To address this issue, we have developed a tablet PC software named Monsakun for learning by posing arithmetic word problems based on Triplet Structure Model. It uses the mechanism of sentence-integration, an efficient implementation of problem-posing that enables agent-assessment of posed problems. The learning environment has been used in actual Japanese elementary school classrooms and the effectiveness has been confirmed in previous researches. In this study, ten Indonesian elementary school students living in Japan participated in a learning session of problem posing using Monsakun in Indonesian language. We analyzed their learning activities and show that students were able to interact with the structure of simple word problem using this learning environment. The results of data analysis and questionnaire suggested that the use of Monsakun provides a way of creating an interactive and fun environment for learning by problem posing for Indonesian elementary school students.

Drinking correlates of DSM-IV alcohol use disorder diagnostic orphans in college students.

PubMed

Hagman, Brett T; Cohn, Amy M

2012-01-01

One major limitation of the DSM-IV criteria for alcohol abuse and dependence is that a cluster of individuals who endorse a subthreshold number of dependence criteria and no abuse criteria do not receive a formal diagnosis; despite elevated risk for alcohol-related problems relative to those with an abuse diagnosis. These individuals have been referred to as diagnostic orphans. The primary aim of this study was to examine alcohol use correlates of a group of diagnostic orphans in a sample of 396 nontreatment seeking college students who reported drinking on at least one occasion in the last 90 days. DSM-IV criteria were assessed using a modified version of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM). Diagnostic orphans represented 34.1% (n = 135) of the original sample who did not receive a formal diagnosis; with the most frequently endorsed dependence criteria being tolerance and drinking larger/longer amounts than intended. Diagnostic orphans reported a range of alcohol-related negative consequences and reported greater frequencies of social and enhancement drinking motives in comparison to coping motives. They were similar to alcohol abusers and dissimilar to those with dependence or those without a diagnosis on alcohol consumption, alcohol problem severity, drinking motives and restraint variables. The present findings indicate that diagnostic orphans in college students represent a distinct group of drinkers who may be at risk for the development of alcohol use disorders and may be in need of intervention, given their similarity to those with an abuse diagnosis. Prevention and intervention efforts across college campuses should target this group to prevent escalation of alcohol problem severity. Copyright © American Academy of Addiction Psychiatry.

Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems

PubMed Central

2013-01-01

Background This article reviews the current debate on developmental trauma disorder (DTD) with respect to formalizing its diagnostic criteria. Victims of abuse, neglect, and maltreatment in childhood often develop a wide range of age-dependent psychopathologies with various mental comorbidities. The supporters of a formal DTD diagnosis argue that post-traumatic stress disorder (PTSD) does not cover all consequences of severe and complex traumatization in childhood. Discussion Traumatized individuals are difficult to treat, but clinical experience has shown that they tend to benefit from specific trauma therapy. A main argument against inclusion of formal DTD criteria into existing diagnostic systems is that emphasis on the etiology of the disorder might force current diagnostic systems to deviate from their purely descriptive nature. Furthermore, comorbidities and biological aspects of the disorder may be underdiagnosed using the DTD criteria. Summary Here, we discuss arguments for and against the proposal of DTD criteria and address implications and consequences for the clinical practice. PMID:23286319

Matrix metalloproteinases in cancer: their value as diagnostic and prognostic markers and therapeutic targets.

PubMed

Hadler-Olsen, Elin; Winberg, Jan-Olof; Uhlin-Hansen, Lars

2013-08-01

Biomarkers are used as tools in cancer diagnostics and in treatment stratification. In most cancers, there are increased levels of one or several members of the matrix metalloproteinases (MMPs). This is a family of proteolytic enzymes that are involved in many phases of cancer progression, including angiogenesis, invasiveness, and metastasis. It has therefore been expected that MMPs could serve as both diagnostic and prognostic markers in cancer patients, but despite a huge number of studies, it has been difficult to establish MMPs as cancer biomarkers. In the present paper, we assess some of the challenges associated with MMP research as well as putative reasons for the conflicting data on the value of these enzymes as diagnostic and prognostic markers in cancer patients. We also review the prognostic value of a number of MMPs in patients with lung, colorectal, breast, and prostate cancers. The review also discusses MMPs as potential target molecules for therapeutic agents and new strategies for development of such drugs.

Cancer diagnostics: The journey from histomorphology to molecular profiling.

PubMed

Ahmed, Atif A; Abedalthagafi, Malak

2016-09-06

Although histomorphology has made significant advances into the understanding of cancer etiology, classification and pathogenesis, it is sometimes complicated by morphologic ambiguities, and other shortcomings that necessitate the development of ancillary tests to complement its diagnostic value. A new approach to cancer patient management consists of targeting specific molecules or gene mutations in the cancer genome by inhibitory therapy. Molecular diagnostic tests and genomic profiling methods are increasingly being developed to identify tumor targeted molecular profile that is the basis of targeted therapy. Novel targeted therapy has revolutionized the treatment of gastrointestinal stromal tumor, renal cell carcinoma and other cancers that were previously difficult to treat with standard chemotherapy. In this review, we discuss the role of histomorphology in cancer diagnosis and management and the rising role of molecular profiling in targeted therapy. Molecular profiling in certain diagnostic and therapeutic difficulties may provide a practical and useful complement to histomorphology and opens new avenues for targeted therapy and alternative methods of cancer patient management.

A General Architecture for Intelligent Tutoring of Diagnostic Classification Problem Solving

PubMed Central

Crowley, Rebecca S.; Medvedeva, Olga

2003-01-01

We report on a general architecture for creating knowledge-based medical training systems to teach diagnostic classification problem solving. The approach is informed by our previous work describing the development of expertise in classification problem solving in Pathology. The architecture envelops the traditional Intelligent Tutoring System design within the Unified Problem-solving Method description Language (UPML) architecture, supporting component modularity and reuse. Based on the domain ontology, domain task ontology and case data, the abstract problem-solving methods of the expert model create a dynamic solution graph. Student interaction with the solution graph is filtered through an instructional layer, which is created by a second set of abstract problem-solving methods and pedagogic ontologies, in response to the current state of the student model. We outline the advantages and limitations of this general approach, and describe it’s implementation in SlideTutor–a developing Intelligent Tutoring System in Dermatopathology. PMID:14728159

The Efficacy of Using Diagrams When Solving Probability Word Problems in College

ERIC Educational Resources Information Center

Beitzel, Brian D.; Staley, Richard K.

2015-01-01

Previous experiments have shown a deleterious effect of visual representations on college students' ability to solve total- and joint-probability word problems. The present experiments used conditional-probability problems, known to be more difficult than total- and joint-probability problems. The diagram group was instructed in how to use tree…

The Development, Implementation, and Evaluation of a Problem Solving Heuristic

ERIC Educational Resources Information Center

Lorenzo, Mercedes

2005-01-01

Problem-solving is one of the main goals in science teaching and is something many students find difficult. This research reports on the development, implementation and evaluation of a problem-solving heuristic. This heuristic intends to help students to understand the steps involved in problem solving (metacognitive tool), and to provide them…

Procedural versus Content-Related Hints for Word Problem Solving: An Exploratory Study

ERIC Educational Resources Information Center

Kock, W. D.; Harskamp, E. G.

2016-01-01

For primary school students, mathematical word problems are often more difficult to solve than straightforward number problems. Word problems require reading and analysis skills, and in order to explain their situational contexts, the proper mathematical knowledge and number operations have to be selected. To improve students' ability in solving…

The Difficult Patron Situation: A Window of Opportunity To Improve Library Service.

ERIC Educational Resources Information Center

Sarkodie-Mensah, Kwasi

2000-01-01

Discusses the problem library patron from various fronts: historical, personality traits, importance of complaints, nature and types of problem patrons and their behavior, technology and the newly-bred problem patron, strategies for dealing with problem patrons, and ensuring that library administrators and other supervisors understand the need to…

Multidimensional Functional Behaviour Assessment within a Problem Analysis Framework.

ERIC Educational Resources Information Center

Ryba, Ken; Annan, Jean

This paper presents a new approach to contextualized problem analysis developed for use with multimodal Functional Behaviour Assessment (FBA) at Massey University in Auckland, New Zealand. The aim of problem analysis is to simplify complex problems that are difficult to understand. It accomplishes this by providing a high order framework that can…

Crisis management during anaesthesia: difficult intubation.

PubMed

Paix, A D; Williamson, J A; Runciman, W B

2005-06-01

Anaesthetists may experience difficulty with intubation unexpectedly which may be associated with difficulty in ventilating the patient. If not well managed, there may be serious consequences for the patient. A simple structured approach to this problem was developed to assist the anaesthetist in this difficult situation. To examine the role of a specific sub-algorithm for the management of difficult intubation. The potential performance of a structured approach developed by review of the literature and analysis of each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 147 reports of difficult intubation capable of analysis among the first 4000 incidents reported to AIMS. The difficulty was unexpected in 52% of cases; major physiological changes occurred in 37% of these cases. Saturation fell below 90% in 22% of cases, oesophageal intubation was reported in 19%, and an emergency transtracheal airway was required in 4% of cases. Obesity and limited neck mobility and mouth opening were the most common anatomical contributing factors. The data confirm previously reported failures to predict difficult intubation with existing preoperative clinical tests and suggest an ongoing need to teach a pre-learned strategy to deal with difficult intubation and any associated problem with ventilation. An easy-to-follow structured approach to these problems is outlined. It is recommended that skilled assistance be obtained (preferably another anaesthetist) when difficulty is expected or the patient's cardiorespiratory reserve is low. Patients should be assessed postoperatively to exclude any sequelae and to inform them of the difficulties encountered. These should be clearly documented and appropriate steps taken to warn future anaesthetists.

Transactional relations between caregiving stress, executive functioning, and problem behavior from early childhood to early adolescence

PubMed Central

LaGasse, Linda L.; Conradt, Elisabeth; Karalunas, Sarah L.; Dansereau, Lynne M.; Butner, Jonathan E.; Shankaran, Seetha; Bada, Henrietta; Bauer, Charles R.; Whitaker, Toni M.; Lester, Barry M.

2016-01-01

Developmental psychopathologists face the difficult task of identifying the environmental conditions that may contribute to early childhood behavior problems. Highly stressed caregivers can exacerbate behavior problems, while children with behavior problems may make parenting more difficult and increase caregiver stress. Unknown is: (1) how these transactions originate, (2) whether they persist over time to contribute to the development of problem behavior and (3) what role resilience factors, such as child executive functioning, may play in mitigating the development of problem behavior. In the present study, transactional relations between caregiving stress, executive functioning, and behavior problems were examined in a sample of 1,388 children with prenatal drug exposures at three developmental time points: early childhood (birth-age 5), middle childhood (ages 6 to 9), and early adolescence (ages 10 to 13). Transactional relations differed between caregiving stress and internalizing versus externalizing behavior. Targeting executive functioning in evidence-based interventions for children with prenatal substance exposure who present with internalizing problems and treating caregiving psychopathology, depression, and parenting stress in early childhood may be particularly important for children presenting with internalizing behavior. PMID:27427803

A Cascade Optimization Strategy for Solution of Difficult Multidisciplinary Design Problems

NASA Technical Reports Server (NTRS)

Patnaik, Surya N.; Coroneos, Rula M.; Hopkins, Dale A.; Berke, Laszlo

1996-01-01

A research project to comparatively evaluate 10 nonlinear optimization algorithms was recently completed. A conclusion was that no single optimizer could successfully solve all 40 problems in the test bed, even though most optimizers successfully solved at least one-third of the problems. We realized that improved search directions and step lengths, available in the 10 optimizers compared, were not likely to alleviate the convergence difficulties. For the solution of those difficult problems we have devised an alternative approach called cascade optimization strategy. The cascade strategy uses several optimizers, one followed by another in a specified sequence, to solve a problem. A pseudorandom scheme perturbs design variables between the optimizers. The cascade strategy has been tested successfully in the design of supersonic and subsonic aircraft configurations and air-breathing engines for high-speed civil transport applications. These problems could not be successfully solved by an individual optimizer. The cascade optimization strategy, however, generated feasible optimum solutions for both aircraft and engine problems. This paper presents the cascade strategy and solutions to a number of these problems.

The stories they tell: How third year medical students portray patients, family members, physicians, and themselves in difficult encounters.

PubMed

Shapiro, Johanna; Rakhra, Pavandeep; Wong, Adrianne

2016-10-01

Physicians have long had patients whom they have labeled "difficult", but little is known about how medical students perceive difficult encounters with patients. In this study, we analyzed 134 third year medical students' reflective essays written over an 18-month period about difficult student-patient encounters. We used a qualitative computerized software program, Atlas.ti to analyze students' observations and reflections. Main findings include that students described patients who were angry and upset; noncompliant with treatment plans; discussed "nonmedical" problems; fearful, worried, withdrawn, or "disinterested" in their health. Students often described themselves as anxious, uncertain, confused, and frustrated. Nevertheless, they saw themselves behaving in empathic and patient-centered ways while also taking refuge in "standard" behaviors not necessarily appropriate to the circumstances. Students rarely mentioned receiving guidance from attendings regarding how to manage these challenging interactions. These third-year medical students recognized the importance of behaving empathically in difficult situations and often did so. However, they often felt overwhelmed and frustrated, resorting to more reductive behaviors that did not match the needs of the patient. Students need more guidance from attending physicians in order to approach difficult interactions with specific problem-solving skills while maintaining an empathic, patient-centered context.

The Portable Patient Problem Pack: A Problem-Based Learning Unit

ERIC Educational Resources Information Center

Barrows, Howard S.; Tamblyn, Robyn M.

1977-01-01

The Portable Patient Problem Pack (P4), a method of simulating a patient's problem in a card deck format, is designed to develop the student's problem-solving or diagnostic skills in a manner consistent with the skills of the practicing clinician. Its effectiveness at McMaster University is reported. (LBH)

Development and Validation of a Novel Diagnostic Test for Human Brucellosis Using a Glyco-engineered Antigen Coupled to Magnetic Beads

PubMed Central

Ciocchini, Andrés E.; Rey Serantes, Diego A.; Melli, Luciano J.; Iwashkiw, Jeremy A.; Deodato, Bettina; Wallach, Jorge; Feldman, Mario F.; Ugalde, Juan E.; Comerci, Diego J.

2013-01-01

Brucellosis is a highly contagious zoonosis and still a major human health problem in endemic areas of the world. Although several diagnostic tools are available, most of them are difficult to implement especially in developing countries where complex health facilities are limited. Taking advantage of the identical structure and composition of the Brucella spp. and Yersinia enterocolitica O:9 O-polysaccharide, we explored the application of a recombinant Y. enterocolitica O:9-polysaccharide-protein conjugate (OAg-AcrA) as a novel antigen for diagnosis of human brucellosis. We have developed and validated an indirect immunoassay using OAg-AcrA coupled to magnetic beads. OAg-AcrA was produced and purified with high yields in Y. enterocolitica O:9 cells co-expressing the oligosaccharyltransferase PglB and the protein acceptor AcrA of Campylobacter jejuni without the need for culturing Brucella. Expression of PglB and AcrA in Y. enterocolitica resulted in the transfer of the host O-polysaccharide from its lipid carrier to AcrA. To validate the assay and determine the cutoff values, a receiver-operating characteristic analysis was performed using a panel of characterized serum samples obtained from healthy individuals and patients of different clinical groups. Our results indicate that, using this assay, it is possible to detect infection caused by the three main human brucellosis agents (B. abortus, B. melitensis and B. suis) and select different cutoff points to adjust sensitivity and specificity levels as needed. A cutoff value of 13.20% gave a sensitivity of 100% and a specificity of 98.57%, and a cutoff value of 16.15% resulted in a test sensitivity and specificity of 93.48% and 100%, respectively. The high diagnostic accuracy, low cost, reduced assay time and simplicity of this new glycoconjugate-magnetic beads assay makes it an attractive diagnostic tool for using not only in clinics and brucellosis reference laboratories but also in locations with limited laboratory infrastructure and/or minimally trained community health workers. PMID:23459192

Intellectual, behavioral, and emotional functioning in children with syndromic craniosynostosis.

PubMed

Maliepaard, Marianne; Mathijssen, Irene M J; Oosterlaan, Jaap; Okkerse, Jolanda M E

2014-06-01

To examine intellectual, behavioral, and emotional functioning of children who have syndromic craniosynostosis and to explore differences between diagnostic subgroups. A national sample of children who have syndromic craniosynostosis participated in this study. Intellectual, behavioral, and emotional outcomes were assessed by using standardized measures: Wechsler Intelligence Scale for Children, Third Edition, Child Behavior Checklist (CBCL)/6-18, Disruptive Behavior Disorder rating scale (DBD), and the National Institute of Mental Health Diagnostic Interview Schedule for Children. We included 82 children (39 boys) aged 6 to 13 years who have syndromic craniosynostosis. Mean Full-Scale IQ (FSIQ) was in the normal range (M = 96.6; SD = 21.6). However, children who have syndromic craniosynostosis had a 1.9 times higher risk for developing intellectual disability (FSIQ < 85) compared with the normative population (P < .001) and had more behavioral and emotional problems compared with the normative population, including higher scores on the CBCL/6-18, DBD Total Problems (P < .001), Internalizing (P < .01), social problems (P < .001), attention problems (P < .001), and the DBD Inattention (P < .001). Children who have Apert syndrome had lower FSIQs (M = 76.7; SD = 13.3) and children who have Muenke syndrome had more social problems (P < .01), attention problems (P < .05), and inattention problems (P < .01) than normative population and with other diagnostic subgroups. Although children who have syndromic craniosynostosis have FSIQs similar to the normative population, they are at increased risk for developing intellectual disability, internalizing, social, and attention problems. Higher levels of behavioral and emotional problems were related to lower levels of intellectual functioning.

Transboundary environmental assessment: lessons from OTAG. The Ozone Transport Assessment Group.

PubMed

Farrell, Alexander E; Keating, Terry J

2002-06-15

The nature and role of assessments in creating policy for transboundary environmental problems is discussed. Transboundary environmental problems are particularly difficult to deal with because they typically require cooperation among independent political jurisdictions (e.g., states or nations) which face differing costs and benefits and which often have different technical capabilities and different interests. In particular, transboundary pollution issues generally involve the problem of an upstream source and a downstream receptor on opposite sides of a relevant political boundary, making it difficult for the jurisdiction containing the receptor to obtain relief from the pollution problem. The Ozone Transport Assessment Group (OTAG) addressed such a transboundary problem: the long-range transport of tropospheric ozone (i.e., photochemical smog) across the eastern United States. The evolution of the science and policy that led to OTAG, the OTAG process, and its outcomes are presented. Lessons that are available to be learned from the OTAG experience, particularly for addressing similar transboundary problems such as regional haze, are discussed.

SYNTHESIS REPORT ON FIVE DENSE, NONAQUEOUS-PHASE LIQUID (DNAPL) REMEDIATION PROJECTS

EPA Science Inventory

Dense non-aqueous phase liquid (DNAPL) poses a difficult problem for subsurface remediation because it serves as a continuing source to dissolved phase ground water contamination and is difficult to remove from interstitial pore space or bedrock fractures in the subsurface. Numer...

Diagnosis of severe developmental disorders in children under three years of age.

PubMed

Markiewicz, Katarzyna; Pachalska, Maria

2007-02-01

Autism, intellectual disability, and specific language impairment (SLI) constitute three important forms of developmental disability that are often mistaken for each other, especially in very young children (under age 4). Diagnostic problems are caused by the fact that a fundamental problem in cognition, language, or behavior has secondary effects on the remaining areas, which makes it difficult to separate cause from effect. A wrong or absent diagnosis can be a major hindrance in providing properly targeted therapy for developmentally disabled children. From a population of 667 children referred to a specialized outpatient clinic for developmentally disabled children, we identified 35 children in whom the fundamental diagnosis of autism, intellectual disability, or SLI was unambiguous, and then analyzed these children's scores on 7 subtests from the Munich Functional Developmental Diagnosis, in order to identify specific features of each of the three syndromes. The most reliable differentiating factor in our research group proved to be the MFDD subtest for self-reliance. A model was constructed to assist in analyzing the complex interactions of symptoms, which frequently overlap. Cognitive and communicative limitations resulting from underlying perceptual dysfunctions can lead to inappropriate adaptive behavior in children with developmental disorders, such as autism, intellectual disability, and specific language impairment. Each of these syndromes has a specific profile in respect to measures of cognitive function, social skills, and verbal communication.

Building confidence and credibility into CAD with belief decision trees

NASA Astrophysics Data System (ADS)

Affenit, Rachael N.; Barns, Erik R.; Furst, Jacob D.; Rasin, Alexander; Raicu, Daniela S.

2017-03-01

Creating classifiers for computer-aided diagnosis in the absence of ground truth is a challenging problem. Using experts' opinions as reference truth is difficult because the variability in the experts' interpretations introduces uncertainty in the labeled diagnostic data. This uncertainty translates into noise, which can significantly affect the performance of any classifier on test data. To address this problem, we propose a new label set weighting approach to combine the experts' interpretations and their variability, as well as a selective iterative classification (SIC) approach that is based on conformal prediction. Using the NIH/NCI Lung Image Database Consortium (LIDC) dataset in which four radiologists interpreted the lung nodule characteristics, including the degree of malignancy, we illustrate the benefits of the proposed approach. Our results show that the proposed 2-label-weighted approach significantly outperforms the accuracy of the original 5- label and 2-label-unweighted classification approaches by 39.9% and 7.6%, respectively. We also found that the weighted 2-label models produce higher skewness values by 1.05 and 0.61 for non-SIC and SIC respectively on root mean square error (RMSE) distributions. When each approach was combined with selective iterative classification, this further improved the accuracy of classification for the 2-weighted-label by 7.5% over the original, and improved the skewness of the 5-label and 2-unweighted-label by 0.22 and 0.44 respectively.

Evaluation of latex agglutination test (KAtex) for early diagnosis of kala-azar.

PubMed

Ahsan, M M; Islam, M N; Mollah, A H; Hoque, M A; Hossain, M A; Begum, Z; Islam, M T

2010-07-01

Kala-azar is one of the major public health problem in Bangladesh. But the diagnosis of the problem often is difficult, unusual and time consuming, a simple, noninvasive, easy to perform, reliable and rapid diagnostic test has been a long-felt need of the clinicians. Therefore, the present study was conducted to see the sensitivity and specificity of Latex Agglutination test (KAtex) to detect leishmanial antigen from urine of kala-azar cases. The study was carried out in the department of Paediatrics, Mymensingh Medical College and Hospital, Bangladesh during July to December, 2008. A total of 100 urine samples were collected of which 50 were confirmed kala-azar cases and 50 were age and sex matched controls. Out of 50 kala-azar cases 47 showed positive result of KAtex. The test was also positive in 01 out of 30 healthy controls. None of the febrile controls was positive by KAtex. The sensitivity, specificity, positive predictive value and negative predictive value of the test using presence of LD bodies in splenic and/or bone marrow aspirate as gold standard were 94%, 98%, 97.91% and 94.23% respectively. KAtex is simple, noninvasive, easy to perform, rapid and reliable test for diagnosing kala-azar in endemic area and useful for small, less equipped laboratories as well as for the laboratories with better facilities.

A Diagnostic Assessment of Evolutionary Multiobjective Optimization for Water Resources Systems

NASA Astrophysics Data System (ADS)

Reed, P.; Hadka, D.; Herman, J.; Kasprzyk, J.; Kollat, J.

2012-04-01

This study contributes a rigorous diagnostic assessment of state-of-the-art multiobjective evolutionary algorithms (MOEAs) and highlights key advances that the water resources field can exploit to better discover the critical tradeoffs constraining our systems. This study provides the most comprehensive diagnostic assessment of MOEAs for water resources to date, exploiting more than 100,000 MOEA runs and trillions of design evaluations. The diagnostic assessment measures the effectiveness, efficiency, reliability, and controllability of ten benchmark MOEAs for a representative suite of water resources applications addressing rainfall-runoff calibration, long-term groundwater monitoring (LTM), and risk-based water supply portfolio planning. The suite of problems encompasses a range of challenging problem properties including (1) many-objective formulations with 4 or more objectives, (2) multi-modality (or false optima), (3) nonlinearity, (4) discreteness, (5) severe constraints, (6) stochastic objectives, and (7) non-separability (also called epistasis). The applications are representative of the dominant problem classes that have shaped the history of MOEAs in water resources and that will be dominant foci in the future. Recommendations are provided for which modern MOEAs should serve as tools and benchmarks in the future water resources literature.

Histopathological diagnosis of acral lentiginous melanoma in early stages.

PubMed

Fernandez-Flores, Angel; Cassarino, David S

2017-02-01

Acral lentiginous melanoma is a rare variant of melanoma that is associated with a relatively low survival rate. The latter is partly due to the advanced stage in which the tumor is usually diagnosed. The diagnostic delay is mainly due to difficulties in identifying the very early histopathological signs of acral melanoma. The current article is a review of diagnostic clues, concepts, and definitions from the literature, as well as illustrating examples from our own archives. We have sought to provide an article that can be easily consulted in difficult cases of acral lentiginous melanoma. Copyright © 2016 Elsevier Inc. All rights reserved.

[Situational diagnostic of an evaluation process of professional perfomance].

PubMed

Gonçalves, Vera Lúcia Mira; Leite, Maria Madalena Januário

2004-01-01

The aim of this study was to realize a diagnostic situational about the evaluation process of the nursing team performance of USP Hospital. Based in two guiding questions, it was carried out 9 interviews with nurses of this hospital. These interviews were analyzed according Analyze of Contend. The most frequent themes were: The meaning of evaluation; the feelings; the difficulties and facilities concerning the instrument and the capacitacion. This experience brought about many feelings, as well as aspects that either favor or make the execution of the evaluation difficult, showing the principal points of vulnerability of the process and, therefore, deserving better attention and short-term intervention.

Psychology Problem Classification for Children and Youth.

ERIC Educational Resources Information Center

Minnesota Systems Research, Inc., Washington, DC.

The development of Psychology Problem Classification is an early step in the direction of providing a uniform nomenclature for classifying the needs and problems of children and youth. There are many potential uses for a diagnostic classification and coding system. The two most important uses for the practitioner are problem identification and…

An Extension of Holographic Moiré to Micromechanics

NASA Astrophysics Data System (ADS)

Sciammarella, C. A.; Sciammarella, F. M.

The electronic Holographic Moiré is an ideal tool for micromechanics studies. It does not require a modification of the surface by the introduction of a reference grating. This is of particular advantage when dealing with materials such as solid propellant grains whose chemical nature and surface finish makes the application of a reference grating very difficult. Traditional electronic Holographic Moiré presents some difficult problems when large magnifications are needed and large rigid body motion takes place. This paper presents developments that solves these problems and extends the application of the technique to micromechanics.

Diagnosis of Celiac Disease: Taking a Bite Out of the Controversy.

PubMed

Turner, Justine M

2018-06-01

Celiac disease is a common autoimmune disorder of the small intestine, triggered by an immunological response to the gluten present in wheat, barley, and rye in individuals who are genetically at risk. A key to reducing the complications of this disease is early diagnosis, preferably in childhood, and consuming a lifelong gluten-free diet once diagnosis is confirmed. Yet, the diagnosis of celiac disease is often considerably delayed, exposing patients to needless suffering and morbidity. It is also difficult to confirm histologically if dietary gluten has been restricted prior to obtaining a diagnostic biopsy, a significant problem given the current growing popularity of gluten-free diets. Furthermore, failure to understand or follow current guidelines means physicians may recommend patients commence the gluten-free diet before initiating referral to a gastroenterologist. Finally, adding further confusion, pediatric guidelines in Europe support a diagnosis based on serology rather than on histology, whereas those based in North America do not. The purpose of this review is to discuss these issues and other controversies in the diagnosis of celiac disease and to consider ways to optimize diagnosis across the lifespan.

Review: The use of bull breeding soundness evaluation to identify subfertile and infertile bulls.

PubMed

Barth, A D

2018-06-01

Efficient and economical herd management depends a great deal on maintaining a short, well-defined calving season. This requires highly fertile females and bulls. Low pregnancy rates are very noticeable, however; potentially greater economic loss may be due to delayed conception. Many studies showed that approximately one of every five bulls had inadequate semen quality, physical soundness, or both, but when evaluation of serving capacity is included about one in four bulls is unsatisfactory. Due mainly to the time and expense that the market will bear, usually only physical soundness and semen quality are evaluated. Breeding soundness evaluation is a useful, low-cost screening method for reducing the risk of using low fertility bulls. The biggest problem with breeding soundness evaluations is not our lack of knowledge or ability, but in the willingness of veterinary schools to provide adequate equipment and training in this area, a lack of diagnostic laboratories equipped to handle the more difficult cases and, most importantly, the weaknesses of human nature that result in negligent testing procedure.

Air travel and the risk of thromboembolism.

PubMed

Gavish, Israel; Brenner, Benjamin

2011-04-01

Almost two billion people use commercial aircraft annually. Long-haul flights are taken by over 300 million people. A serious complication of long-distance travel (or prolonged time of flight) is thromboembolism. The real incidence of the problem is difficult to evaluate since there is no consensus about the diagnostic tests or limitation of time after landing connected to the VTE complication. A direct relation between VTE incidence and long-distance flights has been documented. The risk for DVT is 3-12% in a long-haul flight. The pathophysiologic changes that increase VTE risk at flight are stasis (sitting in crowded condition), hypoxia in the airplane cabin, and dehydration. Individual risk factors for air travel-related VTE include age over 40 years, gender (female), women who use oral contraceptives, varicose veins in lower limbs, obesity and genetic thrombophilia. Prevention measures include environmental protection such as keeping the pressure inside the airplane cabinet in hypobaric condition, avoiding dehydration and prolonged sitting. For individuals at increased risk, venous blood stasis can be reduced by wearing elastic stockings and prophylactic use of low-molecular-weight heparin.

Postdeployment symptom changes and traumatic brain injury and/or posttraumatic stress disorder in men.

PubMed

Macera, Caroline A; Aralis, Hilary J; Macgregor, Andrew J; Rauh, Mitchell J; Galarneau, Michael R

2012-01-01

In Operation Iraqi Freedom and Operation Enduring Freedom, blast-related injuries associated with combat are frequent and can result in traumatic brain injury (TBI) symptoms that may be difficult to distinguish from psychological problems. Using data from the Post-Deployment Health Assessment and Reassessment, we identified 12,046 male U.S. Navy sailors and Marines with reported combat exposure from 2008 to 2009. Symptoms potentially associated with blast-related TBI and posttraumatic stress disorder (PTSD) that were reported immediately after deployment were compared with symptoms present several months later. Our study supports others that have found that subjects with blast-related injuries may experience the development or worsening of symptoms during the months following deployment. Additionally, our study found that those who screened positive for PTSD and TBI formed a unique group, with the presence of TBI exacerbating development of PTSD symptoms at reassessment. Providers should recognize the late development of symptoms, consider the possibility of comorbidity, and be prepared to treat multiple symptoms rather than a specific diagnostic category.

Coronal Diagnostics of Intermediate Activity Star XI Boo A

NASA Technical Reports Server (NTRS)

Drake, Jeremy

2005-01-01

The analysis of Xi Boo A proved difficult to adapt to our line-by-line approach because of the strong wings of the RGS instrumental profile, as has been detailed in earlier reports. While progress was also delayed because of problems in using SAS v4, we succeeded in the past year or so to bring the analysis to conclusion. Abundances have been derived using both EPIC and RGS data, confirming earlier EUVE findings of a mild solar-like FIP effect, though with some evidence of a turn-up in abundances of elements with higher FIP. Plasma densities appear normal for a moderately active stellar corona. Xi Boo A nicely bridges the gap between the very active stars and stars like the Sun, and it indeed does appear that these are the stars in which the solar-like FIP effects begins to change to the "inverse FIP" type of effect seen in the very active stars. Probing this divide was the main goal of the proposal. These results are in the process of being prepared for publication, though we have not decided the target journal as yet.

Microbial Etiology of Pneumonia: Epidemiology, Diagnosis and Resistance Patterns.

PubMed

Cilloniz, Catia; Martin-Loeches, Ignacio; Garcia-Vidal, Carolina; San Jose, Alicia; Torres, Antoni

2016-12-16

Globally, pneumonia is a serious public health concern and a major cause of mortality and morbidity. Despite advances in antimicrobial therapies, microbiological diagnostic tests and prevention measures, pneumonia remains the main cause of death from infectious disease in the world. An important reason for the increased global mortality is the impact of pneumonia on chronic diseases, along with the increasing age of the population and the virulence factors of the causative microorganism. The increasing number of multidrug-resistant bacteria, difficult-to-treat microorganisms, and the emergence of new pathogens are a major problem for clinicians when deciding antimicrobial therapy. A key factor for managing and effectively guiding appropriate antimicrobial therapy is an understanding of the role of the different causative microorganisms in the etiology of pneumonia, since it has been shown that the adequacy of initial antimicrobial therapy is a key factor for prognosis in pneumonia. Furthermore, broad-spectrum antibiotic therapies are sometimes given until microbiological results are available and de-escalation cannot be performed quickly. This review provides an overview of microbial etiology, resistance patterns, epidemiology and microbial diagnosis of pneumonia.

Assessment of Hepatic Fibrosis with the Stiffness of Liver and the Dynamic of Blood in Liver

NASA Astrophysics Data System (ADS)

Chen, Hao; Ye, Lihong; Li, Zhenyan; Jiang, Yi

Cirrhosis affects liver functions, and is a significant public health problem. Early stages of liver fibrosis are difficult to diagnose. The mechanism of fibrosis changing the mechanical properties of the liver tissue and altering the dynamic of blood flow is still unclear. In collaboration with clinicians specialized in hepatic fibrosis, we have developed a mechanical model to integrate our empirical understanding of fibrosis development and connect the fibrosis stage to mechanical properties of tissue and the consequential blood flow pattern changes. We modeled toxin distribution in the liver that leads to tissue damage and collagen deposition. We showed that the excessive collagen forms polygonal patterns, resembling those found in pathology images. Treating the collagen bundles as elastic spring networks, we also showed a nonlinear relationship between liver stiffness and fibrosis stage, which is consistent with experimental observations. We further modeled the stiffness affecting the mechanical properties of the portal veins, resulting in altered blood flow pattern. These results are supported by ultrasound Doppler measurements from hepatic fibrosis patients. These results promise a new noninvasive diagnostic tool for early fibrosis.

Clinical aspects of the Mayo/IBM PACS project

NASA Astrophysics Data System (ADS)

Forbes, Glenn S.; Morin, Richard L.; Pavlicek, William

1991-07-01

A joint project between Mayo Clinic and IBM to develop a picture archival and communications system has been under development for three years. This project began as a potential solution to a pressing archival problem in magnetic resonance imaging. The project has grown to encompass a much larger sphere of activity including workstations, image retrieval, and report archival. This report focuses on the clinical aspects involved in the design, development, and implementation of such a system. In particular, emphasis is placed on the clinical impact of the system both inside and outside of the radiology department. The primary concerns have centered on fidelity of archival data, ease of use, and diagnostic efficacy. The project to date has been limited to neuroradiology practice. This group consists of nine staff radiologists and fellows. Administrative policy decisions regarding the accessibility and available of digital data in the clinical environment have been much more difficult and complex than originally conceived. Based on the observations thus far, the authors believe the system will become a useful and valuable adjunct to clinical practice of radiology.

The dumbest mistake I ever made.

PubMed

Reichman, O Howard

2015-01-01

Life as a Neurological Surgeon is a foreboding responsibility and a gratifying opportunity. Having the confidence and trust of individuals faced with a life or death situation requires extensive training and experience. Curiosity provides the motivation to continuously seek better understanding of complex disease problems, better technology, improved diagnostic capability, and surgical skills. Solution of these challenges has been a constant process for several decades and continues to pose opportunities for progress. Early observation of results provides important information, but in many circumstances it may require long-term evaluation to fully document the benefit, or lack of benefit, for any treatment procedure. The focus of attention by the Neurological Surgeon must be on the proper immediate management of each given situation, but it is also important, and a responsibility to consider the long-term consequences or results. This presents a difficult challenge because patients move into distant places and Neurological Surgeons frequently move to accept new opportunities. It is expensive and cumbersome to retain records for many years. It is also unpredictable which patient's information will become particularly significant. It is an opportunity to describe experience with four patients to illustrate this dilemma.

[Allergy to cosmetics. I. Fragrances].

PubMed

Kieć-Swierczyńska, Marta; Krecisz, Beata; Swierczyńska-Machura, Dominika

2004-01-01

The authors report current information on allergy to aromatic agents present in cosmetics and products of household chemistry. In the perfume industry, about 3000 aromas are used. Single products may contain from 10 to 300 compounds. The problem of difficulties encountered in the diagnosis of hypersensitivity to odors is addressed. The mixture of 8 such products used in diagnostic screening is able to detect allergy only in about 30% of patients who do not tolerate cosmetics. Changing frequency of allergy to individual aromas is discussed. It has been now observed that cinnamon products are less allergic than chemical compounds present in oak moss. Since the 1990s of the last century, allergy to a synthetic aromatic agent, Lyral is the subject of interest in many research centers involved in studies of contact allergy. Half the cosmetics present in European markets, especially deodorants, after shave cosmetics, hand and body lotions contain this agent. It induces positive reactions in about 10% of patients allergic to aromatic agents. Detection of allergy to Lyral is difficult as it is not included in the set of commercial allergens used to diagnose hypersensitivity to aromatic agents.

Auditory Processing Disorder (For Parents)

MedlinePlus

... or other speech-language difficulties? Are verbal (word) math problems difficult for your child? Is your child ... inferences from conversations, understanding riddles, or comprehending verbal math problems — require heightened auditory processing and language levels. ...

White Paper: Movement System Diagnoses in Neurologic Physical Therapy.

PubMed

Hedman, Lois D; Quinn, Lori; Gill-Body, Kathleen; Brown, David A; Quiben, Myla; Riley, Nora; Scheets, Patricia L

2018-04-01

The APTA recently established a vision for physical therapists to transform society by optimizing movement to promote health and wellness, mitigate impairments, and prevent disability. An important element of this vision entails the integration of the movement system into the profession, and necessitates the development of movement system diagnoses by physical therapists. At this point in time, the profession as a whole has not agreed upon diagnostic classifications or guidelines to assist in developing movement system diagnoses that will consistently capture an individual's movement problems. We propose that, going forward, diagnostic classifications of movement system problems need to be developed, tested, and validated. The Academy of Neurologic Physical Therapy's Movement System Task Force was convened to address these issues with respect to management of movement system problems in patients with neurologic conditions. The purpose of this article is to report on the work and recommendations of the Task Force. The Task Force identified 4 essential elements necessary to develop and implement movement system diagnoses for patients with primarily neurologic involvement from existing movement system classifications. The Task Force considered the potential impact of using movement system diagnoses on clinical practice, education and, research. Recommendations were developed and provided recommendations for potential next steps to broaden this discussion and foster the development of movement system diagnostic classifications. The Task Force proposes that diagnostic classifications of movement system problems need to be developed, tested, and validated with the long-range goal to reach consensus on and adoption of a movement system diagnostic framework for clients with neurologic injury or disease states.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A198).

Metacognition: Student Reflections on Problem Solving

ERIC Educational Resources Information Center

Wismath, Shelly; Orr, Doug; Good, Brandon

2014-01-01

Twenty-first century teaching and learning focus on the fundamental skills of critical thinking and problem solving, creativity and innovation, and collaboration and communication. Metacognition is a crucial aspect of both problem solving and critical thinking, but it is often difficult to get students to engage in authentic metacognitive…

Beyond Utility Targeting: Toward Axiological Air Operations

DTIC Science & Technology

2000-01-01

encounter the leader- sociopath , bereft of values, quite willing to live underground in hiding and in- sensitive to the absence of human comforts...that is a mere one thousand value-analysis problems to begin solving. A more difficult problem to solve is the problem of the leader- sociopath

Diagnosing Borderline Personality Disorder: Examination of How Clinical Indicators Are Used by Professionals in the Health Setting

ERIC Educational Resources Information Center

Treloar, Amanda Jane Commons; Lewis, Andrew J.

2009-01-01

This paper reviews the history of the recognition of borderline personality disorder as a clinical disorder, followed by a review of the contemporary practice of diagnosing borderline personality disorder in psychiatric settings. Many researchers have cautioned against the conflation of difficult patients with the diagnostic category of borderline…

Anticholinesterase-Responsive Weakness in the Canine Similar to Myasthenia Gravis of Man.

DTIC Science & Technology

1976-01-01

eyelids, ears , and facial fea- subcutaneous injection of 2 mg of atropine. A tures .18’21 ’25 Difficult prehension~ dysphagia , chok- evident within...acological t esting is very diagnostic but Ia, ’ weakness was noticed at the same t imenot witIu ~u t hazard . Ant icholines lerase given to a . esophageal

Development of an Interactive Mathematics Learning System Based on a Two-Tier Test Diagnostic and Guiding Strategy

ERIC Educational Resources Information Center

Yang, Tzu-Chi; Fu, Hseng-Tz; Hwang, Gwo-Jen; Yang, Stephen J. H.

2017-01-01

Mathematical skills have been recognised as a core competence for engineering and science students. However, learning mathematics has been recognised as a difficult and challenging task for most students, in particular, calculus for first-year students in university. Consequently, the development of effective learning strategies and environments…

Assessment of Language Impairment in Bilingual Children Using Semantic Tasks: Two Languages Classify Better than One

ERIC Educational Resources Information Center

Peña, Elizabeth D.; Bedore, Lisa M.; Kester, Ellen S.

2016-01-01

Background: Significant progress has been made in the identification of language impairment in children are bilingual. Bilingual children's vocabulary knowledge may be distributed across languages. Thus, when testing bilingual children it is difficult to know how to weigh each language for diagnostic purposes. Even when conceptual scoring is used…

Autism Profiles of Males With Fragile X Syndrome

ERIC Educational Resources Information Center

Harris, Susan W.; Hessl, David; Goodlin-Jones, Beth; Ferranti, Jessica; Bacalman, Susan; Barbato, Ingrid; Tassone, Flora; Hagerman, Paul J.; Herman, Kristin; Hagerman, Randi J.

2008-01-01

Autism, which is common in individuals with fragile X syndrome, is often difficult to diagnose. We compared the diagnostic classifications of two measures for autism diagnosis, the ADOS and the ADI-R, in addition to the DSM-IV-TR in 63 males with this syndrome. Overall, 30% of the subjects met criteria for autistic disorder and 30% met criteria…

42 CFR 410.33 - Independent diagnostic testing facility.

Code of Federal Regulations, 2011 CFR

2011-10-01

... problem and who uses the results in the management of the beneficiary's specific medical problem... the results in the management of the beneficiary's specific medical problem. Nonphysician... SERVICES MEDICARE PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS Medical and Other Health Services...

Early developmental characteristics and features of major depressive disorder among child psychiatric patients in Hungary.

PubMed

Kapornai, Krisztina; Gentzler, Amy L; Tepper, Ping; Kiss, Eniko; Mayer, László; Tamás, Zsuzsanna; Kovacs, Maria; Vetró, Agnes

2007-06-01

We investigate the relations of early atypical characteristics (perinatal problems, developmental delay, and difficult temperament) and onset-age (as well as severity of) first major depressive disorder (MDD) and first internalizing disorder in a clinical sample of depressed children in Hungary. Participants were 371 children (ages 7-14) with MDD, and their biological mothers, recruited through multiple clinical sites. Diagnoses (via DSM-IV criteria) and onset dates of disorders were finalized "best estimate" psychiatrists, and based on multiple information sources. Mothers provided developmental data in a structured interview. Difficult temperament predicted earlier onset of MDD and first internalizing disorder, but its effect was ameliorated if the family was intact during early childhood. Further, the importance of difficult temperament decreased as a function of time. Perinatal problems and developmental delay did not impact onset ages of disorders, and none of the early childhood characteristics associated with MDD episode severity. Children with MDD may have added disadvantage of earlier onset if they had a difficult temperament in infancy. Because early temperament mirrors physiological reactivity and regulatory capacity, it can affect various areas of functioning related to psychopathology. Early caregiver stability may attenuate some adverse effects of difficult infant temperament.

Using Predictor-Corrector Methods in Numerical Solutions to Mathematical Problems of Motion

ERIC Educational Resources Information Center

Lewis, Jerome

2005-01-01

In this paper, the author looks at some classic problems in mathematics that involve motion in the plane. Many case problems like these are difficult and beyond the mathematical skills of most undergraduates, but computational approaches often require less insight into the subtleties of the problems and can be used to obtain reliable solutions.…

Nanoparticles for Imaging: Top or Flop?

PubMed Central

Mertens, Marianne E.; Grimm, Jan; Lammers, Twan

2014-01-01

Nanoparticles are frequently suggested as diagnostic agents. However, except for iron oxide nanoparticles, diagnostic nanoparticles have been barely incorporated into clinical use so far. This is predominantly due to difficulties in achieving acceptable pharmacokinetic properties and reproducible particle uniformity as well as to concerns about toxicity, biodegradation, and elimination. Reasonable indications for the clinical utilization of nanoparticles should consider their biologic behavior. For example, many nanoparticles are taken up by macrophages and accumulate in macrophage-rich tissues. Thus, they can be used to provide contrast in liver, spleen, lymph nodes, and inflammatory lesions (eg, atherosclerotic plaques). Furthermore, cells can be efficiently labeled with nanoparticles, enabling the localization of implanted (stem) cells and tissue-engineered grafts as well as in vivo migration studies of cells. The potential of using nanoparticles for molecular imaging is compromised because their pharmacokinetic properties are difficult to control. Ideal targets for nanoparticles are localized on the endothelial luminal surface, whereas targeted nanoparticle delivery to extravascular structures is often limited and difficult to separate from an underlying enhanced permeability and retention (EPR) effect. The majority of clinically used nanoparticle-based drug delivery systems are based on the EPR effect, and, for their more personalized use, imaging markers can be incorporated to monitor biodistribution, target site accumulation, drug release, and treatment efficacy. In conclusion, although nanoparticles are not always the right choice for molecular imaging (because smaller or larger molecules might provide more specific information), there are other diagnostic and theranostic applications for which nanoparticles hold substantial clinical potential. PMID:25247562

Evaluating laboratory approaches to the identification of lupus anticoagulants: a diagnostic challenge from the RCPA Haematology QAP.

PubMed

Bonar, Roslyn; Favaloro, Emmanuel; Zebeljan, Diane; Rosenfeld, David; Kershaw, Geoff; Mohammed, Soma; Marsden, Katherine; Hertzberg, Mark

2012-04-01

Laboratory identification of lupus anticoagulants (LA), an important component of the clinical diagnosis of the autoimmune disorder antiphospholipid syndrome (APS), is challenged by the heterogeneity of tests available, the diagnostic and laboratory approach undertaken, and the heterogeneity of the autoantibodies present. : To assess the laboratory approach for investigation of LA, as well as the utility of various tests and test approaches, given a difficult clinical scenario in which LA might or might not be present. Ninety-three participants in the Royal College of Pathologists of Australasia (RCPA) Haematology Quality Assurance Program (QAP) were sent 4  mL of a complex but strongly positive LA sample blinded to the nature of the abnormality. Seventy-three (79%) participants returned results and in most cases diagnostic interpretations. The laboratory approach to LA investigation of this sample was quite varied: 34.7% of participants concluded the sample was LA negative, with 91.7% of these performing dilute Russell viper venom time (dRVVT) testing without mixing, whereas 43.5% of participants identified a strong LA, with 96.7% of these having performed mixing studies. Most laboratories reporting negative LA instead identified the false presence of specific factor inhibitors against a variety of factors, including II, V and VIII. For this difficult challenge, performance of non-mixing dRVVT was associated with a high false negative LA rate. (C) 2012 Royal College of Pathologists of Australasia.

The Buffer Diagnostic Prototype: A fault isolation application using CLIPS

NASA Technical Reports Server (NTRS)

Porter, Ken

1994-01-01

This paper describes problem domain characteristics and development experiences from using CLIPS 6.0 in a proof-of-concept troubleshooting application called the Buffer Diagnostic Prototype. The problem domain is a large digital communications subsystems called the real-time network (RTN), which was designed to upgrade the launch processing system used for shuttle support at KSC. The RTN enables up to 255 computers to share 50,000 data points with millisecond response times. The RTN's extensive built-in test capability but lack of any automatic fault isolation capability presents a unique opportunity for a diagnostic expert system application. The Buffer Diagnostic Prototype addresses RTN diagnosis with a multiple strategy approach. A novel technique called 'faulty causality' employs inexact qualitative models to process test results. Experimental knowledge provides a capability to recognize symptom-fault associations. The implementation utilizes rule-based and procedural programming techniques, including a goal-directed control structure and simple text-based generic user interface that may be reusable for other rapid prototyping applications. Although limited in scope, this project demonstrates a diagnostic approach that may be adapted to troubleshoot a broad range of equipment.

Endoscopic ultrasound-guided transesophageal thoracentesis for minimal pleural effusion.

PubMed

Rana, Surinder Singh; Sharma, Ravi; Gupta, Rajesh

2018-06-19

Pleural effusion is a common finding both in patients with benign and malignant diseases of pleura and lung with diagnostic thoracentesis establishing the diagnosis in the majority of cases. The diagnostic thoracentesis can be done either blindly or under the guidance of ultrasound or computed tomography. However, minimal pleural effusion is difficult to sample even under image guidance. Endoscopic ultrasound (EUS) is known to detect smaller volume of pleural effusion and, thus, can help in guiding thoracentesis. To analyze the safety and efficacy of EUS-guided diagnostic thoracentesis in patients with undiagnosed minimal pleural effusion retrospectively. Retrospective analysis of the data of patients with minimal pleural effusion, who underwent EUS-guided transesophageal diagnostic thoracentesis over last 2 years, was performed. Thirteen patients (11 male; mean age 46.7 ± 16.2 years) with undiagnosed minimal pleural effusion underwent successful EUS-guided transesophageal diagnostic thoracentesis using a 22-G needle. Seven (53%) patients had fever on presentation whereas two presented with cough and loss of appetite. Eight to 54 mL fluid was aspirated with an attempt to completely empty the pleural cavity. There were no complications of the procedure. EUS-guided diagnostic thoracentesis is a safe and effective alternative for evaluating patients with minimal pleural effusion.

Molecular Diagnostics in Transfusion Medicine: In Capillary, on a Chip, in Silico, or in Flight?

PubMed Central

Garritsen, Henk S.P.; Xiu-Cheng Fan, Alex; Lenz, Daniela; Hannig, Horst; Yan Zhong, Xiao; Geffers, Robert; Lindenmaier, Werner; Dittmar, Kurt E.J.; Wörmann, Bernhard

2009-01-01

Summary Serology, defined as antibody-based diagnostics, has been regarded as the diagnostic gold standard in transfusion medicine. Nowadays however the impact of molecular diagnostics in transfusion medicine is rapidly growing. Molecular diagnostics can improve tissue typing (HLA typing), increase safety of blood products (NAT testing of infectious diseases), and enable blood group typing in difficult situations (after transfusion of blood products or prenatal non-invasive RhD typing). Most of the molecular testing involves the determination of the presence of single nucleotide polymorphisms (SNPs). Antigens (e.g. blood group antigens) mostly result from single nucleotide differences in critical positions. However, most blood group systems cannot be determined by looking at a single SNP. To identify members of a blood group system a number of critical SNPs have to be taken into account. The platforms which are currently used to perform molecular diagnostics are mostly gel-based, requiring time-consuming multiple manual steps. To implement molecular methods in transfusion medicine in the future the development of higher-throughput SNP genotyping non-gel-based platforms which allow a rapid, cost-effective screening are essential. Because of its potential for automation, high throughput and cost effectiveness the special focus of this paper is a relative new technique: SNP genotyping by MALDI-TOF MS analysis. PMID:21113259

New diagnostic perspectives on obsessive-compulsive personality disorder and its links with other conditions.

PubMed

Starcevic, Vladan; Brakoulias, Vlasios

2014-01-01

This review examines the conceptualization of obsessive-compulsive personality disorder (OCPD), its epidemiology and efforts to better understand the relationships between OCPD and other conditions. The alternative Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders conceptualization of OCPD is radically different in that it combines categorical and dimensional diagnostic approaches and introduces a hierarchy of diagnostic criteria. OCPD is one of the most common personality disorders in the general population. The relationship between OCPD and obsessive-compulsive disorder (OCD) is important, but to a large extent obfuscated by the overlap between their diagnostic criteria. Frequent changes in the OCPD diagnostic criteria make it difficult to ascertain the 'true' relationship between OCPD and OCD. It is not uncommon for OCPD to occur with anorexia nervosa, depression, hypochondriasis, certain other personality disorders and Parkinson's disease, but further research is necessary to understand the implications of these links. OCPD is yet to be conceptualized consistently and in the manner that would make a clear and well supported distinction between its core and peripheral features. Future studies need to separate a genuine from overlap-driven co-occurrence of OCPD and other conditions, as that would give a better insight into the way in which OCPD relates to other disorders.

Benchmarking Gas Path Diagnostic Methods: A Public Approach

NASA Technical Reports Server (NTRS)

Simon, Donald L.; Bird, Jeff; Davison, Craig; Volponi, Al; Iverson, R. Eugene

2008-01-01

Recent technology reviews have identified the need for objective assessments of engine health management (EHM) technology. The need is two-fold: technology developers require relevant data and problems to design and validate new algorithms and techniques while engine system integrators and operators need practical tools to direct development and then evaluate the effectiveness of proposed solutions. This paper presents a publicly available gas path diagnostic benchmark problem that has been developed by the Propulsion and Power Systems Panel of The Technical Cooperation Program (TTCP) to help address these needs. The problem is coded in MATLAB (The MathWorks, Inc.) and coupled with a non-linear turbofan engine simulation to produce "snap-shot" measurements, with relevant noise levels, as if collected from a fleet of engines over their lifetime of use. Each engine within the fleet will experience unique operating and deterioration profiles, and may encounter randomly occurring relevant gas path faults including sensor, actuator and component faults. The challenge to the EHM community is to develop gas path diagnostic algorithms to reliably perform fault detection and isolation. An example solution to the benchmark problem is provided along with associated evaluation metrics. A plan is presented to disseminate this benchmark problem to the engine health management technical community and invite technology solutions.

Automated System of Diagnostic Monitoring at Bureya HPP Hydraulic Engineering Installations: a New Level of Safety

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

Musyurka, A. V., E-mail: musyurkaav@burges.rushydro.ru

This article presents the design, hardware, and software solutions developed and placed in service for the automated system of diagnostic monitoring (ASDM) for hydraulic engineering installations at the Bureya HPP, and assuring a reliable process for monitoring hydraulic engineering installations. Project implementation represents a timely solution of problems addressed by the hydraulic engineering installation diagnostics section.

Monitoring Affect States during Effortful Problem Solving Activities

ERIC Educational Resources Information Center

D'Mello, Sidney K.; Lehman, Blair; Person, Natalie

2010-01-01

We explored the affective states that students experienced during effortful problem solving activities. We conducted a study where 41 students solved difficult analytical reasoning problems from the Law School Admission Test. Students viewed videos of their faces and screen captures and judged their emotions from a set of 14 states (basic…

Home Economics Reading Skills: Problems and Selected References.

ERIC Educational Resources Information Center

Cranney, A. Garr; And Others

Home economics presents at least eight problems to secondary school reading teachers. These problems include poor readers, difficult reading material, lack of reading materials, teachers' lack of training in reading instruction, scarce information about home economics for reading teachers, diversity of the home economics field (requiring a wide…

A Fiducial Approach to Extremes and Multiple Comparisons

ERIC Educational Resources Information Center

Wandler, Damian V.

2010-01-01

Generalized fiducial inference is a powerful tool for many difficult problems. Based on an extension of R. A. Fisher's work, we used generalized fiducial inference for two extreme value problems and a multiple comparison procedure. The first extreme value problem is dealing with the generalized Pareto distribution. The generalized Pareto…

Students' and Teachers' Conceptual Metaphors for Mathematical Problem Solving

ERIC Educational Resources Information Center

Yee, Sean P.

2017-01-01

Metaphors are regularly used by mathematics teachers to relate difficult or complex concepts in classrooms. A complex topic of concern in mathematics education, and most STEM-based education classes, is problem solving. This study identified how students and teachers contextualize mathematical problem solving through their choice of metaphors.…

Cognitive Development, Genetics Problem Solving, and Genetics Instruction: A Critical Review.

ERIC Educational Resources Information Center

Smith, Mike U.; Sims, O. Suthern, Jr.

1992-01-01

Review of literature concerning problem solving in genetics and Piagetian stage theory. Authors conclude the research suggests that formal-operational thought is not strictly required for the solution of the majority of classical genetics problems; however, some genetic concepts are difficult for concrete operational students to understand.…

Component-Level Electronic-Assembly Repair (CLEAR) Analysis of the Problem Reporting and Corrective Action (PRACA) Database of the International Space Station On-Orbit Electrical Systems

NASA Technical Reports Server (NTRS)

Oeftering, Richard C.; Bradish, Martin A.; Juergens, Jeffrey R.; Lewis, Michael J.

2011-01-01

The NASA Constellation Program is investigating and developing technologies to support human exploration of the Moon and Mars. The Component-Level Electronic-Assembly Repair (CLEAR) task is part of the Supportability Project managed by the Exploration Technology Development Program. CLEAR is aimed at enabling a flight crew to diagnose and repair electronic circuits in space yet minimize logistics spares, equipment, and crew time and training. For insight into actual space repair needs, in early 2008 the project examined the operational experience of the International Space Station (ISS) program. CLEAR examined the ISS on-orbit Problem Reporting and Corrective Action database for electrical and electronic system problems. The ISS has higher than predicted reliability yet, as expected, it has persistent problems. A goal was to identify which on-orbit electrical problems could be resolved by a component-level replacement. A further goal was to identify problems that could benefit from the additional diagnostic and test capability that a component-level repair capability could provide. The study indicated that many problems stem from a small set of root causes that also represent distinct component problems. The study also determined that there are certain recurring problems where the current telemetry instrumentation and built-in tests are unable to completely resolve the problem. As a result, the root cause is listed as unknown. Overall, roughly 42 percent of on-orbit electrical problems on ISS could be addressed with a component-level repair. Furthermore, 63 percent of on-orbit electrical problems on ISS could benefit from additional external diagnostic and test capability. These results indicate that in situ component-level repair in combination with diagnostic and test capability can be expected to increase system availability and reduce logistics. The CLEAR approach can increase the flight crew s ability to act decisively to resolve problems while reducing dependency on Earth-supplied logistics for future Constellation Program missions.

Labour Market Policies.

ERIC Educational Resources Information Center

Danielsen, Reidar

Skilled labor has always been difficult to recruit, and in a tight labor market unskilled, low-paying jobs with low status are also difficult to fill. Recruitment from outside seems necessary to satisfy demands, but migration creates at least as many problems as it solves. The consumption of theoretical training through the university level (a…

Professional Support for Families in Difficult Life Situations

ERIC Educational Resources Information Center

Zakirova, Venera G.; Gaysina, Guzel I.; Raykova, Elena

2016-01-01

Relevance of the problem stated in the article is determined by the presence of a significant number of families in difficult life situations who need in professional support and socio-psychological assistance. The article aims to substantiate the effectiveness of the structural-functional model of professional supporting for families in difficult…

End of the Day.

ERIC Educational Resources Information Center

Worth-Baker, Marcia

2000-01-01

Describes one seventh grade teacher's experiences with a student from a problem home who was known for his difficult behavior, noting the student's deep interest in the Trojan War and its circumstances, describing his death at age 16, and concluding that it is important to notice and cherish all students, even the difficult ones. (SM)

Nonoperative management of acute spontaneous renal artery dissection.

PubMed

Ramamoorthy, Sonia L; Vasquez, Julio C; Taft, Peter M; McGinn, Robert F; Hye, Robert J

2002-03-01

Isolated spontaneous renal artery dissection is a rare condition that can result in renal parenchymal loss and severe hypertension. Although several risk factors have been identified in association with renal artery dissection, the natural history is not well defined. The rarity and nonspecific presentation of the disease often lead to diagnostic delay. That, coupled with the anatomic limitations imposed by dissection into small branch arteries, frequently precludes successful revascularization. Over a 12-month period, four cases of spontaneous renal artery dissection (SRAD) were treated at a single institution. The patients (ages 44-58 years) presented with acute onset of abdominal/flank pain, fever, and hematuria. Diagnostic work-up included an abdominal CT scan revealing segmental renal infarction. Angiographic evaluation was diagnostic for renal artery dissection in all cases. In one case there was evidence of fibromuscular dysplasia (FMD), and in a second there was acute dissection superimposed upon atherosclerotic disease. Diagnosis was made within 12-72 hr of the onset of symptoms. All patients were managed expectantly with anticoagulation. Two patients were known to have a history of hypertension prior to admission. All four patients have required antihypertensive treatment following dissection, but the condition has been easily controlled. Renal function has remained stable in all cases. None of the four cases required exploration. Two of the four patients underwent repeat angiographic evaluation for recurrent symptoms of pain. In the case of the patient with FMD, a new dissection was seen in the contralateral renal artery, and in the second, repeat angiogram revealed proximal remodeling of the dissected artery. Management strategies for SRAD include surgical revascularization, endovascular intervention, and observation with or without anticoagulation. The available literature does not demonstrate a clear benefit of treatment with any of these modalities. In the short term, the combination of anticoagulation and expectant management appears to produce satisfactory outcomes for this difficult problem.

Functional reasoning in diagnostic problem solving

NASA Technical Reports Server (NTRS)

Sticklen, Jon; Bond, W. E.; Stclair, D. C.

1988-01-01

This work is one facet of an integrated approach to diagnostic problem solving for aircraft and space systems currently under development. The authors are applying a method of modeling and reasoning about deep knowledge based on a functional viewpoint. The approach recognizes a level of device understanding which is intermediate between a compiled level of typical Expert Systems, and a deep level at which large-scale device behavior is derived from known properties of device structure and component behavior. At this intermediate functional level, a device is modeled in three steps. First, a component decomposition of the device is defined. Second, the functionality of each device/subdevice is abstractly identified. Third, the state sequences which implement each function are specified. Given a functional representation and a set of initial conditions, the functional reasoner acts as a consequence finder. The output of the consequence finder can be utilized in diagnostic problem solving. The paper also discussed ways in which this functional approach may find application in the aerospace field.

Android based self-diagnostic electrocardiogram system for mobile healthcare.

PubMed

Choo, Kan-Yeep; Ling, Huo-Chong; Lo, Yew-Chiong; Yap, Zuo-Han; Pua, Jun-Sheng; Phan, Raphael C-W; Goh, Vik-Tor

2015-01-01

Cardiovascular diseases are the most common cause of death worldwide and are characterized by arrhythmia (i.e. irregular rhythm of heartbeat). Arrhythmia occasionally happens under certain conditions, such as stress. Therefore, it is difficult to be diagnosed using electrocardiogram (ECG) devices available in hospitals for just a few minutes. Constant diagnosis and monitoring of heartbeat is required to reduce death caused by cardiovascular diseases. Mobile healthcare system has emerged as a potential solution to assist patients in monitoring their own heart condition, especially those who are isolated from the reference hospital. This paper proposes a self-diagnostic electrocardiogram system for mobile healthcare that has the capability to perform a real-time ECG diagnostic. The self-diagnostic capability of a real-time ECG signal is achieved by implementing a detrended fluctuation analysis (DFA) method. The result obtained from DFA is used to display the patient's health condition on a smartphone anytime and anywhere. If the health condition is critical, the system will alert the patient and his medical practitioner for further diagnosis. Experimental results verified the validity of the developed ECG diagnostic application on a smartphone. The proposed system can potentially reduce death caused by cardiovascular diseases by alerting the patient possibly undergoing a heart attack.

Combined evaluation of commonly used techniques, including PCR, for diagnosis of mouse fur mites.

PubMed

Karlsson, Eleanor M; Pearson, Laura M; Kuzma, Kristen M; Burkholder, Tanya H

2014-01-01

Our study evaluated and compared the false-negative rates (FNR) of a wide array of fur-mite diagnostic tests, including 2 postmortem tests (pelt exam and sticky paper) and 3 antemortem tests (adhesive tape, fur pluck, and PCR). Past publications examining fur-mite diagnostic techniques primarily used paired comparisons, evaluating tests by their level of agreement with only one other test. However, different combinations or pairs of diagnostics are used in the different studies, making the results of these comparisons difficult to interpret across all available diagnostics. In the current study, mice from a conventionally maintained colony endemic for Myobia musculi were identified as positive based on at least one positive diagnostic test. From this pool of positive animals, the FNR of all tests were quantified. The PCR assay and the pelt exam performed the best, with 0% and 2% FNR respectively, whereas tape, fur-pluck, and sticky-paper tests showed 24%, 26%, and 36% FNR, respectively. Our study shows that for mice in a colony naturally infested with Myobia musculi, PCR testing can be used for reliable antemortem detection, and pelt exam performed by experienced examiners is reliable for postmortem detection.

NMESys: An expert system for network fault detection

NASA Technical Reports Server (NTRS)

Nelson, Peter C.; Warpinski, Janet

1991-01-01

The problem of network management is becoming an increasingly difficult and challenging task. It is very common today to find heterogeneous networks consisting of many different types of computers, operating systems, and protocols. The complexity of implementing a network with this many components is difficult enough, while the maintenance of such a network is an even larger problem. A prototype network management expert system, NMESys, implemented in the C Language Integrated Production System (CLIPS). NMESys concentrates on solving some of the critical problems encountered in managing a large network. The major goal of NMESys is to provide a network operator with an expert system tool to quickly and accurately detect hard failures, potential failures, and to minimize or eliminate user down time in a large network.

Formal methods technology transfer: Some lessons learned

NASA Technical Reports Server (NTRS)

Hamilton, David

1992-01-01

IBM has a long history in the application of formal methods to software development and verification. There have been many successes in the development of methods, tools and training to support formal methods. And formal methods have been very successful on several projects. However, the use of formal methods has not been as widespread as hoped. This presentation summarizes several approaches that have been taken to encourage more widespread use of formal methods, and discusses the results so far. The basic problem is one of technology transfer, which is a very difficult problem. It is even more difficult for formal methods. General problems of technology transfer, especially the transfer of formal methods technology, are also discussed. Finally, some prospects for the future are mentioned.

The analysis method of the DRAM cell pattern hotspot

NASA Astrophysics Data System (ADS)

Lee, Kyusun; Lee, Kweonjae; Chang, Jinman; Kim, Taeheon; Han, Daehan; Hong, Aeran; Kim, Yonghyeon; Kang, Jinyoung; Choi, Bumjin; Lee, Joosung; Lee, Jooyoung; Hong, Hyeongsun; Lee, Kyupil; Jin, Gyoyoung

2015-03-01

It is increasingly difficult to determine degree of completion of the patterning and the distribution at the DRAM Cell Patterns. When we research DRAM Device Cell Pattern, there are three big problems currently, it is as follows. First, due to etch loading, it is difficult to predict the potential defect. Second, due to under layer topology, it is impossible to demonstrate the influence of the hotspot. Finally, it is extremely difficult to predict final ACI pattern by the photo simulation, because current patterning process is double patterning technology which means photo pattern is completely different from final etch pattern. Therefore, if the hotspot occurs in wafer, it is very difficult to find it. CD-SEM is the most common pattern measurement tool in semiconductor fabrication site. CD-SEM is used to accurately measure small region of wafer pattern primarily. Therefore, there is no possibility of finding places where unpredictable defect occurs. Even though, "Current Defect detector" can measure a wide area, every chip has same pattern issue, the detector cannot detect critical hotspots. Because defect detecting algorithm of bright field machine is based on image processing, if same problems occur on compared and comparing chip, the machine cannot identify it. Moreover this instrument is not distinguished the difference of distribution about 1nm~3nm. So, "Defect detector" is difficult to handle the data for potential weak point far lower than target CD. In order to solve those problems, another method is needed. In this paper, we introduce the analysis method of the DRAM Cell Pattern Hotspot.

Clinical Problem Analysis (CPA): A Systematic Approach To Teaching Complex Medical Problem Solving.

ERIC Educational Resources Information Center

Custers, Eugene J. F. M.; Robbe, Peter F. De Vries; Stuyt, Paul M. J.

2000-01-01

Discusses clinical problem analysis (CPA) in medical education, an approach to solving complex clinical problems. Outlines the five step CPA model and examines the value of CPA's content-independent (methodical) approach. Argues that teaching students to use CPA will enable them to avoid common diagnostic reasoning errors and pitfalls. Compares…

Social Work Problem Classification for Children and Youth.

ERIC Educational Resources Information Center

Minnesota Systems Research, Inc., Washington, DC.

The development of the Social Work Problem Classification is an early step in the provision of a uniform nomenclature for classifying the needs and problems of children and youth. There are many potential uses for a diagnostic classification and coding system. The two most important for the practitioner are: (1) problem identification and…

Diagnostic methods for insect sting allergy.

PubMed

Hamilton, Robert G

2004-08-01

This review overviews advances from mid-2002 to the present in the validation and performance methods used in the diagnosis of Hymenoptera venom-induced immediate-type hypersensitivity. The general diagnostic algorithm for insect sting allergy is initially discussed with an examination of the AAAAI's 2003 revised practice parameter guidelines. Changes as a result of a greater recognition of skin test negative systemic reactors include repeat analysis of all testing and acceptance of serology as a complementary diagnostic test to the skin test. Original data examining concordance of venom-specific IgE results produced by the second-generation Pharmacia CAP System with the Johns Hopkins University radioallergosorbent test are presented. Diagnostic performance of honeybee venom-specific IgE assays used in clinical laboratories in North America is discussed using data from the Diagnostic Allergy Proficiency Survey conducted by the College of American Pathologists. Validity of venom-specific IgE antibody in postmortem blood specimens is demonstrated. The utility of alternative in-vivo (provocation) and in-vitro (basophil-based) diagnostic testing methods is critiqued. This overview supports the following conclusions. Improved practice parameter guidelines include serology and skin test as complementary in supporting a positive clinical history during the diagnostic process. Data are provided which support the analytical performance of commercially available venom-specific IgE antibody serology-based assays. Intentional sting challenge in-vivo provocation, in-vitro basophil flow cytometry (CD63, CD203c) based assays, and in-vitro basophil histamine and sulfidoleukotriene release assays have their utility in the study of difficult diagnostic cases, but their use will remain as supplementary, secondary diagnostic tests.

Diagnosis of gastrointestinal stromal tumors from minute specimens: cytomorphology, immunohistochemistry, and molecular diagnostic findings.

PubMed

Layfield, Lester J; Wallander, Michelle L

2012-06-01

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal neoplasm arising from the gastrointestinal tract. Workup of these lesions includes morphologic study and immunohistochemical and often molecular diagnostic analysis. Historically, these neoplasms had been included under a number of diagnostic categories including leiomyoma, leiomyosarcoma, schwannoma, and leiomyoblastoma. The lesions that were clearly sarcomatous were difficult to treat and therapeutically refractory to chemotherapeutic agents. Significant progress in our understanding of these neoplasms and our ability to successfully treat them occurred following the discovery that they were immunoreactive for KIT protein and harbored activating mutations in the KIT gene. Many are initially diagnosed by fine-needle aspiration (FNA) but workup may include mutational analysis to help direct therapy. This review outlines a practical approach to the cytologic diagnosis of GISTs and their molecular workup on small specimens obtained by FNA or core biopsy. Copyright © 2012 Wiley Periodicals, Inc.

Economic Considerations for Moving beyond the Kato-Katz Technique for Diagnosing Intestinal Parasites As We Move Towards Elimination.

PubMed

Turner, Hugo C; Bettis, Alison A; Dunn, Julia C; Whitton, Jane M; Hollingsworth, T Déirdre; Fleming, Fiona M; Anderson, Roy M

2017-06-01

While the need for more sensitive diagnostics for intestinal helminths is well known, the cost of developing and implementing new tests is considered relatively high compared to the Kato-Katz technique. Here, we review the reported costs of performing the Kato-Katz technique. We also outline several economic arguments we believe highlight the need for further investment in alternative diagnostics, and considerations that should be made when comparing their costs. In our opinion, we highlight that, without new diagnostic methods, it will be difficult for policy makers to make the most cost-effective decisions and that the potentially higher unit costs of new methods can be outweighed by the long-term programmatic benefits they have (such as the ability to detect the interruption of transmission). Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Principles and applications of polymerase chain reaction in medical diagnostic fields: a review

PubMed Central

Valones, Marcela Agne Alves; Guimarães, Rafael Lima; Brandão, Lucas André Cavalcanti; de Souza, Paulo Roberto Eleutério; de Albuquerque Tavares Carvalho, Alessandra; Crovela, Sergio

2009-01-01

Recent developments in molecular methods have revolutionized the detection and characterization of microorganisms in a broad range of medical diagnostic fields, including virology, mycology, parasitology, microbiology and dentistry. Among these methods, Polymerase Chain Reaction (PCR) has generated great benefits and allowed scientific advancements. PCR is an excellent technique for the rapid detection of pathogens, including those difficult to culture. Along with conventional PCR techniques, Real-Time PCR has emerged as a technological innovation and is playing an ever-increasing role in clinical diagnostics and research laboratories. Due to its capacity to generate both qualitative and quantitative results, Real-Time PCR is considered a fast and accurate platform. The aim of the present literature review is to explore the clinical usefulness and potential of both conventional PCR and Real-Time PCR assays in diverse medical fields, addressing its main uses and advances. PMID:24031310

The value and validation of broad spectrum biosensors for diagnosis and biodefense

PubMed Central

Metzgar, David; Sampath, Rangarajan; Rounds, Megan A; Ecker, David J

2013-01-01

Broad spectrum biosensors capable of identifying diverse organisms are transitioning from the realm of research into the clinic. These technologies simultaneously capture signals from a wide variety of biological entities using universal processes. Specific organisms are then identified through bioinformatic signature-matching processes. This is in contrast to currently accepted molecular diagnostic technologies, which utilize unique reagents and processes to detect each organism of interest. This paradigm shift greatly increases the breadth of molecular diagnostic tools with little increase in biochemical complexity, enabling simultaneous diagnostic, epidemiologic, and biothreat surveillance capabilities at the point of care. This, in turn, offers the promise of increased biosecurity and better antimicrobial stewardship. Efficient realization of these potential gains will require novel regulatory paradigms reflective of the generalized, information-based nature of these assays, allowing extension of empirical data obtained from readily available organisms to support broader reporting of rare, difficult to culture, or extremely hazardous organisms. PMID:24128433

Pancreatic neuroendocrine neoplasms: a current summary of diagnostic, prognostic, and differential diagnostic information.

PubMed

Wick, M R; Graeme-Cook, F M

2001-06-01

Pancreatic endocrine tumors (PETs) continue to be challenging diagnostic and prognostic lesions in surgical pathology and clinical medicine. These neoplasms can be graded into 1 of 3 tiers, based on histologic characteristics in likeness to epithelial neuroendocrine tumors in other anatomic sites. However, grade 1 tumors are by far the most common and are the most difficult to prognosticate. The most helpful features by which to gauge the behavior of such lesions include size (3 cm or larger); mitotic activity (2 or more mitoses per 10 high-power [x400] microscopic fields); marked nuclear atypia, especially with atypical mitoticfigures; predominant tumor synthesis of gastrin, vasoactive intestinal polypeptide, somatostatin, glucagon, calcitonin, or adrenocorticotropic hormone; complete nonfunctionality of the tumor at an immunohistochemical level; or invasion of blood vessels, nerves, or adjacent organs by the neoplasm. Differential diagnosis of PETs includes lesions such as solid-pseudopapillary neoplasms, acinar carcinomas, metastatic neuroendocrine tumors, and plasmacytomas.

Diagnostic Approach to Ocular Toxoplasmosis

PubMed Central

Garweg, Justus G; de Groot-Mijnes, Jolanda DF; Montoya, Jose G

2011-01-01

Toxoplasmic retinochoroiditis is deemed a local event, which may fail to evoke a detectable systemic immune response. A correct diagnosis of the disease is a necessary basis for estimating its clinical burden. This is not so difficult in a typical clinical picture. In atypical cases, further diagnostic efforts are to be installed. Although the aqueous humor may be analyzed for specific antibodies or the presence of parasitic DNA, the DNA burden therein is low, and in rare instances a confirmation would necessitate vitreous sampling. A laboratory confirmation of the diagnosis is frustrated by individual differences in the time elapsing between clinical symptoms and activation of specific antibody production, which may result in false negatives. In congenital ocular toxoplasmosis, a delay in the onset of specific local antibody production could reflect immune tolerance. Herein, the authors attempt to provide a simple and practicable algorithm for a clinically tailored diagnostic approach in atypical instances. PMID:21770803

Malaria, a difficult diagnosis in a febrile patient with sub-microscopic parasitaemia and polyclonal lymphocyte activation outside the endemic region, in Brazil

PubMed Central

2013-01-01

A case of autochthonous Plasmodium vivax malaria with sub-microscopic parasitaemia and polyclonal B-cell activation (PBA) (as reflected by positive IgM and IgG serology for toxoplasmosis, cytomegalovirus, and antinuclear and rheumatoid factors) was diagnosed by polymerase chain reaction (PCR) after consecutive negative rapid diagnostic test results and blood films. The patient, a 44-year-old man from Rio de Janeiro state, Brazil, had visited the Atlantic Forest, a tourist, non-malaria-endemic area where no autochthonous cases of ’bromeliad malaria‘ has ever been described. The characteristic pattern of fever, associated with PBA, was the clue to malaria diagnosis, despite consecutive negative thick blood smears. The study highlights a need for changes in clinical and laboratory diagnostic approaches, namely the incorporation of PCR as part of the current routine malaria diagnostic methods in non-endemic areas. PMID:24200365

Dental radiology.

PubMed

Woodward, Tony M

2009-02-01

Dental radiology is the core diagnostic modality of veterinary dentistry. Dental radiographs assist in detecting hidden painful pathology, estimating the severity of dental conditions, assessing treatment options, providing intraoperative guidance, and also serve to monitor success of prior treatments. Unfortunately, most professional veterinary training programs provide little or no training in veterinary dentistry in general or dental radiology in particular. Although a technical learning curve does exist, the techniques required for producing diagnostic films are not difficult to master. Regular use of dental x-rays will increase the amount of pathology detected, leading to healthier patients and happier clients who notice a difference in how their pet feels. This article covers equipment and materials needed to produce diagnostic intraoral dental films. A simplified guide for positioning will be presented, including a positioning "cheat sheet" to be placed next to the dental x-ray machine in the operatory. Additionally, digital dental radiograph systems will be described and trends for their future discussed.

Interesting and unusual clinical presentations in leprosy at a referral center.

PubMed

Tayshetye, Pritam U; Pai, Vivek V; Khanolkar, Subhash A; Rathod, Vikram; Ganapati, Ramaswamy

2013-10-01

Leprosy is a disease of declining global endemicity but is still an important health-care problem in India. Pure neural leprosy is an important subset of presentations of leprosy in India. Leprosy is a known disease of the skin and nerves, but cases of pure neural involvement are relatively less. We hereby present 10 cases of pure neural leprosy in which the diagnosis of leprosy was difficult with routine methods. The study was conducted at the main referral center and satellite clinics of our organization. A retrospective analysis of patient records for the last four years was undertaken to identify patients presenting with predominantly neurological manifestations and uncommon presentations including those without skin lesions. The medical records of the patients were used as source of data. All the patients were subjected to a detailed clinical examination and bacteriological examination with slit-skin smears. Investigations like nerve biopsy, electromyography, and nerve conduction studies were done in patients with diagnostic difficulties. Patients presented with neurological symptoms like paresthesias (60%), diminished sensations (40%), nonhealing ulcers (30%), and blisters (20%). All except one had thickened nerves on clinical examination. Slit-skin smear was negative in all but one patient. Nerve biopsy confirmed the diagnosis of leprosy in seven cases. Pure neural leprosy is difficult to diagnose with routine methods. The diagnosis should be considered, especially by neurologists and dermatologists, who are more likely to see such patients with predominant neural manifestations. The diagnosis should be confirmed with nerve biopsy to prevent delay in therapy and associated complications.

Plasma process control with optical emission spectroscopy

NASA Astrophysics Data System (ADS)

Ward, P. P.

Plasma processes for cleaning, etching and desmear of electronic components and printed wiring boards (PWB) are difficult to predict and control. Non-uniformity of most plasma processes and sensitivity to environmental changes make it difficult to maintain process stability from day to day. To assure plasma process performance, weight loss coupons or post-plasma destructive testing must be used. The problem with these techniques is that they are not real-time methods and do not allow for immediate diagnosis and process correction. These methods often require scrapping some fraction of a batch to insure the integrity of the rest. Since these methods verify a successful cycle with post-plasma diagnostics, poor test results often determine that a batch is substandard and the resulting parts unusable. Both of these methods are a costly part of the overall fabrication cost. A more efficient method of testing would allow for constant monitoring of plasma conditions and process control. Process failures should be detected before the parts being treated. are damaged. Real time monitoring would allow for instantaneous corrections. Multiple site monitoring would allow for process mapping within one system or simultaneous monitoring of multiple systems. Optical emission spectroscopy conducted external to the plasma apparatus would allow for this sort of multifunctional analysis without perturbing the glow discharge. In this paper, optical emission spectroscopy for non-intrusive, in situ process control will be explored. A discussion of this technique as it applies towards process control, failure analysis and endpoint determination will be conducted. Methods for identifying process failures, progress and end of etch back and desmear processes will be discussed.

Automated Bus Diagnostic System Demonstration in New York City

DOT National Transportation Integrated Search

1983-12-01

In response to a growing problem with the quality and efficiency of nationwide bus maintenance practices, an award was granted to the Tri-State Regional Planning Commission for the testing of an automated bus diagnostic system (ABDS). The ABDS was de...

A Systems Approach to Diagnostic Prescriptive Instruction.

ERIC Educational Resources Information Center

Kozma, Robert B.; And Others

This five-part document presents three approaches to research on instructional improvement, with the final two sections concentrating on problems and implications for diagnostic prescriptive instruction. Part 1 reviews comparative instructional effectiveness studies. Part 2 discusses the Trait-Treatment Interaction Approach (TTI) which is…

An Assessment of the Effect of Collaborative Groups on Students' Problem-Solving Strategies and Abilities

ERIC Educational Resources Information Center

Cooper, Melanie M.; Cox, Charles T., Jr.; Nammouz, Minory; Case, Edward; Stevens, Ronald

2008-01-01

Improving students' problem-solving skills is a major goal for most science educators. While a large body of research on problem solving exists, assessment of meaningful problem solving is very difficult, particularly for courses with large numbers of students in which one-on-one interactions are not feasible. We have used a suite of software…

Solving Classical Insight Problems without Aha! Experience: 9 Dot, 8 Coin, and Matchstick Arithmetic Problems

ERIC Educational Resources Information Center

Danek, Amory H.; Wiley, Jennifer; Öllinger, Michael

2016-01-01

Insightful problem solving is a vital part of human thinking, yet very difficult to grasp. Traditionally, insight has been investigated by using a set of established "insight tasks," assuming that insight has taken place if these problems are solved. Instead of assuming that insight takes place during every solution of the 9 Dot, 8 Coin,…

[The Spanish translation of the Manual of Diagnostic Tests and Vaccines for Terrestrial Animals: current and future solutions].

PubMed

Díez, F Gutiérrez; León, F Crespo

2004-12-01

This article presents some of the problems that arose when preparing the Spanish translation of the Manual of Diagnostic Tests and Vaccines for Terrestrial Animals of the World Organisation for Animal Health (OIE). It contains a list of the language and translation problems encountered and the solutions that were found, some of which are only provisional. The problems are in part due to the lack of a multi-lingual terminological database approved by the OIE. The need for such a database, as well as for the harmonisation of veterinary terminology by the OIE Steering Committee and the Ad hoc Group on language policy, is discussed.

Solving Constraint Satisfaction Problems with Networks of Spiking Neurons

PubMed Central

Jonke, Zeno; Habenschuss, Stefan; Maass, Wolfgang

2016-01-01

Network of neurons in the brain apply—unlike processors in our current generation of computer hardware—an event-based processing strategy, where short pulses (spikes) are emitted sparsely by neurons to signal the occurrence of an event at a particular point in time. Such spike-based computations promise to be substantially more power-efficient than traditional clocked processing schemes. However, it turns out to be surprisingly difficult to design networks of spiking neurons that can solve difficult computational problems on the level of single spikes, rather than rates of spikes. We present here a new method for designing networks of spiking neurons via an energy function. Furthermore, we show how the energy function of a network of stochastically firing neurons can be shaped in a transparent manner by composing the networks of simple stereotypical network motifs. We show that this design approach enables networks of spiking neurons to produce approximate solutions to difficult (NP-hard) constraint satisfaction problems from the domains of planning/optimization and verification/logical inference. The resulting networks employ noise as a computational resource. Nevertheless, the timing of spikes plays an essential role in their computations. Furthermore, networks of spiking neurons carry out for the Traveling Salesman Problem a more efficient stochastic search for good solutions compared with stochastic artificial neural networks (Boltzmann machines) and Gibbs sampling. PMID:27065785

MICROBIAL SOURCE TRACKING

EPA Science Inventory

Fecal contamination of waters used for recreation, drinking water, and aquaculture is an environmental problem and poses significant human health risks. The problem is often difficult to correct because the source of the contamination cannot be determined with certainty. Run-of...

Evolving neural networks for strategic decision-making problems.

PubMed

Kohl, Nate; Miikkulainen, Risto

2009-04-01

Evolution of neural networks, or neuroevolution, has been a successful approach to many low-level control problems such as pole balancing, vehicle control, and collision warning. However, certain types of problems-such as those involving strategic decision-making-have remained difficult for neuroevolution to solve. This paper evaluates the hypothesis that such problems are difficult because they are fractured: The correct action varies discontinuously as the agent moves from state to state. A method for measuring fracture using the concept of function variation is proposed and, based on this concept, two methods for dealing with fracture are examined: neurons with local receptive fields, and refinement based on a cascaded network architecture. Experiments in several benchmark domains are performed to evaluate how different levels of fracture affect the performance of neuroevolution methods, demonstrating that these two modifications improve performance significantly. These results form a promising starting point for expanding neuroevolution to strategic tasks.

Municipalities' Priority Problems and Prospect of Establishing Ordinance to Measures for Marginal Hamlets

NASA Astrophysics Data System (ADS)

Nakanishi, Mayumi; Hoshino, Satoshi; Hashimoto, Shizuka; Kuki, Yasuaki

The problems of Marginal Hamlets are getting worse, in which more than half of the population is over 65 and community-based life is difficult. To contribute to effective policy making, we conducted a questionnaire survey to members of the National Liaison Council of ‘Suigen no Sato’ constituted to share information about problems and effective counter measures for marginal hamlets. Our study clarified that first, most of respondents had common problems such as lack of job-opportunities and animal damage on farm, and second, though most of respondents recognized the effectiveness of selecting target communities in policy implementations, it is difficult for municipal governments to establish such ordinance provided that councilors and those who were not living in areas of policy target wouldn't agree with it. Finally, we pointed out the roles of national and prefectural governments to help municipal governments effectively cope with such entangled situations.

Usefulness and diagnostic value of the NEMA parameter combined with other selected bedside tests for prediction of difficult intubation.

PubMed

Torres, Kamil; Błoński, Marcin; Pietrzyk, Łukasz; Piasecka-Twaróg, Małgorzata; Maciejewski, Ryszard; Torres, Anna

2017-02-01

To assess the usefulness of the new NEMA (Neck Circumference Minus Acromion-Acromion Distance) parameter, in preoperative identification of patients' difficult intubation and compare it with other commonly used scales and tests. Prospective study. District Specialist Hospital of Lublin, Poland. Six hundreds twenty-nine patients underwent nonemergency surgical interventions. The NEMA parameter was confronted with: Modified Mallampati classification, TMD, RHTMD, NC, MPND, SMD, I-I D, A-AD, and medical history of difficult intubation and diagnosed obstructive sleep apnea syndrome or snoring. Higher medians of NEMA and Mallampati parameters were reported in patients with difficult intubation. AUC for Mallampati parameter was 0.733 while the NEMA parameter's AUC was 0.625. Sensitivity and specificity for Mallampati and NEMA parameter were respectively 0.79; 0.55 and 0.42; 0.75. Significantly higher MPN, RHTMD, Mallampati, and NEMA parameter were observed in patients in whom the BURP was used. Easy intubation occurs more frequently in patients with a history of OSAS or snoring than in those with difficult intubation. It seems that none of the known bedside tests for predicting difficult intubation have a discriminating power sufficient for clinicians. Our study draws attention to a novel parameter, called NEMA, which appears to be a strong predictor of DEI, especially in combination with the Mallampati scale. Copyright © 2016 Elsevier Inc. All rights reserved.

Multiple concurrent bilateral groin hernias in a single patient; a case report and a review of uncommon groin hernias: A possible source of persistent pain after successful repair.

PubMed

Matsevych, O Y; Koto, M Z; Becker, J H R

2016-01-01

The wide use of laparoscopy for groin hernia repair has unveiled "hidden hernias" silently residing in this area. During the open repair of the presenting hernia, the surgeon was often unaware of these occult hernias. These patients postoperatively may present with unexplained chronic groin or pelvic pain. Rare groin hernias are defined according to their anatomical position. Challenges in the diagnosis and management of occult rare groin hernias are discussed. These problems are illustrated by a unique case report of multiple (six) coexisting groin hernias, whereof five were occult and two were rare. Rare groin hernias are uncommon because they are difficult to diagnose clinically and are not routinely looked for. They are often occult and may coexist with other inguinal hernias, thus posing a diagnostic and treatment challenge to the surgeon, especially if there is persistent groin pain after "successful" repair. MRI is the most accurate preoperative and postoperative diagnostic tool, if there is a clinical suspicion that the patient might have an occult hernia. Preperitoneal endoscopic approach is the recommended method in confirming the diagnosis and management of occult groin hernias. A sound knowledge of groin anatomy and a thorough preperitoneal inspection of all possible sites for rare groin hernias are needed to diagnose and repair all defects. The preperitoneal mesh repair with adequate overlap of all hernia orifices is the recommended treatment of choice. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Velocity Space Degrees of Freedom of Plasma Fluctuations

NASA Astrophysics Data System (ADS)

Mattingly, Sean

2017-10-01

Small scale wave modes are becoming more important in plasma physics. Examples include turbulent cascades in the solar wind, the energetics of fusion plasma electrostatic turbulence and transport, and low temperature basic plasma physics experiments. In order to improve our understanding of these modes, I present an advance in experimental plasma diagnostics and use it to show the first measurement of a plasma ion velocity-space cross-correlation matrix. From this matrix I determine the eigenmodes of fluctuations on the ion distribution function as a function of frequency. I also determine the relative strengths of these modes - these are the velocity space degrees of freedom of plasma fluctuations. This measurement can detect the aforementioned smaller scale modes in plasmas through a localized measurement. The locality of this measurement means that it may be applied to plasmas in which a single - point velocity sensitive diagnostic is available and multipoint measurements may be difficult. Examples include in situ measurements of space plasmas, fusion plasmas, trapped plasmas, and laser cooled plasmas. This fact, combined with the new perspective it can give on small scale plasma fluctuations, means it may be used to further research on the above cited subjects. Much work remains on fully understanding this measurement. This measurement opens a velocity space interpretation of small scale plasma wave modes, and understanding this perspective from theory requires the application or invention of new mathematical tools. I discuss open problems to follow up on, which include questions from experimental, theoretical, and instrumentation perspectives. NSF-DOE Program Grant DE-FG02-99ER54543.

Lichenoid reaction to carbamazepine in the oral mucosa: case report.

PubMed

Artico, Gabriela; Bruno, Ingrid S; Seo, Juliana; Hirota, Silvio K; Acay, Renata; Migliari, Dante A

2011-01-01

Lichenoid drug reactions are more common in skin, but they may also occur in the oral mucosa. It is difficult to diagnose these lesions due to their clinical similarity to the idiopathic oral lichen planus lesions. The present article reports a case of lichenoid reaction in oral mucosa associated to the use of carbamazepine, emphasizing the diagnostic process.

Evaluating Secondary Students' Scientific Reasoning in Genetics Using a Two-Tier Diagnostic Instrument

ERIC Educational Resources Information Center

Tsui, Chi-Yan; Treagust, David

2010-01-01

While genetics has remained as one key topic in school science, it continues to be conceptually and linguistically difficult for students with the concomitant debates as to what should be taught in the age of biotechnology. This article documents the development and implementation of a two-tier multiple-choice instrument for diagnosing grades 10…

Otogenic Meningitis: A Comparison of Diagnostic Performance of Surgery and Radiology.

PubMed

Bruschini, Luca; Fortunato, Simona; Tascini, Carlo; Ciabotti, Annalisa; Leonildi, Alessandro; Bini, Belinda; Giuliano, Simone; Abbruzzese, Arturo; Berrettini, Stefano; Menichetti, Francesco

2017-01-01

Development of intracranial complications from middle ear infections might be difficult to diagnose. We compared radiological and surgical findings of 26 patients affected by otogenic meningitis. Results of our analysis showed that surgery is more reliable than imaging in revealing bone defects. Therefore, suggest that surgery be performed for diagnosis and eventual management of all cases of suspected otogenic meningitis.

[Functional (psychogenic) vertigo].

PubMed

Diukova, G M; Zamergrad, M V; Golubev, V L; Adilova, S M; Makarov, S A

Psychogenic (functional) vertigo is in second place by frequency after benign positional paroxysmal vertigo. It is often difficult to make the diagnosis, diagnostic program is expensive and traditional treatment often is not effective. This literature review covers current concepts on the terminology, clinical signs, pathogenesis and treatment approaches with regard to functional vertigo. Special attention is given to cerebral mechanisms of the pathogenesis including cognitive aspects.

Multi-Tasking Non-Destructive Laser Technology in Conservation Diagnostic Procedures

NASA Astrophysics Data System (ADS)

Tornari, V.; Tsiranidou, E.; Orphanos, Y.; Falldorf, C.; Klattenhof, R.; Esposito, E.; Agnani, A.; Dabu, R.; Stratan, A.; Anastassopoulos, A.; Schipper, D.; Hasperhoven, J.; Stefanaggi, M.; Bonnici, H.; Ursu, D.

Laser metrology provides techniques that have been successfully applied in industrial structural diagnostic fields but have not yet been refined and optimised for the special investigative requirements found in cultural heritage applications. A major impediment is the partial applicability of various optical coherent techniques, each one narrowing its use down to a specific application. This characteristic is not well suited for a field that encounters a great variety of diagnostic problems ranging from movable, multiple-composition museum objects, to immovable multi-layered wall paintings, statues and wood carvings, to monumental constructions and outdoor cultural heritage sites. Various diagnostic techniques have been suggested and are uniquely suited for each of the mentioned problems but it is this fragmented suitability that obstructs the technology transfer. Since optical coherent techniques for metrology are based on fundamental principles and take advantage of similar procedures for generation of informative signals for data collection, then the imposed limits elevate our aim to identify complementary capabilities to accomplish the needed functionality.

Fast and Efficient Discrimination of Traveling Salesperson Problem Stimulus Difficulty

ERIC Educational Resources Information Center

Dry, Matthew J.; Fontaine, Elizabeth L.

2014-01-01

The Traveling Salesperson Problem (TSP) is a computationally difficult combinatorial optimization problem. In spite of its relative difficulty, human solvers are able to generate close-to-optimal solutions in a close-to-linear time frame, and it has been suggested that this is due to the visual system's inherent sensitivity to certain geometric…

The Problem Solving Studio: An Apprenticeship Environment for Aspiring Engineers

ERIC Educational Resources Information Center

Le Doux, Joseph M.; Waller, Alisha A.

2016-01-01

This paper describes the problem-solving studio (PSS) learning environment. PSS was designed to teach students how to solve difficult analytical engineering problems without resorting to rote memorization of algorithms, while at the same time developing their deep conceptual understanding of the course topics. There are several key features of…

The Software Problem.

ERIC Educational Resources Information Center

Walker, Decker F.

This paper addresses the reasons that it is difficult to find good educational software and proposes measures for coping with this problem. The fundamental problem is a shortange of educational software that can be used as a major part of the teaching of academic subjects in elementary and secondary schools--a shortage that is both the effect and…

Why Inquiry Is Inherently Difficult...and Some Ways to Make It Easier

ERIC Educational Resources Information Center

Meyer, Daniel Z.; Avery, Leanne M.

2010-01-01

In this article, the authors offer a framework that identifies two critical problems in designing inquiry-based instruction and suggests three models for developing instruction that overcomes those problems. The Protocol Model overcomes the Getting on Board Problem by providing students an initial experience through clearly delineated steps with a…

How to Arrive at Good Research Questions?

ERIC Educational Resources Information Center

Gafoor, K. Abdul

2008-01-01

Identifying an area of research a topic, deciding on a problem, and formulating it in to a researchable question are very difficult stages in the whole research process at least for beginners. Few books on research methodology elaborates the various process involved in problem selection and clarification. Viewing research and problem selection as…

Integrating Worked Examples into Problem Posing in a Web-Based Learning Environment

ERIC Educational Resources Information Center

Hsiao, Ju-Yuan; Hung, Chun-Ling; Lan, Yu-Feng; Jeng, Yoau-Chau

2013-01-01

Most students always lack of experience and perceive difficult regarding problem posing. The study hypothesized that worked examples may have benefits for supporting students' problem posing activities. A quasi-experiment was conducted in the context of a business mathematics course for examining the effects of integrating worked examples into…

Beam diagnostics at high-intensity storage rings

NASA Astrophysics Data System (ADS)

Plum, Mike

1994-10-01

Beam diagnostics at high-intensity facilities feature their own special set of problems and characteristics, issues peculiar to high-intensity storage rings include beam loss, beam halos, extraction efficiency, beam in the gap, clearing electrodes, and beam-profile measurement. The Los Alamos Proton Storage Ring (PSR) is a nice example of a high-intensity storage ring. I will discuss in some detail three diagnostic systems currently in use at the PSR: the beam-loss-monitor system, the electron-clearing system, and the beam-in-the-gap monitor. Much of our discussion is inspired by the problems we have encountered and the useful things we have learned while commissioning and developing the PSR. Another inspiration is our work on the next-generation neutron-spallation source, also known as the National Center for Neutron Research (NCNR).

Diagnostic Tools of Pleural Effusion

PubMed Central

2014-01-01

Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references. PMID:24920946

[Current status and clinical application prospect of Akabane's test].

PubMed

Wang, Wenjie; Du, Yanjun

2016-06-12

The Akabane's test is one of the meridian diagnostic methods. Compared with the current meridian diagnostic methods, it has the advantages of convenience and efficiency, but it also has several disadvantages such as the accuracy is difficult to control, the outcome interpretation is limited, etc. In this paper, the influence factors of Akabane's test were analyzed one by one, especially proposed personal opinion on outcome interpretation, which could ascertain the location and nature of disease, leading to disease syndrome. With accurate syndrome, the treatment plan could be established. The application prospect of Akabane's test was initially explored, and it was proposed that wearable automation equipment could be one of the development directions.

Complex Diagnostic and Treatment Issues in Psychotic Symptoms Associated with Narcolepsy

PubMed Central

Ivanenko, Anna

2009-01-01

Narcolepsy is an uncommon chronic, neurological disorder characterized by abnormal manifestations of rapid eye movement sleep and perturbations in the sleep-wake cycle. Accurate diagnosis of psychotic symptoms in a person with narcolepsy could be difficult due to side effects of stimulant treatment (e.g., hallucinations) as well as primary symptoms of narcolepsy (e.g., sleep paralysis and hypnagogic and/or hypnapompic hallucinations). Pertinent articles from peer-reviewed journals were identified to help understand the complex phenomenology of psychotic symptoms in patients with narcolepsy. In this ensuing review and discussion, we present an overview of narcolepsy and outline diagnostic and management approaches for psychotic symptoms in patients with narcolepsy. PMID:19724760

Enhancing and Customizing Laboratory Information Systems to Improve/Enhance Pathologist Workflow.

PubMed

Hartman, Douglas J

2015-06-01

Optimizing pathologist workflow can be difficult because it is affected by many variables. Surgical pathologists must complete many tasks that culminate in a final pathology report. Several software systems can be used to enhance/improve pathologist workflow. These include voice recognition software, pre-sign-out quality assurance, image utilization, and computerized provider order entry. Recent changes in the diagnostic coding and the more prominent role of centralized electronic health records represent potential areas for increased ways to enhance/improve the workflow for surgical pathologists. Additional unforeseen changes to the pathologist workflow may accompany the introduction of whole-slide imaging technology to the routine diagnostic work. Copyright © 2015 Elsevier Inc. All rights reserved.

Enhancing and Customizing Laboratory Information Systems to Improve/Enhance Pathologist Workflow.

PubMed

Hartman, Douglas J

2016-03-01

Optimizing pathologist workflow can be difficult because it is affected by many variables. Surgical pathologists must complete many tasks that culminate in a final pathology report. Several software systems can be used to enhance/improve pathologist workflow. These include voice recognition software, pre-sign-out quality assurance, image utilization, and computerized provider order entry. Recent changes in the diagnostic coding and the more prominent role of centralized electronic health records represent potential areas for increased ways to enhance/improve the workflow for surgical pathologists. Additional unforeseen changes to the pathologist workflow may accompany the introduction of whole-slide imaging technology to the routine diagnostic work. Copyright © 2016 Elsevier Inc. All rights reserved.

Hysteroscopic diagnosis of uterine sarcomas at the Department of Gynaecology, Sant Joan de Déu University Hospital.

PubMed

Gonzalez-Bosquet, E; Suñol, M; Torralba, A; Lozada, C; Miñano, J; Lailla, J M

2011-01-01

Uterine sarcomas are rare and the clinical diagnosis of sarcoma is difficult. Diagnostic and surgical hysteroscopy is a minimally invasive outpatient procedure that makes an accurate diagnosis of malignant intrauterine pathology and could play a role in the diagnosis of the uterine sarcomas. Uterine sarcomas diagnosed at the Department of Gynecology of Sant Joan University Hospital by hysteroscopy between January 2004 and August 2010 are described. In this period 2,441 hysteroscopies were performed; a total of 67 adenocarcinomas of the endometrium and five sarcomas were diagnosed by hysteroscopy. The data are presented with a review of the literature, focusing on the diagnostic value of hysteroscopy in these tumors.

A comprehensive review of diagnostic and treatment options for granulosa cell tumors of the ovary.

PubMed

Stine, Jessica E; Pierce, Stuart; Soper, John T

2014-01-01

Granulosa cell tumors are rare and comprise approximately 2% to 8% of all ovarian malignancies. Research dedicated to these tumors is rare given the low incidence. These tumors are more difficult to diagnose than epithelial ovarian tumors, and understanding how they present may aid in appropriate referral to a gynecologic oncologist. The aim of this review was to summarize the epidemiology, risk factors, and clinical presentation of granulosa cell tumors to aid in provider recognition. We will also explore current diagnostic and treatment modalities with examination of newer, novel treatments. At the end of this review, the reader should understand how to appropriately diagnose and treat these rare malignancies.

Identifying Common Mathematical Misconceptions from Actions in Educational Video Games. CRESST Report 838

ERIC Educational Resources Information Center

Kerr, Deirdre

2014-01-01

Educational video games provide an opportunity for students to interact with and explore complex representations of academic content and allow for the examination of problem-solving strategies and mistakes that can be difficult to capture in more traditional environments. However, data from such games are notoriously difficult to analyze. This…

Overcoming Misconceptions in Neurophysiology Learning: An Approach Using Color-Coded Animations

ERIC Educational Resources Information Center

Guy, Richard

2012-01-01

Anyone who has taught neurophysiology would be aware of recurring concepts that students find difficult to understand. However, a greater problem is the development of misconceptions that may be difficult to change. For example, one common misconception is that action potentials pass directly across chemical synapses. Difficulties may be…

Training Teachers To Work in Schools Considered Difficult. Fundamentals of Educational Planning Series, Number 59.

ERIC Educational Resources Information Center

Auduc, Jean-Louis

This book outlines challenges involved in ensuring that teacher training becomes the gateway to implementation of appropriate strategies for students to achieve and for managing the problems of authority, discipline, and aggressive behavior. The six chapters examine: (1) "Teaching in Schools or Classes Considered Difficult: A Contemporary…

Molecular diagnostics of periodontitis.

PubMed

Korona-Głowniak, Izabela; Siwiec, Radosław; Berger, Marcin; Malm, Anna; Szymańska, Jolanta

2017-01-28

The microorganisms that form dental plaque are the main cause of periodontitis. Their identification and the understanding of the complex relationships and interactions that involve these microorganisms, environmental factors and the host's health status enable improvement in diagnostics and targeted therapy in patients with periodontitis. To this end, molecular diagnostics techniques (both techniques based on the polymerase chain reaction and those involving nucleic acid analysis via hybridization) come increasingly into use. On the basis of a literature review, the following methods are presented: polymerase chain reaction (PCR), real-time polymerase chain reaction (real-time PCR), 16S rRNA-encoding gene sequencing, checkerboard and reverse-capture checkerboard hybridization, microarrays, denaturing gradient gel electrophoresis (DGGE), temperature gradient gel electrophoresis (TGGE), as well as terminal restriction fragment length polymorphism (TRFLP) and next generation sequencing (NGS). The advantages and drawbacks of each method in the examination of periopathogens are indicated. The techniques listed above allow fast detection of even small quantities of pathogen present in diagnostic material and prove particularly useful to detect microorganisms that are difficult or impossible to grow in a laboratory.

Translational HIV-1 research: from routine diagnostics to new virology insights in Amsterdam, the Netherlands during 1983-2013

PubMed Central

2013-01-01

An HIV-1 diagnostic laboratory was established in the Academic Medical Center (AMC) of the University of Amsterdam after the discovery of human immunodeficiency virus (HIV) as the cause of the acquired immunodeficiency syndrome (AIDS). The first AIDS patients were diagnosed here in 1981 and since 1983 we have tested the samples of 50992 patients using a variety of assays that greatly improved over the years. We will describe some of the basic results from this diagnostic laboratory and then focus on the spin-off in terms of the development of novel virus assays to detect super-infections and ultra-sensitive assays to measure the intracellular HIV-1 RNA load. We also review several original research findings in the field of HIV-1 virology that stem from initial observations made in the diagnostic unit. This includes the study of genetic defects in the HIV-1 genome and time trends of the replication fitness over 30 years of viral evolution, but also the description of novel HIV-1 variants in difficult-to-diagnose clinical specimen. PMID:23985078

Translational HIV-1 research: from routine diagnostics to new virology insights in Amsterdam, the Netherlands during 1983-2013.

PubMed

van der Kuyl, Antoinette C; Bakker, Margreet; Jurriaans, Suzanne; Back, Nicole K T; Pasternak, Alexander O; Cornelissen, Marion; Berkhout, Ben

2013-08-28

An HIV-1 diagnostic laboratory was established in the Academic Medical Center (AMC) of the University of Amsterdam after the discovery of human immunodeficiency virus (HIV) as the cause of the acquired immunodeficiency syndrome (AIDS). The first AIDS patients were diagnosed here in 1981 and since 1983 we have tested the samples of 50992 patients using a variety of assays that greatly improved over the years. We will describe some of the basic results from this diagnostic laboratory and then focus on the spin-off in terms of the development of novel virus assays to detect super-infections and ultra-sensitive assays to measure the intracellular HIV-1 RNA load. We also review several original research findings in the field of HIV-1 virology that stem from initial observations made in the diagnostic unit. This includes the study of genetic defects in the HIV-1 genome and time trends of the replication fitness over 30 years of viral evolution, but also the description of novel HIV-1 variants in difficult-to-diagnose clinical specimen.

[Perforation of hollow organs in the abdominal contusion: diagnostic features and prognostic factors of death].

PubMed

Nicolau, A E; Merlan, V; Dinescu, G; Crăciun, M; Kitkani, A; Beuran, M

2012-01-01

Blunt hollow viscus perforations (HVP) due to abdominal contusions (AC), although rare, are difficult to diagnose early and are associated with a high mortality. Our paper analyses retrospectively data from patients operated for HVP between January 2005 and January 2009, the efficiency of different diagnostic tools, mortality and prognostic factors for death. There were 62 patients operated for HVP, 14 of which had isolated abdominal contusion and 48 were poly trauma patients. There were 9 women and 53 men, the mean age was 41.5 years (SD: +17,9), the mean ISS was 32.94 (SD: +15,94), 23 patients had associated solid viscus injuries (SVI). Clinical examination was irelevant for 16 of the 62 patients, abdominal Xray was false negative for 30 out of 35 patients and abdominal ultrasound was false negative for 16 out of 60 patients. Abdominal CT was initially false negative for 7 out of 38 patients: for 4 of them the abdominal CT was repeated and was positive for HVP, for 3 patients a diagnostic laparoscopy was performed. Direct signs for HVP on abdominal CT were present for 3 out of 38 patients. Diagnostic laparoscopy was performed for 7 patients with suspicion for HVP, and was positive for 6 of them and false negative for a patient with a duodenal perforation. Single organ perforations were present in 55 cases, multi organ perforations were present in 7 cases. There were 15 deaths (15.2%), most of them caused by haemodynamic instability (3 out of 6 patients) and associated lesions: SOL for 9 out of 23 cases, pelvic fracture (PF) for 6 out of 14 patients, craniocerebral trauma (CCT) for 12 out of 33 patients.Multivariate analysis showed that the prognostic factors for death were ISS value (p = 0,023) and associated CCT (odds ratio = 4,95; p = 0,017). The following factors were not confirmed as prognostic factors for death: age, haemodynamic instability, associated SVI, thoracic trauma (TT), pelvic fractures (PF), limbs fractures (LF) and admission-operation interval under 6 hours. Hollow viscus perforations due to abdominal contusions have a high mortality, early diagnosis is difficult, repeated abdominal CT and the selective use of diagnostic laparoscopy for haemodynamic stable patients with ambiguous clinical examination and diagnostic imaging are salutary. Prognostic factors for death were the ISS value and associated craniocerebral trauma.

Could our pretest probabilities become evidence based? A prospective survey of hospital practice.

PubMed

Richardson, W Scott; Polashenski, Walter A; Robbins, Brett W

2003-03-01

We sought to measure the proportion of patients on our clinical service who presented with clinical problems for which research evidence was available to inform estimates of pretest probability. We also aimed to discern whether any of this evidence was of sufficient quality that we would want to use it for clinical decision making. Prospective, consecutive case series and literature survey. Inpatient medical service of a university-affiliated Veterans' Affairs hospital in south Texas. Patients admitted during the 3 study months for diagnostic evaluation. Patients' active clinical problems were identified prospectively and recorded at the time of discharge, transfer, or death. We electronically searched medline and hand-searched bibliographies to find citations that reported research evidence about the frequency of underlying diseases that cause these clinical problems. We critically appraised selected citations and ranked them on a hierarchy of evidence. We admitted 122 patients for diagnostic evaluation, in whom we identified 45 different principal clinical problems. For 35 of the 45 problems (78%; 95% confidence interval [95% CI], 66% to 90%), we found citations that qualified as disease probability evidence. Thus, 111 of our 122 patients (91%; 95% CI, 86% to 96%) had clinical problems for which evidence was available in the medical literature. During 3 months on our hospital medicine service, almost all of the patients admitted for diagnostic evaluation had clinical problems for which evidence is available to guide our estimates of pretest probability. If confirmed by others, these data suggest that clinicians' pretest probabilities could become evidence based.

Food preferences and factors influencing food selectivity for children with autism spectrum disorders.

PubMed

Schreck, Kimberly A; Williams, Keith

2006-01-01

Although clinicians and parents widely accept that children with autism spectrum disorder exhibit more feeding problems than their typically developing peers, little information is available concerning the characteristic food items accepted by these children or the possible factors contributing to these feeding problems. This article used an informant-based questionnaire to survey parents of children with autism spectrum disorders (N=138) to determine: (a) the types of feeding problems their children typically exhibit, (b) the food items their children prefer, (c) the relationship of feeding problems to family eating preferences, and (d) the relationship of the diagnostic characteristics of autism to feeding behavior. Results indicated that the children preferred fewer types of food items within groups than their families; however, family food preferences appeared to influence food selection more than the diagnostic characteristics of autism.

Structuring Word Problems for Diagnostic Teaching: Helping Teachers Meet the Needs of Children with Mild Disabilities.

ERIC Educational Resources Information Center

Parmar, Rene S.; Cawley, John F.

1994-01-01

Matrix organization can be used to construct math word problems for children with mild disabilities. Matrix organization specifies the characteristics of problems, such as problem theme or setting, operations, level of computation complexity, reading vocabulary level, and need for classification. A sample scope and sequence and 16 sample word…

Reflectivity of crack sealant.

DOT National Transportation Integrated Search

2002-01-01

Crack sealing is used in road maintenance but presents a problem when crack seal material visually pops out on the roadway, making it difficult to see lane stripes. This problem will increase as New Mexico increases its use of crack sealants. This su...

Autonomous Intersection Management

DTIC Science & Technology

2009-12-01

is irrelevant. Fortunately, researchers are attacking this problem with many techniques. In 2004, Honda introduced an intelligent night vision system...or less a solved problem . The problem itself is not too difficult: there are no pedestrians or cyclists and vehicles travel in the same direction at...organized according to the following subgoals, each of which is a contribution of the thesis. 1. Problem definition First, this thesis contributes a

The resolvent of singular integral equations. [of kernel functions in mixed boundary value problems

NASA Technical Reports Server (NTRS)

Williams, M. H.

1977-01-01

The investigation reported is concerned with the construction of the resolvent for any given kernel function. In problems with ill-behaved inhomogeneous terms as, for instance, in the aerodynamic problem of flow over a flapped airfoil, direct numerical methods become very difficult. A description is presented of a solution method by resolvent which can be employed in such problems.

The molecular matching problem

NASA Technical Reports Server (NTRS)

Kincaid, Rex K.

1993-01-01

Molecular chemistry contains many difficult optimization problems that have begun to attract the attention of optimizers in the Operations Research community. Problems including protein folding, molecular conformation, molecular similarity, and molecular matching have been addressed. Minimum energy conformations for simple molecular structures such as water clusters, Lennard-Jones microclusters, and short polypeptides have dominated the literature to date. However, a variety of interesting problems exist and we focus here on a molecular structure matching (MSM) problem.

Are clinical impressions of adolescent substance use accurate?

PubMed

Wilson, Celeste R; Sherritt, Lon; Gates, Erin; Knight, John R

2004-11-01

To compare providers' impressions of adolescents' level of substance use with diagnostic classifications from a structured diagnostic interview. Secondary analysis of data was conducted from a validation study of the CRAFFT substance abuse screening test of 14- to 18-year-old medical clinic patients (n = 533) and their corresponding medical care providers (n = 109) at an adolescent clinic affiliated with a large tertiary care pediatric hospital. Medical care providers completed a form that recorded their clinical impressions of patients' level of alcohol and drug involvement (none, minimal, problem, abuse, dependence) and demographic characteristics. The form included brief diagnostic descriptions for each level of use. After the medical visit, patients completed the Adolescent Diagnostic Interview (ADI), a structured diagnostic interview that yields diagnoses of abuse and dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). On the basis of their past 12 months of alcohol and drug use on the ADI interview, adolescents were classified into 5 mutually exclusive diagnostic groups. "None" was defined by no reported use of alcohol or drugs during the past year. "Minimal use" was defined as use of alcohol or drugs but no report of any substance-related problems. "Problem use" was defined as reporting 1 or more substance-related problems but no diagnosis of abuse or dependence. "Abuse" was defined by meeting any 1 of 4 DSM-IV diagnostic criteria for either alcohol or drug abuse but no diagnosis of dependence. "Dependence" was defined by meeting any 3 of 7 diagnostic criteria for either alcohol or drug dependence, with or without a diagnosis of abuse. Proportions were compared using Fisher exact test. Agreement was assessed with the weighted kappa, and these analyses were stratified by substance used (ie, alcohol vs drug) and demographic characteristics. Sensitivity, specificity, and positive and negative predictive values were calculated from 2 x 2 tables. Compared with the criterion standard interview, providers identified significantly fewer patients with problem use and abuse and no patients with dependence. Of >100 patients whom the ADI classified with substance problem use, providers correctly identified 18. Of 50 patients who were classified with a diagnosis of alcohol or drug abuse, providers correctly identified 10. Of 36 patients who were classified with a diagnosis of alcohol or drug dependence, providers correctly identified none. For the 86 adolescents who were classified with a substance-related disorder (ie, abuse or dependence), providers' impressions were "none" (24.4%), "minimal use" (50%), "problem use" (15.1%), "abuse" (10.5%), and "dependence" (0%). There was only marginal agreement between providers' impressions and diagnoses related to alcohol use (kappa = .29), drug use (kappa = .31), and any substance use (kappa = .30). Kappa was not significantly affected by the patient's age, but it was by gender. Among boys, kappa was significantly higher for impressions of drug use versus alcohol use (kappa = .48 vs kappa = .27); and, among drug users, kappa was significantly higher among boys compared with girls (kappa = .48 vs kappa = .24). Kappa did not differ significantly across race/ethnicity subgroups, although there is a suggestive trend toward higher agreement for black non-Hispanic compared with white non-Hispanic adolescents (kappa = .35 vs kappa = .21). Kappa did not differ significantly on the basis of the visit type, but the size of this difference (kappa = .36 vs kappa = .24) suggests that the longer well-child visit yielded greater identification of substance-related pathology. Providers' impressions had a sensitivity of .63 for identifying use of alcohol or drugs. However, sensitivity was poor for identification of problem use (.14), abuse (.10), and dependence (0), whereas specificity and positive predictive values were high. Of the 86 adolescents with a diagnosis of abuse or dependence, 75.6% were correctly identified by providers as using substances; however, the level of use in 50% of these adolescents was reported by providers as minimal. In this study, clinical impressions of adolescents' alcohol/drug involvement underestimated substance-related pathology. When providers thought that use was present, there was a very high likelihood that a problem or disorder existed. The use of structured screening devices would likely improve identification of adolescents with substance-related pathology in primary care settings and should be considered for use with all adolescent patients, rather than only those who are perceived to be at higher risk.

New Testing Methods to Assess Technical Problem-Solving Ability.

ERIC Educational Resources Information Center

Hambleton, Ronald K.; And Others

Tests to assess problem-solving ability being provided for the Air Force are described, and some details on the development and validation of these computer-administered diagnostic achievement tests are discussed. Three measurement approaches were employed: (1) sequential problem solving; (2) context-free assessment of fundamental skills and…

The global burden of diagnostic errors in primary care

PubMed Central

Singh, Hardeep; Schiff, Gordon D; Graber, Mark L; Onakpoya, Igho; Thompson, Matthew J

2017-01-01

Diagnosis is one of the most important tasks performed by primary care physicians. The World Health Organization (WHO) recently prioritized patient safety areas in primary care, and included diagnostic errors as a high-priority problem. In addition, a recent report from the Institute of Medicine in the USA, ‘Improving Diagnosis in Health Care’, concluded that most people will likely experience a diagnostic error in their lifetime. In this narrative review, we discuss the global significance, burden and contributory factors related to diagnostic errors in primary care. We synthesize available literature to discuss the types of presenting symptoms and conditions most commonly affected. We then summarize interventions based on available data and suggest next steps to reduce the global burden of diagnostic errors. Research suggests that we are unlikely to find a ‘magic bullet’ and confirms the need for a multifaceted approach to understand and address the many systems and cognitive issues involved in diagnostic error. Because errors involve many common conditions and are prevalent across all countries, the WHO’s leadership at a global level will be instrumental to address the problem. Based on our review, we recommend that the WHO consider bringing together primary care leaders, practicing frontline clinicians, safety experts, policymakers, the health IT community, medical education and accreditation organizations, researchers from multiple disciplines, patient advocates, and funding bodies among others, to address the many common challenges and opportunities to reduce diagnostic error. This could lead to prioritization of practice changes needed to improve primary care as well as setting research priorities for intervention development to reduce diagnostic error. PMID:27530239

Oral to nasal tube exchange under fibroscopic view: a new technique for nasal intubation in a predicted difficult airway.

PubMed

Monclus, Enric; Garcés, Antonio; Artés, David; Mabrock, Maged

2008-07-01

For a predicted difficult airway, oral intubation techniques are well established in pediatric anesthesia, but nasotracheal intubation remains a problem. There are many reports concerning this, but the risk of bleeding, added to the lack of cooperation make this procedure difficult and hazardous. We describe a modification of the nasal intubation technique in two stages. First an oral intubation and then exchanging the oral for a nasal tube, in the case of a 13-year-old boy affected by an advanced stage of cherubism. Oral intubation using a laryngeal mask technique has already been reported, but problems appear during the exchange procedure and even more when direct laryngoscopy is impossible. Fiberscopic control of the exchange, and the introduction of a Cook Exchange Catheter into the trachea through the oral tube before withdrawal, permits oxygenation of the patient and acts as a guide for oral tube reintroduction if required.

On-board fault diagnostics for fly-by-light flight control systems using neural network flight processors

NASA Astrophysics Data System (ADS)

Urnes, James M., Sr.; Cushing, John; Bond, William E.; Nunes, Steve

1996-10-01

Fly-by-Light control systems offer higher performance for fighter and transport aircraft, with efficient fiber optic data transmission, electric control surface actuation, and multi-channel high capacity centralized processing combining to provide maximum aircraft flight control system handling qualities and safety. The key to efficient support for these vehicles is timely and accurate fault diagnostics of all control system components. These diagnostic tests are best conducted during flight when all facts relating to the failure are present. The resulting data can be used by the ground crew for efficient repair and turnaround of the aircraft, saving time and money in support costs. These difficult to diagnose (Cannot Duplicate) fault indications average 40 - 50% of maintenance activities on today's fighter and transport aircraft, adding significantly to fleet support cost. Fiber optic data transmission can support a wealth of data for fault monitoring; the most efficient method of fault diagnostics is accurate modeling of the component response under normal and failed conditions for use in comparison with the actual component flight data. Neural Network hardware processors offer an efficient and cost-effective method to install fault diagnostics in flight systems, permitting on-board diagnostic modeling of very complex subsystems. Task 2C of the ARPA FLASH program is a design demonstration of this diagnostics approach, using the very high speed computation of the Adaptive Solutions Neural Network processor to monitor an advanced Electrohydrostatic control surface actuator linked through a AS-1773A fiber optic bus. This paper describes the design approach and projected performance of this on-line diagnostics system.

Emergency coronary angioplasty with stenting using Cordis® diagnostic coronary catheters when there is difficulty in engaging guide catheters and bench evaluation of diagnostic and guide catheters.

PubMed

Arokiaraj, Mark Christopher

2018-02-01

Difficulty in engaging with guide catheters is not uncommon in acute emergencies. We aimed to evaluate the use of Cordis ® INFINITI diagnostic catheters to perform angioplasty in patients in whom the coronaries cannot be engaged using standard guide catheters. In 34 cases of acute coronary syndrome, when difficulty in engagement with two standard guide catheters was encountered with reasonable manipulations, angioplasty was performed using diagnostic catheters. In total, 40 stents were placed by this technique. Pushability and trackability, distal tip flexion and three-point bending tests were performed to evaluate the performance of the guide and diagnostic catheters. Angioplasty was performed easily in a setting where it would have been very difficult to perform. Coronary dissection occurred in one patient, treated by a stent. The stent and dilatation balloons were easily passed through the diagnostic catheters. Pressure tracings were clearly preserved with certain stent delivery systems, and at angioplasty, although there was slightly reduced opacification of the respective artery, the coronary anatomy was sufficiently visualized to perform angioplasty. No periprocedural target lesion complications were seen in any cases. Pushability and trackability tests showed good force transmission along a tortuous path with diagnostic catheters, and balanced force-displacement curves from three-point bending tests and distal tip softness tests. Angioplasty with stenting can be performed safely through 6F Cordis ® infiniti diagnostic catheters when difficulty in engaging guide catheters is encountered. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Application of Immunosignatures for Diagnosis of Valley Fever

PubMed Central

Navalkar, Krupa Arun; Johnston, Stephen Albert; Woodbury, Neal; Galgiani, John N.; Magee, D. Mitchell; Chicacz, Zbigniew

2014-01-01

Valley fever (VF) is difficult to diagnose, partly because the symptoms of VF are confounded with those of other community-acquired pneumonias. Confirmatory diagnostics detect IgM and IgG antibodies against coccidioidal antigens via immunodiffusion (ID). The false-negative rate can be as high as 50% to 70%, with 5% of symptomatic patients never showing detectable antibody levels. In this study, we tested whether the immunosignature diagnostic can resolve VF false negatives. An immunosignature is the pattern of antibody binding to random-sequence peptides on a peptide microarray. A 10,000-peptide microarray was first used to determine whether valley fever patients can be distinguished from 3 other cohorts with similar infections. After determining the VF-specific peptides, a small 96-peptide diagnostic array was created and tested. The performances of the 10,000-peptide array and the 96-peptide diagnostic array were compared to that of the ID diagnostic standard. The 10,000-peptide microarray classified the VF samples from the other 3 infections with 98% accuracy. It also classified VF false-negative patients with 100% sensitivity in a blinded test set versus 28% sensitivity for ID. The immunosignature microarray has potential for simultaneously distinguishing valley fever patients from those with other fungal or bacterial infections. The same 10,000-peptide array can diagnose VF false-negative patients with 100% sensitivity. The smaller 96-peptide diagnostic array was less specific for diagnosing false negatives. We conclude that the performance of the immunosignature diagnostic exceeds that of the existing standard, and the immunosignature can distinguish related infections and might be used in lieu of existing diagnostics. PMID:24964807

MO-F-204-00: Preparing for the ABR Diagnostic and Nuclear Medical Physics Exams

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

NONE

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

MO-F-204-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

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

Szczykutowicz, T.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

MO-F-204-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

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

Zambelli, J.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

MO-F-204-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

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

McKenney, S.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance of allmore » aspects of clinical medical physics. All parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those unique aspects of the nuclear exam, and how preparing for a second specialty differs from the first. Medical physicists who recently completed each ABR exam portion will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-00: Preparing for the ABR Diagnostic and Nuclear Medicine Physics Exams

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

NONE

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-01: Preparing for Part 1 of the ABR Diagnostic Physics Exam

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

Simiele, S.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-03: Preparing for Part 3 of the ABR Diagnostic Physics Exam

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

Bevins, N.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

WE-D-213-02: Preparing for Part 2 of the ABR Diagnostic Physics Exam

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

Zambelli, J.

Adequate, efficient preparation for the ABR Diagnostic and Nuclear Medical Physics exams is key to successfully obtain ABR professional certification. Each part of the ABR exam presents its own challenges: Part I: Determine the scope of basic medical physics study material, efficiently review this material, and solve related written questions/problems. Part II: Understand imaging principles, modalities, and systems, including image acquisition, processing, and display. Understand the relationship between imaging techniques, image quality, patient dose and safety, and solve related written questions/problems. Part III: Gain crucial, practical, clinical medical physics experience. Effectively communicate and explain the practice, performance, and significance ofmore » all aspects of clinical medical physics. All three parts of the ABR exam require specific skill sets and preparation: mastery of basic physics and imaging principles; written problem solving often involving rapid calculation; responding clearly and succinctly to oral questions about the practice, methods, and significance of clinical medical physics. This symposium focuses on the preparation and skill sets necessary for each part of the ABR exam. Although there is some overlap, the nuclear exam covers a different body of knowledge than the diagnostic exam. A separate speaker will address those aspects that are unique to the nuclear exam. Medical physicists who have recently completed each of part of the ABR exam will share their experiences, insights, and preparation methods to help attendees best prepare for the challenges of each part of the ABR exam. In accordance with ABR exam security policy, no recalls or exam questions will be discussed. Learning Objectives: How to prepare for Part 1 of the ABR exam by determining the scope of basic medical physics study material and related problem solving/calculations How to Prepare for Part 2 of the ABR exam by understanding diagnostic and/or nuclear imaging physics, systems, dosimetry, safety and related problem solving/calculations How to Prepare for Part 3 of the ABR exam by effectively communicating the practice, methods, and significance of clinical diagnostic and/or nuclear medical physics.« less

Evaluating Secondary Students' Scientific Reasoning in Genetics Using a Two-Tier Diagnostic Instrument

NASA Astrophysics Data System (ADS)

Tsui, Chi-Yan; Treagust, David

2010-05-01

While genetics has remained as one key topic in school science, it continues to be conceptually and linguistically difficult for students with the concomitant debates as to what should be taught in the age of biotechnology. This article documents the development and implementation of a two-tier multiple-choice instrument for diagnosing grades 10 and 12 students' understanding of genetics in terms of reasoning. The pretest and posttest forms of the diagnostic instrument were used alongside other methods in evaluating students' understanding of genetics in a case-based qualitative study on teaching and learning with multiple representations in three Western Australian secondary schools. Previous studies have shown that a two-tier diagnostic instrument is useful in probing students' understanding or misunderstanding of scientific concepts and ideas. The diagnostic instrument in this study was designed and then progressively refined, improved, and implemented to evaluate student understanding of genetics in three case schools. The final version of the instrument had Cronbach's alpha reliability of 0.75 and 0.64, respectively, for its pretest and the posttest forms when it was administered to a group of grade 12 students (n = 17). This two-tier diagnostic instrument complemented other qualitative data collection methods in this research in generating a more holistic picture of student conceptual learning of genetics in terms of scientific reasoning. Implications of the findings of this study using the diagnostic instrument are discussed.

A Method to Quantify Visual Information Processing in Children Using Eye Tracking

PubMed Central

Kooiker, Marlou J.G.; Pel, Johan J.M.; van der Steen-Kant, Sanny P.; van der Steen, Johannes

2016-01-01

Visual problems that occur early in life can have major impact on a child's development. Without verbal communication and only based on observational methods, it is difficult to make a quantitative assessment of a child's visual problems. This limits accurate diagnostics in children under the age of 4 years and in children with intellectual disabilities. Here we describe a quantitative method that overcomes these problems. The method uses a remote eye tracker and a four choice preferential looking paradigm to measure eye movement responses to different visual stimuli. The child sits without head support in front of a monitor with integrated infrared cameras. In one of four monitor quadrants a visual stimulus is presented. Each stimulus has a specific visual modality with respect to the background, e.g., form, motion, contrast or color. From the reflexive eye movement responses to these specific visual modalities, output parameters such as reaction times, fixation accuracy and fixation duration are calculated to quantify a child's viewing behavior. With this approach, the quality of visual information processing can be assessed without the use of communication. By comparing results with reference values obtained in typically developing children from 0-12 years, the method provides a characterization of visual information processing in visually impaired children. The quantitative information provided by this method can be advantageous for the field of clinical visual assessment and rehabilitation in multiple ways. The parameter values provide a good basis to: (i) characterize early visual capacities and consequently to enable early interventions; (ii) compare risk groups and follow visual development over time; and (iii), construct an individual visual profile for each child. PMID:27500922

A Method to Quantify Visual Information Processing in Children Using Eye Tracking.

PubMed

Kooiker, Marlou J G; Pel, Johan J M; van der Steen-Kant, Sanny P; van der Steen, Johannes

2016-07-09

Visual problems that occur early in life can have major impact on a child's development. Without verbal communication and only based on observational methods, it is difficult to make a quantitative assessment of a child's visual problems. This limits accurate diagnostics in children under the age of 4 years and in children with intellectual disabilities. Here we describe a quantitative method that overcomes these problems. The method uses a remote eye tracker and a four choice preferential looking paradigm to measure eye movement responses to different visual stimuli. The child sits without head support in front of a monitor with integrated infrared cameras. In one of four monitor quadrants a visual stimulus is presented. Each stimulus has a specific visual modality with respect to the background, e.g., form, motion, contrast or color. From the reflexive eye movement responses to these specific visual modalities, output parameters such as reaction times, fixation accuracy and fixation duration are calculated to quantify a child's viewing behavior. With this approach, the quality of visual information processing can be assessed without the use of communication. By comparing results with reference values obtained in typically developing children from 0-12 years, the method provides a characterization of visual information processing in visually impaired children. The quantitative information provided by this method can be advantageous for the field of clinical visual assessment and rehabilitation in multiple ways. The parameter values provide a good basis to: (i) characterize early visual capacities and consequently to enable early interventions; (ii) compare risk groups and follow visual development over time; and (iii), construct an individual visual profile for each child.

DSM-5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues.

PubMed

Ramtekkar, Ujjwal P

2017-07-27

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are the most common neurodevelopmental disorders. Despite significant comorbidity, the previous diagnostic criteria prohibited the simultaneous diagnosis of both disorders. Sleep problems are highly prevalent in both disorders; however, these have been studied independently for ADHD and ASD. In the context of revised criteria in the Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) that allows combined diagnosis of ADHD and ASD, this short review presents an overview of relationship between sleep problems, ADHD and ASD, as well as conceptualizing the shared pathophysiology. The practical considerations for clinical management of sleep problems in combination with ADHD and ASD are also discussed.