School formation characteristics and stimuli based modeling of tetra fish.

Self-organizing motion is an important yet inadequately understood phenomena in the field of collective behavior. For birds flocks, insect swarms, and fish schools, group behavior can provide a mechanism for defense against predators, better foraging and mating capabilities and increased hydro/aerodynamic efficiency in long-distance migration events. Although collective motion has received much scientific attention, more work is required to model and understand the mechanisms responsible for school initiation and formation, and information transfer within these groups. Here we investigate schooling of black tetra (Gymnocorymbus ternetzi) fish triggered by startle stimuli in the form of approaching objects. High-speed video and tagging techniques were used to track the school and individual members. We then measured several variables including reaction times, group formation shapes, fish velocity, group density, and leadership within the group. These data reveal three things: (1) information propagates through the group as a wave, indicating that each fish is not reacting individually to the stimulus, (2) the time taken for information to transfer across the group is independent of group density, and (3) information propagates across large groups faster than would be expected if the fish were simply responding to the motion of their nearest neighbor. A model was then built wherein simulated fish have a simple 'stimuli/escape' vector based on a hypothetical field of vision. The model was used to simulate a group of individual fish with initial conditions, size, and stimuli similar to the biological experiments. The model revealed similar behavior to the biological experiments and provide insights into the observed patterns, response times, and wave speeds.

How vision governs the collective behaviour of dense cycling pelotons.

In densely packed groups demonstrating collective behaviour, such as bird flocks, fish schools or packs of bicycle racers (cycling pelotons), information propagates over a network, with individuals sensing and reacting to stimuli over relatively short space and time scales. What remains elusive is a robust, mechanistic understanding of how sensory system properties affect interactions, information propagation and emergent behaviour. Here, we show through direct observation how the spatio-temporal limits of the human visual sensory system govern local interactions and set the network structure in large, dense collections of cyclists. We found that cyclists align in patterns within a ± 30° arc corresponding to the human near-peripheral visual field, in order to safely accommodate motion perturbations. Furthermore, the group structure changes near the end of the race, suggesting a narrowing of the used field of vision. This change is consistent with established theory in psychology linking increased physical exertion to the decreased field of perception. Our results show how vision, modulated by arousal-dependent neurological effects, sets the local arrangement of cyclists, the mechanisms of interaction and the implicit communication across the group. We furthermore describe information propagation phenomena with an analogous elastic solid mechanics model. We anticipate our mechanistic description will enable a more detailed understanding of the interaction principles for collective behaviour in a variety of animals.

Evaluating a federated medical search engine: tailoring the methodology and reporting the evaluation outcomes.

BACKGROUND: Federated medical search engines are health information systems that provide a single access point to different types of information. Their efficiency as clinical decision support tools has been demonstrated through numerous evaluations. Despite their rigor, very few of these studies report holistic evaluations of medical search engines and even fewer base their evaluations on existing evaluation frameworks. OBJECTIVES: To evaluate a federated medical search engine, MedSocket, for its potential net benefits in an established clinical setting. METHODS: This study applied the Human, Organization, and Technology (HOT-fit) evaluation framework in order to evaluate MedSocket. The hierarchical structure of the HOT-factors allowed for identification of a combination of efficiency metrics. Human fit was evaluated through user satisfaction and patterns of system use; technology fit was evaluated through the measurements of time-on-task and the accuracy of the found answers; and organization fit was evaluated from the perspective of system fit to the existing organizational structure. RESULTS: Evaluations produced mixed results and suggested several opportunities for system improvement. On average, participants were satisfied with MedSocket searches and confident in the accuracy of retrieved answers. However, MedSocket did not meet participants' expectations in terms of download speed, access to information, and relevance of the search results. These mixed results made it necessary to conclude that in the case of MedSocket, technology fit had a significant influence on the human and organization fit. Hence, improving technological capabilities of the system is critical before its net benefits can become noticeable. CONCLUSIONS: The HOT-fit evaluation framework was instrumental in tailoring the methodology for conducting a comprehensive evaluation of the search engine. Such multidimensional evaluation of the search engine resulted in recommendations for system improvement.

Determining primary care physician information needs to inform ambulatory visit note display.

BACKGROUND: With the increase in the adoption of electronic health records (EHR) across the US, primary care physicians are experiencing information overload. The purpose of this pilot study was to determine the information needs of primary care physicians (PCPs) as they review clinic visit notes to inform EHR display. METHOD: Data collection was conducted with 15 primary care physicians during semi-structured interviews, including a third party observer to control bias. Physicians reviewed major sections of an artificial but typical acute and chronic care visit note to identify the note sections that were relevant to their information needs. Statistical methods used were McNemar-Mosteller's and Cochran Q. RESULTS: Physicians identified History of Present Illness (HPI), Assessment, and Plan (A&P) as the most important sections of a visit note. In contrast, they largely judged the Review of Systems (ROS) to be superfluous. There was also a statistical difference in physicians' highlighting among all seven major note sections in acute (p = 0.00) and chronic (p = 0.00) care visit notes. CONCLUSION: A&P and HPI sections were most frequently identified as important which suggests that physicians may have to identify a few key sections out of a long, unnecessarily verbose visit note. ROS is viewed by doctors as mostly "not needed," but can have relevant information. The ROS can contain information needed for patient care when other sections of the Visit note, such as the HPI, lack the relevant information. Future studies should include producing a display that provides only relevant information to increase physician efficiency at the point of care. Also, research on moving A&P to the top of visit notes instead of having A&P at the bottom of the page is needed, since those are usually the first sections physicians refer to and reviewing from top to bottom may cause cognitive load.

A pilot study on usability analysis of emergency department information system by nurses.

OBJECTIVES: Employing new health information technologies while concurrently providing quality patient care and reducing risk is a major challenge in all health care sectors. In this study, we investigated the usability gaps in the Emergency Department Information System (EDIS) as ten nurses differentiated by two experience levels, namely six expert nurses and four novice nurses, completed two lists of nine scenario-based tasks. METHODS: Standard usability tests using video analysis, including four sets of performance measures, a task completion survey, the system usability scale (SUS), and sub-task analysis were conducted in order to analyze usability gaps between the two nurse groups. RESULTS: A varying degree of usability gaps were observed between the expert and novice nurse groups, as novice nurses completed the tasks both less efficiently, and expressed less satisfaction with the EDIS. The most interesting finding in this study was the result of 'percent task success rate,' the clearest performance measure, with no substantial difference observed between the two nurse groups. Geometric mean values between expert and novice nurse groups for this measure were 60% vs. 62% in scenario 1 and 66% vs. 55% in scenario 2 respectively, while there were some marginal to substantial gaps observed in other performance measures. In addition to performance measures and the SUS, sub-task analysis highlighted navigation pattern differences between users, regardless of experience level. CONCLUSION: This study will serve as a baseline study for a future comparative usability evaluation of EDIS in other institutions with similar clinical settings.

Partitioning and photodegradation of ciprofloxacin in aqueous systems in the presence of organic matter.

Ciprofloxacin is an extensively used antibiotic that has been reported to occur in surface water. Previous studies have indicated that ciprofloxacin photodegrades and sorbs to particulate organic material within aquatic systems. The first objective of the current study was to evaluate the influence of organic material on photodegradation rates of ciprofloxacin. Using a bench top experimental design, ciprofloxacin was added to experimental chambers that contained only water or water and fine particulate organic matter (FPOM) followed by exposure to ultraviolet light. Sorption to FPOM was rapid, reducing the amount of ciprofloxacin that was available for photodegradation. Thus, the presence of FPOM initially decreased the ciprofloxacin concentration in the aqueous compartment. However by the end of the 16 h test, 42% of the ciprofloxacin was recovered from the test system with FPOM present, while only 2% of the ciprofloxacin was recovered in systems that did not contain FPOM. The second objective of this study was to compare the sorption coefficients for ciprofloxacin between two types of organic material: FPOM, classified as amphipod processed leaves, and coarse particulate organic matter (CPOM), represented by intact leaf disks. Sorption to FPOM (log Kd of 4.54+/-0.09 l kg(-1)) was 1.6 orders of magnitude greater than sorption to CPOM (log Kd of 2.92+/-0.10 l kg(-1)) potentially resulting in differential toxicity among similar organisms that occupy these different niches and leading to different estimates of environmental fate and effects.

Joint toxicity of triazine herbicides and organophosphate insecticides to the midge Chironomus tentans.

A series of recent studies demonstrated that the triazine herbicide atrazine, although not itself acutely toxic, potentiated the toxicity of certain organophosphate insecticides (OPs) to the midge Chironomus tentans. In the current study, a series of triazine herbicides and triazine herbicide degradation products were tested to determine if other triazines potentiate OP toxicity to midges. Chlorpyrifos and diazinon were the OPs tested. Toxicity tests were conducted using a factorial design and analysis of variance to statistically determine if each triazine had an effect on expected toxicity. Log-probit procedures were also used to evaluate the magnitude of change in median effective concentration (EC50) values during coexposure with each triazine. All of the triazine herbicides tested (atrazine, simazine, cyanazine, and hexazinone) were capable of potentiating the toxicity of the OPs, whereas the degradation products (s-triazine, deethylatrazine, and deisopropylatrazine) had less effect. In most cases, a triazine concentration of 100 microg/L was necessary to significantly increase OP toxicity, and higher concentrations of triazine caused a greater degree of potentiation. Changes in EC50 values ranged from no change to a 2.5-fold increase in toxicity. Generally, EC50 values changed by less than a factor of 2, indicating that the effect may be of limited concern in regard to future risk assessments of OPs.

Redescription of Besnoitia bennetti (Protozoa: Apicomplexa) from the donkey (Equus asinus).

Besnoitia bennetti tissue cysts were found in four naturally-infected donkeys (Equus asinus) from the USA. Infectivity of its bradyzoites and tachyzoites to animals and cell culture was studied. The bradyzoites were not infectious to out-bred Swiss Webster mice, rabbits or gerbils. When fed tissue cysts, cats did not excrete oocysts. However, the parasite was infectious to interferon-gamma gene knock out mice. The parasite from tissues of two donkeys was grown successfully in bovine monocyte monolayers for the first time. Non-dividing, uninucleate tachyzoites were approximately 6 x 1.5 microm in size. Longitudinally-cut bradyzoites in tissue sections measured 8.7 x 1.9 microm. Ultrastructurally, tachyzoites and bradyzoites were similar to those in other Besnoitia species, and in particular to parasites described from cattle (Besnoitia besnoiti) and reindeer (Besnoitia tarandi), in that their bradyzoites lacked enigmatic bodies. Based on comparative analysis of three portions of nuclear ribosomal DNA (the small and large subunits and the first internal transcribed spacer) B. bennetti was found to be more closely related to the other congeners described from ungulates. The parasite was formally redescribed and specimens deposited in the US National Parasite Collections.

Effects of atrazine on acetylcholinesterase activity in midges (Chironomus tentans) exposed to organophosphorus insecticides.

Acetylcholinesterase activity was determined for midge larvae (Chironomus tentans) exposed to either organophosphorus insecticides (OPs) alone or OP insecticides in binary combination with atrazine (200 microg/l). Although atrazine by itself did not reduce the level of acetylcholinesterase activity, atrazine in combination with chlorpyrifos significantly decreased acetylcholinesterase activity as compared to chlorpyrifos only treatments. Although similar trends existed for malathion and methyl parathion, differences were not statistically significant. These results match previously published toxicity data where atrazine, although not acutely toxic even at much higher levels, decreased EC50 values for chlorpyrifos by a magnitude of 4, decreased methyl parathion values by a magnitude of 2, and did not decrease values for malathion.

A randomized, controlled trial of remacemide for motor fluctuations in Parkinson's disease.

BACKGROUND: Preclinical studies suggest that glutamate antagonists help ameliorate motor fluctuations in patients with PD treated with levodopa. METHODS: In a multicenter, randomized, double-blind, placebo-controlled, parallel-group, dose-ranging study, the authors assessed the safety, tolerability, and efficacy of the glutamate receptor blocker remacemide hydrochloride in 279 patients with motor fluctuations treated with levodopa. The primary objective was to assess the short-term tolerability and safety of four dosage levels of remacemide during 7 weeks of treatment. Patients were also monitored with home diaries and the Unified PD Rating Scale (UPDRS) to collect preliminary data on treatment efficacy. RESULTS: Remacemide was well tolerated up to a dosage of 300 mg/d on a twice daily schedule and 600 mg/d on a four times daily schedule. The most common dosage-related adverse events were dizziness and nausea, as observed in previous studies of remacemide. The percent "on" time and motor UPDRS scores showed trends toward improvement in the patients treated with 150 and 300 mg/d remacemide compared with placebo-treated patients, although these improvements were not significant. CONCLUSION: Remacemide is a safe and tolerable adjunct to dopaminergic therapy for patients with PD and motor fluctuations. Although this study had limited power to detect therapeutic effects, the observed improvement is consistent with studies of non-human primates with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced parkinsonian signs and symptoms. Additional studies are warranted to confirm these results over an extended period of observation, and to explore the potential neuroprotective effects of remacemide in slowing the progression of PD.

Analysis of multiple pesticides in urban storm water using solid-phase extraction.

An analytical method was developed using C(18) solid-phase extraction and gas chromatography-nitrogen phosphorus detection (GC-NPD) to determine the presence and quantity of 12 contemporary pesticides in storm water runoff from an urban environment. The method was validated, using deionized water and water collected from a local pond, for two concentration levels and four holding time regimes. The method was then utilized in a study examining nonpoint source (NPS) pollution in Wichita, KS. Accuracy and precision were demonstrated in each test for each analyte except diazinon, which degraded rapidly during holding times in aqueous solution. For all matrices, concentration levels, and holding times, mean recoveries for the remaining 11 pesticides ranged from 50% to 105% with percent relative standard deviations less than 25%.

Effects of temperature on the toxicity of m-parathion, chlorpyrifos, and pentachlorobenzene to Chironomus tentans.

This study examined the influence of temperature (10, 20, and 30 degrees C) on the acute toxicity and accumulation of two organophosphate (OP) insecticides and a narcotic chemical to the midge (Chironomus tentans). OP insecticides used in this study included chlorpyrifos and m-parathion, and pentachlorobenzene was the chosen narcotic. Chlorpyrifos was the most toxic chemical tested, followed by m-parathion and then pentachlorobenzene. A positive correlation was found between temperature and toxicity for each of the chemicals tested. A reverse trend was noted for total OP insecticide body residues with decreased concentrations found at the higher temperatures. Pentachlorobenzene body residues remained constant at all temperatures. All three chemicals showed increased uptake rates at 20 and 30 degrees C in comparison to 10 degrees C. The noted decrease in midge body residues at the higher temperatures for the OP insecticides was contributed to increased biotransformation and elimination rates at the higher temperatures. Overall, temperature had a greater influence on OP toxicity than for pentachlorobenzene, and this may be due to accelerated biotransformation of the OPs to more toxic o-analog metabolites at the higher temperatures.http://link.springer-ny. com/link/service/journals/00244/bibs/37n4p542.html

Mechanisms and clinical features of posterior border-zone infarcts.

BACKGROUND: Previous studies link posterior border-zone cerebral infarcts between the middle cerebral artery (MCA) and the posterior cerebral artery (PCA) to hemodynamic causes, not embolism. OBJECTIVE: To study the cause of these infarcts. METHODS: We studied 21 patients (unilateral = 18, bilateral = 3) with acute, symptomatic posterior border-zone infarcts shown on CT or MRI to clarify stroke mechanisms. Patients were identified by review of CT and MRI logs and medical records during a 35-month period. An embolic mechanism was assigned when a source of embolism from either the heart, aorta, or parent large artery was present in the absence of intrinsic MCA or PCA disease. A hemodynamic mechanism was assigned when systemic hypotension was present. RESULTS: Among patients with unilateral lesions, 10 were embolic (7 cardiac, 3 carotid), 7 were unknown, and one patient had vasospasm from a ruptured aneurysm. Visual field abnormalities predominated over motor, sensory, and language abnormalities. All patients with bilateral posterior border-zone lesions had perioperative hypotension. Prolonged lethargy, bilateral limb weakness, and cortical blindness were common. CONCLUSIONS: Embolism, either cardiac or from the parent carotid artery, is the predominant stroke mechanism in unilateral posterior border-zone infarcts, not distal field perfusion failure. Bilateral posterior border-zone infarcts have a distinctive clinical presentation and are caused by systemic hypotension. Variability of irrigation of the major arteries, passage of emboli to border-zone areas, and decreased clearance of emboli in these areas explain the findings in the patients with unilateral lesions.

Effects of injectate volume on thermodilution measurements of cardiac output in patients with low ventricular ejection fraction.

OBJECTIVE: To determine the effect of 5-mL injectate on cardiac output measurements in critically ill patients with low ventricular ejection fraction (< 35%). METHODS: Thermodilution cardiac output measurements obtained with three 5-mL and three 10-mL (randomly ordered) iced injectates in 50 patients with low ejection fraction were averaged if the measurements were within 10% of the median. If the 3 measurements were not within those limits, additional measurements were obtained. RESULTS: Cardiac output measured with the 5-mL injectate (mean, 4.63 L/min) and cardiac output measured with the 10-mL injectate (mean, 4.52 L/min) were not significantly different (P = .64). Lower and upper limits of agreement were -1.7 L/min to +1.6 L/min. The bias (mean difference between 10- and 5-mL measurements) of all measurements was -0.09, and the precision was 1.43 L/min, with a 95% confidence limit (mean difference +/- 2 SD) of -1.7 to +1.6 L/min. An additional measurement was necessary in 77% of patients in the 5-mL group but in only 48% of the 10-mL group (P = .006). CONCLUSIONS: Cardiac outputs measured with 5- and 10-mL injectates do not differ significantly. The greater variability of measurements obtained with a 5-mL injectate suggests that more measurements, and thus more time, are needed to measure cardiac output accurately. Clinicians must weigh the benefit of minimizing fluid volume used against the potential decreased reliability of cardiac output measurements.

Thrombus in vertebrobasilar dolichoectatic artery treated with intravenous urokinase.

BACKGROUND: Vertebrobasilar dolichoectasia is often found in patients with posterior circulation ischemia. Brain ischemia is caused by abnormal flow in the dilated artery and obstruction of paramedian arteries or intraluminal thrombus with artery-to-artery embolism. We report a patient with vertebrobasilar dolichoectasia and luminal thrombus treated with intravenous urokinase who did well but died 2 months later of subarachnoid hemorrhage. CASE DESCRIPTION: A 60-year-old man developed right-hand clumsiness, dysarthria and ataxia. Computed tomography showed vertebrobasilar dolichoectasia and thrombus in the basilar artery. Symptoms quickly resolved on heparin but recurred on warfarin and again resolved on heparin. Two weeks later, while on warfarin and aspirin 325 mg, he developed hand numbness, oscillopsia and ataxia. Symptoms again resolved on heparin. Angiography showed severe dolichoectasia of the distal right vertebral artery and basilar artery. A large mural thrombus was detected in the ventral part of the distal basilar artery narrowing the lumen by 50%. He was treated with intravenous urokinase 4,400 units/kg as a bolus followed by 4,400 units/kg/h for 12 h. Repeat angiography showed almost complete recanalization and improved filling of basilar artery branches. He was maintained on warfarin and aspirin 81 mg and had no further ischemic episodes. He died 2 months later of rupture of the basilar artery and subarachnoid hemorrhage. CONCLUSION: Some patients with thrombosis of vertebrobasilar dolichoectactic arteries continue to have ischemic symptoms despite adequate anticoagulation. Intravenous thrombolysis may be effective in reducing the risk of stroke, but the risk/benefit ratio needs to be assessed in each patient.

Treatment of multiple cerebral emboli from an ulcerated, thrombogenic ascending aorta with aortectomy and graft replacement.

Multiple studies link aortic arch atheroma as a donor site for cerebral emboli. However, treatment of this condition remains controversial. We report a patient with recurrent brain emboli from an ulcerated, thrombogenic aorta treated with aortectomy and graft replacement.

Multifocal motor neuropathy presenting as ophthalmoplegia.

A 45-year-old man developed ophthalmoplegia and subsequently multiple cranial nerve palsies in association with bibrachial paresis. Investigations revealed evidence of conduction block occurring at a very proximal location (i.e., the spinal roots) and seemingly sparing sensory fibers. Other causes were ruled out and a diagnosis of multifocal motor neuropathy with conduction block (MMN) was suggested. The patient responded to cyclophosphamide. Differentiating features between MMN and chronic inflammatory demyelinating polyradioneuropathy (CIDP) are discussed. This case demonstrates that MMN may rarely present with ophthalmoparesis and also demonstrates that features of MMN and CIDP may overlap.