Magnetoresistance manipulation and sign reversal in Mn-doped ZnO nanowires.

We report magnetoresistance (MR) manipulation and sign reversal induced by carrier concentration modulation in Mn-doped ZnO nanowires. At low temperatures positive magnetoresistance was initially observed. When the carrier concentration was increased through the application of a gate voltage, the magnetoresistance also increased and reached a maximum value. However, further increasing the carrier concentration caused the MR to decrease, and eventually an MR sign reversal from positive to negative was observed. An MR change from a maximum positive value of 25% to a minimum negative value of 7% was observed at 5 K and 50 KOe. The observed MR behavior was modeled by considering combined effects of quantum correction to carrier conductivity and bound magnetic polarons. This work could provide important insights into the mechanisms that govern magnetotransport in dilute magnetic oxides, and it also demonstrated an effective approach to manipulating magnetoresistance in these materials that have important spintronic applications.

Reducing risk with clinical decision support: a study of closed malpractice claims.

OBJECTIVE: Identify clinical opportunities to intervene to prevent a malpractice event and determine the proportion of malpractice claims potentially preventable by clinical decision support (CDS). MATERIALS AND METHODS: Cross-sectional review of closed malpractice claims over seven years from one malpractice insurance company and seven hospitals in the Boston area. For each event, clinical opportunities to intervene to avert the malpractice event and the presence or absence of CDS that might have a role in preventing the event, were assigned by a panel of expert raters. Compensation paid out to resolve a claim (indemnity), was associated with each CDS type. RESULTS: Of the 477 closed malpractice cases, 359 (75.3%) were categorized as substantiated and 195 (54%) had at least one opportunity to intervene. Common opportunities to intervene related to performance of procedure, diagnosis, and fall prevention. We identified at least one CDS type for 63% of substantiated claims. The 41 CDS types identified included clinically significant test result alerting, diagnostic decision support and electronic tracking of instruments. Cases with at least one associated intervention accounted for $40.3 million (58.9%) of indemnity. DISCUSSION: CDS systems and other forms of health information technology (HIT) are expected to improve quality of care, but their potential to mitigate risk had not previously been quantified. Our results suggest that, in addition to their known benefits for quality and safety, CDS systems within HIT have a potential role in decreasing malpractice payments. CONCLUSION: More than half of malpractice events and over $40 million of indemnity were potentially preventable with CDS.

Increasing patient engagement: patients' responses to viewing problem lists online.

OBJECTIVE: To characterize the opinions, emotions, and actions taken by patients who viewed their electronic problem list via an online personal health record (PHR). MATERIALS AND METHODS: An online survey of patients who viewed their problem lists, as maintained by their healthcare provider, in a web-based PHR linked to an electronic health record for the first time. RESULTS: A total 3,649 patients completed the survey, yielding a response rate of 42.1%. Patient attitudes towards the problem list function were positive overall, with 90.4% rating it at least somewhat useful and 86.7% reporting they would probably or definitely use it again. Nearly half (45.6%) of patients identified at least one major or minor problem missing from their list. After viewing the list, 56.1% of patients reported taking at least one action in response, with 32.4% of patients reporting that they researched a condition on the Internet, 18.3% reported that they contacted their healthcare provider and 16.7% reported changing or planning to change a health behavior (patients could report multiple actions). 64.7% of patients reported feeling at least somewhat happy while viewing their problem list, though others reported feeling sad (30.4%), worried (35.7%) or scared (23.8%) (patients could report multiple emotions). A smaller number of patients reported feeling angry (16.6%) or ashamed (14.3%). Patients who experienced an emotional response were more likely to take action. CONCLUSION: Overall, patients found the ability to view their problem lists very useful and took action in response to the information. However, some had negative emotions. More research is needed into optimal strategies for supporting patients receiving this information.

Provider use of and attitudes towards an active clinical alert: a case study in decision support.

BACKGROUND: In a previous study, we reported on a successful clinical decision support (CDS) intervention designed to improve electronic problem list accuracy, but did not study variability of provider response to the intervention or provider attitudes towards it. The alert system accurately predicted missing problem list items based on health data captured in a patient's electronic medical record. OBJECTIVE: To assess provider attitudes towards a rule-based CDS alert system as well as heterogeneity of acceptance rates across providers. METHODS: We conducted a by-provider analysis of alert logs from the previous study. In addition, we assessed provider opinions of the intervention via an email survey of providers who received the alerts (n = 140). RESULTS: Although the alert acceptance rate was 38.1%, individual provider acceptance rates varied widely, with an interquartile range (IQR) of 14.8%-54.4%, and many outliers accepting none or nearly all of the alerts they received. No demographic variables, including degree, gender, age, assigned clinic, medical school or graduation year predicted acceptance rates. Providers' self-reported acceptance rate and perceived alert frequency were only moderately correlated with actual acceptance rates and alert frequency. CONCLUSIONS: Acceptance of this CDS intervention among providers was highly variable but this heterogeneity is not explained by measured demographic factors, suggesting that alert acceptance is a complex and individual phenomenon. Furthermore, providers' self-reports of their use of the CDS alerting system correlated only modestly with logged usage.

Mutation analysis in Irish families with glomuvenous malformations.

BACKGROUND: Glomuvenous malformations (GVMs) are rare bluish lesions that can affect the skin and mucosal surfaces. They represent defects in vasculogenesis. Lesions can occur sporadically or in an autosomal dominant mode of inheritance. Recent studies have shown that mutations in the glomulin gene (GLMN) on chromosome 1p21-22 are responsible for familial GVMs. OBJECTIVES: To search for mutations in GLMN in Irish families with GVMs. METHODS: We identified four Irish families with GVMs and confirmed linkage to chromosome 1p21-22 in these cases. We sequenced the glomulin gene in all affected and unaffected members of the families. Results Linkage analysis showed that affected individuals from the families shared a common haplotype. Mutation analysis revealed a delAAGAA mutation in exon 3 of the glomulin gene in all four families with GVMs. CONCLUSIONS: We confirm that mutations in the glomulin gene are responsible for GVMs and suggest a founder Irish mutation in the glomulin gene in four Irish families.

The emerging medical/industrial complex. The industrialization of medicine.

Until recently, the traditional practice of medicine has been thought of as a cottage industry practiced by individuals or small partnership groups. The transition of practice settings to large groups, multi-specialty groups, and corporations has paved the way to industrialization, with even larger health care organizations primarily managed by non-physicians. The similarities of these events to the industrial revolution and its impact on crafts guilds are striking. In order to understand this point of view, this article explores the function and influence of crafts guilds during stages of industrial development and the dynamics of the changes of employment needs and employability in an industrial environment as a comparison to what is happening in the health care field.

Estimating human incisal bite forces from the electromyogram/bite-force function.

This study used the electromyogram (EMG)/force-function curve as a means of estimating functional bite forces. Surface EMG recordings were made for the masseter and anterior temporalis muscles bilaterally in ten adults while incisal bite forces were measured using a force transducer embedded in custom-made hydroplastic bite blocks. Measurements were made for mouth openings of 15 and 30 mm. Each subject was first instructed to develop a maximum level of bite force, and then to develop bite-force levels that corresponded to decreasing percentages of his or her maximum, from 90 to 10%, in 10% decrements. After the force measurements had been made, each subject was instructed to incise various food substances. The power-density spectrum and r.m.s. power level were calculated for each sample. Maximum bite-force levels varied considerably among the 10 subjects, ranging from a minimum of 2.5 kg to a maximum of 40 kg. For the subjects as a whole, estimated bite forces for the different types of food ranged from 3.0 to 5.5 kg. This range was independent of the subjects' maximum bite-force levels. Thus, bite forces exerted to incise different foods probably depend more on the food than on the individual's bite capabilities. There was variability within this range, although, as expected, bite forces were least for chocolate and greatest for apple and toffee.

Methodologic and compliance issues in postcoronary bypass surgery subjects.

Persons who engage in preventive health behaviors may reduce the progression of coronary artery disease. The immediate objective of this pilot study was to assess adherence to behavioral lifestyle changes in patients after coronary artery bypass graft surgery by analyzing self-reported responses using objective measures. Data on adherence to diet, exercise, and smoking were collected from questionnaires completed by each subject. Carbon monoxide index, serum cholesterol, pre- and postambulatory pulse rates, and pre- and post-stair-climbing pulse rates were measured. All tests were conducted before discharge and at a one-month follow-up visit. Analysis of objective data showed a statistically significant reduction in total serum cholesterol, decreased smoking behavior, and increased ambulation from before discharge to one-month follow-up. Analyses showed that self reports of adherence to diet, activity, and smoking cessation were consistent with objective measures in at least 50% of subjects. Serial objective measures provide valuable indicators of patient adherence and assist staff in developing individually tailored patient education.

New record for Aedes thelcter in Arizona.

Aedes thelcter was recorded for the first time in Arizona. Three specimens were collected at the Yuma Proving Ground in Yuma County during August 1988. This collection complements previous collections of this species near Bard, California, during 1987.

Cardiovascular, pulmonary, and cancer rehabilitation. 4. Cancer rehabilitation: principles and psychosocial aspects.

This self-directed learning module highlights advances in alternative treatment settings, nutrition, and sexuality in cancer rehabilitation. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section discusses principles of clinical oncology for rehabilitation, and psychosocial aspects of cancer rehabilitation management.

Cardiovascular, pulmonary, and cancer rehabilitation. 5. Cancer rehabilitation: management of pain, neurologic and other clinical problems.

This self-directed learning module highlights new approaches to pain management, postmastectomy treatment, and rehabilitation issues in cancers of specific organ systems. It is part of the chapter on cardiovascular, pulmonary, and cancer rehabilitation for the Self-Directed Medical Knowledge Program Study Guide for practitioners and trainees in physical medicine and rehabilitation. This section discusses management of pain, neuromusculoskeletal compromise, paraneoplastic syndromes, and other clinical problems.

Effect of forced running on rat skeletal muscle with acrylamide neuropathy.

This study was performed to evaluate the effect of prolonged forced running on rat lower limb muscles with acrylamide neuropathy. Twenty-four 4-week-old rats were divided into three groups of eight rats. Acrylamide was given to two groups of sixteen rats to induce mild paralysis. Eight rats with acrylamide injections were forced to run 3,200 m/day on a treadmill for five weeks. Running activities slowed the rate of body weight gain and aggravated paralysis. Although the wet weight of tibialis anterior (TA) and extensor digitorum longus (EDL) muscles was reduced by running, that of soleus (SOL) muscles was unchanged. The ratio of their weight to their body weight (BW) remained constant regardless of exercise. Protein content (PC) of muscles was not altered by exercise, either. We postulated that exercise-induced worsening of paralysis in acrylamide neuropathy rats was not caused by muscle pathology. Deterioration of neuropathic condition due to exercise was suggested.

Overwork weakness in rats with acrylamide neuropathy.

Exercised rats have larger myelinated nerve fibers than sedentary rats and exercised rats with acrylamide neuropathy have smaller fibers than acrylamide-treated sedentary rats. These nerve fiber changes were the result of work hypertrophy and overwork atrophy, respectively. This study was designed to reassess morphologic changes in nerves after overwork was induced in rats with acrylamide neuropathy and to test the effects of rest before and after an overwork period in rats with acrylamide neuropathy. The 4-week-old rats divided into four groups of eight rats. Acrylamide was administered to three groups (Groups 2, 3, and 4) to induce subacute paralysis followed by gradual ameriolation. Group 3 was exercised for the first 5 weeks and was rested for the last 5 weeks. Group 4 was exercised for the last 5 weeks. The diameter distribution of myelinated fibers of the tibial and sural nerves was analyzed. The percentage of larger myelinated fibers was decreased in all acrylamide-treated groups. The average values of fiber diameters in Group 4 were significantly smaller than injected sedentary animals (Group 2) or those with rest (Group 3), whereas no significant difference was found between the latter groups. Axonal degeneration of teased fibers was assessed in the tibial and sural nerves. The percentage of axonal degenerated fibers in exercised animals (Group 4) was significantly higher than in the other acrylamide-injected groups (Groups 2 and 3). This study supports the concept that acrylamide neuropathy worsens with moderate intensity of running activities for a prolonged period and that recovery may occur if vigorous exercise is avoided.

An electrodiagnostic study in chronic alcoholic subjects.

Electrodiagnostic tests were performed on 16 alcoholic subjects and 15 age-matched controls. The tests were done to determine whether nerve conduction parameters differentiate between healthy and alcoholic subjects, and if so, which of these are most useful. Significant differences between alcoholic subjects and controls were found in the following variables: median nerve motor velocity; median nerve sensory latency, amplitude and velocity; ulnar nerve motor amplitude and velocity; ulnar nerve sensory amplitude, latency and velocity; sural nerve sensory amplitude and velocity; and peroneal motor amplitude and velocity. The combination of ulnar and sural sensory conduction velocity tests identified 85% of the chronic alcoholic subjects by stepwise discriminant analysis. Tibial nerve H-reflex latencies were either absent or prolonged in 63% of the subjects. Bilateral facial nerve amplitudes and latencies were normal. The ulnar sensory amplitude and ulnar sensory velocity inversely correlated with the duration of excessive alcohol drinking.

Functional strapping for incomplete Erb palsy: case report.

A simple harness device for the treatment of residual arm posturing in patients with brachial plexus palsy is described. The harness consists of six parts and is made of elastic and cotton webbing. The harness holds the arm in a functional range of movement and permits the patient's hand to be used in bimanual tasks and activities of daily living. The approximate cost of this device is +65, including labor.

Physical medicine in medical curricula: training primary care physicians and students.

The demonstrated need for the education of primary care physicians in the principles of Physical Medicine & Rehabilitation (PM&R) is not matched by the curricula of medical schools and primary care residency programs. This anomaly of medical education is discussed from the standpoint of the hindrances inherent in the medical professional as a whole and more specifically in PM&R itself. Several concepts are suggested to stimulate thought about how PM&R may change perceptions of the specialty. Increased general medical knowledge is an important element of the PM&R learning experience. The emphasis of medical education should be on the students' needs rather than those of the specialty.