Agreement between self-report and medical records on signs and symptoms of respiratory illness

Background: Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. Aims: To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). Methods: Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. Results: Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa=0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged =5 years) and adults. Conclusions: Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients. © 2012 Primary Care Respiratory Society UK. All rights reserved.

Higher education in flight:a new direction for international assignments research

This paper draws attention to the significant internationalisation of the higher education sector and role of international assignments in supporting and driving this. The paper then proceeds to identify the similarities and unique features of the sector in the context of international assignments which we argue, primarily revolve around alternative forms, namely international frequent flyers and short-term assignments. Finally, a model is proposed that may facilitate higher education institutes in more effective international assignment utilisation. © 2012 Copyright Taylor and Francis Group, LLC.

Direction-contingent duration compression is primarily retinotopic

Previous research has shown that prior adaptation to a spatially circumscribed, oscillating grating results in the duration of a subsequent stimulus briefly presented within the adapted region being underestimated. There is an on-going debate about where in the motion processing pathway the adaptation underlying this distortion of sub-second duration perception occurs. One position is that the LGN and, perhaps, early cortical processing areas are likely sites for the adaptation; an alternative suggestion is that visual area MT+ contains the neural mechanisms for sub-second timing; and a third position proposes that the effect is driven by adaptation at multiple levels of the motion processing pathway. A related issue is in what frame of reference – retinotopic or spatiotopic – does adaptation induced duration distortion occur. We addressed these questions by having participants adapt to a unidirectional random dot kinematogram (RDK), and then measuring perceived duration of a 600 ms test RDK positioned in either the same retinotopic or the same spatiotopic location as the adaptor. We found that, when it did occur, duration distortion of the test stimulus was direction contingent; that is it occurred when the adaptor and test stimuli drifted in the same direction, but not when they drifted in opposite directions. Furthermore the duration compression was evident primarily under retinotopic viewing conditions, with little evidence of duration distortion under spatiotopic viewing conditions. Our results support previous research implicating cortical mechanisms in the duration encoding of sub-second visual events, and reveal that these mechanisms encode duration within a retinotopic frame of reference.

Maintaining a grasp on reality – Is our validation and design effort focused in the same direction?

This article examines the influence on the engineering design process of the primary objective of validation, whether it is proving a model, a technology or a product. Through the examination of a number of stiffened panel case studies, the relationships between simulation, validation, design and the final product are established and discussed. The work demonstrates the complex interactions between the original (or anticipated) design model, the analysis model, the validation activities and the product in service. The outcome shows clearly some unintended consequences. High fidelity validation test simulations require a different set of detailed parameters to accurately capture behaviour. By doing so, there is a divergence from the original computer-aided design model, intrinsically limiting the value of the validation with respect to the product. This work represents a shift from the traditional perspective of encapsulating and controlling errors between simulation and experimental test to consideration of the wider design-test process. Specifically, it is a reflection on the implications of how models are built and validated, and the effect on results and understanding of structural behaviour. This article then identifies key checkpoints in the design process and how these should be used to update the computer-aided design system parameters for a design. This work strikes at a fundamental challenge in understanding the interaction between design, certification and operation of any complex system.

Determining the optimal current direction of transcranial magnetic stimulation to induce motor responses in the tongue: A preliminary study of neurologically healthy individuals

Objective
To determine the optimal transcranial magnetic stimulation (TMS) coil direction for inducing motor responses in the tongue in a group of non-neurologically impaired participants.
Methods
Single-pulse TMS was delivered using a figure-of-eight Magstim 2002 TMS coil. Study 1 investigated the effect of eight different TMS coil directions on the motor-evoked potentials elicited in the tongue in eight adults. Study 2 examined active motor threshold levels at optimal TMS coil direction compared to a customarily-used ventral-caudal direction. Study 3 repeated the procedure of Study 1 at five different sites across the tongue motor cortex in one adult.
Results
Inter-individual variability in optimal direction was observed, with an optimal range of directions determined for the group. Active motor threshold was reduced when a participant's own optimal TMS coil direction was used compared to the ventral-caudal direction. A restricted range of optimal directions was identified across the five cortical positions tested.
Conclusions
There is a need to identify each individual's own optimal TMS coil direction in investigating tongue motor cortex function. A recommended procedure for determining optimal coil direction is described.
Significance
Optimized TMS procedures are needed so that TMS can be utilized in determining the underlying neurophysiological basis of various motor speech disorders.