Telemedicine for new neurological outpatients: putting a randomized controlled trial in the context of everyday practice

In a retrospective review, the telemedical management of 65 outpatients from a randomized controlled trial (RCT) of telemedicine for non-urgent referrals to a consultant neurologist was compared with the management of 76 patients seen face to face in the same trial, with that of 150 outpatients seen in the neurology clinics of district general hospitals and with that of 102 neurological outpatients seen by general physicians. Outcome measures were the numbers of investigations and of patient reviews. The telemedicine group did not differ significantly from the 150 patients seen face to face by neurologists in hospital clinics in terms of either the number of investigations or the number of reviews they received. Patients from the RCT seen face to face had significantly fewer investigations but a similar number of reviews to the other 150 patients seen face to face by neurologists (the disparity in the number of investigations may explain the negative result for telemedicine in that RCT). Patients with neurological symptoms assessed by general physicians had significantly more investigations and were reviewed significantly more often than all the other groups. Patients from the RCT seen by telemedicine were not managed significantly differently from those seen face to face by neurologists in hospital clinics but had significantly fewer investigations and follow-ups than those patients managed by general physicians. The results suggest that management of new neurological outpatients by neurologists using telemedicine is similar to that by neurologists using a face-to-face consultation, and is more efficient than management by general physicians.

Bi-sensory, striped representations: comparative insights from owl and platypus

Bi-sensory striped arrays are described in owl and platypus that share some similarities with the other variant of bi-sensory striped array found in primate and carnivore striate cortex: ocular dominance columns. Like ocular dominance columns, the owl and platypus striped systems each involve two different topographic arrays that are cut into parallel stripes, and interdigitated, so that higher-order neurons can integrate across both arrays. Unlike ocular dominance stripes, which have a separate array for each eye, the striped array in the middle third of the owl tectum has a separate array for each cerebral hemisphere. Binocular neurons send outputs from both hemispheres to the striped array where they are segregated into parallel stripes according to hemisphere of origin. In platypus primary somatosensory cortex (SI), the two arrays of interdigitated stripes are derived from separate sensory systems in the bill, 40,000 electroreceptors and 60,000 mechanoreceptors. The stripes in platypus SI cortex produce bimodal electrosensory-mechanosensory neurons with specificity for the time-of-arrival difference between the two systems. This thunder-and-lightning system would allow the platypus to estimate the distance of the prey using time disparities generated at the bill between the earlier electrical wave and the later mechanical wave caused by the motion of benthic prey. The functional significance of parallel, striped arrays is not clear, even for the highly-studied ocular dominance system, but a general strategy is proposed here that is based on the detection of temporal disparities between the two arrays that can be used to estimate distance. (C) 2004 Elsevier Ltd. All rights reserved.

Do dogs (canis familiaris) understand invisible displacement?

Domestic dogs (Canis familiaris) perform above chance on invisible displacement tasks despite showing few other signs of possessing the necessary representational abilities. Four experiments investigated how dogs find an object that has been hidden in 1 of 3 opaque boxes. Dogs passed the task under a variety of control conditions, but only if the device used to displace the object ended up adjacent to the target box after the displacement. These results suggest that the search behavior of dogs was guided by simple associative rules rather than mental representation of the object's past trajectory. In contrast, Experiment 5 found that on the same task, 18- and 24-month-old children showed no disparity between trials in which the displacement device was adjacent or nonadjacent to the target box.

Multiple paths extraction in images using a constrained expanded trellis

Single shortest path extraction algorithms have been used in a number of areas such as network flow and image analysis. In image analysis, shortest path techniques can be used for object boundary detection, crack detection, or stereo disparity estimation. Sometimes one needs to find multiple paths as opposed to a single path in a network or an image where the paths must satisfy certain constraints. In this paper, we propose a new algorithm to extract multiple paths simultaneously within an image using a constrained expanded trellis (CET) for feature extraction and object segmentation. We also give a number of application examples for our multiple paths extraction algorithm.

Evaluating trends in abundance of immature green turtles, Chelonia mydas, in the Greater Caribbean

Many long-lived marine species exhibit life history traits. that make them more vulnerable to overexploitation. Accurate population trend analysis is essential for development and assessment of management plans for these species. However, because many of these species disperse over large geographic areas, have life stages inaccessible to human surveyors, and/or undergo complex developmental migrations, data on trends in abundance are often available for only one stage of the population, usually breeding adults. The green turtle (Chelonia mydas) is one of these long-lived species for which population trends are based almost exclusively on either numbers of females that emerge to nest or numbers of nests deposited each year on geographically restricted beaches. In this study, we generated estimates of annual abundance for juvenile green turtles at two foraging grounds in the Bahamas based on long-term capture-mark-recapture (CMR) studies at Union Creek (24 years) and Conception Creek (13 years), using a two-stage approach. First, we estimated recapture probabilities from CMR data using the Cormack-Jolly-Seber models in the software program MARK; second, we estimated annual abundance of green turtles. at both study sites using the recapture probabilities in a Horvitz-Thompson type estimation procedure. Green turtle abundance did not change significantly in Conception Creek, but, in Union Creek, green turtle abundance had successive phases of significant increase, significant decrease, and stability. These changes in abundance resulted from changes in immigration, not survival or emigration. The trends in abundance on the foraging grounds did not conform to the significantly increasing trend for the major nesting population at Tortuguero, Costa Rica. This disparity highlights the challenges of assessing population-wide trends of green turtles and other long-lived species. The best approach for monitoring population trends may be a combination of (1) extensive surveys to provide data for large-scale trends in relative population abundance, and (2) intensive surveys, using CMR techniques, to estimate absolute abundance and evaluate the demographic processes' driving the trends.

Interpretation of the temperature dependence of rate constants in biosensor studies

A comparison is made between Arrhenius and transition-state analyses of the temperature dependence of rate constants reported in four published biosensor studies. Although the Eyring transition-state theory seemingly affords a more definitive solution to the problem of characterizing the activation energetics, the analysis is equivocal because of inherent assumptions about reaction mechanism and the magnitude of the transmission coefficient. In view of those uncertainties it is suggested that a preferable course of action entails reversion to the empirical Arrhenius analysis with regard to the energy of activation and a preexponential factor. The former is essentially equivalent to the enthalpy of activation, whereas the magnitude of the latter indicates directly the extent of disparity between the frequency of product formation and the universal frequency factor (temperature multiplied by the ratio of the Boltzmann and Planck constants) and hence the likelihood of a more complicated kinetic mechanism than that encompassed by the Eyring transition-state theory. (C) 2004 Elsevier Inc. All rights reserved.

Defining worthwhile and desired responses to treatment of chronic low back pain

Objective To describe patients' perceptions of minimum worthwhile and desired reductions in pain and disability upon commencing treatment for chronic low back pain. Design and Setting Descriptive study nested within a community-based randomized controlled trial on prolotherapy injections and exercises. Patients A total of 110 participants with chronic low back pain. Interventions Prior to treatment, participants were asked what minimum percentage reductions in pain and disability would make treatment worthwhile and what percentage reductions in pain and disability they desired with treatment. Outcome Measures. Minimum worthwhile reductions and desired reductions in pain and disability. Results. Median (inter-quartile range) minimum worthwhile reductions were 25% (20%, 50%) for pain and 35% (20%, 50%) for disability. This compared with desired reductions of 80% (60%, 100%) for pain and 80% (50%, 100%) for disability. The internal consistency between pain and disability responses was high (Spearman's coefficient of association of 0.81 and 0.87, respectively). A significant association existed between minimum worthwhile reductions and desired reductions, but no association was found between these two factors and patient age, gender, pain severity or duration, disability, anxiety, depression, response to treatment, or treatment satisfaction. Conclusions. Inquiring directly about patients' expectations of reductions in pain and in disability is important in establishing realistic treatment goals and setting benchmarks for success. There is a wide disparity between the reductions that they regard as minimum worthwhile and reductions that they hope to achieve. However, there is a high internal consistency between reductions in pain and disability that they expect.

Amodal completion with background determines depth from monocular gap stereopsis

Grove, Gillam, and Ono [Grove, P. M., Gillam, B. J., & Ono, H. (2002). Content and context. of monocular regions determine perceived depth in random dot, unpaired background and phantom stereograms. Vision Research, 42, 1859-1870] reported that perceived depth in monocular gap stereograms [Gillam, B. J., Blackburn, S., & Nakayama, K. (1999). Stereopsis based on monocular gaps: Metrical encoding of depth and slant without matching contours. Vision Research, 39, 493-502] was attenuated when the color/texture in the monocular gap did not match the background. It appears that continuation of the gap with the background constitutes an important component of the stimulus conditions that allow a monocular gap in an otherwise binocular surface to be responded to as a depth step. In this report we tested this view using the conventional monocular gap stimulus of two identical grey rectangles separated by a gap in one eye but abutting to form a solid grey rectangle in the other. We compared depth seen at the gap for this stimulus with stimuli that were identical except for two additional small black squares placed at the ends of the gap. If the squares were placed stereoscopically behind the rectangle/gap configuration (appearing on the background) they interfered with the perceived depth at the gap. However when they were placed in front of the configuration this attenuation disappeared. The gap and the background were able under these conditions to complete amodally. (c) 2006 Elsevier Ltd. All rights reserved.

Is the distribution of Fiji leaf gall in Australian sugarcane explained by variation in the vector Perkinsiella saccharicida?

Fiji leaf gall (FLG) is an important virally induced disease in Australian sugarcane. It is confined to southern canegrowing areas, despite its vector, the delphacid planthopper Perkinsiella saccharicida, occurring in all canegrowing areas of Queensland and New South Wales. This disparity between distributions could be a result of successful containment of the disease through quarantine and/or geographical barriers, or because northern Queensland populations of Perkinsiella may be poorer vectors of the disease. These hypotheses were first tested by investigating variation in the ITS2 region of the rDNA fragment among eastern Australian and overseas populations of Perkinsiella. The ITS2 sequences of the Western Australian P. thompsoni and the Fijian P. vitiensis were distinguishable from those of P. saccharicida and there was no significant variation among the 26P. saccharicida populations. Reciprocal crosses of a northern Queensland and a southern Queensland population of P. saccharicida were fertile, so they may well be conspecific. Single vector transmission experiments showed that a population of P. saccharicida from northern Queensland had a higher vector competency than either of two southern Queensland populations. The frequency of virus acquisition in the vector populations was demonstrated to be important in the vector competency of the planthopper. The proportion of infected vectors that transmitted the virus to plants was not significantly different among the populations tested. This study shows that the absence of FLG from northern Queensland is not due to a lack of vector competency of the northern population of P. saccharicida.

The consumption of alcohol by Australian adolescents: A comparison of revenue and expenditure

Aims: To estimate (i) Australian government taxation revenue collected from the consumption of alcohol by adolescents and (ii) the amount spent by the government on interventions aimed at educating adolescents about the potential dangers of alcohol use. Design: Secondary data analysis. Setting: Australia. Findings: Australian adolescents (aged between 12 and 17 years, inclusive) spent approximately $217 million on alcoholic beverages in 2002, netting the Australian government approximately $112 million in tax revenue. This resulted in an average of $195 earned in tax per adolescent drinker. It is estimated that the Government spent approximately $17 million on adolescent drinking interventions in 2002, equating to an expenditure of about $10.51 per adolescent on the delivery of alcohol interventions. For every dollar spent on alcohol interventions aimed at adolescents, it is estimated that the government receives around $7 in alcohol tax revenue. Conclusions: A substantial disparity exists between the amount of tax revenue received by the Australian Government from adolescent drinkers and the overall amount spent in attempting to prevent and relieve some of the problems associated with adolescent problem drinking. (c) 2006 Elsevier Ltd. All rights reserved.

Risk of serious NSAID-related gastrointestinal events during long-term exposure: a systematic review

Objective: Exposure to non-steroidal anti-inflammatory drugs (NSAIDs) is associated wit increased risk of serious gastrointestinal (GI) events compared with non-exposure. We investigated whether that risk is sustained over time. Data sources: Cochrane Controlled Trials Register (to 2002); MEDLINE, EMBASE, Derwent Drug File and Current Contents (1999-2002); manual searching of reviews (1999-2002). Study selection: From 479 search results reviewed and 221 articles retrieved, seven studies of patients exposed to prescription non-selective NSAIDs for more than 6 months and reporting time-dependent serious GI event rates were selected for quantitative data synthesis. These were stratified into two groups by study design. Data extraction: Incidence of GI events and number of patients at specific time points were extracted. Data synthesis: Meta-regression analyses were performed. Change in risk was evaluated by testing whether the slope of the regression line declined over time. Four randomised controlled trials (RCTs) provided evaluable data from five NSAID arms (aspirin, naproxen, two ibuprofen arms, and diclofenac). When the RCT data were combined, a small significant decline in annualised risk was seen: -0.005% (95% Cl, -0.008% to -0.001%) per month. Sensitivity analyses were conducted because there was disparity within the RCT data. The pooled estimate from three cohort studies showed no significant decline in annualised risk over periods up to 2 years: -0.003% (95% Cl, -0.008% to 0.003%) per month. Conclusions: Small decreases in risk over time were observed; these were of negligible clinical importance. For patients who need long-term (> 6 months) treatment, precautionary measures should be considered to reduce the net probability of serious GI events over the anticipated treatment duration. The effect of intermittent versus regular daily therapy on long-term risk needs further investigation.

Fast stereo matching by iterated dynamic programming and quadtree subregioning

The application of energy minimisation methods for stereo matching has been demonstrated to produce high quality disparity maps. However the majority of these methods are known to be computationally expensive, requiring minutes or even hours of computation. We propose a fast minimisation scheme that produces strongly competitive results for significantly reduced computation, requiring only a few seconds of computation. In this paper, we present our iterated dynamic programming algorithm along with a quadtree subregioning process for fast stereo matching.