Under-investigation of older people with abnormal chest radiographs

Background: Whilst many authors have previously suggested that older people are under-represented in the investigation and management of lung cancer, few data are available as to the effect of age on the subsequent investigation and management of a patient with an abnormal chest radiograph. Methods: During a 3-month period in a university teaching hospital, all abnormal chest radiographs suggestive of a possible diagnosis of lung cancer were identified, and patients subsequently followed to determine investigation, management and date of death over a 5-year period. Results: Thirty-seven younger (less than or equal to69 years, median age 62 years) and 43 older patients ( 670 years, median age 80 years) were identified. Of the 80 patients with a possible bronchial carcinoma only 59% had a further chest radiograph performed. Bronchoscopy was performed in 34% of patients, but a biopsy of the lesion was undertaken in only 24% of patients. Sixteen of the 80 patients, irrespective of what investigations had been undertaken, were referred for an oncological or surgical opinion. During the study period ( 3 months), 24% of the patients died. At 6, 24 and 60 months, respectively, the total deaths were 40, 78 and 88%. Conclusion: Older patients compared with those aged less than 70 years were less likely to be investigated, further, were more likely to be managed differently (i.e., less aggressively) and more likely to die within each time interval. In more of the older group a presumed death certificate diagnosis of pneumonia was made. When an abnormal chest radiograph raises the possibility of an underlying bronchial carcinoma, the finding of this study suggests that an ageist attitude influences the subsequent management of some patients. Copyright (C) 2005 S. Karger AG, Basel.

The effect of colored lenses on the visual evoked response in children with visual stress

Purpose. Some children with visual stress and/or headaches have fewer symptoms when wearing colored lenses. Although subjective reports of improved perception exist, few objective correlates of these effects have been established. Methods. In a pilot study, 10 children who wore Intuitive Colorimeter lenses, and claimed benefit, and two asymptomatic children were tested. Steady-state potentials were measured in response to low contrast patterns modulating at a frequency of 12 Hz. Four viewing conditions were compared: 1) no lens; 2) Colorimeter lens; 3) lens of complementary color; and 4) spectrally neutral lens with similar photopic transmission. Results. The asymptomatic children showed little or no difference between the lens and no lens conditions. When all the symptomatic children were tested together, a similar result was found. However, when the symptomatic children were divided into two groups depending on their symptoms, an interaction emerged. Children with visual stress but no headaches showed the largest amplitude visual evoked potential response in the no lens condition, whereas those children whose symptoms included severe headaches or migraine showed the largest amplitude visual evoked potential response when wearing their prescribed lens. Conclusions. The results suggest that it is possible to measure objective correlates of the beneficial subjective perceptual effects of colored lenses, at least in some children who have a history of migraine or severe headaches.

A review of instruments developed to measure outcomes for carers of people with mental health problems

Objective: Community-based care for mental disorders places considerable burden on families and carers. Measuring their experiences has become a priority, but there is no consensus on appropriate instruments. We aimed to review instruments carers consider relevant to their needs and assess evidence for their use. Method: A literature search was conducted for outcome measures used with mental health carers. Identified instruments were assessed for their relevance to the outcomes identified by carers and their psychometric properties. Results: Three hundred and ninety two published articles referring to 241 outcome measures were identified, 64 of which were eligible for review (used in three or more studies). Twenty-six instruments had good psychometric properties; they measured (i) carers' well-being, (ii) the experience of caregiving and (iii) carers' needs for professional support. Conclusion: Measures exist which have been used to assess the most salient aspects of carer outcome in mental health. All require further work to establish their psychometric properties fully.

Mind-reading difficulties in the siblings of people with Asperger's syndrome: evidence for a genetic influence in the abnormal development of a specific cognitive domain

Background: Previous research suggests that the phenotype associated with Asperger's syndrome (AS) includes difficulties in understanding the mental states of others, leading to difficulties in social communication and social relationships. It has also been suggested that the first-degree relatives of those with AS can demonstrate similar difficulties, albeit to a lesser extent. This study examined 'theory of mind' (ToM) abilities in the siblings of children with AS relative to a matched control group. Method: 2 7 children who had a sibling with AS were administered the children's version of the 'Eyes Test'(Baron-Cohen, Wheelwright, Stone, & Rutherford, 1999). The control group consisted of 27 children matched for age, sex, and a measure of verbal comprehension, and who did not have a family history of AS/autism. Results: A significant difference was found between the groups on the Eyes Test, the 'siblings' group showing a poorer performance on this measure of social cognition. The difference was more pronounced among female siblings. Discussion: These results are discussed in terms of the familial distribution of a neuro-cognitive profile associated with AS, which confers varying degrees of social handicap amongst first-degree relatives. The implication of this finding with regard to the autism/AS phenotype is explored, with some discussion of why this neuro-cognitive profile (in combination with corresponding strengths) may have an evolutionary imperative.

Semi-automatic annotation and retrieval of visual content using the topic map technology

There are still major challenges in the area of automatic indexing and retrieval of multimedia content data for very large multimedia content corpora. Current indexing and retrieval applications still use keywords to index multimedia content and those keywords usually do not provide any knowledge about the semantic content of the data. With the increasing amount of multimedia content, it is inefficient to continue with this approach. In this paper, we describe the project DREAM, which addresses such challenges by proposing a new framework for semi-automatic annotation and retrieval of multimedia based on the semantic content. The framework uses the Topic Map Technology, as a tool to model the knowledge automatically extracted from the multimedia content using an Automatic Labelling Engine. We describe how we acquire knowledge from the content and represent this knowledge using the support of NLP to automatically generate Topic Maps. The framework is described in the context of film post-production.

The DREAM Framework: using a network of scalable ontologies for intelligent indexing and retrieval of visual content

There are still major challenges in the area of automatic indexing and retrieval of digital data. The main problem arises from the ever increasing mass of digital media and the lack of efficient methods for indexing and retrieval of such data based on the semantic content rather than keywords. To enable intelligent web interactions or even web filtering, we need to be capable of interpreting the information base in an intelligent manner. Research has been ongoing for a few years in the field of ontological engineering with the aim of using ontologies to add knowledge to information. In this paper we describe the architecture of a system designed to automatically and intelligently index huge repositories of special effects video clips, based on their semantic content, using a network of scalable ontologies to enable intelligent retrieval.

Visual eye disease simulator

Visually impaired people have a very different view of the world such that seemingly simple environments as viewed by a ‘normally’ sighted people can be difficult for people with visual impairments to access and move around. This is a problem that can be hard to fully comprehend by people with ‘normal vision’ even when guidelines for inclusive design are available. This paper investigates ways in which image processing techniques can be used to simulate the characteristics of a number of common visual impairments in order to provide, planners, designers and architects, with a visual representation of how people with visual impairments view their environment, thereby promoting greater understanding of the issues, the creation of more accessible buildings and public spaces and increased accessibility for visually impaired people in everyday situations.

Designing Hospital Bedside Systems for use by Patients with Visual Impairments

This paper describes the development of an interface to a hospital portal system for information, communication and entertainment such that it can be used easily and effectively by all patients regardless of their age, disability, computer experience or native language. Specifically, this paper reports on the work conducted to ensure that the interface design took into account the needs of visually impaired users.

Early identification of stimulant treatment responders, partial responders and non-responders using objective measures in children and adolescents with hyperkinetic disorder

Background: The aim of this study was to evaluate stimulant medication response following a single dose of methylphenidate (MPH) in children and young people with hyperkinetic disorder using infrared motion analysis combined with a continuous performance task (QbTest system) as objective measures. The hypothesis was put forward that a moderate testdose of stimulant medication could determine a robust treatment response, partial response and non-response in relation to activity, attention and impulse control measures. Methods: The study included 44 children and young people between the ages of 7-18 years with a diagnosis of hyperkinetic disorder (F90 & F90.1). A single dose-protocol incorporated the time course effects of both immediate release MPH and extended release MPH (Concerta XL, Equasym XL) to determine comparable peak efficacy periods post intake. Results: A robust treatment response with objective measures reverting to the population mean was found in 37 participants (84%). Three participants (7%) demonstrated a partial response to MPH and four participants (9%) were determined as non-responders due to deteriorating activity measures together with no improvements in attention and impulse control measures. Conclusion: Objective measures provide early into prescribing the opportunity to measure treatment response and monitor adverse reactions to stimulant medication. Most treatment responders demonstrated an effective response to MPH on a moderate testdose facilitating a swift and more optimal titration process.

Small wars in the age of Clausewitz: the watershed between partisan war and people's war

Around the time of Clausewitz’s writing, a new element was introduced into partisan warfare: ideology. Previously, under the ancien régime, partisans were what today we would call special forces, light infantry or cavalry, almost always mercenaries, carrying out special operations, while the main action in war took place between regular armies. Clausewitz lectured his students on such ‘small wars’. In the American War of Independence and the resistance against Napoleon and his allies, operations carried out by such partisans merged with counter-revolutionary, nationalist insurgencies, but these Clausewitz analysed in a distinct category, ‘people's war’. Small wars, people's war, etc. should thus not be thought of as monopoly of either the political Right or the Left.

A virtual headstick for people with spinal cord injuries

This paper presents a virtual headstick system as an alternative to the conventional passive headstick for persons with limited upper extremity function. The system is composed of a pair of kinematically dissimilar master-slave robots with the master robot being operated by the user's head. At the remote site, the end-effector of the slave robot moves as if it were at the tip of an imaginary headstick attached to the user's head. A unique feature of this system is that through force-reflection, the virtual headstick provides the user with proprioceptive information as in a conventional headstick, but with an augmentation of workspace volume and additional mechanical power. This paper describes the test-bed development, system identification, bilateral control implementation, and system performance evaluation.

Judging size, distance and depth with an active telepresence system

A visual telepresence system has been developed at the University of Reading which utilizes eye tracing to adjust the horizontal orientation of the cameras and display system according to the convergence state of the operator's eyes. Slaving the cameras to the operator's direction of gaze enables the object of interest to be centered on the displays. The advantage of this is that the camera field of view may be decreased to maximize the achievable depth resolution. An active camera system requires an active display system if appropriate binocular cues are to be preserved. For some applications, which critically depend upon the veridical perception of the object's location and dimensions, it is imperative that the contribution of binocular cues to these judgements be ascertained because they are directly influenced by camera and display geometry. Using the active telepresence system, we investigated the contribution of ocular convergence information to judgements of size, distance and shape. Participants performed an open- loop reach and grasp of the virtual object under reduced cue conditions where the orientation of the cameras and the displays were either matched or unmatched. Inappropriate convergence information produced weak perceptual distortions and caused problems in fusing the images.

Anxiety problems in young people with Asperger syndrome: a case series

It is now well established that the prevalence of mental health difficulties in individuals with autism spectrum disorders (ASD) is considerably higher than in the general population. With recent estimates of the prevalence of autism spectrum disorders being as high as one percent, increasing numbers of children and young people are presenting to local and specialist services with mental health problems in addition to a diagnosis of ASD. Many families report that the impact of the mental health problems can be as or more impairing than the autism spectrum difficulties themselves. Clinical services are frequently called upon to treat these difficulties; however, there is limited evidence for the effectiveness of treatments in this population. This paper reports a case series of children and adolescents with ASD and an anxiety disorder who were treated with a standard cognitive behaviour therapy (CBT) rationale adapted to take account of the neuropsychological features of ASD. Common features of the presentation of the disorders and also treatment processes are discussed.