Using Electronic Technology to Improve Clinical Care -- Results from a Before-after Cluster Trial to Evaluate Assessment and Classification of Sick Children According to Integrated Management of Childhood Illness (IMCI) Protocol in Tanzania.

Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI

Lexical Retrieval Behaviors of Subjects With Aphasia and Subjects Without Brain Damage on a Rebus Riddle Task

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Attention modulates motor system activation during action observation: evidence for inhibitory rebound

Perceiving another individual’s actions activates the human motor system. We investigated whether this effect is stronger when the observed action is relevant to the observer’s task. The mu rhythm (oscillatory activity in the 8- to 13-Hz band over sensorimotor cortex) was measured while participants watched videos of grasping movements. In one of two conditions, the participants had to later report how many times they had seen a certain kind of grasp. In the other condition, they viewed the identical videos but had to later report how many times they had seen a certain colour change. The colour change and the grasp always occurred simultaneously. Results show mu rhythm attenuation when watching the videos relative to baseline. This attenuation was stronger when participants later reported the grasp rather than the colour, suggesting that the motor system is more strongly activated when the observed grasping actions were relevant to the observer’s task. Moreover, when the graspable object disappeared after the offset of the video, there was subsequent mu rhythm enhancement, reflecting a post-stimulus inhibitory rebound. This enhancement was again stronger when making judgments about the grasp than the colour, suggesting that the stronger activation is followed by a stronger inhibitory rebound

APPERCEPTIVE AND ASSOCIATIVE FORMS OF PROSOPAGNOSIA

Three prosopagnosic patients were given four face tests, two perceptual (an unknown face identification test and an age estimation test) and two also implying memory (a familiarity check test and a famous face recognition test). The patients' performance was assessed with reference to the score distribution of the normal population. A patient was found to fail both perceptual and mnestic tests, without any noticeable difference between them. Also the second patient had poor scores on both kinds of tests, but his impairment was significantly greater on the perceptual ones. The third patient, on the contrary, showed no perceptual deficit and only failed the mnestic tests. His inability to recognize the individuality of an item among members of the same category was strictly confined to faces and never present for other classes of stimuli (cars, coins, personal belongings). This finding is supportive of the thesis that in a few patients the deficit underlying prosopagnosia is face specific