Influence of Stroke Clinical Pathway on Documentation

The purpose of this study was to determine whether the implementation of a stroke clinical pathway could improve compliance with documentation of specific quality measures for patients admitted with the diagnosis of acute ischemic stroke, hemorrhagic stroke, or transient ischemic attack. The study used the ten standardized performance measures for stroke identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and integrated documentation of those measures into a stroke clinical pathway consisting of physician order sets, an interdisciplinary plan of care, and a patient/family education flow sheet. The American Stroke Association\u27s Get with the Guidelines - Stroke (GWTG-Stroke) database was used to collect data retrospectively on 220 patient records. The control group consisted of 110 randomly selected records of patients admitted with stroke in the year prior to clinical pathway implementation. The intervention group consisted of 110 consecutive records for patients discharged with a stroke diagnosis six months after clinical pathway implementation. Six data collectors reviewed the records to gather the information. Records were entered into the database by a single researcher. A pre-defined measure report was prepared for the \u27JCAHO Pilot-10\u27 from the GWTG-Stroke database. Comparison of the control and intervention groups using the Fisher\u27s Exact test and 95% confidence intervals revealed statistically significantly higher rates of compliance with the patient/family stroke education (p\u3c0.001) and smoking cessation counseling (p\u3c0.001) measures after pathway implementation. Further analysis of the intervention group was done to determine if the use of the clinical pathway forms increased documentation compliance with the measures. There was a statistically significant improvement in documentation of the measures for the lipid profile (p=0.003) and patient/family stroke education (p\u3c0.001) measures when at least one form in the clinical pathway was used. A Chi-square test for linear trend indicated there was a statistically significant increase in the number of measures met as the usage of the clinical pathway increased (p\u3c0.001). This study suggests that implementation of a stroke clinical pathway can improve compliance with documentation of specific performance measures by members of the healthcare team

Communication between oocytes and somatic cells regulates volatile pheromone production in Caenorhabditis elegans

Males of the androdioecious species Caenorhabditis elegans are more likely to attempt to mate with and successfully inseminate C. elegans hermaphrodites that do not concurrently harbor sperm. Although a small number of genes have been implicated in this effect, the mechanism by which it arises remains unknown. In the context of the battle of the sexes, it is also unknown whether this effect is to the benefit of the male, the hermaphrodite, or both. We report that successful contact between mature sperm and oocyte in the C. elegans gonad at the start of fertilization causes the oocyte to release a signal that is transmitted to somatic cells in its mother, with the ultimate effect of reducing her attractiveness to males. Changes in hermaphrodite attractiveness are tied to the production of a volatile pheromone, the first such pheromone described in C. elegans

How brains make decisions

This chapter, dedicated to the memory of Mino Freund, summarizes the Quantum Decision Theory (QDT) that we have developed in a series of publications since 2008. We formulate a general mathematical scheme of how decisions are taken, using the point of view of psychological and cognitive sciences, without touching physiological aspects. The basic principles of how intelligence acts are discussed. The human brain processes involved in decisions are argued to be principally different from straightforward computer operations. The difference lies in the conscious-subconscious duality of the decision making process and the role of emotions that compete with utility optimization. The most general approach for characterizing the process of decision making, taking into account the conscious-subconscious duality, uses the framework of functional analysis in Hilbert spaces, similarly to that used in the quantum theory of measurements. This does not imply that the brain is a quantum system, but just allows for the simplest and most general extension of classical decision theory. The resulting theory of quantum decision making, based on the rules of quantum measurements, solves all paradoxes of classical decision making, allowing for quantitative predictions that are in excellent agreement with experiments. Finally, we provide a novel application by comparing the predictions of QDT with experiments on the prisoner dilemma game. The developed theory can serve as a guide for creating artificial intelligence acting by quantum rules.Comment: Latex file, 20 pages, 3 figure

Searching for the Majority: Algorithms of Voluntary Control

Voluntary control of information processing is crucial to allocate resources and prioritize the processes that are most important under a given situation; the algorithms underlying such control, however, are often not clear. We investigated possible algorithms of control for the performance of the majority function, in which participants searched for and identified one of two alternative categories (left or right pointing arrows) as composing the majority in each stimulus set. We manipulated the amount (set size of 1, 3, and 5) and content (ratio of left and right pointing arrows within a set) of the inputs to test competing hypotheses regarding mental operations for information processing. Using a novel measure based on computational load, we found that reaction time was best predicted by a grouping search algorithm as compared to alternative algorithms (i.e., exhaustive or self-terminating search). The grouping search algorithm involves sampling and resampling of the inputs before a decision is reached. These findings highlight the importance of investigating the implications of voluntary control via algorithms of mental operations

A phase II trial of gemcitabine plus carboplatin in advanced transitional cell carcinoma of the urothelium

<p>Abstract</p> <p>Background</p> <p>Recent studies have demonstrated the effectiveness of cisplatin-based combinations in patients with advanced transitional cell carcinoma(TCC) of the urothelium. Concern over cisplatin toxicity instigated a search for alternative regimens. The aim of the study was to evaluate the activity and tolerability of gemcitabine plus carboplatin combination as first-line treatment in patients with advanced transitional cell carcinoma of the urothelium.</p> <p>Methods</p> <p>Patients with advanced TCC were treated with gemcitabine 1200 mg/m²on days 1 and 8 and carboplatin area under the concentration-time curve(AUC) 5 on day 1 every 21 days.</p> <p>Results</p> <p>Out of 41 patients, thirty-nine were evaluable for efficacy and 41 for toxicity. A median of 5 cycles (range 1–6) was administered. Overall response rate was 46.2% (95% confidence interval: 32–65%) including 10.3% complete responses and 35.9% partial responses. The median time to progression and median overall survival were 7.5 months (95% confidence interval: 6.6–8.4 months) and 13.6 months (95% confidence interval: 10.2–17.0 months), respectively. Grade 3/4 neutropenia, anemia and thrombocytopenia were observed in 36.6%, 26.8, and 24.4% of patients, respectively. Non-hematological toxicity was generally mild. Grade 3 vomiting occurred in 1 (2.4%) patients.</p> <p>Conclusion</p> <p>The gemcitabine plus carboplatin combination is active in advanced TCC with acceptable toxicity and needs to be evaluated further and compared with other non-cisplatin-containing regimens.</p> <p>Trial registration</p> <p>ISRCTN88259320</p

Uncertainty Compensation in Human Attention: Evidence from Response Times and Fixation Durations

BACKGROUND: Uncertainty and predictability have remained at the center of the study of human attention. Yet, studies have only examined whether response times (RT) or fixations were longer or shorter under levels of stimulus uncertainty. To date, no study has examined patterns of stimuli and responses through a unifying framework of uncertainty. METHODOLOGY/PRINCIPAL FINDINGS: We asked 29 college students to generate repeated responses to a continuous series of visual stimuli presented on a computer monitor. Subjects produced these responses by pressing on a keypad as soon a target was detected (regardless of position) while the durations of their visual fixations were recorded. We manipulated the level of stimulus uncertainty in space and time by changing the number of potential stimulus locations and time intervals between stimulus presentations. To allow the analyses to be conducted using uncertainty as common description of stimulus and response we calculated the entropy of the RT and fixation durations. We tested the hypothesis of uncertainty compensation across space and time by fitting the RT and fixation duration entropy values to a quadratic surface. The quadratic surface accounted for 80% of the variance in the entropy values of both RT and fixation durations. RT entropy increased as a function of spatial and temporal uncertainty of the stimulus, alongside a symmetric, compensatory decrease in the entropy of fixation durations as the level of spatial and temporal uncertainty of the stimuli was increased. CONCLUSIONS/SIGNIFICANCE: Our results demonstrate that greater uncertainty in the stimulus leads to greater uncertainty in the response, and that the effects of spatial and temporal uncertainties are compensatory. We also observed compensatory relationship across the entropies of fixation duration and RT, suggesting that a more predictable visual search strategy leads to more uncertain response patterns and vice versa

Coordinated distributed experiments: an emerging tool for testing global hypotheses in ecology and environmental science

There is a growing realization among scientists and policy makers that an increased understanding of today's environmental issues requires international collaboration and data synthesis. Meta-analyses have served this role in ecology for more than a decade, but the different experimental methodologies researchers use can limit the strength of the meta-analytic approach. Considering the global nature of many environmental issues, a new collaborative approach, which we call coordinated distributed experiments (CDEs), is needed that will control for both spatial and temporal scale, and that encompasses large geographic ranges. Ecological CDEs, involving standardized, controlled protocols, have the potential to advance our understanding of general principles in ecology and environmental science

Spoken language processing: piecing together the puzzle

Attempting to understand the fundamental mechanisms underlying spoken language processing, whether it is viewed as behaviour exhibited by human beings or as a faculty simulated by machines, is one of the greatest scientific challenges of our age. Despite tremendous achievements over the past 50 or so years, there is still a long way to go before we reach a comprehensive explanation of human spoken language behaviour and can create a technology with performance approaching or exceeding that of a human being. It is argued that progress is hampered by the fragmentation of the field across many different disciplines, coupled with a failure to create an integrated view of the fundamental mechanisms that underpin one organism's ability to communicate with another. This paper weaves together accounts from a wide variety of different disciplines concerned with the behaviour of living systems - many of them outside the normal realms of spoken language - and compiles them into a new model: PRESENCE (PREdictive SENsorimotor Control and Emulation). It is hoped that the results of this research will provide a sufficient glimpse into the future to give breath to a new generation of research into spoken language processing by mind or machine. (c) 2007 Elsevier B.V. All rights reserved