The real cost of sequencing: higher than you think!

Advances in sequencing technology have led to a sharp decrease in the cost of ''data generation''. But is this sufficient to ensure cost-effective and efficient ''knowledge generation''?     

Effects of damping head movement and facial expression in dyadic conversation using real–time facial expression tracking and synthesized avatars

When people speak with one another, they tend to adapt their head movements and facial expressions in response to each others'' head movements and facial expressions. We present an experiment in which confederates'' head movements and facial expressions were motion tracked during videoconference conversations, an avatar face was reconstructed in real time, and naive participants spoke with the avatar face. No naive participant guessed that the computer generated face was not video. Confederates'' facial expressions, vocal inflections and head movements were attenuated at 1 min intervals in a fully crossed experimental design. Attenuated head movements led to increased head nods and lateral head turns, and attenuated facial expressions led to increased head nodding in both naive participants and confederates. Together, these results are consistent with a hypothesis that the dynamics of head movements in dyadicconversation include a shared equilibrium. Although both conversational partners were blind to the manipulation, when apparent head movement of one conversant was attenuated, both partners responded by increasing the velocity of their head movements.     

脊柱损伤的法医临床学鉴定研究进展

随着社会和现代交通、建筑事业的发展,脊柱损伤的病人发病率呈上升趋势,尤其道路交通事故为其损伤的首要原因。脊柱损伤的现场急救、临床诊断与治疗为人们所关注。然而,伴随着事件的进一步处理,对病人的损伤进行法医学鉴定显得尤为重要。目前,有关脊柱损伤的鉴定标准仅仅是确定的标准,没有规定标准的适用条件。同时,也易导致鉴定人对标准的理解与应用存在差异,由此导致了鉴定结论的争议。本文对脊柱损伤的法医临床学应用研究进展作一综述。     

Flavonoids from Artemisia lanata

A new flavonoid, gossypetin-7,8,3',4'-tetramethyl ether (3,5-dihydroxy-7,8,3',4'-tetramethoxyflavone) was isolated and its structure elucidated by chemical and spectroscopic methods. The known flavonoids 5-hydroxy-6,7,3',4'-tetramethoxyflavone and artemetin were also isolated. Chemical transformations led to the conclusion that the structure previously reported as ‘8,3',4'-trimethoxyizalpinin’ (3,5-dihydroxy-7,8,3',4'-tetramethoxyflavone) must be the isomer quercetagetin 6,7,3',4'-tetramethyl ether (3,5-dihydroxy-6,7,3',4'-tetramethoxyflavone).     

Contributions of the history,physical examination,and laboratory investigation in making medical diagnoses.

We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists'' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians'' confidence in their diagnoses.     

From the Desk of the Editor-in-Chief

The current problems involving Spain's oversized fishing fleet are explained by the growth of the fleet throughout the 20th Century. This article reviews the birth and development of Spain's distant-water fishing fleet that led to it becoming one of the world's largest fleets, albeit a fleet now devoid of fishing grounds, following the implementation throughout the world of the 200-mile exclusive economic zone.     

Ottawa researchers enter home stretch in race to produce artificial heart

An Ottawa team is in a fierce race to produce an artificial heart. If it wins, the prize will be huge: a worldwide market worth billions of dollars. The team, led by Dr. Tofy Mussivand, brings together scientists and entrepreneurs. The goal is to produce a heart that improves patients'' quality of life and doesn''t leave them tethered to a machine in hospital. Current plans are to complete clinical tests by 2000 and to have a commercial product ready for market in 2001-2. Several other groups are also racing the clock.     

A question of rhythm: recent advances in growth hormone research.

Research by Dr. Gloria Shaffer Tannenbaum at the McGill University-Montreal Children''s Hospital Research Institute has led to the development of a new test to differentiate children who are deficient in growth hormone from those who are short but growing normally. This clinical application is the fruit of Tannenbaum''s discovery that growth hormone secretion occurs in a rhythmic pattern regulated by intricate interactions between two neurohormones: growth hormone-releasing hormone (GHRH) and somatotropin release-inhibiting factor (SRIF). In the test an analogue of SRIF is used to allow stores of growth hormone to build up. A subsequent challenge with GHRH is then used to identify children with a genuine deficiency. Tannenbaum''s research also indicates that there are sexual differences in the pattern of growth hormone release and that growth hormone regulates its own secretion by means of a negative feedback system.     

American Kitchens,Luxury Bathrooms,and the Search for a 'Normal' Life in Postsocialist Hungary

Throughout the post-Soviet bloc, people regularly describe as 'normal' high-quality commodities and living environment so therwise considered extraordinary in their local context. In Hungary, this discourse of the normal indicates that middle-class aspirants, claiming 'European' status, now evaluate their own standards of living by comparison to imagined western ones. Looking to the socialist period, I argue that the construction of a socialist modern consumer led to the equation of western standards of living with self-value and dignity. Western material worlds were perceived to be conducive to a form of family life and personhood impossible under the 'abnormal' conditions of state-socialism. As this new standard comes to dictate middle-class fashioning, it becomes instrumental in the ongoing social, economic and material transformation of the country.     

The Plaintiff's Attorney and Obstetrics

This paper was presented before a meeting of plaintiffs'' attorneys, including those who specialize in malpractice actions against physicians—the National Association of Claimants'' Compensation Attorneys (NACCA).Doctor Eastman is known internationally for his contribution in the field of obstetrics. In recent years his interests have led him into the field of forensic obstetrics, a complex and difficult subject. Some of these problems are explored by Dr. Eastman in this paper and his comments will be of interest to physicians and attorneys.It is to be hoped that NACCA members benefited by this accurate and scientific presentation.     

Value of Routine Multiple Blood Tests in Patients Attending the General Practitioner

The paper describes the investigation of 296 patients selected at random from those attending the general practitioners'' surgery and studied by means of multiple biochemical and haematological tests. The tests that would not normally have been requested led to a new diagnosis of clinical significance in 16·9% of patients, in most instances requiring an alteration of the patient''s therapy. The effect of the profile tests on patient follow-up, referral of patients to hospital, and the need for subsequent investigations was studied by comparing the patients profiled with a control group of patients not having a blood profile. The place of such an investigation in general practice is considered.     

Ethical conflicts in long-term care of the aged: nutritional problems and the patient-care worker relationship.

The patient-care worker relationship was analysed by observation and unstructured group discussion in four long-stay somatogeriatric wards at Saint Lars Hospital. Investigation centred on patients entering the terminal phase who could no longer be spoon-fed. The relationship was complicated and reciprocal, and failure by the care worker to interpret her role and the dying patient''s behaviour correctly led to emotional conflict and double-binding, with resultant anxiety for both herself and the patient. Infusions and tube-feeding prescribed in such cases were given not for the patient''s benefit but to relieve anxiety in care workers and relatives. Permitting the patient a natural, painless death from water deficiency may be preferable to prolonging pain and discomfort by intervening with infusion and tube-feeding.     

Effect of counselling on the psychiatric morbidity associated with mastectomy.

A controlled trial was conducted to determine whether counselling by a specialist nurse prevented the psychiatric morbidity associated with mastectomy and breast cancer. Seventy-five patients were counselled by the nurse and monitored during follow-up, while 77 patients received only the care normally given by the surgical unit. Counselling failed to prevent morbidity, but the nurse''s regular monitoring of the women''s progress led her to recognise and refer 76% of those who needed psychiatric help. Only 15% of the control group whose condition warranted help were recognised and referred. Consequently, 12 to 18 months after mastectomy there was much less psychiatric morbidity in the counselled group (12%) than in the control group (39%). These findings highlight the high degree of psychiatric morbidity in patients who have undergone mastectomy and indicate the need to find ways of reducing this morbidity.     

Garden labor exchange among the Ye'kwana

The Ye'kwana Indians of southern Venezuela engage in extensive garden labor exchange. Approximately 40% of a household's labor is committed to gardens owned by other households. Owing to a number of situational constraints inherent in Ye'kwana household organization and garden ownership, individuals are not free to benefit other individuals directly. For example, if an individuals labors in another household's garden he benefits all members of the household who feed from that garden. Knowledge of these constraints led to the formulation and succesful testing of a simple inclusive fitness model that predicts that mean relatedness between households is correlated with the intensity and balance in exchange. In addition, it is argued that the Ye'kwana system of garden labor exchange is a form of reciprocity biased by kinship.     

Selman A. Waksman,Winner of the 1952 Nobel Prize for Physiology or Medicine

The history of the discovery and development of streptomycin is reviewed here from the personal standpoint of a member of Dr. Selman Waksman''s antibiotic screening research team. The team approach of eight individuals illustrates how the gradual enhancement of the screening methodology was developed. I illustrate three study periods with key aspects in the development of streptomycin which led to a Nobel Prize being granted to Professor Waksman. One item not previously emphasized is the employment of a submerged culture technique for large-scale production of streptomycin, thus enabling rapid animal testing and human clinical trials with Mycobacterium tuberculosis. Another is that purified streptomycin was shown by Dr. Waksman to be distinctly different from the substances called natural products, which are no longer patentable in the United States; therefore, streptomycin was found to be patentable. A third item not previously emphasized is his emphasis on the screening of actinomycetes, including the newly named Streptomyces genus. All of these factors contributed to the success of streptomycin in the treatment of tuberculosis. In combination, their successes led to Dr. Waksman''s department becoming a new pharmacological research area, specializing in drug discovery. These unique accomplishments all burnish the prior rationales used by the Karolinska Institute in granting Dr. Waksman alone the 1952 Nobel Prize for Physiology or Medicine.     

History of the Department of Pediatrics Yale University School of Medicine.

The history of pediatrics at the Yale University School of Medicine can be divided into eight historical eras. The "Paleohistorical Era" included colonial figures such as Governor John Winthrop and Hezekiah Beardsley who wrote about children''s disease in colonial times. Eli Ives, Professor of the Diseases of Children at Yale Medical School gave the first systematic pediatric course in America in the first half of the nineteenth century. During the second era, from 1830-1920, the New Haven Hospital was opened. An affiliation between Yale University and the New Haven Hospital led to the formal establishment of clinical departments including pediatrics in the early 20th century. Six eras coinciding with successive pediatric chairman have led the department to its present respected position in American pediatrics. The department''s 75th anniversary in 1996 is an occasion to recognize many of the department''s accomplishments and leaders over the years. It is also a time to reaffirm the mission of the department: to the health needs of the children of Connecticut and beyond, to the advancement of scientific knowledge of infants and children and their diseases, and to the training and educational of the pediatric clinicians, educators and investigators of the future.     

Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial

ObjectiveTo assess the effectiveness of nurse led follow up in the management of patients with lung cancer.DesignRandomised controlled trial.SettingSpecialist cancer hospital and three cancer units in southeastern England.Participants203 patients with lung cancer who had completed their initial treatment and were expected to survive for at least 3 months.InterventionNurse led follow up of outpatients compared with conventional medical follow up.ResultsPatient acceptability of nurse led follow up was high: 75% (203/271) of eligible patients consented to participate. Patients who received the intervention had less severe dyspnoea at 3 months (P=0.03) and had better scores for emotional functioning (P=0.03) and less peripheral neuropathy (P=0.05) at 12 months. Intervention group patients scored significantly better in most satisfaction subscales at 3, 6, and 12 months (P<0.01 for all subscales at 3 months). No significant differences in general practitioners'' overall satisfaction were seen between the two groups. No differences were seen in survival or rates of objective progression, although nurses recorded progression of symptoms sooner than doctors (P=0.01). Intervention patients were more likely to die at home rather than in a hospital or hospice (P=0.04), attended fewer consultations with a hospital doctor during the first 3 months (P=0.004), had fewer radiographs during the first 6 months (P=0.04), and had more radiotherapy within the first 3 months (P=0.01). No other differences were seen between the two groups in terms of the use of resources.ConclusionNurse led follow up was acceptable to lung cancer patients and general practitioners and led to positive outcomes.

What is already known on this topic

Most patients with cancer are routinely seen in outpatient clinics for many years despite lack of evidence of effectivenessDoctors and nurses often fail to detect patients'' emotional distress, and patients have little time to raise concerns

What this study adds

Follow up of patients with lung cancer by clinical nurse specialists is safe, acceptable, and cost effectiveBoth patients and general practitioners were highly satisfied with the nurse led model of follow up     

Framing disputes and organizational legitimation: UK-based Sri Lankan Tamil diaspora groups' use of the ‘genocide’ frame since 2009

The ending of the war in Sri Lanka in 2009 led to significant changes in the political strategies pursued by Sri Lankan Tamil diaspora groups in the UK. One contentious feature of these groups' campaigns has been their use of the ‘genocide’ frame to describe the actions of the Sri Lankan state, which has been predominantly viewed either as a signal of these groups' strategic naivety or as a coded expression of a wider nationalist agenda. In this article I argue that its growing use in the post-war period is more complex and is best understood in relation to these organizations' strategies of legitimation. Deploying the genocide frame has served two key functions: to demonstrate groups' responsiveness to popular demands, and to challenge dominant international approaches to post-war Sri Lanka. Together these functions served to bolster groups' legitimacy in an environment characterized by political change and high levels of inter-organizational competition.     

Crucible of fire: the Boer War and the birth of the Canadian Army Medical Corps.

Although Canada''s military physicians didn''t come to prominence until WW I and WW II, the Canadian Army Medical Corps (CAMC), the forerunner of the Royal Canadian Army Medical Corps and the current Canadian Forces Medical Service, actually had its origins in the Boer War. During that turn-of-the-century conflict, field hospitals accompanied Canadian troops to South Africa. Ian McCulloch discusses that early type of medical service and the steps that led to the creation of the CAMC.