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They suggest the presence of two sub- populations of QA neurons in S1 which behave differently in response to a periodic mechanical stimulus cheap 100 mg viagra super active with amex. QA neurons that respond periodically cheap 100mg viagra super active mastercard, might be closer to the input stimulus and those that modulate their ﬁring rates might integrate the responses of the periodic neurons and transform them into a rate code. A 20 30 20 28 20 26 20 24 20 22 20 20 20 20 20 18 20 16 20 14 20 12 20 10 14 22 10 18 8 14 6 10 40 30 34 26 30 22 26 18 Hz f1 Hz f2 B 40 30 20 10 10 20 30 40 10 20 30 40 Stimulus frequency (Hz) C D 1 60 40 20 0 0 10 20 30 0. Each row of ticks represents a trial and each tick represents an action potential. Periodicity (± SD) as a function of the ﬁrst (f1) and second stimulus (f2) frequencies. This is plotted as the probability that the second stimulus is judged higher than the ﬁrst. Gray and black lines represent psychometric and neurometric functions, respectively. Threshold ratios (psychometric/neurometric thresholds) calculated from neurons with periodicity (gray bars). Open bars represent the threshold ratios between psychometric and neurometric thresholds calculated from a small number of neurons with modulations in their ﬁring rate. A 20 30 20 28 20 26 20 24 20 22 20 20 20 20 20 18 20 16 20 14 20 12 20 10 14 22 10 18 8 14 6 10 40 30 34 26 30 22 26 18 Hz f1 Hz f2 B 100 75 50 25 10 20 30 40 10 20 30 40 Stimulus frequency (Hz) C D 1 30 20 10 0 0 10 20 30 0. Threshold ratios calculated between psychometric and neurometric thresholds for each neuron which varied the ﬁring rate as a function of the stimulus frequency (open bars). Gray bars represent the threshold ratios between psychometric and neurometric thresh- olds calculated from a small number of neurons that show periodicity. NEURONAL CORRELATES OF FLUTTER DISCRIMINATION IN S1 A more direct test for the role of periodicity in ﬂutter discrimination is measuring the discrimination capabilities of these subtypes of QA neurons associated with the psychophysical performance (Figure 4. A second test is to prove whether the evoked neural activity during discrimination in S1 cortex is sufﬁcient for sensory performance. Finally, to test whether the temporal order of the spikes is important for sensory discrimination. These are incisive tests to validate the meaning of the neural encoding of the ﬂutter stimuli in S1 cortex. The vibrotactile discrimination task requires the comparison of the second stim- ulus frequency against the ﬁrst. According to this, the observer could use a simple rule: if the number of spikes during the second stimulus is higher than during the ﬁrst stimulus, then second stimulus is higher than the ﬁrst. The same rule can be used when considering the periodicity values: if the periodicity (estimated as the frequency with greatest power in a Fourier transform of the spiking responses) during the second stimulus period is higher than during the ﬁrst stimulus, then the second stimulus is higher than the ﬁrst. The effect is equivalent to determining the area under the curve ROC (receiver operating characteristic7) generated by the neuronal response distributions for each pair of stimulus frequencies, using both periodicity and ﬁring rate values. In pairs of stimulus frequencies where the neuronal response distributions during the second stimulus are much higher than the neuronal distributions of the ﬁrst stimulus, ROC values are close to 1. If the neuronal response distributions during the stimulus are much lower than the neuronal response distributions of the ﬁrst stimulus, ROC values are close to 0; for overlapping distributions, intermediate ROC values are found. Psychophysical and neu- ronal discrimination thresholds are calculated as half the difference between the stimulus frequency identiﬁed as higher than the standard in 75% of trials and that frequency identiﬁed as higher in 25% of the trials. Neurometric functions based on periodicity or ﬁring rate of single S1 neurons were directly compared to the psychometric thresholds. This is not the case when neuro- metric thresholds based on ﬁring rate are compared to the psychometric thresholds (Figure 4. The goal of computing neurometric functions was not only to reveal the relationship between the neuronal responses of S1 to the mechanical stimulus, but also to discern whether these neural signals account for the psychometric behavior. One possible role is that they simply represent the temporal structure of the stimulus and that monkeys do not use this exquisite representation for frequency discrimination. This would be the case if, for example, discrimination were based on the mean number of spikes (or bursts) ﬁred by the population of QA neurons as a function of the stimulus frequency. If monkeys fail to discriminate between the in mean frequency of two stimuli, this would strengthen the proposal that discrimination of ﬂutter stimuli depends on the periodic structure of the spike trains evoked in S1. However, monkeys were able to extract the mean frequency from the nonperiodic signals and the psychophysical measures were almost identical with the periodic stimuli. Clearly, neurometric thresholds based on the ﬁring rate were again closely associated with the psychometric thresholds (Figure 4. As in the periodic condition, a psychophysical observer could exploit the ﬁring rate for frequency discrimination of aperiodic stimuli. These results suggest that an observer could solve this task with a precision similar to that of the monkey based only on the ﬁring rate produced during the stimulus periods. In summary, ﬁring rates that vary as functions of stimulus frequency are seen in multiple areas activated during the task, in particular in S1, and there is evidence that these rate variations have a signiﬁcant impact on behavior. Clearly, the brain must be able to extract at least some information from the precise timing of S1 spikes evoked during the task for instance, humans can easily distinguish periodic stimuli from aperiodic. However, we found no indication that the high periodicity found in S1 contributes to frequency discrimination although this possibility is hard to rule out entirely. A 20 30 20 28 20 26 20 24 20 22 20 18 20 16 20 14 20 12 20 10 30 20 24 14 30 22 18 10 30 24 10 16 10 18 22 30 14 24 10 20 Hz f1 Hz f2 B 30 20 10 101418222630 101418222630 Stimulus frequency (Hz) C D 1 30 20 10 0 0 101418222630 0. Threshold ratios calculated between psychometric and neuro- metric thresholds for each neuron during the discrimination of period stimulus frequencies (open bars).
Outcomes Successful implementation of the device into daily clinical use will require commitment from patients/carers purchase viagra super active 50mg with amex, individual healthcare professionals as well as healthcare organisations discount 25mg viagra super active with amex. A tailored training infrastructure for all is essential, not only to demon- strate correct use, but also demonstrate benefits that can be achieved from the device on an individual basis. The integration of the device into daily clinical practice will only be achieved if issues associated with it are incorporated into clinical teaching practice and continuous professional development programmes. Although training can be expensive and time consuming, it is an investment that is critical to the acceptance of all home based clinical systems. Home-based drug delivery devices are likely to generate data to populate mature information databases to inform clinical practice and may facilitate the growing trend to decentralisation of care. Conclusions Uptake of novel drug delivery devices will depend on many factors, including organisational support, effective training infrastructure, reliable systems, integration with legacy systems, data standards, workflow patterns, privacy and security, and healthcare standards. In the US, drivers to ensure successful implementation will be improved clinical outcomes and the ability to bill patients for each element of a clinical episode at the point of care. In the UK, more emphasis will be placed on the ability to input and retrieve data and information using an “integrated electronic healthcare record” accessible by clinicians and allied health professionals at the point of care, regardless of location. It is essential to involve all stakeholders in the debate relating to the goals of clinical knowledge management and the strategies required to achieve them. Presently, clinical information is not currently disseminated in a way that facilitates understanding by Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Patient awareness of their rights to access clinical data is patchy and channels of access to information are not well developed. The use of abbreviations and codes acts as a barrier to understanding by non-clinicians. Patients with specific knowledge relating to chronic conditions require tailored communication infrastructures to be developed before they can take their place as equal partners in the care process. It is essential that all stakeholders are comfortable with clinicians adopting a supportive role to enable patients to recognise deteriorating asthma and for patients be relaxed about taking a pivotal role in the self-management of their own medication to prevent deterioration in their condition. Discontinuity and lack of communication between primary care, emer- gency departments, and even within secondary care may hinder the development of an integrated care programme for asthma. The way to address this is through greater involvement of patients in their own management. The use of a drug delivery device that includes the use of a patient diary will go some way to support an integrated care programme for the management of the asthmatic patient. Thus the drug delivery device is the integrator that underpins the integrated care process. The electronic healthcare record is the repository that is pivotal to the knowledge sharing activity that is required to empower all stakeholders in the care process and capture “real time” clinical information to add to knowledge already held about a chronic clinical condition. Many clinicians complain that they suffer from “information overload”; mobile communication devices are one of the tools that can be utilised to support clinical knowledge management in the modern healthcare setting. The expert patient: A new approach to chronic disease management for the 21st century. Evidence suggesting that a chronic disease self- management program can improve health status while reducing hospitalisation – A randomised trial. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Proceedings of the 24th IEEE Engineering in Medical and Biological Sciences Annual International Conference, Houston, Texas (pp. Randomised trial of monitor- ing, feedback and management of care by telephone to improve treatment of depression in primary care. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. The author discusses the evolution of decision support in the healthcare arena, the characteristics and components of a medical decision support system, the medical decision support problem domains, and the popular medical decision support systems. Furthermore, a unique challenge in the healthcare arena—sharing of knowledge among medical decision support systems is discussed. The author discusses about the need for knowledge sharing among medical decision support systems, the evolution of various knowledge sharing standards, and the application of the knowledge sharing standards by the medical decision support systems. Finally, interesting aspects about the future trends in the medical decision support systems, its awareness, its usage and its reach to various stakeholders are discussed. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Medical Decision Support Systems and Knowledge Sharing Standards 197 Introduction The healthcare industry has been a pioneer in the application of decision support or expert systems capabilities. Even though the area of medical informatics and decision support has been around for more than four decades, there is no formal definition for a medical decision support system. Wyatt & Spiegelhalter (1991) describes a medical decision support system as a computer-based system using gathered explicit knowledge to generate patient specific advice or interpretation. The healthcare industry has witnessed a phenomenal growth and advances both in the areas of practice and research. This rapid growth of medical science has made the practice of medicine both challenging and complex. To address these challenges, the recognized medical standards organiza- tions developed medical practice guidelines to simplify the research findings to practical applications in order to improve the overall healthcare quality and delivery. Despite such initiatives, it has been difficult for the physicians to keep up with the guidelines and to tune it to their practice settings. A clear gap began to develop between developing of practice guidelines and the implementation of the same.
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Lysine, on the other hand, suppress- in 2002, researchers announced progress in creating soy- GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1259 beans that could be tolerated by consumers with those Duke, James A. Emmaus, PA: Rodale sensitivities by shutting off a gene in soybean seeds be- Press, 1997. Odle 1260 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 M Ma huang see Ephedra have shown that a diet of this type can significantly re- duce the risk of diabetes, heart disease, stroke, and var- Mace see Nutmeg ious cancers. The macrobiotic diet is rich in vitamins, high in dietary fiber, and low in fatty foods. Description Macrobiotic diet In addition to its holistic approach to nutrition, Definition macrobiotics applies these beliefs to life in general. Its A macrobiotic diet is part of a philosophy of life that philosophy recommends the following behaviors: incorporates the ancient Oriental concept or theory of • eating two or three meals a day yin and yang. The diet itself consists mainly of brown • chewing each mouthful of food approximately 50 times rice, other whole grains, and vegetables. It requires foods to aid digestion and absorption of nutrients to be cooked over a flame, rather than by electricity or microwave. The macrobiotic • using grooming, cosmetic, and household products diet is believed to have originated in nineteenth century made from natural, non-toxic ingredients Japan, with the teachings of Sagen Ishizuka, a natural • wearing only cotton clothing and avoiding metallic healer. George Ohsawa (1893–1966), a Japanese teacher jewelry and writer, introduced macrobiotics to Europeans in the 1920s. Yin and yang are opposite energies that are GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 1261 complementary and harmonious, such as day and night. Lunch should be quick everything in the universe is assigned a yin or yang qual- and light, since afternoon energy is active and expansive. Balance, harmony, order, and happiness are achieved In macrobiotics, it is believed that the dietary stan- when the forces of yin and yang are in balance. Its flexibility enhances entific studies support these claims, there are many peo- its appeal. The macrobiotic diet allows people to design ple who believe the diet helped rid them of the disease their own food regimens based on their personal require- when such conventional treatments as chemotherapy and ments, environment, and medical conditions. Others use the diet to help treat diabetes, One of the principles of the macrobiotic diet is that hypertension, arteriosclerosis, and other forms of heart people should primarily eat organically grown foods na- disease. Propronents of the macrobiotic diet claim that as Macrobiotic foods society has moved away from its traditional ecologically The primary food in the standard macrobiotic diet is based diet, there has been a corresponding rise in chronic whole cereal grains, including brown rice, barley, millet, illness. Therefore, for optimal health, the belief is that rolled oats, wheat, corn, rye, and buckwheat. A small people need to return to a way of eating based on foods amount of whole grain pasta and breads is allowed. Grains produced in their local environment, or at least grown in should comprise about 50% of the food consumed. Fresh vegetables should account for 20–30% of the Foods considered yang (contracted energy) last diet. The most highly recommended vegetables include longer and can originate from a wide geographic area. Whole grains and legumes are also yang, and can etables that should be eaten only occasionally include originate anywhere within the same continent since they cucumber, celery, lettuce, and most herbs. Fresh fruits and vegetables are con- that should be avoided include tomatoes, peppers, pota- sidered yin (expansive energy). Another 10% of the diet should include soups type of foods eaten should change with the seasons. This change is necessary be- barley malt, rice syrup, and apple juice; such seasonings cause—according to the macrobiotic philosophy—the as miso, tamari, soy sauce, rice or cider vinegar, sesame energy of fire is abundant in the form of sunlight and oil, tahini, and sea salt; occasional small amounts of does not need to be drawn from cooked food. In the au- seeds and nuts (pumpkin, sesame, sunflower, and al- tumn and winter, the opposite is true. Bev- The time of day also plays an important role in the erages allowed include tea made from twigs, stems, macrobiotic diet since it relates to atmospheric energy lev- brown rice, and dandelion root, apple juice, and good- els.
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