Patient-centered care in telemedicine - An experimental-design study.

BACKGROUND: Patients using telemedicine expect health providers to meet their expectations and are concerned about losing interpersonal contact. Studies on tailoring telemedicine to patient expectations are scant. This experimental design starts to close the gap in the state-of-the-art testing of patient expectations of communication with healthcare providers in telemedicine based on the patient-centered approach. The study was conducted from June 2021 through September 2021. METHODS: The convenience sample comprised 677 students, 298 females and 379 males, ages 18 to 64 who are all patients of one of four national health funds in Israel, using telemedicine. We used a conjoint-based experimental design. Each respondent evaluated a unique set of 24 vignettes of messages. The dependent variable was patient expectations of communication with healthcare providers in Telemedicine. The independent variables were four acknowledged categories of patient expectations of provider-patient communication. RESULTS: Coefficients for the total panel suggest no significant differences. Applying mathematical clustering, three mindsets emerged. A Post-hoc ANOVA test indicated that the mindsets are significantly different. Members of Mindset 1 expect the provider to walk them through the change process. Members of Mindset 2 expect healthcare providers to refer them to a reliable source of information to enhance their healthcare literacy. Members of Mindset 3 expect respect, both in non-verbal conduct and for their time. We developed a prediction tool enabling to identify the mindset-belonging of each patient in the population to a mindset in the sample. CONCLUSIONS: Findings call healthcare providers to communicate with patients via telemedicine based on mindset-tailored messages rather than based on socio-demographics for optimum patient-centered communication. Using the prediction tool, providers may identify the mindset-belonging of each patient. To enhance patient-centered care via telemedicine, providers are called upon to meet expectations by using mindset-tailored communication that structures the communication with greater specificity enhancing patient-centered care.

Sugar sweetness and pleasantness: evidence for different psychological laws.

Sweetness and the pleasantness of sweetness of sucrose solutions and sweetened food conform to different functions. Sweetness rises with concentration, whereas pleasantness first rises and then decreases. The breakpoint appears to occur at a constant sweetness (that is, constant sensory) level.

Cross-cultural differences in simple taste preferences.

A population of Indian laborers who show high preferences for sour and bitter tastes has been studied. Their judgments of taste intensity and pleasantness of sweet and salty stimuli are in accord with European population estimates, which suggests that dietary history may alter preferences for simple taste stimuli without affecting the gustatory system.

Sodium channel polypeptides in central nervous systems of various insects identified with site directed antibodies.

Immunoprecipitation, radiophosphorylation and SDS-PAGE autoradiography enable the characterization of sodium channel polypeptides in the central nervous system of insects belonging to four phylogenetically distinct orders: grasshoppers, cockroaches, flies and moth larvae. It has been shown that the insect sodium channels: (1) Are recognized by the previously described (Gordon et al. (1988) Biochemistry 27, 7032-7038) site directed antibodies corresponding to a highly conserved segment linking the homologous domains III and IV in the vertebrate sodium channel alpha subunits. (2) Serve as substrates for phosphorylation by cAMP-dependent protein kinase. (3) Are devoid of disulfide linkage to smaller subunits unlike sodium channels in vertebrate brain. (4) Are glycoproteins as shown in the grasshopper by the decrease of apparent molecular weight following endoglycosidase F treatment and specific binding to the lectins concanavalin A and wheat germ agglutinin. (5) Reveal a diversity with regard to their (a) apparent molecular masses which range from 240 to 280 kDa and (b) V8 proteinase digestion phosphopeptides indicating either differences in the positioning of the enzymatic cleavage and/or phosphorylation sites. These results provide the first evidence for structural diversity of sodium channel subtypes among various insect orders and are compared to their mammalian counterparts.

The methylation state of the proviruses in avian sarcoma virus transformed chick and rat cells.

The endogenous viruses in the avian cells are not completely methylated, nor are the Schmidt-Ruppin RSV-D (SRD) proviruses in the infected cells completely unmethylated. Avian sarcoma proviruses integrated in rat transformed cloned cells are heavily methylated. In these cells, a region in the 3' end of the env gene is unmethylated in all the src-containing proviruses but not in the transformed defective (td) proviruses. A possible role for the hypomethylation of the 3' end of the env region is proposed.

Sensory characteristics of foods: new evaluation techniques.

New product development requires the integration of sensory attributes including product taste, texture, and appearance with consumer attitudes and health biases. Both sensory and attitudinal variables determine food preferences, product purchase and food consumption. This review paper describes novel mathematical procedures that allow for study of real foods rather than model systems. Application of the Response Surface Method (RSM) to sensory evaluation of salted snacks is described.

Effects of long-term administration of buspirone and diazepam on driver steering control.

The effects of buspirone, diazepam, and placebo on tracking control were investigated over a nine-day period, using three groups of subjects, each with eight females and eight males. Subjects were tested using an interactive, computer-based driving simulator on days one, eight, and nine of the treatment period. On day nine, subjects received alcohol with their drug treatment. Measures of steering control were derived from car-driver transfer functions. Tracking performance was also measured. Diazepam was found to adversely affect steering control measures in comparison with placebo. This was true both after doses on the first as well as the eighth day of treatment. Thus, there was no evidence of behavioral tolerance to diazepam. In contrast, buspirone was not found to have any adverse effects on steering control; in fact, some evidence of improved tracking control was found. When alcohol was added to each treatment on the ninth day, differences between the drug treatment groups were less pronounced but in the same direction as on the first and eighth days.

Isolation of juvenile hormone esterase and its partial cDNA clone from the beetle, Tenebrio molitor.

Juvenile hormone esterase (JHE) plays an essential role in insect development. It is partially responsible for the clearance of juvenile hormone (JH) which regulates various aspects of insect development and reproduction. Because of its role in regulating JH titer, this enzyme has been targeted for development of biologically-based insecticides. JHE was partially purified from the beetle, Tenebrio molitor, using a transition state analog as the affinity ligand. Two forms of JHE were characterized by activity analysis, isoelectric focusing, two-dimensional SDS-PAGE and N-terminal sequence analysis. The esterase is associated with two proteins of sizes 71 and 150 kDa, both of which are active on JH III. A partial cDNA clone for the enzyme was isolated based on the sequence of N-terminal and internal peptides. Its sequence indicates that JHE from T. molitor and Heliothis virescens may have a common origin.

Effects of chronically administered buspirone and diazepam on driving-related skills performance.

The effects on driving skills of buspirone and diazepam, singly and in combination with alcohol, were examined. Three groups of 16 subjects each (8 men and 8 women) received either 20 mg of buspirone, 15 mg of diazepam, or placebo daily for 9 days. On day 9, they also received alcohol (men, 0.85 g/kg; women, 0.72 g/kg). On days 1, 8, and 9, subjects were tested on a driving simulator and given four sessions of divided attention tasks examining tracking and visual search performance. Extensive evidence of performance impairment associated with diazepam contrasted with improved performance under chronic buspirone treatment. Alcohol effects were additive.

A comparison of the effects of trazodone and amitriptyline on skills performance by geriatric subjects.

Fifteen healthy adults, aged 60 years and older, participated in a double-blind, crossover study of trazodone in comparison with amitriptyline and placebo. A battery of laboratory tests was used to measure drug effects on information processing, attention, and visual-motor skills. Amitriptyline 50 mg impaired vigilance and tracking performance and increased drowsiness. Trazodone 100 mg impaired only the most difficult tracking task. This study demonstrates that cognition and performance are less adversely affected in geriatric subjects by trazodone than by amitriptyline beginning 90 minutes after a single-dosage trial.

Serious injuries and deaths of adolescent girls resulting from interpersonal violence: characteristics and trends from the United States, 1989-1998.

BACKGROUND: Little published data are available concerning the death and disability of adolescent girls resulting from interpersonal violence (adolescents are defined as those aged 12-18 years in this study). OBJECTIVES: To determine whether there were sex differences in (a) the characteristics of those who were injured or died, (b) injury severity and outcomes, and (c) injury mechanism; and to describe time trends in these differences. DESIGN: Analysis of data concerning serious injuries due to assaults, recorded in the National Pediatric Trauma Registry (from January 1, 1989, through December 31, 1998), and homicides, recorded in the Web-Based Injury Statistics and Query Reporting System database (from January 1, 1990, through December 31, 1997). SETTING: Patient data from participating pediatric trauma centers (National Pediatric Trauma Registry) in 45 states and national death certificate data (Web-Based Injury Statistics and Query Reporting System). PATIENTS: Six hundred twelve adolescent girls who were seriously injured because of an assault were compared with 2656 adolescent boys who were seriously injured because of an assault. Three thousand four hundred eighty-seven adolescent girls who died due to a homicide were compared with 17 292 adolescent boys who died due to a homicide. RESULTS: Assaulted adolescent girls were more likely to have preexisting cognitive or psychosocial impairments than were adolescent boys (odds ratio, 1.68; 95% confidence interval, 1.12-2.51). Adolescent girls trended toward more injury-related impairments at discharge from the hospital (odds ratio, 1.16; 95% confidence interval, 0.92-1.47). Adolescent girls were more likely to have been stabbed, and less likely to have been shot. Also, adolescent girls were more likely to have been injured at a home or a residence. Compared with all National Pediatric Trauma Registry admissions, assaults declined at the same rate for adolescent girls and boys. The proportion resulting from penetrating trauma declined more slowly for adolescent girls. CONCLUSIONS: Interpersonal violence causes considerable morbidity and mortality for young women. Research and interventions should be developed to respond to adolescent girls who experience interpersonal violence.

Issues in drug-related performance impairment.

Performance impairment associated with alcohol, drugs, and medical disorders is of increasing concern to clinicians. Understanding and assessing performance impairment associated with a particular drug or condition is complex and requires careful, critical evaluation of the literature. Awareness of the issues involved enhances the ability of the clinician to assess risks for a given patient and of a given medical therapy. Important study variables are described that should be considered when evaluating the literature pertaining to performance impairment. The clinical relevance of the results of performance studies is also discussed.

Solubilization and characterization of the insect neuronal sodium channel.

Locust neuronal sodium channels were solubilized by 1% cholate and 0.2% Triton X-100, and their functionality was monitored by [3H]saxitoxin (STX) binding assays. About 40% of STX binding activity was recovered in the solubilized fraction without affecting affinity (Kd = 0.5 nM) and the time and temperature dependent STX binding activity was significantly stabilized in the presence of 20 nM STX. Partial purification by an anion exchange resin yielded a 20% recovery and a 3.5 times increase in the specific STX binding activity. Identification of the locust solubilized sodium channels by immunoprecipitation and radiophosphorylation revealed a Mr of 245,000 on SDS-PAGE. The present solubilized preparation will enable the study of the unique pharmacology of insect sodium channels.

The effects on performance of two antidepressants, alone and in combination with diazepam.

1. Ninety healthy adult men participated in a study of the effects on performance of 60 mg fluoxetine, 50 mg amitriptyline or placebo, alone and in combination with 5 mg diazepam or placebo. 2. In a 2X3 factorial design study, groups of 15 Ss received one of six possible treatment combinations. 3. Ss were tested with a battery of laboratory tests at two post-dosing times. 4. Amitriptyline impaired the performance of all tasks. When diazepam was added to the amitriptyline treatment, the impairment of three tasks increased. Diazepam alone produced impairment on two measures. 5. Fluoxetine alone impaired no task; some impairment occurred with the fluoxetine-diazepam combination.

Positive cooperativity among insecticidal scorpion neurotoxins.

The insecticidal activity of scorpion neurotoxic polypeptides increased 5-10-fold with no apparent increase in mammalian toxicity when a combination of two toxins was injected. Synergistic combinations could be predicted from binding studies and competitive displacement assays. Our results indicate that simultaneous expression in baculovirus or other transgenic organisms of the synergistic combinations of insecticidal toxins may result in more potent insect-selective biopesticides.

Taste and olfaction in human obesity.

Earlier studies have shown differences between normal weight and obese humans in responsivity to external and internal stimuli. This study shows that normal weight and obese subjects do not differ in hedonic response to sucrose (taste) and benzaldehyde (odor). However, a perceptual typing of individuals based upon hedonic response is possible for both gustatory and olfactory processes. Ratings of pleasantness for the sweet taste of sucrose appear to generalize to the food-related odor of bitter almonds. The method of magnitude estimation as applied to the study of taste and olfaction in man may reveal relationship between changes in internal state and hedonic behavior.

Marihuana and driving.

A review was performed of the marihuana and driving literature, both epidemiological and experimental. It was noted that epidemiological studies face considerable difficulties in obtaining estimates of risks involved for drivers utilizing marihuana due to the rapid decline in blood levels of tetrahydrocannabinol. On the other hand, experimental studies examining the relationship between administered marihuana dose and performance have identified many driving-related areas as exhibiting impairment. Areas impaired include coordination, tracking, perception, vigilance and performance in both driving simulators and on the road. Other behavioral areas of lesser importance for driving also exhibited evidence of impairment by marihuana. Areas for further research are suggested.

Effects of rate of drinking on human performance.

Performance on tests of motor control and of central processing of information was more impaired in rapid drinkers than in slower drinkers.

Alcohol and backward masking of visual information.

Alcohol increased the time necessary to transfer information from the initial sensory information storage system into the short-term memory system.

Police officers' detection of breath odors from alcohol ingestion.

Police officers frequently use the presence or absence of an alcohol breath odor for decisions on proceeding further into sobriety testing. Epidemiological studies report many false negative errors. The current study employed 20 experienced officers as observers to detect an alcohol odor from 14 subjects who were at blood alcohol concentrations (BACs) ranging from zero to 0.130 g/dl. Over a 4 h period, each officer had 24 opportunities to place his nose at the terminal end of a 6 in. tube through which subjects blew. Subjects were hidden behind screens with a slit for the tube to prevent any but odor cues. Under these optimum conditions, odor was detected only two-thirds of the time for BACs below 0.08 and 85% of the time for BACs at or above 0.08%. After food consumption, correct detections declined further. Officers were unable to recognize whether the alcohol beverage was beer, wine, bourbon or vodka. Odor strength estimates were unrelated to BAC levels. Estimates of BAC level failed to rise above random guesses. These results demonstrate that even under optimum laboratory conditions, breath odor detection is unreliable, which may account for the low detection rate found in roadside realistic conditions.