Childhood adversity, health and quality of life in adults with intellectual and developmental disabilities.

BACKGROUND: Associations between childhood adversity and negative health outcomes are well documented within the general population; however, this relationship has yet to be confirmed in adults with intellectual and developmental disabilities (I/DD). Bridging the gap between public health and I/DD research is critical in order to better understand the ways in which the health of people with I/DD are compromised by adversity and social disadvantage and to develop preventative care frameworks and health-promoting practices specifically for adults with I/DD. The aim of this exploratory study was to examine the relationships among adversity, physical health and quality of life in a sample of adults with I/DD. METHOD: Participants were adults with I/DD currently residing within campus-based residences. Demographic data, psychiatric and medical diagnoses, adverse childhood experiences scores and quality of life scores were aggregated from participants' electronic medical records. A health history form was completed for each participant based on a review of participants' medical records. RESULTS: Results indicated childhood adversity was significantly associated with number of chronic medical conditions (r = .35, P < .001, 95% BCa CI [.13, .53]). Childhood adversity was not significantly related to quality of life. After controlling for demographic variables, childhood adversity remained a significant predictor of health history (B = .32, P < .005, 95% BCa CI [.10, .52]), with greater adversity predicting greater medical illness. CONCLUSION: Participants demonstrated higher rates of childhood adversity compared with the general population, suggesting that individuals with I/DD may be particularly vulnerable to experiencing adversity during development. Childhood adversity was a significant predictor of physical illness in adults with I/DD. These findings emphasise the importance of screening for childhood adversity histories in adults with I/DD. Additionally, results demonstrate the importance of offering preventative interventions geared at preventing physical illness and promoting health in adults with I/DD with adversity and trauma backgrounds.

Constraints on geographic variation in fiddler crabs (Ocypodidae: Uca) from the western Atlantic.

A key question in evolutionary biology is how intraspecific variation biases the evolution of a population and its divergence from other populations. Such constraints potentially limit the extent to which populations respond to selection, but may endure long enough to have macroevolutionary consequences. Previous studies have focused on the association between covariation patterns and divergence among isolated populations. Few have focused on geographic variation among semi-connected populations, however, even though this may be indicative of early selective pressures that could lead to long-term divergence and speciation. Here, we test whether covariation in the shape of the carapace of fiddler crabs (genus Uca Leach, 1814) is important for structuring geographic variation. We find that morphological divergence among populations is associated with evolvability in the direction of divergence in only a few species. The shape of the ancestral covariation matrix in these species differs from other species in having notably more variation concentrated along fewer directions (i.e. higher eccentricity). For most species, there is some evidence that covariation has constrained the range of directions into which populations have diverged but not the degree of divergence. These results suggest that even though fiddler crab populations have diverged morphologically in directions predicted by covariation, constraints on the extent to which divergence has occurred may only be manifested in species where variation patterns are eccentric enough to limit populations' ability to respond effectively in many directions.

Moisture dynamics in wall paintings monitored by single-sided NMR.

The durability of historic wall paintings is highly dependent on environmental influences such as moisture ingress, salt crystallization and temperature changes. A fundamental understanding of dynamic transport processes in wall paintings is necessary to apply suitable conservation and restoration methods to preserve such objects with high cultural value. Non-invasive, mobile-NMR techniques with single-sided sensors, such as the NMR-MOUSE(®), enable to monitor the moisture content, transport and apparent diffusion constants in wall paintings. We investigated this technique by experiment and modeling to correlate salt crystallization, moisture transport and local diffusion in wall-painting samples. Moreover, the influence of different painting techniques (fresco and secco) and conservation/consolidation methods on moisture transport and diffusion is discussed. The results are compared with results from field measurements on real fresco paintings in Casa del Salone Nero and the Villa of the Papyri, Herculaneum, Italy.

Communication architecture for AAL. Supporting patient care by health care providers in AAL-enhanced living quarters.

INTRODUCTION: This article is part of the Focus Theme of Methods of Information in Medicine on "Using Data from Ambient Assisted Living and Smart Homes in Electronic Health Records". BACKGROUND: Concepts of Ambient Assisted Living (AAL) support a long-term health monitoring and further medical and other services for multi-morbid patients with chronic diseases. In Germany many AAL and telemedical applications exist. Synergy effects by common agreements for essential application components and standards are not achieved. OBJECTIVES: It is necessary to define a communication architecture which is based on common definitions of communication scenarios, application components and communication standards. METHODS: The development of a communication architecture requires different steps. To gain a reference model for the problem area different AAL and telemedicine projects were compared and relevant data elements were generalized. The derived reference model defines standardized communication links. RESULTS: As a result the authors present an approach towards a reference architecture for AAL-communication. The focus of the architecture lays on the communication layer. The necessary application components are identified and a communication based on standards and their extensions is highlighted. CONCLUSION: The exchange of patient individual events supported by an event classification model, raw and aggregated data from the personal home area over a telemedicine center to health care providers is possible.

Predictive control of thermally induced wavefront aberrations.

In this paper we experimentally demonstrate the proof of concept for predictive control of thermally induced wavefront aberrations in optical systems. On the basis of the model of thermally induced wavefront aberrations and using only past wavefront measurements, the proposed adaptive optics controller is able to predict and to compensate the future aberrations. Furthermore, the proposed controller is able to correct wavefront aberrations even when some parameters of the prediction model are unknown. The proposed control strategy can be used in high power optical systems, such as optical lithography machines, where the predictive correction of thermally induced wavefront aberrations is a crucial issue.

Patients with difficult-to-treat depression do not exhibit an increased frequency of CYP2D6 allele duplication.

The insufficient response of patients to antidepressant medications may result from several factors, including altered drug metabolism. CYP2D6 genotyping may help assess the possible factors that contribute to difficult-to-treat depression. The aim of our study was to determine the frequency of CYP2D6 allelic variants and the prevalence of predicted CYP2D6 phenotypes in patients who were suffering from difficult-to-treat depression and compare the data with those for the healthy population of Hungary.55 patients who failed to respond to 2 or more adequate trials of different CYP2D6-dependent antidepressants were selected for genotyping.The prevalence of the predicted CYP2D6 phenotypes in the patient population was 1.8% for the UMs, 80.0% for EMs, 3.6% for IMs and 14.5% for PMs compared with 1.9% for UMs, 83.3% for EMs, 6.5% for IMs and 8.3% for PMs in the Hungarian population.The CYP2D6 allele frequencies and the predicted phenotype distributions in patients with difficult-to-treat depression were not significantly different to those found in the healthy population of Hungary. The cumulative frequency of the CYP2D6*1XN, *2XN and *35XN alleles was 0.9% in the patient population -suggesting that CYP2D6 duplication or multiplication does not play a significant role in antidepressant pharmacotherapy failure in this patient sample. The cumulative frequency of the non-functional alleles (33.5%) and the prevalence of the genetically determined PM phenotype (14.5%) were relatively high in the patient group. These figures draw attention to the possibility of unrecognised and non-reported side effects and non-adherence to drug treatment.

Neural field theory of plasticity in the cerebral cortex.

A generalized timing-dependent plasticity rule is incorporated into a recent neural field theory to explore synaptic plasticity in the cerebral cortex, with both excitatory and inhibitory populations included. Analysis in the time and frequency domains reveals that cortical network behavior gives rise to a saddle-node bifurcation and resonant frequencies, including a gamma-band resonance. These system resonances constrain cortical synaptic dynamics and divide it into four classes, which depend on the type of synaptic plasticity window. Depending on the dynamical class, synaptic strengths can either have a stable fixed point, or can diverge in the absence of a separate saturation mechanism. Parameter exploration shows that time-asymmetric plasticity windows, which are signatures of spike-timing dependent plasticity, enable the richest variety of synaptic dynamics to occur. In particular, we predict a zone in parameter space which may allow brains to attain the marginal stability phenomena observed experimentally, although additional regulatory mechanisms may be required to maintain these parameters.

An innovative and efficient method to control the shape of push-pull membrane deformable mirror.

We carry out performance characterisation of a commercial push and pull deformable mirror with 48 actuators (Adaptica Srl). We present a detailed description of the system as well as a statistical approach on the identification of the mirror influence function. A new efficient control algorithm to induce the desired wavefront shape is also developed and comparison with other control algorithms present in literature has been made to prove the efficiency of the new approach.

Surface UV aging of elastomers investigated with microscopic resolution by single-sided NMR.

Depth profiles taken from the surface of UV irradiated natural rubber sheets have been measured with microscopic resolution using a Profile NMR-MOUSE. An NMR observable related to the sum of the spin echoes in the Carr-Purcell-Meiboom-Gill pulse sequence was used to characterize the cross-link density changes produced by the action of UV radiation in each sheet. The aging process was investigated as function of irradiation time and penetration depth. An exponential attenuation law with a space dependent absorption coefficient describes the change in the NMR observable with penetration depth. An Avrami model is used to describe the dependence of the absorption coefficient on the aging time. The method can be applied to investigate the effect of various aging agents on the surfaces of elastomers.

Medical informatics education needs information system practicums in health care settings--experiences and lessons learned from 32 practicums at four universities in two countries.

OBJECTIVES: To report about the themes and about experiences with practicums in the management of information systems in health care settings (health information management) for medical informatics students. METHODS: We first summarize the topics of the health information management practicums/projects that the authors organized between 1990 and 2003 for the medical informatics programs at Heidelberg/Heilbronn, Germany, UMIT, Austria, as well as for the informatics program at the University of Leipzig, Germany. Experiences and lessons learned, obtained from the faculty that organized the practicums in the past 14 years, are reported. RESULTS: Thirty (of 32) health information management practicums focused on the analysis of health information systems. These took place inside university medical centers. Although the practicums were time-intensive and required intensively tutoring students with regard to health information management and project management, feedback from the students and graduates was mainly positive. DISCUSSION: It is clearly recommended that students specializing in medical informatics need to be confronted with real-world problems of health information systems during their studies.

Preparing strategic information management plans for hospitals: a practical guideline SIM plans for hospitals: a guideline.

OBJECTIVES: Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. METHODS: The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. RESULTS: The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. CONCLUSIONS: Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.

Modeling Hospital Information Systems (Part 2): using the 3LGM2 tool for modeling patient record management.

OBJECTIVES: We introduce the 3LGM(2) tool, a tool for modeling information systems, and describe the process of modeling parts of the hospital information system of the Leipzig University Hospital (UKL(a)). We modeled the sub information systems of five patient record archiving sections to support the creation of a proposal for governmental financial support for a new document management and archiving system. We explain the steps of identifying the model elements and their relations as well as the analyzing capabilities of the 3LGM(2) tool to answer questions about the information system. METHODS: The 3LGM(2) tool was developed on the basis of the meta model 3LGM(2) which is described in detail in [1]. 3LGM(2) defines an ontological basis, divided into three layers and their relationships. In addition to usual meta CASE tools, the 3LGM(2) tool meets certain requirements of information management in hospitals. The model described in this article was created on the base of on-site surveys in five archiving sections of the UKL. RESULTS: A prototype of the 3LGM(2) tool is available and is currently tested in some projects at the UKL and partner institutions. The model presented in this article is a structured documentation about the current state of patient record archiving at the UKL. The analyzing capabilities of the 3LGM(2) tool help to use the model and to answer questions about the information system. CONCLUSIONS: The 3LGM(2) tool can be used to model and analyze information systems. The presentation capabilities and the reliability of the prototype have to be improved. The initial modeling effort of an institution is only valuable if the model is maintained regularly and reused in other projects. Reference catalogues and reference models are needed to decrease this effort and to support the creation of comparable models.

Strategic information management plans: the basis for systematic information management in hospitals.

Information management in hospitals is a complex task. In order to reduce complexity, we distinguish strategic, tactical, and operational information management. This is essential, because each of these information management levels views hospital information systems from different perspectives, and therefore uses other methods and tools. Since all these management activities deal only in part with computers, but mainly with human beings and their social behavior, we define a hospital information system as a sociotechnical subsystem of a hospital. Without proper strategic planning it would be a matter of chance, if a hospital information system would fulfil the information strategies goals. In order to support strategic planning and to reduce efforts for creating strategic plans, we propose a practicable structure.

Teaching the fundamentals of information systems management in health care. Lecture and practical training for students of medical informatics.

For the management of information systems in health care, it is important that projects are systematically planned and carried out. This is a major task for medical informatics professionals which should be taught in a medical informatics curriculum. In the respective lecture in the Heidelberg/Heilbronn medical informatics curriculum, we teach fundamentals of the management of information systems and of projects. The examples of the lecture are taken from hospital information systems. Furthermore, we have developed a 5-step method for the systematic, goal-oriented planning of projects. The lecture is complemented by a comprehensive practical training, so that the methods taught can be applied to a particular, relevant problem of the Heidelberg University Hospital.

The value of anti-Helicobacter pylori IgG antibodies in establishing eradication of infection in children.

The aim of this study was to evaluate the performance of anti-Helicobacter pylori (H. pylori) IgG antibodies in monitoring eradication of infection in children. Forty-seven H. pylori-infected children (aged 12.5 +/- 3.0 years, range 6.5-18 years) were followed for a mean of 30.3 months (range 6.66 months). Patients were divided into those with eradicated infection and those with ongoing infection, as determined by antral biopsy-related tests (histology, urease and culture). Anti-H. pylori antibodies (EIA) were tested at diagnosis and follow-up and changes of antibody titers were compared between the two groups. Twenty-five of 26 non-eradicated patients showed persistently high levels of antibodies throughout the study. One patient had non-detectable antibodies despite an ongoing infection for 12 months. Patients with eradicated infection showed a progressive fall of antibody levels from 52.9 +/- 32.4 U/ml at diagnosis to 17.5 +/- 4.1 U/ml at 6 months (p < 0.007) and 4.4 +/- 0.7 U/ml at > or = 12 months (p < 0.002). In 17 of 21 eradicated patients, serum antibodies normalized during the follow-up period; in 4 of the 21 patients, a decrease of > or = 40% of the initial value was observed during the 8-month follow-up. The validity of serology in the evaluation of H. pylori infection had a sensitivity of 100%, specificity of 96% and positive predictive and negative predictive values of 95% and 100% respectively. Our conclusion is that serial determination of anti-H. pylori antibodies is a reliable method for the follow-up and monitoring of H. pylori eradication in children and adolescents.

Cytogenetic analysis of fetal chondrocytes: a comparative study.

Progress in the prevention and prenatal detection of birth defects has led to a relative increase in the number of interruption of pregnancies associated with chromosomal abnormalities. There is an inverse relationship between the rate of success of fetal cell cultures and the interval between fetal demise and the initiation of culture. This report describes the cytogenetic analyses of cultured fetal chondrocytes compared with tissue cultures of fetal skin, fetal membranes, and placenta. The results show that cells obtained from the fetal chondrocostal junction and/or patella from missed abortions, intrauterine fetal deaths, or stillbirths can be cultured and successfully karyotyped. Since cartilage cells remain viable for some time after fetal demise, the culture of fetal chondrocytes is a complementary method for fetal chromosome analysis, especially in cases of tissue maceration after fetal demise. The success rate of chondrocyte cultures is similar to that of conventional fetal tissue cultures.

Serum pepsinogen I in childhood Helicobacter pylori gastritis: its relation to mucosal peptic activity.

Serum pepsinogen I (PG I) levels are raised in children with Helicobacter pylori gastritis. To ascertain if this is due to increased production or to increased secretion of pepsin by chief cells, we measured mucosal peptic activity in antrum and gastric body mucosal homogenates and correlated it to serum PG I levels in 122 children with and without H. pylori gastritis. In patients infected with H. pylori, mucosal peptic activity was decreased when compared to control and to children with non H. pylori gastritis. Serum PG I levels were increased (P < 0.001) and were inversely related to mucosal peptic activity (P < 0.01). These findings suggest that H. pylori can promote a leakage of pepsinogen into the circulation.

Colchicine enhances intestinal permeability in patients with familial Mediterranean fever.

OBJECTIVE: Colchicine therapy is complicated by frequent gastrointestinal adverse effects. METHODS: We compared intestinal permeability in 21 patients with familial Mediterranean fever on long-standing colchicine therapy (mean 5.8 years) and significant gastrointestinal complaints and 12 untreated patients and 14 healthy volunteers. The double probe (lactulose/mannitol) permeability test was performed using a hyperosmolar test solution (1580 mosmol) and the differential urinary recovery ratios were calculated. RESULTS: Familial Mediterranean fever patients on colchicine therapy had significantly higher lactulose/mannitol urinary excretion ratios (0.073) compared to untreated patients (0.035) and to healthy controls (0.021). Untreated familial Mediterranean fever patients had significantly greater urinary lactulose/mannitol recovery ratios than controls (P < 0.02). No correlation was found between the degree of enhanced permeability and the length of exposure to the drug or the severity of clinical symptoms. CONCLUSIONS: Intestinal permeability was significantly enhanced in patients with familial Mediterranean fever treated with colchicine.