Prisoner of war experience: effects on wives.

The aim of this study was to compare the wives of Australian soldiers who had been imprisoned during World War II (POWs) with a control group of non-POWs' wives and also to compare the POWs and non-POWs themselves in respect to several psychological and family life characteristics on which differences might be expected to arise from the long-term effects of imprisonment. A random sample of 145 of these veterans and their wives completed several self-administered mood and family life scales, an inventory of somatic symptoms, questions about the impact of the war on the veteran in the postwar decades, and several social background questions. The POWs themselves were more depressed and reported more somatic symptoms and a greater postwar impact of the war than the non-POWs. However, these differences were not accompanied by concomitant differences among their wives. There was some evidence of an influence of the POW's mood on his wife's mood in significant correlations between husbands' and wives' depression and anxiety scale scores in POW couples alone. Otherwise, there was very little indication that the POW experience had any long-term effect on the marriage relationship as measured by the variables included in this study.

A decision-supported outpatient practice system.

We describe a Decision-supported Outpatient Practice (DOP) system developed and now in use at the Columbia-Presbyterian Medical Center. DOP is an automated ambulatory medical record system that integrates in-patient and ambulatory care data, and incorporates active and passive decision support mechanisms with a view towards improving the quality of primary care. Active decision support occurs in the form of event-driven reminders created within a remote clinical information system with its central data repository and decision support system (DSS). Novel features of DOP include patient specific health maintenance task lists calculated by the remote DSS. uses of a semantically structured controlled medical vocabulary to support clinical results review and provider data entry, and exploitation of an underlying ambulatory data model that provides for an explicit record of evolution of insight regarding patient management. Benefits, challenges, and plans are discussed.

Lymphatic air embolism: a new hypothesis regarding the pathogenesis of neonatal systemic air embolism.

Objective. Neonatal systemic air embolism (NSAE) has been thought to result from introduction of air into the pulmonary veins through hypothesized alveolar-capillary fistula. The objective of this paper is to reassess the distribution of intravascular air visualized radiographically in this entity. Based on these data, an alternative theory for the pathogenesis of NSAE is proposed. Materials and methods. Four cases from our institutions and 21 additional reviewable published radiographs of NSAE were evaluated for the presence and location of intravascular air. Nonparametric statistical analysis was performed to determine if the predominance of intravascular air was venous or arterial in location, and to determine the presence or absence of pulmonary interstitial emphysema (PIE), pneumothorax, pneumomediastinum, and pneumopericardium. Results. Isolated systemic venous air was present significantly more often than isolated systemic arterial air (p < 0.0005). In addition, the presence of isolated right-sided cardiac air was found significantly more often than air within left heart chambers alone (p < 0.0005). PIE in patients with NSAE was found to be statistically more prevalent than pneumomediastinum or pneumopericardium, though similar in prevalence to pneumothorax. Conclusion. Our data support the hypothesis that intravascular air in NSAE is predominantly venous in location. PIE was found to be a very common associated finding in NSAE. Based on our current knowledge of pulmonary lymphatics, radiographic anatomy, and the lymphatic location of PIE, we propose that air within the pulmonary lymphatic system (PIE) gains access to the systemic venous system via lymphatic ducts, which results in the clinical entity NSAE. This readily explains the venous predominance of air in NSAE.

Medical Informatics Training at Columbia University and the Columbia-Presbyterian Medical Center.

The Department of Medical Informatics at Columbia University College of Physicians and Surgeons consists of a faculty of 17 full- and part-time faculty. The Department faculty collaborate with the Department of Computer Science and several clinical departments of the medical center. We offer courses in medical informatics, formal degrees (M.A., M.Phil. and Ph.D.) and a postdoctoral training program. In addition to academic offerings, the close affiliation with the Columbia-Presbyterian Medical Center and the primary responsibilities for clinical information systems offers trainees unique opportunities to work with and develop real-world applications. Faculty research programs include work on the Integrated Advanced Information Management System (IAIMS), Unified Medical Language System (UMLS), High-Performance Computing and Communications (HPCC), Electronic Medical Records, automated decision support and technology transfer through the Center for Advanced Technology.

Ventricular fibrillation complicating endomyocardial biopsy of a cardiac allograft.

Transvenous endomyocardial biopsy remains the most useful diagnostic aid in assessing rejection in the transplanted heart. Although invasive, the complications associated with endomyocardial biopsy are few, and the procedure is generally regarded as safe. We report a case of apparent ventricular fibrillation complicating transvenous endomyocardial biopsy. Histologic section revealed evidence of moderate acute rejection. This case represents the first report of a life threatening ventricular dysrhythmia following routine endomyocardial biopsy in a cardiac transplant recipient.

CARTOS II semi-automated nerve tracing: three-dimensional reconstruction from serial section micrographs.

The paper describes the history of tracing activities in the Levinthal lab from 1965 to the present. It also focuses on the evolution of electron micrograph (EM) tracing from early hand tracing reconstruction to the current, nearly fully automated CARTOS II tracing system. The present hardware systems and tracing algorithms are described in detail. Also presented are the partial tracing results of one EM data set in two and three dimensions.

Rhythmic-movement facilitation of learning in working-class Afro-American children.

In this study, we examined whether the cognitive performance of working-class Afro-American children could be enhanced based upon a presumed knowledge of the Black cultural experience. Children (6 and 9 years old) learned to match each of 12 pairs of pictures via a rhythmic movement-coordinated procedure accompanied by a musical beat or through a rote recitation procedure. It was expected and found that subsequent retention of the picture matches was superior in the rhythmic movement condition. Moreover, for the younger children, the effect was stronger for those who came from homes providing high stimulation and who had high levels of movement expressiveness.

Lifestyle assessment: applying microcomputers in family practice.

A randomised trial of assessment by computer was conducted with 180 patients in a family practice clinic. Histories of alcohol, tobacco, and drug use were obtained by computer (n = 60), interview (n = 60), or self completed questionnaire (n = 60). The results of previous research suggest that some patients may provide more accurate information about "sensitive" problems to a computer. No significant differences, however, in levels of consumption or problems were reported for the three methods of assessment. Patients gave differential ratings about the method of assessment, with the computer rated as more interesting but also more mechanical, cold, and impersonal. Although the interview was initially preferred by most, patients who completed the assessment by computer showed a significant increase (13% to 43%) in their preference for the computer after the assessment. The results of our study indicate that patients' acceptance of computers in family practice may be favourably influenced by direct experience with a microcomputer.

Lifestyle assessment: just asking makes a difference.

A 10 minute assessment of 180 family practice patients showed that 11% indicated a problem with drinking alcohol, 20% with cigarette smoking, 36% with consumption of coffee or tea, and 3% with non-medical drug use, while 11% wanted to discuss their use of medications. Moreover, being asked questions resulted in a twofold or threefold increase in the patients' intentions of discussing such a problem with their doctor. Although there was good overall agreement in recognising a problem between the patient and doctor, in roughly 40% of instances where the patient indicated a problem the doctor was unaware of it. These patients tended to be young, well educated, and employed in professional occupations, and were on their first visit to the doctor. Such brief assessments of lifestyle should be routinely conducted in family practice for both case finding and prevention.

Differential assessment of alcoholism. Evaluation of the Alcohol Use Inventory.

The biases of response styles, the internal-consistency reliability, concurrent validity and construct validity of the Alcohol Use Inventory were evaluated.

Correlation between medical and behavioral data in the assessment of alcoholism.

Using the Munich Alcoholism Test, this study examined the prevalence and interrelationships of medical and sociobehavioral disorders in a nonhospitalized sample of 106 males who had been referred to a medical officer for "suspected" problems related to drinking. A further objective was to evaluate measurement properties of the Munich Alcoholism Test (MALT), a new diagnostic instrument for alcoholism. Self-report items focusing on the recognition of drinking problems formed a homogeneous and quite reliable scale. However, clinical signs and symptoms of disorders related to alcohol abuse occurred with relative independence of each other. In this predominantly young group of subjects, many individuals recognized that they had sociobehavioral problems, but few had clinical or laboratory manifestations of diseases associated with chronic alcohol abuse. These findings underscored the advantages of including both biomedical and sociobehavioral data for the early identification of alcohol abuse and dependence.