Faculty Bibliography

This paper presents the algorithm and technical aspects of an intelligent diagnostic system for the detection of heart murmurs. The purpose of this research is to address the lack of effectively accurate cardiac auscultation present at the primary care physician office by development of an algorithm capable of operating within the hectic environment of the primary care office. The proposed algorithm consists of three main stages. First; denoising of input data (digital recordings of heart sounds), via Wavelet Packet Analysis. Second; input vector preparation through the use of Principal Component Analysis and block processing. Third; classification of the heart sound using an Artificial Neural Network. Initial testing revealed the intelligent diagnostic system can differentiate between normal healthy heart sounds and abnormal heart sounds (e.g., murmurs), with a specificity of 70.5% and a sensitivity of 64.7%

BACKGROUND: Experience with a quality improvement (QI) program undertaken to increase the use of beta-adrenergic blockade in at-risk patients at both a major academic medical center and a community hospital suggests barriers to implementation. METHODS: A retrospective and prospective cohort study was performed to establish the incidence and effectiveness of beta-blockade use pre- and postimplementation of a standardized screening tool and a major education program as part of a QI project. Data gathering involved a baseline phase pre-intervention; 6 weeks postintervention; and 3-6 months postintervention. RESULTS: During phase I (baseline) 56% of eligible received beta-blockers, but targeted measures (a pre-induction heart rate < 70 or a systolic blood pressure [BP] < 110 mmHg) were achieved in only 11% of patients. Phase II saw a significant overall increase in beta-blocker administration (79%) and efficacy (50%). However, during phase III (3-6 months postimplementation), the rate of beta-blocker administration fell to 61% overall, while overall efficacy remained stable at 52%. Significant differences between the academic and community hospitals were observed throughout the study. CONCLUSION: Implementation of a quality program for beta-blockade is significantly affected by the presence or absence of ongoing physician and staff education beyond the study period

At the meeting, Merck presented data from clinical trials supporting reports that its vaccine was nearly 100 percent effective in preventing the two types of HPV that cause most cases of cervical cancer. Merck representatives said the company hoped to receive approval next year for its vaccine, which is given as a series of three shots over six months. The survey on the HPV vaccine initially involved 2,500 members of the American Academy of Pediatrics who care directly for patients more than half of the workweek. Dr. [Nicole Liddon]'s team narrowed the group to 431 pediatricians to get a representative sample of such practitioners. For example, 54 percent said incorrectly that genital warts were caused by the same types of HPV that caused cervical cancer. Twenty-three percent incorrectly said that the incidence of HPV in women was highest among women in their 30's, and 48 percent said they did not know

It also urged that adults ages 19 to 65 have the booster against whooping cough, also called pertussis, 10 years after their last shot against the disease. They could receive the vaccine at the same time as their booster against tetanus and diphtheria, because a newly licensed vaccine -- Adacel, made by Sanofi Pasteur -- offers protection against all three diseases. Using estimates made by the disease centers, the panel said routine hepatitis A immunization would prevent up to 180,000 infections and 30,000 illnesses each year among children and adults, advancing the goal of eliminating the disease in this country. Adverse reactions to the vaccine are reported as rare. In recommending hepatitis A shots for toddlers, the panel cited the success of a vaccination program in 17 states that had had a high incidence of the disease: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Missouri, Montana, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington and Wyoming

Penetrating Hollywood, the Radoshes note, was a major Communist goal. Lenin himself had described the motion picture as the ideal outlet for political propaganda, and movies were now the leading form of popular culture in the United States. Those who worked in the stratified, dictatorial world of the Hollywood studios were seen as ideal recruits for the movement -- powerless folk keenly aware of the lopsided distribution of wealth. What the American Communist Party offered was a sense of shared values, a whiff of equality in a wildly unequal town. "I found myself collecting Party dues from Dalton Trumbo and other famous writers," a fellow member noted. "Dalton was making five thousand dollars a week but we were comrades.... I was welcome at the 'red table' at MGM where all the left-wingers ate." There was more to this, however, than the generosity of gullible celebrities. Indeed, the Radoshes demolish the portrait of Hollywood as a place where Reds were akin to fuzzy idealists. During World War II, they note, Communists exerted strong influence over the Screen Writers Guild, the Screen Actors Guild and the back-lot production unions. Led by screenwriter John Howard Lawson, its cultural enforcer, the party rode herd on its legions, deciding, for example, that [Budd Schulberg]'s classic novel, "What Makes Sammy Run?," was an affront to the working class or that an essay by [Albert Maltz] recommending greater artistic freedom for Communist writers was an offense against Stalin himself. A defiant Schulberg decided to quit the party; a penitent Maltz issued one of the most obsequious public retractions on record. The payback came in 1947, when the House Un-American Activities Committee, taking full advantage of early Cold War tensions, began its circus-like probe of communism in Hollywood. The Radoshes portray HUAC as a pack of bigots and retrogrades looking to smear the legacy of Franklin D. Roosevelt and to earn publicity for themselves. What makes "Red Star Over Hollywood" stand out from most other accounts, however, is its contention that those who refused to testify before HUAC -- the so-called Hollywood Ten, which included Maltz, Lardner, Trumbo, Edward Dmytryk and several other distinguished figures -- sealed their own fate and helped bring on the blacklist. The book argues that they did this by shamelessly portraying themselves as wounded patriots and champions of free speech when others considered them hard-line Stalinists who were following every twist and turn of the ever-changing communist line

Lawrence K

The greatest problem among my patients right now isn't bird flu; it is fear of bird flu. The greatest risk of an epidemic is of a fear epidemic. For one thing, comparisons to the terrible scourge of 1918 -- when another bird flu mutated and passed human to human -- have dilated the sense of danger. But there are many differences between 1918 and now. Many of the 1918 flu victims died of pneumonia because of a lack of antibiotics, which we now have in ample supply. There were also no flu vaccines or antiviral drugs back then, and people lived (and died) in wartime conditions of deprivation and sometimes squalor. This is how fear works, how the fear epidemic -- as opposed to a flu pandemic -- spreads. Fear is supposed to be our warning system against imminent dangers, but as a deep-rooted emotion, it interferes with our ability to make sound judgments. And if anything is contagious right now, it's judgment clouded by fear

Trying to calm worldwide alarm about the spread of an avian influenza virus to Europe from Asia, an official of the World Health Organization cautioned yesterday that there were still no signs of an influenza pandemic in humans. The A(H5N1) avian strain is expected to spread to additional countries, and the agency remains concerned about the longer-term potential for the virus to mutate or combine with a human influenza virus to create a new one that could cause a human pandemic, the official, Dr. Mike Ryan, said. A pandemic is an epidemic that is prevalent across a wide area. As he spoke, Greece reported what may be its first case of A(H5N1) avian influenza. Initial tests showed that a virus collected from a turkey farm on the Aegean island of Inousses near the Turkish coast was an A(H5) virus. Additional testing is under way to determine if this virus also has the additional feature of the strain, the N1 protein

He acknowledged my suggestion that he go see a gastroenterologist, writing down the doctor's name -- but he never made an appointment. [FRANK] returned to his lifestyle of heavy eating and smoking. He said the negative results in the ER had reassured him, and now he seemed to be in even more denial. He popped a Prevacid whenever he felt the slightest discomfort. He continued to experience chest pains, and after a few months, he was back in the ER. The initial tests were once again negative, but this time I kept him overnight for observation and arranged for a stress test before discharging him. Frank's cycle of worry and denial is common among men with a poor self-image and untreated depression. Many fail to respond to the warning signs, no matter how serious. Luckily, in Frank's case, the second shock of the ER was enough