Brain and kidney of progressive multifocal leukoencephalopathy patients contain identical rearrangements of the JC virus promoter/enhancer

The kidneys of six progressive multifocal leukoencephalopathy (PML) patients were examined by PCR amplification for the presence of JC virus. Amplification of three different areas of the viral genome from multiple samples of each kidney revealed three that were positive for the virus. The use of a PCR-based typing assay on all tissue samples, and cloned sequences from the viral coding region from each positive kidney showed that the same viral genome was present in the kidney as in the brain of the patient. Regulatory region clones all had the archetypal promoter/enhancer structure. However, when PCR fragments from the regulatory region were digested with a restriction enzyme which cuts in region D, the region most often deleted in PML-type promoters, a low level of undigested DNA remained. This DNA refractory to digestion had a rearranged sequence identical to that of the unique rearranged promoter in the brain of each patient. © 1994 Wiley-Liss, Inc.     

Transformation of standardized clinical models based on OWL technologies: from CEM to OpenEHR archetypes

Introduction The semantic interoperability of electronic healthcare records (EHRs) systems is a major challenge in the medical informatics area. International initiatives pursue the use of semantically interoperable clinical models, and ontologies have frequently been used in semantic interoperability efforts. The objective of this paper is to propose a generic, ontology-based, flexible approach for supporting the automatic transformation of clinical models, which is illustrated for the transformation of Clinical Element Models (CEMs) into openEHR archetypes.Methods Our transformation method exploits the fact that the information models of the most relevant EHR specifications are available in the Web Ontology Language (OWL). The transformation approach is based on defining mappings between those ontological structures. We propose a way in which CEM entities can be transformed into openEHR by using transformation templates and OWL as common representation formalism. The transformation architecture exploits the reasoning and inferencing capabilities of OWL technologies.Results We have devised a generic, flexible approach for the transformation of clinical models, implemented for the unidirectional transformation from CEM to openEHR, a series of reusable transformation templates, a proof-of-concept implementation, and a set of openEHR archetypes that validate the methodological approach.Conclusions We have been able to transform CEM into archetypes in an automatic, flexible, reusable transformation approach that could be extended to other clinical model specifications. We exploit the potential of OWL technologies for supporting the transformation process. We believe that our approach could be useful for international efforts in the area of semantic interoperability of EHR systems.     

Moving the metaphor: An act of surrender

The rationale for this paper is to enquire into the process of embodiment and moving of metaphor. A hypothesis of ‘surrender’ is suggested at the beginning and applied to two different research examples. The reasons for the original research were (for Research Example 1; Hayes, 2004 Hayes, J. (2004). The experience of student dancers in higher education in a dance movement therapy group, with reference to choreography and performance (Unpublished thesis in partial fulfilment of PhD). University of Hertfordshire.  [Google Scholar], 2006) to see how dance students perceived their involvement in DMP and if they found any links with performance and choreography, and (for Research Example 2; Hayes, 2010 Hayes, J. (2010, March). Rebirth [Performance]. Copy in possession of Jill Hayes.  [Google Scholar]) to record and question a somatic phenomenological process during preparation for and performance of a healing ritual. In this paper the author reflects upon these two research examples in order to attend to two questions pertaining to embodiment and expression of metaphor: (1) To what do we feel we surrender? and (2) How does surrender happen? Research Example 1 used a qualitative interpretive and grounded approach towards a multiple group case study (Hayes, 2004 Hayes, J. (2004). The experience of student dancers in higher education in a dance movement therapy group, with reference to choreography and performance (Unpublished thesis in partial fulfilment of PhD). University of Hertfordshire.  [Google Scholar]), while Research Example 2 is more recent heuristic research project (Hayes, 2010 Hayes, J. (2010, March). Rebirth [Performance]. Copy in possession of Jill Hayes.  [Google Scholar]) in which the researcher's own immersion in metaphor is evaluated from an archetypal perspective. A key finding of Research Example 1 was that externalisation of personal feelings through metaphor facilitated group discussion of hidden interpersonal dynamics. A key finding of Research Example 2 was that movement metaphor was the key mode of travel into the archetypal realm. The author concludes that surrender involves three components: physical response-ability, sustainment of organic movement and sustainment of image.     

openEHR 血压原型模型

openEHR规范是一套开放的电子健康档案体系。该规范提出了参考模型和原型双模型架构,参考模型定义信息,原型定义医疗知识,这样可以提高系统对医疗知识变化的适应能力。文章通过思维导图、概念、数据、状态、协议、事件和XML Schemas介绍了openEHR血压原型规范。     

《神曲》沉潜的人类探求精神

《神曲》不朽的谜底在于其深处沉潜着人类永存的探求精神。从象征森林中人类的歧路彷徨和迷失心性到三界的亡灵境遇 ,作品通过诗人的梦幻神游 ,以末日审判的隐喻方式昭告世人 :人性的泛滥与信仰的缺失是酿造人类的悲苦之酒 ,人类只有在理性精神的导引下 ,高举信仰主义的伟大旗帜 ,才能不断超越现实、超越自我。这种求取型主题不仅构成了《神曲》文本的中心意象 ,也是西方文学具有约定性的文学原型。     

基于openEHR的原型关系映射方法

医疗信息的复杂性和动态性给医疗信息系统带来1巨大挑战。openEHR规范的两层建模思想可以提高医疗信息系统的灵活性,适应医疗信息需求的变化。目前虽然已有采用openEHR官方提出的属性+路径(node+path)和openEHR参考模型对象关系映射的openEHR数据存储实现方案,但其性能无法达到临床实际应用的需要。本研究提出一种基于openEHR原型和关系数据库的自动映射方法,将原型映射为关系数据表、原型属性映射为关系数据表字段,在此基础上设计了原型驱动的数据持久化和数据访问平台。基于原型关系映射方法,对原型查询语言进行扩展,添加INSERT、UPDATE、DELETE等语法,使原型查询语言支持完整的数据操作功能。结果表明,原型关系映射方法与属性+路径和openEHR参考模型对象关系映射方法相比,在1 231条数据中查询3条数据时快69倍和8倍,在128 141条数据中查询1 593条数据时快2倍和17倍。原型关系映射和原型查询语言等技术不但可以发挥两层建模方法在医疗信息表达、存储和访问等方面的灵活性优势,而且能大幅提高数据访问的性能。     

openEHR研究综述及对我国电子健康档案的启示

openEHR是一种开放的双模型健康档案标准,其核心在于将医疗领域知识从具体的临床信息中分离出来,并分别建立参考模型和原型模型,从而使不同系统问能实现语义层的互操作。主要介绍了openEHR规范及其两层建模方法,以对我国电子健康档案提供参考。     

Dealing with the Archetypes Development Process for a Regional EHR System

Objectives

This paper aims to present the archetype modelling process used for the Health Department of Minas Gerais State, Brazil (SES/MG), to support building its regional EHR system, and the lessons learned during this process.

Methods

This study was undertaken within the Minas Gerais project. The EHR system architecture was built assuming the reference model from the ISO 13606 norm. The whole archetype development process took about ten months, coordinated by a clinical team co-ordinated by three health professionals and one systems analyst from the SES/MG. They were supported by around 30 health professionals from the internal SES/MG areas, and 5 systems analysts from the PRODEMGE. Based on a bottom-up approach, the project team used technical interviews and brainstorming sessions to conduct the modelling process.

Results

The main steps of the archetype modelling process were identified and described, and 20 archetypes were created.Lessons learned:

• – The set of principles established during the selection of PCS elements helped the clinical team to keep the focus in their objectives;
• – The initial focus on the archetype structural organization aspects was important;
• – The data elements identified were subjected to a rigorous analysis aimed at determining the most suitable clinical domain;
• – Levelling the concepts to accommodate them within the hierarchical levels in the reference model was definitely no easy task, and the use of a mind mapping tool facilitated the modelling process;
• – Part of the difficulty experienced by the clinical team was related to a view focused on the original forms previously used;
• – The use of worksheets facilitated the modelling process by health professionals;
• – It was important to have a health professional that knew about the domain tables and health classifications from the Brazilian Federal Government as member in the clinical team.

Conclusion

The archetypes (referencing terminology, domain tables and term lists) provided a favorable condition for the use of a controlled vocabulary between the central repository and the EMR systems and, probably, will increase the chances of preserving the semantics from the knowledge domain. Finally, the reference model from the ISO 13606 norm, along with the archetypes, proved sufficient to meet the specificities for the creation of an EHR system for basic healthcare in a Brazilian state.     

THE ODYSSEY – A JUNGIAN PERSPECTIVE: INDIVIDUATION AND MEETING WITH THE ARCHETYPES OF THE COLLECTIVE UNCONSCIOUS

Homer's epic tale of the 20-year return of Odysseus from the Trojan War is investigated with particular reference to Jung's theory of individuation. Odysseus' meetings with 'the anima' in the form of goddesses, sirens and female monsters and his visit to Hades demonstrate the confrontation and humanization of aspects of the archetypal level of the psyche, central to Jung's theories of psychic growth and development. Jung's important ideas of the psychoid level and the transcendent function are explored and linked both to his investigations into medieval alchemy and with findings from contemporary neuroscience. The importance of Jung's constructive method of the interpretation of dreams and myths is shown to be central.