Biomedical subjects

Peter Adams

Publications and source records attributed to Peter Adams.

9 recordsLinked to original sources

PubMed2006

Is there any ideal of 'high quality care' opposing 'low quality care'? A deconstructionist reading.

The expressions 'high quality care' and 'low quality care' are cognitive and linguistic artefacts that help to structure people's lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. Through a 'deconstructionist reading,' this article discusses limitations of categorising the quality of care as either high or low. The limitations of this 'binary opposition' can include a lack of defining attributes; vagueness and fuzziness at the 'boundaries' between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce.

Attitude to Health↗

PubMed2006

Unilateral treatment exit: a failure of retention or a failure of treatment fit?

This article highlights perceived weaknesses in the current understanding of unilateral client exit from alcohol and other drug psychosocial treatment. It is argued that unilateral client exit is typically interpreted as a "failure of retention" when it could equally be interpreted as a "failure of treatment fit"; that is, the failure to deliver treatment optimally suited to actual client attendance. The results from an exploratory study conducted within a failure of treatment fit framework are presented. This study explored the possibility that short-term outpatient alcohol and other drug (AOD) treatment attendance may be an intentional service use strategy and that short-term attendees may exit AOD treatment as satisfied, successful, consumers. Standardized questionnaires were administered to clients (n = 109) starting a new treatment episode between June-August 2003 at admission and two-months post admission. Questionnaires explored the accuracy of client estimates of future appointment attendance, the reasons for short-term service exit, the satisfaction and outcome ratings of short-term clients, and the extent to which these compared with their longer-term peers. Findings suggest short-term treatment attendance is not an intentional service use strategy. However, despite attending fewer appointments than intended, most short-term participants reported significant levels of service satisfaction and problem improvement, and at a level comparable with their longer term peers. Problem-improvement was endorsed as the number one reason for short-term service exit. Implications for treatment delivery are discussed in light of these findings.

Adult↗

PubMed2005

Sampling phylogenetic tree space with the generalized Gibbs sampler.

The generalized Gibbs sampler (GGS) is a recently developed Markov chain Monte Carlo (MCMC) technique that enables Gibbs-like sampling of state spaces that lack a convenient representation in terms of a fixed coordinate system. This paper describes a new sampler, called the tree sampler, which uses the GGS to sample from a state space consisting of phylogenetic trees. The tree sampler is useful for a wide range of phylogenetic applications, including Bayesian, maximum likelihood, and maximum parsimony methods. A fast new algorithm to search for a maximum parsimony phylogeny is presented, using the tree sampler in the context of simulated annealing. The mathematics underlying the algorithm is explained and its time complexity is analyzed. The method is tested on two large data sets consisting of 123 sequences and 500 sequences, respectively. The new algorithm is shown to compare very favorably in terms of speed and accuracy to the program DNAPARS from the PHYLIP package.

Algorithms↗

PubMed2004

Algorithms for sequence analysis via mutagenesis.

MOTIVATION: Despite many successes of conventional DNA sequencing methods, some DNAs remain difficult or impossible to sequence. Unsequenceable regions occur in the genomes of many biologically important organisms, including the human genome. Such regions range in length from tens to millions of bases, and may contain valuable information such as the sequences of important genes. The authors have recently developed a technique that renders a wide range of problematic DNAs amenable to sequencing. The technique is known as sequence analysis via mutagenesis (SAM). This paper presents a number of algorithms for analysing and interpreting data generated by this technique. RESULTS: The essential idea of SAM is to infer the target sequence using the sequences of mutants derived from the target. We describe three algorithms used in this process. The first algorithm predicts the number of mutants that will be required to infer the target sequence with a desired level of accuracy. The second algorithm infers the target sequence itself, using the mutant sequences. The third algorithm assigns quality values to each inferred base. The algorithms are illustrated using mutant sequences generated in the laboratory.

Algorithms↗

PubMed2004

Unlocking hidden genomic sequence.

Despite the success of conventional Sanger sequencing, significant regions of many genomes still present major obstacles to sequencing. Here we propose a novel approach with the potential to alleviate a wide range of sequencing difficulties. The technique involves extracting target DNA sequence from variants generated by introduction of random mutations. The introduction of mutations does not destroy original sequence information, but distributes it amongst multiple variants. Some of these variants lack problematic features of the target and are more amenable to conventional sequencing. The technique has been successfully demonstrated with mutation levels up to an average 18% base substitution and has been used to read previously intractable poly(A), AT-rich and GC-rich motifs.

AT Rich Sequence↗

PubMed2003

Problematising depression: young people, mental health and suicidal behaviours.

The published literature provides strong evidence for connections between mental health issues, such as depression, and suicidal behaviours. However, in spite of this, no investigations to date have explored young people's perceptions of the interconnections between depression, and suicidal behaviours. This article presents discussive analyses of discussions of the contributions of depression to their suicidal behaviours of young people in New Zealand. Two dominant discourses of depression emerged: a medicalised discourse, and a moral discourse. The medicalised discourse was accessible to the majority of participants, and constructed depression as a disease. This discourse prioritised the voices of health professionals and suggested that depression was difficult to resist. The moral discourse was an alternative to the medicalised discourse, and constructed young people who experienced depression and suicidal behaviours as failures. Both discourses were informed by a mechanistic cause-and-effect relationship between depression and suicidal behaviours: attempting suicide was seen as an inevitable outcome of experiencing depression, and suicidal behaviours were inevitably undertaken by young people who were depressed. Resistance to either of these dominant discourses was problematic, and was best articulated during discussions of the stigma associated with mental ill-health and depression.

Adult↗

PubMed2002

Presentations by youth to Auckland emergency departments following a suicide attempt.

The objective of this study was to describe the population of European youth (15-24 years) presenting to emergency departments (EDs) at one of the three Auckland public hospitals following attempted suicide; and to identify factors associated with presentations to EDs by these youth. A 1-year medical record review was undertaken. A total of 212 presentations (196 individuals) occurred during the surveillance; alcohol was present for 29%. Attempts involving alcohol were more likely to occur at weekends (P < 0.01); involve cutting and piercing (P < 0.05); be undertaken by employed people (P < 0.05), and be undertaken by those not residing with family (P < 0.01). Two groups of particular concern were identified: those who involved alcohol in their attempt; and those who represented during the study period following multiple suicide attempts. These findings have implications for immediate care within an ED setting, and long-term follow-up healthcare options for distressed young people.

Adolescent↗

PubMed2002

A simulated annealing algorithm for finding consensus sequences.

MOTIVATION: A consensus sequence for a family of related sequences is, as the name suggests, a sequence that captures the features common to most members of the family. Consensus sequences are important in various DNA sequencing applications and are a convenient way to characterize a family of molecules. RESULTS: This paper describes a new algorithm for finding a consensus sequence, using the popular optimization method known as simulated annealing. Unlike the conventional approach of finding a consensus sequence by first forming a multiple sequence alignment, this algorithm searches for a sequence that minimises the sum of pairwise distances to each of the input sequences. The resulting consensus sequence can then be used to induce a multiple sequence alignment. The time required by the algorithm scales linearly with the number of input sequences and quadratically with the length of the consensus sequence. We present results demonstrating the high quality of the consensus sequences and alignments produced by the new algorithm. For comparison, we also present similar results obtained using ClustalW. The new algorithm outperforms ClustalW in many cases.

Algorithms↗

PubMed2002

Resiliency in the victim-offender cycle in male sexual abuse.

The prevalence of childhood sexual abuse in child molesters is considerably higher than that in the general population. This finding had led to the "victim-offender cycle" being popularized as an explanation for sexual offending. However, not all child molesters were victimized as children, so it is of interest to examine the factors that contribute to the victim-offender cycle or, conversely, resiliency. This study examined the "moderating factors" that may prevent a male victim of sexual abuse from entering the victim-offender cycle. Two groups were interviewed as part of the study: a "resilient group" (n = 47) and a victim-offender group (n = 41). After correction for age and education level, the resilient group were less likely to have fantasized and masturbated about the abuse, less likely to report deriving pleasure from the abuse, more likely to have had frequent social contact with adolescent peers and to have had more family and nonfamily support during childhood. The findings support the need for multifactorial models of resiliency, the victim-offender cycle, and sexual offending. Recommendations about the prevention of the victim-offender cycle are made, including the need for a thorough systemic assessment of all male victims of sexual abuse and the involvement of their family system in counseling.

Adult↗