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Seeing the changes in breast-feeding and the sources of advice on that knowledge, I make reference to the necessity of breast-feeding education and point out the problems that we must take into account, in the case of carrying forward breast-feeding education.
Most pharmaceutical research carried out today is focused on the treatment and management of the lifestyle diseases of the developed world. Diseases that affect mainly poor people are neglected in research advancements in treatment because they cannot generate large financial returns on research and development costs. Benefit sharing arrangements for the use of indigenous resources and genetic research could only marginally address this gap in research and development in diseases that affect the poor. Benefit sharing as a strategy is conceptually problematic, even if one, as we do, agrees that impoverished indigenous communities should not be exploited and that they should be assisted in improving their living conditions. The accepted concept of intellectual property protection envisages clearly defined originators and owners of knowledge, whereas the concept of community membership is fluid and indigenous knowledge is, by its very nature, open, with the originator(s) lost in the mists of time. The delineation of 'community' presents serious conceptual and practical difficulties as few communities form discrete, easily discernable groups, and most have problematic leadership structures. Benefit sharing is no substitute for governments' responsibility to uplift impoverished communities. Benefit sharing arrangements may be fraught with difficulties but considerations of respect and equity demand that prior informed consent and consultation around commercialisation of knowledge take place with the source community and their government.
The first experiences of nonpharmacological treatment of ectopic atrial tachycardia (EAT), common atrial flutter (AFl), and atrial fibrillation (AF) were performed by surgical techniques. Many studies reported a very high success rate on the use of catheter ablation with radiofrequency current for the treatment of supraventricular arrhythmias; and recently, various preliminary reports are dedicated to the treatment of EAT, AFl, and AF with that source of energy. To our knowledge 108 cases of EAT treated by catheter ablation of the ectopic focus are reported in the literature with a success rate superior to 90%. On the basis of our personal experience regarding 11 cases (4 of right atrium EAT and 7 of left) we discuss here the essential role of unipolar leads derived from the mapping catheter to select the target for radiofrequency applications. Two hundred and one cases of AFl tested by catheter ablation were previously reported. The majority of them (> 80%) were successfully treated with radiofrequency. Some working groups performed the procedure as the basis of electrophysiological findings, while others preferred an anatomical approach applying radiofrequency energy at the isthmus lying between the coronary sinus ostium and the tricuspid ring, near the vena cava orifice. On the basis of these assumptions, we obtained 83% of final success in 12 cases of AFl treated by radiofrequency. Finally, we discuss the problem related to the modulation of atrioventricular (AV) nodal conduction during AF. In our laboratory, five cases with chronic AF and very fast ventricular response were treated with radiofrequency with a posterior septal approach. In all patients, we obtained very encouraging results with a constant decrease of ventricular rate (from 137 +/- 33 to 69 +/- 14 beats per minute). All cases treated by modulation of AV nodal conduction demonstrated an appropriate chronotropic response to the variations of the functional state that persists during the follow-up. More experience with longer follow-up and accurate pre- and postprocedure evaluations are needed to finalize the most appropriate technique of radiofrequency applications in these cases.
Recent challenges to fingerprint evidence have brought forward the need for peer-reviewed scientific publications to support the evidential value assessment of fingerprint. This paper proposes some research directions to gather statistical knowledge of the within-source and between-sources variability of configurations of three minutiae on fingermarks and fingerprints. This paper proposes the use of the likelihood ratio (LR) approach to assess the value of fingerprint evidence. The model explores the statistical contribution of configurations of three minutiae using Tippett plots and related measures to assess the quality of the system. Features vectors used for statistical analysis have been obtained following a preprocessing step based on Gabor filtering and image processing to extract minutia position, type, and direction. Spatial relationships have been coded using Delaunay triangulation. The metric, used to assess similarity between two feature vectors is based on an Euclidean distance measure. The within-source variability has been estimated using a sample of 216 fingerprints from four fingers (two donors). Between-sources variability takes advantage of a database of 818 ulnar loops from randomly selected males. The results show that the data-driven approach adopted here is robust. The magnitude of LRs obtained under the prosecution and defense propositions stresses upon the major evidential contribution that small portions of fingermark, containing three minutiae, can provide regardless of its position on the general pattern.
BACKGROUND: In temporomandibular joint (TMJ) arthritis, knowledge is limited about the source of the inflammatory mediators. The aim of this study was to investigate the immunohistochemical role of tumor necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8) in the development of the antigen-induced arthritis of the rabbit TMJ. METHODS: Unilateral TMJ arthritis was induced in 28 adult rabbits. From 6 h to 6 weeks after induction of arthritis, the topology of TNF-alpha and IL-8 was observed. RESULTS: Positive reaction for TNF-alpha of synovial cells was observed within 3 days after induction and at 3 weeks after induction. TNF-alpha positive vascular endothelial cells and chondrocytes were identified throughout the observation period. IL-8 was detected only during the acute stage. CONCLUSIONS: The cytokines TNF-alpha and IL-8 were observed in specific cells depending on the stage. TNF-alpha was particularly related with angiogenesis and cartilage destruction and IL-8 was involved in the acute stage of inflammation.
Empirical investigation of reminiscence as a naturally occurring process and as a therapeutic nursing intervention has been hampered by the lack of a theoretical framework that can integrate diverse viewpoints and account for existing data. This article presents a preliminary model of reminiscence that can guide future research efforts and assist clinicians in understanding the functions of the reminiscence process. The model proposes that reminiscence is a source of self-referent knowledge, which influences a person's self-worth. It views reminiscence as a process of acquiring personal existential meaning and as a mechanism for adapting to stress.
Many saddle horses are slaughtered at a young age which could be indicative of a welfare problem. Bad riding is probably an underestimated source of poor welfare. Widespread knowledge of 'academic' riding should be encouraged and should be beneficial to all horses, at all schooling levels, for all purposes. In particular, 18th century principles tend to be forgotten and in this article the authors illustrate some differences to modern dressage. Various suggestions are made in order to improve welfare.
The time-reversal process is applied to focus pulsed ultrasonic waves through the human skull bone. The aim here is to treat brain tumors, which are difficult to reach with classical surgery means. Such a surgical application requires precise control of the size and location of the therapeutic focal beam. The severe ultrasonic attenuation in the skull reduces the efficiency of the time reversal process. Nevertheless, an improvement of the time reversal process in absorbing media has been investigated and applied to the focusing through the skull [J.-L. Thomas and M. Fink, IEEE Trans. Ultrason. Ferroelectr. Freq. Control 43, 1122-1129 (1996)]. Here an extension of this technique is presented in order to focus on a set of points surrounding an initial artificial source implanted in the tissue volume to treat. From the knowledge of the Green's function matched to this initial source location a new Green's function matched to various points of interest is deduced in order to treat the whole volume. In a homogeneous medium, conventional steering consists of tilting the wave front focused on the acoustical source. In a heterogeneous medium, this process is only valid for small angles or when aberrations are located in a layer close to the array. It is shown here how to extend this method to aberrating and absorbing layers, like the skull bone, located at any distance from the array of transducers.
A national survey of 509 parents of children with newly diagnosed diabetes elicited a 92% response rate, showing that 96% of children were admitted to hospital, 42% staying in hospital longer than one week and 41% received an intravenous infusion. More than 90% of parents expressed satisfaction with the information given at diagnosis, the preparation they received before discharge home, and the outpatient follow up services. Home visits from a diabetes nurse specialist (DNS) were received by 73% of families and 44% reported that the DNS was the most supportive person in the first year after diagnosis. Readmission during the first 12 months after diagnosis was required by 23% of children, more often in the youngest age group. Poor liaison with schools and the lack of diabetes knowledge in teachers were the sources of greatest dissatisfaction. Children under the care of paediatricians with no specialist interest in diabetes were significantly more likely to be kept in hospital longer at diagnosis and parents were less satisfied with outpatient care and school liaison. The study supports previous recommendations that diabetes nurse specialists are a priority resource in providing support services and that every district should have a paediatrician with a special interest in diabetes and a designated children's diabetic clinic.
Science education is in the process of shifting from the mastery of a large body of factual information to an emphasis on the development of reasoning skills and the solving of practical problems. Such skills are best developed by instructors and students working together in an active learning environment as opposed to instructors and students being, respectively, sources and sinks of factual knowledge. Most models of active learning are geared toward small group (< 15 students) settings in which interactions between students and instructor are optimized. However, basic courses in physiology are often forced to meet in large classes in which it is more difficult to utilize active learning methods. The panelists in this workshop demonstrated techniques that they use in large class settings to promote an active learning experience. We hope that this summary of the workshop will encourage you to experiment with educational approaches to improve the efficacy of teaching in the large class setting.
The cholecystokinin (CCK) and gastrin families of peptides act as hormones and neuropeptides on central and peripheral CCK receptors to mediate secretion and motility in the gastrointestinal (GI) tract in the physiological response to a normal meal. CCK and its receptors are also widely distributed in the central nervous system (CNS) and contribute to the regulation of satiety, anxiety, analgesia, and dopamine-mediated behavior. Although the wide distribution, myriad number of functions, and reported pharmacological heterogeneity of CCK receptors would suggest a large number of receptor subtypes, the application of modern molecular biological techniques has identified two CCK receptors, CCK-A receptor (CCK-AR) and CCK-B receptor (CCK-BR), that mediate the actions of CCK and gastrin; gastrin receptors have been found to be identical to CCK-BR. CCK-AR, found predominantly in the GI system and select areas of the CNS, have high affinity for CCK and the nonpeptide antagonist L-364,718, whereas CCK-BR, found predominantly in the CNS and select areas of the GI system, have high affinity for CCK and gastrin and the nonpeptide antagonist L-365,260. Both CCK-AR and CCK-BR are highly conserved between species, although there is some tissue-specific variation in expression. Recombinant receptor expression faithfully reproduces the native receptor pharmacology and signal transduction pathways, allowing direct comparisons of receptor function between species as well as serving as a convenient source of receptor. Our present knowledge of the chromosomal localization, receptor gene structure, and primary sequence will allow further studies in disease association, receptor regulation, and structure-function analysis.
BACKGROUND: Clinicians often rely on review material rather than analysis of primary research to guide therapy. Systematic reviews use methods to insure thoroughness and to minimize bias, but many clinicians are not familiar with systematic reviews and continue to rely on narrative reviews. OBJECTIVES: To determine whether a traditional narrative review or a systematic review is perceived to be more useful. METHODS: A clinical scenario (patient with chronic Crohn's disease considered for azathioprine therapy) was circulated to gastroenterologists, along with a narrative review of therapy (including azathioprine) for inflammatory bowel disease written by an acknowledged expert, or with a systematic Cochrane review of the use of azathioprine for this disease. Whether knowledge of authorship and journal source influences the perception of usefulness of a narrative review was investigated. RESULTS: The Cochrane review was rated significantly more highly than the narrative review on a 100 mm visual analogue scale (21.3 mm; 95% CI 14.5 to 28 mm). The proportion of respondents who considered the review to be a useful guide was also higher in the group that received the Cochrane review (91%) than in the group that received the narrative review, with author and journal concealed (62%) or identified (70%) (P<0.001 for both comparisons). Ratings from the two groups that received the narrative review were not significantly different. CONCLUSIONS: The focused systematic review was perceived to be more useful than a traditional broad narrative review as a guide to making a decision concerning the use of specific therapy. The possible strengths of systematic reviews should be more fully investigated. If there is additional evidence supporting their greater value to clinicians, they should be made more widely available to clinicians and their strengths should be publicized.
Magnetic source imaging (MSI) combines the unique spatial and temporal functional accuracy of magnetoencephalography (MEG) with the anatomic and pathologic detail of magnetic resonance (MR). This relatively new method of evaluating brain function provides a preoperative mapping of brain function and brain structure by integrating the functional information of MEG with the structural information of MR. This results in data on actual neuronal interactions in clinical patients. The temporal and spatial accuracy of the MEG data, combined with the anatomic and pathologic specificity of MRI, results in the magnetic source image, which offers accurate knowledge of cortical functional organization, and is important in the surgical treatment of brain neoplasms, vascular malformations, and epilepsy. MSI allows the tracking of neuronal activity on the scale of milliseconds with millimeter accuracy, and continues to lead to new understanding of many functional brain disorders.
BACKGROUND: The optimal nutrition approach for the promotion of weight gain in HIV-infected adults with wasting remains unclear. Previous dietary interventions report minimal success and provide inadequate information regarding the counseling approach, contact time, session format, and issues addressed with the subject. The methods we report were incorporated in a 12-week intervention trial for the reversal of HIV-wasting. METHODS: All subjects involved in the intervention trial for the reversal of HIV-wasting received weekly, customized, one-on-one counseling and an oral nutrition supplement (480 kcal/d with 30 g protein). The nutrition aims were to (1) increase caloric intake to surpass daily energy requirements by 500 kcal/d (suggested caloric intake: 40 to 50 kcal/kg current weight); (2) increase protein intake (1.6 to 1.8 g/kg current weight per day); and (3) identify foods that may exacerbate or curtail side effects associated with HIV. Also assessed were preconceptions, nutrition knowledge level and primary information source, and obstacles to healthy eating. Sessions, conducted by a nutritionist in an interactive, action-oriented learning approach, ranged from 30 to 60 minutes. RESULTS: At baseline, subjects harbored many misconceptions, reported numerous HIV-related side effects, and lacked practical nutrition strategies, all of which interfered with weight maintenance and health. The protocol strategies were acceptable to the patients (87% subjects completed all visits), with marked improvements in dietary intake, weight, and body composition, both during and after intervention. CONCLUSIONS: We describe a customized nutrition intervention that produces changes in energy intake, maintenance of appropriate protein intake, and the reversal of unintentional weight loss over 5 to 15 months. Sustained improvements occurred across a socioeconomically diverse population, despite persistent disease- and medication-associated side effects.
Measurements of nickel in body fluids, excreta, and tissues from humans with occupational, environmental, and iatrogenic exposures to nickel compounds are comprehensively reviewed. Correlations between levels of human exposures to various classes of nickel compounds via inhalation, oral, or parenteral routes and the corresponding concentrations of nickel in biological samples are critically evaluated. The major conclusions include the following points: Measurements of nickel concentrations in body fluids, especially urine and serum, provide meaningful insights into the extent of nickel exposures, provided these data are interpreted with knowledge of the exposure routes, sources, and durations, the chemical identities and physical-chemical properties of the nickel compounds, and relevant clinical and physiological information, such as renal function. Nickel concentrations in body fluids should not, at present, be viewed as indicators of specific health risks, except in persons exposed to nickel carbonyl, for whom urine nickel concentrations provide prognostic guidance on the severity of the poisoning. In persons exposed to soluble nickel compounds (e.g., NiCl2, NiSO4), nickel concentrations in body fluids are generally proportional to exposure levels; absence of increased values usually indicates non-significant exposure; presence of increased values should be a signal to reduce the exposure. In persons exposed to less soluble nickel compounds (e.g., Ni3S2,NiO), increased concentrations of nickel in body fluids are indicative of significant nickel absorption and should be a signal to reduce the exposures to the lowest levels attainable with available technology; absence of increased values does not necessarily indicate freedom from the health risks (e.g., cancers of lung and nasal cavities) associated with exposures to certain relatively insoluble nickel compounds.
This study evaluated a training program designed to prepare unlicensed assistive personnel (UAP) in high school settings to recognize and respond effectively to an anaphylactic emergency. Subjects included 53 adults employed by a high school district in the San Francisco Bay Area of California. A training model was developed based on Bandura's theory of sources of self-efficacy. Knowledge and perceived self-efficacy of participants were measured before and after the training program to determine if a theory-based anaphylaxis recognition and epinephrine auto-injector training program would increase participants' knowledge and self-efficacy in responding to an anaphylactic emergency. Paired t tests revealed significant improvement in scores for both knowledge and perceived self-efficacy following the intervention (p < .001). This theory-based training program offers a valuable model for other school nurses in providing knowledge and skill training for unlicensed assistive personnel in other health emergencies.
Nutritional needs for peak athletic performance include sufficient calorie intake, adequate hydration, and attention to timing of meals. Student athletes and their advisors often are misinformed or have misconceptions about sports nutrition. This paper identifies nutritional needs of young athletes, reviews common misconceptions, and examines the nutrition knowledge of athletes and their sources of nutrition information. Topics covered include energy, carbohydrate, protein, fat and micronutrient needs, hydration requirements, timing of meals, and issues related to age, gender, and specific sports. Other issues addressed include "making weight" and ergogenic aids. Proper nutrition for young athletes is critical not only to their athletic success, but more importantly to their growth, development, and overall health. Nutritional recommendations should be based on the most current scientific data; we provide information about appropriate resources for the school nurse when advising student athletes and their coaches and parents.
Extraordinary growth in managed care arrangements over the past decade has been both widely praised and criticized. Proponents and critics agree that the nature of medical practice is being profoundly altered by this growth, even if they cannot articulate the direction and consequences of this change. We explore the roots of this uncertainty by examining the available evidence on critical features of the arrangements managed care plans currently have with affiliated physicians. Our approach is to review and synthesize the literature in several key substantive areas from a broad range of sources. We found that existing knowledge is dated, derived form a limited subset of plans, inattentive to important structural differences between plans, and responsive to a very narrow set of issues poorly reflecting the range of medical practice and change introduced by managed care. We highlight key questions of interest and the knowledge gaps critical to address so that policy and management decisions can both reflect and be informed on these issues that define the arrangements managed care plans make with physicians and ultimately influence medical practice.
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