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PubMed1994

Do doctors address the concerns of patients with diabetes?

Diabetes has an impact on people at both a biomedical and a holistic level. Furthermore there is a legitimate and substantial 'medical agenda' which doctors must address. But does this mean that they fail to deal with the concerns of their patients? A questionnaire study of diabetic patients attending the Manchester Diabetes Centre found that not all the patients' concerns were addressed in 25.5% of consultations. 220 (98%) patients were recruited from 225 approached. Not surprisingly, those who expressed three or more concerns were significantly less likely to have all their concerns addressed compared with those who had only one or two concerns (p = 0.001). The probability of having an individual concern addressed was 0.82. It was also found that Black-Caribbeans were significantly less likely to have their concerns addressed than Whites especially if they were over 60 years old (p = 0.03). This study concludes that doctors should be particularly aware of the needs of patients who express many concerns, and especially if they are Black-Caribbeans. Further research should develop strategies for improving the ability of doctors to identify and address the concerns of their patients.

Black or African American↗
PubMed1984

Age-sex registers as a screening tool for general practice: size of the wrong address problem.

Age-sex registers were compiled and updated for the east London general practices participating in a screening study for hypertension. Of 1435 addresses in the registers of two practices that were checked, 228 (16%) were incorrect, according to the return by the post office of the screening invitations and checking the addresses of the non-responders using telephone directories and the medical records. The non-responders to the screening invitation for whom a new address was not found, were visited at the address as recorded on the age-sex register. This showed that the true address error rate from the original age-sex registers was 26% and thus substantially greater than that calculated from returned letters. It is concluded that the non-acceptance rate of screening in general practice might be exaggerated as a result of the lack of a correct address for a substantial proportion of the patients on a general practice list.

Age Factors↗
PubMed1988

[Highly effective complementary addressed laser modification (cleavage) of oligodeoxynucleotides].

Complementary addressed nonlinear photomodification of oligodeoxynucleotide dAGAGTATTGACTTA ("target") has been carried out by means of fluorescent derivatives of oligonucleotide dpAATACTCT ("addressed chromophore"). Three different ethidium derivatives were used as a chromophore. The photomodification was induced by nitrogen laser radiation (337 nm, 15 MW/cm2), which led to the target cleavage in the addressation region with the yield of the main fragment (8 bases long) about 10%, formation of specific covalent adduct target-addressed chromophore with the yield 20-70%, "hidden" (not revealed by gel electrophoresis) target damages with 7-27% yield (for different chromophores). The total yield of specific (i. e. localized in the vicinity of the addressation site) modification was 50-80%. The target cleavage and hidden damage generation are optically nonlinear processes. Piperidine treatment of the irradiated samples caused addressed cleavage of the target with up to 40% yield. All kinds of observed modification are not effected by high concentrations of free radical scavengers, 1,3 M t-BuOH or 10 mM cystamine. The bulk of the data is in agreement with the mechanism of nonlinear photomodification (the cleavage and hidden damage generation) based on the transfer of two-photon excitation energy from the chromophore to the target.

Base Sequence↗
PubMed1992

Standardization of network addressing in picture archiving and communications systems utilizing the ISO OSI protocols.

The establishment of a communications network requires the definition of addressing schemes to identify systems attached to the network. When it is anticipated that such a network will interconnect to, or communicate with, other similar networks it is beneficial to define standardized addressing schemes. This paper discusses the need for the standardization of network service access point (NSAP) addresses in picture archiving and communications systems (PACS) which use the open systems interconnect (OSI) communications protocols. Possible methods for establishing the necessary hierarchy of address registration authorities are discussed, along with the corresponding address formats.

Computer Communication Networks↗
PubMed1990

Design of peptidomimetic delta opioid receptor antagonists using the message-address concept.

Highly selective nonpeptide ligands with potent delta opioid receptor antagonist activity have been developed using the message-address concept. This approach envisaged the delta opioid receptor to contain two major recognition subsites; a message subsite which recognizes the pharmacophore, and an address subsite that is unique for the delta receptor type and confers selectivity. The message and address components of the delta-selective enkephalins were postulated to be Tyr1 and Phe4, respectively, with Gly2-Gly3 functioning as a spacer. The message component of the target compounds in this study was derived from naltrexone and related structures. An indole system was fused to the C ring of naltrexone as a mimic of the address component. The benzene moiety of indole was viewed as the delta address component, mimicking the phenyl group of Phe4, and the pyrrole portion was used as a rigid spacer. Members of the series (1-23) were evaluated for opioid antagonist activity on the guinea pig ileum (GPI) and mouse vas deferens (MVD) preparations. Naltrindole (NTI, 1) was the most potent member of the series, with Ke values of approximately 0.1 nM at delta receptors. The antagonism by NTI was approximately 220- and 350-fold greater at delta than at mu and kappa opioid receptors. The binding of NTI and selected members of the series to guinea pig brain membranes was qualitatively consistent with their pharmacologic antagonist activity profiles in the MVD and GPI, but the Ki values were not in the same rank order. The selectivity of NTI arises mainly as a consequence of increased affinity at delta receptors. Thus, the Ke and Ki values of NTI were 1/530 and 1/90 that of the delta antagonist enkephalin analogue, ICI 174864. In contrast to NTI, ICI174864 derives its selectivity through greatly decreased recognition at mu and kappa receptors. The implications of the high affinity and selectivity of NTI as a consequence of its conformational rigidity are discussed. It is suggested that any attempt to model a receptor-bound conformation of an opioid peptide should consider affinity and potency at multiple receptor sites rather than selectivity alone.

Animals↗
PubMed1996

Terms of address: implications for nursing.

Nurses are in a position of power over their clients. Power is reflected by status and clients, like all other people, have status relative to their social situation. Terms of address are one of the ways that status and solidarity are demonstrated. They are selected on the basis of the perceived status of the nurse and client, and the solidarity of the relationship. There is a tension between solidarity and status that can cause nurses to select inappropriate terms of address or referring pronouns. The nurse may choose terms of address to increase solidarity in the relationship, for example, to show empathy with the client's apparent vulnerable condition. By increasing solidarity the client's status may seem to be diminished. Clients may have to submit to many invasive, painful, embarrassing or humiliating experiences at the nurse's request. Many of these situations are beyond ordinary acceptable behaviour outside the clinical context. Distress to clients is minimized if they retain as much control as possible and one way keeping a certain amount of control is by maintaining their status. In making a selection of terms of address and pronouns, the nurse must consider the delicate nuances of the options available so that the status of the client is not compromised. This paper discusses the options available in selecting terms of address and referring pronouns, and the sociological implications of those choices.

Age Factors↗
PubMed1997

Spouses with identical residential addresses before marriage: an indicator of pre-marital cohabitation.

This article analyses new data on identical address marriages in England and Wales during 1994. It outlines previous background research which has provided good evidence that identical address marriages are likely to be ones in which the couple premaritally cohabited. Recent evidence, based on results from the General Household Survey, is also presented. The article analyses the number and characteristics of identical address marriages, both to provide new (proxy) information on pre-marital cohabitation, and also to announce the publication of a new set of tables on identical address marriages which will be included in the Marriage and Divorce Statistics annual reference volume in future years. Overall, six in every 10 couples marrying in 1994 gave identical addresses. The pattern of variation of this proportion among different subgroups of couples who married in 1994 is analysed--according to: age at marriage; the previous marital status of the partners before marriage; the manner of solemnisation of the marriage, and, for religious weddings, by denomination; by day of the week; month of the year, and by the county in which the wedding took place.

Adult↗
PubMed1996

Use of participatory ergonomics teams to address musculoskeletal hazards in the red meat packing industry.

Participatory ergonomics teams from two departments of a pork slaughtering plant analyzed musculoskeletal hazards and proposed ergonomics solutions for several jobs in the plant. The jobs were targeted based on association with a large number of injuries, one or more particularly severe injuries, high workers' compensation expenses, and/or high turnover plus absence of obvious solutions to abate the hazards. The teams used a structured problem-solving method that was generally derived from principles associated with quality improvement processes. Workers performing the targeted jobs were involved in the problem-solving process, even if they were not members of the team. The effectiveness of each team was assessed and compared in terms of the number of problem jobs addressed and feedback from team members. One team addressed all nine of its targeted jobs; the other team addressed eight of 12 targeted jobs. Feedback from team members regarding their teams' methods and performance was generally favorable. The major obstacle to effective team functioning in this project was the scheduling of meetings. There were also some obstacles related to team leadership. Overall, this project demonstrated that the use of participatory ergonomics teams that rely on structured problem-solving methods are able to work effectively to address musculoskeletal hazards, especially related to the upper extremities, in the red meat packing industry.

Animals↗
PubMed1994

Addressing alcohol use among primary care patients: differences between family medicine and internal medicine residents.

OBJECTIVES: To determine whether rates of addressing alcohol use differed between family medicine and internal medicine residents, and to determine whether attitudes, confidence, and perceptions affected these relationships. SETTING: Two university outpatient clinics, one staffed by family medicine and the other by primary care and categorical internal medicine residents. DESIGN: Cross-sectional study of consecutive patients who had been followed by second- and third-year residents for at least one year. MEASUREMENTS: Alcohol abuse was determined using the Michigan Alcoholism Screening Test (MAST), with a score > or = 5 considered positive. Rates of addressing alcohol use in the preceding year were determined by patient report and chart review. Attitudes were assessed using the Substance Abuse Attitude Survey (SAAS). RESULTS: 334 patients of 49 residents completed the MAST. Rates of alcoholism among the patient groups were: family medicine, 8.3%; primary care, 29.1%; and categorical medicine, 18.0% (p < 0.001). Screening behavior varied by type of residency: 47% of the family medicine, 71% of the primary care, and 65% of the categorical residents' patients reported being asked about alcohol use in the preceding year (p < 0.001); chart documentation was present for 15% of the family medicine, 38% of the primary care, and 24% of the categorical residents' patients (p < 0.001). Perceived prevalence of alcohol abuse, confidence in intervening, and several scales on the SAAS were related to residency type and to addressing alcohol use, but controlling for these variables did not affect the association between residency type and either patient report or chart documentation of screening. CONCLUSION: Rates of addressing alcohol use differed for internal medicine and family medicine residents, but were not due to differences in resident perceptions and attitudes.

Alcoholism↗
PubMed1979

An investigation of the accuracy of the home address given by patients in an urban community in South India.

Studies were undertaken in three tuberculosis clinics in Madras, a large Indian city with a good civic organization, to assess the accuracy of address recorded routinely by registry clerks at the patient's first clinic attendance. The accuracy was poor, with 20% to 30% of the letters posted not reaching the patients. It was appreciably improved, by 10% to 20%, by supplementing the clerk's efforts with questioning by a motivated, experienced health visitor. An address card, a card on which the patient's address was recorded by the local postman or a literate neighbour, relative or friend, was returned by 90% to 94% of the patients, and the accuracy of addresses was found to be at least as good as that obtained with the health visitor. Even when all three sources of information were considered, the patient's home could not be traced in 3% of cases and was found with difficulty in 4%.

Community Health Nursing↗
PubMed1999

Addressing global warming and biodiversity through forest restoration and coastal wetlands creation

The Climate Challenge is a partnership between the Department of Energy and the electric utility industry to reduce, avoid, and sequester greenhouse gases. A portion of the initiative, the sequestration of greenhouse gases, is the focus of this presentation. Over 4 million acres of bottomland hardwood forests were cleared for agriculture in the Mississippi River Valley in the 1970s. Reestablishing these forests would improve depleted wildlife habitats, serve as wildlife corridors, increase biodiversity, and decrease soil erosion. Louisiana is losing coastal wetlands at a rate of approximately 25 square miles/year. This coastal erosion is due to a number of factors and many efforts are currently underway to address the matter. One such effort is the use of material generated in the dredging of navigational canals; however, this material is low in nutrient value, making the regeneration of marsh grasses more difficult. In addition, bottomland hardwood forests and coastal wetland grasses are excellent 'carbon sinks' because they take carbon dioxide out of the atmosphere and store it in living plant tissue. Entergy Services, Inc. is an electric utility with a service territory that comprises portions of both the Lower Mississippi River Valley and the Gulf of Mexico coastline. This provides an opportunity to positively address both habitat losses noted above while at the same time addressing global warming, forest fragmentation, and biodiversity. Entergy, through its affiliation with the UtiliTree Carbon Company, is participating in projects that will investigate the feasibility of using bottomland hardwood reforestation on cleared marginal farmlands now managed by the Louisiana Department of Wildlife and Fisheries and the US Fish and Wildlife Service. Entergy has also begun a research project with the Environmental Protection Agency and the State of Louisiana. The research is a compost demonstration project that will utilize wood waste generated through our tree-trimming program as a compost material that will be mixed with low nutrient dredge material to create new coastal wetlands. Taken together, Entergy's initiatives will be able to address global warming through carbon sequestration, restore fragmented forest habitats, reduce coastal erosion and improve the quality of a vital coastal aquatic nursery habitat. Efforts will be made to manage the created habitats for biodiversity. Pulling all these ideas together creates an effect in which the whole is greater than the sum of the parts. In such a synergy of ideas, there are no losers and the winners are both industry participants and the environment.

Journal Article↗
PubMed1991

Role of spacer and address components in peptidomimetic delta opioid receptor antagonists related to naltrindole.

A series of heterocyclic analogues 2-5 related to naltrindole (1) (NTI) and 6-arylnaltrexone derivatives 6-8 were synthesized in order to determine the role of the spacer and the address moieties in conferring delta opioid receptor antagonist activity. The benzofuran (NTB), quinoxaline, and quinoline analogues (2, 3, and 4, respectively) were delta-selective opioid antagonists in vitro and bound selectively to delta receptors. The tetrahydroindole derivative 5, while delta-selective, was considerably less potent than its indole analogue 13. The data for 2-4 indicate that heterocycles other than pyrrole can serve as a spacer for the delta address moiety. Moreover, the lower delta antagonist potency of 5 illustrates the importance of the aromatic address component. Molecular dynamics simulations of enkephalin using a zipper binding model are consistent with a delta address subsite that may accommodate the benzene moiety of NTI or the Phe4 phenyl group of leucine enkephalin. The considerably lower delta opioid receptor antagonist potencies of the 6-aryl derivatives 6-8 are consistent with the conformational mobility of the aryl group and its location in the molecule.

Animals↗
PubMedDate not supplied

Addressing organizational issues into the evaluation of medical systems.

New system design and evaluation methodologies are being developed to address social, organizational, political, and other non-technological issues in medical informatics. This paper describes a social interactionist framework for researching these kinds of organizational issues, based on research within medical informatics and other disciplines over the past 20 years. It discusses how effective evaluation strategies may be undertaken to address organizational issues concerning computer information systems in medicine and health care. The paper begins with a theoretical framework for evaluation. It then describes the 4Cs of evaluation: communication, care, control, and context. Five methodological guidelines are given for conducting comprehensive evaluations that address these 4Cs. An example of an evaluation research design that fits the guidelines and was used in an evaluation of an on-line clinical imaging system is discussed. Results of the evaluation study illustrate how this approach addresses organizational concerns and the 4Cs.

Communication↗
PubMed1990

[The use of RNAse H for digestion of alkylated 16S rRNA at the binding sites of addressed reagents--oligodeoxyribonucleotide derivatives].

It is demonstrated that 16S rRNA, complementary-addressed labelled with 2',3'-O-[4-N-methyl-N-(2-chloroethyl)-amino]benzylidene derivatives of oligonucleotides d(pACCTTGTT)rA and d(pTTTGCTCCCC)rA, can be cleaved by RNase H within the adducts, resulted from the modification. Comparative study of the 16S rRNA cleavage with RNase H within the above--mentioned covalent adducts, on the one hand, and within heteroduplexes with the same oligodeoxyribonucleotides, on the other, showed that(i) the complementary-addressed modification proceeds both in perfect and non-per ect complexes; (ii) 16S rRNA is cleaved by RNase H within both perfect and non-perfect complexes resulted from the alkylation, non-perfect complexes being considerably stabilized by the covalent bond between the reagent and the RNA; (iii) non-perfect complexes of 16S rRNA with the free oligodeoxyribonucleotides are unstable even at the high oligonucleotide concentration, so that no cleavage of 16S rRNA in such duplexes is observed. The approach based on cleavage of RNA within covalent adducts resulted from the complementary-addressed RNA modification may be used for fragmentation of RNA molecule in the addressed reagent's binding site.

Alkylation↗
PubMed1995

In search of effective programs to address students' emotional distress and behavioral problems. Part I: Defining the problem.

This article discusses the prevalence and seriousness of emotional difficulties and behavioral problems in students, with a special focus on high school students and the obstacles they encounter when addressing these problems. The educational, psychological, and medical literature which addressed the problem over the past five years was evaluated, and 22 references were selected. It was determined that the lack of consensus on the terms used to describe the problem prevented accurate assessment of its prevalence. However, one fifth to one third of the students were found to be affected, leading to serious educational, psychosocial, and economic difficulties--and more are likely to be affected in the 1990s. Since the school and mental health systems have not been entirely successful in addressing the problem, adolescents' patterns of seeking help indicate that peer support groups can be part of the solution. It was concluded that the enormity of the problem requires a low-cost gate-keeping mechanism to facilitate early identification and intervention. Thus, school peer-support programs, if proven effective, may complement traditional mental health services in addressing adolescents' emotional distress and behavioral problems.

Adolescent↗
PubMed1996

Solution structure of regioselectively addressable functionalized templates: an NMR and restrained molecular dynamics investigation.

Three cyclic peptides that are Regioselectively Addressable Functionalized Templates (RAFT) for use in protein de novo design have been investigated using a combination of nmr, restrained molecular dynamics, and CD spectroscopy. These peptides contain up to four selectively addressable sites (orthogonally protected lysine side chains) or have selectively addressable faces. The results show a common stable conformation for templates of this kind based on two type II beta-turns and an associated beta-sheet structure. A preferential orientation for the side chains is also demonstrated. The significance of these findings is discussed in the context of applications of RAFT that rely on their conformational rigidity and ability to present functionalities in a defined spatial arrangement.

Amino Acid Sequence↗
PubMed1991

Dermenkephalin and deltorphin I reveal similarities within ligand-binding domains of mu- and delta-opioid receptors and an additional address subsite on the delta-receptor.

Dermorphin (Tyr-D-Ala-Phe-Gly-Tyr-Pro-Ser-NH2), dermenkephalin (Tyr-D-Met-Phe-His-Leu-Met-Asp-NH2) and deltorphin I (Tyr-D-Ala-Phe-Asp-Val-Val-Gly-NH2) are the first naturally occurring peptides highly potent for and almost specific to the mu- and delta-opioid receptors, respectively. The amino-terminal domains Tyr-D-X-Phe (where X is either Ala or Met) of these peptides behave as selective and potent mu-receptor ligands. Routing of Tyr-D-X-Phe to the delta- or the mu- receptor is associated with the presence or the absence at the C-terminus of an additional hydrophobic and negatively charged tetrapeptide by-passing the mu-addressing ability of the amino-terminal moiety. A study of 20 Tyr-D-X-Phe-Y-NH2 analogs with substitution of X and Y by neutral, hydrophobic, aromatic amino acids as well as by charged amino acid residues shows that tetrapeptides maintain high binding affinity and selectivity for the mu-opioid receptor. Although residue in position 4 serves a delta-address function, the tripeptide motif at the C-terminus of dermenkephalin and deltorphin I are critical components for high selectivity at delta-opioid receptor. Results demonstrate that mu- and delta-opioid receptors share topologically equivalent ligand-binding domains, or ligand-binding sequences similarities, that recognized Tyr-D-X-Phe as a consensus message-binding sequence. The delta-receptor additionally contains a unique address subsite at or near the conserved binding domain that accommodates the C-terminal tetrapeptide motif of dermenkephalin and deltorphin I.

Amino Acid Sequence↗
PubMed1990

Fate of incorrectly addressed mailed questionnaires.

Mail surveys are a widely used and often inexpensive method for conducting epidemiologic studies, but may suffer from poor response rates. Some of this nonresponse may be due to letters that never reach study subjects rather than nonparticipation. We mailed letters to invalid addresses and to fictitious occupants at valid addresses in order to determine the proportion of letters that were not returned to us by the postal service as undeliverable. All letters mailed to invalid addresses were returned, whereas 13.3% (95% Cl 2.0-24.7%) of letters sent to fictitious occupants were not. Because some undeliverable mail is not returned, investigators may erroneously assume nonresponse for some subjects who never have the opportunity to participate.

Epidemiologic Methods↗