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The ART of rationing--the need for a new approach to rationing health interventions.

A key element in dealing with HIV/AIDS in South Africa depends on the resolution of the antiretroviral therapy (ART) paradox: while a universal First-World-style ART programme is unaffordable, a rationed treatment programme that includes ART is not only affordable but also vital for basic human rights reasons, to enhance prevention efforts and to keep the fabric of society together. Our recent paper on ART demonstrated how such a rationed programme would be both affordable and highly cost-effective. Traditional rationing mechanisms are unable to provide sufficient guidance as to how to go about this novel form of rationing. An alternative rationing mechanism is therefore proposed which seeks to balance ART in terms of three primary dimensions: total resource allocation to treatment, design of the treatment intervention, and setting targets on numbers to treat. Two secondary dimensions, related to total HIV and social spending, deserve equal attention. The current global context that precipitates and exacerbates the parallel contouring of disease burden and poverty should be constantly challenged.

Anti-HIV Agents↗

Clinical evaluation of the ART technique using high density and resin-modified glass lonomer cements.

PURPOSE: The aim of this study was to evaluate the performance of two different glass ionomer cements using the Atraumatic Restorative Treatment (ART) technique in permanent teeth. MATERIALS AND METHODS: A total of 473 ART restorations were placed in 208 schoolchildren (7-12 years of age) by two previously trained operators, using high density and resin-modified glass ionomer cements. All the restorations were photographed at baseline and the patients were asked about postoperative sensitivity. After a period of 8 months, 193 patients were present after recall and 428 restorations were evaluated and photographed. Two independent examiners carried out the evaluation. RESULTS: The results showed a success rate of 86.2% for occlusal restorations with Fuji IX and 88.4% for those restored with Fuji Plus. A total of 86.7% of the approximal restorations with Fuji Plus were also judged to be successful after 8 months. No association was found between the materials and the clinical performance of the ART restorations in class I cavities. CONCLUSION: The type of restorative material did not influence the success or failure rates in class I cavities within this period. Fuji IX showed promising performance for occlusal ART restorations and Fuji Plus is also a promising material for occlusal and approximal ART restorations.

Chi-Square Distribution↗

Mapping of the WHO-ART terminology on Snomed CT to improve grouping of related adverse drug reactions.

The WHO-ART and MedDRA terminologies used for coding adverse drug reactions (ADR) do not provide formal definitions of terms. In order to improve groupings, we propose to map ADR terms to equivalent Snomed CT concepts through UMLS Metathesaurus. We performed such mappings on WHO-ART terms and can automatically classify them using a description logic definition expressing their synonymies. Our gold standard was a set of 13 MedDRA special search categories restricted to ADR terms available in WHO-ART. The overlapping of the groupings within the new structure of WHO-ART on the manually built MedDRA search categories showed a 71% success rate. We plan to improve our method in order to retrieve associative relations between WHO-ART terms.

Adverse Drug Reaction Reporting Systems↗

Odyssey: the history of performing arts medicine.

The first publication to summarize the occupational diseases of musicians was Ramazzini's Diseases of Tradesmen in 1713. While there was sporadic interest in performing arts medicine during the 1800s, the first book devoted to the subject, Singer's Diseases of the Musical Profession, was published in 1932. During the 1960s and 1970s, both physicians and performers became more interested in arts medicine. When pianists Gary Graffman and Leon Fleisher publicly discussed their career-ending hand problems in the early 1980s, a huge, previously unknown group of injured musicians was brought to light. Since that time, publication in the field has dramatically increased, numerous conferences have been held, and clinics catering to the needs to performers have been set up in various large cities. Although we still do not have all the answers to the problems faced by performing artists, arts medicine is now a recognized discipline, reaching out to performers, arts educators, arts administrators, and instrument manufacturers.

Dancing↗

The ethical theory of existential authenticity: the lived experience of the art of caring in nursing administration.

The purpose of this research was to conduct a study of the art of caring in nursing administration. By means of a phenomenologic-hermeneutic approach, the caring experiences of six nurse administrators were revealed and analyzed. Essential themes emerged from their descriptions of their experiences. Interpretation of the data served as the lens through which the expressions of the art of caring related to archetypical philosophies of art: living form, imitation, and expression. An ethical theory, Existential Authenticity, was uncovered as the unity of meaning of nursing administrative caring art. This unity of meaning embodied statespersonship, which was viewed by Plato as the highest form of art. Implications for the transformation of nursing administrative practice as an ethical caring enterprise by the manifestation of statespersonship are presented.

Ethics, Nursing↗

Art within analysis: scapegoat, transference and transformation.

Through clinical example and pictorial illustration, the author examines ways in which art offers a particular means of psychological transformation in states which may otherwise be in expressable. A transference to the art work itself is proposed. It is submitted that, mediated within the transference/ countertransference dynamic, this 'scapegoat transference' facilitates a particular process of psychological differentiation. The aesthetic qualities of art presented within analysis will resonate with other countertransference affects. Clinical material demonstrates how observation of this--aesthetic countertransference--leads to a distinction between the 'diagrammatic' and the 'embodied image. The process of integration of shadow material is furthered by the temporary safe-keeping of the art work by the analyst.

Adult↗

[The human face of medicine--the visual art].

This article discusses the role of art in medicine on the background of experience with art lectures for medical students and courses and exhibitions for doctors. From the last half of the 19th century, Norwegian artists have taken an interest in medical themes. Their paintings are an important contribution to medical history in Norway; more generally, they contribute to our understanding of the development of Norwegian society. Visual art is an important element in the decoration of hospitals. The works on display in the new National Hospital buildings in Oslo show how art may successfully be used in indoor as well as outdoor areas. It is important to let artists in on the planning process prior to the building of a new hospital.

Art Therapy↗

Surgical infection in art.

The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.

Abscess↗

The problem of art quality in the use of human figure drawing tests.

Sixteen clinicians evaluated figure drawings and attempted to determine which were done by psychiatric patients (N = 32) and which were done by matched normal Ss (N = 32). Half of the clinicians received a warning with regard to the error of assessing art ability. Despite the warning, the informed judges relied on art quality in evaluating the drawings, as did the naive judges. The judges achieved a hit rate of 58% (p less than .05). These findings indicate that both the proponents and the critics of figure drawing tests are correct. These tests do have some validity, although limited. At the same time, drawing tests do mistakenly assess art ability. Further, the failure of the effort to decrease the use of art quality indicates that this shortcoming is very difficult to control.

Adult↗

Collagen models as a probe in the decay of works of art: synthesis, conformation and immunological studies.

Proteinaceous substances such as collagen, casein and albumin have been widely used as binding media in a variety of works of art. Damages of these 'sensitive' materials, mainly caused of the influence of the environment, are responsible for the overall decay of works of art, and their identification is essential to understand ancient technologies, determine the extent of deterioration and help in future restoration and preservation processes. The most commonly used techniques for the identification of proteinaceous binding media are staining techniques, chromatography, spectrometry and immunological methods, although for the latter no systematic studies have been carried out until now. Aiming at contributing to the development of a reliable and reproducible immunoassay for the evaluation of the collagen-based decay of works of art, sequential polypeptides (Pro-X-Gly)n where X represents amino acid residues Val, Lys, Glu and (Hyp-Val-Gly)n were prepared as models of collagen fragments derived from artificially and naturally aged animal collagens. Conformational studies of the polypeptides by CD revealed the occurrence of polyproline II-like structures comparable with those of collagen. Polypeptides and collagen I were administered to animals, and the induced antibodies were used for the immunochemical detection and differentiation of collagen and collagen fragments. The combined application of (i) anti-collagen antibodies, which strongly interact with native collagen, but poorly recognized by artificially aged collagen and (ii) anti-polypeptide antibodies, which do not associate with native collagen, but are strongly recognized by collagen fragments in naturally or artificially aged collagen, is a valuable tool in determining the extent of decay in works of art.

Aging↗

Relieving symptoms in cancer: innovative use of art therapy.

Art therapy has been used in a variety of clinical settings and populations, although few studies have explored its use in cancer symptom control. The specific aim of this study was to determine the effect of a 1-hour art therapy session on pain and other symptoms common to adult cancer inpatients. A quasi-experimental design was used (n=50). The Edmonton Symptom Assessment Scale (ESAS) and the Spielberger State-Trait Anxiety Index (STAI-S) were used prior to and after the art therapy to quantify symptoms, while open-ended questions evaluated the subjects' perceptions of the experience. There were statistically significant reductions in eight of nine symptoms measured by the ESAS, including the global distress score, as well as significant differences in most of the domains measured by the STAI-S. Subjects overwhelmingly expressed comfort with the process and desire to continue with therapy. This study provides beginning evidence for the efficacy of art therapy in reducing a broad spectrum of symptoms in cancer inpatients.

Adult↗

In vivo genome editing of central nervous system SIV reservoirs in ART-suppressed rhesus macaques.

Latent human immunodeficiency virus type 1 (HIV-1) reservoirs in the central nervous system (CNS) may sustain viral persistence and neuroinflammation contributing to HIV-associated neurocognitive disorders (HAND) despite suppressive ART. AAV9-delivered CRISPR has successfully edited SIV proviral DNA in peripheral tissues with acceptable safety profiles, but the extent of in vivo genome editing in the brain remains unclear. Using SIV-infected rhesus macaques, we mapped intact proviral DNA across CNS regions and tested systemic AAV9-CRISPR-Cas9 targeting conserved sites within Ψ packaging signal and Gag region. Ten adult rhesus macaques were infected with genetically barcoded SIVmac239, suppressed with ART, then randomized to receive intravenous AAV9-SaCas9 with dual gRNAs (Ψ + Gag) or a Cas9-only control. At necropsy after viral rebound, SIV genomes were detected in multiple brain regions as well as lymphoid tissues, confirming the CNS as a persistent reservoir during ART. Barcode analysis revealed region-specific patterns consistent with compartmentalized CNS persistence. In CRISPR-treated animals, proviral editing was measurable across anatomically distinct CNS sites. These findings demonstrate that intact and potentially replication-competent virus persists in the primate brain under ART and that systemic AAV9-CRISPR can reach and edit proviral DNA in this sanctuary, supporting genome editing as a strategy toward durable remission of CNS reservoirs.

ART↗

A psychoanalytic appreciation of Giotto's mode of artistic representation and its implications for Renaissance art and science.

This paper applies developmental psychoanalytic and cognitive psychological principles to an evaluation of Giotto's Padua frescoes as pivotal in the transition from a medieval to a Renaissance mode of thought. The formulation stresses the importance of the emergence of triadic or operational thinking involving the coordination of multiple dimensions and the capacity for transforming them with reversibility, reciprocity, and conservation. This developmental achievement also results in an expanded sense of time and space. These concepts provide a basis for appreciating more fully the transition from the dyadic classical and medieval artistic representations to the triadic representations of Renaissance art, especially the contributions of Giotto's Padua frescoes to the development of the concept of infinity in nature, a concept central to both Renaissance art and science. The development of this concept in Renaissance thought raises a question about the relation of art and science. Two major modes of encoding or representing experiences are discussed--a sequential lexical and a nonsequential nonverbal mode (or word and thing representations). These formulations lead to the identification of a process that suggests that developments in art often precede those in science and thereby contribute to a fuller appreciation of Giotto's Padua frescoes as a landmark contribution with implications for the entirety of Renaissance thought.

Art↗

Balancing the focus: art and music therapy for pain control and symptom management in hospice care.

Pain and symptom management are a major part of hospice care. Literature and direct experience suggest that pain can be resistant if psychological, emotional, or spiritual issues are not addressed. This article explains how art and music therapies can work in conjunction with traditional medical treatment of pain control in the hospice setting. The process of pain modulation through the use of art and music interventions is diagrammed and described. Brief clinical examples demonstrate the use of art and music therapies for pain reduction with a variety of hospice patients. Information regarding appropriate education and training necessary for art and music therapists to practice in their field is presented.

Adult↗

Is psychiatry an art or a science? The views of psychiatrists and trainees.

OBJECTIVE: It is generally considered by many practitioners that psychiatry is an art, that is, one of the humanities, as well as being a science. We systematically collected the views of practitioners and trainee psychiatrists regarding the question 'Is psychiatry an art or a science?' METHOD: Eleven supervisors and nine trainees were interviewed and their responses analysed, using a qualitative method, the modified framework approach. RESULTS: Several themes emerged from the data: that 'art' and 'science' are different; psychiatry as a discipline is difficult to define; psychiatry demands a broader range of skills than other medical specialties; the relationship of psychology to psychiatry; supervisor cynicism to the 'science' of psychiatry; and the 'art' and 'science' of the assessment process. CONCLUSIONS: The tension that exists within the profession's identity as a discipline has important implications for teaching, learning, and clinical and research practices.

Art↗

The effect of composition (art or music) on the self-concept of hospitalized children.

The purpose of the present study was to determine the effect of composition (art or music) on the self-concept of hospitalized children. The music composition was created using the program Making More Music. The art composition was a drawing using standard medium. The Piers-Harris Children's Self-Concept Scale was used to measure self-concept. When examining subjects as one group, a significant difference from pre- to posttest for the Total score indicated an improved self-concept. Further analyses on each of the 6 categories indicated no significant differences. The art composition group had a significant difference from pre- to posttest for the Total score and for Popularity (POP). Although not significant, scores increased from pre- to posttest for Behavioral Adjustment (BEH), Physical Appearance (PHY), Freedom from Anxiety (FRE), and Happiness and Satisfaction (HAP). The music composition group had no significant difference from pre- to posttest for the Total score but a significant difference from pre- to posttest on Intellectual and School Status (INT) and Physical Appearance (PRY). Although not significant, scores increased from pre- to posttest for TOT, BEH, and HAP. There was a significant difference between the groups on 2 categories that indicated an improved self-concept for the music group under Intellectual and School Status and for the art group under Popularity.

Adolescent↗

Creativity with dementia patients. Can creativity and art stimulate dementia patients positively?

BACKGROUND: Creative activities could be stimulating for dementia patients. This article gives a review of practical forms of treating dementia patients with art therapeutic indications. It is also a ground for long-term research objective: in brief, I take exception to such a view, contrary to the common belief in the society and some professionals in the healthcare of dementia patients, on the ground that the patients do not have the capacity to improve their own creativity. METHODS: The theory of cognition tells us about the principle of being creative as a basis for human life. This specific principle is effective for the aged as well. In the long-term, the creative potential of old patients will be unblocked in individual and group therapy sessions. RESULTS: Creative activity has been shown to reduce depression and isolation, offering the power of choice and decisions. Towards the end of life, art and creativity offer a path of opening up the windows to people's emotional interiors. CONCLUSIONS: Creative- and art therapy provides possibilities that are mostly indicated to sharpen the capacity of the senses and the patients' propensity to act themselves. Nonverbal therapy methods, such as painting, music, etc., are able to influence the well-being of the patients positively, within the modern healthcare system in nursing homes. The elderly and some of the dementia patients take the initiative to combine creativity and arts and to define his/her feeling for aesthetical matters. Furthermore, group therapy sessions help against isolation and lack of life perspective and hope.

Aged↗

Pychoanalysis and art, Freud and Leonardo.

Freud was the first to apply psychoanalysis to art, choosing for his subject the life and work of Leonardo da Vinci. Observing Leonardo's partly fused image of the Virgin and St. Anne, he inferred that the artist had depicted his two mothers, his biological mother and his stepmother. This very early analytic discourse on parent loss and adoption changed the course of the interpretation of art. Freud explored the psychology of art, the artist, and aesthetic appreciation. Confronting the age-old enigma of the Mona Lisa, he proposed a daring solution to the riddle of the sphinxlike smile of this icon of art. His paper prefigures concepts of narcissism, homosexuality, parenting, and sublimation. Lacking modern methodology and theory, Freud's pioneering insights overshadow his naive errors. In this fledgling inquiry, based on a childhood screen memory and limited knowledge of Leonardo's artistic and scientific contributions, Freud identified with this Renaissance genius in his own self-analytic and creative endeavor.

Art↗