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PubMed2005

Quality specifications for seminal parameters based on the state of the art.

BACKGROUND: The aim of this study was to calculate the analytical goal for seminal parameters based on the state of the art, and then to compare these specifications with those previously obtained by our group based on biological variation. METHODS: All data used for analysis were derived from the Spanish programme of external quality control on semen analysis. Over 90 laboratories participated from 1999 to 2003. Using graphs of the state of the art, we also determined the numbers of laboratories that achieved quality specifications. RESULTS: The total allowable error calculated using state of the art graphs is similar to that calculated using biological variation for concentration and total motility. However, it is much higher for morphology and rapidly progressive motility. Over 80% of the laboratories achieved the minimum quality specification based on biological variation for concentration, total and progressive motility. However, only approximately 30% of the laboratories achieved the minimum quality specification based on biological variation for morphology and rapidly progressive motility. CONCLUSIONS: The study enabled us to identify the state of the art of analytical performance for seminal parameters, and revealed the difficulty inherent in meeting the quality specifications based on biological variation.

Andrology↗
PubMed2006

The ICMART glossary on ART terminology.

The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is an independent, international non-profit organization that has taken a leading role in the development, collection and dissemination of worldwide data on ART. Information on availability, efficacy and safety is provided to health professionals, health authorities and the public. The glossary facilitates dissemination of ART data through a set of agreed definitions as seen in the most recent World Report on ART. It provides a conceptual framework for further international terminology and data development of ART.

Journal Article↗
PubMed2006

Sperm DNA fragmentation: paternal effect on early post-implantation embryo development in ART.

BACKGROUND: The relationship between early embryo post-implantation development in couples undergoing assisted reproductive techniques (ARTs) and sperm chromatin alterations has not been satisfactorily explained. The aim of this study was to assess the relationship between sperm DNA fragmentation in IVF/ICSI patients, sperm parameters (concentration, motility and morphology) and ART outcome, especially with regard to clinical pregnancy and pregnancy loss (spontaneous miscarriage or biochemical pregnancy). METHODS: DNA fragmentation was evaluated by TUNEL assay, performed on sperm suspensions after density gradient separation, in 132 men undergoing an ART cycle (82 IVF and 50 ICSI) and correlated with sperm parameters and ART outcome. RESULTS: A highly significant negative correlation was found between DNA fragmentation and sperm parameters. There was a close relationship between DNA fragmentation and post-implantation development in ICSI patients: the clinical pregnancy and pregnancy loss rates significantly differed between patients with high and low sperm DNA fragmentation (P = 0.007 and P = 0.009, respectively). CONCLUSIONS: Sperm DNA fragmentation seems to affect embryo post-implantation development in ICSI procedures: high sperm DNA fragmentation can compromise 'embryo viability', resulting in pregnancy loss.

Abortion, Spontaneous↗
PubMed2003

Amplification of repeat-containing transcribed sequences (ARTS): a transcriptome fingerprinting strategy to detect functionally relevant microsatellite mutations in cancer.

Cancer is a genetic disease caused by mutations in somatic cells. Those that carry advantageous mutations are favoured by natural selection. In most cancers, genetic instability increases mutation rate and facilitates cancer cell evolution. Microsatellite instability (MSI), due to defects of the DNA mismatch repair system, affects in particular repeat sequences (microsatellites) scattered throughout the genome. As mutations in expressed genes are more likely to be functional, we developed a procedure for the systematic identification of mutant repeat-containing expressed sequences (amplification of repeat-containing transcribed sequences, ARTS). The entire cell mRNA was converted into short double-stranded cDNA fragments linked to an adapter at both ends. Repeat-containing cDNA fragments were PCR amplified using the adapter-specific primer in combination with different arbitrary primers including the repeat. ARTS yielded discrete PCR products with lengths that were directly correlated to the lengths of the endogenous repeats. Comparison between ARTS products obtained from control cells and cancer cells with microsatellite instability (MSI+) revealed mRNAs carrying insertions or deletions at repeats. The subsequent sequencing allowed the identification of a series of frameshift-mutated mRNAs in MSI+ cancer cells, including the already described mutant BAX transcript. These data show that ARTS provides an unbiased genome-wide approach to the discovery of functionally relevant genes that could be affected by MSI in cancer.

Acyltransferases↗
PubMed1984

The teaching of liberal arts in internal medicine residency training.

Forty-four members of the Association of Program Directors in Internal Medicine and 58 members of the Society for Research and Education in Primary Care Internal Medicine completed questionnaires on the teaching of liberal arts in internal medicine residency programs and the importance of liberal arts to the practice of medicine. They rated economics of medical care and bioethics as essential to residency training. Law and organization of the health care system as well as economics and bioethics were rated as essential to medical practice. Although there was great variability in the curricula represented, over 40 percent of the respondents reported having formal lecture and/or seminar exposure to these topics in their programs. Problems encountered in implementing liberal arts programs included lack of curriculum time, limited-faculty members, and a lack of interest on the part of residents. There is a need both to arrive at a consensus among residency directors and to explore means of developing interdisciplinary faculties if the liberal arts are to form an established part of internal medicine residency training.

Bioethics↗
PubMed2003

A liberal arts education as preparation for medical school: how is it valued? How do graduates perform?

PURPOSE: This study examines the utility of a liberal arts education on medical students' preparation and performance. METHOD: Data included a survey of admission committee members, a preadmission survey of two cohorts of students, and academic performance and extracurricular involvement during medical school. RESULTS: Some admission committee members perceived applicants with liberal arts backgrounds to have certain advantages. These students preferred "discussing issues," and showed an initial preference for the practice of psychiatry. Despite entering with lower total grade-point average and being less involved in extracurricular activities, they were more likely to receive formal commendation and be elected to Alpha Omega Alpha. CONCLUSIONS: Although similarities outweigh differences, students with liberal arts backgrounds may benefit from an educational breadth well-suited for practicing the "art of medicine."

Education, Medical, Undergraduate↗
PubMed2000

An appreciation of modern ART.

As we have entered into the new millennium, it is difficult not to recognize ART as one of the most dynamic and rapidly emerging fields in all of medicine. What began as an experimental procedure in animals has developed into a multidisciplinary technology. A great debt is owed to the field of animal husbandry. In humans, implantation is inefficient and has been recognized as the rate-limiting step in reproduction. In vitro fertilization has allowed the observation of human gamete interaction in the laboratory. A milestone was reached when ART allowed couples with infertility to have success rates that exceeded those associated with normal human fecundity. Continued innovations are improving the rate of embryonic implantation. Blastocyst transfer will have a major role in the future of ART. It is common for the couple with infertility to battle their problem by increasing the frequency of intercourse because it is the only weapon at their disposal. So, too, did clinicians increase the number of embryos transferred to the uterus. New developments promise to challenge the long-held contention that successful IVF/embryo transfer is positively correlated with the number of oocytes retrieved or the number of embryos transferred. More accurate reporting will enable us to measure the impact of technologic improvements that improve implantation rates and decrease multiple gestations. The future holds the promise of some tangible goals. The development of in vitro maturation of immature oocytes could lead to an era in which oocytes are harvested without the need for controlled ovarian hyperstimulation. This would provide for the possibility of the banking of gametes. Women could preserve or store their fertility at a young age in a manner similar to that which has been possible for men for decades. They could avoid the increased risk for aneuploidy seen with the age of 35, and theoretically, they should have a lower risk for miscarriage. The future is near. One day, ART will be perfected so that a single embryo transfer will be the standard of care. Soon it will be possible to know all about the genetic makeup of that embryo and it will be routinely selected from its cohort by virtue of those genetic traits.

Animals↗
PubMed1976

A comparative study of art expression of schizophrenic, unipolar depressive, and bipolar manic-depressive patients.

The literature on art productions from psychiatric patients consistently suggests that specific graphic characteristics distinguish among various major diagnostic groups. These hypothesized differences are summarized. Systematic collection of art productions as part of separate research programs studying affective psychoses and schizophrenia has enabled us to amass a collection of psychotic patients' drawings which are used in an attempt to evaluate these hypotheses empirically. Art sessions were held with 104 patients hospitalized for affective psychoses and with 62 patients hospitalized for acute schizophrenia at NIH's Clinical Center. Comparing these drawings across diagnostic groups revealed, to our surprise and contrary to extant hypotheses, considerable within-diagnostic group variability and between-group overlap. There were, nonetheless, some trends in the hypothesized directions. These differences, however, disappeared when comparisons were made on a subsample of age-matched patients. This discrepancy between this research and expectations based on the literature is discussed. Our studies indicate that pictorial characteristics are not closely associated with diagnosis. We have, however, found that individual patient's art productions, and their associations to the pictures, are of great value in arriving at a dynamic understanding of the patient, regardless of diagnosis.

Age Factors↗
PubMed1999

CT reconstruction by using the MLS-ART technique and the KCD imaging system--I: low-energy X-ray studies.

We investigated the use of the kinestatic charge detector (KCD) combined with the multilevel scheme algebraic reconstruction technique (MLS-ART) for X-ray computer tomography (CT) reconstruction. The KCD offers excellent detective quantum efficiency and contrast resolution. These characteristics are especially helpful for applications in which a limited number of projections are used. In addition, the MLS-ART algorithm offers better contrast resolution than does the conventional convolution backprojection (CBP) technique when the number of projections is limited. Here we present images of a Rando-head phantom that was reconstructed by using the KCD and MLS-ART. We also present, for comparison, the images reconstructed by using the CBP technique. The combination of MLS-ART and the KCD yielded satisfactory images after just one or two iterations.

Algorithms↗
PubMed1998

Factors affecting pregnancy outcome resulting from assisted reproductive technology (ART).

OBJECTIVE: A retrospective, observational study of pregnancy outcome was performed on variables maintained in an ART database to determine factors that might affect miscarriage rate in pregnancies resulting from assisted reproduction technologies (ART). METHODS: Previously infertile couples, where conception was achieved after ART, were included. Seven hundred and ninety-four consecutive clinical pregnancies, diagnosed by ultrasound documentation of the gestation sac in the first trimester were divided into 2 groups: 'miscarriage' and 'term birth'. Differences between the groups were analysed using crosstable regression analyses or t-test in second yearly cohorts. RESULTS: A statistically significant positive relationship was seen between age and spontaneous abortion rate (p = 0.008) with a major increase after the age of 38 years. There was no significant difference in the mean number of oocytes retrieved between groups (p = 0.17). While there was a significant negative correlation between maternal age and the total number of oocytes collected (p < 0.001), there was no statistical difference between those women who miscarried or delivered a live infant. No relationships were found with any other variables analysed. CONCLUSION: Maternal age is probably the most important factor in pregnancy outcome in ART. This survey could not determine any other variables as being major prognostic determinant for miscarriage once pregnancy was attained.

Adult↗
PubMed1996

Dialectical analysis concerning the rational aspect of the art of nursing.

It is often claimed that nursing is both a science and an art. Science, it is argued, involves a rational process in which empirical findings are used to determine what is the case. Art, on the other hand, is associated with creative and intuitive activities. The author steps back from this position and examines the question of whether the art of nursing is properly conceived as involving a rational aspect. The study upon which this paper is based involved the analysis of a discourse contained in the work of 43 nurse scholars, published between 1860 and 1992. A philosophical approach is used to examine two contrary positions regarding the place of the rational aspect in relation to the art of nursing. The analysis attempts to expand the discourse by delineating questions and concerns that, as yet, have not been fully considered.

Humans↗
PubMedDate not supplied

The art of nursing: a concept analysis.

That nursing is a science and an art is commonly accepted. While much emphasis has been placed on the science in nursing, the art of nursing is less well-understood. A concept analysis using Rodgers' evolutionary perspective was conducted to examine the meaning of the art of nursing. Through the analysis, a definition emerged suggesting that the art of nursing is the intentional creative use of oneself, based upon skill and expertise, to transmit emotion and meaning to another. It is a process that is subjective and requires interpretation, sensitivity, imagination, and active participation.

Creativity↗
PubMedDate not supplied

Evaluation of Class I ART restorations in Brazilian schoolchildren: three-year results.

Atraumatic Restorative Treatment (ART) has been adopted around the world to avoid unnecessary extractions, especially in non-industrialized countries. The development of specific glass ionomer cements marketed for the ART technique has contributed to the technical success rate. In this study, Ketac-Molar (3M ESPE, Dental Medzin, Germany) was used to restore 150 Class I cavities in 118 Brazilian public school children, aged from 7-12 years. At baseline and at subsequent recalls, CPI probes with a ball-end of 0.5 millimeters (mm) were used to assess loss of restorative material, and photographic color transparencies of restorations were made. After six months, 83 patients returned for follow-up examinations, with 71.8% of their restorations designated as acceptable. After three years, 49 patients with 57 ART-restorations were evaluated, with 21.0% of these restorations graded as acceptable. Another 29.8% of their restorations had been replaced by more permanent materials. The main objective of the ART technique is tooth retention; this was achieved for 94.7% of the restored teeth in a high caries risk population who returned for recalls.

Brazil↗
PubMed2005

Radiation-induced root surface caries restored with glass-ionomer cement placed in conventional and ART cavity preparations: results at two years.

BACKGROUND: There are no published studies comparing the clinical performances of more-viscous glass-ionomer cement (GIC) restorations when placed using conventional and atraumatic restorative treatment (ART) cavity preparation methods to restore root surface caries. METHODS: One dentist used encapsulated Fuji IX GP and Ketac-Molar to restore 72 conventional and 74 ART cavity preparations for 15 patients who had received cervicofacial radiation therapy. Two assessors evaluated the restorations at six, 12, and 24 months for retention, marginal defects and surface wear, and recurrent caries. RESULTS: After two years, the cumulative restoration successes were 65.2 per cent for the conventional and 66.2 per cent for the ART cavity preparations, without statistical or clinical significance (P > 0.50). Restoration dislodgement accounted for 82.8 per cent and marginal defects for 17.2 per cent of all failures. There were no instances of unsatisfactory restoration wear or recurrent caries observed. Teeth with three or more restored cervical surfaces accounted for 79.3 per cent of all failures (P < 0.0001). CONCLUSIONS: For root surface caries restored with GIC, the use of hand instruments only with the ART method was an equally effective alternative to conventional rotary instrumentation for cavity preparation. Larger restorations had higher failures, usually from dislodgement.

Adult↗
PubMed2002

Glass ionomer cements used as fissure sealants with the atraumatic restorative treatment (ART) approach: review of literature.

AIM: To review the success of newer, more-viscous aesthetic conventional glass ionomer cements (GICs), that have been marketed specifically for the atraumatic restorative (ART) technique or approach, when used as pit and fissure sealants. As part of this approach, enamel fissures adjacent to the ART restorations are conditioned with poly (acrylic) acid (PAA) and then usually sealed with a GIC, using the finger-press method. RESULTS: The newer GICs appear in vitro to penetrate adequately and seal occlusal fissures in permanent molar teeth, and clinical studies of the ART approach over three years have found sealant retention (full and partial) to be approximately 70%, with fissure caries approximately 0-4%. In two studies, fissure caries was significantly reduced in sealed as compared with unsealed teeth over three years. CONCLUSIONS: Although the results appear to be better with the newer than with earlier conventional GIC products, the ART studies have generally involved populations at low-risk to caries, and further improvements in the mechanical properties of the cements are required for optimal long-term clinical success. Etching the enamel fissures with phosphoric acid, instead of conditioning with PAA, before GIC sealant placement warrants clinical investigation.

Acid Etching, Dental↗
PubMed1988

Martial arts and psychological health.

The misleading public image of the martial arts masks a rich though esoteric psychological legacy containing informative parallels for contemporary psychotherapeutic concepts and practices. To date, empirical research on the martial arts has lacked sophistication in the questions it has posed and in the methodology adopted to answer them. Whilst not entirely consistent, findings from studies of martial artists' personalities, outlooks and behaviour have generally indicated positive psychological effects of training. Clinical and psychotherapeutic applications are at an exploratory stage but appear promising. As an exemplar the psychological facets of the art of Aikido are discussed, and prospective uses of martial arts principles as systemic or adjunctive therapies are considered.

Aggression↗
PubMedDate not supplied

Prevalence of caries and lesions treatable through the ART approach in high caries risk schoolchildren in Damascus, Syria.

OBJECTIVE: To determine the prevalence of dentinal lesions treatable through the atraumatic restorative treatment (ART) approach for high caries risk schoolchildren. SUBJECTS AND METHODS: A convenience sample was taken of 1,542 grade 1 and 931 grade 2 children from 21 primary schools in a low socio-economic area in Damascus. Dentinal lesions in which the smallest excavator (diameter of 0.9 mm) could enter the cavitated lesion were considered treatable using the ART approach. Mann-Whitney U and ANOVA tests were used to analyse the data. RESULTS: The mean dmfs and dmft scores of the 6- to 7-year-olds (grade 1) were 9.0 and 4.4, respectively. The mean DMFS and DMFT scores of the 7- to 8-year-olds (grade 2) were 1.6 and 1.4, respectively. At least 89.9 and 54.9% of the dentinal lesions in the deciduous and permanent dentition that were in need of a restoration, respectively, were diagnosed as treatable using ART. CONCLUSION: A high proportion of dentinal lesions in need of restorations in both deciduous and permanent dentitions in this high caries risk group of 6- to 8-year-olds were diagnosed as being treatable using the ART approach.

Analysis of Variance↗
PubMed2006

Inhibition of cultivable bacteria by chlorhexidine treatment of dentin lesions treated with the ART technique.

The aim of this study was to examine the changes in the cultivable microflora of carious dentin before and after atraumatic restorative treatment (ART) and investigate the inhibitory effect of chlorhexidine-gluconate-based cavity disinfectant in the microflora. Using a split mouth design, 35 primary molar pairs with class II carious lesions in 35 patients (mean age 7.31+/-0.47 years) were selected. The total viable counts (TVC), Streptococcus mutans and lactobacilli were first measured in the center of the infected demineralized lesion and then from the hard dentine after caries removal by the ART technique. Chlorhexidine-gluconate (2%)-based cavity disinfectant was applied to one of the molar pairs and the other molar received no disinfectant treatment. Thereafter, all of the teeth were restored with glass ionomer cement (GIC). Cavities were reassessed after 6 months and again dentine samples were microbiologically investigated. Removal of carious dentine by ART significantly reduced TVC, S. mutans and lactobacilli. After 6 months, application of chlorhexidine exhibited a greater significant reduction in TVC (p=0.013), and a significant reduction in S. mutans compared to the nondisinfected group (p<0.001). A significant reduction in lactobacilli counts was observed in both groups after 6 months, but the difference between the disinfected and nondisinfected groups was not significant (p=0.056). ART was found to be effective in reducing the cultivable microflora and chlorhexidine-gluconate-based cavity disinfectant might serve as a suitable additional agent in inhibiting the residual bacteria in the dentine.

Analysis of Variance↗