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The creative arts therapies as "real therapies".

Elements of a standard definition of psychotherapy are used to support the argument that the creative arts therapies should not be characterized as adjunctive therapies, or discredited as not being "real therapies." Two concepts widely acknowledged as important in the application of the creative arts therapies are discussed: first, that the nonverbal media employed by creative arts therapists tap emotional rather than cognitive processes and evoke responses more directly and immediately than traditional verbal therapies, and, second, that creative arts therapies are reality-based and provide a more immediate and real link to a patient's experience than something he can portray only verbally.

Attitude of Health Personnel↗

A narrative study of nursing art in critical care.

The purpose of this study was to describe nursing art from the perspective of patients who had been nursed in a critical care unit. The study pursued two objectives: (a) to generate stories of occasions in which nursing was considered art in a critical care setting and (b) to describe the meanings made manifest in those stories. Using a narrative inquiry, 10 persons were interviewed twice for the purpose of answering the research question. Stories were generated in open-ended interviews, tape recorded, and analyzed by the primary researcher using Van Manen's hermeneutic phenomenological framework. Five themes were found to represent critically ill persons' experience of nursing art: (a) perpetual presence, (b) knowing the other, (c) intimacy and agony, (d) deep detail, and (e) honoring the body. The stories cultivated a human face and contextual detail for the abstract holistic concept of nursing art.

Adult↗

Effectiveness of single-surface ART restorations in the permanent dentition: a meta-analysis.

Over the past few years, there has been an increase in the number of studies reporting on various aspects of the Atraumatic Restorative Treatment (ART) approach. Five randomized clinical trials in which ART restorations with glass ionomers were compared with amalgam restorations in permanent teeth for a maximum period of 3 yrs constituted the database. This meta-analysis divided the publications into 'early' (1987-1992) and 'late' (1995-) studies on the basis of improvements in the approach. The analysis showed that, in the 'early' studies, single-surface amalgam restorations survived statistically significantly longer than comparable ART restorations after 1, 2, and 3 yrs. This trend did not continue into the late group of studies; no statistically significant difference between the 2 types of restorations was found. Based on the available data, it appears that there is no difference in survival results between single-surface ART restorations and amalgam restorations in permanent teeth over the first 3 yrs.

Confidence Intervals↗

Predictive factors and a corresponding treatment algorithm for controlled ovarian stimulation in patients treated with recombinant human follicle stimulating hormone (follitropin alfa) during assisted reproduction technology (ART) procedures. An analysis of 1378 patients.

BACKGROUND: Identifying parameters that can accurately predict the response to controlled ovarian stimulation (COS) would be of great benefit in assisted reproductive technology (ART) procedures. An analysis was undertaken with the objective of determining whether specific factors could optimally predict a response to stimulation in ART, and to then develop a corresponding treatment algorithm that could be used to calculate the optimal starting dose of recombinant human follicle stimulating hormone (r-hFSH; follitropin alfa) for selected patients. METHODS: The overall population consisted of 2280 normo-ovulatory ART patients from 11 randomised clinical trials. However, for the final analysis population, only patients less than 35 years of age who received r-hFSH monotherapy (N = 1378) were included. RESULTS: Backwards stepwise regression modelling indicated that predictive factors for ovarian response included basal FSH, BMI, age and number of follicles < 11 mm at baseline screening. The concordance probability index was 59.5% for this model. CONCLUSIONS: In the largest data series so far analysed to determine predictive factors of ovarian response, basal FSH, BMI, age and number of follicles < 11 mm at screening were the most important variables in ART patients less than 35 years of age who were treated with r-hFSH monotherapy. Using these four predictive factors, a follitropin alfa starting dose calculator was developed that can be used to select the FSH starting dose required for an optimal response. The relevance of this dose calculator will be evaluated in a prospective clinical trial.

Adolescent↗

Positive and negative interactions of GDNF, NTN and ART in developing sensory neuron subpopulations, and their collaboration with neurotrophins.

Glial cell line-derived neurotrophic factor (GDNF), neurturin (NTN) and neublastin/artemin (ART) are distant members of the transforming growth factor beta family, and have been shown to elicit neurotrophic effects upon several classes of peripheral and central neurons. Limited information from in vitro and expression studies has also substantiated a role for GDNF family ligands in mammalian somatosensory neuron development. Here, we show that although dorsal root ganglion (DRG) sensory neurons express GDNF family receptors embryonically, they do not survive in response to their ligands. The regulation of survival emerges postnatally for all GDNF family ligands. GDNF and NTN support distinct subpopulations that can be separated with respect to their expression of GDNF family receptors, whereas ART supports neurons in populations that are also responsive to GDNF or NTN. Sensory neurons that coexpress GDNF family receptors are medium sized, whereas small-caliber nociceptive cells preferentially express a single receptor. In contrast to brain-derived neurotrophic factor (BDNF)-dependent neurons, embryonic nerve growth factor (NGF)-dependent nociceptive neurons switch dependency to GDNF, NTN and ART postnatally. Neurons that survive in the presence of neurotrophin 3 (NT3) or neurotrophin 4 (NT4), including proprioceptive afferents, Merkel end organs and D-hair afferents, are also supported by GDNF family ligands neonatally, although at postnatal stages they lose their dependency on GDNF and NTN. At late postnatal stages, ART prevents survival elicited by GDNF and NTN. These data provide new insights on the roles of GDNF family ligands in sensory neuron development.

Animals↗

Impact of uterine fibroids on ART outcome.

Our objective was to investigate the effect of subserosal (SS), intramural (IM), and submucosal (SM) fibroids on the outcome of assisted reproductive technology (ART) treatment. A retrospective comparative study at a tertiary referral center for infertility was designed. The treatment outcome of 106 ART cycles in 88 patients with uterine fibroids (33 SS, 46 IM without cavity distortion, 9 SM) was compared with that of 318 ART cycles in age-matched patients without fibroids. The main outcome measure(s) were the findings on transvaginal uterine ultrasonography performed before the initiation of treatment and pregnancy and implantation rates. The pregnancy rates per transfer were 34.1, 16.4, 10, and 30.1% in the patients with SS fibroids, IM fibroids, SM fibroids, and no fibroids, respectively. The implantation rates were 15.1, 6.4, 4.3, and 15.7%, respectively. Both rates were significantly lower in patients with IM fibroids than in those with SS fibroids or no fibroids. We conclude that pregnancy and implantation rates were significantly lower in the groups of patients with IM and SM fibroids, even when there was no deformation of the uterine cavity. Pregnancy and implantation rates were not influenced by the presence of SS fibroids. Surgical or medical treatment should be considered in infertile patients who have IM and/or SM fibroids before resorting to ART treatment.

Adult↗

Changes in HIV-specific antibody responses and neutralization titers in patients under ART.

In this study, we tested for antibody reactivities against gp120 and gp41-derived peptides, recombinant gp160, gp41 and tat in HIV-positive sera under antiretroviral therapy (ART) and determined their neutralization capacity. As a baseline, sera from patients in stage A, B and C of the disease, long term non-progressors (LNPs) and HIV-negative individuals were included. Compared to LNPs or sera from patients in group A, the reactivity of sera in stage B or C against gp120-derived peptides was reduced parallel to disease progression. Reactivity of these samples was compared with sera of patients under ART. Parallel to the decrease of viral load, the reactivity against gp120 and gp41-derived epitopes, recombinant gp160 and gp41 or the native gp120/41 complex was significantly reduced. Antibody-mediated neutralization of HIV-1 was detectable prior to ART but revealed substantial decreases coupled with progression of therapy. Responses to recombinant tat dropped after three months of therapy, increased however at later time points to initial levels. These data indicate that in parallel to the decrease in viral load and antibodies against gp120, the neutralization capacity of sera under ART is reduced, and can not be compensated by an increase in tat-specific antibodies.

Antibodies, Viral↗

Student perceptions of the links between nursing and the liberal arts.

This article examines the extent to which nursing students are aware of the importance of liberal arts in their professional education. Based on a survey of nursing students and alumnae from a small, New York state college, the project further explored the channels through which they became aware of the significant links between these two aspects of their education. One finding is that nursing students give a relatively high weight to the importance of the liberal arts in their total learning process. The more important conclusion is that students, on the whole, believe that they have made the links between liberal arts and nursing themselves. To the extent that other agents help forge these links, the most important seem to be nursing labs and clinicals, other nursing students, and nursing texts and modules. Students perceive that nursing faculty help draw links more often than liberal arts faculty, but neither rank very high.

Adult↗

The T cell response to Art v 1, the major mugwort pollen allergen, is dominated by one epitope.

Mugwort (Artemisia vulgaris) pollen allergens represent the main cause of pollinosis in late summer in Europe. At least 95% of sera from mugwort pollen-allergic patients contain IgE against a highly glycosylated 24- to 28-kDa glycoprotein. Recently, this major allergen, termed Art v 1, was characterized, cloned in Escherichia coli, and produced in recombinant form. In the present study we characterized and compared the T cell responses to natural (nArt v 1) and recombinant Art v 1 (rArt v 1). In vitro T cell responses to nArt v 1 and rArt v 1 were studied in PBMC, T cell lines (TCL), and T cell clones (TCC) established from PBMC of mugwort-allergic patients. Stimulation of PBMC or allergen-specific TCL with either nArt v 1 or rArt v 1 resulted in comparable proliferative T cell responses. Eighty-five percent of the TCC reactive with rArt v 1 cross-reacted with the natural protein. The majority of the CD4(+)CD8(-)TCR alphabeta(+) Art v 1-specific TCC, obtained from 10 different donors, belonged to the Th2 phenotype. Epitope mapping of TCL and TCC using overlapping peptides revealed a single immunodominant T cell epitope recognized by 81% of the patients. Inhibition experiments demonstrated that the presentation of this peptide is restricted by HLA-DR molecules. In conclusion, the T cell response to Art v 1 is characterized by one strong immunodominant epitope and evidently differs from the T cell responses to other common pollen allergens known to contain multiple T cell epitopes. Therefore, mugwort allergy may be an ideal candidate for a peptide-based immunotherapy approach.

Allergens↗

Sustaining the art of practice in occupational therapy.

The art of practice in occupational therapy is intrinsically centered on relationships, on the qualities that make relationships meaningful, and on the meaning of occupation in a life. Demands from today's health care system make it increasingly difficult for practitioners to engage in meaningful relationships with their patients. The art of practice, jeopardized by the health care system, requires sustenance from other sources. A new field, literature and medicine, suggests a source of sustenance for the art of occupational therapy practice. The reading of fictional literature can provide occupational therapists with sustaining images that can reaffirm their commitment to the art of providing occupation as therapy.

Female↗

Antiretroviral therapy (ART) from a neurological point of view. German Neuro-AIDS study group (DNAA).

Human Immunodeficiency virus can affect the peripheral (PNS) and central nervous system (CNS). In the ART / HAART era especially the CNS is said to be a virus reservoir so that neurologists have to be more and more integrated in therapy planning. Therefore the present paper describes neurological indications for ART, ART side effects involving the PNS and CNS and pharmacological interactions of ART with current neurological drug regimen.

Anti-HIV Agents↗

The atraumatic restorative treatment (ART) approach for primary teeth: review of literature.

There is widespread interest in and increasing usage of the atraumatic restorative treatment (ART) technique or approach for the restoration of primary teeth, especially in developing countries. However, most of the published reports of the clinical performance of newer, more-viscous esthetic conventional glass ionomer restorative cements marketed for the technique have been from short-term studies, and there have been very few reports comparing different types of restorative materials and methods of cavity preparation. After 12 months, Class II/multisurface and Class III/IV ART restorations have generally shown success rates of approximately 55-75% and 35-55%, respectively. Failures were usually from restoration losses and fractures. Class I & V/single-surface ART restorations have had much better short-term success rates of approximately 80-90%. Recurrent caries was not a concern at this time, but occlusal wear was relatively high. Further improvements in the mechanical and adhesive properties of the newer cements are still required, together with further clinical investigations of the remineralization of shallow open preparations as an alternative to placing restorations. The ART approach is readily accepted by children and has resulted in the retention of many teeth that would otherwise have been extracted.

Child↗

[Basis of art phonetics in biomedical engineering].

Art phonetics' medicine, a new branch of traditional medicine, has not been developed perfectly, especially in the aspects of objective and scientific study. In this paper, the acoustical and anatiomical basis of art phonetics in viewpoint of biomedical engineering is explored, and then our work of quantitative measurement and analysis of art phonetic is introduced. The experiment data show further that quantitative measurement and analysis plays an important role in art phonetic medicine.

Acoustics↗

Regulation, consultation and divergent community views: the case of access to ART by lesbian and single women.

In the many countries which have some form of regulation of ART, a public consultation of some sort is a frequent feature of either the process leading up to regulation or of the regulatory mechanism itself. Not surprisingly, widely divergent views on the moral and political acceptability of ART are expressed during such consultations. And while such diversity of opinion is to be expected, and some even argue welcomed, in pluralist liberal democratic societies, it is often unclear how these divergent community views are and ought to be fed into the opinion-forming and decision-making processes of governments or the bodies that advise them. This article discusses first why regulation of ART may be justified, even when there is radical moral disagreement in the community, and why public consultations should play a central role in the work that advisory bodies undertake in making regulatory recommendations to government. Then, it both proposes and justifies a method for dealing with the contradictory moral views expressed by interested parties during the consultation process. To illustrate this method, the example of the attempt by single and lesbian women to access donor insemination services and ART is used.

Attitude to Health↗

The art of psychiatry.

Psychiatrists would undoubtedly support the notion of promoting such qualities as empathy, sensitivity and caring in the pursuit of good clinical practice. However, cultivating what we may call the "art of psychiatry" is not straightforward, since the qualities that constitute it are elusive. I propose that the means by which we can accomplish the goal of relating empathically and compassionately to our patients and their families is by regarding the humanities and the sciences as of equal relevance and as complementary. The humanities, particularly literature, the visual arts, film and music, are most suited to promoting empathic skills when they are woven into the clinical scenario. Examples are provided to demonstrate how this may be achieved. Were we to succeed in highlighting the art of psychiatry in our educational programs, and as part of continuing professional development, I surmise that our patients and their families would be the beneficiaries. We cannot merely vow to act empathically and sensitively. Instead, we should embark on a lifelong journey through the wonderful world of literature, the visual arts, film and music. The experience will not only prove appealing and engaging, but it will also go far to enrich our personal and professional lives.

Journal Article↗

DNA sequence analysis using hierarchical ART-based Classification Networks.

Adaptive resonance theory (ART) describes a class of artificial neural network architectures that act as classification tools which self-organize, work in realtime, and require no retraining to classify novel sequences. We have adapted ART networks to provide support to scientists attempting to categorize tandem repeat DNA fragments from Onchocerca volvulus. In this approach, sequences of DNA fragments are presented to multiple ART-based networks which are linked together into two (or more) tiers; the first provides coarse sequence classification while the subsequent tiers refine the classifications as needed. The overall rating of the resulting classification of fragments is measured using statistical techniques based on those introduced by Zimmerman, et al. (1994) to validate results from traditional phylogenetic analysis. Tests of the Hierarchical ART-based Classification Network, or HABclass network, indicate its value as a fast, easy-to-use classification tool which adapts to new data without retraining on previously classified data.

Algorithms↗

Stress in air traffic controllers: effects of ARTS-III.

Physiological, biochemical, and psychological assessments of stress in air traffic controllers were made at Los Angeles (LAX) and Oakland (OAK) Terminal Radar Approach Control (TRACON) facilities before and after installation of Automated Radar Terminal Systems-III (ARTS-III). Heart rates of controllers on duty or at rest scarcely changed from before to after ARTS-III installation. Total stress increased at both TRACONs, and the increase was entirely due to elevated catecholamine excretion. Steroid excretion was significantly reduced at both facilities after ARTS-III had no appreciable effect on work-related anxiety levels of controllers. The post-ARTS-III A-State means for both facilities were not significantly elevated. A-Trait was unchanged at LAX but decreased significantly at OAK. Assessments of A-State showed significant work-related increments but tended to be low. There were no correlations between anxiety and physiological data.

Aerospace Medicine↗

ART success and in vivo sperm cell selection depend on the ultramorphological status of spermatozoa.

Management of male infertility has recently shifted from treatment of the subfertile man towards techniques of assisted reproduction (ART). This study aimed to evaluate the possible role of the ultramorphological status of the spermatozoon with respect to sperm selection in vivo and prediction of ART success. Ultramorphological sperm parameters were assessed retrospectively for 92 males with sufficient sperm density (10(7) spermatozoa ejaculate-1) whose wives conceived following a stepwise discarding of the female genital tract barriers, using intra-uterine insemination (IUI) (n = 26), in vitro fertilization (IVF) (n = 45) or intracytoplasmic sperm injection (ICSI) (n = 21). In parallel, sperm samples of 71 fertile males were examined. Normal ultramorphology of all head and tail subcellular organelles was found to be essential for the ability of spermatozoa to pass the lower female genital tract. The ultramorphological migration threshold for this barrier is apparently higher than that essential for oocyte fertilization. No specific indication associated with passage through the upper genital tract was found. A high prevalence of axonema defects was found to impair the ability of sperm cells to penetrate the oocyte investment. The natural fertility index, based on routine sperm parameters and the ultrastructural status of the spermatozoon's subcellular organelles was confirmed to be beneficial for directing patients to ART. A discriminative score based on axonema integrity was found to contribute additional information for the first choice decision between conventional ART and ICSI (75% prediction ability). Thus it may be helpful in finding the simplest and least expensive procedure with the greatest long-term chance for pregnancy.

Female↗