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In Finland about one-half of the fatal traffic accidents are investigated by special Boards of Inquiry. The cumulating data serves multidisciplinary sciences, juridical and insurance purposes and legislation. The participating physicians benefit from the systematic work of the Boards in many ways. As an example of the results a list of causes of accidents is shown.
Two new technologies (tissue microarrays (TMAs) and proteomics) have generated a great amount of data in life science. High-density TMAs allow for the simultaneous analysis of proteins and RNA by various methods (immunohistochemistry, in situ hybridization, FISH) on a large scale and under highly standardized conditions. Proteomics includes a variety of techniques that are partly high throughput. These techniques aim at the innovation of proteins, the description of the domain structure, the determination of protein sequences and epitope characterization, and ultimately the definition of protein function and protein reactivities in immunologic processes. Proteins that have been characterized accordingly require validation mostly at the morphologic level of defined tissue, linking proteomics to TMAs. In autoimmune diseases, array-based antigenic fingerprinting of autoantibodies will drive the development and the selection of antigen-specific diagnostic tools and therapies. The powerful combination of genomics and proteomics formed in tissue arrays has the potential to change the way the biology of autoimmunity is studied. Novel targets of drug discovery, based on antigen-specific therapies to induce anergy, or regulatory T-cells using the targeted autoantigens of individual patients could be developed in the coming decades.
In Canada, there are two known regional foci where wildlife populations are infected with bovine tuberculosis (Mycobacterium bovis) and considered to be disease reservoirs. Free-ranging populations of wood bison (Bison bison athabascae) in and around Wood Buffalo National Park (WBNP) and wapiti (Cervus elaphus manitobensis) in and around Riding Mountain National Park (RMNP) are infected with bovine tuberculosis. In this paper, we provide an overview of these diseased wild ungulate populations and the complexities of attempting to manage issues relating to bovine tuberculosis in and around protected areas. We do not describe the quantitative science and epidemiological data in detail from these case histories, but instead compare and contrast these two cases from a broader perspective. This is achieved by reviewing the context and process by which a diverse group of stakeholders engage and develop strategies to address the controversial problems that diseased wildlife populations often present. We suggest that understanding the factors that drive the strategic-level management processes is equally important for addressing a wildlife disease problem as the tactical-level issues, such as design and implementation of technically sound field research and management programs. Understanding the experiences within the WBNP and RMNP areas, particularly the strategies that have failed or succeeded, may prove useful to understanding and improving management approaches when wildlife are infected with M. bovis. Applying this understanding is consistent with the principles of adaptive management in which we learn from previous experiences to develop better strategies for the future.
The progressive and irreversible dementia of Alzheimer's disease affects both men and women, but women constitute the majority of persons with the disease. Women may also have relatively more language impairment and a tendency for greater psychiatric involvement. Diagnosis is founded on the recognition of clinical features and exclusion of other causes of dementia. The etiology of the disease remains unknown. Although a variety of genetic factors is increasingly suspected, no diagnostic genetic test is currently recommended. Recent basic science and clinical data suggest the possibility that estrogen may be helpful both in preventing and in treating Alzheimer's disease, and these potential effects may encourage the use of estrogen in postmenopausal women. Standard treatment for Alzheimer's disease involves counseling and support, as well as consideration of tacrine, a cholinergic agent that may stabilize the course in some patients. Until the cause of the disease is elucidated, however, the development of curative treatment is unlikely.
The central nervous system (CNS) and the immune system, communicating through the neuroendocrine system, are closely involved in the individual's adaptation to the environment. The data from basic science research and clinical observations are overviewed, and more recent studies are summarized. As changes in immune function may mediate the effects of psychosocial factors in psychosomatic disorders, it is important for all biopsychosocially oriented physicians to understand the network that connects the central nervous and immune systems.
OBJECTIVE: The study investigates the ability of the electronic nose to differentiate between cerebrospinal fluid (CSF) and serum and to identify an unknown specimen as CSF or serum. STUDY DESIGN AND SETTING: CSF and serum specimens were heated and tested with an organic semiconductor-based Cyranose 320 electronic nose (Cyrons Sciences, Pasadena, CA). Data from the 32-element sensor array were subjected to principal component analysis to depict differences in odorant patterns. RESULTS: The electronic nose was able to distinguish between CSF and serum isolates with Mahalanobis distance >5. Furthermore, the electronic nose was able to place unknown specimens in the appropriate class of CSF or serum. CONCLUSIONS: The electronic nose is a novel method that may allow rapid, low cost, and reliable distinction between CSF and serum in a clinical setting. SIGNIFICANCE: Because the results are available almost immediately, the electronic nose is a powerful tool that in the future may allow for rapid diagnosis of CSF leaks in the office setting.
Skeletal muscle has a high potential for regeneration and healing. After injuries to this tissue the treatment should focus on the limitation of the injury and optimization of the inherent regeneration capacity. This article discusses the prevalence of muscle injuries in soccer including diagnoses and complications, data from basic science, and therapeutic possibilities.
Despite the availability of various sequence analysis models, comparative genomic analysis remains a challenge in genomics, genetics, and phylogenetics. Commutative algebra, a fundamental tool in algebraic geometry and number theory, has rarely been used in data and biological sciences. In this study, we introduce commutative algebra k-mer representations as a nonlinear algebraic framework for analyzing genomic sequences. This representation bridges commutative algebra, algebraic topology, combinatorics, and machine learning to establish a mathematical framework for comparative genomic analysis. We evaluate its effectiveness on three tasks including genetic variant classification, phylogenetic tree reconstruction, and viral classification, typically requiring alignment-based, alignment-free, and machine-learning approaches, respectively. In this work, we show that commutative algebra k-mer representations outperform five state-of-the-art sequence analysis methods across twelve primary datasets, with two additional supplementary fragment-placement benchmarks, especially in viral classification, and maintain relatively stable predictive accuracy as dataset size increases, underscoring scalability and robustness.
TOPIC: The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer's disease (AD). PURPOSE: The purpose is to present a critique of the research on these activities, with an emphasis on methodology. ORGANIZING CONSTRUCT AND SCOPE: Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self-esteem. Other purposes of activities for this population are to create immediate pleasure, re-establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well-being of persons with dementia than the general physical and social environments in which they live. SOURCES: The literature reviewed was identified with the use of computer data bases (Medline - 1991-March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) - 1991-March 2001; and PsychLit - 1988-March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992-2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993-2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies. CONCLUSIONS: While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi-experimental and experimental designs are needed to advance knowledge in this important area.
Visual art dialogues were used in student nurses' education as a teaching and learning complement to theoretical knowledge of nursing care. An intervention group as well as a control group discussed what was characteristic of good nursing care. The control group was used to control for the effects of visual art dialogues in the intervention group. The study was undertaken at two university colleges of health sciences in Sweden. Data were collected from student nurses (n = 267) during their first year of study. The Wheel Questionnaire was used in the intervention group and control group. It measured three aspects of student nurses' perception of nursing situations: structure, the extent of emotional involvement, and motivation. The results showed statistical differences (one way ANOVA) between the intervention group in which visual art dialogues were implemented and the control group. Students in the intervention group, compared to the control group, were more structured, motivated and emotionally balanced when they expressed the elements most typical of good nursing care. They showed personal readiness in caring situations.
Epidural and intrathecal opioid administration has become an important part of contemporary medical practice in a variety of clinical settings. It has been widely assumed that any opioid placed in the epidural or intrathecal spaces will produce highly selective spinally mediated analgesia that is superior to that produced by other analgesic techniques. Unfortunately, this is simply not true. In fact, multiple opioids are currently employed for spinal use despite the fact that clinical evidence has shown that spinal administration does not produce analgesia with a selective spinal mechanism or that the analgesia produced is not superior to that produced by intravenous administration. This chapter presents the basic science and clinical data available to assist clinicians in identifying which opioids are appropriate for spinal use and which are not.
A randomized study was performed to investigate whether a teaching intervention program using a reproduction of Edvard Munch's painting, "The Sick Girl," stimulated student nurses to engage in learning about empathy. A control group was used to control for effects of the visual art dialogues in the intervention group. The study was undertaken at a university college of health science in Sweden. Data were collected from student nurses (n = 144) during their first study year. The result showed a significant improvement in the visual art group compared with the matched control group. Students in the visual art group were more engaged in learning about empathy when measured with the Wheel Questionnaire parameters of structure, motivation, and emotional investment. The present study supported the idea that Edvard Munch's painting could be used in nurse education complementary to theoretical knowledge on empathy to stimulate student nurses to engage in empathy learning.
OBJECTIVES: To describe the nature and focus of published educational intervention trials in prostate cancer in the last 10 years and to examine the state of the research in this particular area of knowledge. DATA SOURCES: Health science and psychosocial electronic databases were searched for studies reporting trials of educational or psychosocial interventions for men with prostate cancer and for the partners or families of these men. CONCLUSIONS: Interventions were characterized by the aspect of the illness trajectory that was targeted. The majority of the studies focused on managing the disease, treatments, and side effects. IMPLICATIONS FOR NURSING PRACTICE: Psychosocial stressors and uncertainty are pervasive throughout the prostate cancer trajectory. Knowledge of psychosocial and educational interventions that have been tested is critical for nurses working with these patients and their families.
Prolonged tissue ischemia and subsequent reperfusion result in significant tissue injury due to the ischemic-reperfusion syndrome. Although skeletal muscle has significant tolerance to ischemic-reperfusion injury (IRI), compared to other organ systems, IRI of skeletal muscle does occur when there is a prolonged ischemic period. In many reconstructive surgical procedures involving microsurgery and prolonged tissue ischemia time, IRI-induced skeletal-muscle injury is a serious clinical concern. Specifically, there are significant vascular complications (venous thrombosis and arteriolar no-reflow) and loss of transplanted muscle function on reperfusion with prolonged ischemia. Ischemic preconditioning (IPC) or adenosine (ADO) pretreatment applied prior to the ischemic period are known to protect against IRI in cardiac muscle. Recent data from basic science research suggest that IPC or ADO pretreatment may be employed to protect skeletal muscle against IRI. This review summarizes the basic mechanisms and potential clinical relevance of ischemia- and reperfusion-induced skeletal muscle injury and describes how skeletal muscle can be protected against IRI with IPC or ADO pretreatment.
Current Advanced Cardiac Life Support (ACLS) guidelines and emergency medical services (EMS) clinical protocols usually recommend immediate defibrillation for victims of out-of-hospital cardiac arrest who have ventricular fibrillation (VF). However, animal studies and results from a small number of clinical investigations now suggest that a short period of chest compressions or ACLS procedures delivered before defibrillation may improve the outcome of patients with prolonged VF. Although the basic science and clinical data supporting a chest-compression-first procedure are compelling, large, multicenter randomized trials are still necessary to determine whether such protocols do indeed improve outcome. In current EMS dispatch practice, traditional cardiopulmonary resuscitation (CPR) instructions are given when needed to bystanders who report a possible cardiac arrest. Recent literature has shown that in certain circumstances, CPR instructions involving chest compressions alone may be given more quickly and can yield an equivalent, if not better, chance of survival. Although this practice is controversial, the general consensus is that any CPR is better than none at all. Therefore, telephone CPR protocols that recommend the immediate initiation of chest compressions may be preferred, particularly for callers who have no previous training in CPR.
BACKGROUND: Little is known about patient outcomes after discharge planning by inpatient palliative care teams. A major difficulty is that successful discharge planning often effectively limits or ends the team's relationship with the patient and family. The goal of this study was to gather a clearer picture of what happened to our palliative care consult patients after discharge. METHODS: This was a longitudinal survey of all patients seen over a one year period by the inpatient palliative care team at Oregon Health & Science University (OHSU). Data were recorded by team members at the time of consultation and supplemented by data from administrative databases and death certificates. RESULTS: The team provided consults to 292 unique patients: 60% were younger than age 65, 39% were female, and 16% were members of an ethnic or racial minority. Almost three quarters of patients carried a non-cancer diagnosis. Of the 292 patients, 37% died in hospital and 63% were discharged alive, either to home (54%), nursing facilities (20%), or inpatient hospice (26%). Of the 183 patients discharged alive, 38% died within 2 weeks, 32% died between 2 weeks and 6 months, 25% were alive at 6 months, and 4% were unknown. Of note, only 10% of patients seen by the consult service were readmitted to OSHU within 30 days, and only 5% of those discharged alive from OHSU ultimately died in an acute care hospital. DISCUSSION: We characterized patient outcomes following inpatient palliative care consultation: where patients are discharged, how long they live, and where they die. Two thirds of patients were able to be discharged, even when death occurred within two weeks. The low rates of readmission and death in an acute care hospital support that the decision to discharge the patients was reasonable and the discharge plan was adequate. Hospital based palliative care teams can play an important and unique role in discharge planning--allowing even patients very near death to leave the hospital if they wish.
In the last 20 years, the issue of disparities in health between racial/ethnic groups has moved from the realm of common sense and anecdote to the realm of science. Hard, cold data now force us to consider what many had long taken for granted. Not only does health differ by race/ethnicity, but our health care system itself is deeply biased. From lack of diversity in the leadership and workforce, to ethnocentric systems of care, to biased clinical decision-making, the American health care system is geared to treat the majority, while the minority suffers. The photos shown here are of patients and scenes that recall some of the important landmarks in research on racial/ethnic disparities in health. The purpose is to put faces and humanity onto the numbers. While we now have great bodies of evidence upon which to lobby for change, in the end, each statistic still represents a personal tragedy or an individual triumph.
The wealth of data in basic science and translational research may often represent a conundrum for clinical oncologists, who need to selectively consider this abundant information and translate it into therapeutic decisions. For the sake of simplicity, we have classified the multiplicity of genetic abnormalities in five repertoires that are rapidly assessable and useful for stratification in clinical trials: allelic imbalance, aberrant promoter methylation, gene mRNA overexpression, microtubule alterations, and polymorphisms. Allelic imbalance refers to chromosomal instability, which is a major feature of cancer, and innovative techniques used in colorectal cancer should also be implemented in lung cancer. Epigenetic changes (variations in transcription levels) have been extensively studied in non-small cell lung cancer. Methylation techniques have shown that these epigenetic changes commonly occur at the same frequency in numerous genes, both well-known ( FHIT, APC, p16 ) and recently discovered ( TMS1, RASSF1 ) in non-small cell lung cancer and in breast cancer. Innovative techniques like quantitative polymerase chain reaction can determine gene expression profiles, mainly overexpression of mRNAs, which may be related to resistance to specific cytotoxic drugs. In the near future, we hope these profiles can be used to individualize chemotherapy. Multiple microtubule alterations related to overexpression of different genes can also be used to predict response to taxanes and Vinca alkaloids. Finally, the assessment of polymorphisms could enable us to understand their functional consequences in chemotherapy response.