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At least 541 records · Page 30Linked to original sources
PubMed2005

Re-use of the original infusional induction chemotherapy as salvage therapy in myeloma patients relapsing after one autograft.

If standard infusional therapy (IC) has been used to treat myeloma at presentation, it is a matter of debate whether patients should receive the original induction therapy or a different drug combination in first relapse. Instinctively, most clinicians may switch treatment, particularly since the advent of new drugs for the treatment of myeloma. Hitherto, there has been no data on the efficacy of repeating standard IC in the salvage setting. We studied 62 myeloma patients whose initial treatment consisted of C-VAMP and a single high dose melphalan procedure and who were retreated with C-VAMP at the time of first relapse. Response to salvage C-VAMP was seen in 50% (95% confidence interval = 0.37-0.62) but we were unable to identify any predictors for response to salvage C-VAMP. Only patients resistant to salvage C-VAMP benefited from a second autograft. The survival of patients who responded to salvage C-VAMP was not prolonged by a second transplant. In conclusion, our data supports the use of C-VAMP for patients with myeloma in first relapse and suggest that only patients resistant to salvage C-VAMP should be offered a second autograft.

Adult↗
PubMed2006

Cerium isotope effects in Ce(III) malate and lactate complex formation studied by long-distance displacement chromatography.

Isotope effects of cerium were observed in malate and lactate complex formations during the long-distance displacement chromatographic processes at 313 K. Heavier isotopes were found fractionated in the frontal edges of the Ce adsorption bands in both the systems, registering a preference of the heavier isotopes for the Ce(III) complexes in the solution phase over the simply hydrated Ce(III) ions in the resin phase. The fractionation coefficients epsilon for the 136Ce/140Ce, 138Ce/140Ce and 142Ce/140Ce isotopic pairs were 7.1 x 10(-6), 5.2 x 10(-6) and -2.1 x 10(-6) for the malate system, and 4.8 x 10(-6), 4.5 x 10(-6) and-2.6 x 10(-6) for the lactate system, respectively. They all show the mass-dependent law if the deviation of epsilon for the 138Ce/140Ce pair was considered merely due to the isobaric interference in Ce isotopic ratio measurements, suggesting the molecular vibration, rather than the nuclear field shift, mainly contributes to the Ce isotope effects in the complex formation systems. The absolute values of epsilon between the two systems are comparable, suggesting no instinct difference in structural properties between Ce malate and lactate complexes involved.

Cerium Isotopes↗
PubMed2004

Attachment, ethology and adult psychotherapy.

This article discusses Bowlby's development of an ethological-evolutionary perspective, and its implications for psychotherapy with adults. According to Bowlby, attachment behavior is instinctive, having emerged throughout the course of evolution to ensure protection and actual survival. Because the environment affects how attachment behavior unfolds, adverse experiences can divert developmental pathways away from resilience, toward dysfunction and emotional distress. Psychotherapy offers the experience of an attachment relationship. Part of the process involves helping patients understand that feelings such as fear and anxiety are inherent responses to safeguard affectional relationships when they are endangered. As working models are re-appraised and revised, there is emphasis on clarifying the attachment experiences that may have intensified these natural feelings.

Adult↗
PubMed1976

Recognition of lactose intolerance.

Evidence has been accumulating that except where dairying has been carried on for centuries, postweaning inability to digest milk is the norm for humans as well as other land mammals. Given the ethnic diversity of the U.S., there may well be 30 million Americans who cannot drink milk without developing symptoms and many instinctively learn to avoid it. A simple lactose tolerance test is described that establishes the diagnosis.

Adolescent↗
PubMed2004

Lip anatomy and its implications for the pollination mechanisms of Bulbophyllum species (Orchidaceae).

BACKGROUND AND AIMS: The lip structure of six Brazilian and one Asiatic species of Bulbophyllum with wind-assisted fly pollination (B. involutum, B. ipanemense and B. weddellii) and non-wind-assisted fly pollination (B. epiphytum, B. glutinosum, B. regnellii and B. rothschildianum) was studied to investigate the presence of secretory tissues related to these pollination mechanisms. METHODS: The lip study was carried out through scanning electron microscopy (lip surface) and light microscopy (anatomical features). KEY RESULTS: In most of the species studied, the osmophores (odour glands) were located in the lobes and in the upper surface of the lip callus. Differences in the lip structure were observed between the two groups (the presence of a nectary and the extent of osmophore surface), depending on the mechanism of pollination. Nectaries were found in the cavity callus in B. ipanemense, B. involutum and B. weddellii, even though their pollinators were presumably attracted by the instinct to oviposit. CONCLUSIONS: These findings corroborate the hypothesis that, because pollination in these species is dependent on an unpredictable external factor (wind), nectar is necessary to keep the insect in the flower for a long period. Despite the occurrence of a liquid-like nectar in the flowers of B. epiphytum, B. glutinosum, B. regnelli and B. rothschildianum, no anatomical evidence for nectaries was found in the lips of these species, although a similar structure may occur in another region of the flowers. This observation agrees with the fact that pollination by lip movement in the latter species requires only gravity, with no additional mechanism being needed to keep the flies in the flower.

Flowers↗
PubMed1994

The neurology of kinetic art.

All visual art must obey the laws of the visual system. The first law is that an image of the visual world is not impressed upon the retina, but assembled together in the visual cortex. Consequently, many of the visual phenomena traditionally attributed to the eye actually occur in the cortex. Among these is visual motion. The second law is that of the functional specialization of the visual cortex, by which we mean that separate attributes of the visual scene are processed in geographically separate parts of the visual cortex, before being combined to give a unified and coherent picture of the visual world. The third law is that the attributes that are separated, and separately processed, in the cerebral cortex are those which have primacy in vision. These are colour, form, motion and, possibly, depth. It follows that motion is an autonomous visual attribute, separately processed and therefore capable of being separately compromised after brain lesions. It is also one of the visual attributes that have primacy, just like form or colour or depth. We conclude that it is this separate visual attribute which those involved in kinetic art have tried to exploit, instinctively and physiologically, from which it follows that in their explorations artists are unknowingly exploring the organization of the visual brain though with techniques unique to them.

Art↗
PubMedDate not supplied

Political, administrative, and economic resources for the control of poliomyelitis.

Control of any major childhood disease in developing countries is dependent on the ability of health services to reach the susceptible population and to administer appropriate therapy or preventive action. Both of these needs are addressed by the development of primary health-care services. The vaccine-preventable diseases, including poliomyelitis, are likely to be controlled only through programs that are executed through the primary health-care system. The implications of the technical aspect of poliomyelitis control on economic resources are secondary to the administrative capability of the programs to manage these technical facilities effectively. The first prerequisite of any health program is the political will on the part of the decision makers to carry it through effectively. This will be reflected in the strength of the administrative structures and the economic resources made available. At present poliomyelitis, with its clinical visibility and its appeal to humanitarian instincts, has an importance as a leader for immunization programs and thus, for primary health care.

Health Policy↗
PubMed2004

The reins of the soul: the centrality of the intercostal nerves to the neurology of Thomas Willis and to Samuel Parker's theology.

Thomas Willis's description of the intercostal nerves has not received much attention by historians of medicine. Yet the intercostal nerves are of paramount importance for his neurology. Willis explained that via these nerves, which connect the brain to the heart and lower viscera, the brain controls the passions and instincts of the lower body. In other words, Willis believed that the intercostal nerves mediate a kind of rationality and that therefore they make a human a rational being. Willis's theory, I argue, must be seen in the context of the early modern mind-body problem. In the second part of the article I discuss how Oxford theologian Samuel Parker took up Willis's argument while stating that the intercostal nerves are the most important instruments (reins) of the soul. They control the bodily passions so that humans can transform into more virtuous beings. The explanation of the intercostal nerves offered by Willis and Parker fits the Anglican optimism about the abilities of human reason as well as about the moral potential of humankind.

History, 17th Century↗
PubMed1999

The importance of intuition in the occupational medicine clinical consultation.

Clinical consultation involves unspoken elements which flow between doctor and patient. They are vital ingredients of successful patient management but are not easily measured, objective or evidence-based. These elements include empathy and intuition for what the patient is experiencing and trying to express, or indeed suppressing. Time is needed to explore the instinctive feeling for what is important, particularly in present day society which increasingly recognizes the worth of psychosocial factors. This time should be available in the occupational health consultation. In this paper the importance of intuition and its essential value in the clinical interview are traced through history. Differences between intuition and empathy are explored and the use of intuition as a clinical tool is examined.

Attitude of Health Personnel↗
PubMed2004

Emergency management: does it have a sufficiently comprehensive understanding of decision-making, process and context?

It is widely recognised in the social and management sciences that the effective support of decision-making requires a multidisciplinary perspective. This trend is also clear in nuclear emergency management (EM). However, communication between disciplines is not easy to maintain in EM contexts when the decision makers (DMs) are likely to be highly stressed. Such circumstances can lead them to revert to the instinctive patterns of perception of their core disciplines, making communication between disciplines difficult and, perhaps, obscuring complex interactions that have not been rehearsed in practice exercises. This paper explores decision making in EM and the nature of the socio-technical issues that will arise, suggesting that despite the lessons of past accidents the research EM community is still not taking a broad enough view of what future incidents may entail.

Decision Support Systems, Management↗
PubMed2000

Modulating emotional responses: effects of a neocortical network on the limbic system.

Humans share with animals a primitive neural system for processing emotions such as fear and anger. Unlike other animals, humans have the unique ability to control and modulate instinctive emotional reactions through intellectual processes such as reasoning, rationalizing, and labeling our experiences. This study used functional MRI to identify the neural networks underlying this ability. Subjects either matched the affect of one of two faces to that of a simultaneously presented target face (a perceptual task) or identified the affect of a target face by choosing one of two simultaneously presented linguistic labels (an intellectual task). Matching angry or frightened expressions was associated with increased regional cerebral blood flow (rCBF) in the left and right amygdala, the brain's primary fear centers. Labeling these same expressions was associated with a diminished rCBF response in the amygdalae. This decrease correlated with a simultaneous increase in rCBF in the right prefrontal cortex, a neocortical region implicated in regulating emotional responses. These results provide evidence for a network in which higher regions attenuate emotional responses at the most fundamental levels in the brain and suggest a neural basis for modulating emotional experience through interpretation and labeling.

Adult↗
PubMed1991

Science policy, science funding, and the science community.

The ongoing federal budget crisis has led to extensive debate over how much money the federal government should spend on scientific research. In the struggle for limited funds, many advocacy groups will covet the large sums proposed for science research, and the scientific community may be called upon to justify its large share of the discretionary funding, especially the large increases for some science agencies and "big science" projects. Many would instinctively support the assertion that scientific progress is a cornerstone of national well-being, but the connection between strong federal support of research and vigorous economic growth or societal vitality is not straightforward. Two variables--science and technology, not science alone, are basic to the larger issues of the economy and social welfare. Federal policy must facilitate development in coordination with support for basic science. Scientists, in turn, must help foster a perspective that encompasses research and development as a whole and that seeks to identify explicitly the connections between the nature of the R&D effort and economic vitality and quality of life. Furthermore, society needs a free flow of information between all members of the science and technology community and an end to the artificial and harmful barriers between them. The science community must focus on setting priorities, refining science and technology policy to maximize available resources, and convincing voters that science can make crucial contributions to the long-term welfare of the nation.

Budgets↗
PubMed2002

Evidence-based medicine and informed consent.

The author applauds the paradigm shift in medical education and practice toward evidence-based medicine. However, he maintains that an important part of this shift should be a careful consideration of its implications for the physician's legal and ethical obligations to sufficiently inform patients about the nature of proposed medical interventions. Should the traditional informed-consent requirement be expanded to mandate that the physician also disclose the basis or reasons for the physician's expectations about likely benefits? Particularly, should the physician have to reveal whether a recommendation is based on scientifically analyzed evidence of efficacy or instead on the sorts of factors (custom, habit, gut instinct, personal impressions and experience) that have influenced much of medical practice in the past in the absence of relevant evidence? What should the physician tell the patient when the evidence base regarding a specific intervention is just beginning to be developed, is ambiguous, or is engulfed in controversy? The author examines the implications of these questions, and cautions that while the trend to evidence-based medicine is commendable, careful consideration of patients' proper roles regarding evidence-based medicine-as both recipients of and decision makers about their own proven and unproven forms of medical care-should not be overlooked.

Education, Medical, Undergraduate↗
PubMed1990

The alien hand sign. Localization, lateralization and recovery.

The alien hand sign was first described by Brion and Jedynak as a "feeling of estrangement between the patient and one of his hands." The affected hand frequently shows a grasp reflex and an instinctive grasp reaction as well as elements of what Denny-Brown referred to as a "magnetic apraxia" associated with frontal lobe damage. Most notably, however, the affected hand is observed to perform apparently purposive behaviors that are perceived as being outside the volitional control of the patient. The patients interpret the behavior of their own affected limb as being controlled by an external agent. They do not feel that they are initiating or controlling the behavior of the hand and often express dismay at the hand's "extravolitional" activity. The patients attempt to control behavior of the alien hand with the unimpaired hand by forcibly restraining the affected limb, an act that may be termed "self-restriction." In this paper, we report an additional four cases of alien hand sign in right-handed subjects: two involving the right hand and two involving the left hand. In each case, the clinical findings were associated with extensive unilateral damage of the medial frontal cortex of the hemisphere contralateral to the affected hand. Furthermore, the alien movement gradually disappears over the course of 6-12 months after the stroke. These clinical case studies are presented and discussed in the context of the "dual premotoer systems hypothesis," an anatomicophysiological model that proposes that action is organized by two separate but interactive premotor brain systems corresponding to evolutionarily defined medial and lateral cortical moieties. It is hypothesized that the alien mode behavior results from unconstrained activity of the lateral premotor system in the damaged hemisphere. The residual volitional control in the limb occurs through the activity of the intact medial premotor system of the ipsilateral hemisphere. Recovery may occur through extension of these ipsilateral control mechanisms by compensatory changes in subcortical systems controlling hemispheric activation associated with adaptive behavior. This observation may be important in understanding mechanisms involved in motor recovery after stroke.

Aged↗
PubMed1997

Mechanism of disinhibition after brain lesions.

Disinhibition syndromes, ranging from mildly inappropriate social behavior to full blown mania, may result from lesions to specific brain areas. Several studies in patients with closed head injuries, brain tumors, stroke lesions, and focal epilepsy have demonstrated a significant association between disinhibition syndromes and dysfunction of orbitofrontal and basotemporal cortices of the right hemisphere. Based on the phylogenetic origin of these cortical areas and their main connections with dorsal regions related to visuospatial functions, somatosensation, and spatial memory, the orbitofrontal and basotemporal cortices may selectively inhibit or release motor, instinctive, affective, and intellectual behaviors elaborated in the dorsal cortex. Thus, dysfunction of these heteromodal ventral brain areas may result in disinhibited behaviors.

Adult↗
PubMed1999

The nature of attachment in a neonatal intensive care unit.

Attachment is defined as the formation of a relationship between a mother and her newborn infant. The concept of attachment has been inadequately defined and often confused with feelings associated with love, instinct, engrossment, and being connected to others. Prematurity and associated maternal-infant separation at birth can affect the attachment process. In this article, a research project, using Leninger's ethnonursing approach is described. Leninger's method was chosen to study the phenomenon of attachment in a neonatal intensive care unit (NICU). Ethnonursing has been found to be a suitable approach for the study of complex situations. Ethnonursing is based on an observation, participation in care, and reflection model. Qualitative data for this study were collected by observation, participation in care, and interviews of mothers (N = 25) in a tertiary NICU. Data were analyzed by comparison of narratives from field notes and transcripts. Findings from the analysis indicate the process of attachment was not automatic. Attachment should be considered as an individualized process. Two dichotomies associated with attachment were identified through the research. These were overt and covert attachment processes and may be dependent on the health status of the infant and the mother, environmental circumstances, and on the quality of care the infant receives.

Adolescent↗
PubMedDate not supplied

Preparing a new workforce.

Human caring, while instinctive, can also be taught, learned, and measured through the nursing education system. For decades information has been obtained that suggests people enter nursing because they value interpersonal relationships, altruism, and a desire to help others. Building on this "caring ethic," nursing students can be professionally trained so that the very best in nursing comes through in their practice. By using nursing theory, students realize their potential while gaining all requisite skills and competencies of today's practicing nurse. They enter the workforce with excitement and enthusiasm, confident that reflective, patient-centered care is always the goal.

Attitude of Health Personnel↗
PubMed1978

Medical management of patients with reflux esophagitis.

Medical management of reflux esophagitis includes physical manipulations, antacids, and antireflux medications (bethanechol and alginic acid). Their combined usage in the continuous dyspeptic and the problem case help "break the cycle," providing relief for long periods of time. Identification of possible inciting factors in cases of recurrence should be pointed out to the patient so that he will develop an instinctive antireflux behavior. The effect of this combined therapy on the pathophysiology and natural history of the disease remains to be determined.

Alginates↗