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PubMed1998

Eye, head and trunk control: the foundation for manual development.

Mastery of reaching and manipulation relies on adequate postural control. The trunk must be balanced relative to a base of support to allow free movements of the arms and hands. Moreover, the head must be supported flexibly by the trunk so that gaze can be directed toward the target to provide a spatial frame of reference for reaching. For fine manipulation it is also crucial to avoid retinal slips which would introduce blur. Stabilizing gaze is generally accomplished through adjustments of both eye and head position. Until gaze is stabilized, it is difficult to establish a frame of reference between the target and the self. Thus, a nested hierarchy of support involving the eyes, head, and trunk forms an important foundation for manual activity.

Child↗
PubMed2001

The Stanley Foundation Bipolar Treatment Outcome Network. I. Longitudinal methodology.

The NIMH-Stanley Foundation Bipolar Treatment Outcome Network, a multisite clinical trials network, has been established to address many of the neglected areas of research in bipolar illness. The Network was designed so that it would be able to conduct randomized clinical trials at several different levels of methodologic rigor (blinded and open-label) both in academic and community practice settings in order to better assess long-term efficacy of existing treatments and develop new ones. In this fashion, large numbers of representative patients with bipolar disorder have been enrolled with an additional focus of elucidating possible clinical and biological predictors of treatment response. The unique focus of the Network is its systematic longitudinal approach to illness so that patients can be assessed comprehensively over the long-term in sequential randomized clinical trials at critical clinical decision points where data on relative efficacy are inadequate. Bipolar I and bipolar II patients with a range of illness variants and comorbidities are included. Daily prospective ratings of severity of mania and depression and associated degree of functional impairment are completed on the NIMH-Life Chart Method and a modified Clinical Global Impressions Scale for Bipolar Illness (CGI-BP) is utilized. More detailed cross-sectional ratings for depression (Inventory of Depressive Symptomatology), mania (Young Mania Rating Scale), and psychosis (Positive and Negative Syndrome Scale) are additionally used at academic centers. This article describes the rationale for the Network, its guiding principles, methods, and study design to systematically assess the highly variable course of bipolar illness and its response to current and future treatments.

Bipolar Disorder↗
PubMed2001

The Stanley Foundation Bipolar Treatment Outcome Network. II. Demographics and illness characteristics of the first 261 patients.

BACKGROUND: Since recent NIMH Bipolar Disorder Workshops highlighted the dearth of longitudinal and controlled studies of bipolar illness, the Stanley Foundation Bipolar Network (SFBN) has recruited a large cohort of patients with bipolar disorder to begin to address these issues. This report describes the demographics and course of illness characteristics of this study population. METHODS: The first 261 outpatients to be diagnosed by the Structured Clinical Interview for DSM-IV (SCID) and complete a detailed patient and a brief clinician questionnaire are described. All patients met DSM-IV criteria for bipolar I (n=211), bipolar II (n=42), or NOS (n=5) or schizoaffective (n=3), bipolar type. Chi-square and t-tests were used to examine statistically significant associations among important demographic and descriptive items. RESULTS: The general demographic and illness characteristics were similar to those in many bipolar clinical samples and not dissimilar from those reported in epidemiological surveys. The majority of patients had been hospitalized, with almost half reporting a worsening of illness over time, and two-thirds were not asymptomatic between episodes. First treatment for patients had been delayed by an average of 10 years from illness onset (by SCID). Almost a third of patients had attempted suicide at least once, and 30% reported current suicidal ideation at study entry. A total of 62% reported moderate to severe impact of the illness on occupational functioning. Early onset bipolar illness (< or =17 years old) was associated with increased frequency of mood switches, worsening course of illness, and history of early abuse (physical, verbal, or sexual). CONCLUSION: The SFBN represents a sample of predominantly BP I patients largely recruited from the community who will be followed in detail longitudinally, participate in clinical trials, and thus help advance our understanding and treatment of this life-threatening medical disorder. While there is a broad range of illness characteristics and severity, the majority of patients have been severely impacted by their illness despite the availability of multiple conventional treatment approaches in the community. These data further underscore the need for development of new and earlier treatment interventions. LIMITATION: The SFBN population is limited by the lack of random selection and represents a cohort willing to be treated and followed intensively in academic tertiary referral centers. While its characteristics are similar to many clinical study populations, the generalizability to non-clinic populations remains uncertain.

Activities of Daily Living↗
PubMed1997

Luigi Galvani and animal electricity: two centuries after the foundation of electrophysiology.

Luigi Galvani and his famous experiments on frogs carried out in the second half of the 18th century belong more to legend than to the history of science. Galvani not only laid the foundations of a new science, electrophysiology, but also opened the way for the invention of the electric battery, and thus for the development of the physical investigations of electricity. However, in spite of the widespread celebration of his work, Galvani's scientific endeavours have been largely misrepresented in the history of science. The scholar of Bologna has a stereotyped image as an 'occasional' scientist, who started his studies by chance, largely ignored the scientific theories of his time and wandered aimlessly in mental elaborations until the physicist of Pavia, Alessandro Volta, entered the field, correctly interpreted Galvani's results and eventually developed the electric battery. With the present understanding of electrical phenomena in excitable membranes, it is now time to reconsider the real matter raised by Galvani's discoveries and by his hypothesis of an intrinsic 'animal electricity', and to make a clearer evaluation of a revolutionary phase of scientific progress.

Animals↗
PubMed1992

The limbic system: a review of its empirical foundation.

The concept of the limbic system is highly influential in many areas of the neurosciences and in their applications to clinical medicine. The value of this concept has been questioned, denied, and defended several times in the past but a comprehensive critical evaluation has never been published. In this article we take several approaches to analyse empirical data of relevance to the limbic system. First we delineate its factual application in different areas. The limbic system has a very wide scope and divergent use. Secondly we extract criteria for its definition from research literature using the bibliographic database Medline. The limbic system has been defined variously on a number of different descriptive levels from morphology to behaviour. Thirdly we review its empirical foundations comparing evidence from different sources. The limbic system lacks an adequate empirical definition in spite of numerous efforts. Last we evaluate its construction as a scientific concept from empirical facts. The limbic system is a non-empirical explanatory concept for poorly understood brain functions. We conclude that the concept of the limbic system cannot be accepted on empirical grounds. However, it is a very attractive concept in the search for explanation of brain function. The non-empirical contents of the limbic system remains largely unexplored.

Animals↗
PubMed1992

An ethical foundation for health care: an emergency medicine perspective. Ethics Committee, Society for Academic Emergency Medicine.

1. What is health and health care? Health is a state of physical and mental well-being that facilitates the achievement of individual and societal goals. Good health over a lifetime is the comparative absence of pain and suffering, illness and disease, each of which could prevent people from pursuing their goals. Health care includes those services that provide adequate nutrition and shelter; sanitary, safe, unpolluted living and working conditions; personal medical services; and nonmedical personal and support services. The medical community can best address the area of personal medical services, which includes interventions to prevent disease, minimize morbidity from existing diseases, diagnose and cure illness, relieve pain and suffering, and provide education for the continued promotion of health. Society must also provide health care services such as adequate nutrition, shelter, and education about health care issues, including prevention that could result in reduced expenditures for curative services. 2. Is health care an ethical or legal right? At this time, there is no legal right to universal health care in the United States, although there is a patchwork of limited legislated rights to health care benefits for some citizens. Ethically, there is a right to health care; however, it is a limited right best expressed as a societal obligation to provide care rather than an open-ended individual right to receive any and all health care resources on demand. In restructuring our health care system, our society must identify the values that will serve as the foundation for our health care system. A health care system that stresses societal rather than individual priorities is essential.(ABSTRACT TRUNCATED AT 250 WORDS)

Beneficence↗
PubMed2000

History of the National Kidney Foundation.

Stimulated by a mother's desire to find a cure for her child's disease, the National Kidney Foundation has grown from a small local group of interested lay persons and medical professionals Into a major national organization with affiliates around the country and national and International programming in renal research funding, patient and family services, public and professional education, and public policy advocacy.

History, 20th Century↗
PubMed2000

History of the National Kidney Foundation's research efforts.

The research programs of the National Kidney Foundation (NKF) are designed to foster research and training in renal disease by providing cutting edge, excellent, state of the art training in basic science, clinical, and translational research. Since the inception of the Fellowship training program in 1968, the beginning of the Young Investigator Grant program in 1987, and the establishment of the Clinical Scientist Award in 1994, hundreds of nephrologists and basic scientists have been supported by the NKF research programs. The annual budget for the various research and training programs of the NKF has increased from approximately $80,000 to more than $1,000,000 for the Fellowship training program, from about $90,000 to more than $400,000 for the Young Investigator Grant program, and from $50,000 to $500,000 annually for the Clinical Scientist award for a total of more than $2,000,000 annually, while future plans are to expand the research budget to almost $3,000,000 annually. In addition to these programs to support outstanding research and training from the national office, many Affiliate chapters of the NKF also support research and training as a mission. It is the goal of the NKF that the research supported by the NKF will ultimately be translated into improved quality of care for patients with kidney disease. Because progress in many diseases is hampered by a lack of knowledge of the underlying pathophysiology of the disease, improved understanding of the mechanisms of renal disease will allow for the development of strategies to prevent or limit renal disease. The NKF is committed to continuing its focus on research and training as one of its major missions so that patients with kidney disease can live better lives in the next millennium.

Awards and Prizes↗
PubMed1994

HLA associations in end-stage renal disease due to membranous glomerulonephritis: HLA-DR3 associations with progressive renal injury. Southeastern Organ Procurement Foundation.

Membranous glomerulonephritis (MGN) is the most common cause of idiopathic glomerulonephritis in American adults. African-Americans develop end-stage renal disease (ESRD) due to chronic glomerulonephritis four times more often than whites. To determine whether HLA phenotype associations existed in the subset of MGN patients with ESRD we analyzed HLA frequencies, by race, in patients with MGN entered in the Southeastern Organ Procurement Foundation registry between 1982 and 1992. HLA frequencies from 250 renal transplant patients with MGN (190 whites and 60 African-Americans) were compared with 4,506 race-matched cadaveric kidney donor controls (4,039 whites and 467 African-Americans). Race-specific odds ratios (ORs) were calculated and fitted into a log-linear model to determine associations between MGN and HLA frequencies. The reported values were considered significant (P < 0.05) after Bonferroni correction for multiple comparisons. HLA-DR3 and HLA-DR5 frequencies were increased in cases of both races compared with race-matched controls (race-combined ORs, 2.22 and 1.61, respectively; all P < 0.02). Interracial analyses revealed that HLA-DR7 frequency was decreased solely in whites with MGN (OR, 0.53; P < 0.04). The results of this study indicate that HLA-DR3 and HLA-DR5 are positively associated with ESRD due to MGN in patients of both races and that HLA-DR7 is negatively associated with MGN in whites. These analyses confirm the published reports of HLA-DR3 association with MGN in Chinese, French, British, Chilean, and American white populations. The novel association of HLA-DR5 may reflect the fact that the MGN cases in this study all had ESRD.(ABSTRACT TRUNCATED AT 250 WORDS)

Black People↗
PubMed1993

A race-controlled human leukocyte antigen frequency analysis in lupus nephritis. The South-Eastern Organ Procurement Foundation.

Systemic lupus erythematosus (SLE) has higher incidence and mortality rates in addition to a greater risk for nephropathy in African Americans (blacks), compared with whites. We analyzed the South-Eastern Organ Procurement Foundation (SEOPF) database from 1982 through 1986 to determine if variation in human leukocyte antigen (HLA) frequencies, beyond those normally present between the races, were associated with lupus nephritis (LN). HLA antigen frequencies in 271 black and 230 white renal transplant recipients with LN as the cause of end-stage renal disease (ESRD) were compared with 4,506 race-matched cadaveric kidney donor controls. Odds ratios (ORs) and chi-square values were computed to assess the prevalence of each HLA phenotype among the cases versus the controls separately for blacks and whites. HLA-B8 and -DR2 frequencies were increased, and HLA-DR4 frequency was decreased in cases of both races compared with race-matched controls (race-combined ORs, 1.68, 1.46, and 0.49, respectively; all P < 0.01). Race-specific analyses showed that HLA-DR6 was decreased in black cases versus black controls (OR, 0.48; P < 0.001) and HLA-DR3 was increased in white cases versus white controls (OR, 1.88; P < 0.001). HLA-B8 and DR2 are positively associated and HLA-DR4 is negatively associated with LN in patients of both races. HLA-DR3 and -DR6 demonstrate race-specificity in LN and place whites at a disadvantage relative to blacks. It is likely that non-HLA-mediated genetic factors and/or environmental factors contribute to the increased risk of nephritis observed in black patients with SLE.(ABSTRACT TRUNCATED AT 250 WORDS)

Chi-Square Distribution↗
PubMed1999

Morbidity and mortality in redefining adequacy of peritoneal dialysis: a step beyond the National Kidney Foundation Dialysis Outcomes Quality Initiative.

The National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF-DOQI) Peritoneal Dialysis (PD) Adequacy Work Group intentionally limited the scope of its work to address adequacy in terms of small-solute removal. This decision was based on the need for rigorous evidence and that mortality is the most objective parameter in the literature. This review attempts to more broadly redefine the concept of the adequacy of PD, particularly as it relates to the most common general medical problems that PD patients experience; namely, cardiovascular disease and malnutrition. Whereas we are sensitive to the developmental process of the NKF-DOQI, we are critical that the definition of adequacy may be too narrow, leading clinicians to overlook other important morbidities. We have reiterated the evidence that suggests a weekly solute clearance (Kt/Vurea) of 1.7 or greater is associated with better patient survival. The arguments to target a greater Kt/Vurea of 2.0 are challenged, yet the concept is ultimately supported. Because cardiovascular disease is the cause of death in half of all patients with end-stage renal disease, dialysis adequacy must be defined, in part, by the potential of that therapy to diminish cardiovascular maladies. Blood pressure, volume, left ventricular hypertrophy, and dyslipidemias are discussed in this context. Lastly, assumptions that increasing total solute clearance leads to improved nutrition in PD patients are challenged. We have attempted to expand on what the NKF-DOQI did not include, and we urge the dialysis community to seek the answers to the many controversies that remain. We need to redefine the adequacy of PD in a holistic manner and find outcome parameters that are not as final as death.

Cardiovascular Diseases↗
PubMed2002

Foundations of psychosocial dynamic personality theory of collective people.

The concept of personality emerged as a part of the development of individualism in the western world to understand the quality of the newborn (individual). In premodern society, roles were the elements that constituted the person. Presently, about 80% of the people (Africa, Asia, and South America) in the world still live in a collective, authoritarian system. Personality theories that have been developed in Europe and North America seem to be limited in understanding and predicting the behavior of these people. One major difference between individualistic and collective peoples is their degree of individuation from the family. Western social-political systems enable individuals at the end of their development course to form an independent personality (or self) that is unique and different from others. For westerners, personality structures and processes enable us to predict behavior. Psychopathology is attributed to an intrapsychic disorder within the personality. Typically, psychotherapy aims to restore that order. For people who live in collective social systems, individuation does not take place. Therefore, norms, values, roles, and familial authority directives predict behavior more than personality. Psychopathology among these people has to do with interpersonal disorder within the family. Therefore, psychotherapy should aim to restore that order. This manuscript suggests foundations of a new psychosocial dynamic theory of personality to better fit our understanding of people living in collective societies.

Arab World↗
PubMed2000

A foundation for the risk-based treatment of gasoline-contaminated soils using modified Fenton's reactions.

The relative oxidation of representative aromatic and aliphatic hydrocarbons found in gasoline was evaluated to provide the foundation for risk-based treatment of petroleum-contaminated soils and groundwater using modified Fenton's reagent (catalyzed hydrogen peroxide). Aromatic components of gasoline are considered more hazardous than the aliphatic fractions due to their higher mobility in the subsurface and their higher acute and chronic toxicities. Benzene, toluene, and mixed xylenes (BTX) were selected as aromatic compounds representative of unleaded gasoline, while nonane, decane, and dodecane (NDD) were used as model aliphatic compounds. The effects of hydrogen peroxide (H(2)O(2)) concentration, iron catalyst concentration, and pH on the degree of treatment of the model compounds were investigated using central composite rotatable experimental designs. Oxidation of the aromatic compounds required less iron and less H(2)O(2) than did oxidation of the aliphatic compounds, while proceeding more effectively at near-neutral pH. Greater than 95% of the BTX was treated at near-neutral pH using 2. 5% H(2)O(2) and 12.5 mM iron (III), while only 37% nonane, 7% decane, and 1% dodecane oxidation was achieved under the same conditions. The results show that the more toxic and mobile aromatic fraction was more effectively oxidized using less H(2)O(2) and more economical conditions, including near-neutral pH, compared to the aliphatic fraction. A process design based on treating only the aromatic fraction of petroleum may provide significantly lower costs when using modified Fenton's reagent for the treatment of contaminated soils and groundwater.

Gasoline↗
PubMed2001

Multivariate analysis of prefrontal cortical data from the Stanley Foundation Neuropathology Consortium.

Prefrontal cortical tissue from the Stanley Foundation Neuropathology Consortium, which contains samples from patients with schizophrenia, bipolar disorder, non-psychotic depression, and normal controls (n = 15 per group), was studied in a blinded fashion in 14 different laboratories between 1997 and 2000. The results of 69 separate data sets were analyzed with univariate and multivariate techniques. A total of 17 abnormal markers were identified that pertained to a variety of neural systems and processes, including neuronal plasticity, neurotransmission, signal transduction, inhibitory interneuron function, and glial cells. Schizophrenia was associated with the largest number of abnormalities, many of which were also present in bipolar disorder. Major depression was associated with relatively few abnormalities. The majority of abnormal findings represented a decline in function and could not be easily explained by exposure to psychotropic or illicit drugs. It is argued that the abnormal findings are not simply due to stochastic processes but represent viable markers for independent replication and further study as candidate genes or targets for new treatments.

Adult↗
PubMed1997

Foundations of chemical microscopy. 1. Solid-state characterization of 5-nitrobarbituric acid (dilituric acid) and its complexes with group IA and group IIA cations.

5-Nitrobarbituric acid (dilituric acid) has been used as a chemical microscopic reagent for the qualitative identification of alkali metal (Group IA) and alkaline earth (Group IIA) cations. This methodology was based on the characterization of observed crystal morphologies, since a unique crystal habit could be associated with each adduct product. To understand the scientific foundations which permitted chemical microscopy to function as a useful analytical technique, the products formed between dilituric acid and the Group IA and IIA cations were characterized using polarizing optical microscopy, powder X-ray diffraction, thermal analysis and solid-state nuclear magnetic resonance. It was found that the origins of the different crystal morphologies associated with each of the adduct arose from the ability of the systems to form various hydrate species, which could also contain structural variations due to cation/diliturate packing patterns.

Barbiturates↗
PubMed1999

Foundations of chemical microscopy, 2 derivatives of primary phenylalkylamines with 5-nitrobarbituric acid.

5-Nitrobarbituric acid (dilituric acid) was extensively used with great success as a chemical microscopic reagent for the qualitative identification of primary phenylalkylamines. This methodology was based on the characterization of observed crystal morphologies, since a unique crystal habit could be associated with each adduct product. To understand the scientific foundations which permitted chemical microscopy to function as a useful analytical technique, the products formed between dilituric acid and a series of primary phenylalkylamines were characterized using polarizing optical microscopy, powder X-ray diffraction, thermal analysis, and solid-state nuclear magnetic resonance. It was deduced that the origins of the different crystal morphologies associated with each of the crystalline adducts arose from the ability of the systems to form differing structural types and/or hydrates upon crystallization. The degree of hydration in the crystalline phenylalkylamine adducts appeared to increase as additional carbon atoms were added between the aromatic ring and the terminal amine group of the aliphatic sidechain.

Barbiturates↗
PubMedDate not supplied

Southcentral Foundation--Dena A Coy: a model program for the treatment of pregnant substance-abusing women.

This article discusses the societal implications of substance abuse by pregnant women and women of child-bearing age and reviews their treatment needs as documented in the literature. It then provides a treatment model for pregnant women, using the Southcentral Foundation-Dena A Coy Residential Treatment Program as a model program. It outlines a number of components that are critical to successful substance abuse treatment of these women; specifically, medical interventions, social service provision, educational/vocational services, psychoeducational programs, psychotherapy, substance abuse interventions, and family preservation and involvement. These components are superimposed on a therapeutic community model that stresses gender and cultural relevance, as well as supportive structure and direction.

Aftercare↗
PubMed1999

The ethical foundation of informed consent in clinical research.

OBJECTIVES: To provide a foundation for understanding the ethical concept of informed consent with particular emphasis on the characteristics and principles that make it a moral imperative. DATA SOURCES: Government reports, published articles, and book chapters from the ethics literature. CONCLUSIONS: Informed consent is central to the conduct of cancer clinical trials and good patient care. It is a thoughtful, collaborative process whereby an individual gives autonomous authorization and the decision of the individual is respected by the health professionals. IMPLICATIONS FOR NURSING PRACTICE: Understanding the theory and practice of informed consent is an essential aspect of the nurses role. There are many challenges to this process in the oncology setting because of the severity of the diseases and the complexity of the research, and nurses must be prepared to assure that informed decision-making takes place.

Clinical Trials as Topic↗