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There is both an art and a science to nursing diagnosis. Art is a creative force, whereas science is a systematic force. Each is necessary for diagnosis development. This paper examines issues confronting nurse clinicians, educators, and scientists interested in continued efforts to generate and validate diagnoses. It concludes with suggestions of tasks necessary for sound diagnosis development.
Despite long-term efforts to use appropriate dental equipment for treating dental caries in economically less developed countries, the predominant treatment remains extraction. The reasons for this failure to save teeth are given in this paper. Supported by results of research undertaken in economically developed countries, a 15-step treatment module for dental caries is presented. This technique, which is called Atraumatic Restorative Treatment (ART), is based on removing decalcified tooth tissue using only hand instruments and restoring the cavity with an adhesive filling material. The technique does not require electricity. The advantages and limitations of the technique are discussed and its use in a school oral health program in Zimbabwe presented. We conclude that ART can make restorative oral care more available to a larger part of the world population than it is today.
The output and energy calibrations for the first clinical Hi-Art 2.0 helical tomotherapy system have been reviewed. Fixed-gantry/fixed-couch and rotational-gantry/fixed-couch measurements were made on a daily basis over a period of 20 weeks to investigate system stability. Static gantry measurements were taken at 10 cm depth in a rectangular stack of Virtual Water at an SSD distance of 90 cm and a field size of 5 x 40 cm. Rotational gantry measurements were taken in a cylindrical phantom Virtual Water phantom for a field size of 5 x 40 cm. The Hi-Art 2.0 system has maintained its calibration to within +/-2% and energy to within +/- 1.5% over the initial 20 week period.
Modern computed tomography systems allow volume imaging of the heart. Up to now, approximately two-dimensional (2D) and 3D algorithms based on filtered backprojection are used for the reconstruction. These algorithms become more sensitive to artifacts when the cone angle of the x-ray beam increases as it is the current trend of computed tomography (CT) technology. In this paper, we investigate the potential of iterative reconstruction based on the algebraic reconstruction technique (ART) for helical cardiac cone-beam CT. Iterative reconstruction has the advantages that it takes the cone angle into account exactly and that it can be combined with retrospective cardiac gating fairly easily. We introduce a modified ART algorithm for cardiac CT reconstruction. We apply it to clinical cardiac data from a 16-slice CT scanner and compare the images to those obtained with a current analytical reconstruction method. In a second part, we investigate the potential of iterative reconstruction for a large area detector with 256 slices. For the clinical cases, iterative reconstruction produces excellent images of diagnostic quality. For the large area detector, iterative reconstruction produces images superior to analytical reconstruction in terms of cone-beam artifacts.
The methods of gamete manipulation used in assisted reproductive technology (ART) are rapidly proliferating and in some instances outpacing the underlying science. In this review, we discuss two major advances in the ART laboratory-intracytoplasmic sperm injection and extended embryo culture before embryo transfer. We outline the rationale for these approaches, discuss results of experiments obtained from animal model systems and human preimplantation embryos that provide the scientific basis for these procedures, and point out potential concerns that have arisen from these studies.
According to numerous commentators, clinical freedom, the art of medicine, and, by implication, a degree of patient welfare, are threatened by evidence based medicine (EBM). As EBM has developed over the last fifteen years, claims about better evidence for medical treatments, and improvements in healthcare delivery, have been matched by critiques of EBM's reductionism and uniformity, its problematic application to individual patients, and its alleged denial of the continuing need for clinical interpretation, insight, and judgment. Most of these attacks on EBM and defences of clinical freedom fail. They are based on erroneous understandings of the relationships between inductive knowledge, clinical uncertainty, and action. Evidence based medicine is a necessary condition for clinical freedom, not a threat to it, and EBM is not something to be balanced with either clinical experience or patient preferences. The art and science of medicine are more conceptually and practically connected than the defenders of clinical freedom, whatever they conceive that to be, are willing to admit.
Fast and robust classification of feature vectors is a crucial task in a number of real-time systems. A cellular neural/nonlinear network universal machine (CNN-UM) can be very efficient as a feature detector. The next step is to post-process the results for object recognition. This paper shows how a robust classification scheme based on adaptive resonance theory (ART) can be mapped to the CNN-UM. Moreover, this mapping is general enough to include different types of feed-forward neural networks. The designed analogic CNN algorithm is capable of classifying the extracted feature vectors keeping the advantages of the ART networks, such as robust, plastic and fault-tolerant behaviors. An analogic algorithm is presented for unsupervised classification with tunable sensitivity and automatic new class creation. The algorithm is extended for supervised classification. The presented binary feature vector classification is implemented on the existing standard CNN-UM chips for fast classification. The experimental evaluation shows promising performance after 100% accuracy on the training set.
BACKGROUND: This paper aims to describe the characteristics of physicians and interventions of a large, multicenter randomized trial of acupuncture for migraine (ART Migraine) in order to enable acupuncturists to assess the study interventions. PATIENTS AND METHODS: 302 patients suffering from migraine were randomized to 12 sessions of semi-standardized acupuncture (6 predefined basic points, recommendations for optional individual choice of additional points given), standardized minimal acupuncture (superficial needling of at least 5 of 10 predefined, distant non-acupuncture points) or a waiting list. 30 physicians trained and experienced in acupuncture from 18 centers in Germany participated in the trial. RESULTS: The median duration of acupuncture training of trial physicians was 500 h (range 140-1350). Physicians had acupuncture experience for 10 (<1 to 25) years and had treated 200 (60 to >1000) patients with acupuncture in the year preceding trial participation. The 6 basic points were needled in 76-93% of sessions. Compliance with treatment instructions varied considerably among centers in the acupuncture group. In contrast, compliance with the minimal acupuncture protocol was very good. 6 of the 30 physicians stated that they would have treated patients somewhat differently outside the trial, 1 completely differently. The trial found a significant effect of those treated with acupuncture compared to those on the waiting list for treatment, but minimal acupuncture was as effective as acupuncture. CONCLUSIONS: The treatment protocols for acupuncture and minimal acupuncture in ART Migraine appeared an adequate compromise in the specific situation and for the predefined purposes. However, a relevant minority of participating physicians would have treated patients differently outside the trial.
This study evaluated the survival of class III and V restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth, after 3 years. A total of 151 restorations were performed in 60 patients. After 3 years, 107 restorations (47 patients) were evaluated. Data were analyzed using exact 95% confidence interval. A total of 97 restorations (91% with 95% CI = 83-99), 76 class III (92% with 95% CI = 82-100) and 21 class V (88% with 95% CI = 77-98) were classified as successful. The survival rate of the ART approach in class III and V restorations in permanent anterior teeth was considered high.
Unconscious fantasy is conceptualized as a representation for drive-related, conflict-laden, wish-fulfilling views of human experience. These are usually related to sexuality, and refer to birth, intrauterine existence, primal scene, castration, and seduction. Unconscious fantasy may be transformed into works of art through a variety of artistic means. The employment of formal means for the representation of fantasy may be the product of an endopsychic perception. Thus, structural attributes of the psyche may also find representation. An example is used from the creative process in the construction of a novel by Henry James, The Spoils of Poynton. In the process of fulfilling artistic purposes in the construction of his plot, the author made use of derivatives of unconscious fantasy which surface in the process of creation. The work of art is the integration of unconscious derivatives which become transformed into artistic structure.
In this article the author discusses three "levels" of the state of the art: the "ideal," for program evaluation; the "practical," with political limitations; and the "actual," for current practices. Starting with a review of the developmental stages of effectiveness variables (from attendance and "happiness' through professional performance and patient outcomes), the article updates a review by Lloyd and Abrahamson (1979) and then discusses current practices. Evaluation as a potential contamination factor leads into consideration of evaluation versus research. Finally a review of "lessons learned" over the last twenty years introduces a look ahead into exploitation of the state of the art.
Individuals and families make sense of the world and their experiences through a process of meaning construction. Narrative is an important means of constructing meaning. The diagnosis of life-threatening or life-altering illness often forces revision in the life narrative and the reconstruction of meaning. This article discusses the process of meaning construction and highlights the use of narrative, the expressive arts, and ritual to create meaning and connection. All members of the palliative care team play an important role in helping patients and families tell the stories of their illness and their lives and find meaning and purpose at the end of life. The use of rituals is discussed along with verbal and art-based methods for eliciting patient and family narratives. The relationships among patient, family, and practitioner are seen as powerfully therapeutic and potentially transformative for all involved.
The aim of this prospective study was to assess the feasibility of a state-of-the-art clinical PET/CT scanner for in vivo tumor imaging in mice in comparison to a small animal PET scanner and a small animal CT scanner. Seventeen female NMRI nude mice bearing a subcutaneous transplanted murine mammary carcinoma (EMT6) on the right hind limb were examined using a clinical PET/CT scanner (biograph Sensation 16), a dedicated small animal PET scanner (MOSAIC system), and a dedicated small animal CT scanner (MicroCAT II). 18F-fluoroazomycin arabinoside (18F-FAZA) was used as PET tracer for imaging of regional tumor hypoxia. The examination of tumor-bearing mice using a state-of-the-art clinical PET/CT scanner, a dedicated small animal PET scanner and a dedicated small animal CT scanner revealed good image quality and allowed the evaluation and correlation of molecular/metabolic alterations of cancers with anatomical/morphological findings. The tumor lesions showed a 1.89 +/- 0.6 higher mean tumor-to-background ratio +/- SD for the dedicated small animal PET scanner than the PET from the clinical PET/CT scanner (P<0.001). The mean tumor-to-background ratio of the PET of the clinical PET/CT scanner showed a high correlation with the mean tumor-to-background ratio of the dedicated small animal PET scanner (r2 = 0.92). The tissue hypoxia in the subcutaneous transplanted EMT6 tumors did not correlate with the tumor volume. Clinical PET/CT scanners are widely available and could contribute not only to human clinical routine examinations, but also to tumor research in animals. The molecular/metabolic information is reduced when imaging small tumors of mice with clinical PET/CT scanners due to the low spatial resolution and sensitivity of the PET scanners. The examination of small tumors in mice should be reserved to research centers with small animal PET/CT scanners because they provide promising hope to achieve accurate measurement of activity concentration. For tumor research in humans and animals using clinical PET/CT scanners, PET scanners with a higher spatial resolution and a higher sensitivity will be highly promising, but will be in competition to PET/MRI.
Prognosis occupied a more prominent place in the medieval curriculum than it does at the modern university. Scholastic discussions were rooted in the Hippocratic Aphorisms and shaped by Galen's treatises On Crisis and On Critical Days. Medical prediction, as an art dependent on personal skills such as memory and conjecture, was taught with the aid of the liberal arts of rhetoric and logic. Scientific predictability was sought in branches of mathematics, moving from periodicity and numerology to astronomy. The search for certitude contributed to the cultivation of astrology; even at its peak, however, astrological medicine did not dominate the teaching on prognostication. The ultimate concern, which awaits further discussion, was not even with forecasting as such, but with the physician and, indeed, the patient.
In a previous paper, the special visual appearance of art glazes was explained using the auxiliary function method (AFM) for solving the radiative transfer equation. Glazes are made of low concentrated colored scattering centers embedded in a transparent medium and the artist modulates the color by varying the number of glaze layers. A simple model of glazes and the new solving method have both been validated by comparison between flux measurements and modeling. The color of art glazes is analyzed here, and the study shows a spectacular maximum of saturation (purity) of the color that is never reached, to the best of our knowledge, with other techniques, such as pigment mixtures. This phenomenon is explained once more using the AFM that allows separation of the different contributions to the scattered fluxes. It is then shown that, on the one hand, single scattering never induces a maximum of saturation. On the other hand, multiple scattering has a typical increasing and decreasing behavior with an increasing number of glaze layers and thus participates to the maximum of saturation, just as the scattering by the diffuse base layer. A comparison between glazes and pigment mixtures, where the proportion of colored pigments with white pigments varies instead of the number of layers, shows that this maximum of saturation is much smaller with the second technique. To the best of our knowledge, we present a new development of the AFM that allows separation of the different origins of light scattering. We also show that it is possible to determine the optical properties of the scattering centers and of the base layer to create the required visual effect of a scattering medium.
BACKGROUND: The authors evaluated the 24-month performance of a packable resin-based composite/dentin bonding system and a high-viscosity glass ionomer cement (GIC) in restorations placed in primary molars with the atraumatic restorative treatment (ART) approach. METHODS: Three dentists placed 419 restorations in 219 children aged 6 through 10 years who had bilateral matched pairs of carious posterior Class I and II primary teeth. They used a split-mouth design to place the two materials, which were assigned randomly to contralateral sides. The authors evaluated the restorations according to U.S. Public Health Service Ryge criteria. RESULTS: After 24 months, 96.7 percent of the Class I GIC restorations and 91 percent of the resin-based composite restorations survived, while the success rates for the Class II restorations were 76.1 percent and 82 percent for the GIC and resin-based composite restorations, respectively. The survival rate of the Class II resin-based composite restorations was 5.9 percent higher than that of the GIC restorations at the 24-month evaluation, but this difference was not statistically significant. However, the study results showed a statistically significant difference in survival rates between Class I and II restorations for both materials. CONCLUSION AND CLINICAL IMPLICATIONS: The two-year clinical performance of both materials was satisfactory for the restoration of Class I and II primary molars using the ART approach.
A cohort of children conceived by assisted reproductive therapy (ART)--in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) has been followed up in a National Child Development Study (Sutcliffe et al. 1999, 2001 and Bonduelle et al. 2005). Their parents were contacted and asked questions designed to elicit any concerns on their part about their child. 329 replies were received (90% response rate), and 86 of the families posed additional questions. We found that a small number of parents (26% of respondents) raised questions about a variety of issues regarding their ART-conceived child. The most commonly expressed theme (8% of all respondents, or 27/86 (31%) of the respondents with questions) pertained to their child's future fertility. This question was asked more frequently by ICSI than IVF parents.
The presented work provides baseline data on the existing airborne conditions in the Miyagi Museum of Art in Sendai, Japan, during the summer of 2000. The chemical composition, size and indoor and outdoor origin of the suspended particulate matter were identified using a number of advanced X-ray techniques, such as Electron Probe X-Ray Microanalysis (EPXMA) and Energy Dispersive X-Ray Fluorescence Analysis (EDXRF). Our results, to the best of our knowledge, represent the first detailed study of the chemical nature of the indoor particulate matter in a Japanese museum and, as such, may contribute to future improvements of the air quality inside museums and to the lasting conservation of works of art.