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PubMed1983

Breast cancer detection with sonography and mammography: comparison using state-of-the-art equipment.

This prospective study, involving 1,000 women referred for routine mammography, compares the breast cancer detecting abilities of state-of-the-art mammography and sonography using an automated water-path scanner. Mammography was found to be the superior technique, detecting 62 (97%) of the 64 pathologically proven cancers, while sonography detected only 37 (58%). When considering those cancers most amenable to cure, mammography detected over 90% in all categories, but sonography detected only 48% of the cancers that had not yet spread to axillary lymph nodes, only 30% of the nonpalpable malignancies, and only 8% of the cancers smaller than 1 cm. These data indicate that sonography is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. The data further suggest that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast ultrasound scanner.

Breast Neoplasms↗
PubMed1977

Communicability and complexity as predictors of creativity: validity of the Barron-Welsh Art Scale.

The construct validity of the Barron-Welsh Art Scale as a measure of creativity was questioned. It was hypothesized that figure preferences of creative subjects are more strongly determined by stimulus communicability than stimulus complexity. In a first study a significant negative relationship between operational measures of communicability and complexity of Barron-Welsh drawing was found. A second study of 24 undergraduate subjects showed communicability to be significantly related to peer ratings of creativity whereas complexity was not. A third study of 60 high school subjects showed that a derived score, reflecting the relative preference for drawings of low communicability and low complexity over those of high communicability and high complexity, was significantly related to staff's ratings of creativity. These results were in direct opposition to an interpretation involving complexity in previous research on the Barron-Welsh Art Scale. An alternative interpretation was discussed.

Creativity↗
PubMed1990

The martial arts and mental health: the challenge of managing energy.

The effective management of energy is an important dimension in the martial arts as well as the mental health professions. The Oriental concept of Ki is described, noting its Indian, Chinese, and Japanese development. Ki and the transfer of energy is studied through the martial encounter, using concepts borrowed from Japanese swordsmanship. Ki is also discussed from a developmental context as youngsters progress in Tae Kwon Do training. In examining the disciplines of Aikido, Tae Kwon Do, and Karate, it becomes clear that more is involved than kicking, punching, and throwing bodies on the floor. These martial arts have some important statements to make in the area of mental health, particularly in terms of energy--within our bodies, psyches, interpersonal relationships, and the universe.

Adaptation, Psychological↗
PubMedDate not supplied

State of the art of nursing research and theory development in adolescent health.

A literature review was conducted to ascertain the state of the art of nursing research and theory development in adolescent health. A conceptual framework and data collection tool were developed to guide evaluation of the research reports. Adolescent health literature reported within the past 10 years (June 1982 to June 1992) was reviewed. Of 124 adolescent health articles identified in literature searches, 46.0% (n = 57) met inclusion criteria and were included in the literature review. A developmental approach, which included the purposes of theory and research (Chinn & Jacobs, 1987), was used to determine the state of the art of nursing research and theory development. Nursing research and theory development in adolescent health were determined to be at a level between adolescence and young adulthood, reflecting beginning maturity.

Adolescent↗
PubMed1998

Elevated basal estradiol levels have no negative prognosis in young women undergoing ART cycles.

The objective of this study was to determine the relationship between serum estradiol levels on day 2 of an in vitro fertilization and embryo transfer (IVF-ET) cycle and the chance of pregnancy and implantation rates according to age. Two hundred and forty-eight cycles of IVF-ET in patients treated with gonadotropin-releasing hormone analog (GnRHa, follicle-stimulating hormone (FSH) and human menopausal gonadotropin (hMG) were divided into several groups according to the basal serum concentrations of estradiol (E2):A < 25 pg/ml, B 26-50 pg/ml, C 51-75 pg/ml, D 76-100 pg/ml, E > 100 pg/ml. Furthermore, the patients were subdivided into two subgroups according to age: I younger; and II, older than 35 years. Pregnancy and implantation rates were analyzed for each subgroup according to basal E2 level and age. Statistical analysis was performed using analysis of variance, chi2 and Fisher's test. The number(s) of cycles for each subgroup were 164 and 84 for I and II, respectively. Even though there were no significant differences among groups for the pregnancy rates for individual groups, there was a tendency for a decreased rate with increasing levels of E2 only in women older than 35 years of age. When pregnancy rates of all women with E2 levels above 25 pg/ml were calculated, the differences between those observed in subgroup I (< or = 35 years) and II (> 35 years) was significant: p = 0.02 (38.7% vs. 18.7%, respectively). When implantation rates in the same groups and subgroups were analyzed, we found that again the differences were statistically significant: p = 0.001 (13.1%vs, 4.3% for I and II). The results of the present studies reveal that basal levels of E2 are a marker of poor prognosis for implantation and pregnancy in assisted reproduction (ART) cycles only in patients over the age of 35 years. These data cast doubt on the use of basal levels of E2 to screen women below the age of 35 prior to initiating an ART cycle. In addition, high levels of basal E2 per se may not be deleterious for reproductive efficiency in younger women, since pregnancy and implantation rates did not differ among patients younger than 35 years old (IA to E).

Adult↗
PubMed2002

Prevalence of body art (body piercing and tattooing) in university undergraduates and incidence of medical complications.

OBJECTIVES: To survey the prevalence of body art (body piercing and tattooing) in university undergraduate students and to determine the incidence of medical complications from these procedures. SUBJECTS AND METHODS: Between February and May 2001, students were offered the opportunity to complete an anonymous, voluntary survey at the beginning of class or organizational meetings. The survey instrument requested information concerning body piercing and tattooing (current or removed) by body site, age, sex, height, weight, body mass index, undergraduate class, athletic status, and the occurrence of medical complications. RESULTS: Four hundred fifty-four (94.4%) of 481 students completed the survey (14.7% of total campus enrollment). The prevalence of body piercing was 51%, and that of tattooing was 23%. The chi2 analysis showed female students were more likely to be pierced than males (P=.002); there was no significant difference in the prevalence of tattooing by sex. Male athletes were more likely to be tattooed than male nonathletes (P=.02). No relationships were shown between piercing/tattooing and age or measures of body somatotype. The incidence of medical complications of piercing was 17%, and these complications included bleeding, tissue trauma, and bacterial infections. Pierced navels were particularly prone to infection. There were no reported medical complications from tattooing. Eighteen percent of piercings (58/315) and 4% of tattoos (6/149) had been removed. CONCLUSIONS: Body art is prevalent among undergraduate university students, and there is a significant incidence of medical complications among students with piercing. Male athletes were significantly more likely to be tattooed than male nonathletes.

Adolescent↗
PubMed1999

The long-term outcome of dysthymia in private practice: clinical features, temperament, and the art of management.

BACKGROUND: With the clinical availability of fluoxetine in the United States, we were interested in documenting improvements in the clinical care of dysthymic patients beyond what was reported from our clinic 2 decades earlier during the "tricyclic (TCA) era." METHOD: In open treatment of 42 consecutive DSM-III-R primary dysthymic patients who were personally followed up in our mood clinic since 1988, response was defined as sustained remission, i.e., no longer meeting criteria for dysthymia and achieving DSM-III-R Axis V Global Assessment of Functioning (GAF) score > 70 throughout much of the mean follow-up of 5 years. RESULTS: Compared to patients with nondysthymic episodic major depressive disorder (N = 42), dysthymic patients had a significantly earlier mean age at onset (12.6 vs. 34 years), were more likely to have never been married, had a greater frequency of superimposed major depressive episodes (except for the 14% [N = 6] with "pure" dysthymia), and had more psychiatric and fewer medical comorbidities; furthermore, patients with dysthymia had significantly greater familial loading of both unipolar and bipolar disorders. Continued treatment with TCA-type antidepressants or fluoxetine (including various augmenting strategies) led to an overall robust and sustained response rate of 76% (N = 32) among dysthymic patients; in tandem, major depressive episodes and suicidality were prevented in all responders. Females treated with fluoxetine had the highest response rate (85% [N = 17]); some were able to walk out of dependent abusive relationships for the first time in their lives. However, dramatic responses with "hyperthymic" switches in temperament occurred in only 12% of dysthymic patients; nearly all were males with bipolar family history. The more prototypic positive change among dysthymic responders consisted of coping with daily hassles without being overwhelmed. Qualitatively, the highest level of adaptive functioning was observed among fluoxetine-treated dysthymics (50% of responders [N = 12] achieved DSM-III-R GAF score of 81-90). Of TCA-treated patients, 39% had intolerable side effects, necessitating switch-over to fluoxetine. Agitation occurred in 11% of fluoxetine-treated patients (N = 4) and was associated with nonresponse and/or dropout; otherwise, this selective serotonin reuptake inhibitor was well tolerated, thereby contributing to long-term compliance. More provocatively, patients with dysthymia who had required extensive psychotherapeutic attention prior to state-of-the-art pharmacotherapy no longer required such therapy. CONCLUSION: These data extend and enrich what has been learned from controlled trials among dysthymic patients. With sustained pharmacotherapy and specialized clinical care in a private mood clinic, 3 of 4 patients immersed in gloom for much of their lives achieved for the first time good to superior levels of functioning that were maintained for an average of 5 years. Although the art of clinical management of dysthymia should be fully grounded in understanding the interpersonal context of depression, we submit that SSRIs such as fluoxetine appear broadly efficacious in areas previously deemed to be the domain of formal psychotherapy.

Adult↗
PubMed1984

The liberal arts connection.

Occupational therapists need to be critical of who teaches, what is taught, how it is taught, how it is applied, and to whom it is taught in the entire education program of prospective occupational therapists. Further, I recommend that occupational therapy educators on campus take the lead in initiating meetings and discussions that facilitate a functional conjoining of occupational therapy practice, occupational therapy theory, and liberal arts studies. An initial effort in this regard might be for the three mutually interdependent and equal partners in the education of occupational therapy students to read and discuss Ernest L. Boyer's work entitled, A Quest for Common Learning--The Aims of General Education. I believe that all occupational therapists would benefit from reading this text, individually and collectively, and the profession and our community would benefit. The question is not whether or not this subject should be incorporated into an occupational therapy student's curriculum. The question for discussion should be at what point in the student's education--the student's intellectual growth and development and professionalization--would this topic and this treatment be best applied? Perhaps from this beginning the three partners--practice, theory, and liberal arts--would recognize and respond to their mutually interdependent and equally important role and responsibility in the design and implementation of the entire occupational therapy educational program, which is future responsive and ensures the highest probability that graduates will be professionally competent.

Curriculum↗
PubMed1996

Diabetes mellitus among Swedish art glass workers--an effect of arsenic exposure?

OBJECTIVES: The purpose of this study was to search for evidence of an association between occupational arsenic exposure and diabetes mellitus, as implied by the relation of this disease to arsenic in drinking water in a recent study from Taiwan. METHODS: A case-referent analysis on death records of 5498 individuals in the art glass producing part of southeastern Sweden was performed. Out of all the enrolled subjects, 888 were glass workers. According to occupational title, glassblowers, foundry workers, and unspecified workers were regarded as potentially exposed to arsenic. Persons with a diagnosis of diabetes mellitus either as an underlying or contributing cause of death were considered cases. Referents were decedents without any indication of cancer, cardiovascular disease, or diabetes. RESULTS: A slightly elevated risk [Mantel-Haenszel odds ratio (MH-OR) 1.2, 95% confidence interval (95% CI) 0.82-1.8] was found for diabetes mellitus among the glassworks employees, especially in combination with cardiovascular disease (MH-OR 1.4, 95% CI 0.81-2.3). For the glassblowers, other foundry workers and unspecified glassworkers probably exposed to arsenic, the M-H odds ratio was 1.4 (95% CI 0.92-2.2). Unspecified glass workers, who probably included persons with high exposure, carried the higher risk (MH-OR 1.8, 95% CI 1.1-2.8). CONCLUSIONS: The observations from this study provide limited support for the possibility that occupational arsenic exposure could play a role in the development of diabetes mellitus. Many other metallic compounds are also used in art glass production, however, and there is a possibility of confounding.

Age Distribution↗
PubMed2001

State-of-the-art ultrasonography is as accurate as helical computed tomography and computed tomographic angiography for detecting unresectable periampullary cancer.

OBJECTIVE: To compare the ability of state-of-the-art ultrasonography with that of helical computed tomography and computed tomographic angiography in detecting unresectable periampullary cancer. In most patients periampullary cancer is unresectable because of either distant metastasis or local vascular involvement. The advent of gray scale and color Doppler ultrasonography has improved the ability of ultrasonography to detect vascular involvement. METHODS: Twenty-three consecutive patients with periampullary cancer were enrolled for prospective staging of their disease by comparing helical computed tomography and computed tomographic angiography with gray scale and color Doppler ultrasonography of the abdomen. Portal vein, superior mesenteric vein, splenic vein, and superior mesenteric artery involvement was graded 0 to 4, grade 0 being no vascular involvement and grade 4 being total occlusion of the vessel. Agreement between ultrasonography and computed tomographic angiography for determining vascular involvement was measured by chi2 analysis. RESULTS: Two patients (9%) were excluded because excessive overlying bowel gas hampered the ability of ultrasonography to visualize the pancreas. For the remaining 21 patients, there was significant agreement between ultrasonography and computed tomographic angiography for detecting vascular involvement in all vessels (P < .001; portal vein, kappa = 0.67; superior mesenteric vein, kappa = 0.67; splenic vein, kappa = 0.85; and superior mesenteric artery, kappa = 0.59). Ultrasonography was in agreement with computed tomographic angiography in all cases of unresectability. Both modalities were equally poor in preoperatively showing lymphadenopathy and metastases. CONCLUSIONS: Provided that there is adequate visualization on ultrasonography of the head of the pancreas in the periampullary region, then state-of-the-art gray scale and color Doppler ultrasonography are as accurate as helical computed tomography and computed tomographic angiography for detecting the unresectability of periampullary cancer. If performed as the initial investigation and the region of the pancreatic head is clearly shown, and if vascular encasement or occlusion or distant metastasis is identified, further investigations are unnecessary.

Adult↗
PubMed2000

Ghost Dancing the Grand Canyon. Southern Paiute Rock Art, Ceremony, and Cultural Landscapes.

Combining rock art studies with ethnohistory, contemporary ethnographic analysis, and the interpretations of people who share the cultural traditions being studied, this paper documents a rock art site in Kanab Creek Canyon that appears to have been the location of a Ghost Dance ceremony performed by Southern Paiute and perhaps Hualapai people in the late 1800s. Using the site as a point of departure, it focuses on the way in which synergistic associations among place, artifact, resources, events, and historic and contemporary Indian people contribute to the construction of a contextual cultural landscape.

Journal Article↗
PubMed2000

The art of forgiveness.

The art of forgiveness is a significant managerial process for dealing with intrapsychic and interpersonal injury and error in the health care environment. The ability to forgive is essential if healthy relationships are to be maintained and job productivity is to be enhanced. This article outlines who needs to be forgiven, the process of forgiveness, why forgiveness is difficult, and strategies for the manager in the art of forgiveness.

Administrative Personnel↗
PubMed2002

Assisted breech delivery, is the art fading?

OBJECTIVE: To review the modes of breech delivery over a 5 year period in Khamis Civil Hospital, Khamis Mushayt, Kingdom of Saudi Arabia, and to evaluate the trend and associated complications. METHODS: Relevant data was extracted from the delivery room records of all women delivered in Khamis Civil Hospital, Khamis Mushayt, Kingdom of Saudi Arabia, from 1st January 1996 through 31st December 2000. Available data was analyzed. RESULTS: There were 375 breech deliveries, constituting 2.8% of the entire deliveries in the hospital. Eighty-two percent of the breeches were delivered by cesarean section while 18% had assisted vaginal delivery (p=0.0193). Amongst 72 primigravidae breeches, 68 (94.4%) were delivered by cesarean section while 238 (78.5%) out of 303 multigravidae were delivered by cesarean section. There were 2 unexplained neonatal deaths among the vaginal delivery group in multigravidae. Cesarean delivery was associated with less morbidity compared to vaginal delivery. CONCLUSION: This study has demonstrated a significant increase in delivery of breeches by cesarean section and the resultant drop, in the number available for assisted breech delivery. Less obstetricians will therefore be exposed practically to the art of assisted breech delivery. Most practicing obstetricians seem to be more inclined towards delivering breeches by cesarean section. If this trend continues, the art of assisted breech delivery may fade.

Breech Presentation↗
PubMed2002

[Two characteristics on the developmental history of art of prescription].

By recalling the history of art of prescription and summarizing its law of development, two apparent characteristics can be shown on its primitive accumulation and clinical treating thoughts. One is the trend of transformation from empirical formula to theoretical formula, and from the discrepancy between medical theories and medical prescriptions to their combination. The other one is from treatment based on differentiation of diseases to differentiation of symptoms and signs, and from correspondence of prescription and diseases to correspondence of prescription and syndrome. It is of realistic significance to further recognize the developmental characteristics of the art of prescription, not only for mastering the prescription rules and main points of matching of ingredients in compounding, but also on comprehending its scientific implication and mechanism.

China↗
PubMed2002

[Flat-panel detector technology -State-of-the-art and future prospects-].

A flat-panel detector (FPD) is a long-awaited technology to implement the digital X-ray imaging technology into the radiological department. This paper describes the state-of-the-art technology and future prospects on the FPD technology. State-of-the-art technology was reviewed taking the CXDI series as an example. Several FPD-based systems have been introduced into the Japanese market since CXDI-11 opened it in November 1998. Accompanying CXDI-C2 for control, CXDI-22 for table position and CXDI-31 for portable, the CXDI series fulfills the requirement of the radiography room being a fully digitalized room. The FPD on the CXDI series is comprised of a scintillator (Gd(2)O(2)S:Tb(3+)) as a primary sensor in which the X-ray is captured and an amorphous silicon detector (LANMIT) as a secondary sensor in which the fluorescent light is detected. Since the scintillator is identical to that of the screen-film systems, it can be said as proven, durable and chemically stable and it is expected to produce the same image quality as the screen-film systems. CXDI-31, a portable FPD-based system, was developed targeting thinner dimensions, lightweight, durability and high spatial resolution. Thoroughly re-designing the mechanical structure and reducing the power consumption at the readout IC realized thinner dimensions. Introducing the portable note PC technologies successfully combined lightweight with durability. Improving the sensor process and re-designing the layout made the sensor high resolution without compromising the signal-to-noise ratio. Future prospects were overviewed in the aspect of technology and applications. Sensitivity, spatial resolution, frame rate and portability were described as the upcoming technology. Increasing gain and reducing noise will realize higher sensitivity, especially by adopting the PbI(2), HgI(2) or such photoconductor materials as the primary sensor. Pixelized amplifier will also achieve higher sensitivity. Layered sensor designed such that TFT layer and sensitive layer are constructed separately will decrease the pixel pitch lower than 100 microm. The FPD has been applied in radiography, mammography and angiography. It will expand the applications into low-dose fluoroscopy to replace the X-ray image intensifiers and into cone-beam computer tomography. What the FPD brought was mainly the efficient workflow of the X-ray technologist. However, diagnosis efficiency and patient benefit must be improved further more by combining FPD technology into computer-aided diagnosis, tele-radiography or other IT-based technologies. Such prospect may come true in the near future.

Fluoroscopy↗
PubMed1992

Endocrine abortion in assisted reproduction technologies (ART).

Luteal function, endometrial receptivity, endometrial prolactin and glycoprotein secretions, blastocyst-secreted immunomodulant factors and embryo quality are nowadays considered the main determinants involved in embryo implantation control. The endometrial factors are progesterone-dependent. Out of 128 cycles of ART (AIH-IU, GIFT, IVF-ET), performed in 67 women at the Dept. of Obstetrics and Gynaecology of Parma during the period 1986-1991, 31 conceptions were obtained (pregnancy rate: 24.21%), 7 of which miscarried (abortion rate: 22.58%). According to these data, ART high abortion rate is possibly connected with poor luteo-endometrial function and poor embryo quality. Controlled ovarian hyperstimulation is thought to inhibit embryo implantation after IVF-ET by decreasing endometrial receptivity. Such a situation can be treated either by exogenous progesterone administration or by tubal techniques (GIFT, TET) performed in non-tubal infertility. Both strategies showed to better endometrial receptivity. A delayed intrauterine embryo transfer at blastocyst stage, when cocultures allow to, is supposed to raise the implantation rate in tubal infertility by enhancing embryo selection and endometrial receptivity. This paper also reports preliminarily on the predictive value of beta-HGC and estradiol levels, as well as of endometrial thickness, on early pregnancy outcome.

Abortion, Threatened↗
PubMed2004

Spreadability of two glass ionomer cements used in atraumatic restorative treatment (ART).

'Press finger' in atraumatic restorative treatment (ART) is used to spread a glass ionomer cement (GIC) to seal the restoration margin and adjacent pits and fissures. This study compared the spreadability of Fuji IX and Ketac-Molar to establish which was best suited for this purpose. Twenty equally spaced cavities (35 mm apart) were machine-cut in each of two Perspex slabs 200 x 100 x 20 mm. Each cavity was 3 mm deep with a 4 mm diameter. Two V-shaped grooves 1 mm deep were cut to traverse the cavities: one 0.5 mm wide, the other 0.25 mm wide. Equal amounts (0.25 ml) of GIC were dispensed, 20 cavities for Fuji IX and 20 for Ketac-Molar and condensed under light finger pressure using a 20 mm diameter cork thinly coated with petroleum jelly. This allowed the GIC to be condensed into the cavity and spread into the differently sized grooves. The samples were stored in deionised water for 24 hours whereafter the length to which the GIC had spread along each groove from the cavity edge was measured to the closest 0.01 mm. The data were analysed using ANOVA and the unpaired Student's t-test (P < 0.05). There was a statistically significant difference between the length of spread of the two GICs (t = 2.534; P = 0.013) which was confined to the 0.25 mm width groove (t = 2.83; P = 0.007) with Fuji IX spreading much further along the groove (10.25 +/- 1.17 mm) than Ketac-Molar (7.66 +/- 4.21 mm). Fuji IX appears to be the better sealant material when selecting for spreadability in ART.

Analysis of Variance↗
PubMed2005

[Evidence-based medicine and art of healing: the dead end of incommensurate paradigms].

What is called the art of healing may refer to mainstream Western medicine (MM) as well as complementary and alternative medicines (CAM). MM asserts to be based on scientific evidence. The analysis of medical thought and practices in Evidence-Based Medicine (EBM) allows us to identify at least three paradigms on which MM is based: materialism (the rules of life are the rules of the natural sciences), reductionism (human diseases are diseases of the molecules) and neo-positivism (theories, diagnoses and treatments must be based on evidence). As in a mirror, CAM refer to the opposite paradigms of vitalism (life is the result of non measurable energies), holism (a whole human being cannot be fully understood from his/her parts) and relativism (there is no absolute reality nor truth, "facts are artifacts"). MM and CAM are thus based on diametrically opposed paradigms and the aim of an "integrative medicine" is aforetic. The problem is that CAM are very popular. The "art of healing" has to meet the expectations of patients wanting their illness taken into account while EBM often fails to identify a disease. EBM is thus faced with an ethical dead-end: patients must be relieved, using information based solely on scientific evidence and at the same time the use of placebo, unbeknown to them, must be rejected for ethical reasons. A solution might be found in a parallel coexistence but not in an integration, of EBM and CAM. Coexistence however does not mean coresponsibility.

Attitude of Health Personnel↗