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PubMed2006

Using imaginative literature to foster cultural sensitivity.

Readings from two novels, Sandra Cisneros' The House on Mango Street and Toni Morrison's The Bluest Eye, were included in maternal-child clinical courses as part of a pilot project to identify potentially effective strategies for increasing student cultural sensitivity and reflective thinking skills. The authors analyzed student journals to determine student values and beliefs during maternal-child clinical experiences. The study sample consisted of 40 young women enrolled in a baccalaureate nursing program in a private, liberal arts university. These young women consistently interpreted ;the other' in their own image. They responded most strongly to themes of belonging, including the struggles of immigrants to ;fit in,' the ways of being acceptable and valued in U.S. society, and the process through which students as nurses learn to accept and care for others who are different.

Adult↗
PubMed1994

The effect of flavor concentration and toxin dose on the formation and generalization of flavor aversions in lambs.

If an animal experiences gastrointestinal malaise after eating a novel feed, it develops a dislike for the feed called a conditioned flavor aversion (CFA). Understanding flavor aversions is important for diet-training procedures, understanding animal responses to poisonous plants, and preparing animals for new foraging environments. Our research objectives were to determine how variation in 1) flavor concentration (oregano) and 2) dose of gastrointestinal toxin (lithium chloride; LiCl) affected the establishment of CFA in lambs. In a series of experiments feeding lambs ground grains mixed with oregano, we examined how the formation of a CFA to one ground grain, with or without oregano, influenced the consumption of another oregano-flavored grain. We determined that 1) the higher the toxin dose, the stronger the CFA, the greater the generalization of the CFA to a similar feed, and the greater the avoidance of a novel feed; 2) lambs generalized aversions from familiar to novel feeds when both feeds had a flavor in common; and 3) the concentration or intensity of feed flavor apparently did not affect the acquisition or generalization of a CFA, but it did influence the acceptance of a novel feed. Our findings suggest that flavor aversions may be important in the acceptance of harvested or processed feeds.

Animal Feed↗
PubMed1979

The pyroelectric vidicon camera as a medical thermograph.

The operating principles of a pyroelectric vidicon (PEV) tube as an infra red (IR) image detector tube are explained. Characteristic requirements such as pedestal operation and sensitivity to time varying scenes are outlined. Of the possible read-out modes, the synchronous chopper mode is considered. The PEV camera properties are discussed in terms of measurement errors. The largest such as pedestal variations, noise and thermal blurring can be reduced to an acceptable level by image processing. A future PEV camera system with specifications comparable to, or even better than, those of existing commerical medical IR scanners seems to be possible.

Humans↗
PubMed1997

A rapid stain-clearing method for video based cytological analysis of cotton megagametophytes.

Optical "clearing" is a cost saving method for preparing large numbers of whole, dissected or thickly sectioned cytological specimens such as plant ovules and ovaries. Minimal labor is required and specimens retain three-dimensional integrity. Previous development of high contrast stain-clearing methods using hemalum to impart contrast has facilitated analysis and photography under bright field illumination for small ovules. The deep stain intensity of hemalum, however, often precludes adequate light transmission and contrast within internal focal planes, limiting the applicability of hemalum-based stain-clearing to small specimens. Having encountered this problem for nucelli of cotton (Gossypium barbadense L.), which are roughly 300 microns thick at fertilization, we have developed a modified stain-clearing system. The two key features of these new methods are the use of azure, C, which allows the intensity of staining to be readily regulated, and contrast manipulation via video signal and image processing. Intensity of azure C stain was readily controlled by modifying the staining and/or dehydration media to produce relatively low contrast specimens. Analysis was facilitated by indirect viewing on a video monitor using adjustments of sensitivity, exposure, and contrast of the charge-coupled device (CCD) camera. Digital processing provided further enhancement. Acceptable images were obtained from virtually all specimens. These methods, which combine low contrast (high transmittance) specimens with high contrast imaging, should facilitate data acquisition on reproduction, thus the developmental and genetic characterization of reproductive mutants. Other applications, e.g., in pathology and embryology, are readily envisioned.

Coloring Agents↗
PubMed2006

[Mothers' experience of caregiving for their children with schizophrenia].

PURPOSE: The purpose of this study was to explore Korean mothers' experiences of caregiving for their adult children with schizophrenia. METHOD: A iterative descriptive qualitative research design was used to understand and explain the caregiving experience from the perspective of mothers. The data were collected by individual in-depth interviews and one focus group interview from 11 mothers. The ages of the participants ranged from 50 to 60 years old and the ages of their sick children ranged from late 20s to early 40s. RESULTS: Three major themes were identified from qualitative thematic analysis: (a) "emotional debris from the disease," (b) "the disease that makes mothers dumb" (c) "space of rational reason." CONCLUSIONS: This study would provide health care professionals insights in establishing intervention for mothers by deeply understanding the process of recognition and acceptance of their children with schizophrenia.

Adult↗
PubMed2006

Apoptosis in activated T cells: what are the triggers, and what the signal transducers?

At the end of an immune response, apoptosis drastically reduces the numbers of activated T cells. It has been a matter of intense research how this form of apoptosis is regulated and initiated, and a number of proteins have been identified that contribute to this process. The present, widely accepted model assumes that the interplay of pro- and anti -apoptotic Bcl-2 family members determines the onset of activated T cell death, with the BH3-only protein Bim activating pro-apoptotic Bax/Bak. In the search for up-stream signals, factors from other immune cells have been shown to play a role, and the NFkappaB family member Bcl-3 has been implicated as a signalling-intermediate in T cells. Recent work has tested the interrelation of these factors and has suggested that Bcl-3 acts as a regulator of Bim activation, that the induction of apoptosis through Bim can be complemented by its relative Puma, and that the presence of certain cytokines during T cell activation delays the activation of Bim and Puma. Here we discuss these recent insights and provide a view on how the regulation of activated T cell death is achieved and how extrinsic signals may translate into the activation of the apoptotic pathway.

Animals↗
PubMed1998

Survival of Listeria spp. on raw whole chickens cooked in microwave ovens.

The prevalence of microwave ovens in North American homes has increased dramatically within the last decade. Although microwave ovens are primarily used for reheating of foods, they are now more commonly being applied to the cooking of raw foods. Although cooking of raw foods, according to manufacturers' instructions targets an organoleptically acceptable end product, the process does not address the microbiological safety of the cooked food. Seventeen microwave ovens from various commercial suppliers were used to cook naturally contaminated whole raw broilers (< or = 1.8 kg) and roasters (> 1.8 kg) according to manufacturers' instructions. Temperature probes (six per chicken) were used to measure the temperature of chickens immediately after cooking and during the holding period. Of 81 Listeria-positive raw broilers and 93 raw roasters, 1 (1.2%) and 9 (9.7%), respectively, yielded viable Listeria spp. after microwave cooking. Of these, two were undercooked (visual inspection), one was over the maximum weight stipulated by the oven manufacturer and another one was over the maximum weight and undercooked. A significantly greater proportion of contaminated cooked birds was observed with roasters than with broilers, where for one of these contaminated roasters, the temperature at all six measured sites was > or = 87 degrees C. Most of the postcook Listeria-positive birds were associated with 2 of the 17 microwave ovens. Factors such as wattage, cavity size, and the presence or absence of a turntable seemingly did not play a significant role in the survival of Listeria spp. in microwave-cooked chicken. However, the general inability of microwave ovens to uniformly heat chicken carcasses was noted. In order to promote greater safety of microwave-cooked foods, general recommendations for consumers are provided.

Animals↗
PubMed1987

Decision analysis: a progress report.

Since its introduction into medicine 15 years ago, decision analysis has been applied to difficult clinical problems. Several important advances have made the process more practical and acceptable: computer programs that eliminate the need for burdensome calculations, improved techniques for designing analytic models, the ability to carry out sensitivity analyses over several dimensions simultaneously, and the elaboration of clinically relevant measures of utility. Using these techniques, analysts have addressed many important clinical issues including screening for and prevention of disease, tradeoffs among tests and treatments, and the interpretation of clinical data under conditions of uncertainty. Problems with the approach remain and applications have not been extensive, but decision analysis is evolving as a powerful clinical tool and gradually is gaining acceptance in medical practice.

Bayes Theorem↗
PubMedDate not supplied

A process for objective review of physician performance.

How do you objectively evaluate physicians at reappointment. How do you establish a common ground for the evaluation process that still acknowledges acceptable differences in performance? Perhaps one physician has some difficulty with documentation and attendance at meetings, but has no quality problems clinically. Another physician may have good documentation and meeting attendance, but has some quality problems. Another physician has a behavior pattern that is disruptive, a few documentation problems, but excellent quality. Yet another physician is a marginal practitioner with major problems in several areas, including quality. Reappointment of these physicians might be extremely difficult, especially if the credentials committee is recently appointed and not familiar with the details of the performance data.

Clinical Competence↗
PubMed1988

Health care delivery update: Part 2. Banking on quality: the call for a quality reserve system.

In the health policy arena, policy-makers listen when physicians use quality as their battle cry in promoting or opposing health care innovations. Physician-managers are being challenged to measure quality and determine whether it is appropriate to deviate from community standards or expert opinion in providing care. Their responsibility extends to shaping their organization's culture and values, strategic planning, technology acquisition, and clinical performance. The effort to ascertain what constitutes genuinely effective medicine would be furthered by construction of a national Quality Reserve System. Designed to help--not police--individuals and organizations, it could accept data on diagnoses, processes of care, and functional outcomes and then provide "depositors" with evaluations of the effectiveness of various diagnostic and therapeutic approaches, suggest improved processes, and report on the clinical performance of each organization.

Information Systems↗
PubMedDate not supplied

The grief involved in change.

In this era of rapid change, people need to be helped through the grieving process at work. "By acknowledging and articulating what is involved, you facilitate people's movement through it ... successful people in growing organizations need to learn to move through the process as quickly and efficiently as possible and help others do the same." Morris Shectman, in Working Without a Net says, "Contrary to the old paradigm--which held that others don't have a right to know about your personal life--the new paradigm says that it's a necessity that they know." If people are to move through the grief that is caused by undesired change, they will have to tell some of their personal feelings. "Each stage of the process--shock and denial, anger, bargaining, depression, and acceptance--is functional ... when people go through the process in a healthy manner, they'll recycle through it in a diluted fashion." Leaders in the organization can help people start the process or move through it if they get stuck at a particular stage.

Grief↗
PubMedDate not supplied

[Functional anatomy of the basal ganglia].

INTRODUCTION: The cerebral cortex of mammals is massively interconnected with the basal ganglia. The manner in which the basal ganglia process information has been accepted since it was described in the 1980s. It is not a definitive model and many aspects of it still need clarification. DEVELOPMENT: The corpus striatum (ST) forms the entrance to the basal ganglia circuit (BG) and receives numerous afferent fibres from the cerebral cortex. Similarly, the internal segment of the globus pallidus (GPi) and the substantia nigra pars reticulata (SNpr) form the main nuclei for exit from the circuit and have an inhibitory effect on the pre-motor neurones of the ventral lamina of the thalamus. Between the entrance nucleus and the exit structures are two parallel systems of projection known as the direct and indirect pathways. The direct pathway projects monosynaptically only on the Gpi/SNpr complex. The indirect pathway projects polysynaptically on to the GR/SNpr complex after passing through the external segment of the globus pallidus (Gpe) and subthalamic nucleus. Imbalance in the activity of these two circuits will lead to alterations in discharge from the Gpi/SNpr complex which will cause bradykinesia or hyperkinesia. The bradykinesia or akinesia would be caused by increased gabaergic inhibition of the thalamic premotor neurones as a result of excessive discharge of the Gpi/SNpr complex. CONCLUSION: Current exploration of the electrophysiology of the basal ganglia and careful analysis of the clinical findings in lesions circumscribed to certain parts of the thalamus, subthalamus and internal globus pallidus in patients with Parkinson's disease, have led to the appearance of paradoxical effects, according to the current basal ganglia model.

Basal Ganglia↗
PubMed2001

Evaluation of the notification of hepatitis C risk to children who received unscreened blood or blood products.

Parents of children who received blood or blood products between 1984 and 1990 were notified about the potential risk of hepatitis C virus (HCV) infection. Data were collected about knowledge, attitudes and intended behaviours to determine the acceptability of the notification process. Demographic variables that may predict responses to notification were also recorded and analysed. Recipients were sent couriered letters explaining HCV risk, and the survey questionnaire. Sera were screened for HCV antibody and reactive samples confirmed with a recombinant immunoblot assay (RIBA). Four letter recipients were RIBA positive for a prevalence of 1.1% (4/358) in the notification group. Thirty-two percent of respondents did not know their child had been transfused and 58% did not know about the potential risk of HCV infection. Although 90% (165/185) felt the notification was valuable, 65% reported emotional distress (fear, worry, anger, very depressed). Responders were similar to non-responders except for HCV testing rate (76.2% v. 59.8%, p < 0.0002). Parents of children at risk of transfusion-acquired HCV virus approved of notification programs, but experienced some emotional distress. Awareness of transfusion history or risk of HCV was not universal, indicating the need to address notification to individuals, rather than through public education campaigns alone.

Adolescent↗
PubMed1975

[Effect of urinary transport function on the development of kidney calculi].

The formation of renal calculus is, according to the currently accepted view, a polyetiological process whose most important components are the composition of the urine and urinary stasis. The second of these factors is discussed. The importance of anatomical lesions is indicated by the finding of a hindrance of flow in 66 of the 100 patients operated for renal calculus. The stasis may, however, have some functional cause, too. X-rays revealed two types of hypomotility: a temporary, or in certain parts constant, lack of contractions and sluggish contractions of normal frequency. Temporary lack or sluggishness of contraction promotes calculus formation because the physiological pyelo-calicous reflux which occurs in three quarters of the intact cases is lacking. These refluxes counteract sedimentation and together with the orthostatic emptying are the most effective factors preventing the retention of calculus nuclei.

Humans↗
PubMed2002

Improving treatment outcomes with a clinical pathway for hysterectomy and myomectomy.

OBJECTIVE: To determine if using a postoperative clinical pathway for women having hysterectomy or myomectomy would improve clinical care. STUDY DESIGN: Data from the literature and patient focus groups guided development of a clinical pathway. Nurses, pharmacists and physicians participated in the development process. Implementation relied on accepted quality improvement methods. We used a case-control design to compare administrative and clinical data for patients managed with (n = 28) and without (n = 28) the aid of the clinical pathway between June 1997 and January 1998. RESULTS: Case and control groups did not differ in age, race, payer status, severity of illness or procedure type. Clinical differences between pathway and nonpathway patients included a mean six-hour-shorter period of indwelling bladder catheters (P = .019), mean 11-hour more rapid return to regular diet (P = .014) and more pain assessments among pathway patients (mean, five vs. two; P < .001). There was no significant difference in length of stay between groups. Clinicians used the pathway for approximately one year, but with personnel changes the pathway gradually fell out of use. CONCLUSION: Clinical pathways can improve quality of care, even if they do not reduce length of stay. A team approach that focuses on patient concerns during pathway development may help ensure that quality improvement, rather than simply cost reduction, arises from the use of clinical pathways.

Adult↗
PubMed2003

Study of the pathogenesis of paralytic ileus in animal models of experimentally induced postoperative and septic ileus.

Paralytic ileus is defined as an inhibition of propulsive intestinal motility. Postoperative ileus is the most common type, however, also during sepsis and critical illness paralytic ileus is a common finding. The pathogenesis of paralytic ileus is still debated. It is believed to result from the activation of inhibitory neural reflex pathways and activation of inflammatory processes. It is generally accepted that postoperative ileus results from the activation of an inhibitory neural reflex pathway. In our rat model we showed that different degrees of nociceptive stimulation activate different reflex pathways: laparatomy activates an adrenergic inhibitory reflex pathway, whereas manipulation results in additional activation of inhibitory NANC neurons releasing NO and VIP as neurotransmitters. We also demonstrated that blockade of the afferent limb of the reflex pathway by peripheral kappa-opioid agonists or by non-steroidal anti-inflammatory drugs ameliorated postoperative ileus. However, the use of prokinetics lead to disappointing results. In the murine septic model we demonstrated an important role for activation of inducible NO synthase in the endotoxin-induced delay in gastric emptying and small intestinal transit. We hypothesise that activation of the residential macrophages in the gut wall leads to the production of iNOS and other inflammatory mediators. These mediators will attract more inflammatory cells and influence smooth muscle contractility. Next, we provide evidence that production of iNOS results in the activation of guanylyl cyclase leading to the production of cGMP and smooth muscle relaxation. However, a parallel mechanism of action for NO via oxidative stress needs further investigation.

Animals↗
PubMed2004

[Diagnostic kits in parasitology: which controls?].

The development of new diagnostic tools particularly for some parasitic "neglected diseases", is slowed or even hindered by limited resources assigned for basic and applied research in public institution and private sector. Even if the time-line and costs needed for developing a new In Vitro Diagnostic (IVD) test are generally lower compared to vaccines or new drugs, industry is poorly engaged in investing resources due to the perception of limited markets. To accelerate the development of diagnostics for the world's most deadly diseases, the World Health Organization's (WHO) Special Programme for Research and Training in Tropical Diseases (TDR), the United Nations Development Programme, the World Bank and the Gates Foundation, last year launched a new initiative, FIND (Foundation for Innovative New Diagnostics, www.finddiagnostics.org). The aim is to "apply the latest biotechnology innovations to develop and validate affordable diagnostic tests for diseases of the developing world". Ideally, a new diagnostic test should be accurately evaluated prior to use in medical practice. The first step would be a pre-clinical evaluation, an analytic study to determine its laboratory performance. A crucial point in this phase is the calibration of reagents (antigens, antibodies, DNA probes, etc.) against a standard reference preparation. WHO, through the WHO International Laboratories for Biological Standards, "provides International Biological Reference Preparations which serve as reference sources of defined biological activity expressed in an internationally agreed unit" (www.who.int/biologicals/IBRP/index.htm). Standardization allows "comparison of biological measurements worldwide" and ensures the reliability of diagnostic procedures. These preparations are generally intended for use in the characterization of the activity of secondary reference preparations (regional, national or in-house working standards). Unfortunately, international reference standards for parasitic diseases are not available at present, except for Toxoplasma antibodies. The first international standard reagent for Anti-Toxoplasma Serum was established in 1968 and at present, an international standard reference serum, Anti-toxoplasma serum, human TOXM is available at the National Institute for Biological Standards and Control (NIBSC) in UK. Several collaborative, multicenter studies were carried out to assess the performance of different methods and commercial tests for the diagnosis of toxoplasmosis, by providing to participating laboratories a panel of well-defined sera to be tested. A four-phase process following well-accepted methodological standards for the development of diagnostics, analogous to those internationally accepted for drugs and vaccines was recently proposed. The pre-clinical evaluation, the analytic study to assess sensitivity, specificity, predictive values in laboratory (phase I), should be followed by a proof of principle study to distinguish diseased from healthy persons in easily accessible populations (phase II). The evaluation of test performance in populations of intended use (phase III), and finally the delineation of cost-effectiveness and societal impact of new tests in comparison with existing tools (phase IV) should complete the validation procedure. In this context, national regulatory agencies play a major role in pre-market approval and post-market surveillance of IVDs. The European Community in 1998 approved a directive (Directive 98/79/EC) which rules the marketing of IVD medical devices, in order to harmonise the performance levels and standards in European countries. But, among IVDs for parasitic diseases, only those to detect congenital toxoplasmosis are submitted to defined procedures to provide the verification of products before their placing on the market and the surveillance after their marketing by a notified body, which perform appropriate examinations, tests and inspections to production facilities to verify if the device meets the requirements of the directive. In U.S.A., the Food and Drug Administration (FDA), through the Office of In Vitro Diagnostic Device Evaluation and Safety (OIVD), provides a comprehensive and regulatory activity for IVDs through pre-market evaluation and post-market surveillance. In developing countries, the scarcity of resources limits the procedures through which the national control authority can assure safety, quality and efficacy of products marketed, both imported and locally manufactured.

Animals↗
PubMed2006

Parasite fauna of the European eel (Anguilla anguilla L, 1758) from the Russian part of the Vistula Lagoon (Baltic Sea).

INTRODUCTION: The european eel is one of the major fishing objects of the Russian fishery zone of the Vistula Lagoon (Baltic Sea). This is the reason that its parasite fauna was studied within 1998-2005. MATERIAL AND METHODS: Totally 142 individuals of 35-81 cm in length were examined. The parasites collected from various organs were fixed and processed according to commonly accepted methods. RESULTS: Twenty two parasite species representing the following higher taxa: Coccidia (2), Oligohymenophorea (2), Myxosporea (5), Monogenea (1), Cestoda (2), Trematoda (2), Nematoda (4), Acanthocephala (2), and Crustacea (2) were recovered. The following main features of the eel parasitofauna were determined: high specificity, predominance of the parasites with simple life cycle, the presence of three invader species (Anguillicola crassus, Pseudodactylogyrus anguillae, and Paratenuisentis ambiguus). The latter species was found in the Vistula Lagoon for the first time.

Anguilla↗