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PubMed2002

Observations with regard to the National Kidney Foundation K/DOQI clinical practice guidelines concerning serum transthyretin in chronic renal failure.

The National Kidney Foundation K/DOQI Guidelines state that, "Serum prealbumin is a valid and clinically useful measure of protein-energy nutritional status in maintenance dialysis (MD) patients." Prealbumin, also known as serum transthyretin (TTR), was not recommended as a nutritional parameter of the same usefulness as the serum albumin. This decision was made, in part, because published research at that time suggested that serum TTR was not a more sensitive index of nutritional status than serum albumin and there was much more clinical and research experience with serum albumin as a nutritional and inflammatory marker. Evidence, including more recently published research data, which is reviewed in this paper has led to the following conclusions by the current authors: 1) In MD patients either protein-energy malnutrition or inflammation can lead to a reduction in serum TTR concentrations. 2) Hence, in MD patients, serum TTR concentrations can be used as a measure of both nutritional and inflammatory status. 3) Serum TTR concentrations are typically increased in MD patients. 4) In maintenance hemodialysis (MHD) patients, serum TTR is a risk factor for mortality that is somewhat independent of serum albumin. 5) Current epidemiological evidence suggests that a serum TTR value of 25 or 30 mg/dl or greater is associated with increased survival and, hence, is desirable in MHD patients. 6) MHD patients with serum TTR levels less than 25-30 mg/dl should be evaluated for protein-energy malnutrition and inflammation.

Humans↗

PubMed2004

The Personality Disorders Institute/Borderline Personality Disorder Research Foundation randomized control trial for borderline personality disorder: rationale, methods, and patient characteristics.

The Personality Disorder Institute/Borderline Personality Disorder Research Foundation randomized control trial (PDI/BPDRF RCT) is a controlled outcome study for borderline personality disorder (BPD), in which 90 participants were randomized to one of three manualized and monitored, active psychosocial treatment conditions. These treatments are: (a) Transference-Focused Psychotherapy (TFP; Clarkin, Yeomans, & Kernberg, 1999), a treatment for BPD based on object-relational and psychoanalytic principles first applied to BPD by Kernberg (1996), notable for its particular emphasis on interpretation of object relations activated in the ongoing therapeutic relationship; (b) Dialectical Behavior Therapy (DBT; Linehan, 1993), a popular treatment for BPD, with evidence of efficacy (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991) that emphasizes a balance between acceptance and change in its combination of cognitive-behavioral and Zen principles; and (c) supportive psychotherapy (Rockland, 1992), another object-relational and psychoanalytically based treatment for BPD which, in contrast to TFP, eschews transference interpretation and places primary emphasis on development of a collaborative engagement with the patient to foster identity development. Patients received medication, if clearly indicated, according to the treatment algorithm developed by Soloff (2000). This article describes the significance and rationale of the study and the overall design, methods, plan of analysis, and demographic characteristics of the recruited sample of patients.

Adult↗

PubMed2004

[In contact with genetic diseases: norm and reason as cultural traditions in medical staff discourse at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil].

This study aims to detect the influence of deeply rooted traditions on physicians' discursive constructions concerning children with genetic diseases involving malformations and mental retardation. It also aims to capture the reflections resulting from the professional care for (and contact with) these children. All the physicians work at the Fernandes Figueira Institute, Oswaldo Cruz Foundation, in Rio de Janeiro, Brazil. Data were collected using oral interviews (in the form of conversational narratives) and were submitted to semiotic analysis. Four traditions were found in the medical discourse: norm, reason, family, and religion. This article focuses exclusively on norm and reason, highlighting how dismorphism, congenital malformations, and mental retardation associated with genetic diseases defy the established norms of perfection, beauty, and productivity. Therefore, feelings of uneasiness, powerlessness, and frustration are increased. The article also discusses how reason, one of the most important cultural traditions organizing modern thought, shapes medical discourse on genetic syndromes associated with mental retardation.

Brazil↗

PubMed2005

[The right to health in Colombia: a proposal for laying down its moral foundations].

The health system reform that was carried out in Colombia in 1993 was based on neoliberal doctrine. That reform increased the inequity in the allocation of resources, access to health services, and the distribution of spending on health. Societal organizations, academic groups, health workers, and some members of the political sector in Colombia have opposed the neoliberal reform, and they have supported the right to health as an alternative for dealing with the inequities in the health sector. According to liberal theories, only civil and political rights are fundamental, and liberty is assumed to be only the freedom of process and the absence of coercive mechanisms. However, there are arguments that support the viewpoint that health is a fundamental human right. This piece analyzes some ethical and moral principles that can help establish the moral foundations for the right to health. Among these principles are equality of opportunity, that part of being free is for people to have the right to develop themselves as human beings, that the right to health is connected to the right to life, that all people deserve equal respect (which requires the equal distribution of goods and of societal responsibilities), and that liberty is the opportunity that all persons should have to carry out the plans that they have for their lives, as chosen from a variety of socially useful alternatives.

Colombia↗

PubMedDate not supplied

Craniofacial analysis of the Tweed Foundation in Angle Class II, division 1 malocclusion.

This study has defined the cephalometric values of the Craniofacial Analysis of the Tweed Foundation for a sample of Brazilian subjects. The sample consisted of 211 cephalometric radiographs from subjects aged 12-15, which were divided into two groups: Class II group, with 168 lateral teleradiographs (cephalograms) of white Brazilian subjects, with Angle Class II, division 1 malocclusion, of both genders (82 males and 86 females); and the Control Group, with 43 lateral teleradiographs (cephalograms) of subjects whose occlusion was clinically excellent, and also of both genders (21 males and 22 females). The teleradiographs were selected from the files of the Department of Orthodontics, School of Dentistry of Piracicaba, State University of Campinas, previously to the orthodontic treatment. The results demonstrated no sexual dimorphism for each group, as attested by the Student's t-test. The exploratory analysis (+/- 0.5 standard deviation) enabled the tolerance limits to be determined and a Craniofacial Analysis Table to be constructed using the respective cephalometric intervals. In addition, the difference between the two groups was not statistically significant according to the maxilla position. The maxilla was in a good position in relation to the cranial base. On the other hand, the mandible was retruded in relation to the cranial base in the Class II cases. The skeletal pattern was not defined because only the Facial Height Index (FHI) showed a vertical pattern in Class II subjects, while the Y Axis, SN.PlO, SN.GoMe and FMA values did not show any statistically significant difference between the groups. The Class II division 1 subjects showed lower incisors more labially tipped and a convex facial profile.

Adolescent↗

PubMed1993

Racial variation in human leukocyte antigen frequency in insulin-dependent diabetic nephropathy. The South-Eastern Organ Procurement Foundation.

Black patients with insulin-dependent diabetes mellitus are at increased risk for the development of diabetic nephropathy compared with white patients. To determine if genetic differences associated with the HLA system account for racial variation in insulin-dependent diabetes mellitus-induced nephropathy, serologically defined HLA phenotypes from renal transplant recipients and donors in the South-Eastern Organ Procurement Foundation database from 1982 to 1986 were analyzed. Renal transplant recipients (N = 1,531) with insulin-dependent diabetes mellitus-induced renal failure as the cause of ESRD (patients) were compared with 4,506 race-matched, nondiabetic cadaveric kidney donors (controls). Log-linear models were used to assess the relationship between insulin-dependent diabetes mellitus-induced renal failure and prevalence of each HLA phenotype. Bonferroni adjustments of P values were used to correct for multiple comparisons. A comparison of HLA frequencies in patients with insulin-dependent diabetes mellitus-induced renal failure demonstrated the presence of racial differences beyond those normally present between the black and white populations. Blacks, compared with whites, had increased frequencies of HLA-B62 (odds ratio [OR] black:white, 6.13:1.97; P < 0.02) and HLA-DR9 (OR black:white, 4.82:1.57; P < 0.008) and decreased frequencies of HLA-A1 (OR white:black, 1.56:0.8; P < 0.008) and HLA-DR3 (OR white:black, 4.9:2.82; P < 0.004). These results suggest that differences in HLA frequency may account, in part, for the observed racial variation in incidence of diabetic nephropathy. In addition, several antigens in positive and negative association with diabetic nephropathy were identified within each race.

Adult↗

PubMed2005

Naming our concerns about neuroscience: a review of Bennett and Hacker's philosophical foundations of neuroscience.

Bennett and Hacker use conceptual analysis to appraise the theoretical language of modern cognitive neuroscientists, and conclude that neuroscientific theory is largely dualistic despite the fact that neuroscientists equate mind with the operations of the brain. The central error of cognitive neuroscientists is to commit the mereological fallacy, the tendency to ascribe to the brain psychological concepts that only make sense when ascribed to whole animals. The authors review how the mereological fallacy is committed in theories of memory, perception, thinking, imagery, belief, consciousness, and other psychological processes studied by neuroscientists, and the consequences that fallacious reasoning have for our understanding of how the brain participates in cognition and behavior. Several behavior-analytic concepts may themselves be nonsense based on thorough conceptual analyses in which the criteria for sense and nonsense are found in the ways the concepts are used in ordinary language. Nevertheless, the authors' nondualistic approach and their consistent focus on behavioral criteria for the application of psychological concepts make Philosophical Foundations of Neuroscience an important contribution to cognitive neuroscience.

Animals↗

PubMed2001

Strengthening the legal foundation for public health practice: a framework for action.

Growing concern that public health laws may be inadequate to the challenges that confront public health practitioners has led to adoption of a Healthy People 2010 objective for improved laws and policies. It has also led to concerted efforts to strengthen the legal foundation for public health practice. In this editorial, the authors present a framework for collaborative research, analysis, and development to strengthen public health laws, skill in applying laws, and law-related information resources.

Centers for Disease Control and Prevention, U.S.↗

PubMed2004

Immunological foundations to the quest for new vaccine adjuvants.

Developing efficient adjuvants for human vaccines that elicit broad and sustained immune responses at systemic or mucosal levels remains a formidable challenge for the vaccine industry. Conventional approaches in the past have been largely empirical and--at best--partially successful. Importantly, recent advances in our understanding of the immune system, most particularly with respect to early proinflammatory signals, are leading to the identification of new biological targets for vaccine adjuvants. This review covers both the current status of adjuvant testing in humans, the residual needs for vaccines in development, and the emerging immunological foundations for adjuvant design. A better understanding of the biology of toll-like receptors, non-conventional T cell subpopulations, T and B cell memory, regulatory T cells, and mucosal immunity has profound implications for a modern approach to adjuvant screening and development. The future lies in the high throughput screening of synthetic chemical entities targeting well-characterized biological molecules. Used alone or in combination, such synthetic adjuvants will allow stimulation or modulation in a safe and efficient manner of strong effector, regulatory and memory immune mechanisms.

Adjuvants, Immunologic↗

PubMed2002

The TB structural genomics consortium: providing a structural foundation for drug discovery.

Structural genomics, the large-scale determination of protein structures, promises to provide a broad structural foundation for drug discovery. The tuberculosis (TB) Structural Genomics Consortium is devoted to encouraging, coordinating, and facilitating the determination of structures of proteins from Mycobacterium tuberculosis and hopes to determine 400 TB protein structures over 5 years. The Consortium has determined structures of 28 proteins from TB to date. These protein structures are already providing a basis for drug discovery efforts.

Acyltransferases↗

PubMed2006

Developing empathy as a foundation of client-centred practice: evaluation of a university curriculum initiative.

BACKGROUND: The foundation of client-centred practice is the therapist's capacity to view the world through the client's eyes and to develop an understanding of the lived experience of disability. PURPOSE: This paper describes the evaluation of an educational initiative promoting student empathy to the lived experience of disability. METHODS: Pairs of first-year occupational therapy students visited adults with disabilities who shared their knowledge and experience of living with a disability. Students reflected on their visits in journals, which were later analyzed using pattern matching. FINDINGS: Students appeared to appreciate the co-existence of health and disorder and demonstrated a holistic understanding of living with a disability. Little attention was focused on cultural and institutional environments. Students struggled to define the nature of their relationship with their tutors. Practice Implications. The evaluation confirmed our belief that this educational initiative could facilitate student empathy, consistent with critical features of client-centred practice.

Canada↗

PubMed2002

[Genetic foundations of vulnerability to depression].

Depression is a complex phenotype probably heterogeneous in its biology and in its aetiology. Genetic studies have contributed to clarifying some aspects of that heterogeneity, but we are still far from being able to establish its molecular foundations, although a certain degree of genetic variability in genes of the serotoninergic system appear to contribute to the risk of the disease and to certain of its clinical aspects. The risk of a major depressive episode increases in relation to the number of genes shared with an affected person but, in genetic terms and given the differential risks found, there is also a certain overlap with bipolar disorder and schizophrenia. These data lead to reflection on the meaning of genetic risk detected in families and its specificity. Perhaps genetic studies will have to leave the categorical definition of phenotypes and begin to use the dimensions of psychopathology for delimiting the biological and genetic subgroups present in functional psychoses.

English Abstract↗

PubMed2004

Evaluation of empirical methods and methodological foundations of human left-handedness.

The methodological and empirical foundations underlying the theories on human left-handedness are examined, including the definition and classification of left-handedness, its relation to pathology, and the results on family, adoption, and twin research. It is argued that major research findings on left-handedness are based on inadequate empirical methods, and the concrete definitions and assessment procedures do not meet validity and reliability criteria. This also casts doubt on the relationship between left-handedness and pathology reported in the literature. Furthermore, findings from family, adoption, and twin studies do not allow interpretation of possible direct genetic contributions to explaining left-handedness. It is concluded that the methodological limitations of a causal explanation should encourage an examination of the epistemological and methodological premises of theory formulation. The functional method and a theoretical framework based on early childhood experiences and the neural plasticity of the brain may be more appropriate for the selection of empirical methods in research of human left-handedness.

Brain↗

PubMed2006

Fitness extraction and the conceptual foundations of political biology.

In well known formulations, political science, classical and neoclassical economics, and political economy have recognized as foundational a human impulse toward self-preservation. To employ this concept, modern social-sciences theorists have made simplifying assumptions about human nature and have then built elaborately upon their more incisive simplifications. Advances in biology, including advances in evolutionary theory, notably inclusive-fitness theory, have for decades now encouraged the reconsideration of such assumptions and, more ambitiously, the reconciliation of the social and life sciences. I ask if this reconciliation is feasible and test a path to the unification of politics and biology, called here "political biology." Two new notions, "fitness extraction" and "fitness exchange," are defined, then differentiated from each other, and lastly contrasted to cooperative gaming, the putative essential element of economics.

Journal Article↗

PubMed1998

Conceptual foundations of schizophrenia: I. Degeneration.

OBJECTIVE: This is the first of two papers that aim to identify some of the institutional processes of 19th century European psychiatry, and some prevailing cultural themes of that era that played a role in shaping the development of schizophrenia as a disease concept. METHOD: Three areas of psychiatric history are examined: the first is concerned with the key figures who coined the concept of dementia praecox; the second with the rise of the asylum; and the third is to do with the ideology of 19th century psychiatric science and its relationship to a broader intellectual milieu. These three literatures are examined for common themes. RESULTS: The theme of degeneration is evident in all three literatures, and denotes both a biological process (neuro-degeneration) and a moral state (degeneracy). CONCLUSIONS: The idea of degeneration, a pervasive cultural theme of the 19th century, dominated psychiatric thinking long before schizophrenia was developed as a diagnostic category. It contributed to the ideational form-work that gave foundation, structure and shape to the concept of schizophrenia.

Disease Progression↗

PubMed1998

Conceptual foundations of schizophrenia: II. Disintegration and division.

OBJECTIVE: This is the second of two papers that aim to identify some cultural themes and institutional processes that shaped the development of schizophrenia as a disease concept. METHOD: A number of domains within 19th century European history are explored for evidence of the concept of the divided or disintegrated person. These include German academic psychiatry, Mesmerism and hypnosis, neurology and neurophysiology, psychoanalysis and German Romantic literature, and its descendants within a wider European literature. RESULTS: Representations of division or disintegration are evident in all these domains, enjoying widespread currency and penetration throughout the 19th century. CONCLUSIONS: These culturally based ideas, combined with the idea of degeneration, were important elements in the foundation of the schizophrenia concept.

Dissociative Disorders↗

PubMed1991

A study of the attitudes of the foundation staff of a new medical faculty to problem-based learning.

The characteristics of the foundation staff of the United Arab Emirates (UAE) University Faculty of Medicine numbering 18 were studied using open-ended questions in an interview setting. All were experienced academically with mean total years of experience being more than 20 years. The mean age of 51.7 years indicated that the majority of staff interviewed were in the latter stage of their academic career. Although one of the criteria for accepting candidates was flexibility in their outlook to new teaching learning systems and positive attitudes to problem-based learning (PBL), only seven understood PBL and five were openly hostile to the system. The reasons for joining the Faculty were protean, but most saw the job as being challenging in nature and a change from routine. The question is raised whether the selection procedure was appropriate and whether more stringent criteria might have been applied, to have included attitudinal aspects in addition to the academic achievements of the candidates, for the rightly motivated and oriented individual to be appointed.

Adult↗

PubMed2000

ADSA Foundation Scholar award. Dairying and the environment.

Increases in average herd size have resulted in increased concentrations of manure at dairies. Inadequate or insufficient manure management practices and greater focus on agricultural pollution from environmental groups have increased the need for scrutiny from regulatory agencies. An overview of the sequence of activities that led to the development and final approval of the National Animal Feeding Operation Strategy is presented. The Strategy and associated policy changes serve as the foundation for new enforcement and compliance goals and probable alterations to existing permit requirements. Lastly, identified research needs and educational opportunities are presented.

Animals↗