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This article introduces the first special section of state-of-the-art reviews. The historical origins of occupational health psychology are briefly discussed to establish a context for the present contributions that focus on job strain, effort-reward imbalance, and methodological problems.
This article introduces the third special section of state-of-the-art reviews. The conceptual and methodologic contributions of the 3 articles in this section are framed, noting the importance of the public health, preventive medicine, and sociological disciplines represented.
In this article, the author introduces the fourth special section of state-of-the-art reviews. He discusses the public policy and epistemological contributions of the 2 articles in this section in terms of the translation of scientific research findings into public policy actions.
The ancient art of acupuncture is becoming more and more popular, and these days of bank-balance and budget mean that practitioners are reconsidering the benefits of a medical technique that is safe, simple and cheap. At a press conference in October, the British Medical Acupuncture Society put their case.
During the past 20 years, treatments for head and neck squamous cell carcinoma (HNSCC) have changed dramatically owing largely to the advent of novel approaches such as combined modality therapy as well as improvements in surgical and radiotherapeutic techniques. Locally advanced disease in particular, which engendered very high recurrence and mortality rates, is now associated with long-term disease-free survival in the majority of cases. This article will focus on locally advanced HNSCC, which frequently remains a clinical challenge, review state-of-the-art therapy, and introduce promising novel therapies. The field continues to evolve rapidly with new evidence during the past year clearly establishing the benefit of adjuvant chemoradiotherapy (CRT), as well as early evidence showing improved survival with the use of an epidermal growth factor receptor inhibitor in combination with radiotherapy. There are varied regimens in use for patients with locally advanced disease, but at the same time the multitude of options can plague the clinician when trying to select the most appropriate one. This article will attempt to put the various approaches into perspective and propose an evidence-based treatment algorithm.
This paper presents a state-of-the-art review of using mobilized-peripheral blood progenitor cells (PBPC) for transplantation in children. Our own data and those from Medline searches and meeting reports, are analyzed and presented for the different sections that involve transplantation. Recommendations concerning the choice of mobilization regimens, venous access, priming of separator extracorporeal line, anticoagulation, and number of CD34+ cells to infuse for rapid engraftment are proposed. In the allogeneic setting, we analyze ethical and safety aspects of pediatric donor mobilization and collection. Data from the literature suggest that the use of cytokine-mobilized PBPC for allogeneic transplantation appears to be safe both for pediatric donors and patients leading a rapid hematopoietic engraftment with a similar incidence of acute graft-versus-host disease (GVHD). The high incidence of chronic GVHD and its management emerge as the most concerning aspect in allogeneic PBPC transplantation.
The objective of this paper is first to describe the different strategies used to communicate risks to patients in the field of cancer or genetics, to review their effectiveness, and to summarise the state of the art of this practice in particular, in cancer genetics. The target audience is health care professionals involved in the communication of cancer risks, and genetic risks of breast/ovarian or colorectal cancer in particular. The methods include a review of the literature (Medline, Pascal, PsycInfo, Embase) by a panel of researchers and clinicians (cancer geneticists, epidemiologists, health psychologists, sociologists) in the context of a European Project on risk communication. We highlight practices that have been shown to be effective in the context of health psychology research and those being still under consideration for use in routine practice. In conclusion, this paper adds clinical relevance to the research evidence. We propose specific steps that could be integrated in standard clinical practice based on current evidence for their usefulness/effectiveness.
This paper addresses the recent advances in gas chromatographic (GC)-based instrumentation for the analytical determination of environmental toxicants using small samples. One-dimensional GC/time-of-flight mass spectrometry (TOFMS) and comprehensive two-dimensional GC (GCxGC) are shown to drastically improve sample component resolution, sensitivity and overall analytical throughput. A presentation of the concepts behind the new state-of-the-art, and results highlighting the advantages of the emerging technologies are presented.
In order to control the quality of butyl- and phenyltin compound determinations in sediment, the Standards, Measurements and Testing Programme (formerly BCR) of the European Commission has started a project, the final aim of which is to certify a freshwater sediment for its contents of a range of organotin compounds (mono-, di- and tributyltin, and mono-, di- and triphenyltin). The first part of this project involved an interlaboratory study which aimed to test the feasibility of preparation of candidate freshwater sediment reference material and to detect and remove most of the pitfalls observed in organotin determinations. This paper presents the main results of this interlaboratory study carried out prior to the certification campaign. The agreement obtained among laboratories for the six compounds determined was considered to reflect the state-of-the-art and was encouraging enough to decide upon the organisation of a certification campaign, which will be concluded in June 1999.
The new European Directive for water intended for human consumption has established a regulatory level for bromate at 10 microg L(-1). This Maximum Admissible Concentration requires analytical methods with detection limits of a least 2.5 microg L(-1). A project funded by the Standards, Measurements and Testing Programme of the European Commission has enabled the improvement and/or development of methods for the determination of bromate at such concentration levels. This collaborative work was concluded by the organisation of an interlaboratory trial involving 26 European laboratories, which enabled the testing of both a draft ISO Standard method and alternative methods. This paper presents the results of this interlaboratory trial, along with results of a bromate stability study. The progress made with respect to the analytical state-of-the-art for bromate will greatly benefit the quality of measurements carried out in water quality monitoring.
Control of workplace exposure to beryllium is a growing issue in the United States and other nations. As the health risks associated with low-level exposure to beryllium are better understood, the need increases for improved analytical techniques both in the laboratory and in the field. These techniques also require a greater degree of standardization to permit reliable comparison of data obtained from different locations and at different times. Analysis of low-level beryllium samples, in the form of air filters or surface wipes, is frequently required for workplace monitoring or to provide data to support decision-making on implementation of exposure controls. In the United States and the United Kingdom, the current permissible exposure level is 2 microg m(-3) (air) and the United States Department of Energy has implemented an action level of 0.2 microg m(-3) (air) and 0.2 microg/100 cm(2) (surface). These low-level samples present a number of analytical challenges, including (1) a lack of suitable standard reference materials, (2) unknown robustness of sample preparation techniques, (3) interferences during analysis, (4) sensitivity (sufficiently low detection limits), (5) specificity (beryllium speciation) and (6) data comparability among laboratories. Additionally, there is a need for portable, real-time (or near real-time) equipment for beryllium air monitoring and surface wipe analysis that is both laboratory-validated and field-validated in a manner that would be accepted by national and/or international standards organizations. This paper provides a review of the current analytical requirements for trace-level beryllium analysis for worker protection and also addresses issues that may change those requirements. The current analytical state of the art and relevant challenges facing the analytical community will be presented, followed by suggested criteria for real-time monitoring equipment. Recognizing and addressing these challenges will present opportunities for laboratories, research and development organizations, instrument manufacturers and others.
1. The results of the Veterans Administration Co-operative Study have been extended by the subsequent clinical trials, which included patients of both sexes and with less vascular disease. The later studies confirm the effectiveness of treatment in preventing most complications except myocardial infarction and sudden death. Furthermore, the lower diastolic blood pressure in which treatment has been shown to have a significant beneficial effect has been lowered from 105 mmHg as indicated by the Veterans Study to 100 mmHg as shown by the much larger Australian trial. The possibility of reducing the incidence of sudden death and fatal myocardial infarction has been suggested by other recent control trials using beta-adrenoreceptor-blocking drugs, an approach that needs further exploration. 2. A number of interesting and useful new drugs have appeared which include tienilic acid, minoxidil, saralasin and captopril, and in addition recent controlled trials have re-emphasized the effectiveness of the old drug, reserpine, when combined with a diuretic. The art of treatment of hypertension therefore appears to be in a healthy state and we should expect more advances in the future.
PURPOSE: Despite numerous calls for reform over several decades, medical educators have been unable to address many significant challenges. Potentially, employing new metaphors and looking at the teaching and learning of medicine in a new way will facilitate the development of creative solutions. MAIN FINDINGS: In this paper we propose the metaphor of medicine as a performing art. Building on this metaphor, string music education is compared to medical education. PRINCIPAL CONCLUSIONS: Looking to string education as a model, suggestions for reorganisation of learning experiences, academic structure and assessment are discussed. Medical educators are encouraged to think about the challenges they face in creative ways. By looking outside traditional medical education, solutions may be found to new and old educational dilemmas.
Contemporary developments in nursing and health-care, which emphasise evidence-based and outcome-oriented practice often fail to recognise the centrality of the caring relationship in everyday practice. This paper aims to examine the therapeutic role of the nurse within the context of an increasingly technicalized and bureaucratic healthcare system. Focusing on the importance of love and its healing potential, we intend to raise awareness of some difficult and often polemic arguments pertaining to the concept of clinical caritas. We return to the fundamental question: why do people enter nursing? In doing so we explore the concept of caring utilising theoretical and experiential examples to illustrate ways in which healthcare systems can both drain and nurture the practitioners' capacity to care. A framework for developing the art of loving within nursing care is presented, which emphasises the balance between discipline, concentration, patience, concern and activity. We conclude by outlining the boundaries in which genuine love may be expressed within the parameters of a professional role.
In a collection of 562 migraine art pictures, seven pieces illustrate various elements of out-of-body experiences (OBEs) and related phenomena, including the somesthetic sensations of a duplicate or parasomatic body and the visual experiences of perceiving the own body, i.e. autoscopy, and its environment from a vantage point out of the body. Phenomenological features of the OBEs depicted are compared with 17 similar case reports reviewed from the literature. It is concluded that OBEs can occur as migraine aura symptom, which supports the notion that OBEs represent a preformed functional response of the brain. This neuropsychological theory supplements existing psychological theories of OBEs, which consider the said phenomena as representing hallucinatory experiences based on imagination and memory.
Bax is a pro-apoptotic Bcl-2 family protein that regulates programmed cell death through homodimerization and through heterodimerization with Bcl-2. Bax alpha is encoded by six exons and undergoes alternative splicing. Bax kappa, a splice variant of Bax with conserved BH1, BH2 and BH3 binding domains and a C-terminal transmembrane domain (TM), but with an extra 446-bp insert between exons 1 and 2 leading to loss of an N-terminal ART domain, was identified from an ischemic rat brain cDNA library. Expression of Bax kappa mRNA and protein was up-regulated in hippocampus after cerebral ischemic injury. The increased Bax kappa mRNA was distributed mainly in selectively vulnerable hippocampal CA1 neurons that are destined to die after global ischemia. Overexpression of Bax kappa protein in HN33 mouse hippocampal neuronal cells induced cell death, which was partially abrogated by co-overexpression of Bcl-2. Moreover, co-overexpression of Bax kappa and Bax alpha increased HN33 cell death. The results suggest that the Bax kappa may have a role in ischemic neuronal death.
Dermabrasion is a resurfacing procedure that has been part of dermatology for almost 100 years. With the advent of laser resurfacing in the 1990s, the art of dermabrasion has temporarily been partially eclipsed. This review article covers the history of dermabrasion, (pre-operative selection of patient equipment, the techniques and the post-operative care of dermabrasion patients. Many clinical examples are illustrated. The combination of dermabrasion with other resurfacing techniques, such as laser (CO(2 )and Erbium) and chemical peels (trichloracetic acid (TCA)) are illustrated.
Three significant advances are responsible for the recent evolution in breast reconstruction. The first of these is the introduction of the transverse rectus abdominis musculocutaneous (TRAM) flap, which made reliable autologous breast reconstruction a reality. The subsequent application of microsurgical principles to this procedure brought further refinements in terms of improved blood supply and lessened donor site morbidity. Finally, the wide acceptance of the skin-sparing mastectomy by oncologic surgeons has allowed further progress in the aesthetic possibilities that can be realized by the plastic surgeon. The authors discuss each of these factors and provide an overview of the current state of the art of autologous free tissue breast reconstruction.