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At least 109 records · Page 6Linked to original sources
PubMed1993

Do elderly patients mind how doctors address them?

A survey was carried out in the Geriatric Unit at Cork Regional Hospital to determine how elderly patients would like to be addressed by their doctor. Two hundred patients over the age of 65 were given a Questionnaire asking them to state their preference. Only a minority (4.5%) expressed a definite preference for the formal mode of address. The remainder either did not mind (38%) or preferred to be addressed by their first name (57.5%). We concluded that most elderly patients do have a preference and this should be established on admission.

Aged↗
PubMedDate not supplied

[Study of kinetic parameters of glucose oxidase and alpha-chymotrypsin, immobilized in polymeric matrices, using a light-addressable sensor].

Light-addressable potentiometric sensors were prepared by immobilizing glucose oxidase or alpha-chymotrypsin on the surface of a pH-sensitive electrode. Two methods of immobilization were used: incorporation into a hydrophilic matrix of bovine serum albumin and incorporation into a hydrophobic matrix of modified polyethylenimine. The glucose oxidase and alpha-chymotrypsin preparations immobilized in the polyethylenimine matrix were characterized by the Michaelis constant values of 6.0 and 3.1. mM, respectively, and by pH optimums at 6.0-7.2 and 7.0-8.0, respectively. These values are consistent with results obtained by other methods. Therefore, light-addressable potentiometric sensors can be used in combination with both hydrophilic and hydrophobic matrices. The ability to combine light-addressable potentiometric sensors with hydrophobic matrices provides an opportunity for the development of potentiometric biosensors for detecting substances poorly soluble in water.

Biosensing Techniques↗
PubMedDate not supplied

Evolutionary adaptations of gene structure and expression in natural populations in relation to a changing environment: a multidisciplinary approach to address the million-year saga of a small fish.

We have used an experimentally based strategy to address molecular mechanisms underlying adaptation in Fundulus heteroclitus. In an attempt to falsify the hypothesis that selection is a major driving force in the maintenance of genetic diversity, we employed a multidisciplinary approach including allelic isozyme and mtDNA phylogeography, kinetic analyses of allelic isozymes, analysis of variation in coding and regulatory DNA sequences, metabolic biochemistry, organismal physiology, and selection experiments. Observed differences in gene structure and expression led us to make testable predictions about differences in metabolic flux, whole organism performance, and differential survival between allotypes. We have shown that variation in the lactate dehydrogenase-B (Ldh-B) protein results in differences in physiological function and is correlated with differences in survival at high temperatures. Recent work has investigated the role of variation in Ldh-B expression. There are differences in the levels of Ldh-B protein, mRNA, and transcription rate. We have addressed the mechanisms responsible for differences in transcription rate by a combination of sequence comparison, DNase I footprinting, and functional analyses both in vitro and in vivo. We have shown that variation in the regulatory sequence of Ldh-B is responsible for the differences in transcription rate between populations and that the patterns of variation are inconsistent with a neutral model of molecular evolution. This functional differentiation, coupled with departures from neutral expectations, suggests that natural selection has acted on the regulation of Ldh-B. This article illustrates the value of a multidisciplinary approach in addressing problems in gene structure, expression, and evolutionary adaptation.

Adaptation, Physiological↗
PubMed2002

Presidential address, 2001. Roots and relevance.

The infrastructure, focus and modus operandi of the Canadian Orthopaedic Association (COA) has been changed to effectively address the needs of the Association in this new century, as well as the possibility of a diminished interest in orthopedic surgery as a career choice. These issues are dealt with in this COA presidential address given at the COA annual general meeting in June 2001.

Canada↗
PubMedDate not supplied

Issues for covariance analysis of dichotomous and ordered categorical data from randomized clinical trials and non-parametric strategies for addressing them.

Analysis of covariance is an effective method for addressing two considerations for randomized clinical trials. One is reduction of variance for estimates of treatment effects and thereby the production of narrower confidence intervals and more powerful statistical tests. The other is the clarification of the magnitude of treatment effects through adjustment of corresponding estimates for any random imbalances between the treatment groups with respect to the covariables. The statistical basis of covariance analysis can be either non-parametric, with reliance only on the randomization in the study design, or parametric through a statistical model for a postulated sampling process. For non-parametric methods, there are no formal assumptions for how a response variable is related to the covariables, but strong correlation between response and covariables is necessary for variance reduction. Computations for these methods are straightforward through the application of weighted least squares to fit linear models to the differences between treatment groups for the means of the response variable and the covariables jointly with a specification that has null values for the differences that correspond to the covariables. Moreover, such analysis is similarly applicable to dichotomous indicators, ranks or integers for ordered categories, and continuous measurements. Since non-parametric covariance analysis can have many forms, the ones which are planned for a clinical trial need careful specification in its protocol. A limitation of non-parametric analysis is that it does not directly address the magnitude of treatment effects within subgroups based on the covariables or the homogeneity of such effects. For this purpose, a statistical model is needed. When the response criterion is dichotomous or has ordered categories, such a model may have a non-linear nature which determines how covariance adjustment modifies results for treatment effects. Insight concerning such modifications can be gained through their evaluation relative to non-parametric counterparts. Such evaluation usually indicates that alternative ways to compare treatments for a response criterion with adjustment for a set of covariables mutually support the same conclusion about the strength of treatment effects. This robustness is noteworthy since the alternative methods for covariance analysis have substantially different rationales and assumptions. Since findings can differ in important ways across alternative choices for covariables (as opposed to methods for covariance adjustment), the critical consideration for studies with covariance analyses planned as the primary method for comparing treatments is the specification of the covariables in the protocol (or in an amendment or formal plan prior to any unmasking of the study.

Analysis of Variance↗
PubMed1992

Addressing national and regional health needs: a framework for health planning.

Completion of the first decade since the Alma-Ata Declaration of 'health for all' (1978) has led to numerous appraisals, in international forums, of progress achieved by the current primary health care strategy. Although this strategy appears to have contributed to improvements in selected health outcomes, changing circumstances in many developing countries may now require a more flexible and country-specific approach to health care programming. This article argues for the development of a pragmatic framework: to articulate problems which should be addressed in the development of national health programs; and, to organize concepts and methodologies to address these problems. Such a framework should enable an assessment of currently implicit value judgments, and enable strategies to be considered that assess several input and output variables simultaneously. Moreover, this framework would, we believe, further the goal of improved health delivery at a national level, and serve as a guide for further methodologic and conceptual development.

Developing Countries↗
PubMed1999

Addressing human variability in risk assessment--the robustness of the intraspecies uncertainty factor.

Addressing human variability and sensitive subpopulations is one of the challenges of risk assessment and is an important aspect of the Food Quality Protection Act, the law passed in 1996 that regulates food use pesticides in the United States. The intraspecies uncertainty factor is intended to address differences in susceptibility within the human population. This paper examines the history and scientific basis for the intraspecies uncertainty factor. Our best source of knowledge about human variability in the response to chemicals comes from clinical trials of pharmaceuticals. This large body of data allows both qualitative and quantitative characterization of variability in pharmacokinetic and pharmacodynamic parameters in the general population and in subgroups such as children. The preponderance of evidence in the areas of pharmacodynamics and pharmacokinetics supports the routine use of an intraspecies uncertainty factor in the range of 1-10 as being protective of greater than 99% of the human population. The intraspecies uncertainty factor is highly protective of various subpopulations, including infants and children.

Animals↗
PubMed1996

Application of the message-address concept to the docking of naltrexone and selective naltrexone-derived opioid antagonists into opioid receptor models.

A binding site model for the opioid family of G-protein coupled receptors (GPCRs) is proposed based on the message-address concept of ligand recognition. Using ligand docking studies of the universal opioid antagonist, naltrexone, the structural basis for "message' recognition is explored across all three receptor types, mu, delta, and kappa. The binding mode proposed and basis for selectivity are also rationalized using the naltrexone-derived ligands, naltrindole (NTI) and norbinaltorphimine (nor BNI). These ligands are docked to the receptor according to the common naltrexone core or message. The resulting orientation places key "address' elements in close proximity to amino acid residues critical to selectivity among receptors types. Selectivity is explained by sequence differences in the mu, delta, and kappa receptors at these recognition points. Support for the model is derived from site directed mutagenesis studies and ligand binding data for the opioid receptors and other related GPCRs.

Amino Acid Sequence↗
PubMed1988

Data compression: 8-dimensional flow cytometric data processing with 28K addressable computer memory.

A method of data analysis for flow cytometry is presented which enables up to eight-dimensional data to be handled by a microcomputer with 28K addressable plus a further 32K non-addressable memory. The multi-parameter coordinates are coded into single numbers using a minimal modification of the array vector mapping equation. These code numbers, each of which corresponds to a given set of coordinates, and then ranked in ascending order according to magnitude and the frequency of each code number is found. Following this step the code is then decoded by integer arithmetic into its original coordinates which are then packed, together with the frequency, into two, three or four 16-bit words depending on the dimensionality of the data set. A five-dimensional data set is used as the illustration. Three regions were set on one two-dimensional data space and the five mono-dimensional histograms, plus a different bivariate distribution, were extracted in a single pass through the processed data file. In addition to considerable space saving the technique has two further attributes, namely, increased speed with which the user can appreciate multiparameter data and the ability to analyse such data sets with a microcomputer.

Algorithms↗
PubMed1989

Bivalent ligands and the message-address concept in the design of selective opioid receptor antagonists.

Metabolically stable receptor antagonists that are subtype selective are indispensable pharmacological tools. In this article, Philip Portoghese describes the bivalent ligand approach to drug design which has resulted in the development of several highly selective non-peptide opioid receptor antagonists, such as the kappa-selective norbinaltorphimine and the delta-selective naltrindole. Models used resemble Schwyzer's message-address concept which originally described the recognition elements of peptide hormones; their success augurs well for the possibility of altering antagonist selectivity in a predictable fashion by simulating a portion of the address peptide component with a rigid nonpeptide moiety.

Animals↗
PubMed1996

Addressing life style in primary health care.

The problem studied concerns how patients and physicians talk about and make use of information regarding patient life style in the daily practice of primary health care. The study has been carried out at two primary health care centers in central Sweden. Transcribed dialogues between 42 patients and 12 physicians have been used as a data corpus. The analyses concern the interactional patterns in the dialogues between patient and physician, how the interlocutors address life style and for what purposes. The results show a similarity between patients and physicians with respect to the extent to which they use the discourse space. However, salient differences were found in the following way: the physicians not only introduced and closed life style topics more frequently than the patients did, they also used what is referred to as an agenda driven strategy to introduce them. The patients, on the other hand, used an interactively anchored strategy. The patients, by taking the reference in the life world and by making use of the life style topics, present and articulate their identity. The physicians subsume life style issues under a medical framing of the patients' problem and they mainly address life style in order to construe a proto-typical patient rather than an individual.

Adolescent↗
PubMed1986

Assessment-based group counseling to address concerns of chronic hemodialysis patients.

A Dialysis Patient Concerns Inventory (DPCI) was administered to 15 chronic hemodialysis outpatients by their nurses to assess concerns related to being a hemodialysis patient. This direct information from patients rather than experts in the field was used to construct a group counseling program to address these and other concerns later acknowledged by patients once group counseling began. Components of the counseling program, how the program was implemented, its effects, and factors important in effective program implementation with nurse involvement are discussed. It was concluded that it is important for nurses to play key roles in group counseling to address patients' concerns. It is also important for such counseling to be based on structured assessment of specific concerns reported from patients. Furthermore, it was concluded that group counseling should be planned and executed in ways that actively involve patients and that allow patients to participate for skill development and for life enhancement, rather than to get help with personal problems--a motivator that is often stigmatized.

Adult↗
PubMedDate not supplied

Following the pioneers. Addressing tobacco in chemical dependency treatment.

Traditionally, tobacco has been ignored as an issue in the treatment of addictions to alcohol and other drugs. Beginning in 1985, and especially since the publication of the 1988 Surgeon General's Report on nicotine addiction, a handful of treatment programs have worked at coming to terms with tobacco. This article explores the reasons for addressing nicotine in the course of managing other addictions and summarizes the lessons learned from the programs which have done pioneering work in this area. The reasons for addressing nicotine are compelling, and the accumulated experiences among the pioneering programs are consistently encouraging. Regional projects to help alcohol and drug treatment programs come to terms with tobacco are an appropriate next step.

Aftercare↗
PubMed1994

Mechanism of delta-opioid receptor selection by the address domain of dermenkephalin.

Dermenkephalin (Tyr-D-Met-Phe-His-Leu-Met-AspNH2) is a highly potent and selective delta-opioid peptide isolated from frog skin. It was recently recognized that the C-terminus His4-Leu5-Met6-Asp7NH2 of dermenkephalin was responsible for the addressing of the peptide towards the delta-opioid receptor. In order to investigate the role played by residues 4, 5 and 6 in this 'delta address', we synthesized and evaluated 20 new analogues for their ability to displace tritiated ligands from mu- and delta-opioid sites. Results showed that position 4 of dermenkephalin contributes to delta selectivity independently of delta-opioid receptor binding by preventing a high affinity mu binding. Position 5 requires a hydrophobic side chain to enhance delta affinity. A high delta affinity was obtained with any amino acids introduced in position 6 suggesting that residue 6 serves as a neutral spacer. Thus, the main features responsible for the high delta-opioid selectivity of dermenkephalin are electrostatic repulsions with the mu-opioid receptor, additional hydrophobic interactions with the delta-opioid receptor and folding of the C-terminal domain.

Amino Acid Sequence↗
PubMed1993

Detection of sub-nanogram quantities of Mojave toxin via enzyme immunoassay with light addressable potentiometric detector.

Sensitive detection of Mojave toxin (MoTX), a potent neurotoxin isolated from the venom of Crotalus scutulatus scutulatus, was developed using an enzyme immunoassay (EIA) and light addressable potentiometric detection. This EIA utilizes both biotin- and fluorescein-labeled anti-MoTX antibodies to immobilize and detect sub-nanogram to nanogram quantities of toxin. Labeled mono- and polyclonal anti-MoTX antibodies were used alone and/or in combination to determine maximum assay sensitivity. Assays performed using a combination of biotinylated poly- and fluoresceinated monoclonal antibodies produced an assay with a lower detection limit near 2.5 ng. Assays performed using labeled polyclonals alone, or in combination with biotinylated mono- and fluoresceinated polyclonal antibodies, indicated increased sensitivity with a detection limit near 300 pg. In conclusion, we describe an enzyme immunoassay using different labeled antibody schemes which detects sub-nanogram quantities of MoTX via light addressable potentiometric detection.

Antibodies↗
PubMed1997

National survey of Clerkship Directors in Internal Medicine on the competencies that should be addressed in the medicine core clerkship.

PURPOSE: To prioritize competencies that should be addressed in the medicine core clerkship, assess factors influencing this prioritization, and estimate the percentage of clerkship time that should be devoted to inpatient versus outpatient care. METHODS: A national survey of the Clerkship Directors in Internal Medicine (CDIM) was used. Using explicit criteria, respondents assigned priority scores, on a 1 to 5 scale, to 17 general competencies and 60 disease-specific clinical competencies pertinent to care of adult patients in inpatient. ambulatory, intensive care, and emergency settings. RESULTS: Ninety-three (75%) of 124 CDIM members responded. The highest mean priority scores were assigned to 6 general competencies: case presentation skills (4.65), diagnostic decision-making (4.64), history and physical diagnosis (4.61), test interpretation (4.47), communication with patients (4.35), and therapeutic decision-making (4.12). Disease-specific clinical competency areas receiving the highest mean priority scores were: hypertension (4.57), coronary disease (4.53), diabetes mellitus (4.45), heart failure (4.42), pneumonia (4.39), chronic obstructive pulmonary disease (4.26), acid-base/electrolyte disorders (4.19), and acute chest pain (4.08). Priorities for general competencies were moderately correlated with importance to the practice of general internists (mean Spearman rho 0.49) and with importance to students pursuing careers outside internal medicine (mean Spearman rho 0.45), but only weakly correlated with the adequacy with which a competency was addressed in other parts of the curriculum. Respondents' mean recommended allocation of clerkship time was: 52% inpatient, 33% ambulatory care, 8% intensive care, and 7% emergency medicine. This time allocation did not differ by any characteristics of respondents. CONCLUSION: There is consensus among medicine clerkship directors that the medicine core clerkship should emphasize fundamental competencies and devote at least one third of the time to clinical competencies pertinent to ambulatory care.

Clinical Clerkship↗
PubMed2003

Other high-risk factors for young drivers--how graduated licensing does, doesn't, or could address them.

PROBLEM: Young drivers, particularly those who are newly licensed, have a very high crash risk. This paper examines the risk factors underlying their high crash rates and assesses the extent to which existing graduated licensing programs address these risks and whether improvements to these programs should be considered. METHOD: Review and synthesis of the literature. RESULTS: The elevated risk among young drivers of being in an injury crash is the result of a number of factors found alone or in combination, such as risky driving, alcohol use, seat belt nonuse, driver distraction, fatigue, and vehicle choice. Nighttime and passenger restrictions, adopted widely in the United States, work by keeping drivers out of hazardous situations rather than by addressing risk factors directly. However, the risk factors remain in play in driving situations not specifically restricted by law. Although other graduated licensing components adopted around the world-more stringent exit tests (i.e., you need to pass a test to move to the next stage), hazard perception tests, and restrictions on speed, vehicle power, and roadway access-make sense based on the identified risk factors, they are not yet supported by research. Should research findings warrant it, consideration should be given to providing guidance to parents about how to keep their beginning drivers safe, including information on vehicle choice. IMPACT ON RESEARCH, PRACTICE, AND POLICY: Researchers should continue to monitor and to evaluate innovative approaches to reduce the crash risk of young drivers. The effectiveness of new approaches should be established before adoption on a wider scale takes place.

Accidents, Traffic↗