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PubMed1977

[Prognosis of childhood brain injuries in relation to acute post-traumatic syndrome].

Long-time follow-up examinations of 196 children, who had been suffering from severe and moderately severe cerebral traumata, gave abundant proof of the view that neurological disorders occurring at the age of childhood are characterized by a positive development of the disease, a view that is held by all authors. Cerebral ailments characterized by attacks usually manifest themselves within one year after the accident. The younger the children at the time of accident, the higher the number of posttraumatic diseases characterized by attacks. Children with convulsive phenomena in the acute posttraumatic phase usually show a greater tendency toward later diseases characterized by attacks. Every fourth child with initial convulsions and every seventh child without such an early symptomatology suffered from attacks in the further course of disease. Four out of 32 children were, in spite of careful treatment, not free from attacks after 10 years from the accident. The younger a child is at the time of accident the more unfavorable is the prognosis as regards personality development, intelligence, and scholastic records. Also, there is a clear dependence upon the severity of the cerebral trauma. Most pronounced permanent handicaps were observed in young children with severe cerebral traumata. A posttraumatic ailment characterized by attacks tends to worsen any prognosis.

Adolescent↗

PubMed2005

Reproduction in same sex couples: quality of parenting and child development.

PURPOSE OF REVIEW: Same sex couples are steadily becoming more open about their relationships. One consequence of this growing openness is that more couples of the same sex are choosing to have children and infertility treatment centers are increasingly faced with requests for assistance in creating these families. The aim of this review is to address new trends in reproduction in same sex couples, to consider the quality of parenting in lesbian mother and gay father households, and to review the literature on the development of children raised by same sex couples. RECENT FINDINGS: The current literature on these families is limited by small sample sizes and a predominance of studies of lesbian mothers and their children, with few studies of gay fathers and their children. A recent study of adolescents living with same sex parents recruited from a large national sample supports the notion that adolescents raised by same sex couples are doing well psychologically and are not more likely to be homosexual. The authors concluded that it was the quality of parenting, not parental sexual orientation that accounted for developmental differences. SUMMARY: The literature supports the notion that children of lesbian mothers and gay fathers are not more likely to become homosexual and are not measurably different from children raised by heterosexual parents in terms of personality development, psychological development, and gender identity. Larger longitudinal studies of same sex parents, particularly gay men, are needed, including those who choose to become parents through the use of assisted reproduction.

Child↗

PubMed2026

Long-read sequencing reveals widespread novel splicing and neojunction-derived neoantigens in nasopharyngeal carcinoma.

The widespread transcriptomic diversity driven by alternative splicing (AS) contributes to all hallmarks of cancer and represents a critical source of neoantigens for personalized immunotherapy. However, unlike other major malignancies, the full repertoire of AS in nasopharyngeal carcinoma (NPC) remains underexplored. Here, we employ long-read sequencing (LR-seq) to generate a high-resolution, isoform-level transcriptomic atlas from a cohort of 14 NPC tumor samples and four immortalized nasopharyngeal epithelial cell lines. We identify a substantial number of full-length novel transcripts (22,687; ∼44.38%), which reveal diverse splicing patterns and previously unannotated splicing events. By integrating short-read RNA-seq data to quantify isoform expression, we discover a subset of novel transcripts that are differentially expressed between tumor samples and immortalized nasopharyngeal epithelial cell lines. Furthermore, LR-seq enables precise identification of chimeric readthrough fusion transcripts, such as CLDN15-FIS1 and FOXRED2-TXN2 Finally, we develop a computational framework, tumor-specific splicing neoantigen detection (TS-SNAD), to predict neoantigens originating from novel exon-exon junctions (neojunctions) in tumor-specific novel transcripts. Using this framework, we identify neojunction-derived neoantigens and experimentally validate the immunogenicity of selected HLA-B*40:01-restricted neoantigens. These neojunction-derived peptides constitute a new class of noncanonical neoantigens with significant potential for developing personalized cancer vaccines for NPC.

Humans↗

PubMed1997

[Pregnancy in adolescent mothers. Study in the district of Beja 1986-1991].

A retrospective and contextual study of pregnancy and delivery in adolescent mothers aged nineteen years or less has been developed in the area of the Beja Health Sub-Authority, with delivery between January 1, 1986 and December 31, 1987 and between January 1, 1988 and December 31, 1991. A universe of 216 young mothers in those conditions, whose complete identification was possible, were interviewed and asked to answer four questionnaires concerning surveillance of the pregnancy and the delivery, the family and psychosocial aspects, data on the child's father and data on the child's first year of life. The results obtained point to the fact that pregnancy in adolescents, in the studied universe, is well assumed and socially well accepted, even by the mothers' families of origin and viewed by the adolescent mothers as an instrument in their process of becoming autonomous in a social setting that offers no alternatives for personal development. The pregnancy, in those young mothers, does not appear to have a significantly higher biological, psychological or social risk than the known identical risks in older mothers. Finally, the results suggest that, even with the offer of quite good health services, it is necessary to review their organization and accessibility to those services in the form of a more well defined adaptation to this very specific kind of public.

Adolescent↗

PubMed2001

Irrational beliefs, attitudes about competition, and splitting.

Rational-Emotive Behavior Therapy (REBT) theoretically promotes actualization of both individualistic and social-oriented potentials. In a test of this assumption, the Belief Scale and subscales from the Survey of Personal Beliefs served as measures of what REBT presumes to be pathogenic irrationalities. These measures were correlated with the Hypercompetitive Attitude Scale (HCAS), the Personal Development Competitive Attitude Scale (PDCAS), factors from the Splitting Index, and self-esteem. Results for the HCAS and Self-Splitting supported the REBT claim about individualistic self-actualization. Mostly nonsignificant and a few counterintuitive linkages were observed for irrational beliefs with the PDCAS, Family-Splitting, and Other-Splitting, and these data suggested that REBT may be less successful in capturing the "rationality" of a social-oriented self-actualization.

Adolescent↗

PubMed2000

Quantitative analysis of cytomegalovirus (CMV) viremia using the pp65 antigenemia assay and the COBAS AMPLICOR CMV MONITOR PCR test after blood and marrow allogeneic transplantation.

The performance of a commercially available qualitative PCR test for plasma (AMPLICOR CMV Test; Roche Diagnostics) and a quantitative PCR test for plasma and leukocytes (COBAS AMPLICOR CMV MONITOR Test; Roche Diagnostics) was evaluated with samples from 50 blood or marrow allogeneic transplant recipients who received short courses of sequential ganciclovir therapy (2 weeks intravenously followed by 2 weeks orally) based on a positive cytomegalovirus (CMV) pp65 antigenemia (AG) assay. The number of persons with a positive CMV test was significantly higher for leukocyte-based assays (AG, 67.5%; PCR, 62.5%) compared to both quantitative and qualitative PCR tests of plasma (42.5 and 35%, respectively). One person developed CMV disease during the study despite a negative AG assay; in this particular case, all PCR assays were found to be positive 10 days before his death. There was a trend for earlier positivity after transplantation and more rapid negativity after initiation of ganciclovir for the tests performed on leukocytes. The mean number of CMV copies as assessed by PCR was significantly higher in leukocytes than in plasma (P = 0.02). Overall, excellent agreement (kappa coefficient, >0.75) was found only between the two PCR assays (qualitative and quantitative) based on plasma. These results suggest that either the pp65 AG assay or the COBAS AMPLICOR CMV MONITOR Test using leukocytes could be used to safely monitor CMV viremia in related allogeneic blood or marrow transplant recipients. Such a strategy will result in preemptive treatment for about two-thirds of the persons with a relatively low rate (<33%) of secondary viremic episodes following short courses of ganciclovir therapy.

Bone Marrow Transplantation↗

PubMed1986

New findings in live, attenuated hepatitis A vaccine development.

Strain CR326F of hepatitis A virus, derived from a fecal specimen of Costa Rican patient 033-03, was passed 15 times in fetal rhesus monkey kidney (FRhK6) cell cultures plus eight times in human diploid lung (MRC5) cell cultures to yield variant F and 16 times in MRC5 cell cultures to yield variant F'. Both variants were purified by limit dilution passages. Virulence for marmosets was assessed at six different passage levels, including variants F and F'. There was a gradual loss of virulence with in vitro passage. Variant F retained slight virulence for marmosets; variant F' showed no evidence of virulence. Both variants induced hepatitis A antibody in most marmosets that received them, and the animals were immune to infection when challenged. Variants F and F' were also assessed in chimpanzees. As in marmosets, F retained slight virulence but F' did not. Experimental vaccines made from variants F and F' were then inoculated parenterally into adult human volunteers. A portion of recipients of variant F showed brief, low-order enzyme elevations; none was seen in recipients of F', although their occurrence could not be totally ruled out. As in the animal models, F' appeared more attenuated than F. Most persons developed hepatitis A antibody, indicating the feasibility of developing a live, attenuated hepatitis A vaccine for human beings.

Animals↗

PubMed2005

Developing a nursing management degree programme to meet the needs of Irish nurse managers.

BACKGROUND: The study is placed within the context of the Irish health care system, which has undergone tremendous change, at the dawn of the new millennium, in particular from the nursing management and leadership viewpoint. AIM OF THE STUDY: The aim of this study is to explore nurses' expectations of the content and delivery of a nursing management degree programme. METHODS: This is an on-going action research study. Data has been collected using a focus group interview, questionnaire, document analysis and a reflective diary. Data was analysed using thematic analysis and SPSS as appropriate to qualitative and quantitative data respectively. To date two action research cycles are near completion and a total sample of 117 students have taken part in the study. FINDINGS: Nurses commencing the programme were unsure of their education and training needs, as they had not yet taken on board the recommendations of the Irish Commission on Nursing (Government of Ireland 1998). The findings suggest that nurse managers may not know what they need to know in light of the many current changes taking place in the Irish health system. The introduction of personal development planning (PDP) is among new strategies taking place as part of the second action research cycle. PDP can help nurse managers to reflect on their current responsibilities and plan for their future career pathways. CONCLUSIONS: The findings are presented in the context of one institution. Action research, which nests comfortably with certain management styles, has proved suitable as a tool for developing and changing this programme. The need for university teachers to focus on management development skills as well as the transmission of management theory is supported.

Education, Nursing, Baccalaureate↗

PubMed2025

The Heterogeneity of Type 1 Diabetes: Implications for Pathogenesis, Prevention, and Treatment-2024 Diabetes, Diabetes Care, and Diabetologia Expert Forum.

This article summarizes the current understanding of the heterogeneity of type 1 diabetes from a June 2024 international Expert Forum organized by the editors of Diabetes, Diabetes Care, and Diabetologia. The Forum reviewed key factors contributing to the development and progression of type 1 diabetes and outlined specific, high-priority research questions. Knowledge gaps were identified, and, notably, opportunities to harness disease heterogeneity to develop personalized therapies were outlined. Herein, we summarize our discussions and review the heterogeneity of genetic risk and immunologic and metabolic phenotypes that influence and characterize type 1 diabetes progression (presented as a palette of risk factors). We discuss how these age-related factors determine disease aggressiveness (along gradients) and describe how variable immunogenetic pathways aggregate (into networks) to affect β-cell and other pancreatic pathologies to cause clinical disease at different ages and with variable severity (described as disease-related thresholds). Heterogeneity of pathogenesis and clinical severity opens avenues to prevention and intervention, including the potential of disease-modifying immunotherapy and islet cell replacement. We conclude with a call for 1) continued research to identify more factors contributing to the disease, both overall and in specific subgroups; 2) investigations focusing on both individuals who surpass metabolic and immune thresholds and develop diabetes and those who remain disease free with the same level of immunogenetic risk; and 3) efforts to identify where the current type 1 diabetes staging system may fall short and determine how it can be improved to capture and leverage heterogeneity in prevention and intervention strategies.

Humans↗

PubMed2005

Developments in source monitoring: the role of thinking of others.

Adults' source judgments are more accurate when they focus on speakers' emotions than when adults focus on their own emotions. Focusing on speakers may lead to better source memory because it encourages processing of the perceptual characteristics of the source and binding of that information to the content of what is being said. The purpose of the current work was to evaluate whether young children's source memory similarly benefits from this outward encoding focus and whether this effect changes developmentally. In Experiment 1, when 4- and 5-year-olds heard an audiotape of two dissimilar speakers, only the 5-year-olds showed better source memory when asked to adopt an other-focus. In Experiment 2, when 4- and 5-year-olds watched a videotape of two similar speakers, the same pattern was found. However, in Experiment 3, when 4-year-olds watched a videotape of two dissimilar speakers (a more optimal encoding condition in which 5-year-olds showed ceiling performance), 4-year-olds benefited from taking an other-focus during encoding. Overall, the data suggest that the benefit for source memory of focusing on another person develops over the preschool years.

Child↗

PubMed2000

[Collective kitchens: the way to promote mental health].

Collective kitchens represent a relatively new social and community practice in the province of Quebec. They provide support that goes far beyond the food they supply, affecting the participants' life conditions and personal development. This qualitative study aimed to evaluate the effects that collective kitchens have on participants. We carried out semistructured interviews with a stratified sample of 25 people between the ages of 20 and 60, a majority of whom were single parents. These 20 women and 5 men were involved in 13 different groups for an average of 1 to 2 years. The results showed that the main reasons for participating in these groups were economic, nutritional, and psychosocial in nature. Prominent among the psychosocial reasons was a desire to overcome a feeling of isolation, which a majority of respondents perceived as one of the most disturbing features of their lives before they were involved in the collective kitchens. We identified 3 types of factors that influence the effects of the respondents' participation in collective kitchens: (a) factors related to the internal dynamics of each collective kitchen (their modes of functioning and organizational structure), (b) factors related to the personal situation of the participants and (c) factors related to the use of other services or to the participants' social involvement. The various effects differ not only in character (psychosocial, economic, nutritional, etc.) but also in the time they appeared in the participation process and in their direct or indirect links with participation in collective kitchens. It would be interesting in future research to evaluate whether the benefits of participation in collective kitchens identified in this study have a long-term impact on the lives of the people in these groups.

Adult↗

PubMed1998

The unified biosocial model of personality in schizophrenia families and controls.

This report describes the application of a unified biosocial model of personality developed by C.R. Cloninger to a sample of families identified through a proband with schizophrenia and a sample of controls. Families of schizophrenic patients were ascertained in USA and Austria. We could detect differences between females and males in their response to positive reinforcement (Reward Dependence) and differences between young and old people with respect to the response to new and/or exciting situations (Novelty Seeking). In general, results obtained for individuals from schizophrenia families and controls were similar. These results are not substantially influenced by psychiatric disorders in individuals. Psychiatric diagnosis may have an influence on the third dimension of Cloninger's model, designated Harm Avoidance. Analysis showed that patients with a diagnosis of schizophrenia or from the schizophrenia spectrum try harder to avoid punishment or aversive stimuli than family members with another psychiatric disorder or without a psychiatric diagnosis as well as controls. The results are promising and further research is needed to evaluate the structure of the proposed personality model in families and the relationship of personality to psychiatric status.

Adult↗

PubMed2007

Age-related macular degeneration and risk of coronary heart disease: the Atherosclerosis Risk in Communities Study.

OBJECTIVE: To examine the association of age-related macular degeneration (AMD) with incident coronary heart disease (CHD) and all-cause mortality. DESIGN: Population-based prospective cohort study. PARTICIPANTS: From the Atherosclerosis Risk in Communities Study (n = 12 536; age range, 49-73 years). METHODS: Participants had retinal photographs of one eye taken between 1993 and 1995. Photographs were evaluated for the presence of early and late AMD signs according to the Wisconsin grading system. Incident CHD events (acute myocardial infarction, silent myocardial infarction, fatal CHD, and cardiac revascularization procedures) and all-cause mortality were identified prospectively using standardized methods. MAIN OUTCOME MEASURES: Incident CHD events and all-cause mortality. RESULTS: Of 11,414 persons at risk of CHD, there were 555 (4.9%) with AMD at baseline, of whom 540 were early AMD and 15 were late AMD cases. Over a 10-year follow-up, 922 persons developed an incident CHD event. After controlling for age, gender, race, systolic and diastolic blood pressure, pack-years of cigarette smoking, and other variables, early AMD was not associated with incident CHD (relative risk, 1.08; 95% confidence interval, 0.82-1.42). However, individuals with late AMD were significantly more likely to have an incident CHD event, with 4 CHD events among the 15 participants with late AMD at baseline (10-year cumulative incidence, 30.9%) as compared with 918 CHD events among the 11 399 participants without late AMD (incidence of 10.0%; P = 0.049, Fisher exact test). In the full cohort (n = 12 536), early AMD was not significantly associated with all-cause mortality. However, individuals with late AMD were more likely to die (10-year cumulative mortality rate, 23.5%) than those without late AMD (mortality rate, 8.9%; P = 0.088, Fisher exact test). CONCLUSIONS: These data provide no evidence of an association between early AMD signs with incident CHD and all-cause mortality in middle-aged persons. Individuals with late AMD appear to have a higher rate of CHD events than those without late AMD, but due to a small number of late AMD cases, this finding should be interpreted cautiously.

Aged↗

PubMed2003

Assessing students' personal and professional development using portfolios and interviews.

BACKGROUND AND PURPOSE: Medical schools are placing more emphasis on students' personal and professional development (PPD) and are seeking ways of assessing student progress towards meeting outcome goals in relation to professionalism. The Faculty of Medicine at the University of Sydney sought an assessment method that would demonstrate the value of reflection in attaining PPD, provide feedback and encourage students to take responsibility for setting and achieving high standards of performance. METHODS: The instruments used to assess Year 1 students in PPD are a portfolio and interview. This assessment format encourages students to explore ideas and values that are important to them and relevant to the PPD theme. A confidential interview, based on the PPD goals, is held with a faculty member who has read the student's portfolio. RESULTS: In 1997/98, 96% of students agreed that they had engaged in useful reflection on their approach to the course and 91% agreed that the experience was worthwhile. A further 76% of students agreed that they could see opportunities to modify their approach in some ways as result of this exercise. CONCLUSION: Sustained PPD is essential in equipping doctors for the varied stresses of careers in medicine. Despite, or perhaps because of, the latitude in the Year 1 assessment, both students and faculty members found the process of value. This form of assessment acknowledges that the most valid assessment formats cannot always be made reliable and that in some parts of the curriculum it is more important to demonstrate trust in students' own motivation to become competent and mindful practitioners. The fact that the portfolio and interview are the only summative assessments in the first year emphasises the importance that the Faculty places on PPD.

Attitude of Health Personnel↗

PubMedDate not supplied

[An uncommon application of counseling in medicine: encountering death in education and in practice].

If scientific knowledge can be acquired through a series of learning strategies that are made easier by the tutorial system, personal and relational training is a more complex task. In fact, it means acquiring a particular mental structure that one only reaches with personal development. The emotional management of patients and of their relatives also requires a set of psychological and communicative abilities that are inborn predispositions, but have to be nurtured: learning from experience, sympathetic listening, self insight and understanding, attention towards transference and counter-transference, cannot be acquired from theory, but have to be experienced and verified hands-on. Living other people's emotional experience is not easy; sympathizing means being able to identify with them, but at the same time, to perceive oneself as separate. Moreover, the contact with suffering and sickness amplifies problems of the self, activating a set of emotions and defence mechanisms. One may get caught into other people's suffering, and be influenced by fear and anguish. Approaching illness, pain and death already represents a border-line experience. Students have to overcome the reassuring reality of theoretical study to carry out a strong and complex relational experience: that of a never-ending alternation of taking care and separation, of fulfilment and frustration, of continuous professional and personal testing. The emotional urge is varied and uninterrupted: managing patients cannot be reduced to a protocol of interventions technically defined.

Adult↗

PubMed2006

The art of observation: impact of a family medicine and art museum partnership on student education.

BACKGROUND AND OBJECTIVES: Compared to verbal communication, teaching the skill of observation is often shortchanged in medical education. Through a family medicine-art museum collaboration, we developed an elective course for second-year medical students titled the "Art of Observation" (AOO). To evaluate the course's effect on clinical skills, we performed a qualitative evaluation of former students during their clinical rotations. METHODS: In the spring of 2005, all students who had completed the AOO course in 2003 or 2004 were invited to take part in an online evaluation consisting of eight journaling survey questions. Students were instructed to answer the survey questions with specific examples. Question areas included the most memorable experience, the course's influence on the doctor-patient relationship, usefulness during clinical years of medical school, and skills unique to AOO. The anonymous data were analyzed qualitatively, coding the responses to categories derived from the data, leading to the formation of themes. RESULTS: Of the 19 students eligible, 17 participated. We found three important themes: (1) the AOO positively influenced clinical skills, (2) both art museum exercises and a clinical preceptorship were necessary to achieve those skills, and (3) the AOO led to a sense of personal development as a physician. In addition, students told us that the training in observation and description skills they learned were unique to the AOO. CONCLUSIONS: This collaboration between a department of family medicine and an art museum produced a course that facilitated observational skills used in successful doctor-patient relationships.

Art↗

PubMed2005

A team approach to musculo-skeletal disorders.

INTRODUCTION: The majority of patients with musculo-skeletal problems referred to hospitals in the UK have to wait for months, if not over a year, before finally seeing an orthopaedic surgeon. In Stobhill Hospital, Glasgow, the waiting time for an out-patient appointment was 182 days in 1995, with only 20% of the referrals requiring surgery. The aim of this paper was to reduce the out-patient waiting times based on a co-ordinated team approach. METHODS: An outpatient musculo-skeletal service was developed over a 7-year period at Stobhill Hospital. The traditional consultant-based model, in which the consultant and a trainee saw all new patients referred to the hospital, was gradually replaced with a team approach, based on continuous reconfiguration of the roles of the orthopaedic surgeon and rheumatologist and extending the roles of nurses, physiotherapists and podiatrists. This was achieved by: (i) protocol-based daily triage for all referrals to the most appropriate health professional in the team, by the senior out-patient nursing staff; (ii) allocation of appointments based on clinical priority, with a fast-track for urgent cases; and (iii) improvement of inter-disciplinary communication, facilitating the retraction as well as the extension of traditional roles. RESULTS: Despite the number of GP referrals to the orthopaedic out-patient department at Stobhill nearly doubling in a period of 5 years, the out-patient waiting time decreased by about 50% (90 days from 182 days). This reduction in waiting times improved patient and GP satisfaction levels. We also noticed an improved morale and personal development of the health professionals as they saw patients appropriate to their skills and expertise. CONCLUSION: The team's experience demonstrates the effectiveness of a team approach in tackling what is often seen as the insoluble problem of orthopaedic waiting times. This is based on excellent communication and collaboration, with a clear aim of improving patient care that is evidence based.

Clinical Protocols↗

PubMed2004

Development of respiratory motion reduction device system (RMRDs) for radiotherapy in moving tumors.

BACKGROUND: The internal target volume (ITV) for tumors in the abdomen or thorax includes sufficient margin for breathing-related movement of tumor volumes during treatment. Depending on the location of the tumor, the magnitude of the ITV margin extends from 1 to 3 cm, which increases substantially the volume of the irradiated normal tissue, hence resulting in an increase in normal tissue complication probability (NTCP). We developed a simple and handy method which can reduce ITV margins in patients with moving tumors: the respiratory motion reduction device system (RMRDs). METHODS: The patient's clinical database was structured for moving tumor patients and patient set-up error measurement and immobilization device effects were investigated. The system is composed of the respiration presser device (RPD) utilized in the prone position and the abdominal strip device (ASD) utilized in the supine position, and the analysis program, which enables analysis of patient set-up reproducibility. It was tested for analyzing the diaphragm movement from patients with RMRDs, the magnitude of the ITV margin was determined and the dose-volume histogram (DVH) was computed using treatment planning software. The dose to normal tissue in patients with and without RMRDs was analyzed by comparing the fraction of the normal liver receiving 50% of the isocenter dose. RESULTS: Average diaphragm movement due to respiration was 16 +/- 1.9 mm in the case of the supine position, and 12 +/- 1.9 mm in the case of the prone position. When utilizing the RMRDs, which was personally developed in our hospital, the value was reduced to 5 +/- 1.4 mm, and in the case in which the belt immobilization device was utilized, the value was reduced to 3 +/- 0.9 mm. In the case where the strip device was utilized, the value was proven to reduce to 4 +/- 0.3 mm. As a result of analyzing the volume of normal liver where 50% of the prescription dose is irradiated in DVH according to the radiation treatment planning, the use of the RMRD can create a reduction of 30% to the maximum. Also by obtaining the digital image, the function of comparison between the standard image, automated external contour subtraction, etc. was utilized to develop a patient set-up reproducibility analysis program that can evaluate the change in patient set-up. CONCLUSION: Internal organ motion due to breathing can be reduced using RMRDs, which is simple and easy to use in the clinical setting. It can reduce the organ motion-related planning target volume margin, thereby decreasing the volume of irradiated normal tissue.

Humans↗