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PubMed2002

Massage and aromatherapy massage: nursing art and science.

This article begins by reviewing the place of complementary therapies in palliative care from the perspective of UK professional organizations, namely the Nursing and Midwifery Council (NMC) (formerly the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC)) and the British Medical Association (BMA). It then reviews recent research on the use of massage and aromatherapy massage in palliative care and comments on their credibility and implications, thereby addressing nursing science. The art of nursing is explored through four case histories where massage was used intuitively when words were difficult or seemed inadequate. To conclude, by focusing on the therapies provided by a UK hospice, there is consideration of the practicalities of implementing massage and aromatherapy massage in a specialist palliative care unit.

Adolescent↗
PubMed1991

Crack cocaine: what constitutes state of the art treatment?

The paper presents a standard against which treatments should be measured; it recognizes the importance of a biopsy-chosocial approach to crack addiction, individualized assessment of patients to determine their needs, matching patients to interventions of appropriate intensity, timing the delivery of specific interventions in accordance with the phase of recovery a patient is negotiating, delivering relapse prevention, and appreciating crack smokers' characteristics. Summary analysis of two state of the art outpatient treatment models permits identification of key features of such programs. Analysis reveals that outpatient programs achieve excellence in service delivery to crack patients by referring the most severely addicted to inpatient treatment first and providing comprehensive and intensive outpatient services on a nearly daily basis for six months to a year. Recommendations for policymakers, administrators, treatment professionals, and researchers are provided in light of the paper's analysis.

Ambulatory Care↗
PubMed1995

Homelessness and substance use among alcohol abusers following participation in project H&ART.

Project H&ART was a randomized intervention trial for homeless alcohol abusers in Albuquerque, N.M. Interventions were four months in duration and included: a high intensity program (case management plus peer-supervised housing), a medium intensity group (peer-supervised housing only); a housed, and a nonhoused control group. Clients were interviewed at baseline and re-interviewed ten months following program entry to determine substance use, housing stability and employment status. Program graduation rates were about 25% for the three housed groups. The outcome evaluation revealed significant within groups improvements in all of the outcomes, no between groups or racial outcome differences, and more favorable alcohol use and housing stability outcomes among program graduates than dropouts. On follow-up, women in the study had fewer days of alcohol use and had more days of stable housing, but were less likely to be employed, compared with men. We suggest that clients' personal motivation for recovery, rather than program-related factors, were most influential in determining outcomes.

Adolescent↗
PubMed1990

Boys in art. The artist and his model: Ferdinand and Hector Hodler. A new approach.

In literature serious attention is rarely paid to the theme of "the boy in art," although many artists used and still use boys as a medium for their message. By a detailed analysis of the symbolism in a series of paintings by Ferdinand Hodler (1853-1918), the author attempts a reinterpretation of the pictures this Swiss artist made of his young son Hector. The author rejects traditional Freudian speculations and uses a hitherto neglected and repudiated source for understanding Hodler's symbolism, the social and artistic ideas of a circle of Rosicrucians to which the painter adhered.

Adult↗
PubMed2002

Attitudes toward gay, lesbian, and bisexual persons among heterosexual liberal arts college students.

This research focuses on attitudes toward homosexuals and homosexuality among 692 heterosexual students at six liberal arts colleges. Attitudes, assessed in a variety of ways, are examined in relation to students' Greek affiliation, sex role attitudes, religion and religiosity, and contact with and knowledge of gays, lesbians, and bisexuals. Results suggest that attributes predicting acceptance of gay, lesbian, and bisexual persons are female sex, liberal sex-role attitudes, lower religiosity as measured both by beliefs and by attendance, membership in more liberal Protestant denominations, attendance at colleges that do not have Greek letter social organizations, and having positive contacts with gay, lesbian, and/or bisexual persons.

Attitude↗
PubMed2006

The (soon forgotten) art of open stone surgery: to train or not to train?

To date, open stone surgery is now performed in a very limited number of selected cases. A review of our own cases revealed that open surgery constituted 1% of all procedures. These procedures were mostly ablative, or operations to deal with complications of failed minimally invasive therapies. Given two continuing trends towards sub-specialisation in urology on the one hand, and minimally invasive therapy on the other, the question arises whether and how sub-specialised stone surgeons should and can learn open stone surgery. Is it merely a lost art not to be bothered with, or is it something worthwhile preserving? This article discusses the pros and cons of the argument and suggests centralisation of complex stone cases as a possible way out of the dilemma.

Education, Medical, Graduate↗
PubMedDate not supplied

Fosamprenavir clinical study meta-analysis in ART-naïve subjects: rare occurrence of virologic failure and selection of protease-associated mutations.

BACKGROUND: In recent ritonavir-boosted protease inhibitor (PI) studies, high efficacy rates have been observed, with few PI mutations detected. METHOD: To better understand the types of mutations observed and their phenotypic impact and the likelihood of virologic failure (VF) on a regimen that includes either a ritonavir-boosted or unboosted PI, fosamprenavir, a meta-analysis of three studies (NEAT, SOLO, and KLEAN) of 922 ART-naïve participants receiving boosted (FPV/r) or unboosted fosamprenavir (FPV) plus abacavir/lamivudine was performed. 70% of participants by the missing and discontinuation equals failure analysis and 95% by the observed analysis had HIV-RNA <400 copies/mL through 48 weeks. Paired genotypes (baseline and follow-up) were obtained for 74/85 participants meeting VF analysis criteria. RESULTS: FPV-associated resistance mutations were detected in 5/74 patients with VF, with 4/5 receiving unboosted FPV; in four patients viruses developed I54L or M and one developed the V32I+I47V combination. No virus from patients with VF receiving FPV/r had reduced FPV susceptibility (RS), whereas virus from 3/4 of participants with VF who received unboosted FPV and who acquired FPV mutations had FPV RS. Little PI cross-resistance was detected in the VF virus; RS was observed for lopinavir, saquinavir, nelfinavir, atazanavir, and indinavir in 0, 0, 2, 0, and 1 of 5 subjects, respectively. CONCLUSION: These data suggest that inclusion of FPV as part of an initial HIV-treatment regimen is associated with low rates of VF. Selection of FPV resistance-associated mutations is unlikely, especially for FPV/r-containing regimens. If selection of FPV-associated mutations does occur, a second-line PI-containing regimen can be easily constructed.

Anti-HIV Agents↗
PubMed2004

Fluorescence lifetime imaging and spectroscopy as tools for nondestructive analysis of works of art.

A system for advanced fluorescence investigation of works of art has been assembled and integrated in a characterization procedure that allows one to localize and identify organic compounds that are present in artworks. At the beginning of the investigation, fluorescence lifetime imaging and spectroscopy address a selective microsampling of the artwork. Then analytical measurements of microsamples identify the chemical composition of the materials under investigation. Finally, on the basis of fluorescence lifetime and amplitude maps, analytical data are extended to the whole artwork. In such a way, information on the spatial distribution of organic materials can be inferred. These concepts have been successfully applied in an extensive campaign for analysis of Renaissance fresco paintings in Castiglione Olona, Italy. Residue of various types of glue and stucco left from a restoration carried out in the early 1970s was localized and classified. Insight into the technique used by the painter to make gilded reliefs was also obtained.

Journal Article↗
PubMed2005

Experimental comparison of a Kerr nonlinearity figure of merit including the stimulated Brillouin scattering threshold for state-of-the-art nonlinear optical fibers.

We introduce a new figure of merit (FOM) including the input pump power limit associated with stimulated Brillouin scattering (SBS) for evaluation of the Kerr nonlinearity efficiency of optical fibers. The new FOM is expressed as gammaL(eff)P(SBS) (gamma is a nonlinearity parameter, L(eff) is effective length, and P(SBS) is the SBS threshold), while the conventional FOM is given by gammaL(eff). Using the new FOM, we perform an efficiency comparison among four types of state-of-the-art nonlinear optical fiber: a Bi2O3-based nonlinear fiber, a silica-based holey fiber, a highly nonlinear dispersion-shifted fiber, and a conventional dispersion-shifted fiber. The Bi2O3-based nonlinear fiber is found to have the best Kerr nonlinearity efficiency owing to the superior nonlinear property of the Bi2O3 glass compared with that of the silica.

Journal Article↗
PubMedDate not supplied

The art and complexity of primary care clinicians' preventive counseling decisions: obesity as a case study.

PURPOSE: Studies have often shown low rates of preventive counseling in primary care, and interventions aimed at improving counseling rates have had disappointing results. Using obesity as a case study, we looked for factors that influence clinicians' decisions to include preventive counseling in the brief primary care encounter. METHODS: A sequential, mixed methods study was conducted among clinicians in RIOS (Research Involving Outpatient Settings) Net, a Southwestern US practice-based research network. Thirty primary care clinicians participated in in-depth interviews or analytic focus groups, and 75% of 195 network members responded to a survey used to estimate the frequency of factors influencing decisions to undertake preventive counseling. RESULTS: Clinicians described a complex set of factors that influence decisions to provide preventive counseling for obesity. These can be grouped into 2 sets of factors: (1) relatively stable factors that "set the stage" for the encounter, such as the clinician's life values, definitions of success, and the availability of community resources; and (2) factors that are more dynamic, exerting their influence "as the door opens" into the examination room. These factors include the patient's agenda and receptivity to the proposed counseling, as well as the presence of teachable moments. Clinician, patient, and external factors are found in both groups. CONCLUSIONS: Clinician decisions to include obesity and other types of preventive counseling in the brief encounter reflect the art and complexity of management of the encounter. Future efforts to enhance the delivery of preventive counseling will need to move beyond linear models of behavior change to recognize this complex environment.

Adult↗
PubMed1997

Small cell lung cancer: state-of-the-art therapy in 1996.

Small cell lung cancer (SCLC) occurs almost exclusively in smokers and represents 15 to 25% of all lung cancer histologic findings. It is distinguished from non-small cell lung cancer by its rapid tumor doubling time, high growth fraction, and early development of widespread metastases. Since patients with SCLC usually present with disseminated disease, treatment strategies have focused on systemic therapy. Single-agent and combination chemotherapy, as well as combined-modality therapy, have produced high response rates (80 to 100% for limited disease; 60 to 80% for extensive disease), but these tend to be short-lived (median duration, 6 to 8 months). Survival beyond 5 years occurs in only 3 to 8% of all patients with SCLC. At least 15 to 20 different chemotherapeutic agents have shown major activity against SCLC in both the untreated and relapsed settings, including etoposide, teniposide, cisplatin, carboplatin, ifosfamide, cyclophosphamide, vincristine, and doxorubicin. This paper reviews state-of-the-art treatment strategies being employed in the treatment of SCLC, including those incorporating high-dose intensive therapy, salvage therapy, new agents, thoracic radiotherapy, prophylactic cranial radiotherapy, surgical resection, and biologic response modifiers.

Antineoplastic Agents↗
PubMed2005

State of the art: gastrointestinal malignancies in the human immunodeficiency virus (HIV) population.

The gastrointestinal tract is one of the most common sites for the development of primary neoplasms arising in patients with pre-existing infection with the human immunodeficiency virus (HIV). Over the past decade, new information on the clinical manifestation, natural history, treatment options, and related toxicity have been reported, mostly notably the integration of highly active antiretroviral therapy (HAART). The following is a concise review summarizing the current state-of-the-art for GI tract malignancies in the HIV-positive patient and is designed to assist the clinical oncology team in developing a rationale plan when caring for these patients.

Antiretroviral Therapy, Highly Active↗
PubMed2005

State of the art and science of endodontics.

BACKGROUND: Advances in the art and science of endodontics have facilitated better understanding of disease processes and have led to development of treatment modalities aimed to restore health to the pulp and periradicular tissues. This article presents a summary of both basic and clinical breakthroughs in endodontics. RESULTS: The author indicates that, on the basis of the reviewed literature, pulp and periradicular diseases are primarily microbial. Basic research has led to development of methodologies that have allowed for specific and accurate identification of pathogens that are likely to cause persistent infections. Close examination of clinical data shows that meticulous débridement of the infected root canal system will result in a high probability of successful treatment outcome. Progress in visualization, mechanical and chemical disinfection, and biological seal of portals of entry will improve quality of care further. CONCLUSIONS AND CLINICAL IMPLICATIONS: A better understanding of the pathogenesis of pulp and periradicular diseases, inflammation and healing, as well as of pain pathways, will improve patient care and result in preservation of natural tissues.

Dental Pulp Diseases↗
PubMed2004

This art of psychoanalysis. Dreaming undreamt dreams and interrupted cries.

It is the art of psychoanalysis in the making, a process inventing itself as it goes, that is the subject of this paper. The author articulates succinctly how he conceives of psychoanalysis, and offers a detailed clinical illustration. He suggests that each analysand unconsciously (and ambivalently) is seeking help in dreaming his 'night terrors' (his undreamt and undreamable dreams) and his 'nightmares' (his dreams that are interrupted when the pain of the emotional experience being dreamt exceeds his capacity for dreaming). Undreamable dreams are understood as manifestations of psychotic and psychically foreclosed aspects of the personality; interrupted dreams are viewed as reflections of neurotic and other non-psychotic parts of the personality. The analyst's task is to generate conditions that may allow the analysand--with the analyst's participation--to dream the patient's previously undreamable and interrupted dreams. A significant part of the analyst's participation in the patient's dreaming takes the form of the analyst's reverie experience. In the course of this conjoint work of dreaming in the analytic setting, the analyst may get to know the analysand sufficiently well for the analyst to be able to say something that is true to what is occurring at an unconscious level in the analytic relationship. The analyst's use of language contributes significantly to the possibility that the patient will be able to make use of what the analyst has said for purposes of dreaming his own experience, thereby dreaming himself more fully into existence.

Dreams↗
PubMed2004

Nanoparticle-mediated gene delivery: state of the art.

With the development of genomic and proteomic technologies, the prospect for gene therapy has progressed rapidly. This has been partly possible due to the emergence of a diverse array of polymeric and non-polymeric nanoparticles that are being investigated for their ability to deliver genes and drugs. In this review, particles have been pragmatically divided as chitosan-related and chitosan-unrelated nanomaterials. The state of the art in terms of the development, characterisation and evaluation of their in vitro and/or in vivo potential is discussed for each of these various particles. Although substantial progress has been made, the potential of these particles in the clinical arena and human responses remain to be evaluated. It is hoped that this review will provide an impetus for further studies of these particles, with the ultimate intent that one or more of these diverse nanoparticle-based non-viral approaches for gene transfer will translate from 'bench to bedside' in the future.

Animals↗
PubMed2002

Preservation of fertility in nature and ART.

Individuals may regard reproduction as optional but sufficient number of them must be productive to perpetuate the species. The reproductive system is surprisingly vulnerable and depends, among other things, on a limited endowment of oocytes, controlled proliferation of spermatogonial stem cells and the genetic integrity of both. The developmental competence of oocytes and spermatogonial stem cells is maintained by evolved mechanisms for cellular detoxification and genomic stability, and excess or damaged cells are eliminated by apoptosis. Gonadal failure as a result of germ cell depletion can occur at any age, and from the effects of chemical cytotoxicity, disease and infection as well as genetic predisposition. Among extrinsic factors, alkylating agents and ionizing radiation are important causes of iatrogenic gonadal failure in young women and men. In animal models, there is evidence that hormonal manipulation, deletion of genes involved in apoptotic pathways and dietary manipulation can protect against natural and induced germ cell loss, but evidence in humans is absent or unclear. Assisted reproductive technologies (ARTs) provide an ensemble of strategies for preserving fertility in patients and commercially valuable or endangered species. Semen cryopreservation was the first technology for preserving male fertility, but this cannot serve prepubertal boys, for whom banking of testicular biopsies may provide a future option. In sterilized rodents, cryopreserved spermatogonial stem cells can recolonize seminiferous tubules and reinitiate spermatogenesis, and subcutaneous implantation of intact tubules can generate spermatozoa for fertilization in vitro by intracytoplasmic sperm injection. Transplantation of frozen-banked ovarian tissue is well-established for restoring cyclicity and fertility and is currently undergoing clinical evaluation for cancer patients. When restoration of natural fertility is unnecessary or reimplantation is unsafe, it is desirable to culture the germ cells from thawed tissue in vitro until they reach the stage at which they can be fertilized. Low temperature banking of immature germ cells is potentially very versatile, but storage of embryos and, to a lesser extent, mature oocytes is already practised in a number of species, including humans, and is likely to remain a mainstay for fertility preservation.

Animals↗
PubMed2003

Children and adolescents with eating disorders: the state of the art.

BACKGROUND: Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues. OBJECTIVES: This article builds on previous background and position papers outlining issues relevant to the care of the adolescent patient with an eating disorder. METHODS: The eating disorder special interest group from the Society for Adolescent Medicine recognized the need to update the state of the art published guidelines for the care of the adolescent patient with an eating disorder. This article was a multidisciplinary, group effort to summarize the current knowledge of best practice in the field. RESULTS: This article summarizes newer findings on pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, care from the primary care clinician's perspective, appropriate use of a multidisciplinary team, and issues of managed care and reimbursement. CONCLUSIONS: Primary prevention combined with early recognition and treatment helps decrease morbidity and mortality in adolescents with eating disorders.

Adolescent↗
PubMed2004

Innovative technologies for the assessment of cardiovascular medical devices: state-of-the-art techniques for artificial heart valve testing.

Prosthetic heart valves (PHVs) are engineered devices used for replacing diseased natural cardiac valves. This article presents several investigational techniques for the evaluation of the performance of these clinical devices, whose implantation is not completely free of drawbacks. The state-of-the-art in the technological approach for PHV testing is addressed. As the fluid dynamics of PHVs are particularly complex, the main focus will be on experimental velocimetric techniques and computational analysis. A methodology for the analysis of the valve's signature, in terms of its characteristic sound in the opening and closing phases, is also presented. The aforementioned techniques are necessary to guarantee an operational life of the implanted device as free as possible from clinical complications. It can be realistically expected that this characterization will help designers in improving PHV performance.

Biotechnology↗