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PubMed2005

Creative solutions: Innovative use of the arts in mental health settings.

A recent study of occupational stress on the unit (Clare, 2004) highlighted that staff valued the importance of the socialization process in reducing their stress levels. This process incorporates the need for peer support and acceptance, and an understanding of what is expected of them (e.g., roles and responsibilities), supported by a culture of learning, problem solving, and working together. This process is similar to the approach taken by the arts project in nurturing ideas and initiatives in a safe, respectful way. It is apparent that the arts project has been more than just a creative activity; it has had wider implications for both staff and service users in reducing stress. It has: * Enabled staff retention. In fact, there is a waiting list of nurses wishing to work on the unit. * Reduced incidents of damage to property. * Reduced use of p.r.n. medication. * Enhanced the good reputation of the service, which is often commented on by visitors to the unit. The arts project promotes well-being and lifelong learning for the ward community through meaningful engagement in creative activity.

Art↗
PubMed1998

Textural modification of processing tomatoes.

Knowledge of the textural properties of processing tomatoes is crucial to ensuing product acceptability; measurement, control, and optimization of these properties through judicious selection of varieties and control of unit operations results in products that the consumer prefers. It is important to first define the terms texture, rheology, consistency, and viscosity prior to discussing principles of their measurement. The textural properties of processing tomatoes may be measured using both sensory and objective tests, and the latter may be either destructive or nondestructive in nature. The unique anatomy of tomato fruit (peel, pericarp, columella, and locules) in part dictates the method of texture measurement. Numerous factors, including variety, maturity, genetic modification, cultural particles, and environmental conditions, processing conditions, and calcium addition affect the textural integrity of tomatoes. Textural properties of raw tomatoes and most processed tomato products are reviewed in this article.

Food Handling↗
PubMed1998

Non-interpretive mechanisms in psychoanalytic therapy. The 'something more' than interpretation. The Process of Change Study Group.

It is by now generally accepted that something more than interpretation is necessary to bring about therapeutic change. Using an approach based on recent studies of mother-infant interaction and non-linear dynamic systems and their relation to theories of mind, the authors propose that the something more resides in interactional intersubjective process that give rise to what they will call 'implicit relational knowing'. This relational procedural domain is intrapsychically distinct from the symbolic domain. In the analytic relationship it comprises intersubjective moments occurring between patient and analyst that can create new organisations in, or reorganise not only the relationship between the interactants, but more importantly the patient's implicit procedural knowledge, his ways of being with others. The distinct qualities and consequences of these moments (now moments, 'moments of meeting') are modelled and discussed in terms of a sequencing process that they call moving along. Conceptions of the shared implicit relationship, transference and countertransference are discussed within the parameters of this perspective, which is distinguished from other relational theories and self-psychology. In sum, powerful therapeutic action occurs within implicit relational knowledge. They propose that much of what is observed to be lasting therapeutic effect results from such changes in this intersubjective relational domain.

Countertransference↗
PubMed1994

How well does a journal's peer review process function? A survey of authors' opinions.

OBJECTIVE: To evaluate the authors' satisfaction or dissatisfaction with the peer review process of the Journal of Clinical Anesthesia. DESIGN: Anonymous questionnaires were sent to authors to survey their opinions about specific aspects of the peer review process. Authors were grouped by status of their manuscripts: AR (accept with revision), RR (reject but may resubmit), and RO (reject outright). PARTICIPANTS: Authors of unsolicited manuscripts submitted in 1991 to 1992. MAIN OUTCOME MEASURES: Factors that determine authors' satisfaction with the relevancy and benefit of peer review of their manuscript. RESULTS: Significantly more authors of AR manuscripts responded to our survey than did authors of rejected manuscripts and viewed the review process more favorably. Authors of AR manuscripts were more satisfied with specific aspects of the review process, which led to improvement in their manuscripts. More authors of RR manuscripts believed that our review process improved subsequent manuscript preparation than did authors of accepted manuscripts. CONCLUSIONS: The surveying of authors, important clients of the peer review process, should guide change necessary to better serve our authors and improve peer review.

Attitude↗
PubMed1992

The castability of unalloyed titanium in three different casting machines.

The general demand for a variety of fine detail work made of titanium has resulted in the development of equipment/systems for the casting of this metal. Dental casting machines suitable for the casting of titanium are now also available. The aim of the present study was therefore to evaluate the possibility of precision casting of dental crown restorations of unalloyed titanium. The three kinds of casting equipment currently used in Sweden were tested by evaluating the crown edge diameter of 10 titanium crowns processed by each one of the titanium casting machines. The results revealed that clinically acceptable margins can be obtained but also that further improvements in processing have to be achieved before titanium casting can be considered as uncomplicated as the casting of traditional dental gold alloys.

Crowns↗
PubMed1981

Ethics and health planning: implications for education.

Over the past decade in this country, there has been a rekindling of interest in the ethical questions of public policy. Moreover, the concern for ethical issues is nowhere more evident than in the field of health care. However, the ethical problems of health planning, particularly as practiced at the regional level, have scarcely received attention. This article explores the ethical dimensions of health planning and argues that health planners have not been adequately prepared, neither through their education nor through socialization in the profession, to deal with the complex ethical issues facing them. However, health planning theory can be enriched and practice improved if the ethical issues are confronted. Health planning is viewed as one means of achieving social justice because the benefits and burdens associated with health care are distributed to the members of society by the decisions made in the health planning process. However, planning decisions are not meekly accepted by the persons affected. More often than not, health planning decisions produce substantial political controversy, which is due, in part, to the planning methods commonly used. The synoptic or comprehensive planning approach avoids ethical questions by ignoring them. The incremental planning approach deals with them but only in terms of political process. Neither of these approaches is particularly useful for resolving health planning's ethical questions. The implications of these findings for education in health planning are discussed. The merits of the case study as a means of ethical education are presented.

Ethical Analysis↗
PubMed1991

Image salvage in panoramic radiography using histogram optimization.

Optical density and contrast recovery from poor quality panoramic radiographs was studied using the histogram modification technique. A series of experimental images of varying density and contrast were obtained by exposing a phantom in 4 kV steps between 50 and 94 kV. A standard of good image quality was selected by 10 observers grading the radiographs. Images were processed using the histogram specification technique and re-evaluated. All the processed images were found to be of acceptable quality. This technique was also shown to be applicable for salvaging unacceptable clinical radiographs.

Humans↗
PubMed2004

Electronic Clinical Communications Implementation (ECCI) in Scotland: a mixed-methods programme evaluation.

AIMS: The Electronic Clinical Communications Implementation programme aims to facilitate implementation of electronic systems for primary-secondary care communication, focusing on laboratory results reporting, outpatient appointment booking, referral, discharge and clinic correspondence, and clinical e-mail. This independent programme evaluation explored the processes and outcomes of implementation, barriers and facilitators to system adoption, and benefits and drawbacks for professional users. METHODS: The mixed methods approach incorporated document review, surveys, stakeholder interviews, consensus exercises, and monthly recording of quantitative process and outcome variables. RESULTS: Qualitative and survey work highlighted wide variation in the technologies and implementation approaches adopted. A consensus process was used to instigate a national minimum dataset. To date, implementation of laboratory results reporting has demonstrated the greatest success and electronic outpatient booking the least. A mixed-format survey of users in clinical practice revealed a more detailed picture of behaviour and attitudes demonstrating that where systems are available and accepted they are utilized, while product usability, process complexity and user-engagement methods influence uptake. CONCLUSIONS: The evaluation has demonstrated the difficulties faced when attempting to implement a multifaceted technological and behavioural change intervention on a national scale, but has also revealed unexpected benefits, including general improvements in Information Management & Technology capability across the Scottish health service.

Efficiency, Organizational↗
PubMed1998

Autoimmunity, immunodeficiency and mucosal infections: chronic intestinal inflammation as a sensitive indicator of immunoregulatory defects in response to normal luminal microflora.

Despite the fact that target antigens and the genetic basis of several autoimmune diseases are now better understood, the initial events leading to a loss of tolerance towards self-components remain unknown. One of the most attractive explanations for autoimmune phenomena involves various infections as possible natural events capable of initiating the process in genetically predisposed individuals. The most accepted explanation of how infection causes autoimmunity is based on the concept of "molecular mimicry" (similarity between the epitopes of an autoantigen and the epitopes in the environmental antigen). Infectious stimuli may also participate in the development of autoimmunity by inducing an increased expression of stress proteins (hsp), chaperones and transplantation antigens, which leads to abnormal processing and presentation of self antigens. Superantigens are considered to be one of the most effective bacterial components to induce inflammatory reactions and to take part in the development and course of autoimmune mechanisms. It has long been known that defects in the host defense mechanism render the individual susceptible to infections caused by certain microorganisms. Impaired exclusion of microbial antigens can lead to chronic immunological activation which can affect the tolerance to self components. Defects in certain components of the immune system are associated with a higher risk of a development of autoimmune disease. The use of animal models for the studies of human diseases with immunological pathogenesis has provided new insights into the influence of immunoregulatory factors and the lymphocyte subsets involved in the development of disease. One of the most striking conclusion arising from work with genetically engineered immunodeficient mouse models is the existence of a high level of redundancy of the components of the immune system. However, when genes encoding molecules involved in T cell immunoregulatory functions are deleted, spontaneous chronic inflammation of the gut mucosa (similar to human inflammatory bowel disease) develops. Surprisingly, when such immunocompromised animals were placed into germfree environment, intestinal inflammation did not develop. Impairment of the mucosal immune response to the normal bacterial flora has been proposed to play a crucial role in the pathogenesis of chronic intestinal inflammation. The use of immunodeficient models colonized with defined microflora for the analysis of immune reactivity will shed light on the mode of action of different immunologically important molecules responsible for the delicate balance between luminal commensals, nonspecific and specific components of the mucosal immune system.

Animals↗
PubMedDate not supplied

Cardiovascular applications of magnetic resonance imaging and phosphorus-31 spectroscopy.

Recent advances in cardiovascular applications of magnetic resonance (MR) imaging and phosphorus-31 spectroscopy are reported. MR velocity mapping is a valuable adjunct to conventional imaging techniques, providing information on flow velocities as well as on absolute blood flow volume in the aorta and pulmonary arteries. Recently, ultrafast MR techniques have become available to evaluate myocardial perfusion with the aid of MR contrast agents as perfusion marker. Dynamic MR imaging is a powerful tool to assess cardiac function and ventricular mass. In particular, right ventricular function and mass can be evaluated with great accuracy, contributing to improved assessment of the significance of disease processes which may affect the right heart. The role of phosphorus-31 spectroscopy of the heart is expanding for the evaluation of ischemic myocardial disease and cardiomyopathies. The phosphocreatine to adenosine triphosphate ratio appears to be a marker of disease in patients with cardiac hypertrophy. In conclusion, MR imaging and phosphorus-31 spectroscopy is gaining widespread acceptance for evaluation of many cardiovascular disease processes.

Heart↗
PubMed1998

Progress in ultrasonic bioreactors for CELSS applications.

An important issue in Controlled Ecological Life Support Systems (CELSS) is the recycling of inedible crop residues to recover inorganic plant nutrients such as nitrates, phosphates, potassium and other macro- and micro-nutrients. In a closed system in space, such regeneration is vital to the long term viability of plant growth necessary for the food production and waste handling process. Chemical approaches to recycling such as incineration and wet oxidation are not compatible with low energy and environmentally friendly regeneration of such nutrients. Biological regeneration is more acceptable environmentally, but it is a very slow process and does not typically result in complete recovery of inorganic and organic nutrients. A new approach to biological regeneration is described here involving the combined use of special enzymatic catalysts and ultrasonic energy in a bioreactor system. This new system has the potential for rapid, efficient, environmentally friendly and complete conversion of crop wastes to inorganic plant nutrients and food recovery from cellulose materials. A series of experimental tests were carried out with a soybean crop residue meal substrate. Biochemical conversion rates were significantly expedited with the addition of enzymes and further enhanced through ultrasonic stimulation of these enzymes. The difference in conversion rates was particularly increased after the initial period of soluble organics conversion. The remaining cellulose substrate is much more difficult to biodegrade, and the ultrasonically-enhanced reaction was able to demonstrate a much higher rate of substrate conversion.

Biodegradation, Environmental↗
PubMed2006

Conformationally gated photoinduced processes within photosensitizer-acceptor dyads based on osmium(II) complexes with triarylpyridinio-functionalized terpyridyl ligands: insights from experimental study.

[(ttpy)Os(tpy-ph-TPH(3)(+))](3+) (2), [(ttpy)Os(tpy-xy-TPH(3)(+))](3+) (3), [(ttpy)Os(tpy-ph-TPH(2)(NO(2))(+))](3+) (4), and [(ttpy)Os(tpy-xy-TPH(2)(NO(2))(+))](3+) (5) are a series of dyads made of an Os(II) bis-tpy complex (tpy = 2,2':6',2"-terpyridine) as the photosensitizer (P) and 2,4,6-triarylpyridinium group (TP(+)) as the electron acceptor (A). These dyads were designed to form charge-separated states (CSS) upon light excitation. Together with analogous Ru(II) complexes (7-10), they have been synthesized and fully characterized. We describe herein how intramolecular photoinduced processes are affected when the electron-accepting strength of A (by nitro-derivatization of TP(+)) and/or the steric hindrance about intercomponent linkage (by replacing a phenyl spacer by a xylyl one) are changed. Electronic absorption and electrochemical behavior revealed that (i) chemical substitution of TP(+) (i.e., TP(+)-NO(2)) has no sizable influence on P-centered electronic features, (ii) reduction processes located on TP(+) depend on the intercomponent tilt angle. Concerning excited-state properties, photophysical investigation evidenced that phosphorescence of P is actually quenched in dyads 4 and 5 only. Ultrafast transient absorption (TA) experiments allowed attributing the quenching in conformationally locked dyad 5 to oxidative electron transfer (ET) from the (3)MLCT level to the TP(+)-NO(2) acceptor (k(el) = 1.1 x 10(9) s(-)(1)). For 4, geometrically unlocked, the (3)MLCT state was shown to first rapidly equilibrate (reversible energy transfer; k(eq) approximately 2 x 10(9) s(-)(1)) with a ligand centered triplet state before undergoing CSS formation. Thus, the pivotal role of conformation in driving excited-state decay pathways is demonstrated. Also, inner P structural planarization as a relaxation mode of the (3)MLCT states has been inferred from TA experiments.

Electrons↗
PubMed1994

A comparative evaluation of the percent acceptable end-rounded bristles: Butler G.U.M., Colgate Plus, Crest Complete, and Reach.

Many researchers have concluded that end-rounded toothbrush bristles reduce the potential of soft tissue trauma. Toothbrushes with a rippled-bristle pattern have been shown to more effectively remove dental plaque from interproximal surfaces than flat-trimmed toothbrushes. Unfortunately, many attempts to utilize rippled-bristle toothbrushes are fraught with difficulty due to poor end-rounding of these bristles in the traditional manufacturing process. In this study, the proportion of acceptably end-rounded bristles has been compared for a rippled bristle design toothbrush (Crest Complete), a traditional flat-trimmed brush (Colgate Plus), a bi-level brush (Reach), and a domeshaped brush (Butler G.U.M. 411). Toothbrush bristles were examined using a stereomicroscope by a grader blind to brush type, and bristle end-rounding was evaluated based on the Silverstone and Featherstone scale used previously in the literature. The results were tabulated for the percent of bristles with acceptable grades, summed, and averaged for five random bristles per tuft, five random tufts per brush, for 30 brushes of each type. Bristles in the Crest Complete toothbrush demonstrated 96.5% acceptable end-rounding. These results were significantly different (p = 0.0001) from those found in the other brushes tested: 34.3% (Reach), 16.1% (Colgate Plus), and 14.0% (Butler G.U.M.) acceptable end-rounding was observed. These results demonstrate that the newly designed rippled-bristle brush (Crest Complete) exhibits excellent bristle end-rounding.

Analysis of Variance↗
PubMed2000

[Is there pancreatic regeneration? Morphological and functional certification after a corporocaudal splenopancreatectomy/].

INTRODUCTION: The process of pancreatic regeneration, well known and accepted, is less known than the hepatic and includes different mechanisms and factors. Pancreatic regeneration is better known in acute pancreatitis. After an extensive pancreatic necrosis, the morphological and functional regeneration is assessed by dynamic computed tomography associated with normalization of glycemia and the exocrine function. Different groups identified and evaluated experimentally and clinically the actions of multiple factors involved in the process of pancreatic regeneration. Even difficult to assess, pancreatic regeneration after partial pancreatectomy is well documented and of capital importance. CASE REPORT: A 57-year-old woman with discomfort in the upper-left abdominal quadrant. CT scans showed a tumor in the body and tail of the pancreas adherent to the spleen. Preoperative CA 19-9 was normal. She was operated on and the tumor resected en bloc with the spleen. Only the head of the pancreas was preserved. Intraoperative pathological examination of the specimen showed a mucinous cistoadenoma with no malignant degeneration. Postoperative course was uneventful and discharged at p.o. day 10, with ongoing diabetes. Four month later she presented pain in the upper-left quadrant with hyperamylasemia. CT scans showed a normal body and tail with an image of pseudocyst at the top of the pancreatic tail. One year after the initial surgery she remained asymptomatic, without diabetes and with no dietary restrictions. Further CT controls showed images of the entire regeneration of the body and tail of the pancreas. DISCUSSION: Several phenomena are well known and accepted to be associated with the regeneration of the pancreas. In 1965, Tiscornia et al demonstrated the restoration of the pancreatic exocrine function after 6 weeks of selective occlusion of the pancreatic duct. The authors proposed pancreatic regeneration as responsible of morphological, histological and functional changes observed in operated patients where the pancreatic duct was decompressed by an anastomosis to the small bowel and constitutes the rational basis for surgical treatment of chronic pancreatitis. Several humoral factors seems to be involved in pancreatic regeneration acting by a specific receptors-mechanisms, like Bombesin, Octeotride, FGF (Fibroblast Growth Factor) and TGF (Transforming Growth Factor). Friess et al demonstrated increased levels of TGF in acute pancreatitis and considered it to be responsible of the pancreatic regeneration. Waguri et al experimentally demonstrated a double mechanism involved in the regeneration of B-cells: cellular and humoral ways could vary according to different situations. Less evident are the mechanisms involved after surgical pancreatic resection. Kato et al demonstrated the importance of zinc after partial pancreatic resection in dogs. Up to now, there are no other associations experimentally nor in humans. Our case showed in several CT scans control the presence of a normal pancreatic body and tails after a splenopancreatectomy, with restoration of endocrine and exocrine functions. Probably, several mechanisms were involved in this case. Further investigations will elucidate the answered. CONCLUSIONS: Pancreatic regeneration was confirmed by CT scans images and also functionally after an extensive resection. Future similar findings could be of great clinical importance.

Cystadenocarcinoma, Mucinous↗
PubMedDate not supplied

[Implementation process evaluation of the Integrated Management Childhood Illness strategy in the Family Health Program, Pernambuco State, Brazil].

This evaluative study attempts to define the contextual determinants of the degree of implementation in the Integrated Management of Childhood Illnesses strategy in Pernambuco State, Brazil. A total of 33 Family Health Program teams were selected from 10 municipalities. In order to define the degree of implementation, the study used a specific score system and the process indicators provided by the strategy. Municipalities were classified as critical, unsatisfactory, and acceptable. All municipalities except for one presented an acceptable degree of implementation in relation to the structure. In relation to process evaluation, two municipalities received one follow-up visit and their scores were unsatisfactory. Four municipalities received two visits, and one was classified as unsatisfactory on the second follow-up visit, while another presented a critical score on the first follow-up visit. Among four municipalities that received three follow-up visits, one was classified as unsatisfactory in the three evaluations. Four municipalities achieved mean unsatisfactory scores, when considering the mean scores acquired in the three follow-up visits. There was no association between the organizational context and degrees of implementation.

Brazil↗
PubMed1999

Methotrexate and misoprostol for early abortion in adolescent women.

STUDY OBJECTIVE: Investigate the potential effectiveness, side effects, and acceptability of medical abortion in female adolescents. DESIGN: Multicenter cohort study. SETTING: Magee-Womens Hospital (Pittsburgh, PA) and University of British Columbia (Vancouver, BC, Canada). PARTICIPANTS: Twenty-five pregnant adolescents less than 18 years old up to 49 days' gestation. INTERVENTIONS: Methotrexate, 50 mg/m2 intramuscularly, followed 5 to 6 days later by misoprostol, 800 micrograms vaginally, self-administered at home. Misoprostol administration was repeated by a doctor if abortion did not occur within 1 or 2 days. Acceptability was assessed before methotrexate injection and at follow-up 5 weeks later. MAIN OUTCOME MEASURES: Successful abortion (complete abortion without requiring a surgical procedure), immediate success (abortion within 24 hours of initial or repeat misoprostol administration), and acceptability. RESULTS: Complete abortion occurred in 24 of 25 (96%; 95% confidence interval [CI], 88%-100%) subjects. Immediate success abortion occurred in 23 (92%; 95% CI, 81%-100%) of these young women; the remaining subject who aborted did so on study day 10. The single failure was an incomplete abortion. Of the 23 participants who completed the follow-up acceptability evaluation, 4 (17%) believed that the process was a negative experience; 83% of participants would choose this same method again for a future abortion if needed and would recommend this method to a friend. Those who would not try this method again were without support of another individual at the time of the abortion. CONCLUSIONS: This medical abortion regimen is effective in adolescents. The overall acceptability in adolescents is similar to that reported for women 18 years of age or older. To minimize the likelihood of a negative experience with this abortion method in adolescents, home support for these patients should be evaluated during pretreatment counseling.

Abortifacient Agents, Nonsteroidal↗
PubMed2003

Development of an automated extraction procedure for detection of human papillomavirus DNA in liquid based cytology samples.

Liquid based cytology samples are being used increasingly to improve cervical screening and have the advantage that residual cell suspension is available for other tests such as human papillomavirus (HPV) detection. However, as the transport medium is optimised for downstream cytology, problems can be experienced during extraction of nucleic acid. This study aimed to develop a robust protocol for automated extraction of HPV DNA from cervical, liquid based cytology samples using a high throughput robotic system. Considerable modification of existing clinical extraction protocols for swab specimens, together with optimisation of required sample input volume was required to reduce sample blockage during the extraction to acceptable levels. The blockage rate and optimal processing volume was assessed by extracting a fixed volume (1/4) of re-suspended material from the centrifuged pellets of 10, 5 and 1 ml aliquots of 200 specimens. Analysis revealed 17.5% blockage with specimens originating from 10 ml aliquots; 3% with 5 ml and no blockage with 1 ml aliquots of the same samples. A 3% blockage level is acceptable for an automatic well clearance procedure to be followed. HPV testing of the extracts by real-time PCR showed a 1.5% loss of sensitivity in extracts originating from 1 ml aliquots as compared with 5 ml aliquots with a consequent loss of detectable HPV genotypes after reverse hybridisation. In short, 5 ml of liquid based cytology specimen is recommended for nucleic acid extraction, to allow optimal detection of HPV types in clinical samples while retaining maximum efficiency of the robotic extraction procedure.

DNA, Viral↗