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At least 1,423 records · Page 79Linked to original sources
PubMed1999

Psychosocial care by general practitioners--where are the problems? Results of a demonstration project on quality management in psychosocial primary care.

OBJECTIVE: Since 1987, psychosocial services have been a part of the primary care setting in Germany. In the framework of an eight-center national demonstration program, problems in the diagnosis and therapy of psychosocial problems and psychosomatic disorders were assessed. Methods to improve quality were also implemented. METHOD: General practitioners (n = 191) from six regions participated in the study. One thousand three hundred and forty-one treatment episodes of patients with predominantly psychosocial symptoms were documented. Differences between psychosocial strain, treatment, and outcome were determined by analyses of variance. RESULTS: Anxiety (62%), depression (51%), and marital/family conflicts (44%) were the most frequent symptoms. Psychosocial treatment was offered more often to those patients who had the highest level of anxiety and depression. Patients with pain and without a psychological attribution to their illnesses were offered less psychosocial treatment and suffered worse results. Partners and family members were rarely integrated into therapy. The procedures employed to improve outcome were quality circles, family-oriented case conferences, consultation services, and collaborative groups. CONCLUSIONS: These initial results are promising. A process of internal quality management has been initiated. Some of the physicians still resist documenting the data. Patients with somatic symptoms without psychological attribution may need special psychosocial interventions to improve their outcomes.

Adolescent↗
PubMed2004

Oil and wasser.

It was supposed to be an amicable "merger of equals," an example of European togetherness, a synergistic deal that would create the world's second-largest consumer foods company out of two former competitors. But the marriage of entrepreneurial powerhouse Royal Biscuit and the conservative, family-owned Edeling GmbH is beginning to look overly ambitious. Integration planning is way behind schedule. Investors seem wary. But for Royal Biscuit HR head Michael Brighton, the most immediate problem is that he can't get his German counterpart, Dieter Wallach, to collaborate on a workable leadership development plan for the merged company's executives. And stockholders have been promised details of the new organizational structure, including a precise timetable, in less than a month. The CEO of the British company--and of the postmerger Royal Edeling--is furious. It's partly a culture clash, but the problems may run deeper than that. The press is harping on details that counter the official merger-of-equals line. For instance, seven of the ten seats on the new company's management board will be held by Royal Biscuit executives. Will the clash of cultures undermine this cross-border merger? Commenting on the fictional case study are Robert F. Bruner, the executive director of the Batten-Institute at the University of Virginia's Darden Graduate School of Business Administration in Charlottesville; Leda Cosmides and John Tooby, the codirectors of the Center for Evolutionary Psychology at the University of California, Santa Barbara; Michael Pragnell, the CEO and director of the board for the agribusiness firm Syngenta, based in Basel, Switzerland; and David Schweiger, the president of the Columbia, South Carolina--based management consulting firm Schweiger and Associates.

Administrative Personnel↗
PubMed1982

In vitro effects of 4-hydroperoxycyclophosphamide on human immunoregulatory T subset function. I. Selective effects on lymphocyte function in T-B cell collaboration.

The alkylating agent cyclophosphamide may suppress or enhance immune responses in vivo but is inactive in vitro unless metabolized by microsomal enzyme activation. 4-hydroperoxycyclophosphamide (4-HC) is a synthetic compound that is spontaneously converted in aqueous solution to the active metabolites. In this report, we examined the in vitro sensitivity of functional human T cell subsets to 4-HC in a polyclonal B cell differentiation assay and in the generation of mitogen-induced suppressor cells for effector B cell function. Con A-induced T suppression of B cell differentiation is completely abrogated by a 1-h pretreatment of T cells at very low concentrations of between 10(-2) and 20 nmol/ml, whereas inducer T cell function is sensitive only to concentrations in greater than 40 nmol/ml. The effects of 4-HC on suppressor T cells appear to occur at concentrations that do not result in DNA cross-linking or decreased blastogenesis. Con A-induced T suppressors are generated from within the OKT4+, OKT8- subset and are sensitive to low-dose 4-HC only before activation, whereas differentiated suppressor cells are resistant to concentrations in greater than 80 nmol/ml. Low-dose 4-HC pretreatment of the B cell population results in abrogation of immunoglobulin secretion when treated B cells are cocultured with unfractionated T cells, however, this effect is completely reversible if pretreated B cells are cocultured with T cells devoid of suppressor activity. These results demonstrate that human presuppressor cells for B-effector function differentiate in response to Con A from the OKT4+, OKT8- subset and are exquisitely sensitive to low concentrations of CYP whereas mature suppressor and inducer functions are resistant to all but very high concentrations in vitro. The differential sensitivity of functional T and B cell subsets to 4-HC in vitro can be a very useful probe in dissecting immunoregulatory interactions with man.

B-Lymphocytes↗
PubMed1986

Selective reversal of H-2-linked genetic unresponsiveness to lysozymes. II. Alteration in the T helper/T suppressor balance, owing to gene(s) linked to Ir-2, leads to responsiveness in BALB.B.

Immune responsiveness to lysozyme in H-2b mice is under the control of H-2-linked Ir genes, with T suppressor (Ts) cells playing a dominant role in strains such as C57BL/6 (B6), C57BL/10 and A.BY. However, non-H-2-genes were found to be capable of specific reversal of the effect of the H-2-linked genes in responsiveness to chicken lysozyme (HEL), but not to human lysozyme (HUL). Therefore, studies were performed to identify any lesion in the suppressor circuit in BALB.B. It was known that HUL-induced suppressor cells could cross-suppress the anti-HEL response in B10.Q mice, which are responsive to HEL but nonresponsive to HUL. Similarly, BALB.B Ts cells were able to suppress the anti-HEL response, using as T helper (Th) source a T cell line (BB-1), derived from HEL-primed BALB.B periaortic and inguinal lymph node cells. A protocol designed to examine the in vivo suppression by the use of HUL-induced suppressor cells also demonstrated a significant suppression of the anti-HEL response. Since the suppressive circuitry seemed intact in the BALB.B, the possibility was examined that a step in T-B cell collaboration was more efficient in this strain than in the B6 nonresponder. With a B6-derived HEL-specific T cell line, BO1H, the B cell and antigen-presenting (B/APC) populations from B6 required addition of concanavalin A supernatant for anti-HEL antibody formation, whereas BALB.B B/APC were capable of responding to HEL in culture without the addition of concanavalin A supernatant. In agreement with this finding, when B/APC cell populations from BALB.B and B6 were compared for their extent of anti-HEL responsiveness, as measured with BB-1 Th cells, BALB.B B/APC populations responded significantly higher than B6 populations when the responses were activated by picogram/nanogram amounts of HEL. The response level of (BALB.B X B6)F1 B/APC measured in the same assay resembled that of B6. However, when HEL was used at the microgram level, both B6 and BALB.B strains responded equivalently. The above data are consistent with the expression of the reversing non-H-2 Ir gene(s) resulting from the balance of antigen presentation to Th and Ts cells in the H-2b mouse. In the B6, processing and handling of antigen may be inefficient in activating response-enhancing Th, and more effective in triggering Ts cells, while the reverse may be true for the BALB.B.

Animals↗
PubMed1997

Meis proteins are major in vivo DNA binding partners for wild-type but not chimeric Pbx proteins.

The Pbx1 and Meis1 proto-oncogenes code for divergent homeodomain proteins that are targets for oncogenic mutations in human and murine leukemias, respectively, and implicated by genetic analyses to functionally collaborate with Hox proteins during embryonic development and/or oncogenesis. Although Pbx proteins have been shown to dimerize with Hox proteins and modulate their DNA binding properties in vitro, the biochemical compositions of endogenous Pbx-containing complexes have not been determined. In the present study, we demonstrate that Pbx and Meis proteins form abundant complexes that comprise a major Pbx-containing DNA binding activity in nuclear extracts of cultured cells and mouse embryos. Pbx1 and Meis1 dimerize in solution and cooperatively bind bipartite DNA sequences consisting of directly adjacent Pbx and Meis half sites. Pbx1-Meis1 heterodimers display distinctive DNA binding specificities and cross-bind to a subset of Pbx-Hox sites, including those previously implicated as response elements for the execution of Pbx-dependent Hox programs in vivo. Chimeric oncoprotein E2a-Pbx1 is unable to bind DNA with Meis1, due to the deletion of amino-terminal Pbx1 sequences following fusion with E2a. We conclude that Meis proteins are preferred in vivo DNA binding partners for wild-type Pbx1, a relationship that is circumvented by its oncogenic counterpart E2a-Pbx1.

Adenovirus E2 Proteins↗
PubMed2004

A grid computing infrastructure for MEG data analysis.

Magnetoencephalography (MEG) is widely used for studying brain functions, but clinical applications of MEG have been less prevalent. One reason is that only clinicians who have highly specialized knowledge can use MEG diagnostically, and such clinicians are found at only a few major hospitals. Another reason is that MEG data analysis is getting more and more complicated, and deals with a large amount of data, and thus requires high-performance computing. These problems can be solved by the collaboration of human and computing resources distributed in multiple facilities. A new computing infrastructure for brain scientists and clinicians in distant locations was therefore developed by the Grid technology, which provides virtual computing environments composed of geographically distributed computers and experimental devices. A prototype system connecting an MEG system at the AIST in Japan, a Grid environment composed of PC clusters at Osaka University in Japan and Nanyang Technological University in Singapore, and user terminals in Baltimore was developed. MEG data measured at the AIST were transferred in real-time through a 1-GB/s network to the PC clusters for processing by a wavelet cross-correlation method, and then monitored in Baltimore. The current system is the basic model for remote-access to MEG equipment and high-speed processing of MEG data.

Computing Methodologies↗
PubMed1997

[Univariate analysis of potential risk factors for early mortality (within 28 days) after aortocoronary bypass in Italy. OP-RISK Study Group].

The multicenter OP-RISK study, developed during 1994-96, was aimed at: 1) investigating early (28 days) death rates following aortocoronary bypass surgery among patients recruited from four Centers representing geographical distribution in Italy; 2) defining possible risk factors for early mortality, also comparing these factors with those reported in previous studies. Average values are reported and compared of 65 variables (36 preoperative, 10 operative and 19 postoperative) out of 984 patients subdivided into alive (n = 940) or dead (n = 44, 4.47%) at 28 days (155 +/- 174 hours, interval between 12 and 576 hours) postoperatively. Causes of death were cardiac in 37 (77%), pulmonary in 3 (0.7%), vascular in 2 (0.5%) and infective in 2(0.5%) patients, respectively. During the study a total of 1126 patients were operated upon in the collaborative Centers with the diagnosis of coronary artery disease and 51 deaths were reported officially in-hospital (4.53%). Therefore, OP-RISK data represent 87% of overall patients and a superposable death rate. The potential role as risk factors of early mortality was assessed univariately for 17 preoperative, 5 operative (in 3 cases for the first time) and 5 postoperative factors. In general, it was confirmed that factors defining left ventricular function are sensitive predictors of mortality. In OP-RISK we were able to show, in addition, that tachycardia (> 130 b/min) at induction of anesthesia, and total time of anesthesia, cardiopulmonary bypass and aortic cross clamping may be significant factors among operative variables as might be among postoperative ones several arrhythmia types or a lower rate in antithrombotic therapy with aspirin at 6-12 hours postoperatively. The protective role of bypass surgery performed with at least 1 arterial segment was also ascertained. Most of these potential factors were significantly related to outcome (either directly or inversely) as were among them, as seen in a subsample (65%) of 639 patients in whom a correlation matrix was performed among 16 factors selected on the basis of the common denominator principle. Our results suggest that it is possible to collect in a multicenter experience univariate predictors of early mortality following aortocoronary bypass surgery in Italy, which are not different from those reported from previous studies performed abroad. Operative indicators may also have predictive capabilities. The effort may be worthwhile and demands further cooperative studies to be undertaken, aimed at obtaining nationwide coefficients of risk along with representative average values of factors that soon might emerge once multivariate statistics will be performed on this material.

Analysis of Variance↗
PubMed1999

Evidence-based medicine and the practicing clinician.

OBJECTIVE: To assess the attitudes of practicing general internists toward evidence-based medicine (EBM-defined as the process of systematically finding, appraising, and using contemporaneous research findings as the basis for clinical decisions) and their perceived barriers to its use. DESIGN: Cross-sectional, self-administered mail questionnaire conducted between June and October 1997. SETTING: Canada. PARTICIPANTS: Questionnaires were sent to all 521 physician members of the Canadian Society of Internal Medicine with Canadian mailing addresses; 296 (60%) of 495 eligible physicians responded. Exclusion of two incomplete surveys resulted in a final sample size of 294. MAIN RESULTS: Mean age of respondents was 46 years, 80% were male, and 52% worked in large urban medical centers. Participants reported using EBM in their clinical practice always (33, 11%), often (173, 59%), sometimes (80, 27%), or rarely/never (8, 3%). There were no significant differences in demographics, training, or practice types or locales on univariate or multivariate analyses between those who reported using EBM often or always and those who did not. Both groups reported high usage of traditional (non-EBM) information sources: clinical experience (93%), review articles (73%), the opinion of colleagues (61%), and textbooks (45%). Only a minority used EBM-related information sources such as primary research studies (45%), clinical practice guidelines (27%), or Cochrane Collaboration Reviews (5%) on a regular basis. Barriers to the use of EBM cited by respondents included lack of relevant evidence (26%), newness of the concept (25%), impracticality for use in day-to-day practice (14%), and negative impact on traditional medical skills and "the art of medicine" (11%). Less than half of respondents were confident in basic skills of EBM such as conducting a literature search (46%) or evaluating the methodology of published studies (34%). However, respondents demonstrated a high level of interest in further education about these tasks. CONCLUSIONS: The likelihood that physicians will incorporate EBM into their practice cannot be predicted by any demographic or practice-related factors. Even those physicians who are most enthusiastic about EBM rely more on traditional information sources than EBM-related sources. The most important barriers to increased use of EBM by practicing clinicians appear to be lack of knowledge and familiarity with the basic skills, rather than skepticism about the concept.

Adult↗
PubMedDate not supplied

Evaluation of a new immunoassay to measure sirolimus blood concentrations compared to a tandem mass-spectrometric chromatographic analysis.

A new immunoassay of sirolimus based on the microparticle enzyme immunoassay (MEIA) principle has been developed with collaboration of Abbott Diagnostics. Laboratories and Axis-Shield. Our laboratory evaluated this new assay on 153 whole blood samples (EDTA) drawn from a population of renal (n = 141) and hepatic (n = 12) transplant patients. Each blood sample was analyzed simultaneously by MEIA (Y) and by a reference method (X) used routinely in our laboratory, namely, liquid chromatography tandem mass spectrometry (LC-MS/MS). The statistical analysis of Passing-Bablok produced the following results: Spearman r value = 0.95, slope = 1.15 and intercept with the Y axis = +0.2 ng/mL. The observed global overestimation of 15% compared to the reference method could be explained by the cross-reactivity of sirolimus metabolites with the antibody. A complementary analysis taking into account the transplanted organ (kidney versus hepatic) did not show any significant difference between the populations, most likely owing to the low number of hepatic transplantation samples. The analytical performance of the MEIA method showed CV < or =10% and a limit of quantification of 1.5 ng/mL, which were acceptable for routine clinical monitoring. In conclusion, the MEIA method has shown robust, stable, reproducible, features with an excellent correlation with the reference LC-MS/MS method.

Chromatography, Liquid↗
PubMed2004

Innovative strategic Canadian research training from TomorrOw's Research Cardiovascular Health Care Professionals (TORCH).

Cardiovascular research training is experiential, and "skills" are traditionally acquired through a master-apprentice paradigm. The complexity of contemporary clinical research requires a new model for research training. Facilitated through a Strategic Training Program Initiative, the Canadian Institutes of Health Research (CIHR), with its partners the Alberta Heritage Foundation for Medical Research and the Heart and Stroke Foundation, supported the Universities of Alberta and Calgary to create a new and innovative training model. Tomorrow's Research Cardiovascular Health Professionals (TORCH) is an integrated 2-year program for health care professionals from diverse disciplines to be mentored toward careers as leaders in translational cardiovascular research, applying discovery to human health. This report describes the vision, mission, core values, objectives, design and curriculum of the program. Our vision is the development of a new generation of cardiovascular research clinician-scientists, with particular emphasis on thought, leadership and collaboration. The program incorporates 4 core values: innovation and discovery, a translational and transdisciplinary focus, an emphasis on collaboration and integration of research concepts, and the teaching of a core body of research knowledge coupled with real-world "survival" skills. The core curriculum, organized according to a cluster concept, traverses the 4 pillars of the CIHR. Through the medium of 1-hour weekly videoconferences, the curriculum cycles through case studies, seminars and a journal club in focused areas of cardiovascular research. Mentors in the TORCH program have diverse backgrounds that epitomize the transdisciplinary translational aspects of the program and are chosen for their proven record of research accomplishment and prior history of successful mentoring. The program has recruited 19 trainees from a broad cross-section of disciplines, integrating 2 University of Alberta campuses. The preliminary experience has been both favourable and gratifying.

Canada↗
PubMed2001

Extraction of R = sigma(L)/sigma(T) from CCFR nu(mu)-Fe and nu(mu)-Fe differential cross sections.

We report on the extraction of R = sigma(L)/sigma(T) from CCFR nu(mu)-Fe and nu(mu)-Fe differential cross sections. The CCFR differential cross sections do not show the deviations from the QCD expectations that are seen in the CDHSW data at very low and very high x. R as measured in nu(mu) scattering is in agreement with R as measured in muon and electron scattering. All data on R for Q(2)>1 GeV(2) are in agreement with a NNLO QCD calculation which uses NNLO parton distribution functions and includes target mass effects. We report on the first measurements of R in the low x and Q(2)<1 GeV(2) region (where an anomalous large rise in R for nuclear targets has been observed by the HERMES Collaboration).

Journal Article↗
PubMed1996

Family physicians' involvement in two hospitals. Two different models of inpatient care.

OBJECTIVE: To describe the roles of family physicians in two hospitals with different models of inpatient care. DESIGN: Cross-sectional descriptive study of a random sample of 11528 patients admitted to two hospitals between 1985 and 1988. SETTING: Two acute-care community hospitals in suburban Montreal, Que. SUBJECTS: Family physicians providing inpatient care at the two hospitals. MAIN OUTCOME MEASURE: How often family physicians were attending physicians (attending responsibility); what percentage of patients were visited by at least one family physician (case load); and what percentage of bedside visits were made by family physicians (workload). RESULTS: In one hospital, where family physicians were actively promoted as primary care providers, they were frequently attending physicians, had heavier case loads, and made more patient visits. Also, they collaborated more often with specialists. In the other hospital, family physicians tended to care for specific populations of patients. CONCLUSION: When hospitals promote different organizational models of medical care, family physicians' roles are affected.

Hospitals, Community↗
PubMed1997

Autoimmune responses against acetylcholine receptor: T and B cell collaboration and manipulation by synthetic peptides.

Myasthenia gravis (MG) and experimental autoimmune MG (EAMG) are induced by antibodies (Abs) against self acetylcholine receptor (AChR). We have mapped the T and B cell epitopes on AChR alpha subunit in human MG and in EAMG-susceptible (C57BL/6, B6) and nonsusceptible mouse strains. A T-cell epitope within residues alpha 146-162 (P14) of Torpedo californica (t)AChR plays an important role in EAMG pathogenesis of the auto Ab-induced disease. P14-specific T cell (P14Th) lines from tAChR-primed B6 mice activated, in vivo and in vitro, tAChR-primed B cells that secreted anti-AChR Abs directed against four other regions on the tAChR alpha-chain, but not against P14 itself. P14Th cells are pathogenic because they help B cells that make Abs against a conserved tAChR region (t alpha 122-150) involved in ACh binding. These Abs cross-react with region alpha 122-150 of mouse (m)AChR, thereby disrupting its normal physiological function. Thus, a T cell epitope not recognized by Abs plays an active role in B cell responses against other epitopes on the protein. We have found that in B6, the MHC region 62-76 of I-A beta(b) is involved in the presentation of P14 to T cells. Anti-peptide Abs, prepared in BALB/c, were found to inhibit in vitro the proliferation of P14-specific T-cells. Furthermore, this MHC peptide elicited Abs in B6 mice and we are investigating whether immunization of B6 with this peptide, before priming with tAChR, would suppress in vivo the T-cell response to the epitope in P14. Thus, these preliminary results would suggest that immunization with the MHC peptide might be employed for control of the autoimmune disease.

Amino Acid Sequence↗
PubMed2003

Re-reading the IPSS research record.

The International Pilot Study of Schizophrenia has had a major influence on mental health and research practice since its inception in the 1960s. It is most famous for demonstrating superior outcomes for people living with schizophrenia in developing countries over those living with schizophrenia in developed countries. Like other international research initiatives, it has been shaped by social, political and economic circumstances that contribute to positive and negative outcomes for participating nations. This paper evaluates the contribution of the pilot study by analyzing the discourse surrounding the dissemination of its results. The discussion of long-term outcomes across cultures is used to scrutinize the process of long-term research collaborations across nations. Discourse analysis of the research records indicates that, in various ways, the discourse was constructed to preserve an image of Western superiority and Third World inferiority. As the international research context shifts in psychiatry, it is hoped that inequitable practices that affect this and other studies will be challenged to benefit knowledge-building and mental health care across the world.

Biomedical Research↗
PubMed2004

Evidence for multiphonon giant resonances in electromagnetic fission of 238U.

Differential cross sections for electromagnetic fission of 238U projectiles (500 MeV/u) in C, Sn, and Pb targets are measured and analyzed in terms of single- and multiphonon giant resonance excitations as doorway states to fission. A novel experimental method exploits the linear relationship between neutron multiplicity and the primary 238U excitation energy. Multiphonon states contribute up to 20% of the cross section; a component at high excitation energies is indicated that may arise from three-phonon dipole and two-phonon GDR x GQRiv giant resonance excitations.

Journal Article↗
PubMed1989

Nosocomial fungal infections. Old problems and new challenges.

The frequency of nosocomial mycoses has substantially increased in recent years, primarily because of the use of intensive therapeutic regimens in patients with cancer and organ transplantation. Furthermore, newer fungi previously considered as contaminants or harmless colonizers have now emerged as significant human pathogens, particularly in the immunocompromised host. Only through the collaboration between clinicians, pathologists, microbiologists, and infection control officers can these fungal infections be recognized and treated early. It is hoped that the proper implementation of infection control policies, the advent of newer antifungals and biological response modifiers, and the advances in immunosuppressive regimens for organ transplant recipients will result in a significant improvement in the prevention and treatment of these life-threatening opportunistic mycoses.

Aspergillosis↗
PubMed2001

Protein Information Resource: a community resource for expert annotation of protein data.

The Protein Information Resource, in collaboration with the Munich Information Center for Protein Sequences (MIPS) and the Japan International Protein Information Database (JIPID), produces the most comprehensive and expertly annotated protein sequence database in the public domain, the PIR-International Protein Sequence Database. To provide timely and high quality annotation and promote database interoperability, the PIR-International employs rule-based and classification-driven procedures based on controlled vocabulary and standard nomenclature and includes status tags to distinguish experimentally determined from predicted protein features. The database contains about 200,000 non-redundant protein sequences, which are classified into families and superfamilies and their domains and motifs identified. Entries are extensively cross-referenced to other sequence, classification, genome, structure and activity databases. The PIR web site features search engines that use sequence similarity and database annotation to facilitate the analysis and functional identification of proteins. The PIR-Inter-national databases and search tools are accessible on the PIR web site at http://pir.georgetown.edu/ and at the MIPS web site at http://www.mips.biochem.mpg.de. The PIR-International Protein Sequence Database and other files are also available by FTP.

Computational Biology↗
PubMed2006

Collaborative science, policy development and program implementation in the transboundary Georgia Basin/Puget Sound ecosystem.

The transboundary Georgia Basin Puget Sound ecosystem is situated in the southwest corner of British Columbia and northwest comer of Washington State. While bountiful and beautiful, this international region is facing significant threats to its marine and freshwater resources, air quality, habitats and species. These environmental challenges are compounded by rapid population growth and attendant uiban sprawl. As ecosystem stresses amplified and partnerships formed around possible solutions, it became increasingly clear that the shared sustainability challenges in the Georgia Basin and Puget Sound required shared solutions. Federal, state and provincial institutional arrangements were made between jurisdictions, which formalized small scale interest in transboundary management of this ecosystem. Formal agreements, however, can only do so much to further management of an ecosystem that spans international boarders. A transboundary regional research meeting, the 2003 GB/PS Research Conference, opened the doors for large-scale informal cross-boarder cooperation and management. In addition to cooperation, continued efforts to stem toxic pollution, contain urban growth, and protect and restore ecosystems, require a commitment from scientists, educators and policy makers to better integrate research and science with decision-making.

Animals↗