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Lisa Hirst won the community dentistry section of the 1988 Desmond Greer Walker Award with her study of the level of awareness and knowledge of orthodontics and orthodontic treatment of patients and their parents, and her assessment of the health education material available about orthodontics. We now publish a summary of her paper.
OBJECTIVE: To determine the antioxidant imbalance in healthy Cuban men 2y after the end of the epidemic neuropathy (50 862 cases from 1991 to 1993) and to evaluate its change over 1 y. DESIGN: Prospective study. SETTING: La Lisa health centres (Havana, Cuba). SUBJECTS: One-hundred and ninety-nine healthy middle-aged men were selected and 106 completed the study. Subjects were studied at 3 month intervals over 1 year. INTERVENTIONS: No invervention. MAIN OUTCOME MEASURES: An assessment of dietary intake and the determination of blood lipid peroxides (TBARS), glutathione, diglutathione, glutathione peroxidase, superoxide dismutase, vitamin E, carotenoids, copper, zinc and selenium were performed at each period. RESULTS: While dietary zinc, vitamins C and E, carotenoids and fat dietary intakes and blood concentrations were low for adult men compared to international reference ranges, serum TBARS concentrations were high at every period. Some significant seasonal variations were observed. The lowest carotenoids (P < 0.002) and vitamin C(P = 0.0001) intakes, serum beta-carotene (P = 0.0001) and lutein/zeaxanthin (P < 0.05) concentrations, and the highest blood TBARS (P = 0.0001) and diglutathione (P < 0.001) concentrations were observed at the end of the rainy season (October). This period seemed to pose the greatest risk of antioxidant imbalance. CONCLUSIONS: Cuban men still represent a vulnerable population in terms of antioxidant imbalance. A national program of vegetable growing and increase in fruit and vegetable consumption is now evaluated in Cuba.
The gas phase sabinene + OH reaction is studied both experimentally and theoretically. Product yields from the reaction of sabinene with OH radicals have been measured in the absence of NOx in the UCC chamber (Cork, Ireland) and in the presence of NOx in the LISA chamber. Three primary carbonyl compounds were observed and quantified: acetone in [(24 +/- 6)%], formaldehyde in [(25 +/- 6)%] and sabinaketone in [(20 +/- 6)%]. The simultaneous quantification of these compounds is one of the major results of this work. The mechanism of product formation for this reaction has been studied using the quantum chemical DFT-B3LYP (6-31G(d,p) method. According to these calculations, the H-atom abstraction channel from sabinene by OH in the initial oxidation step may be taken into account to explain the acetone production. Sabinaketone and formaldehyde are mainly products of the addition channels of OH on the -C=CH2 double bond of sabinene. This is the first theoretical work on the title reaction.
The objective was to assess the effect on health professionals' skills of one to eight hours literature search and retrieval training from electronic health databases. We searched: Cochrane library (2002; Issue 3), MEDLINE (1977-2002/5), EMBASE (1980-2002/7); CINAHL (1982-2002/5); ASSIA (1982-2002/7), BNI (1994-2002/5), ERIC (1985-2002/6); LISA (1969--current), NRR (2002, Issue 2), the world-wide-web and references. The selection criteria consisted of randomised controlled trials, controlled before and after, and controlled cohort studies in comparison with no training. The intervention had to be one to eight hours training in literature search and retrieval skills for health professionals. The outcome was the effect on health professionals' literature search and retrieval skill levels measured through reliable instruments. For data collection and ana-lysis, one reviewer extracted data and assessed the quality of the studies and the second reviewer checked it. The results indicate that there is some evidence of positive impact on health professionals' skill levels in literature searching and they find the training useful. In conclusion, the size of the positive effect is debatable as only three small and methodologically weak studies met the inclusion criteria and out of those only two showed the positive effect.
Nocturnal home hemodialysis (NHD) was made possible in the 1960s by fail-safe monitoring, the Scribner shunt, and low-resistant Kiil dialyzer allowing hemodialysis without a blood pump. In London, Sheldon was the first to use overnight home hemodialysis. The Lynchburg NHD program and Lisa Murphy, a dietician in Bender's NHD program in Kansas City, developed a questionnaire for short daily hemodialysis and NHD. The questionnaire was sent to all known daily hemodialysis programs in North America. Some advances in nocturnal home hemodialysis since 1994 include: improvement in teaching methods, preventing disconnects and air emboli, preventing catheter infections, and using arteriovenous fistulas and grafts for access. As of January 2001, there were 13 centers in North America performing daily nocturnal home hemodialysis caring for 115 patients. Since 1997, all programs performing NHD have validated Pierratos' reported results, showing improvement in quality of life, better blood pressure control with fewer medications, reduced Epogen usage, reduced hospitalizations, control of phosphorous without binders, and a greater sense of hope for patients. Even though this new modality is safe and better for selected patients with ESRD, dialysis providers in Canada and the United States cannot afford to offer NHD within the present reimbursement scheme.
The article highlighted in this issue is "Reversibility and Persistence of Di-2-Ethylhexyl Phthalate (DEHP)- and Phenobarbital-Induced Hepatocellular Changes In Rodents," by Jason S. Isenberg, Lisa M. Kamendulis, David C. Ackley, Jacqueline H. Smith, George Pugh, Jr., Arthur W. Lington, Richard H. McKee, and James E. Klaunig (pp. 192-199).
BACKGROUND: Because of the presence of confounding antigens, the assignment of HLA antibody specificity is difficult in highly sensitized patients, and the definition of an acceptable HLA mismatch requires a significant workload per patient. We describe a new ELISA method, monoLISA, for detection of immunoglobulin (Ig)G HLA antibody using single recombinant HLA class I monomers bound to microtiter plates. METHODS: HLA-A2 and -B8 monomers were synthesized and used as screening targets for 85 sera from renal patients. The sera contained various IgG and IgM HLA-specific antibodies, including anti-A2 and anti-B8,defined in a conventional complement-dependent cytotoxicity test (CDC). Investigations were performed to determine possible effects on antibody binding of differential monomer peptide presentation as well as lack of glycosylation. RESULTS: A good correlation was found between CDC-defined specificities and the reactivity observed with HLA monomers. MonoLISA attained means of 100% sensitivity and 92.5% specificity compared with CDC. Neither the presence of different peptides, nor the absence of glycosylation of the monomer affected the ability of monoLISA to detect antibody. CONCLUSION: This study demonstrates that the mono-LISA method for HLA antibody detection is valid. Because this has the potential to reduce the work involved in screening sensitized patients awaiting transplantation for HLA antibodies, resources aimed at increasing the number of constructed monomers would be well targeted.
Cusps of cosmic strings emit strong beams of high-frequency gravitational waves (GW). As a consequence of these beams, the stochastic ensemble of gravitational waves generated by a cosmological network of oscillating loops is strongly non-Gaussian, and includes occasional sharp bursts that stand above the rms GW background. These bursts might be detectable by the planned GW detectors LIGO/VIRGO and LISA for string tensions as small as G&mgr; approximately 10(-13). The GW bursts discussed here might be accompanied by gamma ray bursts.
It may be possible to construct a laser interferometer gravitational wave antenna in space with h(rms) approximately 10(-27) at f approximately 0.1 Hz in this century. Using this antenna, (1) typically 10(5) chirp signals of coalescing binary neutron stars per year may be detected with S/N approximately 10(4); (2) we can directly measure the acceleration of the universe by a 10 yr observation of binary neutron stars; and (3) the stochastic gravitational waves of Omega(GW) > or similar to 10(-20) predicted by the inflation may be detected by correlation analysis. Our formula for phase shift due to accelerating motion might be applied for binary sources of LISA.
We propose a new method for determining total masses of low frequency eccentric binaries (such as neutron star binaries with orbital frequency f greater or similar to 10(-3) Hz) from their gravitational waves. In this method we use the frequency shift caused by periastron advance, and it works even at low frequency band where the chirp signal due to radiation reaction is difficult to be measured. It is shown that the total masses of several Galactic neutron star binaries might be measured accurately (within a few percent error) by LISA with an operation period of approximately 10 yr.
AIM: To present an overview of the concepts of marketing and to examine ways in which they can be applied to health libraries. METHODS: A review was carried out of literature relating to health libraries using LISA, CINAHL, BNI and Google. RESULTS: Marketing is seen as a strategic management activity aimed at developing customer relationships. Concepts such as the 'four Ps' (product, price, place and promotion), marketing plans, the marketing mix, segmentation, promotion and evaluation are identified and discussed in relation to health libraries. CONCLUSION: In increasingly complex health service and information environments, the marketing and promotion of library services is becoming more important if those services are to justify the resources given to them. Marketing techniques are equally applicable to physical and digital library services.
OBJECTIVE: An updated systematic review was carried out of research studies looking at the value and impact of library services on health outcomes for patients and time saved by health professionals. METHODS: A comprehensive systematic search was undertaken of the published literature to September 2003 in ERIC, LISA, MEDLINE, PREMEDLINE, EMBASE, the Cochrane Controlled Trials Register and Google. Some handsearching was carried out, reference lists were scanned and experts in the field were contacted. Twenty-eight research studies of professionally led libraries for health-care staff, including clinical librarian projects, met the inclusion criterion of at least one health or 'time saved' outcome. Papers were critically appraised using internationally accepted criteria. Data were extracted and results were summarised using a narrative format as the studies were heterogeneous and precluded a statistical analysis. RESULTS: There is evidence of impact from both traditional and clinical librarian services. The higher quality studies of traditional services measured impacts of 37-97% on general patient care, 10-31% on diagnosis, 20-51% on choice of tests, 27-45% on choice of therapy and 10-19% on reduced length of stay. Four studies of clinical librarian projects suggested that professionals saved time as a result of clinical librarian input, and two of these studies showed evidence of cost-effectiveness. However, the clinical librarian studies were generally smaller, with poorer quality standards. CONCLUSIONS: Research studies suggest that professionally led library services have an impact on health outcomes for patients and may lead to time savings for health-care professionals. The available studies vary greatly in quality but the better quality studies also suggest positive impacts. Good practice can be gathered from these studies to guide the development of a pragmatic survey for library services that includes the direct effects for patients among the outcome measures.
Recent studies show that a broad category of materials share "nonclassical" nonlinear elastic behavior much different from "classical" (Landau-type) nonlinearity. Manifestations of "nonclassical" nonlinearity include stress-strain hysteresis and discrete memory in quasistatic experiments, and specific dependencies of the harmonic amplitudes with respect to the drive amplitude in dynamic wave experiments, which are remarkably different from those predicted by the classical theory. These materials have in common soft "bond" elements, where the elastic nonlinearity originates, contained in hard matter (e.g., a rock sample). The bond system normally comprises a small fraction of the total material volume, and can be localized (e.g., a crack in a solid) or distributed, as in a rock. In this paper a model is presented in which the soft elements are treated as hysteretic or reversible elastic units connected in a one-dimensional lattice to elastic elements (grains), which make up the hard matrix. Calculations are performed in the framework of the local interaction simulation approach (LISA). Experimental observations are well predicted by the model, which is now ready both for basic investigations about the physical origins of nonlinear elasticity and for applications to material damage diagnostics.
OBJECTIVE: To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely. DESIGN AND DATA SOURCES: Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science. SELECTION OF STUDIES: We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components. MAIN OUTCOME MEASURES: Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results. RESULTS: 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only" arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people. CONCLUSIONS: No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.
OBJECTIVES: To estimate long-term exposure to traffic-related air pollutants on an individual basis and to assess adverse health effects using a combination of air pollution measurement data, data from geographical information systems (GIS) and questionnaire data. METHODS: 40 measurement sites in the city of Munich, Germany were selected at which to collect particulate matter with a 50% cut-off aerodynamic diameter of 2.5 microm (PM2.5) and to measure PM2.5 absorbance and nitrogen dioxide (NO2). A pool of GIS variables (information about street length, household and population density and land use) was collected for the Munich metropolitan area and was used in multiple linear regression models to predict traffic-related air pollutants. These models were also applied to the birth addresses of two birth cohorts (German Infant Nutritional Intervention Study (GINI) and Influence of Life-style factors on the development of the Immune System and Allergies in East and West Germany (LISA)) in the Munich metropolitan area. Associations between air pollution concentrations at birth address and 1-year and 2-year incidences of respiratory symptoms were analysed. RESULTS: The following means for the estimated exposures to PM2.5, PM2.5 absorbance and NO2 were obtained: 12.8 microg/m3, 1.7x10(-5) m(-1) and 35.3 mug/m3, respectively. Adjusted odds ratios (ORs) for wheezing, cough without infection, dry cough at night, bronchial asthma, bronchitis and respiratory infections indicated positive associations with traffic-related air pollutants. After controlling for individual confounders, significant associations were found between the pollutant PM2.5 and sneezing, runny/stuffed nose during the first year of life (OR 1.16, 95% confidence interval 1.01 to 1.34) Similar effects were observed for the second year of life. These findings are similar to those from our previous analysis that were restricted to a subcohort in Munich city. The extended study also showed significant effects for sneezing, running/stuffed nose. Additionally, significant associations were found between NO2 and dry cough at night (or bronchitis) during the first year of life. The variable "living close to major roads" (<50 m), which was not analysed for the previous inner city cohort with birth addresses in the city of Munich, turned out to increase the risk of wheezing and asthmatic/spastic/obstructive bronchitis. CONCLUSIONS: Effects on asthma and hay fever are subject to confirmation at older ages, when these outcomes can be more validly assessed.
This report described the insight-oriented psychotherapy while both the therapist and patient were pregnant. The patient's pregnancy was not considered a consequence of acting out. With the growing number of female therapists, this issue will become more commonplace. The issues of dependency and traditionally feminine sex roles were initially found in Lisa's therapy and had been a focus for several months. However, her pregnancy catalyzed working through femininity issues and the therapist's pregnancy served to catalyze both issues. Pregnancy in the therapist is a template for dependency, abandonment, and sexuality issues. If the patient is a woman, role-model and identification issues are even more of a concern. In the patient, pregnancy serves to enhance the therapy because direction is already turned inward and there is even further self-absorption. If both the therapist and patient are pregnant, intense transference and countertransference are likely, and the skillful use of these will further the outcome of the therapy.
Freud was the first to apply psychoanalysis to art, choosing for his subject the life and work of Leonardo da Vinci. Observing Leonardo's partly fused image of the Virgin and St. Anne, he inferred that the artist had depicted his two mothers, his biological mother and his stepmother. This very early analytic discourse on parent loss and adoption changed the course of the interpretation of art. Freud explored the psychology of art, the artist, and aesthetic appreciation. Confronting the age-old enigma of the Mona Lisa, he proposed a daring solution to the riddle of the sphinxlike smile of this icon of art. His paper prefigures concepts of narcissism, homosexuality, parenting, and sublimation. Lacking modern methodology and theory, Freud's pioneering insights overshadow his naive errors. In this fledgling inquiry, based on a childhood screen memory and limited knowledge of Leonardo's artistic and scientific contributions, Freud identified with this Renaissance genius in his own self-analytic and creative endeavor.
Many Web sites on the Internet offer health information related to cancer and are increasingly being used by patients, caregivers, and those interested in cancer prevention and treatment. To comprehensively review the cancer literature regarding Internet health information use among those of racial/ethnic populations and low literacy groups, a comprehensive review of the MEDLINE/Pre-MEDLINE, LISA, PsycInfo, CINAHL, Embase, and Web of Science databases was conducted. Eight relevant articles were retrieved: seven are classified as content research and one as outcomes research. Little empirical research exists on this topic of cancer Internet health information use among those of racial/ethnic populations and low literacy groups. This area of research is open for many unique contributions to the scientific literature.