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PubMed1994

The role of migration in labour-market adjustment: the British experience in the 1980s.

"In this paper the role of migration in bringing labour supply and demand into balance (or in mitigating imbalance) in Britain in the 1980s is investigated.... The major trends in migration and unemployment at national and regional scales are outlined, and the key characteristics of job-related migrants are identified. In the main part of the paper the author is concerned with the operationalisation of two contrasting methodological approaches designed to promote a greater understanding of the influences acting on changing migration patterns and the role of migration, alongside other factors in labour-market changes. First, the results from a shift-share approach are discussed; and second, the output from an application of the labour market accounts technique is described."

Demography↗

PubMed2004

Functional assessment of injured workers: a profile of assessor practices.

BACKGROUND: Considerable controversy and limited information surrounds the use of performance-based functional assessments for determining an injured worker's ability to function at work. PURPOSE: Amidst a variety of protocols, philosophies and tools, the key aspects of different assessment approaches are described and compared across a range of assessment provider organizations. METHOD: Qualitative and quantitative strategies were used to generate an in-depth understanding of the different assessment practices among 23 Southern Ontario assessment providers. RESULTS: Assessment approaches share common elements and variations that can be described along the continua of five dimensions: nature of assessor-evaluee interactions, fixed or flexible protocol delivery, efforts to contextualize, perceptions and use of evidence, and provider organizational environment. These approach dimensions are offered as a focus for appraising practices. PRACTICE IMPLICATIONS: Assessors need to reflect upon to what extent they are using a whole person, client-centred approach directed by clinical reasoning amidst a market driven industry.

Adult↗

PubMed1997

Including patient preferences in nurses' assessment of older patients.

The refinement of a patient assessment tool for older patients, Lorensen's Self-Care Capability Scale, is described where a systematic elicitation of patient preferences is included in the assessment. This study tests a decision analytic approach as a strategy for formalizing subjective judgement, which makes it possible to include patients' own values and preferences in planning patient care. Applying this technique to patient assessment contributes to explicitly tailoring nursing care decisions to desired outcomes as preferred by individual patients. A shared approach to decision making between nurse and patient ensures a mutual understanding about goals, priorities and patient values through discussion and negotiation. This pilot study supported the merit of including patient preferences systematically in the assessment of older patients. The method provides an important decision aid for nurses in planning nursing care in accordance with patients' own values and preferences for care.

Activities of Daily Living↗

PubMed2003

Sociopolitical activist or conversational partner? Distinguishing the position of the therapist in narrative and collaborative therapies.

In this article, we explore the similarities and differences of two contemporary family therapy approaches: narrative and collaborative therapies. These therapies are contrasted by describing positioning of the narrative practitioner as sociopolitical activist and the collaborative practitioner as conversational partner. The article begins with a brief overview of the two therapies. Subsequently, we outline their epistemological genealogies and the practice similarities that arise from the theoretical assumptions underpinning these therapies. The remainder of the article addresses the theoretical and therapeutic differences in narrative and collaborative approaches reflected in the positioning of therapist as either sociopolitical activist or conversational partner. While narrative and collaborative approaches share more similarities than differences in relation to their emphasis on the constitutive characteristics of language, focus on sociorelational contexts, and critique of singular objective truths, prominence is given to the starker contrasts in narrative and collaborative understandings of politics, power, dialogue, and discourse. It is proposed that by outlining some provocative contrasts between narrative and collaborative approaches, new conversations and generative practices will emerge in the therapy room.

Family Therapy↗

PubMed2006

What are children's trusts? Early findings from a national survey.

BACKGROUND: The Children Act 2004 and National Service Framework for Children, Young People and Maternity Services require fuller integration of health, education and social services for children and young people in England and Wales. The UK government supported the establishment of 35 experimental children's trust pathfinders (henceforth called children's trusts) in England. METHODS: A questionnaire was completed by managers in all 35 children's trusts a year after their start. Children's trust documents were examined. Census and performance indicators were compared between children's trust areas and the rest of England. RESULTS: Children's trust areas had demographic and social characteristics typical of England. All children's trusts aimed to improve health, education and social services by greater managerial and service integration. All had boards representing the three sectors; other agencies' representation varied. Two-thirds of children's trusts had moved towards pooling budgets in at least some service areas. At this stage in their development, some had prioritized joint procurement or provision of services, with formal managerial structures, while others favoured an informal strategic planning, co-ordination and information sharing approach. The commonest priorities for services development were for disabled children (16 children's trusts), followed by early intervention (11) and mental health services (8). CONCLUSIONS: The diverse strategies adopted by these 35 children's trusts during their first year is due to their own characteristics and to the way government strategy developed during this period. Whilst some prioritized organizational development, joint financing and commissioning, and information sharing, others laid more emphasis on mechanisms for bringing front-line professionals closer together. Their experiences are of value to others deciding how best to integrate children's services.

Adolescent↗

PubMed1995

Least restrictive measures: alternatives to four-point restraints and seclusion.

Following the review and discussion of alternative measures in the use of four-point restraints and seclusion on an acute psychiatric inpatient unit, the staff increased the use of "least restrictive" measures with aggressive patients. This involved increased attention to escalating behavior and using alternatives. Although early recognition did not guarantee success in every situation, patients were included in making choices and being in control of which option to take. When staff became more knowledgeable about the use of alternatives, they were more comfortable offering patients choices and did not wait until restraints and seclusion were necessary. It was beneficial to review the rationale for the use of seclusion and restraints with both patients and staff. Specific approaches for early recognition and intervention focused on verbal control, limit setting, and decreased stimulation. It is important that staff have a clear understanding of their range of treatment strategies from most to "least restrictive" measures during stressful times when patients become confused, angry, or frightened and may lose control. Patients must be made aware of their choices during this cycle and understand the consequences of their behavior. Planning educational inservice programs for staff to address this content and share approaches to specific situations can be effective. Staff debriefing following an incident is crucial to discuss reactions to the use of restraints and seclusion and to plan for the use of alternative measures in the future. All patients need a chance to express themselves. As staff we must take time to stop, look, and listen. We must be aware of our own thoughts and feelings and think of choices. What are the ¿least restrictive¿ measures? We need to work with patients in considering a range of measures without taking unnecessary risks or disregarding issues. We must work with our patients so that we all can learn a valuable lesson. Why not give our patients a chance?

Adult↗

PubMedDate not supplied

Congruent effects of estrogen and T-cell receptor peptide therapy on regulatory T cells in EAE and MS.

Both estrogen (E2) and T-cell receptor (TCR) peptides have beneficial effects on the clinical course of experimental autoimmune encephalomyelitis (EAE) and possibly multiple sclerosis (MS) that involve distinct but congruent mechanisms. Of interest, these two approaches share an ability to enhance expression of the FoxP3 gene and associated activity of regulatory T (Treg) cells. E2 increases the number and activity of FoxP3(+) T cells through Esr-1 signaling during TCR activation of CD4(+)CD25(-) T cells. In contrast, TCR peptide therapy appears to increase the frequency of regulatory FoxP3(+) T cells specific for self-TCR determinants expressed by targeted pathogenic T cells. The combined effects on Treg expansion and activation induced by these distinct immunoregulatory approaches may account for their potent effects on clinical EAE and argue for a similar combined therapeutic approach for MS.

Animals↗

PubMed1997

The view from the tip of the iceberg.

In recent years there has been a growing interest in refining the technique of ego defense analysis. All of these approaches share in common an attempt to work closely with the patient's free associations, to interpret at a level that is accessible to the patient's consciously observing ego, and to avoid bypassing the analysis of the patient's most surface-level resistances in an effort to understand unconscious conflict. These innovations reflect a commendable effort to work in a way that is rigorously empirical, that respects the patient's autonomy, and that minimizes the pressure of the analyst's transferential authority in the patient's acceptance of the analyst's interpretations. Despite the undeniable value of these technical innovations, such approaches to ego defense analysis may inadvertently result in certain overemphases in technique that may unnecessarily constrain the analytic process. They may result in a sort of obsessive tunnel vision that is overly focused on small details to the exclusion of the larger picture. An approach that counterbalances the microscopic and the macroscopic analysis of ego defense is recommended.

Adult↗

PubMed2003

Synergistic computational and experimental proteomics approaches for more accurate detection of active serine hydrolases in yeast.

An analysis of the structurally and catalytically diverse serine hydrolase protein family in the Saccharomyces cerevisiae proteome was undertaken using two independent but complementary, large-scale approaches. The first approach is based on computational analysis of serine hydrolase active site structures; the second utilizes the chemical reactivity of the serine hydrolase active site in complex mixtures. These proteomics approaches share the ability to fractionate the complex proteome into functional subsets. Each method identified a significant number of sequences, but 15 proteins were identified by both methods. Eight of these were unannotated in the Saccharomyces Genome Database at the time of this study and are thus novel serine hydrolase identifications. Three of the previously uncharacterized proteins are members of a eukaryotic serine hydrolase family, designated as Fsh (family of serine hydrolase), identified here for the first time. OVCA2, a potential human tumor suppressor, and DYR-SCHPO, a dihydrofolate reductase from Schizosaccharomyces pombe, are members of this family. Comparing the combined results to results of other proteomic methods showed that only four of the 15 proteins were identified in a recent large-scale, "shotgun" proteomic analysis and eight were identified using a related, but similar, approach (neither identifies function). Only 10 of the 15 were annotated using alternate motif-based computational tools. The results demonstrate the precision derived from combining complementary, function-based approaches to extract biological information from complex proteomes. The chemical proteomics technology indicates that a functional protein is being expressed in the cell, while the computational proteomics technology adds details about the specific type of function and residue that is likely being labeled. The combination of synergistic methods facilitates analysis, enriches true positive results, and increases confidence in novel identifications. This work also highlights the risks inherent in annotation transfer and the use of scoring functions for determination of correct annotations.

Amino Acid Sequence↗

PubMed2001

The Functional Magnetic Resonance Imaging Data Center (fMRIDC): the challenges and rewards of large-scale databasing of neuroimaging studies.

The Functional Magnetic Resonance Imaging Data Center (fMRIDC) (http://www.fmridc.org) was established in the Autumn of 1999 with the objective of creating a mechanism by which members of the neuroscientific community may more easily share functional neuroimaging data. Examples in other sciences offer proof of the usefulness and benefit that sharing data provides through encouraging growth and development in those fields. By building a publicly accessible repository of raw data from peer-reviewed studies, the Data Center hopes to create a similarly successful environment for the neurosciences. In this article, we discuss the continuum of data-sharing efforts and provide an overview of the scientific and practical difficulties inherent in managing various fMRI data-sharing approaches. Next, we detail the organization, design and foundation of the fMRIDC, ranging from its current capabilities to the issues involved in the submitting and requesting of data. We discuss how a publicly accessible database enables other fields to develop relevant tools that can aid in the growth of understanding of cognitive processes. Information retrieval and meta-analytic techniques can be used to search, sort and categorize study information with a view towards subjecting study data to secondary 'meta-' and 'mega-analyses'. In addition, we detail the technical and policy challenges that have had to be addressed in the formation of the Data Center. Among others, these include: human subject confidentiality issues; ensuring investigator's rights; heterogeneous data description and organization; development of search tools; and data transfer issues. We conclude with comments concerning the future of the fMRIDC effort, its role in promoting the sharing of neuroscientific data, and how this may alter the manner in which studies are published.

Brain↗

PubMed1995

Epstein-Barr virus association with early cancers found together with gastric medullary carcinomas demonstrating lymphoid infiltration.

Seven early gastric cancers obtained from patients also demonstrating Epstein-Barr virus (EBV)-positive gastric medullary carcinoma with lymphoid infiltration were investigated using a combined polymerase chain reaction (PCR) and in situ hybridization (ISH) approach. Sharing the same background mucosa as gastric medullary cancers, they comprised four intramucosal carcinomas, predominantly well-differentiated adenocarcinomas, and three submucosal carcinomas, histologically showing mixtures of well and poorly differentiated adenocarcinoma. In the three cases of submucosal carcinoma, the presence of EBV was proven by means of both PCR and ISH. However, not all cancer cells were positive for EBV on the basis of ISH examination, in contrast to the large series of gastric carcinoma with lymphoid infiltration previously investigated. All four mucosal carcinomas were EBV-negative. Lymphocyte-determined membrane antigen (LYDMA) monoclonality, performed by PCR, and latent membrane protein-1 (LMP-1) and Epstein-Barr virus (EBNA2) expression, assessed immunohistochemically, were negative in all seven cases. The results suggest that EBV becomes associated with gastric medullary carcinoma with lymphoid infiltration (GMCL) at a relatively early stage of the disease, shortly after the tumour has initially progressed to an invasive form, and plays some role in the manifestation as GMCL.

Adenocarcinoma↗

PubMed1999

A new multi-quantum version of the HBHA(CBCACO)NH experiment with enhanced sensitivity for partially deuterated samples.

A new multi-quantum version of the HBHA(CBCACO)NH experiment for partially deuterated protein samples is presented. The method is based on the significant reduction of the proton and carbon relaxation rates due to multi-quantum delays in highly deuterated proteins recently published by our group. The introduction of a multi-quantum period in the coherence transfer pathway of the HBHA(CBCACO)NH experiment yields a dramatic increase of sensitivity-on average 46% with a 75% deuterated sample of the homodimeric 31 kDa E. coli IIAMan domain. Additional resolution in the proton dimension can be achieved by a double time shared approach keeping the 1H single-quantum period at a minimum.

Amino Acids↗

PubMed2004

Challenges in end-of-life care in the ICU. Statement of the 5th International Consensus Conference in Critical Care: Brussels, Belgium, April 2003.

The jurors identified numerous problems with end of life in the ICU including variability in practice, inadequate predictive models for death, elusive knowledge of patient preferences, poor communication between staff and surrogates, insufficient or absent training of health-care providers, the use of imprecise and insensitive terminology, and incomplete documentation in the medical records. The jury strongly recommends that research be conducted to improve end-of-life care. The jury advocates a "shared" approach to end-of-life decision-making involving the caregiver team and patient surrogates. Respect for patient autonomy and the intention to honour decisions to decline unwanted treatments should be conveyed to the family. The process is one of negotiation, and the outcome will be determined by the personalities and beliefs of the participants. Ultimately, it is the attending physician's responsibility, as leader of the health-care team, to decide on the reasonableness of the planned action. In the event of conflict, the ICU team may agree to continue support for a predetermined time. Most conflicts can be resolved. If the conflict persists, however, an ethics consultation may be helpful. Nurses must be involved in the process. The patient must be assured of a pain-free death. The jury of the Consensus Conference subscribes to the moral and legal principles that prohibit administering treatments specifically designed to hasten death. The patient must be given sufficient analgesia to alleviate pain and distress; if such analgesia hastens death, this "double effect" should not detract from the primary aim to ensure comfort.

Decision Making↗

PubMed1992

Developing competency objectives as a basis for planning and assessing health visiting practice in training.

Evaluating student performance in health visiting practice is complex. This paper reports the development of a schedule which combines identification of learning needs, planning of learning experiences, implementation of student activities and the evaluation of student competencies for the fieldwork component of a Health Visitor Diploma. The schedule is intended to encourage students and community practice teachers to develop a shared approach to the planning of learning and the assessment of competence. The approach described may have implications for the planners of post-registration nursing courses who wish to meet the learning needs of students with a variety of professional and academic backgrounds.

Clinical Competence↗

PubMed2006

Identification of ligand specificities for glycan-binding proteins using glycan arrays.

Protein-glycan interactions mediate diverse biological processes in cell communication and innate immunity. They involve the binding of a protein on one cell surface to a glycosylated protein or lipid on an opposing cell surface. Understanding the functional significance of these interactions is of major interest to the scientific community. Numerous studies have demonstrated the utility of solid-phase glycan arrays as a means of identifying glycan binding specificity. These approaches share a common format in that glycans are attached in some manner to a solid-phase surface and the glycan-binding protein (GBP) is presented in solution for binding analysis. Multiple options are available to investigators for detecting these interactions, but the most robust reporters are fluorescence based, and binding can be detected as relative fluorescence units. The solid-phase assays have been proved to be highly scalable and suitable for manufacturing processes. The latest innovations have led to the production of miniaturized arrays using microarray printing technology to produce glycan microarrays with the potential to spot and interrogate several thousands of unique glycans simultaneously. This chapter describes two glycan array platforms developed by the Consortium for Functional Glycomics, a microtiter plate-based array and a covalent printed array, and the analytic methods used to conduct binding specificity assays for a broad range of GBPs and organisms.

Animals↗

PubMed2001

Using forecasting models to estimate the effects of changes in the composition of claims for selective serotonin reuptake inhibitors on expenditures.

BACKGROUND: The use of selective serotonin reuptake inhibitors (SSRIs) as antidepressant therapy has increased considerably since the introduction of fluoxetine in 1989. By 1999, 3 of the 4 available SSRIs were among the top 10 most frequently used drugs in the United States. In addition, SSRIs were one of the major contributors to the growth in psychotropic medication expenditures during the past 5 years. OBJECTIVE: The purpose of this article was to examine the utilization patterns of the 4 most commonly used SSRIs and their contribution to rising antidepressant medication expenditures among claimants in a publicly funded drug program. Using the results of forecasting models, we explored possible ways to control these growing expenditures. METHODS: Cross-sectional antidepressant claims and expenditure data from the Ontario Drug Benefits program for 1992 to 1998 were examined. Five scenarios were modeled in which future SSRI expenditures and claims were predicted using exponential smoothing models. RESULTS: If the historical patterns of use continued, a 20% increase in the 1998 level of expenditures was expected to occur by the year 2000. Predicted expenditures are sensitive to the composition of the SSRI claims. Exclusive use of 1 of the 4 major SSRIs (fluvoxamine, fluoxetine, paroxetine, and sertraline) could decrease projected expenditures by 30% or increase them by 11%. An "equal shares" approach, in which each of the 4 SSRIs are used in equal proportions in the population, may reduce expenditures by approximately 8%. CONCLUSIONS: The current trends in the utilization data suggest that sertraline and paroxetine are being used as first-line treatments. The results of the forecasting models suggest that growing expenditures could be curbed if these 2 antidepressants were not used in that manner. Short of limiting the drugs available on benefit formularies, there may be a way to control costs through the use of a prescribing algorithm. Although our results support the use of fluoxetine for first-line SSRI treatment as a cost-control measure, we do not definitively recommend its adoption. These findings contribute to the discussion about using fixed versus flexible formularies as a potential cost-control mechanism.

Adult↗

PubMed2000

Design and evolution of the data management systems in the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial.

This paper describes the design and evolution of the data management systems developed in support of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial. These systems span platforms from stand-alone computers to distributed systems on local area networks to mainframes. Allowing all of these systems to share appropriate information electronically introduces integration, synchronization, testing, and support challenges. For each platform, applications were developed to handle data entry, editing, trial management, reporting, telecommunications, and data sharing. Approaches to issues such as level of data access, integration with other, existing applications, and handling the expansion of the protocol are discussed.

Colorectal Neoplasms↗

PubMed2006

A qualitative study exploring barriers to a model of shared care for pre-school children's oral health.

OBJECTIVE: To explore the oral health beliefs and practices of primary health care professionals which may act as barriers to the development of a model of shared care for the oral health of pre-school children. DESIGN: Qualitative focus group discussions and semi-structured interviews. SETTING: Four rural local government areas in Victoria, Australia, 2003. SUBJECTS AND METHODS SUBJECTS: maternal and child health nurses, general medical practitioners, dental professionals and paediatricians working in the four local government areas. DATA COLLECTION: discipline specific focus groups and semi-structured interviews. DATA ANALYSIS: transcription, coding, clustering and thematic analysis. RESULTS: Several strong themes emerged from the data. All participants agreed that dental caries is a significant health issue for young children and their families. Beliefs about the aetiology of dental caries and its prevention were variable and often simplistic focusing predominantly on diet. Dental professionals did not believe that they had a primary role in the oral health of pre-school aged children but that others particularly maternal and child health nurses did. However other health care professionals were not confident in assuming this role. CONCLUSIONS: This study has identified important barriers and possible strategies for the development of an integrated and shared approach to preventing dental caries in pre-school aged children. Clear and consistent oral health information and agreed roles and responsibilities need to be developed.

Attitude of Health Personnel↗