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Mental healthcare in Wolverhampton had sunk to such depths that two years ago the purchasing authority was openly discussing commissioning its services from another town. Today the situation is transformed. David Jolley and colleagues explain how such marked progress was achieved.
Mildly mentally retarded and MA-matched nonretarded individuals were tested for speed and accuracy in responding to questions requiring different processing depth in the Craik and Tulving paradigm and then given an unexpected recognition task. Retarded individuals required progressively more encoding time relative to nonretarded individuals as processing depth increased. Both encoding and recognition accuracy, however, was equivalent for both groups; greater elaboration improved recognition in both groups. Implications for the study of retardation were presented.
Over the past five years the Tanzanian-Norwegian AIDS Project (MUTAN) has assisted the National AIDS Control Programme in creating and testing innovative HIV/AIDS educational programmes. These programmes, designed to reach a variety of target groups, have been implemented throughout the Arusha and Kilimanjaro regions and include: public meetings, intensive courses, information centres, radio programmes and school-based programmes. A recent survey of 996 participants (15-54 years old) was designed to assess public exposure to HIV/AIDS information. A total of 72% of the participants reported having heard about AIDS on the radio, 74% having read about AIDS in newspapers, and 52% having heard about AIDS from a health worker during the previous month. Furthermore, 26% had listened to MUTAN's weekly radio programme at least once. 31% knew of MUTAN's information centres, and 15% had visited one of these centres. The results indicate that large proportion of the population is receiving in-depth HIV/AIDS information. It is recommended that future work concentrate on how to reach people with no or little formal education, young adults and women.
OBJECTIVE: To determine whether water exposure causes middle ear contamination in patients with collar button tympanostomy tubes (TTs). METHOD AND DESIGN: An in vitro model of a human head that contained an auricle, external auditory canal, tympanic membrane with TT, middle ear, eustachian tube, and mastoid cavity was developed. Two electrodes connected to an external ohmmeter resided in the middle ear to detect water entry. The model was tested with 4 types of water exposure: showering, bathing, hair rinsing, and swimming. Statistical analysis was performed by the Fisher exact test. MAIN OUTCOME MEASURES: A positive test result corresponded to water entering the middle ear via the TT, confirmed by a resistance reading of zero on the ohmmeter. A negative test result indicated no change in the initial high resistance reading. RESULTS: No positive test results were obtained for showering (0 of 60 tests), hair rinsing (0 of 60 tests), or head submersion (12.7 cm) in clean tap water (0 of 60 tests). Ten positive test results were obtained for head submersion in soapy water (10 of 97 tests), which was statistically different from clean water (P< or =.007). Swimming pool depths of 30, 45, 60, and 75 cm elicited positive test results in 2 of 16, 3 of 18, 2 of 20, and 11 of 20 tests, respectively. A higher incidence of water entry into the middle ear occurred at depths of more than 60 cm (P< or =.001). No statistical difference between depths of 60 cm or less occurred (P= .88). CONCLUSIONS: Showering, hair rinsing, and head submersion in clean tap water do not promote water entry into the middle ear. Submersion in soapy water increases the probability of water contamination. Pool water infrequently enters the middle ear with head submersion, but the incidence increases with deeper swimming (>60 cm). These data provide further evidence that many water precautions frequently advised in patients with TTs are unnecessary.
A new electronic direct ion storage (DIS) dosemeter allows accumulated personal dose equivalent Hp(d) at depths of 10 mm and 0.07 mm to be monitored in a few seconds by inserting the dosemeter into a local reader without deleting the accumulated dose. The DIS system meets general requirements on individual monitoring of hospital personnel using ionising radiation. It differs greatly from off-line thermoluminescence dosimetry systems and offers many additional benefits. The non-volatile reading takes only 5 s, is taken as often as needed, and the data are collected into a dose database, where background radiation is subtracted. Individual personnel doses are reported in Intranet as well as on the Internet at regular intervals to the National Regulatory Authorities.
With the clinical implementation of time-variable dose patterns and intensity modulated radiotherapy (IMRT) film dosimetry has regained popularity. Films are currently the most frequently used dosimetric means for patient specific quality assurance in IMRT. A common method is to verify a so-called hybrid IMRT plan, which is the patient specific treatment plan with unmodified fluence patterns recalculated in a dedicated phantom. For such applications the sensitometric curve, i.e., the relation between optical density (OD) and absorbed dose, should not depend critically on beam energy, field size and depth, or film orientation. In order to minimize the influence of all these variables a normalization of sensitometric curves is performed at various photon beam energies (6 MV, 10 MV, 25 MV). By doing so one unique sensitometric curve can be used for these three beam qualities. This holds for both film types investigated: Kodak X-Omat V films and EDR-2 films. Additionally, the influence of field size, depth and film orientation on a normalized sensitometric curve is determined for both film types. For doses smaller than 0.8 Gy for X-Omat V and doses smaller than 3 Gy for EDR-2 films the field size variation of normalized sensitometric curves is much smaller than 3% for fields up to 20 x 20 cm2. For X-Omat V films all differences between sensitometric curves determined at depths of 5, 10, and 15 cm are smaller than 3%. For EDR-2 films deviations larger than 3% are only observed at low net OD smaller than 0.25. The dependence of film orientation (parallel versus perpendicular) on a normalized sensitometric curve is found to be not critical. However, processing conditions have the largest influence and can result in differences up to 20% for sensitometric curves derived from films of the same batch but using different film processors. When normalizing sensitometric curves to the dose value necessary to obtain a net OD=1 for that respective geometry and energy the large energy dependence of sensitometric curves can be almost eliminated. This becomes especially important for the verification of hybrid IMRT plans with multiple energies. Additionally, such a normalization minimizes other influences such as field size, depth, and film orientation. This method is generally applicable to both Kodak X-Omat V and EDR-2 films. In order to achieve the highest accuracy level an upper dose limit of 0.8 Gy for X-Omat V films and 3 Gy for EDR-2 films should be taken into account. However, these dose limits may vary with film reading instrument and film processor.
PURPOSE: To evaluate the association between intelligence and myopia in children. METHODS: Cycloplegic refraction and ocular biometry parameters, including axial length, vitreous chamber depth, lens thickness, anterior chamber depth, and corneal curvature were obtained in 1204 Chinese school children aged 10 to 12 years from three schools who were participants in the Singapore Cohort Study Of the Risk Factors for Myopia (SCORM). Intelligence quotient (IQ) was assessed using the nonverbal Raven Standard Progressive Matrix test. RESULTS: After controlling for age, gender, school, parental myopia, father's education, and books read per week, myopia (spherical equivalent [SE]) of at least -0.5 D was associated with high nonverbal IQ (highest quartile) versus low IQ (lowest quartile) (odds ratio = 2.4; 95% confidence interval, 1.7-3.4). Controlling for the same factors, children with higher nonverbal IQ scores had significantly more myopic refractions (-1.86 D for children with nonverbal IQ in the highest quartile compared with -1.24 D for children with nonverbal IQ in the lowest quartile; P = 0.002) and longer axial lengths (24.06 mm versus 23.80 mm; P = 0.022). Nonverbal IQ accounted for a greater proportion of the variance in refraction compared with books read per week. CONCLUSIONS: Nonverbal IQ may be an independent risk factor of myopia, and this relationship may not be explained merely by increased reading (books per week) among myopes. An interesting observation is that nonverbal IQ may be a stronger risk factor for myopia compared with books read per week. The complexity of the relationships between nonverbal IQ, reading, and myopia warrant additional studies to clarify any cause-effect relationship.
FusionDB (http://igs-server.cnrs-mrs.fr/FusionDB/) constitutes a resource dedicated to in-depth analysis of bacterial and archaeal gene fusion events. Such events can provide the 'Rosetta stone' in the search for potential protein-protein interactions, as well as metabolic and regulatory networks. However, the false positive rate of this approach may be quite high, prompting a detailed scrutiny of putative gene fusion events. FusionDB readily provides much of the information required for that task. Moreover, FusionDB extends the notion of gene fusion from that of a single gene to that of a family of genes by assembling pairs of genes from different genomes that belong to the same Cluster of Orthogonal Groups (COG). Multiple sequence alignments and phylogenetic tree reconstruction for the N- and C-terminal parts of these 'COG fusion' events are provided to distinguish single and multiple fusion events from cases of gene fission, pseudogenes and other false positives. Finally, gene fusion events with matches to known structures of heterodimers in the Protein Data Bank (PDB) are identified and may be visualized. FusionDB is fully searchable with access to sequence and alignment data at all levels. A number of different scores are provided to easily differentiate 'real' from 'questionable' cases, especially when larger database searches are performed. FusionDB is cross-linked with the 'Phylogenomic Display of Bacterial Genes' (PhydBac) online web server. Together, these servers provide the complete set of information required for in-depth analysis of non-homology-based gene function attribution.
The effects of levels-of-processing and word frequency were directly compared in three different memory tests. In the episodic recognition test, the subjects decided whether or not a word or a pronounceable nonword had been previously studied. In the two lexical decision tests with either pronounceable or unpronounceable nonwords as distractors, the subjects decided whether a test item was a word or a nonword. There were four main results: (1) in all three tests, reaction times (RTs) in response to studied words were faster if they had received semantic rather than rhyme processing during study; (2) in the episodic recognition test, RTs were faster for low- than for high-frequency words; in both lexical decision tests, RTs were faster for high- than for low-frequency words, though less so when the nonword distractors were unpronounceable; (3) prior study facilitated lexical decisions more in response to low- than to high-frequency words, thereby attenuating the word-frequency effect, but more so when the nonword distractors were pronounceable; (4) in the lexical decision test with pronounceable nonword distractors, relative to prior rhyme processing, prior semantic processing facilitated performance more for high- than for low-frequency words, whereas the opposite was the case in the episodic recognition test. Discussion focused on the relationship of these results to current views of the mechanisms by which (1) word frequency and depth of processing affect performance in implicit and explicit memory tests, and (2) repetition priming attenuates word-frequency effects for lexical decisions.
Microbiomes play crucial roles in diverse ecosystems, spanning environmental, agricultural, and human health domains. However, in-depth metagenomic data analysis presents significant technical and resource challenges, particularly at scale. Existing computational pipelines are typically limited to either reference-based or reference-free approaches and exhibit inefficiencies in process large datasets. Here, we introduce MetaflowX (https://github.com/01life/MetaflowX), an open-resource workflow integrating both analytical paradigms for enhanced metagenomic investigations. This modular framework encompasses short-read quality control, rapid microbial profiling, hybrid contig assembly and binning, high-quality metagenome-assembled genome (MAG) identification, as well as bin refinement and reassembly. Benchmarking tests showed that MetaflowX completed full metagenomic analyses up to 14-fold faster and with 38% less disk usage than existing workflows. It also recovered the highest number of high-quality and taxonomically diverse MAGs. A dedicated reassembly module further improved MAG quality, increasing completeness by 5.6% and reducing contamination by 53% on average. Functional annotation modules enable detection of key features, including virulence and antibiotic resistance genes. Designed for extensibility, MetaflowX provides an efficient solution addressing current and emerging demands in large-scale metagenomic research.
Contact lens fitting for presbyotic patients needs more than simple fitting shill; patients need additional psychological support. The wearer has to accept optical quality reduction due to the multifocality of the lens design. In general, the technical fitting of presbyotic contact lenses is comparable to monofocal systems. They work with the same rules of performance. The difference lies in the principles of correction by the lens itself. Simple presbyotic systems use uncorrected optical aberration to widen depth perception. These lenses are suitable for young presbyopes, up to a need of 1 diopter plus power for near vision. Uncorrected aspherical designs have a multifocal effect which can be used for presbyotic lenses. There are contact lenses on the market with simultaneous imaging, which is based on concentric rings around the near or distance centre. Another principles are based on segmented reading portions in the lower part of the lens, also called alternating systems. These very few design variations are the basis for the various specific models which are sold on the market today. The results of the fitting can never be foreseen as subjective and psychological aspects of the wearer overlay the objective results. Thus, the fitter needs experience and patient understanding, combined with fundamental knowledge of the specific lens type used.
AIM: The aim of this article is to review the nursing literature on the notion of advanced nursing practice (ANP) and consequently provide clarifications on the concept of advanced nurse practitioner by developing its' generic features. BACKGROUND: This paper commences by critically reviewing the concept of advanced nursing practice as it is portrayed within the literature. From this review, a series of contradictions emerged in terms of definitions and roles. On further analysis of the literature the core aims and goals of the ANP are revealed. METHODS: An informative and narrative systematic literature review was undertaken, using specific inclusion and exclusion criteria. The mass of retrieved material was carefully screened and methods of data saturation were used. Consequently, the material was read, re-read and indexed as to develop seven thematic units that formed the generic features of the ANP. FINDINGS: The generic features that emerged are: (i) the use of knowledge in practice, (ii) critical thinking and analytical skills, (iii) clinical judgement and decision-making skills, (iv) professional leadership and clinical inquiry, (v) coaching and mentoring skills, (vi) research skills and (vii) changing practice. CONCLUSION: Reviewing the literature on the concept of ANP, a great variety of definitions, conceptualizations and roles emerged. Nonetheless, on a closer reading, a common goal was identified, which was the attainment of practice and professional autonomy via ANP roles for enhanced practice provision. Eventually, from the reviewed literature, seven generic features of the ANP were developed, thus providing clarification to the role and the characteristics of the ANP. RELEVANCE TO CLINICAL PRACTICE: Clarifying the confusion surrounding advanced nursing practice and gaining an in-depth understanding of its' generic features would facilitate practitioners, practice educators and clinical managers to develop those skills that would allow them or their staff or students to practise at an advanced level.
According to classical dual-route theory, effects of associative priming and frequency on the naming of printed words arise from lexical access and should be weak or absent when word names are assembled prelexically. Assembled naming would be more likely in a shallow orthography, especially in the presence of nonwords. This hypothesis was examined with the shallow Serbo-Croatian orthography. Interactions between association, frequency, and stimulus quality were also examined in both Serbo-Croatian and English. Contrary to classical dual-route theory, both lexical effects were found for naming words in Serbo-Croatian, with or without nonwords. Neither interaction was significant in Serbo-Croatian and only association x quality was significant in English. Discussion focused on (a) the claim that lexical effects on naming in a shallow orthography constitute prima facie evidence against either prelexical phonology or the orthographic depth hypothesis, and (b) the possible factorization of frequency and active associative knowledge in naming words.
A-scan readings must be taken along the visual axis for accurate axial length measurement. Various fixation targets, which ideally should not induce accommodation, are used to limit eye movements. In this study results using the Humphrey biometer under different fixation conditions were compared to establish the most suitable target. We also investigated corneal applanation effects by comparing optical and ultrasonic measurements of anterior chamber depth. We examined 12 randomly selected normal eyes of 12 young subjects. Three A-scans were recorded for each of five fixation conditions: spotlight at 6 m; Snellen letter at 6 m; solid probe's built-in green fixation target; Snellen letter at 6 m viewed through a -4.00 DS lens; spotlight at 6 m under cycloplegia (the comparison condition). Variability 'within' each fixation condition, estimated by the standard deviation for each subject, was equal throughout the 12 subjects for each fixation condition. Also variation was independent of size of the ocular dimension. The good agreement between the comparison condition and optical anterior chamber depth measurements indicated that the solid probe produced little applanation. Differences 'between' fixation conditions were investigated. It was concluded that a spotlight or letter at 6 m provides a suitable fixation target for biometry. Built-in fixation targets can produce significant errors.
Understanding the surface micromechanical properties of ultra-high-molecular-weight polyethylene (UHMWPE) may allow for improvement in its wear characteristics. Microtomed sections of two UHMWPE tibial bearings, one that had been irradiation sterilized and shelf-aged, and the other irradiation sterilized and used in a patient, were subjected to depth sensing indentation testing. The microtomed sections exhibited a white band in the subsurface region that is characteristic of oxidation, and the indentation testing, followed by FTIR analysis at the same testing locations, was performed across this region and into the bulk of the material. Indentation testing yielded data leading to hardness, modulus, and energy dissipation factor (EDF). FTIR profiling generated information about oxidation; oxidation indices were calculated by taking a ratio of peak heights at 1,716 cm(-1) (ketone) to 2,022 cm(-1) (methylene). The mechanical properties showed a strong linear correlation with oxidation index above a minimum thickness. Modulus, hardness, and EDF all increased with increasing oxidation. The appropriate thickness-to-indentation-depth ratio was determined by two methods and was found to be approximately 20:1. The mechanical properties through the oxidized region were seen to vary with depth into the sample in a profile similar to the oxidation profile. The differing aging environments of the tibial bearings are hypothesized to have had an effect on both the mechanical and oxidation profiles. The retrieved bearing exhibited a narrower oxidation profile with peaks closer to the surface, and oxidation indices of lower magnitude. The mechanical properties proved similar, with less intense and narrower readings for the retrieved sample. This research is consistent with much of the literature.
BACKGROUND: Duplex ultrasonography (DS) is a frequently used noninvasive method for assessing carotid artery stenosis. The level of agreement between panoramic radiographs (PMX) findings of radiopacities in the area of C3-C4 and DS results has not been established. AIMS: (1) to examine the level of agreement between DS results and PMX signs of carotid calcification and (2) to evaluate the association between periodontitis and DS results. MATERIAL AND METHODS: Eighty-three subjects who had received a DS assessment at the University of Washington Medical Center within 36 months volunteered for a periodontal examination, including assessments of probing pocket depth (PPD), attachment level (PAL), evidence of bleeding on probing and bone loss from PMX. Two examiners independently analyzed the radiographs for evidence of carotid calcifications. The distance between the cemento-enamel junction (CEJ) to bone level (BL) CEJ-BL was used to assess alveolar bone loss as a criteria for periodontitis. RESULTS: Twenty-nine subjects (34.9%) presented with positive DS readings. The Mantel-Haentszel common odds ratio estimate for a positive DS score and periodontitis (> 30% of teeth with distance CEJ-BL > or = 4.0 mm) was 38.4 (95% CI: 10.6-138.7, p < 0.0001). For nonsmokers only (n = 72) the odds ratio was 43.0 (95% CI: 16.7-1178.0, p < 0.0001). Evidence of bleeding on probing was 16% of sites both in the DS-positive and -negative subjects. Subjects with a positive DS result had significantly more teeth with clinical evidence of attachment loss > or = 5.0 mm (p < 0.001). The odds ratio of having periodontitis (CEJ-BL > or = 4.0 mm at > or = 30% of the teeth) and medical records confirmed diagnosis of either a stroke or an infarct or both was 7.8 (95% CI: 2.6-23.8, p < 0.001). CONCLUSIONS: Subjects with positive DS readings of the carotid arteries due to calcified arterial plaque are accurately detected by means of conventional PMX. The likelihood of being DS positive and having radiographic evidence of periodontitis is high. A dose-response relationship between the extent of carotid calcification and severity of periodontitis was demonstrated, supporting the hypothesis of an association between periodontitis and cardiovascular diseases.
This paper is concerned with if and how nurses are obtaining information on research into nursing. It is based on the results of a wider survey conducted in Northern Ireland in 1979, the aim of which was to assess the degree to which those most concerned with administering, managing, and teaching patient care were managing to obtain and implement information on nursing research. The main sources examined were nursing journals, nurse education curricula, and libraries relevant to nursing. For the purpose of the survey the writer took the view that, in terms of the relationship between nursing and practice, any dichotomy of opinion as to what nursing research is, or is not, is largely semantic. It was decided, therefore, to adopt the holistic approach to the term 'nursing research' as supported by Treece & Treece (1977) who claimed that 'Nursing Research includes the breadth and depth of the discipline of nursing, the rehabilitive, therapeutic and preventive aspects of nursing, as well as the preparation of practitioners and personnel involved in the total nursing sphere.
BACKGROUND: Accurate biometry is of vital importance in achieving predictable postoperative refraction following cataract surgery. AIM: To evaluate the accuracy and consistency in biometry, achieved by the new generation laser biometric system in comparison with the ultrasound biometric system. METHODS: The study was randomized and prospective. Biometry was performed in 68 eyes of 39 patients by three groups of biometrists (expert, intermediate user, novice). Expert and intermediate users are compared as group A, and expert and novice are compared in group B. Axial length, anterior chamber depth (ACD), and keratometry results are compared by t-test analysis. RESULTS: Axial length measurement variation between expert and non experts was 10 times less using laser than ultrasound (P<0.001). ACD measurement variation was also significantly less when using laser compared to ultrasound (P=0.003). Need for some level of user training is indicated in ACD measurement since group A achieved more consistent readings than group B. Keratometry measurements on the laser system were unreliable due to high range of results. Biometric failure was seen in 12% of eyes undergoing laser and 1% undergoing ultrasound biometry. CONCLUSION: Axial length determination by laser biometry is more accurate and consistent at all levels of biometrist expertise, compared to ultrasound biometry. ACD and keratometry measurements on the laser systems need some degree of user training in order to produce consistent results.