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PubMed2001

Seeking a clarification of meaning: a phenomenological interpretation of the craft of mental health nursing.

This paper gives a description of mental health nursing practice provided by nurses working in a community mental health resource centre, in an inner city area of a northern English city. The centre offered a mental health service for a mixed client group who had enduring and/or acute mental health problems. The nurses engaged as the subjects in a phenomenological study of the nature and meaning of their practice in order to improve the care they gave the clients. The findings from the study suggest that, for the nurses, the meaning of nursing was characterized by holism, relationship-building, partnership and empowerment. The findings revealed that the aim of nursing was to promote a positive self-concept in clients and this was achieved by exploring the lived experience of the client and the nurse through relationship-building processes.

Clinical Competence↗
PubMed2003

Chiropractic-primary care, neuromusculoskeletal care, or musculoskeletal care? Results of a survey of chiropractic college presidents, chiropractic organization leaders, and Connecticut-licensed doctors of chiropractic.

BACKGROUND: The Connecticut Chiropractic Association authorized an ad hoc committee to study Connecticut chiropractic scope of practice in January 1999. This committee was chaired by Richard Duenas, DC, and included 4 other Connecticut-licensed doctors of chiropractic who responded to an appeal to participate. OBJECTIVE: Committee members investigated the terms primary care, primary care provider (PCP) (clinician, physician), neuromusculoskeletal care, neuromusculoskeletal care provider (clinician, physician), musculoskeletal care, and musculoskeletal care provider (clinician, physician) to determine which, if any, apply to the practice of chiropractic. DATA SOURCES: A literature review was performed with in-depth analysis of the definitions of these terms and an interpretation of Connecticut Statutes for chiropractic, comparing the legal description of chiropractic practice to the term definitions. The literature review produced several detailed definitions of primary care and/or primary care provider (clinician, physician); however, no accurate description of neuromusculoskeletal (NMS) care or musculoskeletal care was found. RESULTS: Two opinion surveys were conducted: 1 survey included presidents of accredited chiropractic colleges, as well as leaders of chiropractic organizations throughout the world. The other survey was sent to doctors of chiropractic (DC) licensed in the State of Connecticut. Survey topics addressed definitions of primary care and PCP, the formulation of these terms, neuromusculoskeletal care and neuromusculoskeletal care provider, individual rights in selecting a PCP, and the types of practitioners considered PCPs. The consensus among chiropractic college presidents, organization leaders, and Connecticut-licensed doctors of chiropractic was that the doctor of chiropractic is qualified to provide primary care. Most considered any definition of primary care invalid if the chiropractic profession was not involved in its formulation. The overwhelming majority felt the patient should retain the ultimate choice in determining who should be their PCP. Mission statements of accredited chiropractic colleges were reviewed, paying particular attention to educational goals and professional qualifications of graduates. The committee found these institutions strive to train students in all aspects of primary care. CONCLUSIONS: Upon review of the literature and term definitions, interpretation of the statutes pertaining to chiropractic practice, results of both surveys, and review of the chiropractic college mission statements, the committee concluded that the Connecticut-licensed DC, by education, licensure, definition, and intraprofessional consensus, qualifies as a PCP.

Attitude of Health Personnel↗
PubMed2004

Carr-Purcell echo spectra in the studies of lineshape effects. Nonclassical hindered rotation of methyl groups in 1,2,3,4-tetrachloro-9,10-dimethyltriptycene.

In the standard NMR spectra, the lineshape patterns produced by a molecular rate process are often poorly structured. When alternative theoretical models of such a process are to be compared, even quantitative lineshape fits may then give inconclusive results. A detailed description is presented of an approach involving fits of the competing models to series of Carr-Purcell echo spectra. Its high discriminative power has already been exploited in a number of cases of practical significance. An explanation is given why it can be superior to methods based on the standard spectra. Its applicability in practice is now illustrated on example of the methyl proton spectra in 1,2,3,4-tetrachloro-9,10-dimethyltriptycene TCDMT. It is shown that, in the echo spectra, the recently discovered effect of nonclassical stochastic reorientation of the methyl group can be identified clearly while it is practically nondiscernible in the standard spectra of TCDMT. This is the first detection of the effect at temperatures above 200 K. It is also shown that in computer-assisted interpretation of exchange-broadened echo spectra, the usual description of the stimulating radiofrequency pulses in terms of rotation operators ought to be replaced by a more realistic pulse model.

Journal Article↗
PubMed2004

Grounded theory: reflections on the emergence vs. forcing debate.

AIM: The aim of this paper is to compare Glaser's model of theory generation, where theory rises directly and rigorously out of the data, devoid of interpretivism, to Strauss's conceptually descriptive approach that encourages directive questioning and supports an interpretive stance. BACKGROUND: The discovery of grounded theory (GT) was born out of a merger between Barney Glaser and Anselm Strauss, the proverbial 'fathers' of GT. Since the co-creation of their approach to theory development through research in 1967, these scholars have taken seemingly divergent paths in further developing and evolving the pragmatic use of GT. DISCUSSION: Numerous researchers have used GT as a general method, applying it to both quantitative and qualitative research approaches. In this paper we discuss the stages and strategies of data sampling, collection, coding and analysing used by both Glaser and Strauss. Constant comparative analysis is identified as the primary strategy in the integrated coding and analysing stages of this theorizing method, regardless of the researcher's philosophical or research orientation. We also discuss initial or open coding, advanced coding, memoing, and theoretical sampling, with particular attention to comparing and contrasting the descriptive terms and application strategies that have been suggested by both Glaser and Strauss. CONCLUSION: The reported distinctions in the approach, method, and general intent of GT reflected in this paper are not easy to comprehend. The two methods reflect different basic philosophical paradigms, and therefore represent distinct approaches to GT. Researchers need to be clear about which philosophy and resulting analysis approach they are using, and the effect that approach will have on the research process and outcomes.

Data Collection↗
PubMed2002

Methodologic rigor of clinical trials on surgical management of eyes with coexisting cataract and glaucoma.

OBJECTIVE: To assess the methodologic quality of published studies of the surgical management of coexisting cataract and glaucoma. DESIGN: Literature review and analysis. METHOD: We performed a systematic search of the literature to identify all English language articles pertaining to the surgical management of coexisting cataract and glaucoma in adults. Quality assessment was performed on all randomized controlled trials, nonrandomized controlled trials, and cohort studies. Overall quality scores and scores for individual methodologic domains were based on the evaluations of two experienced investigators who independently reviewed articles using an objective quality assessment form. MAIN OUTCOME MEASURES: Quality in each of five domains (representativeness, bias and confounding, intervention description, outcomes and follow-up, and statistical quality and interpretation) measured as the percentage of methodologic criteria met by each study. RESULTS: Thirty-six randomized controlled trials and 45 other studies were evaluated. The mean quality score for the randomized, controlled clinical trials was 63% (range, 11%-88%), and for the other studies the score was 45% (range, 3%-83%). The mean domain scores were 65% for description of therapy (range, 0%-100%), 62% for statistical analysis (range, 0%-100%), 58% for representativeness (range, 0%-94%), 49% for outcomes assessment (range, 0%-83%), and 30% for bias and confounding (range, 0%-83%). Twenty-five of the studies (31%) received a score of 0% in the bias and confounding domain for not randomizing patients, not masking the observers to treatment group, and not having equivalent groups at baseline. CONCLUSIONS: Greater methodologic rigor and more detailed reporting of study results, particularly in the area of bias and confounding, could improve the quality of published clinical studies assessing the surgical management of coexisting cataract and glaucoma.

Cataract↗
PubMed1997

Underdetermination and incommensurability in contemporary epidemiology.

In the shadowy world between philosophy of science and ethics lie the paired concepts of underdetermination and incommensurability. Typically, scientific evidence underdetermines the hypotheses tested in research studies, providing neither proof nor disproof. As a result, scientists must judge the weight of the evidence, and in doing so, bring scientific and extrascientific values to bear in their approaches to assessing and interpreting the evidence. When different scientists employ very different values, their views are said to be incommensurable. Less prominent differences represent partial incommensurabilities. The definitions and analyses provided by McMullin and by Veatch and Stempsey lay the foundation for the description of partial incommensurabilities in the current practice of assessing and interpreting epidemiologic evidence. This practice is called "causal inference" and is undertaken for the purpose of making causal conclusions and public health recommendations from population-based studies of exposures and diseases. Following the work of Bayley and Longino, several suggestions are examined for dealing with the partial incommensurabilities found in the general practice of causal inference in contemporary epidemiology. Two specific examples illustrate these ideas: studies on the relationship between induced abortion and breast cancer and those on the relationship between moderate alcohol consumption and breast cancer.

Abortion, Induced↗
PubMed1995

Coronary vascular reserve in humans: a critical review of methods of evaluation and of interpretation of the results.

The concept of coronary vascular reserve stems from the description of coronary autoregulation by Mosher in 1964. Schematically, the coronary blood flow at rest depends on the determinants of myocardial oxygen demand (heart rate, contractility and ventricular load). If maximal coronary vasodilation is produced, it results in a linear and steep pressure-flow relationship. The increment of coronary flow above its basal value is called the coronary flow reserve, which indicates the flow added to the basal flow for a given coronary perfusion pressure when the coronary vascular bed is maximally dilated. Thus, in the absence of epicardial coronary artery stenosis, the maximal coronary flow is a function of the coronary perfusion pressure and of the maximal surface area of the coronary circulation at the resistance vessel level. Evaluation of the coronary reserve in humans raises three major concerns: (1) methods for measuring or evaluating coronary flow are imprecise and inconvenient (diffusible indicators), invasive (coronary sinus thermodilution, intracoronary Doppler), expensive and require sophisticated technology (ultrafast computed tomography, positron emission tomography), or in the process of being validated (contrast echocardiography, transoesophageal Doppler echocardiography, myocardial scintigraphy: (2) the compounds used to produce maximal coronary vasodilation are administered either by the intracoronary route (papaverine) or intravenously (dipyridamole, adenosine); (3) how to interpret the data: is the alteration of the coronary reserve due to a modification of the basal coronary flow or/and of the maximal coronary flow? Thus, each method has its own limitations and constraints that must be taken into account in order to avoid crude misinterpretations. In conclusion, the measurement of coronary reserve may be an important means of understanding coronary physiology and pathophysiology. Recently developed non-invasive methods (ultrafast computed tomography, positron emission tomography, echography) and the ability to produce maximal coronary vasodilation by the intravenous route are promising.

Angiography, Digital Subtraction↗
PubMed2005

Simulation of fluorescence anisotropy experiments: probing protein dynamics.

Time-resolved fluorescence anisotropy decay experiments on a protein-attached dye can probe local protein dynamics and steric restrictions, but are difficult to interpret at the structural level. Aiming at an atomistic description, we have carried out molecular dynamics simulations of such experiments. Our simulations describe an Alexa488 fluorescent dye maleimide derivative covalently attached via a single cysteine to the AB-loop of bacteriorhodopsin. Fluorescence anisotropy decay curves obtained from the simulations agree well with the measured ones. Three anisotropy decay components were resolved and assigned to: 1), the fast dynamics of the attached dye on the picosecond timescale; 2), the slower dynamics of the loop at the one nanosecond timescale; and 3), the overall tumbling of the molecule. For the biologically relevant 1-ns component we identified two processes from simulations, the motion of the flexible loop as well as slow conformational dynamics of the dye. These two processes are not separable by experiment alone. Furthermore, analysis of the correlation between the dye and the protein motion revealed which part and which motion of the protein is actually probed by the experiment. Finally, our simulations allowed us to test the usual and inevitable assumption underlying these types of spectroscopic measurements that the attached dye probe does not severely perturb the protein dynamics. For the case at hand, by comparison with a simulation of the dye-free protein, the perturbation was quantified and found to be small.

Anisotropy↗
PubMed2004

Recurrent cerebral fever in the seventeenth and twenty first centuries.

The development of modern neuroscience away from the concepts of Hippocrates and Galen can be traced to the writings of some 17th century clinicians, especially Thomas Willis. His exceptional skills in observation and description allow a window into the experiences of our medical forebears. His approach to the management of infection-related coma in a child is amenable to modern interpretation and comparison with modern management because of the clarity of his clinical descriptions. Modern clinicians may benefit from this historical perspective into influences on the origins of neuroscience. The different outcome for a child presenting in the 17th and 21st century encourage grateful reflection on our current privileged position.

Anti-Bacterial Agents↗
PubMed1988

Typology of mood assessment curves by means of cluster analysis of computerized mathematical descriptions of time-series mood data collected from depressive inpatients treated with antidepressants.

A recently developed method for the computerized description of mood curves was applied to self-evaluation mood data of a large sample of 136 depressive inpatients. The values of the mathematical parameters from this description were analysed by cluster analysis to determine different types of mood courses of patients undergoing therapy with antidepressants. In general, the most unfavorable type of mood course was overrepresented in the group of neurotic depressive patients, the most favorable one in the group of endogenous depressive patients. But in this latter diagnostic group, a remarkable proportion of patients with the unfavorable mood course was observed, indicating the well-known phenomenon of non-response to antidepressants. The results can be interpreted as a validation of the new method of computerized description of mood curves. This method might lead to interesting possibilities in drug treatment evaluation.

Antidepressive Agents↗
PubMed1994

Attitudes towards co-workers affected by occupational hearing loss. II: Focus groups interviews.

This study was undertaken as a complement to a questionnaire inquiry on attitudes towards co-workers affected by occupational hearing loss (OHL). Four groups of 7 to 11 volunteer participants were recruited among respondents to the questionnaire inquiry. They were interviewed using a focus group technique. Scenarios were prepared to serve as a basis for asking questions aimed at three major objectives: (a) to characterize workers' perception of a co-worker who has an impairment involving no visible signs; (b) to identify the conditions that trigger social withdrawal and isolation behaviour among people affected by OHL, and the conditions that might make the latter decide to seek help; and (c) to define the type and methods of help that might minimize social withdrawal and isolation among hearing impaired workers. The interviews were taped and transcribed verbatim for content analysis using a phenomenological-interpretative framework. The findings can be summarized by the following description of the perception of the problem of OHL among industrial workers. The strong fear of being stigmatized leads those affected by OHL to conceal its manifestations and consequences in their everyday life. As a result, significant others, co-workers, employers and the general population are not aware of such manifestations. Within the workplace, the problem of OHL is generally seen as being inconsequential. In daily interactions among co-workers, its effects are ignored. Within the family, hearing difficulties are often not interpreted as such but they nevertheless affect the workers' significant others. People do not know how to facilitate communication with a person affected by OHL. A large scale multi-target awareness programme is proposed to demarginalize workers affected by OHL. Implications of the findings are drawn in such areas as characterization of attitudes toward workers with hearing impairment, rehabilitation for those affected by OHL, and prevention of OHL.

Adult↗
PubMed2003

Performance in reading radiographs: does level of education predict skill?

INTRODUCTION: Previous studies demonstrated lack of progress in electrocardiographic analysis skills with increasing levels of medical education. This study examined radiograph analysis skills, a similar cognitive task, across a range of educational experience: senior medical students (n = 23), family practice residents (n = 16), general practitioners (n = 41), and their family practice educators (n = 7). METHODS: Written records of diagnosis or description of abnormalities were used to detect skill in interpreting radiographs. The instrument was 12 sets of radiographs: 2 normal and 6 abnormal chest radiographs and 2 normal and 2 greenstick radial fractures. RESULTS: The mean score for correctly diagnosing all 12 sets of radiographs was 5.59 +/- 1.68, and the mean score for correctly diagnosing the 4 normal radiographs as normal and the abnormal radiographs as abnormal was 8.76 +/- 1.55. There was no statistically significant difference between the four groups of participants. DISCUSSION: Skill level in interpreting radiographs did not appear to improve with additional experiential training and may require a more formal educational approach to address this issue.

Clinical Competence↗
PubMed1991

Autosomal dominant transmission of the NAME syndrome (nevi, atrial myxoma, mucinosis of the skin and endocrine overactivity).

A family affected in two generations with the NAME syndrome is described, and the literature on this phenotype reviewed. The term "NAME" was originally proposed as an acronym for "nevi, atrial myxoma, myxoid neurofibromata and ephelides". However, in order to give a more comprehensive description of this syndrome, we recommend the following alternative interpretation of "NAME": nevi, atrial myxoma, mucinosis of the skin, endocrine overactivity. Previous family observations suggested a dominant, and probably autosomal, inheritance but an X-linked dominant transmission could not be excluded. We describe male-to-male transmission, strongly supporting the concept of the autosomal inheritance of this trait.

Adult↗
PubMed1995

Syntactic cues in the acquisition of collective nouns.

One basic finding in the study of word learning is that children tend to construe a word describing an object as referring to the kind of whole object, rather than to a part of the object, one of its properties, or the substance it is made of. This has been taken as evidence that there exist certain special constraints on word meaning that guide children to favor the kind-of-object interpretation when exposed to a new word. There are descriptive problems with this proposal, however, as it cannot explain how children learn other kinds of words, such as names for specific people, substances, parts, events, collections, and periods of time. These problems motivate an alternative theory in which young children possess several distinct conceptual categories--including "individual", which is more abstract than "whole object"--and can use syntactic cues to determine the conceptual category that a new word belongs to. This theory is explored in two experiments in which we attempt to use syntactic cues to teach children and adults novel collective nouns--words that refer to groups of objects. The results indicate that children can use such cues to learn names for kinds of individuals that are not whole objects, although they are less able to do so than adults. Candidate explanations for why this developmental difference exists are discussed and implications are drawn for theories of word learning and conceptual representation.

Adult↗
PubMed1976

MUMPS--an economical and efficient time-sharing system for information management.

MUMPS, the Massachusetts General Hospital Utility MultiProgramming System, is a compact time-sharing system for information management. This paper discusses the historical development of MUMPS and describes the basic modules found in its implementation. Detailed descriptions of the time-sharing executive, MUMPS language interpreter, input/output file system, and global data base are given, emphasizing their integration into an easy-to-use yet powerful system for application program design, development and maintenance.

Computers↗
PubMed1986

Areas of spatial interaction for a hyperacuity stimulus.

We report that the ability to detect a small vernier offset (less than 5 sec of arc in many individuals) between two small spots of light separated by a narrow gap can be disrupted by presenting additional targets in close proximity to the vernier stimulus. A rectangular background of light, centered on the vernier stimulus, elevates offset threshold by a factor of two when the total width of the background is 3-4 min arc. Backgrounds narrower or wider than 3-4 min have less or no effect on vernier threshold. These areas of spatial interaction extend to either side of a vertically-oriented vernier stimulus, or above and below a horizontally-oriented stimulus, and their extent is dependent upon the gap size of the two-dot stimulus. The effect of the presence of the background on vernier threshold cannot be accounted for by spatial interval cues nor by changes in the visibility of the stimulus. Two alternative interpretations of the results are presented to develop a description of the underlying mechanisms which produce hyperacuity spatial interactions.

Distance Perception↗
PubMed1988

A view from the center. A former division chief's perspective on being a megadepartmental chairman.

Upon completing his sixth year as chairman of a large department of surgery in a major United States medical school, the author, a neurosurgical chief for 32 years, reflects upon the goals of departmental stewardship. The charges and challenges to any chairman of a multispecialty department are sampled from the perspective of personal experience. The general message could be interpreted as a call to service and a job description.

Neurosurgery↗