bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental Health Link: the development and formative evaluation of a complex intervention to improve shared care for patients with long‐term mental illness
Authors: Byng Richard , Jones Roger 
Published: January 2004

AbstractAims and objectives  This study aims to develop an intervention and related conceptual framework for developing shared care for patients with long‐term mental illness, and to provide a case study of the development of a complex intervention in primary care. Methods   A pragmatic iterative design involved a literature review and focus groups followed by a formative evaluation including reflection, questionnaires and interviews. General practices and associated community mental health teams in Southeast London were involved. Participants included community mental health workers, psychiatrists, practice nurses, general practitioners, managers and local  experts  with  an  interest  in  primary mental health care.Results  The model for shared care includes the core components of improved communication together with the development of a register and database with systems for review and recall. Local needs assessment, audit, training and guidelines are complimentary components. The intervention, Mental Health Link, is a facilitated quality improvement programme which aims to expedite the development of services by bringing the teams together to agree on a model of shared care suited to local needs, skills and interests, and  by  supporting  the development of practice systems. Conclusions   A model for shared care needs to take into account interdependencies of the components as well as the relationship with the context. The heterogeneity of primary and community care need to be reflected in the development of complex interventions designed to enhance shared care. It is possible to develop a generalizable complex intervention which is sensitive to local circumstances.
Change, humanity, and the nature of exile: workforce planning and the future of the health service
Authors: Thompson Nicola 
Published: January 2004

AbstractThere have been many changes in the practice of medicine in the UK in the recent past, including major changes in training and trainees’ hours, treatment options and patient expectations. These, in combination with a need for better accountability and improved continuing medical education, have increased the demands on senior doctors, and made apparent the need for increased medical resource. There would seem to be four areas through which this is being addressed – increased production of doctors; changes in medical training; changes in medical practice, and retention of seniors in post. This paper examines some of the perceived advantages and potential disadvantages of these approaches. It concludes that if the health service is to have a viable long‐term future, its survival in the short term depends on maintaining within the service the skills of those seniors who have borne the brunt of recent change.
Equity and need when waiting for total hip replacement surgery
Authors: Fitzpatrick Ray , Norquist Josephine M. , Reeves Barnaby C. , Morris Richard W. , Murray David W. , Gregg Paul J. 
Published: January 2004

AbstractObjectives  To explore sociodemographic and health status factors associated with waiting times both for first outpatient appointment and for total hip replacement surgery (THR).Methods  A survey of THR in five former English regions was conducted between September 1996 and October 1997. Every patient listed for THR was asked to fill out a questionnaire preoperatively. This questionnaire included the 12‐item Oxford Hip Score (OHS) questionnaire and two questions on the length of time patients waited for an  outpatient  appointment  and  subsequently  for  their operation.Results  From multiple logistic regression analyses, region, private vs. public sector, housing tenure and preoperative OHS were all independently associated with a waiting time for an outpatient appointment for > 3 months. Region, housing tenure and gender were also independently associated with a wait of ≥ 6 months on the surgical waiting list.Conclusions  A large proportion of patients had long waiting times both for an outpatient appointment and while on a surgical waiting list. There were significant differences in waiting time according to social, geographical and health care system factors. Patients with a worse pain and disability at surgery waited longer for an outpatient appointment. The longer patient waited, the worse was their pain and disability, suggesting that patients were not prioritized by these criteria. Benefits of prioritizing should be tested.
Emergency department mental health triage scales improve outcomes
Authors: Broadbent Marc , Jarman Heather , Berk Michael 
Published: January 2004

AbstractThe assessment and management of clients with mental illness is an important facet of providing emergency care. In Australian emergency departments, it is usually the generalist registered nurses* without adequate preparation in the assessment and care for clients with mental illness who conduct the initial assessment at triage. A search of the literature revealed a limited number of publications addressing the provision of triage and management guidelines to assist nurses to make objective clinical decisions to ensure appropriate care for clients with mental illness. This paper examines the need for such guidelines and reviews a number of mental health triage scales that have been evaluated for use in emergency departments. Findings show that these triage scales have led to improvements in staff confidence and attitudes when dealing with clients with mental health problems, resulting in improved outcomes for clients. Strengths and limitations of the evaluations have also been explored. Highlighted is the need for consideration of the inclusion of clients’ reactions to the impact of this change to service delivery in future evaluations.
Picosecond time‐resolved microspectrofluorometry in live cells exemplified by complex fluorescence dynamics of popular probes ethidium and cyan fluorescent protein
Authors: Tramier M. , Kemnitz K. , Durieux C. , Coppey‐Moisan M. 
Published: January 2004

SummaryTime‐resolved microspectrofluorometry in live cells, based on time‐ and space‐correlated single‐photon counting, is a novel method to acquire spectrally resolved fluorescence decays, simultaneously in 256 wavelength channels. The system is calibrated with a full width at half maximum (FWHM) of 90 ps for the temporal resolution, a signal‐to‐noise ratio of 106, and a spectral resolution of 30 (Δλ/Λ). As an exemple, complex fluorescence dynamics of ethidium and cyan fluorescent protein (CFP) in live cells are presented. Free and DNA intercalated forms of ethidium are simultaneously distinguishable by their relative lifetime (1.7 ns and 21.6 ns) and intensity spectra (shift of 7 nm). By analysing the complicated spectrally resolved fluorescence decay of CFP, we propose a fluorescence kinetics model for its excitation/desexcitation process. Such detailed studies under the microscope and in live cells are very promising for fluorescence signal quantification.
Laser scanning confocal microscopy for in situ monitoring of alkali–silica reaction
Authors: Collins C. L. , Ideker J. H. , Kurtis K. E. 
Published: January 2004

SummaryAlkali–silica reaction (ASR) occurs in concrete between reactive siliceous components in the aggregate and the strongly alkaline pore solution, resulting in the formation of a potentially expansive gel product. Lithium additives have been shown to reduce expansion associated with ASR, but the mechanism(s) by which lithium reduces expansion have not been understood. Therefore, development of an in situ method to observe reactions associated with ASR is highly desirable, as it will allow for non‐destructive observation of the reaction product formation and damage evolution over time, as the reaction progresses. A technique to image into mortar through glass aggregate by laser scanning confocal microscopy (LSCM), producing three‐dimensional representations of the sample was developed. This LSCM technique was utilized to monitor the progress of alkali–silica reaction in mortar samples prepared with alkali‐reactive glass aggregate both in the presence and in the absence of lithium additives: LiNO3, LiCl or LiOH. The method proved to be effective in qualitatively monitoring crack formation and growth and product formation, within cracks and at the paste/aggregate interface. In particular, dendritic products were observed at the paste/aggregate interface only in those samples containing lithium, suggesting that these products may play a role in ASR mitigation.
Static and dynamic experiments in cryo‐electron microscopy: comparative observations using high‐vacuum, low‐voltage and low‐vacuum SEM
Authors: Stokes D. J. , Mugnier J‐Y. , Clarke C. J. 
Published: January 2004

SummaryWe carried out a unique comparative study between three modes of cryo‐scanning electron imaging: high‐vacuum, low‐voltage and low‐vacuum, using ice cream as a model system. Specimens were investigated both with and without a conductive coating (Au/Pd) and at temperatures for which ice either remains fully frozen (< −110 °C) or undergoes sublimation (−110 to −90 °C). At high magnification, high‐vacuum imaging of coated specimens gave the best results for ‘static’ specimens (i.e. containing fully frozen ice). Low voltages, such as 1 kV, could be used for imaging uncoated specimens at high vacuum, although slight ‘classical’ charging artefacts remained an issue, and the reduced electron beam penetration tended to decrease the definition between different microstructural features. However, this mode was useful for observing in situ sublimation from uncoated specimens. Low‐vacuum mode, involving small partial pressures of nitrogen gas, was particularly suited to in situ sublimation work: when sublimation was carried out in low vacuum in the absence of an anti‐contaminator plate, sublimation rates were significantly reduced. This is attributed to a small partial pressure of sublimated water vapour remaining near the specimen surface, enhancing thermodynamic stability.
Terminal protein‐induced stretching of bacteriophage φ29 DNA
Authors: Wang H. , Grimes S. , Anderson D. L. , Serwer P. 
Published: January 2004

SummaryStretching of DNA molecules helps to resolve detail during the fluorescence microscopy of both single DNA molecules and single DNA–protein complexes. To make stretching occur, intricate procedures of specimen preparation and manipulation have been developed in previous studies. By contrast, the present study demonstrates that conventional procedures of specimen preparation cause DNA stretching to occur, if the specimen is the double‐stranded DNA genome of bacteriophage φ29. Necessary for this stretching is a protein covalently bound at both 5′ termini of φ29 DNA molecules. Some DNA molecules are attached to a cover glass only at the two ends. Others are attached at one end only with the other end free in solution. The extent of stretching varies from ∼50% overstretched to ∼50% understretched. The understretched DNA molecules are internally mobile to a variable extent. In addition to stretching, some φ29 DNA molecules also undergo assembly to form both linear and branched concatemers observed by single‐molecule fluorescence microscopy. The assembly also requires the terminal protein. The stretched DNA molecules are potentially useful for observing DNA biochemistry at the single molecule level.
Fluorescence microscopy of colour‐tagged nanoparticles that are undergoing thermal motion
Authors: Wang H. , Huang S. , Hayes S. J. , Serwer P. 
Published: January 2004

SummaryTo bypass limitations of conventional biochemical analysis, single‐particle biochemical analysis is used. To improve single‐particle biochemical analysis, procedures are needed to keep nanometre‐sized particles in focus while the particles are undergoing thermal motion. A simple, inexpensive procedure is developed here for keeping particles in focus during the continuous observing/discriminating/recording of two different particles, both of which are undergoing thermal motion. This procedure concentrates the particles in a plane of solution that is in focus when the cover glass surface is in focus. An essential component of the procedure is the addition of molten, low‐melt agarose to the specimen. Motionless binding to glass is inhibited by inclusion of anti‐stick additives in the specimen. Both carrier protein (gelatin) and non‐ionic detergent (Triton X‐100) are anti‐stick additives successfully used here. Intact bacteriophages T3 and T7 are used as model particles, in anticipation of the use of the procedures developed here for the analysis of the assembly of bacteriophages. Observing/discriminating/recording of colour‐tagged bacteriophages T3 and T7 is achieved at video frame rate with image splitting to discriminate colours.
Precision of the fractionator from Cavalieri designs
Authors: Cruz‐Orive L. M. 
Published: January 2004

SummaryA popular procedure to predict the variance of the fractionator consists in splitting the initial collection of fragments into two subsets, in order to use the corresponding particle counts (or any other pertinent measure), in the calculation. The current formula does not account for local or ‘nugget’ errors inherent in the estimation of fragment contents, however. Moreover, it does not account for the fact that the contribution of the variability between fragments or slices should rapidly decrease as the sampling fraction increases. For these reasons, an update to the formula is overdue. It should be stressed, however, that the formula applies to Cavalieri slices designs – its application for arbitrary partition designs is therefore not warranted.
Evidence‐Based Medicine and Women: Do the Principles and Practice of EBM Further Women's Health?
Authors: Rogers Wendy 
Published: January 2004

ABSTRACTClinicians and policy makers the world over are embracing evidence‐based medicine (EBM). The promise of EBM is to use summaries of research evidence to determine which healthcare interventions are effective and which are not, so that patients may benefit from effective interventions and be protected from useless or harmful ones. EBM provides an ostensibly rational and objective means of deciding whether or not an intervention should be provided on the basis of its effectiveness, in theory leading to fair and effective healthcare for all.In this paper I closely examine these claims from the perspective of healthcare for women, using relevant examples. I argue that the current processes of evidence‐based medicine contain a number of biases against women. These biases occur in the production of the research that informs evidence‐based medicine, in the methods used to analyse and synthesise the evidence, and in the application of EBM through the use of guidelines. Finally, the biomedical model of health that underpins most of the medical research used by EBM ignores the social and political context which contributes so much to the ill‐health of women.
On Our Obligation to Select the Best Children: A Reply to Savulescu
Authors: De Melo‐Martín Inmaculada 
Published: January 2004

ABSTRACTThe purpose of this paper is to examine critically Julian Savulescu's claim that people should select, of the possible children they could have, the one who is expected to have the best life, or at least as good a life as the others, based on the relevant, available genetic information, including information about non‐disease genes. I argue here that in defending this moral obligation, Savulescu has neglected several important issues such as access to selection technologies, disproportionate burdens on women, difficulties in determining what is best, problems with aggregate effects of individual choices, and questions about social justice. Taking these matters into account would call such a moral requirement into serious question.
Greater and more rapid depletion of mitochondrial DNA in blood of patients treated with dual (zidovudine+didanosine or zidovudine+zalcitabine) vs. single (zidovudine) nucleoside reverse transcriptase inhibitors
Authors: Reiss P , Casula M , De ronde A , Weverling GJ , Goudsmit J , Lange JMA 
Published: January 2004

BackgroundMost toxicities associated with nucleoside analogue reverse transcriptase inhibitors (NRTIs) are thought to result from mitochondrial toxicity. These toxicities include peripheral neuropathy, pancreatitis, lactic acidosis, and peripheral lipoatrophy. Unfortunately, there are no validated laboratory markers for clinically assessing, let alone predicting, the onset of mitochondrial toxicity associated with NRTI therapy.Objectives To provide preliminary evidence of the potential clinical utility of an assay which has been developed for quantifying mitochondrial DNA (mtDNA) in clinical samples from HIV‐infected patients.Methods A single‐tube duplex real‐time DNA‐nucleic acid sequence‐based amplification (NASBA) assay (MitoxTM, Primagen, Amsterdam, the Netherlands) was used to quantify mtDNA in cryopreserved peripheral blood mononuclear cells (PBMC) obtained from HIV‐1‐infected patients during their prior participation in a randomized placebo‐controlled trial comparing zidovudine (ZDV) monotherapy with combinations of ZDV plus either dideoxycytidine (ddC) or didanosine (ddI) (the Delta trial). Patients were antiretroviral naïve prior to entering the trial. Samples obtained during the initial 48 weeks of treatment were tested.Results A significant decline of mtDNA, both in an intent‐to‐treat and in an as‐treated analysis, was observed in patients treated with ZDV+ddC and ZDV+ddI, but not with ZDV alone, consistent with the results expected from the degree of mtDNA depletion described for each of these drugs in vitro.Conclusions This single‐tube duplex real‐time DNA‐NASBA assay was shown to measure mtDNA accurately in PBMC. Treatment with a combination of two NRTIs was associated with greater reductions in mtDNA than obtained for ZDV monotherapy. The relevance of these results in predicting treatment toxicity requires further evaluation.
Increased microvascular network in bone marrow of HIV‐positive haemophilic patients
Authors: Patsouris E , Katsarou O , Korkolopoulou P , Kotsi P , Kouramba A , Androulaki A , Karafoulidou A 
Published: January 2004

Objectives Angiogenesis has been associated with the pathogenesis of myelodysplastic syndromes (MDSs). However, less is known about the significance of this process in the bone marrow of HIV‐positive patients with myelodysplastic features (MDF).Methods Trephines from 22 HIV‐positive haemophilic patients were immunostained for CD34 antigen, and the microvessel density (MVD) was quantitatively evaluated and compared with that of 21 biopsies from patients with primary MDS and with that of 12 control bone marrows with no evidence of marrow disease.Results Bone marrow MVD in HIV‐positive haemophilic patients was similar to that in patients with MDS; however, both groups revealed significantly higher MVD counts than those of control bone marrows (P=0.002). Mean MVD counts of HIV‐positive haemophilic patients were significantly associated with HIV RNA levels (P=0.008). In contrast, no correlation was found between MVD and clinical HIV stage or CD4 counts at the time of biopsy.Conclusions These results suggest a direct involvement of HIV in the pathogenesis of MDF in HIV infection. Elucidation of the mechanisms underlying bone marrow angiogenesis in HIV‐positive patients may provide further insights into the pathobiology of AIDS.
The onset of HIV infection in the Leningrad region of Russia: a focus on drug and alcohol dependence
Authors: Krupitsky E , Zvartau E , Karandashova G , Horton NJ , Schoolwerth KR , Bryant K , Samet JH 
Published: January 2004

Objectives  Within 5 years, 5 million Russians may be infected with HIV. Currently, injection drug use is the major risk factor for HIV. As Russia's alcohol consumption per capita is among the highest in the world, alcohol‐associated behaviours may be an important contributor to the HIV epidemic. Our objective was to examine the prevalence of HIV infection among drug‐ and alcohol‐dependent patients in a regional narcology hospital and in the general population in Leningrad.Methods  All patients in the Narcology Hospital, Leningrad Regional Center of Addictions (LRCA), were tested for HIV antibody between 1997 and 2001. We reviewed these clinical records (i.e. serostatus, gender, age, and addiction) and data from the HIV/AIDS Center in the Leningrad Region (1997–2001).Results  From 1997 to 2001, HIV prevalence at the LRCA increased from 0 to 12.7% overall, 33.4% among drug‐dependent patients and 1.2% among alcohol‐dependent patients. During the same 5‐year period (1997–2001), 2826 persons were registered at the HIV/AIDS Center: 6, 6, 51, 780, and 1983 persons in 1997, 1998, 1999, 2000 and 2001, respectively.Conclusions  HIV infection is exploding in the Leningrad Region, currently in injection drug users (IDUs) but potentially more broadly. The known high per capita alcohol intake in Russia heightens concern regarding the sexual transmission of HIV. Interventions to prevent such a development should include use, and assessment of the effectiveness, of known HIV prevention measures for at‐risk and infected individuals.
Correlates of antiretroviral treatment breaks
Authors: Grierson JG , Misson SA , Pitts MK 
Published: January 2004

Objective  To identify key relationships between the decision to take a break from antiretroviral treatments and potential clinical and social antecedents.Methods  An analysis of a self‐completed survey of various clinical and social aspects of the lives of people living with HIV/AIDS (PLWHA) distributed nationally in Australia was carried out.Results  The questionnaire was completed by a sample of 894 PLWHA. From this sample, three groups of interest were identified: a ‘no break’ group that had been using antiretrovirals continuously (n=378), a ‘lifestyle break’ group that had taken a break for purely lifestyle reasons on their last occasion (n=76), and a ‘clinical break’ group that had taken a break for purely clinical reasons on their last occasion (n=99). Clinical breaks were found to be longer than lifestyle breaks and involved more consultation with doctors. Differences were also found between the two break types in effects on the respondents' health and well‐being. The clinical break group was further found to experience a higher level of health difficulties on a range of variables, while the lifestyle break group was younger, had a longer experience of HIV and its consequences, and engaged in greater participation in activities associated with both pleasure and risk.Conclusions  The analyses offer a pattern of health and social factors that places the HIV‐positive individual, as a social actor, squarely within the experience of treatment interruptions. Understanding the social motivations and correlates of treatment interruption offers new challenges in maximizing the efficacy of health maintenance and support for PLWHA.