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Better Integrated (good + integrate)
Selected AbstractsDendritic cells: Understanding immunogenicityEUROPEAN JOURNAL OF IMMUNOLOGY, Issue S1 2007Ralph Abstract The impetus for the discovery of dendritic cells in 1972 was to understand immunogenicity, the capacity of an antigenic substance to provoke immunity. During experiments to characterize "accessory" cells that enhanced immunity, we spotted unusual stellate cells in mouse spleen. They had a distinct capacity to form and retract processes or dendrites and were named dendritic cells (DC). DC proved to be different from other cell types and to be peculiarly immunogenic when loaded with antigens. When Langerhans cells were studied, immunogenicity was found to involve two steps: antigen presentation by immature DC and maturation to elicit immunity. Antigen-bearing DC were also immunogenic in vivo and were therefore termed "nature's adjuvants". Several labs then learned to generate large numbers of DC from progenitors, which accelerated DC research. Tolerogenicity via DC, including the control of foxp3+ suppressor T cells, was recently discovered. Two areas of current research that I find intriguing are to identify mechanisms for antigen uptake and processing, and for the control of different types of immunity and tolerance. These subjects should be studied in vivo with clinically relevant antigens, so that the activities of DC can be better integrated into the prevention and treatment of disease in patients. [source] Asymmetry in the intensive care unit: redressing imbalance and meeting the needs of familyNURSING IN CRITICAL CARE, Issue 5 2008Denise Blanchard Abstract Aims and objectives:, The purpose of this study was to develop a way for nurses to understand how they negotiate and work with families in the intensive care unit (ICU). Background:, The importance of family to the critically ill patient is described in previous research; however, research exploring how to work with families in the clinical context of ICU is modest and there is little information and research to understand how the nurse might work to integrate family and understand family needs in the clinical context. Design:, The study was designed using action research methodology where an action research group of registered nurses from ICU proposed changes to how the family are defined, assessed and understood. Methods:, In the action research group and reflective conversations, the group planned new assessment tools to use in ICU to work with the family. Results:, Exploring their pragmatic knowledge of the context, the action research group suggested ways of working with families that did not impede the clinical work of the ICU. Families provided information about themselves and the patient that helped the nurse to plan care that redressed some of the asymmetrical nature of the relationship in the ICU. Conclusions:, This research created novel ways of viewing family and offers strategies to address asymmetry between families and ICU professionals. Relevance to clinical practice:, Positive steps to redress asymmetrical relationships can help ensure that family care is better integrated into ICU practice. [source] A Delphi survey of patients' views of services for borderline personality disorder: A preliminary reportPERSONALITY AND MENTAL HEALTH, Issue 1 2008Daniel Webb Background,Department of Health guidelines stipulate that specialist personality disorder services should gather feedback from service users. Aim,The Gwylfa Therapy Service (GTS) is a new specialist service for people with borderline personality disorder (BPD). The aim of this study was to gather users' views of services sought and/or received before the inception of the GTS and their views of the GTS. Method,A Delphi survey method was used first to elicit patients' views on services, and then to identify levels of consensus on the views generated. Results,The findings presented here identify what service users value in the treatment they receive, namely respect, professionalism, a service that meets their needs and personal support. Opinions regarding non-specialist services indicated that, overall, police, general practitioners, community psychiatric nurses, psychologists and counsellors were viewed positively, and psychiatric hospital staff was viewed positively but with room for improvement. General hospital staff was viewed unfavourably. Users' views of the GTS were favourable. Discussion,This study begins to shed light upon the education, training and supervision needs of staff from services that come into contact with patients with BPD. Furthermore, the way these services may be better integrated with each other and GTS is identified as requiring attention. Care must be taken to avoid distressing, damaging and disaffecting patients as they pass through general services en route to a specialist team. Copyright © 2008 John Wiley & Sons, Ltd. [source] Albatrosses, eagles and newts, Oh My!: exceptions to the prevailing paradigm concerning genetic diversity and population viability?ANIMAL CONSERVATION, Issue 5 2010D. H. Reed Abstract Numerous recent papers have demonstrated a central role for genetic factors in the extinction process or have documented the importance of gene flow in reversing population declines. This prompted one recent publication to declare that a revolution in conservation genetics has occurred. Contemporaneously with this revolution are a series of papers demonstrating long-term population persistence for several species despite having little or no detectable genetic variation. In a couple of notable cases, populations have been shown to have survived for centuries at small population size and with depleted levels of genetic variation. These contradictory results demand an explanation. In this review, I will show that these results do not necessarily fly in the face of theory as sometimes stated. The reconciliation of these two sets of observations relies on the incorporation of two major concepts. (1) Genetic factors do not act in a vacuum and it is their interaction with the environment, the strength and type of selection imposed, and the life history of the organism that determine the relative importance of genetic factors to extinction risk. (2) The relationship between molecular estimates of genetic variation and evolutionary potential, the relevance of genetic bottlenecks to adaptive genetic variation, and the nature of the stochastic process of extinction must be better integrated into expectations of population viability. Reports of populations persisting for hundreds of generations with very little detectable genetic variation provide us not only with valuable information but also with hope. However, recent studies suggest that we should not be sanguine about the importance of genetic diversity in the conservation of biodiversity. [source] Collaborative curriculum development: Clinicians' views on the neurology content of a new occupational therapy courseAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 1 2000Annie McCluskey Academics are often accused of being out of touch with clinical practice. This can result in graduates who are poorly prepared to work in local health-care systems. To avoid this scenario, occupational therapy clinicians in New South Wales were invited by mail to list 10 topics related to neurology, which they felt should be included in a new undergraduate curriculum. Fifty-two clinicians responded. A modified nominal group technique was then used with 10 expert clinicians, to further explore the written responses. Content analysis revealed four areas which clinicians felt needed attention in the new curriculum. These areas or themes have been named: (i) Integrated Foundation Studies; (ii) The Art of a Thorough Assessment; (iii) Treatment Approaches in Neurology; and (iv) Building Confidence. Clinicians felt that neuroscience material needed to be better integrated with professional subjects; that observational skills and activity analysis should receive more class time, and that three different approaches to motor training should be taught. More practical student experience was also recommended, on and off campus, to help increase confidence when conducting initial assessments and upper limb retraining. Information from this study will be of interest to clinicians in neurology and to occupational therapy educators across Australia. [source] The epidemiology of bipolar disorder: sociodemographic, disability and service utilization data from the Australian National Study of Low Prevalence (Psychotic) DisordersBIPOLAR DISORDERS, Issue 4 2005Vera A Morgan Objectives:, Data from the Australian National Study of Low Prevalence (Psychotic) Disorders were used to describe the clinical and sociodemographic profile of individuals with bipolar disorder, their levels of impairment and disability, and use of medication and treatment services. Methods:, A 1-month census of contacts with mental health services, private psychiatric and general practices, as well as contact points in marginalized settings, was conducted in a national catchment of 1.1 million adults. The census yielded 3,800 individuals who screened positive for psychosis, of whom a random sample of 980 were administered a comprehensive semi-structured interview schedule. Results are presented on 112 persons with an ICD-10 diagnosis of bipolar disorder. Results:, Overall, 69.6% of the 112 persons who met the ICD-10 criteria for bipolar disorder reported a recurrent episodic illness, 25.0% had a chronic course without clear remissions, and 5.4% had a single episode of mania. Assessed on a lifetime basis, suicidal ideation was common (78.6%) and levels of drug and alcohol abuse/dependence were high (32.1%). The majority (84.8%) had had at least one contact with inpatient, outpatient or emergency services in the previous year. Those with serious impairment had levels of service utilization similar to the rest of the sample, but were more likely to report a poorer quality of life and unmet service needs. While the percentage experiencing social and occupational dysfunction was substantial and similar for both sexes, women appeared to be better integrated socially than men. Comparisons with schizophrenia patients within the same survey sample highlighted less chronic impairment but equal or greater utilization of services by bipolar patients. Conclusions:, Despite low levels of chronicity, the burden of social disablement associated with bipolar disorder is high. The data suggest a number of important gaps in the provision of services for this predominantly treated population. [source] Workers' compensation in Canada: a case for greater public accountabilityCANADIAN PUBLIC ADMINISTRATION/ADMINISTRATION PUBLIQUE DU CANADA, Issue 1 2000Therese Jennissen The changing nature of occupational risks has created a range of workplace injuries against which current workers' compensation programs do not adequately insure. The existence of workers' compensation alongside the other components of the social-safety net may have created significant numbers of individuals who are either not receiving compensation when they should be or are receiving compensation when they should not be. The implication is that other programs bear some of the costs that should be borne by workers' compensation and, conversely, that some of the costs borne by workers' compensation should be borne by other social programs. These "gaps and overlaps" indicate that workers' compensation should be better integrated with the rest of the programs that make up the Canadian social-safety net. The article concludes with a menu of reforms, including the establishment, through legislation, of a formal reporting relationship; changes to the composition and size of governance structures; the introduction of strategic planning; and the establishment of performance measurement processes. Sommaire: Selon les auteurs de cet article, les politiques concernant les accidents du travail au Canada devraient relever davantage des gouvernements élus. L'évolution des risques professionnels a Créé toute une gamme d'accidents du travail pour lesquels l'assurance des régimes actuels d'indemnisation est inadéquate. L'existence des régimes d'assurance contre les accidents du travail parallèlement aux autres éléments de sécurité sociale aurait pour effet de multiplier le nombre de personnes quisoit ne reçoivent pas de prestations lorsqu'elles devraient en recevoir, soit l'inverse. Par conséquent, d'autres programmes défraient certains des coûts qui incombent au régime des accidents du travail, tandis que ce dernier défraie des coûts imputables a d'autres programmes sociaux. Ces lacunes et chevauchements indiquent que le régime d'assurance contre les accidents du travail devrait être mieux intégré au reste des programmes qui constituent le filet de sécurité sociale au Canada. L'article propose une série de réformes, dont l'adoption légiférée d'une relation formelle de compte rendu, la modification de la composition et de la taille des structures de gouvernance, l'adoption de la planification stratégique, et l'établissement de processus de mesure du rendement. [source] | ||||||||||