How do academic heads of departments of general practice organize patient care? A European survey.

BACKGROUND. Compared with other clinical disciplines, academic general practice is in a difficult situation with respect to patient care. There are at least three different possible models of working arrangements for heads of departments of general practice: to work in a surgery in a medical school; to work in a surgery in the community, separate from a part-time university post; or to work part-time in a surgery in the community, separate from a university post. AIM. A study was undertaken to explore these models and to gain an understanding of academic teachers' organization of patient care in Europe. METHOD. A total of 77 heads of departments in universities in 12 European countries were sent a questionnaire enquiring about important characteristics of their department, the number of patients they treated per week and how they allocated their time. RESULTS. Sixty nine heads of department (90%) responded. Of respondents, 55% worked part-time in a surgery, separate from a university post, nearly one third worked mainly in a surgery, separate from a part-time university post, and 16% worked in a surgery in a medical school. Those working in a surgery with only a part-time university post spent most time in patient care compared with those working in other models (mean of 57%). Respondents working in a surgery in a medical school spent most time on administration (34%); they spent 22% of their time on patient care and 20% on education. Respondents working in a surgery in a medical school spent 25% of their time on research, those working in a surgery separate from a part-time university post spent 12% of their time on research, and those working mainly in a university with a part-time practice post spent 24% of their time on research. Those working mainly in a university post spent only 17% of their time in patient care. CONCLUSION. Working in a surgery in a medical school represented a well-balanced model of time allocation between patient care, research and education and seemed to be a good approach for the integration of general practice into medical schools. Working part-time in a surgery with a university post is an appropriate model for academic integration, but patient care seemed to be neglected. Those doctors working mainly in the community with a part-time university post were able to provide continuity of care and to come into close contact with the everyday problems of general practitioners. However, they might have to struggle for academic recognition.     

The effects of superior colliculus lesions in hamsters: feature detection versus spatial localization

This study was aimed at further documenting the effects of collicular lesions in exploratory activity in the hamster. Following habituation to a set of four objects placed in an open field, collicular and sham-operated hamsters were confronted to a change in the initial situation in which one object was replaced by a new one in a familiar location or in a new location, or a familiar object was moved to a new location, or was left in the same location (control condition). Hamsters sustaining lesions of the superior colliculus and sham-operated hamsters were found to habituate at the same rate. The surgical treatment modified the reactions to the spatial change. Intact hamsters reacted selectively to the new object, whatever its location. In contrast, collicular animals did not react to the familiar object when it was in a new location. Nevertheless, they were able to detect the new object when it replaced a familiar object at the same location. However, when the new object was at a new location, there was only a tendency in collicular hamsters to react to this change. When no change was made in the initial situation, no change in exploratory activity was observed in either group. These results, together with others, suggest that the rodent's superior colliculus is not directly involved in object discrimination, but plays a crucial role in the attentional components of spatial behavior.     

Behavior change from defection to cooperation in a social dilemma: a field study of attitude-behavior consistency in campus parking behavior by motorcyclists

Behavior change by persuasive communications in a social dilemma, in which a university tried to persuade students to park their motorcycles in a designated lot in order to resolve noise problems, was studied by a questionnaire. Hayashi's quantification theory III was applied to variables such as subjective norms, beliefs in the effectiveness of one's cooperation, the perception of campus traffic conditions and attitudes toward one's parking behavior. Factor scores obtained were subjected to a cluster analysis, which, within 105 defectors, yielded three subgroups. Contrary to prediction, subgroups were not different in their cooperation ratio examined 10 months later, but tended to be different in their readiness for acceptance of persuasion and in their intention to cooperate in a social dilemma other than parking. Two mechanisms underlying cooperation were revealed: internalization of prosocial norm, and compliance in which cooperation was unaccompanied by correspondent changes in normative beliefs. The Fishbein model was applicable only to change through internalization. A linear assumption in the Fishbein model between evaluative attitude and behavior should be reexamined in its application to a social dilemma.     

A capacitive method of measuring circadian activity in laboratory animals

An activity monitor is described which enables the activity of a variety of laboratory animals to be analysed quantitatively at low cost. Essentially the monitor consists of an oscillator which is sensitive to changes in the impedance of an antenna attached to it. The movement of the laboratory animal produces a change in antenna capacitance, which in turn causes the frequency of the oscillator to alter. This change in frequency produces, at a different point in the circuit, a corresponding change in voltage, which is amplified to drive a recorder. Tests have demonstrated the high degree of flexibility of the monitor, which has operated successfully in three different media, sensing the activity of a cinnamon shrew in an open cage, a golden mole underground and crabs under water.     

Effect of metal-framed spectacles on microwave radiation hazards to the eyes of humans

A novel measurement technique using a monopole antenna probe has been applied to a full-size, image-plane type model of a human to determine the microwave fields near the eyes and to evaluate the effect of scattering structures, such as metal-framed spectacles, on those fields. The measurement technique relies on a ‘subtraction’ technique to determine the changes in fields when a scattering structure is introduced, and allows a large number of measurements to be performed in a relatively short space of time and with a high degree of accuracy. Investigations conducted in an anechoic chamber yield angles of incidence, test frequencies and wave polarisation values that give details of shielding, enhancement and depolar-isation effects due to this particular scattering structure that appeared not to have been previously studied. It has been found that the introduction of a pair of metalframed spectacles can, in certain cases, cause an increase in field levels by up to approximately 20 dB, a significant perturbation of the incident microwave field which should be accounted for in the setting of safety standards relating to acceptable levels of incident power.     

On the probability that a novel variant is a disease-causing mutation

When a novel variant is found in a patient and not in a group of controls, it becomes a candidate for the disease-causing mutation in that patient. At present, no sampling theory exists for assessing the probability that the novel SNP might actually be a neutral variant. We have developed a population genetics-based method for calculating a P-value for a mutation-detection effort. Our method can be applied to a heterozygous patient, a homozygous patient, with or without inbreeding, or to a patient who is a compound heterozygote. Additionally, the method can be used to calculate the probability of finding a neutral variant at frequencies that differ between a group of patients and a group of controls, given some length of sequence examined. This method accounts for the multiple testing that is inherent in identification of variants through sequencing, to be used in subsequent case-control analyses. We show, for example, that for complete resequencing of 10 kb, the probability of finding a neutral variant in a patient and not in 50 controls is about 15%. Thus, discovery of a variant in a patient and not in a group of controls is, on its own, very weak evidence of involvement with disease.     

Localization and quantification of fluorescent inclusions embedded in a turbid medium

A set-up, based on a CCD camera, to localize fluorescent inclusions in diffusing media was developed. This set-up allows one to acquire a huge dataset along two axes. This aspect is fundamental to performing a tomographic reconstruction in order to quantify the fluorescence amplitude in each voxel of the sample. Firstly, a simple analytical approach to recover the position of a single inclusion, embedded in a turbid medium, was developed. Then, we implemented a reconstruction algorithm to recover the position of one and two inclusions and to estimate their relative concentrations. Finally, we studied the dependence of reconstructed data on the number of injection points of excitation light and the number of detection points of fluorescence emission.     

Enhanced neural activation in brain regions mediating sexual responses following exposure to a conditioned stimulus that predicts copulation

Stimuli associated with sexual behavior increase reproductive success if presented prior to copulation. In Japanese quail, inseminations that take place in a context that predicts the arrival of a female are more likely to result in fertilized eggs. We demonstrate here that in male Japanese quail a sexual conditioned stimulus (CS) also enhances activity in two brain regions that mediate sexual behavior, the medial preoptic area and the medial part of the bed nucleus of the stria terminalis. C-fos expression, a marker of neural activation, was higher in these areas in subjects exposed sequentially to a sexual CS and copulation than in subjects exposed to copulation or the CS alone or in subjects exposed to no sexual stimulus, either an identical, untrained CS or an empty arena. These results suggest a link between a proximate result of sexual CS presentation, male brain activation, and a known ultimate outcome, increased fertilizations.     

The effects of task instructions on pro and antisaccade performance

In the antisaccade task participants are required to overcome the strong tendency to saccade towards a sudden onset target, and instead make a saccade to the mirror image location. The task thus provides a powerful tool with which to study the cognitive processes underlying goal directed behaviour, and has become a widely used index of “disinhibition” in a range of clinical populations. Across two experiments we explored the role of top-down strategic influences on antisaccade performance by varying the instructions that participants received. Instructions to delay making a response resulted in a significant increase in correct antisaccade latencies and reduction in erroneous prosaccades towards the target. Instructions to make antisaccades as quickly as possible resulted in faster correct responses, whereas instructions to be as spatially accurate as possible increased correct antisaccade latencies. Neither of these manipulations resulted in a significant change in error rate. In a second experiment, participants made fewer errors in delayed pro and antisaccade tasks than in a standard antisaccade task. The implications of these results for current models of antisaccade performance, and the interpretation of antisaccade deficits in clinical populations are discussed.     

Saccade-related activity in the primate superior colliculus depends on the presence of local landmarks at the saccade endpoint

Saccade-related discharge in the superior colliculus is greater for saccades made to a spot of light than for saccades in complete darkness. However, it is unclear whether this enhancement is due to the discontinuity of the spot or due to its being a new object of fixation. In these experiments, we examined the saccade-related activity of intermediate-layer neurons in the primate superior colliculus during delayed saccades to the center or corner of a large, bright square, as well as for visual and memory-guided movements to small spots in isolation. The saccade-related discharge for movements made to a local visual landmark present at the time of the saccade, be it a corner of a square or a small spot, was higher than that for saccades made to the center of a square that contained no local visual landmarks within. Moreover, discharge for movements to the center of a square were very similar to that for saccades to blank, dark space. Saccade velocity was similarly dependent on the presence of such a landmark, though less dramatically. The endpoints of saccades directed toward a square's corner were slightly displaced toward the center of the square. Across all neurons, discharge and velocity for saccades to the center of a square increased as the square size was decreased, but were never greater than those for saccades to a small spot of light. These results suggest that both saccade-related discharge in the superior colliculus and saccade metrics are enhanced for movements directed to parts of the visual scene with high contrast, while shifting fixation to a new object is not itself sufficient to elevate discharge and metrics above those of saccades to blank space.     

Developments in the use of nanocapsules in oncology

The application of nanotechnology to medicine can provide important benefits, especially in oncology, a fact that has resulted in the emergence of a new field called Nanooncology. Nanoparticles can be engineered to incorporate a wide variety of chemotherapeutic or diagnostic agents. A nanocapsule is a vesicular system that exhibits a typical core-shell structure in which active molecules are confined to a reservoir or within a cavity that is surrounded by a polymer membrane or coating. Delivery systems based on nanocapsules are usually transported to a targeted tumor site and then release their contents upon change in environmental conditions. An effective delivery of the therapeutic agent to the tumor site and to the infiltrating tumor cells is difficult to achieve in many cancer treatments. Therefore, new devices are being developed to facilitate intratumoral distribution, to protect the active agent from premature degradation and to allow its sustained and controlled release. This review focuses on recent studies on the use of nanocapsules for cancer therapy and diagnosis.     

The dialogical self in psychotherapy for persons with schizophrenia: a case study

Schizophrenia often involves a profound experience of one's identity as diminished, which complicates adaptation to the demands of daily life. Within a backdrop of dialogical self-theory, we provide a report of an individual psychotherapy over the course of 4 years that assisted a patient suffering from schizophrenia to move from a state in which few aspects of self were available for internal or external conversation to one in which there was greater accessibility of multiple aspects of self, leading to richer dialogues, improved function, and a better quality of life. It is suggested a primary intervention of the therapist was continuously to offer the client a view of himself that invited him to experience himself in a plausible manner shared with and listened to by another.     

MiR-34a inhibits proliferation and migration of breast cancer through down-regulation of Bcl-2 and SIRT1

MicroRNA-34a(miR-34a), a pivotal member of the p53 network, was found to be down-regulated in multiple types of tumors and further reported as a tumor suppressor microRNA. However, the profile and biological effects of miR-34a in breast cancer are still unclear. In this study, we aimed to determine the effect of miR-34a on the growth of breast cancer and to investigate whether its effect is achieved by targeting Bcl-2 and SIRT1. We examined miR-34a levels in breast cancer cell lines and breast cancer specimens by qRT-PCR. Proliferation assay, apoptosis assay, and morphological monitoring were performed to assess the tumor suppression effect of miR-34a in breast cancer cell lines. Western blotting was used to identify the targets of miR-34a. We also investigated the anti-tumor effects of the treatment combining miR-34a with 5-FU in breast cancer cells. We found that miR-34a expression was down-regulated in 5 breast cancer cell lines compared with the immortalized normal mammary epithelial cell line 184A1, and was also down-regulated by almost 50 % in breast cancer samples compared with their corresponding adjacent non-malignant breast tissues. Ectopic restoration of miR-34a in breast cancer cells suppressed cells proliferation, invasion, and induced apoptosis. Bcl-2 and SIRT1 as the targets of miR-34a were found to be in reverse correlation with ectopic expression of miR-34a. Furthermore, the treatment combining miR-34a with 5-FU significantly showed more efficient anti-tumor effects than single treatment of miR-34a or 5-FU. Since miR-34a functions as tumor suppressor microRNA in breast cancer, modulating miR-34a level in breast cancer was suggested to be a new and useful approach of breast cancer therapy.     

Effects of physical positions on sleep architectures and post-nap functions among habitual nappers

The post-lunch sleepiness is considered to be part of biological rhythm. Many people take nap as a countermeasure to this afternoon circadian nadir. The aim of the study is to investigate the effect of a short-term midday nap in different physical positions after a full night sleep on subjective and physiological measures. Thirty-six young healthy habitual nappers (18 men, 18 women) aged 18-23 participated in the study. They were randomly assigned to three experimental conditions: to nap in a seat (NS), to nap in a bed (NB) and no-nap (NN). Measures of subjective sleepiness, mood, fatigue, and P300 component were taken before and after a 20 min nap. Results showed that sleepiness, fatigue, and mood for both NS and NB were improved after napping. Moreover, objective alertness was enhanced in NB relative to NS and NN, which showed the larger P300 amplitude after nap. The delta power during sleep stage 2 of NS was inferior to that of NB, which induced a lower alertness after the sitting nap. Consequently, the result demonstrated the function of delta wave during stage 2 on arousal level following the brief midday nap. In general, taking a nap in a seat is a way to subjective restoration but taking a nap in a bed benefits the habitual nappers subjectively and physiologically.     

SOME THOUGHTS ON WORKING WITH REGRESSION IN PSYCHOANALYTIC PSYCHOTHERAPY

This paper on regression during psychoanalytic psychotherapy is largely based on my experience of working with a patient who became profoundly regressed, going back into early infantile states of being. Due to concerns about confidentiality in a therapy which after several years is ongoing, I am only able to refer to the case in a general way; there will be a spectre at the centre of the paper. However, the impact of my experience has informed my thoughts and ideas about the phenomenon of severe regression, and has given birth to this paper. I will explore the dilemmas inherent in including confidential material in a published paper. I want to emphasize the importance of a thorough assessment of patients likely to regress, going on to consider the role of the therapeutic setting. I will talk about adjustments I have found it necessary to make in basic analytic technique in order to accommodate the extreme vulnerability of a regressed patient. I hope to contribute to the discussion among psychotherapists about the value and efficacy of a regressive experience, as well as its dangers, and, lastly, to consider the place that regressive phenomena hold in general psychoanalytic thinking.     

The Courage to Dream: A Beginning Psychotherapist Encounters Bion

In this paper, a psychotherapy student is given an assignment to analyse one of her own dreams using Freudian dream theory. She struggles to engage with the task until she discovers the ideas of Wilfred Bion. The notions of alpha function and beta function offer a framework for the student to understand why she has had so much difficulty in staying connected to her dreams or delineating in a culturally appropriate way between what is reality and what is her dreamworld. The student questions whether her early life, taking place within the political and ideological conflict of apartheid-era South Africa, may have influenced her ability to stay in reality, and wonders about her own ability to contain the affects of her children. She presents a vignette of a dream of her own in which she has to free a naked baby who is stuck in a wall in a bathroom. The writer and her therapist construct the dream as aligning with her own psychoanalytic work to integrate the very young part of herself. In coming to this understanding with the ideas of Bion, the student experiences her own reality in a more vivid and present way.     

A novel pathway determining multidrug sensitivity in Schizosaccharomyces pombe

In this study, we show that a mutation isolated during a screen for determinants of chemosensitivity in S. pombe results in loss of function of a previously uncharacterized protein kinase now named Hal4. Hal4 shares sequence homology to Hal4 and Hal5 in S. cerevisiae, and previous evidence indicates that these kinases positively regulate the major potassium transporter Trk1,2 and thereby maintain the plasma membrane potential. Disruption of this ion homeostasis pathway results in a hyperpolarized membrane and a concomitant increased sensitivity to cations. We demonstrate that a mutation in hal4+ results in hyperpolarization of the plasma membrane. In addition to the original selection agent, the hal4-1 mutant is sensitive to a variety of chemotherapeutic agents and stress-inducing compounds. Furthermore, this wider chemosensitive phenotype is also displayed by corresponding mutants in S. cerevisiae, and in a trk1deltatrk2delta double deletion mutant in S. pombe. We propose that this pathway and its role in regulating the plasma membrane potential may act as a pleiotropic determinant of sensitivity to chemotherapeutic agents.     

A differential effect of C5a and C5a des Arg in the induction of pulmonary inflammation.

Earlier studies have shown that C5 fragments induce an inflammatory reaction when instilled into the rabbit lung. Because C5a is rapidly converted to C5a des Arg in vivo, experiments were performed to determine which fragment was most effective in producing pulmonary inflammation in this animal model. C5a des Arg consistently produced marked inflammation. This was characterized by neutrophil accumulation, edema, hemorrhage, fibrin formation, and damage to alveolar epithelium. The time course of the inflammatory reaction initiated by C5a des Arg showed pulmonary vascular sequestration of neutrophils with no intra-alveolar migration at 30 minutes after injection. By 2 hours, interstitial and alveolar neutrophils were numerous, with the accumulation of neutrophils in the alveoli increasing to a maximum at 6 hours. At 24 and 48 hours, the predominant cells were mononuclear (macrophages). By 120 hours, the lesions were resolving. In contrast, at all doses examined, a similar instillation of C5a induced either no inflammation or a milder, more focal response than C5a des Arg. This inability of C5a to initiate inflammation was not apparently due to the generation of inhibitors, since mixtures of C5a and C5a des Arg were phlogistic. A prolonged, intrapulmonary infusion of C5a (20 minutes), in contrast to a bolus instillation (1 minute), did initiate an inflammatory response, which may reflect the conversion of the C5a to C5a des Arg in the lung. This study points out the inflammatory potential of products of complement activation, particularly of the C5 fragment C5a des Arg, when applied to the airway side of the lungs. This inflammatory response raises the possibility that cleavage of intrapulmonary C5 may play an important role in the initiation of pulmonary inflammation.