Comment on "Ultrapotassic magmatism in the heyday of the Variscan Orogeny: the story of the Trebíc Pluton, the largest durbachitic body in the Bohemian Massif" by Janousek et al.

This comment addresses the incorrect treatment and presentation of data from laser ablation ICP-MS U-Pb age determinations of two samples of the Trebíc Pluton. This results in inaccurate ages and error assessment, invalidating the age interpretations of the authors. To corroborate our arguments, new high-precision chemical abrasion ID-TIMS data are presented that unequivocally define the emplacement age of the Trebíc pluton.

Harmonisation of ethics committees' practice in 10 European countries.

BACKGROUND: The Directive 2001/20/EC was an important first step towards consistency in the requirements and processes for clinical trials across Europe. However, by applying the same rules to all types of drug trials and transposing the Directive's principles into pre-existing national legislations, the Directive somewhat failed to meet its facilitation and harmonization targets. In the field of ethics, the Directive 2001/20/EC conditioned the way of understanding and transposing the "single opinion" process in each country. This led to a situation in which two models of research ethics committees organisation systems exist, being the model in which the "single opinion" is considered to be the decision made by a single ethics committee more effective and simpler in terms of administrative and logistic workload. METHOD: A survey was conducted in 10 European countries. Members of the European Clinical Research Infrastructures Network working party number 1, with expertise in the field of ethics, responded. RESULTS: There is a major heterogeneity in the composition of ethics committees among the surveyed countries based on the number of members, proportion of experts versus lay members and expertise of the scientific members. A harmonized education of the ethics committees' membership based in common curricula is recommended by the majority of countries. CONCLUSIONS: Despite the efforts for harmonization of the European Clinical Trial Directive, from an ethical point of view, there remains a plurality of ethics committees' systems in Europe. It is important to comprehend the individual national systems to understand the problems they are facing.

Patients with skin disease and their relationships with their doctors: a qualitative study of patients with acne, psoriasis and eczema.

OBJECTIVE: To explore the experiences of patients with acne, psoriasis or atopic eczema in their relationships with their treating doctors. DESIGN: Qualitative study, using semi-structured interviews conducted between January 2004 and April 2005, thematic analysis and modified grounded theory methodology. SETTING AND PARTICIPANTS: Participants were patients with acne, psoriasis or atopic eczema recruited from urban general practices and urban dermatology practices. RESULTS: 62 semi-structured interviews were conducted. Reports of negative experiences with doctors treating participants' skin conditions were common. Both general practitioners and dermatologists were reported as having poor comprehension of the psychological implications of skin diseases, being insensitive to their patients' emotional suffering, and trivialising participants' disease. Participants acknowledged that time considerations and other pressures may explain these apparent deficiencies. Some participants perceived their doctors as medical technicians and sought treatment for their physical skin disease, not for its emotional or social aspects. CONCLUSION: We recommend education for GPs about the psychological effects of skin diseases, and education for dermatologists and GPs on how to elicit and manage, or appropriately refer, these problems.

Using problem-based learning in public health service based training.

OBJECTIVES: This study explored the suitability and benefits of problem-based learning (PBL) in competency-based postgraduate public health training. The PBL was delivered within a rural retreat and included site visits. METHODS: Qualitative semistructured interviews with trainee public health officers and key informants. RESULTS: The learning approach (retreat-PBL combination with site visits) was valuable and relevant. Trainees reported a high learning impact with increased knowledge about the problems examined and rural public health practice. They also expressed an openness to work rurally. CONCLUSION: Collaboratively developed and delivered, experiential rural public health PBL provides a positive learning experience for trainees undertaking competency-based training in public health and could play an important workforce role. PBL appears to be suitable in rural and non-rural public health training settings.

Complementary and alternative medicine therapies in acne, psoriasis, and atopic eczema: results of a qualitative study of patients' experiences and perceptions.

OBJECTIVES: The aim of this study was to explore the use of complementary and alternative medicine (CAM) therapies in patients with acne, psoriasis, or atopic eczema and the attitudes about CAM of these patients. DESIGN: This was a qualitative study, utilizing semistructured interviews and thematic analysis. SETTING: Patients were recruited from the practices of dermatologists and general practitioners in a noncapital Australian city. RESULTS: Twenty-six (26) interviews were conducted with patients with acne, 29 with psoriasis, and 7 with atopic eczema. Use of CAM therapies was common. Participants tended to value CAM over orthodox therapies because of their preference for natural approaches to their skin diseases and the perceived lesser potential for adverse effects of CAM therapies. Respondents with acne were more confident about the efficacy of CAM than were those with psoriasis or eczema. The resulting sense of control attenuated psychologic sequelae of acne. This was not apparent in psoriasis or eczema. CONCLUSIONS: Practitioners should be cognizant of the likely use of CAM and its implications (including the potential for attenuation of psychologic morbidity) in their patients who have skin diseases.

Control of foot and mouth disease: lessons from the experience of Ireland.

The authors outline the measures applied in Ireland to prevent the introduction of foot and mouth disease (FMD) from the United Kingdom, France and The Netherlands, to stamp out the disease in Ireland following confirmation of an outbreak on 22 March 2001 and to conduct serological surveillance in order to prove freedom from the disease. Successful control was the result of prompt action and extensive culling in the area around the infected premises. This was achieved by the State Veterinary Service operating with the assistance of the personnel and equipment resources of many Government departments, private industry and private veterinary practitioners, with the co-operation of the farming community and general public. In order to ensure effective use of these resources, good systems of communication and information technology are vital, as are the existence of detailed contingency plans and trained staff.

Response rate viewed as engagement bouts: effects of relative reinforcement and schedule type.

The rate of a reinforced response is conceptualized as a composite of engagement bouts (visits) and responding during visits. Part I of this paper describes a method for estimating the rate of visit initiations and the average number of responses per visit from log survivor plots: the proportion) of interresponse times (IRTs) longer than some elapsed time (log scale) plotted as a function of elapsed time. In Part 2 the method is applied to IRT distributions from rats that obtained food pellets by nose poking a lighted key under various multiple schedules of reinforcement. As expected, total response rate increased as a function of (a) increasing the rate of reinforcement (i.e., variable-interval [VI] 4 min vs. VI 1 mi), (b) increasing the amount of the reinforcer (one food pellet vs. four pellets), (c) increasing the percentage of reinforcers that were contingent on nose poking (25% vs. 100%), and (d) requiring additional responses after the end of the VI schedule (i.e., adding a tandem variable-ratio [VR] 9 requirement). The first three of these variables (relative reinforcement) increased the visit-initiation rate. The tandem VR, in contrast, increased the number of responses per visit. Thus, variables that have similar effects on total response rate can be differentiated based on their effects on the componemts of response rate.

Teaching an elephant to drive. Massive staff education in a tight time frame.

Providing education and development to patient care personnel with minimal disruption to patient care activities is a daily challenge to staff educators. This article describes how a small nursing development department planned and coordinated the orientation to a new facility and the education and training on new equipment to over 1,000 nurses over a period of several months. The strategies used at this large, urban, academic medical center can be applied to other healthcare facilities.

Patient education resource assessment: project management.

To thrive in today's health care environment, hospitals are constantly striving to exceed their customers' expectations in delivering quality care in a cost-effective manner. Meeting the patient educational needs of the consumer is one well-recognized aspect of quality care. Delivering quality care does not happen by chance; rather, it requires intense planning. Our academic medical center formalized this process by empowering professional staff from Nursing Development to develop and implement a patient education strategic plan. This article outlines the project management for the assessment phase of this strategic planning process. The findings were instrumental in outlining the future direction for patient education initiatives that will benefit both the patient and the organization.

Building a 21st century facility.

At Chicago's Northwestern Memorial Hospital, staff worked for 10 years to design a new facility and plan the transition for their patients, their equipment, and themselves.

Dysphoric mood and preference for immediate versus delayed monetary reinforcement.

It has been proposed that depression is the product of deficits in self-management skills: self-monitoring, self-evaluation, and self-reinforcement. While interventions based on this theory have shown promise, some of the basic tenets upon which the theory is based lack empirical support. The present experiment tested one such tenet--the claim that depressed individuals select smaller more immediate reinforcers (an impulsive choice) at the expense of larger more delayed reinforcers (a self-control choice). Currently, empirical support for this notion is sparse and contradictory. This study addressed several methodological problems in earlier studies by creating divergent groups based on Beck Depression Inventory scores, employing a task requiring multiple responses and applying a quantitative model to determine reinforcer value. Analyses indicated no systematic difference between participants in the dysphoric and nondysphoric groups in ability to delay reinforcement. Thus, the current results provide no support for the hypothesis that the 36 dysphoric individuals were unable to delay reinforcement relative to the 21 nondysphoric individuals. Because respondents across the sample as a whole showed a self-control preference, however, the data are consistent with findings in the experimental study of choice responding with adult human subjects. Interpretations in terms of sensitivity and pseudosensitivity to the experimental contingencies are explored.

Patient surveys.

Clinicians continuously gather patient-related information. Histories and physicals, vital signs, lab results, and behavioral descriptions are all part of standard care. In recent years it has also proven advantageous to gather information regarding patient knowledge and satisfaction with the care they receive at our ambulatory and inpatient settings. This article reviews the process of conducting patient surveys throughout the continuum of care. Both the timing of the survey and the format are described in Table 1.

Touch-screen computerized education for patients with brain injuries.

The use of computer technology for patient education has increased in recent years. This article describes a study that measures the attitudes and perceptions of healthcare professionals and laypeople regarding the effectiveness of a multimedia computer, the Brain Injury Resource Center (BIRC), as an educational tool. The study focused on three major themes: (a) usefulness of the information presented, (b) effectiveness of the multimedia touch-screen computer methodology, and (c) the appropriate time for making this resource available. This prospective study, conducted in an acute care medical center, obtained healthcare professionals' evaluations using a written survey and responses from patients with brain injury and their families during interviews. The findings have yielded excellent ratings as to the ease of understanding and usefulness of the BIRC. By using sight, sound, and touch, such a multimedia learning center has the potential to simplify patient and family education.

Putting the pieces in place: the patient education puzzle.

Patient education has always been an integral part of quality patient care. Effective patient education is a necessary component of patient satisfaction and has proven instrumental in decreasing hospital days while improving clinical outcomes. Joint Commission and state public health departments regard patient education as one of many organizational performance standards. To be effective, health education must be coordinated among all disciplines involved in the continuum of care. The Patient Family Educational Advisory Committee (PFEAC) directed its efforts in identifying common patient education issues. The committee's initial work focused on areas dealing with culture, documentation and competency.