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PubMed1977

Supplemented fasting as a large-scale outpatient program.

Although supplemented fasting is now established as an efficient means of achieving substantial weight reduction in massively obese persons, widespread application of this treatment is contingent on its successful adaptation to a large-scale outpatient regimen. Of 519 patients treated as outpatients, 78% lost a minimum of 18.2 kg during the course of treatment. The overall rate of weight loss was 1.5 kg/wk, with females averaging 1.3 kg/wk and males, 2.1 kg/wk. The majority of patients tolerated the regimen well and were able to continue normal daily activities without experiencing any serious side effects.

Body Weight↗

PubMed1993

Medicare program; carrier jurisdiction for claims for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)--HCFA. Final rule.

This final rule would address the provisions of section 1834(a)(12) of the Social Security Act that authorizes us to designate one carrier for one or more regions to process all claims within that region. It incorporates in regulations the four designated carriers that will process claims for durable medical equipment, prosthetics, orthotics, supplies and certain other items covered under Part B of Medicare. We expect the above changes to lead to more efficient and economical administration of the Medicare program.

Durable Medical Equipment↗

PubMed1998

Age-related changes in the initiation of gait: degradation of central mechanisms for momentum generation.

OBJECTIVE: To investigate cross-sectionally age-related changes in the expression and biomechanical efficiency of the gait-initiation motor program. DESIGN: Case-control study. PARTICIPANTS AND SETTING: Twenty healthy young research subjects and 20 healthy elderly subjects who volunteered from the community participated in this study at a university research laboratory. MAIN OUTCOME MEASURES: Participants performed gait-initiation trials at three speeds from a starting position on a force platform while ground reaction force data, 3-D motion analysis data, and electromyographic data were collected. Measures included: latency of tibialis anterior (TA) activation and soleus (SOL) and gastrocnemius (GA) inhibition, magnitude of center of pressure (COP) displacement, magnitude of momentum generated, and final walking velocity. RESULTS: The expression of the central motor program governing gait initiation, as evidenced by the invariant timing between TA activation and SOL/GA inhibition, was seen in both the young and elderly populations, but the frequency was diminished in the latter group. The momentum-generating capacity of the COP shift mechanism was present but significantly diminished in the elderly population. CONCLUSIONS: These findings suggest that the central nervous system uses stable, efficient mechanisms for dealing with the inherent instability of upright bipedalism and that the integrity of these mechanisms degrades with aging.

Adolescent↗

PubMed1996

Health promotion and disease prevention: a look at demand management programs.

This Issue Brief describes employers' efforts to contain health expenditures through demand management programs. These programs are designed to reduce utilization by focusing on disease prevention and health promotion. Demand management includes work site health promotion, wellness programs, and access management. Work site health promotion is a comprehensive approach to improving health and includes awareness, health education, behavioral change, and organizational health initiatives. Wellness programs usually include stress management, smoking cessation, weight management, back care, health screenings, nutrition education, work place safety, prenatal and well baby care, CPR and first aid classes, and employee assistance programs (EAPs). These programs are often viewed positively by workers and can have long-term benefits for employers above and beyond health care cost containment. Demand management can benefit employers by increasing productivity, employee retention, and employee morale and by reducing turnover, absenteeism, future medical claims, and ultimately expenditures on health care. Even though a growing number of employers are offering wellness programs, only 37 percent of full-time workers employed in medium and large private establishments were eligible for wellness programs by 1993. However, a recent survey found that 88 percent of major employers have introduced some form of health promotion, disease prevention, or early intervention initiative to encourage healthy lifestyles among their salaried employees. Distinctions must be drawn between short- and long-term strategies. Demand management can be thought of as a short-term strategy when the focus of the program is on creating more appropriate and efficient health care utilization. Disease prevention is characterized by longer-term health improvement objectives. Whether the purpose is to reduce utilization in the short term or in the long term, the ultimate goal remains the same: to reduce health care expenditures while improving overall health. This goal can be achieved through the use of health risk appraisals, organizational health risk appraisals, high risk programs, awareness programs, medical call centers, return to work programs, EAPs, and smoking cessation programs. Studies of a health program's cost effectiveness must disentangle the effects of many competing factors on cost effectiveness. For example, a health risk appraisal program may identify health problems of which the patient and the health care provider were unaware, resulting in the treatment of these health problems. At the same time, the employer may have switched from a nonmanaged pharmaceutical program to a managed program with incentives for participants to utilize generic and/or mail order drugs. As a result, when evaluating a health promotion program, the long-run impact on the program's cost effectiveness is most important.

Cost Control↗

PubMed2003

Methodological approach to a multidimensional evaluation of food and nutrition policies.

Recommendations arising from global conferences and summits, expressed the need to formulate and implement public policies to improve household food security. In the context of maximizing benefits given available resources, comprehensive evaluations of the nutrition policies and programs are needed. One obstacle to overcome was a clear definition of terminology; the words efficiency, effectiveness, efficacy and impact, widely used in the context of program evaluation, are sometimes interchanged and there is no consensus about their precise definition. Another approach to health evaluation is based in the paradigm structure-process-outcome. The level structure contemplated the installations, resources, instruments (physical and discursive), as well as the technical bureaucratic organizational structures. Process encompassed the whole set of intervention activities developed, whereas the dimension of outcome comprised the effects of interventions on the health and nutrition of beneficiaries. Each of the three dimensions constitutes a continuum in the evaluation procedure: the structure only fulfills its purposes if the processes are adequate and conversely, processes cannot alone supersede structural limitations. Moreover, all the three dimensions only reach their ultimate objectives through the completion of outcomes. The methodology proposed here has been tested in the case of Bahia, Northeast Brazil, and it was found to be adequate for this type of analysis. We hope this approach of a comprehensive multidimensional evaluation, constitutes an effective contribution for program planners and program managers, in particular with regard to the obstacles detected, some of which can surely be overcome.

Developing Countries↗

PubMed1992

The 19-kilodalton adenovirus E1B transforming protein inhibits programmed cell death and prevents cytolysis by tumor necrosis factor alpha.

The adenovirus E1A and E1B proteins are required for transformation of primary rodent cells. When expressed in the absence of the 19,000-dalton (19K) E1B protein, however, the E1A proteins are acutely cytotoxic and induce host cell chromosomal DNA fragmentation and cytolysis, analogous to cells undergoing programmed cell death (apoptosis). E1A alone can efficiently initiate the formation of foci which subsequently undergo abortive transformation whereby stimulation of cell growth is counteracted by continual cell death. Cell lines with an immortalized growth potential eventually arise with low frequency. Coexpression of the E1B 19K protein with E1A is sufficient to overcome abortive transformation to produce high-frequency transformation. Like E1A, the tumoricidal cytokine tumor necrosis factor alpha (TNF-alpha) evokes a programmed cell death response in many tumor cell lines by inducing DNA fragmentation and cytolysis. Expression of the E1B 19K protein by viral infection, by transient expression, or in transformed cells completely and specifically blocks this TNF-alpha-induced DNA fragmentation and cell death. Cosegregation of 19K protein transforming activity with protection from TNF-alpha-mediated cytolysis demonstrates that both activities are likely the consequence of the same function of the protein. Therefore, we propose that by suppressing an intrinsic cell death mechanism activated by TNF-alpha or E1A, the E1B 19K protein enhances the transforming activity of E1A and enables adenovirus to evade TNF-alpha-dependent immune surveillance.

Adenovirus Early Proteins↗

PubMed1993

SETOR: hardware-lighted three-dimensional solid model representations of macromolecules.

SETOR is designed to exploit the hardware lighting capabilities of the IRIS-4D series graphics workstations to render high-quality raster images of macromolecules that can undergo rotation and translation interactively. SETOR can render standard all-atom and backbone models of proteins or nucleic acids, but focuses on displaying protein molecules by highlighting elements of secondary structure. The program has a very friendly user interface that minimizes the number of input files by allowing the user to interactively edit parameters, such as colors, lighting coefficients, and descriptions of secondary structure via mouse activated dialogue boxes. The choice of polymer chain representation can be varied from standard vector models and van der Waal models, to a B-spline fit of polymer backbones that yields a smooth ribbon that approximates the polymer chain, to strict Cardinal splines that interpolate the smoothest curve possible that will precisely follow the polymer chain. The program provides a photograph mode, save/restore facilities, and efficient generation of symmetry-related molecules and packing diagrams. Additionally, SETOR is designed to accept commands and model coordinates from the standard input stream, and to control standard output. Ancillary programs provide a method to interactively edit hardcopy plots of all vector and many solid models generated by SETOR, and to produce standard HPGL or PostScript files. Examples of figures rendered by SETOR of a number of macromolecules of various classes are presented.

Computer Graphics↗

PubMed2003

Screening for low literacy among adult caregivers of pediatric patients.

BACKGROUND AND OBJECTIVES: The association between functional illiteracy and poor health has led to pediatric literacy promotion programs in the primary care setting. These interventions do not address linked parental literacy needs. An obstacle to referring adults to literacy services is the lack of an instrument that can efficiently identify individuals who could benefit from such programs. We sought to identify screening items sufficiently simple to use in clinical practice. METHODS: This cross-sectional study examined 98 adult primary caregivers of preschool children seen in an inner-city primary care setting. Literacy level and 17 variables predicted to be associated with low literacy were assessed. RESULTS: Three items were independently associated with a 6th grade reading level: (1) less than 12th grade completion, (2) not living with the child's other parent, and (3) not reading for pleasure. Receiver operating characteristic (ROC) curve analysis indicates that, used together, these variables have discriminant capacity, with an area under the ROC curve of.76. CONCLUSIONS: Three items for use in a simple screening instrument for parental low literacy were identified. Used together, they had favorable characteristics but must be further tested for generalizability.

Adult↗

PubMed1994

A 12-year preventive program for beta-thalassemia in Northern Sardinia.

From 1980 to 1991, 6.3% of the adult population of the province of Sassari, Northern Sardinia, underwent voluntary beta-thalassemia screening. Of the 28,000 subjects examined, 15.7% proved to be heterozygotes for beta-thalassemia. In addition, the screening of 7500 students in 26 villages in Sassari province fixed the frequency of beta-thalassemia in this part of Sardinia at 10.4%. Of the 539 couples at risk to be expected from this figure, the screening detected 43% (234). The data suggest that inductive screening played a major role in the efficiency of this preventive beta-thalassemia program. Follow up of 221 pregnancies found to be at risk for homozygous beta-thalassemia and referred to the Antenatal Diagnosis Service, Cagliari, Southern Sardinia, showed that antenatal diagnosis was carried out in 80% of them. The overall percentage of couples refusing antenatal diagnosis was 10.8%, but over the years the acceptance rate for the procedure increased from 87% to 96%. Atypical hematological findings in 1.5% of 468 members of the couples at risk required globin chain synthesis and molecular analyses to define the precise beta-thalassemia genotype. Heterogeneous "mild" beta-thalassemia mutations as well as coexisting delta-thalassemia were found in silent type I and type II beta-thalassemia carriers which, without chain synthesis and DNA investigations, would have escaped detection.

Genetic Counseling↗

PubMed2005

Program evaluation from an ecological perspective: supported employment services for persons with serious psychiatric disabilities.

Results of large-scale program evaluations supplement other kinds of evidence regarding interventions for psychiatric disabilities. This paper describes an ongoing 11-year effort to evaluate supported employment services provided to persons with serious psychiatric disabilities by community mental health centers in one Midwestern state. Using an ecological perspective, the evaluation emphasizes multiple kinds of products and the careful development and maintenance of stakeholder relationships. Data from over 4600 individuals in supported employment programs demonstrate that services are effective and efficient, that these employees and employers are satisfied, and that stable employment may sharply reduce the overall costs of mental health care.

Adolescent↗

PubMed1980

Health Care Financing Administration--Medicare program; intermediary nominations, contracts, evaluations, and notices. Final regulation.

These final regulations establish criteria and standards for evaluating the performance of agencies or organizations serving or desiring to serve as fiscal intermediaries under the Medicare program. They also authorize the Administrator to assign or reassign providers of services to particular intermediaries or to designate a single intermediary to serve a class of providers on a regional or national basis after considering intermediary performance measured against the criteria and standards. Affected providers and intermediaries will be given a notice of assignment or reassignment and intermediaries will be afforded a hearing. The purpose of these regulations is to promote increased efficiency in the administration of the Medicare program.

Insurance↗

PubMed1986

Programmed training of visual discriminations: a comparison of techniques.

The efficiency of three discrimination training procedures was compared for mentally handicapped children trained on a shape discrimination presented via a microcomputer. Each of three groups received one of the following training procedures; graded stimulus fading; graded prompt fading, a procedure approximating behavior modification prompting techniques; trial-and-error training. The stimulus fading and graded prompting procedures were equivalent in terms of the number of steps and criteria for fading. Results showed the two programmed techniques did not differ significantly, but both were significantly superior to trial-and-error learning in terms of number of children reaching criterion, number of trials to criterion, and number of errors. The training procedures were continued for subjects from each of the three groups for an additional two problems, followed by a trial-and-error test problem. Over the additional training problems the pattern of differences between the groups in number of errors remained significant, however differences between the groups in number of trials to criterion decreased. There were no significant differences in any of the measures on the trial-and-error test problem. Results are discussed in relation to the literature on errorless learning techniques, and the implications for applied training procedures are elucidated.

Adolescent↗

PubMed1999

Practical implementation of globally priced episodes of care: lessons learned from Oxford's specialty management program.

Globally priced episodes of care afford payers a more efficient method of allocating risk and simultaneously accommodating the now permanent demand for choice and access at the point of service. Foreseeing the trend away from capitated delivery systems, in April of 1996. Oxford Health Plans began to invest considerable resources to implement global fees. When Oxford ran afoul of Wall Street and New York State insurance regulators (for reasons unrelated to the subject of this article), it was forced to abandon the new program. For the growing number of payers interested in pursuing similar contracting strategies, this article may serve as a useful source of information.

Capitation Fee↗

PubMedDate not supplied

The Pyramid Model: an integrated approach for evaluating continuing education programs and outcomes.

Recent mergers and downsizing of health care agencies have made resources for continuing education (CE) increasingly scarce. Nurse educators must demonstrate the effectiveness and sustainability of CE programs and establish the link between nursing professionalism and positive patient outcomes. The Pyramid Evaluation Model expands and enhances previous evaluation frameworks. Simple steps are outlined to evaluate CE programs and outcomes systematically and comprehensively through an impact model that examines goals, reviews program design, monitors program implementation, assesses outcomes and impact, and analyzes efficiency.

Cost-Benefit Analysis↗

PubMed2000

Total time and efficient time management: in search of optimal learning and retention via study-test-rest presentation programs.

Bugelski's total time hypothesis (TTH) assumes that a constant time X is needed to learn Y regardless of how time X is programmed, with no possibility of optimization. Izawa's study-test-rest (STR) hypothesis assumes that optimization in learning and retention is possible. Examined were the effects of varied study (S) and test (T) presentation programs on learning and retention, with total time held constant. Participants learned a list of 12 paired associates under three presentation program types. In S + T list repetitions, each pair was presented once per S cycle and tested once per T cycle; both S and T were repeated in list form. In S + T item repetitions, each pair was repeated 1-6 times before the next pair in the list was presented on both S and T cycles. For S/T alternations, the entire list of pairs was studied and then each pair was tested, with S and T cycles alternating. Under each program type, there were four presentation rates. Item repetition led to more learning than list repetition when the presentation rate was very fast. Learning and retention were greatest with the intermediate S/T alternation program. These findings supported Izawa's STR hypothesis but strongly contradicted TTH.

Attitude↗

PubMedDate not supplied

Addressing issues for early detection and screening in ethnic populations.

PURPOSE/OBJECTIVES: To describe how multicultural knowledge and skills are applied in culturally competent practice to develop and deliver available, accessible, acceptable, and appropriate programs in early cancer detection and screening programs in ethnic communities. DATA SOURCES: Literature and clinical community practice reports. DATA SYNTHESIS: Successful community screening programs can be conducted within ethnic minority populations. Practitioners must tailor care based on salient cultural differences of the population of focus. Culturally based practice results in the (a) increased ability to think critically in community and individual assessments, (b) development of more accurate program plans and designs, and (c) increased likelihood that appropriate outcomes will be used in the evaluation of care. CONCLUSIONS: Greater cultural competence increases the accuracy of care and thereby its effectiveness, efficiency, and success in providing acceptable and optimal programs. IMPLICATIONS FOR NURSING PRACTICE: The first step in a cultural assessment is to know one's own beliefs and attitudes. The second step, conducted in parallel, requires knowledge about the groups that make up the patient and staff populations within the practice setting and then integrating those perspectives into practice. Practitioners then can begin the third step of negotiation of all stages of the project with members of the various communities on an equal basis that recognizes the expertise and integrity of all parties.

Culture↗

PubMed1997

Effect of continuous quality improvement analysis on the delivery of primary percutaneous transluminal coronary angioplasty for acute myocardial infarction.

A successful primary percutaneous transluminal coronary angioplasty (PTCA) program requires a learning process whereby the efficiency of the cardiac catheterization laboratory to deliver prompt intervention can be refined. The purpose of this study was to (1) quantify this learning process in terms of shortening the time to reperfusion, (2) examine the changes in strategy that allowed for this, and (3) determine if expedited reperfusion by primary PTCA improved patient outcomes. A database of all primary PTCA procedures was established in February 1, 1994. Continuous quality assurance analysis was performed, and program modifications introduced as needed. Patients were separated into early (group A = February 1, 1994 through January 31, 1995) and late (group B1 = February 1, 1995 through June 31, 1995, and group B2 = July 1, 1995 through December 31, 1995) cohorts. Time intervals to certain treatment landmarks were compared among groups. In-hospital outcomes were tabulated. Fifty-two consecutive patients were included (group A = 19, group B1 = 17, group B2 = 16). Time intervals shortened significantly (group A vs group B1 vs group B2) with the time from hospital presentation to first balloon inflation decreasing progressively (from 205 to 119 to 97 minutes; p <0.001). Most of this decrease was obtained by shortening the time from hospital presentation to xylocaine administration (158 to 85 to 72 minutes; p <0.005), although the time from xylocaine to first balloon inflation also decreased (from 47 to 33 to 24 minutes; p <0.005). Parallel decreases for in-hospital mortality (26% vs 0%; p = 0.004), adverse events (47% vs 18%; p = 0.05), and length of hospital stay (13.3 +/- 13.7 vs 8.4 +/- 4.4 days; p = NS) were demonstrated for groups A versus B1 and B2. A learning effect following initiation of a primary PTCA program is demonstrated in which reperfusion was more rapidly achieved as the result of procedural changes directed by quality improvement analysis with a concurrent improvement in in-hospital outcomes.

Adrenergic beta-Antagonists↗

PubMed2025

TaLAC129 is a negative regulator of arbuscular mycorrhizal symbiosis but enhanced the growth and yield of bread wheat.

Arbuscular mycorrhizal (AM) symbiosis enhances nutrient acquisition and stress resilience in plants, yet the genetic mechanisms regulating this interaction in wheat remain poorly understood. This study explores the variation in AM colonization rates across a diverse set of wheat varieties and aims to identify key genes that regulate the wheat-AM symbiosis. Understanding these molecular mechanisms is crucial for improving nutrient uptake efficiency and stress resistance in wheat breeding programs. Here, we conducted a genome-wide association study (GWAS) of 291 wheat varieties and integrated transcriptomic data to identify TaLAC129, a laccase (LAC)-encoding gene, as a critical negative regulator of AM colonization in wheat roots. Overexpression of TaLAC129 significantly increased root LAC activity and lignin content, concurrently suppressing AM colonization. While this suppression reduced nitrogen (N), phosphorus (P), and potassium (K) uptake in stems, leaves, and glumes, it markedly enhanced nutrient utilization efficiency (NUE) in grains. Furthermore, TaLAC129 overexpression improved agronomic traits, including grains per panicle, 1000-grain weight, and overall yield. Our findings reveal the dual role of TaLAC129 in balancing AM symbiosis and nutrient allocation, offering a novel genetic target for breeding wheat varieties with improved yield and nutrient efficiency. This study provides critical insights into the molecular coordination between symbiotic trade-offs and agricultural productivity in cereal crops.

Triticum↗

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