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PubMed2001

Towards integrated catchment management, Whaingaroa, New Zealand.

The paper examines progress towards integrated catchment management and sustainable agriculture at Whaingaroa (Raglan), New Zealand. Application of the Canadian "Atlantic Coastal Action Program" model (ACAP) has been only partially successful within New Zealand's bicultural setting. Even before the introduction of the ACAP process there existed strong motivation and leadership by various sectors of the community. A merging of resource management planning and implementation processes of the larger community and that of the Maori community has not occurred. Research carried out by Crown Research Institutes has clearly shown the actions required to make pastoral farming more sustainable. There are difficulties in the transference to, and uptake of, these techniques by farmers. An examination of the socio-economic context is required. There has been a requirement on local government bodies to tighten their focus as part of recent reform. This has occurred concurrently with a widening of vision towards integrated and sustainable forms of management. This (as well as a clear belief in empowerment of local communities) has lead to Council reliance on voluntary labour. There is a need to account for the dynamic interaction between social and political history and the geological and biophysical history of the area. As part of a re-examination of sustainable development, New Zealand needs to reconcile the earning of the bulk of its foreign income from primary production, with the accelerating ecological deficit that it creates. A sustainability strategy is required linking consumer demand, property rights and responsibilities.

Agriculture↗
PubMed1997

The Tufts partnership for managed care education.

The authors describe the formation and the academic activities of the Tufts Managed Care Institute, a collaborative venture of Tufts University School of Medicine and Tufts Health Plan, an independent-practice-association (IPA)-model health maintenance organization (HMO). In 1994, the dean of the medical school and the CEO of the HMO recognized the need for collaboration to prepare students and practitioners for high-quality, cost-effective practice in a managed care environment. They established an advisory committee to oversee a six-month feasibility study to interview experts and opinion leaders and identify critical characteristics of the ideally prepared managed care practitioner. In 1995, with start-up funding from the HMO, the institute began its operations as a freestanding enterprise with board representation from the two sponsoring institutions. While many of the institute's programs have been developed for practicing physicians and other health care professionals, this article focuses on the academic activities. For medical students, the approach has been to blend managed care principles and practices into existing courses, problem-based learning cases, and clerkships, rather than creating separate managed care courses. For primary care residents, the institute has a grant to develop managed care curricula in conjunction with Tufts-affiliated residency training programs. Faculty development is accomplished through dedicated workshops and seminars, and through increased dialogue between traditional faculty and managed care professionals. In all of its programs and activities the institute has fostered greater contact and collaboration between colleagues from both sides of the health plan-academia "divide." Operationally, the institute structure, with dedicated full-time administrative staff, provides the singular focus necessary to establish managed care education as a top priority for the partnership. At the same time, sustaining this freestanding organization and infrastructure requires increased resources. Initial responses to the institute's programs and activities have been positive, both from the local Tufts community and from external parties. Yet the partnership must establish methods to evaluate the institute's long-term impact in its efforts to help practitioners succeed in a transforming landscape.

Academic Medical Centers↗
PubMed1988

Termination of sustained ventricular tachycardia by external noninvasive pacing.

Cardiac pacing has proven useful in the termination of sustained ventricular tachycardia (VT). In this study, the effectiveness of external noninvasive temporary pacing was compared with traditional endocardial burst ventricular pacing for the termination of sustained and hemodynamically stable VT. In 14 patients, 16 VT morphologies induced by programmed right ventricular extrastimulation were reproducibly terminated by endocardial burst pacing (3 to 9 complexes). VT cycle lengths averaged 392 +/- 97 ms (standard deviation) and ranged from 300 to 690 ms. The endocardial burst pacing cycle length used to terminate VT averaged 298 +/- 93 ms (range 220 to 600 ms). External burst pacing terminated 14 of 16 VT morphologies (88%). The pacing cycle length used to terminate these 14 VTs averaged 282 +/- 44 ms. The number of ventricular captures ranged from 5 to 20 beats. Failure to terminate 2 VT morphologies probably represented a failure of the device to capture the ventricle. Acceleration of VT occurred in 1 patient with burst external noninvasive pacing. These observations suggest that external burst pacing may be an effective means of terminating sustained VT in some patients.

Aged↗
PubMed1991

Prospective community evaluation of the signal-averaged electrocardiogram in predicting malignant ventricular arrhythmias: beneficial outcome with electrophysiology guided therapy.

The role of the signal-averaged ECG was prospectively assessed in 517 patients in whom there was a suspicion for malignant ventricular arrhythmias. Patients were divided into Group I with a normal surface QRS width less than 120 ms (426 patients) and Group II with a prolonged QRS duration greater than or equal to 120 ms (91 patients). Late potentials were present in 42 (10%) Group I patients and in 24 (26%) Group II patients. Programmed ventricular stimulation was performed for standard indications in 55 patients without late potentials and in 42 patients with late potentials, combining both groups. The sudden death or recurrent sustained ventricular tachycardia rate in follow-up was evaluated based on the presence or absence of late potentials and whether programmed ventricular stimulation was performed. In the patients without late potentials, these rates were 4 patients (1.0%) in the no EP group and 3 patients (5.5%) in the EP group (p less than .05), respectively (overall 1.6%). In the patients with late potentials, these rates were 7 patients (29%) in the no EP group and 7 patients (17%) in the EP group (p = .19), respectively (overall 21%). In addition, appropriate automatic defibrillator shocks were present in 1 patient without late potentials and in 8 patients with late potentials which were not included in the recurrent sudden death or sustained ventricular tachycardia statistics. The signal-averaged ECG accurately defines patients at a higher risk for malignant ventricular arrhythmias regardless of unfiltered QRS duration.(ABSTRACT TRUNCATED AT 250 WORDS)

Electric Countershock↗
PubMed1986

Circuit weight training in cardiac patients.

This was a prospective, randomized evaluation of the safety and efficacy of 10 weeks of circuit weight training in patients, aged 35 to 70 years, with documented coronary artery disease. Circuit weight training refers to the performance of a series of weight-lifting exercises using a moderate load with frequent repetitions. Patients had participated in a supervised cardiac rehabilitation program for a minimum of 3 months before the study. Control patients (n = 20) continued with their regular exercise consisting of a walk/jog and volleyball program, while the experimental group (n = 20) substituted circuit weight training for volleyball. No sustained arrhythmias or cardiovascular problems occurred. The experimental group significantly increased treadmill time from 619 to 694 seconds while the treadmill time of the control group did not change. Strength in the experimental group increased by an average of 24% while there was no change in the control patients. Circuit weight training appears to be safe, and to result in significant increases in aerobic endurance and musculoskeletal strength compared with traditional exercise used in cardiac rehabilitation programs.

Adult↗
PubMed2000

Programmed cell death, proliferating cell nuclear antigen and p53 expression in mouse colon mucosa during diet-induced tumorigenesis.

Western-style diets (WDs) trigger and sustain the early phases of tumorigenesis in mouse colon, and when continued throughout the life span lead to the development of dysplastic crypts. In order to evaluate the roles both of cell proliferation and programmed cell death (PCD) in WD-induced tumorigenesis, immunohistochemical detection of proliferating nuclear antigen (PCNA), in situ end labeling (TUNEL) of DNA breaks, and p53 protein were carried out in mouse colonic mucosa during prolonged feeding of two WDs. PCNA Labeling Index of colonic crypts was significantly higher in WD-treated animals than in controls only at the beginning of the nutritional study, the gap rapidly bridged by increased cell proliferation spontaneously occurring in the colonic mucosa during aging. A transient early homeostatic activation of PCD at the base of the crypt also was observed in WD groups. No changes in PCD were seen in the upper third of the crypt or in surface epithelium throughout the study, indicating that PCD in that colonic crypt segment produces a constant flux of cell loss, uninfluenced by homeostatic fluctuations. A major finding was an irreversible, progressive, age-related decline of PCD at the crypt base in both control and treated animals that occurred during the second half of the rodents' life span. p53 protein was not immunohistochemically detected, suggesting that neither overexpression of wild-type nor mutated forms of the protein are involved in the above mentioned changes.

Animals↗
PubMedDate not supplied

Evaluation of a sexually transmitted diseases training program.

To determine whether attendance at a sexually transmitted disease (STD) training course produces an immediate and/or sustained gain in knowledge and to assess whether practitioners who might benefit most from such training could be identified easily, 55 practitioners were given one or more standardized written examinations before, immediately after, and four to 15 months after attendance at one of eight intensive one- or two-week training sessions. All practitioners (nine physicians and 46 physician extenders) increased their clinical knowledge of STDs, and most retained this knowledge over a four- to 15-month follow-up period (P less than 0.001). Practitioners with the lowest scores before the course had the least professional training, graduated from professional schools prior to 1965, had less than two years of work experience in STDs, and examined the fewest patients per day (P = 0.028). A lower precourse score was predictive of significant improvement on the postcourse test (P less than 0.001). Our results show that attendance at an STD training course produces both an immediate and a sustained gain in knowledge and indicates that precourse test scores and practitioner characteristics can be useful in identification of practitioners most in need of and most likely to benefit from STD clinical training.

Clinical Competence↗
PubMed2001

Medicare. Can its benefits be sustained as cost of coverage grows?

By many measures Medicare is one of the most successful government programs ever instituted, and its benefit to the health of older citizens is unquestioned. Yet it is not without chronic problems and challenges, including the cost of administering the program, limited insurance coverage for certain services and conditions, lack of standardization, and fraud. Moreover, new challenges arise as societal circumstances change and political demands fluctuate. Chief among the concerns are the imminent influx of baby boomers into the system and the debate over expanding the limited scope of Medicare coverage.

Aged↗
PubMed1987

[Spontaneous and stimulus-induced arrhythmia behavior in dilated cardiomyopathy].

To assess the incidence and significance of spontaneous and induced ventricular arrhythmias in idiopathic dilated cardiomyopathy, 24 h ambulatory electrocardiographic monitoring and programmed ventricular stimulation were performed in 52 patients. The mean left ventricular ejection fraction was 38 +/- 13%. Ventricular arrhythmias were present in 94%: 56% had non-sustained ventricular tachycardia with 3-20 consecutive VPCs and 17% ventricular pairs. In 56% of patients, more than 10(3) single VPCs/24 h were seen. Repetitive ventricular response was induced by programmed stimulation in 28 patients (54%): in 39%, 2-4 VPCs and in 15%, greater than or equal to 5 VPCs. In three patients (6%), sustained ventricular tachycardia (greater than or equal to 30 s) was initiated, which was of a monomorphic configuration in two of them. The incidence of induced ventricular arrhythmias could neither be correlated with the Lown grade of spontaneous arrhythmias nor with the total number of single VPCs/24 h. The inducibility of sustained ventricular tachycardia, however, was only seen in patients with arrhythmias of Lown grade IVb. No clear correlation could be determined between the impairment of left ventricular function and spontaneous or induced arrhythmias. During the 9-48 (median 34) months' follow-up, nine patients (17%) died, three of them died suddenly and five in congestive heart failure. All sudden cardiac death victims and three out of the five who died of congestive heart failure had non-sustained ventricular tachycardia during 24 h ambulatory electrocardiographic monitoring, but no higher incidence of single VPCs than the survivors. All patients who died had a significantly reduced left ventricular ejection fraction as compared to those who survived. In none of the patients who died were there more than three consecutive VPCs induced by programmed ventricular stimulation.

Adult↗
PubMed2005

Neighborhood poverty and public policy: a 5-year follow-up of children's educational outcomes in the New York City moving to opportunity demonstration.

Data from the Moving to Opportunity Program, a randomized mobility experiment in which a subset of low-income minority families living in public housing in high-poverty neighborhoods were given vouchers to move to low-poverty neighborhoods, were used to evaluate 1 policy approach for improving children's educational outcomes. Four hundred twenty-five New York City children were seen 2 1/2 and 5 years following relocation (mean age=14.64 years, SD=3.21 years). Analyses examining program effects on 5-year educational outcomes, accounting for 2 1/2-year outcomes, revealed that program effects on adolescent boys' achievement found at 2 1/2 years were not sustained at 5 years. Rather, male and female youths 14-20 years of age in low-poverty neighborhoods reported lower school grades and engagement relative to youths in high-poverty neighborhoods. From a policy standpoint, the complexity of enhancing low-income minority children's educational outcomes is underscored by the multiple dynamics involved--family, neighborhood, housing, and school.

Adolescent↗
PubMed2005

Heart healthy and stroke free: successful business strategies to prevent cardiovascular disease.

BACKGROUND: Heart disease and stroke, the principal components of cardiovascular disease (CVD), are the first and third leading causes of death in the United States. In 2002, employers representing 88 companies in the United States paid an average of 18,618 dollars per employee for health and productivity-related costs. A sizable portion of these costs are related to CVD. RESULTS: Employers can yield a 3 dollar to 6 dollar return on investment for each dollar invested over a 2 to 5 year period and improve employee cardiovascular health by investing in comprehensive worksite health-promotion programs, and by choosing health plans that provide adequate coverage and support for essential preventive services. The most effective interventions in worksites are those that provide sustained individual follow-up risk factor education and counseling and other interventions within the context of a comprehensive health-promotion program: (1) screening, health risk assessments, and referrals; (2) environmental supports for behavior change (e.g., access to healthy food choices); (3) financial and other incentives; and (4) corporate policies that support healthy lifestyles (e.g., tobacco-free policies). The most effective practices in healthcare settings include systems that use (1) standardized treatment and prevention protocols consistent with national guidelines, (2) multidisciplinary clinical care teams to deliver quality patient care, (3) clinics that specialize in treating/preventing risk factors, (4) physician and patient reminders, and (5) electronic medical records. CONCLUSIONS: Comprehensive worksite health-promotion programs, health plans that cover preventive benefits, and effective healthcare systems will have the greatest impact on heart disease and stroke and are likely to reduce employers' health and productivity-related costs.

Cardiovascular Diseases↗
PubMed1999

Aspects of motivation of a volunteer AIDS care team program.

The South Carolina AIDS Care Team Program, directed by The Ecumenical AIDS Ministry, a component of the South Carolina Christian Action Council, provides emotional and supportive services to people living with HIV and AIDS. A sample of volunteer care team members participated in five focus groups as part of a process evaluation. Care teams were asked to participate based on years since training (new vs. experienced), race (white vs. African American), and location (urban vs. rural). Volunteers were motivated to become involved in a care team through previous contact with a person with AIDS, a general sense of altruism, and influences from their faith community. Due to the emotionally demanding nature of the work, motivation to remain a volunteer was also examined. It was discovered that a support system, the expression of faith, support of their faith community, and coping with the death of a care partner were essential elements for sustaining care team involvement. The implications of this study are useful to volunteer programs through faith communities to meet the growing need of people living with HIV and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Resistive breathing training in patients with chronic obstructive pulmonary disease.

In order to investigate the effect of resistive breathing training on ventilatory muscular endurance, we examined the maximal sustained ventilatory capacity in ten patients with chronic obstructive pulmonary disease (COPD) before and after a six-week program of resistive breathing training. In addition, we investigated the effect of altered breathing strategy on resistive breathing performance. The patients performed two 15-minute sessions of resistive breathing daily for six weeks using an inspiratory resistive device (Pflex). Before and after the training, we found no significant change in spirometric data, pulmonary volumes, maximal inspiratory pressure, and maximal expiratory pressure. Of the ten patients, seven failed to show an improvement in their performance of resistive breathing. Furthermore, the maximal sustained ventilatory capacity was unchanged after the resistive breathing training. After the completion of the training program, seven of the patients participated in an additional experiment in which they were instructed to take long slow inspirations while breathing through the resistive device. With this change in breathing pattern, five of the seven were able to improve their performance of resistive breathing. Analysis of the breathing strategy showed that a reduction in the peak mouth pressure, breathing frequency, and external resistive work with a longer inspiratory time was beneficial. We conclude that neither resistive breathing performance nor ventilatory muscular endurance, as measured by sustained hyperpnea, is improved by resistive breathing training performed according to the current instructions with the resistive device, and alterations in breathing strategy have a profound effect on the performance of resistive breathing. The lack of details of breathing strategy in previous studies of resistive breathing makes it difficult to determine if previously demonstrated improvements were due to a real enhancement of ventilatory muscular performance or merely secondary to a different strategy.

Aged↗
PubMed1992

Spontaneous and inducible ventricular arrhythmias in a canine model of chronic heart failure: relation to haemodynamics and sympathoadrenergic activation.

The relationship between the incidence, frequency and complexity of spontaneous ventricular arrhythmias and the extent of haemodynamic compromise and sympathoadrenergic hyperactivity was evaluated in a canine model of chronic heart failure produced by multiple sequential intracoronary microembolizations. Ambulatory ECG Holter monitoring recorded during chronic heart failure in 18 dogs revealed spontaneous ventricular arrhythmias ranging from single ventricular premature beats (VPBs) to non-sustained episodes of ventricular tachycardia (VT). Single VPBs were present in 94% of dogs, couplets in 67%, triplets in 28% and spontaneous episodes of non-sustained VT in 33%. Dogs with > 28 VPBs.h-1 (n = 9) had a markedly higher plasma norepinephrine (PNE) concentration (1001 +/- 185 vs 561 +/- 31 pg.ml-1) (P < 0.03), and a higher pulmonary artery wedge pressure (PAWP) (18 +/- 2 vs 12 +/- 1 mmHg) (P < 0.03) than dogs with < or = 28 VPBs.h-1 (n = 9). Dogs that developed spontaneous episodes of VT also had significantly higher PNE levels (1119 +/- 247 pg.ml-1) compared to dogs that did not develop VT (612 +/- 64 pg.ml-1) (P < 0.02). Programmed ventricular stimulation performed in seven of 18 dogs resulted in the development of sustained monomorphic VT in three and ventricular fibrillation in three dogs each (43%, 43%). Dogs with inducible sustained monomorphic VT had a significantly higher number of ambient arrhythmias and higher PAWP compared to dogs that did not develop sustained VT. The observed complexity, frequency and incidence of spontaneous and inducible ventricular arrhythmias in this canine model are similar to those described in patients with chronic heart failure.

Animals↗
PubMed2005

Effects of an Internet-based voucher reinforcement program for smoking abstinence: a feasibility study.

The present study tested the feasibility of an Internet-based method to obtain objective evidence of smoking abstinence and to deliver vouchers for evidence of abstinence. Four heavy smokers participated in this 4-week study. Twice daily, participants made video recordings of themselves providing a breath carbon monoxide (CO) sample with a Web camera. The video was sent electronically to the smoking clinic. Participants could earn vouchers for gradual reductions in breath CO during an initial shaping condition, and then for achieving abstinence (CO < or = 4 ppm). Vouchers could be exchanged for merchandise at select Internet vendors. Relative to baseline conditions, participants substantially reduced their smoke intake, and 3 achieved sustained periods of abstinence. The study suggests that an Internet-based voucher reinforcement program is a feasible method to promote abstinence from cigarette smoking.

Feasibility Studies↗
PubMed1982

Femoral mechanics in the lesser bushbaby (Galago senegalensis): structural adaptations to leaping in primates.

One method used to examine the relationship between behavioral strategies and anatomical adaptation is to study the results of mechanical stress associated with a given behavior and compare this with skeletal adaptations to other behaviors. This comparative approach is appropriate for highlighting combinations of features that are specializations to specific types of behavior. The purpose of this paper is to compare femoral mechanics in Galago senegalensis with previously collected data for macaques and humans as a basis for discussing structural adaptations in the primate hindlimb to leaping. The stiffness and load carrying capabilities of the femoral diaphyses of 27 G. senegalensis were analyzed using the SCADS computer program. The data suggest that the galago femur is well adapted to sustain large sagittal plane compressive loads rather than large bending loads. The straightness of the femoral shaft and large midshaft area moments of inertia prevent buckling from these large compressive loads. Calculations indicate that the ratio of critical buckling load to body weight in galago is 31 times that in macaques and 55 times that in humans. The femur of this saltatory primate is morphologically adapted to resist buckling when subjected to large compressive loads, while those of macaques and humans are better adapted to resist bending moments caused by ground reaction forces acting on the extended limb. The differences between galago on the one hand and macaques and humans on the other suggest that relatively smaller moments about the hip and relatively larger moments about the knee accompany more quadrupedal and bipedal walking, while habitual leaping is associated with relatively larger moments about the hip. These data reinforce the apparent similarity of the mechanical effects of quadrupedal and bipedal locomotion on the femur and dissimilarity with femoral mechanics in habitually saltatory primates.

Adaptation, Physiological↗
PubMed2002

Capital assets and intercultural borderlands: socio-cultural challenges for natural resource management.

In their design or implementation, many natural resource management (NRM) programs ignore critical socio-cultural dimensions of the challenge to advance sustainability. Building on particular ideas about culture and human ecosystems, we combine the strengths of the capital assets model of sustainability and the idea of intercultural borderlands to respond to this gap. To advance our thesis about the utility of these tools, we critically reviewed and analysed a cross-disciplinary literature relating to the socio-cultural dimensions of NRM. This paper stems from that labour and examines particular tensions that arise in land management as a result of Australians' specific colonial and postcolonial legacies. These tensions--related to ethnicity, gender, population, age and health--are among the threads in the larger tapestry that comprises the socio-cultural dimensions of NRM. For the Australian case, they are central, longstanding and persistent, and thus worthy of analysis; and they are applicable in general terms to other places with similar histories of settlement and land use.

Adult↗
PubMed2001

Changing approaches to mountain watersheds management in mainland South and Southeast Asia.

Mountain watersheds, comprising a substantial proportion of national territories of countries in mainland South and Southeast Asia, are biophysical and socioeconomic entities, regulating the hydrological cycle, sequestrating carbon dioxide, and providing natural resources for the benefit of people living in and outside the watersheds. A review of the literature reveals that watersheds are undergoing degradation at varying rates caused by a myriad of factors ranging from national policies to farmers' socioeconomic conditions. Many agencies--governmental and private--have tried to address the problem in selected watersheds. Against the backdrop of the many causes of degradation, this study examines the evolving approaches to watershed management and development. Until the early 1990s, watershed management planning and implementation followed a highly centralized approach focused on heavily subsidized structural measures of soil conservation, planned and implemented without any consultation with the mainstream development agencies and local people. Watershed management was either the sole responsibility of specially created line agencies or a project authority established by external donors. As a consequence, the initiatives could not be continued or contribute to effective conservation of watersheds. Cognizant of this, emphasis has been laid on integrated, participatory approaches since the early 1990s. Based on an evaluation of experiences in mainland South and Southeast Asia, this study finds not much change in the way that management plans are being prepared and executed. The emergence of a multitude of independent watershed management agencies, with their own organizational structures and objectives and planning and implementation systems has resulted in watershed management endeavors that have been in complete disarray. Consistent with the principle of sustainable development, a real integrated, participatory approach requires area-specific conservation programs that are well incorporated into integrated socioeconomic development plans prepared and implemented by local line agencies in cooperation with nongovernment organizations (NGOs) and concerned people.

Agriculture↗

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