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Human use regulatory affairs advisor (HURAA): learning about research ethics with intelligent learning modules.

The Human Use Regulatory Affairs Advisor (HURAA) is a Web-based facility that provides help and training on the ethical use of human subjects in research, based on documents and regulations in United States federal agencies. HURAA has a number of standard features of conventional Web facilities and computer-based training, such as hypertext, multimedia, help modules, glossaries, archives, links to other sites, and page-turning didactic instruction. HURAA also has these intelligent features: (1) an animated conversational agent that serves as a navigational guide for the Web facility, (2) lessons with case-based and explanation-based reasoning, (3) document retrieval through natural language queries, and (4) a context-sensitive Frequently Asked Questions segment, called Point & Query. This article describes the functional learning components of HURAA, specifies its computational architecture, and summarizes empirical tests of the facility on learners.

Artificial Intelligence↗

The cultural education of academic evaluators: lessons from a university-Hmong community partnership.

This article explores some of the lessons a university-based evaluation team learned while attempting to hire, retain, and work with staff members from a local Hmong community. These staff members were hired to assist a federally-funded community collaborative with implementing and evaluating a family strengthening program for Hmong families with adolescents. Over the course of two years, a succession of individuals were hired and resigned from a key staff position. These resignations occurred at critical points in the project, undermining a critical component of the program's evaluation. Through interviews, observations, self-reflection, and feedback from colleagues and reviewers, a better understanding of the reasons for these difficulties began to emerge. The challenges examined in this article help to illustrate some of the complexities faced by academics when conducting a community-based project with an underserved racial ethnic population. The article concludes by discussing some of the lessons learned and what they might suggest for others doing similar types of work.

Adolescent↗

Partnership for front-line success: a call for a national action agenda on workforce development.

Despite more than a decade of dialogue on the critical needs and challenges in public health workforce development, progress remains slow in implementing recommended actions. A life-long learning system for public health remains elusive. The Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry in collaboration with other partners in federal, state, local agencies, associations and academia is preparing a national action agenda to address front-line preparedness. Four areas of convergence have emerged regarding: (1) the use of basic and crosscutting public health competencies to develop practice-focused curricula; (2) a framework for certification and credentialing; (3) the need to establish a strong science base for workforce issues; and (4) the acceleration of the use of technology-supported learning in public health.

Centers for Disease Control and Prevention, U.S.↗

Blood lead levels and risk factors for lead poisoning in children and caregivers in Chuuk State, Micronesia.

Lead poisoning is a preventable environmental disease. Children and developing fetuses are especially vulnerable; even low blood lead levels (BLLs) are linked with learning and behavioral problems. We assessed children's and their caregivers' BLLs and risk factors for lead exposure in Chuuk State, Federated States of Micronesia. Children aged 2-6 years were randomly selected within 20 randomly selected villages. Children and caregivers provided venous blood, and caregivers offered information about possible risk factors for lead exposure. Mean BLLs were 39 microg/l for children and 16 microg/l for caregivers. Children with BLLs of > or = 100 microg/l (elevated) were 22.9 (95% CI: 4.5-116.0) times more likely to have a caregiver with an elevated BLL, 6.2 (95% CI: 1.4-27.3) times more likely to live on an outer island, and 3.4 (95% CI: 1.7-6.9) times more likely to have a family member who made lead fishing weights than did other children even after controlling for age and sex. For children, 61% of elevated BLLs could be attributed to making fishing weights. Caregivers with elevated BLLs were 5.9 (95% CI: 1.5-23.7) times more likely to live in a household that melted batteries than other caregivers even after controlling for age and education. For caregivers, 37% of the elevated BLLs could be attributed to melting batteries. The association of elevated BLLs in children and their caregiver suggests a common environmental exposure. Melting batteries to make fishing sinkers is a preventable source of lead exposure for children and their caregivers in Chuuk. Published by Elsevier GmbH.

Adult↗

Proposed framework for cleanup and site restoration following a terrorist incident involving radioactive material.

Cleanup following a terrorism incident involving a radiological dispersal device (RDD) or improvised nuclear device (IND) is likely to be technically challenging, costly, and politically charged. Lessons learned from the Top Officials 2 exercise and the increased threat of terrorist use of an RDD or IND have driven federal officials to push for an agreed-upon process for determining appropriate cleanup levels. State and local authorities generally have the ultimate responsibility for final public health decisions in their jurisdictions. In response to terrorist attacks, local authorities are likely to request federal assistance in assessing the risk and establishing appropriate cleanup levels. It is realistic to expect local and state requests for significant federal assistance in planning and implementing recovery operations. State and local authorities may desire "shared accountability" with the federal government in setting the appropriate cleanup levels. Government officials at all levels will face pressure to say how clean is clean enough and how quickly people can re-enter affected areas. Issues arising include (1) the nature of the relationship between the federal, state, and local leadership involved in the recovery efforts and (2) where the funding for recovery comes from. Many agencies, including the U.S. Environmental Protection Agency (EPA), the U.S. Nuclear Regulatory Commission (NRC), and the U.S. Department of Energy (DOE) have long been involved in cleanup activities involving radioactive materials. These agencies have recognized the need for a participatory process and realize the need to remain flexible when faced with possible unprecedented environmental challenges following a terrorist attack. Currently, the Department of Homeland Security has a committee process underway, with participation of the EPA, NRC, DOE, and other federal agencies, to try to resolve these issues and to begin engaging state, local, and tribal governments, and others as appropriate.

Decontamination↗

An activist looks at nursing's role in health policy development.

Health care delivery systems are evolving and transforming rapidly. Nurses will need new leadership and policy skills to meet the challenge of ensuring patient care safety and quality health care delivery. Nurses bring a unique perspective to health care policy development because of their educational training, professional values and ethics, advocacy skills, and experiential background. Significant progress has occurred over the years toward advancing nursing's presence, role, and influence in the development of health care policy. However, more nurses need to learn how to identify issues strategically; work with decision makers; understand who holds the power in the workplace, communities, state and federal level organizations; and understand who controls the resources for health care services. In health care policy development, nurses are essential in ensuring quality health care that is accessible and affordable for all women and their infants. More nurses need to actively work as leaders in the health policy arena.

Health Policy↗

Beyond transition: a comparison of the employment experiences of American and Canadian adults with LD.

With the passage of the Americans with Disabilities Act in the United States and the Canadian Chartre of Rights and Freedoms, there is a new work environment for individuals with learning disabilities (LD) in North America. This qualitative study sought to compare the employment experiences of 25 U.S. adults with LD and 24 Canadian adults with LD. Areas of comparison were job getting, experiences on the job, and job advancement. Remarkably, the U.S. and Canadian adults with LD had nearly the same employment experiences. In essence, each set of data mirrored the other despite marked differences in U.S. and Canadian federal disability legislation.

Adolescent↗

WISC-III accommodations: the need for practitioner guidelines.

According to professional standards and federal legislation, practitioners should provide reasonable test accommodations to eliminate discriminatory practices and to allow for an "even playing field." However, a contrasting view is concerned with the possible effects of deviating from standard administration procedures--meaningless scores and an unfair edge for individuals with disabilities. Particularly regarding the Wechsler Intelligence Scale for Children-Third Edition, practitioners are lacking guidelines in the following areas: (a) initial selection of tests to administer; (b) modifications in administration, if any; and (c) interpretation and reporting of results. Greater efforts are needed to formulate guidelines based on a synthesis of student needs, professional standards, federal legislation, psychometric theory, and empirical research.

Guidelines as Topic↗

Infection rates drop at hospitals participating in reporting system.

Data Benchmarks: The rates of nosocomial and surgical-wound infections have plummeted at hospitals participating in the National Nosocomial Infections Surveillance, a voluntary program of the federal Centers for Disease Control and Prevention. Compare your hospital's performance with the top benchmarks in a new report and learn what organizers say are the essential components of the program's success.

Centers for Disease Control and Prevention, U.S.↗

Health care consortia: a mechanism for increasing access for the medically indigent.

In response to poor coordination among health and social service providers, health care consortia have emerged in many areas of the United States. Consortia link multiple providers in a common structure to create comprehensive systems of care. They can be formally structured or informal combinations of providers that engage in coordination but otherwise do not comprise an independent organization. The functions most common among all types of consortia are shared services and service coordination; however, a number of consortia also operate outreach/education programs. Consortia represent an innovative response to the need both for vertical integration--case management of all levels of care--and horizontal integration to prevent duplication among primary care providers. We outline the history of consortia in which federally-funded community health centers have participated. We also suggest an analytical framework for the various types of consortia; discuss lessons learned about building and maintaining consortia; and provide preliminary outcome data.

Community Health Centers↗

The angels of Bataan.

Fifty years ago, the strategic Battle of Bataan marked the end of American dominance in the Philippine Islands. Historians record the combat on that peninsula, during the winter and spring of 1942, as among the most brutal the United States Army and Navy ever fought. Eighty-eight women, including the first group of American military nurses to be sent into the field in World War II and 25 Filipina nurses endured the entire battle. The purpose of this article is to examine their experiences during the four months these nurses lived and worked through combat, starvation and illness on Bataan. Analysis of primary archival material from federal, private and military sources and nine oral history interviews indicate the women successfully adjusted from peacetime to war roles. They learned that individual and group self-reliance could help them survive the worse in war. From their earliest memoirs to recent interviews, the nurses displayed both a pride in their service and a sense of grief at the losses suffered on Bataan.

History, 20th Century↗

[Typology of the French medical learned societies. Survey of 129 organizations].

INTRODUCTION: A study on the relationship between the ANDEM--Agence Nationale pour le Développement de l'Evaluation Médicale (French agency for the development of health technology assessment) and the learned societies showed that a definition of the role of these organisations and criteria to define learned societies were lacking. We conducted a survey among the learned societies in the field of medicine so as to elaborate a definition. METHODS: We used the files of the learned societies of the Anaes--Agence Nationale d'Accréditation et d'Evaluation en Santé (French Agency for accreditation and evaluation in health) in 1998, which included 225 organisations. We sent a letter together with a single-page questionnaire and copies of the 2 publications on the relationship between the ANDEM and the learned societies. To analyse the suggestions for a definition, having read the replies, a segmentation of the population, the means and modalities of action and the aims and fields of action were used. A proposal for a definition was discussed during 2002/2003 with the board of the Fédération des Spécialités Médicales (FSM) (Federation of medical specialties) regrouping 33 medical and 12 surgical societies. Three meetings between a representative of the Anaes and the board of the FSM resulted in the proposition of so-called "validation" criteria for learned societies. A search on the French Internet listing such societies was made using a research motor (March 20, 2004). RESULTS: Out of the 225 organisations contacted, 129 (57%) replied. Among the latter, 115 considered themselves as a learned society and 14 did not. Among the 115 organisations defining themselves as a learned society, 97 proposed a definition, 16 made use of the definitions proposed in the questionnaire and 81 proposed their own definition. The analysis identified 6 important elements (reporting, knowledge, education, research, diffusion, promotion). The data analysed permitted the elaboration of a definition based on the proposals of the learned societies: "An organised group, within the framework of a given discipline, the members' aim of which is to report on their work, to improve knowledge on their discipline, to ensure education and research, to diffuse information on their work and research and to support and promote their discipline". Thirty-two of the 45 societies of the FSM accepted the 11 validation criteria proposed, some of which were commented on. Only one society abstained and 12 did not reply. No French Internet web site listing the learned societies specified a definition of criteria for inclusion in the lists. DISCUSSION: A definition of the learned societies and validation criteria, obtained through the participation of the principle actors, could serve as a basis for the recognition and identification of such societies.

Data Collection↗

Fetal therapy, ethics and public policies.

This article reviews the evolution of ethical problems in the first generation of experimental fetal therapy and the prevailing approaches to them. The problems include: review of risks/benefits, case selection, informed consent, twin pregnancies, and refusal of proven fetal therapy. The article further discusses ethical and public policy issues in the lack of U.S. federal support for fetal diagnosis, fetal therapy, and human embryo research. An argument is made for such support, beginning with experimental gene therapy in the fetus. Ethical principles are identified that support an obligation to learn to relieve and treat such human suffering at the earliest time. Contradictions of these principles are also identified in terms of research not now supported.

Aborted Fetus↗

Can an Internet-based system assist with administration and distance learning for third- and fourth-year rural clinical rotations?

This article describes the experience of the West Virginia School of Osteopathic Medicine during the past 5 years in using Internet technology to communicate with osteopathic medical students on remote, community-based clinical rotations. Federal funding initially supported creation of a new Internet-based system to connect students on their rural family medicine rotations. Accomplishments during and after federal funding include development of systems for remote submission and student access to feedback about clinical sites; on-line access to rotation objectives, policies, housing information, maps, and affiliated internship opportunities; access to medical journals and texts; secured access to rotation grades and rotation schedules; on-line reading lists for family medicine and pediatrics rotations; and Internet-based test administration. Remaining challenges include identification or development of interactive learning materials; development of test banks; flawless administration of Web-based examinations; and finding the right balance between patient care-based learning and didactics.

Education, Distance↗

Educating all children: ten years later.

This article reviews the Tenth Annual Report to Congress on the Implementation of The Education of the Handicapped Act (EHA), covering the 1986-1987 school year. In addition to reporting the current status of services (i.e., numbers of students served, their placement, resources allocated and needed for their support), the report also discusses and cites data pertinent to (a) transition from secondary education; (b) state and federal efforts anticipating full implementation of preschool special education services under Public Law 99-457; and (c) the classification of students with learning disabilities. Some directions for research on special education at a national level are suggested.

Adolescent↗

The challenge of implementing the prevention goals: some questions for researchers and communicators.

Two important issues in achieving change are how biomedical and behavioral research advances are viewed and used and the problem of "translation"--that is, how the results are put into practice. Momentum in federally funded research has been continued because we are betting that today's knowledge is limited relative to what remains to be learned about the prevention of disease. Those who administer programs, give primary care, and educate health professionals would benefit if they became fully sensitized to the world of research, and the planning of research would be invigorated by the perceptions of administrators and practitioners. The process of translation depends on the information function, and this function is as important as research and delivery. The schools and the media have created a public interested in science and medicine, but persuading people to change lifestyles is relatively unexplored territory. More knowledge in this area would help to decrease, for example, the number of smokers in the population and the number of accidents on the highways and in the workplace.

Communication↗

[Development of educational technology in dentistry in Brazil].

This article reviews the experiments with educational technology conducted in the School of Dentistry of the Federal University in Rio Grande do Sul, Brazil. An account is given of the production in the Audiovisual Center of teaching-learning materials for dentistry. A summary description is given of programmed instruction techniques for use with an electronic programmer, modules, and sequences of slides with accompanying tape recordings. Some comments are offered on the improvements made with this equipment and techniques in the institution itself and in other universities of Brazil.

Audiovisual Aids↗