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PubMed2003

The U.S.-Mexico Border Infectious Disease Surveillance project: establishing bi-national border surveillance.

In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. During a 3-year period, a binational team implemented an active, sentinel surveillance system for hepatitis and febrile exanthems at 13 clinical sites. The network developed surveillance protocols, trained nine surveillance coordinators, established serologic testing at four Mexican border laboratories, and created agreements for data sharing and notification of selected diseases and outbreaks. BIDS facilitated investigations of dengue fever in Texas-Tamaulipas and measles in California-Baja California. BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border. Reducing administrative, infrastructure, and political barriers to cross-border public health collaboration will enhance the effectiveness of disease prevention projects such as BIDS.

Communicable Disease Control↗
PubMed2000

Contributions and promise of human behavioral genetics.

Human behavioral genetics has contributed greatly to our understanding of human behavioral development. Twin, family, and adoption studies have shown that genetic effects are ubiquitous and that both genes and environments contribute to individual differences in behavior. The unique ability of behavioral genetic methods to separate genetic from environmental effects has also led to important discoveries about how the environment works in development and to the elucidation of the complex ways environments and genes interact across the life span. Although quantitative methods have been the mainstay of the field of human behavioral genetics since Galton's time, the Human Genome Project and advances in molecular genetics are providing new tools and promise as we enter the 21st century. Thus the future of human behavioral genetics lies in the cross-disciplinary exchanges and collaborations that will increasingly occur in the years to come among quantitative and molecular scientists who work with both animal and human systems. This research may someday culminate in an understanding of the biological basis of behavior that spans from how the brain develops and functions to a grasp of how genes influence thought at the molecular level.

Adoption↗
PubMed1992

A psychodynamic approach to the master treatment plan.

Formulating master treatment plans for the hospital treatment of psychiatric patients is especially challenging to psychodynamically oriented clinicians unaccustomed to reducing complex intrapsychic and interpersonal phenomena to specific observable behaviors. In collaboration with a wide cross section of hospital staff members, the authors developed a conceptual framework for treatment plans compatible with psychodynamic thinking. They describe the treatment evaluation research from which the format of the treatment plan evolved, as well as the guide they developed to facilitate its implementation .

Activities of Daily Living↗
PubMed1985

Cross comparison of the Limulus test between laboratories. Two European collaborative studies.

The results of two independent collaborative interlaboratory surveys evaluating limulus amebocyte lysate assays are presented. We investigated the variation of the results from laboratories all using the same reference endotoxin, but working with different gel-clot techniques. In the first study, four lysates were compared in quantitative gel-clot assays using either a macro- or a microtechnique. In the second study, the performance of a proposed limit test was checked under the auspices of the European Pharmacopoeia Commission. A generally good agreement was reached with the limit test; in the quantitative test, however, considerable interlaboratory variation and significant differences among the lysates were observed. In order to obtain consistent results, a thorough validation of all reagents and test parameters is essential. Collaborative studies are an important tool to detect discrepancies between laboratories and to decrease interlaboratory variability.

Endotoxins↗
PubMed1982

[Ovarian cancer: markers, hormones receptors, immunological status].

Like other solid tumors ovarian tumors have been intensely investigated these past years to isolate specific tumoral antigens. These antigens are now used by clinical teams for post therapeutic follow-up. However, out of the 25 major antigens actually described in ovarian carcinomas, the only one that can be used today is the carcinoembryonic antigen (CEA). Moreover, an international collaborative work has demonstrated cross reacting antigenicity between these major tumoral antigens. Cellular enzymes (galactosyl transferase and sialyl-transferase) and hormonal receptors for proteinic hormones such as steroid hormones) are being studied but cannot be used as screening markers at this time.

Antigens, Neoplasm↗
PubMed1993

Reflections on an emerging academic discipline: the prolonged gestation of developmental and behavioral pediatrics.

Expertise in child development and behavior has been acknowledged as a critical prerequisite for the practice of general pediatrics since the early part of the 20th century. Recently, as the knowledge base has expanded, the concept of developmental and behavioral pediatrics as a specialized academic discipline has generated growing interest. The extent to which this emerging field achieves full recognition as a respected pediatric subspecialty will be determined by its response to three critical challenges: the process of academic acculturation, the imperative of creative collaboration and intellectual cross-fertilization, and the requirements of scientific credibility.

Behavioral Medicine↗
PubMed1999

Research utilization and interdisciplinary collaboration in emergency care.

OBJECTIVES: To examine perceptions of nurse-physician collaboration and research utilization in a large, county medical center with an emergency medicine (EM) residency program, to assess differences among nurses, residents, and attending physicians, and to explore the relationship between collaboration and research utilization. METHODS: A cross-sectional, exploratory, correlational design. Questionnaires measuring four aspects of collaboration-leadership, communication, problem solving, and coordination-and four aspects of research utilization-support, attitude, availability, and use-were distributed to 115 nurses, 18 attending physicians, and 33 EM residents (n = 166). A 59% response rate was achieved. RESULTS: The survey instruments demonstrated acceptable reliability at 0.70 or better Cronbach's alpha except for communication timeliness (alpha = 0.64) and predictive validity. Overall, physicians and nurses rated measures of collaboration and research favorably. However, there were significant differences (p < 0.05) between physicians and nurses on four measures of collaboration (i.e., physician leadership, communication openness within group, communication openness between groups, and problem solving within group) and research utilization (research use), with physicians holding more favorable views than nurses. Three measures of collaboration predicted 47% of the variance in research use for physicians; only one measure of collaboration was important for nurses, explaining 9.3% of the variance in research use. CONCLUSION: Interdisciplinary collaboration showed some significance in promoting research use in the ED, especially for physicians. However, nurse-physician differences in perceptions of collaboration and research use should be examined more fully.

Adult↗
PubMed1999

Comparing the psychometric properties of preference-based and nonpreference-based health-related quality of life in coronary heart disease. Canadian Collaborative Cardiac Assessment Group.

A cross-sectional survey (n = 878) was conducted to compare the psychometric properties of three preference-based and one nonpreference-based health-related quality of life measures among healthy subjects with and without treatment for dyslipidemia and/or hypertension and patients with coronary heart disease (CHD). All measures were stable over a 3 to 6 week period. Compared to the Time Trade-off (TTO) and the Standard Gamble (SG), the Rating Scale (RS) correlated with the SF-36 Health Survey most highly. In contrast to the SF-36 General Health Perception (GHP), the SF-36 Physical Component scale and the RS, the TTO and SG were less able to discriminate CHD patients with various levels of physical disability. Only the SF-36 GHP subscale and the RS were able to differentiate healthy participants from participants receiving dyslipidemia and/or hypertension treatment. Neither the SF-36 Physical or Mental Component scales were able to discriminate these two groups. Overall, these results suggest that unlike the RS, the TTO and the SG, as administered in this study, may not be sufficiently sensitive to measure the impact of primary cardiovascular disease prevention strategies on the health-related quality of life of the participants.

Adult↗
PubMed2005

New technologies meeting old professional boundaries: the emergence of carotid artery stenting.

BACKGROUND: Carotid artery stenosis is common and costly. Opinions differ in regard to the impact that carotid angioplasty and stenting (CAS) will have. Vascular surgeons, cardiologists, interventional radiologists, and neurologists all have a stake in the uptake of CAS. We sought to explore physicians' views about the safety and efficacy of CAS and the negotiation of professional boundaries in the treatment of carotid stenosis. STUDY DESIGN: We performed a qualitative analysis of key informant interviews with 15 physicians, including four internationally renowned key opinion leaders, representing five medical centers with differing experience adopting CAS. RESULTS: Variation in beliefs about the safety and efficacy of CAS within specialties was overshadowed by variation across the specialties examined. Most informants emphasized the strengths of their specialty in adopting CAS, including frequent patient care (vascular surgery, cardiology, and neurology), extensive catheter experience (cardiology, interventional radiology), and intimate knowledge of the anatomy of vascular and neurovascular disease (vascular surgery, neurology). Several themes were mentioned in regard to the diffusion of CAS, including risks of premature diffusion into low risk populations and the role of patient preferences in CAS uptake. The most common theme in regard to local management of CAS was the strength of interdisciplinary collaboration in the management of patients with carotid artery stenosis. CONCLUSIONS: CAS challenges physicians from several specialties to safely and effectively manage the uptake of an emerging technology crossing traditional specialty lines. Local collaboration of individual physicians and the departments and professional organizations they comprise, will have an important impact on how this technology is adopted.

Adult↗
PubMed2002

Tobacco use among youth: a cross country comparison.

OBJECTIVE: The Global Youth Tobacco Survey (GYTS) is a worldwide collaborative surveillance initiative that includes governments and non-governmental organisations under the leadership of the World Health Organization/Tobacco Free Initiative (WHO/TFI) and the US Centers for Disease Control and Prevention/Office on Smoking and Health (CDC/OSH). The GYTS was developed to enhance the capacity of countries to design, implement, and evaluate tobacco control and prevention programmes. METHODS: The GYTS employs a standard methodology where self administered questionnaires, consisting of a set of core questions, are completed by a representative school based sample of students primarily between the ages of 13-15 years. RESULTS: Data are presented from 75 sites in 43 countries and the Gaza Strip/West Bank region. Current use of any tobacco product ranges from 62.8% to 3.3%, with high rates of oral tobacco use in certain regions. Current cigarette smoking ranges from 39.6% to less than 1%, with nearly 25% of students who smoke, having smoked their first cigarette before the age of 10 years. The majority of current smokers want to stop smoking and have already tried to quit, although very few students who currently smoke have ever attended a cessation programme. Exposure to advertising is high (75% of students had seen pro-tobacco ads), and exposure to environmental tobacco smoke (ETS) is very high in all countries. Only about half of the students reported that they had been taught in school about the dangers of smoking during the year preceding the survey. CONCLUSIONS: Global youth tobacco use is already widespread throughout the world, but there is great variation among nations. Valid and reliable data on the extent of youth tobacco use, and correlates of use, are essential to plan and evaluate tobacco use prevention programmes. The GYTS has proven the feasibility of an inexpensive, standardised, worldwide surveillance system for youth tobacco use. The GYTS will be expanded to the majority of countries in the next few years, and can serve as a baseline for monitoring and evaluating global and national tobacco control efforts.

Adolescent↗
PubMed2005

Public health measures implemented during the SARS outbreak in Singapore, 2003.

The SARS outbreak hit Singapore between March and May 2003. Public health control measures were applied along three fronts; prevention and control within healthcare settings, community and at the borders. Nosocomial spread composed majority of SARS cases in Singapore. To prevent infection within healthcare facilities, cases were centralized in a SARS-designated hospital, a no-visitors rule was applied and movement of patients and healthcare staff were restricted. For triaging purposes, fever clinics were established. A dedicated ambulance service was used to transport possible cases to the SARS-designated hospital. Hospitals were surveyed for fever clusters. The challenge was to identify cases with atypical presentation. Effective and safe discharge criteria were established from the lessons learnt. To prevent community spread, contacts of cases were stringently traced, quarantined in their homes and monitored daily. For prompt identification of a case and to reduce the time between onset of symptoms and isolation, the Infectious Diseases Act was amended. A large wholesale market closure resulted in massive quarantine thereby limiting the spread of infection. A mass education campaign was implemented in order to educate and raise awareness of the public. At all air, sea and land points-of-entry, exit and entry screening took place that resulted in zero importation and exportation of SARS cases after implementation of screening. Coordinated effort of the cross sectional inter-ministerial collaboration and strong coordination by the Task Force and commitment from different professionals made it possible to conquer the disease.

Contact Tracing↗
PubMed2004

Enhancing radiological volumes with symbolic anatomy using image fusion and collaborative virtual reality.

Radiological volumes are typically reviewed by surgeons using cross-sections and iso-surface reconstructions. Applications that combine collaborative stereo volume visualization with symbolic anatomic information and data fusions would expand surgeons' capabilities in interpretation of data and in planning treatment. Such an application has not been seen clinically. We are developing methods to systematically combine symbolic anatomy (term hierarchies and iso-surface atlases) with patient data using data fusion. We describe our progress toward integrating these methods into our collaborative virtual reality application. The fully combined application will be a feature-rich stereo collaborative volume visualization environment for use by surgeons in which DICOM datasets will self-report underlying anatomy with visual feedback. Using hierarchical navigation of SNOMED-CT anatomic terms integrated with our existing Tele-immersive DICOM-based volumetric rendering application, we will display polygonal representations of anatomic systems on the fly from menus that query a database. The methods and tools involved in this application development are SNOMED-CT, DICOM, VISIBLE HUMAN, volumetric fusion and C++ on a Tele-immersive platform. This application will allow us to identify structures and display polygonal representations from atlas data overlaid with the volume rendering. First, atlas data is automatically translated, rotated, and scaled to the patient data during loading using a public domain volumetric fusion algorithm. This generates a modified symbolic representation of the underlying canonical anatomy. Then, through the use of collision detection or intersection testing of various transparent polygonal representations, the polygonal structures are highlighted into the volumetric representation while the SNOMED names are displayed. Thus, structural names and polygonal models are associated with the visualized DICOM data. This novel juxtaposition of information promises to expand surgeons' abilities to interpret images and plan treatment.

Anatomy↗
PubMed1989

Specificity of antigens on UV radiation-induced antigenic tumor cell variants measured in vitro and in vivo.

In vitro exposure of nonimmunogenic murine tumor cells to UV radiation (UVR) generates highly antigenic variants that are immunologically rejected by normal, syngeneic mice. The purpose of this study was to determine whether these antigenic variants cross-react immunologically with the parental tumor and whether the UVR-associated antigen unique to UVR-induced tumors is also present on the variants. Antigenic (regressor) variants and nonimmunogenic (progressor) clones derived from UV-irradiated cultures of the C3H K1735 melanoma and SF19 spontaneous fibrosarcoma cell lines were used to address these questions. In an in vivo immunization and challenge assay, the antigenic variants did not induce cross-protection among themselves, but each induced immunity against the immunizing variant, the parent tumor cells, and nonimmunogenic clones derived from UV-irradiated parent cultures. Therefore, the variants can be used to induce in mice a protective immunity that prevents the growth of the parent tumor and nonimmunogenic clones, but not other antigenic variants. In contrast, immunization with cells of the parental tumor or the nonimmunogenic clones induced no protective immunity against challenge with any of the cell lines. Utilizing the K1735 melanoma-derived cell lines in vitro, T-helper (Th) cells isolated from tumor-immunized mice were tested for cross-reactivity by their ability to collaborate with trinitrophenyl-primed B-cells in the presence of trinitrophenyl-conjugated tumor cells. Also, the cross-reactivity of cytotoxic T-lymphocytes from tumor-immunized mice was assessed by a 4-h 51Cr-release assay. Antigenic variants induced cytotoxic T-lymphocytes and Th activity that was higher than that induced by the parent tumor and nonimmunogenic clones from the UVR-exposed parent tumor and cross-reacted with the parental tumor cells and nonimmunogenic clones, but not with other antigenic variants. Furthermore, upon transplantation, the UVR-induced antigenic variants grew in UV-irradiated and immunosuppressed mice, but not in untreated mice indicating that the variants expressed the determinant recognized by suppressor T-cells present in UV-irradiated mice. These results demonstrate that highly antigenic cells generated by the in vitro exposure of two different murine tumors to UV radiation express a determinant shared with the parental tumor cells and nonimmunogenic clones, a unique variant-specific determinant and the suppressor cell-defined determinant present on UVR-induced tumors. Based on these results, two models are proposed to explain the make-up of the antigenic determinants present on the UVR-induced antigenic variants.

Animals↗
PubMed2026

A One Health approach to Antimicrobial Resistance: Concepts, challenges, and advances in omics.

Antimicrobial resistance (AMR) is a global threat driven by the interplay between microbial evolution and human activity. Antimicrobial use in human and veterinary medicine, as well as in agriculture, accelerates the selection and dissemination of resistant bacteria and genes across interconnected human, animal, and environmental reservoirs. These dynamic exchanges render single-sector interventions ineffective. A One Health approach integrating human, animal, and environmental health is therefore essential to understand and mitigate the emergence and spread of AMR. This chapter focuses on bacterial antimicrobial resistance, addressing key concepts, major challenges, and emerging technologies within a One Health framework. Advances in next-generation sequencing and omics technologies have transformed our capacity to resolve AMR at unprecedented scale and resolution. These tools enable the tracking of resistance genes and high-risk clones across ecosystems, uncover transmission pathways, and identify key drivers of dissemination. Such insights support real-time epidemiological surveillance, outbreak detection, and targeted interventions. However, translating these advances into routine practice remains a major challenge, requiring harmonized methodologies, data integration, and cross-sector coordination. Addressing AMR demands sustained collaboration across disciplines and stakeholders, including clinicians, veterinarians, farmers, researchers, policymakers, industry, and the public. And framing AMR as a shared ecological and societal responsibility underscores the urgency of coordinated global action. We call for the urgent integration of One Health principles into surveillance, policy, and innovation to preserve antimicrobial effectiveness and safeguard future health.

Humans↗
PubMed2005

Management of the child with a learning disorder.

The label "learning disabilities" is all-embracing; it describes a syndrome, not a specific child with specific problems. Parent involvement in and collaboration with pediatricians and schools in navigating service systems, accessing appropriate services, and case management are particularly relevant for children with LD. Comprehensive service delivery in school settings requires the interface of other service sectors, such as primary care, mental health,and other community agencies that also recognize and address children's problems. To date, marked differences exist among the assessment, classification and diagnostic, and treatment practices of these service systems, despite the fact that they address the same patient population--school-aged youth. Additionally, many of these agencies and systems operate in isolation with limited cross-sector communication or service collaboration. Parent involvement and advocacy, with assistance from pediatricians and knowledgeable school personnel, is necessary to ensure that appropriate resources available from these sectors are well coordinated and provided for children with an LD to improve their school performance and ongoing educational experience.

Child↗
PubMed2003

Comparison of cross-linked polyethylene materials for orthopaedic applications.

Cross-linked polyethylenes are being marketed by orthopaedic manufacturers to address the problem of osteolysis caused by polyethylene particulate wear debris. Wear testing of these cross-linked polyethylenes in hip simulators has shown dramatic reduction in wear rate compared with standard ultrahigh molecular weight polyethylene, either gamma irradiated in air or nitrogen - or ethylene oxide-sterilized. However, this reduction in wear rate is not without cost. The cross-linking processes can result in materials with lower mechanical properties than standard ultrahigh molecular weight polyethylene. To evaluate the effect of the various cross-linking processes on physical and mechanical properties of ultrahigh molecular weight polyethylene, commercially available cross-linked polyethylenes from six orthopaedic manufacturers were tested. This study was the culmination of collaboration with these manufacturers, who provided cross-linked polyethylene for this study, wear characteristics of the material they provided, and review of the physical and mechanical properties measure for their polyethylene. Cross-linked materials were evaluated as received and after an accelerated aging protocol. Free radical identity and concentration, oxidation, crystallinity, melt temperature, ultimate tensile strength, elongation at break, tensile stress at yield, and toughness are reported for each material. By comparing these physical and mechanical properties, surgeons can evaluate the trade-off that results from developing materials with substantially lower wear rates.

Magnetic Resonance Spectroscopy↗
PubMed2000

Multicentre research and the WISECARE experience. Workflow Information Systems for European Nursing Care.

The benefits of collaborative research are becoming recognized increasingly within the profession of nursing due to the associated increased likelihood of funding, variety of practice settings and increased access to resources that collaboration brings. While such benefits have made collaborative research one of the most desirable strategies for achieving the goals of research, the potential problems of language and communication, culturally sensitive instruments, access to subjects, availability of technology and lack of research resources have complicated collaborative international research initiatives. Review of the literature, although encouraging such initiatives, does little to provide information regarding the processes involved in multinational collaboration or the associated advantages and disadvantages to guide those embarking on such large scale, multinational, cross-cultural studies. The diverse meanings of collaboration within research initiatives further hamper this understanding. Positive definitions focus on aspects such as sharing expertise, making a valuable contribution to the research and ultimately shared ownership of the accomplishments of the research. One such research project led by nurses was the WISECARE project. WISECARE (Workflow Information Systems for European Nursing Care) was funded by the European Commission and aimed to improve cancer nursing practice and ultimately patient outcomes through the integration and utilization of state of the art information technology. Such a project was developed as a result of nursing's apparent invisibility within health care delivery and the problems experienced by nurses in articulating their worth within an increasingly cost-conscious health care system. Oncology care was selected as the domain for the project not only because this speciality of nursing already has an established network of nurses throughout Europe in the European Oncology Nursing Society (EONS) but also because the practice of cancer nursing encompasses all aspects of nursing care. This paper will address the advantages and disadvantages associated with collaboration, using the WISECARE project as an example.

Communication Barriers↗