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PubMed2005

AUTOGSCAN: powerful tools for automated genome-wide linkage and linkage disequilibrium analysis.

Genome-wide linkage analysis using multiple traits and statistical software packages is a tedious process which requires a significant amount of manual file manipulation. Different linkage analysis programs require different input file formats, making the task of analyzing data with multiple methods even more time-consuming. We have developed a software tool, AUTOGSCAN, that automates file formatting, the running of statistical analyses, and the summarizing of resulting statistics for whole genome scans with a push of a button, using several independent, and often idiosyncratic, statistical software packages such as MERLIN, SOLAR and GENEHUNTER. We also describe a program, ANALYZE, designed to run qualitative linkage analysis with several different statistical strategies and programs to efficiently screen for linkage and linkage disequilibrium for a given discrete trait. The ANALYZE program can also be used by AUTOGSCAN in a genome-wide sense.

Genetic Linkage↗
PubMed2001

Coordination of health coverage for Medicare enrollees: living with HIV/AIDS in California.

Because Medicare does not cover a large part of the health care that its enrollees living with HIV/AIDS require, they need other coverage to supplement Medicare. Medicaid is a major source of that supplemental coverage. In California, Medicare enrollees with HIV/AIDS who were also enrolled in Medi-Cal (California's Medicaid program) had total payments from both programs of $177 million, or an average of $28,956 per person in the fee-for-service-system in 1998. Of that total, Medicare paid for 38 percent, mainly for inpatient visits and ambulatory care, while Medi-Cal paid 62 percent, mainly for prescription drugs. For these dual enrollees, many of Medicare's benefit gaps--including a large share of prescription drugs, nursing facility services and home care--are being filled by Medi-Cal. Data in this Medicare Brief indicate that the incremental cost to the federal government of filling gaps in the Medicare benefits package would be considerably less than the full cost of the additional benefits. Through Medicaid and other programs, the federal government is already paying a substantial part of public program expenditures for dual enrollees with HIV/AIDS. Other issues to consider are how the dual Medicare-Medicaid funding streams affect the programs' cost efficiency, and from the perspective of Medicare enrollees and providers, how well the dual programs coordinate to meet the needs of people with HIV/AIDS and other chronic conditions.

California↗
PubMed2000

[Effectiveness and efficiency of ambulatory diabetes education programs. A comparison of specialty practice and general practice].

BACKGROUND AND OBJECTIVE: The increasing incidence of NIDDM requires adequate proof of the effectiveness and efficiency of out-patient programmes for diabetics. This study aimed at examining which of the two methods may promise the better results under controlled expenses--modifications of the present standardized diabetes education program in the general practice or specifically developed diabetes education programme in specialist diabetes practice. PATIENTS AND METHODS: 75 diabetics took part in the different out-patient diabetes education programmes at one special practice for diabetology or one of seven general practitioner practices, respectively. The self-developed intensive diabetes education programme of the special practice led by two specialists in diabetology and a dietician was compared with the diabetes education programme of the general practices performed by a doctor's assistant. 38 diabetics in eight training groups at the specialist for diabetology and 37 patients in seven training groups at the general practices were instructed. 32 patients in total (18 patients at the specialist practice and 14 patients at the general practices) additionally received an evaluated support programme which addressed psychosocial impediments related to the topics of a structured diabetes therapy. All patients were asked to complete a questionnaire before, right after, 3 and 6 months after the programme. Weight and glycosylated haemoglobin (HbA1c) were measured before, 3 and 6 months after the programme. RESULTS: The mean weight and glycosylated hemoglobin of all groups decreased as expected. However, the patients of the general practices achieved more lasting reduction of these objective parameters. All patients stated impairments of their quality of life, but the patients of the specialist practice felt more impaired. The motivational support programme achieved only few positive results. CONCLUSION: The standardized diabetes education programme of the general practices and the more intensive and expensive diabetes education programme achieved equally valuable results. Regarding time and expenses, the standardized diabetes education programme may be the more efficient method of NIDDM out-patient education.

Aged↗
PubMed2005

Stochastic efficiency analysis of bovine tuberculosis-surveillance programs in the Netherlands.

We constructed a stochastic bio-economic model to determine the optimal cost-efficient surveillance program for bovine tuberculosis. The surveillance programs differed in combinations of one or more detection methods and/or sampling frequency. Stochastic input variables in the epidemiological module described the dynamics of infection and the probability of detection. By means of an efficiency frontier, the trade-off between the expected cost and the epidemiological risk parameter relating to the outbreak size was evaluated. The surveillance scheme based on visual inspection of lesions on carcasses at slaughter was optimal given the current prevalence of the disease in the Netherlands if the objective was to minimise the expected costs. However, the efficient set also included two other schemes: slaughterhouse inspection in combination with GAMMA-interferon testing of blood samples and slaughterhouse inspection in combination with two-stage tuberculin testing. The choice ultimately will depend on the risk attitude of the decision-maker; a more-stringent surveillance scheme will be enforced if the expected outbreak size is to be constrained. In future scenarios, ELISA testing of bulk-tank milk in combination with the current slaughterhouse inspection procedure would outperform the surveillance scheme of solely slaughterhouse inspection if ELISA testing of bulk-tank milk becomes feasible.

Animals↗
PubMed2002

Developing a positive organisational culture using a management development strategy.

This paper evaluates a management development program, which was piloted at Albury Base Hospital during 2001 for nurse managers. The program uses quantitative assessments of participants using a lifestyle inventory tool and enables managers to identify opportunities and strategies to assist them to become more effective managers. The program also helps identify management "blind spots" and increased awareness of the effect of management's behaviour on team efficiency. The program was evaluated as being relevant to managers from any health discipline and was a means by which workplace culture and behaviour could be improved.

Efficiency, Organizational↗
PubMedDate not supplied

Development of an interdisciplinary case management program for combat veterans.

The terrorist attack on September 11, 2001, prompted a major mobilization of Alabama active military reservists and Alabama National Guardsmen to serve in the Middle East. Health problems related to geographic relocation, environmental threats, combat and other traumatic events, and the stress associated with serving in an active capacity have resulted in an increase in the number of patients and the variety of illnesses being seen at Department of Veterans Affairs Medical Centers. The Tuscaloosa Veterans Affairs Medical Center developed a combat veterans care coordination program to efficiently and effectively manage the care of returning combat veterans. The development and first-year outcomes of the program are described.

Alabama↗
PubMed2000

Biomedical publication for neurosurgery residents: a program and guide.

One of the most pressing obligations in academic neurosurgery is the publication of clinical and basic science research results. Publication documents intellectual property and communicates findings among researchers working to improve neurosurgical treatment. It documents productivity, justifies funding for research, creates reputations, and builds careers. Nonetheless, the actual writing of reports is a skill often learned by osmosis in academic medicine. To give residents the tools necessary to negotiate the biomedical publication process successfully, we developed a publications program based on the premise that residents seeking an academic career must be prepared to generate publishable reports with maximum efficiency. The program consists of a "publication kit," a series of seminars, and one-on-one tutorials with academic biomedical editors that permit residents individually to improve the quality of their reporting. We describe this program, provide guidelines that can help residents write high-quality papers and publish their work more efficiently, and summarize important content regarding the framework for a successful paper, the elements of a conventional research report, brief guidelines for specific types of papers, reporting standards for clinical trials and meta-analyses, keys to citation in bibliographic indexes, and ethical and legal considerations related to research approval, confidentiality requirements, copyright law, permission to use previously published material, and conflict of interest. Residents who are able to view their work with a sharp critical focus and are educated about the standards of biomedical publication are better prepared to succeed in building a career in academic medicine.

Curriculum↗
PubMed1989

Program evaluation.

In this chapter, evaluation was defined as a decision-making process that leads to suggestions for action to maintain and/or improve effectiveness and efficiency of programs and participants. Purposes for evaluating nursing programs in education and service were explained. The principles that govern evaluation in nursing, which are the same as those that govern the evaluation of any programmatic endeavor, were presented. The unique and specific character of nursing and its settings, which must be taken into account when strategies and techniques for implementing these principles are designed and/or selected, were discussed. Of major concern was the selection of an approach to evaluating nursing programs. Models for evaluating programs that have served as prototypes for evaluation in a variety of settings and fields were presented. More specifically, the views addressed included: Tyler's Objective-Based Evaluation, Accreditation/Certification Evaluation, Stake's Client-Centered Evaluation, Stufflebeam's Decision-Oriented Evaluation, Taba's Experimental-Research Evaluation, and Scriven's Consumer-Oriented Evaluation. Also discussed was the Utilization-Focused Approach to Evaluation. However, while all prototypes contribute in some manner to the conditions necessary for conducting a comprehensive evaluation of nursing programs, none are complete or sufficient in this regard. An eclectic approach to evaluating nursing programs developed by Waltz in an attempt to incorporate the strengths of existing models, minimize limitations, and expand thinking to include additional components and concerns with particular relevance to nursing was discussed. Attention was given to definition of terms, purposes for the evaluation, what the focus of the evaluation is, how the evaluation should proceed, when evaluation should occur, and major audiences. Specific considerations that increase the likelihood that an evaluation will be comprehensive but cost-efficient were elaborated.

Accreditation↗
PubMed1985

A community-based program for juvenile firesetters.

In 1981 the Dallas Fire Department began a new program for juvenile firesetters. Based on an interview graphing technique that helps the juvenile firesetter to correlate triggering events with feelings leading to aggressive firesetting behavior, the program is staffed by fire department personnel who are trained by psychiatric faculty of the University of Texas Southwestern Medical School at Dallas. Comparisons with the city's previous program demonstrate the new program's effectiveness in preventing the recurrence of firesetting behavior as well as its cost-efficiency. Similar programs have been successfully adopted in Houston and Fort Worth.

Adolescent↗
PubMedDate not supplied

Cost-effective quality assurance of rented medical equipment.

The Biomedical Engineering Department (BME) at the University Medical Center, Tucson, Arizona, noted a sharp increase in the use of rented medical equipment. To increase efficiency, control costs, and provide effective quality assurance for rented equipment, a Medical Equipment Rental Vendor (MERV) program was formulated. The program increases efficiency by placing the burden of verifying safety and performance on the MERVs. Performance requirements were developed for the MERVs. The vendors who agreed to the requirements were compiled into a list of preferred vendors to be the primary suppliers of rental medical equipment to UMC. These preferred vendors were given preapproval from BME to deliver equipment directly to the requesting clinical department. All other vendors must continue to submit their equipment to BME for inspection. Policies were written to outline the responsibilities of the clinical departments and BME relative to the MERVs. Frequency of sampling, means of documentation, and assurance of user training were included. Response from the vendors and clinical departments has been positive. Communication between the vendors, clinical departments, and BME has improved through the development and implementation of this program. Vendor and equipment quality have been maintained or improved since compliance with the performance requirements is necessary to maintain preferred vendor status.

Arizona↗
PubMed1994

Staff nurse preceptors: a program they "own".

Application of a change theory model to develop a competency-based orientation (CBO) program managed by staff nurse preceptors resulted in preceptor satisfaction, improved patient outcomes, and a more effective, efficient orientation program. After assessing the group using Hersey and Blanchard's framework, the CNS selected change strategies to implement the CBO, including: (1) helping staff nurses to redefine problems with current orientation procedures; (2) anticipating and overcoming their objections to CBO; (3) bolstering their confidence in a trusting, accepting environment; (4) motivating them as preceptors; and (5) providing direction, models, and explanations. These strategies helped preceptors accept and feel an "ownership" of the new program, resulting in many outcomes in the system. Veteran staff nurses gradually assumed ownership for individual orientees and managing orientation activities in the CBO. Rather than precepting individual orientees, the CNS assumed responsibility for establishing CBO and helping preceptors maximize their potential.

Competency-Based Education↗
PubMedDate not supplied

Estimating aquifer transmissivity from specific capacity using MATLAB.

Historically, specific capacity information has been used to calculate aquifer transmissivity when pumping test data are unavailable. This paper presents a simple computer program written in the MATLAB programming language that estimates transmissivity from specific capacity data while correcting for aquifer partial penetration and well efficiency. The program graphically plots transmissivity as a function of these factors so that the user can visually estimate their relative importance in a particular application. The program is compatible with any computer operating system running MATLAB, including Windows, Macintosh OS, Linux, and Unix. Two simple examples illustrate program usage.

Fresh Water↗
PubMed2004

Computing highly specific and noise-tolerant oligomers efficiently.

The sequencing of the genomes of a variety of species and the growing databases containing expressed sequence tags (ESTs) and complementary DNAs (cDNAs) facilitate the design of highly specific oligomers for use as genomic markers, PCR primers, or DNA oligo microarrays. The first step in evaluating the specificity of short oligomers of about 20 units in length is to determine the frequencies at which the oligomers occur. However, for oligomers longer than about fifty units this is not efficient, as they usually have a frequency of only 1. A more suitable procedure is to consider the mismatch tolerance of an oligomer, that is, the minimum number of mismatches that allows a given oligomer to match a substring other than the target sequence anywhere in the genome or the EST database. However, calculating the exact value of mismatch tolerance is computationally costly and impractical. Therefore, we studied the problem of checking whether an oligomer meets the constraint that its mismatch tolerance is no less than a given threshold. Here, we present an efficient dynamic programming algorithm solution that utilizes suffix and height arrays. We demonstrated the effectiveness of this algorithm by efficiently computing a dense list of numerous oligo-markers applicable to the human genome. Experimental results show that the algorithm runs faster than well-known Abrahamson's algorithm by orders of magnitude and is able to enumerate 65% approximately 76% of qualified oligomers.

Algorithms↗
PubMed2003

Computing highly specific and mismatch tolerant oligomers efficiently.

The sequencing of the genomes of a variety of species and the growing databases containing expressed sequence tags (ESTs) and complementary DNAs (cDNAs) facilitate the design of highly specific oligomers for use as genomic markers, PCR primers, or DNA oligo microarrays. The first step in evaluating the specificity of short oligomers of about twenty units in length is to determine the frequencies at which the oligomers occur. However, for oligomers longer than about fifty units this is not efficient, as they usually have a frequency of only 1. A more suitable procedure is to consider the mismatch tolerance of an oligomer, that is, the minimum number of mismatches that allows a given oligomer to match a sub-sequence other than the target sequence anywhere in the genome or the EST database. However, calculating the exact value of mismatch tolerance is computationally costly and impractical. Therefore, we studied the problem of checking whether an oligomer meets the constraint that its mismatch tolerance is no less than a given threshold. Here, we present an efficient dynamic programming algorithm solution that utilizes suffix and height arrays. We demonstrated the effectiveness of this algorithm by efficiently computing a dense list of oligo-markers applicable to the human genome. Experimental results show that the algorithm runs faster than well-known Abrahamson's algorithm by orders of magnitude and is able to enumerate 63% to approximately 79% of qualified oligomers.

Algorithms↗
PubMed1997

Translational misreading: mutations in translation elongation factor 1alpha differentially affect programmed ribosomal frameshifting and drug sensitivity.

The translation elongation feactor 1alpha (EF-1alpha) catalyzes the critical step of delivering aminoacyl-tRNAs to the elongating ribosome. A series of Saccharomyces cerevisiae strains containing mutant alleles of the TEF2 gene encoding EF-1alpha have phenotypes consistent with effects on cellular processes related to translation. These include (1) conditional growth defects, (2) antibiotic sensitivity or resistance, (3) altered +1 or -1 ribosomal frameshifting efficiencies, and (4) altered maintenance of the killer phenotype. Although all the mutant alleles were isolated as dominant +1 frameshift suppressors, the effects of these mutations on the cell are quite different when present as the only form of EF-1alpha. Allele-specific effects are observed with regard to their ability to alter the efficiency of programmed +1 frameshifting as opposed to programmed -1 ribosomal frameshifting. The significantly altered efficiency of -1 frameshifting in strains containing the TEF2-4 and TEF2-9 mutant alleles further correlates with a reduced ability to maintain the killer phenotype and the M1 satellite virus of L-A, an in vivo assay of translational fidelity. In light of the proposed models regarding the different A- and P-site occupancy states required for +1 or -1 ribosomal frameshifting, these results aid analysis of interactions between EF-1alpha and the translational apparatus.

DNA-Binding Proteins↗
PubMed1977

Tentative analysis of the efficiency of fissure sealant in a public program in London.

A tentative analysis was made of the efficiency of allocating resources to fissure sealing, rather than to restorative care, in a public dental program. Data for the study were taken from a 2-year clinical trial in London. The analysis is necessarily tentative because the clinical trial employed the half-mouth design, which does not represent a true-life situation. Over the 2 years of the study, it was found that sealing the population of study teeth took from 24.9% to 33.8% more time than treating the lesions which developed in the control teeth would have. Reasons are given why this finding cannot be accepted as conclusive; rather, it is presented to raise questions and to stimulate additional studies into the efficiency of preventive programs. Guidelines for such studies, which should be conducted in different populations with varying caries prevalence, are suggested.

Child↗
PubMed1980

Evaluation of a screening program in oncology.

As physicians and decision makers we constantly face difficult questions concerning screening tests for cancer. Unfortunately, we cannot determine the most effective and efficient screening program from clinical trials alone. One approach is to use a mathematical decision model that integrates and generalizes the information gained through clinical research and clinical judgment. The basic steps are to define the main components of the problem, identify the relationship between the components, and translate those relationships into quantitative terms. The model is a planning tool. It does not generate answers. It generates insights and understanding, which, when combined with existing research results and clinical experience, can help rationalize our current cancer screening policies and the design of future research.

Cost-Benefit Analysis↗
PubMed2005

IEC 61511 and the capital project process--a protective management system approach.

This year, the process industry has reached an important milestone in process safety-the acceptance of an internationally recognized standard for safety instrumented systems (SIS). This standard, IEC 61511, documents good engineering practice for the assessment, design, operation, maintenance, and management of SISs. The foundation of the standard is established by several requirements in Part 1, Clauses 5-7, which cover the development of a management system aimed at ensuring that functional safety is achieved. The management system includes a quality assurance process for the entire SIS lifecycle, requiring the development of procedures, identification of resources and acquisition of tools. For maximum benefit, the deliverables and quality control checks required by the standard should be integrated into the capital project process, addressing safety, environmental, plant productivity, and asset protection. Industry has become inundated with a multitude of programs focusing on safety, quality, and cost performance. This paper introduces a protective management system, which builds upon the work process identified in IEC 61511. Typical capital project phases are integrated with the management system to yield one comprehensive program to efficiently manage process risk. Finally, the paper highlights areas where internal practices or guidelines should be developed to improve program performance and cost effectiveness.

Accident Prevention↗