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PubMed1997

FPC: a system for building contigs from restriction fingerprinted clones.

MOTIVATION: To meet the demands of large-scale sequencing, thousands of clones must be fingerprinted and assembled into contigs. To determine the order of clones, a typical experiment is to digest the clones with one or more restriction enzymes and measure the resulting fragments. The probability of two clones overlapping is based on the similarity of their fragments. A contig contains two or more overlapping clones and a minimal tiling path of clones is selected to be sequenced. Interactive software with algorithmic support is necessary to assemble the clones into contigs quickly. RESULTS: FPC (fingerprinted contigs) is an interactive program for building contigs from restriction fingerprinted clones. FPC uses an algorithm to cluster clones into contigs based on their probability of coincidence score. For each contig, it builds a consensus band (CB) map which is similar to a restriction map; but it does not try to resolve all the errors. The CB map is used to assign coordinates to the clones based on their alignment to the map and to provide a detailed visualization of the clone overlap. FPC has editing facilities for the user to refine the coordinates and to remove poorly fingerprinted clones. Functions are available for updating an FPC database with new clones. Contigs can easily be merged, split or deleted. Markers can be added to clones and are displayed with the appropriate contig. Sequence-ready clones can be selected and their sequencing status displayed. As such, FPC is an integrated program for the assembly of sequence-ready clones for large-scale sequencing projects.

Algorithms↗
PubMed1980

Treatment of end-stage renal disease in children: a 15-year experience.

From 1964-1979, 154 children 1 to 16 years of age with end-stage renal disease (ESRD) were treated in a regional pediatric dialysis and transplant program. The incidence of ESRD was 1.6 per million total population per year. The survival rate of children undergoing dialysis for an average of 10 months was 93%. After living donor kidney transplantation (LD), patients survival rates in 60 children were 89% at 5 years, 83% at 10 years, and 74% at 15 years. After cadaver donor kidney transplantation (CD), patient survival rates in 85 children were 70% at 5 and 10 years. LD kidney survival was 71% at 5 years, 55% at 10 years, and 40% at 15 years, whereas CD kidney survival was 43% at 5 years and 31% at 10 years. The survival of first and second transplants was similar. Patient and kidney survival have improved since 1972. The survival rate of 26 children 1 to 5 years of age was 46%, but patients with Wilms' tumor accounted for most of the deaths. We attribute these favorable long-term results in children to an integrated program of dialysis and transplantation with special pediatric facilities.

Adolescent↗
PubMedDate not supplied

[Detection, prevention and treatment of postpartum depression: a controlled study of 859 patients].

This study evaluated the clinical effectiveness of a programme aimed at detecting, preventing and treating postpartum depression. The French version of the EPDS was used to measure the intensity of postpartum blues on a sample of 859 women, during their stay at the obstetrical clinic. Subjects under treatment for psychological problems were excluded from the study. Mothers scoring 9 or above on the EPDS, which is predictive of pospartum depression, were randomly assigned to a prevention and a control group. Written informed consent was obtained from the subjects after the study procedure had been explained. The prevention group received a counselling session integrating supportive, educational and cognitive-behavioral components. Therapists included five female Master's Degree level students in psychology. All therapists participated in didactic and clinical training as wells as weekly supervision from the first author. All subjects were given a second EPDS with written instructions to complete the questionnaire during the period 4 to 6 weeks postpartum and return it for analysis. At four to 6 weeks, women in the prevention group had significant reductions in the frequency of probable depression, as defined by a score of 11 or above on the EPDS (30.2% vs 48.2%, chi 2 = 7.36, dl = 1, p = 0.0067) and in the intensity of depressive symptoms measured by the mean score on the EPDS (8.5, SD = 4 vs 10.3, SD = 4.4, t = 3.06, dl = 209, p = 0.0024). Mothers with a probable depression were interviewed at home and assessed using the MINI (Mini Neuropsychiatric Interview, Lecrubier et al., 1997) to diagnose major depressive episode, the SIGH-D (Structured Interview Guide for the Hamilton Depression Rating Scale, Williams, 1988) and the BDI (Beck Depression Inventory, Beck et al., 1988). The baseline depression rating scores, EPDS (mean = 13.6, SD = 4), BDI (mean = 15.7, SD = 5.9), HDRS (mean = 14.8, SD = 6), were consistent with moderate depression. No significant differences in baseline scores were observed between the two groups on all the rating scales (p < 0.001). Mothers with probable depression in the prevention group were offered a program of 5 to 8 home visits. Most of the mothers in the prevention group (72%) agreed to participate in the program. On the contrary, most of the mothers (83.3%) who scored below 9 on the first EPDS and 11 or above on the second, who so did not received the preventive counselling session, declined to participate. This suggests the importance of the preventive session in establishing therapeutic alliance. The home visits program integrated four components, supportive, educational, cognitive-behavioral and psychodynamic centred on the mother-infant relationship in terms of the mother's personal history. Therapist participated in clinical training and weekly supervision. Fifteen women (71.4%) in the study group demonstrated complete symptom remission, as defined by HDRS score below 7 after the intervention, compared with 4 women (10.5%) in the control group (chi 2 = 23, p < 0.0001). A clearly therapeutic response to treatment was observed in the treated group with a mean reduction in HDRS score of 9.5 (DS = 6.7) from baseline. The improvement in the women in the treated group, as measured by the mean HDRS scores was statistically greater than that in the control group (m = 5.35, SD = 3.5 vs m = 15.8, SD = 4.6, t = 8.24, dl = 52, p < 0.0001). Our results indicate that a program based on an intervention at obstetrical clinics and on home visits is efficacious and well accepted for prevention, detection and treatment of postpartum depression.

Adult↗
PubMed1998

In situ assessment of pesticide genotoxicity in an integrated pest management program I--Tradescantia micronucleus assay.

The genotoxicity induced by pesticides applied in an integrated pest management (IPM) program was evaluated with the Tradescantia micronucleus assay (Trad-MCN). Three pesticide application rates were prescribed as follows: (a) Low, no field pesticide spray; (b) Medium, IPM test rate: banded cyanazine plus metolachlor (2.7 kg a.i. and 2.3 l a.i./ha of herbicides, respectively); and (c) High, a preventative pesticide application program: broadcast cyanazine plus metolachlor (same application rates as above) plus chlorpyrifos (1 kg a.i./ha of insecticide). The Trad-MCN was employed for the assessment of (a) the formulated compounds, singly and in combinations; (b) pesticide residues extracted from soils sampled before and after application, and (c) in situ exposures (14-h exposure to pesticide-sprayed field). All pesticides showed clastogenic potency at doses between 10 and 50 ppm. Aqueous extracts of the two pesticide-sprayed soils were clastogenic, but the unsprayed soil extracts were not. Plants exposed in situ to pesticide-sprayed soils (inside a chamber receiving vapors from the soil) also showed significant increases in micronuclei frequency in relation to controls exposed to unsprayed soil. In general, there was no significant reduction in the genotoxic effects from the High to the Medium treatment levels of the IPM program. This suggests that the reduction in pesticide application rates attained with the implementation of the proposed IPM program was not sufficient to abate the genotoxicity of the pesticides, as perceived with the sensitive assays employed. The results indicate that replacing genotoxic compounds may be the only effective remediation measure to eliminate the risks imposed by mutagenic compounds in the agricultural environment.

Acetamides↗
PubMed2004

Cost-effectiveness of post-transplantation quality of life intervention among kidney recipients.

BACKGROUND: The purpose was to demonstrate the cost-effectiveness of an experimental post-transplant care program designed to improve kidney transplant recipients' quality of life (QoL). The intervention program integrated a three-pronged interdisciplinary approach emphasizing: (i) proactive, patient-initiated care to prevent transplant-related morbidities, (ii) employment/vocational counseling, and (iii) enhancement of social support. METHODS: A cost-effectiveness analysis of a clinical trial was performed comparing QoL and costs in two groups: a retrospective cohort (n = 30) and those who received the experimental interventions (n = 150). Data were collected at baseline, 6 and 12 months. The number of quality-adjusted 'treatment-free days' was used as the primary outcome. The costs included those for direct intervention, direct inpatient and outpatient post-transplant health care, and indirect out-of-pocket expenses borne by patients. RESULTS: Patients in the intervention group had more quality-adjusted treatment-free days (289 vs. 272 and statistically significant) and lower cost per patient (although not statistically significant). Further, the superior outcome was delivered at an incremental cost of 29 US dollars per quality-adjusted treatment-free day. A one-way sensitivity analysis confirmed the robustness of the results. CONCLUSION: The experimental post-transplant care program is both effective and cost-effective; the superior results are attributed to improved QoL.

Adult↗
PubMed2006

Northern Rivers Ecosystem Initiative: nutrients and dissolved oxygen - issues and impacts.

Anthropogenic inputs of nitrogen (N), phosphorus (P) and oxygen-consuming material to aquatic ecosystems can change nutrient dynamics, deplete oxygen, and change abundance and diversity of aquatic plants and animals. The Northern Rivers Ecosystem Initiative required a research and assessment program to establish the contribution of pulp mill and sewage discharges to eutrophication and depressions in dissolved oxygen (DO) in the Athabasca and Wapiti rivers of northern Alberta, Canada and examine the adequacy of existing guidelines for protecting these systems. Analysis of long-term data showed that total N (TN) and total P (TP) concentrations in exposed river reaches exceeded concentrations in reference reaches by < or = 2 times for the Athabasca River, and by 9.6 (TP) and 2.6 (TN) times for the Wapiti River. Results from nutrient limitation experiments conducted in situ and in mesocosms showed that benthic algal production was nutrient sufficient downstream of pulp mill discharges but constrained in upper river reaches by insufficient P (Athabasca River) or N + P (Wapiti River). Dissolved oxygen (DO) concentrations in both rivers declined during winter such that median concentrations in the Athabasca River 945 km downstream of the headwaters were approximately 8 mg L(-1) in mid-February. Although water column DO rarely approached the guideline of 6.5 mg L(-1), DO studies undertaken in the Wapiti River showed that pore water DO often failed to meet this guideline and could not be predicted from water column DO. Results from this integrated program of monitoring and experimentation have improved understanding of the interactions between nutrients, DO and aquatic ecosystem productivity and resulted in recommendations for revisions to nutrient and DO guidelines for these northern rivers.

Alberta↗
PubMed2006

Prevalence of soil transmitted nematodes on Nukufetau, a remote Pacific island in Tuvalu.

BACKGROUND: The population of Nukufetau, a remote coral atoll island in Tuvalu in the Western Pacific, received annual mass drug administration (MDA) of diethylcarbamazine and albendazole under the Pacific Elimination of Lymphatic Filariasis program in 2001, 2002 and 2003, with the last MDA occurring six months before a cross-sectional survey of the whole population for soil transmitted helminths (STH). METHODS: A cross-sectional survey in May 2004 recruited 206 residents (35.2% of the population) who provided a single faecal sample that was preserved, concentrated and examined microscopically. RESULTS: Overall prevalence of STH was 69.9%; only hookworm and Trichuris trichiura were diagnosed. Trichuris was present in 68.4% with intensity of infection being light in 56.3%, medium in 11.7% and heavy in 0.5%. Hookworm occurred in 11.7% with intensity of infection 11.2% being light and medium in 0.5%. Twenty individuals (9.7%) had dual infections. The prevalence of Trichuris was constant across all ages while the prevalence of hookworm was significantly lower in residents below 30 years of age. In the age group 5-12 years comparison of results with a 2001 survey 1 suggested that the prevalence of STH has declined minimally, due to sustained high prevalence of Trichuris, while hookworm has declined dramatically from 34.4% to 1.6%. CONCLUSION: The results of this survey suggest that although the MDA appears to have reduced hookworm prevalence in residents below 30 years of age, there has been minimal effect on Trichuris prevalence. An integrated program to control STH is required.

Adolescent↗
PubMed1998

Nutrition and education: a randomized trial of the effects of breakfast in rural primary school children.

Hunger during school may prevent children in developing countries from benefiting from education. Although many countries have implemented school feeding programs, few programs have been rigorously evaluated. We conducted a randomized, controlled trial of giving breakfast to undernourished and adequately nourished children. The undernourished group comprised 407 children in grades 2-5 in 16 rural Jamaican schools (weights-for-age < or = -1 SD of the National Center for Health Statistics references) and the adequately nourished group comprised 407 children matched for school and class (weights-for-age >-1 SD). Both groups were stratified by class and school, then randomly assigned to breakfast or control groups. After the initial measurements, breakfast was provided every school day for 1 school year. Children in the control group were given one-quarter of an orange and the same amount of attention as children in the breakfast group. All children had their heights and weights measured and were given the Wide Range Achievement Test before and after the intervention. School attendance was taken from the schools' registers. Compared with the control group, height, weight, and attendance improved significantly in the breakfast group. Both groups made poor progress in Wide Range Achievement Test scores. Younger children in the breakfast group improved in arithmetic. There was no effect of nutritional group on the response to breakfast. In conclusion, the provision of a school breakfast produced small benefits in children's nutritional status, school attendance, and achievement. Greater improvements may occur in more undernourished populations; however, the massive problem of poor achievement levels requires integrated programs including health and educational inputs as well as school meals.

Absenteeism↗
PubMed2002

Model for community health nursing care: application to an integrated asthma intervention program.

The article describes the use of a model for community health nursing care applied to an integrated asthma intervention program in an inner-city context. Asthma is a chronic childhood disease with broad physical, social, and economic impact on children, families, and communities. Despite recent advances in asthma understanding and treatment, morbidity and mortality continue to rise. This model suggests ways to combine individual, family, school, and community interventions to enhance coordination and increase the impact of services. It outlines needs and opportunities for collegial collaboration between professional nurses in varied practice settings. Application of the model to the management of asthma in the urban setting demonstrates the potential to produce significant improvement in the management of conditions such as asthma and highlights the key role that school nurses play.

Adolescent↗
PubMed1978

Training psychiatrists in social research: problems and prospects.

An integrated program of psychiatric residency training and doctoral studies in social welfare has been conducted by Brandeis University and two Worcester (Mass) clinical institutions over the last five years. Its goal has been to train psychiatrists to conduct psychiatric research using social science concepts and techniques. This article reviews the advantages of such a program, as well as its problems, in the context of current trends in psychiatric education and research. This program is also compared to others with similar goals that use different models of training.

Hospitals, State↗
PubMed2026

Exploring Professional Experiences in Caring for Vulnerable Migrants in an Italian Rural Reception Centre: A Qualitative Study Using Multidimensional Textual Analysis-Professional Experiences in Rural Migrant Care.

AIM: This study aims to explore the experiences, strengths, challenges, and potential improvements for professionals in managing the complex needs of vulnerable migrants (VM) in an Italian rural reception centre. METHODS: A qualitative study using semi-structured interviews was conducted in April 2024. Data were analysed using the Automatic Analysis of Textual Data, based on Fraire's seven-step model for Exploratory Multidimensional Data Analysis. DATA SOURCES: Data were collected from 16 professionals working in a rural reception centre in southern Italy. Interviews were conducted and analysed using AATD in April 2024. FINDINGS: The analysis identified two main dimensions of professionals' roles: balancing systemic responsibilities with personal engagement and managing immediate needs versus long-term integration goals. Professionals face significant challenges, such as resource scarcity, bureaucratic inefficiencies, and emotional fatigue, which impact their well-being and the quality of care provided to migrants. Resilience, adaptability, and multidisciplinary collaboration were identified as key strengths. CONCLUSION: The study highlights the dual nature of professionals' work in reception centres, requiring them to balance operational tasks with emotional involvement in migrant care. Targeted interventions and systemic reforms are necessary to support professionals and enhance the quality of care for vulnerable migrants, particularly in resource-constrained rural settings. IMPLICATIONS FOR PRACTICE AND/OR PATIENT CARE: This study underscores the importance of providing targeted support to professionals working in reception centres, including training in intercultural competence, stress management, and coping strategies. Policies should address systemic challenges and provide resources to enhance healthcare delivery and social integration programs. REPORTING METHOD: This study adhered to the EQUATOR guidelines for reporting qualitative research (COREQ). The findings were reported in compliance with these guidelines, ensuring methodological rigour and transparency. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This study highlights the critical need for targeted support and training for professionals working in reception centres, particularly in rural settings. To improve care for vulnerable migrants, professionals should receive training in intercultural competence, stress management, and coping strategies to better navigate the complex challenges they face. Furthermore, systemic changes are necessary to alleviate the pressures on reception centres, such as streamlining bureaucratic processes and enhancing healthcare infrastructure, particularly in rural areas where resources are limited. By addressing these needs, we can improve the well-being of both the professionals and the migrants they serve, fostering more effective support systems and better care outcomes. Additionally, fostering multidisciplinary collaboration and community engagement can contribute to more comprehensive and sustainable care models. PROTOCOL REGISTRATION: The Ethics Committee of the University of Rome Tor Vergata approved this study on 07/07/2021 (protocol registration number 160.21).

Humans↗
PubMed2002

Development of a constant surface pressure penetration langmuir balance based on axisymmetric drop shape analysis.

A new constant pressure pendant-drop penetration surface balance has been developed combining a pendant-drop surface balance, a rapid-subphase-exchange technique, and a fuzzy logic control algorithm. Beside the determination of insoluble monolayer compression-expansion isotherms, it allows performance of noninvasive kinetic studies of the adsorption of surfactants added to the new subphase onto the free surface and of the adsorption/penetration/reaction of the former onto/into/with surface layers, respectively. The interfacial pressure pi is a fundamental parameter in these studies: by working at constant pi one controls the height of the energy barrier to adsorption/penetration and can select different regimes and steps of the adsorption/penetration process. In our device a solution drop is formed at the tip of a coaxial double capillary, connected to a double microinjector. Drop profiles are extracted from digital drop micrographs and fitted to the equation of capillarity, yielding pi, the drop volume V, and the interfacial area A. pi is varied changing V (and hence A) with the microinjector. Control is based on a case-adaptable modulated fuzzy-logic PID algorithm able to maintain constant pi (or A) under a wide range of experimental conditions. The drop subphase liquid can be exchanged quantitatively by the coaxial capillaries. The adsorption/penetration/reaction kinetics at constant pi are then studied monitoring A(t), i.e., determining the relative area change necessary at each instant to compensate the pressure variation due to the interaction of the surfactant in the subsurface with the surface layer. A fully Windows-integrated program manages the whole setup. Examples of experimental protein adsorption and monolayer penetration kinetics are presented.

Journal Article↗
PubMed2002

Integrating the prevention of eating disorders and obesity: feasible or futile?

The rate of obesity in adults and youth has doubled in the past 20 years; during this same period there has been an increase in the prevalence of "dysfunctional eating behaviors," including eating disorders and unhealthy weight loss practices. Despite the fact that obesity, eating disorders, and unhealthy weight loss practices are cultivated in the same cultural context-an increasingly "toxic" environment regarding food and weight-these problems are regarded as distinct, with different origins, courses, and approaches to prevention and treatment. In this article, we present conceptual and practical reasons for adopting an integrated approach to the prevention of the spectrum of problems related to eating and weight (i.e., eating disorders, obesity, and unhealthy weight loss practices), suggest personal, socioenvironmental, and behavioral factors to be included in an integrated approach to prevention, and provide some ideas for developing an integrated program using a media literacy/advocacy approach. We conclude with a discussion of challenges to the development of interventions aimed at the broad spectrum of weight-related problems and suggestions for addressing these challenges.

Adolescent↗
PubMed1989

Managing innovation to overhaul a patient-care environment.

Innovation in public service organizations must be managed, just as it must be in any business. However, in older, large public organizations, specific strategies are needed. One such strategy is described in development and impact. The first step was utilizing external demands to create an atmosphere in which change was accepted as necessary. This was followed by a relaxation of top down procedural direction accompanied by persistent concentration on establishing new standards and objectives. The final major component was a management system intended to guide and shape development of innovations into an integrated program effectively addressing the new objectives and standards.

Attitude of Health Personnel↗
PubMed2005

Re-entry and reintegration: returning home after combat.

Soldier life exists on a continuum of readiness for deployment. Re-entry and reintegration-the return home and reunion with family and community-key the success of the deployment cycle. In current and projected future operations, the Army and society will both bear the burden of this re-entry and re-integration. Programs and procedures in place work towards improving communication, mitigating distress and resolving crises during reentry and reintegration. Key elements include: inclusion of families and communities early into the planning for reentry and reintegration; normalization (non-medicalization of distress); easy access to behavioral health professionals; and education of families on resources and benefits. Through broad collaboration, maximal benefit to the Soldier, family members and society be realized.

Family↗
PubMed2002

Nonmelanoma skin cancer.

Therapy for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) does not end with treatment of the initial lesion because almost 50% of patients with one nonmelanoma skin cancer (NMSC) develop another NMSC in the next 5 years. An integrated program of skin cancer awareness, sun protection, and prophylactic approaches is critical. The risk profile of the tumor influences which therapies and specialties will be involved. Most NMSCs may be treated with outpatient methods. Primary care physicians may treat low-risk tumors, but dermatologists specially trained in cutaneous oncology and a multidisciplinary team should manage high-risk lesions. Superficial BCC and SCC may be treated adequately with superficial modalities such as electrodesiccation and curettage (EDC) and cryotherapy. Topical 5-fluorouracil is effective for small in situ lesions. Invasive but low-risk lesions may be treated with EDC and cryotherapy provided that the tumor is limited to the papillary dermis, is not recurrent, and does not have high-risk features. High-risk tumors are best treated with excision and histologic examination or Mohs micrographic surgery (MMS). MMS is the therapeutic gold standard for all NMSCs in terms of cure rates, margin control, and tissue conservation. Because of its higher cost and specialized process, MMS is best reserved for specific indications.

Basal Cell Carcinoma↗
PubMed2001

Cervicogenic headache: diagnostic evaluation and treatment strategies.

Cervicogenic headache is a chronic, hemicranial pain syndrome in which the source of pain is located in the cervical spine or soft tissues of the neck but the sensation of pain is referred to the head. The trigeminocervical nucleus is a region of the upper cervical spinal cord where sensory nerve fibers in the descending tract of the trigeminal nerve converge with sensory fibers from the upper cervical roots. This convergence of upper cervical and trigeminal nociceptive pathways allows the referral of pain signals from the neck to the trigeminal sensory receptive fields of the face and head. The clinical presentation of cervicogenic headache suggests that there is an activation of the trigeminovascular neuroinflammatory cascade, which is thought to be one of the important pathophysiologic mechanisms of migraine. Another convergence of sensorimotor fibers has been described involving intercommunication between the spinal accessory nerve (CN XI), the upper cervical nerve roots, and ultimately the descending tract of the trigeminal nerve. This neural network may be the basis for the well- recognized patterns of referred pain from the trapezius and sternocleidomastoid muscles to the face and head. Diagnostic criteria have been established for cervicogenic headache but its presenting characteristics may be difficult to distinguish from migraine, tension-type headache, or hemicrania continua. A multidisciplinary treatment program integrating pharmacologic, nonpharmacologic, anesthetic, and rehabilitative interventions is recommended. This article reviews the clinical presentation of cervicogenic headache, its diagnostic evaluation, and treatment strategies.

Combined Modality Therapy↗