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PubMed2004

Moving diabetes care from science to practice: the evolution of the National Diabetes Prevention and Control Program.

The National Diabetes Prevention and Control Program has a dynamic and evolving scientific foundation. This article describes this program and how seminal research studies provide an impetus for its public health policy and programs. The charge and challenges of integrating science into past, current, and future program designs are detailed, as are the program's accomplishments. Areas requiring new science are explored, including better research to translate new findings into clinical and public health practice and models to evaluate the effect of public health on improved outcomes. The epidemic of diabetes and its increasing burden on public health demands a better understanding of existing science and its limitations and informed public dialogue and policy responses.

Diabetes Mellitus↗
PubMed2001

The Key Extended Entry Program (KEEP): a methadone treatment program for opiate-dependent inmates.

The Key Extended Entry Program (KEEP) is the only known methadone treatment program for incarcerated opiate-dependent inmates in the United States. Initiated in 1987, KEEP performs approximately 18,000 detoxifications and 4,000 admissions for methadone treatment per year. Of those methadone treatment patients discharged to the community, mostly to outpatient KEEP programs, 74-80% report to their designated program. Recidivism rates reveal that 79% of KEEP patients were incarcerated again only once or twice during a recent 11-year period. Finally, KEEP data point to the importance of dedicating slots in the community for released inmates and maintaining them on sufficient blocking doses to eliminate the craving for heroin. About 6% of KEEP patients, some with mental illness have a high incidence of recidivism.

Female↗
PubMedDate not supplied

A retreat for families of children recently diagnosed with cancer.

PURPOSE: The authors describe a clinical intervention program designed for children recently diagnosed with cancer and their families. The rationale for a family weekend retreat, the planning process, and its implementation are outlined. DESCRIPTION OF PROGRAM: Staff members (nurses, social workers, child life specialists, and physicians) at the Children's Center for Cancer and Blood Disorders of the Richland Memorial Hospital in Columbia, South Carolina, conducted a comprehensive needs assessment of the families of children recently diagnosed with cancer. Subsequently, staff members planned and implemented the Family Weekend Retreat for these patients and their families. The program was designed to provide education to patients and parents, to reduce isolation within the family and among family systems, and to reduce individual and family stress. RESULTS: Using a 19-item evaluative questionnaire, the participating families indicated that the Family Weekend Retreat met their needs for education, recreation, and mutual support. The families expressed an interest in, and subsequently held, a retreat reunion. CLINICAL IMPLICATIONS: This program may be useful to other clinicians and/or cancer treatment facilities that wish to provide a network of support among families of recently diagnosed children who are struggling through the cancer experience.

Adaptation, Psychological↗
PubMed2002

Designing a disease management program: a collaboration.

Designing a disease management program is a complex process that can involve a variety of clinical, professional, and research skills. This paper describes a collaborative effort by Mayo Health Plan Arizona and the Mayo Clinic Scottsdale Family Medicine Residency program. Using an evidence-based approach to hypertension management, resident physicians acquired skills in three of the six core competency areas required for future physicians as defined by the Accreditation Council for Graduate Medical Education, Chicago. Resident involvement and feedback for this pilot curriculum were positive and the residents were confident in the skills they developed.

Arizona↗
PubMed2003

SYNOPSIS: SYNthesize and OPtimize System in Silico.

We present a de novo design program called SYNOPSIS, that includes a synthesis route for each generated molecule. SYNOPSIS designs novel molecules by starting from a database of available molecules and simulating organic synthesis steps. This way of generating molecules imposes synthetic accessibility on the molecules. In addition to a starting database, a fitness function is needed that calculates the value of a desired property for an arbitrary molecule. The values obtained from this function guide the design process in optimizing the molecules toward an optimal value of the calculated property. Two applications are described. The first uses an electric dipole moment calculation to generate molecules possessing a strong dipole moment. The second makes use of the three-dimensional structure of a viral enzyme in order to generate high affinity ligands. Twenty eight compounds designed with the program resulted in 18 synthesized and tested compounds, 10 of which showed HIV inhibitory activity in vitro.

Anti-HIV Agents↗
PubMedDate not supplied

Professional autonomy: a pilot study to determine the effects of a professional development program on nurses' attitudes.

In this article, the authors describe a pilot study conducted to evaluate a component of a professional development program designed for Clinical Nurses in a general teaching hospital. Permission was obtained to use an established instrument for measuring attitude toward professional autonomy. A non equivalent pre-test/post-test, control group design was used. Results indicate that the program was influential in changing nurses' attitudes toward autonomy. Implications of using an instrument designed for an American cohort of nurses and modified to depict an Australian nursing culture are discussed.

Adult↗
PubMed2005

A computational tool to optimize ligand selectivity between two similar biomacromolecular targets.

Algorithms for a new computer program designed to increase ligand-receptor selectivity between two proteins are described. In this program ligand-receptor selectivity is increased by functional modifications to the ligand so as to increase the calculated binding affinity of it to one protein and/or decrease the calculated binding affinity of it to the other protein. The structure of the ligand is modified by selective replacement of atoms and/or functional groups in silico based on a specific set of steric and/or hydropathic complementarity rules involving atoms and functional groups. Relative binding scores are calculated with simple grid-based steric penalty, hydrogen bond complementarity, and with the HINT score model. Two examples are shown. First, modifying the structure of the ligand CB3717 is illustrated in a number of ways such that the binding selectivity to wild type L. casei thymidylate synthase or its E60Q mutant may be improved. Second, starting with a non-selective lead compound that had been co-crystallized with both plant and mammalian 4-hydroxyphenylpyruvate dioxygenases, new compounds (similar to selective ligands discovered by screening) to improve the selectivity of (herbicidal) inhibitors for the plant enzyme were designed by the program.

Algorithms↗
PubMed2002

Designing effective nutrition interventions for adolescents.

By altering dietary behaviors, nutrition interventions during adolescence have the potential of affecting children at that time and later in life. The majority of interventions implemented in the teen years have occurred in schools, but other intervention sites have included after-school programs, summer camps, community centers, libraries, and grocery stores. Programs with successful outcomes have tended to be behaviorally based, using theories for the developmental framework; included an environmental component; delivered an adequate number of lessons; and emphasized developmentally appropriate strategies. One planning method that can be used in the development of nutrition interventions is Intervention Mapping. The steps of Intervention Mapping include conducting a needs assessment, developing proximal program objectives, mapping appropriate strategies and methods to address the objectives, planning the program design, planning program adoption and implementation, and evaluation. The use of intervention-planning techniques, coordination of nutrition and physical education interventions, using technological advances such as CD-ROMs, incorporation of policy changes into intervention efforts, and dissemination of effective programs are all trends that will influence the future development of effective nutrition programs for adolescents.

Adolescent↗
PubMed2002

Sourcing sediment using multiple tracers in the catchment of Lake Argyle, Northwestern Australia.

Control of sedimentation in large reservoirs requires soil conservation at the catchment scale. In large, heterogeneous catchments, soil conservation planning needs to be based on sound information, and set within the framework of a sediment budget to ensure that all of the potentially significant sources and sinks are considered. The major sources of sediment reaching the reservoir, Lake Argyle, in tropical northwestern Australia, have been determined by combining measured sediment fluxes in rivers with spatial tracer-based estimates of proportional contributions from tributaries of the main stream entering the lake, the Ord River. The spatial tracers used are mineral particle magnetics, the strontium isotopic ratio, and the neodymium isotopic ratio. Fallout of 137Cs has been used to estimate the proportion of the sediment in Lake Argyle eroded from surface soils by sheet and rill erosion, and, by difference, the proportion eroded from subsurface soils by gully and channel erosion. About 96% of the sediment in the reservoir has come from less than 10% of the catchment, in the area of highly erodible soils formed on Cambrian-age sedimentary rocks. About 80% of the sediment in the reservoir has come from gully and channel erosion. A major catchment revegetation program, designed to slow sedimentation in the reservoir, appears to have had little effect because it did not target gullies, the major source of sediment. Had knowledge of the sediment budget been available before the revegetation program was designed, an entirely different approach would have been taken.

Australia↗
PubMedDate not supplied

Creating a tailored, multimedia, computer-based intervention.

Tailoring of health-related messages is effective in motivating behavior change. However, planning, designing, and implementing a tailored health promotion program can be a challenge. This article describes the process of creating a tailored multimedia program for presentation via computer to promote factory workers' use of hearing-protection devices to prevent noise-induced hearing loss. The creation process was segmented into 5 phases: 1) determination of program content; 2) creation of overall program design, including live action and still video and addition of sound and graphics; 3) development and integration of tailoring pathways into the final intervention; 4) development of a database and participant handouts; and 5) pilot testing of the intervention program. The approach used in this research program can serve as a prototype for future development of computerized multimedia health promotion interventions and can assist others in the effective use of this medium.

Algorithms↗
PubMed1994

AIDS education for primary school children in Tanzania: an evaluation study.

OBJECTIVE: To test the effects of an HIV/AIDS education program. DESIGN: A quasi-experimental, nested cross-sectional design including baseline and 6-month follow-up surveys. Schools, stratified according to location, were randomly assigned to intervention (n = 6) or comparison conditions (n = 12). SETTING: Public primary schools in Arusha and Kilimanjaro regions, Tanzania. PARTICIPANTS: A total of 2026 sixth and seventh grade pupils (average age, 14.0 years) participated at baseline (85%) and 1785 at follow-up. INTERVENTION: The program was designed to reduce children's risk of HIV infection and to improve their tolerance of and care for people with AIDS. Local teachers and health workers attended a 1-week training workshop before implementing the program over a 2-3-month period (averaging 20 school hours per class). MAIN OUTCOME MEASURES: Self-reported exposure to AIDS information, communication regarding AIDS; AIDS knowledge, attitudes towards people with AIDS, attitudes towards having sexual intercourse, subjective norms regarding sexual intercourse, and intention to engage in sexual intercourse. RESULTS: Following this program, intervention pupils reported significantly higher scores for the following outcome measures than pupils attending the comparison schools: AIDS information (13.1 versus 10.5; P = 0.0001), AIDS communication (10.9 versus 7.8; P = 0.0001) AIDS knowledge (14.5 versus 11.5; P = 0.0001), attitudes towards people with AIDS (9.0 versus 6.7; P = 0.0008), subjective norms (45.5 versus 43.9; P = 0.011), and intention (1.3 versus 1.4; P = 0.020). No program effect was seen for attitudes towards sexual intercourse (47.0 versus 46.3, P = 0.44). CONCLUSIONS: These results indicate that it is feasible and effective to provide AIDS education for Tanzanian primary school children.

Acquired Immunodeficiency Syndrome↗
PubMed2005

The FAIMER Institute: creating international networks of medical educators.

One of the many products of Miriam's career was an international network of medical educators. She knew we would learn from each other and gain access to the perspectives, resources, and experiences that such a community brings. More importantly, Miriam understood the need for shared values, support, encouragement, and a sense of global citizenship that can come only from an international network of colleagues and friends. The FAIMER Institute, described in this paper, is a formalization and extension of Miriam's work and we hope it will be as successful as she was. The FAIMER Institute is a two-year fellowship program designed for medical school faculty from developing countries who have the potential to improve medical education. The first year consists of two residential sessions in the US before and after an intersession of distance learning and implementation of an educational project at the participant's home institution. The second year, completed from the Fellow's home country, involves co-mentoring a new Fellow and active engagement in the Institute's Internet discussion group. The program is designed to teach educational methods and leadership skills, as well as to develop strong professional bonds with other medical educators around the world. Preliminary data concerning the efficacy of the program have been encouraging. Fellows' perceptions of their knowledge, skills and attitudes show significant improvement. These self-assessments are supported by the outcomes, which indicate considerable scholarship as well as academic and administrative advancement. There have also been changes in the nature of the professional networks of these medical educators, which enhance their ability to undertake more complex projects in an innovative fashion. Finally, plans for the future focus on conducting regional Institutes in South Asia, sub-Saharan Africa and South America with the goal of fostering the creation of networks of medical educators. The current model will be modified to meet local needs, FAIMER will coordinate its other programs to support development in the regions, and partners will be sought to support and expand this effort.

Curriculum↗
PubMed1999

Dating violence in mid-adolescence: theory, significance, and emerging prevention initiatives.

Adolescent dating violence is an important juncture in the developmental pathway to adult partnership violence. As a window of opportunity for positive change, the present review considers the theoretical and empirical work on adolescent dating and dating violence. A consideration of the scope of the problem, developmental processes, and theoretical formulations precede a review of six relationship violence prevention programs designed for and delivered to youth. Five programs are school-based and one operates in the community. Prevention is targeted toward both universal (e.g., all high school students) and selected adolescent populations (e.g., youths with histories of maltreatment, or problems with peer aggression). Programs addressed specific skills and knowledge that oppose the use of violent and abusive behavior toward intimate partners; one program addressed interpersonal violence more generally, and was also included in this review because of its implications for dating violence initiatives. Positive changes were found across studies in violence-related attitudes and knowledge, also, positive gains were noted in self-reported perpetration of dating violence, with less consistent evidence in self-reported victimization. However, these findings should be considered preliminary due to limited follow-up and generalizability. Conceptual and methodological issues are discussed with a view toward improving assessment methods and research design.

Adolescent↗
PubMed2006

The use of wireless laptop computers for computer-assisted learning in pharmacokinetics.

OBJECTIVE: To implement computer-assisted learning workshops into pharmacokinetics courses in a doctor of pharmacy (PharmD) program. DESIGN: Workshops were designed for students to utilize computer software programs on laptop computers to build pharmacokinetic models to predict drug concentrations resulting from various dosage regimens. In addition, students were able to visualize through graphing programs how altering different parameters changed drug concentration-time curves. Surveys were conducted to measure students' attitudes toward computer technology before and after implementation. Finally, traditional examinations were used to evaluate student learning. ASSESSMENT: Doctor of pharmacy students responded favorably to the use of wireless laptop computers in problem-based pharmacokinetic workshops. Eighty-eight percent (n = 61/69) and 82% (n = 55/67) of PharmD students completed surveys before and after computer implementation, respectively. Prior to implementation, 95% of students agreed that computers would enhance learning in pharmacokinetics. After implementation, 98% of students strongly agreed (p < 0.05) that computers enhanced learning. Examination results were significantly higher after computer implementation (89% with computers vs. 84% without computers; p = 0.01). CONCLUSION: Implementation of wireless laptop computers in a pharmacokinetic course enabled students to construct their own pharmacokinetic models that could respond to changing parameters. Students had greater comprehension and were better able to interpret results and provide appropriate recommendations. Computer-assisted pharmacokinetic techniques can be powerful tools when making decisions about drug therapy.

Computer-Assisted Instruction↗
PubMed2003

Surgical outcomes of a breast cancer-screening program for low-income women.

HYPOTHESIS: Surgical outcomes from a breast cancer-screening program of low-income women are similar to those of other screening programs. DESIGN: Prospective cohort. SETTING: Federally funded screening program. PATIENTS: A total of 15730 women. INTERVENTIONS: A total of 23149 mammograms, 20396 with concomitant clinical breast examination, from January 1, 1997, through December 31, 2001. OUTCOME MEASURES: American College of Radiology scores; associated surgery consultations, biopsies, operations, and pathology results. RESULTS: Most (20868) of the 21296 mammograms assigned an American College of Radiology score were benign; only 428 (2%) were suspicious. Resulting from suspicious clinical breast examinations, the group with American College of Radiology scores of 1 to 3 accounted for 45%, 18%, and 10% of recommended surgical consultations, biopsies, and cancers detected, respectively. A rate of 12.3 cancers per 1000 women was found, greater than with other screening programs. Compliance with therapy was 97%. CONCLUSIONS: This screening program had a higher rate of advanced cancers. Clinical breast examination was an important component, and compliance with surgical recommendations was excellent.

Adult↗
PubMed1986

Psychological services offered to female veterans.

Questionnaires were sent to 153 chiefs of Veterans Administration psychology services to request information on service provision to women veterans; 91 responses were received. Services were classified according to four categories: (a) individual women served in response to requests; (b) individual programs designed to meet specific needs; (c) educational programs offered to female clients; and (d) staff training programs. Correlations between each of the four categories and the following factors were calculated: (a) size of the city as determined by population in which each Veterans Administration Medical Center is located; (b) state population of female veterans; (c) number of female staff psychologists; (d) annual percentage of female clients served; (e) income of female clients; (f) total number of psychologists on the staff; and (g) total annual number of clients. Significant correlations were found between number of services offered routinely in response to requests and each of the following factors: (a) state population of female veterans; (b) income of female veteran clients; (c) total number of psychologists on the staff; and (d) annual number of clients.

Female↗
PubMed1989

Establishing control by spoken words with profoundly mentally retarded individuals.

Five low-functioning mentally retarded subjects were taught initially to insert tokens in a slot only when an auditory-visual complex stimulus was presented. The auditory component was a spoken reinforcer name (e.g., "Food"), and the visual component was a flashing red light in the slot opening. Later, the name was presented without the light on probe trials. Three subjects did not respond, suggesting that their token insertions had been controlled by the visual but not by the auditory component of the auditory-visual complex. These subjects then received a fading program designed to establish auditory stimulus control. The program was successful with two subjects. The third subject required post-program remedial teaching, but ultimately demonstrated exclusive control by the spoken name. The results suggest methods for establishing auditory stimulus control with this population and highlight variables that may influence the reliability of such control in some subjects.

Acoustic Stimulation↗
PubMed1998

Experience with a novel vaginal progesterone preparation in a donor oocyte program.

OBJECTIVE: To compare the efficacy of a vaginal progesterone preparation with our standard IM preparation within a donor egg program. DESIGN: Prospective randomized trial. SETTING: Donor egg program at a university assisted reproductive therapy program (Jones Institute for Women's Health). PATIENT(S): Couples accepted into the donor egg program because of either premature ovarian failure or evidence of diminished ovarian reserve. INTERVENTION(S): Women were randomized into either a group receiving IM progesterone replacement or a group receiving vaginal progesterone replacement. Both groups underwent Estraderm patch/progesterone treatment in a mock cycle leading to an endometrial biopsy on day 26 followed by a second cycle in which ET was performed. Subjects with residual ovarian function received a GnRH agonist. In the IM treatment group, 100 mg was administered from cycle days 15 to 27. In the vaginal treatment group, Crinone 8%, a polycarbophil-based gel preparation containing 90 mg of micronized progesterone, was administered twice daily from the evening of day 14. MAIN OUTCOME MEASURE(S): Endometrial histology, serum levels of progesterone (on days 13, 17, 20, 24, and 26), the occurrence of pregnancy, implantation rate, and pregnancy outcome. RESULT(S): Fifty-four women randomized into the vaginal progesterone treatment group and 18 women in the IM treatment group achieved ET. Mean serum progesterone levels were higher in the IM treatment group than in the Crinone group. Endometrial histology was "in phase" for all subjects in both groups. Clinical pregnancies were observed in 26 of 54 women and 5 of 18 women in the Crinone and IM progesterone groups, respectively. The ongoing pregnancy rate (PR) of 31% (17/54) and implantation rate of 23% in the subjects receiving Crinone was not statistically different from the IM progesterone group's ongoing PR of 22% (4/18) and implantation rate of 18%. CONCLUSION: Vaginal progesterone replacement with the polycarbophil gel preparation was as effective as IM progesterone in producing clinical and ongoing pregnancies within our donor egg program in the dosages administered.

17-alpha-Hydroxyprogesterone↗