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PubMed1978

Evoked potential measurement and analysis on a small laboratory computer.

A program is described for the collection and subsequent analysis of somatosensory evoked potentials using a LINC-8 computer. The program allows simple evoked-potentials analysis in centers where a small laboratory computer may be available but sophisticated instrumentation such as a computer of average transients is not available. This program provides an efficient method of easily obtaining information concerning the conduction pathways of the nervous system as well as the cerebral function; the program can be implemented on small laboratory computers which most hospitals currently own, without the associated cost or complexity of additional hardware in the laboratory. Combining utilization of a small laboratory computer with an easily programmable method provides an approach for evoked potential analysis which is well within the financial and technical scope of most neurophysiology laboratories.

Computers↗
PubMedDate not supplied

[Screening program for hemoglobinopathies based on blood donors from Bragança Paulista, São Paulo, Brazil].

Screening programs for hemoglobinopathies target different population groups such as neonates, students, pregnant women, military personnel, recruits, and blood donors. The feasibility and efficiency of these programs basically depend on the population's receptivity, which in turn is related to highly complex economic, psychological, and sociocultural factors. The purpose of this study was to evaluate the population of Bragança Paulista, São Paulo, based on results from the blood donors' group and to compare these results with those previously obtained in a group of students from the same city. The sample consisted of 1,846 donors who had given blood at the São Francisco University Hematology Center, Bragança Paulista, São Paulo, from October 1998 to April 1999. Analysis of the 1,846 donors identified 31 individuals who were hemoglobinopathy carriers (1.68%). The result was quite similar to that obtained in the group of students and demonstrated that the two methods are similar in relation to detection of hemoglobinopathies; however, the blood donor approach is more practical.

Blood Donors↗
PubMed2005

Reconfigurable systems for sequence alignment and for general dynamic programming.

Reconfigurable systolic arrays can be adapted to efficiently resolve a wide spectrum of computational problems; parallelism is naturally explored in systolic arrays and reconfigurability allows for redefinition of the interconnections and operations even during run time (dynamically). We present a reconfigurable systolic architecture that can be applied for the efficient treatment of several dynamic programming methods for resolving well-known problems, such as global and local sequence alignment, approximate string matching and longest common subsequence. The dynamicity of the reconfigurability was found to be useful for practical applications in the construction of sequence alignments. A VHDL (VHSIC hardware description language) version of this new architecture was implemented on an APEX FPGA (Field programmable gate array). It would be several magnitudes faster than the software algorithm alternatives.

Algorithms↗
PubMedDate not supplied

Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction.

Reperfusion of the infarct-related artery in the very first hour ("golden hour") of acute myocardial infarction (AMI) significantly reduces mortality rates. Several factors may delay the initiation of reperfusion therapy (ie, thrombolytic therapy or primary percutaneous transluminal coronary angioplasty [PCTA]), most of which are related to patients. A total of 520 patients with suspected AMI were evaluated in the emergency department of Dokuz Eylül University Hospital between March 1996 and October 1999. After inclusion criteria were applied, the study consisted of 178 patients with a history of AMI. Analyzed data that affected patients' arrival to the hospital were obtained from responses to a questionnaire. The Statistical Package for the Social Sciences (SPSS; SPSS Inc., Chicago, Ill), version 11.0, was used for all statistical analyses. The mean "symptom onset-hospital arrival time" was 188+/-325 min for the entire study group. The median delay was 110 min (approximately 2 h). Only 39 (22%) patients arrived to the hospital within the first hour. The mean time needed for late responders (n=109, 74%) (hospital arrival later than 1 h after symptom onset) to arrive was 245-/+363 min. According to the results of this study, many patients with AMI who may be eligible for reperfusion therapy miss the "golden hour" because of late hospital arrival. Some groups of patients (ie, elderly, women, those with diabetes) were especially late in arriving. To reduce such delays, training programs may be advised to focus on these groups of patients. Arrival times to the hospital during AMI can be greatly improved by efficient public education programs targeted to these groups.

Emergency Service, Hospital↗
PubMed1991

Prospective comparison of a conventional and an accelerated protocol for programmed ventricular stimulation in patients with coronary artery disease.

BACKGROUND: This study compared the sensitivity, specificity, and efficiency of a "conventional" and "accelerated" programmed stimulation protocol in 293 patients with coronary artery disease who had a history of sustained or nonsustained monomorphic ventricular tachycardia (VT). METHODS AND RESULTS: In the conventional protocol, one and two extrastimuli were introduced during sinus rhythm and during basic drive trains at cycle lengths of 600 and 400 msec at the right ventricular apex and then at the outflow tract or septum. In the accelerated protocol, one, two, and then three extrastimuli were introduced at each of three basic drive train cycle lengths (350, 400, and 600 msec) at the right ventricular apex; the procedure was repeated at a second right ventricular site. Six hundred thirty-four electrophysiological tests were performed using one of these two protocols either in the baseline state (293 tests) or during drug testing (341 tests). The yield of sustained, monomorphic VT was 89% with the conventional protocol and 92% with the accelerated protocol during baseline tests in patients who had a history of sustained VT (p = 0.05); 20% and 34%, respectively, during baseline tests in patients with a history of nonsustained VT (p = 0.06); and 70% and 77%, respectively, during drug testing (p = 0.2). To induce sustained, monomorphic VT, 10.1 +/- 5.0 (mean +/- SD) protocol steps and 14.4 +/- 8.7 minutes were required with the conventional protocol, compared with 4.0 +/- 3.7 steps and 5.6 +/- 6.1 minutes with the accelerated protocol (p less than 0.001 for each comparison). Among the tests in which sustained, monomorphic VT was induced, sustained polymorphic VT or ventricular fibrillation was induced more often with the conventional protocol (3.6%) than with the accelerated protocol (0.9%, p = 0.05). CONCLUSIONS: The efficiency of programmed stimulation can be improved by the early use of a basic drive train cycle length of 350 msec and three extrastimuli. Compared with a conventional stimulation protocol, the accelerated protocol used in this study reduces the number of protocol steps and duration of time required to induce monomorphic VT by an average of more than 50% and improves the specificity of programmed stimulation without impairing the yield of monomorphic VT.

Cardiac Pacing, Artificial↗
PubMed1996

Diabetes and managed care: the Lovelace Health System's Episode of Care Program.

In order to efficiently manage the care of large populations, the health of that population must be evaluated. People identified with chronic medical disorders, such as diabetes mellitus, should have their disease managed proactively in the most cost-effective manner across the continuum of care. Lovelace Health System has established an Episode of Care disease management program based on the principles of clinical practice improvement. The diabetes program is described as an example of this approach to define and monitor best practice and to decrease variation among providers. This approach optimizes the use of health care resources and improves patient outcomes.

Continuity of Patient Care↗
PubMed1968

The Rural Health Program of Southern Monterey County.

The Rural Health Project of Southern Monterey County is attempting to demonstrate that a private group of physicians with the collaboration of the County Medical Society can responsibly and efficiently conduct a program of providing comprehensive medical care to indigent patients. Within the purposes of P.L. 89-749, the Rural Health Project is experimenting with a new way of organizing indigent health care and at the same time is providing the basis for comprehensive health planning at the local level.

California↗
PubMed1991

PNM: a program for parametric and nonparametric mapping of multidimensional data.

A program named PNM is presented for the mapping of multidimensional data within a two-class classification problem. A novel mapping method is used for the purpose. The computing procedure implemented in the program is described in detail. Definitions and examples of the control instructions of the program are given at length. An application of PNM for classifier design concerning differential diagnoses of the cerebrovascular accident is presented. It confirms the efficiency of the program in solving classification problems of relatively large size on a small computer.

Brain Ischemia↗
PubMed1994

A BASIC program for the peak-to-valley estimation of respiratory sinus arrhythmia.

A computer program for the automatic scoring of respiratory sinus arrhythmia (RSA) is described. The program uses the 'peak-to-valley' quantification of RSA. Data was collected on 20 subjects to determine the inter-rater reliability and efficiency of the program. Highly reliable estimates of RSA were found. Advantages and limitations of the program are discussed.

Adult↗
PubMed2006

The health care response to pandemic influenza.

The threat of an H5N1 influenza virus (avian flu) pandemic is substantial. The success of the current U.S. influenza pandemic response plan depends on effective coordination among state and local public health authorities and individual health care providers. This article is a summary of a public policy paper developed by the American College of Physicians to address issues in the U.S. Department of Health and Human Services Pandemic Influenza Plan that involve physicians. The College's positions call for the following: 1) development of local public health task forces that include physicians representing all specialties and practice settings; 2) physician access to 2-way communication with public health authorities and to information technology tools for diagnosis and syndrome surveillance; 3) clear identification and authorization of agencies to process licensing and registration of volunteer physicians; 4) clear guidelines for overriding standard procedures for confidentiality and consent in the interest of the public's health; 5) clear and fair infection control measures that do not create barriers to care; 6) analysis of and solutions to current problems with seasonal influenza vaccination programs as a way of developing a maximally efficient pandemic flu vaccine program; 7) federal funding to provide pandemic flu vaccine for the entire U.S. population and antiviral drugs for 25% of the population; and 8) planning for health care in alternative, nonhospital settings to prevent a surge in demand for hospital care that exceeds supply. *This paper is an abridged version of a full-text position paper (available at http://www.acponline.org/college/pressroom/as06/pandemic_policy.pdf) written by Laura Barnitz, BJ, MA, and updated and adapted for publication in Annals of Internal Medicine by Michael Berkwits, MD, MSCE. The original position paper was developed for the Health and Public Policy Committee of the American College of Physicians: Jeffrey P. Harris, MD (Chair); David L. Bronson, MD (Vice Chair); CPT Julie Ake, MD; Patricia P. Barry, MD; Molly Cooke, MD; Herbert S. Diamond, MD; Joel S. Levine, MD; Mark E. Mayer, MD; Thomas McGinn, MD; Robert M. McLean, MD; Ashley E. Starkweather; and Frederick E. Turton, MD. It was approved by the Board of Regents on 3 April 2006.

Advisory Committees↗
PubMed1997

Structuring training goals for psychodynamic psychotherapy.

A multiaxial model that structures educational goals for psychodynamic psychotherapy has been developed. It specifies core aspects of psychodynamic psychotherapy, clusters them in categories that further define and link related areas, and presents a sequence that enables educators and students to focus on training goals in a consistent progression. This model has been used by the Director of Education as a basis for developing the curriculum, by students as a way of focusing learning and giving perspective to current work, and by supervisors to link individual teaching to the goals of the training program. This method has enhanced consistency, clarity, and efficiency in the psychotherapy program.

Curriculum↗
PubMed2001

Reforming Medicare: impacts on federal spending and choice of health plans.

The rising cost of Medicare and well-documented problems plaguing Medicare+Choice (M+C) have increased interest in "reforming" the program. To improve efficiency, most reform proposals would rely on competitive bidding to establish payments to M+C plans. At the same time, beneficiaries would be given financial incentives to select low-cost M+C plans. A major unknown is the extent to which Medicare reforms would generate federal budgetary savings. To examine this issue, we develop three illustrative Medicare reform options that differ greatly in how Medicare would establish its payments to plans. Our results highlight the fact that Medicare should expect modest savings from reforming the program. However, other goals of reform, such as establishing more efficient payments to plans, would be achieved.

Aged↗
PubMed1984

PMAP, PMAPS: DNA physical map constructing programs.

Computer programs are described, which facilitate the construction of the restriction site (physical) map of DNA molecules. By knowing the length of each fragment and its degree of error in the single and the double restriction enzyme digestions, the programs give all the possibilities for the physical map. This method is applicable to linear DNA molecules. Several examples are presented which indicate the high efficiency of the programs in constructing restriction site maps for the 62 Kb chromosome of bacteriophage 16-3. We have constructed complex maps (i.e. EcoRI map with 16 and EcoRV with 11 fragments).

Base Sequence↗
PubMedDate not supplied

The changing face of the epidemiology of tuberculosis due to molecular strain typing--a review.

About one third of the world population is infected with tubercle bacilli, causing eight million new cases of tuberculosis (TB) and three million deaths each year. After years of lack of interest in the disease, World Health Organization recently declared TB a global emergency and it is clear that there is need for more efficient national TB programs and newly defined research priorities. A more complete epidemiology of tuberculosis will lead to a better identification of index cases and to a more efficient treatment of the disease. Recently, new molecular tools became available for the identification of strains of Mycobacterium tuberculosis (M. tuberculosis), allowing a better recognition of transmission routes of defined strains. Both a standardized restriction-fragment-length-polymorphism-based methodology for epidemiological studies on a large scale and deoxyribonucleic acids (DNA) amplification-based methods that allow rapid detection of outbreaks with multidrug-resistant (MDR) strains, often characterized by high mortality rates, have been developed. This review comments on the existing methods of DNA-based recognition of M. tuberculosis strains and their peculiarities. It also summarizes literature data on the application of molecular fingerprinting for detection of outbreaks of M. tuberculosis, for identification of index cases, for study of interaction between TB and infection with the human immuno-deficiency virus, for analysis of the behavior of MDR strains, for a better understanding of risk factors for transmission of TB within communities and for population-based studies of TB transmission within and between countries.

Humans↗
PubMed2005

Medicare: making it a force for innovation and efficiency.

An aging population, the addition of a prescription drug benefit, and federal budget deficits require policymakers to continue to explore ways to improve Medicare. Because Medicare is such a large share of health care spending, initiatives to improve its efficiency and the quality of care it funds will potentially influence the health care system as a whole. Current strategies to improve the quality of care and efficiency of the program focus on getting beneficiaries to migrate to better-performing providers, or intervening more directly to encourage the system to provide higher quality, more efficient care. Some strategies try to increase information sharing overall, some focus primarily on providers or beneficiaries, while others target specific diseases.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2002

TranScout: prediction of gene expression regulatory proteins from their sequences.

MOTIVATION: The advent of genomics yields thousands of reading frames in search of function. Identification of conserved functional motifs in protein sequences can be helpful for function prediction. RESULTS: A database and a classification of reported DNA-binding protein motifs has been designed. A program ('TranScout') has been developed for the detection and evaluation of conserved motifs in prokaryotic and eukaryotic sequences of proteins with a gene regulatory function. The efficiency of the program is shown in a benchmark against a database obtained from SWISS-PROT without the protein sequences used to train the program. All motifs were detected with a mean average sensitivity of 0.98 and a mean average specificity of 0.92. AVAILABILITY: The program is freely available for use on the internet at http://luz.uab.es/transcout/. The user can find additional information at this site.

Algorithms↗
PubMedDate not supplied

Detection of etiological agent for cholera by PCR protocol.

BACKGROUND: PCR protocol for Vibrio cholerae, the causative agent of the diarrheal disease cholera has been described in this report. We report the detection of Vibrio species in drinking water samples in a duplex PCR reaction. The target loci used in the study were ctxA and tcpA. The sensitivity and efficiency of detection of this protocol can be applied in epidemic conditions, wherein monitoring of target organisms is very crucial. MATERIAL AND METHODS: Single step thermocycling programs have been reported for amplification of specific target loci. We have demonstrated that a gradient multi-step thermocycling program is more efficient in improving the sensitivity of detection by PCR. The method for preparation of template DNA from environmental sample uses filtration of water followed by harvesting the possible bacterial residue. This was further treated with proteinase K and heat to yield DNA compatible for PCR. The protocol was optimized for amplification of target loci from standard strains as well as from environmental water samples. RESULTS: The method can simultaneously detect two different loci of Vibrio cholerae in a single reaction. The sensitivity of detection achieved for the pathogen was 100 cells per reaction. The specificity of the primers was demonstrated by spiking the reaction with non-specific template. The developed protocol was successfully extended to environmental samples. CONCLUSIONS: The developed duplex PCR protocol allows the simultaneous detection of two genetic loci of the target pathogen from water samples. This enhances the efficiency of detection and provides a sensitive tool for the rapid detection of the pathogen that can be useful in epidemic conditions where the time factor involved in the identification of target pathogen is very crucial.

Bacterial Outer Membrane Proteins↗
PubMed1992

Health education and injury control: integrating approaches.

The prevention of injuries, a major public health problem, is of interest to a growing number of public health professionals from a variety of disciplines. Historically, there has been tension between those who propose injury prevention strategies that focus on the adoption of protective behaviors by individuals and those who propose strategies that circumvent the role of individual behavior by providing automatic or passive protection. This tension may be counterproductive to finding comprehensive solutions to injury problems, and a better understanding of the inherent strengths and limitations of each of these approaches is needed. The purposes of this paper are to: (1) describe the arguments over individual liberties and individual behavior that can occur in the design of injury prevention programs; (2) review the principles that typically guide the development of injury control programs and health education programs; and (3) integrate the two most widely used approaches in injury control and health education programs--Haddon's injury countermeasures and Green's PRECEDE framework--into one program planning framework that addresses both behavioral and nonbehavioral components of an injury problem. This unified framework is offered in the hope that its use will facilitate multidisciplinary, comprehensive approaches to developing injury prevention programs that are efficient and effective.

Adolescent↗