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Addressing asthma in Texas: development of a school-based asthma surveillance program for Texas elementary schools.

To address asthma in the state, in October 2000, the Texas Department of State Health Services (DSHS) and the American Lung Association of Texas held a joint meeting of asthma professionals from across the state, with a primary purpose of identifying major issues and potential strategies and actions to be taken. These discussions became the basis of the 2001 Texas State Asthma Plan, which has since been adopted to guide state efforts in asthma surveillance, management, education, and advocacy. The primary purpose of this project, which was conducted with and funded by the DSHS and the Centers for Disease Control and Prevention, has been to develop and implement an asthma surveillance program for Texas school-aged children. The program has been implemented with a sample (n = 42,409) of students from the Texas Education Agency's region IV. An important goal has been to determine the feasibility of conducting school-based statewide asthma surveillance and assist with establishing a network for ongoing, systematic collection, analysis, interpretation, and dissemination of asthma data. This project is expected to become part of a wider asthma surveillance network that will include mortality, hospital discharge, and Behavioral Risk Factor Surveillance System (BRFSS) data. It will also provide information not typically captured by surveillance programs, including the BRFSS, which rely heavily upon a previous diagnosis of asthma to determine both lifetime and current prevalence of asthma. Results from this project indicate that such reliance on a previous diagnosis may considerably underestimate the prevalence of disease-particularly in the Latino population

Adolescent↗

Assessing the use of school public address systems to deliver nutrition messages to children: Shape up Somerville--audio adventures.

Given the current childhood obesity epidemic, it is especially important to find effective ways to promote healthful foods to children. School public address (PA) systems represent an inexpensive and a replicable way of reaching children with health messages. To test the effectiveness of this channel, messages were created to promote 2 dried bean (legume) dishes that had been added to the school lunch menu. Six elementary schools were pair matched, and 1 school from each pair was randomly chosen to play the messages. The impact of the intervention on choice of the 2 new entrees was assessed. Results indicate that for all schools combined, choice was not significantly affected. However, compared to their matched control schools, choice was significantly higher in the school that received the highest dose of the intervention and was significantly lower in the school that received the lowest dose. Choice was not changed in the school that received an intermediate dose. These results suggest that PA systems show promise as an effective and appropriate communications channel but only in schools that are able to play messages frequently.

Audiovisual Aids↗

Commercial insurance vs community-based health plans: time for a policy option with clinical emphasis to address the cost spiral.

The nation continues its ceaseless struggle with the spiraling cost of health care. Previous efforts (regulation, competition, voluntary action) have included almost every strategy except clinical. Insurers have largely failed in their cost-containment efforts. There is a strong emerging body of literature that demonstrates the relationship between various clinical strategies and reductions in utilization and costs. This article describes the organization of health services, including integration of delivery and financing systems, at the community level as a model that effectively addresses the critical structural flaws that have frustrated control of costs. Community-based health plans (CHPs) have been developed and have demonstrated viability. The key elements of CHPs are a legal organizational structure, a full provider network, advanced care-management systems, and the ability to assume financial risk. Common misconceptions regarding obstacles to CHP development are the complexity of the undertaking, difficulty assuming the insurance function, and insured pools that are too small to be viable. The characteristics of successful CHPs and 2 case studies are described, including the types of advanced care-management systems that have resulted in strong financial performance. The demonstrated ability of CHPs to establish financial viability with small numbers of enrollees challenges the common assumption that there is a fixed relationship between health plan enrollment size and financial performance. Organizing the health system at the community/regional level provides an attractive alternative model in the health-reform debate. There is an opportunity for clinical systems and state and federal leaders to support the development of community-based integrated delivery and financing system models that, among other advantages, have significant potential to modulate the pernicious cost spiral.

Community Health Services↗

Developing industrial-governmental-academic partnerships to address micronutrient malnutrition.

Micronutrient malnutrition affects approximately 2 billion people and has a significant impact on mortality, morbidity, reproductive health, individual growth and development, and economic productivity. The World Bank has suggested that micronutrient interventions are among the most cost-effective of all health interventions. Therefore, greatly increased collaborative efforts are needed to bring about further reductions in micronutrient malnutrition. At the FAO/WHO International Conference on Nutrition, the importance of various partners in improving nutrition was recognized in the World Declaration on Nutrition and adopted unanimously by 159 governments: "Governments, academic institutions and industry should support the development of fundamental and applied research directed towards improving the scientific and technological knowledge base" for addressing malnutrition, including micronutrient malnutrition. Food-based strategies, including fortification, provide a good example.

Government↗

Retention of topographic addresses by reciprocally translocated tectal re-implants in adult goldfish.

1. The topographic pattern of retinotectal projections re-established after reciprocal translocation of two tectal re-implants within a whole tectum was studied in adult goldfish with neurophysiological mapping methods. 2. Reciprocal translocations of tectal re-implants along the rostrocaudal axis resulted in retinotectal projections on to these re-implants that showed corresponding reciprocal transpositions of receptive fields along the nasotemporal axis. 3. Similarly, reciprocal translocations of tectal re-implants along the mediolateral axis resulted in retinotectal projections on to these re-implants that showed corresponding reciprocal transpositions of receptive fields along the superoinferior axis. Some regenerating optic fibres in the operated tectum abruptly changed the directions of their courses, as if they were taking direct paths towards their displaced, previous target zones in the tectum. 4. Reciprocal translocation of tectal re-implants either along the rostrocaudal or mediolateral axis, accompanied by 180 degree rotation of the re-implants about the dorsoventral axis, resulted in retinotectal projections on to the re-implants that showed not only the corresponding reciprocal transpositions along the nasotemporal or superoinferior axis but also a localized 180 degree rotation in the order of the receptive fields within these re-implants. The same results were also observed after regeneration of the optic fibres following section of the contralateral optic nerve. 5. These results indicate that translocated pieces of tectal tissue retain not only the topographic polarity indicative of their normal orientation but also the topographic addresses indicative of their original positions in the tectum, with respect to their selective reinnervation by particular groups of optic fibres.

Animals↗

Electrical, chemical, and topological addressing of mammalian cells with microfabricated systems.

This communication describes our work in electrical, topological, and chemical micromodification of surfaces to modulate cellular form and function. We have addressed the surface physico-chemico-mechano properties of cell culture substrates that play a role in modulating cellular behavior. Single factorial model systems have been built using techniques adapted from microlithography. The tools and techniques of microfabrication, if harnessed and used correctly, can be enabling in elucidating the underlying principles and fundamental forces driving the cell-substrate interface. Additionally, the long-term practical applications of microfabrication in medicine and biomaterial/tissue engineering lie in enabling "communication" with living cells/tissues at the cellular and subcellular levels.

Animals↗

Spatiotemporal addressing of surface activity.

We have modified surface catalytic activity in real time and space by focusing an addressable laser beam to differentially heat a platinum (110) single-crystal surface. Ellipsomicroscopy imaging of local conditions (such as reactant and product local coverages) enabled us to close the loop between sensing and actuation (both spatiotemporally resolved). Pulses and fronts, the basic building blocks of patterns, could be formed, accelerated, modified, guided, and destroyed at will. Real-time image processing and feedback allow the design and implementation of new classes of nonlocal evolution rules.

Journal Article↗

Light-directed, spatially addressable parallel chemical synthesis.

Solid-phase chemistry, photolabile protecting groups, and photolithography have been combined to achieve light-directed, spatially addressable parallel chemical synthesis to yield a highly diverse set of chemical products. Binary masking, one of many possible combinatorial synthesis strategies, yields 2n compounds in n chemical steps. An array of 1024 peptides was synthesized in ten steps, and its interaction with a monoclonal antibody was assayed by epifluorescence microscopy. High-density arrays formed by light-directed synthesis are potentially rich sources of chemical diversity for discovering new ligands that bind to biological receptors and for elucidating principles governing molecular interactions. The generality of this approach is illustrated by the light-directed synthesis of a dinucleotide. Spatially directed synthesis of complex compounds could also be used for microfabrication of devices.

Amino Acid Sequence↗

Use of the Addressing Sequence of Yeast D-Lactate Dehydrogenase for Insertion of CYP11A1p into the Inner Membrane of Yeast Mitochondria.

Mammalian cytochrome P450scc (CYP11A1p) is a pseudointegral protein of the inner membrane of mitochondria with the active center exposed in the matrix. Upon import of the CYP11A1p precursor into yeast mitochondria, only a minor part was incorporated into the inner mitochondrial membrane and acquired catalytic activity (Kovaleva, I. E., Novikova, L. A., Nazarov, P. A., Grivennikov, S. I., and Luzikov, V. N. (2003) Eur. J. Biochem., 270, 222-229). The present work is an attempt to increase the efficiency of this process by substitution of the inherent N-terminal presequence of CYP11A1p by the addressing signal of D-lactate dehydrogenase (D-LD) of the yeast Saccharomyces cerevisiae. D-LD is known to be inserted into the inner membrane of mitochondria through its transmembrane domain located close to the N-terminus of the polypeptide chain in such a way that the protein globule is exposed in the intermembrane space. The hybrid protein D-LD(1-72)-mCYP11A1p synthesized in yeast cells was imported into yeast mitochondria, underwent processing, and was inserted into the inner membrane on the side of the intermembrane space. In the presence of adrenodoxin and adrenodoxin reductase, the hybrid protein exhibited cholesterol side-chain cleavage activity. Thus, CYP11A1p insertion into the inner membrane of mitochondria mediated by the D-LD topogenic signal resulted in the catalytically active mCYP11A1p domain in the hybrid protein.

Cholesterol Side-Chain Cleavage Enzyme↗

Progression of eye disease in "cured" leprosy patients: implications for understanding the pathophysiology of ocular disease and for addressing eyecare needs.

BACKGROUND: Ocular damage in leprosy is due either to nerve damage or infiltration by mycobacteria. There is currently little information about the magnitude and nature of incident ocular pathology in cured leprosy patients. This information would increase our understanding of the pathophysiology of ocular involvement in leprosy and help in developing programmes to address the eyecare needs of leprosy patients who have been released from treatment. The cumulative incidence of leprosy related ocular pathology and cataract was measured during an 11 year follow up period in cured leprosy patients released from treatment in Korea. METHODS: In 1988 standardised eye examinations were performed on 501 patients in eight resettlement villages in central South Korea. In May 1999 standardised eye examinations were repeated in this population. RESULTS: Among the patients in whom there was no sight threatening leprosy related ocular disease (lagophthalmos, posterior synechia, or keratitis) in 1988, 14.7% developed one or more of these conditions. Overall, among those with no vision reducing cataract in 1988, 26.4% had developed a vision reducing lens opacity in at least one eye. Among patients examined in both 1988 and 1999, 14.3% developed visual impairment and 5.7% developed blindness. CONCLUSION: This study demonstrates that leprosy related ocular pathology progresses in some patients even after they are cured mycobiologically. The progressive leprosy related lesions are the result of chronic nerve damage; ocular lesions due to infiltration by Mycobacterium leprae did not develop. Based on the factors found to be associated with development of the most visually significant findings (posterior synechia, keratitis, and cataract) certain patients should be targeted at discharge for active follow up eye care. We suggest that patients with lagophthalmos (even in gentle closure), trichiasis, small pupils, and posterior synechiae should be screened regularly for the development of lagophthalmos in forced closure, keratitis, and cataract.

Adult↗

Judging a book by its cover: descriptive survey of patients' preferences for doctors' appearance and mode of address.

OBJECTIVE: To document patients' preferred dress styles of their doctors and modes of address. DESIGN: Descriptive survey. SETTING: Inpatients and outpatients at a tertiary level hospital, New Zealand. PARTICIPANTS: 202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years. MAIN OUTCOME MEASURES: Ranking of patients' opinions of photographs showing doctors wearing different dress styles. A five point Likert scale was used to measure patient comfort with particular items of appearance. RESULTS: Patients preferred doctors to wear semiformal attire, but the addition of a smiling face was even better. The next most preferred styles were semiformal without a smile, followed by white coat, formal suit, jeans, and casual dress. Patients were more comfortable with conservative items of clothing, such as long sleeves, covered shoes, and dress trousers or skirts than with less conservative items such as facial piercing, short tops, and earrings on men. Many less conservative items such as jeans were still acceptable to most patients. Most patients preferred to be called by their first name, to be introduced to a doctor by full name and title, and to see the doctor's name badge worn at the breast pocket. Older patients had more conservative preferences. CONCLUSIONS: Patients prefer doctors to wear semiformal dress and are most comfortable with conservative items; many less conservative items were, however, acceptable. A smile made a big difference.

Adult↗

Rationale for graduated licensing and the risks it should address.

The increased crash risk of young, beginning drivers has long been cause for concern. Graduated licensing systems, which seek to phase in driving experience gradually over time, have recently been adopted by many states in an effort to reduce these risks. In an attempt to define the basic rationale for graduated licensing, relevant research evidence that describes the conditions under which risk is known to be increased for young drivers was reviewed. Potential changes in licensing laws that best address these known risk factors are described. It was found that certain situations contribute to even greater crash risk, most notably nighttime driving and driving with passengers in the peer group. The underlying premise for graduated licensing is that while crash risk of young drivers is heightened under all situations, some situations are more or less risky than others. If experience can be gained initially under lower risk conditions, both in the learning stage and when first licensed, crash risk will be reduced.

Accidents, Traffic↗

Asthma and factory emissions in northern England: addressing public concern by combining geographical and epidemiological methods.

STUDY OBJECTIVE: The prevalence of asthma was assessed to investigate respiratory health effects of airborne emissions from a factory. A geographical information system allowed flexible definition of study areas in terms of their size, distance, and location in relation to the factory. The value of the approach for this type of investigation is focussed on. SETTING: The factory is located in the south western part of a small market town in County Durham. MEASUREMENTS AND MAIN RESULTS: A total of 1573 asthma cases were identified from general practitioner computerised repeat prescribing systems. Population denominators were defined from family health services authority patient registers. The area within 1 km and immediately to the north east of the factory had an age and sex standardised asthma prevalence 24% (confidence interval 4, 44%) in excess of the expected rate (p = 0.01). The increased prevalence was confined to middle aged and elderly adults living in the area between 0.5 and 1 km to the north east of the factory. CONCLUSIONS: The value of combining the skills of geographers and epidemiologists in addressing public health issues is shown, particularly through the use of geographical information systems which proved powerful and effective.

Adolescent↗

Can arguments address concerns?

People have concerns, and ethicists often respond to them with philosophical arguments. But can conceptual constructions properly address fears and anxieties? It is argued in this paper that while it is possible to voice, clarify, create and-to a certain extent-tackle concerns by arguments, more concrete practices, choices, and actions are normally needed to produce proper responses to people's worries. While logical inconsistencies and empirical errors can legitimately be exposed by arguments, the situation is considerably less clear when it comes to moral, cultural, and emotional norms, values, and expectations.

Attitude to Health↗

Addressing students' misconceptions of renal clearance.

Renal clearance is one of the more difficult concepts for students of physiology to learn. We hypothesized that this difficulty is rooted in a student's misunderstanding of virtual volume. This was tested by having students select from several drawings the one they thought plasma would look like after a certain volume of it has been cleared of sodium by the kidneys. About half the participating students selected plasma pictured as having a certain volume of it devoid of sodium molecules. That is, their misconception of clearance seemed to be due to a lack of understanding about virtual volume, a deficiency which is reinforced by the classic definition of clearance. To address this misconception, a demonstration was devised in which a beaker of concentrated colored water was used to represent plasma before renal clearance, a beaker of the same concentrated colored water in which the top third had been replaced by clear mineral oil was used to represent what the definition of clearance said would happen to plasma after a third of it had been cleared of sodium, and a beaker of dilute colored water was used to represent what really happens to plasma when a certain volume of it is cleared of a solute. Incorporating this demonstration into discussions of renal clearance helped students to understand this concept, as evidenced by improved scores on related questions.

Humans↗

The Möbius effect: addressing learner variance in schools.

Currently, educators separate out from typical students those whose learning needs vary from the norm. The norming and sorting process may earmark students as "different" without providing markedly unique instruction and without producing robust academic outcomes. An alternative to fragmentation for some students is the creation of classrooms in which human differences are valued and provided for, yet few teachers (including specialists) seem currently to have the skill or will to develop these sorts of settings. Educators need to examine the potential costs and benefits of alternative approaches to addressing the learning needs that exist among people.

Child↗

When academic assistance is not enough: addressing the mental health issues of adolescents and adults with learning disabilities.

This article focuses on an answer to a critical question for adolescents and adults with learning disabilities: How can professionals assist students with learning disabilities who have psychosocial issues that appear to be affecting their academic progress and life adjustment? Inherent in this inquiry are other, equally important issues, such as: How do learning disabilities service providers know when to involve other service providers? What are the steps in referring a student for further assistance with different mental health issues? When are team interventions necessary? How are team interventions conducted in either secondary or postsecondary settings? How should learning disabilities service providers establish the boundaries of their professional expertise and/or responsibilities to adequately meet the needs of individuals with learning disabilities? This article illustrates answers to these questions by providing examples of interventions and case studies from two federally funded research/demonstration projects at the University of Minnesota: the Learning Disabilities Transition Project and Project Extra. The authors describe theoretical models for mental health services that address the psychosocial issues frequently encountered in academic or vocational settings. Recommendations are also included that discuss how the models can be personalized to fit the reader's home institution or agency.

Adolescent↗

Addressing the inevitable conflicts in reforming teacher education: one department's story.

Embracing a transformative philosophy of special education teacher education, the Department of Special Education at the University of South Florida has undergone significant change over the past several years. Perspectives on the foundational knowledge for this change and the values guiding its realization are shared in this article. Dilemmas arising from the encounter between traditional practice and emerging views are described, along with approaches aimed at understanding and addressing these conflicts.

Child↗