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PubMed2000

Building a foundation for suicide prevention: the contributions of Jack C. Smith.

Among his many other accomplishments, Jack C. Smith nurtured the early development of efforts by the Centers for Disease Control and Prevention (CDC) to address suicide as a public health problem. Smith's vision was to achieve suicide prevention through epidemiology, and his vision shaped the emergence of suicide as a public health issue. With his typical enthusiasm and inherent ability to insinuate himself into critical social networks, Smith spearheaded CDC's initial suicide surveillance activities and established strong partnerships between CDC and the National Institute of Mental Health (NIMH) and the American Association of Suicidology (AAS). These surveillance activities and relationships were the foundation on which subsequent research and programmatic activities addressing suicide as a public health problem were built at CDC. In this paper we document Smith's role in the development of the public health approach to suicide prevention. We also articulate the conceptual basis for a public health approach to suicide and discuss future directions for public health in the prevention of suicide and suicidal behavior. While Smith also made important contributions to development of CDC efforts to address homicide, his special interest was suicide; therefore, this article will emphasize his contributions to this area.

Adolescent↗
PubMed1997

Use of alternative therapies: estimates from the 1994 Robert Wood Johnson Foundation National Access to Care Survey.

This study sought to update national estimates of the use of alternative therapies, to improve the quality of those estimates, and to examine differences between users and nonusers of alternative medicine. Data were analyzed from the general probability sample (N = 3450) of the 1994 Robert Wood Johnson Foundation National Access to Care Survey. The results indicate that nearly 10% of the U.S. population, almost 25 million persons, saw a professional in 1994 for at least one of the following four therapies: chiropractic, relaxation techniques, therapeutic massage, or acupuncture. Even though users of alternative therapies made almost twice as many visits to conventional (or orthodox) medical providers as nonusers made, the former still reported much higher levels of unmet need for medical care. The growing emphasis on market-driven health care and consumer choice suggests that alternative therapies could have a larger role in the health-care system of the future.

Adolescent↗
PubMed1998

A national HIV community cohort: design, baseline, and follow-up of the AmFAR Observational Database. American Foundation for AIDS Research Community-Based Clinical Trials Network.

This article describes the design, methodology, baseline distributions, and general follow-up characteristics of the American Foundation for AIDS Research (AmFAR) National Observational Database (ODB) Project including the benefits and limitations of collecting information on a large simple cohort in the HIV community setting. The study prospectively followed 15,611 HIV-positive men and women and collected longitudinal and cross-sectional data on demographics, medical conditions, drug therapies, laboratory parameters, and survival. Participants were followed between October 1990 and December 1993 by 252 community-based sites coordinated by 22 centers in the Community-Based Clinical Trials Network (CBCT Network) throughout the United States (including Puerto Rico) and Toronto, Canada. The ODB provided quantitative information on a national level needed to track the HIV epidemic and plan clinical trials conducted through the Network, and to provide sites with local databases to monitor patients and facilitate access to therapies in clinical trials. Overall, the ODB contains information on 1,925 women (12%) and 13,686 men (88%), 60% white, 20% African American, 17% Latino/Hispanic, with 56,254 baseline and follow-up forms, a median follow-up of about 12 months, a 16% loss-to-follow-up, and an 11% mortality rate. AmFAR plans to place the ODB in the public domain.

Adolescent↗
PubMed1999

Schizophrenia and bipolar disorder: findings from studies of the Stanley Foundation Brain Collection.

The Stanley Foundation Brain Collection contains a matched set of specimens from patients diagnosed with schizophrenia, bipolar disorder, non-psychotic depression and normal controls. Specimens have been shipped to investigators in more than 50 laboratories around the world. To date, results obtained from studies with this collection indicate that schizophrenia and bipolar disorder may both be characterized by abnormalities in frontal cortical interneurons, although different subpopulations of these neurons may be specifically affected in the two disorders. In samples from patients with familial bipolar disorder and major depression, there are alterations in glial density in cingulate cortex. Specific effects of antidepressant drugs on the transcription factor cAMP regulatory element binding protein and brain-derived neurotrophic factor have also been observed.

Antidepressive Agents↗
PubMed2000

The stanley foundation brain collection and neuropathology consortium.

The Stanley Foundation brain collection is an attempt to supplement existing brain collections for the purpose of promoting research on schizophrenia and bipolar disorder. Specimens are collected with the permission of the families in a standardized manner, with half of each specimen being frozen and half fixed in formalin. The Neuropathology Consortium is a subset of 60 specimens from the collection, well-matched groups of 15 each with diagnoses of schizophrenia, bipolar disorder, major depressive disorder without psychotic features, and normal controls. More than 75000 sections and blocks from the Consortium have been sent to over 50 research groups worldwide to carry out a wide variety of assessments. These data will be integrated to provide a more complete picture of the neuropathology of these disorders.

Adult↗
PubMed2001

A solid foundation: functional specialization of centromeric chromatin.

Centromeres provide a distinctive mechanical function for the chromosomes as the site of kinetochore assembly and force generation in mitosis and meiosis. Recent studies show that a unique form of chromatin, based on the histone-H3-like protein CENP-A and homologues, provides a conserved foundation for this mechanical chromatin domain. CENP-A plays a role in templating kinetochore assembly and may be a central element in the epigenetic maintenance of centromere identity. Cohesion at the centromere, intimately linked to kinetochore assembly, is required for integrating spindle forces exerted across the centromere and for establishing the bipolar geometry of sister kinetochores.

Animals↗
PubMed2002

Creating a culture of medication administration safety: laying the foundation for computerized provider order entry.

BACKGROUND: Computerized provider order entry (CPOE) systems are recognized as an effective tool for reducing preventable adverse drug events; however, implementation is a complex process that involves much more than installing new software. The literature addresses the use of these systems in large tertiary care hospitals and university settings; yet there is little information on their implementation and use in smaller hospitals. Beaver Dam Community Hospital, a small, rural hospital, set about laying the foundation for implementing CPOE. Actions were taken in terms of context (the culture and attitude, acceptance, and importance regarding the change), process (roles, workflow, and policies relating to the change), and content (how-to, such as procedural steps and rules). USE OF THE RAPID-CYCLE IMPROVEMENT PROCESS: The team elected to use the rapid-cycle improvement process for implementation to allow it to move ahead quickly, adjusting changes as necessary for maximum success. Each change was considered an individual Plan-Do-Check-Act cycle, with its own action plan and measurement for successful implementation. PLANNING ACTUAL IMPLEMENTATION: The Patient Safety Committee has begun the planning of actual implementation--Phase II. Issues addressed include how to phase in the system--in which units to bring up first, how to structure the transitional period, how to redesign workflow, and how to plan role changes. SUMMARY: The changes already implemented contribute to medication safety and are important from that perspective alone, without the use of CPOE. The addition of an electronic system will enhance the organization's ability to provide safe, accurate medication administration.

Clinical Pharmacy Information Systems↗
PubMed2000

Analyzing the molecular foundations of commensalism in the mouse intestine.

We maintain complex societies of nonpathogenic microbes on our mucosal surfaces. Although the stability of this flora is important for human health, very little is known about how its constituents communicate with us to forge stable and mutually advantageous relationships. The vast majority of these indigenous microbes reside in the intestine. Recent studies of a gut commensal, Bacteroides thetaiotaomicron, has revealed a novel signaling pathway that allows the microbe and host to actively collaborate to produce a nutrient foundation that can be used by this bacterium. This pathway illustrates the type of dynamic molecular interactions that help define commensal relationships.

Animals↗
PubMed2003

Developing the ontological foundations of a terminological system for end-stage diseases, organ failure, dialysis and transplantation.

The Etablissement français des Greffes (EfG) is a state agency dealing with Public Health issues related to organ, tissue and cell transplantation in France. The evaluation of organ retrieval and transplantation activities, one of its missions, is supported by a national information system (EfG-IS). The EfG-IS is moving towards a new n-tier architecture comprising a terminology server for end-stage diseases, organ failure, dialysis and transplantation (EfG-TS). Following a preliminary audit of the existing coding system and in order to facilitate data recording, to improve the quality of information, to assume compatibility with terminological existing standards and to allow semantic interoperability with other local, national or international registries, a specific work has been conducted on the thesauri to integrate within the EfG-TS. In this paper focusing on the server's content rather than the container, we report first the functional and cognitive requirements that resulted from the preliminary audit. We then describe the methodological approach used to build the terminological server on "sound ontological foundations". We performed the semantic analysis of existing medical terms to set up disease description frame-like structures. These diseases description frames consist of a limited set of nosological discriminating slots such as etiology, semiology, pathology, evolution and associated diseases. Each relevant medical term is thus associated to a concept defined and inserted within a hierarchy according to disease description frame resulting from the semantic analysis. Last, because this terminological server is shared by various transplant and dialysis centers to record patient data at different time point, contextualization of terms appeared as one of the functional requirements. We will also point out various contexts for medical terms and how they have been taken into account.

Automation↗
PubMed2000

Sport and exercise medicine: building the foundations of a new discipline.

New disciplines emerge as medicine evolves. But, to be recognised as a clinical discipline we must be prepared to measure ourselves against established criteria; there should be consensus on the core content of the discipline and an identifiable body of knowledge to allow us to deal with common clinical problems. At this developmental stage in our evolution we have general agreement on what defines sport and exercise medicine but, as most of our clinical skills developed empirically, research is relatively underdeveloped. The volume and quality of this research does not yet reflect a vibrant research culture. The validity of our clinical method is supported by research evaluating the sensitivity and specificity of clinical tests but the evidence supporting other areas of clinical practice is uncertain. Some aspects of prevention have become integrated into clinical practice without sufficient evidence and, screening has been introduced without critical evaluation. To ensure the future success of our discipline and achieve recognition of its value in the wider medical community, we must nurture an evaluative culture and ensure that clinical practice is built on firm foundations of research evidence.

Athletic Injuries↗
PubMedDate not supplied

Information literacy as the foundation for evidence-based practice in graduate nursing education: a curriculum-integrated approach.

As part of a system-wide initiative to advance evidence-based practice among clinicians, graduate students, and educators, the New York University Division of Nursing embarked on a curricular initiative to integrate components of information literacy in all core courses of the master's program. Increasing competency in information literacy is the foundation for evidence-based practice and provides nursing professionals with the skills to be literate consumers of information in an electronic environment. Competency in information literacy includes an understanding of the architecture of information and the scholarly process; the ability to navigate among a variety of print and electronic tools to effectively access, search, and critically evaluate appropriate resources; synthesize accumulated information into an existing body of knowledge; communicate research results clearly and effectively; and appreciate the social issues and ethical concerns related to the provision, dissemination, and sharing of information. In collaboration with the New York University Division of Libraries' Health Sciences Librarian, instructional modules in information literacy relevant to each of the 5 core nursing master's courses were developed, complemented by a Web-based tutorial: http://library.nyu.edu/research/health/tutorial. The Web site is multifaceted, with fundamentals for the beginner, as well as more complex content for the advanced user. Course assignments were designed to promote specific competencies in information literacy and strategies for evaluating the strength of the evidence found. A survey of information literacy competencies, which assessed students' knowledge, misconceptions, and use of electronic information resources, was administered when students entered the program and at 1-year intervals thereafter.

Computer Literacy↗
PubMed2003

The philosophical foundations of Aleksandr R. Luria's neuropsychology.

This article attempts to show that the cultural-historical psychological theory of Aleksandr R. Luria (Luriya) and his colleagues is based on the foundations of historical materialism. It argues in particular that Luria's psychology, neuropsychology, and brain theory are integrated in the same scientific research program and are based on the same philosophical premises, and that his theories must be interpreted in the Marxist context in which they are embedded. Luria's research program asserts that the development of higher mental functions depends on the appropriation of cultural means, particularly language, within social practice. Moreover, the brain structures underlying mental functions are also dependent on the appropriation of cultural means. Luria's clinical diagnosis and his program for rehabilitation of patients with brain lesions are based on his psychological theory and brain theory. The following analysis of Luria's comprehensive program will show that a socio-cultural non-reductive explanation of mental functions and their underlying brain structures may have implications for the philosophical discussion of the mind-brain problem.

Communism↗
PubMed2004

Influence of the foundation layer on the layer-by-layer assembly of poly-L-lysine and poly(styrenesulfonate) and its usage in the fabrication of 3D microscale features.

The layer-by-layer (LBL) assembly of a polypeptide, poly-L-lysine (PLL), with poly(styrenesulfonate) sodium salt (PSS) on flat template-stripped gold (TSG) surfaces precoated with a self-assembled monolayer of alkanethiols terminated with positive (pyridinium), negative (carboxylic acid), and neutral [hexa(ethylene glycol)] groups is investigated. Both the topography and the rate of film thickness growth are found to be strongly dependent on the initial surface foundation layer. LBL assembly of PLL and PSS on patterned TSG surfaces produced by micro contact printing leads to structurally distinct microscale features, including pillars, ridges, and wells, whose height can be controlled with nanometer precision.

Membranes, Artificial↗
PubMedDate not supplied

Peracylation of nucleosides with methionine: foundation for a method to detect carcinogen adducts.

We report the chemical foundation for a new method to detect carcinogen-DNA adducts, which we have designated adduct detection by acylation with methionine (ADAM). The method is based on reaction of DNA adducts with a protected methionine derivative, (tert-butoxycarbonyl)-L-methionine N-hydroxysuccinimidyl ester (TMB-NHS). Acylation of 2'-deoxyguanosine (dGuo), used as a prototypical deoxynucleoside, and N-(deoxyguanosin-8-yl)-4-aminobiphenyl (dGuo-8-ABP), the major DNA adduct formed after in vivo exposure to 4-aminobiphenyl, a known human carcinogen, with TBM-NHS was optimized, and products were characterized by 3H radioactivity, UV absorbance, mass spectrometry, and 1H and 13C NMR. Derivatives acylated on hydroxyl (5' or 3') and/or amine (N2) groups were unambiguously determined to be mono-, bis-, and tris-TBM-acylated nucleosides. Under optimal acylation conditions [TBM-NHS (> or = 4 x 10(5) molar equivalents), pyridine (50 microL), THF (50 microL), and diisopropylcarbodiimide (DIC) (1 microL) and incubation for 2 h at 37 degrees C], the efficiency of acylation for picomole or smaller quantities of dGuo-8-ABP exceeded 95%, with the tris-TMB-acylated nucleoside representing the major product (88%). A linear correlation was obtained between the amount of [3H]dGuo-8-ABP introduced into the reaction and the total amount of TBM-acylated products formed. These results support the validity of this strategy for adaptation as an analytical method for the detection of low levels of DNA adducts through the use of (tert-butoxycarbonyl)-L-[35S]-methionine N-hydroxysuccinimidyl ester.

Acylation↗
PubMed2003

Charitable State-Controlled Foundation Human Tissue and Cell Research: Ethic and Legal Aspects in the Supply of Surgically Removed Human Tissue For Research in the Academic and Commercial Sector in Germany.

Tissue engineering using human cells and tissue has one of the greatest scientific and economical potential in the coming years. There are public concerns during the ongoing discussion about future trends in life sciences and if ethic boundaries might be respected sufficiently in the course of striving for industrial profit and scientific knowledge. Until now, the legal situation of using human tissue material for research is not clear. Accordingly, transparency of action and patients' information are a central component when handling patient material inside and outside of the patient-specific treatment. Whereas in the field of therapeutic use of tissue (e.g. transplantation) there is an emergency situation by the shortage of organs with the risk of the premature death of the potential recipient, this cannot be claimed for tissue donation for research. The basis of every surgical operation is the treatment contract, which places the doctor under obligation to the careful exercise of medical treatment containing the patient's informed consent. This contract only covers the treatment that is intended to cure the patient and the medical measures that are necessary therefor. The further scientific use of body-substances, which are discarded after an operation, are not included. Therefore a personal and independent written enlightenment of the patient and a declaration of informed consent is necessary. Examples of guidelines for tissue supply, Patients information and consent were worked out by theologists, lawyers, scientists and physicians reflecting their practical experience in transplant surgery and liver cell research. As a consequence to cover the ethical and legal aspect of tissue donation in Germany a charitable state-controlled foundation Human Tissue and Cell Research (HTCR) was introduced and established.

Journal Article↗
PubMed2001

Evaluation of the Skin and Cancer Foundation standard series in the diagnosis of allergic contact dermatitis.

The use of a standard series of 37 allergens was evaluated in a retrospective study of 817 consecutive patients seen between April 1988 and January 1993 at the Skin and Cancer Foundation, Melbourne, Australia. Of the 316 patients with clinically relevant patch test results, 134 (42%) reacted to an allergen in the standard series alone, while an additional 122 (39%) had reactions to allergens in both the standard and supplementary series. The remaining 60 (19%) patients reacted only to allergens in the supplementary series. These data suggest that the use of our standard series alone will detect about 80% of allergic contact dermatitis cases, but that many of these may be insufficiently evaluated. Use of supplementary allergen testing in a specialised clinic is recommended for patients who may have allergic contact dermatitis.

Allergens↗
PubMed2006

Contingency, imitation, and affect sharing: Foundations of infants' social awareness.

Predictions about the role of contingency, imitation, and affect sharing in the development of social awareness were tested in infants during natural, imitative, and yoked conditions with their mothers at 5 and 13 weeks of age. Results showed that at both ages, infants of highly attuned mothers gazed, smiled, and vocalized positively more during the natural than during the imitative and yoked conditions, whereas they increased negative vocalizations during the yoked conditions. In contrast, infants of less attuned mothers did not differentiate between the conditions, except at 13 weeks when these infants increased their gazes during the imitative condition. Whereas contingency and imitation draw infant attention to conspecifics, affective communication appears to lay the foundation for infants' social awareness.

Affect↗
PubMed2005

Diffusion of an effective skin cancer prevention program: design, theoretical foundations, and first-year implementation.

This article describes the design and theoretical foundations of the Pool Cool Diffusion Trial and reports 1st-year findings. Aims of the study are to evaluate the effects of 2 strategies for diffusion of the Pool Cool sun safety program on implementation, maintenance, and sustainability; improvements in environmental supports for sun safety in swimming pools; and sun protection habits and sunburn among participating children. There was a high rate of program participation (86.6%; n=375 swimming pools) in the 1st year and somewhat lower study participation (75.8%). Analysis of pool manager surveys revealed a time effect for overall sun safety programs and for sun safety policies, environmental strategies, and programs for pool users. There were few differences in implementation between treatment groups in year one.

Child↗