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PubMed1998

[Drinking decisions: an intoxicating challenge].

As a secondary prevention program for reducing alcohol consumption, l'Alcochoix is designed to be managed by nurses. The underlying principles are those of the cognitive behavioral approach. The target population is adults who consume between 15 to 35 drinks a week but who are not considered alcoholics. Between 1995 and 1996, 207 persons from the Montreal area took part in the evaluation research to determine the efficiency of this program, which originated from Edmonton, Alberta. Consumption declined by half among the participants, three months after program completion. A companion article that describes the Edmonton experience appears in English in this issue, under the title "Drinking Decisions: An innovative approach to problem drinking."

Adult↗
PubMedDate not supplied

Variation in average costs among federally sponsored state-organized cancer detection programs: economies of scale?

BACKGROUND: Societal cost-effectiveness analysis and its variants help decision makers achieve an efficient allocation of resources across the set of all possible health interventions. Sometimes, however, decision makers are focused instead on the efficient allocation of resources within a particular intervention program that has already been implemented. This is especially true when the intervention is being delivered at several different sites. An analysis of average cost across program sites may help program officials to maximize the health benefits that can be achieved with limited resources. In this article, the authors present such an analysis, with special attention paid to the possible existence and implications of economies of scale. METHODS: Focusing on federally sponsored, state-organized cancer detection programs, the authors modeled 19 state programs as productive processes and examined their average costs over a 2- to 5-year period of operation. They considered 3 alternative definitions of output: women served, screens performed, and conditions detected. Average federal costs and average total costs were estimated for each grant period. Multivariate regression analysis was used to help explain the variation in average costs. RESULTS: The average cost estimates were distributed in a skewed pattern with the majority of observations falling close to the median and substantially below the mean. For all measures considered, average cost decreased as output expanded. This inverse relationship between average cost and output level persisted even after controlling for the effects of other predictors, suggesting the possible existence of economies of scale. DISCUSSION: The potential existence of economies of scale calls into question the assumption of a constant average cost frequently made in economic analyses of proposed public health programs. It also implies that a) differences in output level should be taken into account when comparing operating efficiency across program sites; b) conclusions from societal cost-effectiveness analyses may depend on the level of output at which the programs are evaluated; c) cost projections could be inaccurate if they do not take into account the decrease in average cost that occurs as output expands; and d) gains might be possible if similar programs with limited output potential are integrated, perhaps through cost sharing.

Breast Neoplasms↗
PubMed1986

The role of the microsurgical laboratory in orthopedic training programs.

A well-organized, efficiently run microsurgical research and training laboratory can be a valuable asset to an orthopedic training program. The three areas in which the laboratory can lend support are teaching, research, and clinical. Organization and utilization of the laboratory as a multifunctional facility can enable it to provide maximum support for the microsurgical aspects of the orthopedic training program.

Humans↗
PubMed2000

Delivery and interactive processing of visual data for a cooperative telemedicine environment.

Cooperative telemedicine environments are required for many situations such as consultations between residents and senior doctors, case correlations, and for teaching and research purposes. The mode of collaboration may vary with different situations, in terms of the synchronisation of tasks, the sharing of data and the extent of collaboration among participants. It is essential for participants to be able to remotely view and manipulate visual data (images, two-dimensional and three-dimensional graphics, animation, and video) as well as interactively run application programs that involve visual data in real-time. However, this is not possible with current network bandwidth limitations when large amount of visual data are involved. In this article, we first provide an analysis of functional requirements by participants in cooperative diagnosis in different types of situations, before discussing technical requirements, which form the basis for our system architecture design. A new approach is also presented for efficient handling of programs, which involve visual data in real time. This is achieved via the construction and transmission of small messages that encapsulate the operations in a pipelined or hierarchical fashion.

Computer Graphics↗
PubMed1992

Child psychiatry and early intervention: IV. The externalizing disorders.

This paper is the last in a series of four using the concept of the aggregate burden of suffering to review the major psychiatric disorders of childhood. This paper reviews the externalizing disorders of childhood to prioritize early intervention programs. The paper discusses the prevalence, course, risk and early indicators, associated impairments, and responses to intervention. The externalizing disorders affect the individual, family and community and are thought to result in the greatest aggregate burden of suffering of all the childhood mental disorders. Early intervention is advocated and will likely need to be intense and long term for this group of children. The need for research into efficient and effective programs is emphasized.

Adolescent↗
PubMed1999

[Parental assessment of a psycho-oncologic treatment concept in pediatrics].

Treatment-accompanied psychosocial care of pediatric cancer patients and their families is quite established nowadays. In this study a family-oriented psychosocial intervention program was evaluated. 76 parents filled out an questionnaire about the utilization and efficiency of different parts of the program. The results show that the efficiency of the intervention program is very high. Nationality of the families, socioeconomic status und the presence of a relapse of the cancer were the most important predictors of taking part in the different parts of the program. Parents reported that the most positive effects of the psychosocial intervention program consisted in a gain of information and a better intrafamiliar communication. In conclusion the evaluation showed a high acceptance of the family-oriented psychosocial intervention program and positive effects on the whole family.

Adolescent↗
PubMed2005

Using concept mapping to design an indicator framework for addiction treatment centres.

OBJECTIVE: The objective of this study is to determine an indicator framework for addiction treatment centres based on the demands of stakeholders and in alignment with the European Foundation for Quality Management (EFQM) Excellence Model. SETTING: The setting is the Jellinek Centre based in Amsterdam, the Netherlands, which serves as a prototype for an addiction treatment centre. METHOD: Concept mapping was used in the construction of the indicator framework. During the 1-day workshop, 16 stakeholders generated, prioritized and sorted 73 items concerning quality and performance. Multidimensional scaling and cluster analysis was applied in constructing a framework consisting of two dimensions and eight clusters. RESULTS: The horizontal axis of the indicator framework is named 'Organization' and has two poles, namely, 'Processes' and 'Results'. The vertical axis is named ' Task' and the poles are named 'Efficient treatment' and 'Prevention programs'. The eight clusters in the two-dimensional framework are arranged in the following, prioritized sequence: 'Efficient treatment network', 'Effective service', ' Target group', 'Quality of life', 'Efficient service', 'Knowledge transfer', 'Reducing addiction related problems', and 'Prevention programs'. The most important items in the framework are: 'patients are satisfied with their treatment', 'early interventions', and 'efficient treatment chain'. CONCLUSION: The indicator framework aligns with three clusters of the results criteria of the EFQM Excellence Model. It is based on the stakeholders' perspectives and is believed to be specific for addiction treatment centres. The study demonstrates that concept mapping is a suitable strategy for generating indicator frameworks.

Benchmarking↗
PubMed1999

Financial incentives for ambulatory care performance improvement.

BACKGROUND: Measuring and improving the quality of care while curtailing costs are essential objectives in capitated care. As patient care moves from the hospital to outpatient settings, quality management resources must be shifted to ambulatory care process improvement. The Quality Improvement and Efficiency Financial Incentives Program at Stanford University Medical Center was adopted to increase quality improvement efforts and contain costs. THE INCENTIVE PROGRAM: Each department's budget for care of capitated patients was reduced by 5% from the previous year. Return of a reserve fund (10% of payments for specialty care) required completion of substantive quality improvement projects and containing costs. Successful departments were also eligible for bonus funds. Implementation strategies included endorsement by clinical leaders, physician education, use of administrative data to identify project topics and support measurement of quality and cost variables, project templates and time lines, and the availability of clinical quality managers with special expertise in clinical process improvement. RESULTS: Eight of 13 clinical departments developed and implemented 19 ambulatory quality improvement projects to varying degrees. Success in the program was roughly correlated with the potential impact of the incentive on revenues and the status of the lead person selected by the department to spearhead their efforts. Only 5 departments achieved their cost containment goals. DISCUSSION: Financial incentives are one method of encouraging physicians to use clinical process improvement methods. Endorsement by clinical leaders and selection of realistic beginning projects enhance chances for success. The capitated population has attributes that make it an attractive focus for initial quality improvement efforts.

California↗
PubMed1992

Cost-sharing and the future of fees for service for frail elders in state programs.

Although Congress has rejected the concept of mandatory cost-sharing under the Older Americans Act, many states already use client fee systems under state-funded home and community-based services programs. This research included a survey of actual state experiences and a review of earlier studies. States are compared on issues concerning policy and experience with fee systems, including income verification, fee schedules, termination policies, and costs of administration. Although policy and practice differ markedly across states, certain states are close to operationalizing comprehensive policies in this area. The author concludes that there is a need to conduct additional state-level demonstrations that address policy issues identified in the research. Evaluation research is needed to determine program effectiveness and efficiency, particularly concerning whether cost-sharing increases the amount of services available and ensures a high level of services to minorities.

Aged↗
PubMed2005

Cyclophilin A is localized to the nucleus and controls meiosis in Saccharomyces cerevisiae.

Cyclophilin A is conserved from yeast to humans and mediates the ability of cyclosporine to perturb signal transduction cascades via inhibition of calcineurin. Cyclophilin A also catalyzes cis-trans peptidyl-prolyl isomerization during protein folding or conformational changes; however, cyclophilin A is not essential in yeast or human cells, and the true biological functions of this highly conserved enzyme have remained enigmatic. In Saccharomyces cerevisiae, cyclophilin A becomes essential in cells compromised for the nuclear prolyl-isomerase Ess1, and cyclophilin A physically interacts with two nuclear histone deacetylase complexes, Sin3-Rpd3 and Set3C, which both control meiosis. Here we show that cyclophilin A is localized to the nucleus in yeast cells and governs the meiotic gene program to promote efficient sporulation. The prolyl-isomerase activity of cyclophilin A is required for this meiotic function. We document that cyclophilin A physically associates with the Set3C histone deacetylase and analyze in detail the structure of this protein-protein complex. Genetic studies support a model in which cyclophilin A controls meiosis via Set3C and an additional target. Our findings reveal a novel nuclear role for cyclophilin A in governing the transcriptional program required for the vegetative to meiotic developmental switch in budding yeast.

Blotting, Northern↗
PubMed2006

GUUGle: a utility for fast exact matching under RNA complementary rules including G-U base pairing.

MOTIVATION: RNA secondary structure analysis often requires searching for potential helices in large sequence data. RESULTS: We present a utility program GUUGle that efficiently locates potential helical regions under RNA base pairing rules, which include Watson-Crick as well as G-U pairs. It accepts a positive and a negative set of sequences, and determines all exact matches under RNA rules between positive and negative sequences that exceed a specified length. The GUUGle algorithm can also be adapted to use a precomputed suffix array of the positive sequence set. We show how this program can be effectively used as a filter preceding a more computationally expensive task such as miRNA target prediction. AVAILABILITY: GUUGle is available via the Bielefeld Bioinformatics Server at http://bibiserv.techfak.uni-bielefeld.de/guugle

Algorithms↗
PubMed1989

Changes in energy expenditure and work during response acquisition in rats.

The principle of least effort predicts that behavior will tend to maximum efficiency. To test this prediction, changes in the energy expended (VO2) and work performed per reinforcement were monitored continuously as rats learned to press a beam with a criterion force for liquid food rewards. All 12 subjects exhibited significant decreases in energy expended per reinforcement over the 16 days of observation. Of these, 10 subjects also decreased the work performed per reinforcement. Analyses of motor performance were undertaken to determine how motor programs for changing efficiency were generated. The 10 animals showing decreased work reinforcement also exhibited significant decreases in the variability of temporal and kinetic response features and in mean response magnitude (time integral of force or work per response) as a function of practice. Adjustments in work output were primarily accomplished by modifying temporal response features (response duration and, initially, interresponse time). The kinetic features (response recruitment and peak force) remained relatively constant for these animals. The remaining 2 subjects differed in that response recruitment increased after Day 9, resulting in progressively larger amounts of work being performed to earn each reinforcement, and the interval between successive reinforcements decreased.

Animals↗
PubMed2005

Maximizing discovery efficiency with a computationally driven fragment approach.

A reliable and accurate method for the computational design of novel drug candidates has been a passionate pursuit of the pharmaceutical industry. Such technology would dramatically improve the efficiency of drug discovery by quickly and inexpensively providing potent molecules that can be further prioritized for synthesis based on characteristics such as patentability, specific protein-ligand interactions, ease of chemical synthesis, protein selectivity and pharmacological considerations. Described herein is the progress made at Locus Pharmaceuticals Inc toward achieving this ideal with a fragment-driven, computationally directed approach to small-molecule discovery. Specific lead identification examples from Locus Pharmaceuticals discovery programs demonstrate the efficiency and cost-effectiveness realized by such an approach.

Animals↗
PubMed1976

A comparative study to evaluate three separate computer programs for electrocardiographic interpretation.

To compare the efficiency and accuracy of three separate computer programs for interpreting electrocardiograms, 50 EKGs run on patients hospitalized in our institution were transmitted to each of the three participating computer programs. The EKGs were then inspected individually by three cardiologists who later correlated and compared their results with the interpretations provided by the computer. The computer program used by Telemed Corporation provided the greatest frequency of totally correct and clinically acceptable interpretations as well as the least number of unacceptable or incorrect interpretations. The Bonner program was an acceptable second. The Mayo-Smith program had a much larger number of disagreements with the clinical cardiologists, and was far less acceptable for clinical use in their opinion.

Diagnosis, Computer-Assisted↗
PubMed2006

Hybrid maize breeding with doubled haploids: II. Optimum type and number of testers in two-stage selection for general combining ability.

Optimum allocation of test resources is of crucial importance for the efficiency of breeding programs. Our objectives were to (1) determine the optimum allocation of the number of lines, test locations, as well as number and type of testers in hybrid maize breeding using doubled haploids with two breeding strategies for improvement of general combining ability (GCA), (2) compare the maximum selection gain (DeltaG) achievable under both strategies, and (3) give recommendations for the optimum implementation of doubled haploids in commercial hybrid maize breeding. We calculated DeltaG by numerical integration for two two-stage selection strategies with evaluation of (1) testcross performance in both stages (BS1) or (2) line per se performance in the first stage followed by testcross performance in the second stage (BS2). Different assumptions were made regarding the budget, variance components (VCs), and the correlation between line per se performance and GCA. Selection gain for GCA increased with a broader genetic base of the tester. Hence, testers combining a large number of divergent lines are advantageous. However, in applied breeding programs, the use of single- or double-cross testers in the first and inbred testers in the second selection stage may be a good compromise between theoretical and practical requirements. With a correlation between line per se performance and GCA of 0.50, DeltaG for BS1 is about 5% higher than for BS2, if an economic weight of line per se performance is neglected. With increasing economic weight of line per se performance, relative efficiency of BS2 increased rapidly resulting in a superiority of BS2 over BS1 already for an economic weight for line per se performance larger than 0.1. Considering the importance of an economic seed production, an economic weight larger than 0.1 seems realistic indicating the necessity of separate breeding strategies for seed and pollen parent heterotic groups.

Breeding↗
PubMedDate not supplied

Health care marketing of community education programs.

Today's hospital industry is identifying new market philosophies to meet the public's needs. With more informed consumers and increased health options, progressive hospitals are utilizing community health education as a valuable resource for marketing new and existing health services to attract and retain patients. Understanding the changes and barriers in health care, while knowing the institution's strengths and weaknesses through situational and consumer analysis, can assist the community education staff in developing sound health marketing strategies. A systematic approach for probing, planning products, pricing, placing, and promoting community health services with national, hospital, and departmental health focuses can produce a consistent and efficient community education programming system that will aid in the hospital's survival.

Community-Institutional Relations↗
PubMedDate not supplied

Rapid mutation scanning of genes associated with familial cancer syndromes using denaturing high-performance liquid chromatography.

Germline mutations in tumor suppressor genes, or less frequently oncogenes, have been identified in up to 19 familial cancer syndromes including Li-Fraumeni syndrome, familial paraganglioma, familial adenomatous polyposis coli and breast and ovarian cancers. Multiple genes have been associated with some syndromes as approximately 26 genes have been linked to the development of these familial cancers. With this increased knowledge of the molecular determinants of familial cancer comes an equal expectation for efficient genetic screening programs. We have trialled denaturing high-performance liquid chromatography (dHPLC) as a tool for rapid germline mutation scanning of genes implicated in three familial cancer syndromes -- Cowden syndrome (PTEN mutation), multiple endocrine neoplasia type 2 (RET mutation) and von Hippel-Lindau disease (VHL mutation). Thirty-two mutations, including 21 in PTEN, 9 in RET plus a polymorphism, and 2 in VHL, were analyzed using the WAVE DNA fragment analysis system with 100% detection efficiency. In the case of the tumor suppressor gene PTEN, mutations were scattered along most of the gene. However, mutations in the RET proto-oncogene associated with multiple endocrine neoplasia type 2 were limited to specific clusters or "hot spots." The use of GC-clamped primers to scan for mutations scattered along PTEN exons was shown to greatly enhance the sensitivity of detection of mutant hetero- and homoduplex peaks at a single denaturation temperature compared to fragments generated using non--GC-clamped primers. Thus, when scanning tumor suppressor genes for germline mutation using dHPLC, the incorporation of appropriate GC-clamped primers will likely increase the efficiency of mutation detection.

Chromatography, High Pressure Liquid↗
PubMed2002

[Studies of the relationship between the breeding efficiency of anther culture and the use of different hybrid generations as anther-donor plants in wheat].

The wheat haploid plantlets from anther culture were of theoretical and applied interest. Induced haploid spirophytes may play a key role, not only in increasing the efficiency of breeding programs by producing pure lines rapidly, but also in the elucidation of fundamental genetics. However large number of experiments turned out that there are many problems with low rate of green plantlet from anther culture, difficulties of saving plantlets though summer, low rate of double chromosome, extrusive contradiction between technique of wheat anther culture and variety improvement. So wheat anther culture has not played a role in wheat breeding. Studies were carried out on the relationship between the breeding efficiency of anther culture and the use of different hybrid generations as anther-donor plants in wheat. It was shown that previously the low breeding efficiency of anther culture in wheat cross breeding was mainly due to the use of F1 as anther donors. Experimental results demonstrated that the breeding efficiency of anther culture in F1 generation was very low, especially when the doubled haploid population was very small. Based on the experimental results as well as the theoretical analysis this paper proposes that the use of F2 or F3 (especially F3) as anther donors in combination with the conventional selection in the fields will increase the breeding efficiency of anther culture. Under the guidance of this proposal two wheat varieties have been developed within 5-7 years through anther culture.

Culture Techniques↗