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At least 685 records · Page 38Linked to original sources
PubMed1990

Community mental health: who is being served? What is being offered?

Policy changes in the 1980s have altered the financial status of community mental health centers. Directors have operated, in most cases, with fewer resources than in past decades. How have these reduced resources changed the service delivery system and the characteristics of clients being served? To address these questions, a research project including 69 mental health centers from 27 states was conducted in 1987. While most of the originally mandated community mental health services are still provided, consultation, education and prevention services have been cut back substantially or terminated. Revenue-producing programs and time efficient treatment methods are used more frequently. Despite a higher priority given to the chronic mentally ill, community mental health centers are not serving those without the ability to pay in the same numbers as they have in the past. Some thoughts regarding a modification of the community mental health model are offered.

Community Mental Health Centers↗
PubMed2001

[Perioperative anemia].

Anemia is a frequent finding, particularly in the elderly population, and usually indicative of a serious disease. The main causes of preoperative anemia are acute or chronic hemorrhage, iron deficiency, renal insufficiency, inflammatory and neoplastic diseases. A preexisting mild anemia may be enhanced or unmasked by surgically induced bleeding or repeated diagnostic phlebotomies, and by a postoperative erythropoietic dysfunction caused by the surgical trauma, irrespective of any hemorrhage. Low hemoglobin values are associated with a distinct increase of mortality and morbidity, both in the normal population and perioperatively and in the critically ill patients. The anemia-associated risk is exacerbated by preexisting cardiovascular disease, important intraoperative blood loss and advanced age. In contradiction to established therapeutical concepts, the administration of allogeneic blood beyond hemoglobin levels of 8-10 g/dl has not been found to decrease perioperative or intensive care morbidity or mortality. Rather, in addition to the inherent long-term risks of transfusions, a liberal transfusion strategy seems to increase the incidence of postoperative complications. Thus, current transfusion guidelines tend to be interpreted in an increasingly restrictive manner. Depending on the urgency of the clinical situation, the primary goal should be to diagnose and treat the underlying disease, rather than to focus on the symptom anemia. Time permitting, the patient's cardiovascular and pulmonary status should be optimized preoperatively. Furthermore, iron should be substituted to treat and prevent deficiency. Recombinant human erythropoietin has successfully been used to treat anemia of chronic renal failure and chronic disease, as well as in the perioperative and intensive care setting, and to support the efficiency of autologous programs.

Aged↗
PubMed2006

Hybrid maize breeding with doubled haploids: I. One-stage versus two-stage selection for testcross performance.

Optimum allocation of resources is of fundamental importance for the efficiency of breeding programs. The objectives of our study were to (1) determine the optimum allocation for the number of lines and test locations in hybrid maize breeding with doubled haploids (DHs) regarding two optimization criteria, the selection gain deltaG(k) and the probability P(k) of identifying superior genotypes, (2) compare both optimization criteria including their standard deviations (SDs), and (3) investigate the influence of production costs of DHs on the optimum allocation. For different budgets, number of finally selected lines, ratios of variance components, and production costs of DHs, the optimum allocation of test resources under one- and two-stage selection for testcross performance with a given tester was determined by using Monte Carlo simulations. In one-stage selection, lines are tested in field trials in a single year. In two-stage selection, optimum allocation of resources involves evaluation of (1) a large number of lines in a small number of test locations in the first year and (2) a small number of the selected superior lines in a large number of test locations in the second year, thereby maximizing both optimization criteria. Furthermore, to have a realistic chance of identifying a superior genotype, the probability P(k) of identifying superior genotypes should be greater than 75%. For budgets between 200 and 5,000 field plot equivalents, P(k) > 75% was reached only for genotypes belonging to the best 5% of the population. As the optimum allocation for P(k)(5%) was similar to that for deltaG(k), the choice of the optimization criterion was not crucial. The production costs of DHs had only a minor effect on the optimum number of locations and on values of the optimization criteria.

Breeding↗
PubMed2003

Identification of risk factors for future fracture in patients following distal forearm fracture.

The challenge for healthcare systems around the world is delivering timely preventative strategies to subjects most likely to develop fragility fractures. The success or failure of national campaigns will be determined at local level, and many studies to date have found under-utilization of osteoporosis treatment strategies due to reduced public and healthcare professional awareness. An important link between the at-risk patients and their appropriate therapy is their identification and assessment. In the context of a medium sized secondary care provider, this study examined the efficiency of a nurse-led service for assessing women following distal forearm fracture, looking for additional risk factors for future fracture and also looking at uptake of the assessment programme among the target population. Two hundred and two women, median (range) age 69 (50-91) years presented with distal forearm fracture over a 9-month period. Fifty-four subjects did not participate in the study: they were significantly older than those who did ( P<0.002). One hundred and forty-eight subjects underwent assessment of falls risk, future hip fracture risk and calcaneal ultrasound attenuation measurement: 107 attended for assessment at the hospital and 41 required a health professional to visit at their place of residence-the latter group were significantly older ( P<0.0002). Of 148 subjects assessed, 76 (51%) had one or more risk factors for a fall: these subjects were significantly older ( P<0.0002) and more likely to have required a home visit ( P<0.002). Twenty-seven (18%) were considered at risk of a future hip fracture: again they were older and more likely to have required a home visit ( P<0.0005). Ninety-one subjects (61%) had a calcaneal ultrasound attenuation T-score below -2.0, and were referred for bone densitometry: again, they were older ( P<0.0002) and more likely to have required a home visit ( P<0.05). Bone densitometry demonstrated osteoporosis in 47 (52%) of those with low attenuation, osteopenia in 31 and normal bone density in 13. Of 76 subjects deemed to be at risk of falls, 31 (41%) had osteoporosis demonstrated on bone densitometry and of those at risk of future hip fracture, 12 (44%) had osteoporosis. Only nine (22%) subjects who received home visits had no risk factors for falls or hip fracture and normal bone density, compared to 45 (42%) of those who attended hospital. This study has demonstrated that the efficiency of a program to assess additional risk of future fracture in a population who have already fractured may be influenced by where the assessment is delivered: it may be that the patients at greatest risk did not avail of the service.

Accidental Falls↗
PubMed2000

Variation in Sensitivity of Aquatic Species to Toxicants: Practical Consequences for Effect Assessment of Chemical Substances.

/ This study addresses the relation between the sensitivity of aquatic species and mode of action of different classes of organic chemicals. We analyzed large data sets of ecotoxicological information to reveal the interspecies variation in sensitivity, to relate this variation to the compounds' mode of action, and to explain the observed patterns using general biological information. Here we present a general framework and recommendations for risk assessment procedures. We recommend the use of toxicologically based classification schemes at an early stage of the risk assessment procedure. Screening programs are most efficiently run when only one species per compound is tested to prioritize substances. The toxicity of compounds belonging to the class of nonpolar narcotics is highly predictable and shows little interspecies variation. For these compounds quantitative structure-activity relationships (QSARs) can be used to estimate effect levels. Most effort should be put into testing reactive compounds and compounds with a specific mode of action as toxicity to some species can be 10(5)-10(6) times higher compared with less sensitive species. The use of assessment factors in effect assessment procedures may lead to an underestimation of effects on the more sensitive species.For many priority pollutants there is little information on their ecotoxicity. Predictive techniques are needed to compensate for this lack of data. Knowledge of the relation between modes of action of compounds and interspecies variation in sensitivity should be integrated in risk assessment procedures in order to make more efficient use of the limited financial resources available.

Journal Article↗
PubMedDate not supplied

Comparison of commercially available genetic algorithms: gas as variable selection tool.

Many commercially available software programs claim similar efficiency and accuracy as variable selection tools. Genetic algorithms are commonly used variable selection methods where most relevant variables can be differentiated from 'less important' variables using evolutionary computing techniques. However, different vendors offer several algorithms, and the puzzling question is: which one is the appropriate method of choice? In this study, several genetic algorithm tools (e.g. GFA from Cerius2, QuaSAR-Evolution from MOE and Partek's genetic algorithm) were compared. Stepwise multiple linear regression models were generated using the most relevant variables identified by the above genetic algorithms. This procedure led to the successful generation of Quantitative Structure activity Relationship (QSAR) models for (a) proprietary datasets and (b) the Selwood dataset.

Algorithms↗
PubMed1983

Analysis of numerical methods for computer simulation of kinetic processes: development of KINSIM--a flexible, portable system.

A flexible and convenient computational method for the simulation of kinetic progress curves has been developed. A mechanism is represented in conventional chemical format with either kinetic or rapid equilibrium steps separating chemical species. A table describing the differential equations of the mechanism is generated and a direct numerical integration is performed. The same program can be used to simulate any number of mechanisms. The user may interactively set kinetic parameters to seek the optimal fit for a set of experiments, as determined by graphical superimposition of simulated curves with experimental data. Standard error analysis and automatic optimization may also be included. The program is computationally efficient and its interactive nature makes it a good teaching tool. The source code is written in FORTRAN IV and adheres closely with the ANSI 1966 standard, so as to make it maximally portable and machine independent.

Chemistry Techniques, Analytical↗
PubMed1982

Reduction of generalized aversive responding in a post-treatment cancer patient: relaxation as an active coping skill.

A male ostomy patient was successfully taught relaxation as an active coping skill to control generalized aversive gastric upset responses which had originally developed in the context of radiation therapy. Because the patient had completed his medical regimen, intervention focused on applied relaxation outside the medical center setting. Treatment involved minimal therapist contact. The results are discussed in terms of assessing aversive side effects which generalize beyond the course of medical treatment, and the contingent aspects of such treatments. The efficiency of relaxation programs, as well as the importance of active patient involvement, are also discussed.

Adaptation, Psychological↗
PubMed1976

Period analysis of the electroencephalogram.

A program is described which utilizes the Digital Equipment Corporation LINC-8 computer with 4K of memory to process the electrical activity of the brin into a set of meaningful statistics. The program provides an efficient methol of obtaining spectoral information concerning the EEG without the associated cost or complexity of conventional power spectrum techniques. The combination of utilization of a small laboratory computer with an easily programmable method provides an approach for automated EEG analysis which is within the financial and technical scope of most small hospital EEG laboratories;

Computers↗
PubMed1991

Presynaptic input regulates development of beta-adrenergic control of rat brain ornithine decarboxylase: effects of 6-hydroxydopamine or propranolol.

beta-Adrenergic control of ornithine decarboxylase (ODC) activity is exerted only during a critical period in central nervous system development, playing an important role in neurotransmitter modulation of cell replication and differentiation. The current study examines the effects of lesions caused by 6-hydroxydopamine administration to neonatal rats, or of gestational exposure to propranolol, on the subsequent development of the ODC response to beta-adrenergic stimulation elicited by an acute intracisternal challenge with isoproterenol. 6-Hydroxydopamine treatment severely attenuated the ability of isoproterenol to stimulate ODC in the cerebellum, a tissue that shows a postnatal peak of ODC reactivity. In contrast, much smaller effects were seen in the cerebral cortex, which has an earlier (pre/perinatal) peak of ODC, despite the fact that norepinephrine depletion was more persistent in the cortex. On the other hand, blockade of fetal beta-receptors by maternal propranolol infusions resulted in immediate postnatal attenuation of the ODC response in cerebral cortex, but not cerebellum. These data suggest that early exposure of beta-receptors to norepinephrine "programs" the subsequent efficiency of the receptor linkage to ODC during a critical ontogenetic period that occurs prenatally in the cerebral cortex and postnatally in the cerebellum.

Aging↗
PubMed1994

Legal bases for the control of analgesic drugs.

Governments throughout the world have struggled for decades to ensure the availability of narcotic analgesics for legitimate medical and scientific purposes while controlling the abuse and illegal diversion of such substances. While the international drug-control system has effectively limited illicit trafficking of opioids, concerns remain about its effectiveness in ensuring the availability of these drugs for legitimate purposes. In the United States, federal legislation accommodates the use of controlled substances for medical and scientific purposes more effectively than does state law. Many states' controlled substance laws hinder appropriate opioid prescribing through (a) the use of ill-defined terms, (b) restriction of pain prescriptions to a specific number of dosage units; and/or (c) utilization of multiple-copy prescription programs. A more efficient state approach to monitoring inappropriate schedule II prescribing and dispensing may be through an electronic, computer-based pharmacy point-of-sale system, through which pharmacists can be alerted instantaneously to patients receiving the same drug from multiple pharmacies. In addition, states should consider modifying their approaches to drug abuse by adopting the revised Uniform Controlled Substances Act and/or establishing state pain initiatives.

Analgesics↗
PubMed1987

MAPMAKER: an interactive computer package for constructing primary genetic linkage maps of experimental and natural populations.

With the advent of RFLPs, genetic linkage maps are now being assembled for a number of organisms including both inbred experimental populations such as maize and outbred natural populations such as humans. Accurate construction of such genetic maps requires multipoint linkage analysis of particular types of pedigrees. We describe here a computer package, called MAPMAKER, designed specifically for this purpose. The program uses an efficient algorithm that allows simultaneous multipoint analysis of any number of loci. MAPMAKER also includes an interactive command language that makes it easy for a geneticist to explore linkage data. MAPMAKER has been applied to the construction of linkage maps in a number of organisms, including the human and several plants, and we outline the mapping strategies that have been used.

Chromosome Mapping↗
PubMed1988

Geographically-based cancer control: methods for targeting and evaluating the impact of screening interventions on defined populations.

Successful implementation of cancer control programs depends on efficient targeting to those at highest risk of developing and dying from the disease. This study presents a methodology for targeting cancer screening on the basis of population and disease variation among small geographic areas. Techniques for quantifying the impact of targeting on the predictive value of a positive test are demonstrated, using 329 New York City health areas. Age-truncated crude incidence, late-stage incidence and mortality rates for breast, cervix, and colorectal cancer are used, using site-specific truncation points relevant to the age groups appropriate for screening. Coefficient alpha was used to determine rate stability with 2, 3, 5 and 7 years of data. The stability of most small area rates was found to reach acceptable levels only with 5 and 7 years of data. Targeting into areas where breast cancer prevalence was high increased the expected predictive value of a positive test by as much as 50% when compared with areas of average prevalence. Geographic targeting will be most useful where between-area variability in prevalence is large and within-area variability is small. The implications of these results are discussed and future studies are suggested.

Adult↗
PubMed2006

Prediction of RNA secondary structure by free energy minimization.

RNA secondary structure is often predicted from sequence by free energy minimization. Over the past two years, advances have been made in the estimation of folding free energy change, the mapping of secondary structure and the implementation of computer programs for structure prediction. The trends in computer program development are: efficient use of experimental mapping of structures to constrain structure prediction; use of statistical mechanics to improve the fidelity of structure prediction; inclusion of pseudoknots in secondary structure prediction; and use of two or more homologous sequences to find a common structure.

Base Sequence↗
PubMed2005

Metabolic flux analysis of HEK-293 cells in perfusion cultures for the production of adenoviral vectors.

To meet increasing needs of adenovirus vectors for gene therapy programs, development of efficient and reproducible production processes is required. Perfusion cultures were employed to allow infection at greater cell concentrations. In an effort to define culture conditions resulting in enhanced productivities, experiments performed at different feed rates and infected at various cell densities were compared using metabolic flux analysis. The highest specific product yields were achieved in experiments performed at high perfusion rates and/or low cell concentrations. The intracellular flux analysis revealed that these experiments exhibited greater glycolytic fluxes, slightly higher TCA fluxes, and greater ATP production rates at the time of infection. In contrast, cultures infected at high cell density and/or low medium renewal rates were characterized by a more efficient utilization of glucose at the time of infection, but the specific product yields achieved were lower. The intracellular flux analysis provided a rational basis for the implementation of a feeding strategy that allowed successful infection at a density of 5x10(6)cells/ml.

Adenoviridae↗
PubMed1986

Computer-aided, systematic search of peptide conformations constrained by NMR data.

A computer program has been developed which allows exhaustive exploration of the conformation of medium sized rings (8 to 22-membered). This program provides for inclusion of experimental data from NMR measurements in the form of dihedral angles estimated by the Karplus equation and NOE close contacts. A brief description of the principles used in the program to provide high efficiency are given as is a discussion of the application of this program to a cyclic hexapeptide somatostatin analogue.

Chemical Phenomena↗
PubMed1988

Financing residency training in urology.

Five educators concerned with changes occurring in the financing of medical education and care reviewed the present status of residency programs and their financing. Future support depends on political decisions as well as demonstrable needs. The effects of anticipated reductions in funding for residents and their programs may be countered by the development of alternative sources and the restructuring of present programs for more efficient operation. The need for leadership is clear.

Costs and Cost Analysis↗
PubMedDate not supplied

Integrating medical and psychiatric treatment in an inpatient medical setting. The type IV program.

This study compares the treatment of patients with comorbid medical and psychiatric illness admitted to a high-acuity (Type IV) integrated medicine and psychiatry inpatient program with patients having psychiatric symptoms on general internal medicine wards (IMWs). More patients in the Type IV program had agitation, suicidal ideation, or psychosis as psychiatric admission behaviors when compared to IMW patients. Medical symptom improvement was comparable in the two settings, whereas, psychiatric symptoms improved more in the Type IV Program than on the IMWs despite more significant illness and comparable lengths of stay. Integrated care on the Type IV unit allowed shorter total lengths of stay for medical patients with serious psychiatric illness than would have occurred had the traditional sequential approach to care been used. The integrated Type IV medicine and psychiatry treatment program represents an efficient and effective process improvement in the way that medical patients with comorbid medical and psychiatric illness can be treated.

Academic Medical Centers↗