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PubMed1993

Value and cost of teaching hospitals: a prospective, multicenter, inception cohort study.

OBJECTIVE: To examine variations in case-mix, structure, resource use, and outcome performance among teaching and nonteaching intensive care units (ICU). DESIGN: Prospective inception cohort study. PATIENTS: A consecutive sample of 15,297 patients at 35 hospitals, which compared 8,269 patients admitted to 20 teaching ICUs at 18 hospitals vs. 7,028 patients admitted to 17 non-teaching ICUs at 17 hospitals. INTERVENTIONS: None. MEASUREMENTS: We selected demographic, physiologic, and treatment information for an average of 415 patients at each ICU, and collected data on hospital and ICU structure. Outcomes were compared using ratios of observed to risk-adjusted predicted hospital death rates, ICU length of stay, and resource use. MAIN RESULTS: When compared to nonteaching ICUs, teaching ICUs had twice the number of physicians who regularly provided services and cared for significantly younger and more severely ill (p < .001) patients. Risk-adjusted ICU length of stay was similar, but resource use was significantly (p < .001) greater in teaching ICUs, with $3,000 (10.5%) of estimated total costs for an average ICU admission related to increased use of diagnostic testing and invasive procedures in teaching ICUs. Risk-adjusted hospital death rates were not significantly different (p = .1) between all teaching and nonteaching ICUs, but were significantly (p < .05) better in four teaching ICUs, but in only one nonteaching ICU. The 14 hospitals that were members of the Council of Teaching Hospitals had significantly better risk-adjusted outcome in their 16 ICUs than all others (odds ratio = 1.21, confidence interval 1.06 to 1.38, p = .004). CONCLUSIONS: Teaching ICUs care for more complex patients in a substantially more complicated organizational setting. The best risk-adjusted survival rates occur at teaching ICUs, but production cost is higher in teaching units, secondary to increased testing and therapy. Teaching ICUs are also successfully transferring knowledge to trainees who, after their training, are achieving equivalent results at slightly lower cost in nonteaching ICUs.

Adolescent↗
PubMed2001

Application of PROSPECT in CASP4: characterizing protein structures with new folds.

In the Fourth Community Wide Experiment on the Critical Assessment of Techniques for Protein Structure Prediction (CASP4), we predicted all 43 targets using our threading application PROSPECT. PROSPECT guarantees to find an optimal alignment between a protein sequence and a structural fold for a general energy function with pairwise contact potential. For each prediction, it gives a reliability assessment based on a neural network approach. In addition, PROSPECT has been added to the Genomic Integrated Supercomputing Toolkit (GIST) and is deployed on terascale computing resources. Structural predictions in CASP4 included three categories, that is comparative modeling, fold recognition, and prediction for structures with new folds. In the fold recognition category, PROSPECT correctly identified 8 of a total of 22 and finished the sixth in the total scores among 127 assessed groups. In the "new fold" category, it found important structural features for most targets, and its overall performance is among the best of all prediction methods. Our CASP4 performance demonstrates that PROSPECT is a powerful tool to quickly characterize structures with new folds, and it may provide useful structural restraints for ab initio prediction methods.

Computer Simulation↗
PubMed2004

The Peptaibol Database: a database for sequences and structures of naturally occurring peptaibols.

The Peptaibol Database is a sequence and structure resource for the unusual class of peptides known as peptaibols. These peptides exhibit antibiotic and membrane channel-forming activities. The database includes sequence, biological source and bibliographical data for the naturally occurring peptaibols. Information is also collated for the growing number of peptaibol 3D structures determined by either crystallography or NMR spectroscopy. The database can be obtained as a whole or can be queried by name, group, sequence motif, biological origin and/or literature reference. The Peptaibol Database can be freely accessed at http://www.cryst.bbk.ac.uk/peptaibol.

Anti-Bacterial Agents↗
PubMed2005

Racial disparities in self-rated health at older ages: what difference does the neighborhood make?

OBJECTIVES: Racial differences in self-rated health at older ages are well documented. African Americans consistently report poorer health, even when education, income, and other health status indicators are controlled. The extent to which neighborhood-level characteristics mediate this association remains largely unexplored. We ask whether neighborhood social and economic resources help to explain the self-reported health differential between African Americans and Whites. METHODS: Using the 1990 Decennial Census, the 1994-1995 Project on Human Development in Chicago Neighborhoods-Community Survey, and selected years of the 1991-2000 Metropolitan Chicago Information Center-Metro Survey, we examine the impact of neighborhood structure and social organization on self-rated health for a sample of Chicago residents aged 55 and older (N = 636). We use multilevel modeling techniques to examine both individual and neighborhood-level covariates. RESULTS: Findings indicate that affluence, a neighborhood structural resource, contributes positively to self-rated health and attenuates the association between race and self-rated health. When the level of affluence in a community is low, residential stability is negatively related to health. Collective efficacy, a measure of neighborhood social resources, is not associated with health for this older population. DISCUSSION: Analyses incorporating individual and neighborhood-level contextual indicators may further our understanding of the complex association between sociodemographic factors and health.

Age Factors↗
PubMed2003

Expectations of and for clerkship directors: a collaborative statement from the Alliance for Clinical Education.

PURPOSE: The clerkship director (CD) is an essential leader in the education of medical students on clinical rotations. This article represents a collaborative effort of the national clerkship organizations that comprise the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE suggests that selection of a CD be regarded as an implied contract between the CD and the department chair that each will take the steps to ensure the success of the clerkship and of the CD. This article sets standards for what should be expected of a CD and provides guidelines for the resources and support to be provided to the person selected for leadership of the clerkship. SUMMARY: In their roles as CDs, educators engage in three principal activities: administration, teaching, and scholarly activity, such as educational research. This article describes (a) the work products that are the primary responsibility of the CD; (b) the qualifications to be considered in selection of a CD; (c) the support structure, resources, and personnel that are necessary for the CD to accomplish his or her responsibilities; (d) incentives and career development for the CD; and (e) the dedicated time that should be provided for the clerkship and the CD to succeed. Studies by several CD organizations conclude that 25% should be considered a minimum estimate of time for the administrative aspects of running a clerkship. With the added teaching and scholarly activities undertaken by a CD, a minimum of 50% of an full-time equivalent has been recognized as appropriate. The complexity and the need for timeliness in the cyclic and often repetitive tasks of the clerkship require that a full-time administrative assistant be part of the structure dedicated to running the clerkship. CONCLUSION: ACE recommends that institutions have clear standards for what is expected of the director of a clinical clerkship and have correspondingly clear guidelines as to what should be expected for CDs in their career development and in the support they are given.

Career Mobility↗
PubMed2006

Structural interventions to prevent HIV/sexually transmitted disease: are they cost-effective for women in the southern United States?

BACKGROUND: Structural interventions are theoretically promising for populations with a low prevalence of HIV, because they can reach large numbers of people to influence their social norms and collective risky behaviors for a relatively low cost per person. Because HIV transmission is continuing to increase among women in the southern United States, interventions to stem this epidemic are particularly warranted. This study explores whether structural interventions may be a cost-effective way to prevent HIV in this population. METHODS: We used the cost-effectiveness estimator, "Maximizing the Benefit" to determine the relative cost-effectiveness of 6 structural HIV prevention interventions. "Maximizing the Benefit" is a spreadsheet tool using mathematical models to estimate the cost per HIV infection prevented taking into account the epidemiologic contexts, behavioral change as a result of an intervention, and the costs of intervention. We applied estimates of HIV prevalence related to blacks in the southern United States. RESULTS: All the structural interventions were cost-effective compared with average lifetime treatment costs of HIV, but mass media, condom availability, and alcohol taxes theoretically prevented the largest numbers of HIV infections. CONCLUSIONS: Although the assumptions used in cost-effectiveness estimates have many limitations, they do allow for a relative comparison of different interventions and help to inform policy decisions related to the allocation of HIV prevention resources. Structural interventions hold the greatest promise in reducing HIV transmission among low-prevalence populations.

Condoms↗
PubMed2006

Caregiving outside of the home: the effects of race on depression.

OBJECTIVE: This research examines the conditions that determine whether Blacks experience lower or higher levels of depression while caregiving outside of the home, as compared to Whites. Some prior literature has found that African Americans report a lesser caregiver burden despite an increased likelihood that they will acquire this role, and decreased resources to do so. Others have found that African Americans experience the same caregiver burden and distress as Whites. Given these mixed findings, we use the stress process model to examine whether African American caregivers experience lower or higher levels of depression when they provide care outside of the home. DESIGN: A sample of care workers who provide care to others outside of the home was drawn from the 1992-4 National Survey of Families and Households. The final sample included 275 (11%) Blacks, and 2,218 (89%) Whites (not of Hispanic origin). The primary statistical method for predicting differences in caregivers' depressive symptomatology was OLS regression analysis with progressive adjustment. RESULTS: We examined sociodemographics, family structure, resources, and stressors and found that African Americans, those with lower socioeconomic status, the unmarried, spending more weeks caregiving, having a physical impairment, and surprisingly receiving more help from parents are associated with higher depressive symptomatology. Stronger religious beliefs decreased depressive symptomatology for Blacks. The race effect was, in part, explained by family structure, amount of caregiving, and impairment of care worker. CONCLUSION: Contrary to prior literature, we found that Blacks are more depressed than White caregivers in large part because of lower socioeconomic status and greater stressors, and higher levels of physical impairment. Yet, strength in religious belief has a stress-buffering effect for African Americans. We suggest that policies that attempt to eliminate racial disparities in socioeconomic status and health could benefit these caregivers.

Adult↗
PubMedDate not supplied

Recommendations for uniform reporting of data following major trauma--the Utstein Style: an initiative. International Trauma Anaesthesia and Critical Care Society (ITACCS)

Basic and advanced care of trauma patients always has been an important aspect of prehospital and immediate in-hospital Emergency Medicine, involving a broad spectrum of disciplines, specialties, and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources, and operation. This complex background, at least in part, has hindered the development of a uniform pattern or set of criteria and definitions. This in turn, has rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be evaluated or compared readily with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA, and other International Organisations represented in ILCOR--on Uniform Reporting of Data following Out-of-hospital and In-hospital Cardiac Arrest--the Utstein Style, an international working group of ITACCS, has drafted a document, Recommendations for Uniform Reporting of Data following Major Trauma--the Utstein Style. The reporting system is based on the following considerations: 1) A structured reporting system based on an "Utstein style template" that would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance, and quality of care (and enable groups to challenge performance statistics that did not take account of all relevant information); 2) The Recommendations and Template should encompass both out-of-hospital and in-hospital trauma care; 3) The Recommendations and Template should permit further intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives; and 4) The Template should facilitate studies setting out to improve epidemiological understanding of trauma; for example, such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on "prehospital cardiac arrest". It includes a glossary of terms used in the prehospital and early hospital phase as definitions, time points, and time intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance, and finally, one for the hospital. For clarity, data should be reported as core data (i.e., always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein Template for pre- or in-hospital cardiac arrest, respectively, the present Template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: I. INTRODUCTION AND BACKGROUND: II. TRAUMA DATA STRUCTURE DEVELOPMENT: A general outline of the development of structured data using object-oriented modelling (which will be discussed in due course) and includes a set of explanatory illustrations; III. TERMS AND DEFINITIONS: Outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma, and predominant trauma); IV. FACTORS RELATING TO THE CIRCUMSTANCES OF THE INJURY: Describes the following items: a) Cause of injury e.g., type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc.; b) Severity of Injury--e.g., prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from "1" = head to "9" = external; the physiological disability scale ranges ordinally from "0"; c) Mechanism of injury--recording for transportation incidents etc; e.g., the type of impact, possible restraining devices,

Anesthesiology↗
PubMed2000

"Recommendations for uniform reporting of data following major trauma--the Utstein style" (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society (ITACCS).

Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po

Data Collection↗
PubMed2000

Where's the common ground? A survey of hospitals, community health centres and divisions of general practice in Australia.

BACKGROUND: Divisions of general practice are key structures for integration between general practice and other health services in Australia. AIM: To compare the views of divisions of general practice toward integration of care with those of hospitals and community health services. METHOD: Representative national samples of public hospitals and community health centres (CHCs) and a census of divisions of general practice (DGP) were surveyed on their current collaborations and links as well as barriers to and factors that enhance integration between general practitioners and other health services. RESULTS: There is wide agreement on the need for greater integration. Personal links (via letter, phone and face to face) were thought to be useful. However, general practice liaison officers were seen as especially useful. All organizations rated different accountabilities and responsibilities as a highly significant barrier. Resources, structures for collaboration and high level organisational support were rated as being more useful in enabling greater integration. CONCLUSION: Formalizing collaboration will require changes to funding and accountability. However there is also a need for cultural change to support greater integration of patient care between general practice and both hospitals and community health services.

Australia↗
PubMed2000

Taking control: findings of a prospective study of an educational course for patients with leukaemia.

The challenge of coping with a chronic and life-threatening diagnosis such as a haematological malignancy, with the associated repeated, lengthy, and often invasive treatment interventions, can have a profound effect on all aspects of life. Patients and their families not only need information to help them understand the cancer experience, but also need support to generate coping strategies as the demands of the illness and its treatment exceed the individual's resources. Structured psycho-educational interventions, based on a strong informational component that aim to improve participants' adaptation to the disease and cancer situation, are one approach to providing such support. This article presents the findings from a recent prospective evaluation of the Leukaemia Foundation of Queensland's educational support course, Taking Control, which is designed for patients with a haematological malignancy and their families. The aim of this study was to record the participants' understanding of the positive and negative aspects and outcomes of course attendance. This is a prospective study of participants' perceptions of their experience with the 'Taking Control' course during the first half of 1999 (n =35; response rate 74.3%), using an author-designed, self-report questionnaire. The findings indicate that participants experience a high level of satisfaction, gain substantially in terms of knowledge, coping skills, and a positive framework within which to view their illness. Many obtain great value from the opportunity to meet and talk with others in similar situations. This study, which builds on previous retrospective research, affirms that this course has much to offer those who are confronted with the life-altering diagnosis of a haematological malignancy. However, the work also points to the need for special consideration to be given to a consistent minority of participants who will find socialising with their peers difficult whilst they are feeling so vulnerable and who have styles of processing information that can easily lead to 'information overload'. It is anticipated that the discussion of these findings will go some way to providing sufficient information and insight for similar courses to be duplicated, with confidence, elsewhere.

Adaptation, Psychological↗
PubMed1992

Health effects of unemployment--I. Long-term unemployed men in a rural and an urban setting.

Between 1983 and 1987 in an urban and a rural Dutch area employed and long-term unemployed men, between 30 and 50 years old, have been interviewed. The main topics of the study were the independent health effects of unemployment, the factors related to these health effects and socio-cultural differences. Long-term unemployment is considered to be a social phenomenon that restructures individual's social positions into multiple deprived positions. The characteristics of this restructuring are a relative lack of socio-structural resources, low social participation and emotional problems. Independent effects on the health status (perceived somatic and depressive complaints and self reported chronic disease) have been found to exist among both the rural and the urban unemployed. There is no clear effect of unemployment on health care use, but regional differences in health care use among rural and urban unemployed have been found. Between the urban and rural unemployed there are more similarities than differences in the factors and models explaining ill-health. The most important factors are: loneliness, disadvantageous consequences of unemployment, money worries and ill-health prior to job loss (health selection at the labour market). One important difference is that among the urban unemployed the perceived size of the network is an explanatory factor, but among the rural unemployed perceived stigmatization is more important. In general, ill-health can be better explained for the rural unemployed than for the urban unemployed.

Adult↗
PubMed2004

Health systems factors influencing maternal health services: a four-country comparison.

It is widely understood that maternal health care relies on the entire health system. However, little empirical, country-specific, research has been done to trace out the ways in which health system elements can shape maternal health outcomes. This study seeks to redress this situation, by providing an example of how a health systems approach can benefit the understanding of maternal health services. A comparative analysis was conducted based on extensive case studies of maternal health and health systems in Bangladesh, Russia, South Africa, and Uganda. A number of cross-cutting health system characteristics affecting maternal health were identified by comparing these diverse settings. The most important common systems issues underlying maternal health care were found to be the human resource structures, the public-private mix of service provision, and the changes involved with health sector reforms. Specific country contexts can further determine many factors influencing maternal health outcomes and service performance. Systems issues were found to influence the access to and utilization of services, quality of care provided, and ultimately maternal health outcomes. This paper provides a first step in tracing out how such broad systems issues actually work to influence maternal health.

Bangladesh↗
PubMed2006

Use of medication technicians in US nursing homes: part of the problem or part of the solution?

OBJECTIVES: To determine the relation between organizational characteristics and medication technician (MT) use and quantify the impact of MTs on increasing the likelihood of using medications, employing the example of antiosteoporosis medications. DESIGN: Cross-sectional study. SETTING: The setting included 6344 Medicare/Medicaid certified nursing homes in 23 states. PARTICIPANTS: Residents older than 65 years of age. MEASUREMENTS: On-line Survey and Certification of Automated Records (OSCAR) provided facility characteristics information including structural, resource, and staffing levels. The Minimum Data Set (MDS) provided information regarding use of antiosteoporosis medications and resident factors. Adjusted estimates of MT use on antiosteoporosis medication use were derived using logistic regression with generalized estimating equations. RESULTS: MT use varied by state (6.7% in Alaska vs 85% in Kansas). Homes with greater nursing staffing levels per 100 beds (CNA, RN, LPN) were less likely to use MTs, while larger homes, homes using physician extenders, and contracting pharmacy services were more likely to use MTs. Homes with MTs were more likely to have medication error rates of at least 5% (10.1% vs 7.3%) than homes without MTs. After adjustment for resident and facility factors, residents in MT facilities were not more likely to receive antiosteoporosis treatment relative to those in homes without MTs. CONCLUSION: These data call into question the use of MTs in nursing homes. Use of MTs may lead to more errors, yet not increase use of medications that are labor intensive to administer.

Aged↗
PubMed2006

The promise of pharmacogenetics: assessing the prospects for disease and patient stratification.

Pharmacogenetics is an emerging biotechnology concerned with understanding the genetic basis of drug response, and promises to transform the development, marketing and prescription of medicines. This paper is concerned with analysing the move towards segmented drug markets, which is implicit in the commercial development of pharmacogenetics. It is claimed that in future who gets a particular drug will be determined by their genetic make up. Drawing on ideas from the sociology of expectations we examine how pharmaceutical and biotechnology companies are constructing, responding to and realising particular 'visions' or expectations of pharmacogenetics and market stratification. We argue that the process of market segmentation remains uncertain, but that the outcome will be fashioned according to the convergence and divergence of the interests of key commercial actors. Qualitative data based both on interviews with industry executives and company documentation will be used to explore how different groups of companies are developing pharmacogenetics in distinct ways, and what consequences these different pathways might have for both clinical practice and health policy. In particular, the analysis will show a convergence of interests between biotechnology and pharmaceutical companies for creating segmented markets for new drugs, but a divergence of interest in segmenting established markets. Whilst biotechnology firms have a strong incentive to innovate, the pharmaceutical industry has no commercial interest in segmenting markets for existing products. This has important implications, as many of the claimed public health benefits of pharmacogenetics will derive from changing the prescribing of existing medicines. One significant implication of this is that biotechnology companies who wish to apply pharmacogenetics to existing medicines will have to explore an alternative convergence of interests with healthcare payers and providers (health insurers, HMOs, MCOs and national health systems). Healthcare providers may have a strong incentive to use pharmacogenetics to make the prescribing of existing medicine more cost-effective. However, we conclude by suggesting that a question mark hangs over their ability to provide the necessary economic and structural resources to bring such a vision to fruition.

Biotechnology↗
PubMed2006

First derivation of predicted-no-effect values for freshwater and terrestrial ecosystems exposed to radioactive substances.

The FASSET Radiation Effects Database (FRED) constitutes a unique structured resource of the biological effects of ionizing radiation on non-human species mainly from temperate ecosystems, encompassing 26,000 primary data entries. Quality-assessed data were extracted from FRED and dose-effect relationships were constructed to provide estimates of ED50 and EDR10. These estimates are Doses (or Dose Rates) related to the percent change in the average level of the endpoint for a particular effect (50% or 10% for acute or chronic exposure regimes, respectively). Acute and chronic Species Sensitivity Distributions (SSDs) were built on the basis of these data sets, and the Assessment Factor Method (AFM) was applied when data were too scarce. The Hazardous Dose corresponding to 5% of species acutely affected at the 50% effect level varied from 1 to 5.5 Gy according to the ecosystem. For chronic gamma external irradiation exposure, no-effect values varied from 10 microGy/h for freshwaters through application of the AFM to 67 microGy/h for terrestrial ecosystems, corresponding to the 5th percentile of the non-weighted SSD (vs 229 microGy/h when trophic weights are applied). These values are higher by ca. x50 to x100 than the upper bound of natural background, and lower than dose rates triggering effects at individual levels on contaminated sites.

Amphibians↗
PubMed2003

Intracellular compartmentation in the biosynthesis of caulerpenyne: study on intact macroalgae using stable-isotope-labeled precursors.

The biosynthesis of caulerpenyne 1 was studied in the invasive green alga Caulerpa taxifolia. The investigation was performed on intact algae with stable-isotope-labeled precursors administered under mixotrophic growth conditions. According to the labeling pattern, after incorporation of 1-(13)C-acetate and (13)CO(2), respectively, the biosynthesis of the sesquiterpene backbone occurs in the chloroplast and follows the methyl-erythritol-4-phosphate (MEP) pathway. In contrast, the acetyl residues of caulerpenyne 1 are derived from a cytosolic resource. [structure: see text]

Journal Article↗
PubMed2001

Service learning: integrating student learning and community service.

Health professions education is directly effected by changes in health care service delivery and financing systems. In the United States, as the health care industry increasingly shifts to a market economy, service delivery venues are moving away from acute care facilities and into community-based settings. Additionally, there is increased emphasis on primary prevention programs, often provided in public health settings. For health professions programs that traditionally provide clinical training in hospitals and long-term care facilities, there are unique challenges associated with identifying new venues in order to insure that students are exposed to a wide variety of patients with a range of chronic to acute disease conditions. One set of tools that has demonstrated usefulness during these kinds of transitions is service learning. This teaching methodology emphasizes increased partnership with clinical training sites, extensive orientation to patient populations and community resources, structured reflection and instilling the ethic of service in future health care providers. Although this article describes utilization of service learning in the context of current conditions in the United States, we hope that the principles presented here can be readily adapted in any setting.

Journal Article↗