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To build an outstanding health care facility, you need to start with an outstanding project team. That's the premise underlying the first Vista Awards. A look at the winning projects and teams.
Molecular dosimetry techniques were exploited in order to assess the efficacy of experimental chemoprevention assays and to evaluate the involvement of DNA alterations, not only in cancer but also in other chronic degenerative diseases. In agreement with other protective effects previously observed in the same animal models, the thiol N-acetylcysteine (NAC) totally prevented or significantly reduced the formation of carcinogen-DNA adducts in three experimental systems in rats. Thus, as assessed by 32P postlabeling, supplement of the diet with NAC decreased both deoxyguanosine-C8-aminofluorene adducts (butanol enrichment) and deoxyguanosine-N2-acetylaminofluorene adducts (nuclease P1 enrichment) formed in rat liver following dietary administration of 2-acetylaminofluorene for 3 weeks. DNA adducts were detected by synchronous fluorescence spectrophotometry in rat liver, lung, heart, and testis following a daily i.t. instillation of benzo(a)pyrene for 3 consecutive days. The whole-body exposure of rats to mainstream cigarette smoke for 40 consecutive days resulted in the appearance of DNA adducts in heart, lung, and aorta, whereas no adduct was detected by synchronous fluorescence spectrophotometry in liver, brain, and testis. Multiple DNA adducts in the aorta were also measured by 32P postlabeling. Administration of NAC by gavage inhibited the formation of DNA adducts in all organs of rats treated with benzo(a)pyrene or exposed to cigarette smoke. It is of interest that a single chemopreventive agent can display a broad-spectrum protective ability. The selective localization of DNA adducts in different organs depends on pharmacokinetics, metabolic capacity, DNA repair efficiency, and cell proliferation rate. Whereas inhibition by NAC of DNA adducts in testis can be correlated with its demonstrated ability to prevent dominant lethal mutations, we raise the hypothesis that DNA adducts in lung, heart, and aorta may be pathogenetically associated with lung cancer, cardiomyopathies, and arteriosclerosis, respectively. In order to explore the involvement of molecular and biochemical alterations in human arteriosclerosis, we started an extensive collaborative project and report here preliminary data showing the presence of DNA adducts in aorta smooth muscle cells obtained from arteriosclerotic patients.
The Internet started as a research project by the Department of Defense Advanced Research Projects Agency for networking computers. Ironically, the networking project now predominantly supports human rather than computer communications. The Internet's growth, estimated at 20% per month, has been fueled by commercial and public perception that it will become an important medium for merchandising, marketing, and advertising. For the clinical laboratory, the Internet provides high-speed communications through e-mail and allows the retrieval of important information held in repositories. All this capability comes at a price, including the need to manage a complex technology and the risk of instrusions on patient privacy.
Subject of this article is the empirical base, the goal, origin and founding of the "Agenzia isa (informazioni, scambi e aiuto nel vicinato)". The "Agenzia isa" is a small agency promoting and mediating mutual voluntary neighbourhood help among Italian immigrants in the city of Zürich, Switzerland. The agency started its services in June 1993. Improving social support among the Italian immigrants is considered to be preventive health care to promote health (especially in the realm of stress-provoked illness). The founding and development of the agency are followed up documented and evaluated. The problem of segregation was an important theoretical starting point for the project. A third way between the classical concepts (assimilation/integration and remigration) was conceptualised for the Italian immigrants. This third way aims at establishing a link between the agency and the Swiss medical and social care system. An important idea for this innovative project was that people living in the context of emigration possible need new types of structures for help. This idea is based on the experience that often traditional structures from the home context of the immigrants are longer sufficient and Swiss structures are not utilised possible because they are considered too foreign. The situation of social support and help needed by Italian immigrants is discussed on the basis of empirical results of a survey in one district of the city of Zürich. The realisation of the "Agenzia isa" is then described.
A mandatory cardiopulmonary resuscitation (CPR) program that started as a pilot project in Ottawa-area high schools is expanding to other Canadian schools. Besides CPR techniques, Grade 9 students are being taught about healthy lifestyles and how to recognize cardiac arrest. Emergency physician Justin Maloney, the program's principal architect, believes that in a decade this mandatory training will translate into increased bystander-initiated CPR and improved chances of survival for victims of cardiac arrest.
In order to investigate the prevalence of atherosclerosis in Mexico, high resolution ultrasound and color Doppler flow imaging of carotid arteries were carried out in a group of participants in CUPA project, a cohort study started in 1989 among persons 60 years and older living permanently in a high rise in México City. Imaging studies included identification of 4 atherosclerosis related abnormalities: 1) intima media thickness; 2) kinkings and tortuousness; 3) non-stenosing plaques; and 4) significant carotid stenosis (> 50%). Analysis of 198 Doppler ultrasonographic studies in 56 males and 142 females showed an overall prevalence of atherosclerosis related lesions of 65.6%, with increasing frequency by age groups: 33% in younger than 65 year-old, 71% in 65-74 years, and up to 88% in the 75 years and older group. The prevalence of high grade stenosis was low (6%) whereas the overall frequency of non-stenosing plaques and intima-media thickness was higher than 60%. Intima-media thickness was more common in males while non-stenosing plaques and high grade stenosis were more frequent in females. However, there were not significant differences among women and men when atherosclerotic lesions were analyzed by age groups. This is the first report on the prevalence of atherosclerosis in a Mexican population using ultrasonography. Findings of the investigation document the high prevalence of atherosclerosis among elderly resident in Mexico City.
Human vision starts with the activation of rod photoreceptors in dim light and short (S)-, medium (M)-, and long (L)- wavelength-sensitive cone photoreceptors in daylight. Recently a parallel, non-rod, non-cone photoreceptive pathway, arising from a population of retinal ganglion cells, was discovered in nocturnal rodents. These ganglion cells express the putative photopigment melanopsin and by signalling gross changes in light intensity serve the subconscious, 'non-image-forming' functions of circadian photoentrainment and pupil constriction. Here we show an anatomically distinct population of 'giant', melanopsin-expressing ganglion cells in the primate retina that, in addition to being intrinsically photosensitive, are strongly activated by rods and cones, and display a rare, S-Off, (L + M)-On type of colour-opponent receptive field. The intrinsic, rod and (L + M) cone-derived light responses combine in these giant cells to signal irradiance over the full dynamic range of human vision. In accordance with cone-based colour opponency, the giant cells project to the lateral geniculate nucleus, the thalamic relay to primary visual cortex. Thus, in the diurnal trichromatic primate, 'non-image-forming' and conventional 'image-forming' retinal pathways are merged, and the melanopsin-based signal might contribute to conscious visual perception.
Interprofessional and inter-agency working are important features of UK government initiatives, such as Sure Start local programmes for children under 4 years old and their families. Part of the vision for Sure Start was that providers of services and support would work together in new ways that cut across old professional and agency boundaries and focus more successfully on family and community needs. This paper describes the development and functioning of a Referral and Allocation Project in one trailblazer Sure Start local programme. The Programme employs staff with backgrounds that include health, social work, education and clinical psychology who work in a shared location. The Referral and Allocation Project sought to develop, through regular meetings, a whole-team inter-agency focus on discussing the needs of families who had been referred, or had referred themselves, to Sure Start and on suggesting ways in which support or advice could be offered and accessed in order to meet their needs. The paper examines issues that arose during the development of the Project, in particular psychodynamic dimensions such as emotional impact and professional anxiety. These may have implications for the format and culture of interprofessional team meetings and for training and professional development.
OBJECTIVE: To develop and test a system for delivering a completed audit cycle for summative assessment of general practitioner registrars in the United Kingdom. DESIGN: A trainer-based questionnaire on criteria for a completed audit cycle, followed by two marking exercises of audit projects submitted by general practice registrars. SETTING: Training practices in the West of Scotland between 1997 and 1998. SUBJECTS: Trainers and registrars in the above practices. RESULTS: 116 (89%) agreed that two collections of data were an essential or desirable part of an audit project. All 57 registrars who started in August 1997 successfully completed an audit cycle, seven (12%) after resubmission. Using two rather than three independent assessors to screen the projects, the marking instrument was shown to have a sensitivity of 95% (95% confidence interval (CI) +/-3.9%) and a specificity of 77% (95% CI +/-7.5%). All assessors found the new system easier to mark and 47 registrars (87%) found completing an audit cycle as or easier than expected. CONCLUSION: Evidence from the pilot project has shown that a general practice registrar's ability to review and critically analyse a piece of his/her work, with appropriate management of any necessary change, can be tested feasibly by means of a completed audit cycle within the registrar year. The process retains adequate levels of sensitivity and specificity and requires fewer assessors for marking the projects.
THE PATHOPHYSIOLOGY of most autoimmune diseases is often poorly understood. EXPERIMENTAL CONSIDERATIONS and clinical experience suggest that high doses immunoablation followed by stem cell transplantation is a therapeutic option to consider for certain severe autoimmune disorders. THE CONCEPT OF RESTORING NORMAL IMMUNE REACTIVITY must in part br true since current results of 466 transplants (445 autologous, 21 allogeneic) patients suffering from various autoimmune diseases show a beneficial outcome in approximately 2/3 of the patients. TO IMPROVE THE EFFICACY AND SAFETY OF SUCH AN AGGRESSIVE PROCEDURE in patients with potentially affected vital organs by the underlying autoimmune disease, it is especially important to follow international consensus guidelines and to centrally collect clinical data for in depth analysis in the EBMT International Stem Cell Project for Autoimmune Disease in Basel, Switzerland. PHASE III STUDIES ARE RUNNING FOR SYSTEMIC SCLEROSIS (Astis, Autologous Stem cell Transplantation International Rheumatoid Arthritis Trial) started in 2003. A STUDY PROJECT IS PLANNED FOR MULTIPLE SCLEROSIS (Astims, Autologous Stem cell Transplantation International Multiple Sclerosis).
The postnatal development of retinogeniculate, retinopretectal and retinotectal projections has been studied by the anterograde transport of proline-labeled proteins in 20 pouch young opossums aged from 10 to 60 days. Radioautographical findings suggest delayed development of uncrossed as compared to crossed projections. There is a phase of overlapping projections from both eyes in thalamic and tectal target sites. Partial segregation of projections to the dorsal lateral geniculate nucleus (GLD) is preceded by differential distribution of crossed and uncrossed terminal fields along its dorsoventral axis (at age 23 days). The quasilaminar pattern of projections in the dorsocaudal region of GLD pars alpha is incipient by 42 days and is fully established at 60 days of age, as eye opening starts. The mature pattern of projections to the ventral lateral geniculate nucleus (GLV) is established much earlier, at 23 days of age. The development of retinopretectal projections is assessed mostly from the analysis of the olivary pretectal nucleus (PO). Distribution of silver grains into discrete areas coextensive with PO is relatively delayed (by 23 days of age) as compared to the nuclei of the lateral geniculate body. Soon after, however, the mature pattern of projections to PO is established (at 33 days of age). The early development of retinotectal projections (from 10 to 23 days) is compatible with an initial tangential course of crossed optic fibers in the superior colliculus (CS) but other alternatives remain open, such as a sequential outside-in arrangement of terminal fields of deeply coursing fibers. Arborization of uncrossed fibers is delayed at extreme rostromedial and caudolateral portion of the territory of the main uncrossed retinotectal projection. Segregation of uncrossed projections at different depths of CS is nearly complete by 42 days. Differences in the development of terminal fields in different target nuclei or in regions of a given target site are discussed in relation to retinal and local factors.
Rabbit, a domestic species exploited both in animal production and medical research has only recently begun to be included in gene mapping projects, in particular by the French National Institute of Agronomics. By 2002, less than 60 genes had been precisely localised on rabbit chromosomes, which led us to start a large-scale project on gene mapping in rabbit with the publication of 133 gene localisations in 2003 (Chantry-Darmon et al., 2003). Here, we report the localisation of 102 new genes resulting in good coverage of the rabbit genome and an eight-fold enrichment of the gene map. In addition, we have detected a new conserved segment between rabbit chromosome 4q15.3 and part of human chromosome 22 and thus improved the comparative map with the human genome.
PURPOSE: A model for calculating the three-dimensional volume of arteriovenous malformations from biplane angiography. METHODS AND MATERIAL: Three-dimensional (3D) volume reconstruction is easily feasible with axial, coronal, or sagittal computer tomography (CT) and nuclear magnetic resonance (NMR) scans. On the other hand, radiosurgical treatment of arteriovenous malformations (AVM) is exclusively based on two orthogonal stereotactic projections, obtained with angiographic procedures. Most commonly, AVM volumes have been calculated by assimilating the nidus volume to a prolate ellipsoid. We present an algorithm dedicated to 3D structure reconstruction starting from two orthogonal stereotactic projections. This has been achieved using a heuristic approach, which has been widely adopted in the artificial intelligence domain. RESULTS: Tests on phantom of different complexity have shown excellent results. CONCLUSION: The importance of the algorithm is considerable. As a matter of fact: (a) it allows calculations of complex structures far away from regular ellipsoid; (b) it permits shape recovery; (c) it provides AVM visualization on axial planes.
Three-dimensional (3D) volume reconstruction is easily feasible with axial, coronal or sagittal CT and MRI scans. On the other hand, radiosurgical treatment of arteriovenous malformations (AVMs) is exclusively based on two orthogonal stereotactic projections, obtained with angiographic procedures. Most commonly AVM volumes have been calculated by assimilating the nidus volume to a prolate ellipsoid. We present an algorithm dedicated to 3D volume reconstruction starting from two stereotactic orthogonal projections. This has been achieved using a euristic approach which has been widely adopted in the artificial intelligence domain. Tests on phantoms of different complexity have shown excellent results. The importance of the algorithm is considerable. Firstly, it allows calculations of complex structures far removed from a regular ellipsoid. Secondly, it permits shape recovery. Thirdly, it provides AVM visualization on axial planes.
Adolescents are at high risk for developing acquired immunodeficiency syndrome (AIDS) because of their sexual curiosity and exploration, drug experimentation, and lack of knowledge. At present, the only way to reduce this risk is through education. In an effort to increase AIDS education among adolescents, a program called Students Teaching AIDS to Students (STATS) is proposed. The goal of this project is to help train medical students to become AIDS educators in the schools, churches, and youth organizations of their local communities. The project involves preparation and distribution of a package of materials which can be used by medical students to initiate a STATS program. The package consists of a manual which explains the essentials of starting a youth health education project, suggests how to gain approval for the project within the community, and contains curriculums with basic AIDS information and exercises. The curriculum material is tailored for presentation to students over two school-class periods on separate days and contains age-appropriate information. Another component of the package is the slide show tailored to explain STATS to school boards, parent groups, and the leaders of other youth organizations. A video tape to help answer difficult questions put by students has been selected to be part of the curriculum for school grade levels 7 to 12. These materials are geared to facilitate the start of a successful AIDS education program for adolescents.
A fifth-year follow-up of teenage mothers who had enrolled in Project Redirection, a comprehensive program of services for pregnant and parenting teenagers, revealed many long-term benefits of the program. Administered when the young mothers were, on average, 22 years old, the follow-up found that program participants had better employment records, higher average earnings and lower rates of welfare dependency than a comparison group of similar young mothers who had not enrolled in Project Redirection. Moreover, participants had higher scores on a test of parenting, were more likely to have breastfed their infants and were more likely to have registered their children in Head Start. The children of the Project Redirection participants (whose average age was five and one-half) were better off than their comparison-group counterparts in terms of cognitive, social and emotional development. The two groups of young mothers were similar in terms of their educational attainment after five years, but differences in fertility were observed. Although the two groups had experienced similar numbers of pregnancies, Project Redirection participants were less likely to have terminated a pregnancy by means of induced abortion, and as a result had had a higher average number of live births. The economic status of women who were able to limit their child-bearing was generally more favorable than for those who were not able to do so, but participation in Project Redirection was associated with improved employment outcomes and greater self-sufficiency among all of the women, regardless of the size of their family.
The MeduMobile project or Mobiler Campus Charité was started in the beginning of 2003 to evaluate new, multimedia supported teaching and learning scenarios. The project focuses especially on acute and rare diseases to which students usually have are very limited access. During the teaching sessions the MeduOnCall team and the academic teacher communicate with the students who are equipped with individual notebooks through a wireless net. In dermatology the MeduMobile project focused in summer 2003 and winter 2003/2004 on bedside teaching. Despite some technical difficulties in the beginning the project was well received by teachers and students. The possibility of simultaneous online searches by Internet as well as the possibility to include photographs depicting the course of the skin disease was felt to be one of the main advantages of this project. Based on these positive experiences an attempt will be made to integrate the project further into the regular teaching of the Charite.
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