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PubMed1993

Dopaminergic neuron B20 generates rhythmic neuronal activity in the feeding motor circuitry of Aplysia.

We have identified a buccal neuron (B20) that exhibits dopamine-like histofluorescence and that can drive a rhythmic motor program of the feeding motor circuitry of Aplysia. The cell fires vigorously during episodes of patterned buccal activity that occur spontaneously, or during buccal programs elicited by stimulation of identified cerebral command-like neurons for feeding motor programs. Preventing B20 from firing, or firing B20 at inappropriate times, can modify the program driven by the cerebral feeding command-like neuron CBI-2. When B20 is activated by means of constant depolarizing current it discharges in phasic bursts, and evokes a sustained coordinated rhythmic buccal motor program. The program incorporates numerous buccal and cerebral neurons associated with aspects of feeding responses. The B20-driven program can be reversibly blocked by the dopamine-antagonist ergonovine, suggesting that dopamine may be causally involved in the generation of the program. Although firing of B20 evokes phasic activity in cerebral command-like neurons, the presence of the cerebral ganglion is not necessary for B20 to drive the program. The data are consistent with the notion that dopaminergic neuron B20 is an element within the central pattern generator for motor programs associated with feeding.

Animals↗
PubMed2006

Protecting rare, old-growth, forest-associated species under the Survey and Manage Program guidelines of the Northwest Forest Plan.

The Survey and Manage Program of the Northwest Forest Plan (NWFP) represents an unparalleled attempt to protect rare, little-known species associated with late-successional and old-growth forests on more than 9.7 million ha of federal lands. Approximately 400 species of amphibians, bryophytes, fungi, lichens, mollusks, vascular plants, arthropod functional groups, and one mammal were listed under this program because viability evaluations indicated the plan's network of reserve land allocations might not sustain the species over time. The program's standards and guidelines used an adaptive approach, protecting known sites and collecting new information to address concerns for species persistence and to develop management strategies. Since implementation in 1994, approximately 68,000 known sites have been recorded at an expense of several tens of millions of dollars. New knowledge from surveys reduced concern for nearly 100 species, and they were removed from the protection list. Although successful in protecting hundreds of rare species not typically considered in most conservation programs, some of the enacted conservation measures created conflicts in meeting other management objectives of the plan, particularly timber harvest. The program accrued important gains in knowledge, reduced uncertainty about conservation of a number of species, and developed new methods of species inventory that will be useful in future management planning and implementation at many scales. The program, however was not completed because of changes in land-management philosophy. Ongoing litigation regarding its termination and potential changes to the plan cast further uncertainty on how the original goal of maintaining persistence of late-successional and old-growth species will be met and measured. The outcomes, controversies, and management frustrations of the program exemplify the inherent difficulties in balancing broad, regional conservation goals with social and economic goals of the NWFP Defining acceptable trade-offs to reach that balance and developing practical conservation solutions remain challenges for the science and management communities. Lessons learned from the program provide a valuable biological and managerial reference to benefit future discussion on meeting those challenges.

Amphibians↗
PubMed1998

Automatic adaptation of the basic pacing rate in response to minute ventilation. Chorum French Investigational Group.

Rate responsive pacing based on minute ventilation (VE) correlates highly with metabolic demand. This type of sensing also recognizes extended periods of rest. The Chorum pacemaker includes a rate responsive algorithm that modulates the basic rate according to phases of activity versus sleep. Forty-six patients (mean age 78 +/- 15), received a Chorum pacemaker for atrioventricular block in 17 cases, sick sinus syndrome in 25, and mixed disorders in 4. Holter monitoring was performed to analyze to heart rate and to examine the circadian adaptation of the minimal pacing rate. The mean basic rate was programmed at 63 +/- 5 beats/min, and the sleep rate at 52 +/- 4 beats/min. Seventeen patients had spontaneous heart rates consistently above the programmed basic rate, and 6 had sustained supraventricular tachyarrhythmias. One-half of the patients had periods of pacing at the programmed sleep rate. The mean diurnal pacing rate was 68 +/- 5 beats/min compared to a mean nocturnal rate of 60 +/- 4 beats/min (P < 0.0001). The average time spent at the basic rate was 37 +/- 30 min (0-110) during daytime (4%), versus 242 +/- 153 min (20-477) at night (45%, P < 0.0001). No adverse effect was observed in this patient population. VE allows a reliable detection of the sleeping periods as well as an adjustment of the basic rate in accordance. Caution is advised in cases of bradycardia dependent tachyarrhythmias.

Aged↗
PubMed1986

Solitary beta-blocker therapy for idiopathic life-threatening ventricular tachyarrhythmias.

To determine the clinical characteristics of patients with life-threatening ventricular tachyarrhythmias with no identifiable heart disease, we analyzed six patients who presented with either cardiac arrest or syncope associated with documented ventricular tachycardia or fibrillation. Electrocardiographic and echocardiographic examination and cardiac catheterization results were normal in all patients. Electrocardiographic monitoring revealed ventricular tachycardia in all patients. Exercise testing did not provoke sustained ventricular tachycardia in any patient. Programmed extrastimulation did not induce ventricular tachycardia in any patient. Isoproterenol infusion facilitated provocation of sustained ventricular tachycardia in only one patient. All six patients were treated with solitary beta-blocker therapy. Following treatment, there was a significant reduction in the incidence of ventricular tachycardia, couplets and total ventricular ectopic beats. During a follow-up period ranging from 16 to 36 (mean 22) months, all patients remain alive without clinically significant recurrence. Therefore, patients with life-threatening ventricular tachyarrhythmias without identifiable heart disease may respond to solitary beta-blocker therapy.

Adrenergic beta-Antagonists↗
PubMed2002

The Chilean legacies in health care quality.

OBJECTIVE: The Chilean quality assurance (QA) program evaluation took place in July 1999, at the request of the Chilean Ministry of Health. The main objectives of the evaluation were to identify key aspects of the 8-year-old Chilean QA program that could be considered by other countries and to make strategic recommendations. SETTING: In 1991, the Ministry of Health of Chile launched a national QA program. A national-level team initiated countrywide training of health care providers in QA skills, the development of quality committees at facility levels to direct local quality improvement activities, and training of quality monitors to provide technical support for training and quality improvement activities. DESIGN: The evaluation team, consisting of two international consultants and a regional consultant from the Costa Rican Ministry of Health, visited six regions and seven health 'servicios' (geographically defined administrative units within a region). The regions and servicios were purposefully chosen to represent different geographic areas, types of facilities, and levels of performance of QA activities. The evaluation was based on a framework developed and applied by the Quality Assurance Project (Center for Human Services, USA). Group and individual interviews with staff complemented document and record reviews. RESULTS: The evaluation team found that Chile's QA program had been successful in achieving sustainability and institutionalization. Factors contributing to this success included the enabling environment, management and leadership, technical functions, and support functions. CONCLUSION: The Chilean QA program constitutes an interesting experience for consideration by other countries. Key features include its sustainability, nationwide coverage, decentralization, and alliance of quality improvement and regulation. Training results are impressive: almost 20% of Ministry of Health personnel received training, and 19 training modules are in use. Coaches are active and technically sustaining quality assurance activities nationwide.

Chile↗
PubMed2004

Worksite-based research and initiatives to increase fruit and vegetable consumption.

BACKGROUND: Worksite initiatives to promote increased consumption of fruits and vegetables include a wide range of programs. Some initiatives focus on the physical and informational environments, with the dual aim of increasing the availability of healthful food options and providing education and support through point-of-choice labeling and signage. METHODS: Authors reviewed recent literature on comprehensive worksite health promotion programs that have addressed some type of environmental/organizational intervention to increase fruit/vegetable consumption. RESULTS: This review revealed that environmental/organizational initiatives rely on management commitment, supervisory support, and supportive organizational structures to sustain policy efforts over time. Program effectiveness is enhanced when they are based on social ecological approaches; include worker participation in program planning and implementation (e.g. employee advisory boards and peer-delivered interventions); address multiple (vs. single) risk factors for change; and integrate workers' broader social context (e.g. families, neighborhoods, etc.). CONCLUSIONS: Priorities for future worksite-based interventions include identifying and reducing barriers to organizational and environmental change, addressing social disparities in fruit and vegetable consumption, addressing social contextual factors driving behaviors, and building expanded networks of community partnerships. Future research is needed to identify key policy and program components that will yield meaningful increases in fruit and vegetable consumption; barriers/facilitators of organizational and environmental change within worksites; effective community-based participatory methods; and methods to disseminate cost-effective interventions for all worksites.

Feeding Behavior↗
PubMed2000

Empirical assessments of social networks, fertility and family planning programs: nonlinearities and their implications.

Empirical studies of the diffusion of modern methods of family planning have increasingly incorporated social interaction within nonlinear models such as logits. But they have not considered the full implications of these nonlinear specifications. This paper considers the implications of using nonlinear models in empirical analyses of the impact of family programs, modulated by social interaction, on reproductive behavior. Three implications of nonlinear models, in comparison with linear models, are developed. 1) With nonlinear models, there may be both low and high contraceptive-use equilibria (i.e., the ultimate level of use of modern family planning that a population can be expected to reach after the effects of a sustained change in a family planning program have worked through the population) rather than just one equilibrium as in linear models. If there are multiple equilibria, then one striking and important result is that a transitory large program effort may move a community from sustained low- to high-level contraceptive use. 2) With nonlinear models, the extent to which a social interaction multiplies program efforts depends on whether the community is at a low or high level of contraceptive use rather than being independent of the level of contraceptive use as in linear models. 3) With nonlinear models, intensified social interaction can retard or enhance the diffusion of family planning, in contrast to only enhancing diffusion as within linear models. To clarify these implications, for comparison a simple and more transparent linear model is also discussed. Illustrative estimates are presented of simple linear and nonlinear models for rural Kenya that demonstrate that some of these effects may be considerable.

Contraception↗
PubMed1992

Hip fractures in geriatric patients. Results of an interdisciplinary hospital care program.

The care of geriatric patients who sustain hip fractures is difficult because of associated medical comorbidities, the risk of medical and surgical complications, and the functional limitations that are often present before the fracture. The authors developed and used a comprehensive, interdisciplinary care program that has so far treated 431 geriatric hip fracture patients. The results of the program group were compared to a matched nonprogram group of patients (n = 60) cared for before the initiation of the program (and before the initiation of diagnosis-related groups). The program patients had fewer postoperative complications, significantly fewer (p less than .05) intensive care unit transfers (10.2% versus 20%), significantly improved (p less than .001) ambulatory ability at discharge (56.3% independent with assistive devices versus 18.2%), and proportionately fewer discharges to nursing homes (8.1% versus 19.3%). These results support the use of an interdisciplinary approach as a means of improving the inhospital care of geriatric hip fracture patients.

Aged↗
PubMed2004

Rapid relapse of thyroid dysfunction and goiter in school-age children after discontinuation of salt iodization.

BACKGROUND: In programs to control iodine deficiency disorders (IDD), sustainability is a major concern. IDD has recently recurred in countries where salt iodization programs have lapsed. OBJECTIVE: The objective of the study was to describe the evolution of thyroid dysfunction after the discontinuation of salt iodization in a cohort of children in an area of severe endemic goiter. DESIGN: Moroccan children (aged 6-16 y, n = 159) with severe IDD received iodized salt (IS) for 1 y. Because of practical and financial constraints, including a lack of infrastructure and electricity at the production site, salt iodization abruptly ceased. The children were followed for another 14 mo, and concentrations of urinary iodine, thyrotropin, total thyroxine, and thyroglobulin and thyroid volume were measured. RESULTS: Before iodization, median urinary iodine was 18 microg/L, 88% of children had elevated serum thyroglobulin concentrations, and 72% were goitrous. One year after the introduction of IS, median urinary iodine and thyroglobulin concentrations had normalized, mean thyroid volume had decreased by 34%, and median thyrotropin and mean total thyroxine concentrations were improved. Five months after the discontinuation of salt iodization, median urinary iodine had fallen to 20 microg/L. Fourteen months after the discontinuation of salt iodization, the rate of goiter was again similar to the rate before salt iodization; median thyrotropin and thyroglobulin concentrations were sharply higher than before the introduction of IS (P < 0.001); and the prevalence of hypothyroidism was 10%, compared with 3% before the introduction of IS (P < 0.001). CONCLUSIONS: In IDD-affected areas, cessation of salt iodization is associated with a rapid deterioration of thyroid function in school-age children. These findings underline the importance of sustainability in IDD control and the vulnerability of children to even short-term lapses in IS programs.

Adolescent↗
PubMed2000

Immunization (EPI) in Ethiopia: acceptance, coverage, and sustainability.

Ethiopia has been engaged in expanding immunization services against the six childhood diseases since 1980. According to plans set at the beginning of the program, the country should have achieved universal child immunization by now. However, the child immunization coverage has never reached the level that is desired to curtail disease transmission and to reduce the morbidity burden associated with the target diseases. This study used the potential of social science research methods in understanding social, cultural, political and economic factors that influence the efficiency and effectiveness of immunization programs in the Ethiopian context. A better understanding of these factors is believed to improve the quality and sustainability of immunization programs. This research focused on relevant issues at micro- and macro-levels. The study basically utilized qualitative research methods involving multiple data collection tools and information sources. Factors related to acceptors, immunization service providers and organization of health services that influence the successful implementation and sustainability of the immunization program in the Ethiopian context are identified and discussed. Strengthening efforts to improve technical capacity of service providers, increasing social mobilization activities, instituting quality assurance schemes and improving management of resources (human, finance and material) are among the major recommendations.

Child↗
PubMed1999

Effective prevention programs for tobacco use.

Several types of prevention programs have shown effects on delaying or reducing youth tobacco use for periods of 1-5 years or more. These are referred to as evidence-based programs. However, they are not widely used. At the same time, with few exceptions, adolescent tobacco use rates have been stable or have increased in the 1990s. The challenge for prevention is to identify critical components shared by effective prevention programs--that is, components most associated with effect, and then to evaluate factors that are most likely to promote adoption, implementation, and diffusion of effective programs across schools and communities in the United States. Effective tobacco prevention programs focus on counteracting social influences on tobacco use, include either direct training of youth in resistance and assertiveness skills or, for policy and community organization interventions, direct or indirect (through adults) training in community activism, and are mainly theory-based, with an emphasis on three levels of theory: (a) personal (attitudes, normative expectations, and beliefs); (b) social (social or group behavior); and/or (c) environmental (communications and diffusion). Program effects increase with the use of booster sessions, standardized implementor training and support, multiple program components, and multiple levels of theory. Overall, multi-component community programs that have a school program as a basis, with supportive parent, media, and community organization components, have shown the most sustained effects on tobacco use. Positive program adoption by the school or community, extent and quality of program implementation, and existence of credible networks of leaders to promote the program are critical for any effect. Research on predictors of adoption, implementation, and diffusion of evidence-based programs is scanty relative to outcome research. In addition, more research is needed on why multi-component programs appear to be most effective, whether effect is related to existing tobacco policies, whether prevention programs have differential effects on youth with different natural trajectories of tobacco use, and whether prevention programs can be used to recruit smokers into cessation programs.

Adolescent↗
PubMed1992

[Comparative effects of anti-arrhythmia agents on ventricular refractory period and prevention of ventricular tachycardia induced by stimulation].

The efficacy of antiarrhythmic drugs is attributed to their actions on the refractory periods or conduction velocity in the reentry circuit. The aim of this study was to determine the relationship between these factors and the prevention of electrically inducible ventricular tachycardia (VT). Twenty-seven patients with sustained monomorphic postinfarction VT underwent programmed stimulation under basal conditions and after administration of oral Class I antiarrhythmic drugs. The protocol of stimulation consisted of delivering one to three extrastimuli to the right ventricular apex on two basic cycle lengths. Sustained VT was induced in all patients. After the same protocol under antiarrhythmic therapy (1 to 5 tests, average 2.9 +/- 1) sustained VT could not be induced in 12 patients (44%). The effective right ventricular refractory period was significantly increased in patients without inducible VT under treatment (247 +/- 18 versus 302 +/- 26 ms). The increase in the right ventricular effective refractory period in patients with persistence of inducible VT was much less (from 270 +/- 28 to 287 +/- 30 ms). In all patients in whom several antiarrhythmic drugs were tested the right ventricular effective refractory period was higher when the treatment was judged to be effective (299 +/- 27 ms) than ineffective (272 +/- 27, p < 0.02). The prevention of inducible VT by class I antiarrhythmic agents seems therefore to be related to their effect on the ventricular refractory period.

Anti-Arrhythmia Agents↗
PubMed2006

Self-reported infection control practices and perceptions of HIV/AIDS risk amongst emergency department nurses in Botswana.

This descriptive exploratory study investigated the reported practices and perceptions of emergency nurses related to infection control in the context of the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) pandemic in Botswana. Quantitative and qualitative data were collected using a self-administered questionnaire. Forty questionnaires were distributed to nurses with emergency department experience in Botswana, with a response rate of 55% (n = 22). Quantitative data were analysed using descriptive statistics while qualitative data were subjected to thematic and content analysis. The majority of respondents reported compliance with universal precautions at the hospital emergency department. However, qualitative data highlighted resource constraints that may hinder compliance with universal precautions such as a lack of appropriate facilities, a shortage of equipment and materials, inadequate staffing and absence of sustainable in-service education programs. Further, the reported compliance with Universal Precautions had not removed the fear of exposure to HIV/AIDS and perceived risk of transmission to family. The authors recommend in-service education and practice initiatives to promote sustainable compliance with universal precautions and realistic risk perception among nurses. Further research is required to evaluate nurses' compliance with universal precautions in developing countries using observational methods or in-depth interviews. This would enable exploration of nurses' actions regarding compliance with universal precautions.

Blood-Borne Pathogens↗
PubMed1991

Immediate and sustained reduction in serum cholesterol achieved in 4-week Heart Tune program.

Currently, there is limited information about educational models effective in assisting individuals to lower their serum cholesterol. Dietitians and nutritionists involved in cholesterol-reduction programs need to inform other health professionals about programs utilized and the success of those programs. The National Cholesterol Education Program has published guidelines for the detection, evaluation, and treatment of high blood cholesterol in adults. Educational programs should be systematically evaluated to confirm their success in cholesterol reduction. The Heart Tune program is a 4-week class developed by a dietitian to assist clients in cholesterol reduction. An evaluation of the lipoprotein levels of 49 program participants demonstrated that serum total cholesterol levels significantly decreased at the completion of the 4-week class (0.65 mmol/L) and after 1 year (0.80 mmol/L).

Adult↗
PubMed2005

Heterogeneity of heart failure management programs in Australia.

BACKGROUND: Heart Failure Management Programs (HFMPs) have proven to be cost-effective in minimising recurrent hospitalisations, morbidity and mortality. However, variability between the programs exists which could translate into variable health outcomes. OBJECTIVE: To survey the characteristics of HFMPs throughout Australia and to identify potential heterogeneity in their organisation and structure. METHOD: Thirty-nine post-discharge HFMPs were identified from a systematic search of the Australian health-care system in 2002. A comprehensive 19-item questionnaire specifically examining characteristics of HFMPs was sent to co-ordinators of identified programs in early 2003. RESULTS: All participants responded with six institutions (15%) indicating that their HFMP had ceased operations due to a lack of funding. The survey revealed an uneven distribution of the 33 active HFMPs operating throughout Australia. Overall, 4450 post-discharge HF patients (median: 74; IQR: 24-147) were managed via these programs, representing only 11% of the potential caseload for an Australia-wide network of HFMPs. Heterogeneity of these programs existed in respect to the model of care applied within the program (70% applied a home-based program and 18% a specialist HF clinic) and applied interventions (30% of programs had no discharge criteria and 45% of programs prevented nurses administering/titrating medications). Sustained funding was available to only 52% of the active HFMPs. CONCLUSION: Inequity of access to HFMPs in Australia is evident in relation to locality and high service demand, further complicated by inadequate funding. Heterogeneity between these programs is substantial. The development of national benchmarks for evidence-based HFMPs is required to address program variability and funding issues to realise their potential to improve health outcomes.

Aftercare↗
PubMed1999

Induction of atrial fibrillation and flutter in dogs using methacholine.

Systemic infusion of methacholine has been used to facilitate induction of atrial fibrillation. However, the dose-response relationship, reproducibility and effect of anesthetic agents on induction are not well understood. The use of methacholine to facilitate electrical induction of sustained (>10 minutes duration) atrial fibrillation or flutter was examined. In 25 dogs induction of atrial arrhythmias was attempted using a series of ten 50 Hz trains of 10 seconds duration delivered via an endocardial catheter in the baseline anaesthetized state and subsequently in the presence of graded doses of intravenous methacholine (maximum 5 microg/kg/min). Studies were repeated in 13 dogs to assess reproducibility. Twelve dogs (48%) had inducible sustained atrial flutter or fibrillation lasting greater than 10 minutes in the baseline state. During infusion of methacholine the remaining 13 (52%) dogs also had inducible sustained atrial flutter or fibrillation (mean infusion rate 1.6 +/- 1.9 microg/kg/min). Induction of sustained atrial flutter or fibrillation was reproducible in all but one dog. The type of anesthetic did not significantly affect inducibility. Induction of prolonged atrial fibrillation or flutter is possible in the baseline anaesthetized state in approximately half of dogs using high frequency programmed electrical stimulation. The yield of inducible sustained atrial fibrillation or flutter with programmed stimulation during intravenous infusion of methacholine was increased to 100%. Induction of sustained atrial fibrillation or flutter was highly reproducible.

Anesthetics, Inhalation↗
PubMed1987

Effects of intravenous disopyramide and quinidine on normal myocardium and on the characteristics of arrhythmias: intraindividual comparison in patients with sustained ventricular tachycardia.

Intraindividual comparison of the acute response to intravenous quinidine and to intravenous disopyramide was performed in 27 patients with sustained ventricular tachycardia (VT) who underwent serial electrophysiological studies. In each patient, sustained VT could be reproducibly initiated by programmed ventricular stimulation during control studies. Quinidine and disopyramide prevented inducibility of sustained VT in 7 and 8 of the 27 patients, respectively. Six patients were concordant responders to both drugs and 18 patients were concordant non-responders resulting in a total of 24 patients (89%) who had a concordant result (P less than 0.01). In the 18 non-responders with inducible sustained VT after both drugs, quinidine and disopyramide caused qualitatively and quantitatively similar changes in the characteristics of the VT: prolongation of the interval between the initiating extrastimulus and the first beat of VT by 36 and 39%, and an increase in VT cycle length by 21 and 29%, respectively. The QRS morphology of VT was concordantly altered in 13 of these 18 patients (72%). In all 27 patients, quinidine and disopyramide caused a quantitatively similar prolongation of ventricular refractoriness by 12 and 14%, of the QRS duration by 14 and 13% and of the QTc interval by 13 and 13%, respectively. The clinical data obtained at comparable plasma concentrations confirm the experimental presumption that quinidine and disopyramide have qualitatively and quantitatively similar electrophysiological effects not only on normal myocardium but also on the characteristics of VT, resulting in a significant concordance of antiarrhythmic responses.

Adult↗
PubMed1998

The importance of the health education program environment for pregnant and parenting teens.

Teenage Pregnancy is recognized as one of this country's most critical social issues. Each year, one out of ten females aged 15 to 19 becomes pregnant. In addition, there are a number of documented complications and consequences for the pregnant teenagers, their children, families and society. In response a number of health education programs have been developed to meet the myriad needs of this aggregate. Unfortunately, most of this cohort do not participate in these health education programs. This study, a part of a larger study, was conducted to identify the health education program elements most important to attract and sustain the participation of pregnant and parenting teens in a health education program. The sociodemographics of the pregnant and parenting teens were identified and linked to program elements. Since sociodemographics are often the first information known about a target group, linking these demographics to health education program elements has implications for program development and marketing. An exploratory survey methodology was used in this study and data were analyzed by measures of central tendency, dispersion, and analysis of variance to understand better the relationship between sociodemographic characteristics and importance of the health education program environment for pregnant and parenting teens.

Adolescent↗