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PubMed1989

Values and priorities: their effect on knowledge utilization in public mental health programs.

Developing and maintaining shared values and priorities in public mental health systems is crucial to clinical, program, policy and administrative success. The issues of establishing priority populations, mobilizing resources, and improving quality of care and personal leadership style are discussed as examples of the ways in which such consensus contributed to progress in Pennsylvania's public mental health system.

Health Planning↗
PubMed1999

Cytosine methylation and mammalian development.

Programmed methylation and demethylation of regulatory sequences has been proposed to play a central role in vertebrate development. We report here that the methylation status of the 5' regions of a panel of tissue-specific genes could not be correlated with expression in tissues of fetal and newborn mice. Genes reported to be regulated by reversible methylation were not expressed ectopically or precociously in Dnmt1-deficient mouse embryos under conditions where demethylation caused biallelic expression of imprinted genes and activated transcription of endogenous retroviruses of the IAP class. These and other data suggest that the numerous published expression-methylation correlations may have described not a cause but a consequence of transcriptional activation. A model is proposed under which cytosine methylation represents a biochemical specialization of large genomes that participates in specialized biological functions such as allele-specific gene expression and the heritable transcriptional silencing of parasitic sequence elements, whereas cellular differentiation is controlled by conserved regulatory networks that do not depend on covalent modification of the genome.

Alleles↗
PubMed2002

Ventricular assist devices: developing and maintaining a training and competency program.

Ventricular assist devices (VADs) have made it possible for patients with end-stage heart failure to survive until a donor heart is available. In addition to serving as a bridge to transplantation, evolving indications for VADs include bridge to recovery and destination therapy. There are many VAD programs, but in the majority of programs only a small number of devices are implanted each year. Low volume poses a challenge in terms of provision of comprehensive education and training for nurses who will care for patients with VADs and in terms of maintaining competency to care for these patients. This article briefly addresses current VAD technology and VAD program development. The major focus is on the education and competency challenges and solutions the authors have experienced as infrequent users of VAD technology.

Clinical Competence↗
PubMed1996

Evaluating the Healthy Start program. Design development to evaluative assessment.

The national evaluation of the federally funded Healthy Start program involved translating a design for a process and outcomes evaluation and standard maternal and infant data set, both developed prior to the national evaluation contract award, into an evaluation design and client data collection protocol that could be used to evaluate 15 diverse grantees. This article discusses the experience of creating a process and outcomes evaluation design that was both substantively and methodologically appropriate given such issues as the diversity of grantees and their community-based intervention strategies; the process of accessing secondary data sources, including vital records; the quality of client level data submissions; and the need to incorporate both qualitative and quantitative approaches into the evaluation design. The relevance of this experience for the conduct of other field studies of public health interventions is discussed.

Child Health Services↗
PubMedDate not supplied

Extending the role of nurses in staff development by combining an organizational change perspective with an individual learner perspective.

Nurses in staff development have a strong focus on developing programs that support the needs of individual learners. They are much less focused on ways that their programs may support ongoing practice change in the workplace. This article outlines a number of characteristics of staff development programs that are trying to incorporate an organizational change perspective. It then illustrates these characteristics with a case study of a specific staff development program.

Aged↗
PubMedDate not supplied

The HRSA-APA Faculty Development Scholars Program: executive leadership track.

BACKGROUND: The work environment and characteristics and behaviors of leaders are key components to successful programs. Pediatric primary care education has suffered from a lack of effective leaders. OBJECTIVE: The Executive Leadership Track of the Health Services Resources Administration-Ambulatory Pediatrics Association (HRSA-APA) National Faculty Development Scholars Program was designed to develop a cadre of teaching faculty with the knowledge, attitudes, and skills to lead primary care faculty development efforts in their home institutions, regions, and the nation. METHODS: Senior faculty from each APA region were selected to participate in a basic series of three 2-day leadership workshops. Three workshops addressed topics shown to be essential to development of productive work environments, 3 emphasized career development, and 3 addressed development of effective administrative skills. Participants were expected to give at least one workshop in their home institution or region every 6 months. Outcome measures included number of scholars successfully completing the program, number of workshops given by scholars, number of participants in scholars' workshops, indicators of professional growth, and indicators of changes in their work environment that support medical education and teaching. RESULTS: Thirty-two scholars conducted 90 workshops attended by 1082 participants. Scholars reported professional accomplishment, including assuming positions of leadership and promotion. Changes to the scholar's work environment included increased emphasis on educational scholarship in promotion and tenure considerations, mission-based budgeting, and closer collaboration between academic and community faculty. CONCLUSION: The program participants became effective leaders of and advocates for medical education.

Ambulatory Care↗
PubMed1999

Reflections on two decades of research on teen sexual behavior and pregnancy.

During the past 20 years, both researchers and program developers made great progress in their efforts to reduce adolescent unprotected sex and prevent teen pregnancy. Research studies are now more likely to employ experimental designs with random assignments, to have large sample sizes with adequate statistical power, to measure actual sexual and contraceptive behaviors, to measure longer term effects, to employ proper statistical methods, and to report results in an unbiased manner. As a result of this body of research, large advances have occurred in our understanding of: 1) the incidence of teen pregnancy, and its consequences; 2) the effects of improving adolescent knowledge, increasing access to contraception, and improving parent/child communication; and 3) the characteristics of effective programs. The on-going evaluation of sex and HIV education programs coupled with creativity and perseverance on the part of program developers led to two groups of effective programs--sex and HIV education programs that reduce sexual risk-taking behavior, and youth development programs that reduce teen-age pregnancy and childbearing.

Adolescent↗
PubMed2000

Using evaluation methods to guide the development of a tobacco-use prevention curriculum for youth: a case study.

BACKGROUND: Fundamental to the development of educational programs and curricula is the evaluation of processes and outcomes. Unfortunately, many otherwise well-designed programs do not incorporate stringent evaluation methods and are limited in measuring program development and effectiveness. Using an advertising lesson in a school-based tobacco-use prevention curriculum as a case study, the authors examine the role of evaluation in the development, implementation, and enhancement of the curricular lesson. METHODS: A four-phase formative and summative evaluation design was developed to divide the program-evaluation continuum into a structured process that would aid in the management of the evaluation, as well as assess curricular components. RESULTS AND CONCLUSIONS: Formative and summative evaluation can provide important guidance in the development, implementation, and enhancement of educational curricula. Evaluation strategies identified unexpected barriers and allowed the project team to make necessary "time-relevant" curricular adjustments during each stage of the process.

Adolescent↗
PubMed2002

Involvement of a matrix metalloproteinase in MIS-induced cell death during urogenital development.

Programmed cell death of the Müllerian duct eliminates the primitive female reproductive tract during normal male sexual differentiation. Müllerian inhibiting substance (MIS or AMH) triggers regression by propagating a BMP-like signaling pathway in the Müllerian mesenchyme that culminates in apoptosis of the Müllerian duct epithelium. Presently, the paracrine signal(s) used in this developmental event are undefined. We have identified a member of the matrix metalloproteinase gene family, Mmp2, as one of the first candidate target genes downstream of the MIS cascade to function as a paracrine death factor in Müllerian duct regression. Consistent with a role in regression, Mmp2 expression was significantly elevated in male but not female Müllerian duct mesenchyme. Furthermore, this sexually dimorphic expression of Mmp2 was extinguished in mice lacking the MIS ligand, suggesting strongly that Mmp2 expression is regulated by MIS signaling. Using rat organ genital ridge organ cultures, we found that inhibition of MMP2 activity prevented MIS-induced regression, whereas activation of MMP2 promoted ligand-independent Müllerian duct regression. Finally, MMP2 antisense experiments resulted in partial blockage of Müllerian duct regression. Based on our findings, we propose that similar to other developmental programs where selective elimination or remodeling of tissues occurs, localized induction of extracellular proteinases is critical for normal male urogenital development.

Animals↗
PubMed2006

The International Atomic Energy Agency (IAEA) program on radiation and tissue banking: a successful program for developing countries.

Since its inception the IAEA program in radiation and tissue banking supported the establishment of twenty five tissue banks in different countries. Now more than 103 tissue banks are now operating in these countries. The production of sterilized tissues has grown in an exponential mode within the IAEA program. From 1988 until the end of 2000 the production of sterilized tissues was 224,706 grafts, with an estimated value of at least $51,768,553 million dollars at the mean current charge rate in non-commercial banks in Europe and USA. During the period 1997-2002 several countries from Asia and the Pacific region produced more than 155,000 grafts, with an estimated value of about $36.7 million dollars. Training was considered to be one of the most important tasks to be supported. A total of 192 students were registered in the training program and 146 students graduated with a University Diploma. For many developing countries an additional benefit is not having to import expensive sterilized tissues from developed countries, but the exposure of orthopedic and plastic surgeons working, to new methods of using allografts in specific surgical treatments.

Developing Countries↗
PubMed1996

Cross-modality grief therapy: description and assessment of a new program.

A recently developed program for extensive inpatient grief therapy in groups, administered on a time-limited basis, is outlined, an illustrative case study is described, and empirical assessment of the program's efficacy is provided. During a 3-month stay in a Dutch Health Care Centre, a combined treatment program was offered that integrated behavior and art therapy [so-called Cross-Modality Grief Therapy, (CMGT)]. Assessment (levels of symptomatology on the General Health Questionnaire) was made at pretest, post-test, and follow-up and was compared with levels at comparable time points among participants in a more traditional program. Systematic advantages were found for CMGT. Discussion focuses on the identification of elements within CMGT that were responsible for its effectiveness.

Adult↗
PubMed1993

Clinical aspects of nimodipine.

This overview describes the result of the clinical development program in organic brain syndrome (impaired brain function in old age), where efficacy was proven in 11 double-blind, placebo-controlled studies. Another study within this development program showed nimodipine not only to be superior to placebo but also to hydergine. Furthermore, in a placebo-controlled clinical trial, nimodipine caused further improvement in performance compared to regular mental exercise at home. Due to the results in the organic brain syndrome program, registration was granted in 23 countries worldwide for this indication. In one clinical trial in the dementia development program, patients with dementia were carefully allocated either to primary degenerative dementia (PDD) or multi-infarct dementia (MID) stratum; nimodipine was shown to be superior to placebo independent of the etiology. Other clinical trials conducted in this indication supported the evidence for efficacy and showed that nimodipine-treated patients performed better than placebo patients. The safety profile of the drug is well established and substantiated by extensive postmarketing surveillance. In general, nimodipine was well tolerated, showing few adverse events. Finally, topics for future research are covered such as developing new instruments to assess more severe patients, expanding the patient collective to secondary dementias such as AIDS and Parkinson dementia, implementation of cost/utility elements in the development program, and the issue of nimodipine's potential role in the prevention of disease.

Aged↗
PubMed2006

Data to action: using formative research to develop intervention programs to increase physical activity in adolescent girls.

Formative research is used to inform intervention development, but the processes of transmitting results to intervention planners and incorporating information into intervention designs are not well documented. The authors describe how formative research results from the Trial of Activity for Adolescent Girls (TAAG) were transferred to planners to guide intervention development. Methods included providing oral and written reports, prioritizing recommendations, and cross-checking recommendations with intervention objectives and implementation strategies. Formative work influenced the intervention in many ways. For example, results indicated that middle schools offered only coeducational physical education and health education classes, so the TAAG intervention was designed to be appropriate for both sexes, and intervention strategies were developed to directly address girls' stated preferences (e.g., enjoyable activities, opportunity to socialize) and barriers (e.g., lack of skills, fear of injury) for physical activity. The challenges of using formative research for intervention development are discussed.

Adolescent↗
PubMed1993

Use of focus group methodology to develop an asthma self-management program useful for community-based medical practices.

Health education programs developed in academic medical centers are not optimally disseminated to community clinical settings. Strategies are needed to translate the findings of research on health education programs into programs useful in a wide range of health care settings. Focus group techniques were used to provide data for revising a successful university-based asthma self-management program to make it more practical for use by community physicians. Physicians representing a variety of specialties attended the sessions and provided feedback on the utility of various components of the original program. The discussions revealed that many physicians felt they did not have the time or resources to conduct the original program and identified elements viewed as impractical. This physician input contributed significantly to the development of a revised program with a briefer, less costly intervention. The revised program was later evaluated by focus group participants. Eighty-eight percent of those who evaluated the revised program agreed they would be able and willing to use the program in their own practices. As a formative evaluation tool, the focus group technique made available useful information that would have been difficult to obtain through evaluation forms alone.

Adult↗
PubMed2004

Na Liko Noelo: a program to develop Native Hawaiian researchers.

Native Hawaiians are underrepresented in health research. They also have expressed dissatisfaction with the way in which many non-native researchers have formulated research questions, conducted research, and disseminated findings about Native Hawaiians. 'Imi Hale - Native Hawaiian Cancer Network was funded by the National Cancer Institute to increase research training and mentorship opportunities for Native Hawaiians. To this end, 'Imi Hale has followed principles of community-based participatory research to engage community members in identifying research priorities and assuring that research is beneficial, and not harmful, to Native Hawaiians. Developing indigenous researchers is a cornerstone of the program and, in its first 4 years 'Imi Hale enrolled 78 Native Hawaiian "budding researchers (called Na Liko Noelo in Hawaiian), of which 40 (68%) have participated in at least one training and 28 (36%) have served as investigators, 40 (51%) as research assistants, and 10 (13%) as mentors on cancer prevention and control studies. The major challenge for Nă Liko Noelo is finding the time needed to devote to research and writing scientific papers, as most have competing professional and personal obligations. Program evaluation efforts suggest, however, that 'Imi Hale and its Na Liko Noelo program are well accepted and are helping develop a cadre of community-sensitive indigenous Hawaiian researchers.

Biomedical Research↗
PubMed2002

[Nobel Prize for Physiology or Medicine 2002 is awarded for research into the genetic regulation of organ development and programmed cell death].

The human body consists of hundreds of cell types, all originating from one fertilized egg. During the embryonic and foetal periods, the number of each cell type increases dramatically. The cells mature and become specialised to form the various tissues and organs of the body. Large numbers of cells are also formed in the adult body. Cell death is a normal process, which runs parallel to this generation of new cells. It takes place in both the foetus and adult, thereby maintaining the appropriate number of cells in the tissues. This delicate, controlled elimination of cells is termed programmed cell death or apoptosis. This year's Nobel laureates in Physiology or Medicine (Sydney Brenner, H. Robert Horvitz and John E.Sulston) have made seminal discoveries relating to the genetic regulation of organ development and programmed cell death. The nematode Caenorhabditis elegans was used as an experimental model system for following cell division and differentiation from the fertilized egg to the adult. The laureates have identified key genes that regulate organ development and programmed cell death and have also shown that corresponding genes exist in higher species, including humans. The discoveries are important for medical research and have shed new light on the pathogenesis of many diseases.

Animals↗
PubMed1995

Identification of human gene structure using linear discriminant functions and dynamic programming.

Development of advanced technique to identify gene structure is one of the main challenges of the Human Genome Project. Discriminant analysis was applied to the construction of recognition functions for various components of gene structure. Linear discriminant functions for splice sites, 5'-coding, internal exon, and 3'-coding region recognition have been developed. A gene structure prediction system FGENE has been developed based on the exon recognition functions. We compute a graph of mutual compatibility of different exons and present a gene structure models as paths of this directed acyclic graph. For an optimal model selection we apply a variant of dynamic programming algorithm to search for the path in the graph with the maximal value of the corresponding discriminant functions. Prediction by FGENE for 185 complete human gene sequences has 81% exact exon recognition accuracy and 91% accuracy at the level of individual exon nucleotides with the correlation coefficient (C) equals 0.90. Testing FGENE on 35 genes not used in the development of discriminant functions shows 71% accuracy of exact exon prediction and 89% at the nucleotide level (C = 0.86). FGENE compares very favorably with the other programs currently used to predict protein-coding regions. Analysis of uncharacterized human sequences based on our methods for splice site (HSPL, RNASPL), internal exons (HEXON), all type of exons (FEXH) and human (FGENEH) and bacterial (CDSB) gene structure prediction and recognition of human and bacterial sequences (HBR) (to test a library for E. coli contamination) is available through the University of Houston, Weizmann Institute of Science network server and a WWW page of the Human Genome Center at Baylor College of Medicine.

Algorithms↗
PubMed1993

Development of residency program guidelines for interaction with the pharmaceutical industry. Education Council, Residency Training Programme in Internal Medicine, Department of Medicine, McMaster University, Hamilton, Ont.

Medical residency programs are likely to face increasing pressure to address their relations with the pharmaceutical industry. Our internal medicine residency program has developed guidelines that were adopted after extensive debate by residents and faculty members. The guidelines are based on the principles that residents and faculty should set the educational agenda and that the residency program should not allow gifts of any sort from industry to residents. Specific policies include obtaining and screening educational materials from the industry before residents are exposed to them, proscribing "drug lunches" and accepting industry sponsorship only when the residency program maintains complete control of the educational event being sponsored. The industry response to the guidelines was split; about half reacted negatively, and half found the guidelines acceptable. Our experience suggests that productive debate about guidelines for the interaction of residency programs with the pharmaceutical industry is possible and desirable and that explicit policies can clarify areas of ambiguity.

Drug Industry↗