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PubMedDate not supplied

Meeting the continuing education needs of pediatric nurses: the Pediatric Nurse Exchange Program.

Today's dynamic health care environment offers multiple challenges as hospitals attempt to design and implement successful nursing career plans and support the development of professional nurses along such plans. The Pediatric Nurse Exchange Program is designed as a means for personal and professional development to support professional nurses as they are challenged to provide quality nursing care to children and their families. A pilot project is designed to provide experiences for professional nurses in three children's hospitals in Ohio. Exchange experiences, of two to five days in length, provide opportunities for nurses to share expertise, exchange patient care strategies, and develop skills as consultants, change agents, educators, and communicators. Nurse participants in the program are awarded continuing education contact hours for the experience.

Clinical Competence↗
PubMedDate not supplied

Finding anchors for genomic sequence comparison.

Recent sequencing of the human and other mammalian genomes has brought about the necessity to align them, to identify and characterize their commonalities and differences. Programs that align whole genomes generally use a seed-and-extend technique, starting from exact or near-exact matches and selecting a reliable subset of these, called anchors, and then filling in the remaining portions between the anchors using a combination of local and global alignment algorithms, but their choices for the parameters so far have been primarily heuristic. We present a statistical framework and practical methods for selecting a set of matches that is both sensitive and specific and can constitute a reliable set of anchors for a one-to-one mapping of two genomes from which a whole-genome alignment can be built. Starting from exact matches, we introduce a novel per-base repeat annotation, the Z-score, from which noise and repeat filtering conditions are explored. Dynamic programming-based chaining algorithms are also evaluated as context-based filters. We apply the methods described here to the comparison of two progressive assemblies of the human genome, NCBI build 28 and build 34 (www.genome.ucsc.edu), and show that a significant portion of the two genomes can be found in selected exact matches, with very limited amount of sequence duplication.

Algorithms↗
PubMed1984

The relative success of the Kainji resettlement scheme as compared with that of Volta.

The author compares the population resettlement programs undertaken in connection with the construction of dams at Lake Volta in Ghana and Kainji Lake in Nigeria. Data are from published sources and from a 1971 survey conducted by the author in Nigeria. Differences between the policies and procedures are outlined. It is noted that "these differences resulted in the differences in the patterns of adjustment of the resettled people."

Africa↗
PubMed2002

Computationally intensive econometrics using a distributed matrix-programming language.

This paper reviews the need for powerful computing facilities in econometrics, focusing on concrete problems which arise in financial economics and in macroeconomics. We argue that the profession is being held back by the lack of easy-to-use generic software which is able to exploit the availability of cheap clusters of distributed computers. Our response is to extend, in a number of directions, the well-known matrix-programming interpreted language Ox developed by the first author. We note three possible levels of extensions: (i) Ox with parallelization explicit in the Ox code; (ii) Ox with a parallelized run-time library; and (iii) Ox with a parallelized interpreter. This paper studies and implements the first case, emphasizing the need for deterministic computing in science. We give examples in the context of financial economics and time-series modelling.

Computer Communication Networks↗
PubMed1998

Timing of HIV interventions on reductions in sexual risk among adolescents.

Examined the effectiveness of an HIV intervention program among 151 adolescents ages 13 to 24 years who were randomly assigned to (a) seven sessions of 1.5 hr each (10.5 hr); (b) three sessions of 3.5 hr each (10.5 hr); or (c) a no-intervention condition. Using cognitive-behavioral intervention strategies, social skills and HIV-related beliefs, perceptions, and norms were targeted in both the three- and seven-session, small-group intervention conditions. Regression analysis indicated that over 3 months, the number of unprotected risk acts and the number of sexual partners were lower in the seven-session condition compared to the other conditions. Factors mediating risk acts changed in a complex manner. For example, perceived vulnerability increased for those with initially lower vulnerability scores among youths in the seven-session condition compared to others. Self-approval of condom use was also higher for those with initially low scores in the seven-session compared to the three-session condition. Self-efficacy for risk avoidance and condom use was significantly higher in the three-session condition for those with initially low scores compared to other groups. On the role-play measure, those with higher baseline scores in the low-pressure situation improved significantly only in the three-session intervention; in the high-pressure situation, the participants reported significantly higher scores in the seven-session intervention, and those with higher scores improved the most. Results suggest the importance of multisession HIV intervention programs to be delivered with fidelity in community settings.

Adolescent↗
PubMedDate not supplied

Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities.

CONTEXT: A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy. METHODS: A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. RESULTS: There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community. CONCLUSIONS: This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.

Adolescent↗
PubMed1984

Effects of beta 1-selective and nonselective beta-adrenoceptor blockade during exercise conditioning in healthy adults.

The interaction of beta 1-selective (cardioselective) and nonselective beta-adrenoceptor blockade with exercise conditioning was investigated in 30 healthy adult persons. A double-blind protocol was used and the effects of atenolol (100 mg/day), propranolol (80 mg twice daily), and placebo were studied by treadmill testing (Bruce protocol) before and after a 2-month supervised program of dynamic exercise. Exercise tolerance was assessed by time and work performed to exhaustion. Subjects who received propranolol, but not those who received atenolol or placebo, showed an acutely impaired exercise tolerance after drug administration but before training (-8 +/- 4%, p less than 0.05). All 3 groups showed significantly improved exercise capacity following training after drug treatment had been discontinued (atenolol, 22 +/- 6% improvement; propranolol, 13 +/- 6%; placebo, 10 +/- 3%). However, when tested while still receiving medication, subjects who received propranolol failed to show significant improvement in exercise capacity. In contrast, patients who received atenolol and placebo improved significantly. The data indicate that enhancement of maximal work capacity by exercise conditioning can occur despite administration of either beta 1-selective or nonselective beta-adrenoceptor antagonists. However, the fatiguing effects of propranolol that were evident when work performance during propranolol therapy was compared with work performance while not receiving propranolol before the training program persists after training and may limit the net improvement in work capacity induced by exercise conditioning compared with the pretraining state.

Adult↗
PubMed2000

Cost-effectiveness of screening programs for Chlamydia trachomatis: a population-based dynamic approach.

BACKGROUND: Models commonly used for the economic assessment of chlamydial screening programs do not consider population effects. GOAL: To develop a novel dynamic approach for the economic evaluation of chlamydial prevention measures and to determine the cost-effectiveness of a general practitioner-based screening program. STUDY DESIGN: The dynamic approach was used to estimate the cost-effectiveness of a screening program for the first 10 years of screening in The Netherlands. Screening involved a ligase chain reaction test on urine followed by standardized therapies and partner referral. Eligible persons were sexually active, 15 to 24 years, visited a general practitioner, and had no symptoms of sexually transmitted diseases. The heterosexual model population, which consisted of persons 15 to 64 years, had a total chlamydial prevalence of 4.1% before screening. Screening effects on chlamydial incidence were computed by using a population-based stochastic simulation model. Incidence data were connected with a decision analysis model to determine the health effects of the program. The net costs of the program were calculated (investment costs minus averted costs, in 1997 US$) from a societal perspective and expressed per major outcome averted (symptomatic pelvic inflammatory disease, chronic pelvic pain, ectopic pregnancy, infertility, neonatal pneumonia). RESULTS: Unlike the standard static approach, our model adequately addresses dynamic processes such as chlamydial transmission and the impact of screening programs on chlamydial incidence in the population. During the first 10 years of screening, the investigated program yields savings of US $492 or US $1,086 per major outcome averted, excluding or including indirect costs, respectively. These results depend on chlamydial prevalence and partner referral. CONCLUSIONS: The cost-effectiveness of chlamydial screening programs seems best to be determined by using dynamic modeling on a population basis. In addition to preventing negative health outcomes, the investigated screening program may save costs.

Adolescent↗
PubMedDate not supplied

Splinting in the management of proximal interphalangeal joint flexion contracture.

Proximal interphalangeal (PIP) flexion contracture is a common complication following hand injuries and conditions. This study investigated the treatment outcome of 20 subjects with PIP flexion contracture who followed a dynamic splinting program using either a Capener or low-profile outrigger. The splint applied a 250-g force to the distal end of the middle phalanx. Each patient was instructed to wear the splint for 8 to 12 hours per 24 hours for 8 weeks followed by a 2- to 3-week weaning period. Passive extension was evaluated objectively using torque range-of-motion measurement. The average pretreatment flexion contracture was 39 degrees. Final extension deficit averaged 21 degrees, an improvement of 18 degrees. There was no statistically significant effect on final results based on joint stiffness (as expressed by the slopes of the torque angle curves). Total end-range time (TERT) averaged 10 hours per 24 hours, for an average period of 4.3 months. Statistical analysis showed that splinting time was the only statistically significant factor affecting outcome. The correlation coefficients showed that the longer the contracture was present, the stiffer the joint and the less the contracture resolved. Dynamic splinting was an effective form of treatment for PIP flexion contracture.

Adult↗
PubMed1993

A randomized trial of psychiatric day treatment for patients with affective and personality disorders.

OBJECTIVE: The outcome of a day treatment program for psychiatric outpatients with affective and personality disorders was evaluated. The program was dynamically oriented, intensive, group focused, and time limited (18 weeks). METHODS: The prospective trial used a randomized treatment-versus-control (delayed-treatment) design to examine 17 outcome variables covering five areas: interpersonal functioning, symptomatology, self-esteem, life satisfaction, and defensive functioning. Those variables, plus individualized treatment objectives, were monitored before and after the treatment and control periods and at follow-up an average of eight months later. RESULTS: Treated patients showed significantly better outcome than control patients for seven of the 17 outcome variables: social dysfunction, family dysfunction, interpersonal behavior, mood level, life satisfaction, self-esteem, and severity of disturbance associated with individual goals of treatment as rated by an independent assessor. The findings could not be accounted for by diagnosis or use of medication. Benefits were maintained over the follow-up period. The average treatment-versus-control effect size for all 17 variables was .71. CONCLUSIONS: The study supports the efficacy of an intensive day treatment program for patients who manifest significant difficulties associated with affective and personality disorders.

Adolescent↗
PubMed1992

Aboriginal migration and labour market programs.

"Despite the potential for government employment policies both to encourage and preclude migration among the Aboriginal workforce, little is known about the impacts of such policies. This paper seeks to construct a base line for identifying these impacts by establishing the spatial structure of labour migration among the Aboriginal and Torres Strait Islander population. It makes use of 1986 Census data to describe the volume and pattern of net and gross flows of working-age Aborigines and Islanders through the national settlement system, distinguishing between movements in remote and closely settled parts of the country. Full determination of the links between policy and migration flows awaits comparison with 1991 Census results."

Australia↗
PubMed1981

Reduction of mortality in rural Haiti through a primary-health-care program.

Deaths and their causes in a rural Haitian population of 8820 were studied through hospital records, death registration, a disease survey, and health surveillance. The results were used in selecting eight diseases for the delivery of health services by village-level health workers. The impact of the services was measured by monitoring annual age-specific and disease-specific mortality rates and by comparing them with officially estimated national mortality rates. Mortality rates fell progressively during five years, to levels only one fourth as high as the national estimates. The fall in mortality was associated principally with services that prevented deaths due to tetanus, malnutrition, diarrhea, and tuberculosis. The total program of hospital and village health services saved 495 years of potential life per thousand population per year. Most of the saving was attributable to preventive services. The program eventually served more than 115,000 persons, and it has been replicated by other agencies for an additional 135,000 Haitians.

Adolescent↗
PubMedDate not supplied

Levonorgestrel implant use among adolescents.

The levonorgestrel implant (Norplant System; Wyeth-Ayerst Laboratories, Philadelphia, Pa.) is a highly effective and desirable form of contraception for the adolescent population today. Not originally marketed toward this group of young women, it has become a very popular form of birth control for this age group. Even though common side effects are frequently experienced with the use of the Norplant System, timely and reassuring counseling from nurse practitioners is very effective in allaying fears and dissatisfaction. At the Pediatric Clinic for Denton County, Texas, nearly one half of all teenagers enrolled in the Teen Pregnancy Program in 1992 chose the Norplant System as their method of birth control, with very successful results.

Adolescent↗
PubMed1997

T-lymphocytopaenia, opportunistic infections and pathological findings in Ghanaian AIDS patients and their sexual partners.

Ninety-nine patients at Center for Disease Control (CDC) clinical stage IV were studied. Twelve (12.12%) of these patients turned out to be HIV seronegative. Ten out of the 12 HIV negative patients were immunocompetent whereas the other two had proportional decreases in both CD4+ and CD8+ T-lymphocytes. HIV-1, HIV-2, and dual infection, were detected in 51.5%, 2%, and 22.2% respectively of clinical AIDS patients. The other 12.12% of clinical AIDS patients were indeterminate for HIV antibodies. All HIV positive patients with the exception of two, were immunocompromised with respect to CD4+ and CD8+ T-lymphocyte counts. Two healthy spouses and three children of patients who died from the disease were seronegative for HIV antibodies. Herpes simplex virus type 2 (HSV-2) and cytomegalovirus (CMV) antibody titres were higher in HIV infected than uninfected blood. Patients with chronic diarrhoea, lymphadenopathy, pneumonia, and tuberculosis, either alone or in combination of two or more of such symptoms, were found to be more likely to be confirmed by serology and immunology as definitive AIDS patients in Ghana. In postmortem studies on 20 patients, pneumonia due to tuberculosis constituted the major cause of death. Toxoplasmosis, cytomegaloviral eosophagitis and enteritis, and cryptococcosis were the major opportunistic infections detected. Programmed cell death (apoptosis) was found by the DNA gel electrophoresis method to be an unlikely major mechanism of accelerated culture induced death of PBMCs from CDC stage IV AIDS patients.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

The clandestine epidemic: the practice of unsafe abortion in Latin America.

In Latin America, induced abortion is the fourth most commonly used method of fertility regulation. Estimates of the number of induced abortions performed each year in Latin America range from 2.7 to 7.4 million, or from 10 to 27 percent of all abortions performed in the developing world. Because of restrictive laws, nearly all of these abortions, except for those performed in Barbados, Belize, and Cuba, are clandestine and unsafe, and their sequelae are the principal cause of death among women of reproductive age. One of every three to five unsafe abortions leads to hospitalization, resulting in inordinate consumption of scarce and costly health-system resources. Increased contraceptive prevalence and restrictive abortion laws have not decreased clandestine practices. This article addresses how the epidemic of unsafe abortion might be challenged. Recommendations include providing safer outpatient treatment and strengthening family planning programs to improve women's contraceptive use and their access to information and to safe pregnancy termination procedures. In addition, existing laws and policies governing legal abortion can be applied to their fullest extent, indications for legal abortion can be more broadly interpreted, and legal constraints on abortion practices can be officially relaxed.

Abortion, Illegal↗
PubMed2005

A distributed computing system for multivariate time series analyses of multichannel neurophysiological data.

We present a client-server application for the distributed multivariate analysis of time series using standard PCs. We here concentrate on analyses of multichannel EEG/MEG data, but our method can easily be adapted to other time series. Due to the rapid development of new analysis techniques, the focus in the design of our application was not only on computational performance, but also on high flexibility and expandability of both the client and the server programs. For this purpose, the communication between the server and the clients as well as the building of the computational tasks has been realized via the Extensible Markup Language (XML). Running our newly developed method in an asynchronous distributed environment with random availability of remote and heterogeneous resources, we tested the system's performance for a number of different univariate and bivariate analysis techniques. Results indicate that for most of the currently available analysis techniques, calculations can be performed in real time, which, in principle, allows on-line analyses at relatively low cost.

Algorithms↗
PubMedDate not supplied

Educational outcomes in teenage pregnancy and parenting programs: results from a demonstration.

A comparison of five in-school educational and service approaches offered at seven sites in Arizona to 789 pregnant and parenting teenagers shows that except for those who enroll in a program in their third trimester, pregnant and parenting teenagers who attend a comprehensive, school-based, community-linked program are significantly more likely to continue in school than are those who have no access to a special program. The comprehensive program's impact is greatest among Hispanic students, younger students, those in grades 9-10, those who are living with their partner and those who enter the program in the first trimester. Two of the program components--strong outreach efforts and case management-are believed to have an especially favorable impact on continuation in school.

Adolescent↗
PubMed1991

The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems.

Acute Disease↗