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PubMed2006

Cost-effectiveness of rosiglitazone combination therapy for the treatment of type 2 diabetes mellitus in the UK.

INTRODUCTION: Recent clinical trial results have demonstrated that, in patients with type 2 diabetes, second-line treatment of rosiglitazone in combination with metformin can lead to significant improvements in the control of fasting plasma glucose/ glycosylated haemoglobin A1c (HbA1c) after the failure of metformin monotherapy. Our objective was to assess the cost-effectiveness of the use of rosiglitazone in combination with metformin in overweight and obese patients with type 2 diabetes in the UK, failing to maintain glycaemic control with metformin monotherapy compared with conventional care using metformin in combination with sulfonylurea. METHODS: The Diabetes Decision Analysis of Cost--type 2 (DiDACT) model, an established long-term economic model of type 2 diabetes, which projects the relationship between treatment and HbA1c over extended periods, was used to determine the health outcomes and economic impact for matched age and sex cohorts of 1000 patients with type 2 diabetes. The perspective was that of the UK National Health Service and all costs were in UK pounds sterling. RESULTS: Treatment with rosiglitazone in combination with metformin provides better glycaemic control over the remaining lifetime of patients than metformin and sulfonylurea combination therapy. Patients treated with rosiglitazone combination therapy were predicted to have a longer life expectancy, gaining 123 and 140 additional life years per 1000 patients in the obese and overweight cohorts, respectively. Improvements in morbidity and a delay in the start of insulin therapy resulted in a projected improvement in quality of life. These effects combine with projected improved survival to yield 131 and 209 additional quality-adjusted life-years (QALYs) per 1000 patients in the obese and overweight cohorts, respectively. Discounted incremental cost-effectiveness ratios were estimated at pounds 16,700 per QALY gained for the obese cohort and pounds 11,600 per QALY gained for the overweight cohort. CONCLUSION: The model predicts that rosiglitazone in combination with metformin is a cost-effective treatment in the UK for both obese and overweight patients failing on metformin monotherapy, compared with conventional therapy using metformin in combination with sulfonylurea.

Combined Modality Therapy↗
PubMed2004

Update and projection on HIV/AIDS in Taiwan.

The HIV/AIDS epidemic in Taiwan started in 1986, with 5,221 cases of HIV infections, 1,596 cases of AIDS, and 911 deaths reported through 2003. National surveillance data indicate that men who have sex with men accounted for 48.2% of HIV infections, followed by heterosexual men (33.8%) and heterosexual women (6.1%). Only 353 (6.8%) of all HIV cases are females. The average age of HIV-infected persons, AIDS cases, and deaths was 31.2, 36.2, and 39.0 years, respectively. The incidence of HIV infection has increased by approximately 15% every year since 1997. The continuing epidemic will likely burden the national health care system and may result in an estimated socioeconomic loss of U.S. dollars 1.6 billion in 2010, as 15,125 HIV infections and 1,420 deaths from AIDS are projected. To respond to the HIV/AIDS epidemic in Taiwan, the government has been working with nongovernmental organizations to promote HIV testing, conduct various education programs, and reach out to high-risk groups. HIV/AIDS patients are linked to medical care and provided with free highly active antiretroviral treatment. The main challenge is to reduce HIV-related stigma. Prevention focused on preventing further transmission of HIV by seropositive persons to others is urgently needed in fighting the HIV/AIDS epidemic.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Ramazzini Foundation cancer program: history and major projects, life-span carcinogenicity bioassay design, chemicals studied, and results.

The Ramazzini Foundation research program was started over thirty years ago. The features of this program are: (1) systematic and integrated project design; (2) consistency over time; (3) homogeneity of approach: key members of the team remain unchanged; and (4) choice to work on new frontiers of scientific research. The program centers mainly on three projects: Project 1: experimental carcinogenicity bioassays; Project 2: experimental anticarcinogenesis assays to identify factors and active principles (compounds) capable of opposing the onset of tumors while being suitable for preventive/chemopreventive intervention; Project 3: epidemiological studies, both descriptive and analytical, on tumor incidence and mortality in persons professionally and environmentally exposed to industrial carcinogenic risks. The project involving experimental carcinogenicity bioassays for the identification of exogenous carcinogens (environmental and industrial above all) began in 1966. This project has included 398 experimental bioassays on 200 compounds/agents using some 148,000 animals monitored until their spontaneous death. Among the studies already concluded, 47 agents have shown "clear evidence" of carcinogenicity. The results have demonstrated for the first time that (1) vinyl chloride can cause liver angiosarcoma as well as other tumors; (2) benzene is carcinogenic in experimental animals for various tissues and organs; (3) formaldehyde may produce lymphomas and leukemias; and (4) methyl-tert-butyl ether (MTBE), the most common oxygenated additive used in gasolines, can cause lymphomas/leukemias. Many of the results achieved have led to the introduction of norms and measures of primary prevention.

Animals↗
PubMedDate not supplied

Home training experience in peritoneal dialysis patients.

The objective of nursing is to increase health and well being, prevent morbidity and obtain the best physical and social rehabilitation. The nurse's role in Peritoneal Dialysis (PD) consists of promoting and supporting patients to perform self-care. In the'Text Book of Peritoneal Dialysis, published in 2000,the chapter dedicated to the nurses' role says:"Regular home visits are an important part of follow-up care, as the family and patient need to realize that continuing support is available... It is advisable that the first exchange after discharge from hospital is in the presence of a nurse... Early recognition and management of problems will assist in keeping the patient healthy and well rehabilitated, and will hopefully reduce hospital visits and inpatient stays" (1). Home care in Hospital Universitario La Paz has been developed with varying dedication over the years. Firstly, it was offered if significant problems appeared (1979-1990), later, home visits were started for some new PD patients (1990-1994) and follow up visits then ensued (1995-1996). In 1997, a project was undertaken which included home training for the first time in our unit, as well as periodic follow up visits. This project was shown to the Hospital Nurse Direction, and approved immediately. It started during the first term of 1997. There were several reasons which led us to undertake this project including the importance of providing PD at home and making it lifelong and it was felt that the hospital was an unfriendly environment in which to learn PD. The main objective was to establish early on, the patient's social environment and psychological status, and to assess how these influenced aspects of learning and adapting to PD. Most patients expressed a very good opinion about the home training. Only one patient rejected the presence of the nurse at home. The nursing team was very satisfied because early knowledge about the patient's psychosocial conditions and family environment was established. The incidence of peritonitis decreased.

Adult↗
PubMed2005

Conducting HIV interventions for Asian Pacific Islander men who have sex with men: challenges and compromises in community collaborative research.

This article describes the process of implementing a community collaborative HIV prevention intervention research project targeting Asian and Pacific Islander (API) men who have sex with men (MSM). This article traces the genesis of the project--which linked university researchers with an API--focused community based organization--starting from its original concept and study design to the actual implementation and evaluation. This project provides a case study for analyzing the challenges and barriers encountered in community collaborative HIV intervention. Strategies and best practices for building community capacity in evaluation research are provided, and theoretical considerations for conducting community-based health interventions are raised.

Adolescent↗
PubMed2005

MODELKEY. Models for assessing and forecasting the impact of environmental key pollutants on freshwater and marine ecosystems and biodiversity.

BACKGROUND: Triggered by the requirement of Water Framework Directive for a good ecological status for European river systems till 2015 and by still existing lacks in tools for cause identification of insufficient ecological status MODELKEY (http:// www.modelkey.org), an Integrated Project with 26 partners from 14 European countries, was started in 2005. MODELKEY is the acronym for 'Models for assessing and forecasting the impact of environmental key pollutants on freshwater and marine ecosystems and biodiversity'. The project is funded by the European Commission within the Sixth Framework Programme. OBJECTIVES: MODELKEY comprises a multidisciplinary approach aiming at developing interlinked tools for an enhanced understanding of cause-effect-relationships between insufficient ecological status and environmental pollution as causative factor and for the assessment and forecasting of the risks of key pollutants on fresh water and marine ecosystems at a river basin and adjacent marine environment scale. New modelling tools for risk assessment including generic exposure assessment models, mechanistic models of toxic effects in simplified food chains, integrated diagnostic effect models based on community patterns, predictive component effect models applying artificial neural networks and GIS-based analysis of integrated risk indexes will be developed and linked to a user-friendly decision support system for the prioritisation of risks, contamination sources and contaminated sites. APPROACH: Modelling will be closely interlinked with extensive laboratory and field investigations. Early warning strategies on the basis of sub-lethal effects in vitro and in vivo are provided and combined with fractionation and analytical tools for effect-directed analysis of key toxicants. Integrated assessment of exposure and effects on biofilms, invertebrate and fish communities linking chemical analysis in water, sediment and biota with in vitro, in vivo and community level effect analysis is designed to provide data and conceptual understanding for risk arising from key toxicants in aquatic ecosystems and will be used for verification of various modelling approaches. CONCLUSION AND PERSPECTIVE: The developed tools will be verified in case studies representing European key areas including Mediterranean, Western and Central European river basins. An end-user-directed decision support system will be provided for cost-effective tool selection and appropriate risk and site prioritisation.

Animals↗
PubMed1994

Quality in obstetrics using a telematic system.

A telematic based system for antenatal care has been developed to be used in service integration between primary and secondary health care units. The system is based on low cost platforms and has a user friendly human computer interface. This system will provide better integration and coordination between the health care providers involved, improving the quality of the services. This experiment is being funded in the framework of the EC.Project-A 2007-EPIC. Quality indicators, agreed in the "European concensus conference of quality indicators for perinatal care", organized in conjunction with OBSQID project (AIM.2125) were integrated in the system. Data collection has started and the outcome will be used to validate the indicators on a transeuropean basis under the framework of the OBSQID Project.

Data Collection↗
PubMed2001

Implications of the Human Genome Project for medical science.

The year 2000 marked both the start of the new millennium and the announcement that the vast majority of the human genome had been sequenced. Much work remains to understand how this "instruction book for human biology" carries out its multitudes of functions. But the consequences for the practice of medicine are likely to be profound. Genetic prediction of individual risks of disease and responsiveness to drugs will reach the medical mainstream in the next decade or so. The development of designer drugs, based on a genomic approach to targeting molecular pathways that are disrupted in disease, will follow soon after. Potential misuses of genetic information, such as discrimination in obtaining health insurance and in the workplace, will need to be dealt with swiftly and effectively. Genomic medicine holds the ultimate promise of revolutionizing the diagnosis and treatment of many illnesses.

Human Genome Project↗
PubMedDate not supplied

[Current malaria situation in Turkey].

Geographically, Turkey is situated in an area where malaria is very risky. The climatic conditions in the region are suitable for the malaria vector to proliferate. Due to agricultural infrastructural changes, GAP and other similar projects, insufficient environmental conditions, urbanization, national and international population moves, are a key to manage malaria control activities. It is estimated that malaria will be a potential danger for Turkey in the forthcoming years. The disease is located largely in south-eastern Anatolia. The Diyarbakir, Batman, Sanliurfa, Siirt, and Mardin districts are the most affected areas. In western districts, like Aydin and Manisa, an increase in the number of indigenous cases can be observed from time to time. This is due to workers moving from malaria districts to western parts to final work. Since these workers cannot be controlled, the population living in these regions get infected from indigenous cases. There were 84,345 malaria cases in 1994 and 82,096 in 1995, they decreased to 60,884 in 1996 and numbered 35,456 in 1997. They accounted for 36,842 and 20,963 in 1998 and 1999, respectively. In Turkey there are almost all cases of P. vivax malaria. There are also P. vivax and P. falciparum malaria cases coming from other countries: There were 321 P. vivax cases, including 2 P. falciparum ones, arriving to Turkey from Iraq in 1995. The P. vivax malaria cases accounted for 229 in 1996, and 67, cases P. vivax including 12 P. falciparum cases, in 1997, and 4 P. vivax cases in 1998 that came from that country. One P. vivax case entered Turkey from Georgia in 1998. The cause of higher incidence of P. vivax cases in 1995, it decreasing in 1999, is the lack of border controls over workers coming to Turkey. The other internationally imported cases are from Syria, Sudan, Pakistan, Afghanistan, Nigeria, India, Azerbaijan, Malaysia, Ghana, Indonesia, Yemen. Our examinations have shown that none of these internationally imported cases are important in transmitting the diseases. The districts where malaria cases occur are the places where population moves are rapid, agriculture is the main occupation, the increase in the population is high and the education/cultural level is low. Within years, the districts with high malaria cases also differ. Before 1990 Cucurova and Amikova were the places that showed the highest incidence of malaria. Since 1990, the number of cases from south-eastern Anatolia has started to rise. The main reasons for this change are a comprehensive malaria prevention programme, regional development, developed agricultural systems, and lower population movements. The 1999 statistical data indicate that 83 and 17% of all malaria cases are observed in the GAP and other districts, respectively. The distribution of malaria cases in Turkey differs by months and climatic conditions. The incidence of malaria starts to rise in March, reaching its peak in July, August and September, begins to fall in October. In other words, the number of malaria cases is lowest in winter and reaches its peak in summer and autumn. This is not due to the parasite itself, but a climatic change is a main reason. In the past years the comprehensive malaria prevention programme has started bearing its fruits. Within the WHO Roll Back Malaria strategies, Turkey has started to implement its national malaria control projects, the meeting held on March 22, 2000, coordinated the country's international cooperation for this purpose. The meeting considered the aim of the project to be introduced into other organizations. In this regards, the target for 2002 is to halve the incidence of malaria as compared to 1999. The middle--and long-term incidence of malaria will be lowered to even smaller figures. The objectives of this project are as follows: to integrate malaria services with primary health care services to prove more effective studies; to develop early diagnosis and treatment systems, to provide better diagnostic services, and to develop mobile diagnostic ones; to make radical treatment and monitoring patients; to conduct regular active case surveillance studies; to conduct regular vector control studies; to monitor the sensitivity of vectors to insecticides and to provide their alternatives; to design malaria control studies for the specialists of districts; to implement educational programmes among the population and attract it in controlling malaria.

Humans↗
PubMed2001

Continuous quality improvement in small general medical practices: the attitudes of general practitioners and other practice staff.

OBJECTIVES: Continuous quality improvement (CQI) offers opportunities to improve care in small-scale office-based practice. Little is yet known about the implementation of CQI in small primary care practices. We studied the attitudes of physicians and staff in small family practices to a model of CQI tailored to office-based practice setting. PRACTICES AND DESIGN: An exploratory study in 20 family practices in The Netherlands. Practices were stimulated to adopt the model for continuous quality improvement. MAIN OUTCOME MEASURES: The use of the model at the end of the study period, the perception of the physicians and staff of their success with adopting the model, their view of its usefulness, their willingness to continue and personal and practical obstacles. Measurements were made using written questionnaires. RESULTS: The rate of implementation of the model varied between practices. Participants rated their success in performing improvement projects, holding regular quality meetings and setting targets and priorities. They were positive about the usefulness of the model and they were generally willing to continue to use it. Barriers included the size of workload and the tendency to postpone actions until external support by an outreach visitor was provided. Physician and staff attitudes were homogeneous at a practice level. CONCLUSION: Our findings stress the importance of starting CQI with small, easy-to-handle projects. Workload reduction might be an important issue to focus on. Personal obstacles should be addressed throughout the introduction. We found attitudes in small-scale practices to be homogeneous, so that it was important to pay explicit attention to commitment to CQI from the start of the introduction.

Attitude of Health Personnel↗
PubMed2003

Editorial board of the Russian journal of immunology: the 2003 update.

The year 2002 has been, probably, the most complicated and eventful in the short history of the RJI. During that year many projects planned by the Editorial Board in the beginning-middle of the year 2001 started to become a reality. Unfortunately, one of the main initiators of these projects - Editor-in-Chief of the RJI, Professor Anatoly N. Cheredeev - cannot witness this success. On May 3rd, 2003 it will be a year since A.N. Cheredeev died. One of the important projects that we have accomplished is the creation of a joint Internet site of the RSI and the RJI that provides online access to the full text of articles of the journal. Although this «Russian Immunology» site (www.rji.ru) still needs a lot of work, it already takes a noteworthy place among other immunology resources on the Internet. The number of visitors of this site increased in four times during 2002, reaching more than 1500 users a month. A second important project accomplished during the past year has been the inclusion of the RJI to the biggest international bibliographic databases. At the beginning of 2002 the RJI was added to the list of indexed and cited journals of the oldest database - the Chemical Abstracts. In addition, we are glad to announce that the complete archive of articles published in the RJI has just been added to the most popular and visited bibliographic database, the Index Medicus/Medline/PubMed. Following the tradition every two years the RJI makes changes in the Editorial Board. The reasons for these changes are the advances in the field of Immunology, the establishment of new research directions, the opening of new laboratories, and the appearance of new scientific leaders. The incorporation of these new leaders into the Editorial Board improves the journal productivity, making the review process more effective and attracting new interesting authors. We would like to introduce the new members of our Editorial Board.

Databases, Bibliographic↗
PubMed2007

Relative tolerance of mesostable and thermostable protein homologs to extensive mutation.

Evolvability, designability, and plasticity of a protein are properties that are important to protein engineers, but difficult to quantify. Here, we directly compare homologous AroQ chorismate mutases from the thermophile Methanococcus jannaschii and the mesophile Escherichia coli with respect to their capacity to accommodate extensive mutation. The N-terminal helix comprising about 40% of these proteins was randomized at the genetic level using a binary pattern of hydrophobic and hydrophilic residues based on the respective wild-type sequences. Catalytically active library members were identified by a survival-selection assay in a chorismate mutase-deficient E. coli strain. Functional variants were found approximately approximately 10-times more frequently with the thermostable protein compared to its mesostable counterpart. Moreover, detailed sequence analysis revealed that functional M. jannaschii enzyme variants contained a smaller number of conserved residues and tolerated greater variability at individual sequence positions. Our results thus highlight the greater robustness of the thermostable protein with respect to amino acid substitution, while identifying specific sites important for constructing active enzymes. Overall, they support the notion that redesign projects will benefit from using a thermostable starting structure, even at very high mutational loads.

Amino Acid Sequence↗
PubMed2005

Behavioral and anatomical effects of quinolinic acid in the striatum of the hemiparkinsonian rat.

Parkinson's disease (PD), a hypokinetic disorder, and Huntington's disease (HD), a hyperkinetic disorder, share the fact that in the motor pathways the dysfunction starts in the striatum. In PD the projection neurons are overactive due to decreased inhibitory regulation by lost dopamine afferents, while in HD the output from the striatum is insufficient due to loss of projection neurons. This study aimed to determine whether the introduction of a mild HD condition in the PD striatum can counter the hypokinetic condition. The experiment was carried out in the 6-OHDA rat model for PD in which amphetamine, 5 mg/kg, evokes an asymmetric rotation response toward the side of the 6-OHDA lesion (ipsilateral rotation). The response to amphetamine in this study was fractionated into multiple components and measured automatically. After baseline measurements, the subjects were divided into four groups. Group I was unilaterally sham-lesioned in medial, central, and lateral striatum. Group II was injected quinolinic acid (QA) 20 nM in medial, central, and lateral striatum. Group III was injected QA 60 nM in central striatum. Group IV was injected QA 120 nM in central striatum. The effects of QA were measured weekly. The sham lesions in Group I had no effects. In Group II, ipsilateral rotation was reduced and replaced by oral stereotypy, a competitive behavior. In Group III, ipsilateral rotation decreased, but to a lesser degree than in Group II. In Group IV, QA had no effects. Histological findings show a unilateral loss of tyrosine immunoreactive (TH) neurons in substantia nigra and of fibers in striatum in all subjects. In addition, in Group II the striatum was atrophied. These findings suggest that the shift in Group II from ipsilateral rotation to oral stereotypy after QA was due to reduced striatal output caused by a loss of projection neurons, a loss insufficient to induce HD symptoms, but sufficient to counter the PD condition.

Adrenergic Agents↗
PubMed2005

[Needs of health insurers regarding surgery for the aged in Germany].

The increasing proportion of elderly persons presents one of the most urgent problems to European societies and has a decisive effect on social insurance systems. Costs are rising rapidly due to longer life and the falling number of births. Health care is especially hard-hit because of medical progress and growing numbers of procedures during old age. Despite these problems, the German health care system is still effective. In contrast to neighboring European states, there are neither waiting lists nor rationing of services. With respect to financing, future developments cannot be predicted. Planning scenarios taking enormously higher costs into account often result in demands for rationing, which the German health insurance companies do not accept. This study examines economic figures from the largest German health insurer and attempts to draw a picture of future health care for old people. New possibilities for prevention and resourcing and the need for rationing are discussed. The first, promising projects in these respects have already been started, with the aim of better health and quality of life for the elderly.

Aged↗
PubMed2004

Diffusion of the new antiepileptic drug lamotrigine in Dutch clinical practice.

INTRODUCTION: Lamotrigine is one of the recently introduced antiepileptic drugs (AEDs) licensed in the Netherlands in 1995. The objective of this study was to examine the diffusion of lamotrigine into clinical practice. Three different aspects of this diffusion process were examined: incidence of use, patient characteristics and changes in prescription patterns in the first 5 years following its introduction. METHODS: A retrospective follow-up study has been conducted using drug prescription data from the database of the Dutch Drug Information Project (GIP database). Patients were included who started with lamotrigine, carbamazepine, phenytoin or valproate in the period between January 1996 and December 2000. Incidence of use was calculated for the four drugs. Multiple logistic regression analysis was used to determine differences in baseline characteristics. The Chi-square test was used to analyse changes in the usage patterns of lamotrigine. RESULTS: The study population consisted of a total of 29,718 patients who were prescribed carbamazepine, phenytoin, valproate or lamotrigine for the first time in the study period. Carbamazepine and valproate accounted for the majority of all new prescriptions; the incidence of lamotrigine use remained stable with 4.4 patients per 100,000 per year. Baseline characteristics of lamotrigine differed depending on the patient's age and gender (OR 3.7, 95% CI 3.3-4.2; OR 1.4, 95% CI 1.3-1.5) relative to the conventional AEDs. In a large majority of cases, lamotrigine was used as a second-line or third-line AED. Physicians prescribing lamotrigine were predominantly neurologists, in contrast to prescribers of conventional AEDs. The prevalence of psychotropic medication and migraine-abortive drugs was significantly lower in users of lamotrigine than in users of conventional AEDs. During follow-up, several significant trends were noticed in the prescribing of lamotrigine with regard to age groups, gender, antiepileptic history and off-label use. DISCUSSION: Lamotrigine is prescribed to a population different from that using conventional AEDs. The uptake of lamotrigine in clinical practice is slow, for reasons probably related to characteristics of the drug itself and the prescribers. During the observation period, lamotrigine diffused gradually towards more first-line use as an AED and more off-label use.

Adolescent↗
PubMed2000

The need for a shared database infrastructure: combining X-ray crystallography and electron microscopy.

Advances in structural biology are opening greater opportunities for understanding biological structures from the cellular to the atomic level. Particularly promising are the links that can be established between the information provided by electron microscopy and the atomic structures derived from X-ray crystallography and nuclear magnetic resonance spectroscopy. Combining such different kinds of structural data can result in novel biological information on the interaction of biomolecules in large supramolecular assemblies. As a consequence, the need to develop new databases in the field of structural biology that allow for an integrated access to data from all the experimental techniques is becoming critical. Pilot studies performed in recent years have already established a solid background as far as the basic information that an integrated macromolecular structure database should contain, as well as the basic principles for integration. These efforts started in the context of the BioImage project, and resulted in a first complete database prototype that provided a versatile platform for the linking of atomic models or X-ray diffraction data with electron microscopy information. Analysis of the requirements needed to combine data at different levels of resolution have resulted in sets of specifications that make possible the integration of all these different types in the context of a web environment. The case of a structural study linking electron microscopy and X-ray data, which is already contained within the BioImage data base and in the Protein Data Bank, is used here to illustrate the current approach, while a general discussion highlights the urgent need for integrated databases.

Crystallography, X-Ray↗
PubMed2006

Ethnographically informed community evaluation: a framework and approach for evaluating community-based initiatives.

OBJECTIVES: This paper describes ethnographically informed community evaluation (EICE), a framework for evaluating complex community-based interventions, and illustrates its use in the evaluation of Baltimore City Healthy Start, a federally funded infant mortality prevention project. EICE, which is influenced by cultural anthropology and assets-based community assessment, supports continuous program improvement, resident involvement, and measurement of community-level change. This approach takes into account both individual and contextual levels of analysis. METHODS: The evaluation coupled a participatory approach with qualitative and survey research methods to study community context and how it might contribute to infant mortality and influence program implementation, and to assess community change resulting from the program. Data collection included focus groups, key informant interviews, surveys, neighborhood mapping, journaling, and a study of community problem-solving. RESULTS: The evaluation provided program-related feedback to staff, contributed to a collective understanding of the local context, validated and augmented outcome findings, and imparted skills and a sense of empowerment to the neighborhood. Results reveal a community burdened by crime and social problems, yet showing great diversity in physical and social conditions when examined at the census block group level. Nevertheless, these social and physical hazards in the community are more salient than any specific health issue such as infant mortality. CONCLUSIONS: EICE is a powerful evaluation approach able to respond to the complexities of community-based maternal and child health initiatives designed to institute changes across multiple domains. EICE may be used, in whole or in part, as a supplement to traditional designs.

Anthropology, Cultural↗
PubMed2006

Development of imaging selection criteria and procedures should precede cephalometric assessment with cone-beam computed tomography.

Cone-beam computed tomography (CBCT) systems for craniofacial imaging are now available from several manufacturers. CBCT potentially provides opportunities for 3-dimensional cephalometrics in orthodontic assessment of bony landmarks and air-bounded surfaces such as the facial skin. Two-dimensional cephalogram simulation could facilitate the transfer of growth projections from existing data sets as a starting point for use of a new 3-dimensional paradigm. Three methods are described to simulate conventional 2-dimensional cephalograms from CBCT images and volumetric data sets. However, certain precautions are required to assure that selection criteria and imaging parameters guarantee a radiation dose that is as low as reasonably achievable.

Algorithms↗