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PubMed2001

The Community Partnerships Experience: a report of institutional transition at East Tennessee State University.

The Community Partnerships Program, sponsored by the W. K. Kellogg Foundation, served as a catalyst for significant changes within East Tennessee State University (specifically its schools of medicine, nursing, and public and allied health) and the rural communities involved. The authors describe the development and implementation of the program and its effects on the students, faculty, communities, and the three participating schools over the period 1992-1999. They also review the changes the program fostered in health professions education and the resulting institutional changes at their university. The primary motivation for change at East Tennessee State University was the desire to develop primary care providers who could more effectively function in an interdisciplinary and interprofessional health care system and who would be sensitive to community needs in rural and underserved areas. The planning process, curricular transformation, implementation of inquiry-based learning, community collaboration, and interdisciplinary education involving students from the three health professions schools are described, including challenges and difficulties (e.g., student attrition; retention of volunteer community-based clinical preceptors; initial faculty resistance; a climate of competition rather than cooperation). Outcomes are described, including students' enrollment and attrition in the program over time, performances on the U.S. Medical Licensing Examination, program graduates' career choices, and the types and locations of their practices. The program's students performed as well on professional licensing examinations as did their peers enrolled in traditional programs. Program graduates have been much more likely to select primary care careers and to practice in rural locations than have their non-program peers. The development strategies and experience gained could give useful insights to other universities contemplating a community-based component for health professionals within their existing curricula.

Community Participation↗

PubMed2003

The Centre for Medical Humanities, Royal Free and University College Medical School, London, England.

The Centre for Medical Humanities is based within the Royal Free and University College Medical School. With a student body of more than 2,000, this large United Kingdom medical school benefits from being a fully integrated component of University College London. With its strong humanities and science faculties, University College London was founded more than 175 years ago to make education available to wider social and religious groups. With this background, it is logistically and ideologically well suited to sustaining a medical humanities program. The Centre's aims are to raise awareness of the field of medical humanities, to develop resources for the academic and teaching communities, and to build a broad and well-grounded educational program supported by sound educational principles and innovative research. Since 1998, the Centre and its predecessor, the Medical Humanities Unit, which was established by a group of medical educators with a diverse range of interests in the arts and humanities, has built interdisciplinary links and collaborative relationships with individuals and institutions within the university and beyond, nationally and internationally. These links and relationships have provided invaluable contributions and stimulus to the Centre's activities. The undergraduate educational program described in this article includes core and optional teaching throughout the curriculum, and a 1-year intercalated Bachelor of Science in Medical Humanities degree. For postgraduates, the Centre offers the United Kingdom's first continuing professional development accredited 2-day course in medical humanities, and an annual residential retreat open only to graduates of the course.

Curriculum↗

PubMed2003

The cost effectiveness of universal antenatal screening for HIV in New Zealand.

OBJECTIVE: To model the incremental costs and benefits of a universal antenatal HIV screening programme in New Zealand (NZ). DESIGN: Cost effectiveness analysis, including only health service costs, using secondary data sources and expert opinion. Uncertainty assessed in multi-way sensitivity analyses. SETTING: The NZ Health Care System. SUBJECTS: Antenatal population of NZ. INTERVENTION: Universal antenatal HIV screening programme. MAIN OUTCOME MEASURES: Incremental cost per true-positive HIV case detected in mothers; incremental cost per HIV case avoided in babies; and incremental cost per discounted life-year gained, for mothers and babies, due to screening. RESULTS: Using base case values the application of universal screening would cost an additional $NZ 723 607 ($US 307 917) and would lead to the identification of an additional 6.25 true-positive women. After terminations have been excluded, the screening programme would detect five HIV exposed babies. There would be 1.15 avoided cases of HIV infection in babies and a net gain of 41.97 discounted life-years, for mothers and babies combined. The cost per incremental HIV-positive woman detected was $NZ 115 859 ($US 49 301), HIV infected baby avoided $NZ 629 669 ($US 267 944) and discounted life-year gained $NZ 17 241 ($US 7336). CONCLUSION: The discounted cost per life gained in NZ compares favourably to estimates reported in studies of similar interventions in other developed countries and other health care interventions in NZ. The decision of whether to implement universal screening in NZ would be clarified if the prevalence of antenatal HIV infection was known and policy makers identified their willingness to pay for an additional life-year gained.

Cost-Benefit Analysis↗

PubMed1989

The relationship between knowledge about acquired immunodeficiency syndrome and the implementation of universal precautions by registered nurses.

The relationship between the level of knowledge of registered nurses (RNs) concerning acquired immunodeficiency syndrome (AIDS)-related issues and the practical observance of universal precautions was studied. It was hypothesized that the more knowledge a nurse has concerning AIDS the more likely he or she is to implement universal precautions. All registered nurses who have direct patient contact (N = 400) and are employed at a Northeastern teaching medical center, were provided a packet of three questionnaires and encouraged to participate. Two hundred thirteen (53%) RNs returned completed questionnaires. Subgroups were examined for trends relating such parameters as age and the amount of AIDS knowledge, using analysis of variance. The major hypothesis was tested by correlating the overall scores for AIDS knowledge and the implementation score. Results indicated no relationship between knowledge and the implementation of universal precautions (r = -0.12). When evaluating scores according to work areas, those subjects with higher knowledge scores had lower practice scores. Other demographic variables showed no influence on either knowledge or implementation scores as measured by this study. Further study is needed to understand what factors will motivate RNs to implement universal precautions.

Acquired Immunodeficiency Syndrome↗

PubMed2002

The University of California at San Francisco international orthopaedic elective.

International volunteerism helps remedy global inequities in orthopaedic care and provides relief for increasing professional disillusionment experienced by many orthopaedic surgeons in the United States. From 1992 to 1998, 41% of residents from the Department of Orthopaedic Surgery at the University of California, San Francisco volunteered overseas. Approximately one half of those have continued volunteering internationally after residency, including many who led later trips with residents. Based on the success of these trips, the University of California, San Francisco Department of Orthopaedic Surgery established a 1-month elective rotation in Umtata, South Africa in conjunction with Orthopaedics Overseas. Seventy-six percent of residents have chosen this opportunity since the program's inception in 1998. The University of California, San Francisco experience suggests that early exposure to international volunteerism during residency promotes continued participation in volunteer activities after graduation. By providing residents with the opportunity to volunteer overseas, the University of California, San Francisco hopes to enhance resident education, foster a lifelong spirit of volunteerism, and serve as a model for other orthopaedic training programs.

Humans↗

PubMed1998

Lowering the burden of suffering from child psychiatric disorder: trade-offs among clinical, targeted, and universal interventions.

OBJECTIVE: To examine the trade-offs among clinical, targeted, and universal interventions aimed at lowering the burden of suffering from child psychiatric disorders. METHOD: Data from clinical and research studies were organized to show the advantages and disadvantages of the three strategies. RESULTS: Important trade-offs exist among these three approaches. The strategy to reduce the burden of suffering from child psychiatric disorder should consist of a number of concurrent steps. First, effective universal programs should be in place. Targeted programs should follow for those not helped sufficiently by the universal programs. Finally, for those unaffected by the targeted programs, clinical services should be available. CONCLUSION: An optimal mix of universal, targeted, and clinical programs is needed. The nature of the combination will change as knowledge accumulates, and there will always be trade-offs among these three. Acad.

Child↗

PubMed1977

Prepaid group practice under universal health insurance in Canada.

This paper describes the experience of the two prepaid group practice plans in Ontario before and after universal health insurance. Both plans were capitalized, before national health insurance, by member contributions and both have had persistent problems with enrollment constraints and professional opposition. The Sault Ste. Marie Plan began in 1963, six years before Canadian medicare. The plan was paid a capitation fee for medical services but did not share in savings from its reduced hospital use. After universal insurance sharing in decreased hospital use was offset by regulations which allowed plan members to use non-plan physicians at Plan expense. Payments to non-plan physicians now take up 20 per cent of Plan income. Active enrollment of members has been replaced by a Ministry of Health registration system which is based on overall utilization. The St. Catharine's Plan began at the same time as universal insurance in 1969. Its out-of-plan use averaged about 40 per cent of total income. Most recently this program has shifted from capitation to cost-reimbursement payment. In Canada present trends include cost containment, financing by general tax revenues rather than premiums and increased categorical benefits. Under Canadian universal health insurance prepaid group practice has an uncertain future.

Canada↗

PubMed2006

The Arabian Gulf University College of Medicine and Medical Sciences: a successful model of a multinational medical school.

In the late 1970s, leaders of the Arabian [corrected] Gulf countries proposed a novel idea of a joint educational and cultural venture: establishing a new regional university based in the Kingdom of Bahrain that would be managed as a multinational consortium of Gulf countries including Saudi Arabia, United Arab Emirates, Kuwait, Oman, Qatar, and Bahrain. It was intended to promote higher education and research in the Gulf region; to serve the development needs of the region; to reflect the unique economic, social, and cultural attributes of the Gulf communities and their environments; and to respond to the health care needs of the member countries. Since its inception in 1982, the College of Medicine and Medical Sciences (CMMS) at Arabian Gulf University (AGU) has adopted the educational philosophy of problem-based learning (PBL) and self-directed, student-centered education. The curriculum is integrated, with early introduction of education to foster clinical skills and professional competencies. The strategic alliance with the health care systems in Bahrain and other Gulf regions has created a successful model of efficient and effective initialization of health care resources in the community. The experience that has accumulated at the AGU-CMMS from introducing innovative medical education has allowed it to take a leadership position in medical education in the Gulf region. The original goals of this unique experiment have been realized along with unanticipated outcomes of spearheading changes in medical education in the Gulf region. Old and new medical schools have adopted several characteristics of the AGU educational program. Several elements contributed to its success: a clear vision of providing quality medical education and realizing and sustaining this vision by a supportive leadership at the university and college levels; an alliance with the regional health care systems; a dedicated faculty who have been able to work as a team while continually developing themselves; proper student selection and the creation of a culture of student/faculty partnerships in education and in building an international reputation and credibility by cooperating with reputable international universities and organizations.

Bahrain↗

PubMed2005

A patient-centered health care delivery system by a university obstetrics and gynecology department.

At the University of Texas Medical Branch at Galveston, we developed an off-site clinic system that offers a wide array of services to low-income women and their infants over a large geographic area. These clinics strove toward cultural sensitivity and competency. This patient-centered approach was well accepted and appreciated by our patients. The clinics offered unique, value-added services including combined location with other needed services, on-site laboratory and antepartum testing, the option for delivery at the University of Texas Medical Branch at Galveston in a Birth Center by certified nurse midwives from the clinics, 2 high-level ultrasound "hub" centers in the outlying region that offer level II ultrasound and maternal-fetal medicine specialist consultation on site, and linkage of all sites to our electronic medical record, telemedicine, and telegenetics consultation. We also developed an off-site domiciliary facility at the University of Texas Medical Branch at Galveston. From 1989 to 2004, our clinics grew from 12 to 38 (now serving 123 Texas counties). Annual patient visits increased from approximately 34,000 to 342,926. Deliveries at the University of Texas Medical Branch at Galveston grew from 3,959 in 1990 to an estimated 6,400 in 2004. Underscoring this increase was the probable loss of at least 1,500 deliveries to local hospitals that had previously denied or discouraged admission to Medicaid-eligible pregnant women. Many women chose to deliver in our hospital even although they had to travel a longer distance to reach our facility. Our experience has shown that patient-centered care can be a viable business strategy to maintain and expand patient volumes and will work even where there are serious geographic disadvantages.

Female↗

PubMed2004

Uprobe: a genome-wide universal probe resource for comparative physical mapping in vertebrates.

Interspecies comparisons are important for deciphering the functional content and evolution of genomes. The expansive array of >70 public vertebrate genomic bacterial artificial chromosome (BAC) libraries can provide a means of comparative mapping, sequencing, and functional analysis of targeted chromosomal segments that is independent and complementary to whole-genome sequencing. However, at the present time, no complementary resource exists for the efficient targeted physical mapping of the majority of these BAC libraries. Universal overgo-hybridization probes, designed from regions of sequenced genomes that are highly conserved between species, have been demonstrated to be an effective resource for the isolation of orthologous regions from multiple BAC libraries in parallel. Here we report the application of the universal probe design principal across entire genomes, and the subsequent creation of a complementary probe resource, Uprobe, for screening vertebrate BAC libraries. Uprobe currently consists of whole-genome sets of universal overgo-hybridization probes designed for screening mammalian or avian/reptilian libraries. Retrospective analysis, experimental validation of the probe design process on a panel of representative BAC libraries, and estimates of probe coverage across the genome indicate that the majority of all eutherian and avian/reptilian genes or regions of interest can be isolated using Uprobe. Future implementation of the universal probe design strategy will be used to create an expanded number of whole-genome probe sets that will encompass all vertebrate genomes.

Alligators and Crocodiles↗

PubMed2003

The genetic core of the universal ancestor.

Molecular analysis of conserved sequences in the ribosomal RNAs of modern organisms reveals a three-domain phylogeny that converges in a universal ancestor for all life. We used the Clusters of Orthologous Groups database and information from published genomes to search for other universally conserved genes that have the same phylogenetic pattern as ribosomal RNA, and therefore constitute the ancestral genetic core of cells. Our analyses identified a small set of genes that can be traced back to the universal ancestor and have coevolved since that time. As indicated by earlier studies, almost all of these genes are involved with the transfer of genetic information, and most of them directly interact with the ribosome. Other universal genes have either undergone lateral transfer in the past, or have diverged so much in sequence that their distant past could not be resolved. The nature of the conserved genes suggests innovations that may have been essential to the divergence of the three domains of life. The analysis also identified several genes of unknown function with phylogenies that track with the ribosomal RNA genes. The products of these genes are likely to play fundamental roles in cellular processes.

Animals↗

PubMed2002

Statistical properties of spike trains: universal and stimulus-dependent aspects.

Statistical properties of spike trains measured from a sensory neuron in vivo are studied experimentally and theoretically. Experiments are performed on an identified neuron in the visual system of the blowfly. It is shown that the spike trains exhibit universal behavior over a short time, modulated by a stimulus-dependent envelope over a long time. A model of the neuron as a nonlinear oscillator driven by noise and by an external stimulus is suggested to account for these results. In the short-time universal regime, the main biophysical effect is refractoriness, which can be described as a repulsive ( 1/x) interaction law among spikes. A universal distribution function for intervals is found, defining a point process with special symmetry properties. The long-time modulations in the spike train are related in a simple way to the properties of the input stimulus as seen through the neuronal nonlinearity. Thus our model enables a separation of the effects of internal neuronal properties from the effect of external stimulus properties. Explicit formulas are derived for different statistical properties, which are in very good agreement with the data in both the universal and the stimulus-dependent regimes.

Animals↗

PubMed2005

Numerical method for accessing the universal scaling function for a multiparticle discrete time asymmetric exclusion process.

In the universality class of the one-dimensional Kardar-Parisi-Zhang (KPZ) surface growth, Derrida and Lebowitz conjectured the universality of not only the scaling exponents, but of an entire scaling function. Since and Derrida and Lebowitz's original publication [Phys. Rev. Lett. 80, 209 (1998)] this universality has been verified for a variety of continuous-time, periodic-boundary systems in the KPZ universality class. Here, we present a numerical method for directly examining the entire particle flux of the asymmetric exclusion process (ASEP), thus providing an alternative to more difficult cumulant ratios studies. Using this method, we find that the Derrida-Lebowitz scaling function (DLSF) properly characterizes the large-system-size limit (N--> infinity) of a single-particle discrete time system, even in the case of very small system sizes (N< or =22). This fact allows us to not only verify that the DLSF properly characterizes multiple-particle discrete-time asymmetric exclusion processes, but also provides a way to numerically solve for quantities of interest, such as the particle hopping flux. This method can thus serve to further increase the ease and accessibility of studies involving even more challenging dynamics, such as the open-boundary ASEP.

Journal Article↗

PubMed2005

Improved site percolation threshold universal formula for two-dimensional matching lattices.

A universal formula is proposed for predicting the site percolation threshold of two-dimensional matching lattices. The formula is slightly more accurate for these lattices than the formulas of Galam and Mauger, based on a comparison over a class of 38 lattices, and does not require two universality classes for two-dimensional lattices. The formula is constructed from the Galam-Mauger square root formula for site thresholds, by a modification which makes it consistent with the theoretical relationship between percolation thresholds of matching pairs of lattices. In the framework for evaluation of universal formulas introduced by Wierman and Naor, the formula is currently the best performing universal formula for site thresholds on this class of lattices.

Journal Article↗

PubMed2006

Universal mean moment rate profiles of earthquake ruptures.

Earthquake phenomenology exhibits a number of power law distributions including the Gutenberg-Richter frequency-size statistics and the Omori law for aftershock decay rates. In search for a basic model that renders correct predictions on long spatiotemporal scales, we discuss results associated with a heterogeneous fault with long-range stress-transfer interactions. To better understand earthquake dynamics we focus on faults with Gutenberg-Richter-like earthquake statistics and develop two universal scaling functions as a stronger test of the theory against observations than mere scaling exponents that have large error bars. Universal shape profiles contain crucial information on the underlying dynamics in a variety of systems. As in magnetic systems, we find that our analysis for earthquakes provides a good overall agreement between theory and observations, but with a potential discrepancy in one particular universal scaling function for moment rates. We primarily use mean field theory for the theoretical analysis, since it has been shown to be in the same universality class as the full three-dimensional version of the model (up to logarithmic corrections). The results point to the existence of deep connections between the physics of avalanches in different systems.

Journal Article↗

PubMed2003

Universal elasticity and fluctuations of nematic gels.

We study elasticity of spontaneously orientationally ordered amorphous solids, characterized by a vanishing transverse shear modulus, as realized by nematic elastomers and gels. We show that local heterogeneities and elastic nonlinearities conspire to lead to anomalous nonlocal universal elasticity controlled by a nontrivial infrared fixed point. Namely, such solids are characterized by universal shear and bending moduli that, respectively, vanish and diverge at long scales, are universally incompressible, and exhibit a universal negative Poisson ratio and a non-Hookean elasticity down to arbitrarily low strains. Based on expansion about five dimensions, we argue that the nematic order is stable to thermal fluctuation and local heterogeneities down to d(lc)<3.

Journal Article↗

PubMed1984

General intellectual ability of university entrants in Sri Lanka.

Students are admitted to university in Sri Lanka on the basis of aggregate marks above a certain cut-off point obtained at the GCE (advanced level) examination. On this criterion and on a district-quota basis operative for the whole island, high performers are admitted to the medical faculties. Those with lower aggregate marks are admitted to the other life science faculties. High performance at the GCE (advanced level) examination is considered to reflect high general intellectual ability and vice versa. A group of students who failed to obtain university admission on their relatively poor GCE (advanced level) examination performance was used for a preliminary study. This study revealed that several students were of high general intellectual ability. A similar study carried out on groups of new entrants to the life science courses at the University of Peradeniya (which included medical students) showed that the groups did not differ significantly in general intellectual ability from the non-University group. Students of high general intellectual ability were found distributed evenly in all the groups studied.

Allied Health Personnel↗

PubMed1986

Combined premedical-medical programmes: programme structure and student outcomes at four universities.

Many American universities now support combined premedical-medical programmes which shorten and integrate the education of doctors. This paper reviews combined baccalaureate-MD programmes at four institutions: Boston University, the City College of New York, The University of Michigan-Ann Arbor, and the University of Missouri-Kansas City. In comparison to most US medical schools, the combined programmes have admitted and educated larger portions of women students. In addition, some have had large proportions of graduates choosing primary-care careers.

Boston↗